causes of stress in college students essay

Stress Among College Students: Causes, Effects and Overcomes Essay

Introduction, causes of stress in college students, effects of stress, overcoming stress, works cited.

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

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

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

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

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

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

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

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

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

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

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

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

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

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Understanding Academic Stress in College

How can you tell if your college stress is unhealthy, signs you may need professional support, get more academic stress tips.

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If you’re like most college students, you experience school-related stress. Stress isn’t always a bad thing. At manageable levels, it’s necessary and healthy because it keeps you motivated and pushes you to stay on track with studying and classwork. 

But when stress, worry, and anxiety start to overwhelm you, it makes it harder to focus and get things done. National studies of college students have repeatedly found that the biggest stumbling blocks to academic success are emotional health challenges including:

• Not getting enough sleep
• Depression 

Many things can create stress in college. Maybe you’re on a scholarship and you need to maintain certain grades to stay eligible. Maybe you’re worried about the financial burden of college on your family. You may even be the first person in your family to attend college, and it can be a lot of pressure to carry the weight of those expectations.

Stress seems like it should be typical, so it’s easy to dismiss it. You may even get down on yourself because you feel like you should handle it better. But research shows that feeling overwhelming school-related stress actually reduces your motivation to do the work, impacts your overall academic achievement, and increases your odds of dropping out.

Stress can also cause health problems such as depression, poor sleep, substance abuse, and anxiety.

For all those reasons—and just because you deserve as much balance in your life as possible—it’s important to figure out if your stress is making things harder than they need to be, affecting your health, or getting in the way of your life.

Then you can get help and learn ways to reduce the impact of stress on your life. 

First identify what’s causing your stress.

• Is it a particular class or type of work?
• Is it an issue of time management and prioritization?
• Do you have too much on your plate?
• Is it due to family expectations or financial obligations?

Next think about how college stress affects you overall.

• Does it prevent you from sleeping?
• Does it make it take longer to do your work or paralyze you from even starting?
• Does it cause you to feel anxious, unwell, or depressed?

If any of that feels familiar, it’s time to find support to ease your stress and help you feel better. Check out these tips to figure out the best support and approach for you. 

It’s important to be able to recognize when stress starts to become all-encompassing, affecting your overall mental health and well-being. Here are some signs you might need to get help:

• Insomnia or chronic trouble sleeping
• Inability to motivate
• Anxiety that results in physical symptoms such as hair loss, nail biting, or losing weight
• Depression, which may manifest as not wanting to spend time with friends, making excuses, or sleeping excessively
• Mood swings, such as bursting into tears or bouts of anger

Learn how to find professional mental health support at your school or elsewhere. 

If you need help right now, text HOME to 741-741 for a free, confidential conversation with a trained counselor any time of day, or text or call 988 or use the chat function at 988lifeline.org .

If this is a medical emergency or there is immediate danger of harm, call 911 and explain that you need support for a mental health crisis.

Tips for Managing Academic Stress in College

How to Reduce Stress by Prioritizing and Getting Organized

5 Ways to Stay Calm When You’re Stressed About School

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If you or someone you know needs to talk to someone right now, text, call, or chat  988 for a free confidential conversation with a trained counselor 24/7. 

You can also contact the Crisis Text Line by texting HOME to 741-741.

If this is a medical emergency or if there is immediate danger of harm, call 911 and explain that you need support for a mental health crisis.

• ACADEMIC ADVICE

The Effects of Stress on College Students & Ways to Overcome it

• June 1, 2022

Table of Contents

What is academic stress, physical effects of stress, psychological effects of stress, relationships or lack of friends, homesickness, tips to overcome stress during college, avoid procrastinating, on-campus mental health services, off-campus centers and hotlines.

We have all heard at least one person being nostalgic about the great time they had in college. And it’s true. Being on your own for the first time ever, pursuing a degree, meeting new people, and living in a new city can give you a new purpose and perspective in life. But we also have to admit that college can be stressful too. While all these great new opportunities might be a dream come true for some, they can be overwhelming for many others. And this overwhelming feeling might go away when you get settled in after a week or might stick around in the form of academic stress.

To understand academic stress, we first need to understand what the term “stress” really means. In simple terms, stress refers to a distressed state of mind caused by various factors. Mental stress manifests differently based on the person or level of stress.

Now that we have clarified what “stress” is, it will be pretty easy to understand what academic stress is. We use the term “academic stress” to refer to the kind of psychological distress caused by factors pertaining to one’s academic performance. The stressors that cause academic stress vary depending on the student, but they all have in common the fear of failure in some way or another.

How Stress Affects College Students & Their Mental Health

While virtually everyone has experienced stress at some point in their lives, its intensity and the way we deal with it differs with every person. For some people, it’s just jitters before a presentation, and that’s it, but for others who don’t know how to deal with or manage it, stress can be a serious problem in their everyday lives. High levels of stress concerning academic performance have a negative impact on one’s mental and physical health. Ironically, academic stress also negatively affects a student’s academic performance.

Though we have stated that stress is related to the mind, you may easily detect someone with higher stress levels due to the physical manifestations of academic stress. While physically, the signs of stress may differ from person to person, there are some more prevalent physical symptoms among students:

Muscle pain & headache

Many of us usually attribute headaches and muscle pain to factors such as dehydration, physical activity, etc. The truth is that muscle pain and headaches are also widespread symptoms of academic stress. When you are stressed, muscles in your body tense up; and when these muscles are tensed for a more extended period, it results in aches and pains in your body.

Nausea & stomach aches

Other common symptoms of academic stress in students include stomach aches and digestive issues like diarrhea or constipation. In even more extreme cases, academic stress manifests itself in the form of nausea and vomiting.

As we have already established, academic stress originates from the need to perform well academically for various reasons. The fear of failure in academic challenges can seriously strain students psychologically. Here are some of the most prevalent psychological symptoms that derive from academic stress:

Anxiety & depression

It is no news that academic stress can worsen symptoms for those that already have an anxiety disorder or depression. According to a survey conducted by the Anxiety & Depression Association of America (ADAA) , 30% of students admitted that stress had a negative impact on their academic performance .

Sleep disorder

High levels of stress can disrupt your sleep schedule or quality. Whether in quantity or quality, less sleep pushes the body to produce more stress hormones like cortisol. And while it is normal for the body to produce cortisol, this particular hormone negatively affects your memory, metabolic rate, and blood glucose regulation when at high levels. This, in turn, will put a student on a vicious cycle where academic stress negatively affects your sleep, and the lack of sleep negatively affects your academic performance.

Causes of Stress During College

Academic stress may affect students of all educational levels, one way or another: whether they are performing in front of an audience, entering an exam, or some other way. However, it is essential to note that college students have some additional stressors that set them apart from students of other levels of education. College students experience stress due to external or internal factors. Here are some of the most common stress-causing factors in college students:

There are a few reasons why some people choose not to pursue a college degree, and the cost of tuition is one of them. Many of those who enroll in college have problems making ends meet due to tuition and other college-related expenses. Simultaneously working and studying can put a strain on the mental health of many students as they try to balance personal, academic, and work life. One possible solution to this problem may be to apply for scholarships, grants, or even loans.

One of the main challenges for many college students is actually making time for themselves or socializing with others. This is especially difficult when they need to work to be able to afford college. Lack of quality time with friends or absence of a social life altogether has a negative effect on a student’s mental health as there is virtually no time to “recharge.”

Think about this: One day, you are a carefree 17-year-old, eating home-cooked meals every day and having the best time of your life in high school. A few months later, you are legally an adult, getting your first job and probably moving thousands of miles away from everything you have ever known to go to college. Even the mere thought of such a transition is enough to stress you out. College students are now far away from their families and responsible for everything that concerns their own lives.

The transition from high school to college can be tough on many students for various reasons. One of the main stressors for college students is the coursework. Students usually struggle to meet deadlines or handle the increased workload that comes with enrolling in college.

Ending the Stigma

The best thing to do in order to help students deal with academic stress is to end the stigma. This can be done by spreading awareness of the effects of academic stress on students’ mental, physical, and emotional health. Only by continually and persistently addressing this issue and educating each other can we overcome or at least learn how to manage academic stress.

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If you or someone you know are experiencing academic stress and its adverse effects on your mental and physical health and your academic performance, it is time to take action . Learning what to do to prevent becoming stressed due to academic workload or even how to manage your academic stress is extremely important for many reasons we have already discussed. Here are some tips on how to overcome academic stress when in college:

Maintain a healthy diet

A healthy diet is a well-balanced diet that includes vitamins, minerals, antioxidants, and a regular eating schedule and daily exercise. While maintaining a healthy diet should be a priority for everyone, a healthy diet can also help with overcoming academic stress. Eating healthy will keep your blood pressure and glucose stable, both of which may fluctuate when a person is in a stressful situation. While many students make it a habit of drinking caffeinated drinks to stay focused on their studies, it is best to opt for water or milk. This is because caffeinated drinks raise cortisol levels in the body, similar to what stress does.

Remain physically active

Being physically active does not mean you need to be all closed up in a gym sweating away. Any sport or physical activity counts as exercise as long as it increases your heart rate. When exercising or taking part in physical activity, your body releases hormones (endorphins) that, among other benefits, reduce stress.

Make sure you spend time outdoors

Sometimes just being in a room by yourself you will associate with stress and anxiety and hence stress out. College students can also deal with academic stress by spending time outdoors. Leaving your dorm room or library and simply going outside for a walk can do wonders for your focus. Being surrounded by nature and greenery significantly reduces your cortisol levels.

The change in workload is one of the leading causes of academic stress in college students. By learning how to manage your time better, you make sure to always meet your deadlines. By avoiding procrastination, you spread out the workload, so you don’t have to worry about working under pressure when the deadlines approach.

Seeking Medical Support

While totally manageable for a lot of people, academic stress can have powerful adverse effects on others. Some of the negative effects of academic stress may be too exhausting to deal with on your own. That is why it is always essential to know places to seek help if needed:

Lately, there has been an increase in awareness surrounding mental health issues, including academic stress. That is why many institutions offer on-campus health services for their students. You can learn more about these services by visiting your college’s website.

If you feel that on-campus mental health services won’t do for you personally, you can always seek help in off-campus centers. Another great source that offers support is the hotlines available 24/7. Check the number for suicide prevention lifelines to consult with specialists on anything you might be dealing with, including anxiety, depression, stress, etc. You can contact the National Suicide Prevention Lifeline at 1-800-273-8255 .

Though there has been some progress in awareness regarding mental health, specifically the effects of stress on mental and physical health, there is still so much to do. There are a few steps students can take to better deal with academic pressure, like eating healthy, exercising, managing their time better, consulting with loved ones and specialists, etc. As academic stress can have serious negative effects on one’s health, everyone should take it seriously and work towards overcoming it the best they can.

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Home Essay Samples Education College Students

Understanding the Causes of Stress in College Students

Table of contents, academic pressure, financial concerns, social pressures, time management challenges.

• Abramson, L. Y., Seligman, M. E., & Teasdale, J. D. (1978). Learned helplessness in humans: Critique and reformulation. Journal of Abnormal Psychology, 87(1), 49-74.
• American College Health Association. (2018). American College Health Association-National College Health Assessment II: Reference Group Executive Summary Fall 2018. American College Health Association.
• Chapell, M. S., Blanding, Z. B., Silverstein, M. E., Takahashi, M., Newman, B., Gubi, A., & McCann, N. (2005). Test anxiety and academic performance in undergraduate and graduate students. Journal of Educational Psychology, 97(2), 268-274.
• El Ansari, W., Stock, C., & Mills, C. (2013). Is alcohol consumption associated with poor academic achievement in university students? International Journal of Preventive Medicine, 4(10), 1175-1188.
• Mokhtari, K., Reichard, C. A., & Gardner, A. (2009). The impact of internet and television use on the reading habits and practices of college students. Journal of Adolescent & Adult Literacy, 52(7), 609-619.

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Stress in College Students: What to Know

Strong social connections and positive habits can help ease high levels of stress among college-age adults.

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From socializing to working out, here's how college students can better manage stress.

From paying for school and taking exams to filling out internship applications, college students can face overwhelming pressure and demands. Some stress can be healthy and even motivating under the proper circumstances, but often stress is overwhelming and can lead to other issues.

"Stress is there for a reason. It's there to help mobilize you to meet the demands of your day, but you're also supposed to have times where you do shut down and relax and repair and restore," says Emma K. Adam, professor of human development and social policy at Northwestern University in Illinois.

Chronic and unhealthy levels of stress is at its worst among college-age students and young adults, some research shows. According to the American Psychological Association's 2022 "Stress in America" report , 46% of adults ages 18 to 35 reported that "most days they are so stressed they can't function."

In a Gallup poll that surveyed more than 2,400 college students in March 2023, 66% of reported experiencing stress and 51% reported feelings of worry "during a lot of the day." And emotional stress was among the top reasons students considered dropping out of college in the fall 2022 semester, according to findings in the State of Higher Education 2023 report, based on a study conducted in 2022 by Gallup and the Lumina Foundation.

As students are navigating a new environment and often living independently for the first time, they encounter numerous opportunities, responsibilities and life changes on top of academic responsibilities. It can be sensory overload for some, experts say.

“Going to college has always been a significant time of transition developmentally with adulthood, but you add to it everything that comes along with that transition and then you put onto it a youth mental health crisis, it’s just compounded in a very different way," says Jessica Gomez, a clinical psychologist and executive director of Momentous Institute, a researched-based organization that provides mental health services and educational programming to children and families.

Experts say college students have experienced heightened stress since the COVID-19 pandemic, a trend likely to continue for the foreseeable future.

“What some of our research at Gallup has shown is that we had a rising tide of negative emotions, not just in the U.S. but globally, in the eight to 10 years leading up to the pandemic, and of course it got worse during the pandemic," says Stephanie Marken, senior partner of the education research division at Gallup who conducted the 2023 study. “For currently enrolled college students, there’s so many contributing factors.”

Adam notes that multiple factors combine to contribute to heightened stress among younger adults, including the nation’s racial and political controversies, as well as anxiety regarding their futures fueled by climate change, global unrest and economic uncertainty. Female students reported higher levels of stress than males in the Gallup poll, which Marken says could be attributed to several factors like increased internal academic pressure, caregiving responsibilities and the recent uncertainty regarding abortion rights following the reversal of Roe v. Wade.

All of this, plus the residual effects of pandemic learning, has contributed to rising stress for college students, Marken says.

