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Determinants of adolescent stress: A narrative review

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DOI: 10.4103/2395-2555.170719

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Original Article
Determinants of adolescent stress: A narrative
review
Kallol Roy, Veena Ganesh Kamath, Asha Kamath
Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India

ABSTRACT
Aim: Stress has become an inevitable part of our daily life. Adolescence can be considered one such stage in our life where
we experience various stressors. Globally, studies have reported the adolescent stress levels range from 20% to 45%. The
objective of this literature review was to identify the common determinants of stress and coping strategies among mid
aged adolescents by reviewing observational studies published between the years 2003 and 2013. Methodology: Academic
databases including PubMed, PsychInfo, EMBASE, Biomedcentral, and Science Direct were included for the search.
STROBE checklist was used to assess the quality of the studies and data extraction. Result: A total of 12 studies were
selected for the review for the study design; sample and population; settings; tools used; objectives and the results of the
study. Based on our review, it could be reported that adolescents were more concerned about the socioeconomic status of
parents, financial conditions, and academic life. The most common coping strategies used by adolescent boys are distraction
and relaxation. Contrasting these features, the girls use more avoidance coping, more willing to seek support, resolving
conflicts, and the always openly express their emotions. With comparison to boys, girls are kept under a strict supervision
and given much less freedom which makes them prone to be more stressed. Conclusion: Focus should be directed to the
mental health issues faced by adolescents. Studies addressing the prevalence of stress and interventions to counter the same
must be conducted. Both adolescent boys and girls seem to be affected by stress in some way or the other. Supportive care
from parents, teachers and health professionals is the need of the hour.

Key words: Adolescent stress, coping abilities, determinants, global, narrative review, stress

Introduction by rapid and potentially tumultuous transition,

Stress can be defined as the imprecise response of
the body to any demand for change. Stress in terms of
equilibrium can be defined as a state of equilibrium
where individuals ability to cope with stressor is
productively less as compared to the demands of the
situation.[1] Even in our life span, adolescence can
debatably be one of the stages that is most marked
Address for correspondence:
Mr. Kallol Roy, Department of Community Medicine, Kasturba
Medical College, Manipal University, Manipal ‑ 576 104, Karnataka,
India. E‑mail: kallol.karan@gmail.com
including various changes in biological, social, and
psychological aspects. Adolescents can be broadly
classified into three stages. First being the early
adolescents  (11–13  years of age), second being the
middle adolescents (14–16 years) and third being the
late adolescents (17–19 years).[2] The stress associated
with adolescent changes is termed as adolescent
stress, and factors that produce stress are termed as
“stressors.”
Globally, studies have reported the adolescent stress
levels range from 20% to 45%.[3,4] Adolescent stressors
can be broadly classified under five broad dimensions

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How to cite this article: Roy K, Kamath VG, Kamath A. Determinants

DOI: 10.4103/2395-2555.170719
of adolescent stress: A narrative review. Eur J Psychol Educ Studies
2015;2:48-56.

48 © 2015 European Journal of Psychology & Educational Studies | Published by Wolters Kluwer ‑ Medknow

