Cogent Education

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Academic stress as a predictor of mental health in

university students

Pamela Córdova Olivera, Patricia Gasser Gordillo, Hernán Naranjo Mejía,

Isabel La Fuente Taborga, Alberto Grajeda Chacón & Alberto Sanjinés
Unzueta

To cite this article: Pamela Córdova Olivera, Patricia Gasser Gordillo, Hernán Naranjo Mejía,
Isabel La Fuente Taborga, Alberto Grajeda Chacón & Alberto Sanjinés Unzueta (2023) Academic
stress as a predictor of mental health in university students, Cogent Education, 10:2, 2232686,
DOI: 10.1080/2331186X.2023.2232686

To link to this article: https://doi.org/10.1080/2331186X.2023.2232686

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Córdova Olivera et al., Cogent Education (2023), 10: 2232686
https://doi.org/10.1080/2331186X.2023.2232686

EDUCATIONAL PSYCHOLOGY & COUNSELLING | RESEARCH ARTICLE

Academic stress as a predictor of mental health
in university students
Pamela Córdova Olivera1*, Patricia Gasser Gordillo2, Hernán Naranjo Mejía3,
Isabel La Fuente Taborga2, Alberto Grajeda Chacón4 and Alberto Sanjinés Unzueta5
Received: 22 June 2022
Accepted: 26 June 2023 Abstract: Identifying the relationship between academic stress and mental health
of undergraduate university students is crucial for reducing and understanding its
*Corresponding author: Pamela
Córdova Olivera, Center for Research negative effects, enhancing students’ ability to cope with stressful situations, and
in Economics and Entrepreneurial
Sciences, Universidad Privada
thereby reducing the harm it causes on academic performance and overall well-
Boliviana, Cochabamba, Bolivia being. This study aims to examine the correlation and predictive value of academic
E-mail: pcordova@upb.edu
stress on mental health in undergraduate university students. A representative
Reviewing editor:
Richard Kruk, Psychology, University
sample of 1,265 undergraduate university students from a private university in
of Manitoba, Canada

Additional information is available at

the end of the article
ABOUT THE AUTHORS
Pamela Córdova Olivera, expert in Health
Economics and Impact Evaluation, holds a PhD
in Economics from UPB. She is a professor,
researcher and Head of the Economics program
at UPB.
Patricia Gasser Gordillo, in Social Psychology
from Universidad Complutense de Madrid, Spain;
directed the Organizational Psychology program
at UPB and, currently, conducts research on
mental health and emotional states.
Hernán Naranjo Mejía, professor and researcher
in the Data Analysis Unit for Innovation and
Academic Quality at UPB, is a doctoral candidate
in the field of Agri-food Economics at the
Universitat Politècnica de València, Spain.
Isabel La Fuente Taborga is a researcher, pro­
fessor and Head of Organizational Psychology
program at UPB. Expert in Organizational
Psychology and Human Talent Management, she
holds a PhD from Universidad Complutense de
Madrid, Spain.
Alberto Grájeda Chacón, PhD in Business
Innovation from the Universitat Politècnica de
València, Spain; leads the Center for Innovation
in Information Technology for Education at UPB.
His expertise lies in the effective implementation
of educational tools utilizing TIC.
Alberto Sanjinés Unzueta, expert in Business
Ethics, Compliance, and Social Responsibility;
holds a PhD in Business Administration from
UPB, Bolivia. He is the Academic Vice President
at UPB, leading the process of academic and
tech-ed innovation.
PUBLIC INTEREST STATEMENT
This study examines the correlation between
academic stress and mental health in university
students. Through analysis of a sample of 1,265
students, the study reveals that high levels of
academic stress, particularly self-inflicted stress,
increase the probability of experiencing
Languishing Mental Health. The findings underline
the significance of identifying stressors and
implementing educational programs to prevent
the negative impact of stress on mental health.
Additionally, students need to develop coping
mechanisms to manage stressful situations in
academic environments. The research has signif­
icant implications for universities and policy­
makers as it provides insight into the specific
stressors that affect students and the measures
that can be taken to mitigate their effects.
Ultimately, the study aims to enhance mental
health and academic performance among uni­
versity students.

© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution
License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribu­
tion, and reproduction in any medium, provided the original work is properly cited. The terms on
which this article has been published allow the posting of the Accepted Manuscript in
a repository by the author(s) or with their consent.

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Bolivia was assessed using Pearson’s correlation analysis to determine the predic­
tive value of academic stress on mental health. To validate the measurements
obtained, a stepwise Hierarchical Multiple Linear Regression analysis was applied.
A probability model was estimated to identify academic stressors that contribute to
the probability of students experiencing Languishing Mental Health. The study
revealed that Self-inflicted Stress was the most significant stressor among under­
graduate students. This indicates that students’ self-demands and self-efficacy
perceptions are essential factors in the development of high academic stress levels.
There is a clear correlation between high levels of academic stress and the prob­
ability of experiencing Languishing Mental Health.

Subjects: Educational Psychology; Mental Health; Study of Higher Education; Educational

Research; Education & Training

Keywords: academic stress; mental health; Languishing Mental Health; Self-inflicted

Stress

1. Introduction
Stress is a ubiquitous phenomenon in daily life that results from a natural physiological and
psychological response of the body to situations perceived as challenging or threatening, acting
as a catalyst to confront and resolve problems. However, excessive exposure to it can have
detrimental long-term physical and mental effects (Flórez & Sánchez, 2020).

In recent years, numerous studies have demonstrated that chronic stress, when sustained for
extended periods, can trigger anxiety disorders, depression, and other mental health issues.
O’Connor et al. (2021) found that chronic stress can have adverse effects on cognitive functioning,
emotional regulation, and overall quality of life. Furthermore, emerging research, such as that
conducted by Mariotti (2015) suggested that chronic stress can increase the likelihood of devel­
oping psychiatric disorders among susceptible individuals.

The findings of stress studies emphasize the importance of addressing stress as a critical factor
in promoting mental health by comprehending the biological mechanisms underlying stress. Dai
et al. (2020) conducted research revealing that chronic stress can activate a sequence of neuro­
biological responses, including the hypothalamic-pituitary-adrenal axis and cortisol release.
Prolonged exposure to cortisol, a hormone released in response to stress, can negatively impact
the hippocampus, a crucial brain structure involved in emotional regulation and memory proces­
sing. These findings provide a biological foundation for understanding the connection between
chronic stress and mental health disorders.

