Stress Coping Strategies Among Secondary School-Aged Students in Government Schools in Northern West Bank/Palestine

Background of the study

Childhood and adolescence is an important transitional period in the development of coping mechanisms for stress. The ability to cope with stress is considered a central feature of human development. Naturally, all humans are confronted with threatening and challenging events in their daily life that need for action and readjustment.¹ Adolescents might face problems in coping with stress, and they need new educational programs in schools to learn how to cope with stress.² Most students face different problems, challenges, obstacles and situations that can produce or increase stress. The different level of stress and or poor management of stress may affect the academic performance and achievements of students. Managing and coping with these stressors are the cornerstones to pass any transitional period. Identifying how students cope with stress in their daily life is a crucial issue as maladaptive and poor management will inversely affect students' future. The results of this study might help to take effective steps to reduce stressors among students through designing related training programs for all staff caring for school-aged children and adolescents.

Coping and coping strategies

Coping is defined as the ability to deal with an attempt to overcome problems and difficulties.³ Carver and Connor-Smith define coping as efforts to prevent or diminish threat, harm, and loss or to reduce associated distress.⁴ Coping strategies also refer to specific efforts, both behavioral and psychological, that people employ to master, tolerate, reduce, or minimize stressful events.^5,6 Three types of coping strategies have been identified by Xiao⁷ and Chen.⁸ The first is the passive coping strategies that include withdrawal, imagining, ignoring, waiting, and catharsis. The second is the maintenance coping strategies which include self-adjustment, self-restraint, and replacement. Thirdly, active coping strategies and include problem-solving, seeking support, cognitive reconstruction, and comparison.

According to Carver et al.,⁹ coping strategies are categorized into three categories. First is the “problem-focused coping” which includes active coping, planning, and suppression of competing activities, restraint coping and seeking of instrumental social support. The second is the “emotion-focused coping” which contains seeking of emotional social support, positive reinterpretation (positive reframing), acceptance, denial, and turning to religion. The third category is the “less useful” one and includes focus on and venting of emotions (venting), behavioral disengagement, mental disengagement (self-distraction), humor, and substance use. Other two forms of coping were developed by Lazarus & Folkman,¹⁰ the-problem-focused coping and emotional-focused coping.

Using the problem-focused coping strategy, individuals develop more skills to help them cope with other situations in the future.¹¹ It includes four steps: 1) Define the problem, 2) Generate alternative solutions, 3) Learn new skills to deal with stressors, 4) Reappraise and find new standards of behaviour.”¹² Alternatively, using the emotion-focused coping, individuals change their emotional response to the stressor by diminishing the negative emotion such as embarrassment, fear, and frustration that is associated with stress. It includes different responses, such as self-soothing, expression of negative emotion, and attempts to escape stressful situations.⁴ It involves gaining strategies for regulating stress such as 1) Avoiding (I am not going to school), 2) Distancing (yourself from the stress, ‘it doesn't matter’), 3) Acceptance (I failed that exam, but I have 4 other subjects), 4) Seeking medical support, 5) Turning to alcohol.¹²

Education system in palestine

Until the year 2019, the education system in Palestine was divided into two phases. The first phase constitutes the basic phase from the first to 10^th grade, and the second phase includes the 11^th - 12^th grade. Thus, the total number of study years in school is 12 years. By the end of 10^th grade, regular students can select the study branches based on their grades; these branches are scientific, the humanities, and commercial branches.¹³ At the end of the academic year, the 12^th grade, students sit for the General Secondary Schools Examination (Tawjihi Exam), which is a unified examination according to each study branch.

This examination is crucial for most students as they considered it a gateway to study at university. In this period, many students expend vast efforts to achieve as highly as they can. Based on their total marks, they can gain admission to the college and specialty; the higher the total marks, the better the opportunity to select from among the most prestigious faculty/school. For example, a student who wants to study medicine or pharmacy requires a total mark in his or her Tawjihi exam of not less than 95%. In the Palestinian community, most students suffer from tension and stress due to the culture prevailing in society. Students who achieve high grades can select between the medicine, engineering or pharmacy which are considered the highest specialties and so they earn respect among their families, community and society. In general, it is widely known that students in all academic years are distressed regardless of country or its educational system. In Palestine, no studies have explored the nature of the stressors or the coping methods to overcome them. This study will highlight the most predominant methods used by Palestinian students and provide options on how to potentially help them.

Objectives of the study

This study aimed at identifying the coping strategies used by general secondary students in governmental schools in the North West Bank. For this study, we hypothesized that there are no significant differences in the domains of coping strategies used by students according to gender. We also hypothesized that there would be no significant difference in the domains of coping strategies used by students according to study branch.

Ethical approval

A formal consent form was signed by the parents of students; in addition, the study was approved by the Institutional Review Board (IRB) of An-Najah National University and Palestinian Ministry of Education. Due to a limitation in time, efforts, and money the study was confined to only governmental schools and to only two study variables (gender and study branch).

Sociodemographic characteristics

Table 1 shows that 61.4% of participants were female. Of this number, about 69.2% studied in the humanities branch. Table 2 shows that 46.7% of the students reported that they have a little bit of stress, but it did not affect their general functioning, and 4.2% of them reported that they don't feel any stress. It also showed that the prevalence rate of stress among female students was 61.4% and among students who studied in the humanities branch was 69.2%.

Table 3 represents the distribution of the percentage of students regarding the coping strategies that were used. It was found that religion and planning strategies were the domains of coping strategies that were used a lot by students with a mean score of 6.30±1.61, and 6.11±1.35, respectively. Students who used the least coping strategies were using “denial,” “behavioral disengagement” and “substance use” as coping strategies with mean scores of 3.79± 1.51, 3.52±1.36, and 2.90±1.77, respectively.

Covariates

Table 4 illustrated the differences among students in using coping strategies in relation to gender by using two-independent t-test. It showed that the mean scores of religion, 6.64±1.43; positive reframing, 6.05± 1.44; use of instrumental support, 5.80± 1.80; self-distraction, 5.55±1.44; and venting, 5.38± 1.42 strategies were higher among females than male students, with statistically significant differences (p<0.05). It also showed that humor, 5.03±2.01; substance use, 3.79±2.27; and behavioral disengagement, 3.72± 1.43 were strategies adopted more by male students than female students. The differences between the two groups were statistically significant (p<0.05).

In addition, our results indicate that the mean scores of planning as a coping strategy was 6.15±1.39; active coping was 5.90±1.36; acceptance was 5.79±1.47; use of emotional support was 5.44± 1.53; and self-blame was 5.24± 1.80. These strategies were higher among female students than male students but were not statistically significantly different. The use of denial as a coping strategy was 3.89±1.45, and was utilized more by male students than female students, although the differences were not statistically significant (p>0.05) (Table 4).

Table 5 shows the differences among students in using coping strategies in relation to study branch using two-independent t-test. The use of instrumental support, denial, and behavioral disengagement were used more by students in the humanities branch than those in the scientific, with mean scores of 5.77±1.70, 3.92± 1.54, and 3.63±1.43, respectively.

These differences were statistically significant (p<0.05). Results indicated that the mean scores of religion, planning, positive reframing, acceptance, active coping, self-distraction, use of emotional support, humor, and substances use strategies were higher among the humanities branch students than the scientific branch students. The mean scores were 6.32±1.61 for religion; 6.12±1.34 for planning; 5.96± 1.47 for positive reframing; 5.88± 1.48 for acceptance; 5.82±1.47 for active coping; 5.42±1.44 for self-destruction; 5.38±1.47 for use of emotional support; 4.76± 1.92 for humor; and 3.01 ±1.90 for substance use, although the differences were not statistically significant (p>0.05). We also found that venting and self-blame as coping strategies used more by the scientific branch students compared to the humanities branch students, with mean scores 5.26± 1.46, and 5.28± 1.89, respectively but not statistically significantly different (p>0.05).

