Background and Research Question
Although university students are often perceived to have an advantaged position in the community and deemed immune to ill-health and morbidity, there is mounting evidence that seems to suggest that a substantial percentage experience poor physical and mental health, and that the prevalence of etiological factors that lead to various psychological deficits is higher in university students than in the general population (Mikolajczyk et al., 2008; Vandervoort & Skorikov, 2002). However, a strand of existing literature (e.g., Mane et al., 2011; Wu et al., 2009) demonstrates that much of the recent research studies on the health and wellbeing of university students has focused predominantly on self-reported risky health behaviors such smoking, drug and alcohol use, anger, impulsivity, sensation-seeking as well as unsafe sexual practices, but have failed to acknowledge the rising importance of studies on self-rated physical health by university students, which could be of fundamental value in shaping many lifestyle-related attitudes and habits that are thought to take root at this stage and persist across the lifespan (Mandal et al., 2012; Mikolajczyk et al., 2008).
To address this gap in knowledge, the present study aims to investigate the perceptions of university students at Kennesaw University about physical, psychological, social, and mental stress factors within the university setting and their relationship to self-rated health. Consequently, the study is guided by the following research question:
What are the perceptions of first-year undergraduate students studying at Kennesaw State University about physical, psychological, social, and mental health stress factors, and their relationship to self-rated health behaviors?
Brief Review of Literature
The physical and mental health of university students is increasingly gaining currency in recent years, particularly in light of the realization that adolescence and young adulthood has been associated with the onset of a substantial percentage of mental health disorders diagnosed during adulthood, and also due to the perseverance of mental illness across the lifespan (Vaez & Laflamme, 2003). Extant psychological scholarship demonstrates that “student life, especially during the first year, is a period of vulnerability during which young students establish, test and adjust new psychological identities” (Verger et al., 2009 p. 644). While it is believed that some students join institutions of higher learning with a pre-existing mental illness, there is compelling evidence suggesting that stress factors associated with university can occasion a manifestation of symptoms in this group of the population (Mikolajczyk et al., 2008), and that the prevalence of psychological distress (PD) and other associated disorders has been noted to be higher among college students than among working nonstudent populations of the same sex and age (Verger et al., 2009 p. 644).
Psychological Distress
Academic interest in the study of psychological distress among college and university students has grown tremendously in recent years, particularly due to the sustained increase in stress-producing incidents associated with college life (Li et al., 2005). In their study, Verger et al (2009) note that psychological distress is a routinely utilised conception for which an operationalised definition might be the presence of psychological symptoms above a certain threshold, indicative of poor mental health and/or linked to psychological help seeking, and that the concept is associated with an elevated risk of anxiety, depression, smoking, substance use and personality disorders, and also with academic collapse, job-related challenges, and diverse social outcomes later in life.
A study by Armstrong and Oomen-Early (2009) found that a substantial proportion of university students rated above the clinical cut-off for psychological distress, depression and/or anxiety, with female students scoring substantially worse than their non-student peers in these domains. In another study, psychological distress among university students appeared to be related to academic demands, social and emotional problems, as well as deficiencies in socialisation processes and network quality; however, these factors were found to be mediated by ethnicity (Vandervoort & Skorikov, 2002). In this particular study, the authors’ noted that the risk factors for psychological distress are not well known, in particular those stressors that may be exclusively associated with a shift in the living conditions and educational demands that occur upon entry into an institution of higher learning.
