Exploring the interplay between anxiety and academic procrastination: An institution-based cross-sectional study from Pakistan

Abstract

Background:

Procrastination, the unnecessary delay of tasks, is common among college students, especially in academic settings. Academic procrastination often leads to last-minute rushes and increased anxiety. The relationship between procrastination and anxiety is intricate, complicating the determination of which triggers the other.

Aim:

To examine how anxiety and procrastination interact among medical students, particularly focusing on their reciprocal influence.

Materials and Methods:

This descriptive cross-sectional study included 311 MBBS students, recruited through simple convenient sampling. Procrastination was assessed with the Irrational Procrastination Scale (IPS) and anxiety with the Generalized Anxiety Disorder 7-item (GAD-7) scale. Data analysis was conducted using SPSS version 27, with Chi-square tests, Pearson correlation, and linear regression. Statistical significance was set at P < 0.05.

Results:

Pearson correlation showed a significant, weak positive correlation between anxiety and procrastination (r = 0.346, P < .001). Subcategories of the IPS correlated with anxiety from negligible to high. Chi-square analysis found a significant association of anxiety with procrastination (P < 0.001) and gender (P = 0.038), but no significant link of anxiety or procrastination with the year of study was observed. Linear regression revealed that anxiety significantly predicted procrastination (B = 0.354, P < 0.05) and vice versa (B = 0.339, P < 0.05), explaining 12% of the variance.

Conclusion:

The study found a weak yet significant positive correlation between anxiety and procrastination, indicating that the relationship might be bidirectional. However, the cross-sectional design and reliance on self-reported data highlight the need for further longitudinal research to better understand these dynamics.

According to psychology, a person is an entity whose nature shows in their behavior, which is determined by their habits and conventions as well as by emotional and psychological elements.[1] Academic procrastination is a common behavior in the context of education. It describes the propensity to routinely put off doing academic work in order to avoid feeling bad.[2]

Procrastination is widespread among people of different nationalities, socioeconomic statuses, and educational backgrounds.[3] Among the various forms of procrastination, academic procrastination is a common tendency to avoid starting or finishing essential academic tasks, although delaying it can lead to negative consequences.[4] According to a recent survey, approximately 55% of medical students at a university procrastinate on their academic tasks.[5] Similarly, a study comparing procrastination rates among university students in Pakistan (PK) and Malaysia (MY) revealed that 19% of Pakistani and 21% of Malaysian students exhibited mild procrastination. 70% of Pakistani and 67% of Malaysian students showed moderate procrastination, while 11% of Pakistani and 12% of Malaysian students displayed severe procrastination.[6]

Putting off tasks often results in a last-minute rush to complete them, leading procrastinators to frequently experience anxiety when faced with demanding responsibilities. Short-term academic procrastination is linked to late assignment submission, test anxiety, and academic underachievement, all of which can have an impact on students’ mental well-being.[7,8]

Anxiety is a complex experience involving worry, emotional instability, fear of failure, low self-esteem, and a lack of confidence and peace of mind.[9,10] Among medical students worldwide, the prevalence of anxiety is 33.8%, while in the Middle East, it is 42.4%.[11] The increasing prevalence of anxiety poses a significant threat to the well-being and quality of life of the population.[12] Multiple studies have found a significant prevalence of anxiety among medical students in Pakistan, with rates ranging from 44% to 74.2%.[13,14]

The relationship between anxiety and procrastination has received considerable attention in the past three decades.[15] The relationship between procrastination and anxiety is intricate, making it challenging to determine whether procrastination is a cause or consequence of anxiety.[16] Some studies have explored the influence of anxiety on individual variations in procrastination, proposing that procrastination could worsen feelings of stress and anxiety.[15] However, most studies consider anxiety to be a precursor to procrastination.[17] Similarly, Cassady and Johnson’s study found that students with high levels of anxiety exhibited more procrastination tendencies than their peers.[18] According to another study by Saplavska et al.,[19] students displaying high levels of procrastination are more susceptible to anxiety. Therefore, the relationship between anxiety and procrastination may be bidirectional; that is, while anxiety may cause procrastination, it is also plausible that delay may induce nervousness.[17]

