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The Health Care Manager

Volume 35, Number 3, pp. 231–240


Copyright # 2016 Wolters Kluwer Health, Inc.
All rights reserved.

Management of Stress and


Anxiety Among PhD Students
During Thesis Writing
A Qualitative Study
Leila Bazrafkan, PhD; Nasrin Shokrpour, PhD; Alireza Yousefi, PhD;
Nikoo Yamani, MD, PhD
Today, postgraduate students experience a variety of stresses and anxiety in different situations of
academic cycle. Stress and anxiety have been defined as a syndrome shown by emotional exhaustion
and reduced personal goal achievement. This article addresses the causes and different strategies of
coping with this phenomena by PhD students at Iranian Universities of Medical Sciences. The study
was conducted by a qualitative method using conventional content analysis approach. Through
purposive sampling, 16 postgraduate medical sciences PhD students were selected on the basis of
theoretical sampling. Data were gathered through semistructured interviews and field observa-
tions. Six hundred fifty-four initial codes were summarized and classified into 4 main categories and
11 subcategories on the thematic coding stage dependent on conceptual similarities and differences.
The obtained codes were categorized under 4 themes including ‘‘thesis as a major source of stress,’’
‘‘supervisor relationship,’’ ‘‘socioeconomic problem,’’ and ‘‘coping with stress and anxiety.’’ It
was concluded that PhD students experience stress and anxiety from a variety of sources and apply
different methods of coping in effective and ineffective ways. Purposeful supervision and guidance
can reduce the cause of stress and anxiety; in addition, coping strategy must be in a thoughtful ap-
proach, as recommended in this study. Key words: anxiety, coping, PhD student, qualitative
study, stress

ECENT STUDIES HAVE demonstrated that


Author Affiliations: Department of Medical Education,
Medical Education Research Center, University of
R many university students experience stress,
anxiety, and depression while studying at
Medical Sciences, Isfahan (Drs Bazrafkan, Yousefi, and
Yamani); and Applied Linguistics, Shiraz University of college.1-3 This is related to the institution at-
Medical Sciences (Dr Shokrpour), Shiraz, Iran. mosphere, faculty members, student colleagues,
Authors’ Contributions: Leila Bazrafkan developed the and traditional education.4,5 Evidence available
study design, conducted the interviews and analysis, in the past 4 decades has revealed high levels
ensured trustworthiness, and drafted the manuscript.
Alireza Yousefi, as the supervisor, participated in the of stress and anxiety endured by medical and
study design, supervised the codes and data analysis dental students. Medical students also show
process, and revised the manuscripts. Nikoo Yamani prominent scores for fatigue, headache, stress,
and Nasrin Shokrpour, as research consultants,
participated in the study and advised during the study. and eating problems.6,7 It is generally believed
that PhD students show more stress and anxiety
Funding/Support: The present article was extracted
from the thesis written by Leila Bazrafkan and was in thesis writing than in other stages of study
financially supported by Esfahan University of Medical life. The reason of the mentioned problem is
Sciences (grant no. 92-6746). the thesis supervisors, personal time, work
The authors have no conflicts of interest. field, role conflict, and social support.8,9 Stress
Correspondence: Nikoo Yamani, MD, PhD, Department and anxiety have been defined as a syndrome
of Medical Education, Medical Education Research shown by emotional exhaustion and reduced
Center, Isfahan University of Medical Sciences, Esfahan, personal goal achievement. In addition, un-
Iran ([email protected]).
solved stress may result in emotional withdrawal
DOI: 10.1097/HCM.0000000000000120 and educational attrition.10 Several studies have
231