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Roy, et al.: Narrative review on adolescent stress
namely stressors at school, family, peers, personal
health, and appearance.[5] Probably these stressors
could be the possible determinants of adolescent
stress, which was further substantiated by.[6] School
environment and socioeconomic status (SES) of children
determine the stress levels among adolescents. Studies
have shown that the type of schools does affect the
adolescents stress levels.[7‑9] The socioeconomic factor
which includes occupation, income, and cultural features
at home (Stephan, 1980) has been widely researched
among adolescents.
There are enormous volumes of stress related research,
but research on stress among adolescents has received
less attention than comparable research among
adults.[10] Moreover, the research done among them
have focussed more among the higher age group.[3,4,11,12]
However, studies specific to the determinants of stress
and coping strategies, among mid‑age adolescents is
largely unexplored.
Methodology
The objective of this literature review was to identify
the common determinants of stress and coping
strategies among mid‑aged adolescents by reviewing
observational studies published between the years
2003 and 2013.
Research question
What are the common determinants of stress and coping
strategies among mid‑aged adolescents?
Search strategy
Academic databases including PubMed, PsychInfo,
EMBASE, Biomedcentral and Science Direct was included
for the search. Other sources were Google Scholar
and the list of references of other research articles
and reviews. Authors of certain research articles were
contacted to provide their full papers for this review.
The last search for this review was completed on March
11, 2014, and it included the studies published between
January 2003 and March 10, 2013.
Selection criteria
Inclusion criteria
• All observational and longitudinal studies that
addressed the research question
• Studies carried out among age group 12–16 years
• Studies in English language and papers which were
retrieved for the synthesis of review.
Exclusion criteria
• Cluster randomized trials, randomized controlled
European Journal of Psychology & Educational Studies, Vol 2 / Issue 2 / Apr‑Jun‑2015
trials, quasi  –  experimental studies, qualitative
studies
• Studies with subjects suffering from any other
mental, physical illness, posttraumatic stress
disorders.
Keywords for the search strategy
Stress, adolescents, daily hassles, psychological stress,
coping, stress symptoms.
Data collection and analysis
Figure 1 displays the entire data collection.
STROBE checklist was used to assess the quality of
the studies and data extraction. The 12 studies were
reviewed for the study design; sample and population;
settings; tools used; objectives and the results of the
study. Owing to the diversity of the outcomes in the
included studies a quantitative synthesis of study
findings was not feasible. Thus, a narrative synthesis
was undertaken.
Results
A total of 12 studies were selected for the review.
The summary of the studies are displayed in Table 1.
The total sample size of the studies was 12,787. Three
studies each have been done in Asia (two in India and
one in Pakistan) and Europe  (Germany, Canada and
Sweden). Five studies were done in North America.
Only one cross‑cultural study was done which
included 20 countries. The objective of the studies
were to assess any association among social, economic,
cultural determinants of stress, and its outcomes on
adolescent health status. It was observed that higher
stress perception was more in females as compared to
males. However, the stressors were common for both.
However, the coping strategies differed. SES of parents,
financial conditions and academic life of students were
the main determinants of stress identified in this review.
Various tools were employed to assess the stress levels.
The only common study tool employed in five studies
was Perceived Stress Scale (PSS‑14).
Keywords Database search
Duplicate article headings, higher age
5660 titles
group studies were removed
113 abstracts Studies not in English, authors who did
not agree to share their full papers
12 studies
Figure 1: Methodology of selecting review articles
49
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Roy, et al.: Narrative review on adolescent stress

Table 1: 12 studies that met our inclusion criteria for the review
Author Study Place Sample size Age (SD) Objectives Tools used Results
design and
settings
Elizabeth Cross USA Mixed, 1209 15.1 (1.6) To determine the Subjective No difference in
Good man sectional Males ‑ 49.2% relationships of Social status perceived SES
et al. 2005 study; Females ‑ 50.8% race/ethnicity scale, Perceived between black and
School and socio stress scale white adolescents
economic status Perceived SES was
to adolescents’ higher among those
perceived stress who had at least one
scores in a college‑educated
socioeconomically parent
diverse, PSS scores were
non‑Hispanic higher in black
black and white compared to white
school sample teens (P=0.001) and
among those without
a college educated
parent compared to
those with at least
one college educated
parent (P=0.001)
Daniel M. Longitudinal USA Mixed, 1021 Grade Whether the Youth risk Overall prevalence
Finkelstein school‑ Males ‑ 48.4% relation between behaviour of current smoking
et al. 2006 based study Females ‑ 51.6% 7‑12 social status and survey, was 7.4%. Twice as
perceived stress subjective social many females as
could explain status scale, males were current
the association Perceived smokers (P=0.05)
between lower stress scale Whites had more than
social status a three‑fold higher rate
and increased of current smoking
risk of smoking than blacks (P=0.0001)
Smoking prevalence
did not differ by
parental education
Both perceived SES
and school SSS were
significantly associated
with smoking
Karin Schraml Cross Sweden Mixed, 304 16 (1) To survey the Karolinska Sleep 68 (45.9%) females
et al. 2011 sectional Males ‑ 52% incidence of Questionnaire, and 32 (20.5%)
study; Females ‑ 48% severe stress Shirom Melamed males ‑high degree
Schools symptoms Burnout of stress symptoms
and chronic measure, 25 participants
stress among Rosenberg self (8.2%) ‑chronically
adolescents esteem scale, stressed
To determine Performance Highly stressed
which factors based self individuals, more
may contribute esteem scale likely felt worse about
to or exacerbate themselves (self
stress symptoms esteem measure) and
in adolescents more sleep problems
Whether there as compared to
are possible non‑stressed group
gender 56% of the variation
differences in stress symptoms
was predicted by high
demands, low global
self‑esteem, sleep
disturbances, low
social support and
negligent eating habits

Contd...

