Stress during studies. Mental stress and illness among students in face-to-face and distance learning

Bachelor Thesis, 2017

116 Pages, Grade: 1,7


Table of contents


List of abbreviations

1 Introduction
1.1 Problem statement
1.2 Objective of this paper
1.3 Structure of the paper

2 Theoretical foundations
2.1 Forms of study
2.2 Stress
2.3 Psychological stress
2.4 Derivation of research questions relevant to investigation

3 The empirical investigation
3.1 Object of investigation: Students in Germany based on current figures
3.2 The survey

4 Results of the survey
4.1 Methodology for evaluation
4.2 Evaluation of the data material of the survey
4.3 Verification of assumptions
4.4 Interpretation and assessment of the psychological stress of students

5 Discussion
5.1 Critical reflection of the methodology
5.2 Critical reflection of the results
5.3 Conclusion with a view to the future


Internet sources


Appendix 1: Overview – Invitation List Survey Participants

Annex 2: Questionnaire

Annex 3: SPSS Additional Evaluations


The main focus of this bachelor thesis is on the topic of psychological stress for students in face-to-face studies as well as for students in distance learning. In the work, not only the basic theory on the subject of stress is included, but also the consequences of psychological stress: the mental disorders. The students in Germany represent the object of the empirical investigation.

The empirical study focuses on the following three aspects: the degree of psychological stress on students, the stressors that cause these psychological stresses and the impairment of mental health, which may show signs of a mental disorder. In order to explore these central aspects, the author interviewed 1,039 students from all over Germany who are currently completing a face-to-face or distance learning course.

The aim of this work is therefore to answer three research questions that cover the above-mentioned aspects and consequently to assess the mental health of students in Germany.

The study did not confirm any of the three research questions. However, the results clearly show that the degree of psychological stress differs between face-to-face and distance learning students. Students in face-to-face studies are therefore much more burdened. This is manifested not only in the impairment of mental health, but also in the form of physical complaints. Students who developed a mental disorder after starting their studies state that the study program contributed significantly to its development (59.2%).

Lack of time, pressure to perform and the fear of one's own failure are cited as the main stressors by both attendance and distance learning students. This shows that these stressors are almost 20% lower in each of the distance learning students. While for the distance learning students the family, children and the professional activity are perceived as stressors, for the attendance students a possible move or move, the detachment from the parental home and the financial situation as further stressors are in the foreground.

Although students in face-to-face studies feel significantly more impaired in their mental health by studying (41%), it should be noted that 21% of distance learning students also feel impaired in their mental health. The results of the evaluation with regard to a mental disorder show that both signs of anxiety symptoms and depression can be seen in the students.

In summary, the results of this empirical study show that psychological stress is present in both face-to-face and distance learning students, but is more pronounced among students in face-to-face studies. Contrary to the assumption of society, the results of the survey on psychological stress during studies may, Stress only arises in everyday working life, should not be overlooked.

This thesis serves above all to uncover stresses and stressors that occur during the studies and arise from the study. Students can be sensitized to the topic and universities and colleges can identify points at which, for example,.B. can be intervened by means of psychological counseling centers.

The author of this work hopes for herself an interdisciplinary gain of knowledge, insights into the differences between face-to-face and distance learning and the expansion of her skills in empirical research.

keywords: Study – Face-to-Face Studies – Distance Learning – Students – Stress – Stressors – Transactional Stress Model – Psychological Stress – Depression – Anxiety Disorder – Addiction Disorder

List of abbreviations

AUDIT Alcohol Use Disorders Identification Test

BAföG Federal Training Assistance Act

BDI Becks Depression Inventory

B-L List of complaints

e.g. for instance

regarding. concerning

or. respectively

specifically. That is

ECTS European Credit Transfer System: Europe-wide, uniform rating system

etc. and so on

Possibly. perhaps

F. following

ff. subsequent

FS Distance learning

GAD-7 Generalizied Anxiety Disorder Scale-7

if necessary. if necessary

G8 eight-year high school

h hour

ICD-10 International Classification of Diseases, 10th revision

ID Identifiers for assigning the data to the corresponding number

Incl. Included

n.a. not specified

Lt. acc. to

Mind. at least

Million. millions

n Number of cases

NC Numerus Clausus

or similar or similar

PHQ Patient Health Questionnaire

S. side

s. see

SCI Stress and coping inventory

undertow. so-called

TIM Trier inventory for drug addicts

u.a. among other things

cf. comparisons

Vs. versus

WHO World Health Organization (WHO)

Z. B. For example

1 Introduction

Everyone knows it: The school has been completed and the question arises as to how to proceed. Studying is often the first choice. There are now many different study options: a course of study at the university, at the university of applied sciences, at the university of teacher education, a dual course of study or distance learning. The study requires a high level of resilience of the students due to submission deadlines and exams as well as from a private point of view such as the handling of the financial situation or the detachment from the parental home. Thus, students are often exposed to enormous stress. It is not uncommon for students to even develop mental health problems such as depression. For example, mental disorders are increasingly being diagnosed in students, medication is being prescribed and the need for psychological counseling centers at universities is increasing.1 It is obvious that stress states can already begin during studies and not only with the entry into the professional world. The study, stress and other stresses result in a complex interaction, which is influenced by a variety of other factors.

