ORIGINAL ARTICLE MUHAMMAD BILAL SAJID', SAIMA HAMID’, FAZAILA SABIH’, AAMNAH SAJID* "Lecturer, Heay Industries Taxa Education City-nstitute of Metical Sciences MITECIMS Taxa “associate Professor, Health Senices Academy lamabad, 'Asstant Profesor, islamic Intemational Medical College “PhO Scholar, slam Intemational Medical College Submitted: May 17, 2016 ‘CORRESPONDENCE: DR. M. BILAL SAJID, &-mai: muhammadbissajacahatmallcom ‘Accepted: April 30, 2017 ABSTRACT INTRODUCTION OBJECTIVE College ife fsa great time forts charm and challenges. Yet there are so To determine the most prevalent types of stress among college studentsin Pakistan as well ast identify the coping strategies todealwiththestess STUDY DESIGN Cross-sectional study PLACE AND DURATION OF STUDY The study was conducted in different educational Institutions oflstamabad and duration of study was months from July2015toDecemiber2015. SUBJECTS AND METHODS The sample consisted of 120 college students selected through purposive convenient sampling technique. There were 76 males and 46 females in the participants. The Student Life Stress inventory (SUS) a self-reported measure wasused toassesstypesand sources ofstressand Brief COPE was used to assess coping stategies of students. The Information regarding socio-demographic variables was ‘obtained ona separate sheet. Thedatawasanalyzedthrough P5521 RESULTS ‘The scores of 98% of the study participant fell between 25% ‘and 75% Te top five stressorsin herespondents were: Self Imposed stresses, Emotional stresses, Cognitive Appraisal Pressures and Changes. The east common stressor reported by respondents was behavioral reactions to stressors. The top five coping mechanisms of our participants were: Religion (6 32+1 68), Active Coping (6.19+1.55), Acceptance (5.924183), Planning (5.80+1.61) and Positive reframing (6.564168), CONCLUSION SelF-mposed, emotional, cognitive appraisal, pressures and changes were dominant stressors. The most commen coping behaviors present were using religion, active coping, acceptance of their stresses, planning and positive reframing. Female students were foundtereact emotionally srorethanmale students. KEY WORDS Suress, Coping mechanisms, College Students ‘many things thatthe students have to worry about Somany stressors are presentthataffectthe tudents'performancein thei academia as wellas social interaction, Stress can thus foster unhealthy behaviors tke ‘smoking, substance abuse illegal activities and moral issues. According to the NIH (USA), many students experience the first symptoms of depression during their college years but yet there are no sufficient counseling services available to al of them’. During these years the ‘competition for higher scores and the expectations of family and ‘teachers increased stress levels in students. Every student strives to get ahead of everyone else and has to undergo so many college specific problems and difficulties. College students are specifically more Precisposed testes. This is because college isa phase of change from high school lif tostressfuland demanding colege/universiy ie. ‘Stressors that may affect college students can be broadly classified as academic time or health related, selFimposed and economic. These Stressors do not cause anslety oF tensions by themselves rather stress results from the interaction between these stressors and one’s own Perception and reaction to these factors. The past research work has reported that students had difficulties in concentration when under stress, This consequently leads to difficulties in their academic performance. The findings of other studies showed that increased stress levels caused dissatisfaction, poor health, impairment in performance, behavioral, psychological and acedemic problems in college students population”. In the USA, a disturbing trend in college student health i the reported increase in student stress nationwide’. According tothe Assocation for University and College Counseling Center of America, about 95% of college counseling centerdiectorsreported thatthe numberof students vith significant psychological problems is growing everyday in their respective University's campuses. Up to 70% of these directors are ‘convinced that the number of students with psychological problems haveincreased drastically nthelastyearorso\. In 2008, Stalman conducted a study to find out the prevalence of psychological problems in university students who were patients atthe University health service. Hereported that more than hafofthe students ‘that were patients in the university’ health service presented mild to high levels of psychological distress in the 6-13 weeks of thelrrespective academic calendars. The study aso found out that 22% ofthe students ‘aged 18and below had very high evelsof psychological distressand that thissessaffectedtheirstudiesand workifequiteadversely". {JULY-SEPTEMBER 2017 | YOLUME 14 NUMBER 3Journal of Pakistan Psychiatric Society Yetagain,in anther study conducted inaKarachimedicalcolege by Babar . Sheikh tal, (2004), more than 90% of the students under study reported that theyhad had multiple epiodes of stress while in college, 94.19 of males and 91.1% of females maintained this ‘positon. twas also noted that females were more prone to fatigue, Ineadaches and episodes of short temperedness as compared with their male counter parts The top coping behaviors cited by the participants included sleeping, listening to music, plying sports, ‘pending time wth fiends