Abstract
Test anxiety is a widespread problem among university students, with negative consequences for their social, physical, and academic well-being. Therefore, students may engage in activities that might alleviate anxiety symptoms, including taking medication. The study aimed to identify factors affecting test anxiety among medical and non-medical students during examination period and their coping approaches. A cross-sectional study was conducted using a survey to collect data. The westside test anxiety scale was used to measure the students’ anxiety levels. Univariate and post hoc analyses were used. The number of participants was 925 from 14 colleges, and 82.9% of them were female. The results indicated that the test anxiety was moderately high. Young students, females, junior students, and students with low cumulative grade point averages (cGPAs) has statistically significant high test levels with p-values 0.042, 0.01, < 0.001, and < 0.001, respectively. Most students used multi methods to cope with anxiety. The most common non-pharmacological coping approaches are praying (59.5%), drink caffeine and/or energy beverages (49.6%). Only a few students (6.6%) used medications to cope with test anxiety, with only 2.2% using propranolol. The study concluded the test anxiety was a common among university students and an action should be taken to reduce the anxiety level. The priority of support programs should target females, young students, and those with low cGPA. In addition, there is a need to raise awareness among students to reduce caffeine and energy drinks consumption, maintain enough and quality sleep during this period and avoid using medication without expert advice.
Keywords: Test anxiety, University students, Propranolol, Coping strategies
Subject terms: Human behaviour, Risk factors
Introduction
Anxiety is a common mental disorder that can manifest in various ways. The symptoms and severity of anxiety can vary from person to person. The cause of the condition is complex and influenced by a variety of factors1.
One common type of anxiety among university students is test anxiety, which significantly affects performance and overall well-being. Experiencing test anxiety involves the physical stress that individuals go through when they encounter a situation where they are being evaluated during exams or assessments2. It is characterized by a feeling of intense apprehension or fear before and/or during an exam, and might cause physical, cognitive, and behavioural symptoms. Additionally, short-term memory-related tasks such as exam preparation and public speaking are more sensitive to the negative effects of test anxiety3. The prevalence of test anxiety varies among individuals and educational systems. For instance, it has been reported by different studies that over one-third of undergraduate students experienced elevated levels of non-specific anxiety4,5. The test anxiety can have a significant negative impact on students’ social being, emotions, academic performance, and overall well-being6. In severe cases, it may even lead to panic attacks7.
The causes of test anxiety are complex and can vary from person to person. However, the most common factors include academic pressures, personality traits, social issues, and financial problems8,9. Most college-related factors contribute to student anxiety include the transition to college, the heavy workload, and summative assessments6. These factors are commonly reported among undergraduate university students, especially those studying medicine or health-related fields3,10. There is a growing body of research suggesting a relationship between anxiety and test performance. Other factors contributing to exam anxiety include gender, excessive course load, low self-efficacy, poor social support, family overprotectiveness, lack of self-confidence, lack of home learning, maladaptive perfectionism, and inadequate preparation and time management11,12.
Worldwide, several studies indicated that a moderate to high prevalence of depression, anxiety, and stress are common among undergraduate students13–15. For instance, a study by Hanfesa et al. found that more than half of the students surveyed experienced test anxiety12. In another study, psychological morbidity was reported in more than half of medical undergraduate students16.
Various coping strategies are used by students to overcome exam anxiety. These include changes in daily activities, such as sleep patterns, seeking social and family support, relaxation techniques, praying, exercise, and changes in eating and drinking habits, such as increased consuming energy and caffeine drinks. In addition, some students relied on medication through using it before exams to reduce stress and anxiety. Several studies in Saudi Arabia have found that medical and health students used various prescription drugs to enhance concentration for a particular task and reduce exam fear. The proportion of participants in these studies was high and ranged from 6.4 to around 40% of the entire number of participants3,17–19. There is a wide range of medication misuse among students, depending on the conditions or illnesses they experience. While it is important to consult with a healthcare professional for most medications, as they can evaluate the specific situation, provide personalized advice, and determine the most appropriate course of action. Furthermore, some individuals may self-medicate with new medications or change the dose and/or duration of a prescribed medication given for a specific dose and duration.
In the United Arab Emirates (UAE), the examination period is a major source of stress for students, with anxiety being a prevalent experience20. Our study focused on medical and non-medical students, trying to find the anxiety levels difference between students that requires constant hard work, which leads to chronic stress and anxiety, especially during exam periods due to high expectations and pressures. There is insufficient data related to the level of anxiety during the exam among the university students in the UAE, and factors that impact on the test anxiety. Understanding the prevalence of test anxiety, contributing factors, and coping strategies among university students may help develop effective strategies that support students’ development and academic and professional success21. This study aimed to identify factors affecting the level of test anxiety among university students during examination period and their coping approaches.
Results
Characteristics of the participants
A total of 925 students participated in the study, with 82.9% being female. More than half of the participants (51.8%) were less than 20 years of age and from non-medical colleges of participants (62.5%). Less than half of the participants (46.1%) were either first-year (or foundation at the medical colleges) or second-year students. More than half of participants (58.4%) reported a cGPA above 3. More than three-quarters of participants (75.5%) live with their families while studying. The participants’ main university fees payment method was either self-paying (43.4%) or scholarship (48.4%). Table 1 shows the association between participants’ characteristics (including sociodemographic data, studying status, college, studying style, etc.) and the test anxiety (WTAS score).
Table 1.
Association between participants’ characteristics and test anxiety level (WTAS score) (n = 925).
