stress and anxiety among students essay

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Stress, Anxiety, and Depression Among Undergraduate Students during the COVID-19 Pandemic and their Use of Mental Health Services

Jungmin lee.

1 Department of Educational Policy Studies and Evaluation, University of Kentucky, 597 S. Upper Street, 131 Taylor Education Building, Lexington, KY 40506-0001 USA

Hyun Ju Jeong

2 Department of Integrated Strategic Communication, University of Kentucky, Lexington, KY USA

3 Division of Biomedical Informatics, University of Kentucky, Lexington, KY USA

Associated Data

Not applicable.

The coronavirus 2019 (COVID-19) has brought significant changes to college students, but there is a lack of empirical studies regarding how the pandemic has affected student mental health among college students in the U.S. To fill the gap in the literature, this study describes stress, anxiety, and depression symptoms for students in a public research university in Kentucky during an early phase of COVID-19 and their usage of mental health services. Results show that about 88% of students experienced moderate to severe stress, with 44% of students showing moderate to severe anxiety and 36% of students having moderate to severe depression. In particular, female, rural, low-income, and academically underperforming students were more vulnerable to these mental health issues. However, a majority of students with moderate or severe mental health symptoms never used mental health services. Our results call for proactively reaching out to students, identifying students at risk of mental health issues, and providing accessible care.

The coronavirus 2019 (COVID-19) has brought significant and sudden changes to college students. To protect and prevent students, faculty, and staff members from the disease, higher education institutions closed their campus in the spring of 2020 and made a quick transition to online classes. Students were asked to evacuate on a short notice, adjust to new online learning environments, and lose their paid jobs in the middle of the semester. The pandemic has also raised concerns among college students about the health of their family and friends (Brown & Kafka, 2020 ). Because all these changes were unprecedented and intensive, they caused psychological distress among students, especially during the first few months of the pandemic. There is abundant anecdotal evidence describing students’ stress and emotional difficulties as impacted by COVID-19, but there are only a few empirical studies available that directly measure college student mental health since the outbreak (e.g., Huckins et al., 2020 ; Kecojevic et al., 2020 ; Son et al., 2020 ). Most existing studies focus on mental health for general populations (e.g., Gao et al., 2020 ) or health care workers (e.g., Chen et al., 2020 ), whose results may not be applicable to college students. Given that college students are particularly vulnerable to mental health issues (e.g., Kitzrow, 2003 ), it is important to explore their mental health during this unprecedented crisis.

In this study, we describe the prevalence of stress, anxiety, and depression for undergraduate students in a public research university during the six weeks after the COVID-19 outbreak alongside their usage of mental health services. Using a self-administered online survey, we measured stress, anxiety, and depression levels with well-established clinical tools and asked the extent to which college students used on-campus and off-campus mental health services for the academic year. Our results revealed that more than eight out of ten students surveyed experienced modest or severe stress, and approximately 36–44% of respondents showed moderate or severe anxiety and depression. However, more than 60% of students with moderate or severe stress, anxiety, or depression had never utilized mental health services on- or off-campus. Although focusing on a single institution, this paper is one of the few studies that empirically examine mental health of college students in the U.S. during the early phase of the pandemic. Findings from this paper reassure the seriousness of student mental health during the pandemic and call for a proactive mental health assessment and increased support for college students.

Literature Review

Covid-19 and student mental health.

Empirical studies reported a high prevalence of college mental health issues during the early phase of COVID-19 around the world (Cao et al., 2020 ; Chang et al., 2020 ; Liu et al., 2020 , Rajkumar, 2020 ; Saddik et al., 2020 ). In the U.S. a few, but a growing number of empirical surveys and studies were conducted to assess college students’ mental health during the pandemic. Three nationwide surveys conducted across the U.S. conclude that college student mental health became worse during the pandemic. According to an online survey administered by Active Minds in mid-April of 2020, 80% of college students across the country reported that COVID-19 negatively affected their mental health, with 20% reporting that their mental health had significantly worsened (Horn, 2020 ). It is also concerning that 56% of students did not know where to go if they had immediate needs for professional mental health services (Horn, 2020 ). Another nationwide survey conducted from late-May to early-June also revealed that 85% of college students felt increased anxiety and stress during the pandemic, but only 21% of respondents sought a licensed counselor or a professional (Timely MD, n.d. ) According to the Healthy Minds Network’s survey (2020), which collected data from 14 college campuses across the country between March and May of 2020, the percentage of students with depression increased by 5.2% compared to the year before. However, 58.2% of respondents never tried mental health care and about 60% of students felt that it became more difficult to access to mental health care since the pandemic. These survey results clearly illustrate that an overwhelming majority of college students in the U.S. have experienced mental health problems during the early phase of COVID-19, but far fewer students utilized professional help. Despite the timely and valuable information, only Healthy Minds Network ( 2020 ) used clinical tools to measure student mental health, and none of them explored whether student characteristics were associated with mental health symptoms.

To date, only a few scholarly research studies focus on college student mental health in the U.S. since the COVID-19 outbreak. Huckins et al. ( 2020 ) have longitudinally tracked 178 undergraduate students at Dartmouth University for the 2020 winter term (from early-January to late-March of 2020) and found elevated anxiety and depression scores during mid-March when students were asked to leave the campus due to the pandemic. The evacuation decision coincided with the final week, which could have intensified student anxiety and depression. The anxiety and depression scores gradually decreased once the academic term was over, but they were still significantly higher than those measured during academic breaks in previous years. Conducting semi-structured interviews with 195 students at a large public university in Texas, Son et al. ( 2020 ) found that 71% of students surveyed reported increased stress and anxiety due to the pandemic, but only 5% of them used counseling services. The rest of the students explained that they did not use counseling services because they assumed that others would have similar levels of stress and anxiety, they did not feel comfortable talking with unfamiliar people or over the phone, or they did not trust counseling services in general. Common stressors included concerns about their own health or their loved ones’, sleep disruption, reduced social interactions, and difficulty in concentration. Based on a survey from 162 undergraduate students in New Jersey, Kecojevic et al. ( 2020 ) found that female students had a significantly higher level of stress than male students and that upper-class undergraduate students showed a higher level of anxiety than first-year students. Having difficulties in focusing on academic work led to increased levels of stress, anxiety, and depression (Kecojevic et al., 2020 ).

College Student Mental Health and Usage of Mental Health Services Before COVID-19

College student mental health has long been studied in education, psychology, and medicine even before the pandemic. The general consensus of the literature is that college student mental health is in crisis, worsening in number and severity over time. Before the pandemic in the academic year of 2020, more than one-third of college students across the country were diagnosed by mental health professionals for having at least one mental health symptom (American College Health Association, 2020 ). Anxiety (27.7%) and depression (22.5%) were most frequently diagnosed. The proportion of students with mental health problems is on the rise as well. Between 2009 and 2015, the proportion of students with anxiety or depression increased by 5.9% and 3.2%, respectively (Oswalt et al., 2020 ). Similarly, between 2012 and 2020, scores for depression, general anxiety, and social anxiety have constantly increased among those who visited counseling centers on college campuses (Center for College Mental Health [CCMH], 2021 ).

Some groups are more vulnerable to mental health problems than others. For example, female and LGBTQ students tend to report a higher prevalence of mental health issues than male students (Eisenberg et al., 2007b ; Evans et al., 2018 ; Wyatt et al., 2017 ). However, there is less conclusive evidence on the difference across race or ethnicity. It is well-supported that Asian students and international students report fewer mental health problems than White students and domestic students, but there are mixed results regarding the difference between underrepresented racial minority students (i.e., African-American, Hispanic, and other races) and White students (Hyun et al., 2006 ; Hyun et al., 2007 ). Many researchers find either insignificant differences (e.g., Eisenberg et al., 2007b ) or fewer mental health issues reported for underrepresented minority students compared to White students (e.g., Wyatt et al., 2017 ). This may not necessarily mean that racial minority students tend to have fewer mental health problems, but it may reflect their cultural tendency against disclosing one’s mental health issues to others (Hyun et al., 2007 ; Wyatt & Oswalt, 2013 ). In terms of age, some studies (e.g., Eisenberg et al., 2007b ) reveal that students who are 25 years or older tend to have fewer mental health issues than younger students, while others find it getting worse throughout college (Wyatt et al., 2017 ). Lastly, financial stress significantly increases depression, anxiety, and suicidal thoughts among college students (Eisenberg et al., 2007b ).

Despite the high prevalence of mental health issues, college students tend to underutilize mental health services (Cage et al., 2018 ; Hunt & Eisenberg, 2010 ; Lipson et al., 2019 ; Oswalt et al., 2020 ). The Healthy Minds Study 2018–2019, which collected data from 62,171 college students across the country, reports that 57% of students with positive anxiety or depression screens have not used counseling or therapy, and 64% of them have not taken any psychotropic medications within the past 12 months (Healthy Minds, 2019 ). Even when students had visited a counseling center, about one-fourth of them did not return for a scheduled appointment, and another 14.1% of students declined further services (CCMH, 2021 ). When asked the barriers that prevented them from seeking mental health services, students reported a lack of perceived needs for help (41%), preference to deal with mental health issues on their own or with families and friends (27%), a lack of time (23%), financial difficulty (15%), and a lack of information about where to go (10%). Students who never used mental health services were not sure if their insurance covered mental health treatment or were more skeptical about the effectiveness of treatment (Eisenberg et al., 2007a ). Stigma, students’ view about getting psychological help for themselves, is another significant barrier in seeking help and utilizing mental health services (Cage et al., 2018 ).

Current Study

While previous studies have advanced our understanding of student mental health and their usage of mental health services, we find a lack of empirical studies on these matters, particularly in the context of COVID-19. The goal of this study is to fill the gap with specific investigations into the prevalence and pattern of U.S. college student mental health with regard to counseling service use during the early phase of COVID-19. First, very few studies focus on college students and their mental health during the pandemic, and most nationwide surveys conducted in the U.S. did not use clinically validated tools to measure student mental health. In this study, we have employed the three clinical measures to assess stress, anxiety, and depression, which are the most prevalent mental health problems among college student populations (Leviness et al., 2017 ). Secondly, it should be noted that while empirical research conducted in U.S. institutions clearly demonstrate that college students were under serious mental distress during the pandemic (Huckins et al., 2020 ; Son et al., 2020 ; Kecojevic et al., 2020 ), such studies have relatively small sample sizes and rarely examined whether particular groups were more vulnerable than others during the pandemic. To overcome such limitations, the present study has recruited a relatively large number of students from all degree-seeking students enrolled at the study institution. Further, given the high prevalence of mental health issues, we have identified vulnerable student groups and provided suggestions regarding necessary support for these students in an effort to reduce mental health disparity. Lastly, previous studies (e.g., Healthy Minds, 2019 ) show that college students, even those with mental health issues, tended to underutilize counseling services before the pandemic. Yet, there is limited evidence regarding whether this continued to be the case during COVID-19. Our study provides empirical evidence regarding the utilization of mental health services during the early phase of the pandemic and identifies its predictors. Based on the preceding discussions, we address the following research questions in this study:

First, how prevalent were stress, anxiety, and depression among college students during the early phase of the pandemic? Second, to what extent have students utilized mental health services on- and off-campus? Third, what are the predictors of mental health symptoms and the usage of mental health services?

We collected data via a self-administered online survey. This survey was designed to measure student mental health, the usage of mental health services, and demographics. The survey was sent to all degree-seeking students enrolled in a public research university in Kentucky for the spring of 2020. An invitation email was first sent on March 23, which was two days after the university announced campus closure, and two more reminder emails were sent in mid-April and late-April. The survey was available until May 8th, which was the last day of the semester.

A total of 2691 students (out of 24,146 qualified undergraduate and graduate degree-seeking students enrolled for the semester) responded to the survey. The response rate was 11.14%, but this is acceptable as it is within the range of Internet survey response rates, which is anywhere from 1 to 30% (Wimmer & Dominick, 2006 ). We deleted responses from 632 students who did not answer any mental health questions, which left 2059 valid students for the analysis. In this study, we focused on undergraduate students because they are significantly different from graduate students in terms of demographics (e.g., racial composition, age, and income) and major stressors (Wyatt & Oswalt, 2013 ). As a result, 1412 undergraduate students are included in our sample. 90% of these students had complete data. The rest of students skipped a couple of questions (usually related to their residency) but answered most of the question. Thus, we conducted multiple imputation, created ten imputed data sets, and ran regression models using these imputed data (Allison, 2002 ). Our regression results using imputed data are qualitatively similar to the estimates using original data; however, for comparison, we also provided the regression estimates using original data in Appendix Tables  6 and ​ and7. 7 . Please note that we still used original data for descriptive research questions (presented in Tables  1 , ​ ,2, 2 , and ​ and4) 4 ) to accurately describe the prevalence of mental health symptoms and use of counseling services.

Descriptive statistics of sample characteristics

Descriptive statistics for stress, anxiety, and depression prevalence

Usage of mental health services among students with moderate or severe symptoms

Ordinal logistic regression models for severity of mental health symptoms (original data)

Odds ratio are reported, and numbers in parentheses are standard error

+ p  < 0.1, * p  < 0.05, ** p  < 0.01, *** p  < 0.001

Logistic regression models predicting the usage of mental health services (original data)

+ p < 0.1, * p < 0.05, ** p < 0.01, *** p < 0.001

Table  1 provides descriptive statistics for students in our data. Female (73%), White (86%), and students who are below 25 years old (95%) are the vast majority of our sample. About one in four students are rural students and/or students from Appalachian areas (27%) and first-generation students (23%). Wealthier students (whose family income was $100,000 or more) make up about 44% of the sample (44%). Compared to the undergraduate student population at the study site, female students (56.3% at the study site) are overrepresented in our study. The proportion of White students is slightly higher in our sample (86%) than the study population (84%), and that of first-generation students is slightly lower in our sample (23%) than that in the study population (26%).

There are five key outcome variables for this study. The first three outcome variables are stress, anxiety, and depression, and the other two variables are the extent to which students used on-campus and off-campus mental health services for the academic year, respectively. Our mental health measures are well-established and widely used in a clinical setting. For stress, we used the Perceived Stress Scale (PSS) that includes ten items asking students’ feelings and perceived stress measured on a 5-point Likert scale from 0 (strongly disagree) to 4 (strongly agree) (Cohen et al., 1983 ). Using the sum of scores from the ten items, the cut-off score for low, moderate, and high stress is 13, 26, and 40, respectively. PSS scale was used in hundreds of studies and validated in many languages (Samaha & Hawi, 2016 ). PSS also has a high internal consistency reliability. Of the recent studies that used the instrument to measure mental health of U.S. college students, Cronbach’s alpha was around 0.83 to 0.87, which exceeded the commonly used cut-off of 0.70 (Adams et al., 2016 ; Burke et al., 2016 ; Samaha & Hawi, 2016 ).

We used the General Anxiety Disorder 7-item (GAD-7) scale to measure anxiety. This is a brief self-report scale to identify probable cases of anxiety disorders (Spitzer et al., 2006 ). The GAD scores of 5, 10, and 15 are taken as the cut-off points for mild, moderate, and severe anxiety, respectively. In a clinical setting, anyone with a score of 10 or above are recommended for further evaluation. GAD is moderately good at screening three other common anxiety disorders - panic disorder (sensitivity 74%, specificity 81%), social anxiety disorder (sensitivity 72%, specificity 80%), and post-traumatic stress disorder (sensitivity 66%, specificity 81%) (Spitzer et al., 2006 ) In their recent study, Johnson, et al. ( 2019 ) validated that “the GAD-7 has excellent internal consistency, and the one-factor structure in a heterogeneous clinical population was supported” (p. 1).

Lastly, depression was assessed with the eight-item Patient-Reported Outcomes Measurement Information System (PROMIS) Depression Short Form (Pilkonis et al., 2014 ). A score less than 17 is considered as none to slight depression, a score between 17 and 21 is considered as mild depression, a score between 22 and 32 is considered as moderate depression, and a score of 33 or above is considered as severe depression. PROMIS depression scale is a universal, rather than a disease-specific, measure that was developed using item response theory to promote greater precision and reduce respondent burden (Shensa et al., 2018 ). The scale has been correlated and validated with other commonly used depression instruments, including the Center for Epidemiological Studies Depression Scale (CES-D), the Beck Depression Inventory (BDI-II), and the Patient Health Questionnaire (PHQ-9) (Lin et al., 2016 ).

When it comes to the usage of psychological and counseling services, we asked students to indicate the extent to which they used free on-campus resources (e.g., counseling center) and off-campus paid health professional services (e.g., psychiatrists) anytime during the academic year on a scale of 1 (never) to 5 (very often), respectively. These questions do not specifically ask if students utilized these services after the COVID-19 outbreak, but responses for these questions indicate whether and how often students had used any of these services for the academic year until they responded to our survey.

We also collected data about student demographics and characteristics including student gender, race or ethnicity, age, class levels (freshman, sophomore, junior, and senior), first generation student status (1 = neither parent has a bachelor’s degree, 0 = at least one parent with a bachelor’s degree), family income, residency (rural and/or Appalachian students, international students), GPAs, and perceived stigma about seeking counseling or therapy (i.e., “I am afraid of what my family and friends will say or think of me if I seek counseling/therapy”) measured on a 5-point Likert scale. We used these variables to see if they were associated with a high level of stress, anxiety, and depression and the usage of mental health services.

We used descriptive statistics, ordinal logistic regression, and logistic regression models in this study. To address the first and second research questions, we used descriptive statistics and presented the prevalence of stress, anxiety, and depression as well as the frequency of using mental health services. For the third research question, we adopted ordinal logistic regression and logistic regression models depending on outcome variables. We used ordinal logistic regression models to identify correlates of different levels of stress, anxiety, and depression, which were measured in ordinal variables (e.g., mild, moderate, and severe). For the usage of mental health service outcomes, we employed logistic regression models. Because more than two-thirds of students in the sample never utilized either type of mental health services, we re-coded the usage variables into binary variables (1 = used services, 0 = never used services) and ran logistic regression models.

Limitations

Our study is not without limitations. First, we do not claim a causal relationship in this study, but we describe the state of mental health for students soon after the COVID-19 outbreak. We acknowledge that many students may have suffered from mental health problems before the pandemic, with some experiencing escalation after the outbreak (e.g., Horn, 2020 ). Even if our study does not provide a causal relationship, we believe that it is important to measure and document student mental health during the pandemic so that practitioners can be aware of the seriousness of this issue and consider ways to better serve students. Secondly, our study results may not be applicable to students in other institutions or states. We collected data from a public research university in Kentucky where the number of confirmed cases and deaths were relatively lower than other states such as New York. The study site mainly serves traditional college students who attend college right after high school, who live on campus, and who do not have dependents. Therefore, mental health for students at other types of institutions or in other states could be different from what is presented in our study.

Prevalence of Stress, Anxiety, and Depression

Table  2 shows the prevalence of stress, anxiety, and depression. Overall, a majority of students experienced psychological distress during the early phase of the pandemic. When it comes to stress, about 63% of students had a moderate level of stress, and another 24.61% of students fell into a severe stress category. Only 12% of students had a low level of stress. In other words, more than eight in ten students in the survey experienced moderate to severe stress during the pandemic. This result is comparable to the Active Minds’ survey results that report 91% of college students reported experiencing feelings of stress and anxiety since the pandemic (Horn, 2020 ).

In terms of anxiety, approximately 24% and 21% of students in our study had moderate and severe anxiety disorders, respectively. Given that those who scored 10 or above on the GAD-7 scale (moderate to severe category) are recommended to meet with professionals (Spitzer et al., 2006 ), this finding implies that nearly half of students in this study needed to get professional help. This proportion of students with moderate to severe anxiety is almost double that for university students in China (e.g., Chang et al., 2020 ) or the United Arab Emirates soon after the COVID-19 outbreak (Saddik et al., 2020 ). Lastly, approximately 30% and 6% of students suffered from moderate and severe depression, respectively. These proportions are far higher than college students in China measured during the pandemic (Chang et al., 2020 ) but slightly higher than a nationwide sample of U.S. college students assessed before the pandemic (Healthy Minds, 2019 ). Given that our study measured these mental health symptoms for the first six weeks of the pandemic, we speculate that the proportion of students with moderate or severe depression would increase over time.

In order to explore predictors of a higher level of stress, anxiety, and depression, we ran ordinal logistic regression models as presented in Table  3 . Overall, it is clear and consistent that the odds of experiencing a higher level of stress, anxiety, and depression (e.g., severe than moderate, moderate than mild, etc.) were significantly greater for female students by a factor of 1.489, 1.723, and 1.246 than the odds for male students when other things were held constant. This gender difference in mental health symptoms is quite consistent with other studies before and during the pandemic (Eisenberg et al., 2007a ; Kecojevic et al., 2020 ). When it comes to race or ethnicity, the odds of experiencing a higher level of stress, anxiety, and depression for African-American students were almost as half as the odds for White students. However, there was no significant difference in the odds for Hispanic and Asian students compared to White students. Student class level was significantly related to stress and anxiety levels: The odds were greater for upper-class students than lower class students. This result is consistent with Kecojevic et al. ( 2020 ), which reported significantly higher levels of anxiety among upper-class students compared to freshman students. It may reflect that one of major stressors for college students during the pandemic is the uncertain future of their education and job prospects, which would be a bigger concern for upper-class students (Timely MD, n.d.).

Ordinal logistic regression models for severity of mental health symptoms (imputed data)

One’s rurality, family income, and GPA were significantly associated with the severity of mental health symptoms. The odds of experiencing a severe level of anxiety and depression were 1.325 and 1.270 times higher among rural students than urban and suburban students. With every one unit increase in family income or students’ GPAs, the odds of experiencing a more severe stress, anxiety, and depression significantly decreased. This result suggests that students from disadvantaged backgrounds were even more vulnerable to psychological distress during the early phase of the pandemic. The negative association between GPAs and mental distress levels was consistent with previous studies that showed that college students were very concerned about their academic performances and had difficulty in concentration during the early phase of the pandemic (Kecojevic et al., 2020 ; Son et al., 2020 ).