1.1 Problem statement

In today's generation, the stress factors are taking up more and more space. Thus, people are already under a lot of pressure at an early school age, because the performance in primary school decides on the further type of schooling, which has further consequences: Only students who perform well can attend high school. In turn, they have to complete this well so that they can start the study they imagine. With the increasing number of students today, the admission requirements at universities and colleges are also increasing, which is illustrated, for example, by an NC of 1.0 for the study of medicine.2 If it is possible to start a course of study with the achievements achieved, the burdens continue to increase: The examination requirements are high, the learning material is very comprehensive and the time is usually too short. As a result, the students are repeatedly under stress. But as already indicated, not only the performance requirements represent a burden in the lives of the students. Especially for students who are starting a face-to-face course of study, moving out of their parents' home represents several burdens at the same time. On the one hand, the detachment from the parental home is in the foreground and on the other hand, the new financial situation through the financing of the apartment, the study and the further livelihood. For this reason, students often take up a professional activity in addition to their studies, e.g. in the form of a mini-job or a working student activity. For students in distance learning, this burden is usually even higher, as they often pursue a full-time occupation and additionally study. The desire to further educate oneself has risen sharply in recent years. Studying at a distance learning university is often considered, especially if a master's degree is sought, but this is only started after a few years of professional activity. The goal is often a positive career change.3 Nevertheless, the burden on students is high. As a result, there is already a risk that the mental health of the students will suffer. There are already a large number of studies in which the psychological stress in the study is examined. The results are similar: Students feel stressed above average.4 It is precisely this stress that contributes to the fact that students are increasingly suffering from a mental disorder. For example, the report of the Techniker Krankenkasse (2015) shows that every fifth student receives a mental diagnosis.5

The main goal of this thesis is to empirically investigate these psychological stresses of the students and to draw a comparison between students in face-to-face studies and students in distance learning. The teaching of the necessary theoretical foundations and a detailed explanation of the empirical investigation takes place in the further course of this work.

1.2 Objective of this paper

As can be clear from the above problem, studying is often a great challenge. Not only the learning of the new material, but also many other factors can not be ignored: financial worries, exam fears, too high demands on themselves, part-time jobs, possibly the detachment from the parental home, younger students due to the shortened school career by the eight-year high school (G8) etc. These challenges can quickly develop into psychological stress.

This bachelor thesis aims to empirically measure these psychological stresses and to determine factors that cause or can increase the psychological stress and stress. In addition to this measurement, it will also be investigated to what extent or whether the psychological stress of students in a face-to-face study differs from the burdens of distance learning students, what differences there are with regard to the stressors and how the students' own limits are set with regard to psychological resilience. These three questions represent the main objective of the empirical investigation of this work and are presented in detail in Chapter 2.4.

The psychological stress of students is often underestimated by describing student life as a relaxed time full of new acquaintances, semester parties and a lot of free time. The exams and other tasks often get out of sight here. The present work gets to the bottom of this prejudice in theory and practice.

1.3 Structure of the paper

The present work is divided into two main parts. At the beginning, the necessary theoretical basic knowledge is imparted in order to create a common basic understanding of this work. The theory includes on the one hand the forms of study and on the other hand the problem areas of stress and psychological stress. In the following second part, the empirical study carried out is presented. The methodology used and the conduct of the study will be discussed. Furthermore, the results of the survey will be presented and critically reflected on in the following discussion section. At the end of this bachelor thesis, the psychological stress of the students is assessed in order to be able to give a conclusion with a future outlook.

2 Theoretical foundations

This chapter serves to impart basic theoretical knowledge that is relevant to the present work. At the beginning, a fundamental distinction is made between face-to-face and distance learning. In the following, on the one hand, the topic of stress is considered and on the other hand, the psychological stress and the mental disorders are explicitly addressed. Furthermore, the connections to the study are taught. Finally, with the help of the processed knowledge, the research-relevant research questions for the practical part of this work are presented.

2.1 Forms of study

School is over and for the students the question arises about their professional path. A large number of school graduates decide to study. The course of study represents an education at a university or college according to scientific standards.6 Depending on the degree programme, there are other types of universities such as.B the University of Teacher Education, music academies, sport universities or similar. The term is derived study from the Latin word "studere" and means "to strive for something, to strive for something".7 Within the course of study, a distinction can be made between the following forms of study: Face-to-face studies (full-time or part-time), distance learning (full-time or part-time) and dual studies.8 Since only face-to-face and distance learning are of importance for this work and the empirical investigation, only these two variants are defined and presented in more detail in the following.

