Study of perceived academic stress and salivary cortisol levels among medical students: a cross-sectional observational study.
DOI:
https://doi.org/10.51168/sjhrafrica.v7i2.2652Keywords:
academic stress, medical students, perceived stress, salivary cortisol, undergraduate medical educationAbstract
Background.
Medical training is academically demanding and can produce sustained psychological stress, with activation of the hypothalamic-pituitary-adrenal axis reflected by salivary cortisol.
Objectives.
To assess perceived academic stress, measure salivary cortisol, and examine their association according to sex and year of study among medical students.
Methods.
This cross-sectional observational study included 100 undergraduate medical students at Jaipur National University Institute for Medical Sciences and Research Centre, Jaipur, from August 2025 to April 2026. Participants were recruited across four MBBS years using stratified convenience sampling. Perceived stress was assessed with a structured questionnaire based on the 10-item Perceived Stress Scale, and morning unstimulated saliva was collected for cortisol estimation. Means, standard deviations, percentages, independent-samples t tests, one-way analysis of variance, and Pearson correlation were used.
Results.
Participants had a mean age of 20.8 ± 1.6 years, and 58% were female. Moderate stress was present in 52%, whereas 30% had high stress. Mean salivary cortisol increased from 8.9 ± 2.1 ng/mL in the low-stress group to 12.3 ± 2.8 ng/mL in the moderate-stress group and 16.4 ± 4.0 ng/mL in the high-stress group (p < 0.001). Females had higher mean stress scores than males (25.8 ± 6.1 vs 23.2 ± 6.2; p = 0.041). Final-year students recorded the highest stress and cortisol values. Stress scores correlated positively with salivary cortisol (r = 0.62, p < 0.001).
Conclusion.
Academic stress was frequent and showed a clear positive association with salivary cortisol, indicating measurable neuroendocrine activation among students with greater perceived stress.
Recommendations.
Medical colleges should integrate periodic stress screening, mentoring, counselling, and wellness support, particularly for senior students and female students.
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