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Procedia - Social and Behavioral Sciences 205 (2015) 189 – 194

6th World conference on Psychology Counseling and Guidance, 14 - 16 May 2015

Anxiety and self-esteem among university students: comparison

between Albania and Kosovo
Sevim Mustafaa*, Erika Melonashib, Fleura Shkembib, Kaltrina Besimic, Naim Fanajb
a
Qeap – Heimerer, Pristina; Kosovo
b
European University of Tirana, Tirana; Albania
c
Fama College, Prizren; Kosovo

Abstract

The purpose of the study was to investigate the level of anxiety and self-esteem among university students and determine links
between. Participants were 125 students, aged 18 - 44 years old (M=23.54; SD=5.16); from Kosovo and Albania. The measures
used included the Albanian versions of Zung Self-Rating Anxiety Scale and the Rosenberg Self-Esteem Scale. 14.3% (Albania)
and 32.3 % (Kosovo) of participants reported mild to moderate levels of anxiety, only 12.9 % Kosovo sample had marked to
severe level of anxiety; 6.3 % (Albania) and 1.6 % (Kosovo) reported low self-esteem. Self-esteem and gender was significantly
negatively correlated with anxiety only in Albanian sample. No significant differences in self-esteem levels based on country, but
students from Kosovo had significantly higher anxiety.
© 2015 The
© 2015 TheAuthors.
Authors.Published
Publishedbyby Elsevier
Elsevier Ltd.Ltd.
This is an open access article under the CC BY-NC-ND license
Peer-review under responsibility of Academic World Research and Education Center.
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Peer-review under responsibility of Academic World Research and Education Center.
Keywords: anxiety; self-esteem; students; Albania, Kosovo

1. Introduction

1.1. Anxiety

Anxiety is one of the most widely experienced emotions defined as a displeasing feeling of uneasiness,
nervousness, apprehension, fear, concern or worry (Barlow, 2002; Karatas, Alci & Aydin, 2013; Lenka & Kant,

* Sevim Mustafa. Tel.: +38649666510.

E-mail address: sevimmustafa2@gmail.com

1877-0428 © 2015 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Peer-review under responsibility of Academic World Research and Education Center.
doi:10.1016/j.sbspro.2015.09.057
190 Sevim Mustafa et al. / Procedia - Social and Behavioral Sciences 205 (2015) 189 – 194

2012). The criteria for the normality or abnormality of anxiety can be determined by its cause and intensity (Barker,
2009). Indeed moderate anxiety can motivate people to manage their problems and be a success in their life
(Abolghasemi, Mehrabizadeh-Honarmand, Najarian, & Shokrkon, 2004).

Nonetheless, anxiety might also escalate in disorders, which are the most common class of psychological
disorders. Anxiety disorders are present in almost all cultures (Demyttenaere, 2004) and estimates show that they
will be experienced by about 18% of adults every year and by about 32% of people during their lifetimes (Kessler,
2005).

Yılmaz and Ocakçı (2010) found that 77.2% of the students experienced a mild level and 19.6% experienced a
moderate level of anxiety. A study conducted by Wong, Cheung, Chan, Ma & Tang (2006) in a sample of university
students across 10 universities in Hong Kong revealed that 41% of students experienced moderate levels of anxiety.
Webb et al. (1996) reported that 54% of UK university students reached the subthreshold for anxiety.

The anxiety level might interfere with everyday functioning like studies, their daily activities, and social life
among students. Anxiety is a major predictor of academic performance (McCraty, 2007; McCraty, Dana, Mike, Pam
& Stephen, 2000) and various studies have demonstrated that it has a detrimental effect (Heather & April, 2008;
McCraty, 2007). Students with higher level of anxiety will achieve a lower academic performance (McCraty, 2007;
Heather & April, 2008) and greater anxiety is associated with poorer academic achievement (problems with
memory, attention and reasoning) (Luigi, Francesca, Maria, Eleonora, Valentina & Benedetto, 2007).

