J Happiness Stud

https://doi.org/10.1007/s10902-017-9948-9

RESEARCH PAPER

Longitudinal Effects of Examination Stress

on Psychological Well‑Being and a Possible Mediating
Role of Self‑Esteem in Chinese High School Students

Zhoulei Xiang1 · Shen Tan1 · Qian Kang1 · Baoshan Zhang1 · Lei Zhu1

© Springer Science+Business Media B.V., part of Springer Nature 2017

Abstract  Through using a latent growth curve model (LGCM), the present study inves-
tigated longitudinal relationships between examination stress, self-esteem, and psychologi-
cal well-being in Chinese high school students. This paper presents results of a three-wave
longitudinal study among 248 Chinese high school students who were followed over the
course of one semester. The students completed questionnaires about once every 2 months
from the beginning to the end of a school semester for a total of three questionnaires includ-
ing the shorten version of Academic Stress Scale, the Rosenberg Self-Esteem Scale and
the Chinese version of Psychological Well-Being Scale. The results obtained from latent
growth curve modeling (LGCM) showed that the initial examination stress level negatively
predicted the students’ initial level of psychological well-being. Also, changes in examina-
tion stress over time negatively predicted changes in psychological well-being. In addition,
self-esteem can mediate the effects of examination stress on psychological well-being: first,
initial level of examination stress can influence the initial level of psychological well-being
via self-esteem; second, examination stress at Time 1 predicted psychological well-being
at Time 3 mediated by self-esteem at Time 2. These findings contributed the theoretical
explanation about the effect of stress in damaging psychological well-being and the medi-
ating mechanism of self-esteem. There are also some practical implications on improving
psychological well-being among the high school students through reducing the levels of
examination stress.

Keywords  LGCM · Psychological well-being · Examination stress · Adolescents

Zhoulei Xiang and Shen Tan have contributed equally to this paper and should be considered as co-first
authors.

* Baoshan Zhang
zhangbsh@gmail.com
1
Shaanxi Key Laboratory of Behavior and Cognitive Neuroscience, School of Psychology, Shaanxi
Normal University, No. 199, South Chang’an Road, Yanta District, Xi’an 710062, China

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 Z. Xiang et al.

1 Introduction

Psychological well-being (PWB) refers to that individuals have a positive self-regard,

positive relationships with others, purpose in life, and are able to develop own potential
through personal growth and choose/create environments that are suitable to one’s psy-
chic condition, self-determination, and independence (Ryff and Singer 2008). With the
development of positive psychology, psychological well-being has been recognized as a
highly relevant research topic in the area of social psychology because it has been found
to contribute to a range of critical outcomes in life, including increased social support,
greater life satisfaction, improved physical health (Ryff and Singer 2008), and better
academic performance (Norvilitis and Reid 2012; Topham and Moller 2011).
Among the factors that affect psychological well-being, perceived stress has received
considerable attention. Lazarus and Folkman (1984) defined stress as “a particular rela-
tionship between the person and the environment that is appraised by the person as tax-
ing or exceeding his or her resources, and as endangering his or her well-being.” In
order to address the effects of stressors on well-being as well as their possible media-
tors, Lazarus and Folkman (1984) proposed a stress process model. In this model, they
emphasized two central processes, cognitive appraisal and coping, as critical mediators
between stress and immediate or long-range outcomes. When encounter stressful event
that is relevant to their well-being, people will make cognitive appraisals. They first
evaluate whether the encounter (stressful event) is harmful or beneficial for their well-
being (first cognitive appraisal) and then evaluate whether there are resources to over-
come harm or to improve the benefit (second cognitive appraisal) (Folkman et al. 1986).
For the second process, coping is defined as a personal effort to manage demands,
which is appraised as exceeding the person’s resource. When the available resources can
not satisfy the demands, individual may develop strategies to search available resources
that would help to decrease their stress (Folkman et  al. 1986). How people appraise
events can make a difference in their coping strategies, and then result in various out-
comes. However, when stress continues increasing and coping resources still cannot
meet demands, the buffering psychological resources would be threatened (Lee et  al.
2013). Based on this model, previous studies examining relationships between stress
and well-being indicated that social stress condition and coping resources were impor-
tant for well-being (e.g., Eisenbarth 2012; Chao 2011).
Furthermore, researchers have identified several resources that may mediate the
relationship between stress and well-being including psychological resource and social
resource according to the stress process model (Goode et al. 1998). In previous litera-
ture, self-esteem has been employed as a robust psychological resource to establish a
positive view of the self (e.g., Hobfoll 1989). When confronted with stressful events,
people who have positive view of themselves are less likely to experience overwhelmed
than people who do not, because people with positive self-view would see themselves
as being able to cope with various problems (DeLongis et  al. 1988). Without higher
self-esteem, stressors accumulate in life can overwhelm individual’s available cop-
ing resources to support mental health (Taylor and Stanton 2007). Moreover, Hobfoll
(1989) further developed the stress process model and more directly emphasized that
people strive to reserve, protect, and build resources for keeping psychological health. It
is the potential or actual loss of available resources, such as self-esteem, resilience and
self-efficiency that threatening to them and leading to unhealthy psychological status
(Hobfoll 1989). Therefore, it is reasonable to expect that stress is closely associated

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Longitudinal Effects of Examination Stress on Psychological…

with psychological well-being, and that self-esteem may play some intervening roles in
the relationship between stress and psychological well-being.
Adolescence, as an important stage in the development of personality and learning,
is also an important period for the development of psychological well-being. Being one
of the most important factors that affect adolescents’ psychological well-being, examina-
tion stress is one of the most important kinds of academic stress perceived by teenagers,
which has received considerable attention. It is well known that in some Eastern cultures
(e.g., China), examination performance is a key criterion for evaluating students and an
important developmental indicator of successful school lives among adolescents. That is,
in order to become a good student, individuals should struggle to achieve a good grade
on important examinations, so that stress may easily stem from the process of academic
examinations preparation. Previous studies have shown that changes in examination stress
are significantly correlated with changes in levels of anxiety as measured by salivary corti-
sol (Singh et al. 2011). Similarly, Li et al. (2010) demonstrated that examination stress has
obvious impacts on emotions of individuals. Therefore, examination stress can be expected
to have a negative impact on psychological well-being in adolescent students. However,
despite a large number of studies focusing on the relationship between examination stress
and positive affect (Srivastava 2015), only a few studies have examined the patterns of the
relationships between changes in the levels of examination stress and psychological well-
being over time, and almost no studies have examined the possible mediating mechanism
of examination stress on psychological well-being.
Drawing on previous literature about the relationship between stress and psychological
well-being, the current study employed a longitudinal study design to explore the patterns
of relationship between changes in the levels of examination stress and psychological well-
being over time and further explored the possible mediating role of self-esteem in the rela-
tionship between examination stress and psychological well-being in adolescent students.

