thesis on academic stress

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Stress and Coping Mechanisms Among College Students

• Masters Thesis
• Cornejo, Joaquin
• Park, Hyun Sun
• Brown, Jodi
• Acuña, Maria
• Social Work
• California State University, Northridge
• self-acceptance.
• college students
• self-compassion
• Dissertations, Academic -- CSUN -- Social Work.
• coping mechanism
• 2020-06-01T19:29:25Z
• http://hdl.handle.net/10211.3/216140
• by Joaquin Cornejo
• California State University, Northridge. Department of Social Work.

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Assessment of academic stress and its coping mechanisms among medical undergraduate students in a large Midwestern university

• Open access
• Published: 27 July 2020
• Volume 40 , pages 2599–2609, ( 2021 )

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• Nitin Joseph   ORCID: orcid.org/0000-0002-3639-510X 1 , 2 ,
• Aneesha Nallapati 2 , 3 ,
• Mitchelle Xavier Machado 2 , 3 ,
• Varsha Nair 2 , 3 ,
• Shreya Matele 2 , 3 ,
• Navya Muthusamy 2 , 3 &
• Aditi Sinha 2 , 3  

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Academic stress is the most common mental state that medical students experience during their training period. To assess academic stress, to find out its determinants, to assess other sources of stress and to explore the various coping styles against academic stress adopted by students. Methods: It was a cross sectional study done among medical students from first to fourth year. Standard self-administered questionnaires were used to assess academic stress and coping behaviour. Mean age of the 400 participants was 20.3 ± 1.5 years. 166(41.5%) of them were males. The academic stress was found to be of mild, moderate and severe level among 68(17%), 309(77.3%) and 23(5.7%) participants respectively. Overall coping with stress was found to be poor, average and good among 15(3.8%), 380(95%) and 5(1.2%) participants respectively. Passive emotional ( p  = 0.054) and passive problem ( p  = 0.001) coping behaviours were significantly better among males. Active problem coping behaviour ( p  = 0.007) was significantly better among females. Active emotional coping behaviour did not vary significantly between genders ( p  = 0.54). Majority of the students preferred sharing their personal problems with parents 211(52.7%) followed by friends 202(50.5%). Binary logistic regression analysis found worrying about future ( p  = 0.023) and poor self-esteem ( p  = 0.026) to be independently associated with academic stress. Academic stress although a common finding among students, the coping style to deal with it, was good only in a few. The coping behaviours were not satisfactory particularly among male participants. This along with other determinants of academic stress identified in this study need to be addressed during counselling sessions.

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Introduction

Academic stress has been reported to be the most common mental state that medical students experience during their training period (Ramli et al. 2018 ). It is on the rise among them probably due to increasing course requirements (Ramli et al. 2018 ; Drolet and Rodgers 2010 ). Kumaraswamy ( 2013 ) observed that the issues known to precipitate academic stress were excessive assignments, peer competition, examinations and problems related to time management. University students, for the life phase they are going through, also have to deal with many other stresses such as detachment from the family, building of self-identity and issues concerning adolescence period and those in relation to student-workers. The stress of the medical student is also connected to the relationship with the patient in the clinical period.

Some amount of academic stress is beneficial as it brings about healthy competition with peer group, promotes learning and helps to excel in academics (Malathi and Damodaran 1999 ; Afolayan et al. 2013 ). Lumley and Provenzano ( 2003 ) however reported that, excess of academic stress adversely affects academic performance, class attendance and psychological well-being of students. If it is not identified early and managed, it can cause depression, anxiety, behavioural problems, irritability, social withdrawal and physical illnesses (Adiele et al. 2018 ; Deb et al. 2015 ; Verma et al. 2002 ; Chen et al. 2013 ).

In addition to assessment of academic stress among under graduate medical students, it is also essential to analyze the various stress coping mechanisms adopted by them. This will help researchers in suggesting appropriate intervention strategies for the benefit of the students. Students in turn can educate their patients in future to identify stress and suggest measures to deal with it.

Previous studies have reported that medical students used active coping mechanisms (Al-Dubai et al. 2011 ; Chawla and Sachdeva 2018 ; Gade et al. 2014 ; Abouammoh et al. 2020 ), positive reframing (Al-Dubai et al. 2011 ; Chawla and Sachdeva 2018 ), planning (Chawla and Sachdeva 2018 ; Wu et al. 2018 ), positive reappraisal (Wu et al. 2018 ), emotional support (Chawla and Sachdeva 2018 ; Gade et al. 2014 ), peer discussions (Oku et al. 2015 ) and acceptance (Al-Dubai et al. 2011 ; Chawla and Sachdeva 2018 ) as means for coping stress. There were minimal reports of usage of avoidance strategies for coping stress among medical students (Al-Dubai et al. 2011 ; Chawla and Sachdeva 2018 ).

Royal College of Psychiatrists ( 2011 ) reported that students with secure attachments to family and those residing in a supportive community are in a better position to handle stress. Therefore assessment of various determinants of academic stress is essential to frame most suitable remedial measures for the benefit of the affected. This study was hence done to assess academic stress, to find out its determinants, to assess other sources of stress and to explore the various coping styles adopted by medical students to deal with academic stress in a coastal city in south India.

Materials and Methods

This cross sectional study was conducted in the month of March 2018 at a private medical college in Mangalore. The institutional ethics committee approval was taken before the commencement of the study. Permission to conduct the study was taken from the Dean. Sample size of 364 participants was calculated at 95% confidence intervals (CI), 90% power and the proportion of medical students with average level of academic stress taken as 51.4% based on the findings of Mostafavian et al. ( 2018 ). A non-response rate of 10% was added to arrive at the final sample size which was calculated as 400 participants. A total of 100 students of Bachelor of Medicine and Bachelor of Surgery course from first year to fourth year were therefore chosen to participate in this study using simple random sampling method.

The students were briefed about academic stress and the objectives of this study, in the classroom setting, and written informed consent was taken for their participation. In order to maintain anonymity, the filled in consent form were first collected back from the participants. Later the questionnaires were distributed by the investigators. It was a semi-structured questionnaire containing both closed and open ended questions. It was pre-tested in a group of ten students before its use in the current study. No changes in the questionnaire resulted following the pre-testing and the data collected in this phase were not included in the final study.

Data Collection Tools

Academic stress was assessed using the academic stress inventory tool for university students prepared by Lin and Chen ( 2009 ). They had reported the alpha value of Cronbach’s reliability test for this questionnaire as 0.90. The questionnaire was slightly modified during the content validation phase in this study to incorporate questions on career related issues along with few other minor changes. This questionnaire contained 35 items which were designed in a five point Likert scale. The responses in the scale were “completely disagree,” “disagree,” “neutral,” “agree,” and “completely agree”, with scores ranging from one to five points respectively. Cumulative scores ranging from 35 to 81, 82 to 128 and 129 to 175 were considered as mild, moderate and severe levels of academic stress respectively.

The coping techniques employed by the respondents was assessed using the academic stress coping style inventory developed by Lin and Chen ( 2010 ). The Cronbach’s alpha value of internal consistency for the stress coping style questionnaires was reported by them to be 0.83. It was shortened during the content validation phase to result in 25 questions designed again in Likert’s five-point scale. Scores were ranging from 5 for “completely agree” to 1 for “completely disagree”. Overall coping with stress was rated as poorly adoptive when cumulative score of the participant ranged from 25 to 58, average when it was 59 to 92 and good when it was 93 to 125.

Coping behaviour were grouped as active emotional coping, active problem coping, passive emotional coping and passive problem coping behaviours. Active emotional coping behaviour involved individuals adopting the attitude of emotional adjustment like positive thinking emotions and self-encouragement, when faced with academic stress. Active problem coping behaviour involved dealing academic stress by focussing at the centre of the problem and finding a solution themselves by being calm and optimistic or by searching assistance from external sources. Passive emotional coping behaviour involved constraining emotions, self-accusation, getting angry, blaming others or God or by giving up. Passive problem coping behaviour involved procrastinations, evasive behaviours or going into alcohol or drug abuse while facing academic stress (Lin and Chen 2010 ).

The overall alpha value of Cronbach’s reliability test for the academic stress and coping style inventory questionnaire used in this study was calculated to be 0.901, indicating excellent reliability.

Statistical Analysis

The data entry and analysis were done using IBM SPSS for Windows version 25.0, Armonk, New York. Statistical tests like Chi square test, Fisher’s exact test, Student’s unpaired t test and Karl Pearson’s coefficient of correlation were used for analysis. All the determinants of academic stress significant at 0.15 level were placed in the multivariable model. Backward stepwise elimination procedure was done to identify the independent determinants of academic stress in the model at the last step. p value 0.05 or less was used as the criterion for significance.

A total of 400 students participated in this study and all of them gave satisfactorily filled forms. Their mean age was 20.3 ± 1.5 years and median age was 20 years with an Inter Quartile Range (19, 22) years. As many as 166(41.5%) of them were males. Out of the total participants, 45(11.2%) were local residents, 51(12.8%) were outsiders but within the same state, 262(65.5%) were from other states within India, 35(8.8%) were non-residential Indians and the rest 7(1.7%) were foreigners. Medium of schooling among 388(97%) students was English.

Among the participants, 67(16.7%) were currently staying at their home or rented apartment while the rest 333(83.3%) were staying in the hostels or were staying as paying guests. Majority of them [228(57%)] were staying with their friends. Among others, 118(29.5%) were staying alone, 46(11.5%) with their parents, 7(1.8%) with their relatives and one with her elder sibling.

With respect to lifestyle habits, majority of the participants [249(62.2%)] went to college by walk, and majority [339(84.7%)] slept for 6 to 8 h on an average per day. (Table 1 ).

Sources of Stress among Participants

Majority of students either agreed or strongly agreed that some teachers provided so much of academic information, making it difficult for students to assimilate knowledge [177(44.2%)]. Fear of failure in the exams was the other major cause of academic stress [206(51.5%)]. (Table 2 ).

Majority of students either agreed or strongly agreed that by missing few lectures, they felt anxious about falling short of attendance towards the end [204(51%)]. They also regretted having wasted time set apart for studies [240(60%)]. (Table 3 ).

Overall the level of academic stress was found to be mild among 68(17%), moderate among 309(77.3%) and severe among 23(5.7%) participants. The mean academic stress score was found to be 100.6 ± 19.7. Gender wise variation in academic stress levels was noticed. It was of mild, moderate and severe level among 29(17.5%), 129(77.7%) and 8(4.8%) males and among 39(16.7%), 180(76.9%) and 15(6.4%) females respectively (X 2  = 0.472, p  = 0.79).

The other non-academic sources of stress reported by participants were lack of sufficient vacations [130(32.5%)], staying away from family [103(25.7%)], worrying about future [70(17.5%)], low self-esteem [52(13%)], having trouble with friends 39(9.7%)], facing financial difficulties [33(8.2%)], interpersonal conflicts [28(16.7%)], conflicts with roommates [26(6.5%)], issues with partners [23(5.8%)], sleeping disorders [21(5.2%)], transportation problems [20(5%)], problems in the family [18(4.5%)], searching a partner [17(4.2%)] and lack of parental support [5(1.2%)].