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


232 THE HEALTH CARE MANAGER/JULY–SEPTEMBER 2016

identified that stress and anxiety can be the OBJECTIVES


earliest causes of improper academic perfor-
mance in undergraduate students.11 This phe- This study proposed to identify themes that
nomenon calls for educational interventions to can explain thesis supervision challenges through
improve the quality of life and reduce stress the postgraduate years of medical sciences
and anxiety rates within the training periods.12 students and faculties in Iran.
Despite the existing evidence for coping with
stress in different groups of students, there METHODS
are some specific factors affecting stress and
stress coping styles, for instance, study strat- The qualitative approach was used by con-
egy and lifestyle.7,13 It is expected that dif- tent analysis with an appropriate design to
ferent students can undergo different stages allow participants to describe their experiences
of stress and tension, but generally, there are on factors that can improve coping with stress
significant differences in the amount of stress, and anxiety.17,18 To gather the data, semist-
stress coping styles, and social support among ructured interviews were implemented. Key
different students.14 Ford et al15 reported that informants in a convenience sample of PhD
high levels of perceived stress were found students from 4 different universities of medi-
among pharmacy students, which were mostly cal sciences (Shiraz, Tehran, Iran, and Isfahan)
related to academic workload. Vasegh and were selected according to a variety of academic
Mohammadi’s16 findings in Tehran University disciplines, age and sex, and university locations.
of Medical Sciences provide further evidence Sampling started using purposive sampling
for the protective role of religion against anx- method with a high range of variation (discipline,
iety and depression. In addition, Marjani et al3 academic ranks, and sexes) and followed by
at Golestan University of Medical Sciences theoretical sampling.18 These universities were
revealed that stress management courses are chosen because of their different student popu-
organized by medical schools when the stu- lations, variations in disciplines, geographic
dents arrive and cope with stress in the com- locations, and the researchers’ access to stu-
ing years. These courses may reduce the negative dents to accomplish the interview.
effects of stress on medical students. By hold- Interviews started with general topics, such
ing such courses and reducing the stress level, as ‘‘Please talk about your thesis experiences,’’
medical students may improve their perfor- and probing questions were also used to deeply
mance in medical education. Kamler9 also explore the conditions and significant factors
investigates publication-related anxiety in doc- in participants’ point of view. The interview
toral students and academic attention to writ- process was dependent on the questions asked
ing for publication. However, they focused between the interviewer and interviewees.
less on the co-authorship that helped students The interview was performed in a private and
to pass through the struggles and anxieties of proper place and in a suitable time for partici-
publishing. However, there is a need to change pants to feel comfortable; then, subsequent in-
co-authorship more clearly as a pedagogic prac- terviews were coordinated. To describe what
tice and create more purposeful structures in the participants stated, demographic data were
subject disciplines to structure and support recorded. The interviews lasted for approxi-
doctoral publication. mately an hour, and each interview was done
This study aimed to explore PhD stu- in 1 or 2 sessions with interviewers taking notes
dents’ experience of stress and anxiety while or memos and field notes.
writing their thesis and how they cope with Interviews lasted from September 2013 to
their approach at Iranian Universities of Med- December 2014. During the study, after obtain-
ical Sciences. There is an attempt to find ing the participants’ permission, each inter-
out how PhD students experience and cope view was recorded. During the data analysis,
with stress and anxiety in their educational MAXQDA software (version 10, package series)
years. was used for indexing and charting. Qualitative

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Stress and Anxiety Among PhD Students 233

content analysis design with a conventional Table. Themes and Subthemes Used
approach was also used to analyze the data. in the Interview
First, in content analysis, semantic units should
be specified, and the related codes should be Themes Subthemes
extracted and categorized based on their sim-
Thesis as a major Selection of a good idea or
ilarity.19 Finally, when the information is highly source of stress topic for thesis
abstracted, themes can be determined. To give Ambiguity in thesis stages
structure and discipline to the data, content Lack of resources
Poor writing
analysis method was used to verify whether Supervisor’s Nonresponsive supervisors
certain words and concepts exist in the text. relationship Ineffective evaluation
In the conventional approach, the use of pre- Lack of feedback
Socioeconomic Busy life
arranged classes is avoided, and classes and problem Lack of enough finances
their names are permitted to directly come out Fear of unemployment
of the data. For this, manuscript of interviews after graduation
Stress, anxiety, and depression
was read and recorded and listened for several Coping with Efficient communication with
times afterward until the overall goal was stress and someone
achieved. Then, the manuscript was read in anxiety Internet, music, and movies
Excessive information
words, and the codes were extracted. In addi- Finalizing the thesis
tion, interviews were continued with others
to continue coding of the texts, and subcodes
were categorized within the general topics. explained to the participants, and informed
Then, similar codes were classified in cate- consent was obtained to interview and record
gories.17,18 To make sure about the accuracy them. Because of ethical considerations, at all
of the data, we used peer review, the re- stages of the research, the data remained con-
searchers’ adequacy, check member, and the fidential. Participants had permission to leave
long and continuing evaluation through in- the study at any time they wanted.
depth, prolonged, and repeated interviews
by the participants, using the colleagues’ com-
ments to increase the dependability and con- RESULTS
firmability approved by maximum variation of
data in the sampling. In addition, to increase The mean age of the students in this study
the power of data transferability, adequate was 31.54 ± 8.60 years, and all of them were
explanation of the data was provided in the married. The main categories of data included
research for critical review of the findings by ‘‘thesis as a major sources of stress,’’ ‘‘supervi-
other researchers.20,21 sor’s relationship,’’ ‘‘socioeconomic problem,’’
The number of initial codes was decreased, and ‘‘coping with stress and anxiety.’’
reaching 654 codes finally. These codes were Thesis as a major source of stress
summarized and classified into 4 main cate-
gories and 11 subcategories on the thematic Thesis as a major source of stress was one
coding stage dependent on conceptual simi- of the important results obtained from the
larities and differences. The major themes participants. The subthemes that emerged in
included ‘‘thesis as a major source of stress,’’ this category included factors related to selec-
‘‘supervisor relationship,’’ ‘‘socioeconomic tion of a good idea or topic for thesis, time man-
problem,’’ and ‘‘coping with stress and anxiety’’ agement, lack of resources, and poor writing.
(Table).
Selection of a good idea or topic
Ethical considerations for thesis
This study is approved by the ethics com- In the participants’ views, it is a fact that
mittee of Shiraz University of Medical Sciences. the thesis should be the highest achievement
The goal of the research and interview was of their studies and will influence the trend of