1.1 Theoretical Framework and Hypotheses

1.1.1 Examination Stress and Psychological Well‑Being

Examination stress is physical and mental tension caused by the imbalance between an
actual or perceived requirement and coping ability when people are in the process of adapt-
ing to a specific examination. Examination stress focuses exclusively on examinations,
and is different from “academic stress” which refers to a wider range of school activities
(Putwain 2007). There is an abundance of evidence to suggest that changes in levels of
examination stress co-occur with a number of physiological and psychological changes,
including changes in emotion (Singh et al. 2011; Weekes et al. 2006), cognitive function
(Kofman et al. 2006; Lewis et al. 2008), even personality characteristics (Rohrmann et al.
2003; Wadee et  al. 2001). For example, Weekes et  al. (2006) have observed that exami-
nation stress is a significant trigger of elevations in negative mood states such as anxi-
ety which is associated with a rise in cortisol level. Previous researches also showed that
examination stress was influenced by many factors, such as gender (e.g., Lewis et al. 2008;
Rohrmann et  al. 2003), age (e.g., Yang 2016), and school environmental factors (e.g.,
Ortuño-Sierra et al. 2015). Although some studies showed no gender difference in exami-
nation stress in laboratory experiments (e.g., Lewis et  al. 2008; Rohrmann et  al. 2003),
studies in real school situation demonstrated significant gender differences on examination
stress, with female students being more likely to report higher levels of examination stress

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 Z. Xiang et al.

(e.g., Eman et al. 2012). In terms of age, the students from 10th grade to 12th grade faced
different levels of examination stress in Chinese school environment. Yang (2016) found
that the 12th grade students experienced the highest stress for the coming college entrance
examination. Examination stress did not show differences between the 10th and 11th grade
in school environment (Yang 2016). It is interesting that in the real school environments,
students even appear to feel examination stress as soon as they entered the school. The
closer to important exams, the more stress they are likely to have (Mohapatra et al. 2012).
In sum, it has been well established that examination stress widely exists and may have sig-
nificant effects on various aspects of daily lives in adolescent students (Srivastava 2015).
Examination stress, as a type of academic stress often experienced by adolescent stu-
dents, is one cause of perceived stress. Based on the stress process model as well as pre-
vious research, examination stress could be expected to be associated with psychological
well-being through at least two ways. First, the overall level of examination stress can
be expected to have a negative impact on psychological well-being. Martin and Ickovics
(1987), who conducted a longitudinal study on army wives, found that both military life
stress and marital stress have important independent negative effects on the level of gen-
eral psychological well-being. Similarly, Edwards (2004) found that a higher level of stress
could predict a lower level of well-being. Second, changes in examination stress overtime
can be expected to be negatively associated with changes in psychological well-being. Pre-
vious researchers have found that reduced perceived stress tends to increase well-being
(Schwartz et al. 1992). Similarly, Rusch et al. (2014) found that a decrease in stress pre-
dicted a better sense of well-being at follow-up. Examination stress usually comes from the
preparing for academic examinations. It is also a typical type of stress for youths and can
be expected to have a deleterious effect on an adolescent’s well-being. Therefore, based on
these previous studies, we developed two hypotheses:

Hypothesis 1:  The overall level of examination stress is a significant predictor of the
level of psychological well-being in adolescent students.

Hypothesis 2:  Changes in examination stress across time negatively predict changes in
psychological well-being in adolescent students.

1.1.2 Mediation Role of Self‑Esteem

Self-esteem reflects a person’s overall subjective emotional evaluation of his or her own
worth. It is a judgment of oneself as well as an attitude toward the self. Self-esteem
encompasses beliefs (e.g., “I am competent”) and emotions such as triumph, despair,
pride, and shame (Lopez and Snyder 2004). According to the literature reviewed above,
self-esteem as a psychological resource (Hobfoll 1989), should play an important role
between stress and well-being. Notably, some research confirmed a moderating role of
self-esteem between stress and well-being and revealed that having high level of self-
esteem alleviated the negative effects of acculturative stress against psychological well-
being (Gardner and Parkinson 2011; Kim et  al. 2014). Some other research demon-
strated that self-esteem can also be an important predictor of perceived stress (Albertsen
et al. 2010). However, it is more likely to expect a mediating role of self-esteem in the
relationship between stress and well-being on the basis of stress process model (Lazarus
and Folkman 1984), which indicated some buffering resource that could be used to
mediate stress-well-being relationship. Some empirical research, which took self-esteem