"We need to give them a lot of credit," she says. "They had the most challenge in remote learning of all the learners that have come before them. Many of them had to graduate high school and study remotely, or were a first-year college student during the pandemic, and that was incredibly difficult."

The challenges that came with that learning environment will likely affect students throughout college, she says, as well as typical stressors like discrimination, harassment and academic challenges.

"Those will always be present on college campuses," she says. "The question is, how do we create a student who overcomes those challenges effectively?"

Experts suggest a range of specific actions and positive shifts that can help ease stress in college students:

• Notice the symptoms of heightened stress.
• Build and maintain social connections.
• Sleep, eat well and exercise.

Notice the Symptoms of Heightened Stress

College students can start by learning to identify when normal stress increases to become unhealthy. Stress will appear differently in each student, says Lindsey Giller, a clinical psychologist with the Child Mind Institute, a nonprofit focused on helping children and young adults with mental health and learning disorders.

"Students prone to anxiety may avoid assignments as well as skip classes due to experiencing shame for being behind or missing things," she says. "For some, they may also start sleeping in more, eating at more random times, foregoing self-care, or look to distraction or escape mechanisms, like substances, to fill time and further avoid the reality of workload assignments."

Changes in diet and sleeping are also telling, as well as increased social isolation and pulling away from activities that once brought you pleasure is also a red flag, Gomez says.

She warns students to watch for signs of irritability, a classic indicator of increased stress that can often compound issues, especially within interpersonal relationships.

"Your body speaks to you, so be in tune with your body," she says.

Build and Maintain Social Connections

Socializing can help humans release stress. Experts say having fun and finding joy in life keep stress levels manageable, and socializing is particularly important developmentally for young adults. In the 2023 Gallup poll, 76% of students reported feeling enjoyment the previous day, which Marken says was an encouraging sign.

But 39% reported experiencing feelings of loneliness and 36% reported feeling sad. “We are in the midst of an epidemic of loneliness in our country, where we are noticing people don’t have the skills to build friendships,” Gomez says.

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Talking about feelings of stress can help college students cope, which is why the amount of students feeling lonely is concerning, Marken says. If students don't feel like they belong or have a social network to call on when feeling stressed, negative emotions are compounded.

“I think we’re more connected, and yet we’re more isolated than ever," she says. "It feels counterintuitive. How can you be more connected to your network and campus than ever, yet feel this lonely? Just because they have a device to connect with each other in a transactional way doesn’t mean it’s a meaningful relationship. I think that’s what we’re missing on a lot of college campuses is students creating meaningful connections about a shared experience."

Setting boundaries on social media use is crucial, Gomez says, as is getting plugged in with people and organizations that will be enriching. For example, Gomez says she joined a Latina sorority to be in community with others who shared some of her life experiences and interests.

Sleep, Eat Well and Exercise

Maintaining healthy habits can help college students better manage stressors that arise.

"Prioritizing sleep, moving your body, getting organized, and leaning on your support network all help college students prevent or manage stress," John MacPhee, CEO of The Jed Foundation, a nonprofit that aims to protect emotional health and prevent suicide among teens and young adults, wrote in an email. "In the inevitable moments of high stress, mindful breathing, short brain breaks, and relaxation techniques can really help."

Experts suggest creating a routine and sticking to it. That includes getting between eight and 10 hours of sleep each night and avoiding staying up late, Gomez says. A nutrient-rich diet can also go a long way in maintaining good physical and mental health, she says.

Getting outdoors and being active can also help students limit their screen time and use of social media.

“Walking to campus, maybe taking that longer walk, because your body needs that to heal," Gomez says. "It’s going to help buffer you. So if that’s the only thing you do, try to do that."

Colleges typically offer mental health resources such as counseling and support groups for struggling students.

Students dealing with chronic and unhealthy stress should contact their college and reach out to friends and family for support. Reaching out to parents, friends or mentors can be beneficial for students when feelings of stress come up, especially in heightened states around midterm and final exams .

Accessing student supports and counseling early can prevent a cascading effect that results in serious mental health challenges or unhealthy coping mechanisms like problem drinking and drug abuse , experts say.

"Know there are lots of resources on campus from academic services to counseling centers to get structured, professional support to lower your workload, improve coping skills, and have a safe space to process anxiety, worry, and stress," MacPhee says.

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The Phenomenon of Academic Stress

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Published: Aug 31, 2023

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Understanding academic stress, causes of academic stress, effects of academic stress, coping strategies and resilience, support systems and resources, balancing academic demands and well-being, addressing systemic factors, prevention and intervention strategies, conclusion: a call for holistic approaches to education.

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College students’ stress and health in the COVID-19 pandemic: The role of academic workload, separation from school, and fears of contagion

Chunjiang yang.

School of Economics and Management, Yanshan University, Qinhuangdao, Hebei, China

Yashuo Chen

Associated data.

All relevant data are within the manuscript and its Supporting Information files. In addition, all data are available form the OSF database. The link is https://osf.io/ajfhw/ and the DOI is 10.17605/OSF.IO/AJFHW .

The COVID-19 pandemic has unhinged the lives of people across the globe. In particular, more than 30 million Chinese college students are home-schooling, yet there is little understanding of how academic workload, separation from school, and fears of contagion lead to a decrease in their health. This study examined the relationships between Chinese college students’ three critical stressors and two types of health in the COVID‐19 pandemic context. We used a three-wave lagged design with a one-week interval. All the constructs were assessed by self-report in anonymous surveys during the COVID‐19 pandemic. College students were asked to report their demographic information, academic workload, separation from school, fears of contagion, perceived stress, and health. The results of this study showed that academic workload, separation from school, and fears of contagion had negative effects on college students’ health via perceived stress. In the COVID-19 crisis, multiple prevention and control measures focusing on college students may lead them to have different degrees of stress and health problems. Our results enrich the literature on stress and health and offer novel practical implications for all circles of the society to ensure students’ health under the context of the COVID-19 epidemic.

Introduction

Compared with other student groups, such as primary school students and middle school students, the traditional view is that college students bear more pressure and have more serious physical and mental health problems [ 1 ]. In previous research, there is a strongly held consensus that dealing with intimate relationships, financial difficulties, and fulfilling responsibilities and roles are the main sources of stress for college students. Due to the recent social changes in the education domain (e.g., the sharing of educational resources and advances in communication technology), the use of distance education is more and more, which changes the communication patterns between teachers and students, increases the isolation and independence of students, and thus becomes an important source of pressure for students [ 2 ]. Today, the spread of coronavirus disease 2019 (COVID-19) is becoming unstoppable, having infected more than 12 million people [ 3 ]. In response to this unprecedented challenge, the Chinese government has ordered a nationwide school closure as an emergency measure to prevent the spreading of the infection among teachers and students. As a consequence, 30.315 million Chinese college students are trapped at home, learning online courses through the internet to complete the required academic tasks. So far, the new virtual semester has been going on for nearly three months, and various courses are offered online in a well-organized manner. Although these decisive actions and efforts are highly commendable and necessary, there are also reasons to worry that drawn-out school suspension, home confinement, and distance learning may have adverse effects on college students’ physical and mental health [ 4 ]. In addition, a series of issues, such as fear of contagion, frustration and boredom, inadequate information, and lack of private space at home, would continue to emerge and increase during the COVID-19 outbreak [ 4 ]. However, previous research failed to give enough attention to college students in the epidemic context. For example, some studies have shown that large-scale isolation measures and loss of income have led to mental health problems among migrant workers during COVID-19 outbreaks [ 5 ]. Chen et al. [ 6 ] have discussed the problems in psychological intervention services of medical workers. The present study aimed to fill the void by focusing on college students to explore the influence of several important stressors on their health during the COVID-19 outbreak. Specifically, we identified three important stressors among college students—academic workload, separation from school, and fear of contagion and further explored the mechanism behind the relationships between three stressors and mental and physical health.

Academic stressors refer to any academic demands (e.g., environmental, social, or internal demands) that cause a student to adjust his or her behavior. Learning and examination, performance competition, especially mastering much knowledge in a short time, would lead to different degrees of academic pressure [ 7 ]. Although all planned courses have been affected by the COVID-19 epidemic, online learning still leaves college students with the same academic burden as usual. In addition, previous evidence shows that separation anxiety disorder of adults is similar to that of children and adolescents in phenomenology. College students who are attached to their classmates may experience separation anxiety after leaving school. Emerging problems during the COVID-19 outbreak, such as conflicting family schedules, changes in eating and sleeping habits, separation from classmates, and loneliness, may have adverse effects on college students [ 8 ]. Seligman and Wuyek suggested that college students may experience separation anxiety when they go home for the holidays [ 9 ]. Finally, the COVID-19 pandemic has projected humanity into an unprecedented era characterized by feelings of helplessness and loss of control. As Sontag [ 10 ] noted, unknown diseases cannot be totally controlled and thus are often considered more threatening than factual evidence. During this period, populations remained almost entirely susceptible to COVID-19, causing the natural spread of infections to exhibit almost perfect exponential growth [ 11 ]. Therefore, feelings of fear and apprehension about having or contracting COVID-19 may be a significant stressor for college students. Considering the actual situation of college students during an outbreak of COVID-19, the first aim of the study is to identify academic workload, separation from school, and fears of contagion, which are the three important stressors of college students.

Moreover, previous studies demonstrated that diseases (e.g., SARS) [ 12 ], academic (e.g., academic expectations) [ 13 ], and attachments (e.g., attachment to parents) [ 14 ] are closely associated with students’ health. However, it is still not fully understood how these stressors lead to health-related outcomes. In particular, we know little about the mechanism through which these stressors affect physical and mental health in the context of the COVID-19 outbreak. Brewster et al. [ 15 ] have suggested that further research is needed to establish the different mechanisms through which stressors impact health in order to have a profound understanding of the nature of stress. In response to these calls for further research, the second aim of this study thus was to examine the potential mediating roles of perceived stress in the relationships between the three stressors and physical and psychological health.

Overall, the current study focuses on college students and presents an integrated framework to investigate whether and how three types of stressors influence physical and mental health. Our study contributes to the current literature on stress and health in three unique ways. First, to the best of our knowledge, this study is the first to explore home-schooling college students’ physical and mental health during the COVID-19 outbreak. It makes up for the lack of understanding of the situations of college students who are ongoing home-schooling during the COVID-19 outbreak. Second, we discovered that academic stressors, interpersonal stressors, and environmental stressors of college students are critical factors that influence their health. This investigation not only overcomes the previous analysis focusing primarily on the effect of a single stressor on college students’ health but also enlarges the scope of current research on students’ stress and health by shifting the locus of theorizing away from campus domain to family domain. Third, by examining the mediating role of perceived stress, we exposed the “black box” in the relationship between stressors and health.

Three stressors among college students during the COVID-19 outbreak

College students’ stressors have been typically grouped into three major categories: academic pressure [ 16 – 19 ], social and interpersonal pressure [ 20 , 21 ], and environmental pressure [ 22 , 23 ]. Specifically, this study focuses on academic workload (representing academic pressure), separation from school (representing social and interpersonal pressure), and fear of contagion (representing environment pressure).

Academic workload

Academic problems have been regarded as the most common stressor for college students [ 24 , 25 ]. For example, in Schafer’s [ 26 ] investigation, students reported that the most significant daily hassles were academics-related stressors such as constant study, writing papers, preparing for exams, and boring teachers. The academic pressure easily comes from taking and preparing for exams, grade level competition, and acquiring a large amount of knowledge in a short period of time [ 7 ]. Perceived stress is a response to stressors, referring to the state of physical or psychological arousal [ 27 ]. College students experience adverse physical and psychological outcomes when they perceive excessive or negative stress. Excessive stress may induce physical impairments, including lack of energy, loss of appetite, headaches, or gastrointestinal problems [ 28 ]. Numerous studies have evaluated academic stress associated with various adverse outcomes, such as poor health [ 29 , 30 ], anxiety [ 31 ], depression [ 32 ], and poor academic performance [ 33 , 34 ]. In particular, Hystad et al. [ 35 ] found significant associations between academic stress and health, both psychological and physical.

Separation from school

Previous studies have shown that students view the transition from high school to college as a source of some degree of stress and emotional dissonance [ 36 ]. College students’ adaptability is closely related to their attachment with different people, such as parents and friends. Indeed, extant research on attachment has four research directions. First, the most systematic studies have focused on adolescents’ psychological separation from parents, suggesting that the healthy development of adolescents depends largely on psychological separation from parents [ 37 ]. The second field focuses on the attachment relationship between parents and adolescents, assuming that attachment to parents is a necessary prerequisite for adolescents’ adaptive function [ 38 , 39 ]. The third research stream emphasized the importance of psychological separation and attachment. According to this point of view, a balanced parent-child relationship between psychological separation and parental attachment is the best choice for students’ development [ 37 , 40 ]. Finally, a fourth research stream focuses on attachment to a group or group members in a campus environment and suggests that this attachment may influence students’ affective and behavioral outcomes [ 41 ]. From the above-mentioned research fields, we can discover that the existing literature mainly focuses on the effects of attachment on college students in their campus life. Of course, it is undeniable that the campus is the primary field for college students, while the family field becomes more important for college students during the weekends, holidays, and internships. Unfortunately, there is a dearth of research on the influence of attachment on college students in their family life. According to the literature on attachment and separation, attachment relationships between college students and their classmates may affect their stress and health when they are at home.

Social cohesion theorists believed group formation was entirely a function of individual relationships among the group members: As individuals were attracted to one another, they were consequently attracted to the group as a whole. Furthermore, group formation can occur independently of interpersonal attraction [ 42 ]. Based on the social identity theorists’ research, in minimal groups, people formed group attachment without having any contact or even knowing the other members in their group [ 41 ]. Thus, whether or not there is a close relationship with group members, one can feel the attachment to the group to which he belongs. However, some scholars reasoned that students with a stronger and healthier sense of themselves as individuals would be better equipped to handle the demands for independent functioning that accompany the college transition. An investigation among medical students shows that students with greater group cohesion reported less stress [ 43 ]. Separation anxiety begins with separation from parents, peers, and other significant persons. The national mandate force college students to separate from school in the COVID-19 pandemic, leading to separate from their peers and thus may cause their stress.