isolation, praying, watching movies and online chatting Coping behaviors are justas important tobe studied. Some students may take to healthy activites such as sports, exercise or creative pathways while others may lean towards smoking, drugs, aleohol abuse and other self-damaging actives. Therefore, itis quite Important to find out the various coping actives of college students Inview ofthe higherrate of symptoms stress the resent study was undertaken to find out the most prevalent types of stress in college ‘students of Pakistan aswellasto identify the major coping tategies employed by thestudentsto dealwiththestress SUBJECTS AND METHODS Participants Thiscrosssectiona study was carried outinclifferent universities and Insitutions of klamabad. The sample ofthe study consisted of 120, callage students selected ‘fom Riphah International Univesity CCOMSATS University, Babvia University and SKANS School of ‘Accountancy. The purposive convenient sampling technique was sed to select the sample. Sample size calculations were made based Conthisformula:n=Z" p(1-p)/e. According tothis formula minimum requicedsamplesizewas68. The refusal rate was 14% Instruments. Data was collected using a close-ended structured questionnaire Student Life Sess Inventory (SL tis a Sel-reporced measure to assess evel of stress among college students. The SLSI comprised of 51 items having 9 sections indicating diferent types of stressors {frustrations, conflicts, pressures, changes, and self-imposed Stressors) and reactions to the stressors (physiological, emotional ‘behavioral and cognitive) Thelnterna consistency coefficient of his ‘scale was 0.83 indicating that the scale is reliable for the Pakistani student population. The coping strategies were measured through the Urdu Brief COPE (Carver, 1997) comprising of 28 items, categorized into 14 subscale. The response format ofthe esis 24 point Likert format (1= Never, 2= Very less, 3= Sometimes and 4= A Jot). The high score on each subscale shows more use of that particular coping strategy and vice versa. A demographic Information sheet was also used to obtain information regarding background varablespertinenttothisstudy. Procedure ‘The Proposal was approved by Ethical Review Committee. The potential institutions were identified and contacted, Written approval was taken from the concemed authorities, Data was collected after the signed consent ofthe participants of study. The confidentiality ofthe information was assured to the students. The {questionnaires were administered in group setting, The participants were given verbalas wellas written instructions. Data was used solely for the purpose of present study. There was no monetary compensation to the study participants. Scores were added Individually foreachsub section to getatotal scoreforeach subscale ‘There was no ovealor total score calculated inthsinstrument. Each sub scale was independent. For data analysis SPSS software version 21 wasused. Then diferentvarables were computed anddescriptive Statistics were applied othe data, The tables and figures were made Using Mirosof Offic Suite 2011, Tablet Demographic Dats of Sty Population 1 [Asses a3 7 | eer tae THT Fem aR 7 eran SSIs 54 [se Oren ae Tass [Of omg singe 1387 © | Dine ody ae Ba acr TRIGA cA CASE SoM 350) 3S ar 7 | ay Fa TSS PE 79, Sih 35%) ‘ach a) Abo aa 1 | anes Oxspaon ome TAS Busnes Baa Reed cc} 7 | aiers Orpen Howe we Bae ofc HESS 10 | Fer cart rinen To Sune San Tay Tami TAIGA Becel “SA, Mas Soa D a7 1 were rina oo Esato Sen TRIS Trem TATE Bee ST) Mase Baa) PAD a Te) Fam Near TROT sctre Comin 5070) ‘The overall mean score ofthe inventory was 129.94 + 2620. The scores of9854of the study samplefellbetween 25%and 75% The top five stressors in the respondents were: SeImposed stresses, Emotional stresses, Cognitive Appraisal, Pressures and Changes. The least common stressor reported by respondents was behavioral {JULY-SEPTEMBER 2017 | VOLUME 14 ouMaeR 3Journal of Pakistan Psychiatric Society reactions to stressors. The mean scores and percentages of score of the partcipants both males and females in each of the nine categories ofthe Student LifeStress Inventory aregivenin the Table 2. Women scored mare in the emotional stress category than men (Table2} RESULTS (One hundred and twenty students voluntarily participated in the current study. The mean age ofthe participants was 2131 + 813 years. The mean number of siblings was 351 + $4. There were 61.7% males and 383% females enrolled in the present study. Disciplines of study varie from MBBS (24.29), BET (10.8%), CA 55%), [MSC/MPhil (2.5%) and BS (7.5%), The respondents hailed from different cities of Punjab. The most common occupation of the fatherso the respondents was an officejob followed by having their ‘own businesses and a smal percentage was retired citizens. Most of themothers oftherespondentswerehousewivesie. 