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BAOJ Psychology Aysheha Yousef Mosallam, et al, BAOJ Psychol 2016 1: 3 1: 011

Research

Coping With Stressful Life Events and Mental Health Disorders among University Students Aysheha Yousef Mosallam and Abdel Aziz Thabet2*

1

Lecturer at University College of Applied Science, Gaza - Palestine

1

Al Quds University, School of Public- Consultant Psychiatrist at Child and Family Training and Counseling Center-Gaza-Palestine

2*

Abstract

Clinical Implication

Aim

The findings of the current study suggest that undergraduate students need extra measures. To create a special counseling unit that helps university students overcome the crises and pressures they may face by offering guidance and training programs that can introduce methods of effective dealing with challenging situations. To include basic concepts of effective dealing with stress, problems and management in the curriculum in order to help students overcome these problems.

The aims of this study were to investigate the types and severity of stressors, to find the prevalence of anxiety and depression, to illustrate the types of coping strategies used in stressful situations, and to understand the relationship between stressful life events and mental health disorders including depression and anxiety, and other sociodemographic variables among universities students. Method It was a descriptive analytical study; the sample consisted of randomly selected 392 university students enrolled from the main four universities in Gaza Strip (Al-Aqsa, Al-Azhar, Al-Quds Open, and Islamic University) at the second semester of the academic year 2013 - 2014. The researcher used five questionnaires; a predesigned Socio- demographic sheet, Stress Life Events Scale (SLES), Beck depression inventory - II (BDI-II), Taylor anxiety inventory (TAI), and Ways of Coping (WOC). Results This study showed that mean life stressors was 63.34, male student significantly reported more economic, family, and personal stressors. While, female student reported more emotional and university environment stressors. The study showed that 28% had severe anxiety to very severe anxiety. There was no significant difference in anxiety according to gender. However, there was significant difference in anxiety toward students enrolled in Al Azhar University than the other three universities students according to the university or college type. The study showed that 14.2% of university students had moderate to severe depression. The study showed no significant gender difference in depression and according to university enrollment. The result showed that there was positive significant relationship between total stress and anxiety and depression. The results showed that mean total coping was 42.02, positive reappraisal was 25.96, self-control was 19.87. The result showed no significant differences in all coping strategies according to gender. According to university enrollment, students from Islamic university scored significantly in self-control coping than the other three universities. Our study showed that depression anxiety and coping positive reappraisal, wishful thinking, and student level significantly predict the manifestation of stress. BAOJ Psychology, an open access journal

Key words: Stress, Anxiety; Depression; Coping; University Students; Gaza Strip

Introduction Stress has been defined as a ‘particular relationship between the person and the environment that is appraised by person as taxing or exceeding his or her resources and endangering his or her wellbeing’ [1]. Both individual and contextual factors influence the experience of stress, as well as the individual’s cognitive perception and behavioral responses to the perceived stressor. Anxiety then is an aversive emotional state that one may experience when faced with a stressful situation. Related to the experience of stress and anxiety is the ability to deal or cope with the perceived stressor. Stress has been identified as a 20th century disorder and has been viewed as a dynamic transaction between individuals and their environment. Stress can be regarded as a psychological threat, in which the individual perceives a situation as a potential threat [2]. The university environment and its system, regulations and obligations, as well as openness, independence and freedom *Corresponding author: Abdel Aziz Thabet, Emeritus Professor of Child and Adolescent Psychiatry, Al Quds University, School of PublicConsultant Psychiatrist at Child and Family Training and Counseling Center-Gaza-Palestine, Email: [email protected] Sub Date: November 24, 2016, Acc Date: December 2, 2016, Pub Date: December 4, 2016. Citation: Aysheha Yousef Mosallam and Abdel Aziz Thabet (2016) Coping With Stressful Life Events and Mental Health Disorders among University Students. BAOJ Psychology 1: 011. Copyright: © 2016 Aysheha Yousef Mosallam, 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. Volume 1; Issue 3; 011

Citation: Aysheha Yousef Mosallam and Abdel Aziz Thabet (2016) Coping With Stressful Life Events and Mental Health Disorders among University Students. BAOJ Psychology 1: 011.

