CHAPTER TWO

LITERATURE REVIEW

 Conceptual framework
 Definition and concept of stress
 Factors contributing to stress among undergraduate students
 Impact of stress on academic achievement
 Coping mechanisms and interventions
 Theoretical Framework
 Summary of Literature Review

Conceptual Framework

Stress is defined as an individual's psychological and physiological reaction to

perceived threats, challenges, or expectations that beyond their coping mechanisms. It

includes the intricate relationship that exists between stressors in the environment and how

those stressors are perceived cognitively by an individual. Stressors can be internal (such as

self-imposed demands or fears) or external (such societal expectations, academic constraints,

or financial challenges).

The concept of stress is central to the human experience, encompassing a complex

interplay of physiological, psychological, and environmental factors. Fundamentally, stress is

the body's normal reaction to demands, pressures, or challenges—internal or external—that

upset its balance. Although stress is commonly associated with negative outcomes, it's crucial

to acknowledge that under certain circumstances, it can function as an adaptive mechanism

and a driving force. From a physiological perspective, stress sets off a series of hormonal and

neurological reactions that prime the body for action. The sympathetic nervous system

triggers the "fight-or-flight" response, which raises blood pressure, heart rate, and level of
awareness among other physiological changes. The molecular mechanisms underlying stress

responses have been clarified by recent studies, emphasizing the part played by stress

hormones like cortisol and neurotransmitters like norepinephrine in regulating physiological

processes (McEwen, 2017). Stress, a complex and multifaceted phenomenon, can be broadly

classified into two main types: acute stress and chronic stress. These two forms of stress

differ in duration, intensity, and impact on individuals' physical and mental health; acute

stress and chronic stress.

Acute stress is a short-term response to immediate stressors or challenges, and they

are frequently typified by a quick activation of the body's physiological stress response

system. This kind of stress usually lasts only a short while and is brought on by certain

occurrences or circumstances that require for quick response or adjustment. Speak in front of

an audience, be faced with an impending deadline, or sense an impending threat are a few

instances of acute stressors. Acute stress causes the body to generate stress hormones like

cortisol and adrenaline, which set off a series of physiological reactions meant to prime the

body for action. The "fight-or-flight" reaction is the result of these alterations, which also

include rising blood pressure, increased heart rate, increased muscular activity, and

heightened attention. While acute stress can be adaptive, helping individuals respond

effectively to challenging situations and perform optimally in the face of adversity, prolonged

or recurrent exposure to acute stressors can have detrimental effects on health and well-being.

Research has linked chronic activation of the body's stress response system to an increased

risk of cardiovascular disease, immune dysfunction, digestive disorders, and mental health

problems such as anxiety and depression (McEwen, 2007; Selye, 1956).

Chronic stress, unlike acute stress, chronic stress lasts for a longer amount of time

and is frequently brought on by recurring or persistent pressures that people believe are

beyond their control or capacity to handle. A persistent sense of tension, concern, and strain
that affects many aspects of life—including relationships, job, money, and health—is what

defines this kind of stress. There are many different types of chronic stresses, such as ongoing

work-related demands, money problems, caregiving obligations, and exposure to

unfavourable social or environmental circumstances. Chronic stress has a long-lasting

negative impact on the body and mind, upsetting physiological balance and compromising

general health, in contrast to acute stressors, which cause rapid physiological reactions

followed by recovery (Cohen et al., 2007; McEwen, 1998).

Factors Contributing to Stress Among Undergraduate Students

Stress is a common and alarming problem in the globe among undergraduate students.

Student stress is influenced by a variety of factors, including the adjustment to university life,

demands on their time and grades, financial limitations, social interactions, and career-related

worries. By using pertinent research papers and academic articles, this study seeks to

investigate the many aspects that lead to stress in undergraduate students.