2.1.1 Face-to-face studies

Face-to-face study is the form of study in which students study on site full-time or part-time at a university or university of applied sciences. In the case of face-to-face studies, the study is the main activity of the students, both in terms of content and time. The organization and time structures are based on the usual working days. This means that the attendance times usually extend to the period from Monday to Friday from about 8 a.m. to 6 p.m. These attendance times include lectures, excursions, seminars, exams, etc. Usually, a time expenditure of about 10 to 25 hours is estimated for these presences.9 For the students, everyday life takes place mainly on campus. In this form of study, the students are therefore "present" and have direct contact with their professors, lecturers and fellow students. Likewise, exams and other examinations are provided directly on site. The standard period of study is six to eight semesters for a Bachelor's degree and two to four semesters for the completion of a Master's degree.10 For a successful completion, students must have 180 (Bachelor) or 120 (Master) so-called ECTS points11 achieve.

With regard to enrolment at a university, there are certain requirements for students, depending on the course of study, which they must meet. Due to the increasing number of first-year students, there is now a numerus clausus (NC) for highly sought-after courses of study, such as.B medicine or psychology. Due to the numerus clausus, the course of study is limited to a certain maximum number of students and the study places are allocated according to different criteria, often e.B. according to the average grade of the Abitur.12 If this NC is not fulfilled by a student, it is possible to get a study place at a later date through so-called waiting semesters. This waiting period depends on the number of applicants and the average Abitur grade and describes the time between the acquisition of the university entrance qualification and the start of studies. The only requirement for crediting the waiting period is that no enrolment has taken place at a German university.13

After the approval of the state parliament for a referendum, the tuition fees were gradually abolished in the 16 federal states. Thus, since 2014 at the latest, there are no longer any tuition fees at state universities in Germany. Long-term students can be an exception, depending on the federal state.14 It should be noted that tuition fees may still be charged at private universities.

In summary, face-to-face study can be described as studying on the university campus, in which lectures, seminars, exams or other services are provided directly on site. Positive aspects (e.B. no tuition fees) and negative aspects (e.B. time commitment to lectures) are equally present.

2.1.2 Distance Learning

In contrast to the face-to-face study just presented, distance learning is the distance learning. As the name suggests, students in distance learning do not have any presence at the university. The main feature of distance learning is the spatial distance between learners and teachers.15 As a result, distance learning can be defined as a space- and time-bridging, remotely controlled, supra-regional study. The teaching content is communicated using technical media. Comprehension checks and performance confirmations can be carried out both directly, through central and decentralized tutorials or seminars, as well as indirectly, e.B. via technical media.16

For students who opt for distance learning, there is the possibility to enrol at a distance learning university. On the one hand, there is the possibility to attend a state university such as.B the Fernuniversität Hagen or on the other hand a university with a private sponsor such as.B. the SRH Fernhochschule Riedlingen. It should be borne in mind that this incurs tuition fees for most distance learning courses. If the respective distance learning university is recognized by the state, students can complete their studies with the Bachelor's or Master's degree, which is equivalent to a degree from a face-to-face university. For this degree, 180 (Bachelor) or 120 (Master) ECTS points are required, as in a classroom study program.

In a distance learning course, in addition to the spatial distance, there are other special features compared to a face-to-face study. The main thing to mention here is the temporal flexibility. Distance learning enables individual time and learning management. This mainly results from the renunciation of face-to-face courses, which are to be compensated by the distance learning media (study letters, online recordings, etc.).17 Nevertheless, it should be added at this point that many distance learning universities offer e.B (voluntary) attendance weekends. At many distance learning universities, it is even possible to choose so-called part-time semesters, in which a semester with the original six months can be extended to a period of twelve months, i.e. the standard period of study for the Bachelor's degree, for example, can be between six and twelve semesters.

Due to these presented aspects, students are offered the opportunity to pursue a professional activity in addition to their studies. Therefore, it is not uncommon for older people to be among the study speeches who, for example, have already worked for several years and only then decide to start studying on the side.

In conclusion, it can be said that distance learning also has both positive and negative sides. The time flexibility is a great advantage, especially for working people who want to continue their work in addition to their studies. Disadvantages can.B the lack of attendance times and the lack of personal contact with the lecturers.

2.1.3 Key differences between face-to-face and distance learning

After both face-to-face and distance learning have been presented in detail in the previous chapters, the central differences between the two forms of study are summarized in tabular form in this chapter:

Abbildung in dieser Leseprobe nicht enthalten

table : Central differences between face-to-face and distance learning (Source: Own presentation)

2.2 Stress

For most of society, stress is a very common term. A life without stress is hardly imaginable. People are hectic and have a lot to do – the time seems too little for that. A problem that poses difficulties not only in everyday working life, but also for students at the university. A study shows that for 43% of respondents, work, school or study is the main trigger for stress.18

Since stress significantly determines the psychological well-being of people, it is important for the understanding of the present work to impart the theoretical knowledge regarding the topic of stress. For this purpose, the term stress is defined in this chapter and then put in connection with the transactional stress model according to Lazarus. Possible stressors are then worked out. Finally, the problem of stress during studies is explicitly addressed.