can make the student find difficulty in facing and overcoming stressful situations. These situations may not be the problem, but the problem is in the methods used to face those situations and interpret them properly. Moreover, the concepts and influences that the student holds may prevent him from reaching a suitable solution to face the stress, especially when it cannot be solved or removed [3]. It also requires finding effective ways of thinking that are compatible with the demands of the current age and that can contribute to easing the stressors and crises, get rid of them or at least minimize their effects on the individual’s mental. Social and physical health [4]. Research indicates that prolonged or excessive stress has deleterious effects on well-being and is related to a range of psychological, behavioural, and physical health difficulties [5]. For example, stress in university students is associated with increased risk of depression [6], anxiety [7]. Coping is the process of managing external and/or internal demands that tax or exceed the resources of the person. It is a complex and multidimensional process that is sensitive to both the environment and the personality of the individual. According to Lazarus & Folkman [1], coping as constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person. Several studies have specifically investigated how university students cope with the stressors. [8] Described the relationship among sources and levels of stress, coping patterns, sources and levels of social support, and psychological distress for 372 students. Students reported moderate to high levels of stress compared to the general population. Students who reported three or more stressors had higher psychological distress scores than students reporting none, one, or two stressors. Depression was the stressor associated with the highest level of psychological distress. A total of 89.3% of students reported using healthy coping styles with only 1.3% reported using unhealthy (maladaptive) coping. [9], assessed the levels of stress in the face of terrorism and the adopted coping strategies, amongst the student population of universities in Karachi. Results showed that 65.8% of the students had mild stress levels, 91.5% of university students were exposed to terrorism through television, while only 26.5% students reported personal exposure to terrorism. 67.4% students were forbidden by their parents to go out. Most of those who had self-exposure to an attack were the ones whose parents forbade them from going out. Most commonly used coping strategy was increased faith in religion. Irritability was the most common stress symptom. Thus Abu Skheila [10], aimed to recognize the psychological stress for the 200 university students, who have the destroyed houses in northern Gaza city. The study results showed that the common psychological stress were the emotional stress, the psychological stress were the emotional stress, cognitive stress and the behavioral stress. Females are suffered from psychological stress more than males. Tsai M [11], compared 49 university students (juniors) in a traditional writing class (TW) with 49 students in an online writing class (OW) at a university in Taiwan. The findings indicated the TW and OW classes significantly differed in worries of stress. The traditional writing class had higher anxiety level than the online BAOJ Psychology, an open access journal

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writing class both in overall and individual categories. The findings suggested that the computerized grading system was doing a better job than the traditional class in reducing students’ anxiety. The appraisal of an event as harmful or threatening will generate stress that may exceed the coping resources available to the person. This theory suggests that the degree to which an individual experiences stress and associated strain is determined by both the objective characteristics of the stressors in their environment, and the individual’s appraisal of these stressors, in addition to their coping strategies and coping resources [12]. This study aims were: 1) to investigate the types and severity of stressors, 2) to find the prevalence of anxiety and depression, 3) to illustrate the types of coping strategies used in stressful situations, and 4) to understand the relationship between stressful life events and mental health disorders including depression and anxiety, and other sociodemographic variables among universities students.

Method Participants Participants were 392 Palestinian university students enrolled in four universities in Gaza strip (Al-Aqsa University Al-Azhar University, Al-Quds Open University and Islamic University). Two hundred and thirty two of the participants (59.9%) were females and 157 (40.1%) were males. Measures A Predesigned Socio- Demographic Sheet This questionnaire included; gender, age, name of the university, place of residence, and family monthly income. Stress Life Events Scale The SCAS has 70 items on a 0 (never), 1 (sometimes), and 2 (always) and consists of six subscales, namely academic stress (8 items), economic stress (13 items), family stress (14 items), personal stress (11 items), social stress (8 items), emotional stress (8 items), and university environmental stress (8 items). The internal consistency of the scale was calculated using Chronbach’s alpha, and was high (α = .88). Beck Depression Inventory The long form of the BDI is composed of 21 questions or items, each with four possible responses. Each response is assigned a score ranging from zero to three (0, 1, 2, 3), indicating the severity of the symptom [13]. Individual questions of the BDI -2 assess mood, pessimism, sense of failure, self-dissatisfaction, guilt, punishment, self-dislike, self-accusation, suicidal ideas, crying, irritability, social withdrawal, body image, work difficulties, insomnia, fatigue, appetite, weight loss, bodily preoccupation, and loss of libido. Items 1 to13 assess symptoms that are psychological in nature, while items 14 to 21assess more physical symptoms. The scores of the BDI-2 were, where a score ‹ 20 = no depression, 21-31= mild depression, 32-41 = moderate depression, and 42 and above = severe depression. The Arabic version of the scale was used in the current study. We calculated the reliability of the Beck Depression Volume 1; Issue 3; 011