Academic Pressure, it describes the strain, pressures, and expectations that students

experience in learning environments. It can originate from a number of people, including

friends, parents, instructors, and even self-imposed expectations. These pressures frequently

show themselves as high standards for overall accomplishment, extracurricular activity

participation, exam performance, and grades. Academic pressure may offer advantages as

well as disadvantages. Although it can inspire students to pursue greatness and reach their

objectives, if it is too intense or overpowering, it can also result in anxiety, burnout, and

mental health problems. Effectively handling academic pressure requires striking a balance

between academic aspirations and self-care and emotional health. One of the main causes of

stress for undergraduate students is academic pressure. Stress levels might rise due to the

rigors of exams, coursework, and the desire for excellent marks (Gall, 2016). According to a
2000 study by Misra and McKean, academic pressures have a major negative effect on

students' general health and psychological well-being.

Financial constraints, refers to limitations or restrictions imposed by a lack of financial

resources. It means being unable to afford certain goods, services, or opportunities due to

insufficient income or financial resources. These constraints can impact students’ academic

performance limiting their ability to meet basic academic needs and pursue educational goals

or engage in activities that require money. Undergraduate students' stress levels are

frequently made worse by financial restrictions. Growing tuition, living expenditures,

textbook costs, and other educational costs can put a strain on finances, which can cause

anxiety and concern over money management (Hunt & Eisenberg, 2010). Financial stress

appears to have a detrimental effect on students' mental health and academic performance,

according to research by Chapman et al. (2004).

Social relationships, for students, social ties may be a source of both stress and comfort.

Negative experiences like arguments, peer pressure, or feeling socially alienated can cause

stress, but pleasant encounters with friends, family, and peers can offer emotional support and

a sense of belonging. Students frequently experience pressure to blend in, uphold

connections, and handle tricky social situations, particularly in settings like schools and

universities where social contact is common. The need to manage social obligations and

academic obligations might make this pressure worse. social relationships play a crucial role

in students' lives, and both positive and negative interactions can influence their overall stress

levels and well-being. It's essential for students to cultivate healthy relationships, seek

support when needed, and develop coping strategies to manage social stressors effectively.

Although social ties are important for students' general wellbeing, they may sometimes be

stressful. Stress among undergraduate students is caused by difficulties in interpersonal

interactions, loneliness, peer pressure, and social isolation (Dyrbye et al., 2010). A 2007
study by Eisenberg et al. brought to light the connection between college students' elevated

stress levels and a lack of social support.

Career concerns, Career concerns can significantly impact students' academic performance

and lead to stress. The fear of making the wrong choice and the competitive job market can

cause anxiety and uncertainty. Students may be overwhelmed by questions about their chosen

career path, job market demand, and securing internships or job opportunities. The pressure

to excel academically can also lead to burnout and mental well-being. Furthermore, students

may feel pressured to choose occupations that align with external impressions rather than

their own inclinations due to their fear of falling short of societal or familial standards. It

takes a holistic approach that includes guidance counselling, mentorship, and exploratory

opportunities to address these career-related issues. Giving students access to tools, helping

them make decisions, and fostering an atmosphere that values personal development can all

help students feel less stressed about uncertain careers and perform better academically.

Undergraduate students' stress levels are increased by the pressure to find work after

graduation. It's common to feel excessively concerned about one's ability to meet social

expectations, compete in the job market, and advance one's career (Wong, Wong, & Scott,

2007). A study conducted in 2017 by Levecque et al. discovered a strong correlation between

stress related to one's career and mental health problems in students.

Time management, Effective time management is essential for students' academic success,

but it may also be stressful. Because of their many homework assignments, tests,

extracurricular activities, and personal responsibilities, students sometimes find it difficult to

manage their time well. Ineffective time management can cause people to procrastinate, feel

guilty, and lose focus, which can affect their academic achievement. Multitasking-related

burnout and tiredness can also have a detrimental impact on wellbeing and productivity. In an

effort to meet deadlines and manage their workload, students may forgo sleep, leisure, and
self-care, which can worsen stress levels and have a detrimental effect on academic

performance. Stress is a factor for undergraduate students who have trouble managing their

time well. According to Macan et al. (1990), juggling extracurricular activities, part-time

work, personal commitments, and academic obligations can cause overwhelm and anxiety. A

study conducted in 2015 by Beiter et al. found a significant relationship between college

students' perceived stress levels and their ability to manage their time effectively.

