thesis statement stress among college students

ORIGINAL RESEARCH article

Academic stress and mental well-being in college students: correlations, affected groups, and covid-19.

• 1 Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, United States
• 2 Rutgers New Jersey Medical School, Newark, NJ, United States
• 3 Office for Diversity and Community Engagement, Rutgers New Jersey Medical School, Newark, NJ, United States
• 4 Department of Biology, The College of New Jersey, Ewing, NJ, United States

Academic stress may be the single most dominant stress factor that affects the mental well-being of college students. Some groups of students may experience more stress than others, and the coronavirus disease 19 (COVID-19) pandemic could further complicate the stress response. We surveyed 843 college students and evaluated whether academic stress levels affected their mental health, and if so, whether there were specific vulnerable groups by gender, race/ethnicity, year of study, and reaction to the pandemic. Using a combination of scores from the Perception of Academic Stress Scale (PAS) and the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS), we found a significant correlation between worse academic stress and poor mental well-being in all the students, who also reported an exacerbation of stress in response to the pandemic. In addition, SWEMWBS scores revealed the lowest mental health and highest academic stress in non-binary individuals, and the opposite trend was observed for both the measures in men. Furthermore, women and non-binary students reported higher academic stress than men, as indicated by PAS scores. The same pattern held as a reaction to COVID-19-related stress. PAS scores and responses to the pandemic varied by the year of study, but no obvious patterns emerged. These results indicate that academic stress in college is significantly correlated to psychological well-being in the students who responded to this survey. In addition, some groups of college students are more affected by stress than others, and additional resources and support should be provided to them.

Introduction

Late adolescence and emerging adulthood are transitional periods marked by major physiological and psychological changes, including elevated stress ( Hogan and Astone, 1986 ; Arnett, 2000 ; Shanahan, 2000 ; Spear, 2000 ; Scales et al., 2015 ; Romeo et al., 2016 ; Barbayannis et al., 2017 ; Chiang et al., 2019 ; Lally and Valentine-French, 2019 ; Matud et al., 2020 ). This pattern is particularly true for college students. According to a 2015 American College Health Association-National College Health Assessment survey, three in four college students self-reported feeling stressed, while one in five college students reported stress-related suicidal ideation ( Liu, C. H., et al., 2019 ; American Psychological Association, 2020 ). Studies show that a stressor experienced in college may serve as a predictor of mental health diagnoses ( Pedrelli et al., 2015 ; Liu, C. H., et al., 2019 ; Karyotaki et al., 2020 ). Indeed, many mental health disorders, including depression, anxiety, and substance abuse disorder, begin during this period ( Blanco et al., 2008 ; Pedrelli et al., 2015 ; Saleh et al., 2017 ; Reddy et al., 2018 ; Liu, C. H., et al., 2019 ).

Stress experienced by college students is multi-factorial and can be attributed to a variety of contributing factors ( Reddy et al., 2018 ; Karyotaki et al., 2020 ). A growing body of evidence suggests that academic-related stress plays a significant role in college ( Misra and McKean, 2000 ; Dusselier et al., 2005 ; Elias et al., 2011 ; Bedewy and Gabriel, 2015 ; Hj Ramli et al., 2018 ; Reddy et al., 2018 ; Pascoe et al., 2020 ). For instance, as many as 87% of college students surveyed across the United States cited education as their primary source of stress ( American Psychological Association, 2020 ). College students are exposed to novel academic stressors, such as an extensive academic course load, substantial studying, time management, classroom competition, financial concerns, familial pressures, and adapting to a new environment ( Misra and Castillo, 2004 ; Byrd and McKinney, 2012 ; Ekpenyong et al., 2013 ; Bedewy and Gabriel, 2015 ; Ketchen Lipson et al., 2015 ; Pedrelli et al., 2015 ; Reddy et al., 2018 ; Liu, C. H., et al., 2019 ; Freire et al., 2020 ; Karyotaki et al., 2020 ). Academic stress can reduce motivation, hinder academic achievement, and lead to increased college dropout rates ( Pascoe et al., 2020 ).

Academic stress has also been shown to negatively impact mental health in students ( Li and Lin, 2003 ; Eisenberg et al., 2009 ; Green et al., 2021 ). Mental, or psychological, well-being is one of the components of positive mental health, and it includes happiness, life satisfaction, stress management, and psychological functioning ( Ryan and Deci, 2001 ; Tennant et al., 2007 ; Galderisi et al., 2015 ; Trout and Alsandor, 2020 ; Defeyter et al., 2021 ; Green et al., 2021 ). Positive mental health is an understudied but important area that helps paint a more comprehensive picture of overall mental health ( Tennant et al., 2007 ; Margraf et al., 2020 ). Moreover, positive mental health has been shown to be predictive of both negative and positive mental health indicators over time ( Margraf et al., 2020 ). Further exploring the relationship between academic stress and mental well-being is important because poor mental well-being has been shown to affect academic performance in college ( Tennant et al., 2007 ; Eisenberg et al., 2009 ; Freire et al., 2016 ).

Perception of academic stress varies among different groups of college students ( Lee et al., 2021 ). For instance, female college students report experiencing increased stress than their male counterparts ( Misra et al., 2000 ; Eisenberg et al., 2007 ; Evans et al., 2018 ; Lee et al., 2021 ). Male and female students also respond differently to stressors ( Misra et al., 2000 ; Verma et al., 2011 ). Moreover, compared to their cisgender peers, non-binary students report increased stressors and mental health issues ( Budge et al., 2020 ). The academic year of study of the college students has also been shown to impact academic stress levels ( Misra and McKean, 2000 ; Elias et al., 2011 ; Wyatt et al., 2017 ; Liu, C. H., et al., 2019 ; Defeyter et al., 2021 ). While several studies indicate that racial/ethnic minority groups of students, including Black/African American, Hispanic/Latino, and Asian American students, are more likely to experience anxiety, depression, and suicidality than their white peers ( Lesure-Lester and King, 2004 ; Lipson et al., 2018 ; Liu, C. H., et al., 2019 ; Kodish et al., 2022 ), these studies are limited and often report mixed or inconclusive findings ( Liu, C. H., et al., 2019 ; Kodish et al., 2022 ). Therefore, more studies should be conducted to address this gap in research to help identify subgroups that may be disproportionately impacted by academic stress and lower well-being.

The coronavirus disease 19 (COVID-19) pandemic is a major stressor that has led to a mental health crisis ( American Psychological Association, 2020 ; Dong and Bouey, 2020 ). For college students, the COVID-19 pandemic has resulted in significant changes and disruptions to daily life, elevated stress levels, and mental and physical health deterioration ( American Psychological Association, 2020 ; Husky et al., 2020 ; Patsali et al., 2020 ; Son et al., 2020 ; Clabaugh et al., 2021 ; Lee et al., 2021 ; Lopes and Nihei, 2021 ; Yang et al., 2021 ). While any college student is vulnerable to these stressors, these concerns are amplified for members of minority groups ( Salerno et al., 2020 ; Clabaugh et al., 2021 ; McQuaid et al., 2021 ; Prowse et al., 2021 ; Kodish et al., 2022 ). Identifying students at greatest risk provides opportunities to offer support, resources, and mental health services to specific subgroups.

The overall aim of this study was to assess academic stress and mental well-being in a sample of college students. Within this umbrella, we had several goals. First, to determine whether a relationship exists between the two constructs of perceived academic stress, measured by the Perception of Academic Stress Scale (PAS), and mental well-being, measured by the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS), in college students. Second, to identify groups that could experience differential levels of academic stress and mental health. Third, to explore how the perception of the ongoing COVID-19 pandemic affected stress levels. We hypothesized that students who experienced more academic stress would have worse psychological well-being and that certain groups of students would be more impacted by academic- and COVID-19-related stress.

Materials and Methods

Survey instrument.

A survey was developed that included all questions from the Short Warwick-Edinburgh Mental Well-Being ( Tennant et al., 2007 ; Stewart-Brown and Janmohamed, 2008 ) and from the Perception of Academic Stress Scale ( Bedewy and Gabriel, 2015 ). The Short Warwick-Edinburgh Mental Well-Being Scale is a seven-item scale designed to measure mental well-being and positive mental health ( Tennant et al., 2007 ; Fung, 2019 ; Shah et al., 2021 ). The Perception of Academic Stress Scale is an 18-item scale designed to assess sources of academic stress perceived by individuals and measures three main academic stressors: academic expectations, workload and examinations, and academic self-perceptions of students ( Bedewy and Gabriel, 2015 ). These shorter scales were chosen to increase our response and study completion rates ( Kost and de Rosa, 2018 ). Both tools have been shown to be valid and reliable in college students with Likert scale responses ( Tennant et al., 2007 ; Bedewy and Gabriel, 2015 ; Ringdal et al., 2018 ; Fung, 2019 ; Koushede et al., 2019 ). Both the SWEMWBS and PAS scores are a summation of responses to the individual questions in the instruments. For the SWEMWBS questions, a higher score indicates better mental health, and scores range from 7 to 35. Similarly, the PAS questions are phrased such that a higher score indicates lower levels of stress, and scores range from 18 to 90. We augmented the survey with demographic questions (e.g., age, gender, and race/ethnicity) at the beginning of the survey and two yes/no questions and one Likert scale question about the impact of the COVID-19 pandemic at the end of our survey.

Participants for the study were self-reported college students between the ages of 18 and 30 years who resided in the United States, were fluent in English, and had Internet access. Participants were solicited through Prolific ( https://prolific.co ) in October 2021. A total of 1,023 individuals enrolled in the survey. Three individuals did not agree to participate after beginning the survey. Two were not fluent in English. Thirteen individuals indicated that they were not college students. Two were not in the 18–30 age range, and one was located outside of the United States. Of the remaining individuals, 906 were full-time students and 96 were part-time students. Given the skew of the data and potential differences in these populations, we removed the part-time students. Of the 906 full-time students, 58 indicated that they were in their fifth year of college or higher. We understand that not every student completes their undergraduate studies in 4 years, but we did not want to have a mixture of undergraduate and graduate students with no way to differentiate them. Finally, one individual reported their age as a non-number, and four individuals did not answer a question about their response to the COVID-19 pandemic. This yielded a final sample of 843 college students.

Data Analyses

After reviewing the dataset, some variables were removed from consideration due to a lack of consistency (e.g., some students reported annual income for themselves and others reported family income) or heterogeneity that prevented easy categorization (e.g., field of study). We settled on four variables of interest: gender, race/ethnicity, year in school, and response to the COVID-19 pandemic ( Table 1 ). Gender was coded as female, male, or non-binary. Race/ethnicity was coded as white or Caucasian; Black or African American; East Asian; Hispanic, Latino, or of Spanish origin; or other. Other was used for groups that were not well-represented in the sample and included individuals who identified themselves as Middle Eastern, Native American or Alaskan Native, and South Asian, as well as individuals who chose “other” or “prefer not to answer” on the survey. The year of study was coded as one through four, and COVID-19 stress was coded as two groups, no change/neutral response/reduced stress or increased stress.

Table 1 . Characteristics of the participants in the study.

Our first goal was to determine whether there was a relationship between self-reported academic stress and mental health, and we found a significant correlation (see Results section). Given the positive correlation, a multivariate analysis of variance (MANOVA) with a model testing the main effects of gender, race/ethnicity, and year of study was run in SPSS v 26.0. A factorial MANOVA would have been ideal, but our data were drawn from a convenience sample, which did not give equal representation to all groupings, and some combinations of gender, race/ethnicity, and year of study were poorly represented (e.g., a single individual). As such, we determined that it would be better to have a lack of interaction terms as a limitation to the study than to provide potentially spurious results. Finally, we used chi-square analyses to assess the effect of potential differences in the perception of the COVID-19 pandemic on stress levels in general among the groups in each category (gender, race/ethnicity, and year of study).

In terms of internal consistency, Cronbach's alpha was 0.82 for the SMEMWBS and 0.86 for the PAS. A variety of descriptors have been applied to Cronbach's alpha values. That said, 0.7 is often considered a threshold value in terms of acceptable internal consistency, and our values could be considered “high” or “good” ( Taber, 2018 ).

The participants in our study were primarily women (78.5% of respondents; Table 1 ). Participants were not equally distributed among races/ethnicities, with the majority of students selecting white or Caucasian (66.4% of responders; Table 1 ), or years of study, with fewer first-year students than other groups ( Table 1 ).

Students who reported higher academic stress also reported worse mental well-being in general, irrespective of age, gender, race/ethnicity, or year of study. PAS and SWEMWBS scores were significantly correlated ( r = 0.53, p < 0.001; Figure 1 ), indicating that a higher level of perceived academic stress is associated with worse mental well-being in college students within the United States.

Figure 1 . SWEMWBS and PAS scores for all participants.

Among the subgroups of students, women, non-binary students, and second-year students reported higher academic stress levels and worse mental well-being ( Table 2 ; Figures 2 – 4 ). In addition, the combined measures differed significantly between the groups in each category ( Table 2 ). However, as measured by partial eta squared, the effect sizes were relatively small, given the convention of 0.01 = small, 0.06 = medium, and 0.14 = large differences ( Lakens, 2013 ). As such, there were only two instances in which Tukey's post-hoc tests revealed more than one statistical grouping ( Figures 2 – 4 ). For SWEMWBS score by gender, women were intermediate between men (high) and non-binary individuals (low) and not significantly different from either group ( Figure 2 ). Second-year students had the lowest PAS scores for the year of study, and first-year students had the highest scores. Third- and fourth-year students were intermediate and not statistically different from the other two groups ( Figure 4 ). There were no pairwise differences in academic stress levels or mental well-being among racial/ethnic groups.

Table 2 . Results of the MANOVA.

Figure 2 . SWEMWBS and PAS scores according to gender (mean ± SEM). Different letters for SWEMWBS scores indicate different statistical groupings ( p < 0.05).

Figure 3 . SWEMWBS and PAS scores according to race/ethnicity (mean ± SEM).

Figure 4 . SWEMWBS and PAS scores according to year in college (mean ± SEM). Different letters for PAS scores indicate different statistical groupings ( p < 0.05).

The findings varied among categories in terms of stress responses due to the COVID-19 pandemic ( Table 3 ). For gender, men were less likely than women or non-binary individuals to report increased stress from COVID-19 (χ 2 = 27.98, df = 2, p < 0.001). All racial/ethnic groups responded similarly to the pandemic (χ 2 = 3.41, df = 4, p < 0.49). For the year of study, first-year students were less likely than other cohorts to report increased stress from COVID-19 (χ 2 = 9.38, df = 3, p < 0.03).

Table 3 . Impact of COVID-19 on stress level by gender, race/ethnicity, and year of study.

