Chapter Two: Literature Review

When talking about adjustment and stress, the issue of stress management and
coping strategies cannot be avoided. The review of literature given the importance of
coping strategy and its implication to students adjustment, this chapter provides an
overview of literature on sources of stress that how perceived stress and coping strategies
are related to adjustment. The chapter includes three sections. First deals the stress related
to adjustment, second cover the stress related to coping strategies, and third deals the
relationship of coping strategies and adjustment.

2.1 STUDIES OF STRESS RELATED TO ADJUSTMENT

Martin, Chemers & Garcia (2001) examined the effects of academic self-
efficacy that is confidence in ability to perform well academically, optimism, and stress
on the academic performance and adjustment of first year university students. The sample
was composed of 256 first year students. Result indicated that self-efficacy yielded of
direct and indirect powerful relationships with academic performance and adjustment of
first year college students. Optimism was also found to be related to academic
performance adjustment. Academically confident and optimistic students were more
likely to see the university experience as a challenger rather than a threat and they
experienced less stress.

Leo Wilton & Madonna Constantine (2003) examined cultural adjustment and
psychological distress issues in 190 Asian and Latin American international college
students. Findings revealed that Latin American students reported higher levels of
psychological distress than did their Asian peers. Moreover, length of residence in the
U.S. was negatively associated with psychological distress symptoms, and acculturative
distress and intercultural competence concerns were positively related to psychological
distress in both groups.

Hocking & Lochman (2003) examined the literature on psychosocial factors

associated with adjustment to sickle cell disease and insulin-dependent diabetes mellitus

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 Chapter Two: Literature Review

in children through the framework of the transactional stress and coping (TSC) model.
The transactional stress and coping model views adaptation to a childhood chronic illness
as mediated by several psychosocial factors. This review examines the utility of the
model in explaining adjustment in two different childhood diseases, identifies needed
research and intervention targets, as well as highlights potential changes to the model.
The major conclusions of this review suggest that, in addition to child-specific factors,
family functioning is an area that interventions should address in sickle cell disease and
insulin-dependent diabetes mellitus.

Brennan, Christopher & Karen (2004) examined the influence of congruence

between partners perceived infertility related stress, and its impacts on depression and
marital adjustment in infertile men and women. Couples belong to infertility treatments at
a University affiliated teaching hospital. Fertility Problem Inventory FPI, the Beck
Depression Inventory BDI, and the Dyadic Adjustment Scale DAS have been completed
by couples. Results of study provided that the couples who understanding equal levels of
social infertility stress reported higher levels of marital adjustment compared with
couples who perceived the stress differently. Whereas, women in couples who felt a
similar need for parenthood reported significantly higher levels of marital satisfaction,
compared with women in couples where the males reported a greater need for
parenthood. Moreover, there is no related between couple incongruence and depression in
males. In addition, there is related between incongruence over relationship concerns and
need for parenthood in favor of female depression.

Crystal Park & Juliane Fenster (2004) Stress Related Growth: Predictors of
Occurrence and Correlates with Psychological Adjustment. Ninety-four college students
completed measures of personal resources and adjustment. Six months later, they
completed a second set of measures that also included questions about their most stressful
experience in the past six months as well as cognitive processing, coping, and growth
related to the stressor. Results suggested that specific coping processes (resources,

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 Chapter Two: Literature Review

appraisals, and coping activities) and, to a lesser extent, cognitive processing, were
related to growth. Stress-related growth predicted increases in personal resources and
positive states of mind, but was unrelated to depressive symptoms. Implications for future
research and potential clinical applications are discussed.

Gutman, Vonnie & Tokoyawa (2005) tested the financial strain, neighborhood
stress, parenting behavior, and adolescent adjustment. The sample consisted of 305
African American families living in inner city neighborhoods. Of the families, 40% were
living at or below the U.S. poverty threshold. The primary caregiver and a focal
adolescent (mean age 13.5 years) were interviewed separately in each family. The results
indicated that the income-to-need ratio was significantly related to financial strain and
neighborhood stress, both of which were positively associated with psychological
distress in parents. Parent psychological distress was positively related to more negative
and less positive parentadolescent relations, which predicted a lower positive and
higher negative adjustment in adolescents. The results extend previous findings by
demonstrating that neighborhood characteristics are an important mediator between
economic hardship and parent and adolescent behaviors.

Hampel & Petermann (2006) investigated the age and gender effects on
perceived interpersonal stress, coping with interpersonal stressors, and adjustment among
early and middle adolescents. Moreover, the associations of perceived stress and coping
with adjustment were examined. Total sample were 286 Austrian adolescents aged 10 to
14 years who attended the fifth to seventh grade. Self report data on perceived stress,
coping, as well as emotional and behavioral problems, were assessed. Results of this
study indicate that Fifth graders scored lower on maladaptive coping strategies and
externalizing problems and reported more adaptive coping strategies than sixth and
seventh graders. Compared with boys, girls evaluated a higher amount of perceived
interpersonal stress and used more social support. Furthermore, girls scored higher on

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 Chapter Two: Literature Review

maladaptive coping strategies and emotional distress and scored lower on distraction than
boys.

Emotion-focused and Problem-focused coping were negatively related to

behavioral and emotional problems, while perceived stress and maladaptive coping was
positively associated with adjustment problems. The relations were stronger in female
than in male adolescents. The evaluating multidimensional coping patterns are supported.
Particularly, implementation of primary preventive programs during late childhood is
suggested. All rights reserved.

