Jump to ContentJump to Main Navigation
Show Summary Details
More options …

International Journal of Nursing Education Scholarship

Editor-in-Chief: Andrusyszyn, Mary-Anne

Ed. by Goldenberg, Dolly / Cragg, Betty / Maltby, Hendrika J. / McWilliam, Carol / Babenko-Mould, Yolanda

1 Issue per year

CiteScore 2017: 1.13

SCImago Journal Rank (SJR) 2017: 0.503
Source Normalized Impact per Paper (SNIP) 2017: 0.929

See all formats and pricing
More options …

Stress, Depression, and Anxiety among Undergraduate Nursing Students

Wanda M. Chernomas / Carla Shapiro
Published Online: 2013-11-07 | DOI: https://doi.org/10.1515/ijnes-2012-0032


Admission to a professional program marks the beginning of fulfilling a career goal. However, the rigors of professional education can be demanding. Stress, depression, and anxiety (SDA) can interfere with learning, affect academic performance, and impair clinical practice performance. Studies report a general increase in the severity of and extent of mental health problems among college/university students. The literature regarding nursing students’ mental health distress identifies academic and personal sources of stress and coping efforts, with emphasis on the stress and anxiety associated with clinical practice. This cross-sectional descriptive exploratory study investigated levels of SDA among nursing students in 3 years of a university-based program. The association between quality of life indicators including known stressors, such as financial concerns and balance between school and personal life, and SDA was also investigated. Through an online survey, 437 participants from one mid-western Canadian undergraduate nursing program completed the Depression Anxiety Stress Scales and provided data on quality of life indicators and demographic information. Participants also were invited to provide narrative data about their experiences with SDA. This article will present significant findings including: levels of SDA; comparisons between our sample and a normative sample on the dimensions of SDA; and the results of multiple regression analysis identifying significant predictors of each dimension. Themes from the qualitative comments from 251 of the participants were identified and added depth and clarity to the quantitative findings. The predominant themes represented were: perceptions of clinical practice, coping, personal issues, and balancing school, work, and personal life. Implications and recommendations for curriculum design, ensuring students understand program expectations prior to admission, and enhancing accessibility to mental health/support services need to be considered.

Keywords: nursing students; stress; anxiety; mixed methods


  • Altiok, H. O., & Üstün, B. (2013). The stress sources of nursing students. Educational Sciences, Theory and Practice, 13(2), 760–766.Google Scholar

  • Beddoe, A. E., & Murphy, S. O. (2004). Does mindfulness decrease stress and foster empathy among nursing students? Journal of Nursing Education, 43(7), 305–312.Google Scholar

  • Billingsley, S. K., Collins, A. M., & Miller, M. (2007). Health student, health nurse: A stress management workshop. Nurse Educator, 32(2), 49–51.Web of ScienceCrossrefGoogle Scholar

  • Capp, S. J., & Williams, M. G. (2012). Promoting student success and well-being: A stress management course. Holistic Nursing Practice 26(5), 272–276. .CrossrefWeb of SciencePubMedGoogle Scholar

  • Chan, C. K. L., So, W. K. W., & Fong, D. Y. T. (2009). Hong Kong baccalaureate nursing students’ stress and their coping strategies in clinical practice. Journal of Professional Nursing, 25(5), 307–313.CrossrefGoogle Scholar

  • Cook, L. J. (2007). Striving to help college students with mental health issues. Journal of Psychosocial Nursing, 45(4), 40–44.Google Scholar

  • Crawford, J. R., & Henry, J. D. (2003). The depression anxiety stress scales (DASS): Normative data and latent structure in a large non-clinical sample. British Journal of Clinical Psychology, 42(1), 111–131.CrossrefGoogle Scholar

  • DASS Home page. (2013). http://www2.psy.unsw.edu.au/groups/dass/

  • Dzurec, L. C., Allchin, L., & Engler, A. J. (2007). First-year nursing students’ accounts of reasons for student depression. Journal of Nursing Education, 46(12), 545–551.Google Scholar

  • Galbraith, N. D., & Brown, K. E. (2011). Assessing intervention effectiveness for reducing stress in student nurses: Quantitative systematic review. Journal of Advanced Nursing, 67(4), 709–721. .CrossrefPubMedGoogle Scholar

  • Gibbons, C. (2010). Stress, coping and burn-out in nursing students. International Journal of Nursing Studies, 47, 1299–1309. .CrossrefPubMedGoogle Scholar

