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Top 10 Stress Management Techniques for Students

Elizabeth Scott, PhD is an author, workshop leader, educator, and award-winning blogger on stress management, positive psychology, relationships, and emotional wellbeing.

Akeem Marsh, MD, is a board-certified child, adolescent, and adult psychiatrist who has dedicated his career to working with medically underserved communities.

Most students experience significant amounts of stress. This can significantly affect their health, happiness, relationships, and grades. Learning stress management techniques can help these students avoid negative effects in these areas.

Why Stress Management Is Important for Students

A study by the American Psychological Association (APA) found that teens report stress levels similar to adults. This means teens are experiencing significant levels of chronic stress and feel their stress levels generally exceed their ability to cope effectively .

Roughly 30% of the teens reported feeling overwhelmed, depressed, or sad because of their stress.

Stress can also affect health-related behaviors. Stressed students are more likely to have problems with disrupted sleep, poor diet, and lack of exercise. This is understandable given that nearly half of APA survey respondents reported completing three hours of homework per night in addition to their full day of school work and extracurriculars.

Common Causes of Student Stress

Another study found that much of high school students' stress originates from school and activities, and that this chronic stress can persist into college years and lead to academic disengagement and mental health problems.

Top Student Stressors

Common sources of student stress include:

• Extracurricular activities
• Social challenges
• Transitions (e.g., graduating, moving out , living independently)
• Relationships
• Pressure to succeed

High school students face the intense competitiveness of taking challenging courses, amassing impressive extracurriculars, studying and acing college placement tests, and deciding on important and life-changing plans for their future. At the same time, they have to navigate the social challenges inherent to the high school experience.

This stress continues if students decide to attend college. Stress is an unavoidable part of life, but research has found that increased daily stressors put college-aged young adults at a higher risk for stress than other age groups.

Making new friends, handling a more challenging workload, feeling pressured to succeed, being without parental support, and navigating the stresses of more independent living are all added challenges that make this transition more difficult. Romantic relationships always add an extra layer of potential stress.

Students often recognize that they need to relieve stress . However, all the activities and responsibilities that fill a student’s schedule sometimes make it difficult to find the time to try new stress relievers to help dissipate that stress.

10 Stress Management Techniques for Students

Here you will learn 10 stress management techniques for students. These options are relatively easy, quick, and relevant to a student’s life and types of stress .

Get Enough Sleep

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Students, with their packed schedules, are notorious for missing sleep. Unfortunately, operating in a sleep-deprived state puts you at a distinct disadvantage. You’re less productive, may find it more difficult to learn, and may even be a hazard behind the wheel.

Research suggests that sleep deprivation and daytime sleepiness are also linked to impaired mood, higher risk for car accidents, lower grade point averages, worse learning, and a higher risk of academic failure.

Don't neglect your sleep schedule. Aim to get at least 8 hours a night and take power naps when needed.

Use Guided Imagery

David Malan / Getty Images

Guided imagery can also be a useful and effective tool to help stressed students cope with academic, social, and other stressors. Visualizations can help you calm down, detach from what’s stressing you, and reduce your body’s stress response.

You can use guided imagery to relax your body by sitting in a quiet, comfortable place, closing your eyes, and imagining a peaceful scene. Spend several minutes relaxing as you enjoy mentally basking in your restful image.

Consider trying a guided imagery app if you need extra help visualizing a scene and inducting a relaxation response. Research suggests that such tools might be an affordable and convenient way to reduce stress.

Exercise Regularly

One of the healthiest ways to blow off steam is to get regular exercise . Research has found that students who participate in regular physical activity report lower levels of perceived stress. While these students still grapple with the same social, academic, and life pressures as their less-active peers, these challenges feel less stressful and are easier to manage.

Finding time for exercise might be a challenge, but there are strategies that you can use to add more physical activity to your day. Some ideas that you might try include:

• Doing yoga in the morning
• Walking or biking to class
• Reviewing for tests with a friend while walking on a treadmill at the gym
• Taking an elective gym class focused on leisure sports or exercise
• Joining an intramural sport

Exercise can help buffer against the negative effects of student stress. Starting now and keeping a regular exercise practice throughout your lifetime can help you live longer and enjoy your life more.

Take Calming Breaths

When your body is experiencing a stress response, you’re often not thinking as clearly as you could be. You are also likely not breathing properly. You might be taking short, shallow breaths. When you breathe improperly, it upsets the exchange of oxygen and carbon dioxide in your body.

Studies suggest this imbalance can contribute to various physical symptoms, including increased anxiety, fatigue, stress, emotional problems, and panic attacks.

A quick way to calm down is to practice breathing exercises . These can be done virtually anywhere to relieve stress in minutes.

Because they are fast-acting, breathing exercises are a great way to cope with moments of acute stress , such as right before an exam or presentation. But they can also help manage longer-lasting stress such as dealing with relationships, work, or financial problems.

Practice Progressive Muscle Relaxation (PMR)

Another great stress management technique for students that can be used during tests, before bed, or at other times when stress has you physically wound up is progressive muscle relaxation ( PMR ).

This technique involves tensing and relaxing all muscles until the body is completely relaxed. With practice, you can learn to release stress from your body in seconds. This can be particularly helpful for students because it can be adapted to help relaxation efforts before sleep for a deeper sleep.

Once a person learns how to use PMR effectively, it can be a quick and handy way to induce relaxation in any stressful situation, such as bouts of momentary panic before a speech or exam, dealing with a disagreement with your roommate, or preparing to discuss a problem with your academic advisor.

Listen to Music

A convenient stress reliever that has also shown many cognitive benefits, music can help relieve stress and calm yourself down or stimulate your mind depending on what you need in the moment.

Research has found that playing upbeat music can improve processing speed and memory. Stressed students may find that listening to relaxing music can help calm the body and mind. One study found that students who listened to the sounds of relaxing music were able to recover more quickly after a stressful situation.

Students can harness the benefits of music by playing classical music while studying, playing upbeat music to "wake up" mentally, or relaxing with the help of their favorite slow melodies.

Build Your Support Network

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Having emotional support can help create a protective buffer against stress. Unfortunately,  interpersonal relationships can also sometimes be a source of anxiety for students. Changes in friendships, romantic breakups, and life transitions such as moving away for college can create significant upheaval and stress for students.

One way to combat feelings of loneliness and make sure that you have people to lean on in times of need is to expand your support network and nurture your relationships.

Look for opportunities to meet new people, whether it involves joining study groups or participating in other academic, social, and leisure activities.

Remember that different types of relationships offer differing types of support . Your relationships with teachers, counselors, and mentors can be a great source of information and resources that may help you academically. Relationships with friends can provide emotional and practical support.

Widening your social circle can combat student stress on various fronts and ensure you have what you need to succeed.

Eat a Healthy Diet

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You may not realize it, but your diet can either boost your brainpower or sap you of mental energy. It can also make you more reactive to the stress in your life. As a result, you might find yourself turning to high-sugar, high-fat snacks to provide a temporary sense of relief.

A healthy diet can help combat stress in several ways. Improving your diet can keep you from experiencing diet-related mood swings, light-headedness, and more.

Unfortunately, students are often prone to poor dietary habits. Feelings of stress can make it harder to stick to a consistently healthy diet, but other concerns such as finances, access to cooking facilities, and time to prepare healthy meals can make it more challenging for students.

Some tactics that can help students make healthy choices include:

• Eating regularly
• Carrying a water bottle to class
• Keeping healthy snacks such as fruits and nuts handy
• Limiting caffeine, nicotine, and alcohol intake

Find Ways to Minimize Stress

One way to improve your ability to manage student stress is to look for ways you cut stress out of your life altogether. Evaluate the things that are bringing stress or anxiety into your life. Are they necessary? Are they providing more benefits than the toll they take on your mental health? If the answer is no, sometimes the best option is just to ditch them altogether.

This might mean cutting some extracurricular activities out of your schedule. It might mean limiting your use of social media. Or it might mean learning to say no to requests for your time, energy, and resources. 

While it might be challenging at first, learning how to prioritize yourself and your mental well-being is an important step toward reducing your stress.

Try Mindfulness

When you find yourself dealing with stress—whether it's due to academics, relationships, financial pressures, or social challenges—becoming more aware of how you feel in the moment may help you respond more effectively.

Mindfulness involves becoming more aware of the present moment. Rather than judging, reacting, or avoiding problems, the goal is to focus on the present, become more aware of how you are feeling, observe your reactions, and accept these feelings without passing judgment on them.

Research suggests that mindfulness-based stress management practices can be a useful tool for reducing student stress. Such strategies may also help reduce feelings of anxiety and depression.

A Word From Verywell

It is important to remember that stress isn't the same for everyone. Figuring out what works for you may take some trial and error. A good start is to ensure that you are taking care of yourself physically and emotionally and to experiment with different stress relief strategies to figure out what works best to help you feel less stressed.

If stress and anxiety are causing distress or making it difficult to function in your daily life, it is important to seek help. Many schools offer resources that can help, including face-to-face and online mental health services. You might start by talking to your school counselor or student advisor about the stress you are coping with. You can also talk to a parent, another trusted adult, or your doctor.

If you or a loved one are struggling with anxiety, contact the  Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline  at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our  National Helpline Database .

American Psychological Association. Stress in America: Are Teens Adopting Adults' Stress Habits?

Leonard NR, Gwadz MV, Ritchie A, et al. A multi-method exploratory study of stress, coping, and substance use among high school youth in private schools . Front Psychol. 2015;6:1028. doi:10.3389/fpsyg.2015.01028

Acharya L, Jin L, Collins W. College life is stressful today - Emerging stressors and depressive symptoms in college students . J Am Coll Health . 2018;66(7):655-664. doi:10.1080/07448481.2018.1451869

Beiter R, Nash R, McCrady M, Rhoades D, Linscomb M, Clarahan M, Sammut S. The prevalence and correlates of depression, anxiety, and stress in a sample of college students . J Affect Disord . 2015;173:90-6. doi:10.1016/j.jad.2014.10.054

Hershner SD, Chervin RD. Causes and consequences of sleepiness among college students . Nat Sci Sleep . 2014;6:73-84. doi:10.2147/NSS.S62907

Gordon JS, Sbarra D, Armin J, Pace TWW, Gniady C, Barraza Y. Use of a guided imagery mobile app (See Me Serene) to reduce COVID-19-related stress: Pilot feasibility study . JMIR Form Res . 2021;5(10):e32353. doi:10.2196/32353

Cowley J, Kiely J, Collins D. Is there a link between self-perceived stress and physical activity levels in Scottish adolescents ? Int J Adolesc Med Health . 2017;31(1). doi:10.1515/ijamh-2016-0104

Paulus MP.  The breathing conundrum-interoceptive sensitivity and anxiety .  Depress Anxiety . 2013;30(4):315–320. doi:10.1002/da.22076

Toussaint L, Nguyen QA, Roettger C, Dixon K, Offenbächer M, Kohls N, Hirsch J, Sirois F. Effectiveness of progressive muscle relaxation, deep breathing, and guided imagery in promoting psychological and physiological states of relaxation . Evid Based Complement Alternat Med . 2021;2021:5924040. doi:10.1155/2021/5924040.

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By Elizabeth Scott, PhD Elizabeth Scott, PhD is an author, workshop leader, educator, and award-winning blogger on stress management, positive psychology, relationships, and emotional wellbeing.

Essay on Stress Management

500 words essay on stress management.

Stress is a very complex phenomenon that we can define in several ways. However, if you put them together, it is basically the wear and tear of daily life. Stress management refers to a wide spectrum of techniques and psychotherapies for controlling a person’s stress level, especially chronic stress . If there is effective stress management, we can help one another break the hold of stress on our lives. The essay on stress management will throw light on the very same thing.

Identifying the Source of Stress

The first step of stress management is identifying the source of stress in your life. It is not as easy as that but it is essential. The true source of stress may not always be evident as we tend to overlook our own stress-inducing thoughts and feelings.

For instance, you might constantly worry about meeting your deadline. But, in reality, maybe your procrastination is what leads to this stress than the actual deadline. In order to identify the source of stress, we must look closely within ourselves.

If you explain away stress as temporary, then it may be a problem. Like if you yourself don’t take a breather from time to time, what is the point? On the other hand, is stress an integral part of your work and you acknowledging it like that?

If you make it a part of your personality, like you label things as crazy or nervous energy, you need to look further. Most importantly, do you blame the stress on people around you or the events surrounding you?

It is essential to take responsibility for the role one plays in creating or maintaining stress. Your stress will remain outside your control if you do not do it.

Strategies for Stress Management

It is obvious that we cannot avoid all kinds of stress but there are many stressors in your life which you can definitely eliminate. It is important to learn how to say no and stick to them.  Try to avoid people who stress you out.

Further, if you cannot avoid a stressful situation, try altering it. Express your feelings don’t bottle them up and manage your time better. Moreover, you can also adapt to the stressor if you can’t change it.

Reframe problems and look at the big picture. Similarly, adjust your standards and focus on the positive side. Never try to control the uncontrollable. Most importantly, make time for having fun and relaxing.

Spend some time with nature, go for a walk or call a friend, whatever pleases you.  You can also try working out, listening to music and more. As long as it makes you happy, never give up.

Get the huge list of more than 500 Essay Topics and Ideas

Conclusion of the Essay on Stress Management

All in all, we can control our stress levels with relaxation techniques that evoke the relaxation response of our body. It is the state of restfulness that is the opposite of the stress response. Thus, when you practice these techniques regularly, you can build your resilience and heal yourself.

FAQ of Essay on Stress Management

Question 1: What is the importance of stress management?

Answer 1: Stress management is very efficient as it helps in breaking the hold which stress has on our lives. Moreover, you can also become happy, healthy and more productive because of it. The ultimate goal should be to live a balanced life and have the resilience to hold up under pressure.

Question 2: Give some stress management techniques.

Answer 2: There are many stress management techniques through which one can reduce stress in their lives. One can change their situation or their reaction to it. We can try by altering the situation. If not, we can change our attitudes towards it. Remember, accept things that you cannot change.

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Managing Stress in High School

Our reasons may vary, but everyone experiences stress. Here are some of the common reasons high school students feel stressed, and what they can do about it.

Pamela Reynolds

Exams. Choosing a college. Figuring out what to do with your life.

No doubt, high school can be a high-pressure time in life. And high school students, as a result, get stressed out.  

In fact, according to the American Psychological Association’s Stress in America 2020 survey, teens who are already under stress due to the normal pressures of high school have felt even more stress in recent years, thanks to the pandemic. About 43 percent of teens surveyed in 2020 said their stress levels had gone up, and 45 percent said they had a hard time concentrating on schoolwork. Many reported feeling less motivated.

Although life has mostly returned back to normal, that doesn’t mean the stress that high school students feel has disappeared. 

The typical challenges that anyone faces in high school continue as they always have, and, in some cases, have grown more complicated. Consequently, surveys suggest, many teens continue to experience a decline in mental and physical health. 

If you’re in high school and stressed, we get it. In this blog, we’ll talk about what stress is, what triggers it, and how you can manage it. 

What is Stress?

“Stress” is a term we use constantly in conversation, but what does it really mean? 

Stress can be defined as our physical and mental responses to some external event. The event might be considered “good” like preparing to go to the prom, or bad, like feeling tense after an illness, an argument with a friend, or while preparing for an upcoming test. 

The good thing about most stress is that it usually goes away once the external event causing the stress is over. 

Alternatively, there is a type of stress that results more from an internal dialogue than an external event. We call this “anxiety.” It involves persistent feelings of dread or apprehension that interfere with your daily life, even after the test, the argument, or prom, are just a distant memory. 

Why Are Teens So Stressed? 

Simply being a teenager can be hard. Your body is changing. You may be grappling with your sexuality or gender identity. Add to that the academic demands of high school and throw in the pressures of social media, and the tension mounts. 

“Some of the common triggers of stress in teens might be anxiety to perform well in academics such as getting into a good college, peer pressure, interpersonal relationships, or body image issues,” says Sakshi Khurana, Research Fellow at Harvard’s Weisz Lab for Youth Mental Health. “Other larger issues that the world is going through — for example, climate change or war— might also act as stressors for teens as they are learning about the world.”

The most common source of stress for high school students, according to the 2017 APA Stress survey , is school itself, with about 83 percent of teens identifying school as a major stressor. The second biggest source of student stress, (according to 69 percent of students), was getting into a good college or deciding what to do after high school. The third biggest teen stress was financial concerns for the family (65 percent of students). 

Here’s a quick breakdown of broad categories of factors that may stress you out:

• Academics. In high school, not only are you worried about next week’s English, History or Calculus exam, but you’re also worried about applying to college and taking the SAT tests, too. It can all feel overwhelming, and you may feel pressure to please your parents and teachers.
• Social Stress. Even without the pressures of academics, life in high school can be demanding. Dealing with friends and classmates, starting new romantic relationships, handling bullies and peer pressure both online and off, can be a lot to handle.
• Family Issues. If your parents are divorcing, if your family is experiencing financial problems, or even if you just have trouble getting along with siblings, your stress levels can go up.
• Trauma . Dramatic life events ranging from a death in the family, to an accident, to emotional and physical abuse, can cause stress. Also in this category, you can include the collective trauma of such global events such as school shootings, terrorism, and natural disasters. 
• Big Life Changes . Changes like moving and starting a new school can be a major stress for teens. 