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Roy, et al.: Narrative review on adolescent stress

Table 1: Contd....
Author Study Place Sample size Age (SD) Objectives Tools used Results
design and
settings
Unni K. Cross Norway Mixed, 1508 14.76 (1.46) To investigate Adolescent Girls scored significantly
Moksnes sectional Males ‑ 48.9% 14.95 (1.55) gender Stress higher on all the stress
et al. 2010 study; Females ‑ 51.1% differences on Questionnaire, domains, higher
Schools domains of Spielberger statemean scores on state
stress and on trail anxiety, depression and anxiety
state depression Rosenberg Boys scored
and anxiety, and self esteem significantly higher
self‑esteem on self‑esteem
To investigate The correlations
the association between the
between the stress domains
predictor variables and adolescents
of stress and scores on state
self‑esteem and depression, anxiety,
the outcome of and self‑esteem were
state depression moderate to strong
and anxiety All stress domains
To investigate showed significant and
the potential positive correlations
moderation effect with depression
of self‑esteem and anxiety and
and gender on significant and
the relationship negative correlations
between each with self‑esteem
of the stress Adolescents’ scores
domains and on stress, self‑esteem
the outcome of and emotional
state depression states did not differ
and anxiety remarkably with age
Adela Cross USA Mixed, 134 12.9 (0.58) To study the Perceived Stress had inverse
Yarcheski, sectional Males ‑ 47.7% relationship Stress Scale, correlation with
et al., 2011 study; Females ‑ 52.2% between perceived Hopefulness hopelessness and
Schools stress and Scale, Revised positive correlation
loneliness among UCLA, with loneliness
young adolescents, Loneliness scale The correlations were
anticipating a in the anticipated
positive relation direction and moderate
M Guszkowska Longitudinal Germany Mixed, 253 15.4 (0.17) To study the role International Adolescents
et al., 2005 school study Males ‑ 32% of physical fitness Test of Physical experiencing high
Females ‑ 67% in adolescent fitness, Profile stress (n=125,36 boys)
stress and of mood states, rated their well‑being
health status My Health less than the lower
Questionnaire stress adolescents
(n=128, 46 boys)
Boys with better
physical fitness levels
had less intensive
negative moods
However, girls with
less physical fitness
had less intensive
negative moods
Students experiencing
lower stress due to
daily hassles had
more of positive mood.
No effects of gender
and physical fitness
More negative
symptoms were
reported in adolescents
experiencing higher
stress and also in boys
as compared to girls
Contd...

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Roy, et al.: Narrative review on adolescent stress

