Exam anxiety and associated factors among Palestinian university students.

Background: Exam anxiety is a specific form of performance anxiety in which students experience intense worry, physical arousal, and unhelpful behavior around exam situations. Exam anxiety is common in higher education and is associated with poor academic performance. Additional political and economic strain may increase anxiety and threaten achievement at Palestinian universities. Aim: This study aimed to investigates exam anxiety and associated factors, such as lifestyle and socio-demographic factors, among Palestinian university students. Methods: This cross-sectional descriptive study was conducted among students from three institutions in Palestine (Al-Quds University, Hebron University, and An-Najah National University), with 1,519 participants completing the survey. Data were collected using self-administered questionnaire; Westside Test Anxiety Scale (WTAS) was used to assess exam anxiety. Descriptive statistics and general linear model were performed to identify factors associated with exam anxiety. Results: Among the 1,519 participants, a significant majority (61.8%) reported elevated exam anxiety levels, with nearly one-third (32.5%) categorized as experiencing "extremely high" anxiety. In contrast, only 38.2% of respondents fell within the lower end of the anxiety spectrum (from low to high normal). Student anxiety arises from a complex interplay of sociodemographic, academic, and lifestyle factors, with the overall model accounting for 21.2% of the variance. The most significant predictors of high anxiety include intense academic overload, lower family income (below $1,140), smoking, and physical illness. Conversely, strong family support and high academic performance (GPA of 80 or above) serve as essential protective factors. Additionally, lifestyle choices are influential, as students who exercise only 1 to 2 days per week report higher anxiety levels compared to those who engage in more frequent exercise. Furthermore, institutional differences are evident, with students from Al-Quds University exhibiting higher exam anxiety levels than those from An-Najah University. Conclusion: The high prevalence of exam anxiety among Palestinian university students highlights the need for systemic institutional support. Universities should implement regular mental health screenings and offer specialized counseling, especially for those in high-stress academic fields. Additionally, reforming assessment methods to reduce academic overload and promoting consistent physical activity are essential evidence-based strategies for alleviating distress. These measures can contribute to a more balanced academic environment and enhance students' overall well-being.