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as a psychological resource, also provided compelling evidence for this mediating effect
(e.g., Choi 2010; Lee et al. 2013). For example, using a longitudinal data, Pearlin et al.
(1981) demonstrated that stress could erode positive concepts of self (e.g., including
self-esteem and mastery). The diminished self-concepts leave one especially vulnerable
to experiencing mental issues. Lee et al. (2013) also revealed that self-esteem mediated
the relationship between work-related stress and depression. In general, self-esteem can
be threatened when an individual considers stress to be uncontrollable or highly disturb-
ing, and threatened self-esteem can consequently undermine well-being.
In line with the rationale reviewed above, the expected mediating role of self-esteem
played in the relationship between stress and well-being can also be expected in a real
school context. Empirical studies have also well established the relationship between
examination stress which is a typical kind of perceived stress, self-esteem and psycho-
logical well-being. On the one hand, a large body of research has consistently revealed
a close link between examination stress and self-esteem. Learning activities are a key
component of adolescent school lives, and examination performance is one of the most
important criteria for evaluating students. To get a reasonable academic performance
and to be evaluated as good students, most adolescent students are expected to struggle
during the semester to get good grades on their academic examinations. Accordingly,
the closer a student gets to important examinations when adolescent students are busy
preparing for the exam, the more likely they are to encounter difficulties. Consequently,
the more likely they are to experience stress and frustration. In the process of preparing
for some of the more important examinations that have a significant implication on indi-
vidual’s later life, a greater level of perceived stress should be expected. From another
perspective, researchers have established that experiencing stress and frustration will
influence an individual’s emotions and sense of self-worth and will further affect the
individual’s self-esteem (Baldwin and Hoffmann 2002; Kernis 2005). Therefore, exami-
nation stress could be a major source of stress and could therefore be closely related
to the sense of self-value. Thus, examination stress may lead to lower self-esteem in
adolescent students. Previous cross-sectional studies have revealed a significant link
between perceived stress and self-esteem, specifically that greater perceived stress is
associated with lower self-esteem in adolescent students (Nikitha et al. 2014; Uba et al.
2013). Using a longitudinal design, Murray et al. (2013) also found that an increase in
stress predicted a reduction in self-esteem in an adolescents’ sample.
On the other hand, some theorists have insisted that self-esteem has some effects
on psychological well-being. A positive attitude toward one’s self should lead to self-
enhancement and then to happiness; that is, there should be a significantly positive rela-
tionship between self-esteem and psychological well-being (Dogan et al. 2013; Rosen-
berg et  al. 1995). In line with these findings, empirical research has confirmed that
self-esteem is a significant predictor of psychological well-being (Cheng and Furnham
2003) and has consistently found that the higher the self-esteem, the greater the psycho-
logical well-being (Paradise and Kernis 2002; Schilling 2015).
Based both on theoretical and empirical literature about the relationship between
examination stress and self-esteem as well as between self-esteem and psychological
well-being, it is reasonable to predict that self-esteem could be a potential mediator in
the relationships between examination stress and psychological well-being. Drawing on
the aforementioned theoretical and empirical research, a third hypothesis regarding the
mediating role of self-esteem was proposed.

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 Z. Xiang et al.

Hypothesis 3:  Self-esteem mediates the relationship between examination stress and
psychological well-being in adolescents.

1.2 The Current Study

The current study used latent growth curve modeling to examine developmental trends in
examination stress and psychological well-being, incorporating a three-wave longitudi-
nal design. The participants in the current study were senior grade one students at a high
school and completed questionnaires (see below section of Measures) three times with an
interval of about 2 months during an entire semester (from the beginning of March to the
end of June in 2015). Based on the three-wave data, we explored the relationship between
examination stress and psychological well-being in two ways. First, we explored the rela-
tionship between the initial level of examination stress and the initial level of psychological
well-being primarily by looking for an intercept–intercept correlation in the latent growth
model. Second, we explored the relationship between a change in examination stress and
a change in psychological well-being primarily by looking for a slope–slope correlation in
the latent growth model. Latent growth modeling was also used to investigate the mediat-
ing role of self-esteem in the relationship between examination stress and psychological
well-being.

2 Methods

2.1 Participants

The participants were recruited from the first year class at a senior high school in 2015. In
this study, participants completed the questionnaires three times with an interval time of
about 2 months throughout the entire term from March to June 2015. A total of 532 partici-
pants completed the questionnaire at Time 1, 356 completed the questionnaires at Time 1
and Time 2, and 248 completed the questionnaires at all three times.
Data from the 248 participants were included in the final analyses, of which missing
data were estimated using the full information maximum likelihood (FIML) method. Of
the participants, 116 were male (mean age  =  15.92  ±  0.51  years), and 132 were female
(mean age = 15.83 ± 0.57 years). There was no significant gender difference with respect
to age (t = 1.39, df = 246, p > .05).

2.2 Measures

2.2.1 Psychological Well‑Being

Psychological well-being was measured with the Chinese version of the 24-item Scales of
Psychological Well-Being (Ryff 1989), as revised by Cheng and Chan (2005), for meas-
uring psychological well-being. This scale has relatively acceptable internal consistency
coefficients (Cheng and Chan 2005). An example item is: “In general, I feel I am in charge
of the situation in which I live”. After reversely scoring the negative items and summing
the items, a high score indicates high overall psychological well-being. In the current study,
Cronbach’s alpha was 0.89 at Time 1, 0.90 at Time 2, and 0.88 at Time 3.

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Longitudinal Effects of Examination Stress on Psychological…

2.2.2 Examination Stress

Six items were extracted from the Academic Stress Scale to assess the levels of examina-
tion stress. The academic stress scale (Kohn and Frazer 1986) is a 35-item scale designed
to measure students’ perceived academic stressors. Respondents report their level of stress
under 35 different stressful situations (e.g., examinations, excessive homework, missing
class) using a 5-point Likert scale (1 = not at all stressful, 2 = rarely stressful, 3 = some‑
times stressful, 4  =  fairly stressful, 5  =  extremely stressful). The scores are obtained by
summing the scores for each item. The academic stress scale has satisfactory internal con-
sistency as measured by Cronbach’s alpha and by split-half reliability (.92 and .86, respec-
tively) (Kohn and Frazer 1986). The aim of the current study was to measure students’
perceived examination stress, we therefore only used the items that related to examinations.
Six items that are designed to assess the perceived stress from examination situations and
that always included the word “examinations” were extracted to form a new “examination
stress scale” to assess the students’ perceived levels of examination stress. Two strategies
were used to examine the validity of the new examination stress scale and validate the
items on the new scale. First, to assess their content validity, a panel of five experts in
psychology assessed the validity of these items. The panel members were provided with
the description (definition) of examination stress and were asked to choose between the
35 items those items which best fit the operational definition of examination stress. All the
six items that we had previously chosen were selected by the experts, indicating that those
items have adequate content validity and discriminant validity. Second, in order to assess
the construct validity and reliability, a pilot study was conducted, in which, an Explora-
tory Factor Analysis (EFA) and a Confirmatory Factor Analysis (CFA) were employed.
For the EFA, we approached 500 students (mean age = 15.85, SD = 0.54, 258 girls, 232
boys) and asked them to complete the academic stress scale. An EFA with a varimax rota-
tion was conducted on these 500 students. Kaiser’s rule was used to determine the num-
ber of factors. We found that out of all 35 items, the six items on the examination stress
scale that were chosen belonged to the same dimension. For the CFA, another 350 stu-
dents were approached (mean age = 15.87, SD = 0.55, 182 girls, 168 boys) and completed
the questionnaire. The CFA results revealed reasonable fit indices, which indicated that
the six items of the examination stress scale belonged to one dimension, χ2(9) = 44.451,
CFI = 0.954, TLI = 0.924, RMSEA = 0.087, SRMR = 0.040. Results of the EFA and CFA
supported that the six items measured a common trait-examination stress. The scale had
good internal consistency as measured by Cronbach’s alpha (0.85 at Time 1, 0.84 at Time
2, and 0.81 at Time 3) in the current study.