There are several classifications of stress, each based on distinct aspects associated with it. The
academic stress is distinguished as a type of situational stress that arises in the educational
context and is related to the demands and requirements of the academic environment, among
others. Barbayannis et al. (2022) note that academic stress can manifest in the form of anxiety,
depression, and emotional exhaustion, which can negatively affect students’ psychological well-
being. Additionally, recent studies such as Espinosa et al. (2020), showed that academic stress can
have harmful consequences on students’ performance, motivation, and self-esteem.

The context of higher education represents a stressful scenario for students who, in addition to
academic aspects, must face the transition from high school to university, which entails additional
challenges such as adapting to new lifestyles, high competitiveness, changes in the environment,
and the initiation of new relationships in an unfamiliar context. High social expectations about the
future can contribute to increased academic stress. Authors such as Bashir et al. (2019), Wang

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et al. (2023) and Guzmán et al. (2023) addressed this topic in recent publications, mentioning that
the university environment involves a series of changes that students must adapt to, including an
accelerated pace of study, deadlines for assignments and projects, and more in-depth coverage of
topics, which can significantly impact students’ mental health.

When students begin university, they are faced with a multitude of scheduled tasks, the need to
familiarize themselves and interact with new people in their academic environment, and a much
higher level of demand compared to their previous years of education, including different work
rhythms, schedules, and academic processes. All these factors create considerable pressure for
students, who must balance their academic and personal responsibilities while adapting and
growing in this new educational environment. A study by Bashir et al. (2019) examined academic
stress in university students and found that high expectations from professors and competition
among peers can increase stress in the university environment. The study points out that stress
can have negative effects on overall well-being, affecting students’ mental and physical health.

In addition, university students often face the pressure of making important decisions for their
future, such as choosing a career or planning their professional path, and this uncertainty can
generate additional anxiety and stress (Guzmán et al., 2023). Another stress-generating aspect is
the pressure to excel academically and stand out in a highly competitive environment, which
creates a constant sense of comparison and self-criticism. Students may experience the so-called
“imposter syndrome,” where they doubt their abilities and feel that they do not deserve to be in
university. This can generate emotional stress and affect their self-confidence (Cokley et al., 2017).

Exposure to peers and other students can also create pressure, as entering university involves
a process of social adaptation. Students find themselves in an environment where they must
establish new relationships and social networks, which can generate social anxiety due to the need
to be accepted into a new group of peers and participate in extracurricular activities. Wang et al.
(2023) explored social stress in university students and found that a lack of social coping skills and
a sense of isolation can contribute to the social stress experienced during university life.

In addition to academic and social factors, other aspects outside of university life can also
contribute to stress. For example, many university students must deal with financial pressure, both
their own and their parents’, as well as the cost of studying, which can generate additional stress
as they try to balance studying and finding income to cover tuition, housing, food, and other
related expenses, especially among those who have migrated to study. McCloud and Bann (2019)
examined the impact of financial stress on the mental health of university students and found that
stress related to finances can have negative effects on the mental well-being of the students,
increasing anxiety and depression.

In this context, after COVID-19 pandemic was declared in 2020 added a new and unpredictable
stressful situation that caused an unprecedented crisis, with education being one of the most
affected areas since face-to-face educational activities were prohibited at all levels. According to
the Economic Commission for Latin America and the Caribbean ECLAC (2020), more than 190
countries closed their educational establishments during the first semester of 2020 to prevent the
spread of the virus and mitigate its impact. As a result, over 1.2 billion students of all levels were
without access to face-to-face education. Data from the United Nations Educational, Scientific and
Cultural Organization, International Institute for Higher Education in Latin America and the
Caribbean reports that by the end of March 2020, more than 98% of the students in Latin
America and the Caribbean from International Standard Classification of Education 5 to 8 levels
were affected (Giannini, 2020).

To address this situation, a radical turn towards virtual teaching and learning modality, which
existed for more than ten years but was not widely applied, was taken. Both teachers and students
had to adapt to new conditions such as online classes, papers, and tests to continue their learning

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Figure 1. Academic model:

Hybrid model.

process (Bautista et al., 2020). Strong changes were made in life habits, having to reorganize their
daily routines to adjust themselves.

Universities that had to migrate to a completely virtual education in 2020 need to adapt their
academic model to ensure the health and well-being of the students, provide timely administrative
service to clients, and ensure and improve academic quality. The academic model presented in
Figure 1 was institutionalized in various universities, taking different names depending on the
institution: hybrid, multimodal, flexible, blended; but with many coincidences.

According to Agyeiwaah et al. (2022), students were given the opportunity to attend classes
either in one of the modalities or a mix of them. These new models required efforts at various
levels: i) intensive training of teachers in the use of information and communication technology for
education, such as video conferencing tools, Learning Management Systems, survey systems,
gamification, active methodologies, etc.; ii) selection of academic subjects that required face-to-
face interaction, such as specialized laboratories, taking into account the relationship between the
modality of the subject and the teaching competence; and iii) equipment and infrastructure
adapted to allow the functioning of the hybrid model.

Initially temporary changes lasted longer than planned, with measures forbidding face-to-face
lectures remaining in place for almost two across various countries worldwide. During this time,
the lack of social contact, changes in socialization routines, and deprivation of extra-academic
activities, among other factors, affected the psycho-emotional state of university students. This is
because their educational process is not solely based on the learning of theoretical and practical
knowledge but also on professional social interaction and the development of group ties. The
isolation inevitably associated with confinement will have effects in terms of socio-emotional
balance that will leave a mark, as emergency distance education has been accompanied by
other manifestations, which are not less important for the different actors, although probably
not very visible and documented (ECLAC, 2020).

Under these circumstances, it is crucial to measure the academic stress experienced by uni­
versity students and its influence on their mental health. Stress can be defined as the relationship
between the individual and their environment, in which the person perceives environmental
demands as a threat to their well-being if they exceed or equal their resources to cope with
them (Lazarus & Folkman, 2013). Academic stress, according to Lin and Chen (2009), is the product
of perceptions, frustrations, or problems related to the academic environment that result in the
inability to adjust to the university requirements, leading to conflicting physical and mental

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phenomena. The most common stressors in this area are Teachers’ Stress, Results Stress, Test
Stress, Studying in Groups Stress, Peer Stress, Time Management Stress, and Self-inflicted Stress.

