Document Type : Original Article


1 Department of Health Information Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Health Information Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran, National Agency for Strategic Research in Medical Education, Tehran, Iran

3 Health Human Resources Research Center, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran

4 Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran, Neuroscience Center, Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), City of Knowledge 084301103, Panama, Visiting Scientist, Society for Brain Mapping and Therapeutics, Brain Mapping Foundation, Los Angeles, CA, USA

5 Department of Medical Physics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran


BACKGROUND: Although a certain amount of stress is essential, excessive stress can adversely
influence the physiological and mental health. Hence, this study aims to assess common stressors
and coping strategies among university students.
MATERIALS AND METHODS: This qualitative study was conducted from October to November
2019 in Iran. Twelve students were recruited based on purposeful sampling to participate focus group
discussions (FGD). Transcripts of three sessions of FGD were analyzed applying Graneheim and
Lundman (2004) approach, and a thematic network was applied to illustrate the findings.
RESULTS: The finding emerged 78 codes, 14 subthemes, and 4 main themes. Stressors were
classified in two main themes, including individual stressors and the social ones. Behavioral strategies
and the cognitive ones were among two categories of coping strategies. According to the thematic
network, a full stress student affecting the precious stressors and the social, cultural, and the economic
context may manage his/her stress applying the coping strategies.
CONCLUSION: The findings revealed that university students experienced different kinds of stress,
and usually, they do not apply right coping strategies. It is important to establish stress counseling
programs for university students. Besides, it is proposing to provide 1st year university students with
workshops about the cause of stress and effective coping strategies.


