Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-27T06:30:33.795Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  09 October 2017

J. O’Flynn
Affiliation:
Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
T. G. Dinan
Affiliation:
Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland APC Microbiome Institute, University College Cork, Cork, Ireland
J. R. Kelly*
Affiliation:
Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland APC Microbiome Institute, University College Cork, Cork, Ireland
*
*Address for Correspondence: Dr J. R. Kelly, Lecturer in Clinical Psychiatry, Department of Psychiatry and Neurobehavioral Science, Rm 5.38, Biosciences Institute, University College Cork, College Road, Cork, Ireland. (Email: johnkelly@ucc.ie)

Abstract

Objectives

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

Methods

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

Results

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

Conclusions

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

Type
Short Report
Copyright
© College of Psychiatrists of Ireland 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

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