RESEARCH ARTICLE

European Journal of Medical and Health Sciences

www.ejmed.org

Measuring Stress Experienced by University Students

Marco Istasy, Rana Elias, Maria Raheb, and Zack Cernovsky

ABSTRACT

Background: University students often report feeling intense stress, high

anxiety, depressive feelings, low self-esteem, suicidal ideation, and Submitted : March 26, 2021
substance abuse. This study presents a new questionnaire measure of Published : April 16, 2021
student stress consisting of 30 items to investigate the symptoms of stress
ISSN: 2593-8339
and potentially protective factors.
DOI: 10.24018/ejmed.2021.3.2.787
Method: A total of 100 Canadian university students (mean age 20.2 years,
SD=2.5, 33 males, 67 females) participated in an internet survey. They all
completed our 30 item questionnaire dealing with the perceived stress of M. Istasy
studying and exams, and with symptoms such as nightmares, depression, Departments of Psychology and of
Human Biology, University of Toronto,
feelings of “being better off dead,” low self-esteem, and with potentially Toronto, Ontario, Canada.
protective factors such as the extent of positive attitude to professors and
(e-mail: istasym@gmail.com)
pride in or contentment with the social status as a university student. R. Elias
Results: High proportions of students reported feeling, at least at times, Psychiatric Clinic, London, Ontario,
better off dead (52%). About a half of them felt that most professors do not Canada.
seem to like them (56%) and many reported nightmares about exams (e-mail: rana.elias.raheb@gmail.com)
(53%). Lower perceived levels of student stress were associated with more M. Raheb
Department of Chemistry, Western
positive feelings towards the professors (r=-.37) and with more pride in University, London, Ontario, Canada.
being a university student and the contentment with the related social
(e-mail: mraheb@uwo.ca)
status (r=-.25). The Cronbach alpha coefficient of internal consistency of Z. Cernovsky*
our questionnaire was .87, i.e., satisfactory. Department of Psychiatry, Western
University, London, Ontario, Canada.
Discussion: The high prevalence of nightmares about exams, feeling of
“being better off dead,” or of not being liked by the professors is worrisome. (e-mail: drcerovsky@gmail.com)
Positive relations towards the professors or pride in or contentment about *Corresponding Author
being a university student function as statistically significant but only weak
and hence insufficient protective factors.
Conclusions: More than 50% of students reported nightmares about exams,
feeling of “being better off dead,” or of not being liked by the professors.
Further research is needed to evaluate correlates of student stress to other
protective factors than those explored in the present study.

Keywords: Stress, Nightmares, University Students, Depression,

Loneliness.

lower socioeconomic status/financial difficulties, having a

I. INTRODUCTION history of drug use, and feeling neglected by parents [4].
A recent large scale meta-analytic study on 634, 662 Another review study determined that insomnia and
college students published in 2018 indicated that about nightmares are associated with elevated prevalence of
10.6% reported suicidal ideation, plans, or attempts within suicidal thoughts and behaviours and that a thwarted sense of
the previous 12 months and 3% of them had suicide plans [1]. belongingness, socio-cognitive factors, and emotional
A recent Mexican study of 4,189 first year university students dysregulation could be important contributing factors [5]. Of
from 6 Mexican universities found similar proportions: 9.7% course, a very important factor is also the perceived stress of
reported suicidal ideation and 3.9% had a suicide plan within college studies. A very brief screening questionnaires of
the last 12 months [2]. A recent Chinese study on 6284 college stress was developed by Feldt consisting of 11 items
college students also reported a similar prevalence for the last [6]: the students’ scores on Feldt’s questionnaire correlated
12 months [3]. inversely at a significant level with their scores on a
A systematic review of 17 studies comprising a total of satisfaction with life scale [7].
13,244 medical students in 13 different countries [4] found An extensive questionnaire comprising 48 items to
that prevalence of suicidal ideation ranged from 1.8% to measure stress experienced by college students was
53.6%. The risk factors were depression and depressive developed by Avdija at Indiana State University in 2018.
symptoms, a previous diagnosis of a psychiatric disorder, Avdija’s scale sampled the perceived practical stress along
the following 5 dimensions: Financial stress, Time

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management stress, Social stress, Academic stress, and III. RESULTS

