The present study

Everyone experiences stress to some extent, and university students are no exception. Academic life can be stressful for many students, with environmental, social, or internal demands that cause them to adjust their behavior. However, this stress does not always take a negative form. Research shows that positive stress can enhance memory and improve risk-taking and decision-making skills [31]. While there is no perfect way to control stress, using effective techniques can help during stressful times and turn students’ academic, social, and emotional circumstances into more positive and successful experiences. When applied to the COVID-19 pandemic, these techniques can limit the adverse effects of online learning, including changes in eating and sleeping patterns, separation from classmates, and loneliness. Therefore, the present study aims to ascertain the association between psychological distress and coping strategies among students engaged in online learning.

Research questions

This study tried to answer the following research questions:

1. What is the prevalence of psychological distress among university students engaged in online learning during the COVID-19 pandemic?
2. Is there any association between psychological distress and students’ socio-demographic characteristics?
3. Is there any association between psychological distress and coping strategies among students engaged in online learning?
4. Which coping strategy has primarily been used in managing stressful events by students occupied with distance learning?

Participants and procedures

This cross-sectional study was carried out at two renowned universities in Bangladesh, the University of Dhaka and North South University. Data was collected from March 26 to April 27, 2021. Participants were both undergraduate and postgraduate students. To be included in this study, participants had to be between 18–35 years and be engaged in online learning. Those who could not respond due to severe physical illness were excluded from this study. The study sample size was determined by the given 80% power and 95% CI (0.05 to 1.96), and the prevalence of severe stress from the previous study was 12.8% [32]. With adjustable for 20% refusal, the required sample size was 207. However, 50% of participants were non-responsive throughout the questionnaire pre-testing. As a result, the target sample size was increased to 220 in order to reach the goal. A multistage sampling technique was performed to collect the data (Fig 1). At first, one public and one private university from Dhaka city were chosen purposively. Both universities serve diverse communities, with a higher percentage of graduate students in Bangladesh. For participant selection, a stratified random sampling technique was applied. From the opinion of an expert statistician, at least 55 undergraduate and 55 postgraduate students from both universities (four strata for two universities) were selected.

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Fig 1. Flowchart of the process of the multi-stage sampling technique.

https://doi.org/10.1371/journal.pone.0270877.g001

As per government directives, the campus was closed with classes resumed online; therefore, four student representatives from each university provided each student’s school email for data collection purposes. At first, an invitation was sent with an informed consent paper explaining the purpose of the study and assurance of confidentiality. Participants were asked whether they would consent to participate in the study and if so, an online questionnaire was sent to their school email address. Participants were requested to feel accessible to any queries. The questionnaire was sent to 278 students. Two hundred forty-six students who were interested in participating in this study gave their informed consent, and 222 completed the online questionnaire. The response rate was 79.8%. Lastly, 210 responses were included in the final analysis after a comprehensive examination and review for consistency verification and reduction.

Data was collected using a structured questionnaire prepared in the English language. The baseline socio-demographic variables concerned in this study were age, gender, area of residence, education, and type of university. Participants were asked about their self-income level, having a personal computer/laptop, and availability of internet/wi-fi connection at home; these responses were recorded as ‘yes/no.’ Further, they were asked about their average time spent on online education each day (1–3 hours, 3–5 hours, 5–7 hours), how helpful university has been offering the resources to learn from home (not at all helpful, moderately helpful, very helpful). Moreover, participants self-reported the presence of any mental health illnesses, and it was recorded as (yes, no, and maybe).

A pilot study was conducted to check the research feasibility, where the questionnaire was approached to 20 people anonymously in a separate sample. Afterward, the questionnaire was modified accordingly. The estimated reliability of each scale was checked by Cronbach’s alpha (value 0.941), showing excellent reliability.

Measures

Kessler-10.

