Qasir Abbas ( Department of Applied Psychology, Government College University, Faisalabad, Pakistan )
Iqra Latif ( Department of Applied Psychology, Government College University, Faisalabad, Pakistan )
Mehwish Muneer ( Department of Applied Psychology, Government College University, Faisalabad, Pakistan )
Muhammad Umar Khan ( Department of Applied Psychology, Government College University, Faisalabad, Pakistan )
Khawer Bilal Baig ( Department of Psychology, Bahria University Lahore Campus, Lahore, Pakistan. )
April 2023, Volume 73, Issue 4
Distress tolerance, anxiety-related symptoms, stress, and depression among dropout and non-dropout university students: a mediation analysis
Qasir Abbas ( Department of Applied Psychology, Government College University, Faisalabad, Pakistan )
This study explores the relationship between distress tolerance and depression with mediating role of anxiety-related symptoms and stress among dropout and non-dropout university students. This cross-sectional study was conducted from October 2019 to December 2020. Participants' age ranged between 20-40 years. Data was collected using the Distress Tolerance Scale and Depression Anxiety and Stress Scale. Descriptive, t-test, and mediation analyses were performed to calculate the results. A sample of 500 respondents was recruited. A significant difference was noted between dropout and non-dropout students on CGPA (p<0.001), depression (p<.001), anxiety (p<0.001), stress (p<0.001), tolerance (p<.001), absorption (p<0.001), appraisal (p<0.001), and distress tolerance (p<0.001). Mediation analysis reveals that stress and anxiety significantly mediates between distress tolerance and depressive symptoms (i.e., F (498) = 31.14, p<0.001; F (498) =34.14, p<0.001; F (496) = 161.21, p<0.001). It is concluded that low distress tolerance increases stress and anxiety, triggering depressive symptoms.
Keywords: Distress Tolerance, Stress, Anxiety, Depression, Dropout-Non-dropout Students.
Submission completion date: 15-04-2022
Acceptance date: 12-11-2022
For the longest time, it has been believed that the student community is more relaxed but actually it is not. For example, high parental expectations, self-expectations, admission competition, unemployment, and financial stability are the main factors that cause distress.1 Due to this situation, mental health problems are increasing among students.2 Academic failure is another issue of psychological distress. Students usaually drop out after they consistantly fail to perform their regular academic tasks; however, after dropping out, many students find it hard to readjust into the society and participate in other economic activities.2 Depression is a common mental disorder that could be reduced by various interventions. Psychological problems are approximately higher in students as compared to the general population and higher in dropout students.3
Low distress tolerance increases mental health problems.4 The high degree of distress among students causes anxious behaviour and provokes the stressful situation, which produces negative emotional and academic outcomes.5 Depressive symptoms significantly affect students' academic performance, trigger negative beliefs, and replicate the negative thoughts which cause severe psychological distress.6 Another study reported that engineering students perceived depression at 25%, anxiety at 32%, and stress at 20%, while social science students perceived 21% depressive symptoms, 30% anxiety-related symptoms, and 17% daily life stressors, and medical students perceived a higher degree of depression at 25%, fear 34%, and stress 23%.7 Similarly, in North America and Europe, it is reported that university students are at higher risk of mental distress.8
This research aimed to explore the prevalence of mental health problems among students who dropout from university, and investigate the impact of distress tolerance on depression with mediating effect of anxiety and stress among university dropout and non-dropout students.
Materials and Methods
A cross-sectional study was carried out at the Government College University, Faisalabad, from August 2019 to December 2020. The current study protocols were approved by the Institutional Review Board (IRB; Ref.NO.GCUF/ERC/204) of the Government College University, Faisalabad. The sample size was estimated using G-Power software9 (version 188.8.131.52) with an effect size of 0.40, α error 0.001 with the power of 0.9521. For the current study, the G-Power calculator generated a sample size of 457 participants; we targetted 560 respondents, and 500 university students met the study inclusion-exclusion criteria. Participants' age ranged between 20 to 40 years. Participants were briefly explained about the study, and written informed consent was taken before applying a detailed demographic form to collect research participants' personal information. The Distress Tolerance Scale comprised 15 items with four subscales. Moreover, Depression Anxiety and Stress Scale (DASS) was administered.
A total of 500 respondents comprising 253 (50.6%) dropout and 247 (49.4%) non-dropout university students (Table 1) participated in the study. There were 242 (48.4%) males, and 258 (51.6%) females; 484 (96.8%) were single and 16 (3.20%) were married
The findings indicate (Table 2) that there is a significant difference between dropout students and non-dropout students on the CGPA (i.e., t=5.22; p<0.000). Moreover, the results show that dropout students perceived high degree of depression, anxiety, stress, and psychological distress as compared to non-dropout students (i.e. t=-29.31, p<0.000; t=-13.11, p<0.000, t=-11.36, p<0.000 & t=-21.93, p<0.000, respectively). Similarly, dropout students perceived a lower degree of tolerance as compared to non-dropout students on the variable of tolerance, absorption, appraisal, regulation, and overall distress tolerance (i.e., t=4.48, p<0.000; t=5.56, p<0.000, t=3.62, p<0.000 & t=4.61, p<0.000 respectively).