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What are Signs of Stress in High School Students?

If you’re a high school student feeling stressed, you may not even recognize the symptoms. 

In fact, many symptoms of stress might be considered normal for teens who are also dealing with natural hormonal and physical changes. For that reason, it’s important to consider whether behavioral changes can be linked in time to an external event. 

Signs of stress include:

• Feeling more agitated, anxious, short-tempered, or depressed  
• Getting sick more often
• Having more headaches, stomachaches, or other aches and pains
• Feeling more tired than usual
• Not being able to sleep, or sleeping too much
• Skipping meals or overeating 
• Neglecting chores or hobbies 
• Trouble concentrating and forgetfulness
• High blood pressure

According to the APA 2017 survey, the most common symptoms of stress among teens were insomnia, overeating or eating unhealthy foods, skipping meals, feeling angry, nervous, or anxious, feeling fatigued, and snapping at friends and classmates.

Why is Stress so Problematic for Teens?

Let’s be clear, a little bit of stress is a normal part of life, and sometimes even desirable. 

Stress can act as a motivator, getting us to do things we might not otherwise. Good stress is called “eustress” and can help get you excited and energized about that first date or taking the stage in your first musical.

But too much unrelieved stress can lead to mental and physical health issues.  

Your body reacts to stress by releasing a hormone called cortisol which regulates blood pressure and immune function. If you’re stressed all the time and your body produces too much cortisol, it can lower your immunity, raise your blood pressure, and impair your cognitive performance.

In teens, the part of the brain regulating the stress response is less developed than in adults, meaning that if you’re a stressed-out teen, you may experience stress longer than an adult. 

“In the teen years, due to hormonal changes, stress tends to influence the emotional functioning of the brain, which in turn impacts the cognitive and executive functioning,” says Khurana.

You might not be able to sleep, you may overeat, or develop digestive, cardiovascular, or immune problems. Stress can even put you at a higher risk for developing mental illnesses like anxiety or depression . 

What are the Best Techniques to Help Students Manage Stress?

Since too much stress is not a good thing for your mind or body, you should think about incorporating a few stress management techniques into your daily life. 

“A few techniques that might help teens manage stress are relaxation through deep breathing, meditation, or mindfulness, channeling energy into sports or creative pursuits such as music, art, theater, and forming meaningful relationships or friendships,” says Khurana. “Additionally, every culture has its own way of enabling young people to manage stress, so drawing from those traditions might be helpful as well.”

Here are few ideas of how high school students can learn how to deal with stress at school: 

• Keeping a journal
• Getting plenty of exercise
• Eating healthy, regular meals
• Making sure you get enough sleep  
• Downloading an app that provides relaxation exercises (such as deep breathing or visualization) or tips for practicing mindfulness
• Limiting excess caffeine in soft drinks or coffee
• Reaching out to friends or family members who help you cope in a positive way
• Making time to do fun things
• Learning to recognize and prepare for stressful periods by doing all of the above

With so many big life decisions ahead, getting through high school happy and whole can definitely feel challenging at times. It’s easy to see why so many high school students feel stressed. The good news is that there are solutions. Adopt the strategies above, take a deep breath, and remember, it’s not forever! 

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About the Author

Pamela Reynolds is a Boston-area feature writer and editor whose work appears in numerous publications. She is the author of “Revamp: A Memoir of Travel and Obsessive Renovation.”

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How to Cope with Stress Essay

Introduction, how do stress and stressors help a person in identifying ways to cope, problem solving approach in coping stress, the identification of the stressor.

According to Aamodt (2009) stress is the psychological and physical reaction to certain life events or situations. Fear, resistance, resentment, change, relations with others, organizational politics, and unfavorable physical environment are the main causes of stress (Aamodt, 2009). Even though stress affects different personalities differently, it could result to grave consequences if not well managed.

Many people often think there is little that can be done about their level of stress. However, the fact is contrary. Individuals should identify their stressors and develop coping strategies aimed at neutralizing and finally eliminating the effects of the stressors. I have in the past adopted various strategies in coping with stress.

There are many stress coping methods. However, individuals often find themselves employing unhealthy and unproductive methods, which end compounding the problem. Such methods include withdrawal from friends and families, use of pills, drinking, smoking, overeating, and taking out of stress on other people. Even though these methods can work, their results are temporary as individuals soon face the reality of the stressor.

Healthier and effective ways of controlling stress require either situation change, or reaction change. Every individual exhibits unique response to stress, which makes it impossible to have a common method of coping. The simplest approaches to coping with stress, which I have used in the past, include problem identification and solving, acceptance, alteration, self-nurturing, and anticipatory approach also suggested by Aldwin (2007).

Problem solving approach is a strategy that its applicability is dependent on the determination of the main cause of stress. Once the stressor is identified, it becomes easy to solve the stress as an individual directs his or her energy towards subduing the stressor. For example, if lack of finances is the main cause of stress, then an individual may seek for new employment to provide for the much-needed cash.

The identification of the stressor also opens a window for an individual to explore other adaptation methods, which can be of help in the future such as avoidance. In anticipatory approach, an individual prepares for possible causes of stress and consequently prepares for them before their actual occurrence. Past trends and acquired knowledge can help an individual in such preparations.

For example, a student subjected to last minute revision pressures and stress for failing to revise in time may expect the same, hence prepare early in the following semesters to avoid going through the same. This method is very effective as an individual can review and continually revise the best method to use every time the stressor reoccurs. Sometimes stressful situations are not only complex, but also impossible to avoid.

It is only prudent for individuals affected to alter and adapt to such situations. This involves finding possible ways of changing an individual’s operation to avoid the stress from reoccurring. For example, stress caused by coworkers could be avoided by expressing ones’ feelings to the specific workers instead of bottling them up. If the desired change is not achieved, then one can go a step further by changing his or her own behaviors.

Stressors such as the death of people we love, fatal accidents, and illness are unavoidable and impossible to ignore. However, letting such stressors take tall of an individual’s life is also unacceptable. In such cases, the best coping strategy is acceptance. Though hard to take, acceptance is the only way out for individuals facing unchangeable life-threatening situations.

There are other effective coping strategies, which even though I have not used, I would consider applying. Self-nurturing is such “effective way of coping with stress” (Aldwin, 2007).

Creating time for fun and relaxing, enhance our ability to copy with life’s unending stressors. It is therefore prudent for an individual to engage frequently in healthy ways of relaxing such as, going for a walk, playing with a pet, going adventures, watching comedies, and lighting scented candles.

Aamodt, M. G. (2009). Industrial/Organizational Psychology: An Applied Approach (6th ed.). Belmont, CA: Cengage Learning.

Aldwin, C. M. (2007). Stress, coping, and development: an integrative perspective (2nd ed.). New York, NY: Guilford Press.

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Stress in College Students: How To Cope

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A college student's guide to stress.

College is an exciting time, full of new challenges that continually drive you to expand your horizons. While some of these experiences can be thrilling, others may simply leave you feeling stressed. In fact, many college students feel stress while going to school. Only 1.6 percent of undergraduates reported that they felt no stress in the last 12 months, according to the National College Health Assessment (NCHA).

Being able to manage stress is crucial for your academic success and personal well-being in college. Luckily, this guide from Western Governors University will provide you with information about how to recognize different kinds of stress, various sources of stress for college students, as well as tips for coping in a healthy way. If you are able to identify and understand stress, you will be able to ensure your time as a student is rewarding and enjoyable.

What is stress?

Stress is a normal and necessary part of life. It is your fight-or-flight response to challenges you see in the world. This natural reaction has certain physical effects on the body to allow you to better handle these challenges, such as increased heart rate and blood circulation. While it can manifest differently for each individual, the National Institute of Mental Health notes that everyone feels stress at some point in their lives, regardless of age, gender, or circumstance.

Though it is a universal human experience, the American Institute of Stress (AIS) notes that defining and measuring stress is difficult because “there has been no definition of stress that everyone accepts” and “people have very different ideas with respect to their definition of stress.” They also state that a definition of stress is incomplete without mention of good stress (called eustress), its physical effects, or the body’s instinctive fight-or-flight response.

Researcher Andrew Baum , however, created a succinct, unique definition. He determines that stress is any “emotional experience accompanied by predictable biochemical, physiological and behavioral changes.” For the purposes of this guide, we will use Baum’s definition of stress.

Acute stress.

According to the American Psychological Association (APA), acute stress is the most common type of stress that every person will experience during the course of their life. It arises quickly in response to unexpected or alarming events to help you better handle the situation at hand. Typically, it fades quickly, either on its own or once the stressful event is over.

Acute stress doesn’t often lead to serious health problems. In certain situations, it can actually be a positive experience; for example, riding a roller coaster can cause acute stress, but in a thrilling way.

This type of stress occurs frequently and is easy to identify. Some signs of acute stress include:

Stomach pain, such as heartburn, diarrhea, or acid stomach.

Heightened blood pressure and heartbeat.

Shortness of breath or chest pain.

Headaches, back pain, jaw pain.

Because it is so common and lasts for a short amount of time, acute stress is usually simple to manage and treat.

Episodic stress.

When acute stress occurs frequently, it is classified as episodic or episodic acute stress. People who suffer from episodic stress are almost always in “crisis mode,” are often irritable and anxious, and may be prone to constant worrying. Essentially, people with episodic stress are often overwhelmed by it and have difficulty managing it.

Symptoms of episodic stress are the same as acute stress, but they can be more extreme or occur constantly. Some signs of long-term episodic stress according to the APA are:

Constant headaches or migraines.

Hypertension.

Heart disease.

People who suffer from episodic stress typically accept this kind of stress as a normal part of life and may not be aware of how detrimental its effects can be. The APA notes that it may be difficult for sufferers of episodic stress to get treatment because they are so used to feeling its effects and accept them as normal.

Chronic stress.

Chronic stress is a form of stress that occurs over a long period of time and that can have serious effects on your physical and mental health . Unlike acute stress, which can be exciting, chronic stress is dull, constant, and seemingly never-ending. It often arises in response to situations that feel hopeless and beyond your control, such as a troubled marriage, a toxic job, or poverty.

Chronic stress is, perhaps, the most dangerous type. This is the kind of stress that can lead to complicated, permanent health problems, such as heart attack, stroke, and suicide. Unfortunately, recognizing that you are experiencing this kind of stress is difficult because most sufferers are used to feeling this way. You may have grown comfortable living this way. Treating chronic stress can be challenging, and almost always necessitates the help of a professional to make long-term progress in recovery.

Signs and symptoms of stress.

Stress isn’t just a physical reaction; it can also affect your emotions, behavior, and cognition. Just as everyone is stressed by different things, everyone experiences its effects in different ways.

Certain signs of stress can be confused with other ailments. Be sure to understand how it affects you so you can correctly identify when you are experiencing stress. Some of the most common signs and symptoms include:

Keep in mind that these are just a few of the many signs of stress; the AIS identifies fifty of them, and notes that there may even be more effects that we haven’t been able to recognize yet.

Understanding stress.

Whether you attend college online or in-person, you will most likely face new stressors during your time at school. As you begin to notice how you and your body react to it, you may come to recognize symptoms that only appear in certain situations. Understanding the type of stress you are experiencing when you encounter these challenges can help you overcome them without feeling drained.

Dr. Karl Albrecht, a social scientist and management consultant, outlined four main varieties of stress: time, anticipatory, situational, and encounter. While these different types can be experienced in many different situations, from the workplace to the home, they are especially relevant to the life of a student.

Time stress.

Time stress occurs when you feel worried about time, and more specifically, when you don’t have enough time to accomplish all necessary tasks. People often experience this when they fear they can’t meet their deadlines, or will be late to a meeting or appointment.

As a student, you may feel time stress in several different ways. You may worry about being late to your classes as you learn the geography of your campus or if you have to get home and log onto your computer for a lecture after running errands. You may also panic about the heft of your workload or the quality of your work for class, which can be a difficult adjustment, whether you’re attending college for the first time or returning after a break .

Anticipatory stress.

Anticipatory stress occurs when you feel anxious about the future. When some people experience anticipatory stress, they may be nervous about a particular upcoming event; for others, it may simply be a general sense of uncertainty about what’s to come.

You may feel this kind of stress in both a vague and concrete way during your studies. If you feel anxious about a forthcoming test, assignment, or presentation, you are experiencing a more concrete form of anticipatory stress. If you have a sense of dread or fear of uncertainty about your future in general, that is a more vague manifestation. Students may feel this kind of stress more frequently as they get nearer to graduation and are making decisions about their life after college.

Situational stress.

You experience situational stress when you are in an upsetting or alarming situation that you cannot control. Unlike time-related and anticipatory stress, this kind of stress happens suddenly and with little — if any — warning. In fact, you may not have anticipated the situation at all.

For students, this type of stress can arise in a number of different circumstances. It may come from something as minor as forgetting your words during a presentation, or as major as a phone call about a family emergency. This kind of stress can occur during a number of situations, from receiving a poor grade on an assignment, to arguing with a friend, to nearly hitting a car in front of you on the road.

Encounter stress.

Encounter stress results when you feel anxious about seeing certain people, either alone or in a group. You may not enjoy spending time with them or have difficulties communicating with them. Whatever the reason, there is something about this person or group that makes you anxious. Encounter stress can also occur if you have spent too much time with others and feel burnt out, even if you like being around them.

Students may feel encounter stress in situations ranging from intimidating professors to unfamiliar classmates. Further, you might only experience this feeling with a person for a limited amount of time. For example, you might dread seeing your roommate for the first time after an argument, but the stress may disappear after you resolve the issue.

Causes of stress in college.

Though everyone experiences it differently and has their own distinct stressors, researchers have found that many college students share several common sources of stress. Whether you major in business or education , you likely share at least one common stressor with your peers. From worries about your health to concerns about your life after graduation, here are some of the most common causes of stress in college students:

In a survey conducted by the APA, 63 percent of adults cite “health-related concerns” as their number one source of stress. For college students, in particular, worries about or issues with health might be a major stressor because of how it can impact academic performance. The NCHA reported that the academic performance of nearly 30 percent of students was impacted by a physical ailment, ranging from allergies to bronchitis.

Regardless if the cause is a simple cold, mental health condition , or chronic illness, one thing remains the same: when you’re sick, it can be difficult to keep up with your studies. If you are contagious, you should avoid attending class (unless you are a distance learner or can sit in on the lecture at home), which means missing out on important information from your professor. Even if you aren’t contagious but are simply feeling under the weather, you may not have the energy to focus on the lectures and assignments.

If a particular illness is going around your campus or community, try your best to avoid contact with anyone who is contagious and wash your hands frequently. Everyone gets sick on occasion; accept that, despite your best efforts, you might too. If you do catch something, take care of yourself and rest as much as possible before resuming your normal activities.

Balancing work, school, and family life.

In college, you have to figure out the right balance between work, family, and school. The academic load in college is often larger and involves more complicated work than in high school. Attempting to keep up with that, on top of your job and family responsibilities, can add additional stress to your daily life — especially if your family and work obligations are so demanding that you fall behind with your schoolwork.

For non-traditional students , in particular, achieving that balance can be difficult. While traditional students may be worried about missing another call from their parents, if you are a non-traditional student, you may have children of your own to take care of. You may have to focus your energy on financially supporting your family or caring for your sick children, instead of school.

These strategies can help you establish boundaries between the different areas of your life, in order to give each one the attention it needs. Keep in mind that it’s also important to be able to adapt to new concerns and demands. You may feel stressed to a greater extent if you feel like you can’t make necessary adjustments to your plans.

Class scheduling and credit load.

Scheduling your college classes may stress you out. Trying to sign up for the courses at times that work well for you, and making sure you’re taking all your necessary prerequisite classes, are just a couple of the many factors that you need to consider.

For some students, this may be the first time they have to create their own schedules. You may not know how many credits you should be taking, or what class times are best for your academic performance. You might get frustrated with yourself after a few weeks of classes if your schedule is not what you hoped it would be.

If your schedule is overwhelming, remember that it isn’t permanent. Your current classes will end, and you will have to build an entirely new schedule in a few short weeks or months. Use that  opportunity to make a schedule  that’s better suited to fit your needs.

Costs of colleges/finances.

Over the past few decades, the cost of college tuition at traditional schools has risen notably. Combined with other expenses — like the cost of housing, food, and books — students may feel stress over their finances while they’re in school. Even if you qualify for aid, receive help from your family members, or work during the school year, you may still feel anxiety about money.

Students may feel further stress because of loans they have to pay off after graduation. The debt you acquire can be a burden before you complete school, because it can affect your finances for years after, as well as during, college.

Always keep in mind why you chose to pursue a degree in the first place, and remind yourself that it can lead to better job opportunities after you graduate. Experts still believe that, in the long-term,  college is worth the investment .

Grades and exams.

Academic performance is another stressor that you may encounter as a college student. You may feel pressure to get certain grades in your classes due to a number of factors, such as meeting the expectations of others, or your desire to go on to a master’s program. You may study frequently, but get so anxious about taking an exam , that you find yourself unable to do well (or in some cases, to even take the test).