14(3.5%) participants had underlying chronic morbidities. These morbidities were allergic rhinitis among 3, migraine among 3, polycystic ovarian disease among 3, menorrhagia among 2 and allergy, peptic ulcer, hypothyroidism, and impaired glucose tolerance in one student each.

Coping Strategies Adopted by Participants

Majority of the participants [294(73.5%)] either agreed or strongly agreed that they tried to think or do something, that would make them feel happier and relaxed when they were stressed. (Table 4 ).

Overall coping with stress was found to be poor among 15(3.8%), average among 380(95%) and good among 5(1.2%) participants.

The mean coping with stress score was 75.2 ± 9.2. The mean score of various coping behaviours like active emotional coping (items 1 to 6), active problem coping (items 14 to 18), passive emotional coping (items 7 to 13) and passive problem coping (items 19 to 25) were found to be 21.7 ± 3.4, 13.2 ± 2.7, 18.6 ± 4.6 and 18.3 ± 4.2 respectively. (Table 4 ).

Mean active emotional coping score among males ( n  = 166) was 21.5 ± 3.5 and among females ( n  = 234) was 21.8 ± 3.3 (t = 0.613, p  = 0.54). Mean passive emotional coping score among males (n = 166) was 19.1 ± 5.0 and among females (n = 234) was 18.2 ± 4.1 (t = 1.933, p  = 0.054). Mean active problem coping score among males (n = 166) was 12.8 ± 2.8 and among females (n = 234) was 13.5 ± 2.5 (t = 2.711, p  = 0.007). Mean passive problem coping score among males (n = 166) was 19.1 ± 4.4 and among females (n = 234) was 17.7 ± 3.9 (t = 3.412, p  = 0.001).

The various measures adopted by participants to deal with stress were sharing problems with others [223(56.2%)], meditation [132(56.8%)], performing yoga [50(12.8%)], sleeping [29(7.5%)], practicing Tai Chi [13(3.5%)] and listening to music [11(3%)]. Other methods like watching television and exercising were reported by 8(2.2%) participants each, aromatherapy and sports by 5(1.3%) each, eating favourite food and consuming alcohol by two each and browsing through the internet by one participant.

Majority of the students preferred sharing their personal problems with parents 211(52.7%), followed by friends 202(50.5%), siblings 71(17.7%) and others 26(6.5%).

Eight(2%) participants reported using medications for the management of stress. One of them had taken Lorazepam tablets while another Sertraline tablets. The rest of them did not specify the medications.

Reasons like lack of sufficient vacations and worrying about future were found to have highly significant association with academic stress among participants ( p  ≤ 0.001). (Table 5 ).

Coping with stress was average/good among 328(98.8%) participants with moderate/severe levels of academic stress in comparison to 57(83.8%) with mild level of academic stress ( p  < 0.00001).

Similarly correlation of academic stress scores with stress coping scores was found to be significant (r = 0.467, p  < 0.001). Also correlation between academic stress scores with passive emotional (r = 0.513, p < 0.001) and passive problem (r = 0.401, p < 0.001) coping behaviours were found to be significant. However academic stress was not significantly correlated with active emotional (r = − 0.036, p  = 0.468) and active problem (r = 0.072, p  = 0.149) coping behaviours.

Binary logistic regression analysis found worrying about future ( p  = 0.023) and poor self-esteem ( p  = 0.026) among participants to be significantly associated with academic stress after adjusting the confounding effect of other variables in the model. (Table 6 ).

For calculating unadjusted Odds Ratio and 95% CI, participants staying with friends/alone were compared with those staying with parents/siblings/relatives (reference value), participants reporting speed of internet connection at place of stay as average/poor were compared with those reporting good connectivity (reference value).

An interesting fact about this study was that the response rate was total. This supports the importance of this study which addresses a felt need of every medical student.

Academic stress of moderate to severe level were reported among 83% participants in this study. In other studies done among medical students, academic stress was reported among 50% (Dyrbye et al. 2008 ), 53% (Bamuhair et al. 2015 ), 61% (Zamroni et al. 2018 ) and 74.6% (Mostafavian et al. 2018 ) participants. Academic stress among university students of other courses were reported among 48.8% (Reddy et al. 2018 ), 70.7% (Sharififard et al. 2014 ) and 73% (Adiele et al. 2018 ) participants. From these comparisons, it was obvious that academic stress was high among the participants in this study probably because of cultural factors.

There was no association between academic stress and gender of participants in this study as also reported by Mostafavian et al. ( 2018 ) and Zamroni et al. ( 2018 ). However several other studies done among university students reported females to have significantly greater academic stress than males (Adiele et al. 2018 ; Bamuhair et al. 2015 ; Reddy et al. 2018 ; Al-Sowygh et al. 2013 ).

Academic stress was found to be more among medical students in the first year (Nakalema and Ssenyonga 2014 ; Abdulghani 2008 ) or in the final year (Bamuhair et al. 2015 ). This was in contrast to the findings in this study were no such association was observed.

Place of residence was not associated with academic stress in this study and also in the study done among medical students in Iran by Mostafavian et al. ( 2018 ).

Academic stress in the present study was found to be least among participants who were staying with their parents, siblings or relatives. This may be because, number of students at this setting are outsiders. Studying over here, might also be their first occasion of moving out of their home environment. They therefore may be lacking their previously learnt support system such as banking on their family members and childhood friends during difficult times, as also observed by Kumar and Nancy ( 2011 ). They now have to find solutions to various problems by themselves, or by being dependent looking out for newer social contacts. If they were staying with their family members, perhaps they might have received the necessary emotional support during examinations and other stressful situations. The other benefits like getting hygienic food, good living conditions and people to take care of one’s health would have been best when family members were around. The observations in this study were however contradicting the observation of Mostafavian et al. ( 2018 ) who observed that the academic stress was significantly more among those living at their houses compared to those at dormitories.

As many as 60% participants regretted having wasted time set apart for their studies. Poor time management was found to be associated with academic stress by other researchers too (Misra and McKean 2000 ; Macan et al. 1990 ). Good time management skills involves prioritization of activities and judicious usage of time available for organization of the tasks to be completed. Time management was found to determine academic performance by Misra and McKean ( 2000 ). Moreover those with sound time management behaviour were found to have fewer psychological and physical symptoms related to stress (Misra and McKean 2000 ; Macan et al. 1990 ). Lammers et al. ( 2001 ) reported that close to half of the students had notable weaknesses in their time management skills.

Fear of failure in exams and falling short of attendance towards the end were the reasons for academic stress among more than half the participants in this study. Teachers can play an important role in alleviating examination related fears and anxieties by conducting frequent mock examinations (Sharma et al. 2011 ). Meeting individual students’ needs (Aherne et al. 2016 ), to find out the reason for missing classes, time scheduling of activities and providing constructive feedback to students (Sharma et al. 2016 ) are the other recommended strategies advised by previous researchers. Abouserie ( 1994 ) stated that the amount of guidance and support offered by teachers would be a key factor in determining the stress levels of students in any institution. Students themselves have opined that social support from teachers and peer groups, consulting services, and various extracurricular activities are the most useful strategies to deal with stress (Chang et al. 2012 ). As opined by the student community themselves, every institution need to offer them psychotherapy sessions, trainings for reducing emotional tension and opportunities to improve social intelligence (Ruzhenkov et al. 2016 ).

Issues like worrying about future and poor self-esteem among participants in this study were significantly associated with academic stress in the multivariable analysis model. These problems may be related to issues like concern about clearing the increasingly competitive entrance exams and also about the fear of them not being able to pursue the specialty of their choice in future. To address such sensitive problems, there is a need of the placement of a professional counsellor at various professional colleges. Pressley and McCormick ( 1995 ) also suggested that the learning environment within classrooms should be non-competitive, collaborative and task-oriented and not performance oriented, so as to create a stress free learning environment.

Having said this, the course work at medical schools should not be too light either. Kanter ( 2008 ) suggested that this approach can affect the quality of education. Rather students need to be trained in the right way to directly solve the problems related to academic stress by themselves being a part of a self-help program (Chen et al. 2013 ; Aherne et al. 2016 ).

The various sources of academic stress among medical students listed in other studies were, vastness of curriculum as reported by 61.6% (Anuradha et al. 2017 ), 82.2% (Bamuhair et al. 2015 ), and 82.3% (Oku et al. 2015 ), fear of failure in examination by 61.8% (Anuradha et al. 2017 ), frequency of examination by 52.2% (Anuradha et al. 2017 ), lack of recreation and inadequate holidays by 51.8% (Anuradha et al. 2017 ) and by 76.4% (Oku et al. 2015 ), sleep related problems by 64.3% (Bamuhair et al. 2015 ), worrying about future by 78.2% (Bamuhair et al. 2015 ), family problems by 54% (Bamuhair et al. 2015 ), interpersonal conflicts by 57.1% (Bamuhair et al. 2015 ), low self-esteem by 51.7% (Bamuhair et al. 2015 ) and transportation problems by 56.2% participants (Bamuhair et al. 2015 ).

Coping with stress was found to be average among 95% participants in the present study. Almost three-fourth of the participants in the present study tried to think or do something that would make them feel happier and relaxed when they were stressed. Coping methods commonly used by students in previous studies were effective time management, sharing of problems, planned problem solving, going out with friends, social support, meditation and getting adequate sleep. Even emotion-based strategies to cope stress like self-blaming and taking self-responsibility have been reported (Wolf 1994 ; Supe 1998 ; Stern et al. 1993 ; Redhwan et al. 2009 ).

Coping with stress in this study was better among participants with higher levels of academic stress which was similarly observed among Saudi Arabian medical students by Bamuhair et al. ( 2015 ). This suggests that students who perceived greater academic stress where in a position to apply coping strategies against it in a much better way. However the significant correlation between academic stress scores and passive emotional and passive problem scores indicates that the coping behaviour adopted by participants to deal with stress was not satisfactory. Therefore counselling the participants to adopt active coping behaviours is very essential at this setting. In a study done in Ghana by Atindanbila and Abasimi ( 2011 ), wrong or inadequate coping strategies were practiced by university students resulting in reduction of academic stress by mere 4%. Bamuhair et al. ( 2015 ) observed that 32.1% medical students felt too often that, they could not cope with stress. Therefore coping strategies against academic stress among university students in other parts of the world was not satisfactory either. The coping strategies adopted are generally found to vary depending on socio-cultural factors like region, social group, gender, age, and by individuals’ previous experiences as per the WHO/EHA ( 1998 ).

Passive emotional and problem coping behaviours were significantly more among males. This meant that males adopted a number of unhealthy behaviours to deal with academic stress. Unpleasant social coping behaviour was found to reduce social support and increase loneliness by Kato ( 2002 ). Felsten ( 1998 ) observed that specifically procrastination as a coping behaviour was found to result in depression in both men and women.

Female students on the other hand had significantly better active problem scores under coping behaviour. They were hence more mature and composed than the male participants in analysing the centre of the problem in a calm and optimistic manner, and in finding solutions for the same. Bamuhair et al. ( 2015 ) observed that the mean of coping strategies score was significantly higher among females. Females were also found to be better at time management compared to their male counterparts (Misra and McKean 2000 ; Khatib 2014 ). Males therefore need to be counselled about healthy coping behaviours in dealing with academic stress.

