College students have experienced unique challenges in adjusting to disruptions associated with the COVID-19 pandemic, such as displacement from the traditional university setting and the abrupt shift to remote learning.1 Even before the pandemic, however, it was well-known that this population faces substantial stress related to the college experience, including the transition to independent living and changes in peer relationships. In addition, overwhelming academic demands represent a significant source of distress for many college students. 

In a study published in Frontiers in Psychology, Barbayannis et al examined the relationship between perceived levels of academic stress and mental well-being among 843 college students (78.5% women; 66.4% White) in the United States.2 Scores on the Perception of Academic Stress Scale (PAS) and the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) were significantly correlated (r=0.53; P <.001) and showed an association between worse academic stress and poor mental well-being in all students surveyed.

Based on SWEMWBS scores, nonbinary students demonstrated the highest levels of academic stress and worst mental health across the sample, while men showed the lowest academic stress levels and highest mental well-being. PAS scores revealed higher levels of both academic stress and COVID-related stress among women and nonbinary students compared to men. 

Second-year college students demonstrated higher academic stress and worse psychological well-being compared to students in other years of study, which may be due in part to “this group taking advanced courses, managing heavier academic workloads, and exploring different majors,” the authors wrote.

For those at higher risk, individualized counseling and stress reduction strategies are needed.

According to study co-author Xue Ming, MD, PhD, professor of neurology at Rutgers New Jersey Medical School in Newark, the potential reasons for the observed impact of academic stress on college students’ mental health include “ranking systems, peer pressure, global competition in the job market, and parental and societal demands regarding grades,” among others. “Colleges are perceived by some as a competition stage and less of pure learning environment,” she said. 

These findings align with those from other recent research, including a 2022 study showing that academic stress was a significant predictor of anxiety (β=0.247, t=5.462; P <.001) among college students in China.3 Other studies have demonstrated links between various sources of stress and the risk for mental health disorders in college students.

In 2020, results of the World Health Organization World Mental Health Surveys International College Student Initiative showed a significant dose-response relationship between the degree of perceived stress in each of 6 life areas (health, finances, family relationships, romantic relationships, work and school relationships, and problems experienced by loved ones) and higher 12-month odds of at least 1 of 6 mental health disorders (major depressive disorder, generalized anxiety disorder, panic disorder, bipolar disorder, drug use disorder, and alcohol use disorder) in first-year college students (n=20,842) from 24 universities in 9 countries.4

Additionally, estimates of population attributable risk proportions indicated that targeted stress prevention interventions may eliminate up to 80% of the prevalence of the disorders observed in the study.4

“Awareness is paramount in implementing help for these students,” Dr Xue said. “For those at higher risk, individualized counseling and stress reduction strategies are needed.” Helpful strategies may include peer support groups and training in mindfulness skills.5

Results of another study published in 2022 suggest that resources aimed at improving time management and self-regulation skills may reduce academic stress in college students, and findings from a 2018 study support the utility of a social-emotional program to improve psychological well-being in this population.1,6

We interviewed clinical psychologist Jenny C. Yip, PsyD, ABPP, clinical assistant professor of psychiatry at the Keck School of Medicine of the University of Southern California and founder of the Renewed Freedom Center for the treatment of anxiety disorders, to learn more about the effects of academic stress on the mental health of college students and how clinicians, schools, and parents can best support these individuals.

What are believed to be the reasons why academic stress has such as significant impact on college students’ mental health, as found by Barbayannis et al and other researchers?

Dr Yip: Being a student has never been more difficult because of the increased demand for kids to be the most perfect that they can be. Many parents have the expectation that their kids will strive for perfection or will perform perfectly, and that’s just not realistic. Kids know that it’s much more difficult today to get into a university than it’s ever been. There’s more demand and less supply, and therefore, the competition is very anxiety-provoking.

On top of that, a lot of kids go into freshman year feeling unprepared to be independent, which has a lot to do with how we’re parenting our children. With helicopter parenting, we’re not giving our children the same opportunities they had in the past to solve their own problems, to find their own solutions. Therefore, they don’t feel capable of doing that on their own when they enter college. 

Socially, our kids are also very underprepared to engage with others independently due to the dependence on digital devices to communicate.

What might be the reasons for the greater impact of this stress on nonbinary students and women in particular?

Dr Yip: We are living in a world today where everyone is adjusting to gender neutrality. Someone who is nonbinary will have a taller order of struggle to overcome.

Women traditionally have had a glass ceiling. Research has demonstrated that teachers pay more attention to men than women. On top of that, young women who enter college also have the added concern of sexual harassment and assault on campus. For most female students, this is the first time they’re living in a co-ed environment without parental presence for more than just a week or 2 at summer camp. That presents new stressors for those who identify as women.

What are recommendations for mental health professionals to help reduce the impact of academic stress on the mental health of patients who are college students?

Dr Yip: As a mental health professional, I suggest helping the student adjust to independent living. Begin practicing assertive communication so that they can advocate for themselves and problem-solve for the challenges that will come up, whether it’s with their roommates, classmates, or professors. Too often kids today are not advocating for themselves. They’re responding passive-aggressively and avoiding uncomfortable situations. For mental health professionals, the number 1 priority is to help patients practice assertive communication skills to help them feel independent by having agency to speak up for themselves in a way that is conducive to problem solving.

What broader measures are needed to help minimize the effects of academic stress on college students?

Dr Yip: Number 1, parents and schools should start preparing college students for the demand and the transition to college before college even starts. I see a lot of high schools doing that now because of the high attrition rate of incoming freshmen. There are college campuses offering more mental health support than before, but we need to start much earlier than when a student becomes a freshman. Conversations need to be had even before a child starts elementary school. It’s a systemic adjustment.

Mental health adjustments need to be incorporated in colleges, especially with incoming freshmen. It should be mandatory that each incoming student meets with a mental health professional on a regular, consistent basis to evaluate their emotional adjustment. It’s often required for a new college student to meet with a college counselor to be sure they’re taking the coursework that is conducive to them. Why is that not being done with each student’s mental health?

Jenny C. Yip, PsyD, ABPP is a clinical assistant professor of psychiatry at the Keck School of Medicine of the University of Southern California and founder of the Renewed Freedom Center.

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This article originally appeared on Psychiatry Advisor



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