Further, balancing your classes, family responsibilities, work schedule, and social life can be hard due to the increased workload and greater difficulty of college courses. In some classes, tests or projects also make up a large percentage of students’ grades.

Conquering school-related anxiety can be tricky, as you are constantly surrounded by your stressors and equally stressed classmates. However, you are at school to learn and grow, not to get straight A’s on your report card. Focus on getting your education instead of on getting certain grades.

Preparing for post-graduation life.

For many students — traditional ones in particular — being in school is comfortable. The prospect of life after college can be daunting simply because it is unknown and unfamiliar. For even the most well-prepared student, the unpredictability of life outside of school can be anxiety-inducing.

Your stress may be amplified if it seems like all of your friends and peers already have a post-graduation plan that they seem confident about. You might feel anxious if you don’t have any idea what you want to do; on the other hand, you may question decisions you’ve already made about your future.

The uncertainty of the future can be difficult to handle, but you aren’t alone. Don’t hesitate to reach out to your friends, family, professors, or advisors for help and advice as you start to think about what you want to do after graduation.

Relationships.

Your relationships with friends, family members, and significant other can change after you start college. School may be a bigger priority than ever before, and as you navigate the challenges associated with that, you may have less energy to give to your loved ones. Feeling like you aren’t as close to your support system, in addition to dealing with the pressures of school, can create tension in your life.

Make an effort to only befriend people whose company you enjoy. Your time at college is too short to spend interacting with people who you don’t get along with. Whether you are working in a group project online, or engaging in a class discussion via chat, you have the opportunity to be selective about who you give extra energy to. You can make lifelong friends in college, so try your best to only invest your time and attention into the relationships that matter to you.

Managing stress as a student.

There are many ways you can manage your stress as a college student. Just as everyone experiences stress in their own way, we all have our preferred methods of coping with it. However, not all stress management strategies are healthy, and some may leave you feeling even worse than you did before.

To overcome stress while going to school, it’s crucial to learn how to cope with it productively. After all, you can’t control the stressors in your life, but you can choose how to respond to them.

Unhealthy ways to manage stress.

Healthy ways to manage stress..

In college, stress is inevitable, but it doesn’t have to dominate your life. Do your best to understand what kind of stress you’re feeling, what’s causing it, and how you can respond to it productively. By addressing your stress in a healthy way, you are doing all that you can to make the most of your college education.

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5 ways to manage student stress

Stress is an inevitable part of the student journey. Alongside all the laughs and good times you'll have to deal with worries surrounding your academic, work and social life. Here are five things you can do to minimise feelings of stress

'The stress response (fight/flight) is vital for human existence as it alerts us that something is wrong. It gives us the opportunity to act and respond,' says Alison Simmons, mental health and counselling manager at the University of Chester.

Student stress can be caused by a variety of factors, including:

• struggling with your  mental health
• loneliness,  homesickness  or relationship difficulties
• finding it hard to  save money  or deal with debt
• not knowing  how to balance work and study
• worrying about  revising for exams
• struggling with  writing essays  or  dissertations
• feeling unsure about  what to do after graduation
• harmful use of, or withdrawal from, alcohol or drugs.

There are a number of common reactions to stressful circumstances including:

• Behavioural  - these could involve avoiding or escaping from the situation and turning to alcohol or drugs, a change in appetite or an inability to concentrate.
• Physical  - you may experience an increased heart rate, sweating, shaking, headaches, butterflies and over-breathing.
• Psychological  - stress can lead to fear, panic and the feeling that something bad is going to happen.

'Ideally we should engage with stress management strategies all the time as part of our daily and weekly routines, this supports us in responding to challenges and helps to minimise the feeling of complete overwhelm,' explains Louise Gill, wellbeing adviser at Queen Margaret University Edinburgh.

'When you recognise that you have become overwhelmed with stress and are struggling to work through solutions, it's a good time to ask for help or adopt strategies to help you manage your triggers more effectively.'

This doesn't have to be a gruelling gym session or a ten mile run - you simply need to get your heart racing, for example by going for a brisk walk or a bike ride.

'Regular exercise can help relieve stress in many ways,' says Louise. 'There is breathing centred exercise like yoga and Pilates, which is good for grounding and breathing management. Aerobic exercise can equally manage stress hormones, release tension and increase endorphin levels creating a 'feel good' vibe. Team sports and activities can add a social dimension that can additionally support someone with stress management, as we know that social engagement benefits our mental health and wellbeing.'

If you'd like to get moving but are struggling for inspiration, see what schemes are available at your institution and get involved with clubs and societies . There's usually an array of activities on offer from hiking to dancing, basketball to boxing and martial arts to cycling.

Mindfulness

A relaxation technique originating in Buddhism, mindfulness is a popular coping mechanism for those tackling stress or anxiety. Used by clinicians to improve patients' physical and mental health, it can significantly lower stress levels. It is most often practised through deep breathing or guided meditation.

Alison explains, 'mindfulness can be useful at allowing us time to step away from automatic thoughts and reactions, to remove intensity from our emotions. It is more effective if practiced regularly. There is evidence to show that after eight weeks of regular practice, mindfulness can improve the body's response to stress and changes the shape of the brain.'

One of the most accessible ways to practice this is through free smartphone apps such as The Mindfulness App, Calm and Headspace. A number of books are also available on the subject.

Look into what mindfulness activities are available at your university. At Queen Mary University there’s a mindfulness programme that is free for all students and staff.

For an introduction to the field, the Mental Health Foundation provides an  online mindfulness course .

Talking to someone

Isolation can have an extremely negative impact on your happiness. Accepting that you need help and talking to someone is often the first step to feeling better.

'Stress thrives in the dark, it convinces us we can't cope, so reach out to people who can help. Talking about what's stressing you out can be useful. Be clear on whether you're looking for advice or just need someone to listen,' says Alison.

Speak to your friends and family - they know you best and care about you the most. What's more, studies suggest that socialising with a friend just once a week can reduce your stress levels and improve your mood as much as therapy or counselling.

If you talk to other students on your course, you’ll probably find that you’re not alone. This can help put things in perspective. Ask them what techniques they use to manage stress.

'Sometimes sharing with someone can create perspective as well as lead to additional support, which can relieve our sense of overwhelm and stress experience,' advises Louise.

Alternatively, make an appointment with your student wellbeing service. The majority of institutions have these and they should be your first port of call if you're worried, stressed or upset about anything. They'll provide a listening ear and can signpost you to specialist services if needed. While wellbeing services don't provide counselling support, most universities offer free counselling and support groups. Sessions tackle wide-ranging themes, from surviving freshers' week to coping with post-Christmas exam stress.

Time management

Do you ever feel like there aren't enough hours in the day? Well, you're not alone. People often get stressed when they feel that they're running out of time to complete a task - this could be study or work related, or even stem from feeling overwhelmed with social activities. However, simple time management techniques can help you to feel more relaxed and focused.

Try creating a written schedule, breaking your tasks down into manageable chunks, planning accordingly and allocating yourself time every day to relax or socialise. Divide your work into urgent and non-urgent tasks, and important and non-important tasks. Read up on our 7 time management tips for students .

Take a look on your institution's website. Most universities produce useful content pages, skills guides and toolkits to help you get to grips with soft skills such as time management and organisation.

Getting enough sleep

This might sound like an obvious solution but it's often overlooked. Your mental health and wellbeing relies on you getting enough sleep, as no one functions at 100% when they're tired.

Try to wake up and go to sleep at the same time each day. Seven to eight hours of sleep is recommended. This might not be realistic every night of the week but aim towards this goal more often than not.

'Sleep is important for recuperating the body's systems and allowing us to process memories. If we don't get enough sleep, this can make us more irritable, impact on our concentration, coordination and memory and make us more vulnerable to mental health problems or exacerbate existing ones,' explains Alison.

Try to do everything you can to relax yourself before going to bed. Take a bath or have a warm shower to wind down, watch your favourite TV show, listen to a podcast or sit quietly and read. Avoid screen time as much as possible and switch off laptops, phones and tablets at least an hour before going to sleep.

If you study in the same room you sleep in, put all study materials away. 

Other stress-busting methods

• Take your mind off it.  Do something you enjoy and that will distract you for a while like listening to music, reading, baking or crafts.
• Eat healthily and consume fresh foods .
• Change your mindset  and adopt a positive attitude.
• Take a break from social media . Comparing yourself and your productivity to others is a recipe for disaster.
• Laugh . Laughing out loud actually increases oxygen and blood flow, which immediately reduces stress. Spend time with a funny friend, watch something silly or book tickets to the local comedy club.

'Self-care is really important when we are facing challenges and experiences that have the potential to overwhelm us and create stress,' adds Louise. 'Consider establishing a self-care routine and schedule and prioritise activities that will support your coping mechanisms - for example, exercise, eating regularly and well, fluids, sleep, hygiene, social engagements and 'downtime' hobbies.'

If you've tried all these coping strategies but can't conquer the cycle of stress, it's a good idea to visit your GP to check that the symptoms you are experiencing are in fact stress related, and that there are no underlying issues.

Find out more

• Discover how to make the most of university life .
• If you're worried about your wellbeing, get in touch with mental health charity Student Minds .

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Risk factors associated with stress, anxiety, and depression among university undergraduate students

Mohammad mofatteh.

1 Lincoln College, University of Oxford, Turl Street, Oxford OX1 3DR, United Kingdom

2 Merton College, University of Oxford, Merton Street, Oxford OX1 4DJ, United Kingdom

3 Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford OX1 3RE, United Kingdom

It is well-known that prevalence of stress, anxiety, and depression is high among university undergraduate students in developed and developing countries. Students entering university are from different socioeconomic background, which can bring a variety of mental health risk factors. The aim of this review was to investigate present literatures to identify risk factors associated with stress, anxiety, and depression among university undergraduate students in developed and developing countries. I identified and critically evaluated forty-one articles about risk factors associated with mental health of undergraduate university students in developed and developing countries from 2000 to 2020 according to the inclusion criteria. Selected papers were analyzed for risk factor themes. Six different themes of risk factors were identified: psychological, academic, biological, lifestyle, social and financial. Different risk factor groups can have different degree of impact on students' stress, anxiety, and depression. Each theme of risk factor was further divided into multiple subthemes. Risk factors associated with stress, depression and anxiety among university students should be identified early in university to provide them with additional mental health support and prevent exacerbation of risk factors.

1. Introduction

Mental health is one of the most significant determinants of life quality and satisfaction. Poor mental health is a complex and common psychological problem among university undergraduate students in developed and developing countries [1] . Different psychological and psychiatric studies conducted in multiple developed and developing countries across the past decades have shown that prevalence of stress, anxiety, and depression (SAD) is higher among university students compared with the general population [2] – [4] . It is well established that as a multi-factorial problem, SAD cause personal, health, societal, and occupational issues [5] which can directly influence and be influenced by the quality of life. The level of stress cited in self-reported examinations and surveys is inversely correlated with life quality and well-being [6] .

Untreated poor mental health can cause distress among students and, hence, negatively influence their quality of lives and academic performance, including, but not limited to, lower academic integrity, alcohol and substance abuse as well as a reduced empathetic behaviour, relationship instability, lack of self-confidence, and suicidal thoughts [7] – [9] .

A 21-item self-evaluating questionnaire, Beck Depression Inventory (BDI), is the most common tool used for diagnoses of depression [10] . A BDI-based survey in five developed countries in Europe (European Outcome of Depression International Network-ODIN in the United Kingdom, Netherlands, Greece, Norway, and Spain) concluded that overall 8.6% (95% CI, 7.95–10.37) of the resident population are dealing with depression [11] . Similar studies confirmed that about 8% of the population in developed and developing countries suffer from depression [12] . Data from systematic review studies revealed that this depression rate is much higher among university students and around one third of all students in the majority of the developed countries have some degree of SAD disorders; and depression prevalence has been increasing in academic environments over the past few decades [3] .

Despite all the efforts to increase awareness and tackle mental health problems among university students, there is still an increasing number of depression and suicide among students [13] , indicating a lack of effectiveness of the measures adopted. In addition to an increase in the prevalence of mental health issues, comparing students and non-college-attending peers demonstrated that the severity of psychological disorders that students receive treatment for has also increased [14] . For example, the rate of suicide among adolescents has increased significantly over the past few decades [15] . In fact, suicide as a result of untreated mental health is the second cause of death among American college students [16] , emphasizing the importance of identifying and treating risk factors associated with SAD.

SAD can be manifested in different forms; however, some common overt symptoms include loss of appetite, sleep disturbance, lack of concentration, apathy (lack of enthusiasm and concern), and poor hygiene. Studying SAD is particularly important among university students who are future representatives and leaders of a country. Furthermore, most undergraduate students enter university at an early age; and dealing with SAD early in life can have long-term negative consequences on the mental and social life of students [3] . For example, a longitudinal study in New Zealand over 25 years demonstrated that depression among people aged 16–21 could increase their unemployment and welfare-dependence in long-term [17] .

A better understanding of SAD among students in developed and developing countries not only helps governments, universities, families, and healthcare agencies to identify risk factors associated with mental health problems in order to minimise such risk factors, but also provides them with an opportunity to study how these factors have been changing in the academia.

This review aims to provide an updated understanding of risk factors associated with SAD among post-secondary undergraduate and college students in developed and developing countries by using existing literature resources available to answer the following question:

“Aetiology of depression and anxiety: What are risk factors associated with stress, anxiety and depression among university and college undergraduate students studying in developed and developing countries?”

It is worth mentioning that this review focuses on SAD risk factors of university students in developed and developed countries, and does not cover underdeveloped countries which can have their own niche problems (such as poverty). However, this review takes into account international students who migrate from underdeveloped countries to developed and developing countries to pursue their education.

2.1. Aims and objectives

The aims of this review were to identifying principal themes associated with depression and anxiety risk factors among university undergraduate students. The objectives of this review are to design a rigorous searching methodology approach by using appropriate inclusion and exclusion criteria, to conduct literature searches of publicly available databases using the designed methodology approach, to investigated collected literature resources to identify risk factors associated with the depression and anxiety which have not changed, and to identify principal themes associated with SAD risk factors among university undergraduate students.

2.2. Designed approach for literature review

A narrative review based on a comprehensive and replicable search strategy is used in this review. This approach is justified and preferred, over other approaches such as primary data gathering, because of the timescale of the research (2000 to 2020-temporal reasons), and extent of the research (developed and developing countries-spatial reasons).

2.3. Criteria for inclusion and exclusion of articles

Inclusion and exclusion criteria for articles and academic writings used in this review are as follows:

2.3.1. Date

2000 to 2020 are included Academic writings which are published between in this review. Initially, during a pilot search, search strategies covered 1990 to 2020. However, the majority of the search results (more than 80% of the search results and more than 88% of applicable search results) were from 2000 to 2020, which indicates the importance of mental health issue and increased awareness over the past two decades. Therefore, for the final search, papers from 2000 to 2020 were included.

2.3.2. Study design

Literatures included in this narrative review were primary research articles, review articles, systematic reviews, mini-reviews, opinion pieces, correspondence, clinical trials, and cases reports published in peer reviewed journals.

2.3.3. Country

The narrative review was limited to developed and developing countries definition by the United Nations Department of Economic and Social Affairs [18] . Abstract and method sections of search results were screened to check the country of research.

2.3.4. Language

Peer-reviewed articles published in English were only included in this narrative review.

2.3.5. The explanation for papers exclusion

The main reason for papers excluded from consideration after search results was that they focused on intervention and therapies associated with SAD. Other reasons for exclusion was that studies were conducted on a mixture of undergraduate and graduate students or focused solely only graduate students. Studies which focused on other types of mental disorders such as eating disorders but did not focus on SAD were excluded too. The conducted search did not exclude any gender or specific age category.

2.4. Strategies used for search and limitations

In this review, a robust and replicable search strategy was designed to identify appropriate articles by searching PubMed, MEDLINE via Ovid, and JSTOR electronic databases. These databases were selected because they encompass biopsychosocial papers published on SAD. The date chosen for this search was for articles published between 2000 to 2020 which covers the past two decades. Once key articles were identified, a search for citation of those papers was conducted, and the bibliography of those papers were further screened to identify potential articles which can be relevant.

2.5. Search terminologies used

To conduct searches in databases mentioned above, the following search terms were used: students stress, anxiety, depression risk factors, university stress, anxiety, depression risk factors, student mental health developed and developing countries, students stress, anxiety and depression developed and developing countries. The operation AND was used to connect stress, anxiety, depression, mental health, developed, developing, countries, students. The search for each term was conducted in all fields (title, abstract, full text, etc.).

2.6. Screening, selecting search results, and data extraction

The search results were exported into separate Excel and EndNote X8 files. Titles and abstracts from all articles were screened to determine their relevance to the topic of this review. Potentially relevant articles were fully read to establish their relevance. Each paper which was included according to the inclusion criteria described above was read fully. A word file was created to identify themes associated with SAD risk factors which is included in the Results. An initial search resulted in 1305 articles. The title and abstract of individual papers were read for relevance, resulting in 60 papers which were relevant for the research question asked in this review. All 60 papers were read completely, and from those, 19 were excluded based on the criteria mentioned before. Therefore, the total number of papers for consideration was 41. A flowchart explaining the procedure for identification, screening, eligibility, and inclusion of papers is shown in Figure 1 .