Our primary findings showed a positive correlation between perceived academic stress and mental well-being in United States college students, suggesting that academic stressors, including academic expectations, workload and grading, and students' academic self-perceptions, are equally important as psychological well-being. Overall, irrespective of gender, race/ethnicity, or year of study, students who reported higher academic stress levels experienced diminished mental well-being. The utilization of well-established scales and a large sample size are strengths of this study. Our results extend and contribute to the existing literature on stress by confirming findings from past studies that reported higher academic stress and lower psychological well-being in college students utilizing the same two scales ( Green et al., 2021 ; Syed, 2021 ). To our knowledge, the majority of other prior studies with similar findings examined different components of stress, studied negative mental health indicators, used different scales or methods, employed smaller sample sizes, or were conducted in different countries ( Li and Lin, 2003 ; American Psychological Association, 2020 ; Husky et al., 2020 ; Pascoe et al., 2020 ; Patsali et al., 2020 ; Clabaugh et al., 2021 ; Lee et al., 2021 ; Lopes and Nihei, 2021 ; Yang et al., 2021 ).

This study also demonstrated that college students are not uniformly impacted by academic stress or pandemic-related stress and that there are significant group-level differences in mental well-being. Specifically, non-binary individuals and second-year students were disproportionately impacted by academic stress. When considering the effects of gender, non-binary students, in comparison to gender-conforming students, reported the highest stress levels and worst psychological well-being. Although there is a paucity of research examining the impact of academic stress in non-binary college students, prior studies have indicated that non-binary adults face adverse mental health outcomes when compared to male and female-identifying individuals ( Thorne et al., 2018 ; Jones et al., 2019 ; Budge et al., 2020 ). Alarmingly, Lipson et al. (2019) found that gender non-conforming college students were two to four times more likely to experience mental health struggles than cisgender students ( Lipson et al., 2019 ). With a growing number of college students in the United States identifying as as non-binary, additional studies could offer invaluable insight into how academic stress affects this population ( Budge et al., 2020 ).

In addition, we found that second-year students reported the most academic-related distress and lowest psychological well-being relative to students in other years of study. We surmise this may be due to this group taking advanced courses, managing heavier academic workloads, and exploring different majors. Other studies support our findings and suggest higher stress levels could be attributed to increased studying and difficulties with time management, as well as having less well-established social support networks and coping mechanisms compared to upperclassmen ( Allen and Hiebert, 1991 ; Misra and McKean, 2000 ; Liu, X et al., 2019 ). Benefiting from their additional experience, upperclassmen may have developed more sophisticated studying skills, formed peer support groups, and identified approaches to better manage their academic stress ( Allen and Hiebert, 1991 ; Misra and McKean, 2000 ). Our findings suggest that colleges should consider offering tailored mental health resources, such as time management and study skill workshops, based on the year of study to improve students' stress levels and psychological well-being ( Liu, X et al., 2019 ).

Although this study reported no significant differences regarding race or ethnicity, this does not indicate that minority groups experienced less academic stress or better mental well-being ( Lee et al., 2021 ). Instead, our results may reflect the low sample size of non-white races/ethnicities, which may not have given enough statistical power to corroborate. In addition, since coping and resilience are important mediators of subjective stress experiences ( Freire et al., 2020 ), we speculate that the lower ratios of stress reported in non-white participants in our study (75 vs. 81) may be because they are more accustomed to adversity and thereby more resilient ( Brown, 2008 ; Acheampong et al., 2019 ). Furthermore, ethnic minority students may face stigma when reporting mental health struggles ( Liu, C. H., et al., 2019 ; Lee et al., 2021 ). For instance, studies showed that Black/African American, Hispanic/Latino, and Asian American students disclose fewer mental health issues than white students ( Liu, C. H., et al., 2019 ; Lee et al., 2021 ). Moreover, the ability to identify stressors and mental health problems may manifest differently culturally for some minority groups ( Huang and Zane, 2016 ; Liu, C. H., et al., 2019 ). Contrary to our findings, other studies cited racial disparities in academic stress levels and mental well-being of students. More specifically, Negga et al. (2007) concluded that African American college students were more susceptible to higher academic stress levels than their white classmates ( Negga et al., 2007 ). Another study reported that minority students experienced greater distress and worse mental health outcomes compared to non-minority students ( Smith et al., 2014 ). Since there may be racial disparities in access to mental health services at the college level, universities, professors, and counselors should offer additional resources to support these students while closely monitoring their psychological well-being ( Lipson et al., 2018 ; Liu, C. H., et al., 2019 ).

While the COVID-19 pandemic increased stress levels in all the students included in our study, women, non-binary students, and upperclassmen were disproportionately affected. An overwhelming body of evidence suggests that the majority of college students experienced increased stress levels and worsening mental health as a result of the pandemic ( Allen and Hiebert, 1991 ; American Psychological Association, 2020 ; Husky et al., 2020 ; Patsali et al., 2020 ; Son et al., 2020 ; Clabaugh et al., 2021 ; Lee et al., 2021 ; Yang et al., 2021 ). Our results also align with prior studies that found similar subgroups of students experience disproportionate pandemic-related distress ( Gao et al., 2020 ; Clabaugh et al., 2021 ; Hunt et al., 2021 ; Jarrett et al., 2021 ; Lee et al., 2021 ; Chen and Lucock, 2022 ). In particular, the differences between female students and their male peers may be the result of different psychological and physiological responses to stress reactivity, which in turn may contribute to different coping mechanisms to stress and the higher rates of stress-related disorders experienced by women ( Misra et al., 2000 ; Kajantie and Phillips, 2006 ; Verma et al., 2011 ; Gao et al., 2020 ; Graves et al., 2021 ). COVID-19 was a secondary consideration in our study and survey design, so the conclusions drawn here are necessarily limited.

The implications of this study are that college students facing increased stress and struggling with mental health issues should receive personalized and specific mental health services, resources, and support. This is particularly true for groups that have been disproportionately impacted by academic stress and stress due to the pandemic. Many students who experience mental health struggles underutilize college services due to cost, stigma, or lack of information ( Cage et al., 2020 ; Lee et al., 2021 ). To raise awareness and destigmatize mental health, colleges can consider distributing confidential validated assessments, such as the PAS and SWEMWBS, in class and teach students to self-score ( Lee et al., 2021 ). These results can be used to understand how academic stress and mental well-being change over time and allow for specific and targeted interventions for vulnerable groups. In addition, teaching students healthy stress management techniques has been shown to improve psychological well-being ( Alborzkouh et al., 2015 ). Moreover, adaptive coping strategies, including social and emotional support, have been found to improve the mental well-being of students, and stress-reduction peer support groups and workshops on campus could be beneficial in reducing stress and improving the self-efficacy of students ( Ruthig et al., 2009 ; Baqutayan, 2011 ; Bedewy and Gabriel, 2015 ; Freire et al., 2020 ; Green et al., 2021 ; Suresh et al., 2021 ). Other interventions that have been effective in improving the coping skills of college students include cognitive-behavioral therapy, mindfulness mediation, and online coping tools ( Kang et al., 2009 ; Regehr et al., 2013 ; Molla Jafar et al., 2015 ; Phang et al., 2015 ; Houston et al., 2017 ; Yusufov et al., 2019 ; Freire et al., 2020 ). Given that resilience has also been shown to help mediate stress and improve mental well-being during the COVID-19 pandemic, interventions focusing on enhancing resilience should be considered ( Surzykiewicz et al., 2021 ; Skalski et al., 2022 ). Telemental health resources across colleges can also be implemented to reduce stigma and improve at-risk students' access to care ( Toscos et al., 2018 ; Hadler et al., 2021 ). University campuses, professors, and counselors should consider focusing on fostering a more equitable and inclusive environment to encourage marginalized students to seek mental health support ( Budge et al., 2020 ).

Limitations

While our study has numerous strengths, including using standardized instruments and a large sample size, this study also has several limitations due to both the methodology and sample. First, the correlational study design precludes making any causal relationships ( Misra and McKean, 2000 ). Thereby, our findings should be taken in the context of academic stress and mental well-being, and recognize that mental health could be caused by other non-academic factors. Second, the PAS comprised only the perception of responses to academic stress, but stress is a multi-factorial response that encompasses both perceptions and coping mechanisms to different stressors, and the magnitude of stress varies with the perception of the degree of uncontrollability, unpredictability, or threat to self ( Miller, 1981 ; Hobfoll and Walfisch, 1984 ; Lazarus and Folkman, 1984 ; Wheaton, 1985 ; Perrewé and Zellars, 1999 ; Schneiderman et al., 2005 ; Bedewy and Gabriel, 2015 ; Schönfeld et al., 2016 ; Reddy et al., 2018 ; Freire et al., 2020 ; Karyotaki et al., 2020 ). Third, the SWEMSBS used in our study and the data only measured positive mental health. Mental health pathways are numerous and complex, and are composed of distinct and interdependent negative and positive indicators that should be considered together ( Margraf et al., 2020 ). Fourth, due to the small effect sizes and unequal representation for different combinations of variables, our analysis for both the PAS and SWEMSBS included only summed-up scales and did not examine group differences in response to the type of academic stressors or individual mental health questions.

An additional limitation is that the participants in our study were a convenience sample. The testing service we used, prolific.co, self-reports a sample bias toward young women of high levels of education (i.e., WEIRD bias) ( Team Prolific, 2018 ). The skew toward this population was observed in our data, as 80% of our participants were women. While we controlled for these factors, the possibility remains that the conclusions we draw for certain groups, such as nonbinary students, ethnic/racial minorities, and men, may not be as statistically powerful as they should be. Moreover, our pre-screening was designed to recruit undergraduate level, English-speaking, 18–30-year-olds who resided in the United States. This resulted in our participant demographics being skewed toward the WEIRD bias that was already inherent in the testing service we used. Future research will aim to be more inclusive of diverse races/ethnicities, sexual orientations, languages, educational backgrounds, socioeconomic backgrounds, and first-generation college students.

Another limitation of our study is the nature of satisficing. Satisficing is a response strategy in which a participant answers a question to satisfy its condition with little regard to the quality or accuracy of the answer ( Roberts et al., 2019 ). Anonymous participants are more likely to satisfice than respondents who answer the question face-to-face ( Krosnick et al., 2002 ). We sought to mitigate satisficing by offering financial incentives to increase response rates and decrease straight-lining, item skipping, total missing items, and non-completion ( Cole et al., 2015 ). Concerns of poor data quality due to surveys offering financial incentives found little evidence to support that claim and may do the opposite ( Cole et al., 2015 ). On the other hand, social desirability bias may have influenced the participant's self-reported responses, although our anonymous survey design aimed to reduce this bias ( Joinson, 1999 ; Kecojevic et al., 2020 ).

Future Studies

Future studies should replicate our study to validate our results, conduct longitudinal cohort studies to examine well-being and perceived academic stress over time, and aim for a more representative student sample that includes various groups, including diverse races/ethnicities, sexual orientations, socioeconomic backgrounds, languages, educational levels, and first-generation college students. Additionally, these studies should consider examining other non-academic stressors and students' coping mechanisms, both of which contribute to mental health and well-being ( Lazarus and Folkman, 1984 ; Freire et al., 2020 ). Further explorations of negative and other positive indicators of mental health may offer a broader perspective ( Margraf et al., 2020 ). Moreover, future research should consider extending our work by exploring group differences in relation to each factor in the PAS (i.e., academic expectations, workload and examinations, and self-perception of students) and SWEMBS to determine which aspects of academic stress and mental health were most affected and allow for the devising of targeted stress-reduction approaches. Ultimately, we hope our research spurs readers into advocating for greater academic support and access to group-specific mental health resources to reduce the stress levels of college students and improve their mental well-being.

Utilizing two well-established scales, our research found a statistically significant correlation between the perceived academic stress of university students and their mental well-being (i.e., the higher the stress, the worse the well-being). This relationship was most apparent among gender and grade levels. More specifically, non-binary and second-year students experienced greater academic burden and lower psychological well-being. Moreover, women, non-binary students, and upper-level students were disproportionately impacted by stress related to the COVID-19 pandemic.

Studies regarding broad concepts of stress and well-being using a questionnaire are limited, but our study adds value to the understanding of academic stress as a contributor to the overall well-being of college students during this specific point in time (i.e., the COVID-19 pandemic). Competition both for admission to college ( Bound et al., 2009 ) and during college ( Posselt and Lipson, 2016 ) has increased over time. Further, selective American colleges and universities draw applicants from a global pool. As such, it is important to document the dynamics of academic stress with renewed focus. We hope that our study sparks interest in both exploring and funding in-depth and well-designed psychological studies related to stress in colleges in the future.

Data Availability Statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics Statement

The studies involving human participants were reviewed and approved by Institutional Review Board at Rutgers University. The patients/participants provided their written informed consent to participate in this study.

Author Contributions

GB and MB contributed to conceptualization, study design, IRB application, manuscript drafting, and revision. XZ participated in the conceptualization and design of the questionnaires. HB participated in subject recruitment and questionnaire collection. KP contributed to data analysis, table and figure preparation, manuscript drafting, and revision. XM contributed to conceptualization, study design, IRB application, supervision of the project, manuscript drafting, and revision. All authors contributed to the article and approved the submitted version.

This study was made possible by a generous donation from the Knights of Columbus East Hanover Chapter in New Jersey.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Acknowledgments

The authors wish to thank Shivani Mehta and Varsha Garla for their assistance with the study. We also thank all the participants for their efforts in the completion of the study.

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Keywords: academic stress, well-being, college students, Perception of Academic Stress, Short Warwick-Edinburgh Mental Well-Being Scale, COVID-19

Citation: Barbayannis G, Bandari M, Zheng X, Baquerizo H, Pecor KW and Ming X (2022) Academic Stress and Mental Well-Being in College Students: Correlations, Affected Groups, and COVID-19. Front. Psychol. 13:886344. doi: 10.3389/fpsyg.2022.886344

Received: 28 February 2022; Accepted: 20 April 2022; Published: 23 May 2022.

Reviewed by:

Copyright © 2022 Barbayannis, Bandari, Zheng, Baquerizo, Pecor and Ming. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Keith W. Pecor, pecor@tcnj.edu

† These authors have contributed equally to this work and share first authorship

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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Home > Student Research, Creative Works, and Publications > Masters Theses and Doctoral Dissertations > 512

Masters Theses and Doctoral Dissertations

The role of resilience, emotion regulation, and perceived stress on college academic performance.

Katherine A. Pendergast , University of Tennessee at Chattanooga Follow

Committee Chair

Ozbek, Irene Nichols, 1947-

Committee Member

Clark, Amanda J.; Rogers, Katherine H.

Dept. of Psychology

College of Arts and Sciences

University of Tennessee at Chattanooga

Place of Publication

Chattanooga (Tenn.)

