Stress Factors, Stress Levels, and Coping Mechanisms among University Students

Aims To explore university students' levels of stress, stressors, and their coping style. Methods A cross-sectional correlational design with a convenience sample (n = 676) of university students who completed the Student-Life Stress Inventory (SSI) and Coping Strategies Indicator (CSI) was used. Findings. Overall, two-thirds of the participant reported moderate levels of stress. Students with chronic illness, living alone, low CGPA, and having exams today experienced a statistically higher mean level of stress. Students who are living alone used the “avoidance” method more significantly and the “social support” method significantly less compared with students who are living with their families and friends. Conclusion This study concurs with others that university students are prone to distress. To our knowledge, this is the first study in the region to explore the students' coping skills. Some of the employed coping and associated factors could be used to lay the groundwork for evidence-based prevention and mitigation.


Introduction
Mounting evidence supports the belief that university students experience moderate to high levels of stress [1][2][3][4][5]. Te interplay between biology and the environment renders vulnerable adolescents and young adults to experience stress and distress. Researchers have identifed various predictors of stress among university students, including individual, environmental, and coping factors. Personality traits are an example of individual factors. A study by Rettew et al. [6] found that students with high levels of neuroticism, a personality trait characterized by anxiety and negative thinking, reported higher levels of stress. In addition, students who are introverted and have a tendency to withdraw from social situations may be more susceptible to stress than those who are extroverted and enjoy social interaction [7]. Tere is evidence to suggest that other personality traits, such as conscientiousness and agreeableness, may also be positively associated with stress levels among university students [6].
Environmental factors such as specialisation, living situation, social support, and campus resources are also important explanatory variables of stress among university students. For example, a study by McLean et al. [8] found that students who reported lower levels of social support had higher levels of stress. In addition, students who have supportive peers and family members are more likely to have positive attitudes toward university and lower levels of stress [9]. Similarly, a meta-analysis found that students who had access to mental health services and other campus resources reported lower levels of stress than those who lacked such support [10]. Additionally, students who have access to other campus resources, such as academic support services, may be better equipped to manage stress and succeed academically [10]. Other factors which were signifcantly associated with a higher level of stress were smart phone use and sleeping hours [11].
Coping styles are another important predictor of stress among university students. Coping styles refer to the strategies that individuals use to manage stress and negative emotions [12,13]. Research has shown that students who use avoidance coping strategies, such as substance abuse or denial, are more likely to experience stress than those who use positive coping strategies, such as seeking social support or engaging in physical activity [14][15][16]. Tis suggests that the way students cope with stress can have a signifcant impact on their stress levels and overall well-being. Amirkhan [17] conducted a factor analysis of the strategies people employ during stress and identifed three strategies, known as Amirkhan's tripartite model of coping strategies [18]. Te frst is to seek support, the second is to try to solve the problem, and the third is to try to avoid facing the problem. Studies have been undertaken to examine the heuristic value of these coping strategies in diferent populations of students around the world [19,20]. While stress has been widely documented, there is a dearth of studies on the tripartite model among students in tertiary education. Te presence of stress and distress can afect the lives of students extensively if not carefully managed, as it can lead to poorer quality of life and overall life dissatisfaction [21]. It also leads to mental health problems, such as sleep disturbances [22], headaches [23], and depression [11]. A systematic review found that students who reported higher levels of stress had lower grades and were more likely to miss classes [24].
While studies examining this topic are abundant across the globe, the inconsistent fndings warrant the need for further investigation, particularly since there were very few studies on this topic in the Arabian Gulf region. Te 54 million-strong native population of the Arabian Gulf countries is passing through a second stage of "demographic transition" characterized by a preponderance of youth in the population [25], and the region has been labelled as "home to one of the youngest populations in the world" [26], with the majority below 25 years of age [27]. Furthermore, it is not clear how emerging changes to the academic platform, brought about by the recent pandemic, recession, and economic challenges experienced worldwide, have afected the well-being of students in tertiary education.
1.1. Purpose. Te study explores university students' stress, stressors, and coping styles, with the aim of resolving the following: (i) level of stress among university students, (ii) types of stressors they face, (iii) their coping mechanisms, and (iv) the relationships between the level of stress and some academic, health-related, and sociodemographic variables.