  • Gibbons, C., Dempster, M., & Moutray, M. (2010). Stress, coping and satisfaction in nursing students. Journal of Advanced Nursing, 67(3), 621–632. .CrossrefPubMedGoogle Scholar

  • Goff, A. M. (2011). Stressors, academic performance, and learned resourcefulness in baccalaureate nursing students. International Journal of Nursing Education Scholarship, 8(1), 1–18. .CrossrefGoogle Scholar

  • Halter, M. J. (2004). Stigma & help seeking related to depression: A Study of nursing students. Journal of Psychosocial Nursing, 42(2), 42–51.Google Scholar

  • Hawker, C. L. (2012). Physical activity and mental well-being in student nurses. Nurse Education Today, 32, 325–331. .CrossrefWeb of SciencePubMedGoogle Scholar

  • Hegge, M., & Larson, V. (2008). Stressors and coping strategies of students in accelerated baccalaureate nursing programs. Nurse Educator, 33(1), 26–30. .CrossrefWeb of SciencePubMedGoogle Scholar

  • Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. .CrossrefPubMedGoogle Scholar

  • Jimenez, C., Navia-Osorio, P. M., & Diaz, C. V. (2010). Stress and health in novice and experienced nursing students. Journal of Advanced Nursing, 66(2), 442–455. .CrossrefGoogle Scholar

  • Jones, M. C., & Johnston, D. W. (1997). Distress, stress and coping in first-year student nurses. Journal of Advanced Nursing, 26, 475–482.PubMedCrossrefGoogle Scholar

  • Jones, M. C., & Johnston, D. W. (2000). Reducing distress in first level and student nurses: A review of the applied stress management literature. Journal of Advanced Nursing, 32(1), 66–74.CrossrefPubMedGoogle Scholar

  • Kim, K. H. (2003). Baccalaureate nursing students’ experiences of anxiety producing situation in the clinical setting. Contemporary Nurse, 14(2), 145–155.CrossrefGoogle Scholar

  • Levett-Jones, T., & Lathlean, J. (2008). Belongingness: A prerequisite for nursing students’ clinical learning. Nurse Education in Practice, 8, 103–111. .CrossrefPubMedGoogle Scholar

  • Lo, R. (2002). A longitudinal study of perceived level of stress, coping and self-esteem of undergraduate nursing students: An Australian case study. Journal of Advanced Nursing, 39(2), 119–126.PubMedCrossrefGoogle Scholar

  • Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales (2nd ed.). Psychology Foundation Monograph. Sydney, NSW: University of New South Wales, School of Psychology.Google Scholar

  • Magnussen, L., & Amundson, M. J. (2003). Undergraduate nursing student experiences. Nursing and Health Sciences, 5, 261–267.CrossrefGoogle Scholar

  • Martin, D., & Seguire, M. (2013). Creating a path for indigenous student success in baccalaureate nursing education. Journal of Nursing Education, 52(4), 205–209. .CrossrefGoogle Scholar

  • McMillan, D., & Edwards, M. (2013). Assessment, contributing factors, and perceived consequences of sleep health in student nurses. SLEEP, 36(Abstract Supplement), A423.Google Scholar

  • Melincavage, S. M. (2011). Student nurses’ experiences of anxiety in the clinical setting. Nurse Education Today, 31, 785–789. .CrossrefPubMedWeb of ScienceGoogle Scholar

  • Moscaritolo, L. (2009). Interventional strategies to decrease nursing student anxiety in the clinical learning environment. Journal of Nursing Education, 48(1), 17–23.Web of ScienceCrossrefGoogle Scholar

  • Parrack, S., & Preyde, M. (2009). Exploring stress and social support in Aboriginal students at the University of Guelph. Journal of Aborginal and Indigenous Community Health, 7(2), 225–239.Google Scholar

  • Pryjmachuk, S., & Richards, D. A. (2007). Predicting stress in pre-registration nursing students. British Journal of Health Psychology, 12, 125–144.CrossrefPubMedGoogle Scholar

  • Pulido-Martos, M., Augusto-Landa, J. M., & Lopez-Zafra, E. (2011). Sources of stress in nursing students: A systematic review of quantitative studies. International Nursing Review, 59, 15–25. .CrossrefWeb of ScienceGoogle Scholar

  • Queens University, Human Resources. (2013). Mental health first aid training. Retrieved from http://www.queensu.ca/humanresources/news/mentalhealthfirstaidtraining.html