Stress is a common problem for college students. The goal of this thesis was to examine the relationships between protective and risk factors to experiencing stress and how these factors may predict academic performance in college students. 125 college students were surveyed twice over the course of a semester on emotion regulation strategies, trait resilience, and perceived stress. The relationships between these variables and semester GPA were analyzed using correlational, multiple regression, and hierarchical regression analyses. It was determined that trait resilience scores do predict use of emotion regulation strategies but change in stress and trait resilience do not significantly predict variation in academic performance during the semester. Limitations and future directions are further discussed.

Acknowledgments

Thanks to my advisor, Dr. Ozbek, and committee members, Dr. Clark and Dr. Rogers, for invaluable feedback and support. Additional thanks to Dr. Jonathan Davidson, M.D., for his permission to use the CD-RISC to better understand resilience in the college population. Also, I would like to extend thanks to Linda Orth, Sandy Zitkus, and the entire records office staff of the University of Tennessee at Chattanooga for their willingness to collaborate and assist with this project. Lastly, I would like to thank the faculty and students of the Psychology Department for their overall support.

M. S.; A thesis submitted to the faculty of the University of Tennessee at Chattanooga in partial fulfillment of the requirements of the degree of Master of Science.

Stress (Psychology); Academic achievement -- Education (Higher)

Stress; Resilience; Emotion regulation; Academic performance

Document Type

Masters theses

xi, 72 leaves

https://rightsstatements.org/page/InC/1.0/?language=en

http://creativecommons.org/licenses/by-nc/3.0/

Recommended Citation

Pendergast, Katherine A., "The role of resilience, emotion regulation, and perceived stress on college academic performance" (2017). Masters Theses and Doctoral Dissertations. https://scholar.utc.edu/theses/512

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• Open access
• Published: 04 June 2024

The way to relieve college students’ academic stress: the influence mechanism of sports interest and sports atmosphere

• Mengfan Liu 1 ,
• Bo Shi 2 &

BMC Psychology volume  12 , Article number:  327 ( 2024 ) Cite this article

139 Accesses

Metrics details

Background and research objectives

Given the enduring popularity of higher education, there has been considerable attention on the correlation between college students’ engagement in sports and their academic stress levels. This study seeks to delve deeply into how university physical education fosters academic performance by influencing students’ sports interests, particularly in enhancing their psychological resilience to mitigate academic pressure. Through this investigation, the aim is to offer both theoretical underpinnings and empirical evidence to support the holistic enhancement of higher education.

Research methods

Initially, this study undertakes an analysis of the fundamental relationship between college students’ physical activities and their experience of academic stress. Subsequently, utilizing a structural equation model, specific research models and hypotheses are formulated. These are then examined in detail through the questionnaire method to elucidate the mechanism by which college sports interests alleviate academic stress.

Research findings

The study reveals a significant positive correlation between psychological resilience and academic stress, indicating that a robust psychological resilience can effectively diminish academic pressure. Furthermore, both the sports atmosphere and sports interest are found to exert a notable positive impact on academic stress, mediated by the variable of psychological toughness. This underscores the pivotal role of physical education in fostering positive psychological traits and enhancing academic achievement.

This study underscores the central importance of cultivating and nurturing college students’ sports interests, as well as fostering a conducive sports atmosphere, in fortifying psychological resilience and mitigating academic pressure. By offering novel perspectives and strategies for alleviating the academic stress faced by college students, this study contributes valuable theoretical insights and practical experiences to the broader development of higher education.

Peer Review reports

Introduction

In the context of the rapid evolution of higher education, there is a growing focus on enhancing academic resilience to stress [ 1 ]. Numerous studies have demonstrated that physical activity serves as a positive psychological intervention, with significant effects on fostering learning, alleviating academic pressure, and reducing psychological anxiety. Given that college students represent the future workforce, their academic stress has garnered widespread concern [ 2 ]. Thus, investigating the link between college students’ sports interests and academic pressure holds considerable practical significance and social value. Research on the correlation between sports interests and academic stress has made considerable strides in recent decades. However, most studies have primarily examined their direct relationship, overlooking potential additional factors and complex interactive mechanisms [ 3 ]. In recent years, researchers have increasingly turned their attention to the moderating role of mediating variables in the relationship between sports interests and academic stress, such as self-esteem, self-efficacy, and body image. These variables are viewed as pivotal factors influencing the impact of sports interests on academic stress. This study aims to construct a comprehensive theoretical framework and delve deeply into the mechanisms of these mediating variables in the relationship between college students’ sports interests and academic pressure. The goal is to offer more effective strategies and recommendations for alleviating academic pressure among college students.

With the proliferation of higher education and the intensifying social competition, the academic pressure confronting college students has become increasingly pronounced. This pressure not only jeopardizes their mental well-being but also has the potential to impede their academic performance and future career prospects. In recent years, physical activities have garnered widespread attention as an effective means of alleviating academic stress. Research conducted by Karagiorgakis and Blaker [ 4 ] underscores the efficacy of sports participation in relieving academic stress among college students. Their findings reveal a significant reduction in anxiety and depression levels among students engaging in sports activities, particularly for those with sustained participation. This discovery presents a positive coping strategy for students to mitigate the psychological stress induced by academic studies through sports engagement. Further evidence from Dexter et al. [ 5 ] corroborates the beneficial impact of physical activity in managing academic stress. Their study indicates that students who regularly partake in physical activities demonstrate heightened mental resilience when confronted with academic pressure. This enhanced mental fortitude enables them to confront challenges more adeptly and mitigate negative emotions associated with stress. Approaching the issue from a different angle, O’Connor [ 6 ] explores the psychological benefits of sports engagement in alleviating academic stress. He contends that participation in sports fosters feelings of enjoyment and accomplishment, thereby mitigating negative emotions stemming from academic pressure. This sense of fulfillment contributes to heightened life satisfaction and self-confidence among college students, empowering them to confront academic challenges proactively. Storm and Eske [ 7 ] emphasize the role of physical activities in nurturing college students’ capacity to cope with challenges and stress. They argue that sports participation equips students with essential coping skills, vital not only for navigating current academic pressures but also for addressing future life and work challenges. From a social standpoint, Green et al. [ 8 ] highlight the role of sports participation in fostering social connections among college students. Their research indicates that engagement in sports facilitates the formation of friendships and social networks, providing crucial social and emotional support. This support network aids in mitigating feelings of isolation and helplessness, thereby bolstering students’ psychological resilience in the face of academic stress. Despite the considerable role of physical activity in mitigating academic stress among college students, current research on the relationship between sports interest and academic stress remains limited. Berdida and Grande [ 9 ] underscore the growing societal concern regarding the pressure faced by college students, emphasizing the importance of delving deeper into the impact and mechanisms of sports interest on academic stress. Moreover, Basri et al. [ 10 ] emphasize the significance of mental health issues among college students, particularly those facing financial hardships, who may experience elevated stress levels and associated psychological challenges. In conclusion, physical activities serve as a potent positive psychological intervention in alleviating the academic stress experienced by college students. Future research endeavors should further explore the impact and mechanisms of sports interest on academic stress, providing both theoretical foundations and practical guidance for mental health education and psychological intervention among college students. This concerted effort will facilitate a better understanding and management of academic stress issues, promoting holistic development and well-being among college students.

Hence, this study endeavors to furnish both theoretical groundwork and practical directives for alleviating academic stress among college students by conducting a systematic review and meta-analysis of extant research. Additionally, it aims to furnish references and insights for prospective investigations in this domain. The primary focus of this inquiry encompasses two key aspects: (1) scrutinizing the relationship between college students’ engagement in sports activities and their academic stress levels, and (2) exploring the moderating variables that influence this relationship. Through a comprehensive examination of pertinent literature and the adoption of both quantitative and qualitative methodologies, this study aims to elucidate these facets. Consequently, it not only furnishes valuable support for ameliorating academic stress among university students but also constitutes a substantial contribution to the advancement of higher education.

Relationship between college students’ sports interest and academic stress

Factors influencing academic stress.

Academic stress represents a primary challenge encountered by college students, emanating from diverse sources including coursework demands, examinations, paper submissions, internships, and employment responsibilities [ 11 ]. Prolonged exposure to excessive academic stress can precipitate a range of issues such as anxiety, depression, insomnia, and physical discomfort, exerting adverse effects on the mental and physical well-being of college students. Consequently, it is imperative to comprehend the factors contributing to academic stress and to institute tailored coping mechanisms accordingly [ 12 ].

Currently, research on academic stress primarily examines individual and environmental factors. Individual factors encompass abilities, interests, and self-expectations, while environmental factors encompass familial, school, and societal pressures. Additionally, factors such as sports interest, sports atmosphere, and psychological resilience play crucial roles in influencing academic stress [ 13 ]. Sports interest refers to an individual’s favorable disposition and inclination towards participating in sports activities [ 14 ]. College students who harbor sports interests are more predisposed to actively partake in sports, thereby mitigating stress and alleviating anxiety. Research indicates a noteworthy positive correlation between sports interest and mental health status—heightened sports interest correlates with improved mental well-being. Sports atmosphere pertains to the milieu and ambiance surrounding sports activities, encompassing both school and community environments. A conducive sports atmosphere can invigorate college students’ enthusiasm for engaging in sports, thereby enhancing their sports interest and involvement. Studies suggest that an enhanced school sports atmosphere correlates with better mental health among students [ 15 ]. Psychological resilience refers to an individual’s capacity to adapt and cope effectively with setbacks, stressors, and adversity [ 16 ]. College students endowed with higher levels of psychological resilience demonstrate adeptness in managing academic stress and other pressures, thereby sustaining a positive outlook and fostering good mental health. Research indicates that psychological resilience exerts a significant ameliorative effect on academic stress.

In summary, academic stress emerges as a complex issue influenced by various factors. Among these, sports interest, sports atmosphere, and psychological resilience play pivotal roles in shaping the academic stress experienced by college students. The study advocates for the implementation of strategies aimed at enhancing college students’ sports interests, fostering a positive sports atmosphere, and nurturing psychological resilience. These measures are deemed effective in alleviating academic stress and enhancing the mental and physical well-being of college students. Consequently, within the realm of higher education, emphasis should be placed on cultivating students’ sports interests and psychological resilience, while also fostering a conducive sports environment and atmosphere. Figure  1 illustrates the interrelationships between the variables examined in this study.

Schematic diagram of the relationship between college students’ mental health and sports activities

Figure  1 depicts the positive impact pathway of sports activities on the mental health of college students. Firstly, sports activities contribute to stress relief by triggering the release of substances such as endorphins and dopamine, thereby alleviating anxiety, depression, and fostering positive emotions [ 17 ]. Secondly, participation in sports bolsters college students’ self-esteem and confidence. Through showcasing their abilities and achieving success, students garner recognition and affirmation of their self-worth. Additionally, forging close connections with fellow athletes facilitates the formation of a supportive social network, offering emotional reinforcement and encouragement. Consequently, this diminishes feelings of social isolation and loneliness, augmenting happiness and mental well-being [ 18 ]. Moreover, engagement in sports endeavors can enhance body image and satisfaction, fostering increased self-acceptance and contentment with one’s physical appearance, thereby mitigating anxiety and stress associated with appearance. Importantly, the relationship between college students’ sports activities and mental health is reciprocal: active involvement in sports enhances mental well-being, while robust mental health status further motivates students to participate actively in sports. Hence, actively promoting campus sports activities emerges as a potent means to nurture the mental health of college students [ 19 ].

Application of structural equation models

Structural equation models (SEMs) stand as a robust statistical technique extensively employed in social science research, particularly for elucidating intricate causal relationships and latent variables. In this study, SEMs are utilized to delve deeply into the interplay between college students’ sports interests, sports atmosphere, and academic stress, while also examining the potential role of psychological resilience. Through SEMs, interactions among multiple variables can be simultaneously estimated, encompassing the direct effects of independent variables (e.g., sports interest and sports atmosphere) on dependent variables (e.g., academic stress), as well as their indirect effects mediated through latent variables (e.g., psychological resilience) [ 20 ]. This comprehensive analytical approach fosters a more precise comprehension of the complex relationships among these variables and their collective impact on college students’ academic stress and mental health. It is noteworthy that although sports interest and sports atmosphere serve as independent variables, they do not directly function as moderators. Moderating factors typically denote variables that can influence the relationship between independent and dependent variables, such as gender, age, or cultural background. For instance, gender can be regarded as a moderating factor in research aimed at exploring disparities between different gender groups regarding the influence of sports interest and sports atmosphere on academic stress. By introducing gender as a moderator, researchers can attain a more holistic understanding of whether the relationship between college students’ sports interest, sports atmosphere, and academic stress varies across genders. This, in turn, facilitates the development of tailored educational and intervention measures to better cater to the diverse needs of different gender groups and promote their holistic development [ 21 ].

Figure  2 illustrates the design of variable relationships in this study, based on the preceding discussion.

Relationship of study variables

The research hypotheses for this study are as follows:

Sports interest has a direct positive impact on psychological resilience.

Sports interest has an indirect positive impact on academic stress through psychological resilience.

Sports atmosphere has a direct positive impact on psychological resilience.

Sports atmosphere has an indirect positive impact on academic stress through psychological resilience.

Through the utilization of SEMs, this study can effectively test these hypotheses and estimate the effects of each pathway [ 22 ]. This facilitates a comprehensive understanding of the intricate relationships among sports interest, sports environment, psychological resilience, and academic stress. Moreover, it furnishes a theoretical foundation for intervening and preventing psychological health issues among college students [ 23 ].

While SEMs offer a potent tool for investigating complex relationships, they are not without challenges and limitations [ 24 ]. For example, SEMs can solely manage known and pre-defined variables and are unable to accommodate unknown or undefined variables [ 25 ]. Additionally, the hypothesis-testing nature of SEMs necessitates cautious interpretation of the results in this study. To mitigate these limitations and ensure the reliability of results, this study employs an appropriate sample size and relied on reliable measurement tools for assessing variables [ 26 ].

This study predominantly employs a questionnaire survey method to gather data to thoroughly investigate the relationship between college students’ sports interests, sports atmosphere, psychological resilience, and academic pressure. The questionnaire design encompasses four primary sections: basic information of college students, sports interests, sports atmosphere, and psychological resilience, and academic pressure.

(1) Questionnaire design

To ensure the scientific rigor and validity of the questionnaire, this study opted for four widely validated scales:

Athletic Climate Scale: Developed by Jackson and Marsh in 1996, this scale evaluates college students’ experiences in athletic environments. It comprises 8 single-dimensional indicators and is scored on a 10-point scale [ 27 ].

Intrinsic Motivation Scale: This scale, devised by Ryan and Deci in 2000, gauges college students’ interest in physical activities. It consists of 8 indicators and is scored on a 7-point scale [ 28 ].