While American and European contexts have conducted some studies on procrastination, Asian contexts have notably lacked this research.[20] Procrastination is a common issue among students and can lead to significant problems, particularly academic failures. Identifying factors related to academic procrastination is essential for prevention, as students must progress and achieve academic success.[8]

Existing literature has established a connection between these two issues, but their relationship is complex, and we still don’t fully understand the directionality and mechanisms behind this effect. Therefore, the purpose of this study was to explore the interplay between anxiety and procrastination in medical students, with a focus on the bidirectional relationship between these two variables. By examining specific elements such as task avoidance, time management, and regret, this research aims to identify the factors most likely to contribute to both anxiety and procrastination. These findings could inform the development of evidence-based strategies to mitigate the negative effects of these issues, thereby supporting medical students’ well-being and academic success.

MATERIALS AND METHODS

Study design

This study employed a descriptive cross-sectional study design.

Participants/sample

The sample size, calculated using OpenEpi, was 301 with a 95% confidence interval keeping the population size 1,375 with 5% margin of error. The sample consisted of undergraduate medical students from a medical college in Pakistan. The inclusion criteria included MBBS students from their first year to their final year of study. The exclusion criteria were as follows: 1) students who did not provide informed consent; 2) those who either did not complete the online questionnaire or provided incomplete responses; and 3) participants with preexisting psychological, neurological, learning, or other impairments that could interfere with their academic performance to ensure accurate measurement. Furthermore, we offered confidential medical assistance to participants with any psychiatric disorder, contingent upon their consent; 53.7% of the participants were male and 46.3% were female. The distribution of students across academic years was as follows: 20.9% in the 1^st year, 37.0% in the 2^nd year, 19.6% in the 3^rd year, 13.5% in the 4^th year, and 9.0% in the final year.

Procedure

We collected data from the selected participants using a standardized, structured, self-administered questionnaire. Participants had to consent to the Free and Informed Consent form on the first page to access the study’s instruments, confirming their voluntary participation. We omitted personal identifiers from the questionnaire to ensure confidentiality and minimize information bias. The instruments were administered in the following order: the sociodemographic questionnaire, the Irrational Procrastination Scale (IPS), and the Generalized Anxiety Disorder 7-item (GAD-7) scale. The average time required to complete the forms was approximately 10 minutes. Simple convenient sampling was used.

Instruments

Demographics

For this study, we specifically developed a sociodemographic questionnaire to assess characteristics such as sex and year of study.

Procrastination

The Irrational Procrastination Scale (IPS) measured procrastination by assessing the extent of irrational delay in daily activities. This questionnaire consisted of nine items rated on a five-point Likert scale (1 = very seldom, 2 = seldom, 3 = sometimes, 4 = often, and 5 = very often). Higher scores on the scale indicate a greater level of procrastination (e.g. “I put things off so long that my well-being or efficiency unnecessarily suffers”). Three items on the scale (items 2, 5, and 8) require reverse scoring as they refer to behaviors contrary to procrastination. The author validated the scale using a sample of 16,413 adults from eight English-speaking countries (58.3% women, 41.7% men), with a mean age of 38.3 years.

We further categorized the items into three subcategories: time management (containing questions 2, 5, and 8), regret (containing questions 3 and 7), and task avoidance (containing questions 1, 4, 6, and 9).

The total score categorized individuals into various levels of procrastination tendencies:

• 19 or less: The bottom 10% exhibit minimal procrastination.

• 20–23: Bottom 10–25%: Low procrastination

• 24–31: Middle 50%: Average procrastination

• 32–36: Top 10–25%: High procrastination

• 37 or more: Severe procrastination ranks in the top 10%.

For convenience, we assigned specific names (minimal procrastination, low procrastination, average procrastination, and high procrastination) to IPS scores.