Physical and Mental Health Issues
While the study conducted by Vaez and Laflamme (2003) showed that mental-illness issues have the capacity to occasion adverse outcomes such as risky health behaviour, poor academic performance and attrition, physical illness, and antisocial behaviour among the students’ population, the study by Vandervoort and Skorikov (2002) found evidence of high prevalence of depression and anxiety amongst college students with physical health problems. Citing other sources in their study, Vandervoort and Skorikov (2002) acknowledged that “reviews of the literature indicate that individuals suffering from chronic illnesses, particularly those that interfere with daily functioning, are especially susceptible to problems with depression and anxiety, and [that] this relationship has been found across cultures” (p. 51). It is important to note that while an assessment of physical health issues is primarily concerned with investigating the frequency of occurrence of minor symptoms (e.g., cold and flu) as well a multiplicity of major health challenges (e.g., heart attacks) and chronic challenges (e.g., hypertension, diabetes, asthma), the assessment of mental health problems investigates challenges such as depression, anxiety, suicidal ideation, and other stress-related problems that may require the use of mental and counselling services (Fuatai & Soon-Schuster, 2001; Vandervoort & Skorikov, 2002).
Academic, Financial and Social Challenges
A strand of existing literature demonstrates that academic, financial and social challenges associated with college life can make this a very stressful time for students, leading to burnout, fatigue, low quality of life, poor academic performance, and affective isolation (Armstrong & Oomen-Early, 2009). The study by Vandervoort and Skorikov (2002) demonstrated compelling evidence that social challenges which occur upon entry into the university, along with facing a new environment and dealing with increased performance pressure, may occasion adverse health outcomes among students particularly in the context that university students receive far less individual support from instructors and must become much more independent-minded in obtaining and understanding information and knowledge. Allied with this may be the inability of the students as well as the university administration to develop strategies that may assist students against academic, financial and social challenges, such as mastery and social support (Wu et al., 2009). Fuatai and Soon-Schuster (2001) argue persuasively that academic, financial and social challenges arising upon entry into the university may explain increased instances of reported suicidal ideation, suicide attempts, depression, anxiety, interpersonal challenges, motivational challenges and depressed affect among this group of the population.
Self-Rated Health
Extant literature demonstrates that “self-rated health status is a reliable and valid measure for assessing the subjective and objective health of individuals” (Mikolajczyk et al., 2008 p. 215). Such a measure, according to Vaez and Laflamme (2003), is of immense importance in trying to understand the health needs of university students, who face a heavy workload, demonstrate a low degree of control over their situations, receive minimal appreciation and feedback for their work, and deal occasionally with a whole range of concerns, burdens and worries that are different from other population groups.
Hence unsurprisingly, a number of studies cited in Mikolajczyk et al (2008) found that many university students in the United States and Europe have lower perceived quality of life when compared with their working peers, and that young people in this population group preferentially employ psychological or behavioural factors as a rating frame for their health, thus the need to develop a better understanding and a separate analysis of the critical factors associated with self-rated health status (SRHS) for this younger age group. The study by Mikolajczyk et al (2008) asked university students to self-rate their health across five areas under investigation (physical characteristics, psychological aspects, socio-demographic characteristics, social contacts and academics), with the view to acquiring and compiling knowledge that could be used to create health promotion activities and meet the health, well-being and self-efficacy needs and concerns of this group of the population.
The Sample
The sample frame for the present study consists of all full-time first year students at Kennesaw State University, located in the State of Georgia in the United States. The on-campus students live either in university halls of residence or in nearby towns in private accommodation, and the student demographics demonstrates the socio-economic, gender and ethnic diversity of the university population, where 60% of the students are female and 31% of the students come from minority groups (Kennesaw State University, 2012). The justification for selecting this sample frame is predicated upon two interrelated facts:
- Full-time first year students demonstrate considerable inexperience in dealing with a multiplicity of stressors within the university setting, such as heavy workload, socialisation difficulties, and low degree of control over their personal situations (Vaez & Laflamme, 2003).
- They have a lower perceived quality of life than their counterparts in other years of study (Mikolajczyk et al., 2008).
