Insights into the Psychological Strains of University Life: A Study of Albanian Students

During university years, mental health and behavioural challenges become more prevalent. The unique lifestyle of students often exposes them to increased levels of anxiety, depression, and social isolation. Additionally, mental well-being is closely linked to factors such as anxiety, stress, and adjustments to new lifestyle habits, particularly in the crucial transition period of the first year at university. A longitudinal study was conducted among students enrolled at universities in Albania. Descriptive statistics were used to show the difference between gender, levels of education and age. A sample of 594 students participated in the study completing the battery of questionnaires. Psychological instruments and exposure measurements were considered. Research has confirmed the challenges faced by students during their university years, revealing a correlation between insufficient financial support and a rise in symptoms of depression and anxiety. The findings underscore the impact of lifestyle changes on the manifestation of clinically significant psychological symptoms. It suggests that enhancing financial support and providing additional resources could alleviate psychological distress among university students.


Introduction
The college or university years are a crucial developmental period, where students transition from late adolescence to adulthood (Arnett, 2015).For students, university years are positioned during a key developmental transition toward adulthood (Sussman & Arnett, 2014).This represents a period that involves taking on greater responsibilities and exploring identity within a new social context, which may not necessarily be stable (Auerbach et al. 2018).Life as a university student can be filled with unpredictability, including continuous changes in social groups and life choices related to academic life that can cause greater stress and decrease social support, which are contributing factors to mental health problems (Slavich & Auerbach, 2018).In the last decade, there has been an increase in mental health issues among college and university students experiencing symptoms of anxiety and depression (Pinder-Amaker & Bell 2012).Globally, about 31% of students tested positive for a mental health disorder in 2018 (Auerbach et al. 2018).Furthermore, studies have shown and argued that treatment for these issues present in students is difficult.Despite the efforts of mental health specialists, many students have insufficient information about mental health and do not consider specialized treatment necessary.Students generally believe that symptoms of depression and anxiety are typical college stress and do not see treatment as necessary (Eisenberg et al. 2007).But of course, there are students who consider mental health services necessary

Methodology
The study has been conducted by a colourful team of researchers at different universities in Albania (Wisdom University College, University of Tirana, LOGOS University College, University of Medicine, etc.).The study took the Ethical Committee Approval from Ministry of Education.The investigation has been conducted online by all the team of researchers.Data was codified according to Ethical Committee Guidelines, and confidentiality was guaranteed.Every student was invited to read the Informed Consent Form and was free to withdraw every moment from the study.For every participant information regarding age, sex, nationality, family background, community living, and exposure habits was collected.

Inclusion and exclusion criteria
There could participate at the study people enrolled in a university, adults, with ability to fluently read and comprehend English and Albanian, because questionnaires were presented in one of these languages.

Assessment phase
Participants were recruited between April 2021 to March 2022, via online with google form compilation of the battery.It was used a convenience sample, based on the possibility to contact students from the easiest way through their lecturers.Time to complete the whole battery was of 25 minutes.

Measures
The battery included socio-demographic information, parents' education, parent job engagement, field of study, standardized BDI-ll for the construct of depression, Perceived Stress scale and SF-12 to measure mental and physical health.Moreover, other exposure measurements investigated the engagement in the living community, individual and family income, life in rent houses in Tirana, inclusion to groups or associations, peers' relations, alcohol and smoking habits, and physical activities.Perceived Stress Scale is a questionnaire of 14 items that measure stress level.It is presented in a Likert scale from the minimum (0) to a maximum (4) (Cohen et al. 1983).Moreover, Beck Depression Inventory is a questionnaire that measure depressive symptoms in clinical and non-clinical population.It has 21 items, presented in a 4 Likert scale from 0 to 3. Short Form (SF-12) of quality of life, consisted in 12 items, with higher scores that indicated better mental and physical health.Questions regarding daily lifestyle included alcohol and smoking habits, in the present and in the last months.