Stress among undergraduate students is caused by a variety of complex and linked

factors. Students' stress levels are significantly influenced by a number of factors, including

time management, career concerns, social relationships, financial constraints, and academic

pressure. Comprehending these variables is imperative in the execution of efficacious

interventions and support systems aimed at alleviating stress and advancing the welfare of

students during their academic tenure.

Impact Of Stress on Academic Achievement

Stress, defined as a physiological or psychological response to external pressures or

demands, can manifest in various forms for students, ranging from academic pressures to

personal challenges and social expectations. The effects of stress on academic performance

are multifaceted and can significantly influence students' ability to succeed in their studies.

Student stress, especially in the academic setting, has drawn a lot of attention because it may

have an effect on academic performance. Using data from recent studies, such as Al-Busaidi's

(2019) investigation on the frequency of stress among Omani medical students, this review of

the literature attempts to investigate the impact of stress on academic achievement.

Al-Busaidi's research sheds light on the extent of this phenomenon in a particular

academic cohort and offers insightful information about the prevalence of stress among

medical students. Despite the study's Oman-specific focus, its conclusions are consistent with
more general research on stress and academic performance in a variety of educational

contexts.

Numerous studies that have looked into the connection between stress and academic

performance have shown how intricately psychological, physiological, and environmental

factors interact. LeBlanc, McConnell, and Monteiro (2019) conducted a meta-analysis that

examined the determinants and consequences of stress in international medical students. The

study highlighted the adverse impacts of stress on academic performance.

There are several ways in which stress affects academic performance. First of all,

stress can negatively impact cognitive performance, making it harder to focus, recall

information, and process information (Regehr, Glancy, & Pitts, 2014). Stress mostly impacts

cognitive functioning, which is one way it affects academic achievement. Excessive stress

can hinder a person's ability to concentrate, remember things, and process information. As a

result, it can be challenging for students to concentrate on assignments, remember

knowledge, and perform well on tests. Because of this cognitive interference, students may

find it difficult to understand the content being covered in class or to give their best effort on

tests, which can result in lower academic accomplishment.

Students may perform worse academically as a result of this cognitive impairment

since it may make it more difficult for them to interact with academic tasks. The pervasive

nature of stress can also disrupt students' motivation, engagement, and self-regulatory

behaviours, all of which are critical for academic achievement (LeBlanc et al., 2019).

Furthermore, stress can worsen emotional distress, such as depression and anxiety

symptoms, which makes it harder for students to succeed academically (Al-Busaidi, 2019).

Emotional health issues such as anxiety, depression, or burnout can also be brought on by

stress in students. As a result of decreased motivation, engagement, and general learning

satisfaction, these emotional disorders may also impair academic achievement. Stressed-out

students may avoid difficult assignments, become disengaged from academic life, or put off

crucial tasks until later, all of which can harm their academic performance and marks.

Prolonged stress has been connected to physical health issues like weariness, immune

system deterioration, and sleeplessness. These health problems may make it more difficult for

students to attend class, engage in extracurricular activities, or stick to a regular study

schedule, which can worsen the detrimental effects of stress on academic performance.

Severe chronic stress can cause students to feel overwhelmed or incapable of meeting the

demands of their coursework, which can result in academic disengagement or dropout.

Stress can have a substantial impact on students' academic performance indirectly by altering

their coping strategies and health behaviours in addition to its direct effects. For instance,

people who are experiencing high levels of stress may turn to unhealthy coping mechanisms

like substance abuse, avoidance, or procrastination, all of which have a negative effect on

their capacity to perform well academically (Regehr et al., 2014).

Even though stress poses enormous challenges, strategies to lessen its impact and

promote wellbeing have shown to be highly effective in enhancing academic performance.