The effects of stress, regardless of the factor that generates it, can impact physiological,
emotional, cognitive, and behavioral levels (Barraza & Silerio, 2007). Therefore, it is crucial to
measure its impact on mental health. Mental health is a term that has been conceptualized,
measured, and studied based on the concept of well-being (Ryff, 1989), which is defined as
individuals’ perception and subjective assessment of their lives (Keyes et al., 2008). Mental health
is understood as a series of subjective factors such as thoughts, emotions, and beliefs that, if
positive, produce positive functioning and functional contextual adaptation capacity in individuals.
In this sense, mental health does not only involve the measurement of a single factor, but rather
of several dimensions that condition it, according to the Mental Health Continuum Short Form
(MHC-SF) (Keyes et al., 2008) used in this study, mental health is based on three general dimen­
sions or areas: emotional, psychological and social well-being, which together determine the
individual’s mental health.

In this context, the present study aimed to understand the relationship between academic
stress and the mental health of university students in the new social and learning environment
resulting from the COVID-19 pandemic. The research sought to answer the question of how
academic stress affects the mental health of university students. The main objective was to
evaluate the correlation and predictive value between academic stress and its different stressors
on the mental health of university students. The study had three specific objectives: i) to measure
the level of academic stress and its associated stressors (as mentioned above) in university
students; ii) to evaluate the level of mental health in university students; and iii) to determine
the relationship between academic stress and mental health in university students. The study also
proposed the following hypotheses: a) University students encountered high levels of academic
stress; b) The mental health levels of the students were languishing or moderate; and c) Academic
stress had a correlation with languishing and moderate levels of mental health. Among the
academic stressors, Result Stress, Test Stress, and Time Management Stress were identified as
having the strongest association with mental health.

A representative sample of 1,265 undergraduate university students from a private university in

Bolivia was assessed. Correlational analysis, stepwise Hierarchical Multiple Linear Regression
analysis, and estimation of a probabilistic model of Languishing Mental Health were performed.

2. Materials and methods

2.1. Research design

The study adopted an ex post facto design as data on the level of academic stress and mental
health of the students were collected after they had experienced these situations. Therefore,
participants were not randomly assigned to experimental or control groups, but their condition
was observed and measured using appropriate instruments for this study. The objective was to
analyze the relationship between academic stressors and mental health of undergraduate uni­
versity students.

2.2. Population and sampling

A cross-sectional, descriptive, relational, and analytical study was conducted during the second
semester of 2021, with undergraduate students from all programs and faculties of a private
university in Bolivia. The total number of enrolled students was 3,309, with 55.7% men, 44.3%
women, and a mean age of 21 years. The sample size was calculated by considering the three
university campuses as strata and faculties as clusters. The resulting total was a required sample
of 1,060 students, with a 95% confidence level and an initial sampling error of 5%.

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The study managed to obtain voluntary responses from 1,265 undergraduate university students
(38% of total student population), surpassing the established sample size calculation. An invitation
with a link to the questionnaires was sent to all students enrolled to conduct a full coverage study
(census). Previous studies showed that not everyone responded to the invitation. Therefore, it was
considered that those who responded to the questionnaires did so spontaneously, and the choice
to respond or not was considered a random factor.

The response rate to the questionnaires was representative of the university’s overall student
population, as well as segmented by campus, gender, faculty, and semester. At a general level
throughout the university, the sampling error was calculated to be 3%. Additionally, it was possible
to calculate the sampling error at the campus, gender, faculty, and semester levels, which did not
exceed 7%.

2.3. Procedures
The questionnaires selected to determine academic stress and mental health were translated into
Spanish and incorporated as components in a digital survey form for this study. A platform
developed by the university in 2017, was utilized for this purpose. This platform is fully integrated
with the university academic system database and aimed to enable teachers to generate surveys
in their assigned subjects so that students could access them, thereby achieving better interaction
between teachers and students.

The digital survey form was prepared in October 2021 and was validated for content, length, and
language translation through a pilot test with university students. This test allowed for corrections,
especially in the Spanish language translation of questions, to make them clearer. This resulted in
the final version of the survey form being ready for implementation.

With the data collection tools ready, support was requested from university authorities to
distribute the questionnaires to all students at each its campuses. The academic authorities
reviewed the questionnaires and requested approval from the Ethics in Research Committee of
the University to administer them to the students.

The university’s ethics committee reviewed the survey and concluded that the research did not
incorporate an experimental approach at any of its stages. The purpose was simply to observe and
measure specific characteristics of the study subjects without implicitly or explicitly seeking to
modify their behavior, actions, or interpretation of reality. Furthermore, since the questionnaires
were completely anonymous and students could voluntarily respond to them, the ethics commit­
tee approved the work, as the identity of respondents was guaranteed.

Once the ethics committee approval was obtained, university authorities approved the ques­
tionnaires to be shared with students throughout the university via a link in an official email,
requesting voluntary support from students. The data collection officially started on
27 October 2021, and lasted until the end of the second semester of 2021, before the students’
vacation.

The survey responses were downloaded into an Excel format database, which was then reviewed
and transformed into STATA 17 format for econometric analysis.

2.4. Measurements
The instrument used in this study to measure mental health were the Mental Health
Continuum-Short Form (MHC-SF). This 14-item questionnaire (Keyes, 2002, 2005, 2006; Keyes
et al., 2008) assesses mental health across three dimensions: a) Emotional Well-being (positive
affect and life satisfaction); b) Social Well-being (including acceptance, actualization, social
contribution, coherence, and social integration); and c) Psychological Well-being (autonomy,
control, personal growth, positive relationships, self-acceptance, and purpose) (Ryff, 1989). The

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MHC-SF has demonstrated strong internal consistency with a Cronbach’s alpha above 0.70
(Keyes et al., 2008), and its three-factor structure (emotional, psychological, and social) has
been confirmed in several studies (Gallagher et al., 2009; Góngora & Castro, 2018; Joshanloo
et al., 2013; Lamers et al., 2010).