| Variables | n (%) | Level of anxiety [categories for test anxiety] | The average score of test anxiety (± SD) | p value | Cramers V | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| Comfortably low n (%) |
Normal n (%) |
High normal n (%) |
Moderately high n (%) |
High n (%) |
Extremely high n (%) |
|||||
| Total | 925 (100.0%) | 82 (8.9%) | 126 (13.6%) | 119 (12.9%) | 162 (17.5%) | 159 (17.2%) | 277 (29.9%) | 3.34 (± 0.97) | < 0.001* | NA |
| Age (years) | ||||||||||
| < 20 | 479 (51.8%) | 27 (32.9%) | 68 (54.0%) | 61 (51.3%) | 84 (51.9%) | 81 (50.9%) | 158 (57.0%) | 3.44 (± 0.92) | 0.042 | 0.09 |
| 20–23 | 302 (32.6%) | 28 (34.1%) | 39 (31.0%) | 45 (37.8%) | 55 (34.0%) | 54 (34.0%) | 81 (29.2%) | 3.28 (± 0.95) | ||
| 24–27 | 63 (6.8%) | 10 (12.2%) | 8 (6.3%) | 5 (4.2%) | 11 (6.8%) | 12 (7.5%) | 17 (6.1%) | 3.20 (± 1.06) | ||
| 28–31 | 41 (4.4%) | 8 (9.8%) | 4 (3.2%) | 4 (3.4%) | 7 (4.3%) | 8 (5.0%) | 10 (3.6%) | 3.17 (± 1.15) | ||
| ≥ 32 | 40 (4.3%) | 9 (11.0%) | 7 (5.6%) | 4 (3.4%) | 5 (3.1%) | 4 (2.5%) | 11 (4.0%) | 3.05 (± 1.21) | ||
| Gender | ||||||||||
| Female | 767 (82.9%) | 54 (65.9%) | 109 (86.5%) | 98 (82.4%) | 136 (84.0%) | 133 (83.6%) | 237 (85.6%) | 3.38 (± 0.95) | 0.001 | 0.14 |
| Male | 158 (17.1%) | 28 (34.1%) | 17 (13.5%) | 21 (17.6%) | 26 (16.0%) | 26 (16.4%) | 40 (14.4%) | 3.14 (± 1.00) | ||
| Field of study | ||||||||||
| Medical | 347 (37.5%) | 24 (6.9%) | 51 (14.7%) | 52 (15.0%) | 61 (17.6%) | 58 (16.7%) | 101 (29.1%) | 3.36 (± 0.92) | 0.42 | 0.03 |
| Non-medical | 578 (62.5%) | 58 (10.0%) | 7.5 (13.0%) | 67 (11.6%) | 101 (17.5%) | 101 (17.5%) | 176 (30.4%) | 3.33 (± 0.99) | ||
| Year of study | ||||||||||
| First year (foundation year)**/second year | 437 (47.2%) | 27 (32.9%) | 54 (42.9%) | 53 (44.5%) | 76 (46.9%) | 84 (52.8%) | 143 (51.6%) | 3.44 (± 0.91) | < 0.001 | 0.14 |
| Third year/fourth year | 321 (34.7%) | 29 (35.4%) | 43 (34.1%) | 38 (31.9%) | 59 (36.4%) | 45 (28.3%) | 107 (38.6%) | 3.39 (± 1.02) | ||
| Fifth year*** | 57 (6.2%) | 4 (4.9%) | 10 (7.9%) | 12 (10.1%) | 8 (4.9%) | 13 (8.2%) | 10 (3.6%) | 3.16 (± 0.87) | ||
| Postgraduate: Master or PhD | 110 (11.9%) | 22 (26.8%) | 19 (15.1%) | 16 (13.4%) | 19 (11.7%) | 17 (10.7%) | 17 (6.10%) | 2.89 (± 0.97) | ||
| cGPA | ||||||||||
| Below 2.00 | 29 (3.1%) | 2 (2.4%) | 3 (2.4%) | 1 (0.8%) | 2 (1.2%) | 5 (3.1%) | 16 (5.8%) | 3.75 (± 1.00) | ||
| 2.00–2.99 | 345 (37.3%) | 13 (15.9%) | 31 (24.6%) | 50 (42.0%) | 65 (40.1%) | 57 (35.8%) | 129 (46.6%) | 3.55 (± 0.88) | < 0.001 | 0.16 |
| 3.00–4.00 | 551 (59.6%) | 67 (81.7%) | 92 (73.0%) | 68 (57.1%) | 95 (58.6%) | 97 (61.0%) | 132 (47.7%) | 3.18 (± 0.98) | ||
| Fees payment method: self payer | ||||||||||
| No | 525 (56.8%) | 45 (54.9%) | 70 (55.6%) | 66 (55.5%) | 95 (58.6%) | 91 (57.2%) | 158 (57.0%) | 3.35 (± 0.97) | 0.90 | 0.02 |
| Yes | 400 (43.2%) | 37 (45.1%) | 56 (44.4%) | 53 (44.5%) | 67 (41.4%) | 68 (42.8%) | 119 (43.0%) | 3.33 (± 0.97) | ||
| Live with family during the study period | ||||||||||
| No | 227 (24.5%) | 21 (25.6%) | 30 (23.8%) | 31 (26.1%) | 43 (26.5%) | 43 (27.0%) | 59 (21.30%) | 3.28 (± 0.94) | 0.74 | 0.05 |
| Yes | 698 (75.5%) | 61 (74.4%) | 96 (76.2%) | 88 (73.9%) | 119 (73.5%) | 116 (73.0%) | 218 (78.7%) | 3.36 (± 0.98) | ||
| Working during the study (part-time) | ||||||||||
| No | 886 (95.8%) | 75 (91.5%) | 122 (96.8%) | 113 (95.0%) | 153 (94.4%) | 156 (98.1%) | 267 (96.4%) | 3.35 (± 0.96) | 0.19 | 0.09 |
| Yes | 39 (4.2%) | 7 (8.5%) | 4 (3.2%) | 6 (5.0%) | 9 (5.6%) | 3 (1.9%) | 10 (3.6%) | 3.09 (± 1.11) | ||
| Exercise (at least 30 min regularly) | ||||||||||
| No | 331 (35.8%) | 19 (23.2%) | 48 (38.1%) | 38 (31.9%) | 57 (35.2%) | 63 (39.6%) | 106 (38.3%) | 3.44 (± 0.93) | 0.17 | 0.09 |
| Sometimes | 411 (44.4%) | 37 (45.1%) | 56 (44.4%) | 56 (47.1%) | 71 (43.8%) | 74 (46.5%) | 117 (42.2%) | 3.31 (± 0.95) | ||
| Yes | 183 (19.8%) | 26 (31.7%) | 22 (17.5%) | 25 (21.0%) | 34 (21.0%) | 22 (13.8%) | 54 (19.5%) | 3.23 (± 1.06) | ||
| Study patterns | ||||||||||
| At weekends | 251 (27.1%) | 22 (26.8%) | 29 (23.0%) | 38 (31.9%) | 46 (28.4%) | 37 (23.3%) | 79 (28.5%) | 3.33 (± 0.93) | 0.16 | 0.08 |
| During the exam period | 252 (27.2%) | 24 (29.3%) | 36 (28.6%) | 39 (32.8%) | 37 (22.8%) | 39 (24.5%) | 77 (27.8%) | 3.33 (± 1.01) | ||
| Daily | 222 (45.7%) | 36 (43.9%) | 61 (48.4%) | 42 (35.2%) | 79 (48.8%) | 83 (52.2%) | 121 (43.7%) | 3.35 (± 0.97) | ||
| Smoking status | ||||||||||
| No | 860 (93.0%) | 74 (90.2%) | 120 (95.2%) | 112 (94.1%) | 152 (93.8%) | 148 (93.1%) | 254 (91.7%) | 3.34 (± 0.96) | 0.69 | 0.05 |
| Yes | 65 (7.0%) | 8 (9.8%) | 6 (4.8%) | 7 (5.9%) | 10 (6.2%) | 11 (6.9%) | 23 (8.3%) | 3.34 (± 1.05) | ||
*One-way Chi-square test.
**Foundation year is the first year in the College of Medicine and College of Dental edicine.
***Seiner students in three colleges: Medicine, Dentistry, and Pharmacy.
Significant values are in bold.
The average score of participants was 3.34 (± 0.97). The lowest average score for the WTAS was reported for postgraduate students 2.89 (± 0.97), while the highest score was for students with cGPA less than 2.00; 3.75 (± 1.00). The results showed that 277 participants (29.9%) had extremely high anxiety level, while only 82 participants (8.9%) had comfortably low test anxiety level. Female students had more anxiety than male students (3.38 ± 0.95 vs. 3.14 ± 1.00). Participants from first- and second-year reported higher test anxiety scores compared to students at other study levels and students with low cGPA had higher levels of test anxiety than others. In addition, students who were self-funded and students with a scholarship had higher levels of test anxiety than students who did not pay their fees or who did not have a scholarship. Four variables have statistically significant associations with the score for WTAS; they are Age, Gender, Year of study, and cGPA.