Connor-Davidson Resilience Scale: Developed by Connor and Davidson in 2003, this scale assesses an individual’s psychological resilience. It encompasses 25 indicators and is scored on a 5-point scale [ 29 ].

Academic Stress Scale: Based on Lefcott’s 1981 study, this scale is utilized to evaluate college students’ experience of academic stress. It includes 15 indicators, also scored on a 5-point scale [ 30 ].

(2) Sampling method

To ensure the breadth and representativeness of the sample, this study meticulously designs and implements the sampling strategy. Initially, the target groups are meticulously segmented based on multiple dimensions such as geographical location, school type, and subject area, thereby forming multiple levels or subgroups with distinct characteristics. This segmentation facilitates a more comprehensive coverage of college students from diverse backgrounds, thereby ensuring the diversity of the sample. Subsequently, within each subpopulation, a random sampling method is employed to ensure that individuals in each subgroup have an equal opportunity of being selected. This randomness effectively mitigates sampling errors and enhances the representativeness of the sample. Through random sampling, it is ensured that individuals in the sample are sufficiently dispersed across geographical locations, school types, and subject areas, thus authentically reflecting the overall scenario of the target group. Furthermore, clear inclusion criteria are established to ensure homogeneity of the sample and the reliability of the study. Specifically, survey participants are required to be full-time college students, ensuring uniformity in educational backgrounds and experiences. This inclusion criterion serves to control for confounding factors within the sample and bolster the internal validity of the study. By employing stratified random sampling and setting explicit inclusion criteria, this study successfully constructs a broad and representative sample, laying a robust foundation for subsequent data analysis and the dissemination of research findings.

(3) Data collection and processing

Through meticulously planned online survey initiatives, 725 questionnaires are successfully distributed across major online survey platforms. These questionnaires are widely circulated among university students from diverse regions, age groups, and academic backgrounds, ensuring the diversity and representativeness of respondents. Following the collection of questionnaires, rigorous screening and sorting procedures are implemented to eliminate incomplete or erroneous responses, as well as those that do not meet the predefined inclusion criteria, thereby ensuring the validity and reliability of the data. Subsequently, after this thorough screening and sorting process, a total of 706 valid questionnaires are retained, yielding an effective rate of 97.38%. This high retention rate underscores the rationality of the questionnaire design and the active cooperation of the respondents. The respondents to these valid questionnaires hail from various regions across the country, spanning diverse age groups and academic disciplines. Their responses furnish a rich database, facilitating a comprehensive and in-depth understanding of college students’ sports interests, sports atmosphere, psychological resilience, and academic pressure, among other aspects. Upon completion of data collection, the collected data undergo detailed analysis utilizing SPSS statistical software. Initially, descriptive statistics are conducted to delineate the distribution of each variable, providing a preliminary insight into the overall sample characteristics. Subsequently, correlation analysis is performed to explore the interrelationships between variables, laying the groundwork for subsequent regression analysis. Finally, regression analysis and other analytical techniques are employed to delve deeply into the relationships and influencing mechanisms among variables such as sports interest, sports atmosphere, psychological resilience, and academic pressure, furnishing robust evidence for understanding the intricate interplay among these variables. The specific outcomes of the statistical analysis are elucidated in Fig.  3 .

Sample statistical results

As depicted in Fig.  3 , the research sample of this study comprises 706 college students, 363 girls and 343 boys. Furthermore, the sample encompasses students from all academic years within the university, indicating that the research sample encompasses the entire student body on campus. This comprehensive coverage of the student population imbues the research findings with significant practical relevance and applicability.

The defined results of variables in this study are as follows:

Sports atmosphere comprises three subclassifications: Cooperation (M1), Input (M2), and Sense of belonging (M3). Sports interests contains 3 subclassifications: Self(I1), Mode (I2), and Participate (I3). Psychological resilience contains 4 subclassifications: Self-regulation (R1), Help from others (R2), and Ability dictates (R3), Learning effect (R4). Academic stress contains 4 subclassifications: Influence of others (P1), Competitive Impact (P2), Ability Impact (P3), and Environmental impact (P4).

In summary, this study process meticulously defines key variables, including sports interest, sports atmosphere, mental toughness, and academic stress. Sports interest is gauged through pertinent questions in the questionnaire, reflecting individuals’ preferences and willingness to engage in sports activities. The sports climate is evaluated using a specialized sports climate scale, elucidating the extent to which an individual’s sports environment or community fosters and supports sports participation. Mental toughness is assessed employing the well-established Resilience Scale, capturing an individual’s capacity to adapt and rebound amidst challenges and adversity. Academic stress is quantified using the Academic Stress Scale, focusing on the intensity of pressure and tension experienced by students during the learning process. To ensure the accuracy and reliability of these variables, the study conducts a thorough literature review, selects validated scales, and performs factor analysis as necessary to delve deeper into the structure and dimensions of the variables. These variables play pivotal roles in the study, and understanding their interactions and collective influence on an individual’s psychological state and academic performance constitutes the core content of the investigation. Research inquiries centers on elucidating the interrelationships among these variables and how they synergistically shape an individual’s holistic development. Drawing from theoretical analysis and literature review, the research team formulates a series of hypotheses to be tested through data collection and analysis. By meticulously measuring and analyzing these variables, this study aims to offer a nuanced understanding of the nexus between sports interest, sports atmosphere, mental toughness, and academic pressure, furnishing valuable insights for both research and practical applications in related fields.

Analysis of the impact of college students’ sports on mental health

Questionnaire reliability analysis.

Reliability pertains to the consistency and stability of measurement results obtained from a questionnaire, constituting a crucial criterion for evaluating questionnaire quality. Various methods exist for assessing reliability, with test-retest reliability, split-half reliability, and Cronbach’s Alpha being commonly utilized tools. Among these, Cronbach’s Alpha coefficient method has emerged as one of the most prevalent reliability analysis techniques due to its simplicity and effectiveness. It assesses the internal consistency of a questionnaire by computing the correlation between all items within the questionnaire. Typically, a Cronbach’s Alpha coefficient exceeding 0.7 signifies good reliability of the questionnaire.

In this study, the reliability of the questionnaire is evaluated using Cronbach’s Alpha coefficient method. The analysis reveals a Cronbach’s Alpha coefficient of 0.961, significantly surpassing the generally accepted threshold for good reliability (0.7). This outcome unequivocally indicates that the questionnaire employed here exhibits exceptionally high internal consistency, implying that each item within the questionnaire demonstrates strong consistency when measuring the same construct. Thus, the questionnaire can be deemed to possess good reliability.

Furthermore, to ascertain the suitability of the questionnaire for further factor analysis, a Kaiser-Meyer-Olkin (KMO) test is conducted. The KMO test evaluates the adequacy of raw data for factor analysis by assessing the ratio of partial correlations to simple correlations between variables. A KMO value approaching 1 signifies strong correlation between variables, rendering the original variables more conducive for factor analysis. Conversely, a KMO value nearing 0 suggests weak correlation between variables, rendering the original variables unsuitable for factor analysis.

In this study, the KMO test yields a result of 0.975, indicating a very high value close to 1, signifying robust correlation between variables in the questionnaire. Consequently, it can be inferred that the questionnaire utilized in this study is highly suitable for factor analysis, thereby further validating the reliability and applicability of the questionnaire. In summary, based on the aforementioned analysis, it can be concluded that the questionnaire employed in this study exhibits both good reliability and good validity.

Influence of personal factors

When assessing the influence of gender, grade, place of origin, and academic performance on college students’ engagement in physical exercise and mental health, this study employs the following statistical methods:

For examining the relationship between categorical variables such as gender, grade, place of origin, participation in physical exercise, and mental health level, a Chi-square test is utilized. This method is employed to ascertain whether the observed frequency distribution across different categories significantly differs from the expected frequency distribution, thereby determining the presence of a correlation between two categorical variables.

Moreover, one-way ANOVA is employed for assessing the relationship between the continuous variable of academic performance and physical exercise participation and mental health levels. This statistical method is utilized to examine the effect of one or more independent variables (in this study, academic performance) on a continuous dependent variable (such as physical activity participation or mental health levels). Through the application of the aforementioned statistical methods, the results presented in Table  1 are obtained. This table provides a comprehensive overview of the statistical analysis outcomes concerning gender, grade, place of origin, academic performance, physical exercise participation, and mental health level.

The findings depicted in Table  1 reveal that only gender demonstrates a significant correlation with psychological resilience, while grade level exhibits a noteworthy relationship with sports interest. Moreover, throughout the testing process, the influence of gender, grade level, hometown, and academic performance on the variables under investigation in this study is deemed insignificant. These results suggest that external factors exert minimal impact on the study, thereby affirming its reliability.

Correlation analysis

This study analyzes the relationship between various variables using the Pearson correlation coefficient to examine the linear relationships within the model. The Pearson correlation coefficient is a statistic that measures the strength and direction of the linear relationship between two variables, ranging from − 1 to 1. A correlation coefficient close to 1 indicates a strong positive correlation, close to -1 indicates a strong negative correlation, and close to 0 indicates almost no linear relationship between the variables. By calculating the Pearson correlation coefficient for the relevant variables in the dataset, the intensity and direction of the linear relationship between them are obtained. The results are summarized in Table  2 , providing an important basis for further analysis of interactions between variables and the construction of statistical models.

The results presented in Table  2 from the linear correlation test shed light on the relationships between sports interest, psychological resilience, academic pressure, and psychological well-being. While sports atmosphere is not directly listed, its impact on psychological well-being is discussed based on the provided description. These tests offer crucial insights into how these variables interrelate. The unstandardized coefficient for sports interest is -0.042, indicating that increased sports interest is associated with a small yet significant positive effect on psychological well-being. Although the standardized coefficient Beta is -0.087 and the t value is -0.709 (low), the p value is 0.480 (greater than 0.05 significance level), suggesting that the direct correlation between sports interest and psychological well-being is not strong. However, this doesn’t undermine the importance of sports interests. Conversely, the unstandardized coefficient for psychological resilience is 0.078, indicating that enhancements in psychological resilience are linked to significant positive effects on psychological well-being. With a standardized coefficient Beta of 0.177, a t value of 1.773, and a p value of 0.079 (close to the significance level of 0.05), the role of mental toughness in bolstering mental health is underscored. Moreover, the unstandardized coefficient for academic stress is -0.041, indicating that heightened academic stress is associated with negative effects on psychological well-being. Although the standardized coefficient Beta is -0.139, the t value is -1.141, and the p value is 0.257 (greater than 0.05 significance level), implying that the direct negative impact of academic stress on psychological well-being is not significant, its negative impact trend is noteworthy. Regarding sports atmosphere, although its coefficient is not listed, the p-value is 0.480, indicating its insignificant impact on psychological well-being. This warrants further exploration in future research to discern the potential influence of sports atmosphere on psychological well-being. In terms of analysis of variance, the model’s R² value is 0.087, indicating that sports interest, mental toughness, and academic stress jointly explain approximately 8.7% of the variation in psychological well-being. Though modest, this proportion holds significance given the multifaceted nature of psychological well-being. The adjusted R² value is 0.058, showing a slight decrease in the model’s explanatory power after accounting for the number of variables. With an F statistic value of 3.042 and a corresponding p-value of 0.033 (less than the 0.05 significance level), the entire model is statistically significant in predicting psychological well-being. The Durbin-Watson (D-W) value of 1.710 indicates no evident autocorrelation between residuals, ensuring the model’s data independence. In conclusion, this study elucidates the intricate relationships between sports interest, psychological resilience, academic stress, and psychological well-being. While the direct effect of sports interest on psychological well-being may not be significant, it likely plays a significant role alongside other variables. The substantial positive impact of psychological resilience on psychological well-being offers novel insights into enhancing mental health. Conversely, the negative trend of academic stress on psychological well-being underscores its potential harm. Future research can delve deeper into the interaction mechanisms between these variables and devise interventions to enhance college students’ psychological well-being.

Effects of sports on academic stress in the SEMs

Indeed, correlation analysis and SEMs are robust analytical tools that are wisely chosen for this study to comprehensively evaluate research hypotheses and explore relationships between variables. Correlation analysis serves as an initial step to ascertain statistical correlations between variables, providing a foundation for deeper investigation. By assessing the strength and direction of these correlations, researchers gain insights into potential associations and can identify variables that warrant further examination. SEMs, on the other hand, offers a sophisticated approach to analyze complex relationships among multiple variables simultaneously. It allows researchers to construct models that incorporate both observed variables and latent variables, providing a more nuanced understanding of their interactions and overall impact. SEMs serve as an efficacious statistical approach for probing the association between sports activities and academic stress. This methodology facilitates the examination of both the direct and indirect impacts of various types of sports activities on academic stress, while also considering the influence of individual differences on this nexus. Such an approach not only enhances comprehension of the mechanisms by which sports activities influence academic stress but also furnishes valuable insights for ameliorating academic stress. Table  3 ; Fig.  4 illustrate the research findings pertaining to the influence of sports activities on academic stress, as explored through SEMs in this study.

The path analysis results presented in Table  3 ; Fig.  4 provide strong support for the research hypotheses, confirming the significant impact of sports interest and sports atmosphere on college students’ psychological resilience and academic stress. Let’s break down these findings based on each hypothesis:

The path coefficient of 0.47, with a t value of 5.26 and a p value of less than 0.001, indicates a significant positive relationship between sports interest and mental toughness. This result confirms the hypothesis, suggesting that higher levels of sports interest are associated with greater psychological resilience among college students.

The path coefficient of 0.36, with a t value of 4.15 and a p value of less than 0.001, supports the indirect effect of sports interest on academic stress through psychological resilience. Thus, not only does sports interest directly enhance psychological resilience, but it also indirectly reduces academic stress by bolstering psychological toughness.

The path coefficient of 0.58, with a t value of 5.14 and a p value of less than 0.001, indicates a significant positive impact of sports atmosphere on psychological resilience. This finding corroborates the hypothesis, suggesting that a positive sports environment fosters greater psychological resilience among college students.

The path coefficient of 0.49, with a t value of 4.56 and a p value of less than 0.001, provides evidence for the indirect effect of sports atmosphere on academic stress via psychological resilience. Therefore, a conducive sports atmosphere not only enhances psychological resilience but also indirectly mitigates academic stress by bolstering mental toughness.