Although probability sampling techniques can be used in this type of study, the researcher utilises purposive sampling technique to select a sample of 20 participants due to gender and ethnicity concerns. Of the 20 participants, 12 are female and 8 are male to represent the gender distribution at the university, and 6 of the participants come from minority groups (e.g., Asian, Black). Extant scholarship on quantitative methodology demonstrates that participants in a purposive sample are selected based on their compatibility to the study aim and objectives, as well as a demonstrated understanding of the phenomenon under investigation (Sekaran, 2006), hence the justification to use this sampling strategy is firmly nested on the fact that the researcher receives responses rich in context and scope because participants have demonstrated knowledge and understanding regarding the topic of interest.
Instrumentation
Summary Description
Available methodology scholarship demonstrates that the instrumentation plan is composed of several decisions that need to be arrived at prior to the commencement of the study, such as how to gather data, when to gather data, where to gather data, and how to analyze data (Sekaran, 2006). To report on the summary description for the instrumentation, therefore, it is acknowledged that a self-administered questionnaire has been administered to the sampled first year undergraduate students at Kennesaw State University for purposes of data collection. The final questionnaire included 25 items and covered various aspects including demographic information (age, gender, ethnicity, family structure and accommodation type), financial situation, education challenges, social connectedness and challenges, behavioural indicators (delinquent behaviour, alcohol, smoking and drug use), psychological distress and mental health, and self-rated health. Most items have been ranked on a five-point Lickert-type scale.
Education challenges are measured by asking participants how much they think about dropping out of school rather than asking them whether or not they consider dropping out of the institution, and participants are provided with five response options ranging from “not at all” to “time-to-time”, “often”, “frequently”, and “very seriously”; the same response options are also used to measure social connectedness and challenges as well as financial difficulties in school. A frequency approach using five response options (“never”, “once a month”, “2-4 times a month”, “2-3 times a week”, “4 times a week or more” is used to measure relevant behavioural indicators, such as recent delinquent behaviour, alcohol consumption, cigarette smoking, and drug use. This scale is also used to measure the physical activity of participants.
Psychological distress and mental health are assessed using screening questions that focus around feelings of depression, burnout and/or anxiety on a four-point Lickert type scale using the response options of “never”, “sometimes”, “often”, and “always”, as well as whether the participants have self-harmed themselves. The specific items used to measure depression and anxiety include “feelings of anxiousness in new situations”, “finding it hard to cope with presenting situations”, “worrying about how other people think”, “getting sudden panic attacks”, “feeling unhappy and tearful”, “feeling there is nothing to look forward to”, “thoughts of dying”, as well as “thoughts of self harm”. To assess overall health, participants are requested to use a 5-point Licker-type scale to rate their physical, psychological and overall health using the response options of “excellent”, “very good”, “satisfactory”, “poor”, and “not sure”; however, the researcher does not make any further analyses of overall health in the present study.
The justification for selecting the questionnaire as the primary data collection instrument for the present study is predicated upon issues of cost-effectiveness when administered via online platforms (Bryman & Bell, 2007), ease of application and adaptability (Sekaran, 2006), capability to guarantee anonymity of participants, as well as liberty to incorporate unstructured items in the pursuit of new information or new horizons of knowledge previously unknown by the researcher (Philips & Starwaski, 2008).
Reliability of the study has been achieved by (1) making sure that measures incorporated into the questionnaire instrument only capture data that is of interest in answering the research question, (2) utilizing multiple indicators to guarantee the collection of quality data from participants, and (3) increasing the range of measurement of the questionnaire instrument (Creswell, 2002), while internal validity has been achieved by (1) utilising a wide spectrum of content rather than a constricted one, (2) using appropriate sampling technique to meet the needs of the study, (3) accentuating important material, and (4) utilising a validated and reliable instrument for purposes of collecting data (Sekaran, 2006). However, it may be difficult to generalise the results of this particular study to other contexts owing to the use of a small sample, implying that external validity is not guaranteed. Data for this study has been analysed using a statistical software program known as SPSS for Windows (version 18).