2.2.3 Self‑Esteem

Self-esteem was measured with the Rosenberg Self-Esteem Scale (RSES) (Rosenberg
1965). The RSES is a self-report scale that contains 10 items, each of which is assessed
using a 4-point scale that ranges from 1 (strongly disagree) to 4 (strongly agree). It con-
tains an equal number of positively (e.g., “I take a positive attitude toward myself”) and
negatively (e.g., “I certainly feel useless at times”) worded items. After reversal scoring
the negative items and summing the item results, a high score indicates high overall self-
esteem. To ensure that the score of the scale was an indicator of participants’ state self-
esteem in that particular week and was sensitive to changes in an individual’s self-esteem,

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 Z. Xiang et al.

we stressed that the participants should assess each item according to their general feelings
over the past 7 days. Cronbach’s alpha was 0.87 in previous studies (Carrard et al. 2012)
and was 0.87 at Time 1, 0.90 at Time 2, and 0.86 at Time 3 in the current study.

2.2.4 Socio‑Demographic Variables

The participants completed a self-reported questionnaire including students’ socio-demo-

graphics variables such as age, gender, sibling status, and family income.

2.3 Procedure

In this study, the participants completed the questionnaires three times throughout the
entire term (from the beginning of March to the end of June in 2015). The first wave (Time
1) was on a Monday 2  weeks before the first school exam at the very beginning of that
semester. Because the exam was at the beginning of a new semester, the students did not
have time to get well adapted from holiday to their school lives. Everything in the class
tends to seem very difficult at the beginning because of the lack of background knowledge
in each discipline. Therefore, the first exam should be the most objectively and subjec-
tively difficult one in the semester, and it seems to be generally accepted as the hardest. In
addition, a student’s performance on this examination will determine the evaluations and
attitudes of teachers, parents, and classmates as well as their social status and the quality
of their lives throughout the following semester. Thus, the level of examination stress is
expected to be much higher than that at any other time in the semester. The second wave
(Time 2) was on a Monday 2 weeks before the mid-term examination. The mid-term exam
is generally carried out in the middle of the semester, primarily to examine the students’
quality of learning during the first half of the semester. The mid-term exam seems easier
than the first one because of some accumulation of knowledge in each discipline, so we
supposed that the examination stress is lower than in the first wave. The third time (Time 3)
was a Monday 2 weeks before the final exam. The students had gone through a full term of
study by that time, and most of them are well-prepared for the final exam. The final exam
is thought to be less difficult because of good preparation, greater proficiency of knowledge
about the subjects, and students’ skill in applying knowledge before the final examination.
In addition, we conducted the third wave of questionnaires at a time that was close to the
beginning of the summer holiday, so it is reasonable to assume that the perceived examina-
tion stress is the lowest for the adolescent students at this time.
At each time point before the questionnaires were distributed to students in their class-
rooms, female researchers explained the procedure and assured the participants that the
study was conducted purely for research purposes and that participation was voluntary. The
students were free to decline participation without any negative consequences. All samples
were administered as an anonymous self-report survey, however, students needed to write
down an identifying number that allowed us to match each participant’s data from the three
times the questionnaires were filled out. All the participants in the study received a small
gift as a reward (e.g., a notebook, worth around 20 Chinese yuan).

2.4 Data Analysis

In the current study, latent growth curve modeling (LGCM) was used for all analy-
ses. LGCM models individual growth trajectories for observed variables over time by

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Longitudinal Effects of Examination Stress on Psychological…

specifying latent intercept and slope variables for each construct of interest (Duncan et al.
2013). The scores from Time 1, Time 2, and Time 3 were used as the observed variables.
For each model, the intercept was centered relative to the scores at the baseline so that the
intercept represented the initial status of the growth curve. The linear slope represents the
functional form of the growth trajectory across three time points.
A series of models was tested in the following sequence. First, the growth trajectory of
examination stress, self-esteem, and psychological well-being were examined separately.
For each construct, as in Fig. 1, a model containing a latent intercept factor and a latent
growth factor, in which the intercept was set at the baseline, was estimated. The three load-
ings of the latent growth factors were set to 0, 1, and 2. Second, the effects of academic
examination stress on psychological well-being were examined by the parallel process
models shown in Fig. 2. This model coded two latent variables for LGCM of examination
stress as a predictor of the latent growth factors in psychological well-being. Third, two
approaches were applied to examine the mediation hypothesis. One was to test whether
stress at Time 1 predicted well-being at Time 3, mediated by self-esteem at Time 2. The
other one was to examine a mediation model (see Fig. 3) with the latent growth factors of
self-esteem. In this model we first used a causal-step strategy to inspect the specific paths,
and used the bootstrap method to test the indirect effects (MacKinnon 2008; Preacher and
Hayes 2008; Zhao et al. 2010). A significant indirect effect indicates that the asymmetric
confidence intervals did not include zero. In addition, many studies have found that demo-
graphic variables, such as gender (Kling et al. 1999), age (Twenge and Campbell 2001),
family income (Zhang and Postiglione 2001), and sibling status (Fleming and Courtney
1984; Rosenberg 1965), affect self-esteem in adolescents. Thus, the impacts of those
demographic variables on self-esteem were controlled during the mediation model.
All the models were estimated using Mplus 7 (Muthén and Muthén 2012). Maximum
likelihood estimation with robust standard errors (Satorra and Bentler 1994) was employed
for the LGCMs. To allow for analysis of the data containing missing values, all the LGCMs
were estimated using full information maximum likelihood (FIML), which assumes that
data are missing at random. The model fit was assessed by χ2, the Tucker–Lewis index

Fig. 1  Latent growth model for

all variables. x1–x3, one variable
from Time 1 to Time 3 (e.g.,
examination stress from Time 1
to Time 3); Ix, the intercept for
this variable (e.g., examination
stress intercept); Sx, the slope of
this variable (e.g., examination
stress slope)

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 Z. Xiang et al.