76.7% followed by having an office job or retired from service. Regarding educational status of fathers of respondents, 08% had primary education, 9.2% had secondary education, 10.8% had intermediate education, 25.8% hhadabachelor'sdegree,41.7%6hadamasters degree and 1.796 hada PRD degree. Regarding mothers educational status, the majority of the mothers (46.7%) had a Bachelors degree, 21.7% had Master's degree and the rest had primary/secondary education. Sixty five percentofthe study sample ivedinanuclearfamilysystemwhilethe rest were living in a combined family system. The details of the partcipants demographic dataare given in Table | ‘Table ‘Mean Percentages of Scores of Partipants on SLST 1 [ Fron 420% 2 [coi 50% 3 [Sateen Tea 6 [Paysite ae 9 [oss apd ax Table 3 depitsthe mean scores of the partcipantsaccordingto their ‘gender and discipline of study. The mean scores and percentages of scores of the participants according to the discipline of study are 127.86 + 25.74 for MBBS; 134.08 + 43,52or BET; 131.60 + 26384 for (CX 123.33 472 for MS/MPhil and 121.22 + 27.96 for BS. Students ‘of MBBS and CA reportedly scored higher inthe emotional reactions to stresses than students of other disciplines. Mean scores of other lscipines were slighty more than MBBS and CA in the behavioural reactions to stressors, Mean score of the inventory fr female was slightly higher than their male counterparts. Mean score of students of BET was higher than students of other disciplines. The coping mechanisms of college students were also explored vihich are depictedin Table, ‘Tables “Mean Scores according to Gender & Discipline of Study Male | 27A6= 7175 Female [153265 200 MBBS | 1a7H6= 2574 2 |Disciineof Stay Sr ToS MSRP | massa Bs TIT ‘Tables ‘Mean Scores of Coping Mcchanism Rate Coe Vas Of Eaten soon Tas OF arms Suppor SaTah 6 ‘Bhaionl Diensneonen sone Vern ae Seah Aseranee ae Rekigon Gaal Sane a7 DISCUSSION Lives of our modern day students are plagued by various stresses Which eadto clsturbancesin thelr personalas wellasacademiclves. The present study was cartied out not only to find out the most prevalent types of stress in college students’ population but aso to ‘explore ajorcopingmechanismstodeal withthe stress. Paststudleshave reported thatapproximately 75% to 80% of college students are moderately stressed and about 1036to 12% areseverely stressed. It has been assumed that emerging adulthood, a transitional phase fromadolescence into adulthood, augmented the college students! vulnerability to stess12. This stress can further cutivate mutiple biolagical as well as psychosocial complexities resulting in detrimental health consequences. Qut study also has revealed that unhealthy coping mechanisms such as substance abuse, behavioral disengagement as well self blame are associated withhigher levels of stress. ‘The findings ofthe present study revealed that the predominant stressors present in the students were self-imposed stressor, emotional stressors, cognitive appraisal, pressures and changes Emotional reactions to stressors were present more in females than inmen. These finding are inline wth previous study caried out by Hyde & Plant in 199513, Another interesting finding in our work has shown gender differences which influence the student stresses and thereactionsto such stresses Female students are more often seen to let out their feelings while male students more often hide their JULY-SEPTEMBER 2017 | VOLUME 18 NUMER 3 pase a2Journal of Pakistan Psychiat erations accept tas such and ignore or try to forget about it Most Imporanty, males put in more effons at problem solving than femalestudents”. Inastudy donein apivate medical college in Karachi Pakistan, twas found that approximately 70% of the students suffered rom anxiety and depression. Mos ofthe students the study were femalesIn another similar study done by Shah etal (2010), moderate to severe stress were foundin medical students, Gender difeence turned out tobe the mostimporantstatistial Females were reported tohave bigher stress levels than their male counterparts, The most frequent causes of stress reported by the students in this study were, examinations, sleep disorders, vast curriculum, unrealistic expectations of parents, worying about thelr futures, loneliness etc" Our results however, measured stres diflerently than other Studes and top stressors ere: Seltimposed stresses, Emotional stresses, Cognitive Appraisal, Pressures and Changes. Our finding aso comelate with 2 study conducted in 2008 by Sajid & Sabin regarding thehigherrateofsymotomsof niet in female students hic found that up to 77% of he students aking parti the study had undergone multiple bouts of stress and extended periods of severe ane. Female students reported higher rates of symptoms ofanvlety during fistyearofcolegelife®. ‘he most frequent coping mechanisms used by college students were religious coping, active coping, acceptance, planning and postive relraming. The significant gender ciferences were alo observed regarding coping styles to deal with the stressors. When compared at similar levels of stress, women exhibited stress more covertly than males13. Male students tended to accept their stress more than thelr female counterparts. High male acceptance comparedto females wasalsoconsistentwithpreviousstudies IMPLICATIONS This work also provides evidence regarding various stressors affecting the performance ofstuents uring thelr ollege/universty life This study can be used by the student counseling cals of various colleges, univestes and institutions to address this crucial sue Healthy coping strategies coulé then be encouraged and a system put into place to support the students to adopt useful coping strategies such as religion, sports, music and other leisure time activities to alleviate ther stresses. fis therefore, imperative establish a student-counseling center In each campus for this purpose. Further studies shouldbe conducted with more dscipines fn alargerstudent population inordertogetabroader vision of the problem. REFERENCES 1. 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