Anxiety

We measured anxiety using the Generalized Anxiety Disorder 7-item (GAD-7) scale. The GAD-7 consists of seven items that assess symptoms of worry and anxiety. A four-point Likert scale (0–3) rates each item: not at all (score of 0), several days (score of 1), more than half the days (score of 2), and nearly every day (score of 3). The total scores range from 0 to 21, with higher scores indicating a greater severity of anxiety. Scores exceeding 10 were deemed to be within the clinical range. The GAD-7 has demonstrated excellent reliability and construct validity.

Data analysis

We used SPSS version 27 for data analysis. We calculated means and standard deviations for quantitative variables and percentages and frequencies for qualitative variables. We applied a Chi-square test between anxiety, procrastination, gender, and year of study. A correlation was applied between procrastination, anxiety, and the subcategories of the Irrational Procrastination Scale. Then we applied a linear regression between procrastination and anxiety.

Statistical significance was set at P < 0.05.

RESULTS

Descriptive statistics

This study included a total of 311 participants. The results of this study revealed that 167 (53.7%) of 311 participants were male and 144 (46.3%) were female. The participants ranged from their first to their final year of the study. The mean (SD) anxiety score at baseline was 0.9968 (1.00161). The mean (SD) procrastination score at the baseline was 2.9453 (1.02244). The procrastination scores among participants ranged from a minimum of 1.00 to a maximum of 5.00. The anxiety scores varied between a minimum of. 00 and a maximum of 3.00. Table 1 summarizes the descriptive statistics.

Table 1.

Descriptive statistics

Variables	Frequency (n)	Percentage (%)
Gender
Male	167	53.7%
Female	144	46.3%
Total	311	100.0%
Year of Study
1st year	65	20.9%
2nd year	115	37.0%
3rd year	61	19.6%
4th year	42	13.5%
Final year	28	9.0%
Total	311	100%
Procrastination
Minimal Procrastination (bottom 10%)	34	10.9%
Low Procrastination (bottom 10-25%)	45	14.5%
Average Procrastination (middle 50%)	160	51.4%
High Procrastination (top 10-25%)	48	15.4%
Severe Procrastination (top 10%)	24	7.7%
Anxiety
Minimal Anxiety	120	38.6%
Mild Anxiety	108	34.7%
Moderate Anxiety	47	15.1%
Severe Anxiety	36	11.6%

Chi-square test results

We examined the relationships between anxiety, procrastination, gender, and year of study using Chi-square tests. Table 2 displays the relationship between anxiety, year of study, gender, and procrastination. Table 3 shows the relationship between procrastination, year of study, and sex. The Chi-square test revealed that the relationship between anxiety and procrastination (P < 0.001), as well as the relationship between anxiety and gender (P = 0.038), was statistically significant. However, the relationship between anxiety and years of study was not significant (P = 0.435). For procrastination, the Chi-square test indicated that its relationship with both sex (P = 0.728) and year of study (P = 0.726) was not statistically significant.

Table 2.

Anxiety Chi-square test

	Minimal Anxiety (n)	Mild Anxiety (n)	Moderate Anxiety (n)	Severe Anxiety (n)	P
Year of Study					0.435
1st year	27	18	10	10
2nd year	41	44	19	11
3rd year	26	20	7	8
4th year	18	18	3	3
Final year	8	8	8	4
Gender					0.038
Male	76	50	21	20
Female	44	58	26	16
Procrastination					<0.001
Minimal procrastination (bottom 10%)	28	3	1	2
Low procrastination (bottom 10-25%)	21	17	3	4
Average procrastination (middle 50%)	54	67	27	12
High procrastination (top 10-25%)	13	14	13	8
Severe procrastination (top 10%)	4	7	3	10

Table 3.

Procrastination Chi-square test

	Minimal (bottom 10%) (n)	Low (bottom 10-25%) (n)	Average (middle 50%) (n)	High (top 10-25%) (n)	Severe (top 10%) (n)	P
Year of Study						0.726
1st year	7	14	29	10	5
2nd year	13	11	64	21	6
3rd year	7	10	31	8	5
4th year	6	6	22	4	4
Final year	1	4	14	5	4
Gender						0.728
Male	20	23	84	29	11
Female	14	22	76	19	13

Reporting Pearson correlation

H₀: “There is no relationship between academic procrastination and anxiety.”