1.2. Anxiety and Self-esteem

The relation between self-esteem and anxiety has only rarely been studied (Roberts, 2006). Self-esteem might
serve as a protective factor, as a moderator, mediator or simply a result of emotional well-being or difficulties
(Lackovic-Grgin, 2000; Lee & Hankin, 2009; Restifo, Akse, Valle Guzman, Benjamin & Dick, 2009; Tambelli,
Laghi, Odorisio, & Notari, 2012; Laghi, Pallini, D'Alessio, & Baiocco, 2011; Myers, 2013).

Low self-esteem has been associated with anxiety symptoms and somatic complaints while high self-esteem has
been considered as an important buffer against anxiety (Millings et al.,2012; Morley & Moran, 2011; O’Brien,
Bartoletti, & Leitzel, 2006). Cross-sectional research studies have reported correlations of medium of high statistical
power between self-esteem and anxiety (Lee, & Hankin, 2009). Overall, the available research suggests that high
self-esteem may have positive consequences for the well-being and success of the individual and that low self-
esteem may be a risk factor for negative outcomes (Sowislo & Orth, 2013).

1.3. Anxiety / Self-esteem studies in students Albania & Kosovo

The search in internet (google scholar etc) is not helpful because we find no study in this topic.

2. Methods

2.1. Sample and procedure

Participants were 125 students aged between 18 and 44 years old (M=23.54; SD=5.16); 62 from Kosovo and 63
from Albania. The Albania sample in terms of gender composition, there were girls 43 (68.3 %), boys 20 (31.7 %).
The Kosovo sample in terms of gender composition, there were girls 33 (53.2 %), boys 29 (46.8 %). In terms of age
the Albania sample ranged from 19-42 (Mage=21.34; SD=4.07); the Kosovo sample ranged from 18-44
(Mage=25.77; SD=5.22). Participants completed two scales: The Albanian versions of Zung Self-Rating Anxiety
Scale (Zung, 1971) and the Rosenberg Self-Esteem Scale (Rosenberg,1989).
 Sevim Mustafa et al. / Procedia - Social and Behavioral Sciences 205 (2015) 189 – 194 191

2.2. Measuring instrument

x Zung Self-Rating Anxiety Scale (SAS) (Zung, 1971) .The measure is a 20-items self-report assessment
device build to measure anxiety levels. It consists of four categories assessing cognitive, autonomic, motor
and central nervous system symptoms. Participants should indicate how much each statement applies to
them. Each question is scored on a Likert-type scale from 1 (a little of the time) to 4 ("most of the time").
The total raw scores range from 20-80. The raw score needs to be subsequently converted into an "Anxiety
Index" score which can be then used to clinically determine one's level of anxiety. Therefore scores 20-44
fall in the Normal Range, scores 45-59 are considered Mild to Moderate Anxiety Levels, scores 60-74
Marked to Severe Anxiety Levels, and 75-80, Extreme Anxiety Levels. In the present study, the internal
consistency of the measure was acceptable (Cronbach’s alpha .81).
x The Rosenberg self-esteem scale (Rosenberg,1989)- provides a valid and reliable index of one’s global or
trait self-esteem. This questionnaire consists of ten items with which are scored on a four-point Likert scale
ranging from strongly agree to strongly disagree. Five of the items are reversely scored. Each item was
coded from 1 to 4 and summed so that the possible score range was 10 to 40, (cut-off point at 15) with
higher scores indicating higher self-esteem. In the present study, the internal consistency of the scale was
acceptable (Cronbach’s alpha .68).
The questionnaires were translated into Albanian by using the translation back translation method to ensure
correct translations.

2.3. Study design

The study was a cross-sectional correlational study, with age, gender, self-esteem as independent variables and
anxiety as the dependent variable. The purpose of the study was to investigate and compare the levels of anxiety
among university students and determine whether self-esteem, age and gender might serve as significant predictor of
these difficulties. All data has been analyzed by SPSS 21 and Excel 2007.

3. Results

3.1. Descriptive analyses

The following table shows the classification of participants in terms of each variable investigated in the study.