The results also demonstrate that students who lived with their families during study period had higher levels of test anxiety than students who did not live with their families (3.28 ± 0.94 vs. 3.36 ± 0.98); however, there was no statically significant relationship. When comparing smoking status, there was no difference between the two groups: smoker and non-smoker, with 3.34 scores for both groups. In addition, only (19.8%) of the participants exercise at least 30 min regularly, with no significant difference between the groups. Furthermore, there was no differences in studying pattern among the participants.
Figure 1 shows the test anxiety scores of both genders in the study according to their colleges. The results indicated some variations in mean scores of the test anxiety in other colleges. Generally, male students have less scores than female students, as male students in five colleges recorded mean scores less than 3.0 with no record of more than 3.5, while female students reported mean scores more than 3.5 in six colleges. However, there was no significant difference in the mean scores between the colleges.
Figure 1.
Test anxiety scores of male and female students according to their colleges.
Health and smoking status, and study patterns of the participants
Table 2 shows data related to health status, smoking status before and during the exam period, and study patterns of the participants. Some participants (18.1%) have at least one chronic disease. The highest chronic diseases were migraine (5.8%) and asthma (4.9%).
Table 2.
Health status, smoking status, and study patterns of the study participants (n = 925).
| n (%) | |
|---|---|
| Types of chronic diseases among the participants (n = 167)* | |
| Migraine | 54 (5.8%) |
| Asthma | 46 (4.9%) |
| Diabetes | 26 (2.8%) |
| Anxiety | 22 (2.4%) |
| Hypertension | 19 (2.1%) |
| Other chronic diseases and disorders: seizure, anemia, irritable bowel syndrome, depression, psychological disorders, and others | 50 (5.4%) |
| Smoke status | |
| Yes | 65 (7.0%) |
| Degree of smoking (n = 65) | |
| Light smoker | 35 (53.9%) |
| Moderate smoker | 10 (15.4%) |
| Heavy smoker | 12 (18.5%) |
| Unknown | 8 (12.3%) |
| Type of smoking** | |
| Cigarette | 9 (13.9%) |
| E-cigarette | 43 (66.2%) |
| Hookah (shisha) | 9 (13.9%) |
| Midwakh | 8 (12.3%) |
| More than one type of smoking | 4 (6.2%) |
*Many participants have more than one chronic disease.
**Several participants were dual users of nicotine products.
The prevalence of smoking among the participant was 7.0%, and e-cigarettes were most used device for smoking. More than half of smokers (61.5%) have increased smoking during exam periods.
Medications taken during the exam periods among the participants
Table 3 shows medications used (with or without prescription) among the participants at the exam period. The results indicated that 53 participants (5.7%) had used at least one medication during the written and/or oral exam period. Among the participants who used medication, the most used drug was propranolol (37.7%), and the usual dose used was 40 mg and less (65.0%). The other used medications among the participants were non-prescribe medications such as medications to treat GIT disturbance and analgesics (18.9%). More than half of the participants (56.6%) took medications usually before the exam period and presentation time, and they reported that the medication helped them to reduce their anxiety (71.1%). More than a third of the students (40.0%) took the medications based on doctor prescriptions, and the second sources was family and colleagues (30%). The participants’ awareness of the complications was reported by 49.1% of the participants.
Table 3.
Medications used with or without prescription during the exam period among the participants (n = 53).
| N (%) | |
|---|---|
| Medications used: with or without prescription | |
| Prescribed medication | 43 (81.1%) |
| Non-prescribed medication | 10 (18.9%) |
| Period of using the medications | |
| Less than 1 year | 18 (34.0%) |
| More than 1 year | 35 (66.0%) |
| Source of information about the medication | |
| Doctor (by prescription) | 25 (47.2%) |
| College colleagues, friends and/or family | 18 (34.0%) |
| Internet and social media | 5 (9.4%) |
| Pharmacist (without prescription) | 5 (9.4%) |
| Propranolol (Inderal®) was used and doses (n = 20) | |
| Less than 20 mg | 5 (25.0%) |
| 20 mg | 3 (15.0%) |
| 40 mg | 5 (25.0%) |
| 80 mg | 2 (10.0%) |
| I do not remember/know the dose | 3 (15.0%) |
| I used various doses | 2 (10.0%) |
| Source of obtaining propranolol (n = 20) | |
| By prescription | 8 (40.0%) |
| From college colleagues, friends, and/or family | 6 (30.0%) |
| From the pharmacy directly (without prescription) | 6 (30.0%) |
| Situations used the medication | |
| Oral presentation or exam | 9 (17.0%) |
| Written exam | 14 (26.4%) |
| Both | 30 (56.6%) |
| Effectiveness of the medication based on participants’ opinion | |
| Yes | 38 (71.7%) |
| No | 15 (28.3%) |
| Awareness of the possible complications of using the medication | |
| No | 26 (49.1%) |
| Experienced side effects of using the propranolol* (n = 20) | |
| Low blood pressure | 9 (30.0%) |
| Shortness of breath | 12 (40.0%) |
| Fatigue | 17 (56.7%) |
| Dizziness | 8 (26.7%) |
| Fainting | 6 (20.0%) |
*Some participants reported more than one side effect when using the medication.
Coping strategies of the participants to test anxiety
The majority of the participants (87.9%) dealt with at least one method to cope with their test anxiety. In addition, most of them have used more than one coping strategy (71.9%). The three common non-pharmacological coping methods used were praying (58.3%), reducing the sleeping time during the exam period (40.3%), and consuming more caffeine beverages (36.0%). In addition, most smoker participants (61.5%) reported increasing nicotine consumption during the exam period. Table 4 shows coping methods to deal with test anxiety among the participants (n = 925).
Table 4.
Coping methods to deal with test anxiety among the participants (n = 925).