H₁: “There is a link between academic procrastination and anxiety.”

Pearson correlation analysis revealed the following relationships:

The Pearson product correlation of procrastination and anxiety was found to be lowly positively correlated and statistically significant (r = 0.346, P < 0.001). Hence, H₁ is supported. This indicates that when one variable increases, the other increases correspondingly.

Similarly, there was a correlation between anxiety and procrastination and the subcategories within the Irrational Procrastination Scale. Time management had a moderately positive correlation with procrastination (r = 0.567, P < 0.001) and a negligible correlation with anxiety (r = 0.193, P < 0.001). Regret had a high positive correlation with procrastination (r = 0.730, P < 0.001) and a negligible correlation with anxiety (r = 0.293, P < 0.001). There was a high positive correlation between procrastination and task avoidance (r = 0.857, P < 0.001) and a low positive correlation between task avoidance and anxiety (r = 0.368, P < 0.001).

All correlations were statistically significant (P < 0.001), with r values ranging from 0.193 to 0.857, indicating varying strengths of association between procrastination, anxiety, and all subcategories made within the Irrational Procrastination Scale as illustrated in Table 4.

Table 4.

Anxiety-Procrastination–Correlation

	Procrastination	Anxiety	Time Management	Regret	Task Avoidance
Procrastination	1	0.346**	0.567**	0.730**	0.857**
Anxiety		1	0.193**	0.293**	0.368**

Where** represents a P<0.01

Linear regression

We used the dependent variable (procrastination) to predict anxiety. The independent variable significantly predicted procrastination (F (1, 309) =42.112, P < 0.05), indicating that the factors under study have a significant impact on procrastination. Furthermore, R = 0.120 indicated that the model explained 12% of procrastination›s variance. We also assessed the coefficient to determine the impact of each factor on the criterion variable (procrastination). The findings showed that anxiety had a significant positive impact on procrastination (B = 0.354, t = 6.489, P < 0.05). Similarly, procrastination significantly affected anxiety (B = 0.339, t = 6.489, P < 0.05). Table 5 presents the results.

Table 5.

Linear regression

Regression Weights	Beta coefficient	R 2	F	t	P
Anxiety -> Procrastination	0.354	0.12	42.112	6.489	<0.05
Procrastination -> Anxiety	0.339	0.12	42.112	6.489	<0.05

DISCUSSION

This study primarily focuses on the relationship between anxiety and procrastination. Both the Chi-square test and correlation analysis confirmed the alternate hypothesis, “there is a link between academic procrastination and anxiety,” rejecting the null hypothesis. The Chi-square test showed a significant association between anxiety and procrastination (P < 0.001), indicating that these variables were not independent. Correlation analysis further supported the alternate hypothesis, revealing a significant positive relationship (r = 0.346, P < 0.001), consistent with previous studies.[19,21]

Procrastination is a key factor that significantly disrupts the academic process. As reported previously,[5] nearly 55% of medical students at a university delayed their academic tasks. Our study found that among the 311 participants, 48 (15.4%) exhibited high procrastination, and 24 (7.7%) had severe procrastination. Regarding anxiety, 47 participants (15.1%) reported moderate anxiety, whereas 36 (11.6%) experienced severe anxiety. These findings indicate that a substantial proportion of the sample struggled with high or severe procrastination and anxiety, suggesting a strong overlap between these conditions. Onwuegbuzie (2004) observed that high expectations and competitive pressures in academic environments can intensify anxiety and procrastination, particularly in cultures that place a high value on academic success.[22]

In our study, linear regression analysis identified anxiety as a precursor to procrastination (B = 0.354, t = 6.489, P < 0.05). This aligns with previous research showing that One important indicator of procrastination is anxiety.[23] Cassady and Johnson also found that students with higher anxiety levels were more prone to procrastination.[18] Persistent anxiety disrupts decision-making and delays task initiation, leading to procrastination.