Al-Sowygh et al. ( 2013 ) observed that the denial and behaviour disengagement as stress coping strategies were reported to be significantly more among females while self-blame was reported to be more among males. Bang ( 2009 ) reported that the coping mechanism of choice is related to the differences in the roles expected from gender. Males are expected to deal stressful situations by their outward actions while females are expected to focus on emotions and seek social support. Soffer ( 2010 ) stated that women usually choose health-promoting behaviours while men prefer health-risky behaviours.

There was no association between age of participants with the perceived level of academic stress or with the level of adaptability to cope with it in this study supporting the observations of Bamuhair et al. ( 2015 ).

Limitations

This was a cross-sectional study conducted in a single medical college. Therefore the findings of this study cannot be generalized to all medical students across India.

The results of the study reflect important insights into the nature of stress faced by the medical students and the ways they deal with the same. Academic stress was found to be common and was of moderate level in more than three-fourth of the participants. Level of coping with stress was found to be average among 95% of them. Worrying about future and poor self-esteem were independently associated with academic stress among students. Male participants adopted more of unhealthy means of coping with academic stress. Therefore they need to be educated regarding the healthy coping methods. Counselling sessions and other students’ support systems need to be more organized to cater to the issues like career guidance, healthy coping behaviours, time management and to improve the self-esteem among the affected. Attention should also be paid to make the study environment in the classrooms more stress free without excessive academic load. Educating students about unpleasant consequences of stress is equally important. Teachers can also play a constructive role in mentoring and guiding students regarding choosing the right measures to cope with stress. Interactive academic sessions on stress control can further encourage medical students to single out each and every problematic issue. This would accomplish the aim of reducing the academic stress, adopting healthy academic stress coping behaviours, improving academic performance and minimizing anxiety among those with forethoughts about their future professional careers.

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Acknowledgements

We authors thank all the medical students of who took part in this study.

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This manuscript has been read and approved by all the authors, the requirements for authorship as stated earlier in this document have been met, and each author believes that the manuscript represents honest work.

Nitin Joseph: guarantor of this research work, design, literature search, tool preparation, manuscript preparation, revising the work critically for important intellectual content.

Aneesha Nallapati: data collection, data analysis, statistical analysis, interpretation of data, revising the work critically for important intellectual content.

Mitchelle Xavier Machado: data collection, data entry, literature search, manuscript preparation, manuscript editing, revising the work critically for important intellectual content.

Varsha Nair: concept of this study, data collection, data entry, manuscript editing, revising the work critically for important intellectual content.

Shreya Matele: data collection, literature search, manuscript editing, revising the work critically for important intellectual content.

Navya Muthusamy: data collection, literature search, manuscript editing, revising the work critically for important intellectual content.

Aditi Sinha: data collection, literature search, manuscript editing, revising the work critically for important intellectual content.

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Joseph, N., Nallapati, A., Machado, M.X. et al. Assessment of academic stress and its coping mechanisms among medical undergraduate students in a large Midwestern university. Curr Psychol 40 , 2599–2609 (2021). https://doi.org/10.1007/s12144-020-00963-2

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ACADEMIC STRESS AND ACADEMIC PERFORMANCE OF BEEd STUDENTS OF THE COLLEGE OF TEACHER EDUCATION IN OCCIDENTAL MINDORO STATE COLLEGE A THESIS PROPOSAL

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Deciphering the influence: academic stress and its role in shaping learning approaches among nursing students: a cross-sectional study

• Rawhia Salah Dogham 1 ,
• Heba Fakieh Mansy Ali 1 ,
• Asmaa Saber Ghaly 3 ,
• Nermine M. Elcokany 2 ,
• Mohamed Mahmoud Seweid 4 &
• Ayman Mohamed El-Ashry   ORCID: orcid.org/0000-0001-7718-4942 5  

BMC Nursing volume  23 , Article number:  249 ( 2024 ) Cite this article

380 Accesses

Metrics details

Nursing education presents unique challenges, including high levels of academic stress and varied learning approaches among students. Understanding the relationship between academic stress and learning approaches is crucial for enhancing nursing education effectiveness and student well-being.

This study aimed to investigate the prevalence of academic stress and its correlation with learning approaches among nursing students.

Design and Method

A cross-sectional descriptive correlation research design was employed. A convenient sample of 1010 nursing students participated, completing socio-demographic data, the Perceived Stress Scale (PSS), and the Revised Study Process Questionnaire (R-SPQ-2 F).

Most nursing students experienced moderate academic stress (56.3%) and exhibited moderate levels of deep learning approaches (55.0%). Stress from a lack of professional knowledge and skills negatively correlates with deep learning approaches (r = -0.392) and positively correlates with surface learning approaches (r = 0.365). Female students showed higher deep learning approach scores, while male students exhibited higher surface learning approach scores. Age, gender, educational level, and academic stress significantly influenced learning approaches.

Academic stress significantly impacts learning approaches among nursing students. Strategies addressing stressors and promoting healthy learning approaches are essential for enhancing nursing education and student well-being.

Nursing implication

Understanding academic stress’s impact on nursing students’ learning approaches enables tailored interventions. Recognizing stressors informs strategies for promoting adaptive coping, fostering deep learning, and creating supportive environments. Integrating stress management, mentorship, and counseling enhances student well-being and nursing education quality.

Peer Review reports

Introduction

Nursing education is a demanding field that requires students to acquire extensive knowledge and skills to provide competent and compassionate care. Nursing education curriculum involves high-stress environments that can significantly impact students’ learning approaches and academic performance [ 1 , 2 ]. Numerous studies have investigated learning approaches in nursing education, highlighting the importance of identifying individual students’ preferred approaches. The most studied learning approaches include deep, surface, and strategic approaches. Deep learning approaches involve students actively seeking meaning, making connections, and critically analyzing information. Surface learning approaches focus on memorization and reproducing information without a more profound understanding. Strategic learning approaches aim to achieve high grades by adopting specific strategies, such as memorization techniques or time management skills [ 3 , 4 , 5 ].

Nursing education stands out due to its focus on practical training, where the blend of academic and clinical coursework becomes a significant stressor for students, despite academic stress being shared among all university students [ 6 , 7 , 8 ]. Consequently, nursing students are recognized as prone to high-stress levels. Stress is the physiological and psychological response that occurs when a biological control system identifies a deviation between the desired (target) state and the actual state of a fitness-critical variable, whether that discrepancy arises internally or externally to the human [ 9 ]. Stress levels can vary from objective threats to subjective appraisals, making it a highly personalized response to circumstances. Failure to manage these demands leads to stress imbalance [ 10 ].

Nursing students face three primary stressors during their education: academic, clinical, and personal/social stress. Academic stress is caused by the fear of failure in exams, assessments, and training, as well as workload concerns [ 11 ]. Clinical stress, on the other hand, arises from work-related difficulties such as coping with death, fear of failure, and interpersonal dynamics within the organization. Personal and social stressors are caused by an imbalance between home and school, financial hardships, and other factors. Throughout their education, nursing students have to deal with heavy workloads, time constraints, clinical placements, and high academic expectations. Multiple studies have shown that nursing students experience higher stress levels compared to students in other fields [ 12 , 13 , 14 ].

Research has examined the relationship between academic stress and coping strategies among nursing students, but no studies focus specifically on the learning approach and academic stress. However, existing literature suggests that students interested in nursing tend to experience lower levels of academic stress [ 7 ]. Therefore, interest in nursing can lead to deep learning approaches, which promote a comprehensive understanding of the subject matter, allowing students to feel more confident and less overwhelmed by coursework and exams. Conversely, students employing surface learning approaches may experience higher stress levels due to the reliance on memorization [ 3 ].

Understanding the interplay between academic stress and learning approaches among nursing students is essential for designing effective educational interventions. Nursing educators can foster deep learning approaches by incorporating active learning strategies, critical thinking exercises, and reflection activities into the curriculum [ 15 ]. Creating supportive learning environments encouraging collaboration, self-care, and stress management techniques can help alleviate academic stress. Additionally, providing mentorship and counselling services tailored to nursing students’ unique challenges can contribute to their overall well-being and academic success [ 16 , 17 , 18 ].

Despite the scarcity of research focusing on the link between academic stress and learning methods in nursing students, it’s crucial to identify the unique stressors they encounter. The intensity of these stressors can be connected to the learning strategies employed by these students. Academic stress and learning approach are intertwined aspects of the student experience. While academic stress can influence learning approaches, the choice of learning approach can also impact the level of academic stress experienced. By understanding this relationship and implementing strategies to promote healthy learning approaches and manage academic stress, educators and institutions can foster an environment conducive to deep learning and student well-being.

Hence, this study aims to investigate the correlation between academic stress and learning approaches experienced by nursing students.

Study objectives

Assess the levels of academic stress among nursing students.

Assess the learning approaches among nursing students.

Identify the relationship between academic stress and learning approach among nursing students.

Identify the effect of academic stress and related factors on learning approach and among nursing students.

Materials and methods

Research design.

A cross-sectional descriptive correlation research design adhering to the STROBE guidelines was used for this study.

A research project was conducted at Alexandria Nursing College, situated in Egypt. The college adheres to the national standards for nursing education and functions under the jurisdiction of the Egyptian Ministry of Higher Education. Alexandria Nursing College comprises nine specialized nursing departments that offer various nursing specializations. These departments include Nursing Administration, Community Health Nursing, Gerontological Nursing, Medical-Surgical Nursing, Critical Care Nursing, Pediatric Nursing, Obstetric and Gynecological Nursing, Nursing Education, and Psychiatric Nursing and Mental Health. The credit hour system is the fundamental basis of both undergraduate and graduate programs. This framework guarantees a thorough evaluation of academic outcomes by providing an organized structure for tracking academic progress and conducting analyses.

Participants and sample size calculation

The researchers used the Epi Info 7 program to calculate the sample size. The calculations were based on specific parameters such as a population size of 9886 students for the academic year 2022–2023, an expected frequency of 50%, a maximum margin of error of 5%, and a confidence coefficient of 99.9%. Based on these parameters, the program indicated that a minimum sample size of 976 students was required. As a result, the researchers recruited a convenient sample of 1010 nursing students from different academic levels during the 2022–2023 academic year [ 19 ]. This sample size was larger than the minimum required, which could help to increase the accuracy and reliability of the study results. Participation in the study required enrollment in a nursing program and voluntary agreement to take part. The exclusion criteria included individuals with mental illnesses based on their response and those who failed to complete the questionnaires.

socio-demographic data that include students’ age, sex, educational level, hours of sleep at night, hours spent studying, and GPA from the previous semester.

