Skip to main content
×
×
Home

Examining stress: an investigation of stress, mood and exercise in medical students

  • J. O’Flynn (a1), T. G. Dinan (a1) (a2) and J. R. Kelly (a1) (a2)
Abstract
Objectives

Stress is an event that threatens homoeostasis and thus causes physiological and behavioural responses to reinstate equilibrium. Excessive and/or chronic stress can be psychologically and physiologically detrimental. Examinations can represent a significant source of stress for students. The hypothalamic–pituitary–adrenal axis (HPA) is the core endocrine stress system. Investigations into the HPA response to examinations have yielded inconsistent results. The aim of this study is to further explore the relationship between examination stress, HPA axis activity, mood, sleep and exercise in students undergoing a naturalistic examination period stressor.

Methods

In total, 16 medical students participated. Students completed self-reported stress, anxiety, mood, sleep and physical activity questionnaires, and provided saliva samples during an examination-free period and an examination period 1 month later. The cortisol awakening response, representative of HPA activity, was determined from saliva samples by enzyme-linked immunosorbent assay.

Results

Anxiety levels increased (p=0.04) and mood decreased (p=0.05) during the examination period. There was concomitant decease in physical activity levels (p=0.02). There was no significant increase in HPA activity during the examination period (p=0.29). Sleep quality did not significantly worsen (p=0.55) during the examination period.

Conclusions

Examination periods are associated with increased anxiety levels, lower mood and decreased physical activity. Future studies incorporating examination results and cognitive function may help to identify potential protective interventional strategies, while optimising performance.