Andreas Maerckera, Simon Forstmeiera, Anuschka Enzlera, Gabriela

Krsia, Edith Hrlera, Christine Maiera & Ulrike Ehlertb (2007) Explored the
adjustment disorders as stress response syndromes: a new diagnostic concept and its
exploration in a medical sample, the total of study sample was 160 mean age 63 years,
results of this study indicated that the items tapping the individual symptoms meet
psychometric requirements for diagnostic applications. Whereas, the diagnostic algorithm
chosen indicates a 17% prevalence of AD in the sample, moreover the subtype most
commonly diagnosed is AD with mixed emotional features (41%). In a subsample,
diagnostic sensitivity was 0.58 and specificity 0.81 in relation to traditional AD cases
diagnosed by the Structured Clinical Interview for DSM-IV. By applying the most
strongly conservative exclusion rule analogous to the Structured Clinical Interview for
DSM-IV, the AD prevalence was reduced to 9%.

Laura Friedlander, Graham Reid, Naomi Shupak & Robert Cribbie (2007)
explored the joint effects of stress, social support, and self esteem on adjustment to
university. The total samples were 115 First-year undergraduate students, spss package
have been used to analysis the data where multiple regressions predicting adjustment to
university from perceived family social support, stress, and self-esteem were conducted.
From the fall to winter semesters, increased social support from friends, but not from
family, predicted improved adjustment. Decreased stress predicted improved overall,
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 Chapter Two: Literature Review

academic, personal-emotional, and social adjustment. Increased global, academic, and

social self-esteem predicted decreased depression and increased academic and social
adjustment. Results are discussed with respect to potential mechanisms through which
support and self-esteem may operate.

Akbar Hussain, Ashutosh Kumar & Abid Husain (2008) examined the level of
academic stress and overall adjustment among Public and Government high school
students and also to see relationship between the two variables (academic stress and
adjustment). For that purpose 100 students of class IX were selected randomly from two
different schools out of which 50 were taken from Public and the remaining 50 were
taken from Government school Sinha. And Sinha scale for measuring academic stress
was used to see the magnitude of stress and Sinha and Singh Adjustment Inventory for
school students was used to examine level of adjustment among the students. Results
indicated that magnitude of academic stress was significantly higher among the Public
school students where as Government school students were significantly better in terms
of their level of adjustment. However, inverse but significant relationships between
academic stress and adjustment were found for both the group of students and for each
type of school.

Suldo, Shannon M.; Shaunessy, Elizabeth; Thalji, Amanda; Michalowski,

Jessica & Shaffer, Emily (2009) investigated the environmental stressors and
adjustment of 162 students participating in the IB program and a comparison sample of
157 students in general education. Factor analysis indicated students experience 7
primary categories of stressors, which were examined in relation to students' adjustment
specific to academic and psychological functioning. The primary sources of stress
experienced by IB students were related to academic requirements. In contrast, students
in the general education program indicated higher levels of stressors associated with
parent-child relations, academic struggles, conflict within family, and peer relations, as
well as role transitions and societal problems. Comparisons of correlations between

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 Chapter Two: Literature Review

categories of stressors and students' adjustment by curriculum group reveal that students
in the IB program reported more symptoms of psychopathology and reduced academic
functioning as they experienced higher levels of stress, particularly stressors associated
with academic requirements, transitions and societal problems, academic struggles, and
extra-curricular activities. Applied implications stem from findings suggesting that
students in college preparatory programs are more likely to (a) experience elevated stress
related to academic demands as opposed to more typical adolescent concerns, and (b)
manifest worse outcomes in the face of stress.

Fatima Nihal Otlu (2010) investigated the role of gender, acculturative stress,
coping skills, cultural distance, and perceived social support in predicting college
adjustment scores of international students who attend universities in Ankara. The sample
of the study consisted of 170 (135 males and 35 females) volunteered international
students from one private and four state universities in Ankara. A Personal Data Sheet
developed by the researcher, Student Adaptation to College Questionnaire (Baker &
Siryk, 1984), Acculturative Stress Scale for International Students (Sandhu & Asrabadi,
1994), Brief cope (Carver, 1997), Cultural Distance Scale (Bekta, 2004), and the
Multidimensional Scale of Perceived Social Support (Zimet, Dahlem, Zimet, & Farley,
1988) were used to collect data.

Hierarchical multiple regression analysis was conducted to analyze data. The

results of the analysis revealed that acculturative stress, positive coping skills, and
cultural distance were significant predictors of college adjustment scores of international
students while gender, negative coping skills, passive coping skills, and perceived social
support were not. All predictor variables explained 9.8 % of the total variance in college
adjustment scores. The study results demonstrated that international students who have
low acculturative stress, low perceived cultural distance and high use of positive coping
skills were better adjusted to college.

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 Chapter Two: Literature Review

2.2 STUDIES OF STRESS RELATED TO COPING STRATEGIES

Lightsey, Owen Richard, Jr. Hulsey & Duncan (2000) investigated whether
coping styles moderated the relationship between (a) impulsivity and stress and, (b) stress
and gambling behavior and tested whether impulsive persons who use avoidant or
emotion focused coping under high stress conditions are most likely to gamble. Among
202 university student volunteers, 33% of men but only 3% of women reported problem
or pathological gambling, and neither stress impulsiveness, nor coping predicted
gambling among women. Among men, impulsiveness, task coping, and emotion coping
accounted for significant and unique variance in gambling. For higher task coping and
lower emotion focused coping, impulsiveness had a weaker relationship to gambling.
Additionally, among non impulsive men, emotion focused coping in high stress
conditions was most likely to result in gambling.

Sinha, Birendra, Willson, Leanne, Watson & David (2000) Identified of stress
and coping among 198 students in India and 344 in Canada all Students aged 16-25 years
were compared with respect to stress, coping, and selected psychosocial variables
namely, locus of control, self esteem, life orientation, optimism, pessimism, and social
support. The two main hypotheses postulated that, compared to the Canadian students,
Indian students would experience more stress and would prefer emotion focused coping
strategies for dealing with stress. It was also predicted that the Indian students would
have an external locus of control, low self esteem, pessimistic life orientation, and greater
social support satisfaction. The results reveal instead that the Indian students report less
stress than the Canadian students and prefer emotion focused coping strategies. The
Indian students score higher on chance control, but are similar to the Canadian students
on powerful others and internal control. The Indian students are less satisfied with social
support than are their Canadian counterparts.