Absolutely, interpreting path coefficients in SEMs requires careful consideration of various factors that may influence their reliability and validity. Sample size, measurement error, model specification, and data characteristics can all impact the accuracy of path coefficients and the overall fit of the model to the data. Sample size plays a crucial role in the statistical power of SEMs. Larger sample sizes generally provide more reliable estimates of path coefficients and increase the likelihood of detecting significant relationships. Measurement error can introduce bias into path coefficient estimates, leading to potential inaccuracies in model interpretation. Therefore, it is essential to use validated measurement tools and carefully consider the reliability and validity of the measures used in the study. Furthermore, model fit statistics, such as the comparative fit index and root mean square error of approximation, are critical for assessing the overall goodness of fit of the SEM to the data. Poor model fit may indicate discrepancies between the proposed theoretical model and the observed data, highlighting the need for model refinement or reconsideration of data processing methods. Figure  4 provides a visual representation of the path analysis results, offering an intuitive understanding of the relationships between sports atmosphere, sports interest, mental toughness, and academic pressure among college students. This visualization aids in interpreting the complex interplay between these variables and facilitates communication of the study findings. In conclusion, addressing issues related to sports atmosphere, sports interest, mental toughness, and academic pressure among college students requires a multifaceted approach. Strategies such as strengthening physical education programs, providing mental toughness training, optimizing curriculum design, and improving teaching methods can contribute to promoting the physical and mental well-being of college students and equipping them with the skills to navigate the challenges of modern society.

This study delves into the influence of physical exercise on academic stress among college students, with a specific focus on how it shapes students’ psychological resilience and consequently impacts their academic stress levels. In today’s university milieu, characterized by escalating competition, academic stress emerges as a formidable challenge for college students. Hence, investigating the efficacy of physical exercise as a stress-relief mechanism assumes paramount significance in safeguarding the psychological well-being of students. While extant literature extensively examines the correlation between physical exercise and physical health, scant attention has been paid to its ramifications on academic stress and psychological resilience. This study bridges this gap by employing SEMs to meticulously scrutinize the intricate interplay among physical exercise, psychological resilience, and academic stress. This methodological approach not only offers a novel research perspective but also sheds light on the pivotal roles played by sports interest and the sports atmosphere in shaping college students’ psychological resilience and mitigating academic stress. The findings underscore the substantial mediating role of psychological resilience between physical exercise and academic stress. Moreover, they reveal that both sports interest and the sports atmosphere wield a significant positive influence on psychological resilience, and bolstering psychological resilience effectively diminishes academic stress levels among college students. These findings underscore the multifaceted significance of sports in higher education, extending beyond mere physical health promotion to encompass a distinctive role in safeguarding psychological well-being and alleviating academic stress.

This study makes a significant contribution by explicitly elucidating the inherent connections among interest in sports, the sports atmosphere, psychological resilience, and academic stress, thereby underscoring the positive role of sports in maintaining the psychological well-being of college students. This finding not only enriches theoretical understanding in relevant fields but also provides practical strategies and recommendations for schools and educational institutions. Firstly, schools and relevant departments should further recognize the importance of sports in alleviating academic stress and promoting psychological health, intensifying efforts to promote sports activities. By offering diverse sports programs and facilities and encouraging active participation in sports activities among college students, schools can nurture their interest in sports and cultivate healthy sports habits. Secondly, educational institutions and educators should integrate sports into daily educational teaching, making it an essential means of promoting students’ comprehensive development and enhancing psychological resilience. By creating a positive sports atmosphere through various forms such as sports classes, sports clubs, and sports events, educators can help students establish healthy lifestyles. Finally, future research could further explore other factors that may influence the relationship between interest in sports, psychological resilience, and academic stress, such as individual traits, family background, and social environment. This will contribute to a more comprehensive understanding of the role of sports in the growth of college students, providing scientific evidence for the development of more effective intervention measures. In conclusion, this study offers a new perspective on understanding the regulatory mechanism of college students’ psychological health by deeply exploring the relationship between physical exercise, psychological resilience, and academic stress. By fostering interest in sports, enhancing psychological resilience, and creating a positive sports environment, academic stress among college students can be effectively alleviated, promoting their comprehensive development and psychological health. These findings hold significant practical implications for schools, society, and families alike.

With societal development and the acceleration of life’s pace, academic pressure has garnered widespread attention. Sports interest and a favorable sports atmosphere are increasingly recognized as effective methods for alleviating academic pressure. This study aims to explore the influence of physical activities and psychological resilience among college students on academic stress, offering valuable insights for addressing the academic stress levels of college students. Through a literature review and SEM analysis, this study presents significant conclusions and contributions. Firstly, it establishes a notable relationship between psychological resilience and academic stress, demonstrating that the sports atmosphere and sports interest significantly impact academic stress through psychological resilience. This underscores the importance of fostering sports interests and cultivating a positive sports atmosphere among college students to enhance psychological resilience, consequently alleviating academic pressure. This finding provides vital guidance for college educators, highlighting the importance of organizing and promoting sports activities. Secondly, through SEM analysis, this study identifies psychological toughness as a mediating factor in the relationship between sports interest and academic stress. This underscores the positive impact of physical activity on mental health, specifically in reducing academic stress by enhancing psychological toughness. This contribution enriches the theoretical framework surrounding the interplay of academic stress and physical activity and offers novel perspectives and strategies for mental health education in higher education institutions. Finally, this study validates its research hypotheses through empirical data analysis and offers specific recommendations and future prospects. However, certain limitations exist, including potential subjectivity in self-reporting and memory constraints inherent in the questionnaire method. Thus, future research endeavors may focus on diversifying samples and expanding coverage to enhance the reliability and representativeness of research outcomes. In summary, this study provides valuable insights and strategies for ameliorating the academic stress experienced by college students by delving into the influence of physical activities and psychological resilience on academic stress. This not only aids university educators in better addressing students’ mental health concerns but also serves as a significant reference for future related research.

Data availability

The datasets generated and analysed during the current study are not publicly available due to privacy reasons, but are available from the corresponding author on reasonable request.

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Acknowledgements

We sincerely appreciate every participant in our survey.

This research was funded by the General Project of Jilin Provincial Education Science Plan during the 14th Five-Year Plan Period, 2022, with the project titled “Research on the Impact of New Era National Defense Physical Education on Enhancing College Students’ Physical Literacy.” The project number is GH22169.

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BS contributed to the conception and design of the study and wrote sections of the manuscript. ML organized the database, performed the statistical analysis, and wrote the first draft of the manuscript. XG made careful revisions to the first draft of the manuscript. All authors contributed to the manuscript revision, read, and approved the submitted version.

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Liu, M., Shi, B. & Gao, X. The way to relieve college students’ academic stress: the influence mechanism of sports interest and sports atmosphere. BMC Psychol 12 , 327 (2024). https://doi.org/10.1186/s40359-024-01819-1

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Stress Among College Students: Causes, Effects and Overcomes Essay

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Introduction

Causes of stress in college students, effects of stress, overcoming stress, works cited.

Stress is a considerable problem in the modern society. People often experience high levels of stress due to being overwhelmed with a wide range of duties, such as work, studying, family duties, etc. In particular, college students are one group that is rather susceptible to stress, and can feel the adverse consequences of it very often (Brougham et al. 85); however, there are certain techniques that might help these learners overcome stress.

There are a number of causes of stress among college students (Lund et al. 127-129); according to Brougham et al., some of these causes include daily hassles, financial factors, and academic factors (90). The daily hassles that students are forced to deal with in the process of studying as identified by Brougham et al. are not directly related to college life; in fact, they include such problems as being stuck in traffic congestions, awakening too late in the morning, and the inability to find a place for parking (89). The financial causes of stress that college students are faced with include such issues as the need to pay one’s bills, the dearth of financial resources, and spending too much money when one should have not done so (Brougham et al. 89). Finally, the academic causes of stress, which are clearly specific to this population, include the need to write papers, especially final papers or assignments; worrying about the possibility to obtain low grades during an exam, or regret resulting from having received such; and difficulties related to the selection of one’s major (Brougham et al. 89). It is clear that students who are challenged with a large number of such stressors at the same time are more likely to develop a larger number of symptoms of stress, which have an adverse effect on these students’ ability to function effectively.

Due to stress, college students may experience such adverse outcomes as the decreased levels of cognitive functioning, the impaired ability to study, and, consequently, lower academic performance (Abdulghani et al. 516). First of all, the fact that a student is experiencing stress might have a considerable adverse effect on their ability to perform a wide range of cognitive functions, which are necessary for both proper social functioning and for participation in learning activities. Students who are stressed might feel too tired, not be able to think clearly, or unable to focus on the task at hand. Second, as a result of this, stressed learners may find themselves incapable of concentrating on learning activities and tasks, whether listening to a lecture, reading a book or article, or writing text.

Some students might also start feeling despair or experience depression, which creates further barriers for carrying out their academic duties. Finally, the inability to properly do the tasks related to learning results in decreased academic performance, leading to grades which are lower than those of learners who do not suffer from the symptoms of stress (Abdulghani et al. 517-520). It should be pointed out that the decreased academic performance, as has already been noted above, plays the role of a stressor as well, thus further impairing the learners’ ability to study. Therefore, apart from impairing the student’s ability to function, stress also accumulates and, to a certain degree, starts being the cause of itself.

Because of the serious impact of stress on the academic performance of college students, it might be recommended that students utilize coping strategies in order to decrease the level of stress (Jimenez et al. 444-447); one such strategy includes goal regulation (Neely et al. 88-89). Some authors state that goal regulation “consists of both the ability to disengage from goals that are unattainable and reengage in the pursuit of alternative goals” (qtd. in Neely et al. 89). There are a number of effects of this technique. First, a student who practices goal regulation is able to identify goals that are not attainable, and redirect their attention to aims that can be achieved in practice, which results in a more efficacious use of the temporal resources and the energy that a student possesses; consequently, students are less overwhelmed with tasks and thus may experience lower levels of stress.

Second, pursuing more concrete goals permits a student to direct their efforts towards these goals, thus considerably increasing their chance to achieve them; such an achievement can be viewed as a certain type of reward, thus increasing the student’s level of satisfaction and demonstrating them that they can achieve aims that they set. And finally, students who can disengage from pursuing unattainable and wasteful goals may be able to start “seeing the light at the end of the tunnel”; in practice, they experience fewer intrusive thoughts and lower levels of helplessness (Neely et al. 89). Therefore, goal regulation has a considerable potential as a method for overcoming stress, for it permits students to better distribute their resources, gain certain achievements, and stop feeling helpless.

Thus, college students often suffer from stress, which can have profoundly adverse effects on their lives; however, certain techniques might allow these people to overcome this problem (Caldwell et al. 433-435). Numerous issues cause stress in college students; these include daily hassles, financial and academic factors. Stress can impair students’ cognitive function, the ability to learn, and decrease their academic performance. However, goal regulation might help them to overcome stress. It should also be noted that this and other techniques for stress coping might be useful not only for college students but for other populations as well.

Abdulghani, Hamza M., et al. “Stress and Its Effects on Medical Students: A Cross-Sectional Study at a College of Medicine in Saudi Arabia.” Journal of Health, Population and Nutrition , vol. 29, no. 5, 2011, pp. 516-522.

Brougham, Ruby R., et al. “Stress, Sex Differences, and Coping Strategies Among College Students.” Current Psychology , vol. 28, 2009, pp. 85-97.

Caldwell, Karen, et al. “Developing Mindfulness in College Students Through Movement Based Courses: Effects on Self-Regulatory Self-Efficacy, Mood, Stress, and Sleep Quality.” Journal of American College Health , vol. 58, no. 5, 2010, pp. 433-442.

Jimenez, Cristobal, et al. “Stress and Health in Novice and Experienced Nursing Students.” Journal of Advanced Nursing , vol. 66, no. 2, 2010, pp. 442-455.

Lund, Hannah G., et al. “Sleep Patterns and Predictors of Disturbed Sleep in a Large Population of College Students.” Journal of Adolescent Health , vol. 46, 2010, pp. 124-132.

Neely, Michelle E., et al. “Self-Kindness When Facing Stress: The Role of Self-Compassion, Goal Regulation, and Support in College Students’ Well-Being.” Motivation and Emotion Journal , vol. 33, 2009, pp. 88-97.

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Impact of Stress Levels on Eating Behaviors among College Students

Weight gain is a common phenomenon among college students, especially those in their first year of university. Transitioning from high school to the college environment might increase perceived stress levels, thus affecting dietary behaviors and metabolism to promote overweight and obesity. The purpose of this study was to investigate the physical activities and dietary behaviors of college students in the context of their perceived stress levels. In addition, the demographic characteristics of the students were compared to ascertain their impact on dietary behaviors. Self-reported questionnaires were distributed to college students on campus in Korea. Perceived stress was measured by the 10-item Perceived Stress Scale (PSS-10), the scores for which were evaluated by independent t -tests to compare the dietary behaviors of the high- and low-perceived stress groups. Exploratory factor analysis was performed and Cronbach’s alphas were computed to assess the validity and internal consistency of the PSS-10 measurement items. Differences in the physical activities and dietary behaviors of the college students based on demographics such as sex, academic year, and residence type were found. Several dietary behaviors were significantly different between students with low and high perceived stress levels. Students with high perceived stress levels exhibited increased unhealthy dietary behaviors such as ready-prepared meal consumption ( p < 0.001). These results suggest that stress management should be offered to college students. In addition, programs should be provided to help first-year students adjust to the college environment in order to promote healthy dietary behaviors.

1. Introduction

Being physically and psychologically healthy has been shown to improve quality of life. Despite the benefits of being healthy, the rate of obesity has increased two- to three-fold in the last 20 years [ 1 ]. Notably, data published in 2009 by the American College Health Association’s National College Health Assessment indicated that 36.7% of college students were overweight or obese [ 2 ]. When investigating the relationship between sleep and obesity among U.S. and South Korean college students, Sa [ 3 ] observed higher overweight/obesity rates (59.4%) in Korean males than Black (51.5%) and White males (46.8%) and in Black women (53.8%) than in White (38.8%) and Korean women (24.8%) based on the standard body mass index (BMI) cut points for U.S. students and Asian BMI cut points for Korean students.

Dietary habits are influenced by various genetic, sociodemographic, and environmental factors. Food preferences developed and established in childhood may change during the college years because of decreased parental influence [ 4 , 5 , 6 , 7 , 8 ]. An abundance of literature demonstrates that most students gain weight during the first year of college [ 9 , 10 , 11 ]. During the transition from high school to university, the failure of college students to adjust to the new environment and associated stressors can lead to negative dietary habits such as excessive alcohol consumption and stress-related under- or over-eating [ 4 ].