Figure 2 provides a quantitative summary of the papers included in this narrative review. In terms of the distribution of the countries where the research was conducted, included papers were mainly articles which carried out studies in the USA (n = 17), followed by China and Canada (each n = 5), UK (n = 4), Japan (n = 3), Germany and Australia (each n = 2), South Korea, Hungary, Switzerland (each n =1) ( Figure 2A ). As for article types included in this review, original research articles, including quantitative and qualitative studies, which relied on obtaining data including cross-sectional studies, interviews, case-control studies, surveys, and questionnaire, were the highest (n = 37) followed by meta-analysis, literature and systematic reviews ( Figure 2B ). Another interesting observation was that although the search was carried out from 2000–2020, most papers were concentrated in the period from 2016 to 2020 ( Figure 2C ). This can be due to the reason that mental health is becoming more important over the past few years. Alternatively, a higher number of papers included from 2016 onward can be due to unintended selection bias. The smallest study covered in this narrative review was conducted on 19 students and the largest one on 153,635 students, adding up to 236,104 students, who were included in articles covered in this narrative review in total. Most studies on mental health, anxiety, and depression use standardised approaches such as patient-filled general health questionnaires, Pearling coping questionnaire, internally regulated surveys, BDI, DSM-IV symptomology, and general anxiety and burnout scales such as Maslach Burnout Inventory.

3.1. Literature search results

Following the search protocol shown in Figure 3 , a list of included papers identified which can be found in the Table 1 .

3.2. Prevalence of mental health disorders in students

Literature showed that mental health problems are common phenomenon among students with a higher prevalence compared to the general public. For example, surveying more than 2800 students in five American large public universities demonstrated that more than half of them experienced anxiety and depression in their last year of studies [19] . Similarly, a survey of Coventry University undergraduate students in the UK showed that more than one-third of them had experienced mental health issues such as anxiety and depression over the past one year since they were surveyed [20] . In agreements with these results, Maser et al. [21] found that prevalence of mental health disorders including anxiety and depression was higher among medical students compared to the general non-student population of the same age. These studies demonstrated that the prevalence of SAD among students has remained higher than the average population over the past two decades.

SAD are not only prevalent among students, but also persistent. By conducting a follow-up survey study of students over two years, Zivin et al. [19] demonstrated that more than half of students retain their higher levels of anxiety and depression over time. This can be due to a lack of SAD treatment or persistence of existing risk factors over time.

3.3. Risk factors associated with stress, anxiety, and depression

SAD are multifactorial, complex psychological issues which can have underlying biopsychosocial reasons. Multiple risk factors which affect the formation of SAD among undergraduate university students in developed and developing countries were identified in this review. These factors can be categorized into multiple themes including psychological, academic, biological, lifestyle, social and financial. A summary of risk factors and their associated publications are shown in Table 2 .

3.3.1. Psychological factors

Self-esteem, self-confidence, personality types, and loneliness can be associated with SAD among university students. Students who have a lower level of self-esteem are more susceptible to develop anxiety and depression [22] . Also, students with high neuroticism and low extraversion in five-factor personality inventory [23] are more likely to develop SAD during university years [24] . Other psychological factors such as feeling of loneliness plays important roles in increasing SAD risk factors [24] . Moving away from family and beginning an independent life can pose challenges for fresher students such as loneliness until they adjust to university life and expand their social network. Indeed, Kawase et al. [24] showed that students who live in other cities than their hometown for studying purposes are more likely to develop anxiety and depression.

Some students enter the university with underlying mental conditions, which can become exacerbated as they transition into the independent life at university. While depression is higher among university and college students compared to the general public, students with a history of mental health problems, such as post-traumatic stress disorder (PTSD), are more prone to development of anxiety and depression during their university lives compared to students who did not have such experience before starting their degrees [25] . Furthermore, exposure to violence in childhood either at the household or the community correlates with SAD formation later in life and at University [26] . Therefore, low self-esteem and self-confidence, having an underlying mental health condition before beginning the university, personality type (high neuroticism and low extravasation), and loneliness can increase the probability of SAD formation in students.

3.3.2. Academic factors

Multiple university-related academic stressors can lead to SAD among students. One of these factors which was strongly present in many studies evaluated in this review was the subject of the degree. Medical, nursing, and health-related students have a higher prevalence of depression and anxiety compared to their non-medical peers [24] , [27] – [28] . Medical and nursing students who have both theoretical duties and patient-related work usually have the highest level of workload among university students, consequently deal more with anxiety and depression [27] , [29] . In addition, students who major in psychology and philosophy, similar to nursing and medical students, are more likely to develop depression during their studies compared to others [24] . These studies did not identify whether students who have underlying mental health conditions are more likely to choose certain subjects such as philosophy, psychology, or subjects which lead to caring roles such as nursing and medicine. Because of the nature of their work, medical and nursing students who deal with people's health can experience depression and anxiety as a result of fears of making mistakes which can result in harming patients [27] . Students with practical components in their degree are required to travel to unfamiliar places for fieldwork and work experience which can add to their stress and anxiety [27] .

Also, some prospective students, especially those who study nursing and medicine, usually do not have a clear understanding of the curriculum and workload associated with the subject before entering the university, therefore, they can face a state of disillusionment once they begin their studies at university [27] – [29] . It is worth mentioning that not all studies found a significant correlation between the subject of study and SAD development [30] . This can be explained by differences in sample type and size which results in variations existing in the amount of workload and curriculum in similar subjects taught in various universities in different countries.

Studying a higher degree can be a challenging task which requires mental effort. Mastery of the subject can negatively correlate with self-esteem, anxiety, and depression among university students with students who have a mastery of subject demonstrating a lower level of stress and anxiety [31] . Also, students who study in a non-native language report the highest level of anxiety and depression during their freshman years, and their stress levels decrease during the subsequent study years [32] . This can be explained by the fact that students who are studying in a foreign language usually are those who have migrated abroad, therefore, require some time to adjust to their new lives. Different studies showed that the level of anxiety and depression among both international and home students could correlate with the year of study with fresher students who enter the university and students at the final year of their studies experience the greatest amount of anxiety and depression with different risk factors [22] , [32] . While fresher students experience SAD because of challenges in adjustments to university life, past negative family experience, social isolation and not having many friends, final year students report uncertainty about their future, prospective employment, university debt repayment and adjusting to the life after university as major risk factors for their SAD [22] , [32] . Therefore, a shift in SAD risk factors themes are observed as students make a progress in their degrees.

Students spend a significant portion of their time at university being engaged with their academic activities, and unpleasant academic outcomes can influence their mental health. Receiving lower grades during the time of studies can negatively influence students' mental health, causing them to develop SAD [33] , [34] . Academic performance during undergraduate studies can determine the degree classification, which can, subsequently, influence students' opportunities such as employment success rate or access to postgraduate courses [27] . Conversely, both the number of students with mental health problem symptoms and the severity of students' SAD increase during exam time [35] , reflecting a direct relationship between academic pressure and students' mental health states. However, the causal relationship is not well-established; it is possible that depression and associated problems such as temporary memory loss and lack of concentration [36] are reasons for poor academic grades or inversely, students feel stressed leading to depression because of their poor performance in their exams. A mutual relationship can exist between grades and mental health, as having a poor mental health can reciprocally cause students to get lower grades [34] , leading to a vicious cycle of mental health and academic performance. Interestingly, students' sense of social belonging and coherence to the university community was reduced during exam periods [35] . This can be explained by the reduced participation rate of students in university social activities and clubs as well as an increased sense of competition with their peers. Furthermore, students interact directly and indirectly with teachers, lecturers, tutors, and other staff; therefore, the relationship between students and academic staff can influence students' mental health. A negative and abusive relationship with teachers and mentors can be another factor causing SAD among undergraduate students [27] .

On the other hand, being a part-time student is a protective factor for anxiety and depression, and part-time students have better mental health compared to students with full-time status [34] . This can be explained by financial securities which have a source of income can bring or because part-time students are usually older than full-time students [34] , and therefore, more emotionally stable. In conclusion, risk factors increasing SAD among university students include high workload pressure, fear of poor performance in exams and assessments, wrong expectations from the course and university, insufficient mastery in the subject, year of study, and a negative relationship with academic staff.

3.3.3. Biological factors

Mental health can be influenced by ones' physical health. Presence of an underlying health condition or a chronic disease before entering the university can be a predictor of having SAD during university years [31] , [33] . Students with physical and mental disabilities can be in a more disadvantaged position and do not fully participate in university life leading to SAD formation [33] .

An association between gender and depressive disorders have been observed in several studies [21] , [27] , [34] , [37] . Female students had a higher prevalence of SAD compared to male students. Interestingly, while female students demonstrated a higher level of SAD, the dropout rate of female students with a mental health problem from university was lower compared to their male counterparts [33] . On the other hand, while females are at a higher risk of developing depressive disorders, males with depressive disorders are less willing to seek professional help and ask for support due to the stigma attached to mental health [38] , causing exacerbation of their problem over time [20] .

Age can be another factor related to SAD. Younger students report a higher level of SAD compared to older students [34] , [37] . However, other meta-analysis studies did not find a significant correlation between students' age and their mental health which can be due to sampling differences [39] . Some studies showed that while older undergraduate students have a higher determination to do well in the university [40] , those who have family commitments are more prone to develop SAD during their degrees [27] . These discrepancies in findings can be explained by different sample sizes and types of studies which can be influenced by various confounding factors such as nationality, country of study, degree of studies, gender, and socioeconomic status. Similarly, a lack of correlation between depression prevalence and year of study is observed as some studies have reported a higher prevalence among earlier years of studies, while others have shown a higher prevalence among students as they move closer to the end of their studies [41] . These differences can be explained by different causes of depression in a different age; for example, while depression in younger adults can be due to changes in their environment and difficulties in adapting to a new life, older adults can have depression symptoms because of a lack of certainty for their future and employment. Nevertheless, differences exist between SAD risk factors associated with young and older students. Overall, biological risk factors affecting SAD include age of students, gender, and underlying physical conditions before entering the university.

3.3.4. Lifestyle factors

Moving away from families and beginning a new life requires flexibility and adaptation to adjust to a new lifestyle. As most undergraduate students leave their family environment and enter a new life with their peers, friends, and classmates, their behaviour and lifestyle change too. Multiple lifestyle factors such as alcohol consumption, tobacco smoking, dietary habits, exercise, and drug abuse can affect SAD. Alcohol consumption is high among students with SAD [28] ; a causal relationship was not been established in this study though.

Tobacco smoking is another risk factor associated with SAD which is common among students, especially students who study in Eastern developed and developing countries such as China, Japan and South Korea [24] , [42] . Most students, especially male students, smoke because of social bonding and the rate of social smoking is directly correlated with SAD [24] , [42] . Social smokers are less willing to quit smoking, and more likely to persist in their habit, resulting in long term negative physical and psychological health consequences [42] . Illegal substance abuse can be another factor important in SAD among young people [43] . Academic-related stress and social environment in university dormitories and student accommodations can encourage students to use illegal drugs, smoke tobacco and consume alcohol excessively as a coping mechanism, resulting in SAD [44] . Interestingly, students who perceived they had support from the university were feeling less stressed and were less at the risk of substance abuse [45] , indicating the important role of social support in preventing and alleviating depression symptoms. This is of particular importance as a new social habit and behaviour adapted early during life can last for a long time. Furthermore, students who do not have a healthy lifestyle can feel guilt, which can worsen their SAD condition [46] . Interestingly, Rosenthal et al. [47] showed that negative behaviours resulting from alcohol consumption such as missing the next day class, careless behaviour and self-harm, verbal argument or physical fight, being involved in unwanted sexual behaviour, and personal regret and shame could be the main reasons for depression associated with drinking alcohol, rather than the amount of alcohol consumed.

In contrast, a moderate to vigorous level of physical activity can be a protective factor against developing SAD during university life [37] , [48] . Students who have a perception of having inadequate time during their studies do not spend enough time for exercise and can develop SAD symptoms [27] .

Another lifestyle-related risk fact associated with SAD is sleep. Many young people do not receive sufficient sleep, and sleep deprivation is a serious risk factor for low mood and depression [28] , [47] . Self-reported high level of stress and sleep deprivation is common among American students [31] , [49] . Insufficient sleep can act as a vicious cycle- academic stress can cause sleep deprivation, and insufficient sleep can cause stress due to poor academic performance since both sleep quality and quantity is associated with academic performance [28] . Overall, poor sleeping habit is associated with a decreased learning ability, increase in anxiety and stress, leading to depression.

Different negative lifestyle behaviours such as tobacco smoking, excessive alcohol consumption, unhealthy diet, lack of adequate physical activity, and insufficient sleep can increase the risk of SAD formation among university students.

3.3.5. Social factors

Having a supportive social network can influence students' social and emotional wellbeing, and subsequently lower their probability of having anxiety and depression in university [27] , [37] , [50] . The quality of relationship with family and friends is important in developing SAD. Having a well-established and supportive relationship with family members can be a protective factor against SAD development, which, in turn, can affect the sense of students' fulfilment from their university life [27] . The frequency of family visits during university years negatively correlates with SAD development [33] . Family visits can be more challenging for international students who live far away from their families, therefore adding to existing problems of international students who live and study abroad.

In contrast, having a negative relationship with family members, especially parents, can cause SAD formation among students in university [51] . Similarly, having a strict family who posed restrictions on behaviours and activities during childhood can be a predictor of developing SAD during university years [51] .

Also, it is shown that being in a committed relationship has a beneficial protective factor against developing depressive symptoms in female, but not male, students [52] . Interestingly, both male and female students who were in committed relationships reported a lower alcohol consumption compared to their peers who were not in committed relationships [52] .

Involvement in social events such as participating in sporting events and engaging in club activities can be a protective factor for mental health [32] , [37] . Assessing preclinical medical students' social, mental, and psychological wellbeing showed that while first year students demonstrate a decrease in their mental wellbeing during the academic year, they have an increase in their social wellbeing and social integration [53] . This can be explained by the time period required for fresher students who enter the university to adjust to the social environment, make new friends, and integrate into the social life of the university.

Access to social support from university is another factor which is negatively correlated with developing anxiety and depression [31] . It is worth mentioning that different universities provide different degrees of social support for students which can reflect on different anxiety and depression observed among students of different universities.

Importantly, sexual victimization during university life can be a predictor of depression. By surveying female Canadian undergraduate students, McDougall et al. [54] found that students who were sexually victimized and had non-consensual sex were at a higher chance of developing depression following their experience, emphasizing the importance of safeguarding mechanism for students at university campuses.

While the internet and social media can be great tools for maintaining a social relationship with classmates, pre-university friends and family members, it can have negative mental health effects. Excessive usage of social media and the internet during freshman year can be a predictor of developing SAD during the following years [55] . Students who have a higher dependence on the social media report a higher feeling of loneliness, which can result in SAD [56] . Students with internet addiction and excessive usage of social media are usually in first year of their degrees [55] , [56] which can reflect a lack of adjustment to university life and forming a social network. Also, students who use social media more often have a lower level of self-esteem and prefer to recreate their sense of self [56] , indicating an intertwined relationship between biopsychosocial factors in developing SAD among students.

Demographic status, ethnic and sexual minority groups including international Asian students, black and bisexual students were at an elevated risk of depression and suicidal behaviour [16] , [50] . The frequency of mental health is usually more common among ethnic minorities. For example, Turner et al. [20] showed that ethnic minority students report a higher level of anxiety and depression compared to their white peers; however, they do not ask for help as much. Other studies supported these findings by showing that students from ethnic and religious minorities, regardless of their country of origin and country in which they study, have a higher prevalence of anxiety and depression compared to their peers [50] . Also, students' expectations from university can be different among ethnic minorities students, and most of them do not have a sufficient understanding of the services that university can provide for them [40] .

Therefore, lack of support from family and university, adverse relationships with family, lack of engagement in social activities, sexual victimization, excessive social media usage, belonging to ethnic and religious minority groups, and stigma associated with the mental health are among risk factors for SAD in university students.

3.3.6. Economic factors

Students' family economic status can influence their mental health. A low family income and experiencing poverty can be predictors of SAD development during university years [22] , [50] , [57] , [58] . A higher family income can even ameliorate negative psychological experiences during childhood, which can have long-term negative consequences on the mental health of students once they enter university [57] . Also, experiencing poverty during childhood can have negative long-term consequences on adults, leading to SAD development during university life [58] .

Some students take up part-time job to partially fund their studies. Vaughn et al. [59] showed that relationship of employed students with their colleagues in the workplace could affect students' mental health; and those students who had a poor relationship with their colleagues had worse mental health. However, it is worth mentioning that a causal relationship was not established. It can be possible that students who have poor mental health cannot get along with their co-workers, resulting in an adverse working relationship.

Because of paying higher tuition fees and less access to scholarships and bursaries available, international students can have more financial problems, causing a higher degree of anxiety and depression compared to home students [60] .

Lack of adequate financial support, low family income and poverty during childhood are risk factors of SAD in students of undergraduate courses in developed and developing countries.

