Examination stress in academic students: a multimodal, real-time, real-life investigation of reported stress, social contact, blood pressure, and cortisol

The Cortisol Awakening Response: Regulation and Functional Significance

In healthy individuals, the majority of cortisol secretion occurs within several hours surrounding morning awakening. A highly studied component of this secretory period is the cortisol awakening response (CAR), the rapid increase in cortisol levels across the first 30 to 45 minutes after morning awakening. This strong cortisol burst at the start of the active phase has been proposed to be functional in preparing the organism for the challenges of the upcoming day. Here, we review evidence on key regulatory and functional processes of the CAR and develop an integrative model of its functional role. Specifically, we propose that, in healthy individuals, the CAR is closely regulated by an intricate dual-control system, which draws upon key circadian, environmental, and neurocognitive processes to best predict the daily need for cortisol-related action. Fine-tuned CAR expression, in turn, is then assumed to induce potent glucocorticoid action via rapid nongenomic and slower genomic pathways (eg, affecting circadian clock gene expression) to support and modulate daily activity through relevant metabolic, immunological, and neurocognitive systems. We propose that this concerted action is adaptive in mediating two main functions: a primary process to mobilize resources to meet activity-related demands and a secondary process to help the organism counterregulate adverse prior-day emotional experiences.

A cross-sectional comparison of the association between self-reported sources of stress and psychological distress among Canadian undergraduate and graduate students

Objective: This study aimed to (1) descriptively compare stressors experienced by postsecondary students at the undergraduate versus graduate levels of study, and (2) evaluate the relationship between stressors and psychological distress, controlling for the effects of level of study. Participants: Undergraduate (n = 3774) and graduate (n = 889) students across 15 Canadian universities who completed the Post-Secondary Student Index electronic survey in October of 2020. Methods: Mean severity score for stressors were compared between level of study. Regression analyses evaluated the association of student specific stressors and overall stress. Results: Undergraduate students generally had higher levels of perceived stress compared to graduate students, notably in areas of academics, the learning environment, and campus culture. Multiple stressors were associated with an increase in stress; a prior mental health diagnosis was the main predictor in increased stress. Conclusions: Stressors differed between level of study. Results can inform supports, particularly regarding exams/assignments weighing and communication of expectations for institutions.

Examining recovery experiences as a mediator between physical activity and study-related stress and well-being during prolonged exam preparation at university

Prolonged study periods such as preparing for comprehensive exams pose a significant source of chronic stress for university students. According to the Conservation of Resources Theory, the replenishment of resources during leisure time is essential to a successful stress recovery process. This study examined the role of recovery experiences as a mediator of the relationship between physical activity as one specific recovery activity and both study-related stress and well-being. We applied a longitudinal design and approached students on three measurement occasions over seven months. The sample consisted of N = 56 advanced law students enrolled at one large German university who were all in their exam preparation to take their final exams. Students gave self-reports on their respective levels of physical activity (predictor), and recovery experiences (mediator), as well as on their study-related stress and well-being (outcomes). Results showed a negative trend in recovery-related variables and the outcomes as exam preparation progressed. There were mostly small correlations between physical activity and both stress and well-being at each measurement occasion. Recovery experiences partially mediated the relationship between physical activity and the outcomes on some measurement occasions. Our results suggest that the positive effects of recovery experiences related to physical activity become more sustained as exam preparation progresses and have a particularly positive impact on well-being. Future research can build on these findings by further examining recovery as an important means to help students better cope with long-lasting and stressful study periods.

A Comparison of Physical Therapist Educational Outcomes Before and During the COVID-19 Pandemic: A Multicenter Study

INTRODUCTION

The purpose of this study was to analyze and compare educational outcomes of Doctor of Physical Therapy (DPT) graduates before and during the COVID-19 pandemic.

REVIEW OF LITERATURE

Reports show increased stress, anxiety, and burnout during the COVID-19 pandemic, which may have negatively affected academic performance. Historically, academic performance is predictive of National Physical Therapy Examination (NPTE) scores. Yet, there is little evidence analyzing student outcomes during the pandemic.