College students have lifestyles and dietary habits that differ from those of the general population, often relying on meals they can access quickly and easily [ 12 ]. Besides taste, convenience is the most important motivator for food choices [ 12 , 13 ]. Thus, fast food consumption is common among the dietary habits of college students [ 12 , 14 , 15 , 16 ]. Furthermore, most college students ignore the food group recommendations [ 17 ], frequently skip meals, have inappropriate snacks, and consume excessive amounts of alcohol [ 6 ]. Inconsistencies in food choices have been observed between the sexes. In some studies, female students tended to avoid fat, eat fruit [ 12 ], and were less likely to purchase high-energy foods [ 18 ], whereas male students were more likely to purchase alcoholic beverages [ 18 ]. Conversely, another study showed similar fruit and vegetable consumption among female and male students, but female students ate more fatty foods than males [ 19 ]. Perhaps these differences depend on the individual’s level of perceived stress because stress can affect eating behaviors [ 20 ]. For instance, stress can increase one’s consumption of snacks [ 21 , 22 , 23 ].

Stress is defined as a disturbance to one’s “physiological homeostasis or psychological well-being” [ 24 ]. A cross-sectional study of first-year university students studying at an Australian university found that more than half of the students were experiencing some degree of stress, with comparatively more women suffering than men, and that stress was associated with the selection of less healthy food [ 25 ]. There is also evidence that women under stress seek comfort from highly palatable foods or snack foods [ 26 ]. Another study showed that when under stress, people chose “unhealthy food” (e.g., high-calorie, high-fat snack food, sugary food, sweets [ 21 , 27 ], and carbohydrate-rich food [ 27 ]) rather than healthy food [ 21 ]. Nonetheless, the associations between eating behaviors, stress, and sex are inconclusive. In some individuals, stress increased food intake, while others displayed decreased food intake [ 26 , 28 , 29 ].

Recent research has recognized the importance of the analysis of dietary or food consumption patterns for assessing the overall diet [ 30 , 31 ]. Therefore, this study investigated the college students’ physical activities, dietary behaviors, and perceived level of stress in order to offer suggestions that support a healthier diet for college students, who were most lacking in sufficient nutrient intake and were vulnerable to stress. First, this study measured and compared the physical activities and dietary behaviors based on the respondents’ demographic characteristics. Second, the stress level of each participant and its association with physical activities and dietary behaviors were investigated.

2. Materials and Methods

2.1. participants.

Questionnaires were distributed for two months on a university campus in Korea. In 2019, when this study was carried out, there were 9725 students including 5170 males (53%) and 4555 females (47%), enrolled at the university. The study was approved by the institutional review board (1041549-191011-SB-80). Of the 420 questionnaires distributed to students enrolled in a 4-year college program, 396 questionnaires were collected. The students were informed about the study’s purpose and gave consent to participate before the survey proceeded. After screening, three questionnaires were excluded because of inappropriate responses, and the remaining 393 were retained for further analysis.

2.2. Measurements

Nineteen questions regarding physical activity and dietary habits such as “I usually exercise regularly each week” and “I usually eat more than two pieces of fresh fruit per week” were adopted from previous studies [ 32 , 33 ]. Responses were rated on a 5-point Likert scale ranging from 0 (zero times per week) to 4 (at least seven times per week). The Perceived Stress Scale (PSS) is a valid and reliable instrument to measure stress [ 34 , 35 , 36 ]. Of the three PSS versions, which are comprised of 4-, 10-, and 18-item measurements, the PSS-10 has the most satisfactory psychometric properties [ 35 , 37 ]. The PSS-10 consists of six positively worded items and four negatively worded items. A two-factor PSS-10 model (perceived helplessness as a positive factor and perceived self-efficacy as a negative factor) has been identified [ 35 ]. The perceived stress level was evaluated by the PSS-10 [ 34 , 38 ]. Each item in the PSS-10 is rated on a 5-point Likert scale ranging from never (0 points) to very often (4 points). The last part of the questionnaire sought to obtain demographic information, establish whether the participant was on a diet, and collect weight and height data to calculate the BMI of each participant.

2.3. Statistical Analysis

Data were coded in Excel and then analyzed using the Statistical Package for the Social Sciences (SPSS) [ 39 ]. Descriptive analyses were conducted to determine the patterns of college students’ dietary behaviors and demographic information. Independent t -tests were run on dietary behaviors by sex (one-sided). Tukey’s test was undertaken on dietary behaviors according to each respondent’s academic year and residence type. Multiple regression was performed on BMI, with dietary behaviors as the independent variables. The construct validity of the PSS-10 was assessed by exploratory factor analysis using maximum likelihood estimation. Cronbach’s alphas (>0.60) were computed to measure the internal consistency of the PSS-10 factors. Independent t -tests were performed to investigate dietary behavior differences between the low- and high-stress groups. In addition, stress differences were measured for sex, academic year, and residence type. Alpha was set at 0.05 for all statistical tests.

The demographic characteristics of the respondents are shown in Table 1 . Males represented 45.2% of the respondents and 54.8% were female. Approximately 35% of the respondents were freshmen, and 31% were sophomores. Most of the respondents answered that they lived alone (71.2%). Only one-third of the respondents (24.2%) were on a diet. BMI was calculated based on self-reported height (cm) and weight (kg). BMIs (kg/cm 2 ) < 18.5, 18.5–22.9, 23–24.9, and >25 were defined as low weight, normal weight, overweight, and obese, respectively [ 40 ]. About 50.3%, 18.3%, 13.6%, and 17.8% of the respondents were normal weight, overweight, low weight, and obese, respectively. The mean BMI was 20.854 (SD = 7.074), thereby falling in the normal weight range.

Characteristics of respondents regarding demographics, dieting, and BMI ( n = 393).

Sex differences in BMI were significant ( t = 7.722, p < 0.001). Males (M = 23.683, SD = 4.046) had a higher BMI than females (M = 18.462, SD = 8.134), who, in general, fell in the low-weight range. Students who were on a diet had a significantly ( t = 3.369, p = 0.001) higher BMI (M = 22.894, SD = 6.501) than those not on a diet (M = 20.193, SD = 7.167). Significant differences were found among the academic years of the students (F = 4.186, p < 0.01). Freshmen (M = 22.470, SD = 5.094) had a higher BMI than sophomores (M = 19.488, SD = 6.784).

Table 2 displays the physical activities, alcoholic beverage consumption, and dietary behaviors of the respondents. The majority of the respondents exercised 1–2 times a week (43.8%) for more than 30 min, whereas 42% did no exercise. A total of 46.1% of the respondents consumed alcoholic beverages 1–2 times a week, and more than half of the respondents were not taking dietary supplements (54.5%). Nearly 47% of the respondents answered that they ate when stressed. The respondents reported that they ate the following foods 1–2 times per week: over 40% ate more than two pieces of fresh fruits, nearly 44% ate fish and seafood, and over 43% ate dairy products such as milk, yogurt, and cheese (43.3%). Meats (39.7%) and bread or noodles made with wheat (43%) were consumed as a meal 3–4 times a week. Most of the respondents had snacks such as cakes, candies, and soft drinks (40.4%), fruit, milk, and nuts (41.1%), and ready-prepared meals (41.4%) 1–2 times a week. Fast food consumption 1–2 times a week had the highest frequency (51.7%), and 33.8% of the respondents ate out 3–4 times a week. Some 33.4% of the respondents skipped breakfast seven times a week, but most did not skip lunch (49%) or dinner (55.2%). The frequency of overeating 1–2 times a week was 49.4%.

Characteristics of respondents regarding physical activities, alcoholic beverage consumption, and dietary habits.

Dietary habits were compared between sexes ( Table 3 ). More males exercised regularly (M = 2.21, SD = 1.019, t = 5.823, p < 0.001) and for at least 30 min (M = 2.14, SD = 1.040, t = 5.701, p < 0.001) than females (M = 1.67, SD = 0.766; M = 1.60, SD = 0.780). However, more females ate to release stress (M = 2.30, SD = 0.879, t = −2.263, p < 0.05) and consumed more than two pieces of fresh fruit (M = 2.16, SD = 1.022, t = −2.168) than males (M = 2.09, SD = 0.915; M = 1.94, SD = 0.984). Males consumed more meat (M = 3.35, SD = 0.998, t = 6.173, p < 0.001) and fish/seafood (M = 1.94, SD = 0.828, t = 3.311, p < 0.01) than females (M = 2.77, SD = 0.863; M = 1.67, SD = 0.777). Unhealthy dietary behaviors were more prevalent in females, as they more often had snacks such as cakes, candies, and soft drinks (M = 2.73, SD = 0.984, t = −2.368, p < 0.05), and skipped dinner (M = 1.73, SD = 0.917, t = −2.068, p < 0.05) than males (M = 2.49, SD = 1.005; M = 1.55, SD = 0.820).

Results of the comparisons of the students’ physical activities, alcoholic beverage consumption, and dietary habits based on sex, academic year, and residence type.

* p < 0.05, ** p < 0.01, *** p < 0.001.

There were significant differences in the students’ physical activities and dietary behaviors based on academic year. Exercising for more than 30 min was less prevalent among freshmen (M = 1.82, SD = 0.791, F = 4.245, p < 0.01) than seniors (M = 2.27, SD = 0.919). Freshmen also consumed fewer dietary supplements (M = 1.88, SD = 1.230, F = 4.343, p < 0.01) than seniors (M = 2.81, SD = 1.600). Moreover, freshmen (M = 1.60, SD = 0.637, F = 4.074, p < 0.01) consumed fewer alcoholic beverages than sophomores (M = 1.83, SD = 0.874) and juniors (M = 1.88, SD = 0.813). Sophomores (M = 2.21, SD = 1.044, F = 3.999, p < 0.01) had a higher intake of snacks such as fruit, milk, and nuts than juniors (M = 1.85, SD = 0.954), who in turn, had the lowest consumption of such snacks.

Dietary behaviors differed significantly based on residence type. Students who lived with their parents were more likely to consume more than two pieces of fresh fruit per week (M = 2.52, SD = 1.114) than those who lived on their own (M = 1.87, SD = 0.891) and showed higher fish intake (M = 2.08, SD = 0.851 vs. M = 1.67, SD = 0.755). Students who lived on their own (M = 1.96, SD = 0.907) had a lower intake of snacks such as fruit, milk, and nuts when compared with those who lived with their parents (M = 2.33, SD = 1.106) and those who lived in the dormitory (M = 2.94, SD = 1.144). The same patterns were noticed regarding skipping breakfast and lunch. Respondents who lived on their own skipped breakfast (M = 3.60, SD = 1.392) and lunch (M = 1.95, SD = 1.054) more often relative to those who lived with their parents (M = 2.77, SD = 1.492; M = 1.57, SD = 0.865).

Multiple regression was conducted on BMI as the dependent variable and dietary behaviors as the independent variables. The model (F = 2.622, p < 0.001, R 2 = 0.126, adjusted R 2 = 0.078) showed that the intake of meat (B = 1.831, SE = 0.444, t = 4,124, p < 0.001) and fast food (B = 1.583, SE = 0.560, t = 2.826, p < 0.01) had a positive effect on BMI, whereas the intake of snacks such as cakes, candies, and soft drinks (B = −1.371, SE = 0.433, t = −3.167, p < 0.01) negatively affected BMI.

The PSS-10 items are shown in Table 4 . Exploratory factor analysis was conducted and Cronbach’s alphas were computed to assess the validity and reliability of the PSS-10 measurements. Two factors were extracted, of which one was positively coded (six items) and one was negatively coded (four items). All PSS-10 items were added and each total score was then divided by its mean value (M = 18.425, SD = 5.279). Results below the mean value were coded as “1” (“low stress”) and results above the mean value were coded as “2” (“high stress”). Independent t -tests were conducted on the dietary behaviors of the low- and high-stress groups ( Table 5 ), which revealed that the high-stress group (M = 1.81, SD = 0.854) performed less regular exercise (M = 2.02, SD = 0.981, t = 2.137, p < 0.05). In addition, the high-stress group (M = 2,43, SD = 0.933) had a higher frequency of eating to release stress than the low-stress group (M = 1.94, SD = 0.781, t = −5.556, p < 0.001) as well as a higher frequency of eating fast food, ready-prepared meals, and snacks (e.g., cakes, candies, and soft drinks); skipping meals (breakfast, lunch, and dinner); and overeating. However, meat consumption was higher in the low-stress group (M = 3.12, SD = 0.982) than the high-stress group (M = 2.93, SD = 0.956). A significant difference in stress was found based on sex ( t = −4.049, p < 0.001), with a higher perceived stress level in females (M = 19.379, SD = 4.876) than males (M = 17.216, SD = 5.486) (not shown in table). The stress level did not differ with the respondents’ academic year, residence type, or dieting.

Measurement items for the Perceived Stress Scale (PSS-10).

Results of the comparisons of physical activities, alcoholic beverage consumption, and dietary habits of low- and high-stress groups.

4. Discussion

This study found several characteristics of college students’ dietary behaviors including a strong reliance on meat consumption and eating out 3–4 times a week. The frequency meat intake was higher than that of fish/seafood and fresh fruit. The majority of the respondents did not exercise regularly or take dietary supplements. One-third of the respondents skipped breakfast almost every day, but few skipped lunch and dinner. Skipping meals has been associated with unhealthy dietary behaviors [ 41 ].

The observed dietary behaviors differed based on the students’ sex, residence type, and academic year. More male students exercised regularly and for more than 30 min when compared with female students. Moreover, meat and fish/seafood consumption was more prevalent among males than females. Female students tended to eat to release stress, which supports the previous findings that females are more likely to be emotional eaters than males [ 21 , 42 ]. Interestingly, some studies have suggested that females eat more fresh fruit [ 12 ] and consume more snacks such as cakes, candies, and soft drinks than males [ 22 ]. Overall, the male students in this study tended to exhibit healthier dietary behaviors than the females, in contrast to a previous study [ 25 ].

Differences in the students’ dietary behaviors based on academic year suggest the potential of academic institutional support and educational interventions. Some surveys have shown that first-year students display a low frequency of regular exercise, and it has been suggested that they fail to adjust to the new environment [ 4 , 20 ]. Hence, college administrations should provide assistance that supports first-year college students in their transition to the institution as well as implement recommended educational interventions regarding nutritional information, disseminated via leaflets or posters, to reinforce healthy dietary behaviors.

The majority of the respondents answered that they lived alone, which was the same as the general college population [ 43 ]. However, great differences were observed in the dietary behaviors of the students based on residence type [ 44 ]. Students who lived with their parents displayed much healthier dietary behaviors than those who lived on their own. For most students, this is their first time away from home, and so might lack the time, organization, or cooking skills to prepare meals [ 15 ]. Providing easy-cooking leaflets would encourage college students to cook for themselves and choose better food options by decreasing their reliance on eating out, fast food, and ready-prepared meals.