The psychological distress instrument, Kessler-10 (K10), a 10-item self-measured and straightforward questionnaire, was used to measure psychological distress levels. The responses observed participants’ emotional states in the last 4-weeks [33]. Each of these items begins with the proposition: “During the last 30 days, about…” followed by ten items with 5-point Likert response options that range from 1 (none of the time) to 5 (all of the time). A sample item is “…how often did you feel tired out for no good reason?” Based on the stems of the 5-point Likert scale, the scores ranged into four categories (score 10–19 well/no stress, score 20–24 mild stress, score 25–29 moderate stress, score ≥30 severe stress). This study determined the cutoff score of ≥29.5 from each domain, showing a strong predictor of the outcome. The inventory cutoff point was assessed using the receiver operating characteristics (ROC) curve and the area under the ROC curve (AUC). The cutoff point that best discriminated was 29.5; that is, anyone with a score equal to or more than 29.5 was considered severe stress. This value represents a specificity of 71.5% and a sensitivity of 89.4%; the area under the curve (AUC) was found to be [0.885 (CI = 0.841–0.929), p-value<0.01)] (Fig 2).

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Fig 2. ROC curve; K10 score.

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Brief COPE.

A shortened version of the brief-COPE Inventory was used to measure the participants’ coping strategies. COPE Inventory is a multidimensional scale comprised of two items on 14 subscales [29]. These subscales fall into three categories problem-focused, emotion-focused, and avoidance. Brief-COPE Inventory was assessed using a four-item Likert scale ranging from 1 (I usually do not do this at all) to 4 (I usually do this a lot). Each item showed a moderate reliability Cronbach alpha score (0.745–0.783) and a moderate internal consistency of 0.677 (Table 5). Confirmatory factor analysis (CFA) evaluated the construct validity of the hypothesized model [28–30]. Multiple indices were estimated to consider the goodness of the fitted model, the Comparative Fit Index (CFI), the Tucker-Lewis Index (TLI), the Root Mean Square Error of Approximation (RMSEA), the Standardized Root Mean Squared Residual (SRMR) [34]. An acceptable model fit criteria was indicated by RMSEA < 0.05, SRMR < 0.08, TLI, and CFI > 0.90 [35]. The Chi-square test of absolute model fit indicated a fitted model. The overall χ2 for this model was 168.81 (df 74) (p<0.001). After including all the hypothetical pathways, the model also demonstrated an adequate fit to the data (CFI = 0.993; TLI = 0.946; RMSEA = 0.078; SRMR = 0.049). The model explained 34% of the variance in brief COPE (Fig 3).

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Fig 3. CFA model for the brief-COPE inventory.

https://doi.org/10.1371/journal.pone.0270877.g003

Statistical analysis

Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 25.0. The z-score transformation was performed for each outcome variable to check outliers. Cases with |z| ≥ 3.29 typically indicate potential outliers. By using these criteria, no significant outliers were identified. Descriptive statistics was denoted as means and standard deviations (SD) for continuous variables and number (n) and percentages (%) for categorical variables. Cronbach alpha and intra-class correlation coefficients (ICC) were used to assess the reliability and internal consistency of Kessler-10 (K10) items. Additionally, Pearson (r) correlational coefficients were stated as evidence of concurrent validity. Confirmatory factor analysis was performed to examine the hypothetical model of the brief COPE using SPSS AMOS version 24.0. Pearson’s chi-square test was applied to see the associations between socio-demographic characteristics and psychological distress, where a p-value less than 0.05 was considered significant. A multiple linear regression model was generated to calculate the standardized coefficients (Beta) value with a 95% confidence interval. All 14 COPE inventory variables were entered into the model to evaluate the association with the Kessler category. The logistic regression model’s tolerance and variance inflation factors (VIF) were also obtained to check potential multicollinearity. The association between coping strategies outcomes with Kessler categories was conducted using the Spearman correlation test due to its non-parametric distribution.