Fig. 2  Parallel growth mode for examination stress and psychological well-being. x1–x3, examination
stress from Time 1 to Time 3; Ix, examination stress intercept; Sx, examination stress slope; y1–y3, psycho-
logical well-being from Time 1 to Time 3; Iy, psychological well-being intercept; Sy, psychological well-
being slope

Fig. 3  Mediation model. Ix,

examination stress intercept; Sx,
examination stress slope; Iy, psy-
chological well-being Intercept;
Sy, psychological well-being
slope; Iz, self-esteem intercept;
Sz, self-esteem slope

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Longitudinal Effects of Examination Stress on Psychological…

(TLI), the comparative fit index (CFI), the root-mean-square error of (RMSEA), and the
standardized root-mean-square residual (SRMR).

3 Results

To capture a general idea of the data, we performed a preliminary analysis. Tables 1 and 2
presents the correlations and descriptive statistics for all the variables. The mean levels of
all variables decreased from Time 1 to Time 3. The results showed that psychological well-
being had a significantly negative correlation with examination stress across three times.

3.1 Univariate Growth Curves

We first estimated univariate growth curves for each variable. Linear, nonlinear, and quad-
ratic slopes were tested for each variable. We found that the data has a perfect fit for the
linear one, but not fit either the non-linear or quadratic models. Therefore, Fig. 1 shows the
linear slope model.
Because all of the growth curves showed significant variances in the intercept and the
slope terms (see Table 3), none of these variables were eliminated from further analyses.
Furthermore, these significant variances indicate the presence of meaningful individual
differences in study constructs in both the initial level and the rate of change over the study
period. The mean value of the linear slope for each study variable indicates the average rate
of linear change for that variable over time, and the variance of the linear slope shows the
variability around that average rate.
The respective linear univariate LGCMs for all variances in Fig.  1 demonstrated an
adequate to excellent fit to the data (see model fit indicators in Table  3). The statistical

Table 1  Descriptive statistics for all variables

Variables n M (SD) Male Female t (df) p
M (SD) M (SD)

Examination Stress at 243 18.65 (4.73) 17.45 (4.75) 16.66 (4.49) − 3.72 (241) < .01
Time 1
Examination Stress at 243 17.74 (5.10) 16.40 (5.18) 18.94 (4.73) − 3.99 (241) < .01
Time 2
Examination Stress at 246 17.22 (4.64) 16.50 (4.90) 17.87 (4.31) − 2.34 (244) .02
Time 3
Psychological Well-being at 245 103.02 (16.49) 107.37 (18.03) 102.71 (15.05) 0.32 (243) .75
Time 1
Psychological Well-being at 241 100.72 (17.69) 100.96 (19.66) 100.50 (15.81) 0.20 (239) .84
Time 2
Psychological Well-being at 243 99.49 (15.60) 98.97 (17.43) 99.94 (14.09) − 0.48 (241) .63
Time 3
Self-esteem at Time 1 246 32.05 (4.71) 32.33 (5.09) 31.80 (4.36) 0.88 (244) .38
Self-esteem at Time 2 248 31.48 (5.49) 31.26 (5.80) 31.67 (5.20) − 0.60 (246) .55
Self-esteem at Time 3 243 31.26 (5.33) 30.95 (5.89) 31.52 (4.80) − 0.84 (241) .40

The total number of variables is not consistent, because there were a few missing data points

13


13
Table 2  Correlations statistics for all variables
1 2 3 4 5 6 7 8 9

1. Examination stress at Time 1 –

2. Examination stress at Time 2 .659** –
3. Examination stress at Time 3 .441** .542* –
4. Psychological well-being at Time 1 − .367** − .251** − .149* –
5. Psychological well-being at Time 2 − .305** − .215** − .163* .662** –
6. Psychological well-being at Time 3 − .251** − .190** − .229** .621** .719** –
7. Self-esteem at Time 1 − .258** − .150* − .117 .729** .573** .568** –
8. Self-esteem at Time 2 − .198** − .132 − .122 .613** .757** .652** .696** –
9. Self-esteem at Time 3 − .164* − .077 − .193** .500** .578** .755** .627** 724** –

*p < .05, two-tailed; **p < .01, two-tailed

Z. Xiang et al.
 Table 3  Univariate growth curve
Variable Intercept (variance) Linear slope (variance) Covariance χ2(df) RMSEA CFI TLI SRMR

Examination stress 18.550*** − 0.684 *** − 5.212** 0.612 (1) 0.000 1.000 1.009 0.011
(20.399)*** (4.260)**
Psychological well-being 102.971*** − 1.769*** − 33.799** 0.806 (2) 0.000 1.000 1.011 0.031
(214.310)*** (41.126)***
Self-esteem 32.037*** − 0.421** − 5.514* 0.474 (1) 0.000 1.000 1.008 0.008
Longitudinal Effects of Examination Stress on Psychological…

(19.998)*** (3.640)**

N = 248; RMSEA root-mean-square error of approximation, CFI comparative fit index, TLI Tucker–Lewis index, SRMR standardized root-mean-square residual
*p < .05, two-tailed; **p < .01, two-tailed; ***p < .001, two-tailed

13
 Z. Xiang et al.

significance of the mean value of the linear slope suggests that the mean level of all the
variables decreased significantly from Time 1 to Time 3.
The results also revealed significant negative relationships between the intercepts and
their corresponding slopes for the three variables (see covariance in Table 3). The values of
covariance ranged from − 5.212 (p < .01) to − 33.799 (p < .01), with all p’s < .05, indicat-
ing that individuals who had higher initial levels for all three variables tended to decrease
at steeper rates (e.g., have more negative slopes) in these respective constructs.

