Iranian University students’ stressors and coping strategies: A qualitative study

Abstract

BACKGROUND:

Although a certain amount of stress is essential, excessive stress can adversely influence the physiological and mental health. Hence, this study aims to assess common stressors and coping strategies among university students.

MATERIALS AND METHODS:

This qualitative study was conducted from October to November 2019 in Iran. Twelve students were recruited based on purposeful sampling to participate focus group discussions (FGD). Transcripts of three sessions of FGD were analyzed applying Graneheim and Lundman (2004) approach, and a thematic network was applied to illustrate the findings.

RESULTS:

The finding emerged 78 codes, 14 subthemes, and 4 main themes. Stressors were classified in two main themes, including individual stressors and the social ones. Behavioral strategies and the cognitive ones were among two categories of coping strategies. According to the thematic network, a full stress student affecting the precious stressors and the social, cultural, and the economic context may manage his/her stress applying the coping strategies.

CONCLUSION:

The findings revealed that university students experienced different kinds of stress, and usually, they do not apply right coping strategies. It is important to establish stress counseling programs for university students. Besides, it is proposing to provide 1^st year university students with workshops about the cause of stress and effective coping strategies.

Introduction

Stress is an integral part of our daily lives, and it has been known as a health epidemic of the 21^st century by the World Health Organization.[1] Based on different studies, students’ stress level is high. For instance in Egypt, anxiety and stress are 70% and 60% in students, respectively.[2] Moreover, there is a high level of stress and anxiety in students of other countries, including 61% in Bangladesh,[3] 74% of international students in China,[4] and finally, more than 60% of medical students in Saudi Arabia.[5] In Iran, it is also reported that students have been suffering from high level of stress. According to the study carried out in Tehran University of Medical Sciences, 83% of students have experienced stress.[6] Stress has been defined as a situation in which internal or external demands are appraised beyond an individual's resources to cope with.[7] Although a certain amount of stress is essential to adding opportunities and challenges to our lives and pushing us toward our goals, excessive stress can influence adversely the physiological and mental health.[8] Stress has been associated with various disorders, such as anxiety, depression, metabolic syndrome, obesity, polycystic ovary syndrome, Type 2 diabetes mellitus, autoimmune disorders,[9] cardiovascular disease,[10] asthma,[11] gastrointestinal problems,[12] Alzheimer's disease,[13] and MS.[14] Many researchers have reported that university students are exposing to alarming level of stress. There are different sources of stress that the students may encounter during their academic life. Assignments and workload,[15] new responsibilities,[16] worried about the future, interpersonal conflicts, low self-esteem, and challenges related to transportation.[17] Besides, another kind of factors causes stress among students, including desire to do the best, the fulfillment of parents' expectation,[18] finances and money problems, keeping study/life balance,[19] family problems, lack of sleep, the achievement of good grades, academic requirements, relationships with faculty members, time pressure, and loneliness.[20] To complete this list, we can mention the other factors such as time management skills, migrating from home to a metropolis for higher education, romantic relationships, career-related stress,[8] being away from home,[21] live independently, and adjust to a new social life.[22] Although stress is a part of the student's life experience, how they cope with it can affect their health status and behaviors. It is not the stressor that led to stress but the individual's perception of stress and emotional response to it.[20] Stress coping strategies are behavioral and psychological responses that used to control, tolerate, and reduce or minimize stressful situation.[23] Lazarus defined eight coping strategies usually used by individual to reduce the level of stress. These are encountering, seeking social support, planned problem-solving, self-control, taking responsibility, distancing, positive reappraisal, and escape/avoidance.[24] Poor coping skills can lead to excessive stress, negative behavioral pattern, development of psychosomatic symptoms, and impaired academic performance.[19] However, studies reveal that students with active coping strategies experienced lower levels of stress;[25] the lack of effective coping skills causes the students not to select effective coping strategies.[26] Today, the emergence and evolution of technology in various health-care fields, including education, is promising.[27] According to a study, reliable and evidence-based mental health app are available in the field of mental health that can be useful for college students.[28] In this way, students can communicate with psychologists and counselor as well as learn desired coping strategies without physical referral and fear of being labeled.[29] However, the results of a study showed that students' health literacy level is low,[30] and it is necessary to train them to use these type of technologies.