Usage of Mental Health Services

In Table  4 , we first describe the extent to which students with moderate to severe symptoms of stress, anxiety, or depression used mental health services on- and off-campus during the academic year. The university in this study has provided free counseling services for students, and the counseling services have continued to be available for students in the state via phone or Internet even after the university was closed after the outbreak. Table ​ Table4 4 presents the frequency of students using on-campus mental health services (Panel A) and off-campus paid mental health services (Panel B) on a five-point scale. For this table, we limited the sample to students with moderate to severe symptoms of stress, anxiety, or depression to focus on students who were in need of these services. Surprisingly, a majority of these students never used mental health services on- and off-campus even when their stress, anxiety, or depression scores indicated that they needed professional help. More than 60% of students with moderate to severe symptoms never used on-campus services, and more than two-thirds of students never used off-campus mental health services. This underutilization of mental health resources is concerning but not surprising given that college students tended not to use counseling services before and during the pandemic as presented in previous studies (e.g., CCMH, 2021 ; Healthy minds, 2019 ; Son et al., 2020 ).

In order to explore predictors of the usage of mental health services, we ran logistic regression models as shown in Table  5 . We included all students in these regression models to see whether a severity of mental health symptoms was related to the usage of mental health services. Table ​ Table5 5 presents the results for the usage of any mental health services, on-campus mental health services, and off-campus mental health services, respectively. Overall, stress, anxiety, and depression levels were positively associated with using mental health services on- and off-campus: With every one unit increase in each of these mental health symptoms, the odds of using on- and off-campus mental health services significantly increased. This result is relieving as it suggests that students who were in great need of these services actually used them. Other than mental health symptoms, there were different predictors for utilizing on-campus and off-campus services. African-American and Hispanic students were significantly more likely to use on-campus services than White students. The odds of using on-campus mental health services were 3.916 times higher for African-American students and 2.032 times higher for Hispanic students than White students. This result is interesting given that the odds of having severe mental distress were significantly lower for African-American students than White students, according to Table ​ Table3. 3 . It may suggest that African-American students reported relatively lower levels of mental health symptoms as they had been using on-campus mental health services at higher rates. The odds of using on-campus mental health services were 2.269 times higher for international students than domestic students, but there was no significant difference in the odds of using off-campus services between the two groups. Students’ age was significantly associated with the usage of on-campus and off-campus mental health services: The odds of using on-campus services were significantly lower for older students, while the odds of utilizing off-campus services were significantly higher for older students compared to younger students. When it comes to using off-campus mental health services, the odds were significantly higher for female students, older students, and upper-class students than male students, younger students, and lower classman students. Students who were concerned with stigma associated with getting counseling and therapy were less likely to utilize off-campus mental health services.

Logistic regression models predicting the usage of mental health services (imputed data)

Discussions

Our paper describes the prevalence of stress, anxiety, and depression among a sample of undergraduate students in a public research university during an early phase of the COVID-19 outbreak. Using well-established clinical tools, we find that stress, anxiety, and depression were the pervasive problems for college student population during the pandemic. In particular, female, rural, low-income, and academically low-performing students were more vulnerable to psychological distress. Despite its prevalence, about two-thirds of students with moderate to severe symptoms had not utilized mental health services on- and off-campus. These key findings are very concerning considering that mental health is strongly associated with student well-being, academic outcomes, and retention (Bruffaerts et al., 2018 ; Wyatt et al., 2017 ).

Above all, we reiterate that college student mental health is in crisis during the pandemic and call for increased attention and interventions on this issue. More than eight in ten students in our study had moderate to severe stress, and more than one thirds of students experienced moderate to severe anxiety and/or depression. This is much worse than American college students before the COVID-19 (e.g., American College Health Association, 2020 ) and postsecondary students in other countries during the pandemic (e.g., Chang et al., 2020 ; Saddik et al., 2020 ). In particular, rural students, low-income students, and students with low GPAs were more vulnerable to psychological distress. These students have already faced multiple barriers in pursuing higher education (e.g., Adelman, 2006 ; Byun et al., 2012 ), and additional mental health issues would put them at a high risk of dropping out of college. Lastly, although they were dropped from the main analysis due to the small sample size ( n  = 17), it is still noteworthy that a significantly higher proportion of LGBTQ students in our sample experienced severe stress, anxiety, and depression, which calls for significant attention and care for these students.

Despite the high prevalence of mental health problems, a majority of students with moderate to severe symptoms never used mental health services during the academic year, even though the university provided free counseling services. This result could be partially explained by the fact that the university’s counseling center switched to virtual counseling since the COVID-19 outbreak, which was available only for students who stayed within the state due to the license restriction across state boarders. This transition could limit access to necessary care for out-of-state students, international students, or students in remote areas where telecommunications or the internet connection is not very stable. Even worse, these students may also have limited access to off-campus health professionals due to the geographic restrictions (rural students), limited insurance coverage (international students), or a lack of financial means. Our results support that international students relied significantly more on on-campus resources than domestic students. We urge practitioners and policy makers to provide additional mental health resources that are accessible, affordable, and available for students regardless of their locations, insurance, and financial means, such as informal peer conversation groups or regular check-ins via phone calls or texts.

It is also important to point out that the overall usage of both on-campus and off-campus mental health services was generally low even before the COVID-19 outbreak. Previous studies consistently report that college students underutilize mental health services not only because of a lack of information, financial means, or available seats but also because of a paucity of perceived needs or stigma related to revealing one’s mental health issues to others (Cage et al., 2018 ; Eisenberg et al., 2007a ; Son et al., 2020 ). Our results support this finding by demonstrating that stigma one associated with getting counseling or therapy negatively influenced their utilization of off-campus mental health services. Considering these barriers, practitioners should deliver a clear message publicly that mental health problems are very common among college students and that it is natural and desirable to seek professional help if students feel stressed out, anxious, or depressed. In order to identify students with mental health needs and raise awareness among students, it can be also considered to administer a short and validated assessment in classes that enroll a large number of students (e.g., in a freshman seminar course), inform the entire class of how to interpret their scores on their own, and provide a list of available resources for those who may be interested. This would give students a chance to self-check their mental health without revealing their identities and seek help, if necessary.

We recommend that future researchers longitudinally track students and see whether the prevalence of mental health problems changes over time. Longitudinal studies are generally scarce in student mental health literature, but the timing of assessment can influence mental health symptoms reported (Huckins et al., 2020 ). The survey for our study was sent out right after the university of this study was closed due to the pandemic. It is possible that students may adjust to the outbreak over time and feel better, or that their stress may add up as the disease progresses. Tracking students over time can illustrate whether and how their mental health changes, especially depending on the way the pandemic unfolds combined with the cycle of an academic year. Secondly, there should be more studies that evaluate the effect of an intervention program on student mental health. Hunt and Eisenberg ( 2010 ) point out that little has been known about the efficacy of intervention programs while almost every higher education institution offers multiple mental health resources and counseling programs. During this pandemic, it can be a unique opportunity to implement virtual mental health interventions and evaluate their efficacy. Future research on virtual counseling and mental health interventions would guide practices to accommodate mental health needs for students who exclusively take online courses or part-time students who spend most of their time off campus. Lastly, we recommend future research investigate the extent of mental health service utilization among students with mental health needs. Existing surveys and studies on this topic usually rely on responses from those who visit a counseling center or students who respond to their surveys. Neither of these groups accurately represents those who are in need of professional help because there may be a number of students who are not aware of their mental health issues or do not want to reveal it. An effective treatment should first start with identifying those in need.

Our study highlights that college students are stressed, anxious, and depressed in the wake of COVID-19. Although college students have constantly reported mental health issues (e.g., American College Health Association, 2020 ), it is remarkable to note that the broad spectrum of COVID-19-related challenges may mitigate the overall quality of their psychological wellbeing. This is particularly the case for at-risk students (rural, international, low-income, and low-achieving students) who have already faced multiple challenges. We also present that a majority of students with mental health needs have never utilized on- and off-campus services possibly due to the limited access or potential stigma associated with mental health care. Systematic efforts with policy makers and practitioners are requested in this research to overcome the potential barriers. All these findings, based on the clinical assessment of student mental health during the early phase of the pandemic, will benefit scholars and practitioners alike. As many colleges and universities across the country have re-opened their campus for the 2020–2021 academic year, students, especially those who take in-person classes, would be concerned about the disease and continuing their study in this unprecedented time. On top of protecting students from the disease by promoting wearing masks and social distancing, it is imperative to pay attention to their mental health and make sure that they feel safe and healthy. To this end, higher education institutions should proactively reach out to all student populations, identify students at risk of mental health issues, and provide accessible and affordable care.

Biographies

is Assistant Professor of Higher Education at the University of Kentucky. She studies higher education policy, program, and practice and their effects on student success.

is an Assistant Professor of Integrated Strategic Communication at the University of Kentucky. She earned her Ph.D. in Media and Information Studies at Michigan State University. Her research interests include prosocial campaigns, consumer wellbeing, and civic engagement.

is an associate professor in the Division of Biomedical Informatics in the College of Medicine at the University of Kentucky. Dr. Kim’s current research includes: consumer health informatics, personal health information management, and health information seeking behaviors. She uses clinical natural language professing techniques and survey methodologies to better understand patients’ health knowledge and their health information uses and behaviors.

Author’s Contribution

The order of the authors in the title page reflects the share of each author’s contribution to the manuscript.

Data Availability

Code availability, declarations.

The authors declare that they have no conflicts of interest.

All authors agree to publish this paper.

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Contributor Information

Jungmin Lee, Email: [email protected] .

Hyun Ju Jeong, Email: [email protected] .

Sujin Kim, Email: ude.yku@miknijus .

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Instructor Strategies to Alleviate Stress and Anxiety among College and University STEM Students

• Jeremy L. Hsu
• Gregory R. Goldsmith

*Address correspondence to: Jeremy L. Hsu ( E-mail Address: [email protected] ).

Schmid College of Science and Technology, Chapman University, Orange, CA 92866

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While student stress and anxiety are frequently cited as having negative effects on students’ academic performance, the role that instructors can play in mitigating these challenges is often underappreciated. We provide summaries of different evidence-based strategies, ranging from changes in instructional strategies to specific classroom interventions, that instructors may employ to address and ameliorate student stress and anxiety. While we focus on students in science, technology, engineering, and mathematics, the strategies we delineate may be more broadly applicable. We begin by highlighting ways in which instructors can learn about and prepare to act to alleviate stress and anxiety. We then discuss how to better connect with students and build an inclusive, equitable, and empowering classroom environment. When coupled with strategies to change student evaluation and assessment, these approaches may collectively reduce student stress and anxiety, as well as improve student performance. We then discuss the roles that instructors may play in empowering students with skills that improve their time management, studying, and approach toward learning, with an eye toward ensuring their success across all their academic endeavors. We conclude by noting areas in which further research is needed to determine best practices for alleviating student stress and anxiety.

INTRODUCTION

Several recent measures have indicated increases in mental health challenges in U.S. college students ( Eisenberg et al. , 2013 ; Beiter et al. , 2015 ; Lipson et al. , 2018 ). In particular, a nationwide survey of undergraduate students in the United States identified stress (40% of all students) and anxiety (29% of all respondents) as the two most common impediments to academic performance ( American College Health Association [ACHA], 2019 ). Stress and anxiety are complex concepts, and their denotation has been the subject of considerable debate ( Lazarus and Folkman, 1984 ). Stress can be described as an individual’s perception that a situation exceeds their ability to cope and endangers their well-being, while anxiety is described as the ambiguous feelings that arise from unresolved stress (sensu Lazarus and Folkman, 1984 ; as described in Bamber and Kraenzle Schneider, 2016 ). It is important to note that studies in educational research do not always provide formal definitions for stress and anxiety, nor do they necessarily even distinguish between the two.

While stress and anxiety may differ, it is clear that both are major challenges facing college students. In fact, more than one-third of all college students report experiencing stress that impacted their academic performance within the past academic year ( ACHA, 2019 ; Morey and Taylor, 2019 ), and students with high stress are more at risk of attrition or leaving college ( Muller et al. , 2017 ). In addition, student anxiety can also negatively influence persistence in the biology major ( England et al. , 2017 , 2019 ). The prevalence of these mental health challenges is a complex issue that requires engaging stakeholders from across an institution, and there are undoubtedly many factors that can contribute to student anxiety and stress beyond academics. Here, we focus specifically on the role that instructors can play in supporting students and mitigating their stress and anxiety, providing a review of evidence-based practices that instructors can use to lower student stress and alleviate anxiety.

Learning and preparing to act

Connecting with students

Building an empowering atmosphere in the classroom

Reducing testing anxiety

Promoting effective academic skills

In addition, we provide a summary of these strategies ( Table 1 ) and a short list of recommended literature for instructors to read to learn more about these strategies ( Box 1 ). In all these strategies, we recognize that instructors may feel unqualified or uncomfortable addressing such challenges and may be wary of exacerbating mental health concerns ( White and LaBelle, 2019 ). We emphasize that our advice here does not suggest that instructors take the role of mental health professionals; clear boundaries must be established when interacting with students regarding issues of mental health more generally. However, we hope that these evidence-based strategies can help instructors become informed and improve their ability to act proactively and respond to such challenges.

Box 1. An Annotated List of Additional Reading

Cooper and Brownell (2020) : In this book chapter, Cooper and Brownell summarize the literature on how active learning impacts anxiety in the college science classroom and provide more information on how to best employ active-learning techniques while minimizing stress.

Tanner (2013) : In this synthesis paper, Tanner provides a summary of strategies instructors can take to improve engagement and equity in the classroom. While this article was not written in the context of reducing stress and anxiety, it provides direct and useful strategies for building an inclusive classroom, and several of the strategies outlined (learn or have access to students’ names, do not judge responses, use praise with caution, etc.) may increase instructor immediacy. Promoting an empowering classroom atmosphere and increasing instructor immediacy may lower stress and anxiety.

Hodges (2018) : In this article, Hodges discusses different types of group work in the classroom, group formation, how students learn in groups, and why some groups fail. This article provides insight into how instructors can most effectively manage group work, thus lowering stress.

Regehr et al. (2013) : In this article, Regehr and coauthors provide a review and meta-analysis of interventions to lower stress in college students. While most of the interventions are broader campus-level interventions that are not realistically implemented in a classroom by an instructor, the article provides great insight into what techniques are most effective at lowering stress in college students.

LEARNING AND PREPARING TO ACT

In this first category, we describe the steps that instructors can take to familiarize themselves with the many ways that stress and anxiety can manifest in students, as well as the campus resources for helping students in crisis. Instructors, in part because of their frequent contact with students, can play a critical role as “first-line responders” in recognizing challenges, rendering support, and redirecting students to other resources ( Di Placito-De Rango, 2018 ).

Recognizing Underlying Mental Health Challenges

Academic performance and the pressure to succeed (or, conversely, the fear of failing) are known drivers of stress and anxiety in college students ( Beiter et al. , 2015 ). Both stress and anxiety have been closely associated with depression and other mental health challenges as well as physical illness in college students ( Kumaraswamy, 2013 ; Mahmoud et al. , 2012 ; Rawson et al. , 1994 ). These mental health challenges can manifest in many different forms, including depression and thoughts of, or attempts at, suicide ( Garlow et al. , 2008 ).

Although instructors cannot (and should not) serve as health professionals, instructors can learn about common mental health challenges relating to stress and anxiety. Instructors who familiarize themselves with and are aware of mental health challenges can better direct students to the proper resources and likewise will have greater insight into how to approach these conversations with students if and when they arise.

Many universities offer seminars or short trainings led by the campus health resources that are explicitly intended for instructors. While there is no replacement for seeking professional help, and some students may need more intensive mental health supports, these workshops provide instructors with basic training on how to provide support and identify students in need. Trainings can enable instructors to be more familiar with the range of potential mental health challenges students may be facing, guide instructors through how to hold conversations supporting students and referring them to mental health resources when needed, and provide a range of possible resources for instructors to be aware of. Trainings often include role-playing practice sessions to allow instructors to be more comfortable in conversations in which students approach an instructor and appear anxious, depressed, or suicidal. Trainings may also discuss the role of faculty as mandated reporters in connecting students in danger with additional resources. For those who wish to educate themselves further or whose campuses lack resources, the American College Health Association ( www.acha.org ) and the Jed Foundation ( jedfoundation.org ) are two organizations that provide accessible starting points. The more instructors become familiar with these underlying mental health challenges, the better prepared they are to appropriately respond and refer students to the proper resources when faced with a student in need.

Know and Promote Campus Resources

Instructors can familiarize themselves with various campus resources, such as where to refer students if they need mental health assistance, as well as the campus public safety office and emergency medical services. However, many universities also have an explicit protocol for contacting the office of student affairs (or equivalent) if an instructor is concerned about a student who is experiencing an emergency and/or needs more immediate mental health assistance. Having a list of phone numbers and addresses easily accessible can be helpful so that instructors can connect a student to the appropriate resources or contact such resources directly when appropriate if there is a student in need (e.g., if a student appears to be struggling, has abruptly changed their behavior, or has communicated major stressors, like a death in the family, with the instructor). Similarly, instructors should encourage students to use the resources available on campus. Common resources (albeit with different titles, depending on the institution) include counseling services, academic tutoring centers, and disability services. College students consistently report a poor understanding of what mental health resources are available to them, and instructors can play a role in increasing awareness ( Zivin et al. , 2009 ; Dobmeier et al. , 2013 ). Even if they are aware of the resources, students may be hesitant to reach out due to a perceived stigma or other barrier ( Eisenberg et al. , 2009 ; Wu et al. , 2017 ). Engaging students in conversation does not guarantee that they will seek additional help ( Mitchell et al. , 2012 ). Nevertheless, discussing these resources and encouraging students to use these support systems can ensure that more students experiencing stress, anxiety, or other mental health challenges are paired with the proper resources.

A range of other campus resources are often available to students to help alleviate stress and anxiety stemming from academic pressures. Many universities offer courses or workshops on academic skills, study strategies, and time management; different variants of these programs have been shown to promote student performance and retention and lower stress, as discussed later in the section on effective academic skills ( Macan et al. , 1990 ; Kimbark et al. , 2017 ). Some universities also offer peer tutors who can assist with either course content or academic skills. Instructors can familiarize themselves with these resources, ensure that students in their classes are aware of these resources, and refer students to these support systems when needed.

CONNECTING WITH STUDENTS

In this category, we discuss several strategies that instructors can use to promote connections with students. Establishing these connections increases instructor immediacy, the perception of relational closeness and connection between the student and the instructor ( LeFebvre and Allen, 2014 ). This can make students more comfortable in class and more willing to engage with the instructor both inside and outside class ( Cooper et al. , 2017 ). Unsurprisingly, it has been demonstrated in both non-STEM and STEM classes that student anxiety decreases as instructor immediacy increases ( Williams, 2010 ; Mazer et al. , 2014 ; Kelly et al. , 2015 ). Thus, while there are only a limited number of studies directly examining the impact of the strategies we describe here on student stress or anxiety, each strategy has been shown to promote instructor immediacy and thus may help mitigate student anxiety.

Use Student Names

One of the simplest steps that instructors can take to connect with students and increase instructor immediacy may be to learn and use their preferred names and pronouns. While learning names may be more challenging for instructors teaching large classes, there are several strategies that instructors can use to learn student names more effectively. For instance, many institutions offer photo rosters to help instructors recognize and learn student names. Similarly, an increasing number of institutions now allow students to record their name out loud, helping instructors pronounce names more easily. Cooper et al. (2017) find that using name tents—pieces of paper on which students write and display their preferred names—helped dramatically increase the perception that the instructor knew student names in a high-enrollment biology class, which led students to report positive impacts on their attitudes, behaviors, and perceptions of the course. For instance, many students felt more valued, more invested in the course, and more comfortable communicating with the instructor and reaching out for help; they also stated that the use of names made them feel like the instructor cared about them and helped establish better student–instructor relationships ( Cooper et al. , 2017 ). These are all attributes that promote increased instructor immediacy and are thus associated with reduced anxiety ( Jaasma and Koper, 1999 ; Baker, 2004 ; Creasey et al. , 2009 ). Notably, the results reported by Cooper et al. (2017) are despite the fact that the instructor did not actually know the names of all students. Instructors can also ask students to write preferred pronouns on their name tents if the students are comfortable doing so; this optional use of pronouns provides an opportunity for lesbian, gay, bisexual, transgender, queer, intersexual, or asexual (LGBTQIA) students to convey their preferred pronouns for both the instructor and their classmates if they so wish, thus creating a more inclusive environment and potentially lowering their stress ( Cooper et al. , 2020 ). Students have also reported that instructors learned their names through interactions during class, immediately before and after class, during office hours, and in other conversations outside class time ( Cooper et al. , 2017 ). However, instructors should be cognizant that the use of names in some contexts may increase anxiety; students in K–12 classrooms have reported anxiety if instructors mispronounce their names ( Kohli and Solórzano, 2012 ), and the use of names for random cold-calling can also increase anxiety ( Cooper et al. , 2018a ; Waugh and Andrews, 2020 ). Beyond using name tents, we have found that arriving a few minutes before the start of class to allow for time to set up, as well as to check in and greet students, allows us to more effectively connect with students and learn their names.

Empathize with Students and Provide Opportunities for Interpersonal Connection

In addition to learning and using student names, instructors should work to empathize with students and provide opportunities for interpersonal connection; these attributes have been shown to increase the perception of students that instructors care about them ( Teven, 2001 ), which has been shown to be associated with increased instructor immediacy ( Schutt et al. , 2009 ). In addition to the informal conversations that occur in the few minutes before and after each class, sharing personal stories can also enliven the classroom and help counter student perceptions about the course, topic, and/or instructor. The use of “noncontent instructor talk” in class—defined as any instructor language that does not directly convey the course concepts—has been documented as a way to build the relationship between the instructor and student, establish classroom culture, and increase instructor immediacy ( Seidel et al. , 2015 ). Our own experiences suggest that noncontent instructor talk outside class (e.g., during office hours or individual meetings with students) may also provide the same benefits. By sharing certain personal experiences, we enable interpersonal connection and may promote a growth mindset by illustrating our own growth when we were students (as discussed later). For instance, when faced with students who struggle on a quiz or exam, we often bring up an example of an undergraduate exam gone wrong from our own experiences as students. We then discuss how we changed our study habits and how we improved following that experience. Sharing these stories encourages students and likely promotes greater instructor immediacy that may lower anxiety by showing that it is possible to recover from a poor test performance.