  • Reeve, K. L., Shumaker, C. J., Yearwood, E. L., Crowell, N. A., & Riley, J. B. (2013). Perceived stress and social support in undergraduate nursing students’ educational experiences. Nurse Education Today, 33, 419–424. .CrossrefWeb of SciencePubMedGoogle Scholar

  • Sawatzky, J. V. (1998). Understanding nursing students’ stress: A proposed framework. Nurse Education Today, 18, 108–115.CrossrefPubMedGoogle Scholar

  • Shaban, I. A., Khater, W. A., & Akhu-Zaheya, L. M. (2012). Undergraduate nursing students’ stress sources and coping behaviours during their initial period of clinical training: A Jordanian perspective. Nurse Education in Practice, 12, 204–209. .CrossrefPubMedGoogle Scholar

  • Sheu, S., Lin, H.-S., & Hwang, S.-L. (2002). Perceived stress and physio-psycho-social status of nursing students during their initial period of clinical practice: The effect of coping behaviors. International Journal of Nursing Studies, 39, 165–175.CrossrefPubMedGoogle Scholar

  • Shikai, N., Shono, M., & Kitamura, T. (2009). Effects of coping styles and stressful life events on depression and anxiety in Japanese nursing students: A longitudinal study. International Journal of Nursing Practice, 15, 198–204. .CrossrefPubMedWeb of ScienceGoogle Scholar

  • Storrie, K., Ahern, K., & Tuckett, A. (2010). A systematic review: Students with mental health problems – A growing problem. International Journal of Nursing Practice, 16(1), 1–6. .CrossrefPubMedWeb of ScienceGoogle Scholar

  • Warne, T., Johansson, U.-B., Papastavrou, E., Tichelaar, E., Tomietto, M., Van den Bossche, K., … Saarikoski, M. (2010). An exploration of the clinical learning experiences of nursing students in nine European countries. Nurse Education Today, 30, 809–815. .CrossrefWeb of SciencePubMedGoogle Scholar

  • Watson, R., Gardiner, E., Hogston, R., Givson, H., Stimpson, A., Wrate, R., & Deary, I. (2008). A longitudinal study of stress and psychological distress in nurses and nursing students. Journal of Clinical Nursing, 18, 270–278. .CrossrefWeb of ScienceGoogle Scholar

  • World Health Organization. (2004). World health organization quality of life (WHOQOL) – BREF. Geneva, Switzerland. Retrieved from http://www.who.int/substance_abuse/research_tools/whoqolbref/en/

About the article

Published Online: 2013-11-07

We received permission to use selected items from the WHOQOL-BREF in this study. It is important to note that these items do not represent the complete WHOQOL-BREF or provide a composite score of the construct quality of life but are borrowed from the instrument.

Citation Information: International Journal of Nursing Education Scholarship, Volume 10, Issue 1, Pages 255–266, ISSN (Online) 1548-923X, ISSN (Print) 2194-5772, DOI: https://doi.org/10.1515/ijnes-2012-0032.