Tool two: the perceived stress scale (PSS)

It was initially created by Sheu et al. (1997) to gauge the level and nature of stress perceived by nursing students attending Taiwanese universities [ 20 ]. It comprises 29 items rated on a 5-point Likert scale, where (0 = never, 1 = rarely, 2 = sometimes, 3 = reasonably often, and 4 = very often), with a total score ranging from 0 to 116. The cut-off points of levels of perceived stress scale according to score percentage were low < 33.33%, moderate 33.33–66.66%, and high more than 66.66%. Higher scores indicate higher stress levels. The items are categorized into six subscales reflecting different sources of stress. The first subscale assesses “stress stemming from lack of professional knowledge and skills” and includes 3 items. The second subscale evaluates “stress from caring for patients” with 8 items. The third subscale measures “stress from assignments and workload” with 5 items. The fourth subscale focuses on “stress from interactions with teachers and nursing staff” with 6 items. The fifth subscale gauges “stress from the clinical environment” with 3 items. The sixth subscale addresses “stress from peers and daily life” with 4 items. El-Ashry et al. (2022) reported an excellent internal consistency reliability of 0.83 [ 21 ]. Two bilingual translators translated the English version of the scale into Arabic and then back-translated it into English by two other independent translators to verify its accuracy. The suitability of the translated version was confirmed through a confirmatory factor analysis (CFA), which yielded goodness-of-fit indices such as a comparative fit index (CFI) of 0.712, a Tucker-Lewis index (TLI) of 0.812, and a root mean square error of approximation (RMSEA) of 0.100.

Tool three: revised study process questionnaire (R-SPQ-2 F)

It was developed by Biggs et al. (2001). It examines deep and surface learning approaches using only 20 questions; each subscale contains 10 questions [ 22 ]. On a 5-point Likert scale ranging from 0 (never or only rarely true of me) to 4 (always or almost always accurate of me). The total score ranged from 0 to 80, with a higher score reflecting more deep or surface learning approaches. The cut-off points of levels of revised study process questionnaire according to score percentage were low < 33%, moderate 33–66%, and high more than 66%. Biggs et al. (2001) found that Cronbach alpha value was 0.73 for deep learning approach and 0.64 for the surface learning approach, which was considered acceptable. Two translators fluent in English and Arabic initially translated a scale from English to Arabic. To ensure the accuracy of the translation, they translated it back into English. The translated version’s appropriateness was evaluated using a confirmatory factor analysis (CFA). The CFA produced several goodness-of-fit indices, including a Comparative Fit Index (CFI) of 0.790, a Tucker-Lewis Index (TLI) of 0.912, and a Root Mean Square Error of Approximation (RMSEA) of 0.100. Comparative Fit Index (CFI) of 0.790, a Tucker-Lewis Index (TLI) of 0.912, and a Root Mean Square Error of Approximation (RMSEA) of 0.100.

Ethical considerations

The Alexandria University College of Nursing’s Research Ethics Committee provided ethical permission before the study’s implementation. Furthermore, pertinent authorities acquired ethical approval at participating nursing institutions. The vice deans of the participating institutions provided written informed consent attesting to institutional support and authority. By giving written informed consent, participants confirmed they were taking part voluntarily. Strict protocols were followed to protect participants’ privacy during the whole investigation. The obtained personal data was kept private and available only to the study team. Ensuring participants’ privacy and anonymity was of utmost importance.

Tools validity

The researchers created tool one after reviewing pertinent literature. Two bilingual translators independently translated the English version into Arabic to evaluate the applicability of the academic stress and learning approach tools for Arabic-speaking populations. To assure accuracy, two additional impartial translators back-translated the translation into English. They were also assessed by a five-person jury of professionals from the education and psychiatric nursing departments. The scales were found to have sufficiently evaluated the intended structures by the jury.

Pilot study

A preliminary investigation involved 100 nursing student applicants, distinct from the final sample, to gauge the efficacy, clarity, and potential obstacles in utilizing the research instruments. The pilot findings indicated that the instruments were accurate, comprehensible, and suitable for the target demographic. Additionally, Cronbach’s Alpha was utilized to further assess the instruments’ reliability, demonstrating internal solid consistency for both the learning approaches and academic stress tools, with values of 0.91 and 0.85, respectively.

Data collection

The researchers convened with each qualified student in a relaxed, unoccupied classroom in their respective college settings. Following a briefing on the study’s objectives, the students filled out the datasheet. The interviews typically lasted 15 to 20 min.

Data analysis

The data collected were analyzed using IBM SPSS software version 26.0. Following data entry, a thorough examination and verification were undertaken to ensure accuracy. The normality of quantitative data distributions was assessed using Kolmogorov-Smirnov tests. Cronbach’s Alpha was employed to evaluate the reliability and internal consistency of the study instruments. Descriptive statistics, including means (M), standard deviations (SD), and frequencies/percentages, were computed to summarize academic stress and learning approaches for categorical data. Student’s t-tests compared scores between two groups for normally distributed variables, while One-way ANOVA compared scores across more than two categories of a categorical variable. Pearson’s correlation coefficient determined the strength and direction of associations between customarily distributed quantitative variables. Hierarchical regression analysis identified the primary independent factors influencing learning approaches. Statistical significance was determined at the 5% (p < 0.05).

Table  1 presents socio-demographic data for a group of 1010 nursing students. The age distribution shows that 38.8% of the students were between 18 and 21 years old, 32.9% were between 21 and 24 years old, and 28.3% were between 24 and 28 years old, with an average age of approximately 22.79. Regarding gender, most of the students were female (77%), while 23% were male. The students were distributed across different educational years, a majority of 34.4% in the second year, followed by 29.4% in the fourth year. The students’ hours spent studying were found to be approximately two-thirds (67%) of the students who studied between 3 and 6 h. Similarly, sleep patterns differ among the students; more than three-quarters (77.3%) of students sleep between 5- to more than 7 h, and only 2.4% sleep less than 2 h per night. Finally, the student’s Grade Point Average (GPA) from the previous semester was also provided. 21% of the students had a GPA between 2 and 2.5, 40.9% had a GPA between 2.5 and 3, and 38.1% had a GPA between 3 and 3.5.

Figure  1 provides the learning approach level among nursing students. In terms of learning approach, most students (55.0%) exhibited a moderate level of deep learning approach, followed by 25.9% with a high level and 19.1% with a low level. The surface learning approach was more prevalent, with 47.8% of students showing a moderate level, 41.7% showing a low level, and only 10.5% exhibiting a high level.

Nursing students? levels of learning approach (N=1010)

Figure  2 provides the types of academic stress levels among nursing students. Among nursing students, various stressors significantly impact their academic experiences. Foremost among these stressors are the pressure and demands associated with academic assignments and workload, with 30.8% of students attributing their high stress levels to these factors. Challenges within the clinical environment are closely behind, contributing significantly to high stress levels among 25.7% of nursing students. Interactions with peers and daily life stressors also weigh heavily on students, ranking third among sources of high stress, with 21.5% of students citing this as a significant factor. Similarly, interaction with teachers and nursing staff closely follow, contributing to high-stress levels for 20.3% of nursing students. While still significant, stress from taking care of patients ranks slightly lower, with 16.7% of students reporting it as a significant factor contributing to their academic stress. At the lowest end of the ranking, but still notable, is stress from a perceived lack of professional knowledge and skills, with 15.9% of students experiencing high stress in this area.

Nursing students? levels of academic stress subtypes (N=1010)

Figure  3 provides the total levels of academic stress among nursing students. The majority of students experienced moderate academic stress (56.3%), followed by those experiencing low academic stress (29.9%), and a minority experienced high academic stress (13.8%).

Nursing students? levels of total academic stress (N=1010)

Table  2 displays the correlation between academic stress subscales and deep and surface learning approaches among 1010 nursing students. All stress subscales exhibited a negative correlation regarding the deep learning approach, indicating that the inclination toward deep learning decreases with increasing stress levels. The most significant negative correlation was observed with stress stemming from the lack of professional knowledge and skills (r=-0.392, p < 0.001), followed by stress from the clinical environment (r=-0.109, p = 0.001), stress from assignments and workload (r=-0.103, p = 0.001), stress from peers and daily life (r=-0.095, p = 0.002), and stress from patient care responsibilities (r=-0.093, p = 0.003). The weakest negative correlation was found with stress from interactions with teachers and nursing staff (r=-0.083, p = 0.009). Conversely, concerning the surface learning approach, all stress subscales displayed a positive correlation, indicating that heightened stress levels corresponded with an increased tendency toward superficial learning. The most substantial positive correlation was observed with stress related to the lack of professional knowledge and skills (r = 0.365, p < 0.001), followed by stress from patient care responsibilities (r = 0.334, p < 0.001), overall stress (r = 0.355, p < 0.001), stress from interactions with teachers and nursing staff (r = 0.262, p < 0.001), stress from assignments and workload (r = 0.262, p < 0.001), and stress from the clinical environment (r = 0.254, p < 0.001). The weakest positive correlation was noted with stress stemming from peers and daily life (r = 0.186, p < 0.001).

Table  3 outlines the association between the socio-demographic characteristics of nursing students and their deep and surface learning approaches. Concerning age, statistically significant differences were observed in deep and surface learning approaches (F = 3.661, p = 0.003 and F = 7.983, p < 0.001, respectively). Gender also demonstrated significant differences in deep and surface learning approaches (t = 3.290, p = 0.001 and t = 8.638, p < 0.001, respectively). Female students exhibited higher scores in the deep learning approach (31.59 ± 8.28) compared to male students (29.59 ± 7.73), while male students had higher scores in the surface learning approach (29.97 ± 7.36) compared to female students (24.90 ± 7.97). Educational level exhibited statistically significant differences in deep and surface learning approaches (F = 5.599, p = 0.001 and F = 17.284, p < 0.001, respectively). Both deep and surface learning approach scores increased with higher educational levels. The duration of study hours demonstrated significant differences only in the surface learning approach (F = 3.550, p = 0.014), with scores increasing as study hours increased. However, no significant difference was observed in the deep learning approach (F = 0.861, p = 0.461). Hours of sleep per night and GPA from the previous semester did not exhibit statistically significant differences in deep or surface learning approaches.

Table  4 presents a multivariate linear regression analysis examining the factors influencing the learning approach among 1110 nursing students. The deep learning approach was positively influenced by age, gender (being female), educational year level, and stress from teachers and nursing staff, as indicated by their positive coefficients and significant p-values (p < 0.05). However, it was negatively influenced by stress from a lack of professional knowledge and skills. The other factors do not significantly influence the deep learning approach. On the other hand, the surface learning approach was positively influenced by gender (being female), educational year level, stress from lack of professional knowledge and skills, stress from assignments and workload, and stress from taking care of patients, as indicated by their positive coefficients and significant p-values (p < 0.05). However, it was negatively influenced by gender (being male). The other factors do not significantly influence the surface learning approach. The adjusted R-squared values indicated that the variables in the model explain 17.8% of the variance in the deep learning approach and 25.5% in the surface learning approach. Both models were statistically significant (p < 0.001).

Nursing students’ academic stress and learning approaches are essential to planning for effective and efficient learning. Nursing education also aims to develop knowledgeable and competent students with problem-solving and critical-thinking skills.

The study’s findings highlight the significant presence of stress among nursing students, with a majority experiencing moderate to severe levels of academic stress. This aligns with previous research indicating that academic stress is prevalent among nursing students. For instance, Zheng et al. (2022) observed moderated stress levels in nursing students during clinical placements [ 23 ], while El-Ashry et al. (2022) found that nearly all first-year nursing students in Egypt experienced severe academic stress [ 21 ]. Conversely, Ali and El-Sherbini (2018) reported that over three-quarters of nursing students faced high academic stress. The complexity of the nursing program likely contributes to these stress levels [ 24 ].