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234 THE HEALTH CARE MANAGER/JULY–SEPTEMBER 2016

academic life and future career for many . . .It’s not enough to punish yourself
years. It will take years to write and perhaps or feel guilty, when you don’t meet a goal;
organize it for publication. Therefore, some you should notice the reasons of your fail-
factors in the choice of the topic should be ure to attain the goals in future. . .. (partic-
considered in addition to the student’s ability ipant no. 5)
to do it; it actually determines the course and
line of his or her academic life in the future.
Poor writing
Therefore, some factors should be considered
so that the student can choose a topic that can For some students, writing is a very simple
be done by him or her and also determine his and easy process, but for others, basic mis-
or her future research approaches. takes can lead to failure in paper publica-
One of the students said, ‘‘My supervisor tion. Some of the most frequent mistakes that
offered me a subject that I did not like it, and students experience while writing their PhD
he forced me to do it and after some time I thesis were related to research methodology,
realized that my he had not anticipated many designing the results in a logical manner, and
of the problems in that research. . ..’’ concluding the research. Students do their
According to the participants’ experiences best to accomplish the job, but they often do
in the area of research activities, faculty mem- have problems in writing the thesis. Many
bers and medical students have severe weak- students will normally present facts and ideas
nesses in defining high-quality problems, novelty as new because they have not done adequate
and originality of research, choice of a suit- amount of research to realize that the work
able method for research, data analysis, ex- they are quoting was accomplished several
planation of results, and writing systematic years earlier. This sometimes leads one to
papers, and there is no logical and compiled think that the student is idle and does not
program to improve research capabilities. spend much time on the work as he or she
Determining the faculty members’ and stu- should have. It gives the supervisors the im-
dents’ role in thesis activities can lead to im- pression that the student does not take the job
provement of individuals in their competency as seriously as he or she should. One of the
in research. students said:
. . .When I started writing my PhD thesis,
Time management
everything was very good, but over time,
The other problem that was emphasized was problems came up and I felt I could not write
time management by students at universities. an article and publish it in a timely manner;
Writing a thesis requires both short-term and it led to my failure. . .. (student no. 2)
long-term time management skills because it
is a lengthy project that should be done with- Lack of resources
out artificial deadlines. One of the students
stated: Another problem that was emphasized by
most of the students was financial support of
. . .I see many students who are brilliant the students by universities and inadequate
but they just never finalize their thesis. . .. managerial procedures for limited right of entry
to information resources. The students who
Students wish to have a practical guide to write the thesis pay much but do not receive
writing thesis and a knowledgeable director adequate support. One of the students who
of graduate programs. Another way of measur- had experienced many problems in tentative
ing efficiency is to break the thesis into pub- research said:
lishable parts. Setting realistic, measurable goals
is the key, but learning occurs over time and . . .Because I had to use an apparatus
prevents one from meeting goals. One of the which is not available in our country—and
physiology students said: you know that universities don’t have any