2.2.1 Definition

As already indicated, the term stress has become indispensable. The term stress takes on many different meanings. For a common understanding of the present work, the definition of Seyle (1950) is used. Seyle understands stress as the physiological reaction to stress – so-called stressors.19 Sapolsky (1994) defines it in more detail by describing stress as a pattern of (un)specific reactions of an organism to stimulus events that disturb its balance and strain or exceed its coping abilities.20 Furthermore, three different approaches to the definition of stress can be used: Stress as a stimulus, stress as a reaction and stress as a relationship concept. If a situational condition triggers a certain reactive change, stress is referred to as a stimulus. This also results in the distinction between eustress, the positive stress, and distress, which includes the negatively perceived stress. If stress is spoken of as a reaction, stress is referred to as a pattern of (un-) specific reactions of the organism to irritant events. This includes the assumption of three phases: Alarm reaction – phase of resistance – phase of exhaustion. Finally, stress is a relationship concept. In this approach to definition, stress describes different types of relationships between individuals and the environment mediated by cognitive assessment processes.21

These three approaches complement the definitions of Seyle and Sapolsky and thus form the basis for the further course of this work. As has already been briefly indicated, there is not only the negative stress (distress), but also the eustress. The eustress represents the positive stress. It gives momentum and energy for upcoming tasks.22 Since the focus of this work is on psychological stress, distress is of primary importance. Because the distress is perceived as something stressful, unpleasant and threatening.23 This is examined in more detail in the following chapters in order to be able to establish the connection to the psychological stress.

2.2.2 Stressors

As can be seen from the previous chapter, stress can be triggered by certain stimulus events. This chapter now aims to take a closer look at these stimulus events or stressors.

These so-called stimulus events encompass a whole range of external and internal conditions, all of which are referred to as stressors. A stressor is therefore a stimulus event that requires the organism to adapt.24 Seyle describes the stressor shortened as a substance that can generate stress.25

In a first step, these stressors can be distinguished according to internal and external stressors. The inner stressors, which are usually more difficult to identify, include, for example, high demands, unfulfilled wishes, too high expectations, low resilience, perfectionism. The external stressors include, for example: Noise, traffic jams, waiting times, bad weather, cold or heat, pain.26 With regard to studies, the following stressors may be present: Time pressure, too much learning material, conflicts with professors, under/overstrain, competitive pressure or similar

Furthermore, three different types and different dimensions of stressors can be distinguished. With regard to the type, the stressors can be differentiated according to physical (physical level), psychological (cognitive-emotional level) and social (behavioral level) aspects.27 Physical stressors therefore disregard basic needs such as the withdrawal of food or the infliction of pain. The stressors on the psychological level depend on one's own perception and interpretation of certain situations. Examples of this can be called decisive changes in life or tragic events.28 Stressors in the social sphere violate the central mental needs of a person, e.B a lack of recognition or attention.29 In contrast, the differentiation of the different dimensions is dedicated to the aspects of intensity, duration, frequency and predictability of stressors.30

The extent to which the stress and the presented stressors affect the study is explained in chapter 2.2.4. Prior to this, the transactional stress model according to Lazarus is presented.

2.2.3 Lazarus Transactional Stress Model

In order to put stress and stressors into context and illustrate them, the well-known transactional stress model according to Lazarus is presented here.

The transactional stress model assumes that people assess situations differently and also have different coping strategies and competencies. This is also the reason why different people perceive and evaluate the same situation differently and react differently and individually to it.31 According to Lazarus, stress is a form of transaction between a person and his environment. The transaction means a connection between a changing situation and a thinking, feeling and acting person. What the transaction ultimately looks like depends on the cognitive evaluation processes of the individual. These evaluation processes are decisive for whether a situation is stressful or not. This process also determines why and to what extent a particular relationship between a person and the environment is perceived as stress.32

The cognitive evaluations are initially divided into the primary appraisal and the secondary assessment. In the primary assessment, an event can be classified into three different categories. The event may be irrelevant, i.e. no impact on the person's well-being is feared from this event. Another possibility is to evaluate an event as favorable or positive. The third category is the sensation that an event is stressful. Whether a transaction is perceived as stressful depends, among other things, on the balance of power between a person's requirements and abilities, which means coping.33 This category is the crucial one for the transactional stress model. At this point, stress-relevant situations are divided into threat, damage or loss and challenge. A threat and damage or loss are predominantly associated with negative emotions such as.B. fear, anger or concern.34 A threat is characterized by the fact that damage or loss has not yet occurred, but is anticipated. Damage, on the other hand, has already occurred. The challenge is associated with rather positive feelings (e.B. confidence), but is still closely related to the threat. In a second step, the secondary evaluation follows. In this, the person weighs up their own coping skills and possibilities. The primary and secondary evaluations influence each other and can also overlap in time. The main reason for this connection is that the coping skills that a person believes to possess influence whether a situation becomes effective as stressful at all.35

Lazarus distinguishes between problem-oriented and emotion-oriented strategies in terms of the forms of coping strategies. The problem-oriented strategies pursue the goal of eliminating or at least improving the stressful situation, e.B. by searching for information on alternatives, direct actions but also fight or flight. The emotion-oriented strategies are about softening the resulting negative emotions without dealing concretely with the causes, e.B. through distancing or trivialization.36 As a result, reassesses of the situation can take place as a result. By dealing with the environment and the feedback regarding one's own reactions and consequences, reassesses arise in a primary and secondary way. In short, the concept of evaluation is a feedback system.37 For example, a successful management of an examination situation can result in a reassessment, through which the next exam is no longer perceived as a threat and without a feeling of fear.