The current study revealed that nursing students identified the highest sources of academic stress as workload from assignments and the stress of caring for patients. This aligns with Banu et al.‘s (2015) findings, where academic demands, assignments, examinations, high workload, and combining clinical work with patient interaction were cited as everyday stressors [ 25 ]. Additionally, Anaman-Torgbor et al. (2021) identified lectures, assignments, and examinations as predictors of academic stress through logistic regression analysis. These stressors may stem from nursing programs emphasizing the development of highly qualified graduates who acquire knowledge, values, and skills through classroom and clinical experiences [ 26 ].

The results regarding learning approaches indicate that most nursing students predominantly employed the deep learning approach. Despite acknowledging a surface learning approach among the participants in the present study, the prevalence of deep learning was higher. This inclination toward the deep learning approach is anticipated in nursing students due to their engagement with advanced courses, requiring retention, integration, and transfer of information at elevated levels. The deep learning approach correlates with a gratifying learning experience and contributes to higher academic achievements [ 3 ]. Moreover, the nursing program’s emphasis on active learning strategies fosters critical thinking, problem-solving, and decision-making skills. These findings align with Mahmoud et al.‘s (2019) study, reporting a significant presence (83.31%) of the deep learning approach among undergraduate nursing students at King Khalid University’s Faculty of Nursing [ 27 ]. Additionally, Mohamed &Morsi (2019) found that most nursing students at Benha University’s Faculty of Nursing embraced the deep learning approach (65.4%) compared to the surface learning approach [ 28 ].

The study observed a negative correlation between the deep learning approach and the overall mean stress score, contrasting with a positive correlation between surface learning approaches and overall stress levels. Elevated academic stress levels may diminish motivation and engagement in the learning process, potentially leading students to feel overwhelmed, disinterested, or burned out, prompting a shift toward a surface learning approach. This finding resonates with previous research indicating that nursing students who actively seek positive academic support strategies during academic stress have better prospects for success than those who do not [ 29 ]. Nebhinani et al. (2020) identified interface concerns and academic workload as significant stress-related factors. Notably, only an interest in nursing demonstrated a significant association with stress levels, with participants interested in nursing primarily employing adaptive coping strategies compared to non-interested students.

The current research reveals a statistically significant inverse relationship between different dimensions of academic stress and adopting the deep learning approach. The most substantial negative correlation was observed with stress arising from a lack of professional knowledge and skills, succeeded by stress associated with the clinical environment, assignments, and workload. Nursing students encounter diverse stressors, including delivering patient care, handling assignments and workloads, navigating challenging interactions with staff and faculty, perceived inadequacies in clinical proficiency, and facing examinations [ 30 ].

In the current study, the multivariate linear regression analysis reveals that various factors positively influence the deep learning approach, including age, female gender, educational year level, and stress from teachers and nursing staff. In contrast, stress from a lack of professional knowledge and skills exert a negative influence. Conversely, the surface learning approach is positively influenced by female gender, educational year level, stress from lack of professional knowledge and skills, stress from assignments and workload, and stress from taking care of patients, but negatively affected by male gender. The models explain 17.8% and 25.5% of the variance in the deep and surface learning approaches, respectively, and both are statistically significant. These findings underscore the intricate interplay of demographic and stress-related factors in shaping nursing students’ learning approaches. High workloads and patient care responsibilities may compel students to prioritize completing tasks over deep comprehension. This pressure could lead to a surface learning approach as students focus on meeting immediate demands rather than engaging deeply with course material. This observation aligns with the findings of Alsayed et al. (2021), who identified age, gender, and study year as significant factors influencing students’ learning approaches.

Deep learners often demonstrate better self-regulation skills, such as effective time management, goal setting, and seeking support when needed. These skills can help manage academic stress and maintain a balanced learning approach. These are supported by studies that studied the effect of coping strategies on stress levels [ 6 , 31 , 32 ]. On the contrary, Pacheco-Castillo et al. study (2021) found a strong significant relationship between academic stressors and students’ level of performance. That study also proved that the more academic stress a student faces, the lower their academic achievement.

Strengths and limitations of the study

This study has lots of advantages. It provides insightful information about the educational experiences of Egyptian nursing students, a demographic that has yet to receive much research. The study’s limited generalizability to other people or nations stems from its concentration on this particular group. This might be addressed in future studies by using a more varied sample. Another drawback is the dependence on self-reported metrics, which may contain biases and mistakes. Although the cross-sectional design offers a moment-in-time view of the problem, it cannot determine causation or evaluate changes over time. To address this, longitudinal research may be carried out.

Notwithstanding these drawbacks, the study substantially contributes to the expanding knowledge of academic stress and nursing students’ learning styles. Additional research is needed to determine teaching strategies that improve deep-learning approaches among nursing students. A qualitative study is required to analyze learning approaches and factors that may influence nursing students’ selection of learning approaches.

According to the present study’s findings, nursing students encounter considerable academic stress, primarily stemming from heavy assignments and workload, as well as interactions with teachers and nursing staff. Additionally, it was observed that students who experience lower levels of academic stress typically adopt a deep learning approach, whereas those facing higher stress levels tend to resort to a surface learning approach. Demographic factors such as age, gender, and educational level influence nursing students’ choice of learning approach. Specifically, female students are more inclined towards deep learning, whereas male students prefer surface learning. Moreover, deep and surface learning approach scores show an upward trend with increasing educational levels and study hours. Academic stress emerges as a significant determinant shaping the adoption of learning approaches among nursing students.

Implications in nursing practice

Nursing programs should consider integrating stress management techniques into their curriculum. Providing students with resources and skills to cope with academic stress can improve their well-being and academic performance. Educators can incorporate teaching strategies that promote deep learning approaches, such as problem-based learning, critical thinking exercises, and active learning methods. These approaches help students engage more deeply with course material and reduce reliance on surface learning techniques. Recognizing the gender differences in learning approaches, nursing programs can offer gender-specific support services and resources. For example, providing targeted workshops or counseling services that address male and female nursing students’ unique stressors and learning needs. Implementing mentorship programs and peer support groups can create a supportive environment where students can share experiences, seek advice, and receive encouragement from their peers and faculty members. Encouraging students to reflect on their learning processes and identify effective study strategies can help them develop metacognitive skills and become more self-directed learners. Faculty members can facilitate this process by incorporating reflective exercises into the curriculum. Nursing faculty and staff should receive training on recognizing signs of academic stress among students and providing appropriate support and resources. Additionally, professional development opportunities can help educators stay updated on evidence-based teaching strategies and practical interventions for addressing student stress.

Data availability

The datasets generated and/or analysed during the current study are not publicly available due to restrictions imposed by the institutional review board to protect participant confidentiality, but are available from the corresponding author on reasonable request.

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Acknowledgements

Our sincere thanks go to all the nursing students in the study. We also want to thank Dr/ Rasha Badry for their statistical analysis help and contribution to this study.

The research was not funded by public, commercial, or non-profit organizations.

Open access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB).

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Ayman M. El-Ashry & Rawhia S. Dogham: conceptualization, preparation, and data collection; methodology; investigation; formal analysis; data analysis; writing-original draft; writing-manuscript; and editing. Heba F. Mansy Ali & Asmaa S. Ghaly: conceptualization, preparation, methodology, investigation, writing-original draft, writing-review, and editing. Nermine M. Elcokany & Mohamed M. Seweid: Methodology, investigation, formal analysis, data collection, writing-manuscript & editing. All authors reviewed the manuscript and accept for publication.

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Dogham, R.S., Ali, H.F.M., Ghaly, A.S. et al. Deciphering the influence: academic stress and its role in shaping learning approaches among nursing students: a cross-sectional study. BMC Nurs 23 , 249 (2024). https://doi.org/10.1186/s12912-024-01885-1

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Academic stress and suicidal ideation: moderating roles of coping style and resilience

Franca obiageli okechukwu.

1 Department of Home Science and Management, University of Nigeria, Nsukka, Nigeria

Kalu T. U. Ogba

2 Psychology Department, University of Nigeria, Nsukka, Nigeria

Juliet I. Nwufo

Miracle oluchi ogba.

3 Faculty of Law, Abia State University, Uturu, Umuahia, Nigeria

Blessing Nneka Onyekachi

Chinonso i. nwanosike, amuche b. onyishi, associated data.

The datasets generated and/or analyzed during the study are available from the corresponding author based on special request and the corresponding author should be contacted via this email: [email protected].

As a global phenomenon, suicide has generated a lot of concern. Scholars from various fields have conducted extensive research on the prevalence, causes, factors, and/or management or possible solutions to suicidal ideation. Despite the research efforts, suicidal cases worldwide still yell for more empirical attention. No doubt that some of the extant literature have specifically evidenced the causal links and factors in suicidal ideation. Yet, none had focused on the moderating roles of coping and resilience in an academic population. We therefore, examined the moderating roles of coping and resilience in the relationship between academic stress and suicidal ideation.

We used a cross-sectional design to sample 505 participants (329 males and 176 females) from three southern Nigerian universities. Participants who willingly indicated their participatory consent were administered a paper self-report questionnaire containing the Lakaev Academic Stress Response Scale (LASRS), Scale for Suicidal Ideation (SSI), Brief COPE (B-COPE), and Resilience Scale (RS-14). Hierarchical regression analysis was used to test the hypotheses of the study.

Academic stress ( r  = 0.17; p.001) was found to be positively associated with suicidal ideation, whereas resilience ( r  = −.22; p.001) was found to be negatively associated with suicidal ideation. Suicidal ideation had no significant correlation with adaptive coping style, but it did have a significant correlation with maladaptive coping ( r  = .15; p.001). The regression-based PROCESS macro showed that academic stress was a significant predictor of coping [Δ R 2  = .03, F (1, 502)  =  16.18, p  = .01]. Academic stress was positively associated with suicidal ideation at low or moderate levels of adaptive coping styles. At high levels of adaptive coping styles, the association between academic stress and suicidal ideation was not significant. However, resilience negatively predicted suicidal ideation [R = .29, (R 2  = .08), F(1, 499) = 19.94, p  = .00] with academic stress showing a positive association with suicidal ideation at low and moderate levels of resilience, but for those with high resilience, academic stress was not associated with suicidal ideation.

In sum, suicidal ideation is heightened by increased academic stress, with greater resilience ameliorating the tendency of academic stress resulting in suicidal ideation. Also, adopting maladaptive ways of coping promotes suicidal ideation among students, with resilience and adaptive coping strategies moderating the relationship between academic stress and suicidal ideation. It is therefore recommended that educational administrators, policy makers, lecturers, teachers, and tutors incorporate courses, teachings, and sessions that foster as well as inculcate resilience and efficient coping skills in pupils and students.