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 Chapter Two: Literature Review

Bruce E.; Connor Smith, Jennifer K.; Saltzman, Heidi; Thomsen, Alexandria
Harding; Wadsworth & Martha E. (2001) Defined of coping are considered, and the
relationship between coping and other aspects of responses to stress. Questionnaire,
interview, and observation measures of child and adolescent coping are evaluated with
regard to reliability and validity. Studies of the association of coping with symptoms of
psychopathology and social and academic competence are reviewed. Initial progress has
been made in the conceptualization and measurement of coping, and substantial evidence
has accumulated on the association between coping and adjustment. Problems still remain
in the conceptualization and measurement of coping in young people, however, and
aspects of the development and correlates of coping remain to be identified. An agenda
for future research on childadolescent coping is outlined.

Sami Abdel Qawi (2002) studied the coping strategist of dealing with the stress
and manifestations of depression in United Arab Emirate University. The sample
consisted of 234 students, academics, and resulted that females are more depressed, and
are using methods directed emotional they manage with stress, was also found that the
low degree of depression using the methods of reverse oriented high class problem, and
use many methods to deal emotionally oriented can predict many of the manifestations of
depression.

Der Bank & Marita (2002) proposed that personality disposition, coping, stress
and expatriates' motivation for accepting the assignment can predict three criteria of
expatriate success, namely (a) the desire to terminate the assignment, (b) performance,
and (c) the cross-cultural adjustment of expatriates. The study population consisted of 95
expatriates from eight multi-national organizations. The research method for each of the
three articles consists of a brief literature review and an empirical study. A cross-
sectional survey design was used to achieve the research objectives. Descriptive statistics
(e g means, standard deviations, skewness and kurtosis) were used to analyses the data.
Cronbach alpha coefficients and exploratory factor analysis were used to assess the

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 Chapter Two: Literature Review

reliability and validity of the measuring instruments, and multiple regression analyses
was conducted to determine the percentage of the variance in the dependent variables that
is predicted by the independent variables, the Neo-Personality Inventory Revised, Work
Locus of Control Scale, Expatriate Stress Inventory, a biographical questionnaire, which
included expatriates' motivation for accepting the assignment (independent variables) and
expatriates' cross-cultural adjustment. Their desire to terminate the assignment and their
performance (dependent variables) were administered.

The results showed that external locus of control is related to avoidance.

Avoidance coping of expatriates' was best predicted by an external locus of control and
approach coping of expatriates' was best predicted by an internal locus of control. The
results showed that expatriates' desire to terminate the assignment is related to their cross-
cultural adjustment and that personality dimensions are related to their cross-cultural
adjustment and their desire to terminate the assignment. Personality dimensions
explained 12% of the variance in expatriates' cross-cultural adjustment. Assertiveness and
cross-cultural adjustment explained 17% of expatriates' desire to terminate the
assignment. The results showed that cultural stress explained 17% of the variance in
expatriates' cross-cultural adjustment. Assertiveness and cross-cultural adjustment
explained 28% of expatriates' desire to terminate the assignment and extrinsic motivation
explained 20% of expatriates' performance.

Lo Ruth (2002) investigated the perception and sources of stress, coping

mechanisms used, and self esteem in nursing students during three years of their
undergraduate nursing programmer, the sample consisted of a cohort of nursing students
going through three years of a nursing programmer. The method was a descriptive co
relational design. The questionnaire consisted of demographic data, the General Health
Questionnaire GHQ-12, Self esteem Scale, and the modified Ways of Coping Scale. Data
were analyzed using frequency distributions, content analysis, and measures of
correlation. Results indicated that students in year one experienced significantly less

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 Chapter Two: Literature Review

transient stress as compared with year tow, students in year three had more positive self
esteem than year two students. There were no significant differences with regard to
chronic stress, avoidance and proactive coping, and negative self esteem. Chronic and
transient stresses, as measured by GHQ, were significantly correlated (p < 0.01) with
avoidance coping behaviors, and negative self esteem. Positive self esteem was
significantly correlated (P < 0.01) with proactive coping behaviors. The four main
stressors in the last three years for this cohort of students, in descending order are nursing
studies, finance, family and health. They coped by using both problem focused and
emotion focused coping skills. There is a need to review the nursing curriculum and
evaluate what impacts on students' stress levels, and also introduce strategies to reduce
the stress levels of nursing students.

But time spent relaxed was remembered as significantly shorter than time spent in
the control activity F 2,108 = (9.88, p <.01). Stress led to increases in subjective to
objective time ratio T 37 = (2.34, p <.05), and time following a period of stress was
reported to pass quickly. Attention to the present was related to lower reported distress,
whereas attention to the past was positively correlated with self-reported distress. These
data imply that changes in time perception may reflect changes in experiences of stress or
relaxation. Also, interventions to increase focus of attention on the present may be
helpful to reduce distress.

Matud, M Pilar (2004) studied the effect of gender differences in stress and
coping styles, during surveyed of 1566 women and 1250 men, rating age between 18 to
65 years old with respect of different sociodemographic characteristics. The study results
provided that the men scored significantly less than the women in chronic stress and
minor daily stressors. While there is no significant difference in the number of life events
experienced in the previous two years, the women reported their life events as more
negative and less controllable than the men. In addition, there are significantly difference
between women and men in emotional and avoidance coping styles in favor of women,

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 Chapter Two: Literature Review

unlike on rational and detachment coping. And the women reported significantly higher
than the men on somatic symptoms and psychological distress. Moreover, the men were
found to have more emotional inhibition than the women and the effect sizes are low.

Babar, Nawaz, Khan & Khan (2004) Evaluating the perception of stress
amongst medical students and their coping strategies, a cross sectional study using a
semi-structured self-administered questionnaire was carried out over few weeks. The
sample was 264 students. Considerable majority 490% think that they have been stressed
at one time or another. Inability to helplessness, cope, increased stress, mental tension
and too much workload are stress factors for students. A Ninety-four percent 94% of
males have experienced stress; the senior students of the fourth and final year feel more
stressed 95% and 98% respectively. Low moods, inability to concentrate, loss of temper
are most common symptoms. Females report more symptoms.