Finally, the following figure summarizes the idea of the transactional stress model and the processes behind it.

Abbildung in dieser Leseprobe nicht enthalten

Figure 1 Transactional stress model according to Lazarus (Source: Bamberg, E.; Keller, M.; Wohlert, C.; Zeh, A.: 2006, p. 10)

2.2.4 Stress during your studies

Now that the theoretical basics regarding the topic stress and a common understanding exists, the connection between stress and study is established in this chapter.

A survey by Forsa in 2016 showed that 43% of respondents (n=1,014) stated that their job, school or studies were the main trigger for stress.

Abbildung in dieser Leseprobe nicht enthalten

Figure 2 Triggers for stress (Source: Statista (14.11.2016):

In another representative online survey (n> 18,000 university students) of the Chair of Marketing at the University of Potsdam and the Chair of Marketing and Business Development at the University of Hohenheim, 53% of the students surveyed state that they are under a high level of stress. This proportion is higher than that of working people in a comparable study from 2015.38

Now the question arises as to which specific stressors affect the students. It should be noted that the study itself is to be seen as a stressor for the entire load and there are stressors within it that are related to the load study work.

The following figure shows the main stressors in studies:

Abbildung in dieser Leseprobe nicht enthalten

Figure 3 Stressors in studies (Source: Schäfer, A.: 2013, p. 8)

The results of this study show that time constraints and pressure to perform are the main stress triggers. This can be explained by the large amount of learning material for exams and the short preparation time provided for this. For example, 39% of students state that they can hardly come to rest because they are constantly challenged by their studies.39 It also becomes clear that the stressors come from different areas: There are stressors from the field of university-related stress (lack of time) as well as from the areas of intrapersonal stress (fear of the future) and interpersonal stress (competitive pressure).40

It is not surprising that 49% of respondents feel impaired by the stress in their studies when looking at the symptoms of stress.41 In addition to the frequent physical symptoms,.B such as headaches, stomach pain, palpitations, fatigue, non-specific pain, susceptibility to infections, psychological symptoms such as mood swings, brooding, irritability, cynicism, lack of concentration and nervousness can also be found. In addition to these symptoms, there are often changes in behavior, e.g. due to increased smoking/addictions, cravings/loss of appetite, changed sleep behavior or withdrawal from private relationships.42 These symptoms can be at least as distressing for students as the stressor itself.

Stress is therefore a daily companion for the students – sometimes more and sometimes less. This permanently high stress level leads to a psychological burden for a large number of students. How such a psychological stress can manifest itself and what further consequences for the study can result from it is explained in more detail in the following chapter.

2.3 Psychological stress

The psychological stress is of central importance for the present work and especially for the second part, the empirical investigation. Therefore, it is important, at this point, to give an overview of the wide range of psychological stress. For this purpose, a definition is made at the beginning in order to gain a common (basic) understanding. Subsequently, the consequences of psychological stress are explicitly addressed. The main focus is on three selected mental disorders that often occur as a result of stress during studies: depression, anxiety disorder and addiction disorders. Finally, a detailed consideration of the effects of psychological stress on the study takes place.

2.3.1 Definition

In order to define the concept of psychological stress, there is the international standard DIN EN ISO 10075-1: Ergonomic basics with regard to psychological workload. Accordingly, the psychological stress represents the totality of all detectable influences that come from the outside to the person and have a psychological effect on him.43 The totality of the influences refers to cognitive, information processing, motor, social and emotional activities in the worker's confrontation with his specific work situation. For the time being, the term load thereby used in the neutral form, i.e. the load can be both negative and positive.44 In the definition, the term "worker" is used, but this can be transferred to the students with regard to the subject matter of this work.

Due to the large number of different stress factors (also: stressors, p.20), these can be divided into three groups with regard to their causes:

- Apersonal stress factors (physical environment)
- Interpersonal stress factors (social environment)
- Personal stress factors (internal stresses of a person)45

At this point, it should be noted that the psychological stress must be distinguished from the psychological stress. According to the DIN EN ISO 10075-1 standard, psychological stress is the immediate (not the long-term) effect of psychological stress on the individual depending on his or her respective persistent and current situation and resources, including individual coping strategies.46 In simple terms, this means that external stimuli act on the individual (stress) and the body reacts to these stimuli (stress).47 Depending on the degree of stress and the stress limit of the individual, individual consequences occur.

This relationship is illustrated in the following figure:

Abbildung in dieser Leseprobe nicht enthalten

Figure 4 Relationship between psychological stress and psychological stress (Source: Oppolzer, A.: 2009, p. 15)

2.3.2 Consequences of psychological stress

The consequences of psychological stress can be very far-reaching and individual. If the strain and the burden for humans are too high and can no longer be managed, mental disorders can develop. A mental disorder occurs when the functioning of cognitive and emotional processes, as well as behavior, is seriously impaired, so that the affected person suffers from it and is hindered in achieving important goals. Mental disorders therefore lead to a subjective and objective restriction of the quality of life.48 Meanwhile, there are a variety of different mental illnesses, which are in the ICD-1049 are listed. The health report of the Techniker Krankenkasse in 2013 shows that 21% of the students were diagnosed with a mental disorder. The most common forms include depression, somatoform disorders, adjustment and stress disorders, and anxiety disorders.50

In the following, three common mental disorders in students are considered in detail. These are the depression, the anxiety disorders and finally the addiction disorders. Other possible neurotic disorders such as Eating disorders, obsessive-compulsive disorders, dissociative disorders or non-organic sleep disorders are only mentioned at this point, as well as psychotic disorders such as e.B. schizophrenia. Depression

This chapter gives an overview of depression as a mental disorder as a result of psychological stress.