3.2 Parallel Growth Model

To examine the relationship between examination stress and psychological well-being, we

built a parallel growth model which simultaneously estimated the latent growth for both
examination stress and psychological well-being.
Model 2, as presented in Fig. 2, is a parallel growth model, in which the latent growth
factors of examination stress are independent variables and those of psychological
well-being are dependent variables. A parallel growth model which provided an excel-
lent fit to the data was estimated, χ2(9, N  =  239)  =  2.769, CFI  =  1.000, TLI  =  1.026,
RMSEA = 0.000, SRMR = 0.020.
The results showed that the intercept for examination stress negatively and significantly
predicted the initial levels of psychological well-being (β = − 0.444, p < .001). This sup-
ports hypothesis 1. Also, changes in examination stress from Time 1 to Time 3 nega-
tively predicted changes in psychological well-being from Time 1 to Time 3 (β = − 0.23,
p < .05), which is consistent with hypothesis 2. The intercept for examination stress did not
predict the slope of psychological well-being (β = 0.074, p > .05).

3.3 Mediation Analyses

To examine hypothesis 3, in which self-esteem was expected to mediate the relationship

between examination stress and psychological well-being, two mediation analysis strate-
gies were applied.
In the first analysis strategy, we tested whether stress at Time 1 predicted well-being at
Time 3, mediated by self-esteem at Time 2. Our results showed that self-esteem at Time
2 played a partial mediation role between examination stress at Time 1 on psychological
well-being at Time 3. Examination stress at Time 1 had a significant negative effect on
self-esteem at Time 2 (β  =  −  0.25, SE  =  0.077, p  =  .001). The path from self-esteem
at Time 2 to psychological well-being at Time 3 was significant and positive (β = 1.811,
SE = 0.155, p < .001). The path from examination stress at Time 1 to psychological well-
being at Time 3 was significant and negative (β = − 0.399, SE = 0.186, p < .05). The total
effect was significant (β = − 0.258, p < .001), and the total indirect effect was also signifi-
cant (β = − 0.137, p = .001). Asymmetric confidence limits showed a significant mediated
effect (lower limit  =  −  0.218, upper limit  =  −  0.056). This suggests that self-esteem at
Time 2 partially mediated the effect of examination stress at Time 1 on psychological well-
being at Time 3.
Furthermore, in order to verify that it is self-esteem and psychological well-being
influenced by examination stress, but not self-esteem and psychological well-being
influence examination, we tested a second mediation model with psychological well-
being at Time 1 as independent variable, self-esteem at Time 2 as mediating vari-
able, and examination stress at Time 3 as outcome variable. However, we did not find

13
Longitudinal Effects of Examination Stress on Psychological…

mediated effect in this model. Psychological well-being at Time 1 had a significant posi-
tive effect on self-esteem at Time 2 (β = 0.195, SE = 0.020, p < .001). The path from
self-esteem at Time 2 to examination stress at Time 3 was not significant (β = − 0.071,
SE = 0.073, p = .331). The path from psychological well-being at Time 1 to examina-
tion stress at Time 3 was not significant (β = − 0.036, SE = 0.025, p = .147). The total
effect was significant (β = − 0.176, p < .05), but the total indirect effect was not signifi-
cant (β = − 0.049, p = .330). Asymmetric confidence limits, which did include 0, also
showed a non-significant mediated effect (lower limit = − 0.147, upper limit = 0.050).
These two results provided evidence showing that examination stress was a predictor of
psychological well-being, mediated by self-esteem.
In the second analysis approach, based on the results above, we added the latent
growth factors of self-esteem as mediators in our model. As we mentioned before,
gender, age, family income, and sibling status can affect self-esteem, we therefore
added participants’ socio-demographic characteristics as time-invariant covariates
to control the impact of those demographic variables on self-esteem. This model was
found to fit data well, χ2(53) = 122.561, CFI = 0.944, TLI = 0.924, RMSEA = 0.075,
SRMR = 0.079.
In the path from the intercept for examination stress to the intercept for psychologi-
cal well-being via the intercept for self-esteem, the intercept for examination stress had
a significant negative effect on the intercept for self-esteem (β  =  −  0.398, SE  =  0.100,
p < .001). The path from the self-esteem intercept to the psychological well-being inter-
cept was significant and positive (β  =  2.592, SE  =  0.160, p  <  .001). Therefore, support
was found for a mediating path from the intercept for examination stress to the intercept
for psychological well-being via the intercept for self-esteem. The estimate of the indirect
effect was significant (β = − 0.331, p < .001). Asymmetric confidence limits also showed
a significant mediated effect (lower limit − 0.477, upper limit − 0.184). The direct effect
of the intercept for examination stress on the intercept for psychological well-being in the
model was significant (β = − 0.160, SE = 0.055, p < .01). This suggests that self-esteem
partially mediated the effect of the intercept for examination stress on the intercept for psy-
chological well-being (see Table 4).
On the other hand, the path from the examination stress slope to the self-esteem slope
was not significant (β = − 0.249, SE = 0.679, p > .05). The path from the self-esteem slope
to the psychological well-being slope was significant (β  =  3.209, SE  =  2.370, p  <  .05).
The estimate of the indirect effect was not significant (lower limit  =  −  1.709, upper
limit = 1.127). Therefore, there was no mediated effect in this path. The results above par-
tially support Hypothesis 3 (see Table 4).
To further confirm our hypothesis, we swapped the dependent variable and independ-
ent variable to form a new model. In the new model, psychological well-being was the
independent variable, examination stress was the dependent variable, and self-esteem
was a mediator. We employed the same procedure to estimate the new model again while
fixing the growth factor variance of self-esteem to zero to establish convergence of the
model. The results showed that the model fit the data well, χ2(53) = 125.507, CFI = 0.943,
TLI  =  0.923, RMSEA  =  0.075, SRMR  =  0.065. However, the estimate of the indirect
effect, the intercept for psychological well-being to the intercept for examination stress via
the intercept for self-esteem, was not significant (value = − 0.044, SE = 0.351, p > .05).
The estimate of the indirect effect, the slope for psychological well-being to the slope
for examination stress via the slope for self-esteem, was not significant (value  =  0.412,
SE = 1.145, p > .05). This shows that this modified model was not established and was less
appropriate than the original unmodified one.