In this study, the average stress score was 18.43, which was higher than that reported by a group of infertile women (17.48) [ 35 ] and the general population (13.02) [ 36 ]. Adjusting to the college environment can be highly stressful, and stress greatly influences dietary behaviors. The high-stress group exhibited fewer healthy dietary behaviors as they tended to eat more sugar-based snacks, carbohydrate-rich food [ 21 , 27 ], fast food, and ready-prepared meals such as comfort food when compared with the low-stress group [ 26 ]. The results suggest that college students showed two opposing behaviors under stress including the more frequent intake of certain types of food (overeating) and less frequent eating such as skipping meals (undereating).

Two factors of stress are perceived helplessness and self-efficacy. These factors may increase eating in general as well as irregular eating, which can explain stress-induced overeating and undereating behaviors [ 45 ]. In addition, skipping meals is associated with stress and depressed mood [ 46 ], which may mean that skipping meals can be both the cause and result of stress. Regular breakfast consumption may increase physical activity [ 47 ], and so encouraging college students to eat breakfast is necessary for their health. Females have been shown to have a higher perceived stress level than males [ 25 ] and be more likely to diet. Moreover, distressed females are more likely to engage in binge eating [ 48 ] and be loss-of-control eaters [ 49 ]. Dietary restraint predicts overeating when under perceived stress [ 42 ] for both males and females [ 49 ]. Strict limitations on certain foods increase overeating in stressed individuals, so both female and male students should be informed about reasonable food consumption [ 48 ].

Dietary habits related to lifestyle are key elements of healthy living. Poorer mental and physical health-associated quality of life is related to body dissatisfaction, which is also associated with psychological distress [ 48 , 49 ]. For this reason, further studies should investigate the influence of internal and external lifestyle factors on dietary behaviors. Moreover, information on stress management should be provided to students, considering that high-stress students tend to eat when stressed. Emotional eating should be self-monitored and alternative stress-management strategies should be exercised for stress relief. University-affiliated clubs and societies that reflect the students’ interests may help in this regard. The availability of a variety of healthy food options on campus including in cafes and vending machines, along with nutritional information, could prevent strict food limitations. In times of stress, food that is usually prohibited or limited is consumed, so a balanced intake of food from all food groups should be followed in daily life.

The BMI of the respondents in this study was normal and greatly affected by the intake of meat and fast food. A previous report suggested that students eat fast food because of its low cost and convenience [ 12 ]. A lack of cooking ability may explain the high consumption of fast food and meat [ 15 ]. Regarding cooking, meat can be cooked more easily compared with other food ingredients. In addition, a Westernized lifestyle means that college students eat more meat than fish/seafood and fruit. Unexpectedly, the higher consumption of snacks including sugar-based snacks was associated with a low BMI, implying that students eat snacks as replacements for proper meals, resulting in a relatively lower overall calorie intake.

This study has some limitations to be improved for future research. As this study was conducted with students attending a single college campus in Korea, a geographical limitation exists. Most students in this study lived alone, whereas different results would be expected among students living with family. Stress levels associated with long commutes, a factor not examined in this study, may also affect outcomes. More college students should be included for further analysis because the students’ perceived stress levels may decrease with time spent at university as they adjust to the environment. This study used the frequency of intake of particular foods to determine dietary behaviors, whereas neither the amount of consumed food nor caloric information was considered. For further research, various food behaviors should be included to detect dietary behaviors more accurately. Moreover, the internal and external influences of dietary behaviors should be examined in the context of perceived stress levels. For example, body dissatisfaction, eating disordered behavior, and emotional eating should be assessed in future studies.

5. Conclusions

In this study, college students displayed a variety of dietary habits that differed between males and females. Moreover, differences were found in dietary habits based on the students’ academic year and residence type. It is important to investigate and understand the environments that affect college students’ dietary behaviors because eating patterns at this time in one’s lifespan can affect health and food behaviors throughout adulthood. Support from college administrations such as educational interventions is necessary to improve unhealthy food behaviors. Moreover, measured stress was relatively high for college students, implying they were under stress due to the new academic environment. Students with high stress showed less healthy dietary behaviors compared to students with low stress. Thus, college students’ stress should be managed properly to prevent unhealthy dietary behaviors related to stress. Stress management needs to start before college life, as stress should not hinder the college students’ ability to engage in healthy dietary behaviors.

This research was funded by Woosong University Academic Research.

Conflicts of Interest

The author declares no conflict of interest.

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Stress in College Students

According to the American Psychological Association in 2024 stress levels among K-12 students are alarmingly high, with seven out of ten U.S. teens (ages 13-17) identifying anxiety or depression as major issues among their peers. In school, 75% of high school students report experiencing boredom, anger, sadness, fear, or stress. On a 10-point scale, where adult stress averages 3.8, American teens rate their stress at 5.8. Additionally, three-quarters of high school students and half of middle schoolers consistently feel stressed due to schoolwork.

College Students Face Even Greater Challenges

• 40% of U.S. college students feel inadequately rested most days.
• 25% of students admit that lack of sleep negatively impacts their academic performance, resulting in lower grades or missed deadlines.
• Students who sleep six or fewer hours a night have lower GPAs compared to those who get eight or more hours of sleep.
• 45% of American college students report experiencing "more than average stress."
• Only 9% of students report "no stress" or "less than average stress."
• In the U.K., 80% of university students report stress and anxiety.
• 45% of U.K. students feel stressed by their coursework.

Addressing Student Stress

Understanding the prevalence and causes of student stress is crucial for educators, administrators, and parents. By identifying stress factors and their impact, stakeholders can develop strategies to support students better. Since no one can avoid stress, and the prevalence is so high, students are encouraged to take one of the scientifically validated online stress assessments available at The American Institute of Stress website; Either the Stress Mastery Questionnaire (SMQ) or the Rosch Stress Profiler (RSP).

Awareness and proactive measures can help alleviate some of the pressures students face, ensuring they have the necessary resources and support to succeed both academically and personally.

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PTSD, anxiety is rising among college students

by Ernie Mundell

America's college students seem to be more stressed than ever, with a new report finding a sharp rise in cases of post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) on campuses across the country.

In a "national sample of U.S. college students , we found a notable increase in the prevalence of PTSD and ASD," concluded a team led by Yusan Zhai, of the University of Alabama at Birmingham.

Rates of PTSD rose by 4.1 percentage points between 2017 and 2022, and stress disorder diagnoses rose by 0.5 percentage points, the data showed.

Their findings were published in the journal JAMA Network Open .

As Zhai's group explained, any number of events—campus shootings, sexual assault , physical violence and natural disasters , for example—can trigger either PTSD or ASD. PTSD can lead to more persistent symptoms, while ASD's impact may be more transient—anywhere from a few days to a month.

In their study, the Birmingham researchers focused on 2017 through 2022, "a period marked by escalated societal stressors and global health crises," including, of course, the pandemic.

They looked at data from the ongoing Healthy Minds study, which tracks the mental health of over 392,000 people attending 332 different colleges and universities across the United States. About 58% of the students were female.

The data showed that during the study period, 19,349 (4.9%) of the college students had been diagnosed with PTSD, while 1,814 (0.5%) had been given a diagnosis of ASD.

"We observed upward trends in the prevalence of PTSD and ASD from 2017 to 2022," Zhai and colleagues wrote.

PTSD rates rose from 3.4% of participants in 2017-2018 to 7.5% by 2021-2022, and acute stress disorders rose from 0.2% to 0.7% over the same period.

The study wasn't designed to detect the main drivers of these trends. However, they "highlight the escalating mental health challenges among college students, which is consistent with recent research reporting a surge in psychiatric diagnoses," the researchers said.

Still, they speculated that pandemic-related losses (for example, the deaths of loved ones), campus shootings and racial trauma on and off campus might be contributing factors.

Whatever the reasons, the findings "suggest the need for targeted, trauma-informed prevention and intervention strategies by mental health professionals and policy makers to support the affected student population," Zhai and colleagues wrote.

Yusen Zhai et al, Trends in Diagnosed Posttraumatic Stress Disorder and Acute Stress Disorder in US College Students, 2017-2022, JAMA Network Open (2024). DOI: 10.1001/jamanetworkopen.2024.13874

2024 HealthDay. All rights reserved.

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PTSD Has Surged Among College Students

The prevalence of post-traumatic stress disorder among college students rose to 7.5 percent in 2022, more than double the rate five years earlier, researchers found.

By Ellen Barry

Post-traumatic stress disorder diagnoses among college students more than doubled between 2017 and 2022, climbing most sharply as the coronavirus pandemic shut down campuses and upended young adults’ lives, according to new research published on Thursday.

The prevalence of PTSD rose to 7.5 percent from 3.4 percent during that period, according to the findings . Researchers analyzed responses from more than 390,000 participants in the Healthy Minds Study, an annual web-based survey.

“The magnitude of this rise is indeed shocking,” said Yusen Zhai, the paper’s lead author, who heads the community counseling clinic at the University of Alabama at Birmingham. His clinic had seen more young people struggling in the aftermath of traumatic events. So he expected an increase, but not such a large one.

Dr. Zhai, an assistant professor in the Department of Human Studies, attributed the rise to “broader societal stressors” on college students, such as campus shootings, social unrest and the sudden loss of loved ones from the coronavirus.

PTSD is a mental health disorder characterized by intrusive thoughts, flashbacks and heightened sensitivity to reminders of an event, continuing more than a month after it occurs.

It is a relatively common disorder , with an estimated 5 percent of adults in the United States experiencing it in any given year, according to the most recent epidemiological survey conducted by the Department of Health and Human Services. Lifetime prevalence is 8 percent in women and 4 percent in men, the survey found.

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PTSD is rising among college students, recent studies find — here’s how to manage it

The covid-19 pandemic, among other factors, could be contributing to the rise of mental health disorders among young adults.

By Caroline McDonald

Recent studies have shown that post-traumatic stress disorder and anxiety are on the rise in college students.

The research, published on JAMA Network , indicated that PTSD among college students increased from 3.4% to 7.5% between 2017 and 2022. Over 390,000 participants were involved in the study.

The study also analyzed the rise in ASD, acute stress disorder. The data revealed a “notable increase” in both PTSD and ASD, which “highlight the escalating mental health challenges among college students.”

Experts are now seeking to understand why these disorders are increasing among young adults.

Why are college students struggling with PTSD?

According to The New York Times , the disorder diagnoses peaked during the COVID-19 pandemic, when campuses across the nation shut down and “upended young adults’ lives.”

The research pointed to contributing factors such as “pandemic-related stressors (e.g., loss of loved ones) and the effect of traumatic events (e.g., campus shootings, racial trauma).”

About six out of every 100 people will experience PTSD in their lifetime, according to the National Center for PTSD . The disorder occurs after an individual has “been through a traumatic event.” The likeliness of developing the disorder is higher in women than it is in men.

The symptoms of PTSD can include flashbacks, intrusive thoughts and sensitivity to reminders of a traumatic event, according to The New York Times , with the symptoms continuing more than a month after the event occurs.

Academic researcher Shannon E. Cusack told The New York Times that some are skeptical about whether the “profound disruptions” caused by the pandemic connote the kinds of “triggering events” linked to PTSD.

“They’re causing symptoms that are consistent with the PTSD diagnosis,” Cusack said. “Am I not going to treat them because their stressor doesn’t count as a trauma?”

According to the study , “these findings suggest the need for targeted, trauma-informed prevention and intervention strategies by mental health professionals and policy makers to support the affected student population.”

How can I cope with PTSD in college?

“It is important for anyone with PTSD symptoms to work with a mental health professional who has experience treating PTSD,” according to the National Institute of Mental Health . Professionals are equipped with the knowledge and expertise necessary to help people with treatment plans.

The National Institute of Mental Health provided further methods to help those struggling with symptoms of PTSD:

• Create realistic, manageable goals.
• Practice activities, like exercise, that reduce stress.
• Avoid drugs and alcohol.
• Have routines for meals, sleep and exercise.
• Understand that your symptoms will “improve gradually, not immediately.”
• Talk with a trusted friend or member of your family.

Harvard Health provided some ways college students can manage symptoms of anxiety:

• Work on self-care. Self-care is a critical way to ease stress. A self-care routine can consist of healthy eating habits, exercise and proper sleep.
• Utilize campus resources. Campuses have resources to help students cope with stress and adapt to new situations. Search for mental health counseling, academic advising and student groups.
• Don’t avoid others. Some students try to combat intense stress by skipping class or avoiding stressors. But this will make anxiety worse. Try introducing yourself to someone new or emailing a professor or TA. Practice the small steps.

• Open access
• Published: 06 June 2024

Stress and exhaustion among medical students: a prospective longitudinal study on the impact of the assessment period on medical education

• Isabela Silva Santiago 1 ,
• Safira de Castro e Castro 1 ,
• Ana Paula Amaral de Brito 1 , 2 ,
• Daniel Sanches 3 ,
• Luiz Fernando Quintanilha 1 , 4 ,
• Katia de Miranda Avena 1 , 4 &
• Bruno Bezerril Andrade 1 , 4  

BMC Medical Education volume  24 , Article number:  630 ( 2024 ) Cite this article

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Stress significantly affects both the physical and emotional health of individuals, particularly students in health-related fields. Medical students in Brazil face unique challenges due to the demanding nature of their studies, especially during assessment periods, which heighten academic pressure. These pressures often lead to poor coping strategies and mental health concerns. It is crucial to understand the complex dynamics of stress within medical education to develop strategies that improve student well-being and promote a healthier academic environment. This study aims to investigate the intricate relationship between assessment periods and stress levels among medical students. It seeks to understand how academic demands and sociodemographic factors contribute to stress dynamics during these periods.

An online observational, longitudinal, and prospective study was conducted from February to October 2022. Medical students were recruited through snowball sampling and participated in surveys administered via Google Forms at two timepoints: before (T1) and during (T2) assessment periods. The surveys collected sociodemographic data and stress symptoms using Lipp’s Inventory of Stress Symptoms for Adults (LSSI).

The transition from T1 to T2 was defined by a rise in the prevalence of stress from 59.6 to 84.2% ( p  = 0.001) and a decline in symptom-free students from 40.4 to 15.8% ( p  = 0.001). There was a significant increase in exhaustion, from 12.3 to 31.6% ( p  = 0.0001). Higher stress levels were notably more prevalent among younger students (≤ 24 years), females, those from wealthier families, students without scholarships, those without prior degrees, and those in the clinical phase of their studies. However, non significant correlations were found between these sociodemographic and academic factors and the increase in stress.

The findings highlight significant concerns regarding the mental health of medical students during assessment periods, marked by increased stress and exhaustion levels. These results emphasize the need for proactive interventions to manage stress effectively in medical education, considering its profound impact on students’ well-being.

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Stress, as the body’s response to various stimuli triggering psychophysiological adaptation, profoundly influences an individual’s physical and emotional well-being. These stimuli can wield either positive or negative impacts, yet their persistence over time can significantly deteriorate an individual’s mental and physical health [ 1 ].