Although some stressors and coping strategies have been known among college and university students, it should study more to go beyond of the common views about student's stressors and coping strategies. It is also considerable to pay attention to the social, cultural, and economic context of the students who feels the stress and try to propose the customized coping strategies in this regard, it cannot be achievable unless providing a friendly environment and asking the students to express their experiences about stressful situation to gain a deeper understanding. According to this, the present study aims to determine the main stressors and coping strategies among Iranian university students.

Materials and Methods

This qualitative study was conducted from October to November 2019 in Iran. In this study, 12 students were recruited from the Shiraz University of Medical Sciences as the largest medical university in South of Iran, based on purposeful sampling method and sampling continued until data was saturated. The inclusion criteria were male and female students of various ages with B.Sc. and M.Sc. degrees studying at School of Management and Medical Informatics and School of Health, and agreed to actively participate in focus group discussions (FGD); also, the exclusion criteria included 1^st year B.Sc. students and 1^st semester M.Sc. students, and lack of willingness to participate in the study. Furthermore, the participants were selected from two faculties as well as different field to achieve data transferability criteria. Data collection was conducted based on FGD. FGD help students to express their thoughts and feelings with their peers and to discuss their personal experiences. Prior to the study, a discussion guide consisting of two domains (first, what were the most important causes of stress in student's life, and second, how they cope with stressors) was developed in advance of facilitate FGD. The FGD was conducted in a quiet, distraction free conference room on campus at the agreed times. Each FGD session lasted for nearly an hour and a half. The corresponding author was the facilitator for focus group sessions. The facilitator asked probing questions and guided the discussion in which all students participated actively and equal time were given for discussion. At first, a number of open-ended questions were asked, such as “Have you ever experienced stress” and continued with probing questions such as “Can you explain, give an example.” In addition, the researcher took field notes during discussions to keep significance. When FGD had reached a point of saturation, i.e., all desired topics have been discussed and the conversation had stopped, participants were given the opportunity to comment on any topic they felt had not been said. Initially, 12 students were invited to participate in this study. In the first session, all students participated, and the issues were discussed and exchanged. Due to the fact that the data were still not saturated, these students were again invited to participate in the second session. The second session was attended by seven students, and the rest of them could not participate due to personal reasons. In the third session, 10 students managed to participate in the session. Finally, saturation was achieved after three focus group sessions. These meetings were held on a weekly basis. At the end of each session, a summary of notes was reviewed by students and if necessary, the notes, especially key points, were corrected or modified. As well as, written informed consent was obtained from all participants. This form explained the study and the individuals' rights to confidentiality and privacy. Besides, all sessions were digitally recorded and transcribed immediately following each focus group sessions. Any identifying information were removed and replaced with a code to ensure anonymity. During three sessions of focus group, transcripts were analyzed manually using the approach of Graneheim and Lundman (2004) for content analysis. Transcribed interviews were read several times to create an overall sight of the data, and then, important sentences were highlighted and smallest meaningful units were determined. Meaningful units were labeled with codes, and comparative analysis was performed for the purpose of extracting primary codes. Next, the primary codes were classified based on differences and similarities to reach sub themes. Finally, for achieving the most intellectual concepts, the main themes were emerged by merging and categorizing the subthemes. For achieving the reflexivity of the qualitative study, three of the researchers who were more familiar with qualitative analysis participated in the data coding process. For better understanding of the relations among the main themes, the thematic network was illustrated. Continuous data analysis began from the beginning of codification, and continued to the end of data collection. Trustworthiness of the data was assured according to Guba and Lincoln's criteria.[31] Dependability was achieved through the process of independent researcher review of the data followed by discussion between researchers and identification and consensus about the findings. The supervisor and advisor professors reviewed some quotations, codes and extracted categories and confirmed the accuracy of the coding process to achieve conformability. It is confirmed that there was no conflict of interest in the process of data analysis. Participants were compensated for their time to research with a small gift.

