Mental distress is a public health concern including anxiety, stress and depression having symptoms like sleep disorder, headache, loss of appetite, irritating behavior and detached from social life and frequently requires counseling and medical attention . Mental health may be defined as the successful execution of mental function in terms of conception, mood and behavior which generates productive activities, maintenance of relationship within social context and the ability to adapt with time course . The term stress has different meanings to different people depending on circumstances. Stress may be defined as the non specific response of the body to any demand. According to behavioral sciences, stress is regarded as the perception of threat with resulting anxiety, emotional tension and difficulty in adjustment . On the other hand, anxiety is a kind of response of the body to a perceived threat that is triggered by personal beliefs, feelings and thoughts and is characterized by a number of symptoms like worried thoughts, increased blood pressure and pulse, sweating, chest pain, etc. Manifestations of depression include loss of interest or pleasure, sadness, felling of guilt, sleeplessness, loss of appetite and poor concentration and can also affect the outcome of many chronic diseases, e.g. diabetes, cardiovascular disease and obesity .
According to WHO, mental health disorders are one of the leading causes of disability worldwide. It is reported that three of ten leading causes of disability in people between the ages of 15 to 44 are mental disorders . Stressful events during educational period have significant negative influence on academic, professional, personal and social life  . It is already proved in many research articles that mental health problems among students are increasing every year and students of higher education institutions are experiencing serious mental health problems at a greater rate than their peers who are not student . Studies on mental health/stress in our society/country are inadequate. This study is the first of its kind in our country to find out stress level and associated factors involved in stress development among university students.
2.1. Study Design
This research was conducted as a cross sectional study among sufficient number of students of the Department of Pharmacy of University of Asia Pacific, Dhaka, Bangladesh. This study was conducted in the month of May, 2018, when there was no exam, so stress related to exam was eliminated. The aim of this study was to investigate the demographic characteristics, level of feeling of stress, predisposing factors of their feeling of stress and their significance. Determination of the level of stress was based on individual feelings towards different stressors and modified DASS (Depression, Anxiety and Stress Scale) was used to estimate the level of stress  .
2.2. Study Tools
This study was conducted with a predesigned questionnaire to know the demographic data, socio economic condition and life style of the respondents. Informed consent was obtained from the respondents and no one was forced to participate in this study. Statistical analysis was done by SPSS-12 and Microsoft Excel  .
2.3. Study Population
Total 504 students were participated of both Bachelor and Masters Level voluntarily. All the students studying in the department were invited to participate in the study and among those 504 students of different level of Bachelor and Masters Program gave consent to participate in the study.
2.4. Ethical Consideration
This study was approved by ethical committee (Ref: UAP/Pharm_ETA:04_012018) of the Department of Pharmacy of University of Asia Pacific. Written consent was obtained from the respondents’ prior filling of the questionnaire. Questionnaires obtained from individual respondents were given a code number and strictly preserved to protect the leak of any personal information.
3.1. Demographic Characteristics
Table 1 shows the demographic distribution of the students participated in this study. A total of 504 students (Male: N = 181, % F = 35.91% and Female: N = 323, % F = 64.09) of different level of the university were involved in this study. Respondents were further classified in different age group and level of education. Socio economic class of the respondents was calculated by modified B.G. Prasad Socio-economic Scale for 2016  . Among the participants, 64.09% were female compared to male participant of 35.91%. Frequency of female students studying in the department of Pharmacy of UAP is usually higher compared to male counterpart. After completing Higher Secondary Certificate Examination, students from different parts of the country comes to Dhaka to seek admission to
Table 1. Demographic distribution of respondents.
different universities of their choice, as evidenced by the frequency of students studying in this university were from outer parts of Dhaka (N = 96, 53.04% for male students, N = 100, 30.96% for female students), but number of migrated male students to Dhaka is higher compared to female students. Consequently, frequency of male student living in the hostel was higher (N = 103, % F = 56.91%) than of female students (N = 100, % F = 30.96%). Highest number of students participated in this study were from middle class family. Frequency of smokers was found highest in male students.