Introduction

Suicide is multifarious and a major concern for public health [ 58 , 74 ]. It is a diverse, less comprehensible, life-threatening phenomenon. This is because most victims of suicide hide or conceal their intentions [ 11 , 25 , 70 ], and this makes it difficult (if not impossible) for people to have knowledge of or even gain access to a potential suicide victim. As a result, WHO [ 73 ] noted that one person dies by suicide every 40 seconds despite progress in national prevention strategies. Consequently, it has become the second leading cause of death among youths. Snowdon and Choi [ 58 ] observed that reports of suicide are rare in children under the age of 10, but in the developed world, the prevalence begins to increase for youths between 10 and 14 years of age and in the 15 to 24 year age group [ 14 ]. Among their Nigeria counterparts, Adewuya and Oladipo [ 1 ] observed that the prevalence is 13–29 years, while the Nigeria National Youth Policy [ 43 ] discovered that the prevalence is in the 18–35 year age group. Due to cultural and developmental differences across individuals, there are inconsistencies as to the exact age at which suicidal ideation occurs. This could account for why scholars like [ 1 , 4 , 41 ] noted that evidence from 32 low and middle-income countries in sub-Sahara Africa have high suicide rates among adolescents and young people in general (without reference to a particular age bracket). Uganda, Botswana, Kenya, Zambia, and Nigeria have high prevalence of suicidal ideation among young people [ 55 ]. These youths within “transitory-into-productive” age(s), are seen to be moving from tertiary institutions into the uncertain world of labor markets in the developing (and in some western) worlds. Besides, suicide seems to have had multiple underlying causes [ 9 , 67 ], and therefore requires adopting multiple investigative approach. Hence, our study investigated the moderating impacts of coping and resilience on academic stress and suicidal ideation among students.

Stresses associated with completing tertiary education, as well as concerns about unemployment, poverty, destitution, economic crises, feelings of insecurity, marginalization (including biases), and economic disempowerment [ 8 , 34 , 44 ], are as prevalent in society as the need for adequate coping knowledge [ 8 , 34 , 44 ]. Failure to adequately cope greatly increases the chances of severing youths from the traditional values and moral regulations that seemed to have earlier provided moral foundation and guide, leading to thoughts of suicide. This could account for scholars’ reports (e.g. [ 27 , 36 ]) that suicidal thoughts are more common among younger age groups.

Stress is no longer new to people as it has permeated every aspect of humanity. Hence, the present study would emphasize academic stress. Undergraduateship is not devoid of challenges and stressful circumstances. These circumstances are not limited to adapting to a new academic environment, academic workload, academic performance, attending to lectures, overwork, future employment [ 22 , 49 ], nor social and financial stresses [ 19 ]. Whether these stressors are short-term or long-term, they have significant impact on undergraduates’ coping (either adaptive or maladaptive) capacity [ 19 ]. Productive (adaptive) coping protects students from suicide and suicidal ideation [ 10 , 18 ]; whereas ineffective/dysfunctional (maladaptive) coping skills among students experiencing persistent academic stress and negative emotions trigger higher risk of suicide. The relationship between academic stress and suicidal ideation has been well documented in literature (e.g [ 31 , 48 , 66 ]). Generally, the role of stressful life events in suicidal ideation, attempts, and completion has been a key area of study in the epidemiology of mental disorders [ 35 , 69 ]. There is a need to understand the moderating roles of some factors in the observed association [ 45 ] between academic stress and suicidal ideation in a bid to advance research knowledge on suicide, intervention, and treatment. This is an important contribution that the current study offers to the body of knowledge. Since stress has been implicated in suicide [ 31 , 48 ], with no drugs for identified victims of suicidal ideation, coping is very germane.

Lambert and Lambert [ 38 ] noted that coping is a conscious effort to reduce stress, and entailing masterful ways of tolerating, reducing, or minimizing stressful events. The conceptualization and categorization of different coping styles is inconsistent in literature (cf. [ 57 ]). Notwithstanding divergent opinions on conceptions of coping, coping has colossal impacts on stress (academic not exempted) and suicidal ideation. For instance, behavioural disengagement and self-blame increase suicidal vulnerability [ 30 ], deficient coping and problem solving skills heighten suicidal ideation [ 59 , 62 ], passive coping (usually fantasizing) fosters suicidal ideation [ 75 ], while ineffective coping skills and negative emotions trigger higher risk of suicide [ 15 ]. Coping skills such as active coping and positive reframing were negatively associated with suicide, whereas coping skills like self-distraction, substance abuse, behavioural disengagement, venting, and self-blame were positively associated with suicide (e.g. [ 39 ]).

Besides these direct associations, psychopathological factors, including depression [ 68 ], hopelessness [ 21 ], and psychological distress [ 63 ], have been tested as mediators between life stress and suicidal ideation, with fewer research enquiries involving resilience. Resilience is an individual’s tendency to bounce back to a previous state of normal functioning, or simply not showing negative effects after stress and adversity. Wagnild [ 71 ] noted that resilience is an ability to recover from stress. As a helpful behavioural disposition, it promotes an individual’s healthy survival and soothes the negative outcome of stress. Resilience is important as it ensures healthy social functioning, morale, and somatic health, as well as helps an individual maintain emotional stability in the midst of stress [ 64 ]. Hence, understanding resilience appears to provide homeostasis [ 51 ] and personal endurance [ 33 ]. A study [ 40 ] on the relationship between resilience and well-being associated resilience with a positive view of the self. Cleverly and Kidd [ 16 ] found youths’ perceived resilience related to less suicidal ideation, whereas higher psychological distress was associated with higher suicidal ideation. Furthermore, depression has been linked to suicidal ideation, with anxiety, mental health, resiliency, and daily stress playing important roles [ 32 ]. Again, resilience dimensions such as social resources and familial cohesion were strongly and negatively correlated with humiliation, interpersonal sensitivity, and depression in subjects with previous suicidal attempts [ 52 ].

To our knowledge, no study has combined coping and resilience as moderators of the relationship between academic stress and suicidal ideation. Rather, extant related literature have either focused on stress (not academic stress) and suicidal ideation [ 17 , 20 ] or coping and suicidal ideation [ 10 ]. Although Zimmerman [ 76 ] provided useful theoretical explanations and understandings as to how some ‘promotive factors’ could interrupt the pathways to mental health difficulties among youths, we believe it is necessary to investigate as many of these promotive factors (including coping and resilience) as possible with respect to suicidal ideation. The present study might support as well as enhance, and further the theoretical explanations of Zimmerman [ 76 ]. However, it is important to note that some studies have investigated coping as a moderator in relationship of stress (but not necessarily academic stress) and suicidal ideation (e.g. [ 17 , 20 , 68 ]). We assume that coping styles will have moderating impact on suicidal ideation and academic stress among undergraduates, especially for those who adopt functional or adaptive coping styles, compared to those who do not. In the same vein, we equally propose that resilience will moderate the link between academic stress and suicidal ideation. When confronted with the aforementioned potential stressors, a student who is stressed but adopts dysfunctional or ineffective coping styles (blaming oneself for problems, ignoring them, or escaping through fantasizing thoughts) may likely consider suicide as an option to end the perturbation [ 26 ]. Those who use effective or functional strategies (positive reevaluation, planning, and seeking help) are less likely to consider suicide [ 39 ]. In other words, coping could either increase or decrease the effect of academic stress on suicidal ideation, whereas resilience helps them bounce back after having adaptively coped with academic stress. Therefore, we hypothesized first, that academic stress would predict suicidal ideation; second, while adaptive coping style would not predict suicidal ideation, maladaptive coping style would; third, adaptive coping style would moderate the association between academic stress and suicidal ideation such that at low or moderate levels of adaptive coping styles, academic stress would be positively associated with suicidal ideation; but at high levels of adaptive coping style, the relationship of academic stress and suicidal ideation would not be significant. Finally, resilience would negatively predict suicidal ideation [ 54 ] as well as moderate the association between academic stress and suicidal ideation, such that academic stress would show a positive association with suicidal ideation for students at low and moderate levels of resilience, but for those with high resilience, academic stress would not be associated with suicidal ideation.

In comparison with most western societies, single studies on the moderating roles of coping, resilience on academic stress and suicidal ideation in a Nigerian sample are very rare. Also, studies with Nigerian (and perhaps other) samples have rather dominated the areas of protective and risk factors for suicidal behaviour and ideation (e.g. [ 1 , 2 , 46 , 53 ]). Our study is relevant because it advances the knowledge quest for preventive and management approaches for students and school administrators who may struggle to successfully navigate academic-related stress without deteriorating to suicidal ideation.

The understanding that suicidal ideation may decrease among undergraduates because of adaptive or functional coping skills; and that students who practice functional coping skills may suppress the negative experiences, anxiety, and psychological distress that emanate due to academic stress, is very crucial in proposing and inculcating a positive academic survival approach. This outcome could equally be transferred into other domains of students’ lives even after school. It is also essential to policymakers, educational administrators, parents, students, and society at large as no one is exempted from the scorching heat of rampant suicide among undergraduates- a generational transitory population. Therefore, the study encourages stakeholders to teach and practice adaptive coping skills as well as resilient techniques whose ripple effects not only reduce suicidal ideation but also help in healthy living.

Participants and procedure

The study adopted a cross sectional design to sample a total of 505 undergraduates from three South-Eastern universities in Nigeria. They consisted of 329 (65.1%) males and 176 (34.9%) females who were conveniently sampled at their clustering and administered a self-report battery of measures. Out of the five federal universities in the Southeast, three universities were randomly selected using a table of random numbers. The three universities were: the University of Nigeria, Nsukka (UNN), the Alex Ekwueme Federal University, Ndufu Alike Ikwo (AE-FUNAI), and the Michael Okpara University of Agriculture. The University of Nigeria, Nsukka was founded by Nnamdi Azikiwe in 1955 and formally opened in 1960. UNN has more than nine faculties, including the faculties of Agriculture, Arts, Biological Sciences, Education, Engineering, Pharmaceutical Sciences, Physical Sciences, Social Sciences, Veterinary Medicine, a School of General Studies, etc. The Alex Ekwueme Federal University Ndufu Alike Ikwo (AE-FUNAI) is located in Ndufu, Alike Ikwo in Ebonyi State, Nigeria. It was established in 2011. Courses offered include: Agriculture, Basic Medical Sciences, Education, Engineering and Technology, Humanities, Management Sciences, Social Sciences, Biological Sciences, Environmental Sciences, College of Medicine, Physical Sciences, Law, etc. The Michael Okpara University of Agriculture is located in Umudike, Abia State, Nigeria and was established as a specialized university in 1992. Education, Veterinary Medicine, Applied Food Science and Tourism, Agricultural Economics, Rural Sociology, Extension, Animal Science & Animal Production, Physical & Applied Sciences, Natural Resources & Environmental Management, Natural Sciences, Management & Social Sciences, Engineering & Engineering Technology, Crop & Soil Sciences, and Humanities [ 13 ].

In terms of setting, these universities were similar. In that, the establishment of a university automatically transforms even the most rural of places into an urban setting. However, these universities differed in terms of courses offered and socio-economic status. At the selected federal universities, participants were met at their various hostels and lecture quadrangles. Those who indicated their participatory consent prior to the creation of rapport were administered the self-report battery of measures. Age, sex, ethnic group, marital status, and educational qualifications were assessed through the self-report battery of measures. Participants were asked to indicate by ticking in the appropriate boxes their age (in years); sex (male and female); ethnic group (Igbo, Hausa, Yoruba, and others); marital status (single and married); and educational qualification. Educational qualification was removed from the analysis because the participants were still undergraduate students. The four instruments were prepared in a questionnaire format. A brief statement of consent that sought the participant’s consent was attached to the questionnaire. Participants were expected to first read through the brief consent letter and indicate their participatory consent by ticking on the appropriate boxes. Those who declined their interest in participation in the consent letter were asked to kindly return the questionnaire. The questionnaires were administered on a one-on-one basis and retrieved upon completion [ 29 ]. In addition to the consent letter, the questionnaires were distributed to students who willingly accepted to take part in the study, with a preceding self-introduction and explanation of the objective of the study. Participants were verbally appreciated. Out of the 530 copies of the questionnaire distributed, 523 were returned (98.7% return rate), while 18 were discarded due to improper completion. To preserve the homogeneity of the sample, all participants were undergraduates, irrespective of other demographic characteristics. Our procedures met relevant ethical guidelines and legal requirements in Nigeria to warrant the ethical approval obtained on (November 21, 2019) from the Institutional Review Board, University of Nigeria, Nsukka.