Results

A total of 12 students (6 students from School of Management and Medical Informatics and 6 students from School of Health) with a mean age of 26.66[23,24,25,26,27,28,29,30,31,32,33,34] years were participated.

According to the findings, 78 final codes were emerged. These codes have led to four main themes. Two of them were associated with the main stressors, and two of the others were related to the coping strategies. Table 1 shows the main themes and sub themes of stressors following with nine sub themes. Moreover, Figure 1 revealed the thematic network of the study. Accordingly, coping strategies can help students to manage their stress; however, the role of social, cultural, and financial factors is noticeable. In addition, behavioral and cognitive strategies can be found as an effective coping solution in macro and micro environments.

Table 1.

The main stressors among Iranian University students

Main themes	Sub-themes
Individual stressors	Need for social approval
	Fear of failure
	Dealing with new experience
	Generalizing past anxieties to new situations
Social stressors	Educational system pressure
	Economic difficulties
	Family concern
	Communication concerns
	Security concerns

Figure 1.

The thematic network of the study

Stressors

Individual stressors

Students considered individual factors as part of their stressors. They described these stressors as need for social approval, fear of failure, dealing with new experiences, and generalizing past anxieties to new situations.

Need for social approval

The students have been faced stress while trying to be approved by the others. In this regard, trying to get positive feedback, present a good self-image, fear of being questioned in public, being judged and misunderstood by others caused stress in students. In this regard, one participant said:

“Most of our stress has been caused due to will judge us, accept us, reject us, oppose us, this is very effective” [P4].

Another participant added:

“Personal satisfaction as well as the other's judgment and confirmation are so important for me” [P3].

Or elsewhere, a participant declared:

“One of the problems is that I always expect to be the best. If my score was 19.75, I would cry and get stressed. I always expected to be great and people would admire me and it was always stressful for me” [P1].

And finally, one of the participants said:

“Everyone need to show their skills in the community so that others can see them, but now that I have come to show my abilities, what do others think? Do they accept? Do they ridicule? Do they care?”[P5].

Fear of failure

Other stressors among students were success in achieving goals, aspirations, and expectations. Furthermore, the inability to make decisions independently, trying to make the right decisions, and the need to make decisions in dilemma situations causes them stress out. Here, there is a statement of one participant:

“It was very difficult for me to decide on my university major. Most of us have experienced it by now. Should I continue my education or find a job? I always feel to get stuck in a dilemma” [P10].

Another student said:

“When I join a group, I think what I should do if someone asks me to do something that I am not able to do. So I withdraw and distance from that group and all of this frustrates me” [P4].

Also, another participant said:

“When teacher asks a question, I prefer to be silent for the fear of incorrect answer, which will eventually lead to a decline in my academic performance” [P1].

Dealing with new experience

New situations and responsibilities also cause stress among students such as facing unwanted and unplanned situations, living away from family, financial independence, going to another city due to university education, and experiencing to have opposite sex classmates. Here, there are the words of one of the participants:

“However, I had experienced to live in another city as a student in bachelor degree; I was stressed when I went to the third city for my master degree. In addition to unsafety and robbery, entering to the new place always makes me stress out due to new events such as new roommates, classmates, dormitory situation, city and the university, it does not matter that you had experienced them before, this new opportunity can make you stress”[P10].

Another participant said:

“The first time I entered Shiraz, it was a strange city and I was not familiar with the culture of this region. I did not know what reaction I get from people, who to talk to, who not to talk to, how do they behave?”[P2].

“Every new thing makes me stress. In addition, we have been separated from the opposite sex till getting into the university, therefore, having opposite sex classmates was exciting and strange for me and I did not know how to start communicating with them” [P9].

Generalizing past anxieties to new situations

Students, who had bad experience in the past, were more stressful because they were afraid that experience to be repeated. Besides, listening to the other people's stressors caused listeners to be stressed since they sometimes generalized those stressors to their situation. In this regard, one of the students stated:

“A bad memory can always cause you to be stressed. My own memory about is that 2 years ago in Shiraz, when I was taking a walk, a motorcyclist stole my cellphone. After it, I am always afraid of motorcyclists and have been suffering from stress caused by that memory” [P11].