Fears of contagion

Fears of contagion reflect feelings of apprehension about having or contracting COVID-19. The literature on health anxiety [ 44 ] suggests that threatening events—such as a global pandemic—trigger high levels of stress. Although previous studies have described the pressures triggered by large-scale events, such as natural disasters [ 44 ] and terrorist attacks [ 45 ], the outbreak of infectious diseases (the COVID-19 pandemic) worldwide is different from other large-scale events [ 46 ]. Update to 1 May 2020 , the COVID-19 pandemic has resulted in 3175207 confirmed cases and 224172 deaths [ 3 ]. To prevent the spread of infectious diseases, Chines schools have been closed nationwide, collective activities have been canceled, public transportation has been suspended, and family imprisonment has been strictly enforced in some epidemic areas. The outbreak of COVID-19 has a seriously destructive impact on people’s lives all over the world. The effects of COVID-19 are multifaceted, affecting both physical health (e.g., pneumonia, liver, and renal injury) and psychological well-being (e.g., fear of contracting an infectious disease, avoid exposure to others to reduce the risk of being infected). Although national preventive measures can slow the spread of the epidemic, individuals cannot ensure that they are not infected with the disease. According to Chinese data, a large number of transmissions, both in nosocomial and community settings, occurred through human-to-human contact with individuals showing no or mild symptoms [ 47 ]. The COVID-19 pandemic is an immediate threat, it is unclear how long it will persist, and there are a multitude of unanswered questions regarding its impact. Several anecdotal reports by health care professionals note the COVID-19 pandemic triggers individuals’ anxiety and stress, particularly surrounding the uncertainties brought by COVID-19 [ 48 ]. Therefore, we suggest that fear of having or contracting COVID-19 may lead to college students’ stress and health problems.

Transactional models of stress and coping

Lazarus and Folkman [ 49 ] defined stress as a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being. The Transactional Model of Stress provides a basic framework for explaining the processes of individuals coping with stressful events. A core tenet of this model is that the interaction between the person and the environment creates an individual’s feeling of stress. When faced with a stressor, two appraisals were triggered, an individual evaluates potential threats or harms (primary appraisal), as well as the ability to change the situation and control negative emotional reactions (secondary appraisal). Primary appraisal is an individual’s estimate of the significance of an event as stressful, negative, positive, controllable, challenging, friendly, or irrelevant. The secondary appraisal is a judgment of an individual’s coping resources and choices [ 50 ]. The response described in the transaction model starts after the primary and secondary appraisals [ 49 ]. There are two kinds of coping efforts strongly related to a person’s cognitive appraisal. One is referred to as problem-focused coping, and the other is referred to as emotion-focused coping. The former coping strategy has been shown to be more commonly used in a person’s causal analysis, suggesting that some measures can be taken to change the negative situation. For example, Folkman and Lazarus [ 51 ] show that students will adopt a problem-based coping style before the examination. The latter coping strategy predominates when people assess that they have no options or lack resources to alter the situation, stressors have to be accepted [ 52 ]. Students have reported they often use escape/avoidance ways to cope with stressors. The problem-solving efforts try to change the situation actively, while the emotion-centric coping style will only change the individual’s interpretation of the stressors. Based on these arguments, we suggest that college students who feel stressed (e.g., regard their stress as an environmental source or lack of ability to alter) would adopt emotion-focused coping as a means of reappraising an uncontrollable situation. Thus, perceived stress plays a central role in the attribution–secondary appraisal coping relationship.

The present study

Our primary aim in the study was to examine the influence of stressors on college students’ stress and health during the COVID-19 outbreak. Specifically, we empirically examine the influence of academic workload, separation from school, and fears of contagion on college students’ psychology and physiology health that included perceived stress as a mediator. Based on the literature review, we hypothesized:

H1a: Academic workload is positively correlated with perceived stress.

H1b: Academic workload is negatively correlated with physical and mental health.

H2a: Separation from school is positively correlated with perceived stress.

H2b: Separation from school is negatively correlated with physical and mental health.

H3a: Fears of contagion are positively correlated with perceived stress.

H3b: Fears of contagion are negatively correlated with physical and mental health.

H4: Perceived stress is negatively correlated with physical and mental health.

• H5: Perceived stress mediates the relationship between academic workload and physical and mental health.
• H6: Perceived stress mediates the relationship between separation from school and physical and mental health.
• H7: Perceived stress mediates the relationship between fears of contagion and physical and mental health.

The hypothesized model is presented in Fig 1 .

Ethics statement

All participants were treated following the American Psychological Association ethical guidelines, and the study protocol was approved by the Yanshan University Institutional Review Board (Approval no. 20-03-01). Each participant got an introduction and a link to a questionnaire via WeChat, a widely used instant communication tool in China. In the introduction, anonymity, the aim of the survey, and information on whether participants agreed to participate in the survey were all illustrated in detail. We explained that if you want to participate in the survey, please open the questionnaire link and fill in your true feelings. Some college students expressed their intention to participate in written form through WeChat, and other college students directly participated in the survey with tacit approval according to the instructions. Therefore, all participants completed the questionnaire voluntarily. In addition, participants were undergraduate students recruited from four public universities in China. Thus, participants are adults and not minors, and we do not need to obtain consent from parents or guardians.

Procedure and participants

Our work is situated within an environmental context the COVID-19 pandemic. All variables were assessed with participants’ self-reports in three anonymous online surveys. Data were collected in three waves to minimize common method bias [ 53 ]. In the first-wave survey (Time 1), participants were asked to report their academic workload, separation from school, fears of contagion, and necessary demographic information. In Time 1, 1072 completed questionnaires were returned. One week later (Time 2), students evaluated their level of perceived stress. Time 2 questionnaires were distributed to the 1072 students, with 945 completed questionnaires being returned. Finally, one week after the second-wave survey (Time 3), students evaluated their physical and psychological health. At Time 3, 867 complete questionnaires were returned.

The average age of college undergraduates was 20.17 years, with 69 percent female. There are 348 freshmen, accounting for 40.1%; 200 sophomores, accounting for 23.1%; 305 junior students, accounting for 35.2%; 14 senior students, accounting for 1.6%. The average number of online courses is 8.41. Only 29.2% of the students rated the quality of online courses as good or very good. Nearly half of the participants said they wanted or very much wanted the school to start soon (49.2%). Of the 867 college students who had participated, 56.2% of them were concerned or very concerned about the possibility of contracting COVID-19 after the semester began. The demographic profile of the survey participants is presented in Table 1 .

We translated the measures from English to Chinese following the commonly used translation/back-translation procedure. All measures are reported in S1 Appendix . Unless otherwise noted, participants responded to all items on a 7-point scale (from 1 = strongly disagree to 7 = strongly agree).

It was measured using the three-item scale developed by Hystad et al. [ 35 ]. Items included: “I am spending a lot of time thinking about how this semester’s grades could negatively affect my educational and career goals,” “I am worrying a great deal about the effect this semester’s grades will have on my future,” and “I find myself very concerned about the grades I am likely to receive this semester.” Cronbach’s alpha in their study was .85, which suggests that this scale has good reliability. In the current study, Cronbach’s α of this variable is .883.

Separation from school was measured using the attachment avoidance scale developed by Smith et al. [ 54 ]. The scale has fifteen-item. An example of a reworded scale item is “I find it difficult to allow myself to depend on my group.” Factor analytic results in their research suggested that the scale has good reliability. In our current study, we reworded to refer to participants’ classmates rather than their social group. An example of a reworded scale item is “I find it difficult to allow myself to depend on my classmates.” Cronbach’s α of this variable is .929.

We developed a six-item scale to assess participants’ fears of COVID-19 infection. Six items included “In public, I don’t care about touching the door handle without protection,” “In public, I don’t mind sitting in a chair that has just been sat on,” “In an elevator, I don’t mind pushing a button without protection,” “When I’m in a crowded place, I don’t worry about coronavirus from other people,” “I don’t worry about infection if other people don’t wear masks,” “Wearing a mask would make me feel safe.” In the current study, Cronbach’s α of this variable is .842. The results of confirmatory factor analysis are shown that χ2 = 74.424; df = 8; RMSEA = .098; CFI = .982; TLI = .966; SRMR = .043. Thus, this scale has acceptable reliability and validity.

Perceived stress

The 10-item Perceived Stress Scale [ 55 ] was used to measure the student’s stress level in the past month. Participants responded to the items on a 5-point scale (from1 = never to 5 = very often). A sample item is “In the last month, how often have you felt nervous and “stressed”?” In our research, Cronbach’s α of this variable is .792.

Physical and psychological health

The CHQ-12 of the Chinese version was used to measure physical and psychological health. The CHQ-12 has been widely used in Chinese populations. The 12 items included headaches, heart palpitations, chest pain or tightening, trembling or pins and needles, sleeplessness, nervousness, and hopelessness. Participants responded to the items on a 4-point scale (1 = not at all, 4 = more than usual). A higher score represented a more severe psychosocial impairment. In our research, Cronbach’s α of this variable is .895.

Control variables

We controlled students’ age, gender, grade, and the number of online courses in the study.

Analysis strategy

First, we conducted a series of confirmatory factor analyses ( CFA ) in order to test the discriminant validity of the five prime constructs (academic workload, separation from school, fears of contagion, perceived stress, and health). CFA, as an empirical research technology, is affiliated with structural equation modeling. Therefore, it is necessary to judge the fitting situation according to the fitting indexes from the structural equation model. Common fitting indexes include chi-square( χ2 ), degree of freedom ( df ), CFI , TLI , RMSEA , and S RMR . Specifically, if the ratio of chi square to degree of freedom is less than 5, the model is generally acceptable. When CFI and TLI are higher than 0.9, the model fits well. The smaller the RMSEA and SRMR , the better the result, and in particular, when it is below 0.08, the model is acceptable. Second, we performed Harman’s single-factor test to explore the potential influence of common method variance. No single factor accounting for more than 50% of the variance of all the relevant items indicates that the results are acceptable. Third, we calculated Pearson’s correlation coefficient using SPSS Version 21, which reflects the effect of change in one variable when the other variable changes. Fourth, we tested our hypotheses using a path analysis in Mplus Version 8.3. To examine mediation (Hypothesis 5,6, and 7), we used a bootstrap simulation with 1,000 replications to create our bias-corrected 95% confidence intervals (CIs) around our indirect effects. The bootstrap approach is a more robust strategy than the causal step procedure for small samples for assessing indirect effects and a useful method for avoiding power problems relating to a non-normal sampling of the indirect effect. When the 95% confidence interval of the path coefficient does not contain zero, the mediating effect is significant.

Confirmatory factor analyses

Table 2 presents the CFA results. As shown, the baseline five-factor model fitted the data well ( χ2 = 3020.006; df = 965; RMSEA = .050; CFI = .920; TLI = .914; SRMR = .064). Against this baseline five-factor model, we tested four alternative models: model 1 was a four-factor model with academic workload merged with perceived stress to form a single factor ( χ2 = 5405.203; df = 969; RMSEA = .073; CFI = .827; TLI = .815; SRMR = .112); model 2 was three-factor model with separation from school merged with academic workload and perceived stress to form a single factor ( χ2 = 6756.895; df = 972; RMSEA = .083; CFI = .774; TLI = .760; SRMR = .096); model 3 was a two-factor model, with fears of contagion merged with separation from school, academic workload, and perceived stress to form a single factor ( χ2 = 9752.729; df = 974; RMSEA = .102; CF I = .658; TLI = .636; SRMR = .110) and model 4 was a one-factor model with five constructs merged with one factor ( χ2 = 13665.328; df = 975; RMSEA = .123; CFI = .505; TLI = .475; SRMR = .143). As Table 2 shows, the fit indexes supported the hypothesized five-factor model, providing evidence of the construct distinctiveness of fears of contagion, separation from school, academic workload, and perceived stress and health.

Note: AW = academic workload; SFS = separation from school; FOC = fears of contagion; PS = perceived stress; Two factors = AW+SFS+FOC+PS, Health; Three factors = AW+SFS+PS, FOC, Health; Four factors = AW+PS, SFS, FOC, Health.

Tests for common method variance

Because we collected student’s self-report of fears of contagion, separation from school, academic workload, and perceived stress and health in the study, common method variance (CMV) may present as a problem. Therefore, we measured different constructs at different time points to decrease common method variance as much as possible [ 56 ] and showed high respect for the security, anonymity, and privacy of research objects and informants. In addition, the results of Harman’s single-factor test suggest that an exploratory factor analysis of all items explained 68.86% of the total variance, and the largest factor accounted for only 24.73% of the variance.

Descriptive statistics

The bivariate Pearson Correlation produces a sample correlation coefficient, which measures the strength and direction of linear relationships between pairs of continuous variables. Reported in Table 3 are the means, standard deviations and bivariate correlations of variables. Academic workload, separation from school, fears of contagion, and perceived stress were all negatively correlated with health ( r = -.121, p < .01; r = -.289, p < .01; r = -.242, p < 0.01; r = -.225, p < 0.01, respectively). Academic workload, separation from school, and fear of contagion, were all positively correlated with perceived stress ( r = .152, p < .01; r = .207, p < .01; r = .133, p < 0.01, respectively). It appears that these findings preliminarily provided support for our hypotheses.

** = p < 0.01

* = p < 0.05.

Hypothesis testing

We performed structural equation modeling (SEM) to test the proposed hypotheses and summarized the standardized values of the path coefficients and their significance levels in Fig 2 . The results showed significant positive path coefficients from academic workload to perceived stress ( β = .211, SE = .040, p < .01), providing empirical evidence in support of H1a. Furthermore, academic workload was shown to have a negative effect on health ( β = -.053, SE = .037, n . s .), not providing empirical support for H1b. We also demonstrated that separation from school had a positive association with perceived stress ( β = .324, SE = .043, p < .01) and had a negative association with health ( β = -.252, SE = .039, p < .01), providing empirical evidence in support of H2a and H2b. Moreover, our results showed that fears of contagion were significantly related to perceived stress ( β = .121, SE = .039, p < 0.01) and were significantly related to health ( β = -.088, SE = .035, p < .05), providing empirical evidence in support of H3a and H3b. Perceived stress had a negative effect on health ( β = -.240, SE = .050, p < .01), providing empirical evidence in support of H4.

We further examined the mediating role of perceived stress with nonparametric bootstrapping procedures. As shown in Table 4 , the influence of academic workload on health was mediated by perceived stress because the indirect influence of academic workload on health registered the value of b at -.051 ( SE = .016, p = .001), with the 95% CI [-.081, -.028]. Therefore, H5 was supported. Similarly, the influence of separation from school on health was mediated by perceived stress because the indirect influence of separation from school on health registered the value of b at -.078 ( SE = .020, p = .000), with the 95% CI [-.113, -.049]. Therefore, H6 was supported. The influence of fear of contagion on health was mediated by perceived stress because the indirect influence of fear of contagion on health registered the value of b at -.029 ( SE = .012, p = .014), with the 95% CI [-.053, -.013]. Therefore, H7 was supported.