Results (Table 3) showed that tolerance was a significant negative predictor of depression, whereas anxiety and stress were significant positive predictors of depression (Figure).
The findings indicate that the degree of depression and anxiety-related symptoms increases in students due to academic stressors, especially dropout problems. The degree of these mental health issues is higher in female students than males.10 The dropout students were noted to be more vulnerable to depression, anxiety, and stress, which create a degree of overall psychological distress compared to non-dropout students.11 These findings are consistent with previous studies.11,12 Dropout students were investigated significantly differently on the variable of tolerance, absorption, appraisal, regulation, and the scale of distress tolerance compared to their counterparts. Low intolerant behaviour increases the frequency of depressive symptoms; it also promotes symptoms of anxiety and stresses.12
Mediation analysis indicates that stress and anxiety mediate between tolerant behaviour and mental health problems among students (Table 3, Figure). These findings are in line with the previous studies.13 In students, distress tolerance triggers the degree of stressors and provokes anxiety-related symptoms. The severity of symptoms causes emotional disturbance and mood instability. This phenomenon does not end at this stage; it reflects emotional and behavioural problems.14 The students with unstable emotional and behavioural characteristics perceive depressive symptoms, which significantly affect the students' academic performance.15
It is concluded that mental health problems are rising among university students, and it is significantly associated with dropout rates and academic failure.
Recommendations and limitations of the study
The current study presents very important findings for academicians, practitioners, and mental health professionals to understand and address the pattern of mental health problems among drop-out students. This study does not describe the dropout rate of medical students, engineering students, and students of below undergraduate programmes.
Disclaimer: None to declare.
Conflict of interest: None to declare.
Funding disclosure: None to declare.
1. Reddy KJ, Menon KR, Thattil A. Academic stress and its sources among university students. Biomed Pharmacol J 2018; 11.
2. Azim SR, Baig M. Frequency and perceived causes of depression, anxiety and stress among medical students of a private medical institute in Karachi: a mixed-method study. J Pak Med Assoc 2019; 69: 840-5.
3. Tesfaye Kelemu R, Bayray Kahsay A, Ahmed KY. Prevalence of Mental Distress and Associated Factors among Samara University Students, Northeast Ethiopia. Depress Res Treat 2020; 2020: 7836296.
4. Delara M, Woodgate RL. Psychological Distress and its Correlates among University Students: A Cross-Sectional Study. J Paediatr Adolesc Gynaecol 2015; 28: 240-4.
5. Panova T, Lleras A. Avoidance or boredom: Negative mental health outcomes associated with use of Information and Communication Technologies depend on users' motivations. Computers in Human Behavior 2016; 58: 249-58.
6. Gao Y, Hu D, Peng E, Abbey C, Ma Y, Wu CI, et al. Depressive symptoms and the link with academic performance among rural taiwanese Children. Int J Environ Res Public Health 2020; 17: 2778.
7. Kumar H, Shaheen A, Rasool I. Shafi M. Psychological Distress and Life Satisfaction among University Students. J Psychol Clin Psychiatry 2016; 5: 00283.
8. Iorga M, Dondas C, Zugun-Eloae C. Depressed as Freshmen, Stressed as Seniors: The Relationship between Depression, Perceived Stress and Academic Results among Medical Students. Behavioral Sciences 2018; 8: 70.
9. Faul F, Erdfelder E, Buchner A,Lang AG. Statistical power analysis using G* Power 3.1:tests for correlation and regression analyses. Behavior Research Methods 2009; 41: 1149-60.
10. Chan HWQ, Sun CFR. Irrational beliefs, depression, anxiety, and stress among university students in Hong Kong. J Am Coll Health 2021; 69: 827-41.
11. Asif S, Mudassar A, Shahzad TZ, Raouf M, Pervaiz T. Frequency of depression, anxiety and stress among university students. Pak J Med Sci 2020; 36: 971–6.
12. Naz N, Iqbal S, Mahmood A. Stress, anxiety and depression among dental students of university college of medicine and dentistry Lahore. Pakistan. Pak J Med Health Sci 2017; 11: 1277-81.
13. Saleem S, Renshaw KD, Azhar M, Giff ST, Mahmood Z. Interactive Effects of Perceived Parental Rearing Styles on Distress Tolerance and Psychological Distress in Pakistani University Students. J Adult Dev 2021; 28: 309-18.
14. Carsley D, Heath NL, Gomez-Garibello C, Mills DJ. The importance of mindfulness in explaining the relationship between adolescents' anxiety and dropout intentions. School Mental Health 2017; 9: 78- 86.
15. Masri R, Kadhum M, Farrell SM, Khamees AA, Al-Taiar H, Molodynski A. Wellbeing and mental health amongst medical students in Jordan:a descriptive study. Int Rev Psy 2019; 17: 619–25.
Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: