International Journal of School & Educational Psychology

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Effects of stress on students' physical and mental

health and academic success

Nilani L. Shankar & Crystal L. Park

To cite this article: Nilani L. Shankar & Crystal L. Park (2016) Effects of stress on students'
physical and mental health and academic success, International Journal of School & Educational
Psychology, 4:1, 5-9, DOI: 10.1080/21683603.2016.1130532

To link to this article: https://doi.org/10.1080/21683603.2016.1130532

Published online: 16 Feb 2016.

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INTERNATIONAL JOURNAL OF SCHOOL & EDUCATIONAL PSYCHOLOGY
2016, VOL. 4, NO. 1, 5–9
http://dx.doi.org/10.1080/21683603.2016.1130532

ARTICLE

Effects of stress on students’ physical and mental health and academic success
Nilani L. Shankar and Crystal L. Park
Department of Psychology, University of Connecticut, Storrs, Connecticut, USA

ABSTRACT KEYWORDS
Stress affects students in multiple ways. This article provides a conceptual overview of the direct (e.g., stress; students; health
psychoneuroimmunological, endocrine) and indirect (health behavior) pathways through which behaviors; physiology;
stress affects physical health, the psychological effects of stress on mental health, and the cognitive cognition; psychoneuro-
effects of stress (e.g., attention, concentration) on academic success. We review relevant literature immunology; mental
health; physical health;
highlighting these links and suggest directions for future research and interventions. academic performance

In the United States, the percentage of students who
experience stress in school is at 48% (World Health
Organization [WHO], 2006). Regardless of socioeco-
nomic status, reported perceived stress was shown to
increase with age and students in the United States
ranked higher for perceived stress compared to
international students (WHO, 2006). In particular, the
stress statistics are alarming for teen students. According
to a 2013 American Psychological Association (APA)
report, Stress in America: Are Teens Adopting Adults’
Stress Habits?, American teens have stress levels similar to
or greater than those of adults. The survey also found that
83% of teens reported that school is a significant source of
stress and that unhealthy behaviors associated with stress
may begin manifesting early in life. More specifically,
10% of teens reported receiving lower grades than they
are capable of due to stress, more than half (59%) of teens
reported that managing their time to balance all of their
activities is a “somewhat” or “very significant” stressor,
40% of teens reported they neglect their responsibilities
at home due to stress, and 21% of teens report neglecting
their work or school responsibilities due to stress.
Furthermore, 26% of teens reported snapping at or being
short with classmates or teammates when stressed, 29%
of teens reported general procrastination due to stress,
and 17% of teens reported that social stress causes them
to cancel social plans with friends or family (American
Psychological Association [APA], 2013).
In the present article, we examine some of these effects
of stress on students’ lives in more detail. We begin with a
description of stress and then present a model of its effects
on (a) physical health, (b) mental health, and (c) academic
performance. Our model of these effects suggests that
stress exerts its effects in terms of (a) physiological effects,
(b) health behavior, and (c) cognitive effects as well as
directly on mental health. Next, the effects of stress on
these outcomes will be described. Lastly, the mediating
pathways of physiological effects, health behaviors, and
cognitive effects are discussed (see Figure 1).
Defining and conceptualizing stress and
its effects
Stress is conceptualized as having physical and
psychological components (Lovallo, 2005). Physical
components of stress are those related to direct material
or physiological challenges to the body while psycho-
logical components involve an individual’s perception
of life circumstances. According to Dougall and Baum
(2012), these two components may be examined in three
ways: (a) stress as the environment, whereby stress is
viewed as a physical or psychological stimulus (e.g.,
stressors); (b) stress as a response (e.g., how one reacts
to stressors); and (c) stress as a process (Lazarus, 1999;
Lazarus & Folkman 1984). This latter view emphasizes a
process in which stress is defined according to stressors,
strains, and the relationship between a person and his or
her environment. Stress is neither solely a stimulus nor a
response because the person is influencing the impact of
a stressor through behavioral, cognitive, and emotional

CONTACT Crystal L. Park crystal.park@uconn.edu Department of Psychology, University of Connecticut, Unit 1020, Storrs, CT 06269, USA.
Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/usep.