The use of appropriate humor in class can also lessen anxiety in the classroom ( Wanzer and Frymier, 1999 ; Cooper et al. , 2018b ). While there are many categories of inappropriate humor (such as ones that marginalize or disparage groups of students) that can damage student–instructor relationships, the use of appropriate humor can be used to strengthen the student–instructor relationship and establish a more positive classroom climate ( Bekelja Wanzer et al. , 2006; Cooper et al. , 2020 ) . In addition, the use of humor can also increase student perceptions of learning as well as their motivation and willingness to engage in class ( Wanzer and Frymier, 1999 ; Neumann et al. , 2009 ; Banas et al. , 2011 ). Embedding humor into exams and other assessments has also been shown to lead to lower stress and increased perception of exam performance by students ( Berk, 1996 , 2010 ).

BUILDING AN EMPOWERING ATMOSPHERE IN THE CLASSROOM

While connecting with students is important, it is equally critical to build a classroom atmosphere that empowers all students to feel comfortable learning, which may correlate with reduced student anxiety in the biology classroom in some contexts ( Cooper and Brownell, 2016 ). There are several strategies that instructors can take to promote such a dynamic.

Shape Active-Learning Strategies to Minimize Anxiety

The benefits of active-learning strategies have been well documented, including increased learning for students, a decrease in the achievement gap for identities historically underrepresented in the sciences, and improved attitudes and perceptions toward science ( Armbruster et al. , 2009 ; Haak et al. , 2011 ; Freeman et al. , 2014 ; Theobald et al. , 2020 ). However, recent research has indicated that many active-learning techniques can also increase student anxiety or the perceptions of student anxiety ( England et al. , 2017 ; Cooper et al. , 2018a ; Cooper and Brownell, 2020 ; Downing et al. , 2020 ) and that students employ both adaptive and maladaptive strategies to cope with this anxiety ( Brigati et al. , 2020 ). Ultimately, students with high anxiety may even learn less in an active-learning classroom ( Cohen et al. , 2019 ). Some techniques, such as cold-calling—asking a student to share a response with the class without the student volunteering—have been identified as producing particularly high anxiety in students ( England et al. , 2017 ; Cooper and Brownell, 2020 ; Waugh and Andrews, 2020 ). Even modifying common techniques, such as cold-calling, to reduce apprehension may still lead to increased student anxiety as compared with not using such techniques ( Broeckelman-Post et al. , 2016 ). In addition, different demographics of students (e.g., underrepresented students and students who speak English as a second language) may feel disproportionate amounts of stress and anxiety in an active-learning classroom ( Mak, 2011 ; Freeman et al. , 2014 ; Cooper and Brownell, 2016 ). Similarly, such active learning has the potential to disproportionately impact underrepresented students; for instance, Cooper and Brownell (2016) find that students in biology classes who are LGBTQIA report that in-class group work, particularly if they are not allowed to choose their own groups, can increase their stress and anxiety, given that they are faced with the challenge of potentially working with students who are not accepting of their identities.

While the diversity of active-learning techniques makes it challenging to generalize about active learning and classroom anxiety, there are a few active-learning techniques that may be less stressful than others. For instance, Cooper et al. (2018a) find that some types of active-learning strategies, such as clicker questions and group work, have the potential to help lower anxiety levels for some students. Ultimately, few studies to date have investigated the impact of active-learning interventions on reducing anxiety. While none of these studies suggest that instructors move away from active-learning techniques, given their benefits to student learning and retention, instructors can take steps to minimize the stress and anxiety often associated with these techniques by explaining the rationale behind their pedagogical techniques, allowing students to form their own groups, and providing students the time to think individually and share with partners before being asked to share with the class ( England et al. , 2017 ; Cooper et al. , 2018a ). These steps can also increase trust in the instructor in an active-learning class, which has been shown to lead to increased student performance ( Cavanagh et al. , 2018 ), and would likely promote a more comfortable classroom atmosphere. While the term “active learning” encompasses a wide range of possible techniques in biology education and STEM education more generally ( Driessen et al. , 2020 ), instructors can use evidence-based guides and frameworks to aid their implementation of active learning and their response to student feedback (e.g., Allen and Tanner, 2005 ; Seidel and Tanner, 2013 ; Stains and Vickrey, 2017 ). Our own experiences align, with several students expressing to us in past courses that while they were initially resistant to some of the active-learning techniques we implemented in class, hearing the pedagogical justification and seeing the results made them more accepting of these techniques.

Be Deliberate when Forming Student Groups

There is a growing body of empirical studies examining student group work and its impact on learning and attitudes ( Jensen and Lawson, 2011 ; Chang and Brickman, 2018 ; Hodges, 2018 ).

While the formation of groups is highly context dependent (e.g., size of class, lower division or upper division, duration of group work), several studies have found that student learning and perceptions of learning increase, and anxiety decreases, when students are familiar with and comfortable sharing with their group mates ( Theobald et al. , 2017 ; Downing et al. , 2020 ). Student anxiety is often driven by the fear of negative evaluation by peers and instructors ( Watson and Friend, 1969 ; Weeks et al. , 2005 ; Downing et al. , 2020 ), and thus instructors can take steps to promote student familiarity and comfort with their groups. These include activities that provide an opportunity for students in groups to get to know one another and to establish group norms ( Chapman and Auken, 2001 ). Students have also reported more positive group experiences with increased structure in group work ( Theobald et al. , 2017 ; Chang and Brickman, 2018 ). Thus, instructors may be able to lower student stress by assigning roles for students in groups; providing clear expectations with specific goals, objectives, and deadlines; and structuring activities so that students bring different pieces of expertise to the project.

Instructors may also allow students to choose their own groups, depending on the course context. Doing so can lessen stress and anxiety, particularly among students who may not wish to disclose parts of their identities ( Cooper and Brownell, 2016 ). Allowing students to choose their own groups can also lessen fear of negative evaluation by their peers and thus decrease stress ( Cooper and Brownell, 2020 ; Downing et al. , 2020 ). However, instructors should be aware that doing so may increase stress and anxiety for some students, such as those who do not readily find a group ( Rosser, 1998 ; Strauss et al. , 2011 ; Henning et al. , 2019 ; Juvonen et al. , 2019 ).

Our own experience with group work affirms the complicated nature of forming student groups. Our best outcomes often come from forming groups around an affinity for a theme or topic that will be pursued for the project (e.g., a group of students all interested in doing a final project focused on genetics). We have also observed that allowing groups to remain consistent for a longer period of time (e.g., an entire unit or a semester-long project) can allow for group norms and foster a sense of community in the classroom that also extends outside the classroom, with students forming social networks with their groups and also relying on their partners for studying. Instructors may wish to refer to the evidence-based guide to group work from Wilson et al. (2018) , which provides further context on the formation of groups.

Create an Inclusive and Equitable Classroom

Because student anxiety is often driven by fear of negative evaluation, fostering an inclusive and equitable classroom atmosphere where students are comfortable with being wrong can decrease student anxiety and stress and promote a more inclusive classroom ( Cooper and Brownell, 2020 ; Downing et al. , 2020 ). Downing et al. (2020) find that student fear of negative evaluation may be reduced by allowing students to work in groups with other students whom they know (see previous section), providing a chance for students to talk to their classmate before sharing with the class (referred to as “warm calling”), and framing errors as part of the learning process. Positive error framing can reduce stress and lead to both improved metacognition and learning for the student ( Steele-Johnson and Kalinoski, 2014 ; Downing et al. , 2020 ). If a student does perform poorly, Henry et al. (2019) outline a theoretical framework for how students can appropriately cope (e.g., problem solving, support seeking, and cognitive restructuring); by encouraging student ownership over their own learning and providing support, instructors may lessen the impact of the failure, promote future improvement, and ultimately alleviate stress.

Choose Words Carefully

Instructors can be cognizant of their choice of language and avoid microaggressions that may either consciously or subconsciously lead to some students not feeling welcome or included ( Harrison and Tanner, 2018 ). Microaggressions—directly or indirectly speaking negatively about student identities—can make students feel unwelcome and thus elevate stress and contribute to anxiety ( Harrison and Tanner, 2018 ). In contrast, the use of “microaffirmations”—any nonobvious verbal or nonverbal cues to demonstrate kindness—can counteract the impact of microaggressions and promote student persistence ( Estrada et al. , 2019 ). Such microaffirmations have been suggested to lower stress in certain populations of college students, such as first-generation students ( Ellis et al. , 2019 ), perhaps by alleviating a sense of isolation that can be associated with stress and anxiety ( Harrison and Tanner, 2018 ).

Instructors can similarly reduce stereotype threat, that is, the “risk of confirming a negative stereotype,” or an association/expectation of conforming to a preconceived notion about a certain group of individuals ( Steele and Aronson, 1995 ). Stereotype threat has been shown to increase student anxiety ( Bosson et al. , 2004 ; Osborne, 2007 ) and negatively impact student performance and achievement ( Osborne, 2001 ; Cadinu et al. , 2003 ). In addition to eliminating language that promotes stereotype threat, instructors can also perform specific interventions to mitigate stereotype threat. Seidel et al. (2015) posit that some types of noncontent instructor talk can help reduce stereotype threat. For instance, explicitly delinking the often-perceived association between exams and intelligence can decrease the impact of stereotype threat ( Croizet and Claire, 1998 ; Spencer et al. , 1999 ; Binning et al. , 2020 ). Similarly, Johns et al. (2005) find that explicitly teaching about stereotype threat can help reduce the negative impacts of such stereotype threat; in their study, an intervention in which the instructor explained the idea of stereotype threat to women before those women took a math exam led to lower anxiety and higher performance.

In contrast to the negative impacts of stereotype threat, interventions that promote values affirmation—the process of positively reinforcing values important to students—can counter the effects of stereotype threat ( Jordt et al. , 2017 ). Values affirmation may also lower stress levels ( Creswell et al. , 2005 ), though some specific values affirmation interventions may not alleviate levels of anxiety ( Czech et al. , 2011 ; Peters et al. , 2017 ). Despite this, values affirmation has been found to increase performance and reduce achievement gaps ( Cohen et al. , 2006 ; Miyake et al. , 2010 ; Freeman et al. , 2014 ; Peters et al. , 2017 ). Even simple interventions that ask students to describe their values and how they practice and demonstrate these values in everyday life can be beneficial for students ( Jordt et al. , 2017 ).

REDUCING TESTING ANXIETY

Exams and tests can often be a source of stress and anxiety for students. In this section, we first describe structural changes that instructors can make to such assessments to lower stress and anxiety and then describe interventions that can be used to lower anxiety before or during such assessments.

Reduce or Modify High-Stakes Testing

High-stakes testing has been known to cause anxiety in students across a diversity of settings ( Cizek and Burg, 2006 ; Kruger et al. , 2007 ). In addition, there is evidence that women and underrepresented students may be disproportionately disadvantaged by such high-pressure exams ( Ballen et al. , 2017 ). Test anxiety can also contribute to increased student perceptions of difficulty and lower academic performance ( England et al. , 2019 ). As such, if instructors can reduce or eliminate high-stakes testing whenever possible, then this may reduce student anxiety ( Putwain, 2008 ). For example, instructors can add smaller-stakes quizzes to reduce the proportional weight of exams as well as to create a means for formative assessment that informs both the instructor and learners. In addition, instructors can implement schemes to reward improvement over time (e.g., Bailey et al. , 2017 ) or drop the lowest quiz or exam score. This approach lowers the potential impact of each individual assessment. Finally, instructors can explore alternate means of assessments beyond high-stakes testing, such as problem sets, essays, and lab reports ( Ballen et al. , 2017 ). Beyond the potential to reduce stress, using a diversity of methods for assessments (and thus lowering the weight of exams) has been shown to reduce the achievement gap of females in biology on both exams and the course as a whole ( Ballen et al. , 2017 ).

In addition, multiple studies demonstrate that open-book exams, or exams wherein students can bring in a “cheat sheet” with notes, can lower student stress ( Durning et al. , 2016 ; Erbe, 2007 ; Gharib and Phillips, 2012 ). However, the impacts of modifying exams to allow notes on student learning is unclear; while some studies report some improved learning gains or no impact on student learning or performance ( Sato et al. , 2015 ), other studies have found negative consequences on learning, retention, and student motivation ( Moore and Jensen, 2007 ; Durning et al. , 2016 ).

Perform Classroom Interventions

There are also several interventions that instructors can implement to help reduce student anxiety and/or increase student performance for an exam or a course. For instance, concept mapping has been found to lower student anxiety about the learning of biology, a benefit attributed to increased metacognition, as discussed elsewhere ( Okebukola and Jegede, 1989 ; Jegede et al. , 1990 ). In addition, asking highly anxious students to write about their testing worries immediately before an exam has repeatedly been demonstrated to help counter the expected negative impact of this anxiety on their test performance ( Frattaroli et al. , 2011 ; Ramirez and Beilock, 2011 ; Park et al. , 2014 ). Similarly, several studies on stress reappraisal, the guiding of students to perceive stress and anxiety as beneficial given the possibility of increased focus and attention, have also been shown to both decrease anxiety and increase exam performance ( Jamieson et al. , 2013 ; Jamieson et al. , 2016 ). In sum, these interventions have been shown to increase student performance for all students, including both low- and high-anxiety students ( Harris et al. , 2019 ). Instructors can either implement these interventions or let students know of the relevant research if they struggle with testing anxiety. Similarly, instructors can use published interventions relating to these themes that have been successfully implemented in a variety of courses ( Doherty and Wenderoth, 2017 ; Harris et al. , 2019 ). Finally, there are also a number of more general interventions that instructors can promote to lower stress, such as providing access to “comfort” or therapy dogs before an exam ( Barker et al. , 2016 ; McDonald et al. , 2017 ; Schroder et al. , 2017 ; Trammell, 2017 ; Jarolmen and Patel, 2018 ), or encouraging students to attend mindfulness and meditation classes ( Bamber and Kraenzle Schneider, 2016 ).

PROMOTING EFFECTIVE ACADEMIC SKILLS

The strategies that have been described thus far are implemented by an instructor to reduce student stress and anxiety. However, there are many academic skills and strategies that a student could use to lower stress and anxiety; these strategies can therefore be implemented directly by the student in any course. In this section, we describe strategies that instructors can recommend to their students to improve time management and study skills, as well as promote students’ own thinking about how they learn and their mindset toward the process of learning. While we acknowledge that instructors can also recommend ways in which students can cope with (i.e., manage) stress and anxiety, our intent here is to discuss strategies that instructors can instead take to prevent student stress and anxiety.

Instill Effective Study Habits and Time Management Skills

Ineffective study habits and time management have been found to correlate with anxiety and lower student performance, and thus there have been calls for instructors to facilitate development of these skills in order to lower student anxiety ( Wittmaier, 1972 ; Bruch, 1981 ; Macan et al. , 1990 ; Nonis et al. , 1998 ; Cizek and Burg, 2006 ). Students may not be aware of how to study effectively, and thus instructors can promote these study strategies by discussing them with their classes. These strategies include 1) explicitly discussing the use of learning objectives with students and modeling the writing of a question based on a learning objective ( Osueke et al. , 2018 ); 2) suggesting that students retake past quizzes, exams, and assessments and reflect upon their performance ( Walck-Shannon et al. , 2019 ); 3) teaching students how to self-evaluate their own work ( Osterhage et al. , 2019 ); 4) guiding students toward self-regulated learning, wherein they set goals and monitor progress toward those goals ( Sebesta and Bray Speth, 2017 ); 5) encouraging group studying, so students can clarify concepts with peers ( Kritzinger et al. , 2018 ); and 6) promoting regular and spaced-out study time in preparation for tests ( Roediger and Karpicke, 2006 ).

Similarly, targeted programs to promote time management in college students have lowered their stress and anxiety ( Häfner et al. , 2014a , b ; Aeon and Aguinis, 2017 ). The core elements of these interventions include prioritizing, goal setting, strategy development, daily planning, and the establishment of monitoring and reward structures as achieved by a series of self-reflection questions followed by a planning exercise ( Häfner and Stock, 2010 ). Such interventions may be particularly useful for reducing procrastination and time discounting on larger or more long-term activities ( Koch and Kleinmann, 2002 ). We regularly implement brief self-reflection exercises in the classroom, often focused on daily planning that includes the explicit incorporation of rewards that are also expected to reduce stress and anxiety (e.g., going to the gym to exercise after finishing an assignment).

Use Metacognition

Multiple studies have indicated that promoting metacognition, a process in which students think about and reflect upon their own learning, can lead to reductions in test and course anxiety ( Alaiyemola et al. , 1990 ; Everson et al. , 1994 ; Matthews et al. , 1999 ; Spada et al. , 2006 ). Students generally need to be prompted to deliberately engage in metacognition, and instructor assistance may be needed to guide student thinking about studying, particularly for students earlier in their college careers ( Stanton et al. , 2019 ). For instance, instructors can implement exam wrappers, a questionnaire usually provided to students after an exam that asks them to reflect on their studying, preparation, and performance on the exam ( Pate et al. , 2019 ). The use of exam wrappers may lead to increased knowledge of cognition and higher performance ( Gezer-Templeton et al. , 2017 ; LaCaille et al. , 2019 ; Langdon et al. , 2019 ; Edlund, 2020 ). Instructors may also choose to use “enhanced answer keys” with reflective metacognitive questions embedded to deliberately prompt student metacognition ( Sabel et al. , 2017 ). Similarly, instructors can implement such metacognitive questions into homework or problem sets or ask students questions that promote metacognition during individual or class meetings. For instance, as instructors, we regularly prompt students to use note cards to reflect on what they did well in the past week and what they wish to improve on in the coming week as a simple method for promoting metacognition.

Promote a Growth Mindset

Language that promotes a growth mindset, or the belief that skills, personality, and intelligence can change and be improved, has been linked to greater academic achievement and improved grades ( Claro et al. , 2016 ; Yeager et al. , 2019 ). This contrasts with a fixed mindset, whereby students believe that their intellectual abilities are immutable ( Dweck, 2000 ; Claro et al. , 2016 ). Likewise, fostering a growth mindset has been shown to mitigate stress and anxiety in psychological studies ( Schleider and Weisz, 2016 , 2018 ; Schroder et al. , 2017 ). While the literature examining a growth mindset and the impact on stress in the classroom is sparse, instructors can have a direct influence on students’ perceptions of a growth mindset ( Powers, 2015 ). Instructors can incorporate short messages promoting a growth mindset in the classroom and encourage further growth and improvement in students. We often praise students on improvement and encourage students who struggle to come talk to us, reflect on their learning, and then improve on the next assessment. In addition, course policies that reward increased learning may also promote a growth mindset, reducing anxiety while fostering and maintaining student motivation. For example, Fernandez (2020) describes promoting a growth mindset by structuring grading around mastery, while providing students a second chance at answering questions on an exam.

OPPORTUNITIES FOR FUTURE RESEARCH

While the relationships between student stress and anxiety and academic performance are relatively well established, there remain many opportunities to establish and strengthen our understanding of what practices instructors can adopt to decrease stress and anxiety. We highlight three main areas.

How Applicable Are These Strategies and Interventions for Reducing Stress and Anxiety among Different Demographics?

Students report different levels of stress and anxiety depending on gender, ethnicity, and sexual orientation ( Eisenberg et al. , 2013 ; Posselt and Lipson, 2016 ). It is not clear that a strategy to reduce stress and anxiety studied among one student demographic will be applicable to another. Moreover, there appear to be systematic biases in the current literature. For instance, a recent analysis of biology education research found biases in study populations, with the majority of studies focusing on undergraduate students at research-intensive institutions ( Lo et al. , 2019 ). Relatively few biology education studies have focused on community college and transfer students, despite those students making up nearly half of postsecondary biology students in the United States and generally comprising a more diverse population than students at research-intensive institutions ( Schinske et al. , 2017 ). We found only a few studies that focused explicitly on studying stress or anxiety in these populations ( Powers, 2015 ; Kimbark et al. , 2017 ; Downing et al. , 2020 ). Future research is needed to examine the generalizability of these strategies among different student populations and among different identities more generally.

How Applicable Are These Strategies and Interventions for Reducing Stress and Anxiety in Different Contexts?

Students also report different levels of stress and anxiety depending on STEM major ( May and Casazza, 2012 ). It is not clear that a strategy to reduce stress and anxiety studied in one discipline will be applicable to another or that the strategy will be relevant for different concepts within a discipline. For instance, some of the strongest evidence regarding strategies that can reduce anxiety and increase performance (e.g., informing certain groups about stereotype threat, using humor to connect with students, expressive writing before taking an exam) arise from studies carried out in mathematics and statistics courses ( Spencer et al. , 1999 ; Johns et al. , 2005 ; Neumann et al. , 2009 , p. 200; Williams, 2010 ; Park et al. , 2014 ). Each of these strategies could be applied in biology; however, their efficacy generally remains untested. Similarly, if effective, the strategies could also be applied to reduce math anxiety in the context of the biology classroom (e.g., Madlung, Bremer, Himelblau, and Tullis, 2011 ). Future research is needed to examine whether strategies applied in one context will work in another context. When combined with the need to consider how different student identities respond to a given strategy, this presents a significant challenge for the field moving forward.

What Strategies Have a Weak or Nonexistent Evidence Base?