Administration Methodology
The research design is described in the literature as a blueprint or outline for conducting the study in such a manner that optimal concern is taken over factors that could interfere with the validity of the research results, or as the overall plan that is used by the researcher to implement the study in a way that will assist them achieve the intended outcomes, hence enhancing the chances of obtaining information that could be associated with the real situation (Creswell, 2002; Sekaran, 2006). In light of this exposition, the present study utilises a quantitative research method with a descriptive research (survey research) design to critically analyse the perceptions of first year undergraduate students studying at Kennesaw State University. A strand of existing methodology literature (e.g., Bryman & Bell, 2007) demonstrates that the quantitative research method mainly utilises three research designs, namely descriptive, correlational and causal-comparative, to collect and analyse numerical/empirical data using formal instruments such as questionnaires. A quantitative descriptive research design, which is the focus of the present study, not only identifies the unique characteristics of an observed phenomenon but also examines the situation as it is without changing or modifying it (Creswell, 2002).
Drawing from the above synthesis, there is compelling evidence to suggest that the quantitative descriptive research design selected for this study receives justification from the fact that it assists the researcher to acquire important information about the group under investigation (first year undergraduate students form Kennesaw State University), including their characteristics, opinions, values, attitudes, expectations or previous experiences with their physical and mental health by simply posing questions to them and tabulating their responses (Phillips & Starwaski, 2008). A second justification is predicated upon the fact that the quantitative descriptive research design allows the researcher to learn about a large population (undergraduate university students) by surveying a sample of first year undergraduate students at the university.
Owing to the fact that descriptive/survey research typically employs face-to-face interviews, telephone interviews, or previously written and pretested questionnaire instrument to collect data from the field (Sekaran, 2006), it is important to underscore that the present study employs an online questionnaire schedule requiring participants to respond to a series of statements and/or questions about themselves through the self-report technique. Although this technique is advantageous due to ease of application, minimal costs in management, and capacity to provide participants with flexibility to respond to the questions (Bryman & Bell, 2007), hence its use in this particular study, it nevertheless runs the risk of intentional data misrepresentation as some participants may only be interested in creating a favourable impression to the researcher rather than providing “objective facts” as they know them (Creswell, 2002). No informed consent is required in the present study since the research presents no more than minimal risk of harm to participants, there is no risk that may result from a breach of confidentiality between the researcher and participants, and also due to the fact that the research does not meet the tenets of a clinical investigation subject to regulations from relevant bodies (Office of the Human Research Protection Program, 2011).
Findings
The present study is hinged on the urgent need to investigate the physical, psychological and mental health perceptions of undergraduate students at Kennesaw State University, with the view to understanding a range of stressors affecting the students as well as their self-related health. Towards the realization of this objective, a survey has been conducted on a purposeful sample of 20 participants drawn from the university first-year population. It is important to note that the researcher received 16 duly completed questionnaires representing 80% response rate. The main findings of the study are not only interesting but informative too, though they are generally in line with other previous studies targeting the wider university undergraduate population.
Student Profile
An analysis of the demographic information demonstrates most first year undergraduate students at the university are female and are yet to celebrate their 20th birthday. Specifically, the survey respondents consists of 10 (62.5%) females and 6 (37.5%) males, with a mean age of 19.8 years (SD = 2.77). 12 (75%) of the participants come from two-parent homes while the rest come from single-parent homes, and 13 (81.25%) are predominantly white while 3 (18.75%) of the participants come from minority groupings (Black, Asian, and Indian).
Education and Finances
From the descriptive analysis, it is evident that 7 (43.75%) of the sampled participants have considered terminating their university studies during the last 90 days; of these students, 4 (57.1%) think about it from time to time, 2 (28.6%) consider this option quite frequently, and one of the participant (14.3%) considers dropping out of the university in a very serious way. Likewise, 10 (62.5%) of the participants have thought about finding some work to cater for their needs due to presenting financial challenges at the university; of these students, 3 (30%) acknowledge they think about this from time to time, 4 (40%) think about it frequently, while 3 (30%) think about this option in a very serious way. A cross-tabulation analysis between ethnicity and financial challenges reveals that all the three students who think about finding some work very seriously are from minority groupings.