To measure academic stress and its stressors, this research employed the Lin and Chen (2009)
scale, which comprises seven academic stressors: Teachers’ Stress (TES), Results Stress (RS), Test
Stress (TS), Stress of Studying in a Group (SGS), Peer Stress (PS), Time Management Stress (TMS),
and Self-inflicted Stress (SIS). The questionnaire consisted of 34 five-point Likert scale statements,
with responses ranging from 5 (completely agree) to 1 (completely disagree). The Cronbach
reliability test and alpha values for each of the questionnaire’s components or factors ranged
from 0.85–0.92, and the alpha value of the academic stress questionnaire was 0.90 (Lin & Chen,
2009). The K Pearson’s correlation analysis indicated a significant level of related coefficients
between the components and the total score, ranging from 0.63–0.86.

2.5. Data analysis

The quantitative analysis of the data generated in this study required the application of three
statistical and econometric techniques: Pearson correlation, Hierarchical Multiple Linear
Regression (HMLR) analysis, and a probability model—Probit. These techniques provided
a comprehensive understanding of the relationship between academic stressors and mental
health.

Pearson correlation is a statistical measure that evaluates the linear relationship, strength, and
direction between two quantitative variables. It is an important tool in research and descriptive
statistics, as it can help to understand the relationships between variables and identify patterns
of behavior in data. This measure varies from −1 to 1, where −1 indicates a perfect negative
relationship, 0 indicates no correlation, and 1 indicates a perfect positive relationship
(Bolshakova, 2021). Pearson correlation was used to determine the strength and direction of
the relationship between academic stressors and the mental health in university students.
However, as correlation does not necessarily indicate causality, we also conducted an HMLR
analysis.

HMLR is a statistical technique that allows for the examination of the relationship between
a dependent variable and multiple independent variables while controlling for other factors that
could influence the relationship (Petrocelli, 2003). In this study, the dependent variable was mental
health, while the independent variables were different academic stressors. The HMLR analysis was
conducted by introducing the measurement equation with a significance level of p < 0.05. The inde­
pendent variables (academic stressors) were organized in the equation based on the percentage of
explained variance. This allowed us to identify the unique contributions of each academic stressor to
mental health outcomes while controlling for other factors that could influence the relationship.

Probability model—Probit is a technique used to examine the relationship between the levels of
academic stressors and languishing mental health. The Probit model allowed us to determine the
coefficients of the levels of academic stressors and predict the probability that a student would
experience Languishing Mental Health, treated as a binary variable that took the value of 1 when
an individual had Languishing Mental Health, and 0 otherwise (Greene, 1996). This enabled us to
identify the academic stressors and their levels that contribute to Languishing Mental Health,
which could be used to develop interventions aimed at addressing these factors and improving
mental health outcomes.

In summary, the combination of techniques provided a comprehensive understanding of the

relationship between academic stress and mental health.

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Table 1. Mean and standard deviations for mental health and stressors of academic stress
Variables Mean SD
Academic Stressors
TES 2.72 0.71
RS 2.47 0.97
TS 3.20 1.00
SGS 2.60 0.81
PS 2.21 0.81
TMS 2.83 1.04
SIS 2.65 0.93
Mental Health
MH 2.14 0.69
Notes: TES=Teachers’ Stress, RS=Results Stress, TS=Test Stress, SGS=Studying in Groups Stress, PS=Peer Stress,
TMS=Time Management Stress, SIS=Self-inflicted Stress, MH=Mental Health.

3. Results

3.1. Descriptive statistics and correlations

To conduct this study, a total of 1,265 students from a private university in Bolivia completed the
questionnaires developed specifically for this purpose. Of these, 615 (48.6%) were female and 650
(51.4%) were male, with an age range of 17 to 31 years and a mean age of 21.68 (±2.04) years.
Table 1 presents the means and standard deviations of the variables analyzed in this study.
Academic stress, with its seven analyzed stressors (TES—Teachers’ Stress, RS—Results Stress, TS
—Test Stress, SGS—Studying in Groups Stress, PS—Peer Stress, TMS—Time Management Stress,
and SIS—Self-inflicted Stress), had a mean of 2.67 points with a standard deviation of 0.69 points,
and no outliers were detected. The mental health variable had a mean of 2.14 points with
a standard deviation of 0.69 points, and no significant presence of outliers was detected.

The descriptive analysis of mental health, based on the present levels, showed that 18.1% (229)
of the students presented Languishing Mental Health, 49.8% (630) presented moderate levels
(Moderate Mental Health), and 32.1% (406) presented high levels of mental health (Flourishing
Mental Health). After analyzing the stressors of academic stress, 14.3% (181) exhibited high levels
of TES, 15.7% (198) experienced RS, 44.7% (565) underwent TS, 13.8% (174) experienced SGS, 8.3%
(105) experienced PS, 26.7% (338) experienced TMS, and 22.4% (283) experienced SIS. The break­
down and description of this data are displayed in Table 2.

As observed in the distribution table, among university students, mental health showed
a predominantly moderate trend (49.8%), and the primary academic stressors were related to
TS (44.7%), TMS (26.7%), and SIS (22.4%). The latter was defined as the self-demands resulting
from contextual elements concerning one’s expectations. This factor was associated with stu­
dents’ belief in successfully coping with academic demands, which was an eminently subjective
factor influenced by their beliefs, perceptions, and feelings regarding their abilities to handle the
context.