3.4. Stigma associated with mental health

While efforts have been put to reduce the stigma associated with receiving help for mental health problems, this still remains a challenge. For example, more than half of students who had SAD did not receive any help or treatment for their condition because of the stigma associated with mental health [19] , [61] . This is not related to the awareness of the availability of mental health resources which was ruled out by authors, as most of the students who did not receive any help for their mental health problem were aware of available help and support to them [19] .

Furthermore, the social stigma associated with receiving help for mental health problems was significantly associated with suicidal behaviour, acting as a preventive barrier to seek help (planning and attempt) [16] . Among students, those with a history of mental health problem such as veterans with PTSD are less likely to seek for help compared to non-veteran students [25] , making them more susceptible to struggling with untreated mental health.

4. Discussion

This review tried to identify and summarise risk factors associated with SAD in undergraduate students studying in developed and developing countries. The prevalence of SAD is high among undergraduate university students who study in developed and developing countries. Untreated SAD can lead to eating disorders, self-harm, suicide, social problems [28] . Similar to a complex society, differences exist among students leading to complicated risk factors causing SAD. Because different themes influencing SAD has been investigated as a distinct body of research by different literature, a concept map is created to demonstrate the relationship between various risk factors contributing to the development of SAD in undergraduate students in developed and developing countries. Figure 3 bridges risk factors concepts between different literature. For most students, entering university is a new step in their lives which is associated with certain challenges such as moving into independent accommodation, social identity, financial management, making decisions, and forming a social network. Different students have different needs depending on the stage of their degree, which needs to be fulfilled. For example, coping with a new university life style can be a challenging task for students who enter the university. This becomes more significant for students moving abroad for their studying who need to adapt to a new lifestyle, speak in a different language, and live away from their families. In agreement with this, different levels of anxiety and depression with different risk factors are observed among students as they progress in their degrees. On the other hand, students who are finishing their degrees can have SAD because of uncertainties about their future.

Students learn different modules in different degrees and have different abilities. Mastery of the subject can be a factor affecting students' sense of self-esteem, influencing their anxiety level and developing depressive symptoms. This partially can explain changes in risk factors observed as students' progress in their degrees. Final year students who adjust to the university environment and develop mastery in their subject can deal with academic pressure better compared to freshers who transform from secondary school life to university lifestyle.

Students can come with a varied and challenging background such as those who experienced household and domestic violence, sexual abuse, and child poverty which can make them susceptible to developing anxiety and depression once academic pressure is mounted. As universities are diverse environment which enrol students from different socioeconomic background and different cultures, universities need to identify risk factors for different students and have robust plans to tackle them to provide a fostering environment for future leaders of the society. Therefore, early mental health screening can help to identify those students who are at risk to provide them with special and additional mental health support. Students not only should be screened for their mental health state as they enter university, but also regular follow up check-ups should be conducted to monitor their conditions as they progress in their degrees to detect early signs of SAD.

University and academic staff can play a significant role in either exaggerating or ameliorating risk factors associated with anxiety and depression. While teachers and mentors can support students to cope with SAD, they can be a source of problem too by discriminating, bullying, and hampering students' progress.

Managing finance and expenses can be a challenging task for students who are stepping into an independent lifestyle and need to pay for their tuitions in addition to their maintenance fees. While some students have access to private funding, bursaries, and scholarships, other students receive loans which they need to pay back or have part-time jobs to meet their expenses. Students who work need to have a work-life balance and the time spent in their jobs can affect the quality of their education.

Fresher students try to establish their social network and might feel isolated, which can push them to excessive usage of social media to fill their social gap. While internet addiction and excessive usage of social media can have a negative impact on students' mental health, technology, such as mobile phone applications can be used in universities campuses to promote a healthier lifestyle and reducing risk factors among students. For example, many students refuse to receive face-to-face mental health counselling support during their anxiety and depression due to stigma associated with disclosure of mental health issues. Providing students with anonymized counselling services through mobile phone applications can be one way of delivering help to students at universities.

With the advent of social media platforms such as Facebook, Twitter, Instagram, TikTok, etc., more and more students rely on such networks for socialisation. While the internet and online platforms can have beneficial consequences for students, such as rapid access to a variety of online learning resources and keeping in contact with friends and families, excessive usage of social media and internet can have negative consequences on students' academic performance. A poor mental health state at the beginning of university life is a predictor of internet addiction later during the degree. Heavy reliance on the internet can be a coping mechanism for students with anxiety and depression to overcome their mental health problems.

As governments and educational bodies in developed and developing countries are emphasising recruitment of ethnic minority students to university to increase the range of equality and diversity among students, it is important to consider the mental health of those students in the university as well. Students in minority groups such as black, international Chinese and bisexual student report a higher level of anxiety and depression compared to other non-minority group students. This can be due to either pre-existing conditions which student experience before entering the university, and can be exacerbated during the university, or can be because of problems which can develop during university life.

Also, more mental health support is available in universities as the number of university students is increasing, and there is a better understanding of the importance of mental health in academia; however, the stigma associated with mental health has not changed proportionately.

While research and understanding of mental health have changed significantly over the past two decades and many more articles are present, risk factors associated with SAD remain unchanged.

One caveat with studies of mental health among student is that most studies have been conducted among medical and nursing students and neglected non-medical students. One potential explanation for the tendency to conduct depression surveys among medical students is the higher response rate as medical students are more willing to fill out the questionnaires and surveys. It is understandable that students studying medical subjects, who directly interact with the public and treating them once they enter the healthcare profession should have a reasonably sound mental health to be able to conduct their duties, but it does not justify neglecting the mental health of other students. Therefore, more research on mental health and risk factors associated with SAD of non-medical students is required in the future.

Another caveat with most mental health studies is that they are based on self-reports and surveys. Different people can have different perception and understanding of mental health and anxiety, and many confounding factors can influence the response of participants in the time of participation. Furthermore, students with severe mental health conditions are less likely to participate in any activity including surveys and questionnaires, leading to a non-response bias.

Another area which requires improvement in future studies of mental health is the categorisation of different types of depression and their severity. Depression and anxiety are a spectrum which can comprise of minor and major symptoms; however, most studies did not specify the scale of depression in their findings. Furthermore, while various risk factors were identified, a causal relationship between mental health and behaviours were not established.

While counselling services provided by universities in Western countries such as the UK and USA have increased over the past few years [62] , it is still not clear how effective such services are; therefore, more research is required to assess the effectiveness of counselling services at universities.

Therefore, a better understanding of the aetiology, associated factors is required for an effective intervention to reduce the disease incidence and prevalence among students in the population and providing them with a fostering environment to achieve their potential.

University undergraduate students are at a higher risk of developing SAD in developed and developing countries. Promoting the mental health of students is an important issue which should be addressed in the education and healthcare systems of developed and developing countries. Since students entering university are from different socioeconomic background, screening should be carried out early as students.

A personalized approach is required to assess mental health of different students. In addition, a majority of mental health risk factors can be related to the academic environment. A personalised, student-centred approach to include needs and requirements of different students from different background can help students to foster their talent to reach their full potential. Furthermore, more training should be provided for teaching and university staff to help students identify risk factors, and provide appropriate treatment.

5. Conclusion

Despite all the efforts over the past two decades to destigmatise mental health, the stigma associated with mental health is still a significant barrier for students, especially male students and students from ethnic and religious minorities to seek help for SAD treatment. Universities need to continue to destigmatise mental health in university campuses to enable students to receive more in campus support by providing designated time for positive metal health activities such as group exercise, physical activities, and counselling services. There is no shortage of athletic and group activities in form of clubs and social classes in most universities in developed and developing countries; however, more incentives such as athletic bursaries and prizes should be provided to students to encourage their participation in such activities which can act as protective factors against SAD development. Therefore, universities need to allocate more resources for sporting and social activities which can impact the mental health of students. Furthermore, an increase in mental health problems in universities has created a huge burden on university counselling services to meet the demands of students. More novel approaches, such as online counselling services can help universities to meet those increased demands.

Students in different years of studies deal with different risk factors from the time that they enter the university until they graduate, therefore, different coping strategies are required for students at different levels. Universities should be aware of these risk factors and implement measures to minimise those factors while providing mental health treatments to students.

Future studies are required to investigate long-term effects of experiencing SAD on students. A longitudinal study with a large randomly recruited sample size (different age, sex, degree of study, – socioeconomic status, etc.) is required to address how students' mental health change from entering the university until they graduate. Also, more extended follow up studies can be included to address the effect of depression and poor mental health on people's lives after they graduate from the university.

Abbreviations

Conflict of interest: All authors declare no conflicts of interest in this paper.

Home — Essay Samples — Nursing & Health — Stress Management — Coping Up With Stress

Coping Up with Stress

• Categories: Stress Stress Management

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Published: Jan 21, 2020

Words: 931 | Pages: 2 | 5 min read

• Schwarzer, Ralf. Self-efficacy: Thought control of action. Taylor & Francis, 2014.
• Meichenbaum, Donald. "Stress Inoculation Training: A preventative and treatment approach." The Evolution of Cognitive Behavior Therapy. Routledge, 2017. 117-140.
• Figley, Charles R., and Hamilton I. McCubbin. Stress and the family: Coping with catastrophe. Routledge, 2016.

Should follow an “upside down” triangle format, meaning, the writer should start off broad and introduce the text and author or topic being discussed, and then get more specific to the thesis statement.

Cornerstone of the essay, presenting the central argument that will be elaborated upon and supported with evidence and analysis throughout the rest of the paper.

The topic sentence serves as the main point or focus of a paragraph in an essay, summarizing the key idea that will be discussed in that paragraph.

The body of each paragraph builds an argument in support of the topic sentence, citing information from sources as evidence.

Should follow a right side up triangle format, meaning, specifics should be mentioned first such as restating the thesis, and then get more broad about the topic at hand. Lastly, leave the reader with something to think about and ponder once they are done reading.

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Essay on Examination Stress on Students

Students are often asked to write an essay on Examination Stress on Students in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Examination Stress on Students

Understanding examination stress.

Examination stress is a common issue among students. It refers to the anxiety and nervousness students feel before and during exams.

Causes of Examination Stress

The main causes of exam stress include high expectations from parents, fear of failure, and lack of preparation.

Effects on Students

Examination stress can lead to health problems like headaches, sleep issues, and even depression. It also affects a student’s concentration and performance.

In conclusion, it’s vital to manage exam stress for overall well-being and academic success.

250 Words Essay on Examination Stress on Students

Introduction.

Examinations are an integral part of the academic system, designed to assess students’ understanding and knowledge of subjects. However, they often induce a significant amount of stress among students, which can adversely affect their performance and overall well-being.

The Origin of Examination Stress

Examination stress primarily originates from the pressure to perform well. This pressure can stem from various sources such as high personal expectations, fear of failure, or societal and parental expectations. The competitive nature of the academic system, along with the perception that success in examinations equates to success in life, further exacerbates this stress.

Impacts of Examination Stress

Examination stress can have profound psychological and physiological impacts on students. It can lead to anxiety, depression, sleep disorders, and even physical health problems like headaches and fatigue. Moreover, it can impair students’ cognitive functions, thus negatively affecting their academic performance.

Managing Examination Stress

Effective stress management strategies are crucial for students to navigate through examination stress. Regular exercise, adequate sleep, and a balanced diet can help maintain physical health and reduce stress levels. Psychological strategies such as mindfulness, positive affirmations, and relaxation techniques can also be beneficial.

While examinations are necessary for academic evaluation, it’s essential to address the stress they cause. A balanced approach, focusing on both academic excellence and mental well-being, can help students manage examination stress effectively, thus leading to a healthier and more productive academic life.

500 Words Essay on Examination Stress on Students

Examinations are an integral part of the educational system, designed to evaluate a student’s understanding and knowledge of the subjects studied. However, they often bring with them a significant amount of stress, causing a negative impact on the mental and physical health of students. This essay delves into the phenomenon of examination stress, its causes, effects, and possible solutions.

Examination stress is a psychological condition in which students experience extreme distress and anxiety in the period leading up to, during, and even after examinations. It is characterized by feelings of fear, self-doubt, and apprehension about one’s performance in the exams. While a certain level of stress can be motivational, excessive stress can hinder performance and well-being.

The causes of examination stress are multifaceted. The pressure to perform well, high expectations from parents and teachers, competition amongst peers, and fear of failure are common triggers. Additionally, the lack of effective study habits, poor time management, and the absence of relaxation or recreational activities can exacerbate the stress. The modern educational system, with its emphasis on grades and rankings, often overlooks the individual learning pace and capabilities of students, further contributing to this stress.

Effects of Examination Stress

Examination stress can have severe implications on a student’s mental and physical health. It can lead to anxiety disorders, depression, and in extreme cases, suicidal thoughts. Physically, it can cause headaches, sleep disorders, loss of appetite, and a weakened immune system. Moreover, it can negatively impact a student’s academic performance and hinder the learning process, creating a vicious cycle of stress and poor performance.

Addressing Examination Stress

Addressing examination stress necessitates a multi-pronged approach. Firstly, a change in perspective towards examinations is required. They should be perceived as a part of the learning process rather than a do-or-die situation. Secondly, students should be encouraged to adopt effective study habits and time management techniques, which can reduce last-minute cramming and associated stress.

Moreover, the importance of physical exercise and recreational activities in maintaining mental health should be emphasized. Regular breaks, balanced diet, and adequate sleep are crucial for stress management. Counseling services should also be made available in educational institutions to help students cope with stress.

In conclusion, examination stress is a prevalent and severe issue faced by students. It is crucial to address this problem to ensure the holistic development of students and foster a healthy learning environment. By altering our perspectives, improving study habits, and prioritizing mental health, we can mitigate the effects of examination stress and transform the educational experience into a more enjoyable and less stressful journey.

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'Adjusting the sails' on student stress

Asu professor's study on coping with stress in college earns lasting impact award.

Photo courtesy iStock/Getty Images

The impact of stress on individuals in work and educational contexts poses a significant financial burden, particularly in the workplace, estimated at around $300 billion annually.

And while some stress is to be expected as part of the college experience, according to Christopher P. Neck , the pressure for college students to excel and find a good job is more complex and pervasive than ever before.

Neck, a professor at the W. P. Carey School of Business at Arizona State University, co-authored a paper titled “Effective Stress Management: A Model of Emotional Intelligence, Self-Leadership, and Student Stress Coping” with four other academics Neck’s co-authors include Jeffery D. Houghton, Jinpei Wu, Jeffrey L. Godwin and Charles C. Manz. to explain the complex interplay of emotional intelligence and self-leadership in enhancing students' ability to manage stress effectively.

5 tips for stress regulation

1. Cultivate emotional intelligence: Develop your emotional intelligence by enhancing your ability to perceive, understand and regulate your own emotions.

2. Practice self-leadership: Embrace self-leadership principles to take control of your thoughts, feelings and actions. 

3. Engage in positive self-talk: Foster a positive mindset by engaging in constructive self-talk. 

4. Utilize stress coping strategies: Equip yourself with effective stress coping strategies to manage academic pressures and life transitions.

5. Foster a growth mindset: Cultivate a growth mindset by embracing challenges as opportunities for learning and personal growth.

The Journal of Management Education published the paper in 2012, and a decade later, the research’s relevance has not only persisted but also gained recognition for its enduring impact on the field.

That’s why it was awarded the 2023 Lasting Impact Award by the Management and Organizational Behavior Teaching Society and Sage Publications. This accolade is awarded to publications that have significantly influenced management education or educators, providing insights that remain relevant and vital over the years. The recognition underscores the article’s substantial influence and role in shaping educational approaches to stress management.

As we approach the presentation of this award at the 51st annual MOBTS Teaching Conference in June 2024 and in recognition of  Mental Health Awareness Month , it is poignant to reflect on the developments since the article’s publication and consider the future trajectory of this research area.

ASU News spoke to Neck about how the landscape of student stress has evolved over the years, and what new understandings we need to integrate into our educational systems.

Editor's note: Answers may have been edited for length and/or clarity.

Question: How has stress become more intense for college students over the years, and what don't people understand about what students are dealing with today?

Answer: The adage “You can’t control the wind but certainly can adjust the sails” rings true here. In short, there seems to be a lot more wind facing college students today. Stress among college students has evolved significantly over the years, becoming more intense due to various societal and cultural factors. One prominent contributor is the increasingly competitive nature of academia, with higher expectations for academic achievement and a greater emphasis on career prospects post-graduation. The pressure to excel academically while balancing extracurricular activities, internships and social obligations can be overwhelming.

Additionally, the rise of technology and social media has created a constant state of connectivity, making it challenging for students to disconnect and relax. The pervasive influence of social media also contributes to feelings of comparison and inadequacy, as students often compare themselves to their peers’ seemingly perfect lives portrayed online. Also, the proliferation of social media creates a situation where students are usually multitasking — a problem that increases anxiety and stress.

Furthermore, financial burdens play a significant role in exacerbating stress among college students today. The rising cost of tuition, coupled with concerns about student loan debt and job prospects after graduation, adds additional pressure. Many students also juggle part-time jobs or internships to support themselves financially, further adding to their stress levels. Moreover, issues such as mental health challenges, societal expectations and the uncertainty of the future contribute to the complexity of stress experienced by today's college students. Overall, the multifaceted nature of stressors facing students today highlights the need for comprehensive support systems and effective coping strategies within higher education institutions to help students “adjust the sails.”