Table 1: Contd....
Author Study Place Sample size Age (SD) Objectives Tools used Results
design and
settings
Malte Persike Cross Finland, Mixed, 4000 15.18 (1.76) To compare how Problem Neither gender nor the
et al. 2012 Cultural France, Males ‑ 50.2% adolescents from Questionnaire, region of participants
study; Germany, Females ‑ 48.2% many different Coping across exerted a significant effect
NA UK, countries situation on the overall stress level
Italy, the around the questionnaire Across all regions,
Netherlands, world perceive adolescents perceived
Spain, and minor stressors problems experienced
the USA, occurring in in the domains of
Costa Rica, the domains of parents and school to
Mexico, relationships be the most stressful
Pakistan, and school life compared to the
Peru, South How the domains of peers and
Africa, adolescents cope romantic relationships
Turkey, with these More specifically,
Croatia, stressors compared to males,
Czech females used
Republic, negotiating and seeking
Estonia, support more often
Korea, to deal with stressors
Poland and in the domains of
Russia relationships and school
Adolescents from all
cultures, despite regional
variations, exhibited
more use of emotional
outlet in conflicts with
parents than with peers
or romantic partners
Frank J. Elgar Cross Canada Mixed, 246 12.39 To explore rural/ Checklist of Among urban
et al. 2003 sectional Males ‑ 38.6% (0.32) urban differences adolescent adolescents, males
study; Females ‑ 41.06% in levels of, problems reported more conflict
Schools and relations situation, than females
between, stress, Inventory of Among rural
coping and students recent adolescents, males
behavioural life experiences, and females reported
problems in Life events similar levels of conflict
adolescents questionnaire, No differences between
Ways of coping rural and urban
scale‑revised, samples with regard
Youth Self report to stress, coping or
behavioural problems
Rural adolescents
may be more likely to
appraise interpersonal
conflict as stressful but
not urban adolescents
Dana Landis Cross USA Mixed, 796 13 (2.16) Uncontrollable Urban Uncontrollable
et al. 2007 sectional Males ‑ 44.5% stressors adolescent life stressors are
study: Females ‑ 55.5% experienced in the experience associated with
Schools context of urban scale, Children hopelessness in this
poverty would coping sample of low‑income
be associated strategies, urban adolescents
with increased Hopefulness Active, distraction, and
hopelessness scale social‑support‑seeking
Whether coping coping exacerbate the
strategies might association between
moderate or uncontrollable
mediate the stressors and
relation between hopelessness for boys
uncontrollable For males, distraction
stressors and coping is not an
hopelessness effective means for
in low‑income coping with high levels
urban youth of uncontrollable stress
Contd...

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Roy, et al.: Narrative review on adolescent stress

Table 1: Contd....
Author Study Place Sample size Age (SD) Objectives Tools used Results
design and
settings
Little Flower Cross India Mixed, 114 16.5 (0.97) To assess General Health
The students of
Augustine sectional M=NA stress appraisal Questionnaire,
both Government
et al. 2011 study; F=NA among students Perceived Stress
and Private schools
Schools and to identify questionnaire,
showed similar stress
institution‑specific stressful life
perception, though the
differences event scale former tend to have a
(Private vs. higher mean score
Government) in Students from
stress appraisal Government schools
and coping had significantly
higher scores on
avoidance coping.
Priti Arun Cross India Mixed, 2402 Grades To find out stress, General Health 45.8% of the students
et al. 2009 sectional Males ‑ 57.1% 7‑12 psychological Questionnaire, had psychological
study; Females ‑ 42.9% health, and Mooney problem problems, 50%
Schools presence of checklist, students perceived
suicidal ideas in Suicide risk problems‑role as
school students eleven‑visual students, 45%
analogue scale reported academic
Correlation decline, 8.8% students
between the reported life as burden,
above mentioned 6% reported suicidal
variables ideas and 0.39%
students reported
suicidal attempt
Significant correlation
was seen between
student’s perception
of life as a burden
and class they were
studying, mother’s
working status,
psychological
problems and
problems students
experienced in
relation to study,
peers, future planning
and with parents
Yasmin Parpio Cross Pakistan Mixed, 800 13.7 (1.3) To uncover Perceived 31% subjects reported
et al. 2012 sectional Males ‑ 40.8% the factors Stress Scale stress to financial
study; Females ‑ 59.3% associated issues, 23% reported
Schools with stress parental quarrel
among school Private school
adolescents students were at more
risk of stress
Mean estimated stress
score decreased
with increase in age
of mother and one
number increase of
room in house
Prior information about
pubertal change in
girls reduced the mean
estimated stress score.
No difference in boys
SD=Standard deviation; PSS=Perceived stress scores; SES=Socio economic status; UCLA=University of California, Los Angeles