Lakaev academic stress response scale (LASRS [ 37 ])

The LASRS is a 21-item structured scale that measures students’ responses to stress in physiological, behavioural, cognitive, and affective domains. Respondents rated how much of the time they experienced symptoms on a 5-point Likert scale [ 37 ] with the anchors: None of the Time (1), A Little of the Time (2), Some of the Time (3), Most of the Time (4), and All of the Time (5). Items were summed for subscale scores, and subscales were summed for a total LASRS stress response score. Higher scores indicated a greater stress response. It has excellent psychometric properties with internal consistency ranging from .64 to .92 [ 37 ]. Our pilot testing of the scale yielded a Cronbach’s alpha of .83.

Scale for suicidal ideation (SSI [ 6 ])

SSI is a 19-item self-report scale designed to quantify the intensity of current conscious suicidal intent, by scaling various dimensions of self-destructive thoughts or wishes. The items assessed the extent of suicidal thoughts and their characteristics, as well as the respondent’s attitude towards them; the extent of the wish to die, the desire to make an actual suicide attempt, and details of plans, if any; internal deterrents to an active attempt; and subjective feelings of control or “courage” regarding a proposed attempt. Each item consisted of three alternative statements graded in intensity from 0 to 2. Suicidal ideation was analysed dimensionally with scores ranging from 0 (low ideation) to 38 (high ideation) [ 6 ]. In other words, a positive rating (> 1) on any of the ideation scale’s 19 items was considered as a potential indicator of suicide ideation. Out of 29 items, 16 had positive and significant item-total correlations, and a Cronbach alpha of .89 was obtained, which indicated the high reliability of the SSI and also supported the validity of this scale [ 6 ]. The validity of SSI was also indicated by the moderate correlations with clinical ratings of suicidal risk and self-harm [ 7 ]. The scale was pilot tested and the result yielded a Cronbach’s alpha of .82.

Brief COPE (B-COPE [ 12 ])

The B-COPE provides researchers a way to quickly assess potentially important coping responses. It consists of 14 sub-scales, each of two items. Therefore, B-COPE has a total of 28 items, which measure 14 conceptually differentiable coping skills. Some of these skills are known to be generally adaptive (such as active coping, planning, positive reframing, acceptance, humor, religion, emotional support-seeking, and instrumental support-seeking); others are known to be problematic or maladaptive (such as self-distraction, denial, venting, substance use, behavioral disengagement, and self-blame). The response options ranged from 0 (I haven’t been doing this at all) to 3 (I have been doing this a lot). Researchers have variously shown B-COPE to have had good psychometric properties [ 24 , 28 ]. All dimensions demonstrated good internal consistency (.70) in our pilot testing of the scale, with the exception of religion (=.63) and venting (=.61). We re-analyzed the adaptive and maladaptive dimensions, and they both showed high reliability (=.85 and.79, respectively). Higher score on the adaptive dimension indicates higher adaptive measures, while a lower or moderate score on the maladaptive dimension indicates adaptive coping.

Resilience scale (RS-14 [ 72 ])

RS-14 measures the capacity to withstand life stressors and derive meaning from them. It contains items which measure two major dimensions of psychological resilience: personal competence (as indicated in items 1, 2, 5, 6, 7, 8, 9, 11, 12, 14), and acceptance of self and life (as indicated in items 3, 4, 10, 13). It has a composite internal consistency reliability of .93. All the 14 items were positively worded, and participants responded on a 7-point scale that ranged from “strongly disagree” (1) to “strongly agree” (7). We obtained a Cronbach’s alpha of .90. A higher score on RS-14 indicates greater resilient capacity.

Statistical analysis

The research was a survey. A Pearson’s Correlation ( r ) analysis was conducted to examine the relationships between the demographic factors both with themselves and the other independent and dependent variables in the study. The reason for the choice of correlation is based on Urbina’s [ 65 ] assertion that correlations play a major role in demonstrating linkages between (a) scores on different tests, (b) test scores and non-test (demographic) variables, (c) scores on parts of tests and scores on whole tests, etc. [ 65 ]. Demographic variables such as gender were dummy coded before they were included in the correlation analysis. Dummy coding was recommended by experts in statistics as very important in correlation and regression as a “way of representing people using only zeros and ones” [ 23 ]. In order to clearly test the hypotheses, the study variables were submitted to a hierarchical regression analysis. Hierarchical regression analysis allows researchers to simultaneously examine the contributions of each of several predictor variables in one study. In the regression analysis, the demographic variable of marital status that was significantly correlated with suicidal ideation was first included in the analysis in order to control for its possible effect. This formed Step 1 in the analysis. Thereafter, academic stress was included in the regression to test for its predictive association with suicidal ideation, and this formed Step 2 of the analysis. Afterwards, the adaptive dimension of the coping strategy (which was considered as a separate entity) was included in the analysis, and this formed Step 3. Subsequently, the maladaptive dimension of the coping strategy was added to the analysis and this formed Step 4. Finally, resilience was added to the analysis and that formed Step 5. These variables were “entered” “step-by-step” (separately) into the analysis in order to examine the various respective accounts or percentage contributions of each predictor variable in the relationship [ 50 ].

The Hayes regression-based PROCESS macro was used to test for the moderation relationships. The PROCESS macro was chosen because it offers the opportunity to determine the interaction effect by generating a series of plots that can be later put together into a diagram or graph. The diagram further illustrates the conditional effect of X (main predictor) on Y (dependent variable), as a function of M (moderator variable). The moderating effects are thereafter examined using the regions of significance in accordance with the Johnson-Neyman technique. Process is a better choice for research where the variables are all directly measured (e.g., in clinical, health, and psychological settings that use hard data). All analyses were conducted using the Statistical Package for Social Sciences (SPSS) version 22 [ 42 , 61 ].

From the results of the brief descriptive statistics (Table  1 ) performed on the demographics like age, marital status, and religion, the ages of the participants ranged from 18 to 32 years, with a mean age of 25 years and a standard deviation of .45. A total of 492 (97.4%) were single, while 7 (1.4%) were married. The number of Christians in the sample was 486 (96.2%), traditional 17 (3.4%), and Islam 2 (.4%). Age, marital status, religion, etc., that have been either positively or negatively implicated in suicidal ideation [ 1 , 4 ], were included in the preliminary stage of the analysis. Inclusion criteria included full-time registered, non-working class undergraduate students of federal universities under study, while exclusion criteria included working class and postgraduate students who were known to be registered students of federal universities under study.

Descriptive statistics of the participants

Results in Table  2 showed that suicidal ideation had a positive association with marital status ( r  = .08, p.05) but did not correlate with gender, age, or ethnic group. Academic stress ( r  = .17; p.001) was found to be positively related to suicidal ideation, whereas resilience ( r  = −.22; p.001) was found to be negatively related to suicidal ideation. Gender, age, and ethnic group that did not correlate with suicidal ideation were excluded from the analysis, and marital status, which correlated with suicidal ideation, was controlled in the subsequent moderation analysis. Suicidal ideation had no significant relationship with adaptive coping style ( r  = −.02), but it did have a significant relationship with maladaptive coping ( r  = .15; p.001).

Mean, standard deviation and correlation results of academic stress, resilience and coping (Maldaptive and adaptive) on suicidal ideation

SD standard deviation, ACS adaptive coping style, MALCS maladaptive coping style, Str stress

* p  < .05

** p  < .01

*** p  < .001

Table  3 indicates that subscales of coping were correlated with suicidal ideation. The separation of B-COPE into adaptive and maladaptive styles was done after the various dimensions of adaptive and maladaptive coping styles were correlated with suicidal ideation as shown in Table ​ Table3. 3 . Subsequently, strategies that negatively correlated (active, planning, positive refraining, acceptance, religion, and emotional support) with suicidal ideation were indicated as protective or adaptive and were summed together, while strategies that positively correlated (humour, instrumental support, self-distraction, denial, venting, behavioural disengagement, self-blame, and substance use) with suicidal ideation were maladaptive and summed together. This categorization is in line with extant literature (e.g. [ 5 , 47 ]), which specifically suggested and categorized substance use (such as alcohol) as a maladaptive coping style because it impairs judgment and disinhibits impulses, and as such, users of such substances are more likely to harm themselves or die by suicide.

Correlation results between B-COPE and suicidal ideation

** p  < .001

Results in Table  4 showed that Step 1, which involved only the demographic variable (marital status), revealed no significant result. R = 08, (R2 = .01), F(1, 503) = 2.93. Step 2 yielded a significant result: R = .19, (R 2  = .04), F (1, 502) = 16.18, p  = .01. The results showed that the addition of academic stress accounted for an additional 3 % of significant variance in suicidal ideation. ΔR2 = .03, F (1, 502) = 16.18, p  = .01. However, Step 3 did not yield any additional significant results. Δ R 2  = .04, (R 2  = .06, F (1, 501) = .09. Step 4 produced a significant overall model, with R = .22, (R 2  = .05), F (1, 500) = 5.44, p  = .00. This means that the inclusion of a maladaptive coping style accounted for 1% of the significant variance in suicidal ideation, R2 = .01, F (1, 500) = 5.44, p  = .00. And finally, Step 5 yielded a significant result, R = .29, (R 2  = .08), F (1, 499) = 19.94, p  = .00. Furthermore, the inclusion of resilience accounted for an additional 4% variance in suicidal ideation, R2 = .04, F (1, 499) = 19.94, p  = .00.

Hierarchical regression model results of academic stress, resilience and coping (Maldaptive and adaptive) on suicidal ideation

ACS adaptive coping style, MALCS maladaptive coping style, B standardized beta coefficient, β unstandardized beta coefficient, t total, F f-ratio, R 2 R Squared

Results in Table ​ Table4 4 indicated that marital status, which was initially correlated with suicidal ideation, failed to predict suicidal ideation. However, academic stress was a significant predictor of suicidal ideation. At low (B = .12, t = 4.40, p  < .001) and moderate (B = .02, t = 3.19, p  < .01) levels of adaptive coping style, academic stress was positively associated with suicidal ideation, but the association between academic stress and suicidal ideation was not significant at high levels of adaptive coping style (B = .03, t = 1.41, p  < .16), (Fig.  1 ). Suicidal ideation, on the other hand, was negatively predicted by resilience (B = −.07, SE = .02, p.001). However, academic stress was positively associated with suicidal ideation at low (B = .12, t = 3.93, p  < .001) and moderate (B = .06, t = 2.91, p  < .01) levels of resilience; but for those students with high resilience, academic stress was not associated with suicidal ideation (B = .03, t = 1.08, p  < .281), (Fig.  2 ). To avoid potentially problematic high multi-collinearity with the interaction terms, the variables were centered and an interaction term between adaptive coping style and suicidal ideation as well as the interaction between resilience and suicidal ideation were created [ 3 ]. Examination of the interaction plots is illustrated in Figs.  1 and ​ and2 2 .