Students now have the resilience and coping skills necessary to handle the demands of

academic stress thanks to initiatives like stress management workshops, mindfulness training,

and specialized academic support programs (Regehr et al., 2014).

In summary, stress can have a profound impact on academic performance, affecting

cognitive functioning, emotional well-being, physical health, and overall student success.

Recognizing the importance of addressing stress in educational settings is essential for

promoting positive learning experiences and facilitating academic achievement. By

implementing strategies to support student well-being, foster resilience, and reduce stressors,
educators and institutions can help mitigate the negative effects of stress on academic

performance and promote a culture of learning that prioritizes student success and holistic

development. The impact of stress on academic performance is a complex phenomenon that

needs to be studied more thoroughly by academics, teachers, and policymakers. Stakeholders

can prioritize students' well-being while supporting academic goals by recognizing the ways

in which stress affects academic performance and putting targeted interventions in place.

Coping Mechanisms and Interventions

Stress and how it affects academic performance; stress results from a perceived

disparity between what is expected of people and how well they believe they can handle

those expectations. Stress in the academic setting can take the form of exam anxiety, failure-

related fear, time constraints, or an excessive workload. It can stem from various sources,

including high academic expectations, social pressures, financial constraints, and personal

issues. This stress can manifest in physical symptoms such as fatigue, headaches, and

difficulty concentrating, ultimately hindering students' academic performance. Despite the

challenges posed by stress, interventions aimed at reducing stress and promoting well-being

have shown promise in enhancing academic achievement. Strategies such as stress

management workshops, mindfulness training, and academic support programs have been

effective in equipping students with coping skills and resilience to navigate academic

stressors (Regehr et al., 2014).

Undergraduate experiences will inevitably involve stress, but how students handle

stress has a big impact on both their general well-being and academic performance. The

mental and behavioural techniques people use to deal with the pressures of stressful situations

are known as coping strategies.

Problem-focused coping techniques involve taking immediate action to address the stressor

in question by making changes to the situation or lessening its effects. Common problem-
focused coping strategies used by undergraduate students include breaking down tasks into

smaller, more manageable components, actively seeking academic assistance, and using

effective time management techniques (Folkman & Lazarus, 1980). Research suggests that

students who use problem-focused coping strategies do better academically and experience

less psychological distress (Seiffge-Krenke & Klessinger, 2000).

Emotion-Focused Coping involves managing emotional responses to stressors rather than

addressing the stressor itself. To avoid stress, undergraduate students may use emotion-

focused coping strategies such as seeking social support, practicing relaxation techniques, or

participating in leisure activities (Lazarus & Folkman, 1984). While emotion-focused coping

does not always eliminate the underlying stressor, it can help students relieve emotional

distress and regain a sense of well-being (Compas et al., 2001).

Adaptive coping strategies are crucial for students to manage stress, setbacks, and

uncertainties during their academic journey. These strategies, based on psychological theories

and empirical research, help students overcome difficulties and thrive in their educational

pursuits. Problem-solving is a fundamental coping strategy, involving identifying and

developing practical solutions to address challenges.

Adaptive coping strategies support positive adjustment and psychological well-being

in response to stressors. These strategies include maintaining control, resilience, and

flexibility in the face of adversity. Seeking professional counselling, practicing mindfulness

and self-care, and developing a supportive social network are all examples of adaptive coping

strategies (Skinner et al., 2003). According to research, adaptive coping is associated with

improved psychological outcomes and overall academic success among undergraduate

students (Carver et al., 1989).

Maladaptive coping strategies, such as avoidance, substance abuse, rumination, and self-

destructive behaviours, provide temporary relief from stress but can lead to long-term harm.
These behaviours can exacerbate mental and physical health issues, such as depression and

anxiety, and can impede academic performance and personal development. research

underscores the detrimental effects of maladaptive coping on mental and physical health. A

study by Aldao, Nolen-Hoeksema, and Schweizer (2010) found that rumination—a common

maladaptive coping strategy—was associated with increased symptoms of depression and

anxiety. Similarly, substance abuse as a coping mechanism has been linked to addiction,

impaired cognitive function, and heightened risk of mental health disorders (Brady & Sinha,

2005).