Academics and exams are the most powerful stressors, sports, music, hanging out
with friends, sleeping or going into isolation are various coping mechanisms. Stress can
affect the academic performance. If needed, students prefer to talk to a peer. They need
better counseling facilities and improvement in student and teacher relationship. The
prevalence of perceived stress seems to be high among medical students, which tends to
affect not only their academic performances but also of health. More leisure time
activities, better interaction with the faculty and proper guidance, advisory services and
peer counseling at the campus could do a lot to reduce the stress.

Marinos Themistocleous & Zahir Irani (2004) examined whether coping and
affect both negative and positive influence adjustment anxiety, depression and stress
among Information Technology students. Total sample was 100 Information Technology
students from Australia completed questionnaires which contained measures for
adjustment ,affect state, and coping strategies. The use of hierarchical regression
analyses demonstrated that specific individual characteristics influenced the adjustment
of the Information Technology students. Information technology students who engaged in
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 Chapter Two: Literature Review

a more problem focused style of coping , such as active coping were found to be better
adjusted than those who engaged in a more emotion focused styles of coping, such as
cognitive avoidance coping, social coping, accepting responsibility , and self controlling
coping. This study find out that the adjustment of Information Technology students is
influenced by the types of coping strategies they use, specific individual demographics,
and their Affect state.

Deniz (2006) examined the relationships among styles of coping with stress,
decision self esteem, decision making styles and life satisfaction the sample consisted of
492 universities students. Life satisfaction was found to be positively correlated to
problem focused coping and seeking social support. It was also found that life satisfaction
is significantly correlated to decision self esteem and all decision making styles vigilance,
buck passing, procrastination, and hyper-vigilance, In addition, significant relationships
were found among coping with stress, decision self esteem and decision making styles.

Nader Fahmi Zeuod (2006) studied the coping strategies of stress among
students in Qatar university, the variable was gender, level of study, academic
achievement, specialization, nationality, and the impact of these in coping strategies, the
researcher has use stress scale, the sample was 284 students, 144 male and 140 female
were selected randomly, The study found that the most common strategies used by the
students is to think positive and recourse of Allah, venting emotional, and
showed no statistically significant differences in the strategies to deal with the stress due
to the variable of gender, nationality, faculty , academic achievement , and level of
study.

Hampel & Petermann (2004) investigated the perceived stress, coping, and
adjustment in adolescents. The total sample was 286 Austrian adolescents aged between
10 - 14 years, who attended the fifth to seventh grade. Fifth graders scored lower on
maladaptive coping strategies and externalizing problems and reported more adaptive
coping strategies than sixth and seventh graders. Compared with boys, girls evaluated a
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 Chapter Two: Literature Review

higher amount of perceived interpersonal stress and used more social support.
Additionally, girls scored higher on maladaptive coping strategies and emotional distress
and scored lower on distraction than boys. Problem-focused and emotion-focused coping
were negatively related to emotional and behavioral problems, whereas perceived stress
and maladaptive coping was positively associated with adjustment problems. These
relations were stronger in female than in male adolescents.

Rachael Dyson & Kimberly Renk (2006) studied the relationships among
femininity and masculinity, depressive symptomatology, levels of stress, and the types of
coping strategies used by college fresh students. Results suggest that these variables were
related uniquely for first year college students. Femininity and Masculinity significantly
predicted problem focused coping, and femininity significantly predicted emotion
focused coping. Moreover the levels of family and college stress informed by college
students, as well as their endorsement of avoidant coping, significantly predicted their
levels of depressive symptoms. Results of the study recommended that understanding the
relationships among the gender role, the levels of depressive symptomatology, and the
levels of stress exhibited by college freshmen may be important in facilitating their
transition and adjustment to university life.

Chandrasekhar Sreeramareddy, Pathiyil Shankar, VSBinu, Chiranjoy

Mukjopadhyay, Biswabina Ray & Ritesh Menezes (2007) focused on the prevalence
of psychological morbidity, sources and severity of stress and coping strategies among
medical students in our integrated problem stimulated undergraduate medical curriculum.
A cross sectional, questionnaire based survey was carried out among the undergraduate
medical students of Manipal College of Medical Sciences, Pokhara, Nepal. The
psychological morbidity was assessed using General Health questionnaire. A 24 item
questionnaire was used to assess sources of stress and their severity. Coping strategies
adopted was assessed using brief cope inventory.

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 Chapter Two: Literature Review

The overall response rate was 75.8%, 407 out of 525 students. The overall
prevalence of psychological morbidity was 20.9% and was higher among students of
basic sciences, Indian nationality and whose parents were medical doctors. By logistic
regression analysis, GHQ caserne was associated with occurrence of academic and health
related stressors. The most common sources of stress were related to academic and
psychosocial concerns. The most important and severe sources of stress were staying in
hostel, high parental expectations, vastness of syllabus, exams, lack of time and facilities
for entertainment.

The students generally used active coping strategies and alcohol; drug was a least
used coping strategy. The coping strategies commonly used by students in our institution
were positive reframing, planning, acceptance, active coping, self distraction and
emotional support. The coping strategies showed variation by GHQ casernes, year of
study, gender and parents' occupation. The higher level of psychological morbidity
warrants need for interventions like social and psychological support to improve the
quality of life for these medical students. Student advisors and counselors may train
students about stress management. A prospective study is necessary to study the
association of psychological morbidity with demographic variables, sources of stress and
coping strategies.