3.2. Predictive value of academic stress about mental health

The study analyzed the predictive value of academic stress on mental health, and the results are
presented in Table 3. The analysis showed significant negative correlations between all academic
stressors and mental health levels, with (r) larger than 0.20 as an absolute value. Among the
academic stressors, TES (r ¼ 0:24; p < 0:01) and PS (r ¼ 0:24; p < 0:01) showed weak negative
correlations, followed by TS (r ¼ 0:27; p < 0:01), RS (r ¼ 0:33; p < 0:01), SGS

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Table 2. Distribution of mental health levels according to stressors of academic stress in

undergraduate students from a private university in Bolivia, 2021
Academic Levels Levels of Mental Health
Stressors
Languishing Moderate Flourishing
Fx Fx Fx
% % %
TES Low 51 241 223
4.0% 19.1% 17.6%
Medium 117 310 142
9.2% 24.5% 11.2%
High 61 79 41
4.8% 6.2% 3.2%
RS Low 73 324 305
5.8% 25.6% 24.1%
Medium 73 218 74
5.8% 17.2% 5.8%
High 83 88 27
6.6% 7.0% 2.1%
TS Low 13 124 144
1.0% 9.8% 11.4%
Medium 64 226 129
5.1% 17.9% 10.2%
High 152 280 133
12.0% 22.1% 10.5%
SGS Low 68 252 268
5.4% 19.9% 21.2%
Medium 91 285 127
7.2% 22.5% 10.0%
High 70 93 11
5.5% 7.4% 0.9%
PS Low 105 358 315
8.3% 28.3% 24.9%
Medium 87 219 76
6.88% 17.31% 6.01%
High 37 53 15
2.9% 4.2% 1.2%
TMS Low 39 207 249
3.1% 16.4% 19.7%
Medium 70 255 107
5.5% 20.2% 8.5%
High 120 168 50
9.5% 13.3% 4.0%

(Continued)

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Table 2. (Continued)
Academic Levels Levels of Mental Health
Stressors
Languishing Moderate Flourishing
Fx Fx Fx
% % %
SIS Low 34 214 269
2.7% 16.9% 21.3%
Medium 79 283 103
6.2% 22.4% 8.1%
High 116 133 34
9.2% 10.5% 2.7%
Notes: TES=Teachers’ Stress, RS=Results Stress, TS=Test Stress, SGS=Studying in Groups Stress, PS=Peer Stress,
TMS=Time Management Stress, SIS=Self-inflicted Stress.
Fx=Frequency.
%=Percentage.

Table 3. Matrix of correlation coefficients (r) between the mental health levels and stressors
of academic stress in undergraduate students from a private university in Bolivia, 2021
MH TES RS TS SGS PS TMS SIS
MH —
TES −0.24*** —
RS −0.33*** 0.36*** —
TS −0.27*** 0.50*** 0.42*** —
SGS −0.33*** 0.38*** 0.28*** 0.38*** —
PS −0.24*** 0.40*** 0.36*** 0.37*** 0.47*** —
TMS −0.37*** 0.42*** 0.42*** 0.46*** 0.35*** 0.39*** —
SIS −0.42*** 0.52*** 0.56*** 0.50*** 0.42*** 0.45*** 0.56*** —
Notes: MH=Mental Health, TES=Teachers’ Stress, RS=Results Stress, TS=Test Stress, SGS=Studying in Groups Stress,
PS=Peer Stress, TMS=Time Management Stress, SIS=Self-inflicted Stress.
***p <0.01 (significant at 99% confidence).

(r ¼ 0:33; p < 0:01), and TMS (r ¼ 0:37; p < 0:01). The SIS had a moderate negative correla­
tion (r ¼ 0:42; p < 0:01).

Additionally, a HMLR analysis was performed, and the results are presented in Table 4. The
analysis showed that the stressors of SIS, TMS, SGS, and RS met the predictive criteria with
a significant value (R2 ¼ 0:304; F ¼ 116:96; p<0:01). SIS had the strongest correlation according
to the adjusted R2 (R2 ¼ 0:238; F ¼ 342:62; p<0:01). The introduction of TMS, SGS, and RS stressors
increased the prediction by 6.60%, while the other stressors were excluded due to their insignif­
icant correlation. The analysis revealed a significant increase in the explanation of the academic
stress and mental health among university students. The additional predictive value, when entered
the SIS equation, was related to the TMS, SGS, and RS (p<0:01) stressors.

The estimated models did not present any problems of heteroscedasticity in the residuals (Ho:
Constant variance, chi square ¼ 0:00; p ¼ 0:96), high collinearity between regressors (variance
enlargement factor -VIF- not greater than 1.85), and no omitted relevant variables at 95%

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Table 4. Hierarchical multiple linear regression analysis of mental health on each stressor of
academic stress
Mental Beta t p>|t| R2 F
Health
Model 1
SIS −0.39*** −18.51 0.00 0.238 342.62
Model 2
SIS −0.27*** −10.03 0.00 0.266 196.04
TMS −0.16*** −6.63 0.00
Model 3
SIS −0.19*** −6.74 0.00 0.299 151.84
TMS −0.14*** −6.09 0.00
SGS −0.20*** −7.30 0.00
Model 4
SIS −0.16*** −4.88 0.00 0.304 116.96
TMS −0.13*** −5.60 0.00
SGS −0.20*** −7.18 0.00
RS −0.07*** −2.82 0.00
Notes: SIS=Self-inflicted Stress, TMS=Time Management Stress, SGS=Studying in Groups Stress, RS=Results Stress.
Beta=Estimated coefficient, t=Values Student’s t-Distribution, R2= R-Squared, F= Values Snedecor-Fisher’s F -
distribution.
***p < 0.01 (significant at 99% confidence).

confidence (Ramsey test—RESET, Ho: the model has not omitted variables, F ¼ 0:63; p ¼ 0:60). In
conclusion, the final model was well-adjusted.

Three dimensions of mental health were analyzed: psychological, emotional, and social well-
being. The results showed that 26% of the variance in the Emotional Well-being dimension was
explained by five academic stressors, with SIS, TMS, RS, SGS, and PS being the most significant in
that order. In addition, 14.5% of the variance in the Social Well-being dimension was explained by
SIS, TMS, and SGS, while 30% of the variance in the Psychological Well-being dimension was
explained by SIS, TMS, SGS, and RS. The study findings suggest that the mental health of the
student population is related to subjective, psychological, emotional, and perceptual factors
regarding their ability to cope with academic and economic realities. Academic stressors for
these students are primarily psycho-emotional rather than operational, and subjective perceptions
play a crucial role in how students react to the academic environment.