Recognizing and addressing these coping behaviours is crucial for promoting

healthier alternatives. Cognitive-behavioural therapy and mindfulness-based interventions

can help individuals replace maladaptive coping strategies with adaptive ones, enhancing

academic success and overall well-being.

Social support coping; includes emotional, instrumental, and informational assistance from

peers, family, teachers, and other important members of one's social network. Research

consistently shows that social support has a positive impact on mental health and well-being,

especially during stressful times (Thoits, 2011). For students, the availability of social

support can reduce the negative impact of academic stressors while also fostering a sense of

belonging and connection to the academic community.

One important aspect of social support coping strategies is to seek emotional support

from trusted people who provide empathy, validation, and encouragement. Friends, family

members, and mentors can lend a listening ear, offer perspectives on challenges, and validate

students' experiences, reducing feelings of isolation and distress (Rees et al., 2020). Also,

participating in peer support groups or student organizations. Informational support provides

guidance and access to resources for students to make informed decisions and navigate

academic challenges. Social support coping strategies are crucial for students' well-being and
academic success. Institutions can implement peer mentoring programs, counselling services,

and student support networks to foster a supportive environment. Raising awareness about

social support encourages students to use resources and build resilience.

Theoretical Framework

The Transactional Models of Stress and Coping

Stress, a common experience in human life, can take many forms, influencing our

thoughts, emotions, and behaviours. Richard Lazarus and Susan Folkman developed the

Transactional Model of Stress and Coping (TMSC) in 1984, and it provides a comprehensive

framework for understanding how people perceive and manage stressful situations. This

model emphasizes the dynamic interaction between the individual and their environment,

emphasizing the importance of cognitive appraisal in mediating the stress response.

Core concepts of the transactional models of stress and coping.

Core Concepts of TMSC

a. Stress as a Transaction: The TMSC differs from traditional models that see stress as

a simple stimulus-response phenomenon. Instead, it views stress as the result of a

dynamic interaction between the individual (their characteristics, beliefs, and

resources) and the environment (demands, constraints, and opportunities) (Lazarus &

Folkman, 1984).

b. Cognitive Appraisal: The concept of cognitive appraisal, or evaluating the

significance of an event or situation, is central to the TMSC. This appraisal takes

place on two levels:

- Primary appraisal: This initial assessment considers whether the situation is

perceived as a threat, harm, challenge, or benefit (Lazarus, 1993). A situation that

is deemed threatening or harmful is likely to be classified as stressful.

 - Secondary Appraisal: Following the initial evaluation, individuals evaluate their

coping resources and ability to effectively manage the situation (Lazarus, 1993).

A perceived lack of resources can amplify the stress response.

c. Coping Processes: Coping refers to the cognitive and behavioural attempts that

people make to moderate their stress reaction and accompanying emotions. The

TMSC recognizes two major categories of coping strategies:

- Emotion-focused coping: Strategies to manage or regulate emotional distress

associated with the stressor, such as seeking social support, relaxation techniques,

or positive reframing.

- Problem-focused coping: Strategies to directly address the problem causing the

stress, such as problem-solving, negotiation, or information seeking (Lazarus &

Folkman, 1984).

Strengths of TMSC

Dynamic and contextual: The Transactional Model of Stress and Coping (TMSC) highlights

the dynamic and context-dependent character of stress. Unlike prior linear models that saw

stress as a simple stimulus-response process, the TMSC recognizes that stress is impacted not

just by external events but also by people' subjective perceptions and assessments. This

awareness emphasizes the complexities of stress experiences, since the same circumstance

can be interpreted differently by various people depending on their unique environment, prior

experiences, cultural background, and personal traits. For example, what one person sees as a

difficult opportunity may be perceived as a threat by another, resulting in different stress

levels. By emphasizing the dynamic nature of stress assessment and response, the TMSC

provides a more thorough framework for understanding how individuals navigate and adapt

to stress in diverse contexts.