| n (%) | Level of anxiety [Categories for test anxiety] | p value | Cramers V | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Comfortably low n (%) |
Normal n (%) |
High normal n (%) |
Moderately high n (%) |
High n (%) | Extremely high n (%) | The average score of test anxiety (± SD) | ||||||
| Coping strategy* | ||||||||||||
| No | 112 (12.1%) | 15 (13.4%) | 15 (13.4%) | 17 (15.2%) | 16 (14.3%) | 15 (13.4%) | 34 (30.4%) | 3.23 (± 1.04) | 0.34 | 0.04 | ||
| Yes | 813 (87.9%) | 67 (8.2%) | 87 (10.7%) | 126 (15.5%) | 146 (18.0%) | 144 (17.7%) | 243 (29.9%) | 3.36 (± 0.94) | ||||
| Pray | ||||||||||||
| No | 386 (41.7%) | 41 (50.0%) | 49 (38.9%) | 43 (36.1%) | 67 (41.4%) | 59 (37.1%) | 127 (45.8%) | 3.34 (± 1.01) | 0.18 | 0.09 | ||
| Yes | 539 (58.3%) | 41 (50.0%) | 77 (61.1%) | 76 (63.9%) | 95 (58.6%) | 100 (62.9%) | 150 (54.2%) | 3.34 (± 0.93) | ||||
| Relaxation and meditation | ||||||||||||
| No | 671 (72.5%) | 45 (54.9%) | 90 (71.4%) | 83 (69.7%) | 117 (72.2%) | 113 (71.1%) | 223 (80.5%) | 3.42 (± 0.94) | < 0.001 | 0.16 | ||
| Yes | 254 (27.5%) | 37 (45.1%) | 36 (28.6%) | 36 (30.3%) | 45 (27.8%) | 46 (28.9%) | 54 (19.5%) | 3.12 (± 1.00) | ||||
| Less sleep on the night of the exam than the usual day | ||||||||||||
| No | 552 (59.7%) | 65 (79.3%) | 78 (61.9%) | 79 (66.4%) | 91 (56.2%) | 92 (57.9%) | 147 (53.1%) | 3.23 (± 0.99) | < 0.001 | 0.15 | ||
| Yes | 373 (40.3%) | 17 (20.7%) | 48 (38.1%) | 40 (33.6%) | 71 (43.8%) | 67 (42.1%) | 130 (46.9%) | 3.51 (± 0.90) | ||||
| Talk with others: family members and/or friends | ||||||||||||
| No | 639 (69.1%) | 58 (70.7%) | 87 (69.0%) | 71 (59.7%) | 112 (69.1%) | 103 (64.8%) | 208 (75.1%) | 3.37 (± 0.99) | 0.049 | 0.11 | ||
| Yes | 286 (30.9%) | 24 (29.3%) | 39 (31.0%) | 48 (40.3%) | 50 (30.9%) | 56 (35.2%) | 69 (24.9%) | 3.26 (± 0.90) | ||||
| Change my sleep pattern from night to any time during the day | ||||||||||||
| No | 816 (88.2%) | 75 (91.5%) | 117 (92.9%) | 107 (89.9%) | 147 (90.7%) | 137 (86.2%) | 233 (84.1%) | 3.30 (± 0.97) | 0.072 | 0.1 | ||
| Yes | 109 (11.8%) | 7 (8.5%) | 9 (7.1%) | 12 (10.1%) | 15 (9.3%) | 22 (13.8%) | 44 (15.9%) | 3.61 (± 0.93) | ||||
| Drink more caffeine (tea and/or coffee) | ||||||||||||
| No | 592 (64.0%) | 61 (74.4%) | 91 (72.2%) | 86 (72.3%) | 103 (63.6%) | 95 (59.7%) | 156 (56.3%) | 3.24 (± 0.97) | 0.002 | 0.14 | ||
| Yes | 333 (36.0%) | 21 (25.6%) | 35 (27.8%) | 33 (27.7%) | 59 (36.4%) | 64 (40.3%) | 121 (43.7%) | 3.52 (± 0.94) | ||||
| More sleep on the night of the exam than the usual day | ||||||||||||
| No | 818 (88.4%) | 71 (86.6%) | 113 (89.7%) | 105 (88.2%) | 142 (87.7%) | 143 (89.9%) | 244 (88.1%) | 3.34 (± 0.97) | 0.96 | 0.03 | ||
| Yes | 107 (11.6%) | 11 (13.4%) | 13 (10.3%) | 14 (11.8%) | 20 (12.3%) | 16 (10.1%) | 33 (11.9%) | 3.32 (± 0.98) | ||||
| Energy drink | ||||||||||||
| No | 803 (86.8%) | 77 (93.9%) | 118 (93.7%) | 109 (91.6%) | 143 (88.3%) | 131 (82.4%) | 225 (81.2%) | 3.29 (± 0.97) | 0.001 | 0.15 | ||
| Yes | 122 (13.2%) | 5 (6.1%) | 8 (6.3%) | 10 (8.4%) | 19 (11.7%) | 28 (17.6%) | 52 (18.8%) | 3.66 (± 0.86) | ||||
| Herbal product | ||||||||||||
| No | 864 (93.4%) | 76 (92.7%) | 119 (94.4%) | 110 (92.4%) | 150 (92.6%) | 152 (95.6%) | 257 (92.8%) | 3.34 (± 0.96) | 0.84 | 0.04 | ||
| Yes | 61 (6.6%) | 6 (7.3%) | 7 (5.6%) | 9 (7.6%) | 12 (7.4%) | 7 (4.4%) | 20 (7.2%) | 3.36 (± 1.04) | ||||
| Increased in nicotine consumption (increased in number of cigarettes or smoking times) (n = 65) | ||||||||||||
| No | 25 (38.5%) | 5 (20.0%) | 4 (16.0%) | 2 (8.0%) | 6 (24.0%) | 3 (12.0%) | 5 (20.0%) | 2.96 (± 1.10) | 0.09 | 0.07 | ||
| Yes | 40 (61.5%) | 3 (7.5%) | 2 (5.0%) | 5 (12.5%) | 4 (10.0%) | 8 (20.0%) | 18 (45.0%) | 3.62 (± 0.89) | ||||
| Taking medication (with or without a prescription) related to test anxiety | ||||||||||||
| No | 872 (94.3%) | 79 (96.3%) | 121 (96.0%) | 113 (95.0%) | 158 (97.5%) | 147 (92.5%) | 254 (91.7%) | 3.32 (± 0.96) | 0.1 | 0.05 | ||
| Yes | 53 (5.7%) | 3 (3.7%) | 5 (4.0%) | 6 (5.0%) | 4 (2.5%) | 12 (9.5%) | 23 (8.3%) | 3.69 (± 1.03) | ||||
| Type of medication (n = 53) | ||||||||||||
| Propranolol | 20 (37.7%) | 1 (5.0%) | 2 (10.0%) | 4 (20.0%) | 0 | 2 (10.0%) | 11 (55.0%) | 3.77 (± 1.12) | NA | NA | ||
| Other prescribed medication | 17 (32.1%) | 2 (11.8%) | 1 (5.9%) | 3 (17.6%) | 1 (5.9%) | 4 (23.5%) | 6 (35.3%) | 3.46 (± 1.17) | ||||
| Prescribed and non-prescribed medications | 6 (11.3%) | 0 | 0 | 0 | 1 (16.7%) | 2 (33.3%) | 3 (50.0%) | 3.97 (± 0.61) | ||||
| Non-prescribed medication | 10 (18.9%) | 0 | 1 (10.0%) | 0 | 2 (20.0%) | 4 (40.0%) | 3 (30.0%) | 3.78 (± 0.83) | ||||
*Most participants have more than one method of coping with test anxiety.
**Participants used medications with a prescription, in addition to non-prescribed medications (OTC).
Significant values are in bold.
Five methods that have a statistically significant association with the score for WTAS. Out of these methods, three methods were linked to higher test anxiety scores among the participants who applied compared with people who did not use these methods. These methods are reducing sleeping time during the exam period, consuming more caffeine beverages, and rising energy drink consumption. On the other hand, the participants who applied the remaining two methods; relaxation and meditation, and engaging in chatting with friends and family, reported lower test anxiety scores compared to those who did not utilize these methods.
Post hoc analysis
Tables 1 and 4 present the statistically significant associations between various variables and the WTAS score. The variables demonstrating the strongest associations were cGPA (Cramers V = 0.16, p < 0.001) and practicing relaxation and meditation (Cramers V = 0.16, p < 0.001). Additionally, sleep on the night before the exam and using energy drinks showed significant associations with coefficients of 0.15 and p < 0.001 for both variables. Following closely were gender, year of study, and caffeine consumption with coefficients of 0.14 and p = 0.001, p < 0.001, and p = 0.002, respectively. The weakest association was observed with age (Cramers V = 0.09, p = 0.042).