  1. W o r l d H e a l t h O r g a n i z a t i o n . “ S t r e s s : T h e H e a l t h
    Epidemic of the 21st Century”: HCA Today; 2019.
    Available from:
    stress‑the‑health‑epidemic‑of‑the‑21st‑century/. [Last accessed
    on 2020 Jun 04].
    2. Fawzy M, Hamed SA. Prevalence of psychological stress,
    depression and anxiety among medical students in Egypt.
    Psychiatry Res 2017;255:186‑94, 2020 April 20.
    3. Islam S, Akter R, Sikder T, Griffiths MD. Prevalence and factors
    associated with depression and anxiety among first‑year University
    students in Bangladesh: Across‑sectional study. Int J Mental Health
    Addict 2020.‑020‑00242‑y
    4. Lian Z, Wallace BC. Prevalence of past‑year mental disorders and
    its correlates among Chinese international students in US higher
    education. J Am Coll Health 2020;68:176‑84.
    5. Alotaibi AD, Alosaimi FM, Alajlan AA, Bin Abdulrahman KA.
    The relationship between sleep quality, stress, and
    academic performance among medical students. J Family
    Community Med 2020;27:23‑8.
  2. 6. Borjalilu S, Mohammadi A, Mojtahedzadeh R. Sources and
    severity of perceived stress among Iranian medical students. Iran
    Red Crescent Med J 2015;17:e17767.
    7. Lazarus RS. Psychological Stress and the Coping Process:
    New York, McGraw‑Hill; 1966.
    8. Majumdar B, Ray A. Stress and coping strategies among university
    students: A phenomenological study. Indian J Soc Sci Res
    9. Stefanaki C, Pervanidou P, Boschiero D, Chrousos GP. Chronic
    stress and body composition disorders: Implications for health
    and disease. Hormones (Athens) 2018;17:33‑43.
    10. Kivimäki M, Steptoe A. Effects of stress on the development
    and progression of cardiovascular disease. Nat Rev Cardiol
    11. Barnthouse M, Jones BL. The impact of environmental chronic and
    toxic stress on Asthma. Clin Rev Allergy Immunol 2019;57:427‑38.
    12. Huerta‑FrancoMR, Vargas‑LunaM, TiendaP, Delgadillo‑HoltfortI,
    Balleza‑Ordaz M, Flores‑Hernandez C. Effects of occupational
    stress on the gastrointestinal tract. World J Gastrointest
    Pathophysiol 2013;4:108‑18.
    13. DuraisamyK, Mentor S, ThangavelR, AhmedME, SelvakumarGP,
    Raikwar SP, et al. Mast cells in stress, pain, blood‑brain barrier,
    neuroinflammation and Alzheimer’s disease. Front Cellul
    Neurosci 2019;13:54.
    14. Lamis DA, Hirsch JK, Pugh KC, Topciu R, Nsamenang SA,
    Goodman A, et al. Perceived cognitive deficits and depressive
    symptoms in patients with multiple sclerosis: Perceived stress and
    sleep quality as mediators. Mult Scler Relat Disord 2018;25:150‑5.
    15. Alsaqri SH. Stressors and coping strategies of the Saudi nursing
    students in the clinical training: a cross‑sectional study. Educ Res
    Int 2017;2017:2017.
    16. Nivethitha P, Rita S. A study on stress management among
    student community. Int J Eng Sci Res Technol 2016; 5 (11): 481‑483.
    17. Bamuhair SS, Al Farhan AI, Althubaiti A, Agha S, Ibrahim NO.
    Sources of stress and coping strategies among undergraduate
    medical students enrolled in a problem‑based learning
    curriculum. J Biomed Educ 2015; 2015 (10):1‑8.
    18. Graf H, Melton B, Gonzalez S. A qualitative study of stressors,
    stress symptoms, and coping mechanisms among college students
    using nominal group process. J Georgia Public Health Assoc
    19. Okoro E. Assessment of Stress Related Issues and Coping
    Mechanisms among College Students. All Theses, Dissertations,
    and Other Capstone Projects; 2018. p. 825. Available from: [Last accessed on
    2020 May 02].
    20. Aan R, Ar S, Mi Z. Stress and coping strategies among
    management and science university students: A qualitative study.
    Int Med J 2009;8:11‑5.
    21. Seyedfatemi N, Tafreshi M, Hagani H. Experienced stressors and
    coping strategies among Iranian nursing students. BMC Nurs
    22. Adams DR, Meyers SA, Beidas RS. The relationship between
    financial strain, perceived stress, psychological symptoms, and
    academic and social integration in undergraduate students. J Am
    Coll Health 2016;64:362‑70.
    23. Watson JM, Logan HL, Tomar SL. The influence of active coping
    and perceived stress on health disparities in a multi‑ethnic low
    income sample. BMC Public Health 2008;8:41.
    24. Lazarus RS, Folkman S. Stress, Appraisal, and Coping. New York:
    Springer Publishing Company; 1984.
    25. Wolf L, Stidham AW, Ross R. Predictors of stress and coping
    strategies of US accelerated vs. generic Baccalaureate Nursing
    students: An embedded mixed methods study. Nurse Educ Today
    26. Jensen C, Forlini C, Partridge B, Hall W. Australian University
    students’ coping strategies and use of pharmaceutical stimulants
    as cognitive enhancers. Front Psychol 2016;7:277.
    27. Khademian F, Rezaee R, Pournik O. Randomized controlled
    trial: The effects of Short Message Service on mothers’ oral health
    knowledge and practice. Community Dent Health 2020;37:125‑31.
    28. Salehi F, Kermani ZA, Khademian F, Aslani A. Critical Appraisal
    of Mental Health Applications. Stud Health Technol Inform
    29. Rosenfield S. Labeling Mental Illness: The Effects of Received
    Services and Perceived Stigma on Life Satisfaction. Washington:
    American Sociological Review; 1997. p. 660‑72.
    30. KHademian F, Arshadi Montazer MR, Aslani A. Web‑based
    health Information Seeking and eHealth Literacy among College
    students. A Self‑report study. Invest Educ Enferm 2020;38: e08.
    31. Yvonna L, Egon G. Naturalistic Inquiry. Illustrated, Reprint ed.
    New York: SAGE Publishing; 1985.
    32. Desalegn GT, Getinet W, Tadie G. The prevalence and correlates
    of social phobia among undergraduate health science students
    in Gondar, Gondar Ethiopia. BMC Res Notes 2019;12:438.
    33. Pitt A, Oprescu F, Tapia G, Gray M. An exploratory study of
    students’ weekly stress levels and sources of stress during the
    semester. Act Learn Higher Educ 2017;19:61‑75.
    34. Tariq S, Tariq S, Tariq S, Jawed S. Perceived stress, severity and
    sources of stress among female medical students in a private
    medical college in Pakistan. J Pak Med Assoc 2020;70:162‑7.
    35. Peltz JS, Bodenlos JS, Kingery JN, Rogge RD. The role of financial
    strain in college students’ work hours, sleep, and mental health.
    J Am Coll Health 2020;15:1‑8.
    36. Abraham J, Navya C, Joshy V. Perceived stress and coping
    strategies among post graduate students of a medical college in
    Thrissur, Kerala. Int J Community Med Public Health 2019;6:814‑7.
    37. Rafati F, Nouhi E, Sabzevari S, Dehghan‑Nayeri N. Coping
    strategies of nursing students for dealing with stress in clinical
    setting: A qualitative study. Electron Physician 2017;9:6120‑8.
    38. Yikealo D, Tareke W. Stress coping strategies among college
    students: A case in the college of education Eritrea institute of
    technology. Open Sci J 2018;3:1‑18.
    39. Kożusznik MW, Peiró JM, Soriano A, Navarro Escudero M. “Out
    of sight, out of mind? The role of physical stressors, cognitive
    appraisal, and positive emotions in employees’ health. Environ
    Behav 2018;50:86‑115.
    40. LiMH, EschenauerR, Persaud V. Between avoidance and problem
    solving: Resilience, self-efficacy, and social support seeking.
    J Counsel Develop 2018;96:132‑43.
    41. Labrague LJ, McEnroe‑Petitte DM, De Los Santos JAA, Edet OB.
    Examining stress perceptions and coping strategies among
    Saudi nursing students: A systematic review. Nurse Educ Today
    42. Areba EM, Duckett L, Robertson C, Savik K. Religious coping,
    symptoms of depression and anxiety, and well‑being among
    Somali college students. J Relig Health 2018;57:94‑109.