Stress-related symptoms, beliefs, and behaviors in college students
A number of studies have indicated that college students experience substantial stress resulting from a variety of sources (Greenberg, 1981; LaCivita, 1982; Sciacca & Hyner, 1986). Many of these students appear to lack the knowledge and skills needed to effectively cope with their stressful experiences (Sciacca & Hyner, 1986; Johansson, 1991). Ineffective coping strategies may contribute to student health problems, increased demand for health services, and higher student attrition rates (Landward & Hepworth, 1984; Mechanic & Greenly, 1976; Selye, 1976).
The purpose of this cross-sectional study was to identify selected health-related beliefs and behaviors associated with common symptoms of stress.
We designed a questionnaire to assess college students' health-related knowledge, attitudes and behaviors. The instrument was inspected for content validity by a panel representing a broad spectrum of college health services and organizations, and was modified according to consensus opinion. The questionnaire was pilot-tested with approximately 50 undergraduates. An item analysis of responses was performed and appropriate modification was made.
The sample consisted of students (n = 2, 610) who were selected randomly through a computer that was programmed to pool ten percent of the undergraduate students at a large midwestern university. As incentive for participation, four $25 prizes were offered to students randomly chosen from among those completing the questionnaire.
The questionnaire included a list of problems and complaints (selected from a review of the literature on human stress) commonly associated with stress. Preceding this list of common stress symptoms were the following instructions:
"Below is a list of problems and complaints that people sometimes have. Read each one carefully and select the response that best describes how much discomfort that problem has caused you within the past 3 months."
The following choices were offered as possible responses:
1 no discomfort,
2 a little discomfort,
3 a fair amount of discomfort,
4 quite a bit of discomfort.
Students were also asked if they agreed or disagreed that "learning to relax is very important for one's health," and to respond to the following:
"When I'm tense or under pressure I respond by eating, drinking. or smoking."
"It's hard for me to find time to relax."
"Even when I do have the time to relax, I still worry and feel tense."
A total of 1,226 undergraduates from the random sample returned a completed questionnaire, yielding a response rate of 47%. A comparison of respondents with all undergraduate students regarding major, year in school, age, and other variables yielded no significant differences. The survey respondents appeared to be quite representative of the overall undergraduate student body.
Stress Symptom Scales
The lowest possible "stress symptom score" was 20, representing "no discomfort (1)" for each of the 20 stress-related symptoms. The highest possible score was 80, representing "quite a bit of discomfort (4)" for each of the 20 stress symptoms. The mean score for all respondents was found to be 40.9.
There were few major differences on stress symptom scores when examined by various sociodemographic variables. However, females exhibited higher scores (43.4) than did males (38.7), and freshmen and the youngest students (under 17) exhibited higher stress scores (41.9 and 46.5) than their counterparts.
Factor analysis revealed three separate stress symptom subscales (see Table 1) [insert table 1 about here]. The Chronbach alpha reliability was greater than 0.75 for each of the three scales. Scale one assessed symptoms associated with insomnia, irritability, anger, loss of appetite, temper outbursts, and headaches. Scale Two included symptoms of nervousness, worrying, fatigue, depression, anxiety, and difficulty concentrating. Scale Three assessed symptoms of low self-esteem, suicidal thoughts, hurt feelings, guilt, sexual difficulties, and problems with friends. Female students reported a greater magnitude of stress symptoms than did the males, for each of the three stress symptom subscales.
Eating, Drinking, or Smoking as a Response to Stress
Significantly more women students (33.6%) reported "usually" and "always or almost always" eating, drinking, or smoking when tense or under pressure, as compared to male students ( 17. 5%), (Z = 41.4, df = 1, p < .001) (see Table 2). As the frequency of eating, drinking, or smoking as a response to tension and pressure increased for both males and females, so too did the magnitude of stress symptoms.
Relaxation and Stress
Ninety-nine percent of the respondents agreed that "learning to relax is very important to one's health,. yet 80% reported difficulty in finding the time to relax and approximately 27% reported "usually. or "almost always or always" worrying and feeling tense even when they found the time to relax.
The results of this study indicate that university undergraduates experience a variety of stress-related symptoms. Furthermore, many students appear to cope with their stress in inappropriate, unhealthy ways.
Students who do not cope effectively with the stress they encounter in college environments are at higher risk for health problems and academic failure. This study supports the need for campus stress management interventions, especially those targeting women and new students.
Table 1. Stress Symptom Scales
Scale 1 Scale 2 Scale 3
temper outbursts nervousness low self-esteem
difficulty sleeping fatigue guilt
tendency to cry worrying thoughts of suicide
loss of appetite depression hurt feelings
anger anxiety sexual difficulties
headaches difficulty con- problems with
irritability centrating friends
a reliability = 0.76 a reliability - a reliability =
score ranger = 7-28 score range = score range = 6-24
 The higher the score, the greater the magnitude of stree
Table 2. Reported Frequency of Eating, Drinking, or Smoking as a
Response to Pressure or Tension.
Frequency of Response n % n %
Never or Rarely 230 39.8 128 23.5
Occasionally 246 42.6 233 42.8
Usually 85 14.7 140 25.7
Always or Almost Always 16 2.8 43 7.9
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Johansson, N. (1991). Effectiveness of a stress management program in reducing anxiety and depression in nursing students. Journal of American College Health, 40; 125-129.
LaCivita, R (1982). Stress management programming and the college student: A report. Journal of American College Health, 30: 237-239.
Landward, S. & Hepworth, D. (1984). Support systems for high risk college students: Findings and issues. College and University, 59; 119-127.
Mechanic, D. & Greenly, J. (1976). The prevalence of psychological distress and help seeking in a college student population. Social Psychiatry. 11; 1-14.
Sciacca, J., & Hyner, G. (1986). Stress management education for undergraduates: Why colleges should intensify their efforts. Journal of the Arizona Association of Health. Physical Education. Recreation. and Dance. 28; 16-18, 25.
Selye, H. (1976). The stress of life. New York: McGraw-Hill.
The authors would like to acknowledge Dr. Paul Femea for his assistance in analyzing the data.
John Sciacca Northern Arizona University
Chris Melby Colorado State University
Gerald Hyner Purdue University
John Sciacca is an Associate Professor of Health Education at Northern Arizona University, Flagstaff, 86011. Chris Melby is an Associate Professor of Nutrition Science at Colorado State University. Gerald Hyner is an Associate Professor of Health Education at Purdue University.