Definition and classification according to ICD-10 Depression is one of the affective mental disorders. Depression is a symptom complex consisting of a depressed, sad mood, lack of interest and drive disorders, a motor and psychological inhibition, typical depressive thought contents and certain somatic (physical) disorders.51 Characteristic of depression is the impairment of the person concerned in physical well-being, thinking, feelings, mood, relation to the environment, but also in relation to one's own person and future.52 Comorbidities, the so-called concomitant diseases of depression, are not uncommon. Anxiety disorders, substance abuse and personality disorders are common concomitant diseases that should be taken into account, especially with regard to appropriate and successful treatment.53

In ICD-10, affective disorders represent a separate chapter – F3. A distinction is made in this chapter between the manic, depressive and bipolar forms. Depression (unipolar depression) then carries the F32 (depressive episode) in diagnostics. A further distinction is made between a mild, moderate and severe episode and courses with and without psychotic symptoms such as.B hallucinations or delusions.54 Another requirement for depression according to the ICD-10 classification is a duration of the depressive episode of at least two weeks, as well as the presence of at least four defined symptoms that have already been mentioned.55 These symptoms, possible causes and consequences are discussed in more detail below, after taking a look at the epidemiology and prevalence.

Epidemiology and prevalence

Depression is one of the most common mental illnesses. Approximately 8% of the German population suffers from depression requiring treatment, with women (about 15.5%) are affected more often than men (about 8%). Furthermore, it can be observed that there are two frequency peaks: between the 20th – 29th year of life and between the 50th – 59th year of life. Similarly, higher rates of depression are to be assigned to the unemployed and city dwellers in particular.56 There are other correlations with regard to age, gender and socio-economic status.57

Estimates of the lifetime prevalence of depressive disorder range from 3% to 18%. The probability of developing depression is about 12% for men and about 26% for women.58

Causes and symptoms

The causes and symptoms of depression are very diverse and complex.

Above all, the causes are very complex and individual, so that they cannot be listed in their entirety in this thesis. Possible causes are listed below as examples:

- genetic factors
- Disorder in neurotransmission (relative lack of serotonin and norepinephrine)
- critical life events (e.B. loss of a caregiver)
- chronobiological factors (disturbances of biological rhythms)
- physical illnesses or medication (e.B Parkinson's disease)
- Undesirable developments in early childhood.59

Equally extensive is the list of possible symptoms of depression. These symptoms can be divided into four categories:

- Abnormalities in the mood Sadness, loss of joy and activities, feelings of anxiety, shame and guilt
- Abnormalities in thinking Low self-esteem, pessimism and hopelessness also with regard to the future, suicidal thoughts
- Abnormalities in motivation Inhibition of initiative and reactions ("paralysis of the will"), impaired decision-making ability
- Abnormalities on a physical level Loss of appetite, sleep disorders, feeling of weakness, fatigue60

Other possible symptoms include e.B depression, tendency to ponder, feeling of numbness, emptiness or the inability to laugh or cry.61 At this point, it should be noted that the symptoms are individually different and do not occur in the same way in all those affected.

To record the symptoms and to support the diagnosis of depression, there are a number of clinical-psychological test procedures. A well-known and proven test procedure is Beck's Depression Inventory (BDI questionnaire for short). The BDI is a self-assessment procedure that tries to measure the severity of depressive symptoms. The basis for the development of this test is the symptoms that have often been expressed by psychiatric patients with a diagnosed depression. The BDI includes the affective, somatic and cognitive symptom levels. The test comprises a total of 21 groups of statements, each of which has four possible answers. The severity is now determined by the sum value of the answers. Excerpts from this test procedure are also used in the context of the empirical investigation of this work.62

The consequences and effects of depression are discussed in Chapter 2.3.3, especially with regard to studies. Anxiety

As a result of psychological stress, the anxiety disorders, which are presented in this chapter, also count.