Table 1: Frequencies and percentages of participants by gender, self-esteem and anxiety

Variables Albania Kosovo

N % N %
Gender
Male 20 31.7 29 46.8
Female 43 68.3 33 53.2
Self-esteem
Low 4 6.3 1 1.6
Normal 59 93.7 61 98.4
Anxiety
Normal 54 85.7 34 54.8
Mild to moderate 9 14.3 20 32.3
Marked to severe 0 0 8 12.9
Extreme 0 0 0 0

The mean value for Rosenberg self-esteem scale in Albanian students was 22.31 (SD=4.09), in Kosovo students
was 23.58 (SD=4.72). In terms of classification by self-esteem level, 4 (6.3%) of Albanian students and 1 (1.6 %) of
Kosovo students reported low self-esteem (see Table 1).
192 Sevim Mustafa et al. / Procedia - Social and Behavioral Sciences 205 (2015) 189 – 194

The mean value for anxiety in Albanian students was 37.77 (SD=5.82), in Kosovo students was 45.24
(SD=10.05). In terms of classification by level of anxiety, 9 (14.3 %) of Albanian students and 20 (32.3 %) of
Kosovo students were classified with mild to moderate levels of anxiety, and only 8 students (12.9 %) of Kosovo
sample had marked to severe anxiety .

3.2. Comparative analysis for self-esteem and anxiety

Normality assessment with Kolmogorov-Smirnov statistic of distribution of scores for variables suggested a
violation of the normality assumptions. Consequently nonparametric tests were used.
x Self-esteem: Mann-Whitney Test found no significant gender differences in self-esteem in both samples.
Additionally there were no significant differences in anxiety levels based on self-esteem (low and normal
self-esteem groups). Kruskal-Wallis test also found no significant differences in self-esteem based on
anxiety levels in both samples.
x Anxiety: Mann-Whitney test revealed significant gender differences in anxiety only in Albanian sample
(Mdfemales=39, N=43; Mdmales=20, N=35; Z=-2.019, p < .04, r = .27). Additionally there were significant
differences in anxiety levels based on self-esteem (low and normal self-esteem groups) only in Albanian
sample (MdlowSE=45, N=4; MdnormalSE=37, N=59; Z=-2.541, p < .01, r = .35).
x Comparative analysis for self-esteem and anxiety between samples: Mann-Whitney Test didn’t found
significant differences in self-esteem levels based on country. Mann-Whitney Test found significant
differences in anxiety levels based on country (Md albania=37; N=63; Mdkosovo=42; N=62) as students from
Kosovo had significantly higher anxiety as compared to students from Albania (Z=-4.151, p<.000).

3.3. Correlations between variables

Correlational analyses indicated significant correlations between anxiety and gender (r=.256, p<.000); age (r=-
.317, p<.011), and self-esteem (r=-.315, p<.015) only in Albanian sample of students (see Table 2). Anxiety showed
no significant correlation with any of the variables in the Kosovo sample (see Table 2).

Table 2. Correlations between gender, age and self-esteem and anxiety

Variables Anxiety

Albania Kosovo

Gender .256* .610

Age -.317* .422
Self-esteem -.315* .074

*. Correlation is significant at the 0.05 level (2-tailed).

Multiple regression analysis was conducted with gender, age and self-esteem as independent variables
(predictors) and anxiety as the dependent variable. A model didn’t resulted significant in both samples.

4. Discussion

Our findings show the very marked presence of anxiety in the Kosovo student sample (a cumulative 45.2% of
students falling in the category of mild - moderate anxiety to severe anxiety) but only 14.3 % of mild - moderate
anxiety. These findings are in line with those reported by Webb et al. (1996) who found prevalence as high as 54 %,
in UK university students for anxiety subthreshold and by Wong, Cheung, Chan, Ma & Tang (2006) in a sample
across 10 universities in Hong Kong revealed that 41% of students experienced moderate levels of anxiety. It is
difficult to explain these differences. Our first impression maybe the fact the Kosovo is one postwar country, and
 Sevim Mustafa et al. / Procedia - Social and Behavioral Sciences 205 (2015) 189 – 194 193

with great socio-economic difficulties.