In recent years, several studies have illuminated a troubling trend: health profession students exhibit markedly higher rates of mental illness compared to the general population [ 2 , 3 , 4 , 5 ]. This concerning observation highlights the unique challenges faced by those pursuing careers in health-related fields.

Among these professions, medicine stands out for its notorious blend of heavy workload and high degree of self-demand, which requires an intense routine and arduous dedication to academic pursuit [ 6 ].

Within the challenging environment of medical school, students contend with a myriad of stressors capable of disrupting the delicate balance between their academic and personal lives [ 7 ]. These stressors frequently manifest in nonadaptive coping mechanisms [ 7 ], potentially stemming from challenges in acknowledging and confronting their fears [ 7 , 8 , 9 ]. This exacerbates the susceptibility to debilitating mental health conditions, including anxiety, depression, general mental disorders, and burnout [ 10 , 11 ].

In Brazil, some educational institutions adopt a specific interval within the academic calendar during which students undergo evaluations, examinations, or assessments of their academic performance. Within this context, the assessment period stands out as a temporal crucible within the university environment. This period, characterized by an intensified need for academic commitment, brings with it a cascade of challenges that reverberate through students’ lives [ 12 ]. It is a time marked by relentless self-critique, the burden of study overload, sleep deprivation, and a pervasive sense of isolation from familial and social support networks [ 13 ].

Faced with increasing academic pressures, students may resort to inappropriate coping strategies to increase their study time and performance [ 14 ], further compounding their psychological distress. The pursuit of academic excellence often collides with the erosion of well-being, raising questions about the true pedagogical value of assessments in such an environment.

In light of these pressing concerns, this study aimed to explore the nuanced interplay between the assessment period and stress levels among medical students. By examining the associations with academic and sociodemographic profiles, we aim to elucidate the multifaceted landscape of stress within the medical education environment.

Study design and sampling methods

To achieve the study’s objectives, an online observational, longitudinal, and prospective study was conducted between February to October 2022.

At the beginning of the 2022 academic year, all medical students from a private medical shool in Brazil ( n  = 906) were invited to participate in the study through virtual messages sent via instant messaging applications. The snowball sampling methodology was adopted for the recruitment of participants. This non-probabilistic technique is frequently used in virtual research to recruit participants with specific characteristics. The process allows participants themselves to recruit other participants who are also suitable for the study, allowing them to gradually expand the sample size [ 15 , 16 ]. The response rates were 19,4% ( n  = 176).

Participants

The study involved undergraduate medical students at Shool of Medicine from Salvador, Bahia, Brazil. Participants were recruited if they met the following inclusion criteria: (a) aged 18 years and above; and (b) regularly enrolled in the course. Students who did not respond to the questionnaire at both scheduled times were excluded.

Measurements

Data collection occurred in 2022, being carried out at two timepoints: before (T1) and during (T2) the assessment period of the first unit of each academic semester (2022.1 and 2022.2). For the 2022.1 semester, T1 occurred in February, while T2 occurred in April, while for the 2022.2 semester, T1 and T2 occurred in the months of August and October, respectively. We collected the data by administering student questionnaires via Google Forms.

During T1, participants completed a sociodemographic questionnaire covering age, sex, academic cycle, scholarship or student financing status, and prior graduation. Additionally, the Lipp’s Inventory of Stress Symptoms for Adults (LSSI) [ 17 ] was administered at both T1 and T2. This inventory comprises three parts with objective questions identifying physical and psychological stress symptoms, enabling differentiation into four phases: alertness, resistance, near exhaustion, and exhaustion.

The first part of LSSI comprised 12 physical and three psychological symptoms experienced in the past 24 h; the second part included 10 physical and five psychological symptoms from the previous week, while the third part encompassed 12 physical and 11 psychological symptoms from the last month. Notably, some symptoms from the first part reappeared with increased intensity in the third part [ 17 ]. LSSI consists of 53 items, 34 of which are somatic and 19 psychological. A positive stress diagnosis is determined based on the cumulative symptoms reported in each inventory part [ 17 ].

Data analysis

The data were analyzed using IBM SPSS statistical software, version 25.0. In terms of descriptive statistics, categorical variables were presented as the distribution of categorical frequencies, expressed in absolute numbers and percentages. The numerical variables were presented as arithmetic means and standard deviations when they had a normal distribution and as medians and interquartile ranges when they had an non-Gaussian distribution.

The analyses were conducted on both the entire sample and on groups of students categorized based on their current academic cycle. The academic cycle was divided into two main groups: the basic cycle, comprising 1st and 2nd years, and the clinical cycle, encompassing 3rd and 4th years. This subgrouping analysis is important because students experience distinct challenges within each academic phase, potentially resulting in different influences on their stress levels.

For analytical statistics, we applied the Kolmogorov‒Smirnov normality test for quantitative variables. The unpaired t test and the Mann‒Whitney U test were used to compare continuous variables between groups, and the chi‒squared test was used for categorical variables. Compared with the sociodemographic and academic variables, the stress variable was dichotomized according to whether it had increased. Comparisons between the “before” (T1) and “during” (T2) assessments were performed using the nonparametric Wilcoxon signed rank test for paired samples.

To assess changes in stress levels and the presence of symptoms between the two study timepoints, we created two variables called “stress behavior” and “symptoms behavior”, representing the difference between T2 and T1 assessments. Results were categorized as increased, maintained, or decreased of stress or symptoms. Increased stress was considered the primary outcome. To analyze Tab1associations between sociodemographic and academic variables and increased stress, we used odds ratios (ORs), contingency coefficients, and chi-square tests with Bonferroni post hoc correction for multiple comparisons. For all analyses, the level of statistical significance was set at 0.05 or 5%.

Ethics approval and consent to participate

The study complied with Resolution 466/12 of the Brazilian Health Council and was approved by the Brazilian Research Ethics Committee (protocol No. 44150621.7.0000.5032).

The participants’ autonomy, confidentiality, and privacy were carefully maintained throughout the study. Data confidentiality and participant privacy were ensured by restricting information access to the involved researchers exclusively. Each participant was assigned a unique random number, and responses were matched using the first three letters of their first name and the initial three digits of their Brazilian Individual Taxpayer Identification Number. To uphold the principle of autonomy, participants were provided access to the data collection instrument via a link distributed by the researchers before completing the survey. This allowed them to review the questionnaire items before deciding whether to participate in the study. These stringent measures were implemented by ethical principles and research guidelines, aiming to safeguard participant well-being and ensure the scientific validity of the study. These measures are also in compliance with the Brazilian General Personal Data Protection Law. Moreover, all study participants were fully informed about the research objectives and methods and provided their consent by signing the informed consent form.

A total of 176 students responded to the survey. One hundred forty-five medical students participated in the study during the initial data collection (T1), and 88 participated in the subsequent stage (T2). Among this cohort, only 57 students completed the questionnaire at both time points, thus composing the final study population.

Most of the study participants were female (77.2%), with a mean age of 24.0 ± 4.7 years and a monthly family income ranging from 3 to 9 times the minimum wage (29.8%). Regarding academic aspects, the majority were in the clinical cycle (42.1%), did not hold a previous degree (80.7%), and did not receive student grants or funding (59.6%) (Table  1 ).

Despite the distinct challenges experienced in each academic cycle, no statistically significant differences were found between the groups of students in the basic or clinical cyle, with regard to the evaluated features emcompassing sociodemographic, academic, or stress characteristics (Table  1 ). This suggests that the subgroups of students based on academic cycle appeared to have similar characteristics regardless of when they completed the questionnaires. Consequently, the further analyzes concatenated all the medical students primarily included in the research, without the necessity of dividing them into subgroups based on the ongoing academic cycle.

When comparing the data from T1 and T2, there was an increase in the prevalence of stress (T1: 59.6% vs. T2: 84.2%, p  = 0.001) and a decrease in the number of students reporting no physical or psychological symptoms of stress (T1: 40.4% vs. T2: 15.8%, p  = 0.001). Additionally, a significant rise was observed in the proportion of students experiencing exhaustion (T1: 12.3% vs. T2: 31.6%, p  = 0.0001) (Table  2 ).

During the evaluation period, heightened stress levels were predominantly observed among students aged up to 24 (73.1%), females (76.9%), with a family income exceeding 12 times the minimum wage (26.9%), without a student grant (65.4%), lacking a previous degree (84.6%), and enrolled in the clinical cycle (53.8%). However, a logistic regression analysis including those variables did not show a significant association with increased stress in the study population (Table  3 ).

Assessment plays a crucial role in undergraduate medical education, essential for students’ academic and professional development. It provides continuous feedback, identifies areas for knowledge improvement, and adapts teaching to individual and collective needs to promote deep, self-directed, meaningful, and motivated learning [ 18 ]. A well-designed assessment period evaluates theoretical knowledge, practical skills, ethics, and communication, essential for training competent and committed physicians for the challenges of clinical practice.

Several educational organizations advocate for a global reconsideration of the assessment period, promoting procedures that stimulate skill and competency development, as well as critical thinking [ 19 , 20 , 21 ]. Despite diverse assessment methods, multiple-choice tests continue to dominate medical education and selection processes [ 22 ], including Brazil’s essential examinations such as the National Undergraduate Student Achievement Examination and the National Residency Examination are based on this strategy. Therefore, medical students must be adequately prepared, both physically and psychologically, for these exams.

In this context, Sein, Dathatri, and Bates [ 18 ] proposed guidelines to assist stakeholders in medical education, emphasizing strategies to reduce exam-related anxiety and stress. Despite stress’s perceived neutrality on academic performance [ 23 , 24 , 25 , 26 ], its high prevalence among students warrants educators’ attention due to its potential physical and psychological impacts [ 17 ].

Our study revealed a notable stress prevalence among medical students (59.6%), with 15.8% experiencing “near exhaustion” or “exhaustion”. Consistent with national and international studies [ 12 , 24 , 27 , 28 , 29 , 30 ], stress factors include university adaptation, study methods, performance pressure, poor sleep quality, and financial concerns [ 25 , 26 , 28 , 29 , 31 ]. Although few studies explore the assessment period’s impact on stress, our findings suggest a negative influence, particularly among students on the verge of exhaustion.

While sociodemographic and academic characteristics did not correlate with increase in stress in our logistic regression analysis, it is important to highlight that younger and female students experienced higher stress levels. This trend is particularly significant in the context of medical education, characterized by feminization and juvenilization processes [ 32 ]. Medical education stakeholders should carefully consider this scenario, especially considering evidence of a higher prevalence of disorders among these demographic groups [ 24 ].

Despite the significant number of students experiencing stress, it’s essential to acknowledge that some remain unaffected, either before or during the assessment period. This underscores the significance of individual coping mechanisms and personal resilience in shaping one’s perception of stress. Strategies to reduce stress levels include valuing interpersonal relationships, time management, nutritional and sleep care, religious engagement, building support network, and seeking psychological assistance.

Neglecting student well-being poses individual and public health risks, impacting future physicians’ training and healthcare system users [ 10 , 33 ]. Understanding stress causes and implications is crucial for proposing effective institutional strategies [ 34 ]. In addition, sensitizing students to their psychological aspects and reactions to course-related experiences is imperative. Medical schools must prioritize student care [ 7 ] and create safe and supportive environments permeated by respect, attentive listening, and acceptance to address diverse psychological demands throughout medical training.

Strengths and limitations

The study’s limitations call for special attention. One potential limitation is the reduced participant adherence during the second phase of data collection, resulting in a significant exclusion rate of those who completed only the first phase of the study. Furthermore, it is important to consider the questionnaire’s length and the possibility of student fatigue during completion, factors that may have contributed to reduced participation, particularly during the exam week. Another relevant point is that the study was conducted at a single private medical school in Brazil, although it is the largest medical school in the country in terms of the number of medical students. This indicates that the findings described here require additional validation in other medical schools, ideally encompassing programs from various regions of the country, including public institutions. Regional disparities and the differing impacts of public versus private investment could influence stress levels differently, necessitating broader validation efforts to ensure the robustness and generalizability of the results.

Despite limited participant adherence during the second phase, our study provides longitudinal and prospective suggestions indicating the negative impact of the assessment period on stress and exhaustion among medical students. These findings prompt reflection on institutional intervention proposals aimed at alleviating the issue without compromising teaching quality and ensuring meaningful learning in future physicians’ training [ 35 , 36 ].

Thus, the results underscore the urgent need for specific strategies and interventions targeting student groups identified as more vulnerable to increased stress. The medical education environment should implement preventive and supportive measures for students’ mental health, as although evidence regarding its impact on academic performance is insufficient, the significant increase in stress symptoms during the assessment period warrants reflection and action to mitigate the problem. These findings highlight the importance of personalized medical education approaches aiming not only for academic excellence but also for the holistic well-being of future health professionals.

Together, the findings of the present study uncover worrying results regarding the mental health of medical students during the evaluation period, as medical students experienced a significant increase in the presence of stress and the incidence of exhaustion. Given the complexity and implications of stress in the educational context, especially in the demanding environment of medical courses, the results of this research highlight the relevance of a careful and proactive approach to understanding and mitigating the factors that amplify stress among students in this critical learning period.

Data availability

The datasets used and analysed during the current study are available from the corresponding author on reasonable request.

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This study was funded by the Intramural Research Program of the Oswaldo Cruz Foundation (Fiocruz). The funding source played no role in the study design; the data collection, analysis or interpretation; or the writing of the manuscript. The researchers retained complete independence in the conduct of the study.

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Contributions

Conception and design of the work: KMA, APAB. Literature review: ISS, SCC, KMA, LFQ, APAB.Data acquisition and analysis: ISS, SCC, KMA, APAB. Interpretation of the data: ISS, SCC, KMA, APAB. Drafted the manuscript: ISS, SCC, KMA, APAB.Substantively revised the manuscript: KMA, DS, LFQ, APAB, BBA. All the authors reviewed the manuscript and approved the final version.

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Correspondence to Katia de Miranda Avena .

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The authors confirm that all methods were carried out in accordance with relevant guidelines and regulations. Research was performed in accordance with the Declaration of Helsinki and with Resolution 466/12 of the Brazilian Health Council.

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The authors declare no competing interests.

The study was approved by the Brazilian Research Ethics Committee (protocol no. 44150621.7.0000.5032) and all participants previously signed a written informed consent form (ICF).

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Santiago, I.S., de Castro e Castro, S., de Brito, A.P.A. et al. Stress and exhaustion among medical students: a prospective longitudinal study on the impact of the assessment period on medical education. BMC Med Educ 24 , 630 (2024). https://doi.org/10.1186/s12909-024-05617-6

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DOI : https://doi.org/10.1186/s12909-024-05617-6

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