Definition and classification according to ICD-10

The concept of fear itself first describes a state of arousal of the psychic system in response to the perception of empirical evidence or imagined ideas about a danger or threat.63 Fear is a condition that every person feels in certain life situations. In the case of anxiety disorder, the extent of the anxiety experienced is particularly decisive. The transition from natural anxiety to anxiety disorder is usually not clear. Nevertheless, it can be stated that anxiety becomes an anxiety disorder if it is perceived as so threatening by the person concerned and thus severely impairs coping with everyday life or is no longer possible at all. This includes that the fear is inappropriate for the situation and is felt without sufficient reason or without any actual threat. Consequently, there is fear of fear – the fear is avoided and not the triggers.64

In ICD-10, the anxiety disorders are in the chapter Neurotic, stress and somatoform disorders can be found. It is separated by phobic disorders (F40) and other anxiety disorders (F41). In phobic disorders, anxiety is predominantly caused by clearly defined situations or objects, e.B agoraphobia (claustrophobia) or social phobia. The other anxiety disorders include panic disorder and generalized anxiety disorder. Fear does not refer to a specific environmental situation, but it represents the manifestation of anxiety as the main symptom.65

Epidemiology and prevalence

According to international studies, the lifetime prevalence of anxiety disorders is between 14 – 29%. For the population in Germany, a lifetime prevalence of about 15% was determined. Furthermore, it could be observed that both phobic fears and the other anxiety disorders occur more frequently in women than in men. The lifetime prevalence of panic disorder is 2% and occurs more frequently between the ages of 35 and 65. Generalized anxiety disorder, on the other hand, usually begins in adolescence and young adulthood.66

Causes and symptoms

There is no one explanation for the anxiety disorder. Rather, the anxiety disorder arises from a variety of different factors. According to the current state of science, the following factors can be cited as the cause of an anxiety disorder:

- moderate to significant hereditary factor (factors are distributed over several genes)
- Change in neurotransmitter systems in the brain
- Incorrect conditioning/cognitions
- early childhood trauma
- parental parenting styles
- acute stress and strain.67

Now that a look at the broad spectrum of possible causes has been taken, the specific symptoms of an anxiety disorder are discussed here. Again, it should be noted that the symptoms occur individually and may differ in the manner of occurrence in each person affected. The symptoms are classically divided into three areas, which are now briefly listed below:

- Physical symptoms Palpitations, accelerated pulse, palpitations, sweating, tremors, shortness of breath or suffocation, hot flashes, cold showers, nausea, dizziness, drowsiness, weakness
- Psychological symptoms Derealization, depersonalization, fear of losing control/going crazy/dying
- Social and health consequences as symptoms Inability to do something alone, dependence on the caregiver, occupational disability, depression, substance abuse (alcohol, sedatives).68

As for depression, there are also clinical-psychological test procedures for anxiety disorders that investigate this problem and thus support the diagnosis. As an example, the GAD-7 questionnaire (Generalizied Anxiety Disorder Scale-7) briefly presented, as this was used in the survey carried out for this work. The GAD-7 is part of the Patient Health Questionnaire (PHQ) and is used to identify generalized anxiety disorders and assess overall anxiety. The seven questions are answered using a scale of 3 according to the frequency of occurrence. The evaluation is based on the sum value of all answers.69

The extent to which the anxiety disorder affects the study, among other things due to the symptoms just described, is explained in more detail in chapter 2.3.3. Addiction disorders

Psychological stress can lead to dependencies in many cases. This includes both alcohol dependence and dependence on drugs or medications. These are examined in more detail in this chapter. Non-substance-related addictions or addictive behavior, such as gambling or shopping addiction, are left out in this chapter.

Definition and classification according to ICD-10

The term dependence describes a condition that follows the abuse of special substances. The misuse of these harmful substances can therefore be regarded as a precursor to dependence and as a consequence lead to physical and mental damage. The dependence is characterized by the indomitable desire to take the substances, such as e.g. Alcohol, drugs or medications. With abstinence, the body then reacts with withdrawal symptoms. In the case of this disease, a distinction must generally be made between a physical and a psychological dependence.70 Physical dependence includes the process by which the physiology of the body adapts or adjusts to the continuous supply of substances and therefore becomes dependent. This is justified by the fact that certain endogenous neurotransmitters are only available to a lesser time due to the constant presence of the substances. On the other hand, this is referred to as a psychological dependence, when the use of the substance triggers a pleasant and desirable feeling and thus a strong desire – the so-called "desire". craving – developed. However, the psychological dependence can also arise without a physical dependence of the substance.71

The ICD-10 provides for a separate chapter for addiction disorders. Chapter 2 Psychological and behavioral disorders caused by psychotropic substances (F10 – F19) involves both the intake of alcohol, drugs and various medications, the latter being further distinguished and receiving their own diagnosis.72


1 cf. Focus Online (29.01.2017):

2 cf. Frankfurter Allgemeine (29.01.2017):

3 cf. Riße, D.: 2016

4 cf. Autumn, U.; Müller, M.; Voeth, M.; Eidhoff, A.; Stief, S.: (1999), p. 246 f.

5 cf. Spiegel Online (29.01.2017): bei-studenten-nehmen-zu-a-1041520.html

6 cf. Definition (04.11.2016):

7 cf. Technische Universität Darmstadt (04.11.2016): https://www.osa.tu

8 cf. Klumpp, M.; Rybnikova, I.: p.25 f.

9 cf. Klumpp, M.; Rybnikova, I.: p.25 f.