Copyright
Corresponding author
*Address for Correspondence: Dr J. R. Kelly, Lecturer in Clinical Psychiatry, Department of Psychiatry and Neurobehavioral Science, Rm 5.38, Biosciences Institute, University College Cork, College Road, Cork, Ireland. (Email: johnkelly@ucc.ie)
References
Hide All
Allen, AP, Kennedy, PJ, Cryan, JF, Dinan, TG, Clarke, G (2014). Biological and psychological markers of stress in humans: focus on the Trier Social Stress Test. Neuroscience and Biobehavioral Reviews 38, 94124.
Beiter, R, Nash, R, McCrady, M, Rhoades, D, Linscomb, M, Clarahan, M, Sammut, S (2015). The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Journal of Affective Disorders 173, 9096.
Bloch, S, Brackenridge, CJ (1972). Psychological, performance and biochemical factors in medical-students under examination stress. Journal of Psychosomatic Research 16, 2533.
Bradley, AJ, Dinan, TG (2010). A systematic review of hypothalamic-pituitary-adrenal axis function in schizophrenia: implications for mortality. Journal of Psychopharmacology 24, 91118.
Buysse, DJ, Reynolds, CF, Monk, TH, Berman, SR, Kupfer, DJ (1989). The Pittsburgh Sleep Quality Index – a new instrument for psychiatric practice and research. Psychiatry Research 28, 193213.
Chida, Y, Steptoe, A (2009). Cortisol awakening response and psychosocial factors: a systematic review and meta-analysis. Biological Psychology 80, 265278.
Cohen, S, Janicki-Deverts, D (2012). Who’s stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006, and 2009. Journal of Applied Social Psychology 42, 13201334.
Cohen, S, Janicki-Deverts, D, Doyle, WJ, Miller, GE, Frank, E, Rabin, BS, Turner, RB (2012). Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proceedings of the National Academy of Sciences of the United States of America 109, 59955999.
Curcio, G, Ferrara, M, De Gennaro, L (2006). Sleep loss, learning capacity and academic performance. Sleep Medicine Reviews 10, 323337.
de La Rosa-Rojas, G, Chang-Grozo, S, Delgado-Flores, L, Oliveros-Lijap, L, Murillo-Perez, D, Ortiz-Lozada, R, Vela-Ulloa, G, Carreazo, NY (2015). Level of stress and coping strategy in medical students compared with students of other careers. Gaceta Medica De Mexico 151, 443449.
de Vivo, L, Bellesi, M, Marshall, W, Bushong, EA, Ellisman, MH, Tononi, G, Cirelli, C (2017). Ultrastructural evidence for synaptic scaling across the wake/sleep cycle. Science 355, 507510.
Duan, H, Yuan, Y, Zhang, L, Qin, S, Zhang, K, Buchanan, TW, Wu, J (2013). Chronic stress exposure decreases the cortisol awakening response in healthy young men. Stress 16, 630637.
Gaab, J, Sonderegger, L, Scherrer, S, Ehlert, U (2006). Psychoneuroendocrine effects of cognitive-behavioral stress management in a naturalistic setting – a randomized controlled trial. Psychoneuroendocrinology 31, 428438.
González-Cabrera, J, Fernández-Prada, M, Iribar-Ibabe, C, Peinado, JM (2014). Acute and chronic stress increase salivary cortisol: a study in the real-life setting of a national examination undertaken by medical graduates. Stress: The International Journal on the Biology of Stress 17, 149156.
Heinen, I, Bullinger, M, Kocalevent, RD (2017). Perceived stress in first year medical students – associations with personal resources and emotional distress. BMC Medical Education 17, 4.
Heins, M, Fahey, SN, Henderson, RC (1983). Law students and medical-students – a comparison of perceived stress. Journal of Legal Education 33, 511525.
Hershner, SD, Chervin, RD (2014). Causes and consequences of sleepiness among college students. Nature and Science of Sleep 6, 7384.
Hewig, J, Schlotz, W, Gerhards, F, Breitenstein, C, Lurken, A, Naumann, E (2008). Associations of the cortisol awakening response (CAR) with cortical activation asymmetry during the course of an exam stress period. Psychoneuroendocrinology 33, 8391.
Hinkelmann, K, Moritz, S, Botzenhardt, J, Riedesel, K, Wiedemann, K, Kellner, M, Otte, C (2009). Cognitive impairment in major depression: association with salivary cortisol. Biological Psychiatry 66, 879885.
Hinkelmann, K, Muhtz, C, Dettenborn, L, Agorastos, A, Moritz, S, Wingenfeld, K, Spitzer, C, Gold, SM, Wiedemann, K, Otte, C (2013). Association between cortisol awakening response and memory function in major depression. Psychological Medicine 43, 22552263.
Hirotsu, C, Tufik, S, Andersen, ML (2015). Interactions between sleep, stress, and metabolism: from physiological to pathological conditions. Sleep Science 8, 143152.
Holsboer, F, Ising, M (2010). Stress hormone regulation: biological role and translation into therapy. Annual Review of Psychology 61, 81109, c1-11.
Kenwright, K, Liddell, PW, Bloom, L, Zucker-Levin, A, Nolen, AH, Faulkner, LW, Batorski, RE (2011). Salivary cortisol levels in students challenged with a testing stressor. Clinical Laboratory Science: Journal of the American Society for Medical Technology 24, 221226.
Khan, M, Fatima, A, Shanawaz, M, Fathima, M, Mantri, A (2016). Comparative study of stress and stress related factors in medical and engineering colleges of a south Indian city. Journal of Evolution of Medical and Dental Sciences 5, 31533156.
Knorr, U, Vinberg, M, Kessing, LV, Wetterslev, J (2010). Salivary cortisol in depressed patients versus control persons: a systematic review and meta-analysis. Psychoneuroendocrinology 35, 12751286.