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Roy, et al.: Narrative review on adolescent stress
Discussion
In our lifespan, stress plays a significant role during
adolescence. Researchers have concluded that
adolescence is a tumultuous phase. The pattern of
stressors during each phase of adolescence, i.e.  early,
middle and late adolescence differs. An early
adolescent  (12–14 years) may consider academic life
stressful whereas a late adolescent (17–19 years) may
be much worried about future jobs etc., The mode of
interaction of adolescents with their surroundings
and oneself predict their stress levels. Stress arises
when adolescents face new, unpredictable situations,
anticipations of something odd, and the fear of losing
something.
As a child grows up, he or she starts experiencing stress.
The places where an adolescent first gets exposed
to matters of self, social surroundings, academic
achievements, etc., is at home and then school. The
most common stressors that adolescents face are
mainly classified as daily hassles and life events.[6] Byrne
et al. prepared a questionnaire to identify adolescent
stressors. He concluded ten different domains. They
were stress at home, performance at school, school
attendance, romantic relationships, sexual attraction,
peer pressure, teacher interaction, leisure activities,
financial pressure, and emerging adult responsibility.
These domains are the ones which are mostly followed
and researched upon by researchers.
A similar study by Elgar et al.[13] reported its findings on
eight domains of daily hassles which were social isolation,
excessive demands, romantic concerns, decisions about
personal future, loneliness and unpopularity, assorted
annoyances and concerns, social mistreatment, and
academic difficulties.
Based on our review, it could be reported that adolescents
were more concerned about the SES of parents, financial
conditions and academic life. These determinants have
been discussed further.
Socioeconomic stressors
Social status is the position of an individual within the
social relationships whereas economic status refers
to the financial conditions and facilities possessed by
the parents. These parameters are widely researched
in terms of an adolescent. Urban adolescents had
lower stress as compared to rural adolescents.[13‑15]
It is evident that if family conditions are fragile then
it directly affects children. Stress symptoms were
reported just in two studies.[16,17] Most of the symptoms
go unchecked among adolescents. Thus, studies
54 European Journal of Psychology & Educational Studies, Vol 2 / Issue 2 / Apr‑Jun‑2015
which aim to evaluate the effects of social factors
such as race/ethnicity, parental SES, educational
qualification, type of household, and a number of
siblings should be carried out among adolescents.[15]
Sleep disturbances, smoking, hopelessness, and poor
self‑esteem were the physical and mental health
outcomes as a result of stress. As parental educational
level increased, it was accompanied by a decrease in
risk of smoking among adolescents.[18] The linkage of
social disadvantage and stress is a piece in the puzzle
of how social inequalities lead to an effect in health
status among adolescents.
Financial and academic stressors
In developing countries, poverty is accompanied by
a range of financial stressors such as a struggle to
make ends meet, interpersonal conflicts over money
matters, inadequate health care, ineffective schooling,
and disruptions to essential services.[19,20] In spite of
financial stressors, an emotional bondage of parents, and
children tend to counter the stress mediated effects. An
interesting hypothesis was framed that rural adolescents
are more family oriented, and thus these economic
issues directly do not leave an impact on adolescent
functioning.
Due to the current global recession, adolescents have
become concerned about their academics rank. In
addition, future unemployment has become high in
many countries.[21] Almost everywhere, adolescents
have become increasingly concerned about academic
performance which makes it the largest contributor to
academic stress determinants. The three studies in Asia
reported that adolescents considered academic life to
be more stressful as compared to other determinants.
This could highlight the fact on the need of a much better
educational system.
Peer and parental stressors
Human expectations are boundless. Research has
suggested that as an adolescent undergoes pubertal
transitions, they seem to become progressively
self‑conscious and easily get affected with the opinion
of others.[22] Distinct changes are evident in terms of
relationships with peers, family and society. Adolescents
give more importance to their independent control on
decisions, emotions and actions, and start to isolate from
parental control. Parallel to this, school context involves
a strong socialization process during which they become
more conscious about the perspectives of teachers,
friends, and other societal influences.[23] Surroundings
of adolescents mould them for future related stressor.
With respect to peer relationships, adolescents tend
to be keener to uphold their position in the peer
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Roy, et al.: Narrative review on adolescent stress
group. Further, when it comes to close friendship then
adolescents also experience stress;[24] particularly when
they begin to advance their approach toward romantic
relationships. Only one cross‑cultural study highlighted
the fact that peer and romantic relationships are major
determinants of stress among adolescents.[21]