Methods
A descriptive cross-sectional design was used to gather the data from students at the only national university in Oman, Sultan Qaboos University (SQU). SQU has a student intake from all parts and strata of society, with nine colleges: Agricultural and Marine Sciences, Art and Social Sciences, Economics and Political Science, Education, Engineering, Law, Nursing, Medicine and Health Science, and Science. A random sampling technique was used. Data were gathered using an online questionnaire. Eligible participants were students who met the following inclusion criteria: (a) registered in the university and (b) can read and understand English. Failure to respond to more than 20% of the items was one of the exclusion criteria. Te sample size was calculated using Slovin's formula (n � N/(1 + N e2), where n � number of participants, N � total population, and e � margin of error (0.05). Te university has 16,000 students; hence, the sample size will be 400 participants.

Data Collection.
Researchers contacted the Public Relations Department in order to send random e-mails to potential participants who met the inclusion criteria. Public Relations Department has access to all students' e-mail addresses and the required information. Te e-mail contained information about the study's objectives and the researchers' contact information to inform them about their willingness to take part in the study. Ten, the researchers sent an e-mail including a link to the consent form and selfreported questionnaires to complete. Te survey was open between December 10 and 20, 2021.

Outcome Measures.
Te outcome measures consisted of structured questionnaires, the Student-Life Stress Inventory (SSI) and Coping Strategies Indicator (CSI), together with the participants' sociodemographic details as well as college factors. Tese three aspects of the study survey are detailed as follows.

Participants' Sociodemographics.
Sociodemographic data included age, gender, current marital status, place of living, academic year, cumulative grade point average (CGPA) (to evaluate students' academic performance, students are assigned grades based on their achievement in each subject. Tey are graded with letters A, B, C, D, E, or F. Te CGPA is derived by taking the average of all subject grade points [28]), cumulative hours (credit hours completed), work status, father's educational level, mother's educational level, monthly family income, the number of family members, the presence of chronic illness, and daily hours of sleep.

Student-Life Stress Inventory (SSI).
Te SSI is a 40-item self-reported survey that assesses student stress. Te scale is composed of four subscales: physical (e.g., headaches), interpersonal relationships (e.g., "My friends did not care about me"), academic (e.g., "I lost interest in courses"), and environmental (e.g. "Messy living conditions distracted me"). Each subscale consisted of 10 items and responses ranging from 1 to 4 (1 � never, 2 � somewhat frequent, 3 � frequent, and 4 � always) [29]. By summing the responses for the respective items, scores were calculated for the entire instrument, each part (stressors and reactions to stressors), and each category. Te response scores ranged from 40 to 160, with higher scores indicating more stress. Te original SSI had a strong internal consistency with Cronbach's α � 85.0 and an acceptable concurrent validity [30]; in the current study, Cronbach's α � 89.0.

Coping Strategies Indicator (CSI). Te Coping Strategies
Indicator is a 33-item scale developed by Amirkhan [17] to assess the coping strategies that persons use to overcome their difculties. It consists of three subscales, each consisting of 11 items: problem-solving (11 items), seeking social support (11 items), and avoidance (11 items). Te responses ranged from 1 to 3 (1 � a lot, 2 � a little, and 3 � not at all). Te CSI had a strong internal consistency with Cronbach's α � 0.84.

Data Analysis Plan.
Data were exported to SPSS version 23 after being transformed from Google Forms to an Excel sheet. Tere were no missing data to treat. Descriptive statistics were used to establish the frequency, mean, and standard deviation, as well as to describe sample demographics. Independent sample t-tests were used to test the diferences in the mean between the dependent continuous variables SSI and CSI and the independent variables which consisted of two levels such as gender, place of living, and having a chronic illness. Te one-way analyses of variance (ANOVA) were used to test the diferences in mean between the dependent continuous variables SSI and CSI and the independent variables which consisted of three levels including family income, CGPA, and with whom you are living. Multiple linear regression was also run to test the association between stress and the rest of the variables. An alpha level of p < 0.05 was set for signifcance in all analyses.

Ethical Considerations.
Ethical approval was obtained from the Research and Ethics Committee of the university before the data collection began (CON/DF/2021/1). Te Helsinki Declaration [31] guided our methods during the research study. Participants were informed that participation was voluntary and that they could withdraw at any time or refuse to answer any questions. Participants' confdentiality was maintained because no personal information was collected.

