Differences in stress levels between junior high school students and college students during online learning

Stress can occur at all ages, including in junior high school and college. Stress is an emotional reaction to excessive demands that affect a person's activities of daily life.1 Stress is a normal response to events that make one feel threatened or require adjustment to a new environment; however, stress can turn into an abnormal response if it interferes with activities for a fairly intense period of time.2 Stress affected students during the change from an offline model to an online model during the COVID-19 pandemic. Changes in the learning system can trigger stress for junior high school students and college students. Moreover, online learning can create academic stress,3 resulting in negative impacts such as insomnia, psychosomatic complaints, anxiety, depression, and emotional distress.3 This can decrease students' academic achievement and impact their physical and mental health.4 Methods This research used a qualitative method with a descriptive-analytic research design and a cross-sectional approach. The variables studied were the stress levels experienced by junior high school students and college students and the differences between groups. The vice dean for education, research, and student affairs in the Faculty of Nursing at the Universitas Indonesia approved this study. Researchers obtained participants' informed consent via a Google form with ethics approval and received permission to research in the school or the university from the Faculty of Nursing researcher approval letter. This study has ethical approval number Ket-23/UN2.F12.D1.2.1/PPM.00.02/2022 for college students and Ket-30/UN2.F12.D1.2.1/PPM.00.02/2022 for junior high school students. Investigators selected respondents, consisting of 120 junior high school students and 120 college students, using a random sampling technique. Investigators used data from the Health Service and direct interviews at schools and universities to determine appropriate school and university data and recruited students using an online randomizer to find undergraduate students at the Faculty of Nursing, Universitas Indonesia and junior high school students at SMP Negeri 23 Pekanbaru and SMP Negeri 40 Pekanbaru. The questionnaires used were a demographic questionnaire created by the researchers and the Perceived Stress Scale (PSS)-10 questionnaire developed by Cohen, Kamarck, and Mermelstein in 1983 and translated by a psychological lecturer at Sanata Dharma University, Yogyakarta. The PSS-10 instrument has an original Cronbach alpha coefficient value of 0.80 for 80 respondents.5 These questionnaires were given to respondents using online forms distributed by their teacher or class group messages. The PSS-10 questionnaire consists of 6 negative items and 4 positive items to determine the respondent's level of stress in the past month. The score results were obtained by adding up the item responses with reverse scoring, that is, 0=4, 1=3, 2=2, 3=1, and 4=0 , as well as the four positive items in questions 4, 5, 7, and 8. Total score on the PSS-10 ranges from 0 to 40. Investigators conducted univariate analysis via the central tendency test, and calculated frequency distributions on stress levels and participant sex. Bivariate analysis used the Mann-Whitney test to determine the differences in stress levels between junior high school and college students. Results The normality test revealed that the data weren't normally distributed (P = .000; alpha = .05). Therefore, the researchers used medians to describe the data concentration. Data on sex using the frequency distribution are presented in Table 1, showing that the junior high school students were predominantly male (n = 67, 55.83%). In contrast, college students were mostly female (n = 112, 93.3%). Table 1: - Sex distribution (N = 240) Level Sex Frequency (n) Percentage (%) Junior high school students Female 53 44.16 Male 67 55.83 College students Female 112 93.3 Male 8 6.7 The stress level of junior high school and college students during online learning are presented in numeric scales using the central tendency test, as presented in Table 2. The median stress level of junior high school students is 20.00 (5-34) from a maximum score of 40 and college students is 20.00 (8-35) from a maximum score of 40. Junior high school and college students have moderate stress levels during online learning with a maximum score of 34 and 35, respectively. Table 2: - Stress levels of junior high school and college students (N = 240) Stress level Median SD SE Min-Max Junior high school students 20.00 6.321 0.577 5-34 College students 20.00 5.817 0.513 8-35 The stress levels of junior high school and college students during online learning with categorical scales were analyzed by frequency distribution. These levels are presented in Table 3. Most students experienced moderate stress: 91 junior high school students (37.9%) and 82 college students (34.2%). The second most common stress level experienced by the students was high stress: 21 junior high school students (8.75%) and 15 college students (6.25%). Fewer students experienced mild stress: 8 junior high school students (3.3%) and 23 college students (9.6%). Table 3: - Stress levels of junior high and college students (N = 240) Low stress (0-13) Moderate stress (14-26) High stress (27-40) Frequency (n) Percentage (%) Frequency (n) Percentage (%) Frequency (n) Percentage (%) Junior high school students 8 3.3% 91 37.9% 21 8.75% College students 23 9.6% 82 34.2% 15 6.25% The stress levels of the respondents by student sex were analyzed using a frequency distribution. These levels are presented in Table 4. Male junior high school students experienced moderate stress (50 students or 20.8%), whereas 32 female junior high students (13.4%) reported moderate stress. Meanwhile, most female students in college experienced moderate stress (74 students or 30.8%) and 23 male students (9.6%) experienced low stress. Table 4: - Stress levels of junior high and college students during online learning by sex (N = 240) Low stress Moderate stress High stress Level Sex Frequency (n) Percentage (%) Frequency (n) Percentage (%) Frequency (n) Percentage (%) Junior high students Female 8 3.3 32 13.4 13 5.4 Male 9 3.8 50 20.8 8 3.3 College students Female 23 9.6 74 30.8 15 6.3 Male 0 0 8 3.33 0 0 This research analyzed the different stress levels of junior high school students and college students using a numerical-categorical scale with the Mann-Whitney test. Their differences are presented in Table 5. Junior high school and college students had significantly different levels of stress (P = .011) from online learning during the COVID-19 pandemic. Table 5: - Different stress levels of junior high and college students during online learning (N = 240) Stress Level P Mann-Whitney U Wilcoxon W Z Junior high school students .011 6121.500 13381.500 -2.547 College students Discussion Excessive demands can trigger various signs and symptoms of stress such as fatigue, irritability, poor quality of work, and depression. Stress is a normal psychological response to events that feel threatening.6 Most environmental adjustments cause normal stress, but abnormal stress can interfere with individual activities for a lengthy period of time.2 Stressors can cause positive body changes (eustress) and negative body changes (distress), depending on a person's perspective of the stressors they're facing and individual coping mechanisms.7 Stress levels relate to the person's external and internal environment and the frequency with which a person is exposed to the stressor.8 In regards to academic stress, internal factors include time pressure, learning motivation, worry about not being able to participate in activities, financial problems, and the fear of being left behind.9 External factors that can trigger academic stress include social relationships with family, friends, or lecturers.6 Future studies could pursue interviews with students to find out more about the stressors they experience. The highest level of stress experienced by junior high school students (91 students or 37.9%) is moderate stress. This number is smaller than the previous study in Jepara Regency, East Java, which found 137 students (70.36%) of 156 students were moderately stressed.10 Another study at a junior high school in Jakarta found results similar to the present study: 36 students (72%) described a medium or moderate stress level.11 Junior high school students have been shown to adapt to and accept the conditions of the COVID-19 pandemic and online learning; that is, they can manage these stressors.10 However, moderate stress that isn't handled properly can develop into high stress that can interfere with the students' daily activities and cause headaches, anxiety, and depression.11 The most common stress level experienced by all students (82 students or 34.2%) was moderate stress. This finding is similar to a previous study in Turkey,12 but is different from that of the research conducted in Indonesia.13 The moderate level of stress experienced by students can cause signs and symptoms of health problems, such as disturbed sleep patterns and decreased concentration.14 Untreated moderate stress can escalate to severe stress that lasts for weeks or years.14 There are several ways for students to deal with moderate stress levels and manage stress during the pandemic, such as spending an hour without smartphone screen exposure before bed, doing meditation, and sharing thoughts and feelings with close friends and family.15 Sex can also influence an individual's stress level. Moderate stress was experienced by 50 male students (20.8%) and 74 female students (30.8%) in junior high school. Further, female students in junior high school (32 students or 13.4%) were more stressed than female college students (8 students or 3.3%). Factors influencing stress in males may include boredom at home, difficulty meeting friends, and boredom with online learning. Meanwhile, female students may also experience aggravating factors, such as the hormone fluctuations that accompany menstruation.10 Hormonal differences can also play a role. For example, testosterone minimizes the production of oxytocin, which can cause feelings of happiness, pleasure, relaxation, and peace with others.10 Stress must be addressed to maintain mental health, especially during the COVID-19 pandemic. Many changes that occurred during this pandemic affected the social environment of students, such as excessive fear for their own and family's safety, changes in lifestyle due to distance learning, changes in socioeconomic status from large-scale social restrictions, and boredom because they were always at home.16 Implications for nurse leaders Nurses need to know the factors that influence stress among junior high and college students. Nurses should be educated about coping strategies to reduce stress and how students respond to their stress. Nurses can also determine psychological support and mobilize an individual's families, friends, and changes in their environment to manage stress. Conclusion Stress may occur in both junior high school students and college students during online learning, and most are likely to experience moderate stress. However, students can adapt and accept the changes that occur during conditions such as the COVID-19 pandemic. It is important to know that stress is influenced by internal and external factors, sex hormones, and individual responses to stressors.