Table 5 illustrates further post hoc analysis for variables that demonstrated statistically significant association with WTAS score. Significantly observed frequencies more than expected (i.e. positive ASR > 3) were recorded low WTAS scores for the following categories: older than 32 years, males, postgraduate students, and students with high cGPA (between 3.00 and 4.00), those who do relaxation and meditation and do not experience less sleep at the night of exam. So those categories would need less awareness and support programs. On the other hand, different other categories that would be in crucial need to support programs as they recorded fewer observed frequencies of low WTAS scores than expected (i.e. negative ASR, absolute value > 3). These include individuals under 20 years old, females, those with a cGPA between 2.00 and 2.99, those who do not engage in relaxation meditation methods, and those who experience less sleep at the night of exam.
Table 5.
Post hoc analysis of the variables and test anxiety levels.
| Variables | Categories/adjusted standardized residuals | Level of anxiety [Categories for test anxiety] | |||||
|---|---|---|---|---|---|---|---|
| Low | Normal | High normal | Moderately high | High | Extremely high | ||
| Age (years) | < 20 | − 3.6 | 0.5 | − 0.1 | 0 | − 0.2 | 2.1 |
| 20–23 | 0.3 | − 0.4 | 1.3 | 0.4 | 0.4 | − 1.4 | |
| 24–27 | 2 | − 0.2 | − 1.2 | 0 | 0.4 | − 0.5 | |
| 28–31 | 2.5 | − 0.7 | − 0.6 | − 0.1 | 0.4 | − 0.8 | |
| ≥ 32 | 3.1 | 0.7 | − 0.6 | − 0.9 | − 1.2 | − 0.3 | |
| Gender | Female | − 4.3 | 1.2 | − 0.2 | 0.4 | 0.3 | 1.4 |
| Male | 4.3 | − 1.2 | 0.2 | − 0.4 | − 0.3 | − 1.4 | |
| Year of Study | Fifth-year | − 0.5 | 0.9 | 1.9 | − 0.7 | 1.2 | − 2.1 |
| First-year/foundation year/second-year | − 2.7 | − 1.1 | − 0.6 | − 0.1 | 1.6 | 1.7 | |
| Postgraduate students: Master or PhD) | 4.4 | 1.2 | 0.6 | − 0.1 | − 0.5 | − 3.5 | |
| Third-year/fourth-year | 0.1 | − 0.1 | − 0.7 | 0.5 | − 1.9 | 1.6 | |
| cGPA | 2.00–2.99 | − 4.2 | − 3.2 | 1.1 | 0.8 | − 0.4 | 3.8 |
| 3.00–4.00 | 4.3 | 3.3 | − 0.6 | − 0.3 | 0.4 | − 4.8 | |
| Below 2.00 | − 0.4 | − 0.5 | − 1.5 | − 1.5 | 0 | 3 | |
| Relaxation and/or meditation | No | − 3.8 | − 0.3 | − 0.7 | − 0.1 | − 0.5 | 3.5 |
| Yes | 3.8 | 0.3 | 0.7 | 0.1 | 0.5 | − 3.5 | |
| Less sleep on the night of the exam than the usual day | No | 3.8 | 0.5 | 1.6 | − 1 | − 0.5 | − 2.7 |
| Yes | − 3.8 | − 0.5 | − 1.6 | 1 | 0.5 | 2.7 | |
| Talk with others: family members and/or friends | No | 0.3 | 0 | − 2.4 | 0 | − 1.3 | 2.6 |
| Yes | − 0.3 | 0 | 2.4 | 0 | 1.3 | − 2.6 | |
| Drink more caffeine (tea and/or coffee) | No | 2.1 | 2.1 | 2 | − 0.1 | − 1.2 | − 3.2 |
| Yes | − 2.1 | − 2.1 | − 2 | 0.1 | 1.2 | 3.2 | |
| Having energy drink | No | 2 | 2.4 | 1.7 | 0.6 | − 1.8 | − 3.3 |
| Yes | − 2 | − 2.4 | − 1.7 | − 0.6 | 1.8 | 3.3 | |
Discussion
The prevalence of test anxiety and levels of anxiety among university students and its possible associated factors were evaluated in the current study. A total of 925 students from 14 colleges, especially females, participated in the study. The level of test anxiety among the participants was moderately high. There are several variables: young age, female gender, early years of undergraduate studies, and low cGPA, which have significant associations with increased scores of test anxiety among the participants. Some methods of coping with test anxiety among participants showed either negative or positive association with test anxiety scores. Many other variables reported in published studies as factors influence the high level of test anxiety, such as study field, using medication to relieve test anxiety, and smoking status6, have no significant associations with test anxiety level in this study.
In terms of age, the highest percentage of participants with high anxiety levels was found in the younger students (less than 20 years). Several reasons behind increased test anxiety level among university students in their early years of college as they experience the stress of adapting to a new environment, adjusting to a new identity as a university student, and learning to transition from adolescence to adulthood, in addition to changes from secondary schools learning mode to different education and assessment styles at the university6,22. In addition, the impact of the global pandemic during the past 3 years on rapid change in the way of learning, including assessment methods. Most of the young students studied online for at least one year, which raised general anxiety among the students and impacted on their university and social life23–26. The test anxiety scores typically decrease as the study progresses, which was apparent in this study as students of higher ages and years of study reported lower anxiety scores. However, the score of test anxiety was in the moderately high category. This also may explain the association between recorded high test anxiety scores and year of study, as junior students significantly higher anxiety levels as compared to their senior counterparts. The current data also revealed that test anxiety levels varied across different years of study, as the first-year (foundation year)/second-year students had extremely high anxiety levels. This implies that the progression through academic years may influence anxiety levels, with early years of study being associated with higher anxiety. There is a similarity with other published studies that used WTAS as a tool to measure the anxiety level or used another test. A study published by Tsegay et al. 2019 reported that being in the first year of university was one of the predicting factors of test anxiety among medical students11. This was also reported by Bhatta et al. 2020 study as a year of study was a significant factor in test anxiety difference, but with no effect on participants’ age27. Finally, it is also important to note that the results indicated that graduate students scored lower on test anxiety than other groups.
When considering gender, the data indicated that females had higher anxiety levels than males. This finding suggests that gender might play a role in the experience of anxiety, with females being more susceptible to higher anxiety levels. In addition, these finding is consistent with published studies that included female gender as a factor in the level of test anxiety6,11,28–30.
The findings also demonstrated that participants with a lower cGPA (below 2.00) had higher proportions of high and extremely high anxiety levels than those with a higher cGPA (3.00–4.00). This suggests that academic performance, as indicated by cGPA, may impact anxiety levels, with lower academic performance associated with the higher anxiety level. This finding is similar to several published studies that indicated the cGPA might be a primary predictor for high test anxiety11,31,32.
Regarding coping strategies with the test anxiety, two methods significantly reduce test anxiety scores: relaxation and meditation, and chatting with family members and/or friends during the exam period. The positive effect of practicing the first method on test anxiety levels was proved in several studies33,34. The second method also has a role in reducing test anxiety. Many studies have supported the impact of this method on reducing test anxiety scores, similar to the results of the current study6,11.
On the other hand, three coping approaches negatively impact the test anxiety level through raising the scores among the participants who applied any of them during the exam period. These methods include less sleep on the night of the exam, drinking more caffeinated beverages, and consuming more energy drinks during the exam period. Sleep quality and duration are primary reasons of increased stress and anxiety among students35. However, students can go far with this approach for further study on the night of the exam36. In addition, consuming more caffeine and energy drinks can also reduce sleep quality, which will end in high test anxiety among the students37–39.
Furthermore, the results indicated that a small percentage of the students used at least one medication to relieve anxiety symptoms before and during the exam period, but there was no significant association with the level of test anxiety; however, the mean scores of test anxiety of the participants who used the medication was higher than scores of students with no-medication. Some of these students used non-selective Beta-blocker based on non-medical recommendations. This rate was relatively low compared to many published studies among medical and health students in neighbouring country3,17–19,40. Nevertheless, the use of these medications was higher among female students, probably because female students experienced more peer pressure and anxiety than males. Furthermore, the use of medications to reduce or manage symptoms of test anxiety among medical students was higher than that in non-medical students. This may be due to lower self-medication among people in the UAE, specifically among students, compared with many other countries41,42.
For smoking students, the test anxiety score was almost the same as for non-smokers; however, around two third of the smoker participants have increased their nicotine consumption as a coping approach during the exam period. The prevalence of smoking in the study was small, but most of them used electronic cigarettes as a source of nicotine, and this type of smoking increased during the last few years in the UAE43,44. Furthermore, it was reported that electronic cigarette smoking was the most common type among all participants, with more common among females. As nicotine is the main content found in tobacco products (cigarettes and hookah) and electronic cigarettes have been found to have an anti-anxiety effect, albeit limited to acute stressors. Research suggests that nicotine can temporarily reduce anxiety and stress when administered in controlled doses45.
Our study has a few limitations that need consideration. Firstly, since we conducted the research in the largest university in the UAE which has the largest number of students and number of colleges and programs, the applicability of our findings may be restricted to other universities in the country. This narrow focus could affect the extent to which our findings can be applied in different settings. Secondly, using a questionnaire with pre-defined questions limits our understanding of participants’ beliefs and thoughts Furthermore, the structured nature of the questions may not capture the full complexity of the participants’ views, as well as it may inadvertently curtail the opportunity for participants to share additional insights, experiences, or perspectives that are important to them. To mitigate this constraint, future research efforts might consider incorporating more open-ended questions or qualitative methods, allowing for a richer and more nuanced exploration of participants’ beliefs and thoughts. Third, relying on an online self-administered questionnaire runs the risk of response bias, as results depend heavily on students’ self-evaluations. Lastly, the study used a non-randomized sampling technique, which might introduce bias and restrict the generalizability of our findings to the wider student population. To address these limitations, future research could adopt a more diverse sampling strategy, include qualitative methods for deeper insights, and explore mixed-methods approaches for a comprehensive understanding. Additionally, involving a broader range of educational institutions would enhance the external validity of the research.
To conclude, the study investigated the prevalence of anxiety and anxiety-related factors among university students. The results showed that a moderately high level of anxiety was reported and that specific subgroups, such as female students, first- and second-year students, and those with low cGPA, reported higher anxiety levels. Interestingly, most participants used multiple coping methods to deal with their anxiety. The practical two methods relied on social support and providing some time for mental self-care through relaxation.
These findings underscore the need for targeted interventions and support services to address issues related to test anxiety among university students, particularly within high-risk subgroups. Future research should focus on practicing the most effective interventions for reducing test anxiety among university students, and raise awareness among the students.
Method
Study design
A cross-sectional study was conducted using an anonymous online survey to collect data on test anxiety levels and coping strategies among current undergraduate and postgraduate students at the University of Sharjah, United Arab Emirates (UAE), who were 18 years of age and older. Graduates and students in non-degree programs at the university were excluded.
All participants agreed to participate in the study by selecting “I agree” on the electronic informed consent form before completing the questionnaire.
This study was approved by the Research Ethics Committee (REC) at the University of Sharjah, UAE (REC-22-10-30-02-S). Informed consent was obtained from every participant before participation. All methods were performed in accordance with the REC guideline. All methods have been performed in accordance with the declaration of Helsinki.
Survey development, validation, and piloting
An electronic questionnaire was designed using Google Forms. The questionnaire was self-administered and required approximately 10-min to be completed. The survey has been developed using the general principles of good survey design46. Participants filled it out without the help of researchers to avoid any potential influence when answering the questions. The survey was conducted in both Arabic and English. The Arabic-translated version of the questionnaire was used and validated by 3-biligual linguistics using forward and backward translation technique to be suitable for researching the Arabic students47.
The primary investigator invited five academic faculty members (two health academic members and three non-health academic members) as well as six students, from health and non-health colleges for a virtual meeting. The purpose of the meeting was to validate the content of the study questionnaire. Each invitee was asked to evaluate every item in the questionnaire using a scale of one to ten. The evaluation criteria included relevance, clarity, appropriateness, question length, and the time required to complete the questionnaire. The average scores (± SD) for relevance, clarity, question length, appropriateness, and time required were 8.3 (± 1.6), 8.5 (± 1.4), 8.7 (± 1.3), 9.1 (± 0.6), and 8.2 (± 1.5), respectively.
To ensure the reliability of the study questionnaire, the research team carefully considered the suggestions for modifications and amendments provided by the invitees. Subsequently, a pilot test was conducted using the validated version of the questionnaire. The pilot test involved 20 participants who were instructed to complete the survey and identify any questions or wording that could potentially hinder their understanding of the questionnaire. The responses obtained were imported into IBM SPSS Statistics version 27 (IBM Corp, Armonk, NY), and the internal consistency of the questionnaire items was calculated.
The survey consists of four sections in addition to a consent form: sociodemographic and health data of the participants, coping methods with exam, medication used to reduce exam fear and anxiety, and the Westside Test Anxiety Scale (WTAS)48.
Study population and period of study
A survey was sent via email to all students enrolled in the Fall semester of the academic year 2022/2023 (from the 15th to the end of November 2022) at the University of Sharjah49. The students were from 14 colleges (from more than 100 academic programs): Arts, Humanities and Social Sciences, Business Administration, Communication, Computing and Informatics, Engineering, Fine Arts and Design, Law, Sciences, Sharia and Islamic Studies, Health Sciences, Dental Medicine; Medicine, and Pharmacy, as well as postgraduate students at the Graduate College.
Test anxiety
The Westside Test Anxiety Scale (WTAS) is a short, 10-item assessment created by Richard Driscoll48. It is used to identify students who may benefit from an intervention to reduce test anxiety. The scale components address self-reported anxiety impairment and performance-impairing concerns. The WTAS asks respondents how frequently they feel anxious before, during, and after exams. A total test anxiety score ranging from 10 to 50 points is produced by scoring each statement response on a 5-point Likert scale. The following six categories for test anxiety are determined by the WTAS score:
Comfortably low test anxiety (score between 1.0 and 1.9).
Normal or average test anxiety (score between 2.0 and 2.4).
High normal test anxiety (score between 2.5 and 2.9).
Moderately high test anxiety (score between 3.0 and 3.4).
High test anxiety (score between 3.5 and 3.9).
Extremely high test anxiety (score between 4.0 and 5.0).
Sample size calculation
University students were selected using convenience sampling method. The Raosoft® software sample size calculator was used to estimate the target sample size50. The calculation was performed for the smallest sample size required for a population of any size. Based on a confidence interval of 95%, a standard deviation of 0.5, and a margin of error of 5%, the minimum required sample size is 384 participants. To include a more representative sample, the authors decided to have a final sample size of 925 participants,
Study data analysis
Study data were analysed using the 27th version of the statistical package for the Social Science (SPSS®). The frequencies, percentages and mean (± SD), were used for continuous and categorical variables respectively. Statistical analyses that carried out were chi-squared test, the Cramer’s V coefficients, and the post hoc analysis, which illustrated the values for adjusted standardized residuals. For all tests in the present study, a p-value of < 0.05 indicates a statistically significant difference. The chi-squared test (X2) for association was used to explore the association between variables and the WTAS (Fisher’s exact test was used in cases where the expected count was less than 5).
For a better understanding of the relationships, the strength of the association was calculated by Cramer’s V coefficient. A strength of association value of 1 indicating complete association, “0” indicates no association, > 0.25 indicates a very strong relationship, > 0.15 indicates a strong relationship, > 0.1 indicates a moderate relationship, and > 0.05 indicating a weak relationship. Furthermore, the strength of association between variables and WTAS score can be ranked and compared based on the value of Cramer's V coefficient51. To further interpret the association between categories of the variables and the WTAS score, Post hoc analysis was carried out to inform which category (or categories) contributed to the significance relationship, i.e., the categories that are mostly responsible for the significant association. Accordingly, the adjusted standardized residuals (ASR) were used to make a cell-by-cell comparison of the expected versus observed frequencies as recommended by agrestic52. The larger the ASR the further the observed frequency is from its expected frequency. If an ASR is positive, it indicates more observed frequencies than expected frequencies. If an ASR is negative, it indicates that there are fewer observed frequencies than expected frequencies. For the present study, category results were highlighted if the absolute ASR values were greater than 3.
Supplementary Information
Author contributions
All authors participated in the study. Conceptualization: FJ, HA, AA, RA, YH, and KA, Methodology: FJ, HA, AA, RA, YH, YA, and ZK, Data curation: FJ, and MO, writing—original draft preparation all authors, Writing—review and editing: KA, YA, HA, and FJ. All authors have read and agreed to the published version of the manuscript.
Data availability
The raw data is provided in the Supplementary Information file.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
The online version contains supplementary material available at 10.1038/s41598-024-59739-4.
References
- 1.Anxiety and Depression Association of America. Tips and Strategies to Manage Anxiety and Stress. https://adaa.org/tips (2023).
- 2.Steinmayr, R., Crede, J., McElvany, N. & Wirthwein, L. Subjective well-being, test anxiety, academic achievement: Testing for reciprocal effects. Front. Psychol.6, 1994. 10.3389/fpsyg.2015.01994 (2016). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Alsini, A. et al. A National survey of self-prescription of beta-blockers and their relation to undiscovered anxiety among medical and pharmacological students in Saudi Arabia. Neuropsychiatr. Dis. Treat.17, 797–807. 10.2147/NDT.S289833 (2021). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Li, W., Zhao, Z., Chen, D., Peng, Y. & Lu, Z. Prevalence and associated factors of depression and anxiety symptoms among college students: A systematic review and meta-analysis. J. Child Psychol. Psychiatry63(11), 1222–1230. 10.1111/jcpp.13606 (2022). [DOI] [PubMed] [Google Scholar]
- 5.Liyanage, S. et al. Prevalence of anxiety in university students during the COVID-19 pandemic: A systematic review. Int. J. Environ. Res. Public Health19(1), 62. 10.3390/ijerph19010062 (2021). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Mofatteh, M. Risk factors associated with stress, anxiety, and depression among university undergraduate students. AIMS Public Health8(1), 36–65. 10.3934/publichealth.2021004 (2020). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.The learning Center at University of North Carolina at Chapel Hill. Test Anxiety. https://learningcenter.unc.edu/tips-and-tools/tackling-test-anxiety/ (2023).
- 8.Zheng, G., Zhang, Q. & Ran, G. The association between academic stress and test anxiety in college students: The mediating role of regulatory emotional self-efficacy and the moderating role of parental expectations. Front. Psychol.14, 1008679. 10.3389/fpsyg.2023.1008679 (2023). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Zwettler, C. et al. The relation between social identity and test anxiety in university students. Health Psychol. Open5(2), 2055102918785415. 10.1177/2055102918785415 (2018). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Khater, W., Akhu-Zaheya, L. & Shaban, I. Sources of stress and coping behaviours in clinical practice among baccalaureate nursing students. Int. J. Hum. Soc. Sci.4(6), 194–202 (2014). [Google Scholar]
- 11.Tsegay, L., Shumet, S., Damene, W., Gebreegziabhier, G. & Ayano, G. Prevalence and determinants of test anxiety among medical students in Addis Ababa Ethiopia. BMC Med. Educ.19, 423. 10.1186/s12909-019-1859-5 (2019). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Hanfesa, S., Tilahun, T., Dessie, N., Shumet, S. & Salelew, E. Test anxiety and associated factors among first-year health science students of university of Gondar, Northwest Ethiopia: A cross-sectional study. Adv. Med. Educ. Pract.11, 817–824. 10.2147/AMEP.S275490 (2020). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Chapell, M. S. et al. Test anxiety and academic performance in undergraduate and graduate students. J. Educ. Psychol.97(2), 268 (2005). [Google Scholar]
- 14.Bembenutty, H. Academic delay of gratification, self-efficacy, and time management among academically unprepared college students. Psychol. Rep.104(2), 613–623. 10.2466/pr0.104.2.613-623 (2009). [DOI] [PubMed] [Google Scholar]
- 15.Ramón-Arbués, E. et al. The prevalence of depression, anxiety and stress and their associated factors in college students. Int. J. Environ. Res. Public Health17(19), 7001. 10.3390/ijerph17197001 (2020). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Iqbal, S., Gupta, S. & Venkatarao, E. Stress, anxiety and depression among medical undergraduate students and their socio-demographic correlates. Indian J. Med. Res.141(3), 354–357. 10.4103/0971-5916.156571 (2015). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Al-Mohrej, O. et al. Prevalence of self-prescribing propranolol among medical and dental students in Riyadh, Saudi Arabia: A cross-sectional study. Health Profess. Educ.4(1), 16–26. 10.1016/j.hpe.2016.10.001 (2018). [Google Scholar]