Family stress [8]. The mean total score was 94.7 (SD=17.3) and the
The present study introduces a new 30 item questionnaire Cronbach alpha coefficient of internal consistency was .87,
that deals with various aspects of perceived emotional stress i.e., satisfactory. The students’ scores ranged from 53 to 145:
in university students. The purpose of the questionnaire is to this indicates that all of them experienced some degree of
provide an overview for therapeutic counselors of the stress.
student’s signs of stress such as sleep problems or In the Table I, the responses very true and true are pooled
nightmares, perceived lack of emotional or therapeutic as “true” and very false and false as “false,” to simplify the
support at the university, loneliness, low self-esteem, lack of overview for the readers. In this table, the scoring of
pride in being a university student, and the absence of positively worded items was left as is: for example, in
viewing professors as role models for oneself. response to Item 22, slightly more than half of the students
(57%) agreed that the professors are their role models.
Worrisome are the high proportions of students who report
II. METHOD feeling, at times, being better off dead (52%), or of those
The 30 item questionnaire (see the item text in Table 1) feeling that most professors do not seem to like them (56%),
offered 5 possible responses: 1=very true, 2=true, 3=neither those who report not having any true friends at the university
true nor false, 4=false, 5=very false. Scoring for 10 items (50%), and those who report having nightmares about exams
was reversed for calculations of the total score (Items 4, 10, (53%).
14, 17, 19, 22, 24, 28, 29, and 30) so the higher total scores Positive findings are the high proportion of those who
on the 30 items would indicate more intense emotional report feeling closer to their professors than to other adults
distress. outside of their family (81%) and of those who considers
University students were recruited for an internet survey professors as their role models (57%).
from 3 major universities in Ontario, Canada. A total of 100
students provided valid responses to all 30 items. Their mean
age was 20.2 years (SD=2.5, range 18 to 30): 33 were males
and 67 females.

TABLE I: RESPONSES OF 100 UNIVERSITY STUDENTS TO INDIVIDUAL ITEMS OF THE STUDENT STRESS QUESTIONNAIRE (SSQ)
% True or % Neither % False or
Item:
very true nor very false
1. I feel anxious about upcoming exams. 8 19 73
2. It seems that most professors do not like me. 56 33 11
3. The studying for my classes is stressful. 9 20 71
4. I admire my professors. 21 30 49
5. I do not have any true friends at the university. 50 20 30
6. I am a financial burden to my parents. 33 27 40
7. Most professors do not care at all about the wellbeing of us, the students. 30 36 34
8. If I compare myself to other persons, I feel useless. 26 26 48
9. I have recently at least once drank alcohol to cope with the stress of university
76 8 16
studies.
10. I often feel happy to be at the university. 28 34 38
11. My sleep is poor because I am too stressed out by the studies. 29 13 58
12. I have nightmares about exams. 53 13 34
13. I know that a student at our university committed suicide within the last 2 years. 36 3 61
14. I can talk more easily to my fellow students than to other persons of the same age. 37 42 21
15. When I compare myself to others, I feel worthless. 36 23 41
16. I have used non-prescribed drugs recently to cope with the university stress. 83 6 11
17. The university studies are making a better person out of me. 31 29 40
18. Depressive feelings often invade my mind. 27 22 51
19. It would make me happy if I would learn to speak as elegantly and precisely as my
32 19 49
professors do.
20. At night, I have anxious dreams about not being able to complete (or about not
36 15 49
having completed) the required assignments for my classes.
21. At times, I feel I would be better off dead. 52 22 26
22. The professors are my role models. 57 27 16
23. Most students at our university suffer from the great pressure to pass their courses. 3 17 80
24. Being a university student makes me feel proud of myself. 20 23 57
25. Since I started at the university, I feel lonely. 28 22 50
26. The university does not provide effective psychological help for me. 25 32 43
27. When asked how I am, I usually lie that I feel OK. 22 16 62
28. University students are the most intelligent group of young persons in this country. 48 34 18
29. I feel closer to my professors than to any other adults (except perhaps for some
81 13 6
members of my family).
30. The university provides very good help for my struggles. 49 41 10