Q: In your paper, you specifically name two types of stress students experience: distress and eustress. Can you summarize each type and how it uniquely applies to college students?

A: Distress and eustress are two distinct types of stress that college students commonly experience, each with unique characteristics and implications.

Distress is the negative type of stress, characterized by feelings of overwhelm, anxiety and pressure. In college, distress often arises from academic deadlines, performance expectations, interpersonal conflicts and personal struggles. ... Distress can harm students' mental and physical well-being if left unaddressed, impacting their academic performance and overall quality of life.

On the other hand, eustress is a positive form of stress that arises from challenging but manageable situations. Unlike distress, which is overwhelming and debilitating, eustress is energizing and motivating. In college, eustress can stem from experiences such as starting a new project, preparing for an exam or pursuing personal growth opportunities like joining clubs or participating in extracurricular activities. ... Eustress can enhance students' motivation, focus and performance, helping them thrive academically and personally.

Understanding the distinction between distress and eustress is crucial for college students as it allows them to effectively identify and manage their stressors. By recognizing the difference between overwhelming challenges that may require support and manageable stressors that can enhance performance, students can develop coping strategies tailored to their specific needs. Additionally, fostering a positive mindset and reframing stressors as opportunities for growth can help students harness the power of eustress to successfully navigate the demands of college life.

Q: Your paper also discusses emotional intelligence and emotion regulation. What are these concepts, and how do they apply to this situation?

A: Emotional intelligence refers to the ability to perceive, understand, manage and utilize emotions effectively in various situations. It encompasses self-awareness, self-regulation, empathy and social skills. Emotion regulation, on the other hand, refers to the process of managing and controlling one's emotional responses to different situations.

These concepts are highly relevant for college students and stress management for several reasons. Firstly, college life often presents numerous challenges and stressors, from academic pressures to personal relationships and career uncertainties. Developing emotional intelligence equips students with the skills to navigate these challenges effectively. For instance, self-awareness allows students to recognize their emotional triggers and responses, while self-regulation enables them to manage stress and maintain balance. Empathy and social skills help students build supportive relationships and seek help when needed, fostering resilience and coping mechanisms.

Moreover, emotion regulation strategies play a crucial role in mitigating the negative impact of stress on students' mental health and well-being. By learning to regulate their emotions, students can reduce feelings of anxiety, overwhelm and burnout commonly associated with college life. Effective emotion regulation also promotes adaptive coping strategies, such as seeking social support, engaging in problem-solving and practicing self-care — essential for managing stress effectively.

Q: You and your co-authors suggest that self-leadership is a primary way of dealing with stress. What is self-leadership, and how can students develop stress-regulating strategies?

A: Self-leadership is the process of influencing oneself to establish self-direction and self-motivation for effective performance. It involves adopting specific behavior-focused and cognitive-focused strategies to enhance individual effectiveness. In essence, self-leadership empowers individuals to take control of their thoughts, feelings and actions, facilitating goal achievement and personal growth.

For college students, developing self-leadership skills is paramount for effectively managing stress and navigating the demands of academic life. One way students can cultivate self-leadership is by practicing behavior-focused strategies such as self-observation, self-goal setting, self-reward and self-correcting feedback. Self-observation entails assessing one's behaviors to identify areas for improvement or change, while self-goal setting involves setting specific, challenging and realistic goals to focus one's efforts. Self-rewarding involves creating incentives linked to goal attainment to motivate and energize oneself, while self-correcting feedback entails evaluating failures constructively and redirecting efforts toward positive outcomes.

Additionally, students can develop cognitive-focused self-leadership strategies to reshape their thought processes and enhance their coping abilities. Cognitive strategies include positive self-talk, constructive mental imagery and challenging dysfunctional beliefs and assumptions. Positive self-talk involves fostering optimistic inner dialogues to combat negative self-talk and promote resilience. Constructive mental imagery visualizes success and positive outcomes to bolster confidence and motivation. Challenging dysfunctional beliefs involves identifying and reframing negative thought patterns contributing to stress and adopting more adaptive perspectives.

Q: What do you envision as the next steps in this field of research and practice?

A: Looking ahead, the next frontier in stress management research for college students lies in exploring the intersection of emotional intelligence, self-leadership and holistic well-being. While our model provides valuable insights into the mechanisms through which these factors influence stress coping, there is still much to uncover in terms of individual differences, contextual influences and long-term outcomes. Future research could delve deeper into the efficacy of specific intervention programs tailored to enhance college students' emotional intelligence and self-leadership skills, evaluating their impact on academic performance, mental health outcomes and overall resilience.

Moreover, as technology continues to reshape the landscape of higher education, there is a growing need to explore innovative approaches to stress management that harness digital platforms and virtual resources. From mobile apps and online support networks to virtual reality-based interventions, the possibilities for leveraging technology to promote student well-being are vast.  

For instance, I’m currently working on a study where students use a daily app on their smartphones to record their self-talk during a particular time each day. The hope is that by helping students become more aware of their mental processes, they can learn to realize when such self-dialogue is creating stress and how they can change this dysfunctional self-talk to less stress-provoking.

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Essay Sample on Causes and Effects of Stress on Students, With Outline

Published by gudwriter on January 4, 2021 January 4, 2021

Cause and Effects Essay Outline About Stress Among Students

Introduction.

Stress in students may have serious harmful effects and thus needs to be addressed.

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Paragraph 1:

One of the causes of stress in students is poor sleeping habits.

• Students who do not get enough sleep at night or lack healthy sleeping habits are likely to develop stress.
• Enough sleep allows the brain and body of a student to relax and recharge.
• Lack of it can limit a student’s ability to learn, concentrate and solve problems.

Paragraph 2:

Student stress is caused by academic pressure.

• They are given homework assignments.
• They have classroom assignments and term papers that are supposed to be completed and submitted in strict deadlines.
• Pressure to do well from those close to them such as family, friends, and teachers.

Paragraph 3:

Student stress may result from poor nutrition and unhealthy eating habits.

• Stress-inducing foods are those that have high refined carbohydrates, sugar, caffeine, and fat.
• A stress-reducing diet is made up of foods that are high in complex carbohydrates and fiber and low in fat content.

Paragraph 4: 

High stress levels could make students develop physical symptoms that could negatively affect their academic performance.

• When a student experiences these symptoms, they might not feel the motivation they once felt about doing their best on academic tasks.
• The symptoms are detrimental to the health of students.

Paragraph 5:

Stress makes students to have poor management skills.

• A student could become disorganized and uncertain about their priorities and goals.
• They become incapable of effectively budgeting and managing their time.
• They develop a tendency of procrastinating and neglecting responsibilities.

Paragraph 6:

Stress leads to self-defeating thoughts.

• A student under stress may consistently think about the adversity or negative situation in which they are.
• They could constantly focus on their weaknesses and failures.

Paragraph 7: 

There are various stress management strategies students may take to reduce stress.

• Get regular physical activity and practice.
• Spend quality time with friends and family, and keeping a sense of humor.
• Find time for such hobbies as listening to music, playing football, and reading a book.
• Get enough sleep and consume balanced diet.
• Stress in students cause serious negative effects, both physical and academic.
• It results from poor sleeping habits, academic pressure, and poor nutrition and unhealthy eating habits.
• It results into physical symptoms, poor management skills, and self-defeating thoughts.
• Parents and teachers should work together to ensure that students do not experience much stress.

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A Cause and Effect Essay on Stress in Students

Stress is the natural response the human body gives to challenges. Students are exposed to stress by various factors. When a student undergoes chronic stress or high stress levels, their ability to learn, memorize, and post good academic performances can be interfered with regardless of their age or grade. Stress can also make a student experience poor mental, emotional, and physical health. Teachers and parents may help students avoid chronic stress in their lives if they learn about and develop a good understanding of common stressors. Stress in students may have serious harmful effects and thus needs to be addressed.

One of the causes of stress in students is poor sleeping habits. Compared to students who get plenty of sleep, students who do not get enough sleep at night or lack healthy sleeping habits are likely to develop stress. Enough sleep allows the brain and body of a student to relax and recharge. It also helps in ensuring that the immune system remains strong. On the other hand, lack of enough sleep can limit a student’s ability to learn, concentrate, and solve problems and can also make them more aggressive. According to Hales and Hales (2016), it is recommended by the National Sleep Foundation that young people, especially students, should maintain a regular sleep schedule and that they should sleep for between 8.5 and 9.25 hours per night.

Another major cause of student stress is academic pressure. As teachers prepare students for standardized tests, they give them homework even if the students are as young as six only. In addition to these homework assignments, there are classroom assignments and term papers that are supposed to be completed and submitted in strict deadlines. The pressure that comes from these assignments coupled with the desire by students to succeed academically culminates into stress. Students also experience pressure to do well in their academic work from those close to them such as family, friends, and even teachers (Raju, 2009). They therefore feel so much pushed that they even resort to academic dishonesty such as cheating in exams so as to match these high expectations.

A student’s stress levels can also increase due to poor nutrition and unhealthy eating habits. Foods that are associated with high stress levels in students include those that have high refined carbohydrates, sugar, caffeine, and fat. This is the case with many types of fast, processed, and convenience foods. Examples of foods that induce stress include French fries, white bread, processed snack foods, candy bars, donuts, energy drinks, and sodas (Kumar, 2015). A healthy stress-reducing diet is made up of foods that are high in complex carbohydrates and fiber and low in fat content. Examples of such foods include lean proteins, nuts, whole grains, vegetables, and fruits.

It is noteworthy that high stress levels can make students develop physical symptoms that could negatively affect their academic performance. These signs and symptoms include chest pain, elevated blood pressure, stomach upset, mumbled or rapid speech, nervous habits such as fidgeting, back and neck pains, tremors and trembling of lips, and frequent headaches (Kumar, 2015). When a student experiences these symptoms, they might not feel the motivation they once felt about doing their best in such academic tasks as completing assignments or preparing for tests. Moreover, the symptoms are detrimental to the health of students, a factor which may father make their academic fortunes to dwindle.

Stress also makes students to have poor management skills. A student could become disorganized and uncertain about their priorities and goals as a result of suffering from high levels of stress. This could further make them incapable of effectively budgeting and managing their time. Moreover, highly stressed students have the tendency to procrastinate and neglect such important responsibilities as meeting deadlines and completing assignments (Hales & Hales, 2016). This, of course, negatively impacts the quality of their academic work and study skills.

High stress levels could further lead to self-defeating thoughts among students. While undergoing stress, it is likely that a student may consistently think about the adversity or negative situation in which they find themselves. In addition, they could constantly focus on their weaknesses and failures while ignoring their strengths and achievements. These are self-defeating thoughts that not only deal a blow to their self-esteem but also affect how they behave and how they feel both as humans and as students (Patel, 2016). They result into a student lacking confidence in their abilities and this negatively impacts their success in school since they cannot perform to their highest potential.

There are various stress management strategies students may take to reduce stress. One of these is to get regular physical activity and practice such relaxation techniques as massage, tai chi, yoga, meditation, and deep breathing. Students may also keep stress away by spending quality time with friends and family, and keeping a sense of humor. Another strategy may be to find time for such hobbies as listening to music, playing football, and reading a book. It is also important that one gets enough sleep and consumes balanced diet (Mayo Clinic Staff, 2019). These strategies may both alleviate and prevent stress among students.

Stress in students cause serious negative effects, both physical and academic. Students may experience stress due to poor sleeping habits, academic pressure, and poor nutrition and unhealthy eating habits. Students need enough sleep and less pressure for their brain to relax and recharge for it to function well. They also need to avoid stress-inducing foods such as fries and sodas. As has been seen, high stress levels could lead to physical symptoms, poor management skills, and self-defeating thoughts among students. As such, parents and teachers should work together in ensuring that students do not experience much stress because it is not good for their health and academic ability.

Hales, D., & Hales, J. (2016). Personal stress management: surviving to thriving . Boston, MA: Cengage Learning.

Kumar, N. (2015). Psychological stress among science students . New York, NY: Springer.

Mayo Clinic Staff. (2019). “Stress symptoms: effects on your body and behavior”. Mayo Clinic . Retrieved March 27, 2020 from https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress-symptoms/art-20050987

Patel, G. (2016). An achievement motivation and academic anxiety of school going students . Lunawada: Red’shine Publication. Inc.

Raju, M. V. (2009). Health psychology and counselling . Delhi, India: Discovery Publishing House.

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What I’ve Learned From My Students’ College Essays

The genre is often maligned for being formulaic and melodramatic, but it’s more important than you think.

By Nell Freudenberger

Most high school seniors approach the college essay with dread. Either their upbringing hasn’t supplied them with several hundred words of adversity, or worse, they’re afraid that packaging the genuine trauma they’ve experienced is the only way to secure their future. The college counselor at the Brooklyn high school where I’m a writing tutor advises against trauma porn. “Keep it brief , ” she says, “and show how you rose above it.”

I started volunteering in New York City schools in my 20s, before I had kids of my own. At the time, I liked hanging out with teenagers, whom I sometimes had more interesting conversations with than I did my peers. Often I worked with students who spoke English as a second language or who used slang in their writing, and at first I was hung up on grammar. Should I correct any deviation from “standard English” to appeal to some Wizard of Oz behind the curtains of a college admissions office? Or should I encourage students to write the way they speak, in pursuit of an authentic voice, that most elusive of literary qualities?

In fact, I was missing the point. One of many lessons the students have taught me is to let the story dictate the voice of the essay. A few years ago, I worked with a boy who claimed to have nothing to write about. His life had been ordinary, he said; nothing had happened to him. I asked if he wanted to try writing about a family member, his favorite school subject, a summer job? He glanced at his phone, his posture and expression suggesting that he’d rather be anywhere but in front of a computer with me. “Hobbies?” I suggested, without much hope. He gave me a shy glance. “I like to box,” he said.

I’ve had this experience with reluctant writers again and again — when a topic clicks with a student, an essay can unfurl spontaneously. Of course the primary goal of a college essay is to help its author get an education that leads to a career. Changes in testing policies and financial aid have made applying to college more confusing than ever, but essays have remained basically the same. I would argue that they’re much more than an onerous task or rote exercise, and that unlike standardized tests they are infinitely variable and sometimes beautiful. College essays also provide an opportunity to learn precision, clarity and the process of working toward the truth through multiple revisions.

When a topic clicks with a student, an essay can unfurl spontaneously.

Even if writing doesn’t end up being fundamental to their future professions, students learn to choose language carefully and to be suspicious of the first words that come to mind. Especially now, as college students shoulder so much of the country’s ethical responsibility for war with their protest movement, essay writing teaches prospective students an increasingly urgent lesson: that choosing their own words over ready-made phrases is the only reliable way to ensure they’re thinking for themselves.

Teenagers are ideal writers for several reasons. They’re usually free of preconceptions about writing, and they tend not to use self-consciously ‘‘literary’’ language. They’re allergic to hypocrisy and are generally unfiltered: They overshare, ask personal questions and call you out for microaggressions as well as less egregious (but still mortifying) verbal errors, such as referring to weed as ‘‘pot.’’ Most important, they have yet to put down their best stories in a finished form.

I can imagine an essay taking a risk and distinguishing itself formally — a poem or a one-act play — but most kids use a more straightforward model: a hook followed by a narrative built around “small moments” that lead to a concluding lesson or aspiration for the future. I never get tired of working with students on these essays because each one is different, and the short, rigid form sometimes makes an emotional story even more powerful. Before I read Javier Zamora’s wrenching “Solito,” I worked with a student who had been transported by a coyote into the U.S. and was reunited with his mother in the parking lot of a big-box store. I don’t remember whether this essay focused on specific skills or coping mechanisms that he gained from his ordeal. I remember only the bliss of the parent-and-child reunion in that uninspiring setting. If I were making a case to an admissions officer, I would suggest that simply being able to convey that experience demonstrates the kind of resilience that any college should admire.

The essays that have stayed with me over the years don’t follow a pattern. There are some narratives on very predictable topics — living up to the expectations of immigrant parents, or suffering from depression in 2020 — that are moving because of the attention with which the student describes the experience. One girl determined to become an engineer while watching her father build furniture from scraps after work; a boy, grieving for his mother during lockdown, began taking pictures of the sky.

If, as Lorrie Moore said, “a short story is a love affair; a novel is a marriage,” what is a college essay? Every once in a while I sit down next to a student and start reading, and I have to suppress my excitement, because there on the Google Doc in front of me is a real writer’s voice. One of the first students I ever worked with wrote about falling in love with another girl in dance class, the absolute magic of watching her move and the terror in the conflict between her feelings and the instruction of her religious middle school. She made me think that college essays are less like love than limerence: one-sided, obsessive, idiosyncratic but profound, the first draft of the most personal story their writers will ever tell.

Nell Freudenberger’s novel “The Limits” was published by Knopf last month. She volunteers through the PEN America Writers in the Schools program.