In many cases, the strategies that we identify here currently lack evidence for direct linkages with reductions in stress and anxiety. For instance, the use of student names is predicated on the linkage between name use and instructor immediacy. There is a need for additional research that explicitly measures student stress and anxiety as a function of different classroom interventions, even if only ancillary to the primary purpose of the study. This research should strive to adopt more explicit definitions of stress and anxiety, although we recognize that the many conceptualizations of stress and anxiety make this quite challenging ( Lazarus and Folkman, 1984 ). In addition, we identified several strategies that are likely to be related to student stress and anxiety but have no clear evidence base. For instance, many students perceive office hours negatively, with students often citing apprehension about using office hours and viewing them as a last resort ( Smith et al. , 2017 ). Despite the stress and anxiety that can be created by office hours, research on best practices remains limited and presents an area for future research.

Some stress and anxiety are likely unavoidable, and students can also learn various coping mechanisms through the adoption of healthy academic (e.g., problem solving, information seeking, emotional regulation, etc.; Henry et al. , 2019 ) and self-care habits (e.g., sufficient sleep, getting exercise, identifying a supportive community of friends; Myers et al. , 2012 ). However, we have focused here on identifying evidence-based strategies that instructors can employ to try to reduce student stress and anxiety so that students can reach their full potential in the classroom. These strategies span a range of approaches, from modifying instructional techniques to empowering students with different mindsets and tools that they can use to alleviate stress. Instructors can pick and choose among these strategies depending on context, but should always think about ways to assess their efficacy. In that sense, our review also exposes the need for new studies that explicitly link instructional techniques with student stress and anxiety and that identify how those relationships vary among STEM disciplines and across diverse student demographics.

ACKNOWLEDGMENTS

G.R.G. is supported by the Grand Challenges Initiative at Chapman University. We thank L. Sanchez for assistance with references. We thank the reviewers and handling editor for valuable suggestions and feedback. In addition, we thank D.S. Newman and the faculty and staff of the Grand Challenges Initiative for helpful comments that improved this essay.

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Submitted: 17 August 2020 Revised: 4 January 2021 Accepted: 8 January 2021

© 2021 J. L. Hsu and G. R. Goldsmith. CBE—Life Sciences Education © 2021 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

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Open Access

Peer-reviewed

Research Article

Persistent anxiety among high school students: Survey results from the second year of the COVID pandemic

Roles Conceptualization, Data curation, Formal analysis, Writing – original draft

Affiliation Irvington High School, Irvington, New York, United States of America

Roles Conceptualization, Writing – review & editing

Roles Investigation

Roles Formal analysis, Methodology, Writing – review & editing

Affiliation HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, New York, United States of America

Roles Conceptualization, Formal analysis, Methodology, Supervision, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

• Olivia Yin, 
• Nadia Parikka, 
• Amy Ma, 
• Philip Kreniske, 
• Claude A. Mellins

• Published: September 30, 2022
• https://doi.org/10.1371/journal.pone.0275292
• Reader Comments

Introduction

National mental health surveys have demonstrated increased stress and depressive symptoms among high-school students during the first year of the COVID-19 pandemic, but objective measures of anxiety after the first year of the pandemic are lacking.

A 25-question survey including demographics, the Generalized Anxiety Disorder-7 scale (GAD-7) a validated self-administered tool to evaluate anxiety severity, and questions on achievement goals and future aspirations was designed by investigators. Over a 2-month period, all students from grade 9–12 in a single high-school (n = 546) were invited to complete an online survey after electronic parental consent and student assent. Bi-variate and chi-square analyses examined demographic differences in anxiety scores and the impact on outcomes; qualitative analyses examined related themes from open-ended questions.

In total, 155/546 (28%) completed the survey. Among students with binary gender classifications, 54/149 (36%) had GAD-7 scores in the moderate or severe anxiety range (scores≥10), with a greater proportion among females than males (47% vs 21%, P<0.001). Compared to students with GAD-7<10, those with ≥ 10 were more likely to strongly agree that the pandemic changed them significantly (51% vs 28%, p = 0.05), made them mature faster (44% vs 16%, p = 0.004), and affected their personal growth negatively (16% vs 6%, p = 0.004). Prominent themes that emerged from open-ended responses on regrets during the pandemic included missing out on school social or sports events, missing out being with friends, and attending family events or vacations.

In this survey of high school students conducted 2 years after the onset of COVID-19 in the United States, 47% of females and 21% of males reported moderate or severe anxiety symptoms as assessed by the GAD-7. Whether heightened anxiety results in functional deficits is still uncertain, but resources for assessment and treatment should be prioritized.

Citation: Yin O, Parikka N, Ma A, Kreniske P, Mellins CA (2022) Persistent anxiety among high school students: Survey results from the second year of the COVID pandemic. PLoS ONE 17(9): e0275292. https://doi.org/10.1371/journal.pone.0275292

Editor: Ravi Shankar Yerragonda Reddy, King Khalid University, SAUDI ARABIA

Received: June 27, 2022; Accepted: September 13, 2022; Published: September 30, 2022

Copyright: © 2022 Yin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information file.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

The long-term impact of the COVID-19 pandemic on the mental health of adolescents is still under investigation. A meta-analysis of 136 studies from various populations affected by COVID-19 found that at least 15–16% of the general population experienced symptoms of anxiety or depression [ 1 ]. The Adolescent Behaviors and Experiences Survey (ABES) an online survey of a probability-based nationally representative sample of students in grades 9–12 (N = 7,705) collected from January-June of 2021 in the United States, found that 37% of students experienced poor mental health during the pandemic [ 2 ]. During the 12 months before the survey, 44% experienced persistent feelings of sadness or hopelessness, 19.9% had seriously considered attempting suicide, and 9.0% had attempted suicide [ 2 ].

Adolescence is a development stage characterized by profound physiological, psychological and social change that could make them particularly vulnerable to stressful events [ 3 , 4 ]. Although fears of infection, sadness related to loss, and overwhelming uncertainty was experienced by people of all ages, the widespread disruption of education had profound effects on the mental health of children and adolescents [ 5 ]. Remote learning, restrictions placed on social gathering, cancellation or modification of sports or clubs, and in-school activities and events present major challenges for the education and social growth of young people. The disruption of school routines and isolation, loss of support from peers and teachers, not only makes learning difficult but can heighten the anxiety that adolescents already feel about their education and career [ 6 ]. Even before the pandemic, there were reports of increases in anxiety, depression, substance use among adolescents faced with excessive pressures to excel in affluent settings [ 7 ]. Social support from other students and teachers, especially during stressful times, is critical for the social-emotional well-being of adolescents and for sustaining academic engagement and motivation [ 8 – 10 ]. The COVID Experiences Survey, a nationwide survey of 567 adolescents in grades 7–12 performed in 2020, found that adolescents receiving virtual instruction reported more mentally unhealthy days, more persistent symptoms of depression, and a greater likelihood of considering suicide than students in other modes of instruction [ 11 ].

The Adolescent Behaviors and Experiences Survey and COVID Experiences Survey both assessed level of stress, symptoms of depression and consideration of suicide among high school students but did not specifically include an evaluation of anxiety [ 2 , 11 ]. Several smaller published surveys of mental health among adolescent high school students in the United States included assessments of anxiety, although not all of them included validated measures of anxiety or examined the consequences of heightened anxiety [ 12 , 13 ]. In addition, all were performed in 2020, during the first wave of the infection. To our knowledge, few if any studies have examined longer-term consequences of the COVID-19 pandemic on adolescent anxiety using validated tools. The goal of this study was to evaluate the longer-term impact of the COVID-19 pandemic on generalized anxiety in high school students using the General Anxiety Disorder-7 (GAD-7), a validated self-report measure, at the end of 2021. Variations by gender and the impact of anxiety on achievement goals, future aspirations and outlook of students were also explored.

Materials and methods

Study design.

This study was conducted at a single public high school in Westchester County of the State of New York. New York was one of the epicenters during the first wave of the COVID-19 epidemic in the United States with a peak daily infection rate of over 9,000 cases/day in April 2020. In response to the New York State Education Department Executive Order, the high school was closed to in-person learning in March 2020 and transitioned to online classes (remote learning). The school remained closed to in-person learning for the remainder of the academic year. After summer break, the school re-opened with remote learning and provided the option for students to return to hybrid learning on October 7, 2020. Hybrid learning consisted of in-person school for half the week and remote learning for the other half of the week with half the capacity of students in the school at any given time. The school also allowed students to continue with full-time remote learning. This decision was made to balance the benefits of in-person learning with safety guidelines by reducing the total number students in school at any given time. On April 7, 2021, the school transitioned from hybrid learning to 100% in-person learning for the remainder of the academic year but still allowed students the option of remote learning. On September 7, 2021, the school re-opened after summer break to 100% in-person learning for all students without the remote learning option. The decision to transition to in-person learning for all students in September 2021 was based upon the low case rates of COVID and the availability of COVID vaccination. The FDA announced the emergency use authorization of the Pfizer-BioNTech COVID-19 vaccine for individuals 16 years of age and older on December 11, 2020 and for individuals 12 years of age and older on April 9, 2021.

Participants

A total of 521 students were enrolled in the high school, with the following numbers of students in each grade: 142 in 9 th ,130 in 10 th , 120 in 11 th and 128 in 12 th grade. The student body composed of 242 females and 279 males, with the following racial/ethnic distribution: 79% White, 13% Asian, 7% Black/African American, 1% American Indian/Native American. This non-selective public high school is the only high school in town. For context, the racial distribution of Westchester County was 73% White, 7% Asian, 17% Black in the 2019 census, with a median household income (in 2019 dollars) of $96,610 and 49% of the population over 25 years having a bachelor’s degree or higher. In the same period, the median household income in the United States was $68,703 with 22.5% of population age 25 and older having bachelor’s degree or higher.

The Irvington School Board approved the survey instruments and the overall study. All students attending the high school in 9 th -12 th grade were eligible to participate. Participation was voluntary, each survey question was optional, and there were no incentives for completion of survey. All participants completed an electronic parental consent and student assent prior to performing the online survey. A survey link was posted by the science teachers on the science classroom pages for all eligible students to complete on November 24, 2021. Science teachers continued to promote the survey until its closure on January 13, 2022.

Study instruments

The survey was conducted online via Google Forms software (version 2018) in English, and contained 25 questions, 23 of which were multiple choice. Participants took approximately 10–15 minutes to complete the survey. The Generalized Anxiety Disorder-7 scale (GAD-7), a validated 7-item self-administered tool to evaluate anxiety severity, was utilized to measure anxiety [ 14 ]. GAD-7 has been utilized in adolescents and demonstrates an acceptable specificity and sensitivity for detecting clinically significant anxiety symptoms in comparison to the Pediatric Anxiety Rating Scale [ 15 ]. Participants are asked how often they were bothered by each of the following symptoms during the last 2 weeks with a 4-point scale ranging from “not at all” (0 points) to “nearly every day” (3 points): feeling nervous, anxious or on edge; not being able to stop or control worrying; worrying too much about different things; trouble relaxing; being so restless that it is hard to sit still; becoming easily annoyed or irritable; feeling afraid as if something awful might happen. The total score indicates the level of anxious symptoms ranging from minimal/no anxiety (0–4), mild (5–9), moderate (10–14) and severe (≥15).

Demographic data were collected, including current grade (9–12), gender (female, male, transgender man, transgender woman, non-binary, other), race (American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian or other Pacific Islander, other), whether attending school by hybrid or remote learning, and COVID-19 vaccination status (none, partial or full series).

Several questions were developed by the study team through an iterative process that included initial development of question by the student researcher, refinement of wording by all investigators including experts in adolescent development and cognition, and testing for comprehension and clarity through review by 2 additional students. Four questions on whether students had more anxiety upon return to in-person learning in April 2021 (after hybrid or remote learning) or September 2021 (after summer break), and factors associated with the anxiety associated with in-person learning were assessed. Thirteen questions were included to assess importance of relationships, safety, achievements and future aspirations (5-point Likert scale from very important to not important): having friends/socializing; perception by friends; making parents proud; maintaining family relationships; good health (not getting COVID); feeling safe; getting good grades; graduating high school; attending college; becoming famous; having adventure; having money/wealth; and having your own family. One additional question addressed outlook on future (5-point Likert scale from strongly agree to strongly disagree): “I think I will have more opportunities in life than my parents.” Three questions designed by the team assessed the impact of COVID-19 (5-point Likert scale from strongly agree to strongly disagree): “The COVID-19 pandemic has changed me significantly”; “The COVID-19 pandemic has made me mature faster”; Overall, the COVID-19 pandemic has affected my personal growth negatively.”

Two additional open-ended questions were included to allow students to reflect upon opportunities lost and gratitude experienced during COVID-19: “Share one moment that you regret missing out on during the COVID-19 pandemic,” and “Share one moment when you felt grateful during the COVID-19 pandemic”

Data analysis

Quantitative analysis..

Overall frequencies for demographics, GAD-7, and responses to questions on the importance of relationships, safety, achievements and opportunities were examined. Bivariate analyses by demographics characteristics (gender, grade, and learning type) were conducted with each response. Chi-square tests were conducted to determine whether responses differed by gender, grade, learning type, and severity of anxiety. All analyses were performed using SPSS Statistics for Mac, version 28.0 (SPSS Inc, Chicago, Ill, USA).

Qualitative analysis.

The answers to each open-ended question were evaluated for themes. The iterative process took the form of a data analysis spiral such that following data collection, the data was organized, read and notated for emerging ideas, described and classified by thematic codes, assessed and interpreted, and presented in this research report [ 16 ]. Author 1 read all the responses and compiled the data and created preliminary thematic codes. Author 2 reviewed the thematic codes and believed that thematic saturation had been reached. Author 1 then discussed all preliminary codes with all authors who provided additional memos. Representative excerpts for each theme are presented in Table 4 . Data saturation was defined using the grounded theory standpoint by Urquhart, that defined saturation as “the point in coding when you find that no new codes occur in the data. There are mounting instances of the same codes, but no new ones”[ 17 , 18 ].

Among the 546 students enrolled in the high school, 155/546 (28%) completed the survey, including 90 females, 59 males, and 6 students who did not identify as gender binary. Since the number of gender non-binary students was too small to include as a separate group in analyses looking at gender differences, results were presented only for students who self-identified as either female or male (n = 149) ( Table 1 ). The proportion of respondents was greater among females (90/262, 34%) than males (59/284, 21%). The response rates were much lower in 12 th grade (25/137, 18%) than in 9 th grade (61/139, 44%). The students were mostly White (69%), Asian (16%) or multi-racial (9%), predominantly engaged in hybrid learning (86%), and almost all (97%) fully or partially vaccinated against SARS-CoV-2 at the time of survey completion ( Table 1 ).

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https://doi.org/10.1371/journal.pone.0275292.t001

Overall, 54/149 (36%) of the students had GAD-7 scores in the range for moderate or severe anxiety (scores≥10), with a greater proportion of the females than males experiencing moderate/severe anxiety (47% vs 21%, X 2 = 21.3984, P<0.001) ( Table 2 ). Among students who answered yes to any of the GAD-7 questions, 3% reported that anxiety made it extremely difficult and 12% reported that anxiety made it very difficult to do their work, take care of things at home, or get along with other people. More females than males (19% vs 7%, p<0.01) reported that anxiety made it very or extremely difficult to do their work, take care of things at home, or get along with other people ( Table 2 ). Severity of anxiety did not differ between students in the lower (9 th and 10 th ) versus the upper (11 th and 12 th ) grades. Severity of anxiety also did not differ between students engaged in hybrid versus remote learning ( Table 2 ).

https://doi.org/10.1371/journal.pone.0275292.t002

More females than males felt anxious returning to in-person school in April 2021 (52% vs 27%; X 2 = 9.3457, p = 0.002) ( Table 1 ). COVID-19 vaccinations were available for individuals 16 years of age or older by December 2020 with emergency use authorization for individuals 12 years of age and older only granted on April 9, 2021. All of the major factors contributing to anxiety measured were more frequently reported in females than males: fear of getting COVID-19 (26% vs 15%), anxiety toward social interactions (20% vs 8%), and schoolwork (10% vs 5%). By September 2021, 51% of females and 44% of males reported feeling less anxious for in-person school than in April 2021. The primary reasons reported for decreased anxiety were the receipt of COVID-19 vaccinations (38%) and normalization of social interactions with in-person school (16%) ( Table 1 ).

Overall, 34% of students strongly agreed that the COVID-19 pandemic “changed me significantly” and 24% strongly agreed that it “made me mature faster” ( Table 3A ). However, only 8% of students strongly agreed that the COVID-19 pandemic “has affected my personal growth negatively.” More females reported that COVID-19 affected their personal growth negatively, but it did not reach statistical significance (11% vs 5%, p = 0.15). In comparison to students with either mild anxiety or no anxiety (GAD-7<10), students with moderate to severe anxiety (GAD-7≥10) were more likely than students with either mild anxiety or no anxiety (GAD-7<10) to strongly agree that the COVID-19 pandemic changed them significantly (51% vs 28%, p = 0.05), made them mature faster (44% vs 16%, p = 0.004), and affected their personal growth negatively (16% vs 6%, p = 0.004) ( Table 3B ).

https://doi.org/10.1371/journal.pone.0275292.t003

We further explored whether moderate/severe anxiety affected students’ outlook on relationships, safety, achievements, aspirations and opportunities. Over half of students reported the following life factors as very important: having friends/socializing (53%), maintaining good health and not getting COVID-19 (53%), getting good grades (62%), graduating high school (82%), and attending college (74%) ( Table 4 ). Females were more likely than males to regard the following factors as very important: money/wealth (28% vs 12%, p<0.01) and having your own family (39% vs 29%, p = 0.02), but did not differ from boys in other reported factors. Students with moderate to severe anxiety (GAD-7≥10) were more likely than students with mild or no anxiety to regard the following as very important: attending college (81% vs 70%, p = 0.04), becoming famous (9% vs 1%, p = 0.04), and having your own family (44% vs 31%, p = 0.01). Only 23% of students reported that they strongly agree with the statement “I will have more opportunities in my life than my parents”, without apparent differences by anxiety status ( Table 4 ).

https://doi.org/10.1371/journal.pone.0275292.t004

In response to “share one moment that you regret missing out on during COVID-19 pandemic,” the following themes emerged, from most common to least common: missing out on school social events and sports; being with friends; family events and vacations, wasted new opportunities that were presented during COVID-19 pandemic, and celebrating milestones like bar mitzvahs, sweet-sixteens and birthdays. In response to “share one moment when you felt grateful during the COVID-19 pandemic,” the following themes emerged, from most common to least common: connecting with friends and family, health and safety, having time for personal development, moments during which there was a sense of return to normalcy, and the decreased stress of remote learning ( Table 5 ). Generally, the noted themes were similar in students with moderate-severe anxiety versus those with mild or no anxiety. However, in comparison to students with mild or no anxiety, more students with moderate-severe anxiety expressed that they regret missing out on being with friends, and less expressed regret for missing out on school-related social events such as the prom, school trips, or sports competitions. Notably, while all the students with moderate-severe anxiety reported missing out on something, 5% of students with either mild or no anxiety reported that they did not miss out on anything during the COVID-19 pandemic. Also, more students with moderate-severe anxiety expressed that they were grateful for health and safety and situations that provided a sense of normalcy.

https://doi.org/10.1371/journal.pone.0275292.t005

In one of the first reports on levels of anxiety in high school students during the second year of the COVID pandemic, this study found that 36% of the students reported moderate or severe anxiety, disproportionately affecting females. Although the GAD-7 is a screener for anxiety and meant to over detect, anxiety scores in this range are considered clinically meaningful and indications for further assessment and/or referral to a mental health professional for more definitive diagnoses. These surveys were completed in late 2021 at a point when over 95% of students had received partial or full vaccinations; therefore, our data suggest that the impact of COVID-19 on the generalized anxiety of high school students may be long-lasting.

Our findings are consistent with several large mental health surveys that included measures of anxiety were conducted on university students in 2020, earlier in the COVID-19 pandemic, and found that females were more likely to report moderate to severe general anxiety then males. The Healthy Minds Survey 2020, one of the largest studies of university students in the United States (N = 36,875), found that 32.2% of students reported moderate to severe anxiety, with a higher proportion in females than males (66.6% vs 28.6% of males) [ 19 ]. Similarly, a survey of over 69,000 university students in France found that females were more likely to report high levels of anxiety than males (30.8% vs 17.1%) [ 20 ].

As noted previously, the largest mental health surveys conducted among high school students in the United States did not specifically include an evaluation of anxiety [ 2 , 11 ], but anxiety was included in two smaller studies. Gazmararian et al. surveyed racial/ethnically and socioeconomically diverse students at 2 semi-rural public high schools in Georgia in 2020 and found that 25% of students were worried about the COVID-19 pandemic and a negative financial impact, with a similar gender difference in girls versus boys (29% vs 16%, p<0.0001) [ 13 ]. The Policy and Communication Evaluation (PACE) Vermont is an online cohort study of 212 adolescents (ages 12–17) and 662 young adults (ages 18–25) that completed questionnaires in the Fall of 2019 and 2020, before and after the onset of the COVID-19 pandemic [ 12 ]. The prevalence of anxiety symptoms measured by the GAD-2 increased from 24.3% to 28.4% among adolescents after COVID-19, similar to the increase from 35.3% to 42.3% observed among young adults [ 12 ].

In our study, 36% of high school students had moderate/severe anxiety by GAD-7, which is slightly higher than the prevalence in aforementioned high school studies, and similar to the prevalence among college students in the Healthy Minds Survey. Female high school students were more likely to report moderate or severe anxiety. Importantly, this study explored potential reasons for anxiety upon return to in-person learning in April 2021, informed by high school students (including lead author) and a greater proportion of females than males endorsed each category: COVID-19 (26% vs 15%), schoolwork (10% vs 5%) and social interactions (20% vs 8%). These data suggest that female high school students had higher anxiety levels not only because of fear of COVID, but also because of more normative stressors pre-COVID, such as school and social pressures. Furthermore, females reported more negative effects of their anxiety compared to boys, with 19% reporting that it is “extremely difficult to do their work, take care of things at home, or get along with other people” as compared to only 9% of males. Notably, severity of anxiety did not appear to differ between students in the lower (9 th and 10 th ) versus the upper (11 th and 12 th ) grades. This was unexpected given higher levels of stress associated with standardized testing and college applications in the upper grades. Severity of anxiety also did not differ between students engaged in hybrid versus remote learning ( Table 2 ). However, since most of the students were engaged in hybrid learning (87%), our power to detect differences was limited. Other investigators found no difference in risk for anxiety among students with remote versus in-person education [ 21 ]; however, the role of hybrid learning has never been adequately assessed.