Social Connectedness and Challenges, Behavioural Indicators and Physical Activity
In Social Connectedness and challenges, an overwhelming majority (75%) of participants admit to frequently discussing their personal issues and concerns with close family members, 10 (62.5%) to experiencing feelings of homesickness while at the university, 7 (43.75%) to encountering instances of bullying, intimidation, and/or harassment from students at the university, and 11 (68.75%) to confiding their worries and concerns in a close friend. These findings demonstrate that 6 (37.5%) of the participants do not discuss their personal issues and concerns with close family members, and 5 (31.25%) do not confide their own problems and concerns in a friend. Figure 1 below shows indicators for social connectedness and challenges
The figure above demonstrates that majority of the 12(75%) participants who admit to discussing their personal issues and concerns with close family members do it from time to time, and many of the 10 (62.5%) students experience homesickness from time to time. Likewise, a majority of bullying encounters are encountered from time to time, as is confiding own problems in a friend.
Descriptive means are employed to demonstrate students’ perceptions of several behavioural indicators that are directly related to health, such as delinquent/antisocial behaviour, alcohol use, smoking, and drug abuse. It is important to note that a 5-point Lickert-type scale (“1=never”, “2=once a month”, “3=2-4 times a month”, “4=2-3 times a week”, 5=4 times a week or more”) is used to rank the responses. The results for the behavioural indicators are shown in the table below.
Table 1: Participant Responses for Behavioural Indicators.
The figures demonstrated in the table shows that of the 62.5 % participants who acknowledge to engaging in delinquent/antisocial behaviour at the university, majority do it at least once a month; similarly, of the 87.5% students who admit to taking alcohol while at school, majority do it at least 2 to 3 times a week. Smoking is done by 37.5% of the participants with the majority doing it at least once a month, while drug use is done 31.25% of the students with a frequency of at least once a month. 12 (75%) of the participants engage in physical exercises while at the university to keep fit, but the frequency is worrying as over half (56.25%) do it 2-4 times a month while the recommended trend should be 2-3 times a week.
Psychological Distress, Mental Health and Self-Rated Health
The findings of the study show that a substantial proportion of first year students at the university are affected by a multiplicity of psychological and mental health stressors, as demonstrated in the following descriptive table. It is important to note that a 4-point Lickert-type scale (“1=never”, “2=sometimes”, “3=often”, and “4=always”) is used to rank the responses.
Table 2: Descriptive Statistics for Psychological Stressors.
From the table, it is evident that most of the 11 (68.75%) participants often experience anxiety in new places; most of the 10 (62.5%) participants sometimes find it hard to cope with presenting challenges and situations at the institution; most of the 8 (50%) participants sometimes worry about how other people think about them; most of the 7 (43.75%) sometimes get sudden panic attacks; most of the 10 (62.5%) often feel sorrowful and dejected; most of the 8 (50%) participants sometimes feel there is nothing of importance to celebrate at the university; most of the 4 (25%) participants sometimes experience thoughts of dying or suicidal ideation; and most of the 5 (31.25%) participants often experience spasms of self-destruction. In self-rating their physical, psychological, and overall health experienced during the last six months, 2 (12.5%) participants feel their health is excellent, 3 (18.75%) feel it is good, 7 (43.75%) feel it is satisfactory, and 4 (25.0%) feel their health is poor.
Applications and Conclusions
Applications
The findings of the preset study are in agreement with comparable research studies (e.g. Mikolajczyk et al., 2008; Vaez & Lafflame, 2003) on the self-rated health status of first-year university students, though a slightly low percentage of students in the current study rate their physical, psychological and overall health status as excellent or very good, with a majority rating their health status as merely satisfactory. In line with the findings of Mikolajczyk et al (2008), such a predisposition calls for concerted efforts by the university’s administration and other relevant agencies to develop strategies and approaches that will improve students’ physical and mental health outcomes. These efforts, according to Mandal et al (2012), consist of initiating more counselling services at the university, developing and implementing student support services, encouraging students to adopt physical exercises as a way of life, and initiating regulations aimed at curbing instances of bullying and intimidation at the university.