Adaptive coping style moderating the link between academic stress and suicidal ideation

Resilience moderating the link between academic stress and suicidal ideation

Our hypothesis that academic stress would significantly predict suicidal ideation was confirmed, and this finding is consistent with extant studies [ 10 , 18 , 39 ]. Other literature (e.g [ 31 , 48 , 66 ]) have also documented the significant relationship between academic stress and suicidal ideation. In line with our goal of examining the moderating roles of coping styles in furthering research knowledge about suicide, intervention, and treatment, we found that adequate coping with academic stressors was key to avoiding suicidal ideation among students. This finding is very important as educational administrators and policy makers should incorporate courses and teachings of effective coping skills into their programs, especially for young students since stressors are inherent in the lives of undergraduate students, especially in our society and at this perilous time.

Stressors have become so prevalent in undergraduate education [ 19 , 22 , 49 ] that adequate coping skills have become a panacea to the likelihood of impending suicidal ideation [ 31 , 48 ]. We found that adaptive coping styles did not significantly predict suicidal ideation, but moderated the relationship such that low or moderate coping with academic stress would most likely lead to suicidal ideation. Students are mostly confronted with the challenges of adapting to a new academic environment, academic workload, academic performance, attending to lectures, overwork, or thoughts of future employment after graduation [ 22 , 49 ], and most seriously, social, emotional, and financial stress [ 19 ]. This is also in consonance with worries about unemployment rates, poverty and destitution, economic crises, feelings of insecurity, marginalization, and economic disempowerment [ 8 , 44 ] that dominate our society today. It is made even worse when the student(s) loses their guardian/parents/sibling who pays their academic bills, or when the guardian/parents/sibling suffers a misfortune that renders him/her almost destitute.

Resilient students have the ability to recover from stress [ 71 ], but not without adequate coping strategies. Our study found that resilience was positively associated with academic stress and negatively predicted suicidal ideation. Thus, the hypothesis which stated that resilience would moderate the relationship between academic stress and suicidal ideation was confirmed. This simply means that those who cope well with academic stress have a better chance of bouncing back than those who do not, and they are less likely to consider suicide. In line with our findings, Tugade et al. [ 64 ] noted that resilient people have much more adaptive behaviours, particularly in the areas of social functioning, morale, and somatic health, and such people equally experience positive emotions amidst stress; given that moral and social functioning are anti-suicidal tonics. The resiliency theory proposed by Richardson [ 51 ] explains that qualities of resilience such as optimism, hopefulness, and meaningful engagement ensure higher immune levels than helplessness, hopelessness, and depression (which are precursors of suicide). Therefore, resilience promotes succor and adequate coping under threats of various academic stressors.

Our findings can be explained by Aaron Anthonovsky’s Salutogenic Model of Resilience. In its explanations of resilience, the salutogenic model ignores the whole notion of risk exposure as a prerequisite for being labelled “resilient” and instead places the emphasis on factors that contribute to health and wellbeing. The salutogenic model specifically focuses on factors that help identify coping resources that may contribute to resilience and effective adjustment, notwithstanding adversity and risk [ 60 ]. It is adequate coping skills that make resilient students able to quickly regain a sense of balance that keeps them going despite academic difficulty and trouble, and equally makes them find meaning amidst academic confusion and turmoil. Resilient students are self-confident and understand their own strengths and abilities. They do not feel a pressure to conform but take pleasure in being unique. Extant literature have documented the relationships between resilience and well-being [ 40 ]. Perceived resilience was associated with less suicidal ideation whereas higher psychological distress was associated with higher suicidal ideation [ 16 ], depression, anxiety, mental health, resiliency, and daily stresses had been linked to suicidal ideations and are noted to play significant role in suicidal ideation [ 32 ]. To our knowledge, it seems that no study had particularly evaluated the moderation of coping and resilience on the path of academic stress and suicidal ideation. Hence, our study becomes an interesting read for students, educational administrators, and some other non-governmental suicidal organizations.

Our study is not without limitations. For instance, the small sample size of our study may not have been large enough to account for generalizations across cultures. In the same vein, university differences in terms of courses offered, and socioeconomic status, which definitely would have ensured a more homogenous population, were not factored in the sampling process. Subsequent studies should consider such university differences and capture course types that might impact on academic stress and suicidality. Again, as a cross-sectional study, our data do not allow for full inferences about causal directionality. As a self-report measure was adopted in the study, there is the possibility of response biases as participants may either have made socially acceptable answers rather than being truthful or were unable to accurately assess themselves; all these threaten the reliability and validity of the measurement. Equally, tools employed in this study, like the Lakaev Academic Stress Response Scale, Scale for Suicidal Ideation, Brief COPE, and Resilience Scale, cannot be viewed as diagnostic tools, but only as screening tests to identify members of groups at risk for these conditions. The results arising from these tools tell us how the students perceive their health but are not in themselves evidence of medical concerns. Therefore, future studies should consider making more directional inferences, perhaps from a more controlled experimental investigation as well as cross cultural variances in suicidal ideation. We did not also take into account several ways people ideate about suicide (e.g., active ideation with plans, thoughts of suicide, and urges) as noted by Rizvi and Fitzpatrick [ 56 ]. There is a likelihood that the frequency, duration, intensity, and future possibility of these ways of ideating suicide could have been propagated by the academic environment and that most students at different times have the urges and thoughts (with or without) active plans. This area should be explored further. Finally, s election bias could undermine the internal validity of the study. However, the use of this approach might not have a significant impact on the outcome of this study. Nonetheless, this can only be ascertained when further studies are conducted while taking into consideration the issues raised. We acknowledge this as a limitation of the sampling technique adopted and advise the exercise of caution in making generalizations from these findings.

Based on the limitations stated above, it is recommended that future studies ensure adequate representativeness, increased homogeneity, etc. in order to foster generalizations of the findings.

Resilient students having the ability to recover from stress are only possible with adequate coping strategies even as resilience positively associated with academic stress and negatively predicted suicidal ideation. Our findings affirm the research trend that academic stress is associated with suicidal ideation, with resilient students able to bounce back from academic challenges. Good coping strategies also enable resilient students recover from stress, consequently reducing their likelihood to ideate about suicide. Our students must adopt positive coping strategies towards solving their academic problems and learn persistence in the midst of threatening academic situations.

Our findings contribute to the growing evidence that adequate coping with academic stressors and resilient skills are keys to avoiding suicidal ideation among young students. Resilient students with adequate coping strategies find it easier to recover from stress even as resilience is positively associated with academic stress and negatively predicted suicidal ideation. This simply indicates that those who cope well with academic stress have more chances of bouncing back than others who do not, and may not likely ideate about suicide.

Acknowledgments

Special thanks to the Heads, Department of Psychology and Department of Home Science and Management, University of Nigeria Nsukka and Dean Faculty of Law Abia State University Uturu for granting us all the necessary approval and support that saw us through the length of time the study lasted.

Informed consent

Written informed consent was duly obtained from all the participants. The informed consent was the first attached document to the questionnaire such that any participant who did not willfully accept to participate will either not be administered the questionnaire or if already administered, will be retrieved.

Authors’ contributions

OFO critically and constantly proof read this work. KTUO, performed the data coding, data analysis and interpretation of the results. OMO and NJI’s expertise were brought to bare in coining the topic, and putting together the introduction of this work. The discussion was however anchored by OBN. While NCI formatted the references, all authors joined OAB in study design, gathering of data and equally approved the final version of the manuscript for submission. The author(s) read and approved the final manuscript.

Authors’ information

Dr. Okechukwu Franca O. held from Anambra State, Nigeria. Obtained her B.Sc, M.Sc and PhD in Home Economics at University of Nigeria, Nsukka. A senior lecturer in Child Development and Family Studies. She teaches and supervises undergraduate and postgraduate students. Her research interest is on children and family related issues.

Ogba, Kalu Timothy. Uyor, is a PhD (Social Psychology) holder and lecturer at the Psychology Department, University of Nigeria, Nsukka where I have taught a number of courses. I belong to a number of professional, religious and social organizations. To my credit are numbers of publications that mainly centered on personality, home safety, suicide, health & wellbeing and other nagging societal issues.

My name is Dr.(Mrs) Juliet Ifeoma Nwufo, Diploma in Ed (UNN), Bsc Psycholog(UNN), M.Sc in Developmental Psychology (UNN), Ph.D in Developmental Psychology (UNN). A lecturer and a researcher at the Department of Psychology UNN. She teaches undergraduates and Msc students and a reviewer to many journals both local and international. She has published in many journals both local and international. Research interests includes: psychological issues in general and mainly on adolescent issues like aggression, violence, and addictive behaviours and most of her publications is on adolescent problem.

Miracle Oluchi Ogba is an indigene of Akanu Ohafia, Abia State of Nigeria. I am a lecturer and MSc/PhD student at the Faculty of Law, Abia State University, Uturu. I specialize in Corporate Organization and Law has won a number academic excellence awards, written and published widely, attended both local and international conferences.

Blessing N. Onyekachi Doctor of social psychology in the University of Nigeria, Nsukka. My research interest spans across social psychological problems, happiness and conflict resolution. A mother of three lovely children, with some publications in both local and international journals,

Chinonso Nwanosike is a Lecturer/ Social psychologist at the University of Nigeria Nsukka where she started the graduate social psychology program for years. Her publications are in the areas of mental health, gender issues, positive psychology, family and marital relations, ethics and sexuality, and domestic violence.

Onyishi Amuche Bonaventure is an experimental psychologist, and Assistant Lecturer at the Department of Psychology, University of Nigeria Nsukka, Enugu State, Nigeria. Amuche Onyishi is a young bright researcher with an interest in Learning, Memory, Cognition and Problem solving. He has published in reputable Journal such as Journal of Social Sciences.

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Availability of data and materials

Declarations.

The above referenced research project has been reviewed and approved in line with the Department of Psychology, University of Nigeria, Institutional Review Board. The reference number is listed beside the title.

In line with our procedures, this approval is valid for 1 year (21st November, 2019 - 22nd December, 2020). Any changes regarding the presented protocol will require reconsideration by the Review Board. You also require to complete and submit the termination form at the end of this project.

The Department of Psychology, University of Nigeria, Institutional Review Board hereby affirms our approval of all the experimental protocols as far as this project is concerned. Our approval was, of course, based on our confirmation that all methods are carried out in line with the relevant guidelines and regulations as stipulated by University of Nigeria, Institutional Review Board.

We declare that our study was carried out successfully without any relationships that would be understood as a potential conflict of or competing interest.

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Contributor Information

Franca Obiageli Okechukwu, Email: [email protected] .

Kalu T. U. Ogba, Email: [email protected] .

Juliet I. Nwufo, Email: [email protected] .

Miracle Oluchi Ogba, Email: moc.liamg@026alakoelcarim .

Blessing Nneka Onyekachi, Email: [email protected] .

Chinonso I. Nwanosike, Email: [email protected] .

Amuche B. Onyishi, Email: [email protected] .