Crockett, Iturbide, Torres, McGinley, Raffaelli & Carlo (2007) explored the
relations between acculturative stress and psychological functioning, as well as the
protective role of social support and coping style, in a sample of 148 Mexican American
college students (67% female, 33% male; mean age = 23.05 years, SD = 3.33). In
vicariate analyses, acculturative stress was associated with higher levels of anxiety and
depressive symptoms. Moreover, active coping was associated with better adjustment
(lower depression), whereas avoidant coping predicted poorer adjustment (higher levels
of depression and anxiety). Tests of interaction effects indicated that parental support and
active coping buffered the effects of high acculturative stress on anxiety symptoms and

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depressive symptoms. In addition, peer support moderated the relation between

acculturative stress and anxiety symptoms. Implications for reducing the effects of
acculturative stress among Mexican American college students are discussed.

Biscomb Devonport & Lane (2008) studied the sources of stress and use of
coping strategies amongst Higher Education lecturers. The researcher had interviewed 10
lecturers reported experiencing a wide range of stressors, briefed by organizational stress,
subject-linked stress, and non-organizational stress. The lectures are described examples
of stress resulting from an unbalanced workload, often exacerbated by insufficient time
allowance for task completion. All participants Identified 19 coping strategies used to
manage stress. Results suggest that interventions designed to reduce stress should request
to increase the use of preventative and proactive coping strategies, thus reducing the need
for reactive coping.

Jayashree nayak & Susheela P.Sawakr (2008) investigated of factors

influencing stress and coping strategies was conducted on a random sample of 200 (100)
male and (100) degree college teachers of Dharwad city. Questionnaire for Demographic
characteristic and Coping Strategies were used along with Employment Organization
Sources of Stressors scale Telaprolu and George 2005. Frequency, percentage, t-test,
correlation and step wise regression were used for analysis. The factors that caused stress
always were mainly due to the interference of the employment organizational
responsibilities with their family organizational role, lack of their involvement in decision
making that reduced their responsibilities and the participatory model in their
organizational set up which enhanced their responsibilities to the point of exhaustion.
Majority of the teachers revealed that stress was basically due to their laziness and also
they were happy with fewer responsibilities.

The overall results of stress level revealed that, higher percentage of teachers was
in low stress category. Gender wise significant difference observe in case of personal
development stressor and inter-personal relation stressors, while it was no significant in
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case of work, role and organizational climate stressors Age was the influencing factor on
the total stressors which was statistically highly significant. Keeping ready well ahead,
taking rest, avoiding strenuous posture, taking balanced diet, walking, using sleeping pills
and hot water therapy were practiced by the teachers when they were physically stressed.
Offering prayer, positive thinking, working in-group, avoiding painful reminders,
delegating the tasks and listening songs were practiced when they were mentally stressed.
There was no significant gender difference found with respect to physical stress
management where as it was significant in.

Celin Chioma & Weng Asuzu (2009) investigated the influence of shift duty and
stress coping strategies among nurses in the university college hospital in Nigeria. The
total sample was 166 students working in various wards. Shift duty was reported as
stressful by (47.6%) of the nurses studied. Whereas the various stress coping responses
were identified which were largely based on planning. Also there are no significant
influence between nurse on the base of their age and seniority. The positive coping styles
correlated negatively with the negative ones but the negative correlations were significant
in only two instances namely between planning and denial (P<0.01) and between positive
interpretations and growth and alcohol drug disengagement (P<0.05) Stress coping
responses of nurses were largely based on planning and active coping.

Brougham, Zail, Christy, Mendoza, Celeste, Miller & Janine R. (2009)

studied the sources of stress academics, financial, family, social, and daily hassles. Also
coping strategies self-help, approach, accommodation, avoidance, and self punishment of
166 college students were examined. The relationship between sex, specific sources of
stress, and coping strategies was also investigated. Students completed a stress
assessment inventory and a stress coping inventory based on a 5-factor revised COPE
model (Zuckerman and Gagne Journal of Research in Personality, 37:169204, 2003).
Results found that college women reported a higher overall level of stress and greater use
of emotion-focused coping strategies than college men. College men and women also

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reported different coping strategies for different stressors; however the use of emotion-
focused coping strategies dominated over problem-solving strategies for both men and
women. These results have implications for designing stress reduction workshops that
build on the existing adaptive emotion-focused strategies of college students.

Redhwan, Sami, Karim, Chan & Zaleha (2009) explored the associated factors
related to causes of stress and coping strategies among university students. As a focus
group discussion, it was universal sampling, conducted among 39 of Medical Science and
Biomedicine students on their second semester from Management and Science University
(MSU), Shah Alam, Malaysia. Three issues were discussed: firstly, how they define the
stress; secondly, what the most important causes of stress in their life are; and thirdly,
how they cope with stress. Verbal consent was obtained from all participants. Due to the
small sample size, the data was analyzed manually. Results: Total of participants was 39
students, their age ranged from 21 to 26 years. Seventeen (43.6%) of the students were 21
years old and the majority were female 31 (79.5%). The most important causes of stress
reported by the students were financial, lack of sleep, and family problems. In terms of
coping with stress, the students were able to describe a variety of strategies to cope with
their stressful situations. These included counseling services, doing meditation, sharing of
problems, getting adequate sleep, and going out with friends.

Elzubeir, Magzoub & Elzubeir (2010) provided a systematic review of studies

reporting on stress, anxiety and coping among Arab medical students and to identify
implications for future research Pub Med was searched to identify peer reviewed English
language studies published between January 1998 and October 2009 reporting on stress
and coping among undergraduate Arab medical students. Search strategy used
combinations of the terms Arab medical student, stress, PBL, psychological distress,
depression, anxiety and coping strategies. Demographic information on defendants, Tool
used, spread, data and statistically significant associations were extractive

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 Chapter Two: Literature Review

The search identified 8 articles that met the specified inclusion criteria. Within the
limited range of Arab medical students studied, studies suggest these students have a high
prevalence of perceived stress, depression and anxiety, with levels of perceived stress as
high as those reported in the international literature for medical students of other regions
of the world. Limited data were available regarding coping strategies, the impact of stress
on academic performance and attrition among Arab students. No data were available
regarding the impact of problem based learning on stress and coping. The existing
literature confirms that stress, depression and anxiety are common among Arab medical
students, as for students elsewhere. Little is known about the contribution of different
curricula approaches to perceived stress and what coping.