In accordance with previous research into the psychological stressors and mental health of university students and the equivalent age group in the general population (e.g. Fuatai & Soon-Schuster, 2001; Mane et al., 2011; Randall et al., 1998), the present study has found that some of the stressors that lead to poor educational achievement, psychological distress and poor mental health outcomes for first year university students include financial incapacity, lack of family support and supportive social networks, behavioural deficiencies (e.g., antisocial behaviour, alcoholism, smoking and drug abuse), physical inactivity, anxiety, depression and absence of effective coping mechanisms. Reinforcing the findings of a research study by Roberts and Danoff-Burg (2010), this study has found that these stressors are harmful to university students as they lead to suicidal ideation and thoughts of self-harm. Consequently, it is important for the university administration in conjunction with other relevant stakeholders to develop policies, action plans and services aimed at dealing with the mentioned stressors to make the life of university students more fulfilling, purposeful and academically productive. In their study, Armstrong and Oomen-Early (2009) found that most university students do not use such services even if they are available to them owing to perceived stigma and lack of privacy. In light of this finding, it should be the task of the university administration to develop and implement psychological, social and mental health services that guarantee confidentiality and reduce stigma.
Conclusions
The findings of the current study contribute to the embryonic literature of the physical, psychological and mental stress factors affecting first year undergraduate students and other comparable groups in the population, as well as the relationship between these stressors and aspects of self-rated health. In assessing the perceptions of first year undergraduate students about their physical health, it is has been noted that 12 (75%) of the students engage in physical exercises while at the university to keep fit though the frequency is worrying as over half (56.25%) do it 2-4 times a month instead of the recommended 2-3 times a week. The study has also found that some of the stressors known to occasion poor educational and mental health outcomes among this group of the population include financial challenges, lack of family support and other supportive social networks, behavioural deficiencies, physical inactivity, anxiety, depression as well as absence of effective coping strategies. The existence of these stress factors, in the view of the researcher, may be responsible for the self-rating scores provided by the university students, particularly in the context that majority of them rate their health as merely satisfactory. The present study provides important seminal data and analyses for the administration of Kennesaw State University to widen health promotion programs, social support services and health education programmes targeted at undergraduate university students, with the view to enhancing their physical, psychological, social and mental health-related outcomes.
Attachment: Survey Questionnaire
Demographic Information
- Age (in completed years)………………………………
- Gender
- Male
- Female
- Family structure
- Two-parents
- Single-parent
- Other
- Accommodation type in the University
- On campus
- Outside
- Ethnicity
- White
- Minority group
Education
How much have you thought about dropping out of the university or terminating your studies all together in the past three (3) months?
Finances
How much have you thought about finding some work to cater for your needs due to persisting financial constraints in the past three (3) months?
Social Connectedness and Challenges
Please respond to the following statements by ranking your position/feelings against the following (“1=not at all”, “2=time to time”, “3=often”, “4=frequently”, and “5=very seriously”)
Behavioral Indicators
Please respond to the following statements by ranking your position/feelings against the following (“1=never”, “2=once a month”, “3=2-4 times a month, “4=2-3 times a week”, and “5=4 times a week or more)
Physical Activity
16. How often do you engage in physical exercises to keep fit while at the university?
Psychological Distress and Mental Health
Please respond to the following statements by ranking your position/feelings against the following (“1=never”, “2=sometimes”, “3=often”, and “4=always”)
Self-Rated Health
25. Kindly rate your physical, psychological, and overall health you have experienced during the last six months using the response options provided in the table, where “1” represents excellent physical, psychological and overall health, and “5” represents a “not sure” entry.
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