• Open access
• Published: 11 May 2024

Nursing students’ stressors and coping strategies during their first clinical training: a qualitative study in the United Arab Emirates

• Jacqueline Maria Dias 1 ,
• Muhammad Arsyad Subu 1 ,
• Nabeel Al-Yateem 1 ,
• Fatma Refaat Ahmed 1 ,
• Syed Azizur Rahman 1 , 2 ,
• Mini Sara Abraham 1 ,
• Sareh Mirza Forootan 1 ,
• Farzaneh Ahmad Sarkhosh 1 &
• Fatemeh Javanbakh 1  

BMC Nursing volume  23 , Article number:  322 ( 2024 ) Cite this article

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Understanding the stressors and coping strategies of nursing students in their first clinical training is important for improving student performance, helping students develop a professional identity and problem-solving skills, and improving the clinical teaching aspects of the curriculum in nursing programmes. While previous research have examined nurses’ sources of stress and coping styles in the Arab region, there is limited understanding of these stressors and coping strategies of nursing students within the UAE context thereby, highlighting the novelty and significance of the study.

A qualitative study was conducted using semi-structured interviews. Overall 30 students who were undergoing their first clinical placement in Year 2 at the University of Sharjah between May and June 2022 were recruited. All interviews were recorded and transcribed verbatim and analyzed for themes.

During their first clinical training, nursing students are exposed to stress from different sources, including the clinical environment, unfriendly clinical tutors, feelings of disconnection, multiple expectations of clinical staff and patients, and gaps between the curriculum of theory classes and labatories skills and students’ clinical experiences. We extracted three main themes that described students’ stress and use of coping strategies during clinical training: (1) managing expectations; (2) theory-practice gap; and (3) learning to cope. Learning to cope, included two subthemes: positive coping strategies and negative coping strategies.

Conclusions

This qualitative study sheds light from the students viewpoint about the intricate interplay between managing expectations, theory practice gap and learning to cope. Therefore, it is imperative for nursing faculty, clinical agencies and curriculum planners to ensure maximum learning in the clinical by recognizing the significance of the stressors encountered and help students develop positive coping strategies to manage the clinical stressors encountered. Further research is required look at the perspective of clinical stressors from clinical tutors who supervise students during their first clinical practicum.

Peer Review reports

Nursing education programmes aim to provide students with high-quality clinical learning experiences to ensure that nurses can provide safe, direct care to patients [ 1 ]. The nursing baccalaureate programme at the University of Sharjah is a four year program with 137 credits. The programmes has both theoretical and clinical components withs nine clinical courses spread over the four years The first clinical practicum which forms the basis of the study takes place in year 2 semester 2.

Clinical practice experience is an indispensable component of nursing education and links what students learn in the classroom and in skills laboratories to real-life clinical settings [ 2 , 3 , 4 ]. However, a gap exists between theory and practice as the curriculum in the classroom differs from nursing students’ experiences in the clinical nursing practicum [ 5 ]. Clinical nursing training places (or practicums, as they are commonly referred to), provide students with the necessary experiences to ensure that they become proficient in the delivery of patient care [ 6 ]. The clinical practicum takes place in an environment that combines numerous structural, psychological, emotional and organizational elements that influence student learning [ 7 ] and may affect the development of professional nursing competencies, such as compassion, communication and professional identity [ 8 ]. While clinical training is a major component of nursing education curricula, stress related to clinical training is common among students [ 9 ]. Furthermore, the nursing literature indicates that the first exposure to clinical learning is one of the most stressful experiences during undergraduate studies [ 8 , 10 ]. Thus, the clinical component of nursing education is considered more stressful than the theoretical component. Students often view clinical learning, where most learning takes place, as an unsupportive environment [ 11 ]. In addition, they note strained relationships between themselves and clinical preceptors and perceive that the negative attitudes of clinical staff produce stress [ 12 ].

The effects of stress on nursing students often involve a sense of uncertainty, uneasiness, or anxiety. The literature is replete with evidence that nursing students experience a variety of stressors during their clinical practicum, beginning with the first clinical rotation. Nursing is a complex profession that requires continuous interaction with a variety of individuals in a high-stress environment. Stress during clinical learning can have multiple negative consequences, including low academic achievement, elevated levels of burnout, and diminished personal well-being [ 13 , 14 ]. In addition, both theoretical and practical research has demonstrated that increased, continual exposure to stress leads to cognitive deficits, inability to concentrate, lack of memory or recall, misinterpretation of speech, and decreased learning capacity [ 15 ]. Furthermore, stress has been identified as a cause of attrition among nursing students [ 16 ].

Most sources of stress have been categorized as academic, clinical or personal. Each person copes with stress differently [ 17 ], and utilizes deliberate, planned, and psychological efforts to manage stressful demands [ 18 ]. Coping mechanisms are commonly termed adaptation strategies or coping skills. Labrague et al. [ 19 ] noted that students used critical coping strategies to handle stress and suggested that problem solving was the most common coping or adaptation mechanism used by nursing students. Nursing students’ coping strategies affect their physical and psychological well-being and the quality of nursing care they offer. Therefore, identifying the coping strategies that students use to manage stressors is important for early intervention [ 20 ].

Studies on nursing students’ coping strategies have been conducted in various countries. For example, Israeli nursing students were found to adopt a range of coping mechanisms, including talking to friends, engaging in sports, avoiding stress and sadness/misery, and consuming alcohol [ 21 ]. Other studies have examined stress levels among medical students in the Arab region. Chaabane et al. [ 15 ], conducted a systematic review of sudies in Arab countries, including Saudi Arabia, Egypt, Jordan, Iraq, Pakistan, Oman, Palestine and Bahrain, and reported that stress during clinical practicums was prevalent, although it could not be determined whether this was limited to the initial clinical course or occurred throughout clinical training. Stressors highlighted during the clinical period in the systematic review included assignments and workload during clinical practice, a feeling that the requirements of clinical practice exceeded students’ physical and emotional endurance and that their involvement in patient care was limited due to lack of experience. Furthermore, stress can have a direct effect on clinical performance, leading to mental disorders. Tung et al. [ 22 ], reported that the prevalence of depression among nursing students in Arab countries is 28%, which is almost six times greater than the rest of the world [ 22 ]. On the other hand, Saifan et al. [ 5 ], explored the theory-practice gap in the United Arab Emirates and found that clinical stressors could be decreased by preparing students better for clinical education with qualified clinical faculty and supportive preceptors.

The purpose of this study was to identify the stressors experienced by undergraduate nursing students in the United Arab Emirates during their first clinical training and the basic adaptation approaches or coping strategies they used. Recognizing or understanding different coping processes can inform the implementation of corrective measures when students experience clinical stress. The findings of this study may provide valuable information for nursing programmes, nurse educators, and clinical administrators to establish adaptive strategies to reduce stress among students going clinical practicums, particularly stressors from their first clinical training in different healthcare settings.

A qualitative approach was adopted to understand clinical stressors and coping strategies from the perspective of nurses’ lived experience. Qualitative content analysis was employed to obtain rich and detailed information from our qualitative data. Qualitative approaches seek to understand the phenomenon under study from the perspectives of individuals with lived experience [ 23 ]. Qualitative content analysis is an interpretive technique that examines the similarities and differences between and within different areas of text while focusing on the subject [ 24 ]. It is used to examine communication patterns in a repeatable and systematic way [ 25 ] and yields rich and detailed information on the topic under investigation [ 23 ]. It is a method of systematically coding and categorizing information and comprises a process of comprehending, interpreting, and conceptualizing the key meanings from qualitative data [ 26 ].

Setting and participants

This study was conducted after the clinical rotations ended in April 2022, between May and June in the nursing programme at the College of Health Sciences, University of Sharjah, in the United Arab Emirates. The study population comprised undergraduate nursing students who were undergoing their first clinical training and were recruited using purposive sampling. The inclusion criteria for this study were second-year nursing students in the first semester of clinical training who could speak English, were willing to participate in this research, and had no previous clinical work experience. The final sample consisted of 30 students.

Research instrument

The research instrument was a semi structured interview guide. The interview questions were based on an in-depth review of related literature. An intensive search included key words in Google Scholar, PubMed like the terms “nursing clinical stressors”, “nursing students”, and “coping mechanisms”. Once the questions were created, they were validated by two other faculty members who had relevant experience in mental health. A pilot test was conducted with five students and based on their feedback the following research questions, which were addressed in the study.

How would you describe your clinical experiences during your first clinical rotations?

In what ways did you find the first clinical rotation to be stressful?

What factors hindered your clinical training?

How did you cope with the stressors you encountered in clinical training?

Which strategies helped you cope with the clinical stressors you encountered?

Data collection

Semi-structured interviews were chosen as the method for data collection. Semi structured interviews are a well-established approach for gathering data in qualitative research and allow participants to discuss their views, experiences, attitudes, and beliefs in a positive environment [ 27 ]. This approach allows for flexibility in questioning thereby ensuring that key topics related to clinical learning stressors and coping strategies would be explored. Participants were given the opportunity to express their views, experiences, attitudes, and beliefs in a positive environment, encouraging open communication. These semi structured interviews were conducted by one member of the research team (MAS) who had a mental health background, and another member of the research team who attended the interviews as an observer (JMD). Neither of these researchers were involved in teaching the students during their clinical practicum, which helped to minimize bias. The interviews took place at the University of Sharjah, specifically in building M23, providing a familiar and comfortable environment for the participant. Before the interviews were all students who agreed to participate were provided with an explanation of the study’s purpose. The time and location of each interview were arranged. Before the interviews were conducted, all students who provided consent to participate received an explanation of the purpose of the study, and the time and place of each interview were arranged to accommodate the participants’ schedules and preferences. The interviews were conducted after the clinical rotation had ended in April, and after the final grades had been submitted to the coordinator. The timings of the interviews included the month of May and June which ensured that participants have completed their practicum experience and could reflect on the stressors more comprehensively. The interviews were audio-recorded with the participants’ consent, and each interview lasted 25–40 min. The data were collected until saturation was reached for 30 students. Memos and field notes were also recorded as part of the data collection process. These additional data allowed for triangulation to improve the credibility of the interpretations of the data [ 28 ]. Memos included the interviewers’ thoughts and interpretations about the interviews, the research process (including questions and gaps), and the analytic progress used for the research. Field notes were used to record the interviewers’ observations and reflections on the data. These additional data collection methods were important to guide the researchers in the interpretation of the data on the participants’ feelings, perspectives, experiences, attitudes, and beliefs. Finally, member checking was performed to ensure conformability.

Data analysis

The study used the content analysis method proposed by Graneheim and Lundman [ 24 ]. According to Graneheim and Lundman [ 24 ], content analysis is an interpretive technique that examines the similarities and differences between distinct parts of a text. This method allows researchers to determine exact theoretical and operational definitions of words, phrases, and symbols by elucidating their constituent properties [ 29 ]. First, we read the interview transcripts several times to reach an overall understanding of the data. All verbatim transcripts were read several times and discussed among all authors. We merged and used line-by-line coding of words, sentences, and paragraphs relevant to each other in terms of both the content and context of stressors and coping mechanisms. Next, we used data reduction to assess the relationships among themes using tables and diagrams to indicate conceptual patterns. Content related to stress encountered by students was extracted from the transcripts. In a separate document, we integrated and categorized all words and sentences that were related to each other in terms of both content and context. We analyzed all codes and units of meaning and compared them for similarities and differences in the context of this study. Furthermore, the emerging findings were discussed with other members of the researcher team. The final abstractions of meaningful subthemes into themes were discussed and agreed upon by the entire research team. This process resulted in the extraction of three main themes in addition to two subthemes related to stress and coping strategies.

Ethical considerations

The University of Sharjah Research Ethics Committee provided approval to conduct this study (Reference Number: REC 19-12-03-01-S). Before each interview, the goal and study procedures were explained to each participant, and written informed consent was obtained. The participants were informed that participation in the study was voluntary and that they could withdraw from the study at any time. In the event they wanted to withdraw from the study, all information related to the participant would be removed. No participant withdrew from the study. Furthermore, they were informed that their clinical practicum grade would not be affected by their participation in this study. We chose interview locations in Building M23that were private and quiet to ensure that the participants felt at ease and confident in verbalizing their opinions. No participant was paid directly for involvement in this study. In addition, participants were assured that their data would remain anonymous and confidential. Confidentiality means that the information provided by participants was kept private with restrictions on how and when data can be shared with others. The participants were informed that their information would not be duplicated or disseminated without their permission. Anonymity refers to the act of keeping people anonymous with respect to their participation in a research endeavor. No personal identifiers were used in this study, and each participant was assigned a random alpha-numeric code (e.g., P1 for participant 1). All digitally recorded interviews were downloaded to a secure computer protected by the principal investigator with a password. The researchers were the only people with access to the interview material (recordings and transcripts). All sensitive information and materials were kept secure in the principal researcher’s office at the University of Sharjah. The data will be maintained for five years after the study is completed, after which the material will be destroyed (the transcripts will be shredded, and the tapes will be demagnetized).

In total, 30 nursing students who were enrolled in the nursing programme at the Department of Nursing, College of Health Sciences, University of Sharjah, and who were undergoing their first clinical practicum participated in the study. Demographically, 80% ( n  = 24) were females and 20% ( n  = 6) were male participants. The majority (83%) of study participants ranged in age from 18 to 22 years. 20% ( n  = 6) were UAE nationals, 53% ( n  = 16) were from Gulf Cooperation Council countries, while 20% ( n  = 6) hailed from Africa and 7% ( n  = 2) were of South Asian descent. 67% of the respondents lived with their families while 33% lived in the hostel. (Table  1 )

Following the content analysis, we identified three main themes: (1) managing expectations, (2) theory-practice gap and 3)learning to cope. Learning to cope had two subthemes: positive coping strategies and negative coping strategies. An account of each theme is presented along with supporting excerpts for the identified themes. The identified themes provide valuable insight into the stressors encountered by students during their first clinical practicum. These themes will lead to targeted interventions and supportive mechanisms that can be built into the clinical training curriculum to support students during clinical practice.

Theme 1: managing expectations

In our examination of the stressors experienced by nursing students during their first clinical practicum and the coping strategies they employed, we identified the first theme as managing expectations.

The students encountered expectations from various parties, such as clinical staff, patients and patients’ relatives which they had to navigate. They attempted to fulfil their expectations as they progressed through training, which presented a source of stress. The students noted that the hospital staff and patients expected them to know how to perform a variety of tasks upon request, which made the students feel stressed and out of place if they did not know how to perform these tasks. Some participants noted that other nurses in the clinical unit did not allow them to participate in nursing procedures, which was considered an enormous impediment to clinical learning, as noted in the excerpt below:

“…Sometimes the nurses… They will not allow us to do some procedures or things during clinical. And sometimes the patients themselves don’t allow us to do procedures” (P5).

Some of the students noted that they felt they did not belong and felt like foreigners in the clinical unit. Excerpts from the students are presented in the following quotes;

“The clinical environment is so stressful. I don’t feel like I belong. There is too little time to build a rapport with hospital staff or the patient” (P22).

“… you ask the hospital staff for some guidance or the location of equipment, and they tell us to ask our clinical tutor …but she is not around … what should I do? It appears like we do not belong, and the sooner the shift is over, the better” (P18).

“The staff are unfriendly and expect too much from us students… I feel like I don’t belong, or I am wasting their (the hospital staff’s) time. I want to ask questions, but they have loads to do” (P26).

Other students were concerned about potential failure when working with patients during clinical training, which impacted their confidence. They were particularly afraid of failure when performing any clinical procedures.

“At the beginning, I was afraid to do procedures. I thought that maybe the patient would be hurt and that I would not be successful in doing it. I have low self-confidence in doing procedures” (P13).

The call bell rings, and I am told to answer Room No. XXX. The patient wants help to go to the toilet, but she has two IV lines. I don’t know how to transport the patient… should I take her on the wheelchair? My eyes glance around the room for a wheelchair. I am so confused …I tell the patient I will inform the sister at the nursing station. The relative in the room glares at me angrily … “you better hurry up”…Oh, I feel like I don’t belong, as I am not able to help the patient… how will I face the same patient again?” (P12).

Another major stressor mentioned in the narratives was related to communication and interactions with patients who spoke another language, so it was difficult to communicate.

“There was a challenge with my communication with the patients. Sometimes I have communication barriers because they (the patients) are of other nationalities. I had an experience with a patient [who was] Indian, and he couldn’t speak my language. I did not understand his language” (P9).

Thus, a variety of expectations from patients, relatives, hospital staff, and preceptors acted as sources of stress for students during their clinical training.

Theme 2: theory-practice gap

Theory-practice gaps have been identified in previous studies. In our study, there was complete dissonance between theory and actual clinical practice. The clinical procedures or practices nursing students were expected to perform differed from the theory they had covered in their university classes and skills lab. This was described as a theory–practice gap and often resulted in stress and confusion.

“For example …the procedures in the hospital are different. They are different from what we learned or from theory on campus. Or… the preceptors have different techniques than what we learned on campus. So, I was stress[ed] and confused about it” (P11).