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Stress and Anxiety Among PhD Students 235

budget for these expenses. Of course, it’s not Lack of feedback


always like this, and in some cases students
The participants in this study often empha-
have to change their topics because it takes
sized the way to improve the research abilities
a long time. . .. (student no. 9)
in supervisor and supervisee, whereas some of
Supervisors’ relationship them have not enough feedback from the
supervisor.
Nonresponsive supervisors, ineffective evalu-
ation, and lack of feedback were the subthemes . . .The most important difficulty of giving
in relationship with supervisors. Participants feedback is the supervisor him/herself.
in this study stated that inappropriate choice Some supervisors do not have enough time
of supervisor, weak structure of thesis super- for this important indirect education. . ..
vision, uneven meetings of supervisors and (student no. 10)
students, lack of concentration on thesis, poor
Socioeconomic problems
and unstructured supervision, lack of system-
atic and inadequate guidance, and insignificant This theme included the following subcate-
provision of time to supervision are the major gories: ‘‘busy life,’’ ‘‘lack of enough budget,’’
problems in this area. and ‘‘fear of unemployment after graduation.’’

Nonresponsive supervision Busy life

Most students described the haphazard nature PhD students usually have busy lives and
of supervision, particularly by clinical faculty different problems and situations of life such
members who often disregard a clear timetable. as marriage, childbearing, and working to earn
income while studying. These cause problems
. . .I worked hard, and read a lot of papers
that reduce their psychological capacity to
because of the fear of response of the super-
cope; one of the students said:
visor, but unfortunately. . .I didn’t know the
answers to his questions—and then he got ‘‘. . .When you are writing a thesis, it is
more and more angry. (student no. 5) probable that a major life change may occur,
for example, disease, a new relationship,
The workload of supervisors was the other becoming parents or something that needs
problem for the relationship of supervisor and accurate management. . .I was attempting
supervisee. Because of the lack of time, thesis to plan my wedding while carrying out the
supervisors are unable to properly guide the last experiments for a script that needed to be
students as well as carry out their regular duties. submitted the day after. . .. ’’(student no. 7)
The rationale in such situation lies in the stu-
dents’ overload in universities and the impro- Insufficient finances
per proportion of students and supervisors.
Participants’ experience shows that PhD stu-
Ineffective evaluation dents are either employed or looking for a job,
and they work to make a living. If they are
One of the key problems of thesis supervi- married and have the responsibility of a family,
sion at the universities is nonstandard evalua- the problem is more complicated. They need
tion criteria, lack of expertise in thesis decision more free time to manage the family affairs
making and scoring, and inadequate standards while the university requires them to attend
in supervision and assessment of the quality of the faculties full time. This leads to conflict.
faculty members’ guidance.
Fear of unemployment after
. . .approximately, I did not sense any
graduation
supervision of my work; I myself chose a
topic, worked on it by error and trial, and When students are to finalize their educa-
after all distress, I presented my thesis. . .. tion, some of them are worried about jobs,
(student no. 4) unemployment, and the potential inability to