- 18.Abukhalaf, A. A. et al. Inappropriate use of beta-blockers among medical and dental students at King Saud University, Riyadh. J Fam. Med. Prim. Care9(8), 4391–4395 (2020). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Alkhatabi, R., Alowfi, J., Arshad, L. & Khan, M. A. The prevalence of beta-blocker use among medical students at King Saud bin Abdulaziz university for health sciences in Jeddah, Saudi Arabia: A cross-sectional study. Cureus12(11), e11450. 10.7759/cureus.11450 (2020). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Saddik, B. et al. Increased levels of anxiety among medical and non-medical university students during the COVID-19 pandemic in the United Arab Emirates. Risk Manag. Healthc. Policy13, 2395–2406. 10.2147/RMHP.S273333 (2020). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Bhurtun, H. D., Turunen, H., Estola, M. & Saaranen, T. Changes in stress levels and coping strategies among Finnish nursing students. Nurse Educ. Pract.50, 102958. 10.1016/j.nepr.2020.102958 (2021). [DOI] [PubMed] [Google Scholar]
- 22.Ladejo, J. A thematic analysis of the reported effect anxiety has on university students. Educ. Urban Soc.55(3), 289–313. 10.1177/00131245211062512 (2023). [Google Scholar]
- 23.Alzubaidi, H. et al. A global assessment of distance pharmacy education amid COVID-19: Teaching, assessment and experiential training. Int. J. Pharm. Pract.29(6), 633–641. 10.1093/ijpp/riab064 (2021). [DOI] [PubMed] [Google Scholar]
- 24.Azmi, F. M., Khan, H. N. & Azmi, A. M. The impact of virtual learning on students’ educational behavior and pervasiveness of depression among university students due to the COVID-19 pandemic. Glob. Health18, 70. 10.1186/s12992-022-00863-z (2022). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Pelucio, L. et al. Depression and anxiety among online learning students during the COVID-19 pandemic: A cross-sectional survey in Rio de Janeiro, Brazil. BMC Psychol.10, 192. 10.1186/s40359-022-00897-3 (2022). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Xu, T. & Wang, H. High prevalence of anxiety, depression, and stress among remote learning students during the COVID-19 pandemic: Evidence from a meta-analysis. Front. Psychol.13, 1103925. 10.3389/fpsyg.2022.1103925 (2023). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Bhatta, K. & Rai, B. Test anxiety and demographic variables affecting academic achievement among undergraduate psychology students. Int. J. Educ. Manag. Stud.10(3), 218–222 (2020). [Google Scholar]
- 28.Shamsuddin, K. et al. Correlates of depression, anxiety and stress among Malaysian university students. Asian J. Psychiatr.6(4), 318–323. 10.1016/j.ajp.2013.01.014 (2013). [DOI] [PubMed] [Google Scholar]
- 29.Núñez-Peñaa, M. A., Suárez-Pellicionic, M. & Bono, R. Gender differences in test anxiety and their impact on higher education students’ academic achievement. Procedia Soc. Behav. Sci.228, 154–160 (2016). [Google Scholar]
- 30.Khoshhal, K. I., Khairy, G. A., Guraya, S. Y. & Guraya, S. S. Exam anxiety in the undergraduate medical students of Taibah University. Med. Teach.39(sup1), S22–S26. 10.1080/0142159X.2016.1254749 (2017). [DOI] [PubMed] [Google Scholar]
- 31.Balogun, A. G., Balogun, S. K. & Onyencho, C. V. Test anxiety and academic performance among undergraduates: The moderating role of achievement motivation. Span. J. Psychol.20, E14. 10.1017/sjp.2017.5 (2017). [DOI] [PubMed] [Google Scholar]
- 32.Alamri, A. & Nazir, M. A. Test anxiety and related factors among health professions students: A Saudi Arabian perspective. Behav. Sci.12(4), 98. 10.3390/bs12040098 (2022). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Regehr, C., Glancy, D. & Pitts, A. Interventions to reduce stress in university students: A review and meta-analysis. J. Affect. Disord.148(1), 1–11. 10.1016/j.jad.2012.11.026 (2013). [DOI] [PubMed] [Google Scholar]
- 34.Lothes, E., Matney, S., Naseer, Z. & Pfyffer, R. Sitting meditation and mindfulness effects on overall anxiety and test anxiety among college students. Mind Brain Educ.17, 61–69. 10.1111/mbe.12344 (2023). [Google Scholar]
- 35.Almojali, A. I., Almalki, S. A., Alothman, A. S., Masuadi, E. M. & Alaqeel, M. K. The prevalence and association of stress with sleep quality among medical students. J. Epidemiol. Glob. Health7(3), 169–174. 10.1016/j.jegh.2017.04.005 (2017). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Alotaibi, A. D., Alosaimi, F. M., Alajlan, A. A. & Bin Abdulrahman, K. A. The relationship between sleep quality, stress, and academic performance among medical students. J. Fam. Community Med.27(1), 23–28. 10.4103/jfcm.JFCM_132_19 (2020). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Park, S., Lee, Y. & Lee, J. H. Association between energy drink intake, sleep, stress, and suicidality in Korean adolescents: Energy drink use in isolation or in combination with junk food consumption. Nutr. J.15, 87. 10.1186/s12937-016-0204-7 (2016). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Pettit, M. L. & DeBarr, K. A. Perceived stress, energy drink consumption, and academic performance among college students. J. Am. Coll. Health59(5), 335–341. 10.1080/07448481.2010.510163 (2011). [DOI] [PubMed] [Google Scholar]
- 39.Bertasi, R. A. O. et al. Caffeine intake and mental health in college students. Cureus13(4), e14313. 10.7759/cureus.14313 (2021). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Tounsi, A. A., Alnowaiser, A., Alsuhibani, A., Alsadhan, L. & Hamdan, H. M. Dental students’ attitude towards propranolol non-medical use: A multi-institutional cross-sectional study in Riyadh, Saudi Arabia. Eur. J. Dent. Educ.26(4), 787–793. 10.1111/eje.12761 (2022). [DOI] [PubMed] [Google Scholar]
- 41.Alzoubi, A. et al. A comparative piloting of determinants of self-medication among university students in the MENA Region; UAE and Jordan as an example. Patient Prefer. Adher.17, 699–709. 10.2147/PPA.S405279 (2023). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42.Jirjees, F. et al. Perceptions of COVID-19 symptoms, prevention, and treatment strategies among people in seven Arab countries: A cross-sectional study. J. Infect. Public Health15(10), 1108–1117. 10.1016/j.jiph.2022.08.019 (2022). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43.Barakat, M. et al. The era of E-cigarettes: A cross-sectional study of vaping preferences, reasons for use and withdrawal symptoms among current E-cigarette users in the United Arab Emirates. J. Community Health46(5), 876–886. 10.1007/s10900-021-00967-4 (2021). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 44.Jirjees, F. et al. Public awareness, prevalence, and regulations for the sale of electronic cigarettes in Arab countries: A narrative review. Tob. Induced Dis.21, 143. 10.18332/tid/168435 (2023). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 45.Picciotto, M. R., Brunzell, D. H. & Caldarone, B. J. Effect of nicotine and nicotinic receptors on anxiety and depression. Neuroreport13(9), 1097–1106. 10.1097/00001756-200207020-00006 (2002). [DOI] [PubMed] [Google Scholar]
- 46.Bolarinwa, O. A. Principles and methods of validity and reliability testing of questionnaires used in social and health science researches. Niger. Postgrad. Med. J.22(4), 195–201. 10.4103/1117-1936.173959 (2015). [DOI] [PubMed] [Google Scholar]
- 47.Wild, D. et al. Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: Report of the ISPOR task force for translation and cultural adaptation. Value Health8(2), 94–104. 10.1111/j.1524-4733.2005.04054.x (2005). [DOI] [PubMed] [Google Scholar]
- 48.Driscoll, R. Westside Test Anxiety Scale. https://files.eric.ed.gov/fulltext/ED495968.pdf (American Test Anxiety Association, 2004).
- 49.University of Sharjah. Academic Section. https://www.sharjah.ac.ae/en/academics/Pages/default.aspx (2023).
- 50.Raosoft®. Software Sample Size Calculator. http://www.raosoft.com/samplesize.html (2004).
- 51.Agresti, A. Categorical Data Analysis 3rd edn. (Wiley, 2013). [Google Scholar]
- 52.Agresti, A. An Introduction to Categorical Data Analysis 2nd edn. (Wiley, 2007). [Google Scholar]
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Data Availability Statement
The raw data is provided in the Supplementary Information file.