However, procrastination is more than just a response to anxiety; it can also contribute to its development. To demonstrate this, we performed a linear regression with anxiety as the dependent variable and procrastination as the independent variable. The results showed that procrastination significantly predicted anxiety levels (B = 0.339, t = 6.489, P < 0.05). When individuals delay important tasks, stress and worry develop, leading to heightened anxiety. As deadlines loom, the pressure to complete tasks increases, causing urgency and panic, exacerbating anxiety. Thus, procrastination may be an indicator of anxiety, as noted in other studies.[16] Likewise, procrastinating students reported higher levels of tension and anxiety as deadlines approached than those who started tasks earlier, according to Tice and Baumeister (1997).[24]

To further investigate the link between anxiety and procrastination, we categorized procrastination into task avoidance, time management, and regret, and analyzed their correlations with both anxiety and procrastination. The analysis revealed moderate-to-high positive correlations between procrastination and anxiety, as well as statistically significant correlations between procrastination and anxiety. Notably, the low positive correlation between anxiety and task avoidance indicates that anxiety has a greater influence on task avoidance. This supports a study showing that high anxiety often leads to task avoidance for immediate relief.[25] Another study indicated that difficult tasks can trigger negative self-talk, resulting in avoidance and reinforcing anxiety.[26] On the other hand, there were negligible correlations between anxiety, time management, and regret, indicating that other factors might influence them.

The above discussion indicates that procrastination and anxiety may influence each other in a bidirectional manner. Subcategory analysis further supports this notion. When faced with a challenging task, anxiety can trigger avoidance, which leads to procrastination. While this provides temporary relief, it increases anxiety as the task remains incomplete. As a deadline approaches, anxiety grows, driving further procrastination and creating a vicious cycle in which nervousness and procrastination continuously reinforce each other. Another study also described this, concluding that the relationship between anxiety and procrastination can be reciprocal, with anxiety sometimes resulting from procrastination rather than merely being its cause.[23] Another study discovered that procrastination can lead to and contribute to poor mood, which is often associated with anxiety.[27]

Our results revealed a significant but weak positive association between procrastination and anxiety. This aligns with earlier studies,[7] which also found a weak positive link between the two. This weak association suggests that reducing anxiety may aid in reducing procrastination, particularly when procrastination stems from anxiety-related factors like perfectionism or fear of negative outcomes.

This study has some limitations. This weak association suggests that factors other than anxiety may influence procrastination. Additionally, the results might not be generalizable to different populations or age groups, owing to sample size and composition variations. The reliance on self-reported data also introduces bias, as individuals may not fully disclose their procrastination or anxiety levels.

Future research could explore several avenues. Longitudinal studies may reveal how the association between procrastination and anxiety evolves, especially in response to anxiety-focused therapies. Experimental studies can provide a more precise understanding of the link between these two factors.

CONCLUSION

This study examined the connection between procrastination and anxiety in MBBS undergraduate students. This study’s findings indicated a weak positive correlation between procrastination and anxiety. The results suggest that the relationship between these two variables can be bidirectional, with procrastination causing and exacerbating anxiety.

These findings suggest that anxiety-focused interventions may reduce procrastination, which carries significant implications. This study adds an important new understanding of how these variables interact, especially in the context of MBBS undergraduate students in Pakistan. Poor research has understudied the associations between these variables in medical students. Addressing both anxiety and procrastination through targeted support and interventions can lead to improved management of these issues, ultimately enhancing academic performance and overall student well-being.

Limitations

There are a few limitations to this study, including its cross-sectional design and reliance on self-reported data, and the fact that it was conducted at a single center. Anxiety was assessed only by GAD-7 and a formal psychiatric evaluation was not carried out. In order to comprehend the intricate connection between anxiety and procrastination, as well as other factors that might affect procrastination, future research should consider experimental and longitudinal approaches.

Authors contribution

Concept, design, literature search, data acquisition, data analysis, statistical analysis, manuscript preparation, manuscript editing, manuscript review: All authors.

Ethical statement

Ethical approval was obtained from the institutional ethical committee.

Data availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.