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


236 THE HEALTH CARE MANAGER/JULY–SEPTEMBER 2016

work in the field of education proportionate to stress, depression, and anxiety. A powerful
their own dignity. They are also concerned about method for dealing with anxiety is removing
their parents for their education investment, but negative moods or reducing the body tension
they may not be able to compensate their troubles. by efficient communication with someone,
They are concerned a great deal about their such as a friend, colleague, or family member.
opportunities and career plans and the fact
. . .I think my university experience was
that college has imposed some expenses on
one of the superior ones—my supervisors
their parents.
were not appropriate for friendly communi-
. . .It’s been a while that I am graduated cation and stress release. They had high
but not employed anywhere yet. It is about expectation of PhD students but were them-
7 or 8 months that I’ve been extremely selves under a lot of pressure to achieve
depressed with having no motivation for something. . . (student no. 1)
living. Most of the time, I feel sad and tired.
I feel alone. It’s hard to make a living. I only Internet, music, and movies
like to sleep. I’ve referred to a counselor. He Students described a variety of ways of
advised me a little which didn’t have any coping, including physical activities, self-
impacts on me. I’ve also referred to a psy- talk, meditation, and listening to music to
chiatrist and took anti-depression medica- help deal with their feelings. Their experi-
tion. That was not effective either. I myself ences show that some of them escape from
know that my problem is not serotonin. It is their current situation with music, movies, or
all because of future darkness and hopeless- surfing to reduce stress.
ness. . .. (student no. 14)
. . .I talk or chat with my friend on net; I
try to forget the problem and change the
Stress, anxiety, and depression
anxiety to excitement. . . (student no. 6)
All students participating in the study had
However, based on the findings of this study,
experienced some degree of stress, anxiety, or
these methods provide temporary help only,
depression. Some people were only nervous,
and very soon, the individuals are again worried.
but most of them had experienced headaches,
stomach aches, digestive problems, fatigue, Search for excessive information
insomnia, and panic attacks. More participants
fully recovered after graduation, but some still According to the participants’ experiences,
see the nightmares of those hard days and have when they have a problem, they try to collect
it in mind. data for more information on the subject and
One of the students told: ‘‘. . .I had never make an attempt to fix the problem; some-
experienced so much stress and anxiety dur- times, it is a problem of gathering lots of infor-
ing all my life. All systems of my body were mation that they do not exactly know how to
disturbed. I was always crying because, I use them. A student of medical education said:
felt. . .I’m dying. . ..’’ . . .I started searching a lot for an alter-
native methodology for the thesis and I
Coping with stress and anxiety learned much about my subject and new
This subtheme of coping with stress and technology in this area; it actually increased
anxiety concerned efficient communication; my depth of knowledge. But this method is
Internet, music, and movies; excessive infor- wasting the time and not useful for students. . .
mation gathering; and finalizing the thesis. (student no. 8)

Efficient communication Finalizing the thesis


According to the participants’ experience, they Students acknowledge that the fundamental
had used different strategies for coping with solution to their problems in the process of

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Stress and Anxiety Among PhD Students 237

academic writing is completing a thesis and Academic workload was the major source of
graduating. Most students say that they have stress for the interviewed college students, as
finally come to the conclusion that they should reported in other studies.15 Walker et al24
as soon as possible get rid of this problem by argued that doctoral education programs must
working more, avoiding laziness, and taking be well planned to prepare the PhD students
their own time in addressing this dilemma. as ‘‘stewards of the discipline,’’ who innova-
The problem is that some students do not have tively create new knowledge and critically
sufficient competence to complete this task. protect valuable ideas.
They offer different reasons for this matter. The second category was supervisors’ rela-
The participants’ experiences revealed that tionship, nonresponsive or ineffective supervi-
ineffective communication and absence of sory evaluation, and lack of sufficient feedback
positive pattern and professional behavior can for correction of work. Ineffective evaluation
lead to negative behavior formation in stu- and lack of sufficient feedback, which emerge
dents; the outcome is a student incompetent from nonresponsive supervisors, unprofessional
in thesis writing. To solve this problem, it is behaviors, and configuration of negative inter-
necessary to pay attention to different ethical actions among supervisor and supervisee, lead
aspects in the research supervision process. to exhausted and depressed students. More-
One of the students said: over, in this study, the participants, both male
and female, complained of fatigue and physical
. . .for example, if I have an assignment to
distress. Another study reported that female
do that I’m really stressed about, I try to
students demonstrated a large and significant
enjoy the process a little more, rather than
increase in emotional distress, such as stress,
disturbing about producing the end result.
fatigue, anxiety, depression, headache, gastro-
Listening to music has really helped me to
intestinal symptoms, and pain, more often
calm down and forget my problems. . ..
than their male peers.25
The supervisory relationship is the key ele-
DISCUSSION ment of guidance in thesis writing. In this
regard, many studies revealed that good super-
This study addressed stress, anxiety, and visor’s relationship and effective evaluation,
coping strategies among PhD students in along with constructive feedback, can improve
Iranian medical sciences universities. Thesis the students’ mental health.8,26 Attaran and
as a major source of stress was one of the colleagues,26 in a study on the optimal satis-
important results obtained from the partici- faction of the student’s relationship with su-
pants. Subthemes emerging in this category pervisor, showed that more than 53% of PhD
include factors related to selection of a good graduates were dissatisfied about their rela-
idea or topic for thesis, ambiguity in the thesis tionships with supervisors.
stage, time management problems, lack of Evans and Stevenson27 pointed out that the
resources, and poor writing style. For the first quality of research supervision experiences is
category, selection of a good idea or topic for mainly influenced by 2 factors: the level of
thesis, ambiguity in thesis guidance, lack of simplicity in expectations and the support
resources, and poor writing skills are included. given to students’ supervisors. They recom-
Accordingly, based on the participants’ views, mend that supervisors’ guidance activities at
PhD students’ stress and anxiety are more re- micro and macro levels will guide the students
lated to thesis and supervisors. These problems throughout the hard and mystifying pathways
are particularly about selection of a good idea of research so that each research project can
or topic for a thesis, ambiguity in thesis guid- create a personal vision.
ance, student’s research project lacking struc- According to the participants, in this re-
ture, and sufficient supportive planning. This search, lack of time and accessibility of the
result is in line with other studies, for exam- supervisor, due to having multiple academic
ple, that presented by Ghadirian et al.22,23 and nonacademic duties in multiple activities

