Sixteen students participated in the study across the three didactic years of the program: three PY1, two PY2, and 11 PY3 students. The total sample size was deemed sufficient given the exploratory nature of this study. Data are reported as a single group and does not distinguish between program year considering the cohort-based sample sizes. Across all participants, 97% (n = 263/272) of the study activities (i.e., baseline PSS10, daily time log, daily stress questionnaire, final PSS10, focus group) were completed, resulting in 3% of study components to be missing (i.e., 2 daily time logs from 2 students, 7 daily stress questionnaires from 7 students). All participants completed both baseline and final PSS10 as well as participated in a focus group.
Students spent the majority of their time on activities of daily life (ADL) during both weekdays (44%) and weekend-days (49%), spending a mean 10.6 h/weekday and 11.7 h/weekend-day on ADL (Table 1). For academic activities directly related to school, students reported spending on average 9.0 h/weekday attending class, studying, completing coursework, and/or participating in co-curriculars, accounting for 37% of their weekday time use. Their average time spent on these activities reduced over the weekend to 20% of their weekend time use with students reporting spending 4.8 h/weekend-day on studying, completing coursework and/or participating co-curriculars. Time spent engaging in discretionary activities such as exercising, engaging in social activities, viewing media, and working for pay were lower, accounting for 18% (4.3 h) of weekday time use and 31% (7.4 h) of weekend time use (Table 1).
Overall, students reported moderate stress on the baseline and final PSS10 questionnaire. While, students scored higher on the final PSS10 stress questionnaire (mean: 18.3, SD: 5.58) than on the baseline PSS10 assessment (mean: 17.8, SD: 6.57), the difference was not statistically significant (t(30) = -0.20, p = 0.84). For the daily stress question, students mainly reported feeling stressed “Sometimes” (40% of responses) and “Fairly Often” (31% of responses) on weekdays, whereas they reported feeling stress “Sometimes” (48% of responses) and “Almost Never” (31% of responses) on weekend-days (Table 2).
Students indicated their main daily causes of stress were related to academic time use (e.g., exams, quizzes, class assignments, grades), having too little time to complete tasks, and anticipatory stress for future events (e.g., exams, quizzes). A student wrote they had, “concerns about grades (midterm exam, quiz), feelings of being overwhelmed by busy or loaded weeks.” Another student shared they were stressed due to “studying for exams, working on assignments, and thinking about how stressful this week will be.” Physical activity (e.g., exercising, running), activities of daily living (e.g., napping, eating), social time, interacting with media (e.g., Netflix, social media platforms), personal hobbies (e.g., baking, watching football), and treating oneself to a reward (e.g., takeout, facial) were all ways students reported coping with daily stress. Students listed “playing with my cat, baking brownies after the exam, watching Brother Bear with my roommate over a bottle of wine,” and “took a nap, got iced coffee, took a (masked) walk with friends” as strategies they used to cope with daily stress.
Focus group themes identified commonalities across students, identifying time use activities associated with increased and decreased stress, as well as coping strategies (Table 3). Students noted academics, co-curriculars, and time spent working for pay increased their stress. One student stated, “my stress is dependent on the school stuff we have going on.” Whereas another student felt their co-curricular involvement was the most stressful, saying “co-curriculars, I would say that is a huge part of my stress.” Working for pay was also noted to increase stress, with one student sharing, “I would say it [work] is stressful … yeah, it is a big part of my stress.” Further, students also reported feeling anticipatory stress knowing they had coursework to complete and tests to study for. For instance, one student shared, “it’s just like thinking about the list of assignments or whatever I have to do…is what really seems to stress me out.”
While the majority of students indicated academics, co-curriculars, and time spent working for pay increased their stress, a handful of students (n = 5) shared a different perspective. For example, one student shared, “I feel like the more time I spend studying the less stress I feel” and another stated, “…attending class and learning doesn’t stress me out…I feel really good about myself for being in class and being focused.” When it came to co-curriculars, a student stated, “…actually attending those [co-curricular] meetings I end up enjoying it more and it’s nice to see everybody.” Finally, a student shared, “It’s [working for pay] a big part of my stress, but the financial aspect alleviates stress for me too because not having any income for three years would stress me out big time.”
Time reserved for social activities, overall, was a source of decreased stress with a student saying, “the more I socialize, the less stressed I am” and another student shared, “I don’t think I realized how much [socializing] helped me until this COVID stuff … I took it for granted before and didn’t realize how much it helped me.” However, some students reported social activities as a source of increased stress because it took time away from schoolwork. One student shared, “With social time I try to take breaks and its fun in the moment, but I also feel like I have this guilt sometimes for taking that time…and it just feels like I’m procrastinating, which then becomes a stressor instead of a stress relief.” To ensure they were making time to socialize, a student noted, “I find myself scheduling my social time into my Outlook calendar and then it pops up on my phone and I’m like ‘Oh great. Now I have to do this’ and it becomes a chore instead of something that’s fun, which adds to my stress.”
Students associated increased stress with feelings of having too little time to complete all necessary tasks in a single day. Limited time led to increased stress levels and prevented students from participating in activities that would decrease their stress, like exercising, taking a break, or spending time with family and friends. One student shared, “I want to do things to de-stress myself but also if I’m doing stuff to de-stress myself, then I’m not doing the thing [school] that’s stressing me out.” Another student echoed this sentiment by saying, “I think that it’s hard to not be stressed out when you’re hanging out with your friends and you feel like you need to do other things.” Feeling as though there is too little time encouraged students to be strategic in how they spent their time. For instance, a student shared, “I’m big on calling my family while I’m making dinner because then I’m being productive and not wasting time on the phone with my mom for hours when I should be doing other things.” In addition to too little time, students also reported feeling as though they did not have effective methods to cope with stress. One student stated, “I need to be more proactive with how I manage my stress, I sometimes tend to be reactive and just impulsively do something like go take a nap or get a milkshake,” and another student shared, “when I get overwhelmed and stressed out I don’t have a good coping method and that was really highlighted that week [time logging week].”
Students described how the ongoing COVID-19 pandemic impacted their stress levels regarding academics, co-curriculars, and how they socialized. For instance, students indicated that virtual learning made it difficult to take breaks from school. One participant shared, “the virtual environment has made it very easy to sit at your desk all day long and only do school.” A student in a leadership position for a co-curricular acknowledged that “COVID … is an added burden [because] now I have to change all of [the plans] and work under completely different circumstances which has definitely added to my stress.” Students also noted that COVID-19 made it more difficult for them to participate in stress relieving activities, like exercising and socializing. For example a student shared, “because of COVID I’m not actually going to the gym … so that limits the activities I can do” and another noted, “with COVID it’s just harder to see people.”