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Worrisome are also the high proportions of students who E. Correlates of Depressive Feelings
reported using alcohol (76%) or non-prescribed drugs (83%) The statement “Depressive feelings often invade my
to cope with the stress of university life. The results on mind” (Item 18) was endorsed by 27% of the students. When
correlations involving the use of alcohol (Item 9) and non- the scores on this item was subtracted from the total stress
prescribed drugs (Item 16) in this sample of 100 students score, the remaining part of the total score of student’s stress
have already been already reported by Istasy’s team in detail was highly correlated with the report of depressive feelings
elsewhere [9]. (r=.60, p<.001, 1-tailed). Students who reported depressive
A. Correlates of Nightmares about Exams or feelings were more often those who also felt lonely (r=.52,
Uncompleted Assignments p<.001, 1-tailed), useless (r=.58, p<.001, 1-tailed),),
worthless (r=.60, p<.001, 1-tailed), and more often
Item 12 (nightmares about exams, reported by 53%) and
complained about not having true friends at the university
Item 20 (anxious dreams of uncompleted assignments,
(r=.29, p=.002, 1-tailed).
reported by 36%) deserve special attention because such
anxiety dreams are considered an important symptom of the F. Correlates of Viewing Professors as Role Models
Post-Traumatic Stress Disorder (PTSD). When the scores on As already mentioned, more than a half of the students
these 2 items were subtracted from the total stress score, the (57%) reported they considered the professors as role models
remaining part of total scores of student’s stress was (Item 22). This viewpoint was inversely correlated with the
moderately correlated with the reports of nightmares about total score for student’s stress (r=-.42, p<.001, 1-tailed) after
exams (r=.49, p<.001, 1-tailed) and also with the reports of the score on that particular item was removed from the total.
anxious dreams about not being able to complete, or about Students who considered their professors as role models were
not having completed, the required assignments (r=56, less likely to report high levels of stress.
p<.001, 1-tailed). Considering professors as role models was uncorrelated
The reports of nightmares were highly correlated with with the feeling better off dead (r=-.030), or feeling useless
reports of anxious dreams about incomplete assignments (r=-.045), or worthless (r=-.005).
(r=.77, p<.001, 1-tailed).
G. Correlates of Good Relationship with Professors
B. Correlates of Low Self-Esteem
Items 4, 19, 22, and 29 indicated a good relationship to the
As shown in Table 1, 26% of students reported feeling professors and the same is also true about Item 2 and Item 7
useless (see Item 8) and 36% reported feeling worthless (see if the scoring of these two items is reversed. Added together,
Item 15), when “compared to others.” These items are these 6 items can form a subscale of positive relationship to
linguistically similar and are highly correlated (r=.89). professors. The Cronbach Alpha coefficient of internal
When the scores on these 2 items were subtracted from the consistency calculated for this subscale is somewhat weak,
total stress score, the remaining part of total score of student’s only .60, but would still be considered by some experts as
stress was moderately correlated with feelings of being acceptable.
useless (r=.52, p<.001, 1-tailed) and with feeling worthless All students reported at least some small degree of positive
(r=52, p<.001, 1-tailed). Those feeling useless or worthless relationship to their professors: the scores on this subscale
felt under higher levels of student stress than students with ranged from 8 to 25. The sum of scores on these 6 items was
better self-esteem. only weakly correlated with the overall student stress (a sum
C. Correlates of Loneliness of all remaining 24 items): those with more positive view of
As shown in Table 1, 50% of the students reported having the professors reported less stress (r=-.37, p<.001, 1-tailed).
no true friends at university (Item 5) and 28% reported Students with a good relationship to professors were less
feeling lonely since starting university (Item 25). When the likely to report being better off dead (r=-.23, p=.011, 1-
scores on these 2 items were subtracted from the total stress tailed), to feel lonely (r=-.23, p=.012, 1-tailed), or to report
score, the remaining part of total score of student’s stress was depressive feelings (r=-.20, p=.023, 1-tailed).
significantly but weakly correlated with having no true Reports of good relationship to professors were not
friends (r=.29, p=.001, 1-tailed) and moderately correlated significantly related (p>.05, 1-tailed) to complaints about not
with feeling lonely (r=.53, p<.001, 1-tailed). Those more having true friends at the university (r=-.13), and having
lonely reported higher levels of student stress. nightmares about exams (r=.-16), or anxious dreams about
uncompleted assignments (r=-.10).
D. Correlates of Feeling “to Be Better off Dead”
H. Correlates of Happiness and Pride of Being a
As already mentioned, about a half of the students (52%) University Student
reported they at times feel they would be better off dead (Item
Several items describe positive feelings about the
21). When the score on this item was subtracted from the total
university: feeling happy to be at the university (Item 10,
stress score, the remaining part of the total score of student’s
endorsed by 28%), being able to talk more easily to fellow
stress was moderately correlated with these reports of feeling
students than to other persons (Item 14, endorsed by 37%),
to be better off dead (r=.55, p<.001, 1-tailed). Those who
pride of being a university student (Item 24, endorsed by
reported being better off dead were somewhat more likely to
20%), viewing university students as the most intelligent
complain that they have no true friends at the university
group of young persons in this country (Item 28, endorsed by
(r=.37, p<.001, 1-tailed), feel lonely (r=.46, p<.001, 1-tailed),
48%), and noticing that university studies are making a better
and feel useless (r=.47, p<.001, 1-tailed), or worthless (r=.53,
person out of me (Item 17, endorsed by 31%).
p<.001, 1-tailed).