Furthermore, some students reported that they did not feel that they received adequate briefing before going to clinical training. A related source of stress was overload because of the volume of clinical coursework and assignments in addition to clinical expectations. Additionally, the students reported that a lack of time and time management were major sources of stress in their first clinical training and impacted their ability to complete the required paperwork and assignments:

“…There is not enough time…also, time management at the hospital…for example, we start at seven a.m., and the handover takes 1 hour to finish. They (the nurses at the hospital) are very slow…They start with bed making and morning care like at 9.45 a.m. Then, we must fill [out] our assessment tool and the NCP (nursing care plan) at 10 a.m. So, 15 only minutes before going to our break. We (the students) cannot manage this time. This condition makes me and my friends very stressed out. -I cannot do my paperwork or assignments; no time, right?” (P10).

“Stressful. There is a lot of work to do in clinical. My experiences are not really good with this course. We have a lot of things to do, so many assignments and clinical procedures to complete” (P16).

The participants noted that the amount of required coursework and number of assignments also presented a challenge during their first clinical training and especially affected their opportunity to learn.

“I need to read the file, know about my patient’s condition and pathophysiology and the rationale for the medications the patient is receiving…These are big stressors for my learning. I think about assignments often. Like, we are just focusing on so many assignments and papers. We need to submit assessments and care plans for clinical cases. We focus our time to complete and finish the papers rather than doing the real clinical procedures, so we lose [the] chance to learn” (P25).

Another participant commented in a similar vein that there was not enough time to perform tasks related to clinical requirements during clinical placement.

“…there is a challenge because we do not have enough time. Always no time for us to submit papers, to complete assessment tools, and some nurses, they don’t help us. I think we need more time to get more experiences and do more procedures, reduce the paperwork that we have to submit. These are challenges …” (P14).

There were expectations that the students should be able to carry out their nursing duties without becoming ill or adversely affected. In addition, many students reported that the clinical environment was completely different from the skills laboratory at the college. Exposure to the clinical setting added to the theory-practice gap, and in some instances, the students fell ill.

One student made the following comment:

“I was assisting a doctor with a dressing, and the sight and smell from the oozing wound was too much for me. I was nauseated. As soon as the dressing was done, I ran to the bathroom and threw up. I asked myself… how will I survive the next 3 years of nursing?” (P14).

Theme 3: learning to cope

The study participants indicated that they used coping mechanisms (both positive and negative) to adapt to and manage the stressors in their first clinical practicum. Important strategies that were reportedly used to cope with stress were time management, good preparation for clinical practice, and positive thinking as well as engaging in physical activity and self-motivation.

“Time management. Yes, it is important. I was encouraging myself. I used time management and prepared myself before going to the clinical site. Also, eating good food like cereal…it helps me very much in the clinic” (P28).

“Oh yeah, for sure positive thinking. In the hospital, I always think positively. Then, after coming home, I get [to] rest and think about positive things that I can do. So, I will think something good [about] these things, and then I will be relieved of stress” (P21).

Other strategies commonly reported by the participants were managing their breathing (e.g., taking deep breaths, breathing slowly), taking breaks to relax, and talking with friends about the problems they encountered.

“I prefer to take deep breaths and breathe slowly and to have a cup of coffee and to talk to my friends about the case or the clinical preceptor and what made me sad so I will feel more relaxed” (P16).

“Maybe I will take my break so I feel relaxed and feel better. After clinical training, I go directly home and take a long shower, going over the day. I will not think about anything bad that happened that day. I just try to think about good things so that I forget the stress” (P27).

“Yes, my first clinical training was not easy. It was difficult and made me stressed out…. I felt that it was a very difficult time for me. I thought about leaving nursing” (P7).

I was not able to offer my prayers. For me, this was distressing because as a Muslim, I pray regularly. Now, my prayer time is pushed to the end of the shift” (P11).

“When I feel stress, I talk to my friends about the case and what made me stressed. Then I will feel more relaxed” (P26).

Self-support or self-motivation through positive self-talk was also used by the students to cope with stress.

“Yes, it is difficult in the first clinical training. When I am stress[ed], I go to the bathroom and stand in the front of the mirror; I talk to myself, and I say, “You can do it,” “you are a great student.” I motivate myself: “You can do it”… Then, I just take breaths slowly several times. This is better than shouting or crying because it makes me tired” (P11).

Other participants used physical activity to manage their stress.

“How do I cope with my stress? Actually, when I get stressed, I will go for a walk on campus” (P4).

“At home, I will go to my room and close the door and start doing my exercises. After that, I feel the negative energy goes out, then I start to calm down… and begin my clinical assignments” (P21).

Both positive and negative coping strategies were utilized by the students. Some participants described using negative coping strategies when they encountered stress during their clinical practice. These negative coping strategies included becoming irritable and angry, eating too much food, drinking too much coffee, and smoking cigarettes.

“…Negative adaptation? Maybe coping. If I am stressed, I get so angry easily. I am irritable all day also…It is negative energy, right? Then, at home, I am also angry. After that, it is good to be alone to think about my problems” (P12).

“Yeah, if I…feel stress or depressed, I will eat a lot of food. Yeah, ineffective, like I will be eating a lot, drinking coffee. Like I said, effective, like I will prepare myself and do breathing, ineffective, I will eat a lot of snacks in between my free time. This is the bad side” (P16).

“…During the first clinical practice? Yes, it was a difficult experience for us…not only me. When stressed, during a break at the hospital, I will drink two or three cups of coffee… Also, I smoke cigarettes… A lot. I can drink six cups [of coffee] a day when I am stressed. After drinking coffee, I feel more relaxed, I finish everything (food) in the refrigerator or whatever I have in the pantry, like chocolates, chips, etc” (P23).

These supporting excerpts for each theme and the analysis offers valuable insights into the specific stressors faced by nursing students during their first clinical practicum. These insights will form the basis for the development of targeted interventions and supportive mechanisms within the clinical training curriculum to better support students’ adjustment and well-being during clinical practice.

Our study identified the stressors students encounter in their first clinical practicum and the coping strategies, both positive and negative, that they employed. Although this study emphasizes the importance of clinical training to prepare nursing students to practice as nurses, it also demonstrates the correlation between stressors and coping strategies.The content analysis of the first theme, managing expectations, paves the way for clinical agencies to realize that the students of today will be the nurses of tomorrow. It is important to provide a welcoming environment where students can develop their identities and learn effectively. Additionally, clinical staff should foster an environment of individualized learning while also assisting students in gaining confidence and competence in their repertoire of nursing skills, including critical thinking, problem solving and communication skills [ 8 , 15 , 19 , 30 ]. Another challenge encountered by the students in our study was that they were prevented from participating in clinical procedures by some nurses or patients. This finding is consistent with previous studies reporting that key challenges for students in clinical learning include a lack of clinical support and poor attitudes among clinical staff and instructors [ 31 ]. Clinical staff with positive attitudes have a positive impact on students’ learning in clinical settings [ 32 ]. The presence, supervision, and guidance of clinical instructors and the assistance of clinical staff are essential motivating components in the clinical learning process and offer positive reinforcement [ 30 , 33 , 34 ]. Conversely, an unsupportive learning environment combined with unwelcoming clinical staff and a lack of sense of belonging negatively impact students’ clinical learning [ 35 ].

The sources of stress identified in this study were consistent with common sources of stress in clinical training reported in previous studies, including the attitudes of some staff, students’ status in their clinical placement and educational factors. Nursing students’ inexperience in the clinical setting and lack of social and emotional experience also resulted in stress and psychological difficulties [ 36 ]. Bhurtun et al. [ 33 ] noted that nursing staff are a major source of stress for students because the students feel like they are constantly being watched and evaluated.

We also found that students were concerned about potential failure when working with patients during their clinical training. Their fear of failure when performing clinical procedures may be attributable to low self-confidence. Previous studies have noted that students were concerned about injuring patients, being blamed or chastised, and failing examinations [ 37 , 38 ]. This was described as feeling “powerless” in a previous study [ 7 , 12 ]. In addition, patients’ attitudes towards “rejecting” nursing students or patients’ refusal of their help were sources of stress among the students in our study and affected their self-confidence. Self-confidence and a sense of belonging are important for nurses’ personal and professional identity, and low self-confidence is a problem for nursing students in clinical learning [ 8 , 39 , 40 ]. Our findings are consistent with a previous study that reported that a lack of self-confidence was a primary source of worry and anxiety for nursing students and affected their communication and intention to leave nursing [ 41 ].

In the second theme, our study suggests that students encounter a theory-practice gap in clinical settings, which creates confusion and presents an additional stressors. Theoretical and clinical training are complementary elements of nursing education [ 40 ], and this combination enables students to gain the knowledge, skills, and attitudes necessary to provide nursing care. This is consistent with the findings of a previous study that reported that inconsistencies between theoretical knowledge and practical experience presented a primary obstacle to the learning process in the clinical context [ 42 ], causing students to lose confidence and become anxious [ 43 ]. Additionally, the second theme, the theory-practice gap, authenticates Safian et al.’s [ 5 ] study of the theory-practice gap that exists United Arab Emirates among nursing students as well as the need for more supportive clinical faculty and the extension of clinical hours. The need for better time availability and time management to complete clinical tasks were also reported by the students in the study. Students indicated that they had insufficient time to complete clinical activities because of the volume of coursework and assignments. Our findings support those of Chaabane et al. [ 15 ]. A study conducted in Saudi Arabia [ 44 ] found that assignments and workload were among the greatest sources of stress for students in clinical settings. Effective time management skills have been linked to academic achievement, stress reduction, increased creativity [ 45 ], and student satisfaction [ 46 ]. Our findings are also consistent with previous studies that reported that a common source of stress among first-year students was the increased classroom workload [ 19 , 47 ]. As clinical assignments and workloads are major stressors for nursing students, it is important to promote activities to help them manage these assignments [ 48 ].

Another major challenge reported by the participants was related to communicating and interacting with other nurses and patients. The UAE nursing workforce and population are largely expatriate and diverse and have different cultural and linguistic backgrounds. Therefore, student nurses encounter difficulty in communication [ 49 ]. This cultural diversity that students encounter in communication with patients during clinical training needs to be addressed by curriculum planners through the offering of language courses and courses on cultural diversity [ 50 ].

Regarding the third and final theme, nursing students in clinical training are unable to avoid stressors and must learn to cope with or adapt to them. Previous research has reported a link between stressors and the coping mechanisms used by nursing students [ 51 , 52 , 53 ]. In particular, the inability to manage stress influences nurses’ performance, physical and mental health, attitude, and role satisfaction [ 54 ]. One such study suggested that nursing students commonly use problem-focused (dealing with the problem), emotion-focused (regulating emotion), and dysfunctional (e.g., venting emotions) stress coping mechanisms to alleviate stress during clinical training [ 15 ]. Labrague et al. [ 51 ] highlighted that nursing students use both active and passive coping techniques to manage stress. The pattern of clinical stress has been observed in several countries worldwide. The current study found that first-year students experienced stress during their first clinical training [ 35 , 41 , 55 ]. The stressors they encountered impacted their overall health and disrupted their clinical learning. Chaabane et al. [ 15 ] reported moderate and high stress levels among nursing students in Bahrain, Egypt, Iraq, Jordan, Oman, Pakistan, Palestine, Saudi Arabia, and Sudan. Another study from Bahrain reported that all nursing students experienced moderate to severe stress in their first clinical placement [ 56 ]. Similarly, nursing students in Spain experienced a moderate level of stress, and this stress was significantly correlated with anxiety [ 30 ]. Therefore, it is imperative that pastoral systems at the university address students’ stress and mental health so that it does not affect their clinical performance. Faculty need to utilize evidence-based interventions to support students so that anxiety-producing situations and attrition are minimized.

In our study, students reported a variety of positive and negative coping mechanisms and strategies they used when they experienced stress during their clinical practice. Positive coping strategies included time management, positive thinking, self-support/motivation, breathing, taking breaks, talking with friends, and physical activity. These findings are consistent with those of a previous study in which healthy coping mechanisms used by students included effective time management, social support, positive reappraisal, and participation in leisure activities [ 57 ]. Our study found that relaxing and talking with friends were stress management strategies commonly used by students. Communication with friends to cope with stress may be considered social support. A previous study also reported that people seek social support to cope with stress [ 58 ]. Some students in our study used physical activity to cope with stress, consistent with the findings of previous research. Stretching exercises can be used to counteract the poor posture and positioning associated with stress and to assist in reducing physical tension. Promoting such exercise among nursing students may assist them in coping with stress in their clinical training [ 59 ].

Our study also showed that when students felt stressed, some adopted negative coping strategies, such as showing anger/irritability, engaging in unhealthy eating habits (e.g., consumption of too much food or coffee), or smoking cigarettes. Previous studies have reported that high levels of perceived stress affect eating habits [ 60 ] and are linked to poor diet quality, increased snacking, and low fruit intake [ 61 ]. Stress in clinical settings has also been linked to sleep problems, substance misuse, and high-risk behaviors’ and plays a major role in student’s decision to continue in their programme.

Implications of the study

The implications of the study results can be grouped at multiple levels including; clinical, educational, and organizational level. A comprehensive approach to addressing the stressors encountered by nursing students during their clinical practicum can be overcome by offering some practical strategies to address the stressors faced by nursing students during their clinical practicum. By integrating study findings into curriculum planning, mentorship programs, and organizational support structures, a supportive and nurturing environment that enhances students’ learning, resilience, and overall success can be envisioned.

Clinical level

Introducing simulation in the skills lab with standardized patients and the use of moulage to demonstrate wounds, ostomies, and purulent dressings enhances students’ practical skills and prepares them for real-world clinical scenarios. Organizing orientation days at clinical facilities helps familiarize students with the clinical environment, identify potential stressors, and introduce interventions to enhance professionalism, social skills, and coping abilities Furthermore, creating a WhatsApp group facilitates communication and collaboration among hospital staff, clinical tutors, nursing faculty, and students, enabling immediate support and problem-solving for clinical situations as they arise, Moreover, involving chief nursing officers of clinical facilities in the Nursing Advisory Group at the Department of Nursing promotes collaboration between academia and clinical practice, ensuring alignment between educational objectives and the needs of the clinical setting [ 62 ].

Educational level

Sharing study findings at conferences (we presented the results of this study at Sigma Theta Tau International in July 2023 in Abu Dhabi, UAE) and journal clubs disseminates knowledge and best practices among educators and clinicians, promoting awareness and implementation of measures to improve students’ learning experiences. Additionally we hold mentorship training sessions annually in January and so we shared with the clinical mentors and preceptors the findings of this study so that they proactively they are equipped with strategies to support students’ coping with stressors during clinical placements.

Organizational level

At the organizational we relooked at the available student support structures, including counseling, faculty advising, and career advice, throughout the nursing program emphasizing the importance of holistic support for students’ well-being and academic success as well as retention in the nursing program. Also, offering language courses as electives recognizes the value of communication skills in nursing practice and provides opportunities for personal and professional development.

For first-year nursing students, clinical stressors are inevitable and must be given proper attention. Recognizing nursing students’ perspectives on the challenges and stressors experienced in clinical training is the first step in overcoming these challenges. In nursing schools, providing an optimal clinical environment as well as increasing supervision and evaluation of students’ practices should be emphasized. Our findings demonstrate that first-year nursing students are exposed to a variety of different stressors. Identifying the stressors, pressures, and obstacles that first-year students encounter in the clinical setting can assist nursing educators in resolving these issues and can contribute to students’ professional development and survival to allow them to remain in the profession. To overcome stressors, students frequently employ problem-solving approaches or coping mechanisms. The majority of nursing students report stress at different levels and use a variety of positive and negative coping techniques to manage stress.

The present results may not be generalizable to other nursing institutions because this study used a purposive sample along with a qualitative approach and was limited to one university in the Middle East. Furthermore, the students self-reported their stress and its causes, which may have introduced reporting bias. The students may also have over or underreported stress or coping mechanisms because of fear of repercussions or personal reasons, even though the confidentiality of their data was ensured. Further studies are needed to evaluate student stressors and coping now that measures have been introduced to support students. Time will tell if these strategies are being used effectively by both students and clinical personnel or if they need to be readdressed. Finally, we need to explore the perceptions of clinical faculty towards supervising students in their first clinical practicum so that clinical stressors can be handled effectively.

Data availability

The data sets are available with the corresponding author upon reasonable request.

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Jacqueline Maria Dias, Muhammad Arsyad Subu, Nabeel Al-Yateem, Fatma Refaat Ahmed, Syed Azizur Rahman, Mini Sara Abraham, Sareh Mirza Forootan, Farzaneh Ahmad Sarkhosh & Fatemeh Javanbakh

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JMD conceptualized the idea and designed the methodology, formal analysis, writing original draft and project supervision and mentoring. MAS prepared the methodology and conducted the qualitative interviews and analyzed the methodology and writing of original draft and project supervision. NY, FRA, SAR, MSA writing review and revising the draft. SMF, FAS, FJ worked with MAS on the formal analysis and prepared the first draft.All authors reviewed the final manuscipt of the article.

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Dias, J.M., Subu, M.A., Al-Yateem, N. et al. Nursing students’ stressors and coping strategies during their first clinical training: a qualitative study in the United Arab Emirates. BMC Nurs 23 , 322 (2024). https://doi.org/10.1186/s12912-024-01962-5

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