Students who reported moderate/severe anxiety had very different responses than students with either mild or no anxiety regarding the impact of the COVID-19 pandemic. Students with moderate/severe anxiety were far more likely to strongly agree that the COVID pandemic changed them (51% vs 28%), made them mature faster (44% vs 16%), and affected their personal growth negatively (16% vs 6%). It is possible that COVID-19 had a greater negative impact on these students resulting in higher anxiety levels, or that students with higher anxiety levels before the pandemic were more susceptible to the negative effects of COVID-19. This question cannot be addressed without pre-pandemic data on these students. However, it is interesting that even though students with moderate/severe anxiety perceived a greater negative impact of COVID-19, they did not differ from other students in their hopes and aspirations for the future. In fact, more students with moderate to severe anxiety responded that attending college, becoming famous, and having their own family was very important ( Table 4 ). This may also reflect a greater underlying expectation for success and a desire for safety and security among students with greater anxiety. This is an important area for future study. While students reported being concerned about good health and “not getting COVID-19,” less than half of the students (45%) rated “feeling safe” as very important. While these data may reflect the higher risk tolerance of adolescents in general vs other age groups, the data also suggest that the heightened awareness of safety measures for COVID-19 did not translate into generalized fear affecting other aspects of their lives. Overall, these data suggest that despite the relatively high proportion of students reporting anxiety, the majority did not perceive negative effects and thus appeared to be coping with the stressors of COVID-19.

This study was not designed for formal qualitative research, but there were two open-ended questions on regrets and gratitude. Missing out on school social or sports events was the most common theme, followed by missing out being with friends or attending family events or vacations. Several students also articulated missed opportunities for growth presented by COVID-19 and shared regrets for not accomplishing more with the extra time. Students shared their gratitude mostly for connecting with friends and family and for health and safety. There were also appreciations written for having a time for personal growth, moments during COVID-19 that provided a sense of normalcy, and the decreased stress from school that remote learning offered ( Table 4 ). Based upon exploratory analyses, it appeared that students with moderate-severe anxiety were more likely to regret missing out on being with friends, less likely to regret missing out on school social or sports events, and more likely to be grateful for health and safety. Further work could examine how these constructs may be important for adolescents experiencing moderate-severe anxiety.

There are now several longitudinal studies of change in mental health measures among children and young adults before and during the COVID-19 pandemic [ 22 ]. Several comprehensive studies of college and university students in the United States include data on pre-pandemic mental health, analyses of predictors, and a focus on serious psychiatric and alcohol/drug use outcomes [ 23 , 24 ], but data are lacking for high school students. Stamatis et al found that the disruption due to the pandemic and limited confidence in the government response were the main predictors of depression among college students [ 24 ]. Bountress et al found that COVID-19 worry predicted post-traumatic stress disorder (PTSD), depression and anxiety even after adjusting for pre-pandemic symptom levels [ 23 ]. In addition, housing/food concerns predicted PTSD, anxiety and depression symptoms as well as suicidal ideation, after adjusting for pre-pandemic symptoms in college students [ 23 ]. Comprehensive longitudinal studies are necessary to assess the true impact of COVID on mental health in high school students. In particular, studies should assess whether symptoms are associated with serious clinical outcomes such as suicidal ideation, alcohol and substance misuse and missed milestones such as graduation from high school, admission to college, and employment.

Strengths and limitations

A strength of our study was the use of the well validated and extensively used GAD-7 to measure anxiety symptoms. There were no data on anxiety for the students prior to COVID-19 as a baseline for comparison nor measures of other indicator of mental health such as depression and suicidality. Other limitations of this study include the performance of the survey at a single high school—our sample size was limited and the analyses were performed on a convenience sample. While only 28% of the study body responded to the survey, this response rate was similar to the response rates of other high school surveys performed in the United States [ 12 , 13 , 25 ]. The lack of racial/ethnic diversity in the student population also limits generalizability to other populations of adolescents. We did not include potential risk factors elicited in other studies such as prior psychiatric history, financial hardship, or illness in family in our survey. We were also unable to evaluate the impact of hybrid versus remote learning on anxiety, since very few of our students chose remote learning. Lastly, the survey questions we created were done so because nothing specifically existed for this age group, the newness of COVID, and the need to implement questions quickly; therefore, we did not utilize a formal validation process.

In this survey of high school students performed almost 2 years after the onset of COVID-19 in the United States, a relatively high proportion reported moderate or severe anxiety symptoms as assessed by the GAD-7. Our data suggest that the negative impact of COVID-19 on the anxiety levels of high school students may be long-lasting. Whether the heightened anxiety results in functional deficits is still uncertain, but resources for assessment and treatment should be prioritized.

Supporting information

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Stress levels are high among college students in the United States. Growth mindset and stress-is-enhancing mindset interventions offer ways to reduce stress, but minimal research has examined them. This study’s aim was to examine the effect of mindset interventions on mindsets, stress, academic motivation, and responses to hypothetical academic scenarios. Participants included 210 college students who were randomized to one of four groups: growth mindset (intelligence is malleable), stress mindset (stress is beneficial), synergistic (intelligence is malleable, and stress is beneficial), or control (brain functions). The growth mindset and the synergistic mindset group increased in growth mindset, and the growth mindset group had higher growth mindset than the stress mindset and control group post-intervention. The stress mindset and the synergistic group increased in stress-is-enhancing mindset, and both groups had higher stress-is-enhancing mindsets than the growth mindset and control group post-intervention. All groups decreased in stress and increased in academic motivation. The synergistic group was the only group to improve on all the main outcomes, and students in this group were less likely to want to withdraw from a course in both negative hypothetical academic scenarios (if they failed an assignment or were faced with a professor with a fixed mindset). Our findings suggest that students would benefit from increased access to mindset interventions.

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The American College Health Association ( 2022 ) reported that approximately 50% of college students in the United States (U.S.) reported experiencing a moderate level of stress, and approximately 30% of students reported experiencing a high level of stress. Stress has been found to be strongly associated with psychological disorders (e.g., depression) and suicidality in college students (Liu et al., 2019 ). Therefore, it is critical to examine what factors are related to stress and how stress can be reduced.

One key factor that influences stress and resilience is one’s mindset (Yeager & Dweck, 2012 ). Mindsets are defined as one’s implicit theories about the flexibility of characteristics such as intelligence. There are two main types of mindsets regarding intelligence: growth and fixed (Dweck & Leggett, 1988 ). A growth mindset believes intelligence can be improved through effort, while a fixed mindset believes that intelligence is set and cannot change despite someone’s effort. Individuals are theorized to be on a continuum between these two mindsets. A meta-analysis found that growth mindsets are negatively correlated with psychological distress and positively correlated with active coping (Burnette et al., 2020 ). This association may be because a growth mindset buffers against maladaptive cognitions that can lead to maladaptive coping and/or adverse psychological outcomes.

A growth mindset is a skill that can be learned through interventions. For example, Smith and Capuzzi ( 2019 ) examined the effect of a single-session growth mindset intervention on anxiety and grades for U.S. college students in a statistics class (Smith & Capuzzi, 2019 ). They randomly assigned students to either a growth mindset intervention (e.g., a 75-minute interactive class session with exercises) or a control group (no intervention). They measured the students’ mindset and anxiety level at baseline and six months after completing the intervention. They found that students in the intervention group had an increased growth mindset, whereas mindset did not change in the control group. While they did not find significant changes in anxiety in either group, they found that a higher growth mindset was associated with lower anxiety and a higher course grade. Another study found that a single-session growth mindset intervention reduced depressive symptoms in U.S. adolescent girls four months after the intervention (Heaman et al., 2023 ).

Furthermore, a growth mindset is related to positive educational outcomes. A meta-analysis across 10 studies concluded that teaching students about a growth mindset increases their motivation and achievement (Sarrasin et al., 2018 ). For example, one study randomized adolescents in the U.S. to a growth mindset group (8-session intervention with information about the brain and growth mindset) or a control group (8-session intervention with information about the brain) (Blackwell et al., 2007 ). Students in the growth mindset group had significantly more positive change in classroom motivation three weeks after the intervention than the control group.

While a growth mindset is associated with lower stress (Burnette et al., 2020 ), two mindsets directly related to stress have been studied as well: stress-is-enhancing and stress-is-debilitating (Crum et al., 2013 ). A stress-is-enhancing mindset views stress as beneficial, whereas a stress-is-debilitating mindset views stress as harmful (Crum et al., 2013 ). Similar to growth and fixed mindsets, individuals are thought to be on a continuum between these two mindsets. Keech et al. ( 2018 ) found that having a stress-is-enhancing mindset was negatively correlated with perceived stress and was positively correlated with proactive behavior. Another study found that a stress-is-enhancing mindset served as a moderator between perceived stress and depressive symptoms in U.S. college students (Huebschmann & Sheets, 2020 ). The stress mindset is theorized to be beneficial in part because it changes how one psychologically experiences stress and how one behaviorally copes with stress (Crum et al., 2013 ).

Similar to a growth mindset, a stress-is-enhancing mindset can be developed through interventions. For example, one study with Australian university students found significant benefits of a stress mindset intervention (Keech et al., 2021 ). Students were randomized to one of two groups: an intervention group who watched videos about the consequences and benefits of stress and completed mental imagery tasks applying the benefits of stress in their own lives (one session of an unspecified length of time), or a control group who completed a mental imagery task unrelated to reframing stress. Two weeks after the intervention, the intervention group increased in stress-is-enhancing mindset from pre- to post-intervention and had a higher stress-is-enhancing mindset than the control group. In participants with high perceived stress, those in the intervention group also had lower distress and more proactive behavior than the control group. Another study using college students in the U.K. found that short videos about the stress-is-enhancing mindset was effective in increasing the stress-is-enhancing mindset immediately after the intervention (Williams & Ginty, 2023 ). However, no previous studies to our knowledge have examined the effect of a stress-is-enhancing intervention on academic motivation.

Yeager et al. ( 2022 ) proposed a mindset that combines the growth mindset and stress-is-enhancing mindset, which they called a synergistic mindset. They created a single-session 30-minute online module that contained information and exercises related to improving both mindsets. In a sample of U.S. college students, they found that this synergistic mindset intervention was more effective than a growth mindset intervention alone, a stress-is-enhancing mindset intervention alone, or a control intervention (learned about brain functions) in reducing cardiovascular reactivity when experiencing a social stressor shortly after the intervention (Yeager et al., 2022 ). In another sample of college students who received the intervention, they found that students made less negative stress appraisals about a quiz one to three days after the intervention and three weeks afterward (Yeager et al., 2022 ).

Having single-session interventions can be valuable as they are time- and cost-effective, but it’s important that they have lasting effects. A meta-analysis on single-session interventions on psychiatric problems in adolescents found that the interventions had the highest effect size for lasting effects on anxiety, which is similar to the present study’s focus on stress in young adults (Schleider & Weisz, 2017 ). Another study specifically examined the longitudinal effects of a single-session synergistic mindset intervention (Hecht et al., 2023 ). At the beginning of the semester, U.S. college students were randomly assigned to receive a 30-minute synergistic mindset or a control intervention (lesson about the brain). Subsequently, half of the students in each group received four 5-minute supportive messages related to the synergistic mindset whereas the other half received 5-minute neutral messages about assessing their learning progress periodically over the remainder of the semester (15-week semester). They found that the synergistic mindset intervention was effective in reducing fixed mindset beliefs and increasing stress-is-enhancing beliefs immediately after the intervention and at 3-weeks post-intervention similar to previous findings (Yeager et al., 2022 ); however, they found that receiving brief continued supportive messages made the initial intervention’s effects stronger over time (Hecht et al., 2023 ). Overall, single-session interventions are promising low-cost, accessible options that need further exploration.

Present Study

The present study is novel in two main ways. First, we examined the impact of mindset interventions on academic motivation and on responses to hypothetical academic scenarios to examine how mindsets could affect one’s potential behaviors, which has not been explored previously to our knowledge. Second, we assessed the efficacy of a shorter and simpler intervention (5 to 10 min) than was used previously (Yeager et al., 2022 ), which could make the intervention even more accessible for students.

Our main study aim was to assess the effect of mindset interventions on growth mindset, stress-is-enhancing mindset, stress, and academic motivation. We randomly assigned participants to one of four groups: growth mindset, stress mindset, synergistic mindset, or control. Participants’ growth mindset, stress-is-enhancing mindset, stress, and academic motivation were measured before and after the intervention. We hypothesized that the synergistic group would have increased growth mindset, stress-is-enhancing mindset, and academic motivation, and decreased stress from pre- to post-intervention. We also predicted that the synergistic group would have lower stress and higher academic motivation post-intervention compared to the other groups. In contrast, we predicted that the control group would have lower growth mindset, stress-is-enhancing mindset, and academic motivation and higher stress compared to the other groups post-intervention. Our second aim was to assess the effect of mindset interventions on responses to hypothetical academic scenarios to examine how mindsets could affect one’s potential behaviors. We did not create hypotheses for the second aim as it was exploratory.

Participants

Any currently enrolled students at a southeastern college who were at least 18 years of age were eligible to participate in the study. According to a G*power analysis using an effect size f 2 of 0.25, a power level of 0.80, and a significance value of 0.05, 136 participants were required for the main analysis (2 × 4 mixed ANOVA) to have sufficient statistical power (Faul et al., 2009 ). Although 272 participants began the survey and provided consent, we removed data from 62 participants because they stopped the study before finishing the pre-post measures ( n  = 58), or they did not follow the instructions in their written responses ( n  = 4). The majority of individuals who stopped early quit on the first survey ( n  = 26) or during the intervention ( n  = 21). There was not a clear trend that one intervention resulted in more drop-out than others ( n  = 4 growth mindset; n  = 4 synergistic; n  = 6 stress-is-enhancing mindset; n  = 7 control group. Our final sample contained 210 participants, which was sufficient for our analyses.

We received approval from the Institutional Review Board of the college and collected data in January 2023 online. Participants were recruited through a campus-wide email. After indicating consent, participants completed a baseline stress scale. Next, they completed measures of growth mindset, stress-is-enhancing mindset, state stress, and academic motivation. Subsequently, they were randomly assigned to one of four groups: growth mindset, stress mindset, synergistic mindset, or control. All groups completed three activities designed to shift their mindset to the group they were assigned. After completing the activities, participants completed the same assessments of growth mindset, stress-is-enhancing mindset, state stress, and academic motivation. Subsequently, participants responded to behavioral questions about hypothetical academic scenarios. Finally, participants completed demographic information. The study took approximately 17 min, and each participant was compensated with a $10 Amazon gift card.

Group Interventions

Our interventions were modeled after Yeager et al. ( 2022 ) but were adapted to be shorter and simpler. Each group first read research on their assigned mindset. The growth mindset group read about the malleability of the brain. The stress mindset group read about the adaptive purposes of stress. The synergistic mindset group read about both of those topics, and the control group read about the functional areas of the brain. Each group then read practical strategies about how to implement the mindsets in their life. Next, participants read an example story about how a student applied the assigned mindset to an academic challenge. Finally, participants were asked to write a short paragraph about how they planned to use a similar mindset and strategies on a future academic setback/challenge. They were prompted to write at least 500 characters (100 words). Each group’s procedure is detailed in the Supplemental Materials.

Baseline Stress

Baseline stress was measured with the Perceived Stress Scale, which asked participants questions to rate their stress levels over the past month (Cohen et al., 1983 ). Participants rated 10 items (e.g., “In the last month, how often have you been upset because of something that happened unexpectedly?”) on a scale from 0 ( never ) to 4 ( very often ). After reverse scoring the necessary items, a total score was calculated. The possible total score ranged from 0 to 40, with higher scores representing more stress. Cronbach’s α was 0.86.

Pre-Post Measures

Growth mindset.

The Growth Mindset Scale assessed whether participants believe they can learn and improve (Dweck et al., 1995 ). Participants indicated their agreement with three items (e.g., “You have a certain amount of intelligence, and you can’t really change it”) on a Likert scale from 1 ( strongly agree ) to 6 ( strongly disagree ). Items were reverse-scored and averaged; higher scores indicated a higher growth mindset. Cronbach’s α was 0.88 for pre- and post-intervention.

Stress Mindset

The Stress Mindset Measure assessed whether participants view stress as enhancing or debilitating (Crum et al., 2013 ). Participants indicated their agreement to eight items (e.g., “Experiencing stress facilitates my learning and growth”) on a Likert scale from 0 ( strongly disagree ) to 4 ( strongly agree ). Scores were averaged, and higher scores indicated a higher stress-is-enhancing mindset. Cronbach’s α was 0.83 for pre-intervention and 0.88 for post-intervention.

State Stress

State stress was measured through a visual analog scale where participants indicated how much they felt stress currently from 0 ( not at all ) to 100 ( extremely ).

Academic Motivation

Academic motivation was measured through a visual analog scale where participants indicated how motivated they felt to complete their coursework currently from 0 ( not at all ) to 100 ( extremely ).

Academic Scenarios

Participants read and responded to three hypothetical academic scenarios. The first scenario involved failing an assignment: “Imagine you fail the first assignment of the semester after completing the work and trying your best.” The second scenario included a professor’s fixed mindset response: “Imagine that you talk to the professor about your failed assignment. Your professor tries to make you feel better by telling you that this subject is hard and isn’t for everyone.” The third scenario demonstrated a professor’s growth mindset response: “Imagine that you talk to the professor about your failed assignment. Your professor tries to make you feel better by telling you that they will help you, and they believe in your ability to improve.” In each scenario, participants were asked to rate how much they would want to withdraw from the course if they could on a visual analogue scale from 0 ( not at all ) to 100 ( extremely ).

Demographic Questions

Participants reported their age, gender, race, ethnicity, and class year.

Manipulation Check

We examined all the written responses to the interventions to make sure they followed instructions of their group assignment. We removed four individuals for not following those instructions.

Statistical Analyses

SPSS version 28 was used for all analyses. Descriptive statistics and reliability analyses were calculated for all main variables. Chi-squared analyses were conducted to assess if there were differences in demographic variables among the four groups. A one-way (group) ANOVA was conducted for baseline stress to determine any baseline differences among the four groups. For aim 1, we conducted 2 (time) x 4 (group) mixed ANOVAs on growth-mindset, stress-is-enhancing mindset, stress, and academic motivation. For aim 2, we conducted one-way between-subjects (4 groups) ANOVAs on desire to withdraw from a course based on three hypothetical scenarios. Post-hoc tests using Bonferroni were conducted to determine where the significant differences occurred.

Descriptive Statistics of Participants

Descriptive statistics including gender, race, ethnicity, class year, and age for participants are displayed in Table  1 . Most participants were White, non-Hispanic/Latinx women. The mean age of participants was 20 years old and ranged from 18 to 22. There were no significant differences by demographic variables among the four groups (Table  1 ).

There was a significant interaction between time and group for growth mindset, F (3, 206) = 10.65, p  < .001, η p 2  = 0.13 (Fig.  1 ). Growth mindset significantly increased from pre-intervention ( M  = 4.21, SD  = 1.05) to post-intervention ( M  = 4.67, SD  = 1.06) in the synergistic group, p  < .001. Additionally, growth mindset significantly increased from pre-intervention ( M  = 4.14, SD  = 1.05) to post-intervention ( M  = 4.78, SD  = 1.07) in the growth mindset group, p  < .001. At post-intervention, the growth mindset group ( M  = 4.78, SD  = 1.07) had significantly higher growth mindset than the control group ( M  = 4.18, SD  = 1.06), p  = .028, and the stress mindset group ( M  = 4.22, SD  = 1.06), p  = .048.

Growth Mindset by Group and Time. Note. Vertical axis was abridged for clarity. The bracket indicates there is a significant difference between the growth mindset group and the stress mindset and control group. Error bars represent standard error. * p  < .05

Stress-is-Enhancing Mindset

There was a significant interaction between time and group for stress-is-enhancing mindset, F (3, 206) = 17.74, p  < .001, η p 2  = 0.21 (Fig.  2 ). Stress-is-enhancing mindset significantly increased from pre-intervention ( M  = 1.76, SD  = 0.67) to post-intervention ( M  = 2.18, SD  = 0.66) in the synergistic group, p  < .001. Additionally, stress-is-enhancing mindset significantly increased from pre-intervention ( M  = 1.72, SD  = 0.65) to post-intervention ( M  = 2.25, SD  = 0.63) in the stress mindset group, p  < .001. At post-intervention, the synergistic group ( M  = 2.18, SD  = 0.69) had significantly higher stress-is-enhancing mindset than the control group ( M  = 1.82, SD  = 0.69), p  = .048, and the growth mindset group ( M  = 1.73, SD  = 0.69), p  = .005. Also at post-intervention, the stress mindset group ( M  = 2.25, SD  = 0.69) had significantly higher stress-is-enhancing mindset than the control group ( M  = 1.82, SD  = 0.69), p  = .011, and the growth mindset group ( M  = 1.73, SD  = 0.69), p  < .001.

Stress Mindset by Group and Time. Note. Vertical axis was abridged for clarity. The bracket indicates there is a significant difference between both the synergistic and stress mindset group and the growth mindset and control group. Error bars represent standard error. * p  < .01

There was a significant main effect by time, F (1, 206) = 21.80, p  < .001, η p 2  = 0.10, such that stress decreased across all groups from pre-exposure ( M  = 46.41, SD  = 23.59) to post-exposure ( M  = 41.76, SD  = 25.04), p  < .001 (Fig.  3 ). However, there was not a significant main effect by group, F (3, 206) = 0.37, p  = .77, η p 2  = 0.005, or a significant interaction by time and group, F (3, 206) = 1.42, p  = .24, η p 2  = 0.02.