Prevalence of Stress and Coping Methods Used by University Students.
Tere were four diferent sources of stress: physical, academic, environmental, and interpersonal relationships. Just over half of the students experienced moderate levels of physical (n � 367; 54.3%) and environmental (n � 353; 52.2%) stressors. Over two-ffths experienced severe forms of academic (n � 302, 44.7%) stressors, and over two-thirds experienced severe forms of environmental (n � 249; 36.8%) stressors. As a response to these stressors, almost two-thirds of the participants (n � 509; 75.3%) used problem-solving methods, more than half (n � 417; 61.7%) used social support methods, and just over a third used (n � 256; 37.9) avoidance coping methods ( Table 2).

Bivariate Analysis of SSI.
A comparison between the total means of diferent SSI items and student characteristics was conducted to investigate whether there were any factors associated with SSI. Te results of the t-test and one-way ANOVA showed that students with chronic illness experienced a statistically higher mean level of stress than their counterparts who do not have a chronic illness (t (674) � 3.173; p � 0.003). Students who are living alone (F (2, 673) � 5.643; p � 0.004) and having exams today (t (674) � 2.464; p � 0.014) have a higher mean level of stress. One-way ANOVA showed a signifcant diference in the mean distribution of the SSI between participants who adopted social support as a coping method (F (3, 672) � 13.76; p < 0.01).
Post hoc tests showed that the mean stress level among students who used social support at a "very low" level was signifcantly higher than that among the rest of the groups (p < 0.05). Te distribution of the mean scores of SSI among students who used "very low" and "low" problem-solving skills was signifcantly higher than that of "average" and "high" users (F (3, 672) � 10.01; p < 0.01). Te average SSI was signifcantly higher among those who were "high" users of avoidance (F (3, 670) � 27.7; p < 0.01). Overall, there was a signifcant positive association between the number of siblings (r (674) � 0.106; p � 0.006) and the number of hours using the smartphone (r (674) � 0.135; p < 0.01) from one side and SSI from another side (Table 3).

Bivariate Analysis of Coping Methods.
A comparison between the total mean of diferent coping methods' scores and student characteristics was conducted to investigate whether there were any factors associated with students' diferent coping methods. Te results of the t-test and oneway ANOVA showed no signifcant diference in the scores for diferent coping methods between gender, marital status, place of living, CGPA, the number of credit hours completed, and income. However, students who are living alone Te Scientifc World Journal used the "avoidance" strategy more signifcantly (F (2, 671) � 5.794; p � 0.003) and the "social support" method signifcantly less (F (2, 673) � 4.89; p � 0.008) compared with students who are living with their families and friends. Interestingly, students with chronic illness were signifcantly less likely to use the "social support" method (t (674) � 2.16, p � 0.031) compared with their healthy counterparts, and students with low income used the "avoidance" strategy signifcantly less than those with high income (F (3, 672) � 4.712; p � 0.003). Interestingly, there was a signifcant mean diference among students in diferent colleges regarding problem-solving (F (8, 625) � 3.09; p � 0.002) and social support (F (8, 625) � 2.33; p � 0.018) coping methods. Post hoc tests showed that students at the Colleges of Medicine, Science, and Economics used problem-solving methods signifcantly more than those at the rest of the colleges. Students at the College of Nursing used social support as a coping method more than their counterparts in the other colleges (Table 4).
Multiple linear regression was used to test the association between the outcome variable stress and rest of the explanatory variables. Dummy variables were created for categorical variables with more than two levels. Te fnal model was signifcant compared with the constant (F (12,