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These 5 items were added together to form a subscale of study by Saddler and Sacks [12] indicated that depressive
happiness & pride. All students reported at least some pride ideation is correlated with academic procrastination and also
or happiness about being at the university (scores ranged with unconstructive perfectionism. In another study,
from 5 to 22). The Cronbach’s Alpha calculated for this depression was found to be associated with lower grade point
subscale was too low (.54): these 5 items do not form a average [13].
homogeneous group. High levels of depression, anxiety, and of stress symptoms
The sum of these 5 items was weakly and in an inverse of university students are a worldwide problem that is now
manner correlated to the total student stress score from which well documented even in countries such as Nigeria [14], Iran
these 5 items (scored in reverse) were subtracted (r=-.25, [15], Malaysia [16], China [3], [17], [18], and Turkey [19].
p=.014, 1-tailed): those more happy and proud of their status The Turkish scientists Bayram and Bilgel [19] emphasized
as university students were reporting somewhat lower levels the need for adequate and appropriate support services for
of stress of being at the university. They less frequently this vulnerable but especially valuable group of the general
complained about not having true friends at the university population. Psychological screening of students at the end of
(r=-.24, p=.008, 1-tailed). The sum of the 5 items (the “happy the first or second semester with questionnaires such as the
and proud” subscale) was not significantly (p>.05, 1-tailed) one used in the present study is preventively important.
correlated with depressive feelings (r=-.14), or feeling Oliver and Burkham [20] found that the presence of
useless (r=-.08), or worthless (r=-.06). depression in the students did not vary over three points in
time during the academic year: this suggests that it is present
I. Correlates of Gender and Age
as a persistent health issue.
A large correlation matrix was calculated of all 30 items of The correlational trends found in this study are somewhat
the student stress questionnaire to age and gender. The difficult to interpret because the causal direction remains
following correlations significant at p<.05 (2-tailed) were unknown. In many cases, the causal influence might be mutual
found. Older students reported feeling less anxious about rather than unilateral. For example, as already mentioned,
upcoming exams (r=-.26), considered the studying as less more than a half of the students (57%) reported they
stressful than those of younger age (r=-.21), less often considered the professors as role models and this viewpoint
viewed themselves as financial burden to their parents was inversely correlated with the total score for student’s stress
(r=-.20), less often felt useless (r=-.21) or worthless (r=-.21), (r=-.42, p<.001, 1-tailed). The causal direction that underlies
and were less likely to agree that “most students at the this correlation remains unclear. Students displaying a too
university suffer from the great pressure to pass their overtly negative attitude to the faculty staff in their social
courses” (r=-.22), perhaps because they were more interactions with their professors already in their first classes
experienced or had better financial resources. might experience a reciprocal retribution in the form of
Females somewhat less often reported impaired sleep additional stress or perhaps students who feel excessively
(r=-.20) due to the stress of studies. Although statistically stressed by the academic pressure from their professors
significant, all these correlations involving age and gender develop a more negative view of their professors.
are extremely weak and of negligible value for practical It is noteworthy that considering professors as role models,
clinical predictions. viewing the professors as a positive influence, or also being
Neither age nor gender were significantly correlated with happy or proud of one’s social status as a university student
the total score of student stress, and they were also does not completely shield or protect the student from the
uncorrelated to the group of 6 items indicative of a good stress of university studies. Some students decide to view the
relationship to the professors or to the group of 5 items stress of studies in a positive light and emphasize the positive
indicative of feeling happy or proud about being a university aspect of the challenging environment, as if following the
student. principles of cognitive behavior therapy.
In the present study, the reports of nightmares about exams
correlated significantly (but only weakly) with the students’
IV. DISCUSSION endorsement of the Item 1 “I feel anxious about upcoming
Our results are consistent with the conclusions of exams.” This is not surprising. The stress in the waking life
Eisenberg’s research team [10] that “Mental health among finds its reflection in the content of dreams. Cernovsky’s
university students represents an important and growing study [21] on Swiss university students found that 50% of
public health concern for which epidemiological data are them admitted to having had at least one nightmare in the last
needed.” All students in the present study reported some 2 years. In 18.2%, these nightmares dealt with examinations.
degree of university stress. This is not necessarily negative The proportion of students reporting nightmares about exams
because stress has some activating value: when the stress is seems higher in the present study (53%) than in Cernovsky’s
not excessive, it motivates the student to maintain attentional Swiss study (18.2%) conducted at the University of Berne
focus in the lectures, or when studying from textbooks, or several decades ago, but the reasons for this are unclear.
while preparing assignments. Nightmares are considered an important symptom of PTSD
Ibrahim’s team [11] undertook an extensive review of which may linger, in a milder form, over many years. Even
literature on the prevalence of depression at universities and Sigmund Freud himself [22] admitted to still having, in his
concluded that “university students experience rates of later adult years, recurrent anxious dreams about having to
depression that are substantially higher than those found in re-take examinations, those he passed many years ago.
the general population.” The impact of depressive ideation
on academic performance could be adverse. For example, a

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V. CONCLUSIONS [15] Sarokhani D, Delpisheh A, Veisani Y, Sarokhani MT, Manesh RE,

Sayehmiri K. Prevalence of Depression among University Students: A
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