Stress by Group and Time. Note. Vertical axis was abridged for clarity. Error bars represent standard error. * p  < .01

There was a significant main effect by time, F (1, 206) = 13.74, p  < .001, η p 2  = 0.063, such that academic motivation increased across all groups from pre-exposure ( M  = 51.74, SD  = 25.94) to post-exposure ( M  = 55.19, SD  = 25.98) (Fig.  4 ). However, there was not a significant main effect by group, F (3, 206) = 0.31, p  = .82, η p 2  = 0.004, or a significant interaction by time and group, F (3, 206) = 0.05, p  = .99, η p 2  = 0.001.

Academic Motivation by Group and Time. Note. Vertical axis was abridged for clarity. Error bars represent standard error. * p  < .01

There was a significant main effect for group about wanting to withdraw from a course if they could when they failed the first assignment after trying their best, F (3, 206) = 5.99, p  < .001, η p 2  = 0.08. The synergistic group ( M  = 40.54, SD  = 33.60) had a significantly lower likelihood of wanting to withdraw from the course compared to the control group ( M  = 67.15, SD  = 33.59), p  < .001. In addition, the stress mindset group ( M  = 46.22, SD  = 33.64) had a significantly lower likelihood of wanting to withdraw from the course compared to the control group ( M  = 67.15, SD  = 33.59), p  = .01.

There was also a significant main effect for group about wanting to withdraw when participants were faced with a professor with a fixed mindset, F (3, 206) = 2.88, p  = .037, η p 2  = 0.04. Participants in the synergistic group ( M  = 51.37, SD  = 35.52) were significantly less likely to want to withdraw from the course than those in the control group ( M  = 71.48, SD  = 35.57), p  = .03. When a professor had a growth mindset, participants did not differ significantly in their likelihood to want to withdraw from the course based on their mindset group, F (3, 206) = 1.08, p  = .36, η p 2  = 0.02.

This study’s main aim was to examine the effect of mindset interventions on mindsets, state stress, and academic motivation. Our hypotheses were partially supported. Each mindset intervention improved mindsets as intended. In addition, state stress decreased, and academic motivation increased from pre- to post-intervention in the mindset groups as predicted, but we did not predict that state stress would decrease and academic motivation would increase in the control group as well. In addition, we did not find that the synergistic group had better outcomes compared to the other three groups for stress and academic motivation. The study’s second aim was to examine the effect of the mindset interventions on hypothetical academic scenarios. We found that students in the synergistic group were the only students who were less likely to want to withdraw from a course in both negative hypothetical academic scenarios (if they failed an assignment or were faced with a professor with a fixed mindset), suggesting the benefits of the synergistic mindset.

Our results showed that the growth mindset intervention (in both the growth mindset group and synergistic group) was successful in increasing a growth mindset. This finding aligns with previous research (Smith & Capuzzi, 2019 ). However, our study also found that the growth mindset intervention reduced stress, whereas Smith and Capuzzi ( 2019 ) did not find a change in anxiety, though they found a negative relationship between growth mindset and anxiety. Perhaps the difference in the construct of anxiety versus stress and the different measures used in those studies played a role in those varying results. However, our study’s intervention was notably shorter (5 to 10 min) than Smith and Capuzzi’s ( 2019 ) 75-minute intervention, which suggests that a growth mindset can be induced more efficiently. Moreover, we found that the growth mindset intervention increased academic motivation, which parallels previous research (Blackwell et al., 2007 ; Sarrasin et al., 2018 ). That said, it is important to note that while participants in the growth mindset group had significantly higher growth mindset than the control group, there were not differences between the groups for stress and academic motivation, indicating a lack of treatment effect for those variables. That lack of difference may be because those variables were more distal outcomes. A meta-analysis found that the largest effects for growth mindset interventions are on more proximal outcomes such as mindset than more distal outcomes such as psychological health (Burnette et al., 2023 ).

Similarly, we found that the stress mindset intervention (in both the stress mindset group and synergistic group) was successful in increasing a stress-is-enhancing mindset. This finding is in concert with previous research (Keech et al., 2021 ). Furthermore, we found that stress decreased in those groups, whereas Keech et al. ( 2021 ) only found decreased stress in participants who had overall higher stress than the other participants. Our sample had high averages of baseline stress across all groups, which may be why we found an overall difference for everyone. We also found that the stress mindset intervention increased academic motivation, which has not been studied previously to our knowledge. Perhaps rethinking academic stress reminded students of the benefits of learning rather than viewing it as threatening, which may have led to an increased desire to complete academic work. However, similar to growth mindset, we only found differences between the stress mindset group and the control group for the proximal outcome of stress-is-enhancing mindset, which indicates there was not a treatment effect for stress and academic motivation.

The control group did not change in growth mindset or stress-is-enhancing mindset over time, which aligns with expectations. Surprisingly, though, the control group had decreased stress and increased academic motivation after learning about the brain, despite us using a similar control group design as Yeager et al. ( 2022 ). It is possible that learning about the function of different brain parts and writing about them led to increased feelings of appreciation of one’s brain. Completing this activity also served as a break from their academic work, which may also have led to students feeling less stressed and more energized for their work.

While the synergistic group was the only group to have improvements in all four outcomes, the synergistic group did not show significantly better results in stress reduction and academic motivation than the other groups. Therefore, it appears that learning about both mindsets does not necessarily have additive effects as they potentially affect stress and academic motivation in a similar way. However, the mechanisms of how those mindsets are related to different outcomes needs to be explored further.

For our second aim, we found that the interventions affected projected behavioral responses to hypothetical academic scenarios. The synergistic and stress mindset groups were significantly less likely to want to withdraw from a course compared to the control group when faced with failing the first assignment in a course after trying their best. Perhaps they were applying what they learned and practiced in the intervention to view the failure as a challenge rather than a stressor.

In addition, participants in the synergistic group were less likely to want to withdraw from a course compared to the control group when faced with a professor who expressed a fixed mindset. This finding is in line with previous research that shows that a professor’s mindset can affect students’ course engagement and dropout intentions (Muenks et al., 2020 ). The synergistic group may have applied both ideas from the growth mindset and stress mindset intervention; they may have trusted their own mindset rather than the professor’s mindset and reframed the situation as a challenge rather than a stressor. These behavioral responses suggest that the synergistic group may confer benefits above and beyond the single mindset groups.

Our sample had multiple limitations regarding participants. For example, the sample was mostly white, educated women, which limits the generalizability of our findings. The demographics of this study’s sample also could have influenced the familiarity of participants with the concepts taught. For example, the concept of a growth mindset is now commonly taught in many college courses, especially psychology courses. Therefore, participants may have already been aware of some of the research about mindsets.

Furthermore, the intervention was limited in several ways. We do not know if participants read and absorbed each piece of information. In addition, twenty-one participants quit the study during the intervention, which could indicate that they were not interested in it or engaged with it. There was not a clear difference in drop-out across intervention groups, so it’s possible it was due to all of them requiring writing. However, further research is needed to determine why some individuals would choose not to continue this type of intervention. A few individuals also had negative responses to the stress mindset intervention as they thought that it was invalidating to the negative impact of stressors. Yeager et al. ( 2022 ) highlighted that mindset interventions are not meant for reappraising traumatic stressors; therefore, it’s possible that the individuals who had a negative response may have had those types of experiences and felt invalidated. In turn, feeling emotionally invalidated has been found to predict negative affect and stress (Schreiber & Veilleux, 2022 ; Zielinski et al., 2023 ). Recent research has discovered that applying a meta-cognitive approach that highlights both the stress-is-enhancing mindset and addresses how to handle society’s messaging around the negative aspects of stress was more effective than a stress-is-enhancing mindset intervention alone (Crum et al., 2023 ). Future research should continue to explore how these interventions can balance providing the benefit of mindset change while not invalidating an individual’s stress.

Moreover, there were limitations to our measures and the timing of them. State stress and academic motivation were single item sliders, which did not allow us to assess reliability. We also administered the intervention at the beginning of the semester, which could have influenced engagement and perceived relevance of the information. Furthermore, since we only assessed participants at one time point, we do not know how long the effects of the short intervention lasted. While single-session mindset interventions have been shown to have long-term effects (e.g., Heaman et al., 2023 ; Hecht et al., 2023 ; Smith & Capuzzi, 2019 ), it is possible that this shorter intervention will not have sustained effects over time. Including brief “booster” sessions after the intervention similar to Hecht et al. ( 2023 ) would potentially be valuable and should be examined in future research.

The main implication of our study is that brief mindset interventions can be effective in shifting student mindsets. Our results also showed that the synergistic mindset intervention provided the most benefits to students; it was the only group that improved on all the main outcomes, and students in this group were less likely to want to withdraw from a course in both negative hypothetical academic scenarios (if they failed an assignment or were faced with a professor with a fixed mindset). This type of brief (5–10 min) mindset intervention could be easily applied online by students or led by teachers in the classroom. Future research should further examine the mechanisms by which these mindsets are effective on various outcomes. In addition, research should examine the longitudinal effects of brief interventions and if students apply them behaviorally. It also would be valuable for studies to examine how individuals’ characteristics (e.g., age, gender) influence the effectiveness of mindset interventions. Overall, continuing this research can have benefits on reducing stress and improving educational outcomes in young adults.

Data Availability

Data can be made available upon request.

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ORIGINAL RESEARCH article

Anxiety, depression, and academic stress among medical students during the covid-19 pandemic.

• 1 Academic Unit of Human Medicine and Health Sciences, Zacatecas Autonomous University, Zacatecas, Mexico
• 2 Pathology and Molecular Diagnosis Laboratory, Academic Unit of Chemical Sciences, Zacatecas Autonomous University, Zacatecas, Mexico
• 3 Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Zacatecas Autonomous University, Zacatecas, Mexico
• 4 Academic Unit of Electric Engineering, Zacatecas Autonomous University, Zacatecas, Mexico

Background: The social distancing policies implemented by the health authorities during the COVID-19 pandemic in Mexico and elsewhere led to major changes in teaching strategies for college undergraduates. So far, there is limited data regarding the impact of the lockdown on the academic stress and mental health of these students.

Objective: To assess the occurrence of academic difficulties, anxiety, depression, and academic stressors resulting in somatization with subsequent coping strategies linked to the pandemic.

Materials and methods: A cross-sectional study was conducted with 728 medical students (years 1–5). A purposely designed questionnaire to assess academic difficulties associated with the pandemic was administered electronically. The validated Goldberg anxiety and depression scale was also used, as well as the SISCO-II inventory on academic stress.

Results: Screening for anxiety and depression led to a prevalence of 67.9 and 81.3%, respectively. Most relevant stressors, reported always or nearly always, included professors’ evaluations (63.9%), and reading overload of academic papers (50.6%). Factorial analyses showed that women were more prone to stress than men ( p  < 0.001). Somatization symptomatology included drowsiness or increased need of sleep, anxiety, anguish, desperation, chronic fatigue, and sleep disorders. Common coping strategies included practicing a hobby, done always or nearly always by 65% of students with high stress, and 34% of those with low stress ( p  < 0.001).

Conclusion: There was a relevant impact of the mandatory lockdown during COVID-19 pandemic on the mental health of medical students reflected in the high prevalence rates of anxiety, depression, and stressors in the studied population pointing to the need for designing and implementing preventive strategies to deal with the effects of lockdowns.

1. Introduction

Coronavirus 2019 disease (COVID-19) is a viral infection that can lead to the potentially lethal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It appeared in December 2019 in Wuhan, Hubei province of China, and since then it spread rapidly throughout the world ( Hopkins, 2020 ; Yang and Wang, 2020 ; World Health Organization, 2022 ).

As to December 2022, the pandemic has caused more than 6.62 million deaths, and it has had a major economic impact coupled with a transformation of the daily life everywhere ( World Health Organization, 2022 ). The social isolation that arose from the mandatory lockdown implemented by many countries has resulted in various psychological problems for the population ( Wang et al., 2020 ). Recent reports show that COVID-19 lockdowns, including curfews, quarantines, and other societal restriction measures, are associated with symptoms of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD), along with other issues such as emotional exhaustion, lack of interest, and mental disturbances including anxiety and depression ( Brooks et al., 2020 ; Nelson et al., 2020 ).

Among students of medicine and other academic tracks, stress (i.e., the body’s reaction to physical, mental, or emotional pressure) is an important concern ( Behere et al., 2011 ), whereas the events responsible for its occurrence are called stressors. Yet, people can react differently to the same stressor; the response can be physical, emotional, or behavioral, and it is usually framed within the physical and social environment of the individual. Such response appears when the assessment of an event appears as a threat to the individual’s wellbeing, and especially when he/she lacks the resources to face it and cope with it ( Arribas Marín, 2013 ; Cohen et al., 2016 ).

Stress affects the lives of many people’s around the world, and it is linked to the psychopathology of various health conditions, and to their inability to adapt to challenging social environments ( Eisenbarth et al., 2019 ). Stressful life experiences and the individuals’ psychological condition influence the clinical manifestations and course of many diseases ( Straub and Cutolo, 2018 ). Back in 1948, Selye theorized that a stressor generally produces an acute response (alarm reaction stage) that can be adaptive (stage of resistance) and resolve or lead to an exhaustion stage with potentially chronic and irreversible physiological, psychological, and psychosocial consequences ( Selye, 1948 ). A theoretical framework on the response to stress (i.e., allostasis) states that the allostatic load could accumulate resulting in an overexposure to stress mediators (immunologic, endocrine, and neural) triggering adverse organic effects that can lead to illnesses ( McEwen, 1998 ). The theory of cognitive activation of stress is centered on the coping response that seems to determine the outcome, potentially resulting in stress-related illnesses if coping strategies are insufficient or inadequate ( Ursin and Eriksen, 2010 ). Continuous thinking about negative events, passed or future (i.e., perseverative cognition), manifested through worry, rumination and brooding, has also been linked to stress-related problems, including cardiovascular, endocrine, and immunologic ( Brosschot et al., 2006 ; Segerstrom et al., 2008 ).

Additionally, many university students experience academic stress associated with educational activities (e.g., exams, assessments, study load, etc.) and financial difficulties that have an impact on their learning performance ( Crego et al., 2016 ). Students can also develop psychophysiological manifestations including memory and concentration difficulties, mental blocks, chronic fatigue, drowsiness, and despair ( Barraza Macías, 2008 ).

Medical students are particularly prone to high levels of stress and psychological disorders such as anxiety and depression ( Guthrie et al., 1995 ; Toews et al., 1997 ; Moffat et al., 2004 ). Studies have shown that most medical students experience different forms of psychological distress ( Dyrbye et al., 2005 , 2006 ; Heinen et al., 2017 ; Zvauya et al., 2017 ), some of which can lead to a higher risk of suicidal ideation and thoughts about quitting medical studies ( Dyrbye et al., 2011 ). Students under stress try to deal with stressors by means of physical, psychological, or social behavioral responses; these coping strategies attempt to overcome or at least attenuate stress situations.

The social distancing policies implemented by the government and health authorities during the COVID-19 pandemic in Mexico and many other countries led to major changes in teaching strategies, including those for medical students, with internet-based learning becoming the cornerstone of these efforts for more than a year. However, so far there is limited data on what has been the impact of the lockdown on the mental health and academic stress in these medical students. Therefore, this study was undertaken to assess the occurrence of academic difficulties, anxiety, depression, and academic stressors that resulted in somatization and coping strategies linked to the pandemic in medical students from a Mexican university. The study proposal was reviewed and approved by the Ethics and Research Committee at the Academic Unit of Human Medicine and Health Sciences of the Autonomous University of Zacatecas (approval ID: AMC/CI/02-ORD/2020, CEICCL0121- ALGDEZA-03). All participant students provided signed informed consent.

2. Materials and methods

2.1. study design and participants.

This was a cross-sectional study conducted with 728 medical students out of the 928 registered at the Autonomous University of Zacatecas, in the homonymous State in the Central Northern region of Mexico. Male and female students from years 1 to 5 were surveyed. At the time of the survey (early Spring 2021), internet-based learning was the educational modality due to the compulsory lockdown.

2.2. Measuring instruments

2.2.1. general questionnaire.

This was a purposely designed tool that contained basic sociodemographic data and a number of questions assessing academic difficulties potentially linked to the COVID-19 pandemic.

2.2.2. Goldberg anxiety and depression scale (GADS)

This screening tool consists of two subscales, one for anxiety and the other for depression, each with nine items with dichotomous responses ( Goldberg et al., 1988 ). An independent score is totalized for each scale. Questions 1–9 relate to anxiety (e.g., Have you had difficulty relaxing?), and questions 10–19 relate to depression (e.g., Have you felt low energy?); the first four questions in each subscale are conditioning questions, so that two and one positive answers are needed to continue answering each subscale, respectively. The individual is questioned about whether he/she has presented any of the relevant symptoms; those lasting <2 weeks or are of mild intensity are not scored. The cut-off points for anxiety and depression used in this study was ≥4 and ≥ 2, respectively. An adequate internal and external validity has been reported; correlation coefficient with the Hamilton Depression Scales is 0.74 ( Holm et al., 2001 ). A total of 728 students completed this questionnaire.

The validity and reliability of the Goldberg anxiety and depression scale has been assessed in two Spanish speaking Latin American countries; one with a sample of 548 Cuban adults that showed a good diagnostic performance (AUC: anxiety 0.64, depression 0.68) ( Martín-Carbonell et al., 2016 ), and another with a sample of 609 psychology students from the Catholic University of Cuenca, Ecuador, that showed a good reliability (Cronbach’s alpha: anxiety 0.75, depression 0.80) ( Reivan-Ortiz et al., 2019 ). In research studies, GADS has been previously used to assess depression symptoms among middle-aged Latin American women with severe menopausal symptoms and obesity ( Blümel et al., 2016 ), to assess anxiety and depression among Mexican patients with dystrophic epidermolysis bullosa ( Fortuna et al., 2016 ), and more recently in two Mexican studies, one with type 2 diabetes patients ( Gonzalez Heredia et al., 2021 ), and another with primary caregivers of patients in dialysis ( Gonzalez Heredia et al., 2021 ).

2.2.3. SISCO-II psychometric inventory on academic stress

This instrument contains eight questions that assess academic stressors (e.g., peer competition, homework overload, teachers’ personality, etc.), and another 17 items that measure physical, psychological, and social behavior reactions (e.g., sleep disorders, chronic fatigue, headache, etc.) in response to academic stress (i.e., dimensions of somatization). An additional six questions measure coping strategies (e.g., ability to defend preferences without harming others, religious practice, information seeking about a situation, etc.) with five possible answers each using a Likert scale (never, seldom, sometimes, nearly always, always) were part of the instrument.

The SISCO-II inventory of academic stress has been considered valid and reliable scale for diagnostic use. It was designed and tested in Mexico showing good reliability (Cronbach’s alpha: stressors 0.85, symptomatology 0.91, and coping 0.69) ( Barraza, 2007 ). It has been validated in other Latin American countries such as Colombia ( Malo et al., 2010 ), Perú ( Manrique-Millones et al., 2020 ), and considered appropriate in these three countries. Thus, it has been considered a valid tool for use in Latin American students ( Castillo-Navarrete et al., 2020 ). A total of 421 students completed this questionnaire.

2.3. Data collection

Students were sent a link where they could access the webpage to participate in the survey, which lasted between 15 and 20 min. Students were sent a reminder email one week after the first contact. All questionnaires were administered electronically using “Google forms.” Participants had to provide informed consent in the first page of the survey to be able to continue. Data was collected anonymously in March 2021. Overall participation rate was 76.1% (728/956), but for the SISCO-II inventory it was 44% (421/956). No data were available for the reasons for not responding.

2.4. Statistical analysis

Percentages were used to describe issues and problems associated with the online teaching modality during the pandemic. Overall prevalence of anxiety and depression was also computed with results stratified by sex an age. Density analysis was used to graph the most frequent responses. An exploratory analysis relating anxiety and depression was done, as these psychiatric illnesses are known to be highly comorbid with each other ( Kalin, 2020 ).

Percentages were used to present the response level for the SISCO-II inventory. Clusters were produced to stratify the population based on the stressors assessed. Responses obtained for each stressor were assessed by K-means. Also, an exploratory factorial analysis was used to reduce the number of variables included in the instrument using various methods (e.g., Bentler, acceleration factor, R 2 , VSS complexity 1, Velicer’s MAP, TLI, RMSEA, optimal coordinates, parallel analysis, and Kaiser criterion); factors were used to assess whether there were significant differences between clusters based on symptomatology. Correlations between stressors were done using Kendall rank correlation coefficients; item dependency was considered statistically significant with p values below 0.05.

From the 728 surveyed medical students from years 1 to 5, 301 (41.3%) were men and 427 women (58.7%). Most students (96%) were aged 18–24 years; differences in sex for grade was not significant (χ2 = 3.24, value of p = 0.52; Table 1 ).

Table 1 . Frequency distributions by sex and age according to grade level.

3.1. Educational difficulties reported during COVID-19 pandemic

The main educational difficulties referred to by the students are presented in Figure 1A . The most common difficulty associated with the learning modality was “problems with internet connectivity,” reported by 30% of the students, followed by the “lack of clinical practice (hospital and/or laboratory)” with 20%. Students also reported “problems with the internet learning modality” (19%) and “problems with the faculty” (15%). “Lack of concentration and motivation” was also reported by 8% of the students each. As to students’ academic performance in the pandemic, 92% reported being affected. Most frequent reasons given were “lack of motivation” (25.2%), “lack of concentration” (18.8%), “lack of clinical practice” (18.4%), “insufficient learning” (17.2%), and “stress” (14.6%; Figure 1B ).

Figure 1 . Main educational problems associated with the COVID-19 pandemic: ( A) problems with learning modality and ( B) resultant academic problem.

3.2. Prevalence of anxiety and depression

Overall, screening for anxiety and depression led to a prevalence of 67.9 and 81.3%, respectively. Women had significantly higher proportions of both, anxiety (73.3% vs. 60.4%; p  < 0.001) and depression (87.1% vs. 73%; p  < 0.001), but no statistical differences were seen by age ( Table 2 ). However, those aged 19 years or less showed a notably lower prevalence of anxiety (nearly 10 percent points below the other ages), and yet a higher prevalence of depression (6–12 percent points above the other ages).