Focus on Cognitive Appraisal: The TMSC places a strong focus on cognitive evaluation,

which is the process by which people assess the relevance of a stressor and their ability to

cope with it. Unlike previous models, which focused mostly on external stressors, the TMSC

emphasizes that the impact of a situation is determined by individuals' subjective perceptions

and judgments of those circumstances, rather than its actual qualities. This finding

emphasizes the significance of knowing individual thought patterns, beliefs, and cognitive

biases in creating the stress response. Individuals use cognitive appraisal to assess whether a

stressor is seen as dangerous, hurtful, or demanding, as well as their perceived resources and

coping methods for managing the stressor. The TMSC offers a more sophisticated view by

taking into account various cognitive processes of how individuals experience and respond to

stress, highlighting the role of perception and interpretation in shaping stress outcomes.

Coping as a Process: In addition to highlighting the dynamic nature of stress assessment, the

TMSC views coping as a continuous process rather than a single event or response. Coping

methods are defined as adaptive efforts to manage the demands of a stressor while restoring

psychological balance. Importantly, coping techniques do not remain set but can vary over

time as people review the stressor and their coping resources. Individuals may use a variety

of coping strategies, including problem-focused coping (directly addressing the stressor),

emotion-focused coping (regulating emotional responses to the stressor), and meaning-

focused coping (finding purpose or growth in adversity), depending on the specific demands

of the situation and their evolving appraisal of the stressor. Recognizing coping as a dynamic

and multidimensional process, the TMSC provides a more complete framework for

understanding how people adjust to stresses and regulate their psychological well-being

throughout time.
Criticism of the Transactional Model

Focus on the Individual: Some believe that the TMSC overemphasizes the individual's

cognitive processes and coping tactics, leaving out the possible effect of social and cultural

elements on stress experience and coping practices.

- Limited Scope of Emotions: The model focuses largely on negative emotions

linked with stress, ignoring the possible significance of pleasant emotions in the

stress and coping process (Aldao et al., 2010).

- Challenges in Measuring Appraisal: Measuring cognitive appraisal accurately may

be difficult, and self-report approaches may be biased.

Applications of The Transactional Model Applications

Understanding an individual's cognitive evaluation and coping methods can help to

build individualized stress management programs and cure stress-related ailments.

Health Psychology: The model may be used to explore the relationship between stress,

coping practices, and health outcomes, therefore influencing treatments to improve healthy

coping strategies for stress reduction.

Organizational Psychology: Understanding how workers perceive work-related stresses and

their preferred coping methods can help shape workplace interventions to increase employee

well-being and minimize workplace stress.

In summary, the Transactional Model of Stress and Coping (TMSC) has various

advantages that help to provide a more nuanced and complete understanding of stress and

coping processes. Its acknowledgment of the dynamic and contextual character of stress,

emphasis on cognitive assessment, and conception of coping as a process highlight the

complexities of people' stress experiences and give useful insights for building resilience and

well-being in a variety of settings.

Summary Of Literature Review

The literature review investigates the diverse phenomena of stress among undergraduate

students, including its conceptual framework, contributory variables, influence on academic

success, coping strategies, and solutions.

The conceptual framework describes stress as an individual's reaction to perceived risks or

difficulties, emphasizing its physiological and psychological components. Stress is classified

as acute or chronic, with varying durations and consequences on health. Academic pressure,

financial limits, social interactions, job worries, and time management challenges are all

sources of stress for undergraduates. These pressures can harm students' emotional and

physical health, as well as their academic performance. The paper goes on to explain how

stress affects academic success, including studies that relate stress to cognitive impairment,

emotional anguish, physical health problems, and disengagement from academic endeavours.