SUBJECTS

Doctor of Physical Therapy graduate records (N = 1,897) were retrospectively collected from a multicenter convenience sample consisting of 5 blended programs. Records were sampled from existing "prepandemic" graduates of Fall 2018-2019 (n = 988) and "pandemic" graduates of Fall 2021-2022 (n = 909).

METHODS

A causal comparative and correlational study design was used. Grade point average (GPA) and NPTE scores were collected. A general linear model examined differences between groups, and a multiple linear regression examined predictors of NPTE performance.

RESULTS

Grade point average was a significant predictor of NPTE score (r2 = 0.56; P < .01) for the overall sample and for the prepandemic and pandemic cohorts (r2 = 0.38, P < .01; r2 = 0.45, P < .01, respectively). Grade point average was not significantly different between the groups (P = .09), nor did it significantly influence differences in NPTE scores (P = .13). Pandemic graduates displayed a significantly lower NPTE pass rate (85.1%) compared with prepandemic graduates (89.7%; P < .01). Pandemic graduates experienced higher rates of academic difficulty (20%; P < .01) and had a approximately 5 times higher likelihood of not passing the NPTE.

DISCUSSION AND CONCLUSION

This is the first study to report on DPT graduate outcomes spanning the COVID-19 pandemic. Similar to previous studies, GPA remained the most significant predictor of NPTE scores. Pandemic graduates demonstrated significantly lower NPTE scores and higher rates of academic difficulty (GPA < 3.0). Continued monitoring of NPTE performance is warranted between prepandemic, pandemic, and postpandemic cohorts across modes of program delivery.

Investigating associations between physical activity, stress experience, and affective wellbeing during an examination period using experience sampling and accelerometry

Previous studies reported that physical activity could buffer the negative association of psychological stress with affective wellbeing. However, the studies that examined this relation in everyday life have assessed physical activity only by self-report but not with objective measures such as accelerometry. We therefore investigated the associations of both subjectively and objectively measured physical activity with stress experiences and affective wellbeing. A total of 90 university students participated in a 10-day experience sampling and diary study during their examination period and reported about stress experiences, physical activity, and affective states. Physical activity was additionally assessed using accelerometry in 50 of the participants. Subjectively assessed physical activity and objectively assessed light physical activity were associated with feeling less stressed in the evening. Also, light physical activity during the day was associated with a smaller increase/higher decrease in feeling stressed from morning to evening. The association of stress experience with negative affect was moderated by objective light physical activity. No interactive effects of stress intensity and physical activity on affective wellbeing were found. On stressful days, physical activity may buffer the negative association between stress and affective wellbeing. Particularly light physical activity as assessed with accelerometry seems to play an important role. It may be beneficial for students' affective wellbeing to increase or at least maintain physical activity during examination periods.

Daily life stress and the cortisol awakening response over a 13-months stress period - Findings from the LawSTRESS project