q 2016 International School Psychology Association

6 N. L. SHANKAR AND C. L. PARK
Physiological
Effects
Health
Behaviors
Stress
Cognitive
Effects
Figure 1. Model of effects of stress on physical and mental health and academic performance.
strategies. We refer to stress comprehensively in this
article as “the circumstance in which transactions lead a
person to perceive discrepancy between the physical or
psychological demands of a situation and the resources of
his or her biological, psychological, or social systems”
(Sarafino & Smith, 2014, p. 59).
In this article, we first provide a conceptual model
of how stress affects physical and mental health and
academic performance, with a focus on children and
adolescents. In our model (see Figure 1), the effects of
stress on physical health are mediated by both direct
physiological effects and through the indirect effects of
health behaviors; and the effects of stress directly impact
mental health, while the effects of stress on academic
performance are mediated by the effects of stress on
cognition. We highlight the links in this model with a
brief review of relevant empirical studies and conclude
with directions for future research and interventions.
Research on the effects of stress
Stress has myriad effects on students’ health and
functioning. As shown in Figure 1, some of these effects
are mediated through other processes. In this section, we
review studies that examine associations between stress
and different types of health.
Physical health
The adverse effects of stress on physical health in
students have been well-documented (Klainin-Yobas
et al., 2014; Molnar, Sadava, Flett, & Colautti, 2012). In a
2013 cross-sectional, correlational study among a sample
of Thai nursing students, those with high stress levels
reported poorer physical health, which was strongly
associated with their psychological distress (Klainin-
Yobas et al., 2014). Stress has also been found to be one
of the main mechanisms linking perfectionism to health
indices (Molnar et al., 2012). More specifically, socially
Physical Health
Mental Health
Academic
Performance
prescribed perfectionism is associated with poorer
physical health (Molnar et al., 2012).
In recent years, researchers have been establishing the
pathways through which stress exerts impacts on physical
health. Its influences have been traced to both
physiological pathways including impaired immune
functioning and cardiovascular stress, and through poor
health behaviors. Physical stress affects hypothalamic-
pituitary-adrenal (HPA) activity, resulting in increased
cortisol release (Dickerson & Kemeny, 2004). However,
excess HPA axis activity leads to too much cortisol release
and results in negative health effects, including physical
health impairment (Dickerson & Kemeny, 2004).
Perceived control (PC) and locus of control (LOC) are
other factors affecting students’ biological responses to
stress. PC and LOC may impact the cortisol response to
stress in some undergraduate students, such that students
with more internal LOC experience smaller cortisol
responses to stressors when they perceive themselves as
having some control over the stressor (Bollini, Walker,
Hamann, & Kestler, 2004). In addition to cortisol
responses, stress also affects serum leptin (an anti-obesity
hormone) levels in students (Haleem, Inam, Haider,
Perveen, & Haleem, 2015). Research has shown serum
leptin levels are positively correlated with academic
performance (Haleem et al., 2015). This suggests that
serum leptin is a stress perception biomarker that
mediates the effects of stress on students’ cognition.
Research shows that stress also affects students
indirectly, through poor health behaviors. One study of
children ages 5 – 12 years old found that higher stress
levels may contribute to less physical activity and more
sweet food consumption, emotional eating, restrained
eating, and external eating (Michels et al., 2015). Another
study found that for older children, ages 16–18 years
old, the health symptoms of headache, tiredness, sleep
difficulties, and musculoskeletal pain were positively
correlated with stress levels (Wiklund, Malmgren-
Olsson, Öhman, Bergström, & Fjellman-Wiklund,
2012). Substance abuse has also been noted as a health
 INTERNATIONAL JOURNAL OF SCHOOL & EDUCATIONAL PSYCHOLOGY
behavior related to student stress (Bobadilla & Taylor,
2007; Park, Armeli, & Tennen, 2004). Low physiological
reactivity and perceived inability to cope with stressors
has been linked to greater substance abuse in college-aged
students (Bobadilla & Taylor, 2007). In particular, female
college students who drink to cope with stress had
indicators of HPA axis overregulation (e.g., higher basal
levels of cortisol and dehydroepiandrosterone [DHEA]),
while their stress response remained flat (Wemm et al.,
2013). This may increase overall stress and may motivate
more drinking (Wemm et al., 2013). Stress has also been
linked to many other student health behaviors including
disordered eating (Osberg & Eggert, 2012; Wichianson,
Bughi, Unger, Spruijt-Metz, & Nguyen-Rodriguez, 2009)
and poor diet and exercise habits (Mouchacca, Abbott,
& Ball, 2013).
Mental health
Recent studies demonstrate high levels of psychological
problems due to students’ stress overload. These issues
include anxiety, panic attacks, and depression (Eisenberg,
Hunt, Speer, & Zivin, 2011; Morris, Ciesla, & Garber,
2010). Study findings suggest that onset of depression
in adolescents can be predicted by both stable and
fluctuating connections between stressful life events,
maternal depression history, and adolescents’ own
history with depression (Morris et al., 2010).
The connections between stress and psychological
issues may be moderated through specific skills and
resources. For instance, the relationship between stress
and depression may be partially influenced by individ-
uals’ stress management self-efficacy (Sawatzky et al.,
2012). Self-concept clarity and self-esteem have also been