Findings on gender differences in anxiety levels are also in line with current research suggesting significantly
higher levels of anxiety among women as compared to men (Zhang et al, 2007; Eisenberg et al, 2012 ) but only for
Albanian students.
On the other hand, our findings replicated the correlation between anxiety and self-esteem and thus are in line
with current research (Lee & Hankin, 2009; Millings et al.,2012; Morley & Moran, 2011; O’Brien, Bartoletti, &
Leitzel, 2006). But, the correlations are significant only for Albanian sample.
Similarly, the reported self-esteem levels (22.31 for Albanians and 23.58 for Kosovar sample of students) seem to
be much lower than levels found in other countries in the region (e.g., scores above 30 in Greece (31.29), Italy
(30.56), Serbia (33.59), Turkey (32.14), Croatia (31.94) (Schmitt & Allik,2005). Nonetheless it should be also
mentioned that these scores derive from samples which are quite different in their sizes and composition; therefore
differences might be explicable in methodological terms.
In conclusion several limitations of the present research should be also mentioned. Firstly the small sample of
students from only one Albanian university and one Kosovo university clearly makes generalization of findings
rather difficult. Also there are differences in findings between samples. Moreover, it should be also acknowledged
that the use of un-standardized measures for anxiety and self-esteem does not allow for any strong interpretations of
the results; hence the use of alternative assessment tools might be suggested for further research. However, despite
the methodological shortcomings, the present study reported some findings, which are worth to be looked further,
e.g., a remarkably high prevalence of anxiety in a quite small sample of Kosovar students. This finding clearly
demands further examination and research especially as regards the socio-demographic or culture-specific factors
involved.

References

Abolghasemi, A., Mehrabizadeh-Honarmand, M., Najarian, B., & Shokrkon, H. (2004). The effectiveness of therapeutic methodology of stress
inoculation training and systematic desensitization in test anxiety students. Journal of Psychology, 8(29), 3-21.
Barlow, D. H. (2002). Unravelling the mysteries of anxiety and its disorders from the perspective of emotion theory. American Psychologist, 55,
1247-1263.
Demyttenaere, K., Bruffaerts, R., Posada-Villa, J., Gasquet, I., Kovess, V., Lepine, J.P., et al. (2004). Prevalence, severity, and unmet need for
treatment of mental disorders in the World Health Organization world mental health surveys. JAMA.Vol. 291, issue 21:2581 90. [1538–3598 :(
Electronic)]
Eisenberg, D., Speer, N., & Hunt, J. (2012) Attitudes and beliefs about treatment among college students with untreated mental health problems.
Psychatric Services. 63(7), 711-713.
Heather, L. V., & April, L. C. (2008). The Relationship between Test Anxiety and Academic Performance. [Online] Available:
http://clearinghouse.missouriwestern.edu/manuscripts/333.php (January 10, 2008)
Karatas, H. ; Alci, B. & Aydin, H. (2013) Correlation among high school senior students’ test anxiety, academic performance and points of
university entrance exam. Educational Research and Reviews Vol. 8(13), pp. 919-926,
Kessler, R., Chiu, W., Demler, O., & Walters, E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National
Comorbidity Survey Replication. Archives of General Psychiatry, 62(6):617–27.
Lackovic-Grgin, K. (2000). Stres u djece i adolescenata. Jastrebarsko, Naklada Slap.
Laghi, F., Pallini, S., D’Alessio, M., & Baiocco, R. (2011). Development and validation of the efficacious self-presentation scale. Journal of
Genetic Psychology, 172, 209–219.
Lee, A., & Hankin, B. L. (2009). Insecure attachment, dysfunctional attitudes, and low self-esteem predicting prospective symptoms of
depression and anxiety during adolescence. Journal of Clinical Child and Adolescent Psychology, 38,219 –231.
Lenka, S. K., & Kant, R. (2012). A study of academic anxiety of special need’s children in special reference to hearing impaired and learning
disabled. International Journal of Multidisciplinary Research, Vol.2 (2), 64-72.
Luigi, M., Francesca, D., Maria, D.S., Eleonora, P., Valentina, G.D., & Benedetto, V. (2007). The Role of Anxiety Symptoms in School
Performance in a Community Sample of Children and Adolescents. BMC Public Health. 2007; 7: 347. Doi: 10.1186/1471-2458-7-347.
McCraty, R. (2007). When Anxiety Causes Your Brain to Jam Use Your Heart. Institute of Heart Math.
McCraty, R., Dana, T., Mike, A., Pam, A., & Stephen, J. (2000). Improving Test-Taking Skills and Academic Performance in High School
Students Using Heart Math Learning Enhancement Tools. Institute of Heart Math.
Millings, A., Buck, R., Montgomery, A., Spears, M., & Stallard, P. (2012). School connectedness, peer attachment, and self-esteem as predictors
of adolescent depression. Journal of Adolescence, 35, 1061-1067.
Morley, T. E., & Moran, G. (2011). The origins of cognitive vulnerability in early childhood: Mechanisms linking early attachment to
later depression. Clinical Psychology Review, 31, 1071-1082.
O’Brien, E. J., Bartoletti, M., & Leitzel, J. D. (2006). Self-esteem, psychopathology and psychotherapy. In M. Kernis, Self-esteem issues and
answers: A source book of current perspectives. New York: Psychology Press.
194 Sevim Mustafa et al. / Procedia - Social and Behavioral Sciences 205 (2015) 189 – 194