It highlights the necessity of managing stress in educational environments in order to promote

pleasant learning experiences and student performance.

Coping mechanisms and treatments are presented as critical ways for reducing the

impact of stress on pupils. Problem-focused coping entails actively addressing stresses,

whereas emotion-focused coping focuses on controlling emotional reactions. Adaptive coping

methods, such as seeking social support and practicing mindfulness, have been identified as

helpful approaches to enhancing well-being and academic performance. Furthermore, the

review underlines the importance of social support in mitigating the detrimental effects of

stress on pupils.

Theoretical frameworks, notably the Transactional Model of Stress and Coping

(TMSC), are investigated to provide a thorough knowledge of stress and coping mechanisms.

The TMSC stresses the dynamic interplay between people and their surroundings, the
cognitive assessment of stressors, and the ongoing aspect of coping. It provides insights into

tailored stress management strategies and therapies from a variety of disciplines, including

health psychology and organizational psychology.

In conclusion, the literature review emphasizes the complexities of stress among

undergraduate students and the significance of addressing it through comprehensive

approaches that include both individual coping mechanisms and environmental support

systems.
REFERENCES
Al-Busaidi, Z. Q. (2019). Prevalence of stress among medical students in Oman. Sultan
Qaboos University Medical Journal, 19(4), e308-e314.
Aldao, A., Nolen-Hoeksema, S., & Alloy, L. B. (2010). Chapter 17: Stress and the emotional
brain. In S. Nolen-Hoeksema, A. Aldao, & L. B. Alloy (Eds.), Handbook of Emotion
Regulation (pp. xxx-xxx). Guilford Press.
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies
across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217-
237.
Brady, K. T., & Sinha, R. (2005). Co-occurring mental and substance use disorders: The
neurobiological effects of chronic stress. The American Journal of Psychiatry, 162(8), 1483-
1493.
Chapman, K., Maben, D., & Thompson, A. (2004). Stress in college students: A study of
students in a British university. College Student Journal, 38(2), 151–160.
Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression,
anxiety, and other indicators of psychological distress among U.S. and Canadian medical
students. Academic Medicine, 81(4), 354–373.
Eisenberg, D., Golberstein, E., & Hunt, J. (2009). Mental health and academic success in
college. The BE Journal of Economic Analysis & Policy, 9(1), 1–37.
Gall, T. L. (2016). The effects of non-traditional college student status on stress, coping, and
academic performance. Journal of Adult and Development, 23(3), 127–137.
LeBlanc, V. R., McConnell, M. M., & Monteiro, S. D. (2019). Predictors and outcomes of
stress among international medical students: A multicenter study. Medical Education, 53(1),
29-39.
Levecque, K., Anseel, F., De Beuckelaer, A., Van der Heyden, J., & Gisle, L. (2017). Work
organization and mental health problems in PhD students. Research Policy, 46(4), 868–879.
Macan, T. H., Shahani, C., Dipboye, R. L., & Phillips, A. P. (1990). College students' time
management: Correlations with academic performance and stress. Journal of Educational
Psychology, 82(4), 760–768.
McEwen, B. S. (2007). Physiology and neurobiology of stress and adaptation: Central role of
the brain. Physiological Reviews, 87(3), 873-904.
Misra, R., & McKean, M. (2000). College students' academic stress and its relation to their
anxiety, time management, and leisure satisfaction. American Journal of Health Studies,
16(1), 41–51.
Regehr, C., Glancy, D., & Pitts, A. (2014). Interventions to reduce stress in university
students: A review and meta-analysis. Journal of Affective Disorders, 148(1), 1-11.
Selye, H. (1956). The stress of life. New York, NY: McGraw-Hill.
Thoits, P. A. (2011). Mechanisms linking social ties and support to physical and mental
health. Journal of Health and Social Behavior, 52(2), 145–161.
Wong, J. G., Wong, S. Y., & Scott, S. (2007). College students' stress and health: An
examination of coping strategies. Journal of College Student Development, 48(6), 219–237.