Descriptive statistics
Descriptive statistics were calculated to investigate levels of stress, anxiety, and depression among students.Data was collected through google form and analysed by the team of researchers.36 tables were created that illustrated the main results of the study.For each table two graphics were exposed that illustrated English and Albanian language sample.For a clear exposure of participants data, a database was created in Statistica 10.     9 ab : there were 594 answers to the question "I have sufficient income to cover monthly costs".33.35% agree with the statement, 25.1% are reluctant to choose side, 14.4% don't agree, and 5.5% don't agree at all.Table 10 ab .Questions regarding group of peers included religion, gender, age, sports, university, political organization, etc. Regarding religion there were 207/594 respondents that share the same religion, in a laic country, but still with 4 coexisting religions.Their peer group is diversified, usually they tend to have mix groups (61.1%).They groups don't have the same age but is diversified too (61.4%).They are fond of sports and follow different teams (66.32%).They come from different universities (56.9%).Lastly, they share common opinion about political matters in almost 40.74% of the cases.In total, 64.7 of them doesn't belong to any clubs, groups, or associations (sports group, hobby groups, cultural societies, religious groups, political groups).
Table 11 ab : 43% of students think they definitively have someone who can help them in case of emergency, 24.8% think families can help them, 31.7% are unsure about this help, and 0.5 affirmed that this is not possible.Table 12 ab .86.4% of students think they should be careful in front of people, only 13.6% of them think people could be trusted.
Table 13 ab .13% of the students strongly agree that people at university can help them in case of need, 55% of them agree with this statement.23.5% are neutral, and just 8.5 don't agree with the statement.14 Table 14 ab .They affirm that if there is a community project, who they are not directly beneficiaries, they still will contribute to time (79.1%) and money (48.8%).
Table 15: in support of the previous question, in the last year only 43.5 of them participated in common projects in favour of the community.
Table 16 ab .Regarding to cooperation between people at their community (ex.water supply), 39.3% agree they cooperate, 38% probably and 11.2% don't know.17 Table 17 ab .Referring to the abilities to make personal decisions, students think that 50.8% of them are partially able to change their lives, 29.5% are fully able to change their lives, 13.5% neither yes nor no to changing their lives, and 6% think they are partially unable to change their lives.20 ab .Most of them never had problems at work related to physical health (34.5%), few of them had a little bit of problems (23.5%),some of them had problems some of the time (29.4%), and just 20.6% had physical health problems all the time.Table 21 ab .3.5% in the last month have had problems at work all the time and accomplished less than they would like, following emotional issues, 11% had problems most of the time, 58.3% accomplished what they desired, 23.9% accomplished with no influence from emotional problems, and 20.7% accomplished their duties without interference from emotional problems such as anxiety or depression.In the last month 6.4% had a decrease all the time in focus or attention, 11.9% had a decrease most of the time, 46.8% did the work less carefully than usual in the last month, 18.5% had a decrease a little bit of the time, 16.5% had no loss of attention in the last month because of emotional problems.Table 22 ab .31.9% of the respondents expressed that they have no pain at all, 30.4% feel a little physical pain, 29.6% feel very little physical pain, 8.1% feel too much physical pain, and 0% feel a lot of pain.
Table 23 ab .13.13% have felt calm and peaceful in the last month all the time, 27% most of the time, 16.4% for a good bit of the time, 31.8% for some bit of the time, 9% almost never and 2% never.Regarding if they took a lot of energy in the last month, 11.9% answered all the time, 25.5% most of the time, 19.5% a good bit of the time, 32.9% some bit of the time, 7.5% almost never, and 2% never.If they felt downhearted or blue in the last month, the respondents answered all the time in 4% of the cases, most of the time (8.7%), a good bit of the time (11.9%),some bit of the time (36.8%),almost never (28.6%), and never (10%).
Table 24 ab .During last 4 weeks, the students answered regarding the interference of emotional problems or physical health with their social activities, 36.7% for some time, 26.8% almost nowhere, 9.5% most of the time, 27% are divided between answers like nowhere and almost always.25 Table 25 ab .81.6% of the respondents stated that they do not smoke, 10.3% consume tobacco occasionally, while 8.1% of them are smokers.32 ab .80% of the sample admitted that they never consume five drinks in a single occasion, 14% do so less than once a month, and 6% do so once a week.Table 33 ab .Regarding the social status of Albanians, considering education, financially gain, etc., in a scale from 1 to 10, where 1 is the minimum and 10 the maximum, they rated Albanians 3.3% at level 1, 1.1% at level 2, 4.8% at level 3, 9.5% at level 4, 32% at level 5, 24.5% at level 6, 44.3% at level 7, 50.6% at level 8, 20% at level 9, and 20% at level 10.

Discussion
The study encompassed a diverse pool of participants hailing from prominent academic institutions in Tirana, such as the University of Tirana, LOGOS University College, Wisdom University College, and other local universities.An overwhelming majority, specifically 99.6% of these individuals, displayed a keen willingness to engage in the study, showcasing a strong interest and commitment to the research objectives.The main result of this study highlighted that a significant proportion of students experienced health issues specifically related to schooling, such as stress, fatigue, impacting their wellbeing.This outcome is supported by less than half of students (42.2%) of students rated their health as very good, indicating that a relevant part, experience low values of good health status.This finding is supported also by 33.3% of students who experience limitations in daily activities due to health issues.However, a significant majority, comprising 50% of respondents, do not experience any limitations at all, suggesting a relatively good overall health status, an outcome correlated probably also with their age group of young adults.Furthermore, 29.4% reported facing problems related to physical health intermittently, suggesting instabilities in their health status impacting work.34.5%, reported never encountering problems at work related to physical health, indicating a relatively smooth experience in this regard.Moreover, the university lifestyle impact led to emotional issues, related with decreased productivity and attention difficulties.The findings revealed how students' emotions can change over time, showing moments of calmness, energy, and especially sadness.That's why we say mental health can be complicated, emphasizing the need to support students' emotional well-being in schools.
The participants in the study spanned a wide age range, from 18 to 46 years old.Particularly, most participants fell within the younger age brackets, with a significant portion aged 18, 19, and 20 years old.Specifically, 52% of the participants were 18 years old, 29% were 19 years old, and 12% were 20 years old, indicating a notable concentration of younger individuals within the participant demographics.It is indicated that 83% of the participants identified as female, while 17% identified as male.Findings illustrate a detailed picture of the participants' demographics, their parents' employment situations, and educational achievements.The distribution across fields of study among participants reveals a strong presence in Business and Economics, perhaps reflecting a significant interest or career orientation in these areas.The sizable representation in Medicine and Psychology shows an interestingly focus on healthcare and psychological sciences.Additionally, the diversity seen in Social Sciences and other fields underscores a broad range of academic interests among the participants.Moreover, employment status of participants' parents indicates a predominant trend of full-time employment, particularly among fathers.However, there's also a relevant presence of part-time work and active job seekers, suggesting a dynamic job market environment.The educational backgrounds of parents showcase a mix of higher education levels, with a considerable percentage holding first-level higher education degrees, and probably educational diversity among parents influences the participants' own educational paths and career aspirations.Furthermore, a relevant number of students, approximately 54.21%, chose to reside with their parents, meanwhile 41% of students opt for independent living arrangements through renting accommodations.This outcome can illustrate the currently trend of housing in Tirana, who offer little opportunity from university campus, and students are forced to stay at parent's home to afford expenses.Even so, a considerable number opt for renting houses, with consequences letting less time for studying, and more time in students' jobs, to afford rent.This tendency is reflected also from financial perceptions, where there's a small percentage of students, 33.35%, that expressed confidence in their ability to cover monthly expenses.Therefore, uncertainty and financial strain could be serious factors for increasing mental health issues on students.Moreover, lifestyle habits exposure was measured exploring various dimensions within respondents' peer groups, including religious, age-related, sporting, educational, and political aspects.Despite being situated in a secular context with multiple religions, 207 out of 594 respondents shared identical religious beliefs within their peer circles.Interestingly, these peer groups were marked by diversity, with 61.1% comprising individuals from diverse backgrounds and 61.4% representing varied age groups.Moreover, a strong affinity for sports was evident, with 66.32% following different sports teams.
Even more, a significant willingness was found among respondents to contribute to community projects, even if they are not direct beneficiaries.An impressive 79.1% expressed readiness to dedicate their time to such activities, indicating a significant commitment to community involvement and service.Additionally, 48.8% stated they would contribute financially, highlighting a substantial willingness to support projects that benefit the broader community, even when they may not directly benefit personally.These findings underscore a sense of social responsibility and altruism among the surveyed individuals towards collective initiatives aimed at improving their communities.In contrast to the high willingness expressed to contribute to community projects, the actual participation rate in such endeavours over the past year was lower.Only 43.5% of respondents reported involvement in common projects that benefited the community, that shows a gap between intention and action, suggesting that while many individuals express a desire to contribute, a smaller proportion actively engage in community-focused initiatives.
When it comes to their abilities to make personal decisions and enact change in their lives, students' perceptions vary, but still there is a significant portion, 50.8%, that feels partially capable of effecting change and making decisions.On the other hand, a smaller but still significant 20.6% indicated experiencing physical health problems consistently throughout their work activities suggesting different degrees of impact physical health could have on youth.On a positive note, 58.3% were able to accomplish what they desired at work, despite emotional challenges.Nearly half of the respondents (46.8%) admitted to working less carefully than usual in the last month, possibly due to emotional challenges, 36.7% indicated that emotional problems interfered with their social activities some of the time.These findings suggest minor discomfort for different groups and indicate that youth could experience some physical and emotional pain in the daily life, although does not interfere into their usual tasks.No smoking is the trend among Albanian students, there is quite a majority of 81.6% that doesn't smoke, indicating a cultural non-smoking behaviour.But this outcome could be biased because most of the participants, as we exposed before, were women, a clear majority of 68.6%, who never smoked.On the other hand, alcohol habit is still significant about the majority (53.8%) whose neve consumed alcohol, and on moderate basis, 38.4% reported moderate alcohol consumption.As we can observe, self-esteem of Albanian students on Albanian social status indicates a positive point of view on the proper social status with responses over the media in almost 70.4% of the sample.
To sum up, the discussion indeed highlights various mental health challenges experienced by students, including stress, fatigue, emotional issues impacting work performance, and fluctuating emotional states such as feelings of calmness, energy levels, and sadness or low mood.These findings are consistent with research indicating high prevalence rates of anxiety and depression symptoms among college and university students (Ibrahim et al., 2013;Auerbach et al., 2016).While it does not explicitly mention clinical diagnoses of anxiety and depression, it does provide evidence of mental health issues among students, supporting the hypothesis that mental health challenges could negatively affect academic performance and lifestyle.Moreover, previous research has shown that mental health challenges during college years can indeed have lasting effects on academic performance and may contribute to long-term adverse outcomes such as decreased earnings and poorer health outcomes in later adulthood (Eisenberg et al., 2009;Lee et al., 2018).While in our study, there is evidence of the negative effects of mental health difficulties on academic performance and lifestyle, it does not fully support the hypothesis regarding long-term adverse outcomes in later adulthood.