Kudielka, BM, Hellhammer, DH, Wust, S (2009). Why do we respond so differently? Reviewing determinants of human salivary cortisol responses to challenge. Psychoneuroendocrinology 34, 218.
Lamers, F, Vogelzangs, N, Merikangas, KR, de Jonge, P, Beekman, AT, Penninx, BW (2013). Evidence for a differential role of HPA-axis function, inflammation and metabolic syndrome in melancholic versus atypical depression. Molecular Psychiatry 18, 692699.
Lee, BK, Glass, TA, McAtee, MJ, Wand, GS, Bandeen-Roche, K, Bolla, KI, Schwartz, BS (2007). Associations of salivary cortisol with cognitive function in the Baltimore memory study. Archives of General Psychiatry 64, 810818.
Loprinzi, PD, Cardinal, BJ (2011). Association between objectively-measured physical activity and sleep, NHANES 2005–2006. Mental Health and Physical Activity 4, 6569.
Lupien, SJ, Maheu, F, Tu, M, Fiocco, A, Schramek, TE (2007). The effects of stress and stress hormones on human cognition: implications for the field of brain and cognition. Brain and Cognition 65, 209237.
McEwen, BS (2017). Allostasis and the epigenetics of brain and body health over the life course: the brain on stress. JAMA Psychiatry 74, 551552.
McEwen, BS, Seeman, T (1999). Protective and damaging effects of mediators of stress. Elaborating and testing the concepts of allostasis and allostatic load. Annals of the New York Academy of Sciences 896, 3047.
Preuss, D, Schoofs, D, Schlotz, W, Wolf, OT (2010). The stressed student: influence of written examinations and oral presentations on salivary cortisol concentrations in university students. Stress 13, 221229.
Pruessner, JC, Wolf, OT, Hellhammer, DH, Buske-Kirschbaum, A, von Auer, K, Jobst, S, Kaspers, F, Kirschbaum, C (1997). Free cortisol levels after awakening: a reliable biological marker for the assessment of adrenocortical activity. Life Sciences 61, 25392549.
Rotenstein, LS, Ramos, MA, Torre, M, Segal, JB, Peluso, MJ, Guille, C, Sen, S, Mata, DA (2016). Prevalence of depression, depressive symptoms, and suicidal ideation among medical students a systematic review and meta-analysis. JAMA-Journal of the American Medical Association 316, 22142236.
Ryan, R, Booth, S, Spathis, A, Mollart, S, Clow, A (2016). Use of salivary diurnal cortisol as an outcome measure in randomised controlled trials: a systematic review. Annals of Behavioral Medicine 50, 210236.
Stalder, T, Kirschbaum, C, Kudielka, BM, Adam, EK, Pruessner, JC, Wust, S, Dockray, S, Smyth, N, Evans, P, Hellhammer, DH, Miller, R, Wetherell, MA, Lupien, SJ, Clow, A (2016). Assessment of the cortisol awakening response: expert consensus guidelines. Psychoneuroendocrinology 63, 414432.
Steptoe, A, Wardle, J, Pollard, TM, Canaan, L, Davies, GJ (1996). Stress, social support and health-related behavior: a study of smoking, alcohol consumption and physical exercise. Journal of Psychosomatic Research 41, 171180.
Stetler, C, Miller, GE (2011). Depression and hypothalamic-pituitary-adrenal activation: a quantitative summary of four decades of research. Psychosomatic Medicine 73, 114126.
Stowell, JR, Tumminaro, T, Attarwala, M (2008). Moderating effects of coping on the relationship between test anxiety and negative mood. Stress and Health: Journal of the International Society for the Investigation of Stress 24, 313321.
Tsai, LL, Li, SP (2004). Sleep patterns in college students – gender and grade differences. Journal of Psychosomatic Research 56, 231237.
Tsigos, C, Chrousos, GP (2002). Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. Journal of Psychosomatic Research 53, 865871.
van Dulmen, S, Tromp, F, Grosfeld, F, ten Cate, O, Bensing, J (2007). The impact of assessing simulated bad news consultations on medical students’ stress response and communication performance. Psychoneuroendocrinology 32, 943950.
van Eck, M, Berkhof, H, Nicolson, N, Sulon, J (1996). The effects of perceived stress, traits, mood states, and stressful daily events on salivary cortisol. Psychosomatic Medicine 58, 447458.
Vedhara, K, Hyde, J, Gilchrist, ID, Tytherleigh, M, Plummer, S (2000). Acute stress, memory, attention and cortisol. Psychoneuroendocrinology 25, 535549.
Weekes, N, Lewis, R, Patel, F, Garrison-Jakel, J, Berger, DE, Lupien, SJ (2006). Examination stress as an ecological inducer of cortisol and psychological responses to stress in undergraduate students. Stress 9, 199206.
Weekes, NY, Lewis, RS, Goto, SG, Garrison-Jakel, J, Patel, F, Lupien, S (2008). The effect of an environmental stressor on gender differences on the awakening cortisol response. Psychoneuroendocrinology 33, 766772.
Weitzman, ED, Fukushima, D, Nogeire, C, Roffwarg, H, Gallagher, TF, Hellman, L (1971). 24 hour pattern of episodic secretion of cortisol in normal subjects. Journal of Clinical Endocrinology & Metabolism 33, 1422.
Yerkes, RM, Dodson, JD (1908). The relation of strength of stimulus to rapidity of habit-formation. Journal of Comparative Neurology and Psychology 18, 459482.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Irish Journal of Psychological Medicine
  • ISSN: 0790-9667
  • EISSN: 2051-6967
  • URL: /core/journals/irish-journal-of-psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score