Rukhsana Kausar & Graham Powell (2011) explored the coping levels and
psychological distress experienced by careers, in relation to the post-onset personality
and physical changes in patients with neurological disorders. The sample of the study was
112 careers a close relative or a friend of patients. Estimate of the careers was carried out
4-18 months after the onset of neurological disorders in the patients. Coping was assessed
using the "ways of coping questionnaire". Psychological distress in careers was measured
in terms of the subjective burden, anxiety and depression they experience. The Leeds'
scales for anxiety and depression, and a 10 point rating scale were used to measure
subjective burden in careers. Data were analyzed using t-test analysis, correlation and
regression analyses. It was found that careers experienced an enormous amount of
psychological distress. Those careers who were more dependent on emotion-focused
coping styles reported greater distress as compared to those who depended more on
problem-focused strategies. These findings have important implications from the point of
view of rehabilitation as well as that of community care.

Rajesh Kumar, Nancy Chew (2011) assessed stress level and coping strategies
among nursing students. A descriptive study was conducted in a private nursing institute
of Punjab affiliated with Baba Farid University of Health sciences, Faridkot, total of 180

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students participated in the study. Perceived Stress Scale -14 (PSS-14) was used to assess
stress level and ACOPE was used to identify the coping strategies. Results of the study
revealed that 34% students were having moderate stress and 33% each were having mild
and severe stress. Class of the students and their courses were found to be significantly
associated with the stress level of nursing students. Majority of subjects tend to use more
of healthy coping strategies as compared to negative or un-healthy ones. "Seeking
diversion" is the most common and "Seeking professional support" is the least common
coping strategy identified in nursing students.

Welle & Graf (2011) surveyed the effectiveness of lifestyle habits and coping
strategies on stress tolerance among college students, specific to race and gender. The
total sample were 459 College students, completed a stress inventory, which was
comprised of three established surveys of stressors, symptoms and coping strategies.
Stress tolerance ratios (STRs) were calculated, and subjects divided into high or low
stress tolerance groups. Statistical differences were determined by chi-square estimates
and odds ratio calculations (95%CI).

Results of the study indicate that the Seven lifestyle coping factors (out of 20)
were significantly associated with high stress tolerance (HST) for males, 13 for females,
and five were commonly shared (P<0.05). Whites had 13 significantly factors associated
with HST while blacks had only three (P<0.05).

Kho Soon Jye & Dahlia Zawawi (2012) explored the associated factors related
to causes of stress and coping strategies among post graduate students. A quantitative
research was carried out and the samples were the MBA students in a renowned business
school in Malaysia. Total participants were 150 students, with 37.3% male and 62.7%
female. The three major sources of stress among students were identified as academic
related stress, time related stress and social/environmental related stress. The results
suggested that the major stressor among these students was indeed the academic related
stress. In addition, among the four coping strategies studied, it was discovered that active
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problem coping was the most applied by many. From the findings of the study, it also
showed that race had no significant relationships with the stressors and coping strategies.
This study contributed both to the academics and the education industry. For the former,
the study has managed to provide further understanding on the issue of stress particularly
among MBA students. Simultaneously, the same understanding is also beneficial
practically for business schools in their efforts to create a good and challenging
environment to enhance students learning.

2.2 STUDIES OF COPING STRATEGIES RELATED TO ADJUSTMENT

Pancer, Hansberger, Pratt & Alisat (2000) explored how perceptions of social
support changed across time during the first semester of university, and how social
support, coping strategies, and adjustment were interrelated among 390 first-year students
in Beijing, China. Results indicated that overall levels of social support among students
did not change significantly across the first term, but that support from different sources
(parents, peers, teachers, siblings) showed distinctive patterns of change. Support was
positively related to adjustment and to coping skills in a dynamic way, and an integrative
structural equations model showed that the role of social support operated both directly in
relation to adjustment and indirectly through its relations to coping styles.

Colleen Ward, Yutaka Okura, Antony Kennedy & Takahiro Kojima (2001)
examined the relationship between coping styles and adjustment with 113 British
expatriates living in Singapore. The Coping Humor and COPE scales were used to
measure coping styles and to predict psychological adjustment. Higher order factor
analysis of the cope resulted in four factors: Approach, Avoidance, Acceptance and
Social Support. Stepwise regression revealed that Avoidance = .40, Coping Humor =
0.24 and Approach ( = -.19) emerged as significant predictors of depression R = .33.

Tamres Janicki & Helgeson (2002) examined sex difference in coping in meta-
analytic review and an examination of relative coping; results indicated that the Women

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were more likely than men to engage in most coping strategies. The strongest effects
showed that women were more likely to use strategies that involved verbal expressions to
others or the self-to seek emotional support, ruminate about problems, and use positive
self-talk. These sex differences were consistent across studies, supporting a dispositional
level hypothesis. Other sex differences were dependent on the nature of the stressor,
supporting role constraint theory. We also examined whether stressor appraisal (i.e.,
women's tendencies to appraise stressors as more severe) accounted for sex differences in
coping. We found some support for this idea. To circumvent this issue, we provide some
data on relative coping. These data demonstrate that sex differences in relative coping are
more in line with our intuitions about the differences in the ways men and women cope
with distress.