Furthermore, one of the participants stated:

“Bus terminal has been a scary place for me. Since my parents especially my dad mentioned bad events such as theft of my cellphone or bag, I always imagined that it might happen for me” [P2].

Social stressors

Social factors have been known as another reason making students stressed such as educational system pressure, financial difficulties, family, communicating, and security concerns.

Educational system pressure

Pressure of educational system has been one of the most important stressor that almost all of the students faced with. Insufficient knowledge of the accepted field, dissatisfaction with the accepted field, and the state of academic performance caused stress in students. Besides, examinations, fear of professor's inappropriate behavior, facing delay to handle assignment and follow schedules, and being late for classes were also identified as stressors. In addition, for postgraduate student's dissertation-related concerns such as choosing good topic of thesis, time working on it, timely defends as well as writing a manuscript and publishing were very stressful. In this regard, one of the students said:

“If the teacher has assigned a task and I have not done it, I will be so stressed, and if I fall behind my schedule, I will be much stressed and I will not even sleep to do it. As a result, later this sleep deprivation leads to disruption of my daily cycle” [P8].

Another student said:

“Postponing dissertation or choosing a professor suggested topic for thesis puts me under stress and sometimes causes I can't get sleep very well”[P10].

Another participant also stated:

“Ever since I became familiar with the word of stress, it has been due to my entering to university and it has had different dimensions. In terms of education, do I pass this course successfully? Do I understand what the teacher is teaching?”[P7].

Another student said:

“However I have been a generally stressful person it's gotten worsened due to the thesis and I have been suffering from nervous stomachache and pain in hand” [P6].

Economic difficulties

One of the factors making students be worried is finding a proper job. Besides, students have introduced some stress factors such as inflation, economic instability, resulting in problems of marriage, and raising a family due to the low income. The student declared that:

“Rising currency have been canceled most of my future plans so I have been used to checking the news every day” [P2].

Or elsewhere, a participant added:

“I usually have the concern for asking my family to send me money; however, they afford to support me, it really causes me to suffer from guilty conscience. Sometimes when I go to cafes with my friends a lot, I have to get more money, which I am very stressed to tell them to give me more money”[P6].

Family concern

There are some family factors resulting university students stress such as meeting parent expectations, approving of success by family, being different with family in attitudes and values, not being understood by family and being compared with others. The student stated that:

“I have been suffered long time from stress due to my mum as she really likes me to get into the university in a good major such as medicine. All members of my family put insist that I have to be a physician in the future so that in the 1^st year, I lied my score to them since I was going to explain to my mum how difficult is to get accepted in medicine major”[P11].

Another student said:

“Since I was last child and my siblings were so successful in their lives, my parents expected me to be better than them for instance my father likes me to be a physician and it makes me stress” [P9].

One student added:

“differences between the society and family norms cause students to be confused and stressed for instance good grades are very important for my family, but my relationship with others is an issue of importance for me such as helping people that my family blame me for it”[P5].

And finally, a student implied:

“My family puts pressure on me to get married to a person who is an ideal person with their eyes while I am not ready for marriage” [P8].

Communication concerns

Another part of the students' stressors were communication and disclosure of their privacy. For instance: Communication with opposite sex, membership in the mixed social groups, and parties that make students concerned. About students' communication, a participant said:

“At the first time that I have a class with opposite sex, I was so stress” [P9].

Another participant also stated:

“I was the only boy in the class with 26 ladies, early I could not sit in class for a long time. I had to wait for the professor to enter the classroom with he/she, taking part in the class was so stressful for me” [P12].

About the disclosure of privacy, a student said:

“We have been used to presenting a good image of ourselves to others so that most of time we have been stress that others especially families know our secrets or relationships. For example, we are stressed that if my dad finds out that I have a boyfriend, if my dad finds out that I have a series of social relationships with the opposite sex, or I attend a series of parties? I do not know maybe men are less worried, but it is very stressful for women” [P10].

Another student stated:

“When I hang out with my friends and my classmates especially opposite sex, I really cannot enjoy the time since I am stress that my family or relative see me. I do not like my family honor gets destroyed” [P9].