Export Citation

©2013 by Walter de Gruyter Berlin / Boston.Get Permission

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

Lara Fenton, Catherine White, Barbara Hamilton-Hinch, and Robert Gilbert
Leisure Sciences, 2018, Page 1
Chen Li, Huiru Yin, Jinping Zhao, Binghan Shang, Mingyue Hu, Ping Zhang, and Li Chen
Journal of Advanced Nursing, 2018
Elizabeth Andersen, Lise Olsen, Jacqueline Denison, Ismat Zerin, and Manuela Reekie
Nurse Education Today, 2018
Penny A. Sauer, C. Elise Thompson, and Margaret M. Verzella
Clinical Simulation in Nursing, 2018, Volume 21, Page 40
Simiso Ntuli, Noleen Nomthi September, and Nozipho Sithole
Journal of Foot and Ankle Research, 2018, Volume 11, Number 1
Pras Ramluggun, Mary Lacy, Martha Cadle, and Mahmood Anjoyeb
International Journal of Mental Health Nursing, 2018
Flora Xuhua He, Bev Turnbull, Marilynne N. Kirshbaum, Brian Phillips, and Piyanee Klainin-Yobas
Nurse Education Today, 2018
Yi-Jung Tung, Kenneth K.H. Lo, Roger C.M. Ho, and Wai San Wilson Tam
Nurse Education Today, 2018, Volume 63, Page 119
Meghan McDonald, Janine Brown, and Crystal Knihnitski
Nurse Education Today, 2018
Jung Jae Lee, Charlotte L. Clarke, and Maggie N. Carson
Nurse Education in Practice, 2017
Latoya Rawlins
Journal of Nursing Education, 2017, Volume 56, Number 12, Page 709
Leodoro J. Labrague, Denise M. McEnroe-Petitte, Ioanna V. Papathanasiou, Olaide B. Edet, Konstantinos Tsaras, Kleisiaris F. Christos, Evangelos C. Fradelos, Rheajane A. Rosales, Jonas P. Cruz, Michael Leocadio, and Katherine Vera S. Lucas
Perspectives in Psychiatric Care, 2017
Colleen Delaney, Cynthia Barrere, Sue Robertson, Rothlyn Zahourek, Desiree Diaz, and Leeanne Lachapelle
Journal of Holistic Nursing, 2016, Volume 34, Number 4, Page 369
Virna Ribeiro Feitosa Cestari, Islene Victor Barbosa, Raquel Sampaio Florêncio, Vera Lúcia Mendes de Paula Pessoa, and Thereza Maria Magalhães Moreira
Acta Paulista de Enfermagem, 2017, Volume 30, Number 2, Page 190
Martha Boulton and Kathleen A. O'Connell
Journal of Nursing Education, 2017, Volume 56, Number 7, Page 404
Susan Mills, Anne M. Krouse, Rose Rossi-Schwartz, and Jean M. Klein
Journal of Nursing Education, 2017, Volume 56, Number 6, Page 337
Brenda G. Kucirka
Journal of the American Psychiatric Nurses Association, 2017, Page 107839031770545
Brenna L. Quinn and Anya Peters
Journal of Nursing Education, 2017, Volume 56, Number 3, Page 145
Katrina Turner and Valerie Lander McCarthy
Nurse Education in Practice, 2017, Volume 22, Page 21
M. Kelly
Journal of Psychiatric and Mental Health Nursing, 2017, Volume 24, Number 1, Page 84
Pearlie Miller, Jeffery Wade Forehand, and Marilyn McBride
Teaching and Learning in Nursing, 2016, Volume 11, Number 4, Page 175
Camellia Torabizadeh, Sanaz Bostani, and Shahrzad Yektatalab
Complementary Therapies in Clinical Practice, 2016, Volume 25, Page 106
Jouni Tuomi, Anna-Mari Aimala, and Boštjan Žvanut
Nurse Education Today, 2016, Volume 45, Page 193
Wei Qi Suen, Siriwan Lim, Wenru Wang, and Yanika Kowitlawakul
International Journal of Nursing Practice, 2016, Volume 22, Number 6, Page 574
Martin Christensen, Aimee Aubeeluck, Diana Fergusson, Judy Craft, Jessica Knight, Lisa Wirihana, and Ed Stupple
Journal of Advanced Nursing, 2016, Volume 72, Number 11, Page 2784
Pan Zhang, Chang-Zai Li, Ya-Ning Zhao, Feng-Mei Xing, Chang-Xiang Chen, Xi-Feng Tian, and Qi-Qun Tang
Nurse Education Today, 2016, Volume 44, Page 121
Elizabeth Andersen
Nurse Education in Practice, 2016, Volume 19, Page 31
Susan M. Duty, Ladonna Christian, Jocelyn Loftus, and Victoria Zappi
Nurse Educator, 2016, Volume 41, Number 2, Page 70
Michelle L. Bartlett, Heidi Taylor, and J. Dirk Nelson
Journal of Nursing Education, 2016, Volume 55, Number 2, Page 87
Camille Payne, M. Penny Ziegler, Diana M. Baughman, and Jackie Jones
Nurse Educator, 2015, Volume 40, Number 6, Page 281
J. Galvin, E. Suominen, C. Morgan, E.-J. O'Connell, and A. P. Smith
Journal of Psychiatric and Mental Health Nursing, 2015, Volume 22, Number 10, Page 773
Paul Ratanasiripong, Janet F. Park, Nop Ratanasiripong, and Duangrat Kathalae
Journal of Nursing Education, 2015, Volume 54, Number 9, Page 520
Toby L. Schonfeld, Kendra K. Schmid, and Deborah Boucher-Payne
Journal of Religion and Health, 2016, Volume 55, Number 1, Page 85
Kimberly A. K. Carhuatanta, Chloe J. A. Shea, James P. Herman, and Ryan Jankord
Frontiers in Behavioral Neuroscience, 2014, Volume 8

Comments (0)

Please log in or register to comment.
Log in