3.2. Level of Stress and Factors Participating behind Feeling of Stress
In this study, severe stress were almost equal (although slightly higher in male) to both sex (Figure 1). But, feeling of moderate level of stress were more associated with female students (N = 253, F = 78.33%). According to this study, we found that feeling of stress were more associated with female students.
Feelings of stress are significantly associated with many factors. Pattern of thought varies extremely among male and female individual. Such distinctive type thought and fear towards future life strongly buildup stress in an individual. In this study, we determined the factors most participating to build up stress and summarized in Table 2.
According this study, students feel highest percentage of stress due to thought towards future career (59.67% for male students and 37.46% for female students). In terms of academic achievements, feeling of stress is significantly
Figure 1. Feeling of level of stress of male and female students.
Table 2. Reasons of feeling stress in both sexes.
higher compared to male students (34.98% for female students vs. 15.47% for male students). Other factors such as unrealistic expectations, family relationship and affairs, social status, being of too busy also significantly participate in the development of stress in young mind.
3.3. Status of Mental Health
Stress significantly affects the quality of life and mental health. Status of mental health and well being is estimated by considering some facts such as feeling of shocked by unwanted events in life, lacking of expression of emotions, reduced feeling of pleasure, unusual thinking, fear of any specific objects, short term memory loss, self identity disorder and lack of self confidence (Table 3). Prevalence of any specific facts of mental health was determined by the presence (Yes) or absence (No).
3.4. Co-Relation of Different Risk Factors to Feeling of Different Level of Stress
In our study, we co-related different risk factors like age, gender, socio-economic condition, unrealistic thought pattern to different level of stress feeling and
Table 3. Factors affecting mental distress.
results are summarized in the following table (Table 4). Feelings of stress are most among the student of 21 - 25 years of age. According to this study, female students were more stressed compared to male counterparts. Socio-economic condition is always a great factor of stress and in our study, middle class society had more stress compared to other socio-economic class.
Globally, among many psychiatric health problems, psychological morbidities are most common and mental health among university students is, now a day’s an important and developing public health concern . Stress among university students arise from both academic and non-academic factors, also including socio-economic and cultural, environmental and psychological attributes . Gender also significantly contributes to the level of stress felling. In our study, analysis of level of stress feeling come out with some interesting data. According to this study, feeling of severe level of stress is almost equal in both sex (20.44 % for male Vs 18.58% for female), but female students felt highest percent of moderate level of stress (78.33%) compared to male (58.56%). The levels of stress are different among students and also different among male and female students . It is already revealed in many literatures that students of health sciences undergo tremendous stress during various level of their education  . There have been several key factors identified as a potential stressor in university life . According to our study, future career, academic achievements and family relationship and affairs are the top three reasons of feeling of stressed among students of both sex. In this present study, we also identified several key factors that significantly contribute to mental distress. It is really a matter of worried and observable that now a day in modern context of life style, there is a significant reduction in the sharing of feelings or emotions, reduce in the feeling of pleasure, feeling of self identity disorder and not being satisfied in the context of life significantly contributing to mental distress among students. More over due to complexity in life and stress, major portion of students are not being satisfied
Table 4. Risk factor analysis of stress.
about their life. Students in between the age of 21 - 25 felt most stress as at this level when they are advancing towards their upper level of tertiary education, they always co-related their academic progress, their future career and many others. Level of feeling of stress is most in case of students from middle class. People of middle class society always face some kind of complexity to maintain their social status could be a reason of their higher stress feeling. University students usually face a kind of transition from adolescence to adulthood as stressful. At university level, students first start to take responsibility for their own decision and life style, career, recreational activities, health and many more. More over adaptation to new environment, new approach of learning, academic and social demands boost up stress in to student life  .
This study found that, students participated in this study had some level of stress, but feeling of stress was higher to female students compared of their opposite. According to this study, some important factors such as future career, academic achievement, certain socio demographic characteristics, personal feeling of satisfaction are significantly associated with feeling of stress. Psychological counseling should be an important part in our educational institution to detect and prevent mental distress among students. Moreover, students should be encouraged to seek help from other and share their feeling to reduce stress and more studies in this area are highly required.
Authors are thankful to the participants in this survey study and the Institute for Energy, Environment, Research and Development (IEERD), UAP for their approval in this research work.