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


238 THE HEALTH CARE MANAGER/JULY–SEPTEMBER 2016

such as teaching, were the other problems. In academic performance, mental health, and
another study in Iran, it was found that super- subjective well-being or happiness. How-
visors work in public and private clinics in ever, some studies suggest that stress man-
addition to their academic activities; thus, lim- agement courses and mindfulness based on
ited time is left for supervising and guiding the stress reduction will be effective in decreasing
students.23 the stress among students.3,31,32
The third category was related to socio- The limitations of this research included
economic problems and subcategories of busy limited access to students from other univer-
life and busy students, shortage of finances, sities in the country. Another limitation was
and fear of unemployment after graduation. difficulty of some students in stating their actual
Curriculum overload and excessive academic problems, due to some considerations with
assignments bring about specific social and regard to their universities.
economic problems for PhD students, who
like to be independent in this age. These prob-
lems include inability to satisfy the family mem- IMPLICATIONS OF THE STUDY
bers’ demands and also worrying about the
lack of financial resources and future career. The findings of the current study confirmed
Several other researchers have reported of the existence of stress and anxiety in PhD
changes in atmosphere, teaching methods and students and recommended directions for re-
strategy, and academic achievement criteria ducing and coping with stress; in addition,
as reasons for stress in medical sciences some suggestions were provided as to thesis
students.8,14 writing strategies. Initially, there is a need for
Unfortunately, this problem is created by PhD students and administrators to increase
disproportionate social needs and the number their awareness about these stressors and
of university admissions. The prevalence of creatively use stress management strategies.
depression among teens holding educational Second, there is a need for postgraduate stu-
degrees but not having related jobs has harm- dents to better understand the thesis as a jour-
ful effects on the society. ney and know the stress factors related to it.
The researchers in this study recommended Finally, both faculty members and students
that we should build a critical and reflective need to discover ways to decrease stressors
community of postgraduate supervisors who and to increase capabilities in dealing with
can develop their supervisory practice through these stressors. Faculty members and super-
reflective conversations. Socioeconomic prob- visors should assess the stressors and help the
lems, busy lives, and fear of unemployment PhD students cope with them by using critical
after graduation were the strongest reasons thinking and problem-solving methods. In ad-
of students’ fear and anxiety, as revealed in dition, training in metacognitive skills such as
other studies.28,29 critical thinking skills and problem solving
To cope with stress and anxiety, the stu- should be considered.
dents have resorted to efficient communica-
tion with friends or other caring persons, Web
searching, music and movies, excessive infor- CONCLUSIONS
mation, and finalizing the thesis. When students
are tired and anxious, they often purposely Stress, anxiety, and coping among PhD
surf Web sites related to their topics, and some students in the thesis supervision process
of them listen to music and watch movies until are caused by the thesis as a major source of
finally the completion of their work reduces stress, relationships with supervisors, and so-
exhaustion and stress. cioeconomic problems, which emerge from
Lepp et al’s30 findings add to the debate the inappropriate and unstructured context
about the use of cellular phones by students and the educational atmosphere in which
and how excessive use may negatively impact the tasks and duties of individuals are not clear

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Stress and Anxiety Among PhD Students 239

and well defined. Doing a thesis scientifically ACKNOWLEDGMENTS


and without stress requires a suitable context
of all aspects and accountability of both stu- The researchers would like to thank all re-
dents and supervisors. Actually, coping with search participants of medical sciences univer-
stress and anxiety requires efficient commu- sities who contributed their time to the study.
nication with the supervisor and other effec- The authors would also like to thank the educa-
tive people who guide the student to finalize tion development center of Shiraz University
the task as a thesis. Medical Sciences for cooperation in this study.

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