Mana Tuna (2003) investigated the differences in the effects of different coping
strategies on different dimensions of university adjustment of the first-year students in
Turkey and in the United States. Three questionnaires have been used to generated the
data student adaptation to college questionnaire (SACQ), Brief Cope, and Demographic
Sheet (DS) from 1143 first year university students from Turkey n = 695 and U.S.A n =
448., multiple hierarchical regression analysis was then carried out to examine the
cultural differences in coping strategies self distraction, active coping, denial, substance
use, using emotional support, behavioral disengagement, positive reframing, planning,
humor, and religion as predictors of overall and four dimensions of university
adjustment, namely, academic adjustment, social adjustment, personal/emotional
adjustment, and goal commitment/institutional attachment. The study results provided
that there were cross-cultural differences in the effects of behavioral disengagement on
social adjustment, goal commitment/institutional attachment, and overall adjustment.
Whereas, there are differences in effects of religion and positive reframing on
personal/emotional and overall adjustment, and effect of active coping was point out to
be significantly different on academic adjustment of first year students from Turkey and
the United States of America.

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Marita McCabe, Suzanne McKern & Elizabeth McDonald (2004) studied the
coping and adjustment among people with multiple sclerosis (MS), and define the
different in these areas from general population people. also evaluated the duration of
illness and the role of severity as well as levels of social support on coping style and
adjustment, the total sample were101 men and 190 women from general population, In
addition to 144 men and 237 woman with MS. Results of this study showed that people
with MS specially woman were more probable to credence coping styles related to
seeking support, explain the poverty levels of adjustment, and problem solving, and on
all dimensions. Whereas, According a wishful thinking coping style, as well as a lack of
failure to seek social support, or problem-focused coping, for both men and women with
MS was also more probable to be associated with poorer psychological adjustment.
Levels of health weakness were only minimally related to psychological adjustment,
especially for men.

Woby Watson , & Roach Urmston (2005) Examined whether coping strategy
use predicted levels of adjustment in chronic low back pain after controlling for the
influence of catastrophic thinking and self-efficacy for pain control. The total sample
was 84 patients with chronic low back pain completed the coping strategies
questionnaire, a pain VAS and the Roland disability questionnaire. To derive composite
measures of coping, the coping strategies questionnaire subscales, excluding the
Catastrophizing subscale and 2 single-item scales, were entered into a principal
components analysis. The extent to which scores on the coping measures predicted levels
of adjustment after controlling for catastrophic thinking Catastrophizing subscale and
self-efficacy for pain control 2 single-item scales was explored using sequential multiple
regression analysis. Results of this study indicate that two coping dimensions emerged
from the principal components analysis, which were labeled Distraction and Praying or
Hoping, and Denial of Pain and Persistence. Scores obtained on these coping measures
explained an additional 5% and 13% of the variance in pain intensity and disability,
respectively. Interestingly, however, the scores on the coping measures did not predict

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pain intensity or disability after controlling for the influence of catastrophic thinking and
self-efficacy for pain control.

Schroevers Kraaij & Garne fski (2007) investigated the goal disturbance,
cognitive coping strategies, and adjustment to deferent types of stressful life event, and
focused on (a) the relationships among goal disturbance, cognitive coping strategies, and
depressive symptoms;, (b) deferences across events in the relationships between
cognitive coping strategies and depressive symptoms, and (c) divergences in goal
disturbance, cognitive coping strategies, and depressive symptoms across deferent types
of stressful event. The total samples of 132 college students are complotted a
questionnaire. These events were categorized into four deferent types of event. Moreover,
depressive symptoms were measured. Results of this study provided that there is
significant deferences across events in the use of certain cognitive coping strategies.
Regression analyses have been used and pointed that there is significant relationships
between cognitive coping strategies and depressive symptoms. While, these relationships
between cognitive coping strategies and depressive symptoms were rather consistent
across the four types of event, implications for developing interventions that help people
to deal with stress and attain their personal goals are discussed.

Lauren Herrmann (2007) explored of existing literature by examining college

freshman's overall adjustment to college as a function of optimism, choice of coping
strategies, and parental attachment. 150 college freshmen completed a self-report
questionnaire packet including the Life Orientation Test-Revised (LOT-R), The Brief
COPE, the Parental Attachment Questionnaire (PAQ), and the Student Adaptation to
College Questionnaire (SACQ). The study showed that persons identified as optimistic,
with secure parental attachment, also were identified as having successful adjustment to
college. The use of active coping methods also were found to be related to a successful
adjustment to college, while avoidant coping methods were related to less successful
college adjustment.

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Ali Habayeb & Jamal Abu-Maraq (2008) examined the reality of adjustment in
social, educational, emotional and discipline wise dimensions on the part of An-Najah
National University students in Palestine. It also aimed at reaching the difference in the
adjustment reality and the interaction amongst its variables, namely, college, gender,
major change and lodging in the university environment. To realize objectives of study,
the researchers have used the adjustment to university questionnaire prepared by Jamal
Alleil, 1993. The sample of study was 845 students, 346 male and 499 female in the
second semester 2007/2008. One finding of the study was that the adjustment reality,
across the four dimensions, was positive first came the social dimension 74.8% and
emotional 56.47% third was the discipline factor 54.80% and last, educational/academic
study 51.53%.

Another finding was that there were no statistically significant differences in the
adjustment reality across the social, educational and discipline dimensions in regard to
the college variable. But differences were found in the emotional domain to the
advantage of humanities faculties. No differences, however, were found in the social and
emotional domains in relation to the gender variable. Notwithstanding, there were
differences in the educational and discipline dimensions in relation to the gender factor to
the advantage of males in discipline and to females in the educational. Another finding
was that there were no differences in the discipline dimension in relation to change of
major variable. However, statistically significant differences were found the social,
educational and emotional level, in relation to change of major at variable to the
advantage of students who did not change their major. Results also showed no differences
in the lodging variable in the emotional and discipline dimensions, but differences in the
social and educational levels were in favor of students who lodged near campus.

Zimmermann, Beveridge, Wang & Zhu. (2008) founded the Adjustment to

college is critical for academic success. Lack college adjustment correlates with poor
academic performance, low graduation rates, and poor success later in life. Limited data

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are available on the effects of inflammatory bowel disease IBD on college adjustment.
We hypothesize that disease activity negatively impacts on QOL, and adversely affects
college adjustment, Undergraduate students 6 Chronics disease, 12 ulcerative colitis and
19 healthy controls completed a standardized college adjustment survey SACQ and QOL
instrument SF-12. Where appropriate, disease specific activity and QOL indices were
obtained HBI, SCCAI, and SIBDQ.