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Table 4  Total and specific indirect effects of examination stress on psychological well-being via self-esteem
Variable Coefficient (standardized) SE (standardized) 95% CI (standardized)

Total indirect effects from Ix on Iy − 1.533*** (− 0.491***) 0.314 (0.092) − 2.131 to − 0.904 (− 0.671 to − 0.311)
Specific indirect effects Via Iz − 1.032*** (− 0.331***) 0.249 (0.075) − 1.519 to − 0.544 (− 0.477 to − 0.184)
Direct effects from Ix on Iy − 0.500** (− 0.160**) 0.179 (0.055) − 0.835 to − 0.154 (− 0.269 to − 0.052)
Total indirect effects from Sx on Sy − 0.724 (− 0.263) 2.387 (0.167) − 3.492 to − 0.131 (− 0.59 1to 0.065)
Specific indirect effects via Sz − 0.800 (− 0.291) 6.944 (0.723) − 11.786 to 0.058 (− 1.709 to 1.127)
Direct effects from Sx on Sy 0.076 (0.028) 5.543 (0.665) − 0.950 to 11.528 (− 1.276 to 1.332)

Ix, examination stress intercept; Sx, examination stress slope; Iy, psychological well-being intercept; Sy, psychological well-being slope; Iz, self-esteem intercept; Sz, self-
esteem slope; SE, standard error; CI, confidence interval
* p < .05, two-tailed. ** p < .01, two-tailed. *** p < .001, two-tailed
Z. Xiang et al.
Longitudinal Effects of Examination Stress on Psychological…

4 Discussion

In the present study, we examined three hypotheses using LGCM. First, univariate growth
curves for examination stress and psychological well-being were assessed using three
waves of data, indicating that the mean levels of examination stress, self-esteem, and psy-
chological well-being decreased significantly from Time 1 to Time 3. The results also
revealed that individuals with higher initial levels of examination stress, self-esteem, and
psychological well-being tended to decrease at steeper rates. Second, a parallel growth
model was employed to explore the relationship between examination stress and psycho-
logical well-being in two ways. The results indicated that initial levels of examination stress
negatively predicted initial levels of psychological well-being and that changes in examina-
tion stress across time predicted significant, reversed changes in psychological well-being.
Specifically, individuals who decreased at steeper rates in examination stress from Time 1
to Time 3 tended to decrease at gradual rates in psychological well-being across the time
span. Third, the mediation analysis suggested that the self-esteem intercept partially medi-
ated the effect of initial levels of examination stress on initial levels of psychological well-
being. In the following sections, we will discuss these findings in more detail.
First, the mean levels of examination stress, self-esteem and psychological well-being
all decreased significantly from Time 1 to Time 3. As we assumed before conducting the
study, the mean levels of examination stress decreased, primarily because of the differ-
ences that students perceived about the timing and content of the three exams. However,
findings that psychological well-being and self-esteem decreased significantly across time
were unexpected. A possible reason could be that our measure of psychological well-
being is omnibus, and did not measure a particular aspect of psychological well- being
(e.g., academic or examination psychological well-being). This omnibus well-being could
be affected by many factors, including individual factors and social factors (Bakhshi et al.
2015), not merely by examination stress. For example, empirical evidences suggest that
social support from teachers, peers, and parents was an important factor that contributed to
the levels of psychological well-being (Chu et al. 2010). As for the decreased self-esteem,
we consider that school environmental change could be an essential reason. In transitioning
from middle school to high school, adolescents have to move to new school environment.
Students are exposed to different peer groups and influences, and may encounter increased
academic rigor and expectations and fewer emotional supports (Hutson et al. 2016). Expe-
rience of frustration with difficulties in relationships and learning can easily switch into
negative judgment and attitude toward themselves at this stage of adolescence, which may
damage self-esteem (Rose 2010). Therefore, self-esteem and psychological well-being
overall showed a downward trend.
Second, our results showed in Univariate Growth Curves analysis suggest signifi-
cantly negative relationships between the intercepts and their corresponding slopes
for the three variables, indicating that individuals who had higher initial levels for all
three variables tended to decrease at steeper rates (e.g., have more negative slopes).
Group dynamics theory could be used to explain such results, which indicates that stu-
dents’ behavior is influenced by the unique characteristics of a group and the school
environment (Lind and Lind 1997). Students at the same high school and same grade,
as a group shared the same norms and exhibited similar physical and mental behavior
(Lawson et al. 2006). Our sample was a combination of Grade one high school students
just graduated from various middle schools. Even though students from different mid-
dle school had vastly different mental state, the psychological state of the students will