3.3. Probability model for Languishing Mental Health

A probability model (probit) was estimated to analyze the probability of having Languishing Mental
Health, which was treated as a binary variable taking the value of 1 when an individual had
Languishing Mental Health and 0 otherwise (Moderate or Flourishing Mental Health). The Kruskal
Wallis Test showed statistically significant differences in the mean scores of each stressor of
academic stress, including TES (Teachers’ Stress), RS (Results Stress), TS (Test Stress), SGS
(Studying in Groups Stress), PS (Peer Stress), TMS (Time Management Stress), and SIS (Self-
inflicted Stress) based on the level of mental health (Languishing, Moderate, and Flourishing
Mental Health). The pairwise comparisons for the Sidak, Bonferroni, and Scheffe post hoc tests
supported the results of the Kruskal Wallis Test and showed statistically significant differences in
the mean scores of each stressor of academic stress based on mental health level at a 99%
confidence level, favoring Flourishing Mental Health compared to Moderate Mental Health
(p<0:01), Flourishing Mental Health compared to Languishing Mental Health (p<0:01), and
Moderate Mental Health compared to Languishing Mental Health (p<0:01). Figure 2 displayed

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Figure 2. Kernel density func­

tions estimated for academic
stressors by mental health
levels.

the Kernel density functions estimated for TES, RS, TS, SGS, PS, TMS, and SIS by mental health levels
(Languishing, Moderate, and Flourishing Mental Health), which confirmed the results of the Kruskal
Wallis Test, Sidak, Bonferroni, and Scheffe post hoc tests.

Considering the statistically significant differences found in each mental health level according
to each stressor of academic stress, a probability model was estimated for Languishing Mental
Health to approximate the differences in the effects that the different stressors of academic stress
have on explaining the variance of mental health in the HMLR model, on the most worrying
(sensitive) level of mental health.

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Table 5. Association between languishing mental health and levels of academic stressors
Variable Marginal Std. Err. z p>z CI 95%
Effects
SIS_Medium 0.08*** 0.03 2.48 0.01 0.02 0.14
SIS_High 0.20*** 0.05 4.06 0.00 0.10 0.29
TMS_ Medium 0.02 0.03 0.56 0.57 −0.04 0.07
TMS_ High 0.11*** 0.04 2.87 0.00 0.03 0.18
SGS_ Medium 0.01 0.02 0.41 0.68 −0.04 0.06
SGS_ High 0.11*** 0.04 2.59 0.01 0.03 0.19
RS_ Medium 0.02 0.03 0.69 0.49 −0.03 0.07
RS_ High 0.12*** 0.04 2.97 0.00 0.04 0.20
Notes: SIS=Self-inflicted Stress, TMS=Time Management Stress, SGS=Studying in Groups Stress, RS=Results Stress.
Std. Err.= Standard error, z=z-score, CI=Confidence Interval.
***p < 0.01 (significant at 99% confidence).

The model presented a pseudo R2 of 0.15; however, other measures were used to check the fit of
the predicted values to the observed values, as the pseudo-McFadden R2 does not have a direct
interpretation. Among these measures were the Hosmer and Lemeshow test and the classification
table. The first indicated a p-value of 0.11, allowing us not to reject the null hypothesis that the
model is well-adjusted (Ho: The data are consistent with a specified distribution). The second
measure is the global classification rate, which measured the percentage of observations for which
the modeling was correctly predicted, showing a value of 82.92%.

Table 5 presented the marginal effects of the different academic stressors on the probability
model estimated for the level of Languishing Mental Health. The results showed that if students
experienced medium levels of SIS, the probability of them experiencing Languishing Mental Health
was higher by 8 percentage points (pp) compared to students who had low SIS. Moreover, if they
experienced high SIS, the probability of them experiencing Languishing Mental Health was even
greater by 20pp compared to students who had low SIS. Similarly, for students who had high levels
of TMS, the probability of them experiencing Languishing Mental Health was greater by 11pp
compared to students who had low TMS. If they suffered from high levels of SGS, the probability
of them experiencing Languishing Mental Health was greater by 11pp compared to students who
had low SGS. Finally, if they suffered from high levels of RS, the probability of them experiencing
Languishing Mental Health was higher by 12pp compared to students who had low RS.

Therefore, it was concluded that moderate academic stress can result in Languishing Mental
Health among university students, which is characterized by indicators of stress, depression,
anxiety, and other psycho-emotional conditions that could potentially affect their performance,
self-perception, and self-efficacy. The findings indicate that students who experience high levels of
SIS and poor TMS are more likely to have Languishing Mental Health. Additionally, Languishing
Mental Health can be associated with high levels of stress related to working in groups and
obtaining negative results in assignments.

4. Discussion
The results of the academic stress and mental health scales applied to the population sample
showed that academic stress in university students was predominantly linked to SIS. According to
Naranjo (2009), any situation that a person perceived as a demand or a threat requiring rapid
change produced stress, but not all situations, nor all stressors, were negative or had to carry
consequences. Thus, the impact of stress on mental health depended on how different situations
were perceived, producing different impacts.

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This study had several strengths, including the wide representation of students based on sex,
age, semester, and faculty. In total, 38% of all enrolled students voluntarily completed the
questionnaire, which is more than other studies on academic stress, such as those conducted by
Restrepo et al. (2020), Luque et al. (2022), Micin and Bagladi (2011), Denovan et al. (2017), and
Kennett et al. (2020).

The results of this study indicated that situations of high academic stress predicted a higher
probability of experiencing Languishing Mental Health, with stress generated by Self-inflicted
Stress being the most relevant factor among the students. This suggests that the self-demands
and perception of self-efficacy of the students are important factors in the appearance of high
stress, highlighting the direct relationship between high levels of academic stress and the like­
lihood of having Languishing Mental Health.

In this way, the correlation results between stress factors and the mental health of university
students showed that academic stress was linked to self-generated stress, with a moderate
correlation, showing that self-demand in academic stressors, personal (and socio-family) expecta­
tions, regarding performance developed into the need to comply with what the student believed
was expected of them (even when this was not the case), causing continuous pressure (momen­
tary and prolonged in time) that would only be alleviated when it was considered that one’s own or
the environment’s expectations had been met, which responded to subjective components, since
they were not stated objectively, they did not generate a measurable data of scope or compliance.
This need to respond to subjective, own, or environmental demands could lead to a constant
feeling of dissatisfaction or failure since they were linked to self-perception of sufficiency, beliefs
about oneself being able to respond to the situations of the environment, and to mental schemes
about one’s abilities, such as being good, successful, unsuccessful, or useless (Álvarez et al., 2018).

