Background

During university, individuals experience significant pressures and obstacles that present various social, emotional and physical difficulties [1]. Several studies have revealed a high prevalence of stress among university students. According to Lazarus and Folkman [2], stress is considered as “a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being”. Several factors were found to be associated with stress levels among university students, including psychological, academic, biological, lifestyle, social, and financial factors [3]. Moreover, students often experience pressure to achieve academic success, plan for their future careers and build interpersonal relationships [4]. A survey at a Pakistani Women University in Sialkot reported that 84.4% of students experienced stress [5]. In Germany, a recent study found that 73.2% of the students at the Technical University of Munich were moderately to highly stressed [6]. Furthermore, a study conducted at University of Sharjah in UAE, found that 12.3% of the students experienced moderate stress [7]. The 2014 American College Health Association report, found that approximately half of the students experienced above-average or high level of stress within the last 12 months [8].

Although stress is not a psychiatric diagnosis, it plays a crucial role in developing psychiatric conditions such as depression and anxiety [9]. Thus, reducing stress levels can help reduce other psychological symptoms [4]. Given that university students are more prone to mental health issues compared to the general population [10]. However, universities often design extracurricular activities (ECA) to improve academic performance, as well as to offer social and emotional development [11–13]. These activities include participating in clubs like sports, social, gaming, music, and cultural clubs, volunteering and community services, and student government. Interestingly, involvement in ECA has been associated with reduced psychological stress among university students [4]. Previous studies, including high school students, have shown that ECAs are associated with positive behavior, improved grades, school completion, and characteristics that contribute to students’ success as adults [14,15]. Similarly, middle-school students involved in ECA have significantly lower dropout rates compared to those who are not [16].

Moreover, studies have highlighted the positive relationship between participation in ECA and university students’ well-being, in which students involved in ECA activities tend to have better connections and networks with their peers. In addition, volunteering and social activities play a key role in enhancing the psychological well-being in individuals and increase the sense of belonging and purpose [17]. A research conducted at a large Indian university showed that participation in ECA moderates the relationship between academic stress and coping [18]. However, there is a huge gap in the literature in Lebanon. One of the few existing studies, conducted among preclinical medical students, revealed that participating in music-related activities was correlated with lower burnout [19].

Students in Lebanon face daily challenges due to the economic and political conditions, as well as the long-lasting psychological and financial impacts resulting from the incomplete recovery from previous crises including theCOVID-19 pandemic and Beirut port explosion. Therefore, assessing stress levels among university students in Lebanon and the impact of ECA in this context is rather crucial.

The American University of Beirut (AUB) is an accredited institution that has around 8000 students and includes seven faculties: Agricultural and Food Sciences, Arts and Sciences, Engineering and Architecture (Maroun Semaan Faculty), Health Sciences, Medicine, Nursing (Rafic Hariri School), and Business (Suliman S. Olayan School). These faculties offer more than 140 programs leading to the bachelor’s, master’s, MD, and PhD degrees. At AUB, student activities involve sport clubs, social clubs, art clubs, volunteer and community services, student governments, societies and many more. These non-academic activities are not part of the regular curriculum and are usually not graded. This study aims to gain insights into AUB students’ engagement in ECA and their stress levels, providing data on the association between ECA and stress among university students in Lebanon.

Thus, the key objective of this study is to evaluate the association between ECA and stress levels among AUB students, and explore whether this relationship varies across population subgroups e.g., socio-demographic characteristics such as gender, age, major and family income.

Methodology

Results

Sociodemographic characteristics and its association with perceived stress (PS) levels

A total of 384 AUB students participated in the online survey, with 365 providing complete responses, resulting in a 95% completion rate. Table 1 summarizes the sociodemographic characteristics of the study population. More than half of the students (55.1%) were between 18 and 20 years old, with junior students (third year of undergraduate study) constituting the highest percentage (47.4%). Almost two-thirds of the participants were female (67.1%). The majority of the students (75.1%) lived with their families. Most students were Lebanese (92.6%) and full-time students (90.4%), with 61.5% enrolled in non-health related majors. Nearly half of the students (49.9%) reported a monthly household income of $1000 or more. Approximately 36% of the students spent 5–10 hours on study per week. Almost half of the participants (53.15%) were employed, and among the 194 employed students, about 26% worked 1–5 hours per week.

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Table 1. Socio-demographic characteristics of AUB students in the study sample (n = 365) (Spring 2024-Lebanon).

https://doi.org/10.1371/journal.pone.0329888.t001

As shown in Table 1, significant differences were observed in the perceived stress levels of AUB students based on their gender (p < 0.001) and employment status (p < 0.001).