Discussion
Te current study explored university students' levels of stress, stressors, and their coping styles. Te results revealed that the majority of students have a moderate level of stress (75.1%), followed by those with a severe level of stress (13.5%) and a mild level of stress (11.4%  [32], Al-Alawi et al. [33], Al-Dabal et al. [34], Al-Khani et al. [35], Al Rasheed et al. [36], and Mahfouz et al. [37] have reported the rate of stress and distress as ranging from 7.4% to 96.3%. In Bahrain, Al Ubaidi et al. [38] and Sanad [39] found 47% and 92% to be subject to stress and distress, respectively; in Qatar, Fadhel and Adawi [40] reported 89.2% stress and distress. In Kuwait, the prevalence of 43% and 43.8% was reported by Ahmed et al. [41] and Badr et al. [42], respectively. Te rate in the present study appears to tend towards a higher fgure, even though such comparison may not be valid because of the use of diferent assessment measures and catchment areas. Te diferent stressors among study participants were also assessed, and the largest groups were found to have a severe level of environmental (36.8%) and academic (44.7%) sources of stress. Most of the undergraduates come from primarily rural areas in Oman, where they have studied for fve to six years. Tus, they fnd themselves in an unfamiliar environment, with stressors that are common in a capital city such as trafc, construction work, and loud noises. Also, students moving to a new environment need to  adjust to cultural disparities among their classmates, differences in socioeconomic status, and physical appearance, which all count as stressors. Furthermore, the majority of the participants reported that they had an exam on the data collection day or the day after, which might explain the high prevalence of severe academic sources of stress among the study groups. Tis fnding is consistent with that reported in other studies, demonstrating that stress from academic work and its related responsibilities were the leading types among university students [43,44]. In comparison, a recent study conducted among medical undergraduate students in Malaysia found that worries about the future and fnancial difculties were the common stressors [45]. However, among our cohort of students, tuition fees and some living expenses are covered for all Omani citizens studying at SQU, which might explain why fnancial difculties were not reported among the top stressors. Nevertheless, this fnding suggests that adequate support services should be provided for university students. Interestingly, students in the Colleges of Medicine, Science, and Economics used problem-solving methods signifcantly more than those at other colleges. Students at the College of Nursing used social support as a coping method more than their counterparts in the other colleges. Students' preferences concerning the methods for managing stress vary according to their feld of study [46]. According to WHO/EHA policy, coping methods have no set criteria; rather, they vary based on sociocultural factors such as geography, social groups, gender, age, and historical period and are heavily infuenced by a person's prior experience [47]. In the current study, we found that the most widely employed coping mechanisms were problem-solving and social support. Tese fndings were consistent with a past experimental study that indicated that it is strongly advised to encourage the students' use of social support as coping mechanisms [48]. Among the Ghanaian and Malaysian university students, active coping, restrain coping, religious coping reframing, and planning were the most frequently reported strategies [45,49]. Te majority of the students in previous studies were found to use social support and problem-solving as coping strategies more than other strategies [44,50]. Tese results point to the necessity for stress-management training programs or workshops tailored to university students' needs, cultures, and religions. Given the negative consequences of stress on an individual's health and academic performance, policymakers in higher education should consider including such training programmes for incoming students.

Strength and Limitations
Te major strength of the current study was its sample size and sampling technique, which strengthened the statistical power and decreased the possibility of type 2 error. For more accurate results that are more representative of the population, we used a sample that was larger than the one that was estimated. Te use of sample size calculations has a direct impact on research outcomes. Small sample sizes jeopardize a study's internal and external validity. Small diferences in very large samples tend to be transformed into statistically signifcant diferences, even when they are clinically unimportant [51]. However, this study has various faws that should be addressed in future research. One of these is the sample composition, which varied in terms of gender representation and degree type. Terefore, the study fndings should be generalized with caution. Also, future studies should employ more extensive recruitment processes to ensure more gender-and degree type-balanced populations [52]. Replicating this study with a larger, diverse, and randomized sample might broaden the body of knowledge of stress among university students.
Based on our fndings, we agree with the results of previous studies highlighting the importance of stress prevention by increasing the student's awareness of efective coping strategies. Te College of Nursing can play a role through starting campaigns to teach students efective coping strategies and life skills. Tey need also to amalgamate topics related to stress and coping in elective courses which discuss health issues.
In conclusion, while this is not the frst study to report stress and distress among students in tertiary education, to date, it is the frst to employ the Student-Life Stress Inventory in Oman. Te most original part of this study is that it reveals the coping strategies of the students. Deciphering whether they employ adaptive or maladaptive coping will make it possible to consider corrective measures. Similarly, the associated factors identifed could also contribute to the prevention and mitigation of stress and distress among students in tertiary education. Te Scientifc World Journal 7

Data Availability
Te data used to support the fndings of this study are available from the corresponding author upon request.

Conflicts of Interest
Te authors declare no conficts of interest for this article.