10 cf. Hochschulkompass (13.11.2016): studieren/studienformen/vollzeitstudium.html

11 ECTS = European Credit Transfer System: Europe-wide, uniform evaluation system

12 cf. Gabler Wirtschaftslexikon: 2005, Vol. 5, p. 2193

13 cf. University of Augsburg (13.11.2016): https://www.uni

14 cf. Deutsches Studentenwerk (13.11.2016):

15 cf. Paragraph 1(1) of the FernUSG (24 August 1976)

16 cf. Gabler Wirtschaftslexikon: 2005, Vol. 3, p. 1035

17 cf. Klumpp, M.; Rybnikova, I.: p.25 f.

18 cf. Statista (03.11.2016): stress/

19 cf. Herder's Lexicon of Psychology: 2007, Vol. 3, p. 2230

20 cf. Zimbardo, P.G.; Gerring, R. J.: (2008), P. 10.

21 cf. Orth, H.; Lauer, T.; Sieber, M.; Koch, A.: 2010, P. 112

22 cf. Kypta, G.: (2018), p. 4.

23 cf. Kury, P.:2010, p. 11

24 cf. Zimbardo, P.G.; Gerring, R. J.: (2008), P. 10.

25 cf. Kury, P.: 2010, P. 80

26 See (14.11.2016):

27 cf. Eppel, H.: (2018), p. 4.

28 cf. Zimbardo, P.G.; Gerring, R. J.: (2008), P. 10.

29 cf. Eppel, H.: (2018), p. 4.

30 cf. Zimbardo, P.G.; Gerring, R. J.: (2008), P. 10.

31 cf. Zimbardo, P.G.; Gerring, R. J.: (2008), P. 10.

32 cf. Bamberg, E.; Keller, M.; Wohlert, C.; Zeh, A.: (2006), p. 12.

33 cf. Orth, H.; Lauer, T.; Sieber, M.; Koch, A.: 2010, P. 113

34 cf. Berufsgenossenschaft Nahrungsmittel und Gastgewerbe (16.11.2016):

35 cf. Orth, H.; Lauer, T.; Sieber, M.; Koch, A.: 2010, P. 115

36 cf. Kessler, H.: (1999), p. 246 f.

37 cf. Orth, H.; Lauer, T.; Sieber, M.; Koch, A.: 2010, P. 117

38 cf. AOK die Gesundheitskasse (14.11.2016): index_17265.html

39 cf. Schäfer, A.: 2013, P. 7

40 cf. AOK Gesundheitskasse (14.11.2016): pressemitteilungen/archiv/2016/08_projektbericht_stressstudie_druck.pdf

41 cf. Schäfer, A.: 2013, P. 7

42 cf. Kypta, G.: (1999), p. 246 f.

43 cf. Nachreiner, F.: (2008), P. 8.

44 cf. Metz, A-M.; Rothe, H.-J.: 2016, P. 7

45 cf. Günther, L.: (2008), P. 9.

46 cf. Nachreiner, F.: (2008), P. 10.

47 cf. Günther, L.: (2008), P. 8.

48 cf. Zimbardo, P.G.; Gerring, R. J.: (2008), P. 10.

49 ICD-10: International Classification of Diseases, 10th revision

50 cf. Focus Online (15.11.2016): physical-complaints-study-more-than-everyone-five-student-gets-psychological-diagnose_id_4787666.html

51 cf. Herder's Lexicon of Psychology: 2007, Vol. 1, p. 354

52 cf. Wolfersdorf, M.: (2018), p. 4.

53 cf. Coleman, L. H.: (2018), p. 4.

54 cf. Koeslin, J.: (2018), p. 4.

55 cf. Disse, S.: (2015), p. 379.

56 cf. Disse, S.: (2015), p. 379.

57 cf. Busch, M.A.; Mask, U. E.; Ryl, L.; Schlack, R.; Hapke, U.: 2013, P. 734

58 cf. Schauenburg, H.; Hofmann, B.: (2018), p. 4.

59 cf. Koeslin, J.: (1999), p. 246 f.

60 cf. Zimbardo, P.G.; Gerring, R. J.: (2008), P. 10.

61 cf. Bandelow, B.: (1999), s. 241 ff.

62 cf. Hautzinger, M.; Keller, F.; Kühner, C.: (2006)

63 cf. Geo Topic Dictionary: 2007, Vol. 12, p. 38

64 cf. Niklewski, G.; Riecke-Niklewski, R.: (1999), s. 241 ff.

65 cf. Disse, S.: (1999), s. 241 ff.

66 cf. Disse, S.: (1999), s. 241 ff.

67 cf. Bandelow, B.; Gruber, O.; Falkai, P.: (1999), p. 246 f.

68 cf. Koeslin, J.: (1999), p. 246 f.

69 cf. PubMed Central® (29.01.2017):

70 cf. Koeslin, J.: (2018), p. 4.

71 cf. Zimbardo, P.G.; Gerring, R. J.: 2003, P. 190

72 cf. Disse, S.: (2015), p. 379.

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Stress during studies. Mental stress and illness among students in face-to-face and distance learning
University of Applied Sciences Riedlingen
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stress, distance learning, face-to-face studies, depression, anxiety disorder, mental stress
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Franziska Pfoser (Author), 2017, Stress during studies. Mental stress and illness among students in face-to-face and distance learning, Munich, GRIN Verlag,


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