Extracurricular activities (ECA)

The results in Table 2 revealed that almost two-thirds of the participants (61.4%) were not involved in ECA during their study period, while 38.6% were involved in either single or multiple activities. The most ECA were student societies (52.5%), sport clubs (34.7%), and social club (26.9%). Among those who participated in ECA (n = 141), more than half (52.5%) spent 1 to 5 hours per week on these activities. A significant majority of students (84.4%) reported making friends and expanding their social network as a result of their ECA engagement. About 28.1% of those engaged in ECA felt that their involvement significantly reduced their stress levels, and 37.4% considered that engagement in ECA had a positive effect on their studies. A small portion of the participants (13.4%) faced certain challenges such as time management due to their ECA engagement. Additionally, 55.7% of the students agreed that the ECA system at AUB is easy to use, while less than half (40.9%) reported being fully informed on how to use the ECA system.

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Table 2. Participation in ECA of AUB students in the study sample (n = 365) (Spring 2024-Lebanon).

https://doi.org/10.1371/journal.pone.0329888.t002

Cohen’s Perceived Stress Scale (PSS)

Among the study sample (Fig 1), the majority of the students (71.5%) exhibited moderate perceived stress level, 18.1% exhibited high perceived stress level, and 10.4% exhibited low perceived stress level.

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Fig 1. Perceived stress of AUB students in the study sample (n = 365) (Spring 2024-Lebanon).

https://doi.org/10.1371/journal.pone.0329888.g001

Multinomial logistic regression analysis

Simple multinomial logistic analysis revealed that four predictors were significantly associated with the perceived stress level among university students (Table 3). Gender was one of the predictors, with males being less likely to exhibit moderate (OR = 0.323, p = 0.002) and high stress levels (OR = 0.174, p < 0.001) than females. Other significant predictors comprised the time spent on study per week (Moderate perceived stress: OR = 2.862, p = 0.044; High perceived stress: OR = 3.500, p = 0.041), unemployment status (OR = 4.983, p < 0.001), and the involvement in ECA (Moderate perceived stress: OR = 2.089, p = 0.036; High perceived stress: OR = 2.309, p = 0.044). These predictors remained significant in the multiple analysis. For instance, males had lower odds of experiencing moderate stress (OR = 0.371, p = 0.008) and high stress (OR = 0.238, p = 0.003) compared to females. In addition, students who studied 10–15 hours per week had higher odds of exhibiting moderate stress compared to those who studied 15 or more hours per week (OR = 3.157, p = 0.043). Unemployed participants had higher odds of experiencing high stress compared to employed (OR = 5.191, p = < 0.001). Finally, students not engaged in ECA were more likely to present high stress level than those who were involved in ECA (OR=2.628, p = 0.031).

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Table 3. Simple and Multiple Logistic Regression Analysis for the predictors of stress among AUB students in the study sample (n = 365) (Spring 2024-Lebanon).

https://doi.org/10.1371/journal.pone.0329888.t003

Discussion

Several studies in Lebanon have addressed the mental health issues, stress levels and their effects on university students [25,26]. However, to the best of our knowledge, few studies have focused on the factors that help reduce stress and improve mental health among university students. This study provides significant insights into the relationship between extracurricular involvement and perceived stress levels of students at AUB.

The results of our study indicate that a significant proportion of students at AUB experienced moderate stress levels (71.5%), while a smaller proportion reported high perceived stress levels (18.1%) and low perceived stress levels (10.4%). These findings differ from a study in Pakistan that indicated a lower prevalence of moderate perceived stress levels among university students [5]. Conversely, several studies demonstrated results aligning with our findings in which the highest proportion of students experienced moderate stress levels [27,28]. One of these studies, conducted in Oman, revealed that almost three-quarters of the students suffered from moderate stress (75.1%) and 13.5% reported severe stressors [27]. In Lebanon, several studies have assessed stress levels among university student using the perceived stress scale (PSS)., One study, which included 261 students from three different universities revealed slightly higher moderate stress level among students (75.1%), and a lower level of high stress (13.4%) [26]. Another study included 427 students demonstrated lower levels of moderate stress (41%) and high stress (16.1) [29]. Additionally, a study performed on 165 pre-clinical medical students, using the General Health Questionnaire (GHQ), found that 62% of the students suffered from stress [19]. The high prevalence of stress among university students in Lebanon could be attributed to several factors, including the economic crisis, political situation, and the lingering impacts of the COVID-19 pandemic [30].