Table 2 . Prevalence of anxiety and depression according to the Goldberg scale by sex and age among medical students at the Autonomous University of Zacatecas, 2021.

Density analysis and linear regression showed that most frequent responses for anxiety were between 4 and 9, and 4 to 8 for depression. Linear regression between both domains (anxiety as predictor of depression) showed a Pearson coefficient of 0.529 ( p  < 0.05; Figure 2 ).

Figure 2 . Linear regresión for anxiety as predictor of depresion.

3.3. SISCO-II inventory on academic stress

The most frequent stressor was the “evaluation of professors” where 40.6% of students reported that caused then stress nearly always, and 23.3% as always, followed by “overload of tasks and academic papers” with 38 and 12.6%, and by “participation in class” with 26.6 and 20.9%, respectively. In contrast, “type of work that professors request,” and “competition with others” were items that caused less stress ( Table 3 ).

Table 3 . Distribution of stressors by response level among medical students ( n  = 728).

The optimization of the number of groups to classify students according to the stressors resulted in two clusters ( Figure 3A ). The cluster plot produced two separated groups, one with low stress ( n  = 216), and another with high stress ( n  = 205; Figure 3B ).

Figure 3 . (A) Number of clusters to classify students according to stressors. (B) Cluster plot depicting the two groups (low and high stress).

Women were more prone to stress than men ( p  = 0.0003), but no statistical differences were observed by mean age ( Table 4 ).

Table 4 . Differences in academic stress (low vs. high) by sex and mean age in medical students at Zacatecas Autonomous University, 2021.

3.4. Dimensions of somatization

The distribution of somatization variables (i.e., physical, psychological, and social behavior response) by response level in groups 1 (low stress) and 2 (high stress) is shown in Table 5 . The proportion of responses with levels 4 (nearly always) and 5 (always) were notably higher in group 2 (high stress) compared with group 1 (low stress), especially for “drowsiness or increased need for sleep,” “anxiety, anguish, or desperation,” “chronic fatigue (permanent fatigue),” and “sleep disorders (insomnia or nightmares).”

Table 5 . Distribution of somatization variables by response level by stress groups.

According to sex, the distribution of response level in somatization, we found significant differences in most of the items ( p  < 0.01), except for the cratching, nail biting, rubbing, etc. and Unwillingness to perform student duties items.

3.5. Coping strategies

Table 6 compares the response level of comping strategies by stress group. Most frequent coping strategies include “practicing a hobby,” performed nearly always or always by 65% of students with high stress and by 34% of those with low stress ( p  < 0.001), followed “getting company by a loved one” with 56 and 34% ( p  < 0.001), respectively. No statistical differences in responses between groups 1 and 2 were seen for strategies such as “ventilation and confidences,” “complimenting oneself,” and “assertive ability.”

Table 6 . Comparison of coping strategies by response level between the two stress groups among medical students ( n  = 728).

According to sex, the distribution of the level of response in the strategies, we did not find significant differences in any of the items.

4. Discussion

This study was carried out to assess the presence of academic difficulties, anxiety and depression, and academic stressors that result in somatization and coping strategies linked to the COVID-19 pandemic in medical students in a Mexican university.

Stress, in general, is a complex multifactorial process that can result in somatic symptomatology, including gastrointestinal problems, insomnia, insulin resistance and overweight/obesity, as well as adaptative disorders, memory alterations, and depression, among others ( Tafet and Nemeroff, 2016 ). When stress occurs in an educational context, it is known as academic stress ( Putwain, 2007 ), which is characterized by physiological, emotional, cognitive, and behavioral stimuli that happens as consequence of a student’s inability to cope with difficulties in a school setting; stressors linked to school procedures can also trigger this reaction ( Barraza Macías, 2008 ). Academic stress associated with poor coping strategies may affect academic performance, school homework, exams, and poor learning ( Eva et al., 2015 ). Therefore, timely identification of academic stressors is essential to prevent somatization and the development of more serious physical and/or mental illnesses ( Zhai and Du, 2020 ).

Academic stress has been widely linked to several negative effects on academic performance, school homework, exams, and learning.

Nearly one out of three students reported difficulties with internet connectivity as the main problem linked to the learning modality, and one in five said that the lack of clinical practice was the main concern. Lack of motivation (24%), concentration (18%), and clinical practice (17%) were the most common academic performance concerns.

Research has shown disproportionally higher levels of stress, anxiety, and depression among medical students compared to nonmedical undergraduates ( Alzahrani et al., 2020 ). The incidence of psychological dysregulation in medical students is often attributed to the competitive and stressful environment along with other academic and professional demands which often lead to emotional exhaustion and psychological distress ( Abdel Wahed and Hassan, 2017 ).

Screening for anxiety and depression resulted in an overall prevalence of 68 and 81%, respectively. Results also showed sex differences for both anxiety and depression with higher proportions in women. These results come from data collected in March 2021, right after the second wave of the pandemic, when mortality was at its highest levels. During this period, strict social distancing measures were in place, leading to complete online teaching in all educational system. However, it is important to consider that even before the COVID-19 pandemic, medical students already had relatively high levels of stress and depression ( Dyrbye et al., 2006 ). A meta-analysis from 2016 had revealed a global prevalence of depression of 28% with first year medical students having the highest rate ( Puthran et al., 2016 ), and with estimates ranging from 8% in American universities assessed with the Center For epidemiologic Studies-Depression scale (CES-D) to as high as 70% in medical schools of Pakistan using the Aga Khan University Anxiety and Depression Scale.

Whether the COVID-19 pandemic has resulted in higher incidence of anxiety and depression is still a contentious topic. For instance, a recent review concluded that the overall prevalence of anxiety in medical students did not increase with the outbreak, as high levels of resilience and healthy coping systems were put in place along with a reduction of academic load together with available family support ( Lasheras et al., 2020 ). Conversely, another study reported that most medical students felt significantly more distressed about their studies due to COVID-19 ( Loda et al., 2020 ). Previous research has shown that stress in preclinical medical students varies depending on the setting, ranging from 20.9% to more than 90% ( Fares et al., 2016 ). In Mexico, before the pandemic, there is data associating high levels of academic stress in medical students with various psychological outcomes such as mental blocks, despair, feelings of depression and anxiety, restlessness, concentration and memory difficulties, and other physiological manifestations including chronic fatigue, drowsiness, headaches, insomnia, and muscle tremors ( Pozos-Radillo et al., 2016 ).

Most relevant stressors, reported as always/nearly always, included professors’ evaluations (63.9%), and reading overload of academic papers (50.6%). Other stressors previously reported include poor academic performance ( Zeppa and Linn, 1984 ), excessive academic workload, high pressure to perform, learning difficulties, poor time management, conflicts in work-life balance, conflictive personal relationships, inadequate peer relations, as well as health and financials problems ( Hill et al., 2018 ). Cluster and factorial analyses led to identification of two groups with low and high stress, showing that women were more prone to stress than men. This is consistent with previous research showing higher distress in female students when exposed to human suffering ( Hill et al., 2018 ), along with other findings pointing to gender differences in stress vulnerability, manifested through medical and psychiatric symptoms ( Nechita et al., 2014 ).

Somatization resulting from of academic stress was higher in the group with high stress especially for drowsiness or increased need for sleep, anxiety, anguish, or desperation, chronic fatigue, and sleep disorders. An earlier study reported that early closure of academic institutions due to COVID-19 resulted in various psychological issues such as lack of sleep, need of emotional and mental support, and the search for social interactions ( Nurunnabi et al., 2020 ).

Recent research on the psychological impact of the COVID-19 pandemic showed that individuals working in the clinical field had higher stress scores ( Alkhamees et al., 2020 ), yet less was known about its impact among medical students. There is also evidence that female medical students had higher levels of stress, anxiety, and depression ( Wang et al., 2020 ). Another study has shown that 71% of college students reported an increase in stress, anxiety levels, and depressive thoughts linked to the COVID-19 pandemic, which appeared to be associated with fear and concern with their own health and that of their loved ones; concentration difficulties, sleep disturbances, decrease in social interactions due to social distancing, and concern about their academic performance were also observed ( Son et al., 2020 ).

In many settings, including the Mexican, medical students usually live in a high-stress environment, due in part to a rigid system that promotes competition. Thus, the COVID-19 pandemic seemed to aggravate this situation by adding new stress factors, including the concern and fear to the infection to oneself and relatives, and by limiting the benefits to engage in activities such as exercise and social interactions that would have reduced the stress; as a result, the lockdown and social distancing measures have led to radical lifestyle changes that took place in a very short period of time ( Brooks et al., 2020 ).

This study found that the most common coping strategies included practicing a hobby, done always/nearly always by 65% of those with high stress and 34% of those with low stress, followed by getting company of a loved one (56 and 34%, respectively). Previous research on coping strategies among preclinical medical students highlight personal engagement, positive reinterpretation and expression of emotion, support programs delivered by senior students and extracurricular activities (mostly musical and physical activities) as valuable mechanisms to reduce anxiety, stress, and burnout ( Fares et al., 2016 ). Other evidence has shown that medical students who adopt active coping, including planning and reality acceptance rather than avoiding strategies such as denial, alcohol and drug intake, and behavioral disengagement have better outcomes ( Abouammoh et al., 2020 ). It has been seen that adaptive coping improves mental health while maladaptive coping strategies, such as negation, are predictors of depression among young adults ( Mahmoud et al., 2012 ). Finally, another study with medical students from King Saud University also reported that mindfulness was associated with lower depressive symptoms ( Alzahrani et al., 2020 ).

5. Conclusion

The results presented here reflect the impact of the prolonged COVID-19 pandemic in terms of the academic performance, occurrence of anxiety and depression, and stressors among medical students potentially linked to the lockdown accompanied with internet-based learning modality. Therefore, it is important to design and implement preventive strategies to deal with the effects of the online learning modality used during the COVID-19 lockdown.

5.1. Limitations

An important limitation relates to the observational design used which make it difficult to determine whether the COVID-19 pandemic could be indeed associated with the observed outcomes. Another limitation was the use of a non-probabilistic sample, and the fact that even in this sample selection bias is still a potential issue, as response rate went down to 76.1% for the Goldberg scale and to 44% for the SISCO-II inventory. Since reasons for not responding were not obtained, it was not possible to run a non-response analysis to compare participants and non-participants to speculate on the possible direction of the bias.

Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.

Ethics statement

Participation was voluntary. The questionnaire was administered via “Google forms.” Participants had to give informed consent in the first page of the questionnaire to be able to proceed with the survey. The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of Unidad Académica de Medicina Humana y C.S at Universidad Autónoma de Zacatecas (approval ID: AMC/CI/02-ORD/2020, CEICCL0121- ALGDEZA-03; approval date: November 6, 2020, and January 29, 2021).

Author contributions

LA-C and MM-F conceptualization. LA-C and DD-A methodology. PV-E, SV-R, JS-G, and AM-G software. AR-L, JM-E, and IG-V validation. AR-L and JM-E formal analysis. AR-L and LA-C data curation and visualization. LA-C and DD-A writing—original draft preparation. JM-E, IG-V, JS-G, and MM-F writing—review and editing. All authors contributed to the article and approved the submitted version.

Acknowledgments

The authors wish to thank the medical students for their participation in this study.

Conflict of interest

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

Publisher’s note

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

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Keywords: academic stress, anxiety, COVID-19, depression, medical students

Citation: Avila-Carrasco L, Díaz-Avila DL, Reyes-López A, Monarrez-Espino J, Garza-Veloz I, Velasco-Elizondo P, Vázquez-Reyes S, Mauricio-González A, Solís-Galván JA and Martinez-Fierro ML (2023) Anxiety, depression, and academic stress among medical students during the COVID-19 pandemic. Front. Psychol . 13:1066673. doi: 10.3389/fpsyg.2022.1066673

Received: 11 October 2022; Accepted: 22 December 2022; Published: 11 January 2023.

Reviewed by:

Copyright © 2023 Avila-Carrasco, Díaz-Avila, Reyes-López, Monarrez-Espino, Garza-Veloz, Velasco-Elizondo, Vázquez-Reyes, Mauricio-González, Solís-Galván and Martinez-Fierro. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

*Correspondence: Lorena Avila-Carrasco, ✉ [email protected] ; Margarita L. Martinez-Fierro, ✉ [email protected]

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

Anxiety and Depression Among College Students Essay

Education is expected to have appositive importance on the student’s life by enhancing their capability to think and improving their competency. However, it often acts as a source of stress that affects students’ mental health adversely. This causation of academic stress often emanates from the need to have high grades, the requirement to change attitude for success, and even pressures put by various school assignments. These pressures introduced by education can make the student undergo a series of anxiety, depression, and stress trying to conform to the forces. The causes of academic stress are well-researched but there is still no explanation why the rate of strain increases despite some measures being implemented to curb student stress. This research explores this niche by using 100 participants who study at my college.

Introduction

Nowadays there are many reasons that cause stress among growing number of students who might not know they are going through the condition most of the time. Hence, undiscovered discouragement or uneasiness can cause understudies to feel that they are continually passing up unique open doors. It prompts substance misuse; self-destruction is the second most typical reason for death among undergrads. The main hypothesis of this article is that college and university students have higher depression rates.

Problem Statement

This proposal undercovers how the problem of anxiety and depression is progressing if not addressed. With such countless youngsters experiencing undiscovered tension, it may be challenging for them to appreciate school. Understudies’ emotional well-being is risked when pressure and trouble go unnoticed, which can prompt social and educational issues (Nelson & Liebel, 2018). Educators might battle to perceive uneasiness since these circumstances manifest themselves contrastingly in different people.

Anxiety and depression are complicated disorders with numerous elements that impact people differently. Teachers and staff must be well trained to deal with these unforeseen events. Understudies coming to college come from various financial foundations, which can prompt an assortment of psychological wellness chances (Li et al., 2021). Additionally, current works will be evaluated to differentiate the risk factors associated with stress among university undergraduates worldwide.

There are various reasons which might cause the onset of anxiety and depression. It can be absence of rest, terrible dietary patterns, and lack of activity add to the gloom in undergrads (Ghrouz et al., 2019). Scholarly pressure, which incorporates monetary worries, strain to track down a decent profession after graduation, and bombed connections, is sufficient to drive a few understudies to exit school or more awful.

Numerous parts of school life add to despondency risk factors. For example, understudies today are owing debtors while having fewer work prospects than prior. Discouraged kids are bound to foster the problems like substance misuse (Lattie et al., 2019). For adaptation to close-to-home trouble, discouraged understudies are more inclined than their non-discouraged companions to knock back the firewater, drink pot, and participate in unsafe sexual practices.

Hypothesis on the Topic

The central hypothesis for this study is that college students have a higher rate of anxiety and depression. The study will integrate various methodologies to prove the hypothesis of nullifying it. High rates of anxiety and depression can lead to substance misuse, behavioral challenges, and suicide (Lipson et al., 2018). Anxiety is one of the most critical indicators of academic success, it shows how students’ attitudes change, reflecting on their overall performance.

Methods Section

Participants.

The study will use college students who are joining and those already in college. The research period is planned to last six months; college students are between the ages of 18 and 21 and life is changing rapidly at this age (Spillebout et al., 2019). This demography will come from the college where I study. The participants will be chosen randomly, the total number will be 100, both female and male, and from all races.

Apparatus/ Materials/ Instruments

Some of the materials to be used in the study will include pencils, papers, and tests. Paper and pencil are typical supplies that students are familiar with, so using them will not cause additional stress. It will be used during the interview with the students and throughout the study will be in effect (Huang et al., 2018). These have been applied in various studies before, and, hence, they will be instrumental in this study.

The study will follow a step-wise procedure to get the required results. First, the students’ pre-depression testing results would be researched and recorded. Second, the students would undergo standardized testing in the same groups. Scholarly accomplishment is impacted by past intellectual performance and standardized testing (Chang et al., 2020). Third, the students’ levels of depression and anxiety would be monitored along with their test results.

The study will use a descriptive, cross-sectional design with categorical and continuous data. The sample demographic characteristics were described using descriptive statistics. Pearson’s proportion of skewness values and common mistake of skewness was utilized to test the ordinariness of the persistent factors. The distinctions in mean scores between sociodemographic variables and stress will be examined using Tests (Lipson et al., 2018). The independent variable will be essential because it will provide the basis of measurement.

The 100 participants had different anxiety levels, as seen from the Test taken and the various evaluations. Forty-five of the participants had high levels, 23 had medium levels, while the remaining 32 had low levels (Lipson et al., 2018). The correlation and ANOVA, which had a degree of era margin of 0.05, were allowed (Lipson et al., 2018). This finding aligns intending to have clear and comprehensive outcomes.

Significance of the Study

If the results would be not significant, it means that students are not subjected to more pressure on average. If the study results in significant outcomes, this would mean that there is much that needs to be done to reduce student’s anxiety. The idea that scholarly accomplishment is indispensable to progress is built up in higher instructive conditions (Nelson & Liebel, 2018). Many colleges devote money to tutoring, extra instruction, and other support services to help students succeed.

APA Ethical Guidelines

The study will have to follow the APA ethical guidelines because it involves experimenting with humans. Some of the policies include having consent from the participant, debriefing the participant on the study’s nature, and getting IRB permission (Nelson & Liebel, 2018). Ethical guidelines should comply with proficient, institutional, and government rules. They habitually administer understudies whom they likewise instruct to give some examples of obligations.

Limitations

The study also had some limitations, making it hard to get the desired outcomes. It was not easy to detect the population-level connections, but not causality. This case hardened the aspect of confounding and getting the relevant random assignment needed for the study had to access (Nelson & Liebel, 2018). For the right individuals for the investigation to be identified, the sampling was not easy.

This study would be essential as it will create a platform for future studies. The result that was gotten shows that many college students are undergoing the problem of anxiety and depression without knowing that it is happening. Educators will have awareness on what aspects of academics they need to modify to ensure their students are not experiencing mental health challenges. Hence, it makes it possible for future researchers to conduct studies to provide possible solutions.

Chang, J., Yuan, Y., & Wang, D. (2020). Mental health status and its influencing factors among college students during the epidemic of COVID-19. Journal of Southern Medical University , 40(2), 171-176.

Ghrouz, A. K., Noohu, M. M., Manzar, D., Warren Spence, D., BaHammam, A. S., & Pandi-Perumal, S. R. (2019). Physical activity and sleep quality in relation to mental health among college students. Sleep and Breathing Journal , 23(2), 627-634.

Huang, J., Nigatu, Y. T., Smail-Crevier, R., Zhang, X., & Wang, J. (2018). Interventions for common mental health problems among university and college students: A systematic review and meta-analysis of randomized controlled trials. Journal of Psychiatric Research , 107, 1-10.

Lattie, E. G., Adkins, E. C., Winquist, N., Stiles-Shields, C., Wafford, Q. E., & Graham, A. K. (2019). Digital mental health interventions for depression, anxiety, and enhancement of psychological well-being among college students: A systematic review. Journal of Medical Internet Research , 21(7), e12869.

Li, Y., Zhao, J., Ma, Z., McReynolds, L. S., Lin, D., Chen, Z.,… & Liu, X. (2021). Mental health among college students during the COVID-19 pandemic in China: A 2-wave longitudinal survey. Journal of Affective Disorders , 281, 597-604.

Lipson, S. K., Kern, A., Eisenberg, D., & Breland-Noble, A. M. (2018). Mental health disparities among college students of color. Journal of Adolescent Health , 63(3), 348-356.

Nelson, J. M., & Liebel, S. W. (2018). Anxiety and depression among college students with attention-deficit/hyperactivity disorder (ADHD): Cross-informant, sex, and subtype differences. Journal of American College Health , 66(2), 123-132.

Spillebout, A., Dechelotte, P., Ladner, J., & Tavolacci, M. P. (2019). Mental health among university students with eating disorders and irritable bowel syndrome in France. Journal of Affective Disorders , 67(5), 295-301.

The following table shows the significant issues that affect the mental health state of most college students. Based on Huang et al.’s research, the biggest concern for most students included stress about their loved ones. Additionally, the authors found that worrying about one’s academics and schooling was the second depressing experience among most college students.

The following figure shows how on top of the current stressors for students, COVID-19 affects their mental health. Li et al.’s research demonstrates that COVID-19 placed more financial burden than before, especially on students with part-time jobs who often face anxiety and stress due to lack of tuition fees (Li et al., 2021). Generally, the research shows that the financial consequences of coronavirus affect the mental state of most college students.

• Chicago (A-D)
• Chicago (N-B)

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How to Manage Stress as a Student: Essay Example

How to manage stress as a student: essay abstract, how to manage stress as a student: essay introduction, stress and anxiety in students: physiological stress, coping with stress and anxiety in students: interventions.

Stress is a part of every life on earth, and everyone has their own strategies for managing it. Stress and anxiety among students, especially teenagers, are widespread. Most of the time, this stress is negative, and they are unable to deal with it.

There are studies that suggest stress and anxiety in students can keep them on track with schoolwork. But if the stress is not taken in a positive attitude, it can be detrimental. Researchers have classified stress into physiological, social, and psychological types. The symptoms of these stresses are also classified into physical, emotional, and mental.

Teenage depression or tension experienced by students growing up further increase academic pressure. If they fail to adapt to the transition and change, teenagers start suffering from anxiety, developing negative personal traits, and having attention problems.

Besides, it is also noted that over-scheduling a student’s life can put them under stress. Anxiety reduction and time management, together with leisure activities, may be helpful approaches for reducing academic stress among college students. This paper discusses some major sources of Physiological, Social, and Psychological stress and anxiety in students. Additionally, it also provides intervention strategies and recommendations to manage stress.

Education is one of humanity’s most fundamental needs, as it is responsible for advancing our civilization. It is difficult to put a price tag on education. Apart from the basic knowledge of various subjects, education brings many intangible benefits.

For instance, it gives individuals the experience and confidence they will use later in life. A good education is the basis for financial, professional, and personal success.

Acquiring knowledge is a large part of studying. Aside from that, the main purpose of education includes learning culture, developing social skills, refining the use of language, and developing problem-solving skills and logical reasoning.

Students learn more than reading, writing, and arithmetic as they discover how to function in society and succeed. The increasing complexity in education today is considered a major source of developing stress and anxiety in many students.

The education system has become an endless stream of papers, assignments, exams, midterms, etc. This turns into a never-ending flow of information that needs to be processed (Ditkofsky, 2004). “Stress can be defined as the biological reaction to any undesirable internal or external stimulus in the form of physical, mental or emotional stability that has a tendency to disturb the person’s homeostasis”.

If the person cannot tolerate the stress reactions, it may lead to the development of disorders. Stress is considered positive if it can stimulate people to grow professionally and personally, learn, or improve. Therefore it is an essential part of our lives (George, et al. 1986).1

Researchers suggest that stress is normal and can keep a student on track with schoolwork. Still, if this purpose is not solved and it prevents them from focusing or maintaining a healthy lifestyle, it can be detrimental.

The amount of stress a person can take comfortably varies from individual to individual. It depends on personal health, energy or fatigue, family situation, and age. Stress tolerance generally decreases with age, when a person is ill, and when they have sleep problems (Rada and Johnson-Leong, 2004).

If we look at the sources of stress, we will see they are numerous. In the case of students, stress may result from various sources both within and outside the school campus, from intense workload and trouble managing their time to economic problems and intricacy with family. There is no answer to this question, as how a student reacts to stress as it is as different as the individual.

In general, the symptoms of stress can be classified into physical, emotional, and mental. Physical symptoms include headaches, stomach upsets, heart pounding, sweaty palms, sleeplessness, and uneasiness. These factors may prevent one from attending class.

Emotional symptoms include being short-tempered, feeling dejected, restless, intimidated, and nervous. These are factors that inhabit or make it difficult for a student to work with others. Mental symptoms of stress are expressed as absent-mindedness, loss of concentration, poor judgment, incompetence, uncertainty, and negative self-talk (Ditkofsky, 2004).

Several studies have reported a disturbing tendency in college student health due to excessive stress (Sax, 1997). Researchers have also classified the stressors affecting students as academic, financial, time- or health-related, and self-imposed (Goodman, 1993; LeRoy, 1988).

In general academic stressors comprise the student’s insight into the broad knowledge base necessary and the perception of an insufficient time to develop it (Carveth, Gesse, & Moss, 1996).

Several studies have found a general pattern of time when students report experiencing academic stress each semester. The peak sources of academic stress result from taking and studying for exams, grade competition, and when there is an extensive syllabus to cover in a small amount of time (Abouserie, 1994; Britton & Tesser, 1991).

For example, suppose a student was not able to attend regular classes due to some illness. In that case, the student will find it very difficult to study the syllabus completed when they were absent. This creates immense mental stress. It is also possible that students may think they’re simply overstressed when their condition has progressed to severe anxiety problems or depression.

It is important for parents and teachers to recognise the symptoms of stress and take necessary actions. Otherwise, stress can build and develop into outbreaks of depression and anxiety. It is also possible that students under pressure can also be more directly triggered by subsequent stressful or traumatic events (Coping with Anxiety and Stress in Everyday Life, 2008).

Studies have estimated that anxiety disorders are serious medical illnesses that affect about 19 million Americans (Regier, et al. 1998). In students, these anxiety disorders are bound together by the common feature of extreme, irrational fear and fright. Unlike the relatively mild, brief anxiety caused by stressful events in a student’s life, anxiety disorders are chronic and harsh and can grow increasingly worse if not treated (NIMH, 2004).

There are several types of physiological stress students undergo. It varies between the genders, age, physique etc. In general, growing up itself can be a difficult experience for both males and females. A boy has a distinct set of likings, friends, etc., than a girl.

During this period, several physical transitions demand a changeover in a student’s mental make-up and their approach towards people and situations. Several researchers have pointed out that children, in general, are often unprepared to handle stress during the transitions from a child to pre-adolescence and from pre-adolescence to adolescence.

For pre-adolescents and teens, an individuality crisis, the threats of peer communication, recognition, and denial of circumstances, persons, and ideas are a regular source of stress and teenage depression.

This is the stage when most of the teens think in terms of “Where do I stand?” and “How do I compare to others?” These are the key questions for this age group. This is also a stage for risky behaviors such as drinking, smoking, drugs, and sex. And these choices are common stressors.

Student life corresponds with adolescence, and stress can be evident in children as a response to the alterations in life and academic pressures. It sometimes becomes the most stressful stage in a student’s life.

Students become more self-aware and insecure, and their thought process becomes more critical and difficult. Simultaneously, this is the stage when some of them become defocused from their academics. They often lack educational motivation and performance, as their concentration is divided among many things, particularly creating an identity for themselves (Life Positive Foundation, 2008).

When stress is perceived negatively, or it becomes too much, students experience physical and psychological impairment (Murphy & Archer, 1996). As mentioned earlier, the differences in genders are also a major point of difference between students.

For instance, studies found that female students had more successful time management behaviors than males. At the same time, they also experienced elevated academic stress and anxiety.

It was also found that males gained more than females from spare time or leisure activities. “Freshmen and sophomore students had elevated reactions to stress when compared to juniors and seniors in the same institution.

Researchers found that anxiety, time management, and leisure satisfaction all impacted the academic stress. Many studies suggested that anxiety reduction and time management together with leisure activities may be a useful approach for reducing academic stress among college students” (Misra, 2000).

Social stress and anxiety disorder are considered the fourth most common psychiatric disorder. The devastating effects of social anxiety extend way beyond an individual feeling of distress in social situations, as will be demonstrated later.

Social anxiety disorder is now and then referred to as social phobia, which generally affects academic success, social situations, and personal relationships among students. “According to a study among college students, it was found that around 40 percent are under the vicious habit of alcohol consumption” (Kennard, 2007).

Another study examined the association between anxiety, social stress, substance use, and gambling behavior. With a sample size of 1,044 high school students from grades 7-11, this study has brought out important observations.

The researchers examined the adolescents’ state, traits, and presence of generalized anxiety, social stress, substance use, and gambling behavior. Results of this study disclosed facts such as “probable pathological gamblers report more daily and weekly alcohol consumption, use more uppers, downers, and hallucinatory drugs, and smoke more cigarettes every day when compared with non-gamblers, social gamblers, and gamblers at-risk for serious problems.

The study also revealed that probable pathological gamblers reported greater levels of state anxiety, trait anxiety, and social stress than non-gamblers, social gamblers, and at-risk gamblers. Further, they established through the study that adolescents with the highest state and trait anxiety scores had more severe gambling and substance abuse problems” (Ste-Marie et al. 2006).

There are also some contradictory results coming from the studies. For instance, recently published research by Ham et al (2007) aimed to reveal the relationship between social anxiety and drinking, particularly within a college student population.

They found that social anxiety was not connected to alcohol-related problems. Furthermore, social anxiety was largely unconnected to students’ motives for drinking alcohol.

Only individuals with high or moderate social anxiety appeared more likely to use alcohol as a coping mechanism. According to a recent report by the National Institute of Health (NIH), it was found that anxiety is a psychological risk factor connected with heavy or problem drinking among college students (Repich, N.D.).

Racial-ethnic differences that increase social anxiety are another cause of social stress among college students. According to a study, it was found that social anxiety was lower for White Americans when compared to Hispanic American and Asian American students.

It was reasoned that racial-ethnic differences in social anxiety might be ethnically linked and precipitated by diverse concerns for racial-ethnic minority groups (Lesure-Lester and King, 2005). For example, Joseph, a 1st generation Korean American student, faces serious psychological stress and depression.

Though he was a student with an excellent track record in his previous educational programs, he is presently facing serious challenges in his health and grades. This is more of a psychological problem that a good counseling program could help. Similar problems are faced by many other students who come from different places to college.

Good counseling at his high school counseling center could be of great help not only to him but also for similar cases. Students with emotional disturbance frequently require services from counseling that apply different eligibility criteria. The teenagers of Joseph’s age are quite diverse in terms of their needs and strengths.

Students present with a complex range of disabilities, from conduct disorder to schizophrenia. Teenagers who feel their ethnicity, culture, values, learning styles, and interests are not in sync with the evident services and mission of the college they attend are placed at risk for underachievement and for leaving. They either seek transfer elsewhere or forsake higher education altogether.

Researchers have found that most causes of psychological stress are perennially linked to emotional and psychological disorders. In fact, students may feel numerous emotional symptoms in stressful situations, whether long-term or short-term.

It may vary from individual to individual and can set forth a series of symptoms such as a feeling of behavior disintegration, fear, nervousness attacks, unfocussed attention or distractions, high levels of emotional responses, and psychological agitation such as gloominess, uncertainty, burn out, etc. Some of this stress and anxiety may become life-threatening through accidents.

Students during their academic life face these psychologically stressful situations and experience anxiety. In fact, researchers have found that almost all anxiety attacks and stress-linked mind-body illnesses are known to cause sleep disorders.

These may include problems such as sleep apnea, overdue sleep phase syndrome, and even oversleeping in classrooms. In intense cases, these stressors can even cause insomnia.

It is proven that students with Attention-Deficiency Disorder, Predominantly Inattentive Type (ADD), show signs of six or more symptoms of lack of concentration and less than six symptoms of hyperactivity-impulsivity.

They typically display some of the following symptoms: lack of concentration, distractibility, incompetence, vagueness, lack of insight, negligence, lack of memory, lack of enthusiasm, lack of determination, and procrastination.

It is a fact that regular stress can damage one’s spirit, slowing down the enthusiasm to live a fulfilling life. The student may fall into compulsive, obsessive behavior and fear during these situations. Stressed-out children seem to be easily attracted to negative habits of procrastination, addiction to alcohol, smoking, and substance abuse. All these incapacitating mental traits arise from a loss of confidence and inner strength (Life Positive Foundation, 2008).

Researchers have also found that several psychological signs of stress manifest as physiological responses. For instance, in a study on dental students it was found that the physical disorder reported most frequently by dentists is lower back pain.

Besides, they often feel physical manifestations such as headaches and intestinal or abdominal problems. Though in most cases these disorders may not be so severe that they require intervention, they may interfere with the dentist’s professional performance and quality of life (Gale, 1998).

Psychological stress is often created by parental pressure to perform and to stand out among other children. When the students fail to rise up to that expectation, or during the process of meeting it, they may suffer from frustration, physical stress, aggression, undesirable complexes, and depression.

Besides, under-performing students exhibit negative traits such as nervousness, unfriendliness, and envy, and may become pathologically introverted (Life Positive Foundation, 2008).

Remarkable advances in the 21st century in information technology have revolutionized modern education. The educational systems must focus on certain issues such as character development, moral formation, discipline, safety, protection from drugs and early sex in schools, etc. These issues are as important as the subject knowledge.

Therefore it is essential that the instructors and the parents look into these aspects more seriously. Stress is a part of a student’s life and can lead to both positive and negative feelings. Therefore it is important to seek appropriate intervention programs in schools and communities.

Exercise is one clear type of stress management that can help students to develop “fight-or-flight” response to stress. It is one of the most important intervention strategies to combat stress.

It helps to check the increased heart rate and the high amounts of insulin and other hormones in the body. Besides, it gives natural mood-enhancing substances known as endorphins, which also counter the stress response. Regular exercise can have a positive impact on a student’s life.

Developing a positive mental attitude is one of the most important parts of stress management. Emotional and mental health is enhanced by exercise, but it also needs to be addressed in terms of some of the behaviors that we choose in the day-to-day life and get rid of harmful coping mechanisms.

Students need to find correct ways of thinking rather than use substances like alcohol, nicotine, and illicit drugs to combat stressful feelings. It becomes necessary to train students’ minds to think positively (Coping with Anxiety and Stress in Everyday Life, 2008).

Having a healthy diet is another aspect that students need to act on. Balanced nutrition is important. A proper diet will go a long way to reducing stress levels among students. When children are stressed, they often eat junk food to comfort themselves.

This leads to the serious problems such as obesity, cardiac problems, etc. at a very young age. Students need to be taught to be careful in their diet, drink plenty of water, and reduce the intake of caffeine and alcohol. All this will go a long way to helping the children cope with stress naturally.

Only then will we be approaching stress management in a healthy and life-extending way. Meditating regularly is quite normal and studies have shown that it is very useful in dropping stress levels and helping to decrease your blood pressure.

It is also essential to get enough sleep as this is the time the body uses to repair and renovate itself. Students after the stressful routines need to take adequate rest. Many students have taken up habits such as depending on alcohol and drugs as a nightcap.

This actually makes the sleep patterns worse. Long hours of reading at night and staying up too late can have serious health problems. Simple techniques like taking a long, soothing bath before bed is a way to support the body to go to sleep. Taking short breaks from routines is a good way to get rid of stress. Even a weekend away will help. Taking a short break will allow the student to recharge and let the stress drain away.

Some institutions offer group therapy for people with social anxiety, which provides an opportunity to learn how to overcome fears in a safe environment with people who understand the personal feelings of children. Researchers have demonstrated that alcohol, in fact, triggers the fight-or-flight response by stimulating the release of stress hormones such as corticosterone and adrenaline.

An important intervention strategy is increasing the sense of control over social anxiety by learning anxiety reduction techniques. Further, nutritional strategies for reducing anxiety, deep breathing, guided meditation, and cognitive-behavioral strategies are just a few examples of anxiety reduction techniques that need to be included in the intervention program.

For instance, “NIH studies indicate that cognitive-behavioral therapy can be as successful as medication in treating anxiety, and even more effective than medication at preventing the long-term reappearance of anxiety” (Repich, N.D.).

Counseling centers on the school campuses seek to support students’ personal and professional growth. It is the responsibility of counseling centers to support as many students as possible by facilitating mental health with the resources available to them. Many counseling centers are multifaceted, offering students direct services, personal, career, and group counseling, and broader outreach programming and consultation.

Counselors in the schools work individually and with other educators to meet the developmental needs of students, including those with special needs or learning disabilities. This program should focus on the academic, career, and personal/social developmental needs of students, including those with special needs.

Abouserie, R. (1994). Sources and levels of stress in relation to locus of control and self-esteem in university students. Educational Psychology , 14(3), 323-330.

Britton, B.K., & Tesser, A. (1991). Effects of time-management practices on college grades. Journal of Educational Psychology , 83(3), 405-410.

Carveth, J.A., Gesse, T., & Moss, N. (1996). Survival strategies for nurse-midwifery students. Journal of Nurse-Midwifery , 41(1), 50-54.

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Ditkofsky, N.G. (2004) Stress and the Student [Online]

George J.M., Milone C.L., Block M.J. and Hollister W.G. (1986) Stress management for the dental team . Philadelphia: Lea & Febiger pp 3–20.

Gale, E.N. (1998) Stress in dentistry. N Y State Dent J 64(8) pp 30–34.

Goodman, E.D. (1993). How to handle the stress of being a student . Imprint, 40: 43.

Ham. L.S., Bonin, M., Hope, D.A. (2007) The role of drinking motives in social anxiety and alcohol use. Journal of Anxiety Disorders 21. pp 991-1003.

Kennard, J. (2007) Students, Social Anxiety & Alcohol Use, [Online]

LeRoy, A. (1988). How to survive a nontraditional nursing student . Imprint, 35(2), 73-86.

Life Positive Foundation, (2008) Anxiety in Children [Online]

Lesure-Lester, E and King, N (2005) Racial-Ethnic Differences In Social Anxiety Among College Students, Journal of College Student Retention: Research, Theory and Practice. Vol6(3) 359 – 367.

Misra, (2000) College Students’ Academic Stress And Its Relation To Their Anxiety, Time Management, And Leisure Satisfaction, American Journal of Health Studies, Wntr, 2000. Findarticles. Web.

Murphy, M.C., & Archer, J. (1996). Stressors on the college campus: A comparison of 1985-1993. Journal of College Student Development , 37(1), 20-28.

NIMH, (2004) Anxiety Disorders , [Online] The National Institute of Mental Health.

Rada, R.E. and Johnson-Leong, C. (2004) Stress, burnout, anxiety and depression among dentists, J Am Dent Assoc , Vol 135, No 6, 788-794.

Regier D.A., Rae D.S., Narrow W.E., Kaelber C.T. and Schatzberg A.F. (1998) Prevalence of anxiety disorders and their co-morbidity with mood and addictive disorders. Br J Psychiatry Suppl ; 34 pp24–28.

Repich, D. (N.D.) College Students Use Alcohol as Way of Coping with Social Anxiety [Online]

Sax, L.J. (1997). Health trends among college freshmen. J of Am College Health , 45(6), 252-262.

Ste-Marie C., Gupta, R. And Derevensky, J.L. (2006) Anxiety and Social Stress Related to Adolescent Gambling Behavior and Substance Use. Journal of Child & Adolescent Substance Abuse :15( 4 ) pp 55 – 74.

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

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

Cause and Effects Essay Outline About Stress Among Students

Introduction.

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

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Paragraph 1:

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

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

Paragraph 2:

Student stress is caused by academic pressure.

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

Paragraph 3:

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

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

Paragraph 4: 

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

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

Paragraph 5:

Stress makes students to have poor management skills.

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

Paragraph 6:

Stress leads to self-defeating thoughts.

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

Paragraph 7: 

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

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

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A Cause and Effect Essay on Stress in Students

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Anxious Parents Are the Ones Who Need Help

By Mathilde Ross

Dr. Ross is a senior staff psychiatrist at Boston University Health Services.

This month, across the country, a new cohort of students is being accepted into colleges. And if recent trends continue, the start of the school year will kick off another record-breaking season for anxiety on campus.

I’m talking about the parents. The kids are mostly fine.

Let me explain. Most emotions, even unpleasant ones, are normal. But the word is out about increasing rates of mental health problems on campus, and that’s got parents worrying. Fair enough. The statistics are startling — in 2022, nearly 14 percent of 18-to-25-year-olds reported having serious thoughts about suicide.

But parents are allowing their anxiety to take over, and it’s not helping anyone, least of all their children. If a child calls home too much, there must be a crisis! And if a child calls too little, there must be a crisis! Either way, the panicked parent picks up the phone and calls the college counseling center to talk to someone like me.

I am a psychiatrist who has worked at a major university’s mental health clinic for 16 years. Much of next year’s freshman class was born the year before I started working here. Technically, my job is to keep my door open and help students through crises, big and small. But I have also developed a comprehensive approach to the assessment and treatment of anxious parents.

The typical call from a parent begins like this: “I think my son/daughter is suffering from anxiety.” My typical reply is: “Anxiety in this setting is usually normal, because major life transitions like living away from home for the first time are commonly associated with elevated anxiety.” Parents used to be satisfied with this kind of answer, thanked me, hung up, called their children and encouraged them to think long-term: “This too shall pass.” And most everyone carried on.

But these days this kind of thinking just convinces parents that I don’t know what I’m talking about. In the circular logic of mental health awareness, a clinician’s reassurance that situational anxiety is most likely normal and time-limited leads a parent to believe that the clinician may be missing a serious mental health condition.

Today’s parents are suffering from anxiety about anxiety, which is actually much more serious than anxiety. It’s self-fulfilling and not easily soothed by logic or evidence, such as the knowledge that most everyone adjusts to college just fine.

Anxiety about anxiety has gotten so bad that some parents actually worry if their student isn’t anxious. This puts a lot of pressure on unanxious students — it creates anxiety about anxiety about anxiety. (This happens all the time. Well-meaning parents tell their kid to make an appointment with our office to make sure their adjustment to college is going OK.) If the student says she’s fine, the parents worry that she isn’t being forthright. This is the conundrum of anxiety about anxiety — there’s really no easy way to combat it.

But I do have some advice for parents. The first thing I’d like to say, and I mean it in the kindest possible way, is: Get a grip.

As for your kids, I would like to help you with some age-appropriate remedies. If your child calls during the first weeks of college feeling anxious, consider saying any of the following: You’ll get through this; this is normal; we’ll laugh about this phone call at Thanksgiving. Or, say anything that was helpful to you the last time you started something new. Alternatively, you could say nothing. Just listening really helps. It’s the entire basis of my profession.

If the anxiety is connected to academic performance — for instance, if your child is having difficulty following the professor and thinks everyone in class is smarter — consider saying, “Do the reading.” Several times a semester, a student I’ve counseled tells me he or she discovered the secret to college: Show up for class prepared! This is often whispered rather sheepishly, even though my office is private.

Anxiety about oral presentations is also quite common. You know what I tell students? “Rehearse your speech.” Parents, you can say things like this, too. Practice it: “Son, you wouldn’t believe how helpful practice is.”

I can prepare you for advanced topics, too. Let’s say your child is exhausted and having trouble waking up for class; he thinks he has a medical problem or maybe a sleep disorder. Consider telling him to go to bed earlier. Common sense is still allowed.

What if a roommate is too loud or too quiet, too messy or too neat? Advise your kid to talk to the roommate, to take the conversation to the problem’s source.

If your child is worrying about something more serious, like failing out of college: This is quite common in the first few weeks on campus. Truth be told, failing all of one’s classes and being expelled as a result, all within the first semester, is essentially impossible and is particularly rare among those students who are worrying about it. The administrative process simply doesn’t happen that fast. Besides, you haven’t paid enough tuition yet.

I’m making my job sound easy, and it’s not. I’m making kids sound simple, and they’re not. They are my life’s work. Some kids walk through my door in serious pain. But most don’t. Most just need a responsible adult to show them the way. And most of what I do can be handled by any adult who has been through a thing or two, which is to say, any parent.

I worry that the current obsession with mental health awareness is disempowering parents from helping their adult children handle ordinary things. People are increasingly fearful that any normal emotion is a sign of something serious. But if you send your adult children to a mental health professional at the first sign of distress, you deprive yourself of the opportunity to strengthen your relationship with them. This is the beginning of their adult relationship with you. Show them the way.

The transition to college is full of excitement and its cousin, anxiety. I enjoy shepherding young people through this rite of passage. Parents should try enjoying it, too.

Mathilde Ross is a senior staff psychiatrist at Boston University Health Services.

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