Note: AW = academic workload; SFS = separation from school; FOC = fears of contagion; We report the 95% confidence intervals (CIs) calculated using 1,000 bootstrap samples, with lower and upper limits in brackets.

The spread of COVID-19 is becoming unstoppable and has already influenced people and countries all over the world. Holmes et al. [ 57 ] called for that multidisciplinary science research must be central to the international response to the COVID-19 pandemic and provide evidence-based guidance on responding to promoting people’s health and wellbeing during the COVID-19 pandemic. To answer this call, we focus on college students getting home-schooling to explore their stress and health problems. Although the COVID-19 is still spreading rapidly and widely worldwide, it has been effectively controlled in China. What has happened in China shows that quarantine, social distancing, and isolation of infected populations can contain the epidemic. Whereas individual coping strategies are possible (e.g., social distancing), the spread of the virus at a state level is still beyond any given individual’s control. The continuous spread of the epidemic, strict isolation measures, and delays in starting schools, colleges, and universities across the country are expected to influence college students. Considering stress and anxiety associated with the current COVID-19 pandemic for college students [ 49 ], it is urgent for the society and management departments to understand the actual situation of college students timely and accurately. Based on the Transactional Model of Stress and coping [ 49 ], this study explored the influence of academic workload, separation from school, and fears of contagion on college students’ physical and physiological health, as well as the mediating effect of perceived stress in those relationships.

The current study contributes to the existing literature. First, the present study goes beyond previous literature on college students’ health during the epidemic by integrating three types of stressors from different fields in the proposed model. As highlighted in previous research on college students’ academic stress, preparing exams, courses, and papers should exhibit a negative effect on individual health. During the COVID-19 outbreak, Chinese college students’ learning was not suspended, but they attend the various courses offered online follow the regular schedule. While those measures of the virtual semester ensure regular study, they also cause stress on students. In addition, given the importance of social groups to an individual’s identity and self-worth, we found that college students were separated from their classmates during the COVID-19 epidemic, which brought them stress and anxiety. Previous evidence suggests that college students usually keep attachment relationships with their social group [ 12 , 58 ]. Attachment figures are usually parents, but may also be siblings, grandparents, or group. Unlike most previous studies that focused on separation from parents [ 9 ], this study focused on the influence of departure from school and schoolmates, which is particularly relevant to the epidemic situation. For college students attached to their school or classmates, school-closure is a kind of separation experience, which may be different from their experience when they leave home. Considering the relatively new separation (separation from school) caused by the outbreak of COVID-19, our findings suggest that separation from school was positively related to college students’ perceived stress during home-schooling. Finally, we found that exposure to a potentially infectious environment would lead to people’s stress, which is in line with previous research that pointed out the negative correlation between the risk of infection and life satisfaction [ 58 ]. Similar results have been found in the study of College Students’ psychological adjustment during SARS. For example, Main et al. [ 12 ] found that the experience of SARS-related stressors was positively associated with psychological symptoms for Chinese college students during the outbreak. Thus, we supposed that during an acute large-scale epidemic such as the SARS and COVID-19 epidemic, even among persons who were not directly contaminated with the disease, the psychological influence of the outbreak on them was significant. In doing so, we identified three important stressors for college students in the COVID-19 pandemic, providing essential inspiration for college students to maintain their physical and mental health during the current epidemic.

Second, based on a transactional model view, we provide a plausible mechanism for explaining the association between academic workload, separation from school, and fears of contagion and health. The transactional model posits that stress responses emerge from appraisal processes that begin when individuals experience a stressor. During primary appraisal, perceptions of elements of the focal stressor are used to determine the degree of threat or harm that this stressor represents; during secondary appraisal, individuals consider if and how they can resolve the underlying stressor. COVID-19, a contagious respiratory illness, is an ongoing, global health crisis, and the greatest challenge we have faced since World War II [ 59 ]. The COVID-19 pandemic is a grim but illustrative anxiety-inducing stressor; an uncertain and ongoing threat that cannot be resolved via individual efforts. When individuals have few resources, ways, or abilities at their disposal to deal with the stressors, they generate stress and anxiety and ultimately lead to negative consequences. Thus, perceived stress may be a mediator, transmitting the effects of academic workload, separation from school, and fears of contagion on health-related outcomes. These findings suggest that academic workload, separation from school, and fears of contagion may contribute to youth’s general perceived stress, which in turn, may negatively influence their physical and psychological health. Our findings supported Lorenzo-Blanco and Unger’s [ 60 ] and Sariçam’s [ 61 ] proposition that perceived stress plays an important role in influencing psychological well-being.

The results of the current study are of significance to practice and policy. First, the administrative department needs to raise the awareness of potential physical and mental health influences of home-schooling during the outbreak. While taking effective prevention measures, the government should guide the mass media to spread positive information and control rumors. Communication can serve as an important resource in dealing with the difficulties of family matters. For instance, parents can share their life experiences with their children and advocate for them to develop good living habits and enjoy a healthy lifestyle. Psychologists can communicate with students by social media platforms to help them cope with mental health issues caused by domestic conflicts, tension with parents, and anxiety from becoming infected. In addition, schools play an important role not only in providing students with educational materials but also in providing students with opportunities to interact with teachers and students. Schools should also provide guidelines and principles for effective online learning and ensure that content meets educational requirements. Nevertheless, it is also important not to overburden students.

Limitations

Despite the potential contribution that the present study makes to the mental health field, limitations of the study should be noted. First, a potential limitation is that all measures came from the same source, raising the potential for same-source measurement biases. However, we used a variety of means to reduce this issue, including varying our response scales and separating our measures in time. Further, as we were interested in how college students have dealt with the pandemic over time, focusing on self-reported experiences was appropriate. Another potential limitation of our study is concerned with causality. Hence, future research should conduct the experimental design or utilize the longitudinal data to ensure the conclusion reflects causation. Finally, our research reflects only the impact of the COVID-19 pandemic for college students, and much work is needed to gain a complete understanding of the implications of this crisis for students. Future research could consider how individual factors, such as self-concept, and contextual factors, such as social support, may influence college students’ response to perceived stress. Moreover, research focused on within-person fluctuations of perceived stress during this time would also be instructive, as there is no doubt that individuals have experienced considerable variability on a daily basis during the pandemic.

Conclusions

Confronting the COVID-19 outbreak and variously rigorous measures to prevent the spreading of the infection, college students may feel stress and have more or fewer health problems. Academic workload, psychological separation from school, and fear of contagion were positively associated with the perceived stress and negatively associated with physical and psychological health. In addition, perceived stress is a key mechanism in the relationships between three stressors and two forms of health. This study makes not only unique theoretical contributions to the stress and health literature during the COVID-19 outbreak but also offers novel practical implications for joint efforts from all circles of society to ensure students’ health.

Supporting information

S1 appendix, funding statement.

National Natural Science Foundation of China (71572170). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Data Availability

• PLoS One. 2021; 16(2): e0246676.

Decision Letter 0

30 Dec 2020

PONE-D-20-32875

College students’ stress and health during the COVID-19 outbreak: the effects of academic workload, separation from school, and fears of contagion

Dear Dr. Yang,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

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Reviewer #1: Partly

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Reviewer #1: Yes

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Reviewer #1: In general, this is a good study considering the concept backed by a sound theoretical framework. However, authors need to improve the study’s write-up in several sections of the manuscript especially the English language. I will strongly recommend a native English Language speaker to edit it.

Knowing that we cannot make a causal inference from this study, it will be more prudent to use associate/relate rather than affect.

Page 8: Procedure and Participants

Can authors justify why they used different samples for each Time wave and how they resolve the confounding issues arising from this method?

Also, there seems to be a typo in the number of data collected for wave one.

Authors should start a sentence with words and not figures as did with 49.2% and 56.2%.

Authors may want to revise this section incorporating the number of items per scale, the original developer (author) of each scale, original psychometric property, and how it was scored in this study. Much more importantly, the psychometric properties of these measures for this study.

Data analysis

Authors may end the method section with the above sub-title. This section may detail the types of analytic tools used and the purposes for using them. Cut-off or other criteria related to these analytic tools may be written here.

Tests for common method variance: The first sentence under this sub-section seems incomplete.

Table 3: for bivariate relationships, authors may take out categorical variables from the results as it does not make meaning.

Table 4: Authors may add further details to the table as effect and CI are not enough to get a better picture of the analysis/data.

Page 14: “Given the ongoing COVID -19 epidemic to inducing panic, and anxiety [49], therefore, timely and…” this sentence is difficult to understand, please revise.

Authors may try to relate the theory to the findings thoroughly.

Explaining the “SFS” with separation anxiety disorder is too far-fetched (exaggerated and unconvincing). Besides, these are students above 17 year old. SFS have a role to play in the lives of students but not from the angle of separation anxiety but probably as a supporting/coping strategy.

The way the authors reported the procedure of the data collection did not reflect a cross-sectional design. Hence, it will make readers doubt the authenticity/validity of this study.

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Author response to Decision Letter 0

13 Jan 2021

A Point-by-Point Response to Editor Comments

Your comment:

One expert in this field has carefully reviewed your submission and he pointed out some merits in your work. However, a major concern regarding the sampling should be tackled in the revision. That says, the samples seemed to be different across time points and the authors should provide clear rationale and how they take care of the methodology issues if they really used different samples. This is a fatal point for me to judge whether the revision can be accepted.

Our response:

Thank you for giving us the opportunity to revise our paper. We hope that you find this revised manuscript significantly improved and up to your expectation.

Thank you for your question. Indeed, although the numbers of participants are different across time points, we didn’t use different samples in our research.

First, we explain what the time-lagged design is and why it is used in our research.

The time-lagged design is a type of research design in which the same person reports information or data of different variables at different time points, which has been widely used in science research (e.g., Laschinger & Fida, 2014; SPENCE LASCHINGER & Finegan, 2008; Kilroy et al., 2017). The time-lagged design can ensure the constructs we concerned would be less influenced by common method bias (e.g., Podsakoff et al. 2003). Generally, the independent variables (IV) are first collected at Time-1, and then the mediation variables (mediators) at Time-2, and finally the dependent variables (DV) at Time-3 from the same person. In our research, academic workload, separation from school, and fears of contagion are independent variables, perceived stress is a mediator, and health is a dependent variable. Thus, we used the time-lagged design and these data of different variables were collected at three time points with one-week interval.

Second, we describe how to conduct the collection of data and explain that we didn’t use different samples in our study.

In the first-wave survey (Time 1), participants were asked to report their academic workload, separation from school, fears of contagion, and necessary demographic information, and we got 1072 questionnaires. One week later (Time 2), perceived stress needs to be measured, and we distributed questionnaires to the 1,072 people who had participated in the first-wave survey. However, 127 participants quit the survey and we got 945 questionnaires at Time 2 (valid response rate: 945/1072=88.15%). One week after the second-wave survey (Time 3), physical and psychological health needs to be measured, and we distributed questionnaires to the 945 people who had participated in both the first-wave and second-wave survey. However, 78 participants quit the survey, and we got 867 questionnaires at Time 3(valid response rate: 867/945=91.95%). That is, we got completed data, including the data of all variables used in our research from 867 participants who participated in three surveys. In the data analysis, we used data from only 867 participants. Because some participants did not participate fully in the three surveys, their data was incomplete and thus could not be included in the study. That is, because some participants dropped out of the survey during the data collection process, the number of participants varied at different time points, as shown in Figure 1.

Podsakoff, P. M., MacKenzie, S. B., Lee, J. Y., & Podsakoff, N. P. (2003). Common method biases in behavioral research: a critical review of the literature and recommended remedies. Journal of applied psychology, 88(5), 879.

Laschinger, H. K. S., & Fida, R. (2014). A time-lagged analysis of the effect of authentic leadership on workplace bullying, burnout, and occupational turnover intentions. European Journal of Work and Organizational Psychology, 23(5), 739-753.

SPENCE LASCHINGER, H. K., & Finegan, J. (2008). Situational and dispositional predictors of nurse manager burnout: a time‐lagged analysis. Journal of Nursing Management, 16(5), 601-607.

Kilroy, S., Flood, P. C., Bosak, J., & Chênevert, D. (2017). Perceptions of high‐involvement work practices, person‐organization fit, and burnout: A time‐lagged study of health care employees. Human Resource Management, 56(5), 821-835.

A Point-by-Point Response to Reviewer Comments

Reviewer #1: Partly

Thank you very much. Following your suggestions, we carefully revised the manuscript. All changes were marked in blue text. Below please see our point-to-point response to your comments. We hope that you find this revised manuscript significantly improved and up to your expectation.

Reviewer #1: Yes

Thank you very much for your recognition and support!

Reviewer #1: No

Thank you very much. We would like to provide and share the data we used in our research.

Reviewer #1: In general, this is a good study considering the concept backed by a sound theoretical framework. However, authors need to improve the study’s write-up in several sections of the manuscript especially the English language. I will strongly recommend a native English Language speaker to edit it.

Thank you very much for your recognition and support! We have had a professional copy editor with English as her first language to thoroughly go through the draft. We are confident that the writing has been improved and hope that the revised manuscript will meet your requirements. All changes were marked in blue in the revised manuscript.

Thank you very much. Following your suggestion, we use associate/relate rather than affect in the revised manuscript. All changes were marked in blue text.

Page 2 Line 44-Page 8 Line 208:

Page 8 Line 210-Page 9 Line 220:

Thank you very much for your advice. We have corrected the typo in the number of data collected for wave one. In addition, we have started the sentence with words and not figures.

Please see Page 9 Line 245- Line 247:

In the first-wave survey (Time 1), participants were asked to report their academic workload, separation from school, fears of contagion, and necessary demographic information. In Time 1, 1072 completed questionnaires were returned.

Please see Page 10 Line 254- Line 256:

Nearly half of the participants said they wanted or very much wanted the school to start soon (49.2%). Of the 867 college students who had participated, 56.2% of them were concerned or very concerned about the possibility of contracting COVID-19 after the semester began.

Thank you very much. We carefully revised this section. In the revised manuscript, we described the number of items per scale, the original developer of each scale, the reliability of the original scale, and the reliability of scale in our research. All items we used in the research has been provided in Appendix. In addition, we described that participants responded to items on a 7-point scale or 5-point scale. Specifically, the scale of physical and psychological health has its Chinese version, and thus we can directly use it in our research. The scales of academic workload, separation from school, and perceived stress have their English version, and thus we followed the translation/back-translation procedure to translate English to Chinese. Finally, we developed the scale of fears of contagion, and test its reliability and validity. Based on the results of Cronbach's α, we found that the psychometric properties of these measures for this study are acceptable.