There was an inverse correlation between disease activity and college adjustment
in CD and UC R = -0.6554, p = 0.0032. IBD students had lower physical QOL SF-12
than controls p = 0.0009. Emotional domain of college adjustment correlated best with
SIBDQ R = 0.8228, p < 0.0001, and correlated better in CD (R = 0.8619) than UC (R =
0.7946). Mental QOL SF-12 was worse in CD than UC (p = 0.0211), but neither differed
from controls (p = 0.4, p = 0.6) Students with active chronics and colitis adjust less well
to college life. Physical and emotional factors likely contribute. More aggressive medical
therapy and better emotional support before and during college may result in happier and
healthier college students, leading to higher graduation rates and future success.
Interventions resulting in better disease control and support systems may improve college
performance and provide long term benefits to young adults with IBD.

Maria Chong Abdullah, Habibah Elias, Jegak Uli & Rahil Mahyuddin
(2010) explored the relationship between coping and university adjustment and academic
achievement amongst first year undergraduates in a Malaysian public university, sample
of study was 250 first year undergraduate students from Malaysian public university.
The results of the study provided that the there is a positive significant relationship
between coping and their overall university adjustment, social adjustment, academic
adjustment, personal-emotional adjustment, students attachment to the university, and
academic achievement students. Moreover, the study presented that throughout a period
of one semester, students overall adjustment and academic achievement was found to be
significantly predicted by their coping strategies.

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Yiqun Gan Yueqin & Yiwen Zhang (2010) compared the relative importance of
proactive coping and preventive coping in the adjustment to university life among 403
freshmen at a Chinese university and evaluated the function of proactive coping in the
stress process. Participants completed the Future Oriented Coping Inventory (Gan, Yang,
Zhou, & Zhang, 2007), the Student-Life Stress Inventory (Gadzella, 1994), and the
College Maladjustment Scale (Kleinmuntz, 1960). Bolger and Zuckermans (1995)
differential exposure model of personality was borrowed to examine whether the students
were exposed to different levels of current stress and to explore the impact of stress on
maladjustment. The results suggest that stress has a mediating effect between proactive
coping and maladjustment but not between preventive coping and maladjustment. The
results also suggest that only proactive coping plays an important role in university
adjustment, and proactive coping is a dispositional trait rather than a coping strategy.

Hong Ji & Lei Zhang (2011) investigated the mental stresses of college students
and argue that there are four sources of stresses, namely employment situations, study
conditions, personal factors, and economic conditions. It shows a significant positive
correlation between employment situations and mental stresses of college students, and a
positive correlation between study conditions and mental stresses. Although there is a
positive correlation between economic conditions, personal factors and mental stresses
respectively, the differences are very prominent for individuals.

Francisco Rodriguez (2012) estimate of coping strategies and adjustment in

children, based on four types of stressors school, family, peer interaction and health,
whence of changes coping, school, stress, and social and clinical maladjustment, the
sample were 402 students their age between 9 to 12 years. The study results presented
that the coping variable with ACS, also stress and clinical maladjustment predict, with
different effect, and the coping strategies appointed by children.

Jordan Picken (2012) surveyed the coping strategies, adjustment and well being
of male inmates in the prison environment, the research area of imprisonment and its
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effects on inmates has had a long and complex history over the past decades, with
researchers having varying opinions. Early researchers suggested that imprisonment had
negative psychological and physical effects on its inmates, leading to psychological
deterioration. More recent research, on the other hand, has suggested that imprisonment
is not as detrimental as first thought. This review aims to provide an overview of the
coping strategies, adjustment and well being of male inmates in the prison environment.
Additionally, a systematic review methodology is adopted to examine the relationships
between coping strategies, adjustment and well being of male inmates. The objectives of
this review were, firstly, to determine if coping strategies affect the adaptation,
adjustment and well being of inmates and, secondly, to determine if institutional changes
can improve inmate adjustment and coping. The results were mixed, but demonstrate that
there is a complex relationship between the coping strategies, adjustment and well being
of male inmates and that institutional opportunities and changes can be beneficial. The
review concludes that there is a link between coping strategies, adjustment and well being
of male inmates and that therapeutic community, such as those at HMP Grendon, would
be useful in conventional prisons to help inmates adjust and reform.

Abbasnia Hashemian & Baba khani (2012) examined the relationship between
copings styles with mental health and social adjustment of undergraduate students (A
Case Study, Ilam Branch, Islamic Azad University, Iran), the total sample were
360students of Islamic Azad University of Ilam city. Result of this study indicated that
the social adjustment can be used as a mediator in the relationship between coping styles
and mental health in students. While, there was a positive relation between problem
solving coping style with mental health and social adjustment and a negative one between
emotional copings style with mental health and social adjustment. In addition, the use of
problem solving coping styles will improve mental health and social adjustment in
students but the use of emotional coping styles leads to social adjustment and mental
health problems among students.

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Most of the studies related to stress, coping skills, and adjustment, reported that
the academic area is a major source of stress among college students, while studies
reported contradictory result regarding gender. Some studies demonstrated that female
students have higher stress levels than male students and having poorer adjustment. In
other studies, it was found that gender has no effect stress, coping, and adjustment. Stress
also found to be related to college adjustment, In addition stress, coping skills were found
to be predictive of college adjustment. Similarly, as a coping strategy was also found to
be effective in adjustment process and higher the coping skills lower the college
adjustment. However, some other studies stated that coping may not be predictive of
adjustment. Lastly, social area was also stated as an influential factor in college
adjustment in most of the studies, higher the social support better the adjustment. It seems
worth examining the value of sources of stress, coping strategies as predictors of
adjustment among university students.

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