Ethical approval

Ethical approval of this study was taken from the Institutional Review Board/Ethical Review Committee of North South University (2021/OR-NSU/IRB/0402). The participants were provided their consent; no incentive was given to anyone, and all data were collected anonymously and would not identify the participants. Participation in this study was entirely voluntary; no one was forced and was allowed to leave while answering the questions. Participants were reassured that all the information collected would be kept strictly confidential and only be used for research purposes.

Main findings

The COVID-19 pandemic forced institutional activities to shift from the conventional format to that of online learning. This sudden alteration to daily life induced higher anxiety, depression, and stress rates in students. A consideration of the benefits of coping strategy resources is necessary for students experiencing stressful situations. This study examined the association between psychological distress and coping strategies among students engaged in online learning. The findings of this study showed that Bangladeshi university students’ psychological distress levels were heightened during the pandemic. In addition, the results also showed that emotion-focused and avoidance coping strategies were effectively utilized by students experiencing stress for a better outcome.

Comparisons with other studies

The severe psychological distress prevalence rate was 55.2% among Bangladeshi university students engaged in online learning. Although this may appear daunting, such experiences are quite common. A recent study conducted at Texas A&M University, USA, found that 71% of students reported higher stress and anxiety during COVID-19 [39]. Similarly, the prevalence of anxiety and stress was 32.9% and 14.6%, respectively, in medical school graduates in China [40]. Perceived stress among University of Nizwa students in Oman reported that 82.5% were experiencing medium stress, while 14.4% experienced raised stress during COVID-19 e-learning [41]. A sample of 420 primary and secondary school students in Palestine showed that 35.7% experienced moderate to severe stress levels [42]. University students are primarily acknowledged as a vulnerable population; therefore, the radical shift in education affects students regardless of their socio-economic status. A cross-national study conducted among university students in nine countries discovered that high stress, depression, and anxiety prevalence was 61.30%, 40.3%, and 30%, respectively [43]. The prevalence of depressive symptoms, suicidal ideation, and perceived stress was reportedly higher among university students in the humanities field in Italy, where 87.7% reported moderate or severe stress [44].

Among all socio-demographic groups, the younger age group of 18–25 years experienced the most distress. Similar results were seen in studies from Malaysia and Switzerland, where psychological well-being and distress-related factors were significant in the 20–25 years age group and in female students [45,46]. Concerning psychological distress severity, another study in Jordan reported that 54.9% of students found no motivation for distance learning, which was very stressful for those 18–22 years of age [47]. Self-reported stress levels were also higher among high school students, resembling statistics of students in primary school in China [48]. In addition, public university students tended to suffer more (54.3%) than private university students. This appeared particularly evident in Bangladesh, as they lacked the facilities to engage in online learning [18,49]. Following the suspension of conventional classes, public university students experienced widespread panic and increased anxiety and stress during the COVID-19 outbreak. A recent survey conducted by the psychology department of six states in the USA showed that only 35% of students had taken one or more courses online before the pandemic. Therefore, anxiety and distress during COVID-19 appear to show a solid correlation to unfamiliarity with online learning [50].

Additionally, 68.1% of participants with no self-income reported being prone to severe stress. According to a study from Australia, female students suffered medium to high psychological distress levels because of employment loss during the pandemic period [51]. From Adams et al., the study conducted among Midwestern university students found that approximately 38% depended on family income as they did not have any self-income source [52]. Another cross-sectional study from the University of Thessaly, Greece, reported that students with financial dissatisfaction were most likely to experience severe psychological distress among all factors. [53]. The 2017 National Health Interview Survey (NHIS) sample showed that U.S. adults experiencing financial worries and food and healthcare insecurity were more likely to face psychological distress [54]. In North America, young adults, females, and low-income groups were the risk factors for pandemic-related stressors during COVID-19 [55]. Similarly, the unemployment rate and loneliness increased the likelihood of experiencing adverse mental health outcomes among German female participants [56].