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Citation: Aysheha Yousef Mosallam and Abdel Aziz Thabet (2016) Coping With Stressful Life Events and Mental Health Disorders among University Students. BAOJ Psychology 1: 011.

Inventory by using Cronbach’s alpha (α = 0.77). The Taylor Manifestation Anxiety Scale (TMAS) Taylor (1953) [14] developed one of the first measures of chronic, manifest anxiety, Taylor’s Manifest Anxiety Scale (MAS). Taylor’s scale consisted of items selected from the Minnesota Multiphase Personality Inventory. We used the Arabic version with 50 items and answer is „Yes= 1“ or „No= 0. The score ranged from (0- 16 no anxiety), (17- 20 Mild anxiety), (21- 26 moderate anxiety), and (2729 severe anxiety), and (30-50 very severe anxiety). 30 In this study, the Cronbach’s alpha coefficient was high and acceptable .79. This scale was validated in Palestine culture [15,16]. In this study, the Cronbach’s alpha coefficient (α= .72). Ways of Coping Questionnaire (Folkman and Lazarus, 1988) Ways of Coping Questionnaire (Folkman and Lazarus, 1988) is a 44-item measure of three primary coping domains: emotionfocused, problem-focused and seeking social support. The measure was developed using the cognitive-transactional theory of stress developed by [1]. A 4-point (0=not at all, 1=sometimes, 2=a lot, and 3=almost all the time) Likert-type format was employed to examine frequency. This scale was used and validated in the Gaza strip on a sample of political prisoners (Qouta et al, 1997). The internal consistency of the scale was calculated using Chronbach’s alpha, was (α = .76).

Study Procedure The data were collected using randomly selected sample from four universities in Gaza Strip (Al-Aqsa University, Al-Azhar University, Al-Quds Open University and Islamic University) after getting an official approval from each university. An official approval from each university has been got in order to enter the university to implement the study, Helsinki Ethical committee (Ministry of Health) gave approval to curry out the study, informed written consents approval from each student has been got, this form included the purpose of the study, confidentiality information and some instruction, it also included statement about student right to participate or refuse. The data was collected by four assistants professionals trained for four hours in data collection of this sample and criteria for selecting students in the second semester of the academic year 2012– 2013. Each student has completed five questionnaires on 15 to 20 minutes, difficult questions if present was explained by data collectors. The data collection was done in two weeks. Statistical Analysis Statistical analyses were carried out using IBM SPSS Statistics version 20.0. Continuous variables were presented as M ± SD and categorical variables were expressed as frequencies (%). The stressor, anxiety, depression, and coping strategies of the participants were exhibited using the mean values and SD. Spearman’s correlation coefficient tested the association between stressor, anxiety, depression, and coping strategies of the participants. Prediction of coping straggles by stressor, anxiety, depression, was tested by BAOJ Psychology, an open access journal

series of stepwise multiple linear regression analyses. A two-tailed p value < .05 was considered statistically significant.

Results Socio-Demographic Results of the Study Sample The sample consisted of 392 Palestinian university student’s male and female living in Gaza strip (Al-Aqsa University, Al-Azhar University, Al-Quds Open University and Islamic University (Table 1). Two hundred and thirty two of the participants (59.9%) were females and 157 (40.1%) were males. Age ranged from 1824 years and mean age was 20.4 years (SD =1.40). According to university, 117 (29.8%) were from Al-Aqsa University, 110 of the participants were from Islamic university (33.8%), 85 from AlAzhar University were (21.7%), and 80 were from Al-Quds Open University (20.4%). Means and Standard Deviation of Stressful Life Events The results showed that mean life stressors was 63.34, academic stressors was 9.2,economic stressors was 9.44, family stressors was 9.16, personal stressors was 10.5, social stressors was 6.05, emotional stressors was 7.9, and the university environment stressors was 11.42. Stress Life According to Gender Independent t Test results in showed that male student significantly reported more economic (t = 3.15, p = 0.001), family (t = 2.51, p = 0.01), and personal stressors (t = 2.71, p = 0.001). While female student reported more emotional (t = 3.83, p = 001) and university environment stressors (t = 3.89, p = 0.001). Table 1: Socio-demographic results of the study sample (N= 392) Variable

N

%

Sex

 

 

Male

157

40.1

Female

235

59.9

Age 18-22 years , Mean 20.4 (SD =1.4)

 

 

Level at the university

 

First level

128

32.7

Second Level

110

28.1

Third Level

80

20.4

Four level

74

18.9

Type of College

 

 

Scientific colleges

155

39.5

Literary colleges

237

60.5

University

 

 

Al-Aqsa University

117

29.8

Islamic University

110

28.1

Al-Azhar University

85

21.7

Al-Quds open University

80

20.4

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Citation: Aysheha Yousef Mosallam and Abdel Aziz Thabet (2016) Coping With Stressful Life Events and Mental Health Disorders among University Students. BAOJ Psychology 1: 011. Table 2: Means and Standard deviation of stressful life events Variables

Minimum

Maximum Mean 63.34

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Table 3: Means and Standard deviation of coping strategies

SD

Minimum

Maximum

Mean

Total coping

.00

64.00

42.02

7.91

3.1

Positive reappraisal

10

36

25.96

5.07

5.66

Self-control

9

28

19.87

3.87

Wishful thinking

8

45

19.40

3.89

Planful problem solving

6

24

16.19

3.44

Accepting responsibility

6

20

14.08

3.11

Seeking social support

6

20

13.51

3.01

Escape avoidance

5

20

12.12

2.93

Total life stressors

12

119

18.85

Academic stressors

3

42

9.2

Economic stressors

0

24

9.44

Family stressors

0

26

9.16

5.63

Personal stressors

0

22

10.5

4.17

Social stressors

0

35

6.05

3.66

Emotional stressors

0

21

7.9

3.04

University environment stressors

0

18

11.42

3.75

Stress Life According to University Post hoc Scheffe analyses revealed that students from Al-Aqsa university reported more general stress (F(392/3)= 2.64, p < = 0.04), family stressor (F(392/3)= 2.89, p < = 0.03), and university environment stressors (F(392/3)= 26.76, p < = 0.001) than the other students enrolled in the other universities. Prevalence of Anxiety The study showed that 58 of university students had no anxiety (14.8%), 81 had mild anxiety (20.7%), 143 had moderate anxiety (36.4%), 43 had severe anxiety (11%) and 67 had very severe anxiety (17.1%). Anxiety According to Socio-Demographic Variables Independent t Test results in showed no significant difference in anxiety according to sex (t= -1.27, p= 0.10). Post hoc Scheffe analyses revealed significant difference in anxiety toward students enrolled in Al Azhar university than the other three universities students according to the university or college type (F (392/3)=5.09, p= 0.002). Prevalence of Depression The study showed that 227 of university students had no depression (54.3%), 124 had mild depression (31.6%), 48 had moderate depression (12.2%), and 7 (1.8%) had severe depression.