Gender differences in stress perception
Although both boys and girls are equally prone to stress
and tend to have the same level of worry regarding
social adequacy, academics, and economics, girls are
much more prone to increased stress regarding issues
surrounding family, personal appearance, future events,
classmates, and personal health.[25] Adolescent boys
report more stressful self‑relevant events than girls.
Adolescent girls have been found to perceive negative
interpersonal events as more stressful than do boys.
An interesting explanation had been devised that
compared to boys, girls are kept under strict supervision
and given much less freedom as compared to boys.
Since it is less frequent for girls to experience that
everything is under their control, they can easily feel
more stressed.[26]
Coping
The theory of coping as suggested by Lazarus and
Folkman[27] is the active, behavioural, emotional, and
cognitive attempts made by an individual to respond to
needs imposed by certain stressors is termed as coping.
Preferences of coping styles
From all the above studies that we have reviewed, our
understanding become more evidence based that when
adolescents fail to use the appropriate coping for the
specific stressor; the health status is at risk. Studies
have shown that in different cultures adolescents coping
deficits during adolescence are the main contributing
factors for the psychopathology.
The most common coping strategies used by adolescent
boys are distraction and relaxation, also focus on more
positive aspects of the situation is adopted by them along
with an approach‑oriented coping style.[13] Denying their
emotions is one of the traits seen among adolescent
boys.
Contrasting these features, the girls use more avoidance
coping, more willing to seek support, resolving conflicts
and the always openly express their emotions. [28]
They tend to prefer those coping strategies which
will not jeopardize their relationships and uphold the
relationship.
European Journal of Psychology & Educational Studies, Vol 2 / Issue 2 / Apr‑Jun‑2015
Summary
From our review, we could summarize that a healthy
relationship at home and school was of central
importance for a proper upbringing of an adolescent.
It was seen that even the financial worries could be
buffered by strong family relations. Peer stressors and
romantic relationships were few determinants which
need further research. Adolescent stress constitutes
an issue of central importance to the understanding of
adolescent health.[10]
Adolescents preferred using involvement or avoidance
strategies most often. These strategies when used for a
much longer time, proved to be maladaptive. Given the
strong impact of maladaptive coping styles on health[29]
these issues are of interest to design effective prevention
and intervention programs across countries.
Conclusions
Our review concludes that the pattern of stressors
for mid‑adolescents revolves around interpersonal
relationships, financial conditions at home and also
personal issues regarding oneself such as doubts,
hopelessness, and anxiety. Coping strategies adopted
by adolescents were more of avoidance and distraction
coping. More research focusing on stress management
interventions is required.
Limitations
All the 12 studies included for this review were published
between 2003 and 2013. Few studies whose full papers
could not be retrieved were not included in this search.
What more we can we know?
Does the SES contribute the most to adolescent stress
levels or are there any other factors? How could the
educational background of parents affect the stress level
of adolescents? Can peer group affect the frequency
and uptake of risky behaviors? Would the promotion
of hopefulness among adolescents be a better way to
control stress? Is a peer group helpful or harmful for
adolescents to cope with stress? Do media influence
rural and urban adolescent stress? Are the stress levels
of adolescents in private school and government school
different?
Acknowledgement
The authors would like to thank all the contributors
who have read and suggested their views on the article
drafting process.
55
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Roy, et al.: Narrative review on adolescent stress
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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 Editorial

Special message of Professor Philip Zimbardo, one of the most famous

psychologists of century, former president of American Psychological
Association to Alireza Memarian, Global Representative at International
Positive Education Network(IPEN):

I wish to send my fondest greetings to all the readers of this new and exciting
European journal of Psychology (positive psychology). I hope it will become a
central marketplace for sharing research and conceptual ideas that can help
inform and inspire educators, business leaders, politicians, parents and youth
to work in harmony to transform Iranian society for the good of all people.

Among the many Iranians I met during my recent visit to academic

institutions, arts and crafts centers, holy places, ancient cities, and dinners in
private homes, I was very impressed by the editor of this new journal, Alireza
Memarian. His enthusiasm for promoting positive psychology throughout his
nation was boundless and his vision well focused. I have agreed to be an
honorary member of his board of directors in his new Iranian Positive
Psychology program (Foundation).

Professor Philip Zimbardo, Ph.D.

Stanford University, Emeritus

President & Founder, Heroic Imagination Project

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