According to Martínez and Díaz (2007), stress is strongly influenced by individuals’ subjective beliefs
about the demands placed on them and their capacity for understanding and control. If the evaluation
of these beliefs is negative, it can generate stress and have a negative impact on mental health.
Recent research supports this idea, highlighting that the way people interpret and evaluate stressful
situations, as well as their beliefs about coping capacity, are important factors in the experience of
stress and its impact on mental health (Rodríguez & Sánchez, 2022). Therefore, these subjective beliefs
about the self and the potential response to environmental demands would generate stress if the
evaluation is negative, consequently also leading to lower levels of mental health.

It is evident from the present study that stress variables generated by objective factors such as
evaluations, academic results, teachers, and peers, as well as studying in groups, have only a weak
correlation with mental health. This finding contrasts with other studies like Ramírez et al. (2015)
and Berrio and Mazo (2011) that have identified task overload, evaluations, time management,
group competitiveness, conflict between classmates, and evaluations as the main academic
stressors in university populations. However, it is important to consider that the pandemic situa­
tion and the virtualization of classes may have influenced the results. In this regard, case studies
conducted during 2021, such as Restrepo et al. (2020) and Luque et al. (2022), have also found
that academic stress in students during the pandemic is linked to task overload, time manage­
ment, evaluations, job type, and participation in virtual classes.

The study conducted by Silva et al. (2020) revealed that the academic stressors of greatest
concern during the pandemic were task overload, evaluations, assignments, and time constraints,
which were not observed in the population studied in this research. The data from this study
indicated that the mental health of the students is linked to academic stress, which can be
predicted by Self-inflicted Stress associated with personal, family, and social expectations. These
self-demands are related to the perception of sufficiency in the face of social and academic
demands, which are subjective factors associated with beliefs about one’s capacity to respond
to environmental demands (Chacón et al., 2019).

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The difference in results could be attributed to contextual factors specific to the Bolivian
environment or peculiarities of the study population. Our study was conducted in a private
university, where the tuition fees are much higher than those of public universities, and during
a pandemic when the economic crisis was at its peak. Furthermore, majority of the university
students (57% of the total number of enrolled students) were beneficiaries of some form of
scholarship before and during the pandemic.

This particular context could lead students to perceive a need for extra effort and dedication to
maintain a high academic level in order to keep their financial support through scholarships and to
acknowledge their family’s efforts to cover the fees to study at a private university, which could
result in Self-inflicted Stress affecting the mental health of this population. On the other hand, the
study results also suggest that this Self-inflicted Stress is related to time management, the feeling
of insufficiency to meet deadlines for assignment delivery, or the belief that it will not be possible
to complete said assignments within the established period. These stressors could be related to
the educational model of the institution, as the subjects are modular, meaning 24 continuous
sessions (Monday to Friday) with assignments delivery and tests every eight days.

As evidenced by the results, one factor that was found to be correlated with mental health is group
studying. The items evaluated in this indicator dealt with sharing group assignments and the challenge
of finding suitable colleagues to work with. This may be since control over the time required to complete
the work is distributed among the members of the group, and therefore, each member may feel anxious
that their colleague will not deliver the work on time, resulting in poor academic results. Additionally, this
indicator measures subjective variables such as fear of being mocked by peers, feeling hurt by it, feeling
nervous when speaking in public, and the perception of hostility and distrust towards others, which may
be exacerbated in a virtual learning environment. It is noteworthy that many of the students have been
taking virtual classes for two years, never having met their classmates or teachers in person, with only
a screen separating them. Various authors have also highlighted the significance of human relationships
as a central cause of stress, given the human need for affection and a sense of belonging.

The study population’s academic stress factors were found to be associated with non-objective
elements, specifically subjective beliefs about their abilities to cope with the demands of the
context, and control over contingent elements. Within the studied university system, most assign­
ments were group-based, and individual students did not always have control over the entire work
process. This lack of control, coupled with a lack of trust in their classmates’ ways of working and
the quality of their work, could be a major source of stress.

In this way, the mental health of the studied population is linked to subjective, psychological,
emotional, and above all, perceptual variables regarding their abilities to react to academic reality
and family economic reality. This means that academic stress for these students is more psychoe­
motional than operational, more subjective than linked to objective variables, and therefore, the
impact it generates at a psychoemotional level is related to how the student perceives themselves
in terms of their possibilities for action in the environment.

It is interesting to note that the study found the opposite of the results obtained in the study
conducted by Restrepo et al. (2020). While they assumed that academic stress was determined by
objective conditions, our research provided evidence to the contrary, showing that stress is
primarily influenced by the individual’s subjective perception of their ability to cope with academic
demands (such as self-demand, beliefs of self-sufficiency, perception of self-efficacy, and personal
expectations), as well as the need to depend on group study to achieve positive academic out­
comes. This indicates that the process of academic stress in this context can be addressed from
a cognitive-behavioral perspective, as opposed to other studies that point to external factors as
stressors for students.

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From an academic perspective, both teachers and students have had to adapt to virtual educa­
tion, changing their habits, routines, and even the way in which teachers teach and students learn.
This shift to virtual and subsequently hybrid learning has had an impact on the results presented in
our research, as students have had to exert more effort to adapt to studying at home, in
environments that are sometimes shared with their entire family, and in many cases where they
have had to share technological resources with parents and siblings (Ariyo et al., 2022). All of this
has required an additional self-learning effort on the part of the students, as noted by Pardeshi
et al. (2022), who found that self-learning was one of the factors that negatively affected learning
during the COVID-19 pandemic, as students had to complete homework, tests, and group work to
maintain and improve their grades.

The relationship between the incidence of academic stress and students’ mental health indicates the
importance of the academic environment and related experiences on students’ psychological, emo­
tional and social well-being. The dimensions that show a greater connection with mental health are
psychological and emotional well-being, suggesting that the possibility of positive functioning is
mediated by the way in which the person lives that stress experience, by the individual coping capacity
and the perception of personal self-efficacy (Díaz et al., 2006). Considering that the greatest stressor is
the one generated by oneself, it can be inferred that the negative perception of the students about their
abilities to respond to the demands of the academic environment puts pressure on students who have
high levels of self-demand, personal or socio-family expectations (real or imaginary) that condition their
functionality. This can generate poor adaptation to the demands, dynamics, and academic processes.