shown to influence the association between stress and
depression, specifically for high school students (Chang,
2001). For numerous mental health issues, vigorous
physical activity and socialization have been shown to
reduce poor mental health and perceived stress in
college-aged students (VanKim & Nelson, 2013).
Emotional-focused coping strategies (e.g., self-help,
planning) are widely used stress management strategies
in both undergraduate men and women (Brougham,
Zail, Mendoza, & Miller, 2009). Emotion-focused coping
strategies such as self-help and planning involve
emotional expression and altering one’s expectations
(Brougham et al., 2009).
Academic performance
The effects of stress on academic performance have also
been widely noted. Of particular importance is the
relationship between chronic stress and poor grades. For
7
middle school students, higher amounts of school
transition stress (e.g., transitioning from one school to
another school) predicted lower grades (Goldstein, Boxer,
& Rudolph, 2015). For high school students and college
undergraduates, severe perceived stress symptoms related
to poorer final grades and academic performance
(Bachrach & Read, 2012; Schraml, Perski, Grossi, &
Makower, 2012). The major sources of stress for
undergraduate students that affected their academic
performance were course load, sleep issues, and social
activities (Talib & Zia-ur-Rehman, 2012). One study of
medical students found that those who were more stressed
suffered from poor sleep quality and performed worse on
tests (Ahrberg, Dresler, Niedermaier, & Genzel, 2012).
Mental illness in students contributes to stress and thus
affects their academic performance. For instance, in
undergraduate students, posttraumatic stress disorder
(PTSD) during the first year of university adversely affected
academic performance (Bachrach & Read, 2012). Further-
more, the students in that study who developed PTSD had a
lower grade point average and experienced greater alcohol
abuse at the end of their freshman year. To counteract
the negative effects of stress on academic performance,
moderate to vigorous physical activity, strength training,
fruit and vegetable intake, and adequate sleep have been
shown to be beneficial and are recommended (Wald,
Muennig, O’Connell, & Garber, 2014).
Implications for interventions
The effects of stress on students’ physical health and
academic success are widespread, affecting physiology,
health behaviors, and cognition. These consequences can
then impact students’ physical health, mental health, and
academic performance. In elementary-aged students,
interventions for promoting stress recovery, social
interaction, and social competence may be helpful to
counteract the negative effects of stress on physical health
and academic performance (Mathewson et al., 2012). For
example, Coping Power, a school-based intervention
program emphasizing social and emotional skills needed
during the transition to middle school, may be a useful
intervention for improving students’ stress management
and coping strategies (U.S. Department of Education,
2011). The recent research on school-based mindfulness
interventions also appears promising. Mindfulness
interventions have been found to help middle school
students to significantly decrease their perceived stress
(Edwards, Adams, Waldo, Hadfield, & Biegel, 2014).
In college-aged students, mindfulness helped to change
perceived stress, sleep problems, and self-compassion
(Greeson, Juberg, Maytan, James, & Rogers, 2014). Brief
mindfulness-based stress reduction (MBSR) programs
8 N. L. SHANKAR AND C. L. PARK
may improve students’ psychological functioning.
However, longer MBSR programs may be needed to
improve students’ psychological distress (e.g., trait
anxiety; Bergen-Cico, Possemato, & Cheon, 2013).
For college-age students, it is recommended that higher
education staff in student health services, student housing,
and student affairs continue to seek ways to support
students’ academic success through referrals to student
health or mental health services (Pedersen, 2012).
Additionally, university administration, faculty, and
parents should focus on effective psychological services
and stress management programs to help students achieve
academic success (Talib & Zia-ur-Rehman, 2012).
Summary
This article provided a brief conceptual overview of the
direct and indirect pathways that stress affects students’
physical health, mental health, and academic performance.
We reviewed relevant research that investigated the effects of
stress on students in elementary grade levels to college-aged
undergraduate students. We also suggested directions for
future interventions. In conclusion, we argue that school-
based mental health practitioners are in a unique role to
intervene with students of diverse ages and backgrounds
affected by stress. To be effective, these practitioners should
have a firm knowledge base on how stress affects students’
health and be familiar with effective school-based interven-
tions (e.g., mindfulness, student health, and mental health
service referral) to use in practice with these students.
About the authors
Nilani Shankar is a school psychology intern at Waterford Public
Schools in Waterford, Connecticut, USA. She is a school
psychology PhD candidate at the University of Connecticut.
Her research focuses on mind-body interventions (e.g., hypnosis,
mindfulness, yoga, biofeedback) for children and adolescents in
school and pediatric settings.
Crystal Park, PhD, is a professor at the University of Connecticut,
Department of Psychology and Director of the Graduate
Certificate Program in Health Psychology. She is a researcher
through the University of Connecticut Center for Health,
Intervention, and Prevention. Her research focuses on stress and
coping, religiosity/spirituality, meaning-making, stress-related
growth, and health psychology.
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