The main objective of this study was to investigate the relationship between extracurricular activities and stress levels among students at AUB. Our findings indicated that students not engaged in ECA were more likely to experience high stress levels compared to those who were involved. On the contrary, previous studies, conducted on undergraduate students in Turkey and medical students in Saudi Arabia, demonstrated no significant difference in stress and burnout levels between students involved in ECA and those who were not [22,31]. This discrepancy could be due to the variety of extracurricular activities available at different universities. On the other hand, our results align with several other findings that found a negative correlation between involvement in ECAs and stress levels, indicating that engagement in ECAs helps reduce stress levels [4,21,32]. This could be due to the fact that students involved in ECA build friendships and develop their social network, thus enhancing their social bonds and reducing feelings of isolation [4]. Besides, participation in physical activities enhances the release of endorphin, which are natural stress relievers [33]. Furthermore, involvement in ECA can help students distract themselves from academic pressure.

Furthermore, various stress factors among the participants were also addressed. Our findings identified three predictors associated with stress levels among the students: gender, time spent on study, and employment. Gender differences revealed that females experienced more stress than males, contradicting previous studies that found no statistically significant difference in stress levels between males and females among college students in Eritrea and China and university students in Pakistan [28,34,35]. However, studies in Turkey and Lebanon align with our results, indicating higher stress levels among females [29,36]. The significant difference in stress levels between males and females can be attributed to several factors. Generally, females are known to exert more effort in their studies than males, which can be a major cause of stress [37]. The pressure to perform and the fear of failure are also critical risk factors for stress. Moreover, a study conducted in the US suggested that females may experience higher stress due to academics and relationships, whereas males report greater stress related to financial issues [38]. Additionally, a review on the differences in anxiety between males and females indicated that psychosocial and biological factors play a major role [39]. Culturally, women in many societies tend to express their emotions more openly than men, which may contribute to the observed differences in stress levels. A study published in the Journal of Personality and Social Psychology found that women are generally more emotionally expressive, whereas men exhibit stronger emotional responses to specific stimuli, such as anger and positive events [40]. Consequently, women’s greater ability to articulate their feelings of stress may partly explain the differences observed in our study.

Additionally, our findings revealed that students who study 10–15 hours per week are more likely to experience moderate stress levels compared to those who study more than 15 hours. In contrast, a study on children in China revealed that time spent on homework is a positive predictor of stress symptoms, leading to depression [41]. This discrepancy could be due to the fact that students who study fewer hours may feel their study time is insufficient, leading to increased stress from believing they should have studied more. Additionally, the difference could be attributed to variations in curriculums between Lebanon and China, which may require different amounts of study time.

Regarding employment, our findings revealed that unemployed students were more likely to experience higher stress levels compared to employed students. These findings align with a study in Ontario, Canada, which demonstrated significant differences in psychosocial experiences between unemployed and employed students [42]. This could be because employed students feel more financially stable than unemployed students, which may experience financial stress [42]. Additionally, the majority of employed students in this study work between 1–5 hours per week, suggesting they do not have full-time jobs, thus avoiding significant time management conflicts. Our study did not identify whether the students have full scholarships, financial aid, or cover their entire tuition fees. Therefore, among unemployed students, there may be those with full scholarships who experience stress while maintaining a high GPA.

Several limitations may have influenced our findings. First, the cross-sectional design of the study allows for the identification of associations but does not allow for establishing causal relationships. Second, the use of a non-random sampling method may have introduced selection bias, as students experiencing higher stress levels may have been more inclined to participate in the study. Third, the study was conducted among AUB students which does not allow for the generalizability of the results to students from other universities in Lebanon and other countries. Additionally, the data was based on self-reports responses, which may be subject to reporting or social desirability bias. Despite these limitations, our findings indicate that engagement in ECA helps lower stress level among AUB students. This provides universities valuable insights into the importance of offering extracurricular activities to students due to their mental health benefits. Moreover, students will be able to understand the importance of these activities in improving their mental and physical health.

Conclusion

The present study investigated the relationship between stress levels and participation in ECA among students at the American University of Beirut (AUB). The study revealed alarming stress levels, highlighting the unique challenges faced by university students in Lebanon. However, engagement in ECA was associated with lower stress levels. Consequently, the Office of Student Affairs has evidence and data-driven insights on the importance of promoting participation in ECA to enhance students’ well-being. Moreover, given that AUB is among the most reputable universities in the MENA region, results suggest that students in other universities may experience even higher level of stress, especially if there is a lack of well-structured ECA program and mental health support system. Thus, there is a need for future research across all universities in Lebanon, particularly those with fewer resources. This could help in identifying disparities and guiding national initiatives to enhance the well-being of students. While this study highlights the importance of ECA in reducing stress levels, it is crucial to understand that different types of ECAs have different psychological effects, with some activities being more effective than others. Future studies should thus examine the various impacts that different forms of ECA have on students’ mental health.

Supporting information