Moreover, the results of this study also found that participants who received moderate resources from the university to continue online learning did not benefit significantly from them, with 57.8% of students reporting severe stress. A study conducted in New Jersey, USA, showed increased concern for academic performance among students engaged in online learning. A lack of social interaction affected their ability to concentrate and caused a rise in stress levels [57]. Results from a cross-sectional study in Munich also showed that severe psychological distress was associated with lower life satisfaction, inadequate social support, lack of social interaction, and worries about financial difficulties [58].

Further, this study found that 7.8% of participants with previous mental illnesses experienced significant psychological distress. Although it is expected that preexisting mental health conditions correlated to raised psychological distress during the pandemic, this was not always the case. A study in Canada showed that students without preexisting mental health concerns were more likely to suffer a decline in mental health [59]. Mboya et al. discovered that a family history of mental illness was significant in predicting future psychological distress [60]. A strong parent-child relationship, regular interactions, a problem-solving mentality, and regular communication have been shown to benefit a child’s mental health. Similarly, a family history of psychiatric disorders increased the likelihood of experiencing depressive symptoms among Italian students, and female university graduates who were already consulting a psychologist or psychiatrist were positively associated with suffering psychological distress [44].

The multivariate analysis of the present study demonstrated that active coping, using emotional support, and self-blame were more commonly used by Bangladeshi university students to overcome the stressful circumstances of online learning during the COVID-19 pandemic. Comparable results were seen in an exploratory study in Poland, where female and postgraduate students used various strategies to manage stress, including active coping, acceptance, and positive reframing [61]. Another study conducted among U.S. Mexican college students found that active coping and avoidance strategies were related to coping with stress [62]. From Ismail et al., Malaysian medical college interns found problem-focused and avoidance coping strategies helpful in coping with stress [45]. In contrast, seeking social assistance was the least favored option among Pakistani students, with most students choosing emotion-focused and problem-focused coping strategies to lower psychological distress [63]. As a result of being forced to stay at home, undergraduate health science students at Jimma University in Ethiopia employed active coping, planning, and positive reframing in their everyday lives during COVID-19 [64]. Acceptance, planning, and seeking emotional support were also the most commonly employed stress management approaches among Polish students [65].

Although there has been some debate about whether avoidance coping strategies have benefits, research has shown that while they may help reduce short-term stress, they are generally considered unhealthy [66]. An increased prevalence rate of depression, anxiety, and stress symptoms was seen in Brazilian undergraduate female students aged 18–24 years old; these students were more likely to use avoidance coping strategies such as self-blame and substance use [67]. Another study conducted in the United Kingdom during the COVID-19 pandemic discovered that participants with previous mental health conditions were more likely to use avoidant coping and social support; in contrast, others preferred supporting strategies such as problem-focused strategies [68]. Further, Vietnamese research of public health and preventive medicine students discovered that individuals experiencing extreme stress were more likely to use avoidance coping techniques [69]. In contrast, substance use was least common among students from Saudi Arabia and Egypt, where coping with religious activities and spiritual beliefs in severe stressful conditions proved beneficial [32,70].

A study by the University of Aberdeen, Scotland, showed that students who self-harmed found coping strategies to be an effective way of dealing with their emotions and behaviors [71]. Among university students, existing mental health difficulties, such as stress and depressive symptoms, are exacerbated by a lack of social support. A Malaysian study found a connection between perceived social support and psychological distress among university graduates [72]. Similar results were seen in Mexican American and Latin American undergraduate students, where students with available perceived social support displayed lower psychological distress than students who did not seek such support [73]. Research showed that Latino College students willing to seek psychological help experienced better health outcomes [74]. University students’ most common coping techniques in the Philippines were resource management, help-seeking, technological skill enhancement, time managing, and learning environment control [75].

This study was conducted during the early stages of the pandemic, surveying Bangladeshi university students’ mental health; it was aimed at identifying strategies that students found helpful in their daily activities. Due to the wealth of information these studies provide, coping strategies and adaptive responses must receive more attention and discussion, as they play an immense role in helping students cope with crises such as COVID-19.