Please see Page 10 Line 259- Page 12 Line 294:

We translated the measures from English to Chinese following the commonly used translation/back-translation procedure. All measures are reported in Appendix A. Unless otherwise noted, participants responded to all items on a 7-point scale (from 1=strongly disagree to 7=strongly agree).

It was measured using the three-item scale developed by Hystad et al. [35]. Items included: “I am spending a lot of time thinking about how this semester’s grades could negatively affect my educational and career goals,” “I am worrying a great deal about the effect this semester’s grades will have on my future,” and “I find myself very concerned about the grades I am likely to receive this semester.” Cronbach’s alpha in their study was .85, which suggests that this scale has good reliability. In the current study, Cronbach's α of this variable is .883.

Separation from school was measured using the attachment avoidance scale developed by Smith et al. [54]. The scale has fifteen-item. An example of a reworded scale item is “I find it difficult to allow myself to depend on my group.” Factor analytic results in their research suggested that the scale has good reliability. In our current study, we reworded to refer to participants' classmates rather than their social group. An example of a reworded scale item is “I find it difficult to allow myself to depend on my classmates.” Cronbach's α of this variable is

We developed a six-item scale to assess participants’ fears of COVID-19 infection. Six items included “In public, I don't care about touching the door handle without protection,” “In public, I don’t mind sitting in a chair that has just been sat on,” “In an elevator, I don’t mind pushing a button without protection,” “When I’m in a crowded place, I don’t worry about coronavirus from other people,” “I don't worry about infection if other people don't wear masks,” “Wearing a mask would make me feel safe.” In the current study, Cronbach's α of this variable is .842. The results of confirmatory factor analysis are shown that χ2 = 74.424; df = 8; RMSEA = .098; CFI =.982; TLI = .966; SRMR = .043. Thus, this scale has acceptable reliability and validity.

The 10-item Perceived Stress Scale [55] was used to measure the student’s stress level in the past month. Participants responded to the items on a 5-point scale (from1=never to 5=very often). A sample item is “In the last month, how often have you felt nervous and “stressed”?” In our research, Cronbach's α of this variable is .792.

The CHQ-12 of the Chinese version was used to measure physical and psychological health. The CHQ-12 has been widely used in Chinese populations. The 12 items included headaches, heart palpitations, chest pain or tightening, trembling or pins and needles, sleeplessness, nervousness, and hopelessness. Participants responded to the items on a 4-point scale (1= not at all, 4=more than usual). A higher score represented a more severe psychosocial impairment. In our research, Cronbach's α of this variable is .895.

Please see Page 24 Line 622- Page 26 Line 677:

1. I am spending a lot of time thinking about how this semester’s grades could negatively affect my educational and career goals.

2. I am worrying a great deal about the effect this semester’s grades will have on my future.

3. I find myself very concerned about the grades I am likely to receive this semester.

1. I find it difficult to allow myself to depend on my group.

2. I sometimes worry that I will be hurt if I allow myself to become too close to my group.

3. I am nervous when my group gets too close.

4. My desire to feel completely at one sometimes scares my group away.

5. I prefer not to depend on my group or to have my group depend on me.

6. I often worry that my group does not really accept me.

7. I am comfortable not being close to my group.

8. I often worry my group will not always want me as a member.

9. I am somewhat uncomfortable being close to my group.

10. My group is never there when I need it.

11. I find it difficult to completely trust my group.

12. I find my group is reluctant to get as close as I would like.

13. I am not sure that I can always depend on my group to be there when I need it.

14. I sometimes worry that my group doesn't value me as much as I value my group.

15. I want to be emotionally close with my group, but I find it difficult to trust my group completely or to depend on my group.

1. In public, I don't care about touching the door handle without protection.

2. In public, I don’t mind sitting in a chair that has just been sat on.

3. In an elevator, I don’t mind pushing a button without protection.

4. When I’m in a crowded place, I don't worry about coronavirus from other people.

5. I don't worry about infection if other people don't wear masks.

6. Wearing a mask would make me feel safe.

1. In the last month, how often have you been upset because of something that happened unexpectedly?

2. In the last month, how often have you felt that you were unable to control the important things in your life?

3. In the last month, how often have you felt nervous and “stressed”?

4. In the last month, how often have you felt confident about your ability to handle your personal problems?

5. In the last month, how often have you felt that things were going your way?

6. In the last month, how often have you found that you could not cope with all the things that you had to do?

7. In the last month, how often have you been able to control irritations in your life?

8. In the last month, how often have you felt that you were on top of things?

9. In the last month, how often have you been angered because of things that were outside of your control?

10. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?

Have you recently...

1. been suffering from headache or pressure in your head?

2. had palpitation and worried that you might have heart trouble?

3. had discomfort or a feeling of pressure in your chest?

4. been suffering from shaking or numbness of your limbs?

5. lost much sleep through worry?

6. been taking things hard?

7. been getting along well with your family or friends?

8. been losing confidence in yourself?

9. been feeling nervous and strung-up all the time?

10. been feeling hopeful about your future?

11. been worried about your family or close friends?

12. felt that life is entirely hopeless?

Thank you very much for your advice. Following your suggestion, we have added the sub-title and provide more details about the types of analytic tools used, the purposes for using them and so on.

Please see Page 12 Line 297- Line 314:

First, we conducted a series of confirmatory factor analyses (CFA) in order to test the discriminant validity of the five prime constructs (academic workload, separation from school, fears of contagion, perceived stress, and health). CFA, as an empirical research technology, is affiliated with structural equation modeling. Therefore, it is necessary to judge the fitting situation according to the fitting indexes from the structural equation model. Common fitting indexes include chi-square(χ2), degree of freedom (df), CFI, TLI, RMSEA, and SRMR. Specifically, if the ratio of chi square to degree of freedom is less than 5, the model is generally acceptable. When CFI and TLI are higher than 0.9, the model fits well. The smaller the RMSEA and SRMR, the better the result, and in particular, when it is below 0.08, the model is acceptable. Second, we performed Harman’s single-factor test to explore the potential influence of common method variance. No single factor accounting for more than 50% of the variance of all the relevant items indicates that the results are acceptable. Third, we calculated Pearson’s correlation coefficient using SPSS Version 21, which reflects the effect of change in one variable when the other variable changes. Fourth, we tested our hypotheses using a path analysis in Mplus Version 8.3. To examine mediation (Hypothesis 5,6, and 7), we used a bootstrap simulation with 1,000 replications to create our bias-corrected 95% confidence intervals (CIs) around our indirect effects. The bootstrap approach is a more robust strategy than the causal step procedure for small samples for assessing indirect effects and a useful method for avoiding power problems relating to a non-normal sampling of the indirect effect. When the 95% confidence interval of the path coefficient does not contain zero, the mediating effect is significant.

Thank you very much for your advice. First, we revised the first sentence under this sub-section and make it complete. Second, we deleted the section of categorical variables in Table 3. Third, we provide more details about the analysis/data.

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Tests for Common Method Variance

Because we collected student’s self-report of fears of contagion, separation from school, academic workload, and perceived stress and health in the study, common method variance (CMV) may present as a problem. Therefore, we measured different constructs at different time points to decrease common method variance as much as possible [56] and showed high respect for the security, anonymity, and privacy of research objects and informants. In addition, the results of Harman’s single-factor test suggest that an exploratory factor analysis of all items explained 68.86% of the total variance, and the largest factor accounted for only 24.73% of the variance.

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Thank you very much for your advice. We have revised this confused sentence.

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The spread of COVID-19 is becoming unstoppable and has already influenced people and countries all over the world. Holmes et al. [57] called for that multidisciplinary science research must be central to the international response to the COVID-19 pandemic and provide evidence-based guidance on responding to promoting people’s health and wellbeing during the COVID-19 pandemic. To answer this call, we focus on college students getting home-schooling to explore their stress and health problems. Although the COVID-19 is still spreading rapidly and widely worldwide, it has been effectively controlled in China. What has happened in China shows that quarantine, social distancing, and isolation of infected populations can contain the epidemic. Whereas individual coping strategies are possible (e.g., social distancing), the spread of the virus at a state level is still beyond any given individual’s control. The continuous spread of the epidemic, strict isolation measures, and delays in starting schools, colleges, and universities across the country are expected to influence college students. Considering stress and anxiety associated with the current COVID-19 pandemic for college students [49], it is urgent for the society and management departments to understand the actual situation of college students timely and accurately.

Thank you very much for your advice. Following your suggestion, we integrated theory with our findings thoroughly in the revised manuscript.

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The spread of COVID-19 is becoming unstoppable and has already influenced people and countries all over the world. Holmes et al. [57] called for that multidisciplinary science research must be central to the international response to the COVID-19 pandemic and provide evidence-based guidance on responding to promoting people’s health and wellbeing during the COVID-19 pandemic. To answer this call, we focus on college students getting home-schooling to explore their stress and health problems. Although the COVID-19 is still spreading rapidly and widely worldwide, it has been effectively controlled in China. What has happened in China shows that quarantine, social distancing, and isolation of infected populations can contain the epidemic. Whereas individual coping strategies are possible (e.g., social distancing), the spread of the virus at a state level is still beyond any given individual’s control. The continuous spread of the epidemic, strict isolation measures, and delays in starting schools, colleges, and universities across the country are expected to influence college students. Considering stress and anxiety associated with the current COVID-19 pandemic for college students [49], it is urgent for the society and management departments to understand the actual situation of college students timely and accurately. Based on the Transactional Model of Stress and coping [49], this study explored the influence of academic workload, separation from school, and fears of contagion on college students’ physical and physiological health, as well as the mediating effect of perceived stress in those relationships.

The current study contributes to the existing literature. First, the present study goes beyond previous literature on college students’ health during the epidemic by integrating three types of stressors from different fields in the proposed model. As highlighted in previous research on college students’ academic stress, preparing exams, courses, and papers should exhibit a negative effect on individual health. During the COVID-19 outbreak, Chinese college students’ learning was not suspended, but they attend the various courses offered online follow the regular schedule. While those measures of the virtual semester ensure regular study, they also cause stress on students. In addition, given the importance of social groups to an individual’s identity and self-worth, we found that college students were separated from their classmates during the COVID-19 epidemic, which brought them stress and anxiety. Previous evidence suggests that college students usually keep attachment relationships with their social group [12,58]. Attachment figures are usually parents, but may also be siblings, grandparents, or group. Unlike most previous studies that focused on separation from parents [9], this study focused on the influence of departure from school and schoolmates, which is particularly relevant to the epidemic situation. For college students attached to their school or classmates, school-closure is a kind of separation experience, which may be different from their experience when they leave home. Considering the relatively new separation (separation from school) caused by the outbreak of COVID-19, our findings suggest that separation from school was positively related to college students’ perceived stress during home-schooling. Finally, we found that exposure to a potentially infectious environment would lead to people’s stress, which is in line with previous research that pointed out the negative correlation between the risk of infection and life satisfaction [58]. Similar results have been found in the study of College Students’ psychological adjustment during SARS. For example, Main et al. [12] found that the experience of SARS-related stressors was positively associated with psychological symptoms for Chinese college students during the outbreak. Thus, we supposed that during an acute large-scale epidemic such as the SARS and COVID-19 epidemic, even among persons who were not directly contaminated with the disease, the psychological influence of the outbreak on them was significant. In doing so, we identified three important stressors for college students in the COVID-19 pandemic, providing essential inspiration for college students to maintain their physical and mental health during the current epidemic.

Second, based on a transactional model view, we provide a plausible mechanism for explaining the association between academic workload, separation from school, and fears of contagion and health. The transactional model posits that stress responses emerge from appraisal processes that begin when individuals experience a stressor. During primary appraisal, perceptions of elements of the focal stressor are used to determine the degree of threat or harm that this stressor represents; during secondary appraisal, individuals consider if and how they can resolve the underlying stressor. COVID-19, a contagious respiratory illness, is an ongoing, global health crisis, and the greatest challenge we have faced since World War II [59]. The COVID-19 pandemic is a grim but illustrative anxiety-inducing stressor; an uncertain and ongoing threat that cannot be resolved via individual efforts. When individuals have few resources, ways, or abilities at their disposal to deal with the stressors, they generate stress and anxiety and ultimately lead to negative consequences. Thus, perceived stress may be a mediator, transmitting the effects of academic workload, separation from school, and fears of contagion on health-related outcomes. These findings suggest that academic workload, separation from school, and fears of contagion may contribute to youth’s general perceived stress, which in turn, may negatively influence their physical and psychological health. Our findings supported Lorenzo-Blanco and Unger’s [60] and Sariçam’s [61] proposition that perceived stress plays an important role in influencing psychological well-being.

Thank you very much for your advice. Following your suggestion, we explained “SFS” from the point of attachment in the revised manuscript. From a supporting/coping strategy, we provided some advice to help college students keep healthy when they separate from school.

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In addition, given the importance of social groups to an individual’s identity and self-worth, we found that college students were separated from their classmates during the COVID-19 epidemic, which brought them stress and anxiety. Previous evidence suggests that college students usually keep attachment relationships with their social group [12,58]. Attachment figures are usually parents, but may also be siblings, grandparents, or group. Unlike most previous studies that focused on separation from parents [9], this study focused on the influence of departure from school and schoolmates, which is particularly relevant to the epidemic situation. For college students attached to their school or classmates, school-closure is a kind of separation experience, which may be different from their experience when they leave home. Considering the relatively new separation (separation from school) caused by the outbreak of COVID-19, our findings suggest that separation from school was positively related to college students’ perceived stress during home-schooling.

Thank you very much for your advice. We revised this point in the revised manuscript. Although we used a time-lagged design to collect data at different times, future research can conduct the experimental design or utilize the longitudinal data to ensure the conclusion reflects causation.

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College students’ stress and health in the COVID-19 pandemic: the role of academic workload, separation from school, and fears of contagion

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ORIGINAL RESEARCH article

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

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

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

Introduction

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

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

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

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

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

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

Materials and Methods

Survey instrument.

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

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

Data Analyses

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

Table 1 . Characteristics of the participants in the study.

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

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

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

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

Figure 1 . SWEMWBS and PAS scores for all participants.

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

Table 2 . Results of the MANOVA.

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

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

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

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

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

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

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

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

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

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

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

Limitations

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

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

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

Future Studies

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

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

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

Data Availability Statement

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

Ethics Statement

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

Author Contributions

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

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

Conflict of Interest

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

Publisher's Note

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

Acknowledgments

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

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Yang, C., Chen, A., and Chen, Y. (2021). College students' stress and health in the COVID-19 pandemic: the role of academic workload, separation from school, and fears of contagion. PLoS ONE 16, e0246676. doi: 10.1371/journal.pone.0246676

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

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

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

Reviewed by:

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

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

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

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

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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Open Access

Peer-reviewed

Research Article

College students’ stress and health in the COVID-19 pandemic: The role of academic workload, separation from school, and fears of contagion

Roles Conceptualization, Funding acquisition, Investigation, Supervision, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation School of Economics and Management, Yanshan University, Qinhuangdao, Hebei, China

Roles Conceptualization, Data curation, Formal analysis, Investigation, Writing – original draft, Writing – review & editing

Roles Conceptualization, Methodology, Writing – original draft, Writing – review & editing

• Chunjiang Yang, 
• Aobo Chen, 
• Yashuo Chen

• Published: February 10, 2021
• https://doi.org/10.1371/journal.pone.0246676
• Peer Review
• Reader Comments

The COVID-19 pandemic has unhinged the lives of people across the globe. In particular, more than 30 million Chinese college students are home-schooling, yet there is little understanding of how academic workload, separation from school, and fears of contagion lead to a decrease in their health. This study examined the relationships between Chinese college students’ three critical stressors and two types of health in the COVID‐19 pandemic context. We used a three-wave lagged design with a one-week interval. All the constructs were assessed by self-report in anonymous surveys during the COVID‐19 pandemic. College students were asked to report their demographic information, academic workload, separation from school, fears of contagion, perceived stress, and health. The results of this study showed that academic workload, separation from school, and fears of contagion had negative effects on college students’ health via perceived stress. In the COVID-19 crisis, multiple prevention and control measures focusing on college students may lead them to have different degrees of stress and health problems. Our results enrich the literature on stress and health and offer novel practical implications for all circles of the society to ensure students’ health under the context of the COVID-19 epidemic.

Citation: Yang C, Chen A, Chen Y (2021) College students’ stress and health in the COVID-19 pandemic: The role of academic workload, separation from school, and fears of contagion. PLoS ONE 16(2): e0246676. https://doi.org/10.1371/journal.pone.0246676

Editor: Chung-Ying Lin, Hong Kong Polytechnic University, HONG KONG

Received: October 19, 2020; Accepted: January 23, 2021; Published: February 10, 2021

Copyright: © 2021 Yang 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 manuscript and its Supporting Information files. In addition, all data are available form the OSF database. The link is https://osf.io/ajfhw/ and the DOI is 10.17605/OSF.IO/AJFHW .

Funding: National Natural Science Foundation of China (71572170). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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

Introduction

Compared with other student groups, such as primary school students and middle school students, the traditional view is that college students bear more pressure and have more serious physical and mental health problems [ 1 ]. In previous research, there is a strongly held consensus that dealing with intimate relationships, financial difficulties, and fulfilling responsibilities and roles are the main sources of stress for college students. Due to the recent social changes in the education domain (e.g., the sharing of educational resources and advances in communication technology), the use of distance education is more and more, which changes the communication patterns between teachers and students, increases the isolation and independence of students, and thus becomes an important source of pressure for students [ 2 ]. Today, the spread of coronavirus disease 2019 (COVID-19) is becoming unstoppable, having infected more than 12 million people [ 3 ]. In response to this unprecedented challenge, the Chinese government has ordered a nationwide school closure as an emergency measure to prevent the spreading of the infection among teachers and students. As a consequence, 30.315 million Chinese college students are trapped at home, learning online courses through the internet to complete the required academic tasks. So far, the new virtual semester has been going on for nearly three months, and various courses are offered online in a well-organized manner. Although these decisive actions and efforts are highly commendable and necessary, there are also reasons to worry that drawn-out school suspension, home confinement, and distance learning may have adverse effects on college students’ physical and mental health [ 4 ]. In addition, a series of issues, such as fear of contagion, frustration and boredom, inadequate information, and lack of private space at home, would continue to emerge and increase during the COVID-19 outbreak [ 4 ]. However, previous research failed to give enough attention to college students in the epidemic context. For example, some studies have shown that large-scale isolation measures and loss of income have led to mental health problems among migrant workers during COVID-19 outbreaks [ 5 ]. Chen et al. [ 6 ] have discussed the problems in psychological intervention services of medical workers. The present study aimed to fill the void by focusing on college students to explore the influence of several important stressors on their health during the COVID-19 outbreak. Specifically, we identified three important stressors among college students—academic workload, separation from school, and fear of contagion and further explored the mechanism behind the relationships between three stressors and mental and physical health.

Academic stressors refer to any academic demands (e.g., environmental, social, or internal demands) that cause a student to adjust his or her behavior. Learning and examination, performance competition, especially mastering much knowledge in a short time, would lead to different degrees of academic pressure [ 7 ]. Although all planned courses have been affected by the COVID-19 epidemic, online learning still leaves college students with the same academic burden as usual. In addition, previous evidence shows that separation anxiety disorder of adults is similar to that of children and adolescents in phenomenology. College students who are attached to their classmates may experience separation anxiety after leaving school. Emerging problems during the COVID-19 outbreak, such as conflicting family schedules, changes in eating and sleeping habits, separation from classmates, and loneliness, may have adverse effects on college students [ 8 ]. Seligman and Wuyek suggested that college students may experience separation anxiety when they go home for the holidays [ 9 ]. Finally, the COVID-19 pandemic has projected humanity into an unprecedented era characterized by feelings of helplessness and loss of control. As Sontag [ 10 ] noted, unknown diseases cannot be totally controlled and thus are often considered more threatening than factual evidence. During this period, populations remained almost entirely susceptible to COVID-19, causing the natural spread of infections to exhibit almost perfect exponential growth [ 11 ]. Therefore, feelings of fear and apprehension about having or contracting COVID-19 may be a significant stressor for college students. Considering the actual situation of college students during an outbreak of COVID-19, the first aim of the study is to identify academic workload, separation from school, and fears of contagion, which are the three important stressors of college students.

Moreover, previous studies demonstrated that diseases (e.g., SARS) [ 12 ], academic (e.g., academic expectations) [ 13 ], and attachments (e.g., attachment to parents) [ 14 ] are closely associated with students’ health. However, it is still not fully understood how these stressors lead to health-related outcomes. In particular, we know little about the mechanism through which these stressors affect physical and mental health in the context of the COVID-19 outbreak. Brewster et al. [ 15 ] have suggested that further research is needed to establish the different mechanisms through which stressors impact health in order to have a profound understanding of the nature of stress. In response to these calls for further research, the second aim of this study thus was to examine the potential mediating roles of perceived stress in the relationships between the three stressors and physical and psychological health.

Overall, the current study focuses on college students and presents an integrated framework to investigate whether and how three types of stressors influence physical and mental health. Our study contributes to the current literature on stress and health in three unique ways. First, to the best of our knowledge, this study is the first to explore home-schooling college students’ physical and mental health during the COVID-19 outbreak. It makes up for the lack of understanding of the situations of college students who are ongoing home-schooling during the COVID-19 outbreak. Second, we discovered that academic stressors, interpersonal stressors, and environmental stressors of college students are critical factors that influence their health. This investigation not only overcomes the previous analysis focusing primarily on the effect of a single stressor on college students’ health but also enlarges the scope of current research on students’ stress and health by shifting the locus of theorizing away from campus domain to family domain. Third, by examining the mediating role of perceived stress, we exposed the “black box” in the relationship between stressors and health.

Three stressors among college students during the COVID-19 outbreak

College students’ stressors have been typically grouped into three major categories: academic pressure [ 16 – 19 ], social and interpersonal pressure [ 20 , 21 ], and environmental pressure [ 22 , 23 ]. Specifically, this study focuses on academic workload (representing academic pressure), separation from school (representing social and interpersonal pressure), and fear of contagion (representing environment pressure).

Academic workload.

Academic problems have been regarded as the most common stressor for college students [ 24 , 25 ]. For example, in Schafer’s [ 26 ] investigation, students reported that the most significant daily hassles were academics-related stressors such as constant study, writing papers, preparing for exams, and boring teachers. The academic pressure easily comes from taking and preparing for exams, grade level competition, and acquiring a large amount of knowledge in a short period of time [ 7 ]. Perceived stress is a response to stressors, referring to the state of physical or psychological arousal [ 27 ]. College students experience adverse physical and psychological outcomes when they perceive excessive or negative stress. Excessive stress may induce physical impairments, including lack of energy, loss of appetite, headaches, or gastrointestinal problems [ 28 ]. Numerous studies have evaluated academic stress associated with various adverse outcomes, such as poor health [ 29 , 30 ], anxiety [ 31 ], depression [ 32 ], and poor academic performance [ 33 , 34 ]. In particular, Hystad et al. [ 35 ] found significant associations between academic stress and health, both psychological and physical.

Separation from school.

Previous studies have shown that students view the transition from high school to college as a source of some degree of stress and emotional dissonance [ 36 ]. College students’ adaptability is closely related to their attachment with different people, such as parents and friends. Indeed, extant research on attachment has four research directions. First, the most systematic studies have focused on adolescents’ psychological separation from parents, suggesting that the healthy development of adolescents depends largely on psychological separation from parents [ 37 ]. The second field focuses on the attachment relationship between parents and adolescents, assuming that attachment to parents is a necessary prerequisite for adolescents’ adaptive function [ 38 , 39 ]. The third research stream emphasized the importance of psychological separation and attachment. According to this point of view, a balanced parent-child relationship between psychological separation and parental attachment is the best choice for students’ development [ 37 , 40 ]. Finally, a fourth research stream focuses on attachment to a group or group members in a campus environment and suggests that this attachment may influence students’ affective and behavioral outcomes [ 41 ]. From the above-mentioned research fields, we can discover that the existing literature mainly focuses on the effects of attachment on college students in their campus life. Of course, it is undeniable that the campus is the primary field for college students, while the family field becomes more important for college students during the weekends, holidays, and internships. Unfortunately, there is a dearth of research on the influence of attachment on college students in their family life. According to the literature on attachment and separation, attachment relationships between college students and their classmates may affect their stress and health when they are at home.

Social cohesion theorists believed group formation was entirely a function of individual relationships among the group members: As individuals were attracted to one another, they were consequently attracted to the group as a whole. Furthermore, group formation can occur independently of interpersonal attraction [ 42 ]. Based on the social identity theorists’ research, in minimal groups, people formed group attachment without having any contact or even knowing the other members in their group [ 41 ]. Thus, whether or not there is a close relationship with group members, one can feel the attachment to the group to which he belongs. However, some scholars reasoned that students with a stronger and healthier sense of themselves as individuals would be better equipped to handle the demands for independent functioning that accompany the college transition. An investigation among medical students shows that students with greater group cohesion reported less stress [ 43 ]. Separation anxiety begins with separation from parents, peers, and other significant persons. The national mandate force college students to separate from school in the COVID-19 pandemic, leading to separate from their peers and thus may cause their stress.

Fears of contagion.

Fears of contagion reflect feelings of apprehension about having or contracting COVID-19. The literature on health anxiety [ 44 ] suggests that threatening events—such as a global pandemic—trigger high levels of stress. Although previous studies have described the pressures triggered by large-scale events, such as natural disasters [ 44 ] and terrorist attacks [ 45 ], the outbreak of infectious diseases (the COVID-19 pandemic) worldwide is different from other large-scale events [ 46 ]. Update to 1 May 2020 , the COVID-19 pandemic has resulted in 3175207 confirmed cases and 224172 deaths [ 3 ]. To prevent the spread of infectious diseases, Chines schools have been closed nationwide, collective activities have been canceled, public transportation has been suspended, and family imprisonment has been strictly enforced in some epidemic areas. The outbreak of COVID-19 has a seriously destructive impact on people’s lives all over the world. The effects of COVID-19 are multifaceted, affecting both physical health (e.g., pneumonia, liver, and renal injury) and psychological well-being (e.g., fear of contracting an infectious disease, avoid exposure to others to reduce the risk of being infected). Although national preventive measures can slow the spread of the epidemic, individuals cannot ensure that they are not infected with the disease. According to Chinese data, a large number of transmissions, both in nosocomial and community settings, occurred through human-to-human contact with individuals showing no or mild symptoms [ 47 ]. The COVID-19 pandemic is an immediate threat, it is unclear how long it will persist, and there are a multitude of unanswered questions regarding its impact. Several anecdotal reports by health care professionals note the COVID-19 pandemic triggers individuals’ anxiety and stress, particularly surrounding the uncertainties brought by COVID-19 [ 48 ]. Therefore, we suggest that fear of having or contracting COVID-19 may lead to college students’ stress and health problems.

Transactional models of stress and coping

Lazarus and Folkman [ 49 ] defined stress as a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being. The Transactional Model of Stress provides a basic framework for explaining the processes of individuals coping with stressful events. A core tenet of this model is that the interaction between the person and the environment creates an individual’s feeling of stress. When faced with a stressor, two appraisals were triggered, an individual evaluates potential threats or harms (primary appraisal), as well as the ability to change the situation and control negative emotional reactions (secondary appraisal). Primary appraisal is an individual’s estimate of the significance of an event as stressful, negative, positive, controllable, challenging, friendly, or irrelevant. The secondary appraisal is a judgment of an individual’s coping resources and choices [ 50 ]. The response described in the transaction model starts after the primary and secondary appraisals [ 49 ]. There are two kinds of coping efforts strongly related to a person’s cognitive appraisal. One is referred to as problem-focused coping, and the other is referred to as emotion-focused coping. The former coping strategy has been shown to be more commonly used in a person’s causal analysis, suggesting that some measures can be taken to change the negative situation. For example, Folkman and Lazarus [ 51 ] show that students will adopt a problem-based coping style before the examination. The latter coping strategy predominates when people assess that they have no options or lack resources to alter the situation, stressors have to be accepted [ 52 ]. Students have reported they often use escape/avoidance ways to cope with stressors. The problem-solving efforts try to change the situation actively, while the emotion-centric coping style will only change the individual’s interpretation of the stressors. Based on these arguments, we suggest that college students who feel stressed (e.g., regard their stress as an environmental source or lack of ability to alter) would adopt emotion-focused coping as a means of reappraising an uncontrollable situation. Thus, perceived stress plays a central role in the attribution–secondary appraisal coping relationship.

The present study

Our primary aim in the study was to examine the influence of stressors on college students’ stress and health during the COVID-19 outbreak. Specifically, we empirically examine the influence of academic workload, separation from school, and fears of contagion on college students’ psychology and physiology health that included perceived stress as a mediator. Based on the literature review, we hypothesized:

• H1a: Academic workload is positively correlated with perceived stress.
• H1b: Academic workload is negatively correlated with physical and mental health.
• H2a: Separation from school is positively correlated with perceived stress.
• H2b: Separation from school is negatively correlated with physical and mental health.
• H3a: Fears of contagion are positively correlated with perceived stress.
• H3b: Fears of contagion are negatively correlated with physical and mental health.
• H4: Perceived stress is negatively correlated with physical and mental health.
• H5: Perceived stress mediates the relationship between academic workload and physical and mental health.
• H6: Perceived stress mediates the relationship between separation from school and physical and mental health.
• H7: Perceived stress mediates the relationship between fears of contagion and physical and mental health.

The hypothesized model is presented in Fig 1 .

• PPT PowerPoint slide
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https://doi.org/10.1371/journal.pone.0246676.g001

Ethics statement

All participants were treated following the American Psychological Association ethical guidelines, and the study protocol was approved by the Yanshan University Institutional Review Board (Approval no. 20-03-01). Each participant got an introduction and a link to a questionnaire via WeChat, a widely used instant communication tool in China. In the introduction, anonymity, the aim of the survey, and information on whether participants agreed to participate in the survey were all illustrated in detail. We explained that if you want to participate in the survey, please open the questionnaire link and fill in your true feelings. Some college students expressed their intention to participate in written form through WeChat, and other college students directly participated in the survey with tacit approval according to the instructions. Therefore, all participants completed the questionnaire voluntarily. In addition, participants were undergraduate students recruited from four public universities in China. Thus, participants are adults and not minors, and we do not need to obtain consent from parents or guardians.

Procedure and participants

Our work is situated within an environmental context the COVID-19 pandemic. All variables were assessed with participants’ self-reports in three anonymous online surveys. Data were collected in three waves to minimize common method bias [ 53 ]. In the first-wave survey (Time 1), participants were asked to report their academic workload, separation from school, fears of contagion, and necessary demographic information. In Time 1, 1072 completed questionnaires were returned. One week later (Time 2), students evaluated their level of perceived stress. Time 2 questionnaires were distributed to the 1072 students, with 945 completed questionnaires being returned. Finally, one week after the second-wave survey (Time 3), students evaluated their physical and psychological health. At Time 3, 867 complete questionnaires were returned.

The average age of college undergraduates was 20.17 years, with 69 percent female. There are 348 freshmen, accounting for 40.1%; 200 sophomores, accounting for 23.1%; 305 junior students, accounting for 35.2%; 14 senior students, accounting for 1.6%. The average number of online courses is 8.41. Only 29.2% of the students rated the quality of online courses as good or very good. Nearly half of the participants said they wanted or very much wanted the school to start soon (49.2%). Of the 867 college students who had participated, 56.2% of them were concerned or very concerned about the possibility of contracting COVID-19 after the semester began. The demographic profile of the survey participants is presented in Table 1 .

https://doi.org/10.1371/journal.pone.0246676.t001

We translated the measures from English to Chinese following the commonly used translation/back-translation procedure. All measures are reported in S1 Appendix . Unless otherwise noted, participants responded to all items on a 7-point scale (from 1 = strongly disagree to 7 = strongly agree).

It was measured using the three-item scale developed by Hystad et al. [ 35 ]. Items included: “I am spending a lot of time thinking about how this semester’s grades could negatively affect my educational and career goals,” “I am worrying a great deal about the effect this semester’s grades will have on my future,” and “I find myself very concerned about the grades I am likely to receive this semester.” Cronbach’s alpha in their study was .85, which suggests that this scale has good reliability. In the current study, Cronbach’s α of this variable is .883.

Separation from school was measured using the attachment avoidance scale developed by Smith et al. [ 54 ]. The scale has fifteen-item. An example of a reworded scale item is “I find it difficult to allow myself to depend on my group.” Factor analytic results in their research suggested that the scale has good reliability. In our current study, we reworded to refer to participants’ classmates rather than their social group. An example of a reworded scale item is “I find it difficult to allow myself to depend on my classmates.” Cronbach’s α of this variable is .929.

We developed a six-item scale to assess participants’ fears of COVID-19 infection. Six items included “In public, I don’t care about touching the door handle without protection,” “In public, I don’t mind sitting in a chair that has just been sat on,” “In an elevator, I don’t mind pushing a button without protection,” “When I’m in a crowded place, I don’t worry about coronavirus from other people,” “I don’t worry about infection if other people don’t wear masks,” “Wearing a mask would make me feel safe.” In the current study, Cronbach’s α of this variable is .842. The results of confirmatory factor analysis are shown that χ2 = 74.424; df = 8; RMSEA = .098; CFI = .982; TLI = .966; SRMR = .043. Thus, this scale has acceptable reliability and validity.

Perceived stress.

The 10-item Perceived Stress Scale [ 55 ] was used to measure the student’s stress level in the past month. Participants responded to the items on a 5-point scale (from1 = never to 5 = very often). A sample item is “In the last month, how often have you felt nervous and “stressed”?” In our research, Cronbach’s α of this variable is .792.

Physical and psychological health.

The CHQ-12 of the Chinese version was used to measure physical and psychological health. The CHQ-12 has been widely used in Chinese populations. The 12 items included headaches, heart palpitations, chest pain or tightening, trembling or pins and needles, sleeplessness, nervousness, and hopelessness. Participants responded to the items on a 4-point scale (1 = not at all, 4 = more than usual). A higher score represented a more severe psychosocial impairment. In our research, Cronbach’s α of this variable is .895.

Control variables.

We controlled students’ age, gender, grade, and the number of online courses in the study.

Analysis strategy.

First, we conducted a series of confirmatory factor analyses ( CFA ) in order to test the discriminant validity of the five prime constructs (academic workload, separation from school, fears of contagion, perceived stress, and health). CFA, as an empirical research technology, is affiliated with structural equation modeling. Therefore, it is necessary to judge the fitting situation according to the fitting indexes from the structural equation model. Common fitting indexes include chi-square( χ2 ), degree of freedom ( df ), CFI , TLI , RMSEA , and S RMR . Specifically, if the ratio of chi square to degree of freedom is less than 5, the model is generally acceptable. When CFI and TLI are higher than 0.9, the model fits well. The smaller the RMSEA and SRMR , the better the result, and in particular, when it is below 0.08, the model is acceptable. Second, we performed Harman’s single-factor test to explore the potential influence of common method variance. No single factor accounting for more than 50% of the variance of all the relevant items indicates that the results are acceptable. Third, we calculated Pearson’s correlation coefficient using SPSS Version 21, which reflects the effect of change in one variable when the other variable changes. Fourth, we tested our hypotheses using a path analysis in Mplus Version 8.3. To examine mediation (Hypothesis 5,6, and 7), we used a bootstrap simulation with 1,000 replications to create our bias-corrected 95% confidence intervals (CIs) around our indirect effects. The bootstrap approach is a more robust strategy than the causal step procedure for small samples for assessing indirect effects and a useful method for avoiding power problems relating to a non-normal sampling of the indirect effect. When the 95% confidence interval of the path coefficient does not contain zero, the mediating effect is significant.

Confirmatory factor analyses

Table 2 presents the CFA results. As shown, the baseline five-factor model fitted the data well ( χ2 = 3020.006; df = 965; RMSEA = .050; CFI = .920; TLI = .914; SRMR = .064). Against this baseline five-factor model, we tested four alternative models: model 1 was a four-factor model with academic workload merged with perceived stress to form a single factor ( χ2 = 5405.203; df = 969; RMSEA = .073; CFI = .827; TLI = .815; SRMR = .112); model 2 was three-factor model with separation from school merged with academic workload and perceived stress to form a single factor ( χ2 = 6756.895; df = 972; RMSEA = .083; CFI = .774; TLI = .760; SRMR = .096); model 3 was a two-factor model, with fears of contagion merged with separation from school, academic workload, and perceived stress to form a single factor ( χ2 = 9752.729; df = 974; RMSEA = .102; CF I = .658; TLI = .636; SRMR = .110) and model 4 was a one-factor model with five constructs merged with one factor ( χ2 = 13665.328; df = 975; RMSEA = .123; CFI = .505; TLI = .475; SRMR = .143). As Table 2 shows, the fit indexes supported the hypothesized five-factor model, providing evidence of the construct distinctiveness of fears of contagion, separation from school, academic workload, and perceived stress and health.

https://doi.org/10.1371/journal.pone.0246676.t002

Tests for common method variance

Because we collected student’s self-report of fears of contagion, separation from school, academic workload, and perceived stress and health in the study, common method variance (CMV) may present as a problem. Therefore, we measured different constructs at different time points to decrease common method variance as much as possible [ 56 ] and showed high respect for the security, anonymity, and privacy of research objects and informants. In addition, the results of Harman’s single-factor test suggest that an exploratory factor analysis of all items explained 68.86% of the total variance, and the largest factor accounted for only 24.73% of the variance.

Descriptive statistics

The bivariate Pearson Correlation produces a sample correlation coefficient, which measures the strength and direction of linear relationships between pairs of continuous variables. Reported in Table 3 are the means, standard deviations and bivariate correlations of variables. Academic workload, separation from school, fears of contagion, and perceived stress were all negatively correlated with health ( r = -.121, p < .01; r = -.289, p < .01; r = -.242, p < 0.01; r = -.225, p < 0.01, respectively). Academic workload, separation from school, and fear of contagion, were all positively correlated with perceived stress ( r = .152, p < .01; r = .207, p < .01; r = .133, p < 0.01, respectively). It appears that these findings preliminarily provided support for our hypotheses.

https://doi.org/10.1371/journal.pone.0246676.t003

Hypothesis testing

We performed structural equation modeling (SEM) to test the proposed hypotheses and summarized the standardized values of the path coefficients and their significance levels in Fig 2 . The results showed significant positive path coefficients from academic workload to perceived stress ( β = .211, SE = .040, p < .01), providing empirical evidence in support of H1a. Furthermore, academic workload was shown to have a negative effect on health ( β = -.053, SE = .037, n . s .), not providing empirical support for H1b. We also demonstrated that separation from school had a positive association with perceived stress ( β = .324, SE = .043, p < .01) and had a negative association with health ( β = -.252, SE = .039, p < .01), providing empirical evidence in support of H2a and H2b. Moreover, our results showed that fears of contagion were significantly related to perceived stress ( β = .121, SE = .039, p < 0.01) and were significantly related to health ( β = -.088, SE = .035, p < .05), providing empirical evidence in support of H3a and H3b. Perceived stress had a negative effect on health ( β = -.240, SE = .050, p < .01), providing empirical evidence in support of H4.

https://doi.org/10.1371/journal.pone.0246676.g002

We further examined the mediating role of perceived stress with nonparametric bootstrapping procedures. As shown in Table 4 , the influence of academic workload on health was mediated by perceived stress because the indirect influence of academic workload on health registered the value of b at -.051 ( SE = .016, p = .001), with the 95% CI [-.081, -.028]. Therefore, H5 was supported. Similarly, the influence of separation from school on health was mediated by perceived stress because the indirect influence of separation from school on health registered the value of b at -.078 ( SE = .020, p = .000), with the 95% CI [-.113, -.049]. Therefore, H6 was supported. The influence of fear of contagion on health was mediated by perceived stress because the indirect influence of fear of contagion on health registered the value of b at -.029 ( SE = .012, p = .014), with the 95% CI [-.053, -.013]. Therefore, H7 was supported.

https://doi.org/10.1371/journal.pone.0246676.t004

The spread of COVID-19 is becoming unstoppable and has already influenced people and countries all over the world. Holmes et al. [ 57 ] called for that multidisciplinary science research must be central to the international response to the COVID-19 pandemic and provide evidence-based guidance on responding to promoting people’s health and wellbeing during the COVID-19 pandemic. To answer this call, we focus on college students getting home-schooling to explore their stress and health problems. Although the COVID-19 is still spreading rapidly and widely worldwide, it has been effectively controlled in China. What has happened in China shows that quarantine, social distancing, and isolation of infected populations can contain the epidemic. Whereas individual coping strategies are possible (e.g., social distancing), the spread of the virus at a state level is still beyond any given individual’s control. The continuous spread of the epidemic, strict isolation measures, and delays in starting schools, colleges, and universities across the country are expected to influence college students. Considering stress and anxiety associated with the current COVID-19 pandemic for college students [ 49 ], it is urgent for the society and management departments to understand the actual situation of college students timely and accurately. Based on the Transactional Model of Stress and coping [ 49 ], this study explored the influence of academic workload, separation from school, and fears of contagion on college students’ physical and physiological health, as well as the mediating effect of perceived stress in those relationships.

The current study contributes to the existing literature. First, the present study goes beyond previous literature on college students’ health during the epidemic by integrating three types of stressors from different fields in the proposed model. As highlighted in previous research on college students’ academic stress, preparing exams, courses, and papers should exhibit a negative effect on individual health. During the COVID-19 outbreak, Chinese college students’ learning was not suspended, but they attend the various courses offered online follow the regular schedule. While those measures of the virtual semester ensure regular study, they also cause stress on students. In addition, given the importance of social groups to an individual’s identity and self-worth, we found that college students were separated from their classmates during the COVID-19 epidemic, which brought them stress and anxiety. Previous evidence suggests that college students usually keep attachment relationships with their social group [ 12 , 58 ]. Attachment figures are usually parents, but may also be siblings, grandparents, or group. Unlike most previous studies that focused on separation from parents [ 9 ], this study focused on the influence of departure from school and schoolmates, which is particularly relevant to the epidemic situation. For college students attached to their school or classmates, school-closure is a kind of separation experience, which may be different from their experience when they leave home. Considering the relatively new separation (separation from school) caused by the outbreak of COVID-19, our findings suggest that separation from school was positively related to college students’ perceived stress during home-schooling. Finally, we found that exposure to a potentially infectious environment would lead to people’s stress, which is in line with previous research that pointed out the negative correlation between the risk of infection and life satisfaction [ 58 ]. Similar results have been found in the study of College Students’ psychological adjustment during SARS. For example, Main et al. [ 12 ] found that the experience of SARS-related stressors was positively associated with psychological symptoms for Chinese college students during the outbreak. Thus, we supposed that during an acute large-scale epidemic such as the SARS and COVID-19 epidemic, even among persons who were not directly contaminated with the disease, the psychological influence of the outbreak on them was significant. In doing so, we identified three important stressors for college students in the COVID-19 pandemic, providing essential inspiration for college students to maintain their physical and mental health during the current epidemic.