SD

coping strategies according to gender of the study sample. According to university enrollment, students from Islamic university scored significantly in self-control coping than the other three universities (F (392/3) = 3.08, p < 0.02) Correlation Coefficients between Total Stress Life Events, Mental Health Problems (Anxiety and Depression), and Coping Strategies Pearson’s correlation coefficients were computed among the subject dimensions studied variables such as stress, anxiety, and coping. The inter-correlation matrix (Table 4) shows highly significant positive correlations between the anxiety and stress scores (r(392) = 0.42, p < 0.001) and depression (r(392) = 0.49, p < 0.001). There were negative significant correlation between total stress and positive reappraisal (r (392) = -0.23, p < 0.01) and planful problem solving (r (392) = -0.20, p < 0.01), There was positive significant correlation between total anxiety and depression (r(392) = 0.42, p < 0.01), positive appraisal (r(392) = 0.17 , p < 0.001), planful problem solving (r(392) = 0.21 , p < 0.001). There were negative significant correlation between total Table 4: Correlation coefficients between stress, anxiety, depression, and coping strategies Stress

Anxiety

Depression

Depression According to Socio-Demographic Variables

Stress Life Events Scale

1.00

.42**

.49**

Independent t Test results in showed no significant difference in depression according to gender (t= -0.87, p= 0.19). Post hoc Scheffe analyses revealed that no there was no significant difference in depression according to the university.

Anxiety

.42**

1.00

.42**

Depression

.49**

42**

1.00

Coping strategies scale

-.03-

.05

-.07-

Means and Standard Deviation of Coping Strategies

Positive reappraisal

-.23-**

.17**

-.25-**

Self-control

-.12-*

.09

-.14-**

.12*

-.12-*

.05

Planful problem solving

-.20-**

.21**

-.21-**

Accepting responsibility

-.01-

-.03-

-.07-

The results showed that mean total coping was 42.02, positive reappraisal was 25.96, self-control was 19.87, wishful thinking was 19.40, planful problem solving was 16.19, accepting responsibility was 16.19, seeking social support was 14.08, and escape avoidance was 12.12.

Wishful thinking

Seeking social support

-.09-

.05

-.17-**

Coping Strategies According to Socio-Demographic Variables

Escape avoidance

.14**

-.22-**

.18**

Post hoc Scheffe analyses reveal that no significant differences in all BAOJ Psychology, an open access journal

*p< 0.05, **p< 0.01, ***p> 0.001 Volume 1; Issue 3; 011

Citation: Aysheha Yousef Mosallam and Abdel Aziz Thabet (2016) Coping With Stressful Life Events and Mental Health Disorders among University Students. BAOJ Psychology 1: 011.

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Table 5: Multiple regression for anxiety, depression and level of coping and other socioeconomic variables predicted the manifestation of stress    

Unstandardized Coefficients B

Standardized Coefficients

95.0% Confidence Interval for B t

Beta

p

Lower Bound

Upper Bound

(Constant)

63.25

16.13

3.92

0.001 31.50

95.00

Depression

.55

.11

.29

5.14

.001

.34

.76

Total anxiety

-.65

.17

-.22

-3.92

.001

-.98

-.33

Coping strategies scale

.55

.23

.22

2.34

.02

.09

1.01

Positive Reappraisal

-1.16

.34

-.31

-3.44

.001

-1.83

-.50

Self-Control

-.35

.39

-.07

-.91

.37

-1.11

.41

Wishful Thinking

.77

.31

.16

2.47

.01

.16

1.38

Planful Problem solving

-.40

.35

-.08

-1.13

.26

-1.10

.30

Accepting responsibility

.27

.44

.04

.61

.54

-.59

1.12

Seeking Social Support

.32

.42

.05

.78

.44

-.50

1.14

Escape Avoidance

-.33

.37

-.05

-.88

.38

-1.07

.41

University environment

1.17

.90

.06

1.30

.19

-.60

2.94

Gender

-2.86

1.85

-.07

-1.54

.12

-6.50

.78

Age

.14

.64

.01

.22

.82

-1.11

1.39

Student level

1.63

.81

.10

2.01

.05

.03

3.23

anxiety and wishful thinking (r (392) = -0.12, p < 0.01) and escape avoidance (r(392) = -0.22, p < 0.01). There was positive significant correlation between total depression and escape avoidance (r(392) = 0.18, p < 0.01). There was negative significant correlation between total depression and positive reappraisal (r (392) = -0.22, p