Discussion

According to the Palestinian Ministry of Education, females students who constitute 58.1% of those who studied in 12^th and 65.5% were in the humanities branch for the academic year 2015/2016.¹⁶ Most of the students (88.3%) have different levels of stress with different effects, and less than tenth 7.5% of them have excessive stress. Other studies found some differences in the prevalence of stress among secondary school students. In Melaka, Malaysia, the prevalence of distress among students was 47.6%,¹⁷ while it was 32.8% among students in Kota Bharu.¹⁸ In Iran, stress among male adolescents from selected government schools was 17.99% (SD=6.02).¹⁹ Moreover, the World Health Organization (WHO) reported that 20% of the world's adolescents have mental disorders or problems.²⁰ This rate of stress in our study may be related to the education system in Palestine, and in most Arab countries, that require students to give complete attention for the last year in the secondary level, which is the key to their future.

In our study, the most used coping strategies were religion, 6.30±1.61, and planning, 6.11±1.35, while the lowest used coping strategies were denial, 3.79±1.51; behavioral disengagement, 3.52±1.36; and substance use, 2.90±1.77. In comparison, the main domain of coping strategies that were used the most by Malaysian secondary school students was religion, 6.29±1.54; while other strategies, including humor were 3.88± 1.56; behavioral disengagement, 3.58±1.50; denial, 3.45±1.40; and substance use, 2.10±0.62 were the lowest used coping strategies.¹⁶ This was similar in Iran where religion, active coping, positive reinterpretation, planning, and use of instrumental support were the main coping strategies used by high school students.²¹ In addition, planning with 13.00±2.59 was the most used strategy among Iranian adolescents in secondary school, while behavioral disengagement, 7.12±2.24 was the least once used.²² These study results indicate that the students tended to use the useful problem- focused and emotion-focused coping strategies in dealing with stressors more than the less useful coping strategies with some differences that might be related to differences in cultures, lifestyles, and other environmental factors.

The results of the study indicated that there were significant differences between gender and use of coping strategies. Religion, positive reframing, instrumental support, self-distraction, or venting were used more among female students than among males, while strategies such as humor, substance use, or behavioral disengagement, were used more by the male students than female students. While in Iran there were significant differences between gender (the mean score was higher among female than male) in using coping strategies, like seeking emotional support 11.8 > 10.46, denial, 8.25 > 7.37 or emotional discharge (venting), 9.4 > 8.3, respectively.²²

In Spain, female students had higher mean scores than male students in the use of emotional (13.19±6.25>11.55±5.69) and avoidance (10.09±3.11>9.02±3.19) coping styles, with statistically significant differences.²³ Male students had higher mean scores than female students in the use of rational (25.06±6.14>23.15±6.21) and detachment (11.61±4.86>10.61±4.64) coping styles, with statistically significant differences.²³ The female students in Hawai'i tended to use adaptive coping strategies more than male students (3.17±0.85>2.91±0.86) (p<0.001),while male students tended to use maladaptive (1.60±0.71>1.52±0.57) and avoidance (2.39±1.10>2.27±1.06) coping strategies more than female student (p<0.05).²⁴

These differences might be related to differences in cultures, and the tools used to measure different types of coping strategies, or it might be due to the fact that Palestinians have been under occupation for a long period of time which has led to political, social and economic problems that affect peoples' lives, especially youth and students. Regarding the differences between the study branches, the findings illustrated that the use of instrumental support 3.92±1.54>3.48±1.39, denial, 5.77±1.70>5.30±1.79, and behavioral disengagement 3.63±1.43>3.28±1.166 coping strategies were higher among the humanities branch students than the scientific branch students with significant differences (p<0.05).

A study in India revealed a significant difference between sciences and arts students in using problem- focused and avoidance coping strategies. In that study, problem-focused coping strategy was used more among sciences students (60.45±6.54>56.54±8.53), while the use of avoidance coping strategy was higher among arts students (28.99±6.08 >26.34±5.53) with a statistically significant difference. But in that study, there was no significant difference between arts and sciences students in using emotion-focused coping strategies.²⁵

Limitations

Due to a limitation in time, efforts, money and difficulty movements in all Palestinian districts, the study was confined to only governmental schools in the four cities in Northern West Bank and in the examination of only two study variables, namely gender and study branch. The inclusion of more variables would have provided more information from the study.

Compliance with Ethical Standards