CHAPTER II

REVIEW OF RELATED LITERATURE

Academic Performance as an Outcome Academic performance becomes relevant at a young age. In grade
school, children are given report cards to inform their caretakers on how they are doing. In middle school,
academic performance determines whether you are in remedial, regular, or advanced courses. In high
school, students that perform well academically can take advanced placement (AP) classes which can lead
to college credit, depending on AP test scores. At the high school level, grade point average (GPA) and
class ranking carry more weight as they are relied on by college admissions staff. Students study for and
take Scholastic Aptitude Tests (SAT) and hope to get higher scores to increase their chances of getting
accepted to the colleges that they apply to. The pressure increases to perform well academically as a
student journey through the education system, and after high school this pattern continues. College
students are under immense pressure internally and externally to succeed. Higher educational settings
reinforce the message that performing well academically is critical to being successful. Many universities
invest resources to assist students to succeed, such as tutoring, supplemental instruction, or other support
services, such as SOAR. SOAR provides support and connects students to available resources. Some
students perform better than others in this environment depending on a multitude of factors. Intellectual
aptitude, cognitive ability, physical health, and mental health are just some of the factors that affect 5
students’ ability to be successful in college. Factors such as past academic performance as well as
standardized testing influence academic performance. Standardized test scores and GPA are frequently
used to measure intellectual aptitude. There is much debate as to how effectively grades measure
academic performance. One of the arguments for this is the subjective nature of grades. Grades given by
different professors can vary significantly for the same level of work. Some may even say that this
undermines a GPA as a reliable measurement of academic achievement. It may be useful to have some
brief background on how grades arose in the educational setting. There are several constituencies of
higher education that are interested in a way to assess institutions and students. These constituencies
include, but are not limited to, governmental agencies (such as the Department of Education), non-profit
organizations (foundations), and corporations. This can be to assess funding of the colleges and
universities, as well as distributing financial aid. There are many merit-based grants and scholarships that
allocate these funds to students using their GPA as a measurement. In addition, a GPA provides graduate
programs with a tangible way to evaluate applicants and organizations with information that may be used
in the hiring process. It is often a flawed system, but grading as a measurement has been used by some
colleges as early as the 1860s. GPA is influenced by a variety of factors such as cognitive ability, physical
health, and mental health. Intellectual aptitude and other cognitive factors can have an influence on how
students perform academically in a higher educational setting. Only approximately twenty-five percent of
variance in academic performance is attributed to cognitive factors. The rest of variance in academic
performance can be attributed to factors related to physical and mental health. To understand mental
health of college students, it is important to be aware of the developmental challenges and strengths that
this demographic faces. A study done by Larson, Orr, and Warne (2016) explored both physical and
mental health issues. Some of the physical health difficulties the study measured included asthma,
allergies, mononucleosis, strep throat, and urinary tract infections. The study found that mental health
issues were significantly and negatively associated with GPA. The results of the study also showed that
physical health issues were often correlated with mental health issues. For example, students who had
high levels of stress, or difficulties handling stress, reported physical health issues affecting their diet and
sleep. In working with students with anxiety and depression, the physical health symptoms are often 7
reported as the presenting problem because they are the symptoms that are externalized. Erikson’s (1966)
theory of psychosocial development is made up of eight stages in which an individual is confronted with
various challenges. Because most individuals entering college are young adults, many of them are in the
fifth and sixth stages of psychosocial development. The fifth stage is labeled identity vs. role confusion
and the sixth stage of psychosocial development is labeled intimacy vs. isolation. This means that college
students are trying to figure out their identity as well as learning to interact and connect with others.
Social interactions and experiences can also affect and reshape identity by shifting values, attitudes, and
goals. Many individuals go to college or a university to pursue the career they would like, and for many, it
is the logical next step. Students in college or attending a university face several challenges. Increased
academic expectations, meeting new people, being away from family for the first time, living on their
own, increased exposure to alcohol and drugs, are some of the trials that this population experience.
(Mitchell, MacInnes, & Morrison, 2008). Many college students can get through this transition
successfully, but others have difficulty adjusting academically and/or psychosocially (Brook &
Willoughby, 2015). Because of these challenges, college students are a population that are at a high risk
for mental health issues (Khubchandani, Brey, Kotecki, Kleinfelder, & Anderson, 2015). Depression and
anxiety are found to be the most common mental health issues that are reported by this population.
Difficulties with mental health symptoms can become 8 serious and even fatal if they go untreated. In a
study done by Drum, Bronson, Denmark & Smith (2009), it was found that eighty percent of college
students that committed suicides had no current or prior counseling. These results were found after
surveying university and college counseling center directors and indicated that many students with mental
health issues suffer silently and do not seek or receive treatment. Psychological distress, including
depression and anxiety, has been associated with lower GPAs. It is also important to note that sometimes
academic pressures as well as adjusting to college can contribute to psychological disorders (Tanaka &
Huba, 1987). Anxiety and Academic Performance The word anxiety is derived from Latin word
“angere,” meaning to cause distress (Sharma & Sharma, 2015). Anxiety has also been defined as a vague,
uncomfortable feeling exacerbated by prolonged stress and the presence of multiple stressors (Lazarus &
Folkman, 1984). Per the DSM V, generalized anxiety is “anticipation of future threat” and is often
associated with “vigilance in preparation for future danger and cautious or avoidant behaviors” (American
Psychiatric Association, 2013, p. 189). A study recently done by the Anxiety and Depression Association
revealed that seven out of ten adults in the General Santos City experience a moderate level of anxiety or
stress daily (as cited in Beiter et al. 2014). Normative anxiety may include being concerned about issues
such as money, health, and/or family problems, but those with an anxiety disorder are extremely worried
about these or other things, even when there is little or no reason to worry about them. They are very
anxious about getting through the day, have a 9 negative outlook, and think that things will go wrong.
Anxiety disorders feature excessive fear or anxiety that persist beyond developmentally appropriate
lengths of time. These disorders cause clinically significant impairment or distress in important areas of
functioning. The different types of anxiety disorders are categorized by the type of objects or situations
that cause the anxiety and can have different ages of onset. One type of anxiety is social anxiety, which is
marked by fear or anxiety of social situations in which individuals feel that he/she will be scrutinized by
others. Social anxiety has been found as a barrier to developing social ties in several studies. This type of
anxiety is found to be more prevalent in college students, ranging from ten to thirty-three percent, when
compared to the general population, ranging from seven to thirteen percent. To meet criteria for an
anxiety disorder diagnosis, the individual must experience the excessive anxiety and worry that he/she
finds difficult to control for at least six months to the extent which it causes significant distress or
impairment in functioning. The individual must also experience three or more of these symptoms: sleep
disturbances, difficulty concentrating, restlessness, fatigue, irritability, and muscle tension. Many children
develop an anxiety disorder when they are young and often go untreated, causing the symptoms and
negative effects to persist and manifest in various forms (American Psychiatric Association, 2013).
Anxiety can also start during the teen years or young adulthood as peer interaction becomes increasingly
important (National 10 Institute of Mental Health, 2013). Symptoms may get better or worse at different
times, and often are worse during times of stress. Young adults often use maladaptive coping skills such
as safety or avoidant behaviors, risk-taking behaviors, alcohol and/or drug abuse to try to manage their
anxiety alone. Many of these will reduce the symptoms in the short-term, while continuing to strengthen
and maintain the disorder in the long term.