Second, based on a transactional model view, we provide a plausible mechanism for explaining the association between academic workload, separation from school, and fears of contagion and health. The transactional model posits that stress responses emerge from appraisal processes that begin when individuals experience a stressor. During primary appraisal, perceptions of elements of the focal stressor are used to determine the degree of threat or harm that this stressor represents; during secondary appraisal, individuals consider if and how they can resolve the underlying stressor. COVID-19, a contagious respiratory illness, is an ongoing, global health crisis, and the greatest challenge we have faced since World War II [ 59 ]. The COVID-19 pandemic is a grim but illustrative anxiety-inducing stressor; an uncertain and ongoing threat that cannot be resolved via individual efforts. When individuals have few resources, ways, or abilities at their disposal to deal with the stressors, they generate stress and anxiety and ultimately lead to negative consequences. Thus, perceived stress may be a mediator, transmitting the effects of academic workload, separation from school, and fears of contagion on health-related outcomes. These findings suggest that academic workload, separation from school, and fears of contagion may contribute to youth’s general perceived stress, which in turn, may negatively influence their physical and psychological health. Our findings supported Lorenzo-Blanco and Unger’s [ 60 ] and Sariçam’s [ 61 ] proposition that perceived stress plays an important role in influencing psychological well-being.

The results of the current study are of significance to practice and policy. First, the administrative department needs to raise the awareness of potential physical and mental health influences of home-schooling during the outbreak. While taking effective prevention measures, the government should guide the mass media to spread positive information and control rumors. Communication can serve as an important resource in dealing with the difficulties of family matters. For instance, parents can share their life experiences with their children and advocate for them to develop good living habits and enjoy a healthy lifestyle. Psychologists can communicate with students by social media platforms to help them cope with mental health issues caused by domestic conflicts, tension with parents, and anxiety from becoming infected. In addition, schools play an important role not only in providing students with educational materials but also in providing students with opportunities to interact with teachers and students. Schools should also provide guidelines and principles for effective online learning and ensure that content meets educational requirements. Nevertheless, it is also important not to overburden students.

Limitations

Despite the potential contribution that the present study makes to the mental health field, limitations of the study should be noted. First, a potential limitation is that all measures came from the same source, raising the potential for same-source measurement biases. However, we used a variety of means to reduce this issue, including varying our response scales and separating our measures in time. Further, as we were interested in how college students have dealt with the pandemic over time, focusing on self-reported experiences was appropriate. Another potential limitation of our study is concerned with causality. Hence, future research should conduct the experimental design or utilize the longitudinal data to ensure the conclusion reflects causation. Finally, our research reflects only the impact of the COVID-19 pandemic for college students, and much work is needed to gain a complete understanding of the implications of this crisis for students. Future research could consider how individual factors, such as self-concept, and contextual factors, such as social support, may influence college students’ response to perceived stress. Moreover, research focused on within-person fluctuations of perceived stress during this time would also be instructive, as there is no doubt that individuals have experienced considerable variability on a daily basis during the pandemic.

Conclusions

Confronting the COVID-19 outbreak and variously rigorous measures to prevent the spreading of the infection, college students may feel stress and have more or fewer health problems. Academic workload, psychological separation from school, and fear of contagion were positively associated with the perceived stress and negatively associated with physical and psychological health. In addition, perceived stress is a key mechanism in the relationships between three stressors and two forms of health. This study makes not only unique theoretical contributions to the stress and health literature during the COVID-19 outbreak but also offers novel practical implications for joint efforts from all circles of society to ensure students’ health.

Supporting information

S1 appendix..

https://doi.org/10.1371/journal.pone.0246676.s001

S1 Data. Anonymized data.

https://doi.org/10.1371/journal.pone.0246676.s002

S1 File. Ethical approval.

https://doi.org/10.1371/journal.pone.0246676.s003

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A four-year study by Dartmouth researchers captures the most in-depth data yet on how college students’ self-esteem and mental health fluctuates during their four years in academia, identifying key populations and stressors that the researchers say administrators could target to improve student well-being. 

The study also provides among the first real-time accounts of how the coronavirus pandemic affected students’ behavior and mental health. The stress and uncertainty of COVID-19 resulted in long-lasting behavioral changes that persisted as a “new normal” even as the pandemic diminished, including students feeling more stressed, less socially engaged, and sleeping more.

The researchers tracked more than 200 Dartmouth undergraduates in the classes of 2021 and 2022 for all four years of college. Students volunteered to let a specially developed app called StudentLife tap into the sensors that are built into smartphones. The app cataloged their daily physical and social activity, how long they slept, their location and travel, the time they spent on their phone, and how often they listened to music or watched videos. Students also filled out weekly behavioral surveys, and selected students gave post-study interviews. 

The study—which is the longest mobile-sensing study ever conducted—is published in the Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies .

The researchers will present it at the Association of Computing Machinery’s UbiComp/ISWC 2024 conference in Melbourne, Australia, in October. 

These sorts of tools will have a tremendous impact on projecting forward and developing much more data-driven ways to intervene and respond exactly when students need it most.

The team made their anonymized data set publicly available —including self-reports, surveys, and phone-sensing and brain-imaging data—to help advance research into the mental health of students during their college years. 

Andrew Campbell , the paper’s senior author and Dartmouth’s Albert Bradley 1915 Third Century Professor of Computer Science, says that the study’s extensive data reinforces the importance of college and university administrators across the country being more attuned to how and when students’ mental well-being changes during the school year.

“For the first time, we’ve produced granular data about the ebb and flow of student mental health. It’s incredibly dynamic—there’s nothing that’s steady state through the term, let alone through the year,” he says. “These sorts of tools will have a tremendous impact on projecting forward and developing much more data-driven ways to intervene and respond exactly when students need it most.”

First-year and female students are especially at risk for high anxiety and low self-esteem, the study finds. Among first-year students, self-esteem dropped to its lowest point in the first weeks of their transition from high school to college but rose steadily every semester until it was about 10% higher by graduation.

“We can see that students came out of high school with a certain level of self-esteem that dropped off to the lowest point of the four years. Some said they started to experience ‘imposter syndrome’ from being around other high-performing students,” Campbell says. “As the years progress, though, we can draw a straight line from low to high as their self-esteem improves. I think we would see a similar trend class over class. To me, that’s a very positive thing.”

Female students—who made up 60% of study participants—experienced on average 5% greater stress levels and 10% lower self-esteem than male students. More significantly, the data show that female students tended to be less active, with male students walking 37% more often.

Sophomores were 40% more socially active compared to their first year, the researchers report. But these students also reported feeling 13% more stressed during their second year than during their first year as their workload increased, they felt pressure to socialize, or as first-year social groups dispersed.

One student in a sorority recalled that having pre-arranged activities “kind of adds stress as I feel like I should be having fun because everyone tells me that it is fun.” Another student noted that after the first year, “students have more access to the whole campus and that is when you start feeling excluded from things.” 

In a novel finding, the researchers identify an “anticipatory stress spike” of 17% experienced in the last two weeks of summer break. While still lower than mid-academic year stress, the spike was consistent across different summers.

In post-study interviews, some students pointed to returning to campus early for team sports as a source of stress. Others specified reconnecting with family and high school friends during their first summer home, saying they felt “a sense of leaving behind the comfort and familiarity of these long-standing friendships” as the break ended, the researchers report. 

“This is a foundational study,” says Subigya Nepal , first author of the study and a PhD candidate in Campbell’s research group. “It has more real-time granular data than anything we or anyone else has provided before. We don’t know yet how it will translate to campuses nationwide, but it can be a template for getting the conversation going.”

The depth and accuracy of the study data suggest that mobile-sensing software could eventually give universities the ability to create proactive mental-health policies specific to certain student populations and times of year, Campbell says.

For example, a paper Campbell’s research group published in 2022 based on StudentLife data showed that first-generation students experienced lower self-esteem and higher levels of depression than other students throughout their four years of college.

“We will be able to look at campus in much more nuanced ways than waiting for the results of an annual mental health study and then developing policy,” Campbell says. “We know that Dartmouth is a small and very tight-knit campus community. But if we applied these same methods to a college with similar attributes, I believe we would find very similar trends.”

Weathering the pandemic

When students returned home at the start of the coronavirus pandemic, the researchers found that self-esteem actually increased during the pandemic by 5% overall and by another 6% afterward when life returned closer to what it was before. One student suggested in their interview that getting older came with more confidence. Others indicated that being home led to them spending more time with friends talking on the phone, on social media, or streaming movies together. 

The data show that phone usage—measured by the duration a phone was unlocked—indeed increased by nearly 33 minutes, or 19%, during the pandemic, while time spent in physical activity dropped by 52 minutes, or 27%. By 2022, phone usage fell from its pandemic peak to just above pre-pandemic levels, while engagement in physical activity had recovered to exceed the pre-pandemic period by three minutes. 

Despite reporting higher self-esteem, students’ feelings of stress increased by more than 10% during the pandemic. By the end of the study in June 2022, stress had fallen by less than 2% of its pandemic peak, indicating that the experience had a lasting impact on student well-being, the researchers report. 

In early 2021, as students returned to campus, their reunion with friends and community was tempered by an overwhelming concern about the still-rampant coronavirus. “There was the first outbreak in winter 2021 and that was terrifying,” one student recalls. Another student adds: “You could be put into isolation for a long time even if you did not have COVID. Everyone was afraid to contact-trace anyone else in case they got mad at each other.”

Female students were especially concerned about the coronavirus, on average 13% more than male students. “Even though the girls might have been hanging out with each other more, they are more aware of the impact,” one female student reported. “I actually had COVID and exposed some friends of mine. All the girls that I told tested as they were worried. They were continually checking up to make sure that they did not have it and take it home to their family.”

Students still learning remotely had social levels 16% higher than students on campus, who engaged in activity an average of 10% less often than when they were learning from home. However, on-campus students used their phones 47% more often. When interviewed after the study, these students reported spending extended periods of time video-calling or streaming movies with friends and family.

Social activity and engagement had not yet returned to pre-pandemic levels by the end of the study in June 2022, recovering by a little less than 3% after a nearly 10% drop during the pandemic. Similarly, the pandemic correlates with students sticking closer to home, with their distance traveled nearly cut in half during the pandemic and holding at that level since then.

Campbell and several of his fellow researchers are now developing a smartphone app known as MoodCapture that uses artificial intelligence paired with facial-image processing software to reliably detect the onset of depression before the user even knows something is wrong.

Morgan Kelly can be reached at [email protected] .

• Mental Health and Wellness
• Innovation and Impact
• Arts and Sciences
• Class of 2021
• Class of 2022
• Department of Computer Science
• Guarini School of Graduate and Advanced Studies
• Mental Health

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Essay on the Causes of Stress for College Students

gerel 1 / -   Apr 8, 2007   #1 The Causes of Stress for College Students Stress is basically defined as an applied force or system of forces that tends to strain or deform a body. It is usually caused by something that is out of the ordinary from everyday life, things like tests, family problems and loss of job. Today students have a lot of stress because of a lot of different reasons. There are many things that cause stress for college students; school-related issues, relationships, and peer pressure. One of the main causes of stress is adapting to the new life which we have suddenly landed in. For me it is the first time that I have lived outside the nurturing and protective security of the family unit. My parents used to provide for me materially and used to set down boundaries on how to live. This no longer applies in college and one of the first tasks that I should undertake is to find an identity and effectively test the rules that were set out by my parents. The uncertainty and lack of identity is a common cause of stress for me. School-related issues also cause stress for students these days. It can be caused by them doing so badly in college that they gave up all hope of doing something worthwhile with their lives, or it could be caused by just not living up to their own standards. Stress also creates the way people deal with things like smoking and drinking, which are worse ways of dealing with stress. I think that these are some of the most common ways to deal with it. For example, one of my friends likes to go out and drink when he feels stressed about doing badly on a test or paper. Another cause of college stress is relationships. Relationship stress can be caused by not living up to their partner's expectation or just plainly by breaking up with someone that they really did care for. Also, it can be caused by an individual liking someone a lot and the finding that feeling is not mutual. All of these aspects can cause students to feel like they are in way over their heads. Most students use alcohol, tobacco, or drugs to relieve stress. That's why for some college students stress makes them sick and their immune system gets run down. Moreover, the cause of the stress is peer pressure. Peer pressure is when "friends" persuade you to doing something that you do not want to do. But maybe you want to do it, and you just don't have the courage to do it and your friends talk you into it. Peer Pressure can be broken down into two areas; good peer pressure and bad peer pressure. Bad peer pressure is being coerced into doing something that you didn't want to do because your friends said that you should. Friends have a tendency to think that they know what is best for you, and if your friends are like some of ours, they always offer their opinion whether it is wanted or not. Many students are vulnerable to bad peer-pressure because they are afraid of being rejected, losing friends, being teased and they don't know how to say "NO". Some students don't think about the consequences and they can't explain why they are not interested that's why peer-pressure can cause stress. In my opinion, to overcome stress we need to balance academic demands and the social demands of college. Socializing and being surrounded by positive people is an important aspect of overcoming stress. It helps to have real supportive people that you like a lot in your life who want you to succeed, especially during finals. There are several strategies that will help us to cope with stressful situations. First, we have to learn to manage our time wisely. Second, we have to set priorities and make the most of our opportunities as a student. Last, we have to learn to say "NO". After all, college students have a lot of stress. There's no denying it, but college is what we make of it. If we stay focused and balance our life, we'll feel much more relaxed and healthier when it's time to wear our cap and gown. Now, that's an achievement we have earned for life!

EF_Team2 1 / 1,708   Apr 9, 2007   #2 Greetings! I think you've written a great essay! You do a good job of transitioning from one paragraph to the next and presenting the causes of the problem and some solutions. I have just a few editing suggestions for you: "Stress is basically defined as an applied force or system of forces that tends to strain or deform a body." - This sounds like you're describing G-forces on an aircraft; see if you can find a definition that fits better with the particular type of stress you're writing about, i.e., emotional stress. "It can be caused by their doing so badly in college that they give up all hope" "caused by an individual liking someone a lot and [omit the] finding that feeling is not mutual." "Peer p ressure can be broken down into two areas : good peer pressure and bad peer pressure." "NO". - Put the period inside the quotation mark (unless you're British): "NO." Great work! Thanks, Sarah, EssayForum.com