Strength and limitations
There are some limits in this investigation, regarding principally the lack of standardized questionnaires.Therefore, researchers tried to fill this gap using the back translation for every questionnaire.Moreover, the whole battery was experimented in a pilot sample.After that, it was ready to be used for participants.Another limit of the study is its generalizability.It is a study who concerns many universities, but that do not represent all universities in Albania, but mostly from Tirana area.That said, regarding advantages, it is an investigation with a hot topic, and very useful for further studies concerning the correlation between university students and mental health issues, unfortunately, increasing year after year.Hence, several universities in European Union and world worldwide are trying to fulfil these necessities with offering different services for students, such as, psychological centres at university, offering rent flats with affordable rates, part time job within university for students, discount for bus tickets, cinemas and free time, sports centres and so more.This practice is recommended Albanian universities should follow.Regarding exposure measurement, it doesn't quantify the impact on mental well-being.While the study provides insights into the nature of stressors, it does not fully evaluate their impact on students' mental well-being and academic performance as hypothesized.Research has shown that exposure to stressors such as financial difficulties and lack of social support can indeed impact mental well-being and academic outcomes among students (Eisenberg et al., 2009;Storrie et al., 2010), therefore, further investigation is needed to assess the specific effects within this context.Moreover, the study's cross-sectional design limits the ability to establish causal relationships or track longitudinal changes over time.Longitudinal studies or mixed-methods approaches could provide deeper insights into the dynamics and trends observed in this study.Despite these limitations, the study's strengths in data comprehensiveness, participant engagement, and thematic relevance contribute significantly to the knowledge base and offer valuable directions for further research and practical interventions in relevant domains.Strengths of this study include its extensive and diverse participant pool, drawn from prominent academic institutions in Tirana.The high participation rate of 99.6% reflects a strong engagement and commitment among participants, ensuring a robust dataset for analysis.The study's focus on a wide age range, particularly the significant representation of younger individuals, provides a comprehensive understanding of various age groups' perspectives and experiences.Additionally, the study's exploration of demographics, educational backgrounds, family contexts, and social engagement offers a whole view of participants' lives, allowing for complete interpretations and insights into complex interrelationships.Overall, the study's strengths lie in its thoroughness, diversity of perspectives, and relevance to key themes in education, social dynamics, and well-being among young adults in Tirana.