Security concerns

Personal security is one the most crucial issues for students. For example, taking a walk in a solitude path or place, physical conflict with the others, being handcuff, robbed and injured can make students stress. The security of students' interest is also important such as the lack of transparency in teamwork and being abused by a friend, classmate, or roommate. One student said about physical security:

“As I live in a dormitory, I have always had stress due to dark path from university to the dorm, pickpockets, etc.” [P10].

Considering stress with teamwork a participant said:

“I experienced a bad stress when I was working on a project with my classmate and spent a long time on it, but she suddenly made a decision to present it alone as according to professor's idea, that project can be done by just one person”[P6].

Another participant said:

“I have experienced team work a lot, but unfortunately my coworkers did not do their duties so that I got stuck in a bad situation and I feel being abused by them”[P7].

Considering unclear situations, a participant said:

“I expected to get the results in accordance with my efforts for instance, I had a student job and I did my best for it, but they did not make any contracts with me so that I was stress during my job due to my payment”[P2].

Other results of the study are summarized in Table 2. According to this table, two main themes and five subthemes are determined as the main and sub coping strategies against stress.

Table 2.

The main coping strategies against stress

Main themes	Sub-themes
Behavioral strategies	Emotional discharge
	Seeking social support
	Distraction
Cognitive strategies	Avoidance strategies
	Psychological strategy

Coping strategies

Students have used different strategies such as behavioral and cognitive strategies to cope with stress.

Behavioral strategies

Behavioral strategies include distraction, seeking social support, and emotional discharge.

Distraction

Students used different methods to distract their attention from stressful issue, including listening to the music, watching movies and series, reading books, eating much, sleeping and cleaning so much, surfing on the Internet, and drinking tea and coffee so much. Considering extremist behavior, a participant said:

“I am used to eating so much without thinking to its results and then I suffer from overweight” [P7].

Another participant said:

“When I am stress, I spent my time with my friends so much, and buy unnecessary things, stop studying, sleep so much and drink a lot of tea and coffee”[P6].

Regarding reading novels as a hobby a participant said:

“When I am stress I put aside my life, work and university and only read novels” [P3].

Considering surfing on the internet and social media a student said:

“When I was in a stressful situation, I was tried to distract myself from stress with spending my time on social media, surfing on the internet, and watching movies and series” [P1].

Seeking social support

Most of students declared that they seek social support when dealing with stressors and they gained this support in different ways such as talking with family members, friends and experts or embracing them. Besides, some of them referred to psychologists and take the medicine. Other students prefer being trained for some skills, including financial and time managements, skills such as social communication, making a speech, accepting criticism, making planes and saying No. Moreover, some students sued strategies such as analyzing stress, identifying the causes, making a list of solutions and evaluating them. In this regard a student said:

“When I got stress, I prefer to be with my friends who make me calm or to be somewhere in which also makes me calm” [P10].

Also another student said:

“I was talked to people who had experience in this field, and their words calmed me down and I was tried to communicate with these people more” [P7].

Besides, other students said:

“When I am stress, talking to my mum and my sister makes ma calm” [P6].

Or:

“Embracing my nieces and nephews help me be calm” [P1].

Regarding the improvement of students' abilities, a participant said:

“If we want to make a progress in our abilities, we have to learn how to accept the criticism and discuss it with others” [P5].

Or:

“I prefer talking to myself when I am stress to know what I am stress for? And why? Is there any worthwhile thing to be stress for?”[P2].

Another student said:

“I have been trying to be independent since independency causes me to believe in myself more. I came to believe that I could and I planned to decrease my sleep from 9 h to 4–5 h so that I could make a better plan for my future” [P8].

In addition, other students said:

“I started working due to financial problems and managed my expense for example I decreased my leisure time, bought less clothes and also I rarely went to coffee shops with my friends so that I learnt how to say No”[P9].

Or:

“I try to investigate the different solutions to manage my stress and choose the best one” [P4].

Emotional discharge

As some students said, emotional discharge can be a good method to decrease stress and there are different ways to do it such as going to gym, doing sports, taking a walk, riding the bike. Of course, some people choose other methods such as shouting at the others, being aggressive, conflicting with the others.

“Sometimes, doing sport causes me to discharge my energy or shouting when it is rainy” [P7].

Another participant said:

“Riding the bike, doing sports and taking a walk help me be calm when I am stress” [P9].

Another student used the unfavorable strategy and said:

“Based on my stress intensity, I would yell at the others making me stress or conflict with them” [P4].

Another student said:

“When I am stress, I blame my relatives or family so that I would be aggressive with them and do not care about them” [P1].

Cognitive strategy

Some coping strategies used by students were cognitive strategies, including psychological and avoidance strategies.

Psychological strategy

Some individuals who participated in this research prefer to pray Quran, supplication to God when they are dealing with stress. Besides, they used other strategies such as going to religious places, positivity, mental meditation, concentrating on the breath, repeating motivated sentences, watching motivated movies. Here, there are conversations of some participants:

“To control my stress related to the future, I read Ashura and Waqiah sura for 40 days and appeal Imams to help me” [P1].

Another student stated:

“When I feel stress, I used relaxation techniques such as meditation and deep breath” [P6].

Or elsewhere,

“I believe in positivity and try to follow it. In addition, I repeat positive sentences and quote motivated sentences” [P8].

Avoidance strategies

Some of students have been trying to escape from stressful events and using avoidance and self-blame methods such as being isolated, withdrawal from the society, self-blaming, allowing the family and others to make a decision for them, not doing assignment, lying, getting disappointment and crying. In this field some students said:

“Since I had problems with one friend of mine, I prefer not to face with her to avoid getting stress and not to take part in the meeting in which she was” [P1].

Another student implied:

“There is no way to do for stress at the moment of occurrence so we have to know how to be patient on it and tolerate it until we can change our viewpoint to the issue making us stress” [P10].

Or elsewhere, another participant declared:

“Since there was a big difference between my family's belief and my friends' belief, I was under pressure how to behave, for instance, my family expected me to go home early, but my friends used to go home late and I did not know how to manage it. Many times I lied because I could not tell my friends that my father or my mother would not allow me to come. I lied to both my family and my friends” [P5].

Another student added:

“I like to deny responsibility and want my family to make a decision for me about important thing such as my marriage” [P11].

Another student talked about his/her previous experience:

“I really have problems to manage my classes with professors who are not my favorite ones. I prefer to cancel classes even though it makes adverse condition for me” [P7].

Someone else said:

“I blame myself due to my foibles and allowed the others to behave me humiliatingly” [P6].

And finally,

“my strategy was to keep quiet and withdraw from my friends that it caused my friends to blame me on being indifferent, but I really preferred being alone”[P8].

Discussion

Different stressors were identified among students. The main stressors were related to fear of being endorsed by others. Fear of being judged negatively, fear of being misunderstood, and developing a positive self-image were stressful for students. This can be related to social anxiety disorder. Result of a study showed that more than 30% of students suffer from social phobia.[32] Therefore, more attention must be paid to psychological well-being of students, as well as effective treatment strategies should be educate to reduce social phobia.

Also, pressure of educational system on students was identified as common stressor by most participants. Poor time management skills in students caused students fall behind on their curricula. Similarly to our results, other studies revealed that university induced pressure can make students stress more than other causes.[33,34] Accordingly, it is very important to provide opportunities for students to develop stress-related academic coping skills.

Exposure to new experiences was also a prominent stressor. This stress result from fear of unknowns, take on new roles, being away from family and accommodation away from home in early academic year. According to Pitt et al. source of this stresses are related to changes in social support and everything being different when students started or moved universities.[33] This should be addressed by university psychology counseling departments to help them adapt to new conditions.

Family related stress was another cause of stress among participant. Finding new values that contradict family values and not being understood by families creates a gap in student-family relationships. Also high parental expectation and trying to get approval from them adds stress to students. Similar finding was reported by previous studies.[17,33,34] Parents need to change their perspective on academic excellence as the key to success. Moreover, parents' awareness of how to support students without causing stress should be increased.

In line with other studies, our participants introduced financial difficulties as an important stressor.[33,34] In this regard, recent study showed that financial strain might lead to adverse effects on sleep and make depressive symptoms in college student.[35] So, special attention should be paid to the financial support of students in order to prevent further problems for them during the critical student period.

Besides, participant identified communication concerns as a cause of stress. This stressor was related to poor communication skill, poor relation with opposite sex, get involved in romantic relationship, loneliness and communicate with professor. The reason could be related to limitation upon relation with opposite sex in Iranian culture. Similar to our results Tariq et al. emphasized on communication in their research.[34] So it's important for college and university students to be guided on how to communicate effectively.

Results also showed that college students used a range of strategies to manage their stressors. The most common coping strategy was seeking social support including talking and sharing problem with friends, family, and peers. Same finding was reported in other studies[26,36,37] which showed that social and emotional support was common coping strategies among college students. Maybe it's because they can easily express their feelings and feels calmer and abler to move forward. However, small number of the participants sought help from professionals or counselor. This finding is achieved in another study[38] and this may be related to student's unawareness about the role of counselors in helping them to solve problems and manage stress. Another reason may be the fear of being labeled mentally ill.

Distraction was also common coping strategies. In this way, most of the students prefer to over-eating, listening to music, reading book, watching movies, taking a long walk, obsessive cleaning and washing, and using internet and social networks when they faced a stressor. This result is consistent with other studies that avoiding the stress causing situation, watching movies, sleeping, and self-distracting were the typical stress coping strategies used by the college students.[36,38] It can help them through bringing rapid but temporary relief. This result might interpret by quoting the popular refrain “out of sight, out of mind,” which lead to stop thinking about bothering things for a while and instead think about something else. The popular proverb can be used in this situation “long absent, soon forgotten” i.e., it had better focus on good thing instead of bad one.[39]

The finding of our study also revealed that many participants apply avoiding strategies to deal with stressors. For instance, self-blaming, crying, giving up responsibilities, and not doing homework. This result is consistent with other studies that avoidance is among the commonly coping strategies among college students.[36,38] Avoidance might be considered as a basic tendency to avoid stressful conditions. The results of a study showed that it is a maladaptive coping mechanism determined by the effort to escape dealing with stressors.[40] In contrary to this finding, avoidance have been considered as the least used coping strategy in another research.[41] An explanation for this difference could be sociocultural differences between the studied subjects.

Also our participant reported other coping strategies such as cognitive strategies and emotional discharge. In this regard they stated praying, positivity, meditation, and doing exercise as a common strategy. In line with our finding, doing regular exercise, listening to spiritual songs, reading spiritual scripts, praying, and going to place of worship were helpful in other studies.[38,42] The reason could be that it causes their negative emotions to go away.

One of the limitations of this research was that we used just focus group methodology. So, it is recommended to use triangulation approach in future studies. Another limitation of this study could be students reluctant to share their experiences due to the sensitive nature of the topic, even though they remained anonymous.

Conclusion

Our finding revealed that university students experienced different kinds of stress and usually they don't apply right coping strategies. These results were confirmed previously identified stressors and coping strategies to deal with university students' stress. This specifies a need for students' stress management programs at the university. Identifying causes of stress and coping solution among students will assist university administrators to monitor and control these causes so that eliminate or at least reduce them. It is important to establish stress counseling programs for university students and inform and encourage them to participate. Besides, it is proposed to provide 1^st year university students with workshops about stressors and effective coping strategies. As well as providing course pertaining to time and financial management, effective social communication, making a speech, accepting criticism, and making planes will be necessary through the academic years. Further, the university psychology service center should provide counselors to respond to students at all times to ensure students' mental well-being and help them to find appropriate solutions to deal with stressors. In addition, stress management workshops specific to the needs of students should be provided.

Ethical aspects of the study

The present study was approved by the Ethics Committee of Shiraz University of Medical Sciences, Shiraz, Iran (IR. SUMS. REC.1398.664). All participants provided informed consent.

Financial support and sponsorship

The present article was extracted from the PhD thesis written by Fatemeh Khademian and was financially supported by Shiraz University of Medical Sciences (grants No. 98-01-07-19451). The funding body did not play any roles in the design of the study, collection, analysis, and interpretation of the data, and writing the manuscript.

Conflicts of interest

There are no conflicts of interest.