Therefore, the need to respond to subjective demands from the environment, and particularly
from oneself, can lead to a constant feeling of dissatisfaction or even failure based on equally
subjective aspects of self-assessment. These are linked to the self-perception of sufficiency and
mental schemas about one’s abilities, such as being good, successful, unsuccessful, or useless.

The stressors of time management and group work, in this research show an important relation­
ship with the e-learning teaching model. Due to the lack of separation between home and
university, many students were unable to manage their time as effectively as before, as noted
by Heo et al. (2021), where time management plays a crucial role in the success of online learning.
In addition, effective communication plays a vital role in promoting positive virtual learning
(Penrod et al., 2022), and the communication between teachers and students and among students
themselves was not as smooth as it was in face-to-face classes. The quarantines during 2020 and
2021 made group sessions and coordination more challenging for students, as a result, the
stressor related to group management is evident in our research.

5. Limitations
The study had certain limitations that needed to be considered when interpreting the results,
primarily due to the presence of other factors that could have influenced mental health and
academic stress at the time of questionnaire completion. For instance, social, economic, and
cultural factors that were not assessed in this study could have had an impact.

The study acknowledged specific limitations that should be taken into consideration when
interpreting the results. Firstly, it should be noted that the study focused on a private university,
where students faced particular social, cultural, and economic conditions. These conditions may
have significantly differed from those of the students at a public university, which could have
influenced the results obtained and made it challenging to generalize the findings. Another
limitation to consider was the virtual modality imposed by the Ministry of Education regulations.
The shift to the virtual teaching-learning environment, inherent in the pandemic situation, intro­
duced new conditions that may have added pressure on students. Finally, adapting to online
teaching could have influenced active participation, interaction with teachers and classmates,
and potentially affected the academic stress levels of students.

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6. Conclusions and implications

This study found that Self-inflicted Stress, time management stress, group work stress, and
performance stress were predictors of mental health, supporting the hypothesis that there is
a negative relationship between academic stress and the mental health of university students.
Identifying specific stressors can help reduce and understand the impact of stress on mental
health, mitigate its damage, and lessen its negative impact on academic performance.
Implementing educational programs to prevent stress and its negative effects can enhance
students’ ability to cope with stressful situations.

Additionally, the results of the stepwise Hierarchical Multiple Linear Regression analysis showed
a relationship between academic stressors and the level of mental health in university students.
Some situations had a greater impact on the overall level of academic stress than others, with self-
generated stress being the most relevant stressor among the students in this research. This
suggests that students with lower self-efficacy and high demands and expectations regarding
their academic results and performance tend to perceive the academic environment as threaten­
ing. This could be due to having less confidence in their abilities or not trusting the work of their
classmates, particularly in group projects. The study also found a significant association between
the level of Languishing Mental Health and academic stressors (SIS, TMS, SGS, and RS). Therefore,
greater attention should be paid to this population of students, as high academic stressors predict
a higher probability of experiencing Languishing Mental Health.

The findings of this study on academic stress in university students and its impact on mental health
have relevant practical implications. First, it is important to focus on the virtual teaching/learning
modality, which requires rethinking the model and implementing support strategies and intervention
programs aimed at managing stress in the academic environment, particularly in the virtual modality.
It is essential to foster healthy university environments that promote the mental well-being of the
students, whether virtual or face-to-face. This could include initiatives such as better planning of
activities and work presentations, creating rest intervals during classes, implementing relaxation
spaces, sports or recreational activities, and promoting an adequate balance between academic
work and other activities of student life. Workshops on stress management and coping techniques,
time management, and self-perception of efficacy in relation to academic processes are also neces­
sary. Finally, the study’s results emphasize the need to raise awareness among teachers and academic
staff about the impact of stress on students’ mental health, train teachers to recognize the signs of
stress, and adapt teaching methodologies to reduce the academic load.

Future studies can be developed based on the findings of this research, focused on comparative
analysis in a post-pandemic context and complemented by measuring and identifying students’
emotions in the classroom.
5
Author details Department of Academic, Academic Vice President,
Pamela Córdova Olivera1 Universidad Privada Boliviana, Cochabamba, Bolivia.
E-mail: pcordova@upb.edu
ORCID ID: http://orcid.org/0000-0002-8644-3157 Disclosure statement
Patricia Gasser Gordillo2 No potential conflict of interest was reported by the author(s).
Hernán Naranjo Mejía3
Isabel La Fuente Taborga2
Alberto Grajeda Chacón4 Authors’ contributions
Alberto Sanjinés Unzueta5 In the study, Pamela Córdova, Patricia Gasser, and
1 Alberto Sanjinés contributed to its conception and
Center for Research in Economics and Entrepreneurial
Sciences, Universidad Privada Boliviana, Cochabamba, design. Hernán Naranjo and Pamela Córdova oversaw
Bolivia. the process of data collection, database development,
2 and data processing and analysis. Patricia Gasser, Isabel
Department of Organizational Psychology, Universidad
Privada Boliviana, Cochabamba, Bolivia. La Fuente, and Alberto Grájeda contributed to data
3 interpretation. The manuscript draft was written by
Data Analysis Center for Innovation and Academic
Quality, Universidad Privada Boliviana, Cochabamba, Pamela Córdova, Patricia Gasser, and Isabel La Fuente,
Bolivia. while Hernán Naranjo, Alberto Grájeda, and Alberto
4 Sanjinés reviewed and revised the draft. All authors
Research Center for Innovation in Information
Technology for Education, Universidad Privada Boliviana, participated in reading the final manuscript and
Cochabamba, Bolivia. approved its submission.

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Availability of data and materials
The datasets generated and analyzed during the current
study are not publicly available due to privacy restrictions
but are available from the corresponding author on rea­
sonable request. The data that can be provided will be
provided in a de-identified manner.
Ethical approval
The Ethics in Research Committee of the University
approved this study, and an ethical exemption letter was
issued. The identity of all participants has been
anonymized.
Citation information
Cite this article as: Academic stress as a predictor of
mental health in university students, Pamela Córdova
Olivera, Patricia Gasser Gordillo, Hernán Naranjo Mejía,
Isabel La Fuente Taborga, Alberto Grajeda Chacón &
Alberto Sanjinés Unzueta, Cogent Education (2023), 10:
2232686.
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