The LawSTRESS project is a controlled prospective-longitudinal study on psychological, endocrine, central nervous and genetic predictors of responses to long-lasting academic stress in a homogenous cohort. In this first project report, we focused on the association between daily life stress and the cortisol awakening response (CAR). The CAR, a distinct cortisol rise in the first 30-45 min after morning awakening, is a well-established marker of cortisol regulation in psychoneuroendocrinology. Law students from Bavarian universities (total n = 452) have been studied over a 13-months period at six sampling points starting 12 months prior exam. The stress group (SG) consisted of students experiencing a long-lasting and significant stress period, namely the preparation for the first state examination for law students. Law students assigned to the control group (CG) were studied over an equally long period without particular and sustained stress exposure. To investigate stress related alterations in the CAR, we examined a subsample of the LawSTRESS project consisting of 204 students with 97 participants from the SG (69.1% female, mean age = 22.84 ± 1.82) and 107 from the CG (78.5% female, mean age = 20.95 ± 1.93). At each sampling point, saliva samples for cortisol assessment were collected immediately upon awakening and 30 as well as 45 min later. Perceived stress in daily life was measured by repeated ambulatory assessments (about 100 queries over six sampling points). The time course of perceived stress levels in the two groups differed significantly, with the SG showing an increase in perceived stress until the exam and a decrease thereafter. Stress levels in the CG were relatively stable. The CAR was not significantly different between groups at baseline. However, a blunted CAR in the SG compared to the baseline measure and to the CG developed over the measurement timepoints and reached significance during the exam. Remarkably, this effect was neither associated with the increase in perceived stress nor with anxiety and depression symptoms, test anxiety and chronic stress at baseline. The present study successfully assessed multidimensional stress trajectories over 13 months and it documented the significant burden, law students preparing for the first state examination are exposed to. This period was related to a blunted CAR with presumed physiological consequences (e.g., on energy metabolism and immune function). Mean psychological stress levels as well as the CAR returned to baseline levels after the exam, suggesting a fast recovery in the majority of the participants.

Insomnia Symptoms, Sleep Hygiene, Mental Health, and Academic Performance in Spanish University Students: A Cross-Sectional Study

BACKGROUND

Insomnia has been associated with decreased academic performance and unhealthy behaviors in university students. Although many studies have analyzed sleep phenomenology among this population, only few have focused on insomnia and its related variables. In addition, such studies do not always include a clinical interview or a specific and validated instrument for measuring insomnia. This study aimed to explore the prevalence of insomnia symptoms and the relationship between insomnia and health habits, mental health, and academic performance in a large university student sample.

METHODS

Five hundred and eighty-two students were recruited from the University of Granada, Spain. Data were collected through an online survey with questions on sociodemographic and academic data and health habits as well as the Pittsburgh Sleep Quality Index, Insomnia Severity Index, Sleep Hygiene Index, and Sleepiness, Depression, Anxiety, and Stress Scales. A multiple regression analysis explored the relationship between academic performance, health habits, mood state, and insomnia symptoms.

RESULTS

The prevalence of students with symptoms of insomnia was high (39.7%). A multiple logistic regression analysis revealed that depression, sleep hygiene, stress and anxiety were significant predictors of insomnia symptoms. Multivariate analyses revealed that subjective insomnia symptoms, sleep efficiency, and depression were significantly correlated with academic performance in a dependent way.

CONCLUSIONS

In university students, anxiety, stress, and poor sleep hygiene are risk factors for insomnia, which plays an important role in academic performance. Promoting sleep and mental health could be a potentially effective way to improve their academic performance.

Under Which Circumstances Does Academic Workload Lead to Stress?

Abstract. Academic stress is associated with a wide range of adverse outcomes, including detrimental effects on mental health, achievement, and well-being. Numerous studies have shown an association between the cortisol awakening response (CAR) and various health and risk factors. Some studies revealed a protective function of the CAR as a stress buffer preventing the stress system from overshooting. We investigated the moderating effect of the CAR on the within-subject association between academic workload and academic stress in participants’ daily lives using ambulatory assessment. We assessed 77 undergraduate university participants for 2 days at the beginning of the semester and approximately 3 months later, individually starting one week before an exam. Participants provided academic stress and academic workload ratings hourly during their waking time using smartphone-based e-diaries and salivary cortisol samples at awakening as well as 30, 45, and 60 min later on two consecutive days during each of the assessment waves. Average within-subject associations between academic workload and academic stress were analyzed using multilevel models. Interactions with indicators of the cortisol awakening response (CAR) were included to test moderating effects of the CAR on the workload-stress associations. There was a significant positive within-subject association between academic workload and academic stress. Significant cross-level interactions showed a moderating effect of the CAR on this association. The results point out the importance of the CAR in the regulation of the workload-stress associations in academic life and underscore the relevance of investigating the influence of specific stressor-dependent reciprocal effects of the CAR on learning and experienced stress.