Conclusions
Experiencing university life could be an exciting journey, but it also presents relevant challenges to students' mental health.Among the academic rigors, social pressures, and newfound independence, many students face with issues like depression, anxiety, and overwhelming stress.This paper tried to highlight these psychological issues and at the same time tried to prioritize mental health resources and support services.Findings highlight the prevalence of mental health problematics among students, such as stress, fatigue, and emotional issues, findings that are consistent with existing research that indicates high rates of anxiety and depression symptoms in college and university students.By raising a culture of openness and destigmatizing seeking help, Albanian universities can empower students to prioritize their mental well-being.Overall, the study's comprehensive exploration of demographics, interests, familial contexts, and social engagement provides valuable insights into the characteristics and perspectives of participants from prominent academic institutions in Tirana.These insights contribute to a deeper understanding of the study's themes and findings, offering implications for educational, social, and policy interventions aimed at supporting diverse student populations.

Results 1 Table 1 ab : Table 1 describes the total number of participants. There were 594 participants from the University of Tirana, LOGOS University College, Wisdom University College, and other universities in Tirana. 99.6% of the participants agreed to participate in the study. 2
Table 2 ab.The range of the participants is 18-46 years old.Most participants are of 18, 19 and 20 years old.Respectively, 52% of the participants are 18 years old, 29% are 19 years old and 12% are 20 years old. 3

Table 3 ab
. 83% of the participants belong to female sex and 17% belong to men sex.

Table 6
ab .73.92% of the respondents affirmed that their fathers are working full time, (431/594).The results for mother employment assure that almost 50% are working full time (299/594).Moreover, 60/594 of the fathers work part-time, 50/594 are not working but are looking for.Same for mothers, but with less percentage of employment regarding part-time job (39/594), a relevant part is looking for (142/594).

Table 7 ab
. Fathers have higher education (Second and PhD studies, 17%), 40% have higher education (first level), 35/594 have a high school degree.Meanwhile for mothers 14.8% have second or third level of studies, 52.69% have higher education degree of first level.60/594 have a high school diploma.

Table 8
ab .54.21% of students live at parents' house, 41% are on rent and 5% live at university campus or similar.9

Table 18 ab
. 42.2% of students have very good health, 30.3% have good health, 21% have health issues related to schooling, and 6.5% have various health issues.

Table 19 ab
. Following the previous question few students are limited from health issues 200/594 (33.3%), 17.7% partially are limited in daily activities, and 50% are not limited at all.

Table 26 ab
. 84.1% of our sample do not smoke cigarettes in a day, 13.5% smoke fewer than 20 cigarettes a day, and 2.4% smoke more than 20 cigarettes a day.

Table 27 ab
. 68.6% say they have never smoked, 16.6% have not reduced tobacco consumption, and 14.8% are reducing tobacco consumption.28

Table 28 ab
. 84.1% of the sample affirm that they have not always smoked tobacco, 15.5% of them have smoked tobacco occasionally, and 0.4% smoke tobacco every day.

Table 29 ab
. 82.2% say they have never started smoking anywhere, 12.5% have spent less than two years avoiding tobacco, while 5.3% have avoided tobacco for over two years.

Table 30 ab
. 53.8% of the sample never drink alcohol, 28.6% drink alcohol once a month, while 17.6% drink alcohol two to four times a month.31

Table 31 ab
. 49.9% have stated that they do not drink at all, 38.4% of the sample said they drink one to two alcoholic beverages, while 3% drink three to four alcoholic beverages.