13
 Z. Xiang et al.

regress to the average level of a group after experiencing the same school atmosphere.
Applying it to our results explanation, individuals who had higher level of examination
stress, self-esteem and psychological well-being would decrease more to the average
level of a group. Therefore, in the meantime, those who scored high on examination
stress, self-esteem and psychological well-being at the initial time would experience a
steeper decrease in respective constructs over time.
Third, the initial levels of examination stress significantly predicted the initial levels
of psychological well-being, a finding which agreed with hypothesis 1. This result is
consistent with previous studies (Arulrajah and Harun 2000; Munir et  al. 2015; Sid-
dique and D’Arcy 1984; Zhong 2009) that showed that the more an individual perceives
stress, the lower their psychological well-being. In addition, changes in examination
stress across time predicted a significant, reversed trend in the changes in psychological
well-being, which is also consistent with Hypothesis 2. That is, students who decreased
steeply in stress have a less pronounced decrease in well-being. These results are in line
with previous studies (Rusch et al. 2014; Schwartz et al. 1992) in that reduced perceived
stress tends to increase well-being. General models of stress posit that perceiving a situ-
ation as being threatening or beyond one’s coping resources causes stress and leads to
a negative affect (Lazarus and Folkman 1984). The rationale for the link between stress
and mental-health outcomes follows from the underlying assumption of social epide-
miological research, which considers mental illness as a pattern of human reaction set in
motion by stressful experiences (Dohrenwend and Dohrenwend 1974; Mechanic 1983;
Susser 1981). It has been suggested that social stress, actual or perceived, tends to act as
a precursor to psychological well-being and exercises a strong direct impact on physical
and mental health. Based on these theories, in our study, the levels of examination stress
that the students had tended to act as precursors to psychological distress and to lead to
changes in psychological well-being.
Fourth, findings that initial levels of self-esteem partially mediated the effect of ini-
tial levels of examination stress on initial levels of psychological well-being and self-
esteem at Time 2 played a partial mediation role between examination stress at Time
1 support Hypothesis 3. The experience of stress has been shown to negatively influ-
ence well-being by decreasing the individual’s positive appraisal of the quality of life
and self-esteem because they may focus on the problem or the emotions related to the
problem, thus limiting their coping ability (Hinton and Earnest 2010). Self-esteem is an
important psychological construct in adolescence and is associated with stress. It has
been theorized that the inability to cope with events outside an individual’s control can
lead to feelings of inadequacy and worthlessness (Youngs et al. 1990), which are obvi-
ous indicators of low self-esteem. A positive attitude toward one’s self could lead to
self-enhancement, which could lead to happiness, which has a positive relationship with
psychological well-being (Dogan et al. 2013; Rosenberg et al. 1995). In contrast, indi-
viduals with low self-esteem are more likely to feel anxious, depressed, hostile, lonely,
embarrassed, jealous, ashamed, guilty, hurt, shy, and generally upset compared to peo-
ple with high self-esteem (Leary 2005). To sum up, when experiencing high examina-
tion stress, adolescent students may focus on the examination and the stress related to
the examination may cause them to feel inadequate and worthless, which would lower
their self-esteem. In turn these adolescent students would be more likely to feel anx-
ious, depressed, ashamed, guilty, as well as generally upset, which would finally lead
to a reduction in psychological well-being. Because self-esteem partially mediated the
effect, there must exist other factors that played a mediating role. Since we found that
the self-esteem slope did not mediate the effect of the examination stress slope on the

13
Longitudinal Effects of Examination Stress on Psychological…

psychological well-being slope, we may conclude that with further research other psy-
chological constructs may be found which have an even greater impact on the relation-
ship between examination stress and psychological well-being.
Additionally, when analyzing the mediating role of self-esteem in the relationship
between stress and psychological well-being, we uncovered a reciprocal relationship
between self-esteem and psychological well-being. These results are in line with previ-
ous studies, which confirmed that self-esteem was a significant predictor in maintaining
psychological health, functioning, and well-being during adolescence (e.g., Cheng and
Furnham 2003; Schilling 2015), as well as that well-being prospectively predicted sub-
sequent levels of self-esteem in turn (e.g., Barendregt et al. 2016). These results indicate
that the relationship between stress and well-being may not be unidirectional but recip-
rocal. Specifically, as a mediator, self-esteem can positively influence psychological
well-being. Increased psychological well-being can also in turn have a beneficial impact
on self-esteem under some other mechanism that different from that revealed in current
study (e.g., psychological well-being can help build self-confidence to one’s life), which
help establish a positive view of the self and build self-esteem in the long run.

4.1 Implications

This study has important theoretical implications by expanding research about the rela-
tionship between stress and psychological well-being among young people. To our
knowledge, this is the first longitudinal study examining the causal relationship between
examination stress and psychological well-being as well as their mediators. Our study
added to previous cross-sectional studies (e.g., Rusch et  al. 2014) on the associations
between perceived stress and psychological well-being by providing robust evidence
showing that examination stress may influence adolescents’ psychological well-being
through self-esteem. In addition, the application of latent growth curve models in this
study further helped to determine the mediating role of self-esteem in the relationship
between initial level of examination stress and psychological well-being, though there is
no mediating result between trends in examination stress and psychological well-being.
These findings enrich the research field about the influencing factors and mechanisms
underlying the psychological well-being of adolescents.
Findings of the present study have relevant practical implications with respect to the
design of intervention for adolescents’ psychological well-being. The most important find-
ing of this study is that self-esteem plays a mediating role between examination stress and
psychological well-being. As such, adolescents with high levels of examination stress were
likely to have lower self-esteem, which in turn contributed to lower psychological well-
being. These findings suggested that school, together with parents, should pay attention
to the examination stress that students may have. In order to maintain and improve ado-
lescents’ psychological well-being, teachers and parents should not put too much pressure
on adolescents, but should give students more guidance and suggestions regarding how
to cope with examination stress. Furthermore, this study also provided clinically relevant
suggestions on how interventions may help to improve students’ psychological well-being.
That is, according to the results of present study, for those students with high examination
stress, engaging in boosting self-esteem which is a very important psychological resource,
may not only buffer the negative effect of examination stress on psychological well-being,
but also contribute directly to students’ psychological well-being in the long run.

13
 Z. Xiang et al.

4.2 Limitations

A limitation with respect to the measurement should be noted. Specifically, our measure
for psychological well-being is omnibus and there might exist other factors that can affect
the general sense of well-being, but were not included in this study. For example, adoles-
cent stress in the life course is marked by physical and psychological maturation, as well as
by changing social roles and environments (Meadows et al. 2006). The stresses emanating
from the family, school, and peer groups have different contents for adolescence (Meadows
et  al. 2006). Examination stress is just one of them that adolescence may face in school
environment. Other stress, such as relationship stress from peers, academic expectation
stress from parents and teachers, and parent-adolescent conflict stress, can also have a seri-
ous impact on psychological well-being (Huang 2014). Accordingly, there may exist some
other variables that may mediate the relationship between examination stress and psycho-
logical well-being among young people. According to stress process model (Lazarus and
Folkman 1984), some social resource such as social support and social network (Donnelly
2010), as well as some psychological resources such as self-esteem, mastery and self-effi-
ciency (Pearlin et al. 1981), might play a possible mediated role between stress condition
and psychology well-being. It should be very important to identify the factors affecting the
general sense of well-being and intervening variables between examination stress and psy-
chological well-being for future theoretical and empirical research.

Acknowledgements  The authors would like to thank National Nature Science Foundation of China
(31200778) and the Fundamental Research Funds for the Central Universities (15SZTZ01) for funding this
research. We thank Drs. Rhoda E. and Edmund F. Perozzi for their extensive review and English language
assistance on this paper.

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