Restifo, K., Akse, J., Valle Guzman, N., Benjamin. C., & Dick, K. (2009). A pilot study of self-esteem as a mediator between family factors and
depressive symptoms in young adult university students. J Nerv Men Dis 2009; 197:166–71.
Roberts, J. E. (2006). Self-esteem from a clinical perspective. In M. H. Kernis (Ed.), Self-esteem issues and answers: A sourcebook of current
perspectives (pp. 298 –305). New York, NY: Psychology Press.
Rosenberg, M. (1989). Society and the Adolescent Self-Image. Revised edition. Middletown CT: Wesleyan University Press, 1989
Schmitt, D., & Allik, J. (2005). Simultaneous administration of the Rosenberg Self-esteem Scale in 53 nations: Exploring the universal and
culture-specific features of global self-esteem. Journal of Personality and Social Psychology, 89, 4, 623-642.
Sowislo, J. F., & Orth, U. (2013). Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychological
Bulletin, 139, 213-240.
Tambelli, R., Laghi, F., Odorisio, F., & Notari, V. (2012). Attachment relationships and internalizing and externalizing problems among Italian
adolescents: age and gender differences. Children and youth services review, 34, 1465–1471.
Webb, C., Ashton, H., Kelly, P. & Kamali, F. (1996). Alcohol and drug use in UK university students. The Lancet, vol. 348, no. 9032, pp. 922–
925, 1996.
Wong, J. G. W. S., Cheung, E. P. T., Chan, K. K. C., Ma, K. K. M., & Tang, S. W. (2006). Web based survey of depression, anxiety and stress in
first-year tertiary education students in Hong Kong. Australian and New Zealand Journal of Psychiatry, 40, 777-782.
Yılmaz, M., & Ocakçı, A.F. (2010). Bir kız ogrenci yurdunda kalan universite ogrencilerinin anksiyete duzeylerinin belirlenmesi [Determination
the anxiety level of university students one dormitory located]. Maltepe Universitesi Hemsirelik Bilim ve Sanatı Dergisi, 3 (1), 16-23.
Zhang, L., Guo, L.X., Li, Y., Zhu, Y.F., Li, Q., Chen, K.J.& Chen, M.J., (2007) The effect of mental education on the mental health of nursing
undergraduates in military university. Chinese Journal of Behavioral Medical Science,16 (2), 153–154.
Zung, W.W.K. (1971). A rating instrument for anxiety disorders. Psychosomatics.12 (6): 371 -379.