Longitudinal associations of academic stress with eating related patterns, nutrition, somatic indicators, and depressive symptoms in university students: A study protocol
This longitudinal, observational study to examine within-semester associations between AS and indicators of nutritional status, eating-related patterns, sleep quality, and depressive symptoms aims to generate evidence that can inform prevention-focused actions and early support strategies in university health contexts.
Abstract
Introduction Academic stress (AS) can be understood as a multidimensional form of chronic stress that has been linked to adverse patterns across physical and mental health in university students. This protocol outlines a longitudinal, observational study to examine within-semester associations between AS and indicators of nutritional status, eating-related patterns, sleep quality, and depressive symptoms. By integrating physiological, behavioral, and psychological indicators within a repeated-measures framework, the study aims to generate evidence that can inform prevention-focused actions and early support strategies in university health contexts. Hypotheses (i) Higher AS will be longitudinally associated with less favorable eating-related patterns, nutritional and somatic indicators, and higher depressive symptoms in university students. (ii) Higher AS will be associated with altered post-awakening cortisol dynamics, specifically a lower cortisol awakening response (CAR) and lower AUCi, together with a higher AUCg, and with higher salivary alpha-amylase (sAA) levels, consistent with stress-related activation of HPA-axis and sympathetic pathways. Design and participants A longitudinal, observational, nonexperimental design with repeated measurements will be implemented across three assessment cycles during an academic semester. A feasibility-based convenience sample will be recruited from undergraduate students (2nd to 4th year) enrolled in the Faculty of Medicine, University of Concepción (Chile). Students receiving psychological or pharmacological treatment will be eligible to reflect real-world heterogeneity and support ecological validity. Methods Data will be collected through standardized questionnaires, nutritional assessments, biological sampling, and wearable-derived somatic indicators. Electronic surveys administered via REDCap will assess AS, perceived stress, eating-related patterns, and depressive symptoms. Diet will be assessed through interviewer-administered nutritional interviews, including repeated 24-hour dietary recalls treated as time-specific observations and modeled longitudinally as time-varying measures, and complemented by diet-quality and dietary inflammatory potential indices. Wearable devices will record nonclinical somatic indicators, including heart rate, oxygen saturation, and sleep-related metrics during monitoring periods. Saliva will be collected twice per week during each assessment cycle to quantify salivary cortisol dynamics and sAA activity, and peripheral blood samples obtained at baseline and end of semester will be used to determine lipid profile, fasting glucose, albumin, globulin, and total proteins. Statistical analysis Analyses will include descriptive and bivariate summaries, followed by multivariable models appropriate to outcome type. Longitudinal associations will be examined using mixed-effects models, and temporal cross-lagged associations will be explored using random-intercept cross-lagged panel models across the three assessment cycles. All inferences will be framed as associational given the observational design. Expected results Rather than prespecifying outcomes, this protocol is expected to generate longitudinal evidence on how within-semester variation in AS aligns with eating-related patterns, diet, nutritional and somatic indicators, depressive symptoms, and stress-related physiological indicators (salivary cortisol dynamics and sAA activity). The integrated, feasibility-oriented measurement framework may serve as a replicable template for future research and inform prevention-focused actions to support student well-being in university settings.
Psychological stress among university students represents an increasingly significant public health issue. This stress affects multiple interconnected systems: mental health, eating behaviors, appetite regulation, and metabolic processes. Understanding these connections is essential for developing comprehensive approaches to student well-being. When students experience chronic stress, their bodies release glucocorticoids, which trigger a cascade of physiological changes. These hormonal shifts can suppress appetite, disrupt nutrient metabolism, reduce insulin sensitivity, and promote the accumulation of visceral fat. Together, these effects elevate the risk of obesity and related metabolic disorders. This study explores how psychological stress, eating behaviors, and nutritional status interact in university students. It considers the prevalence of stress-related nutritional issues, identifies whether these effects differ between genders, and explains the biological and behavioral mechanisms at work. The goal is to provide evidence-based insights that can inform mental health interventions and strategies to support student well-being.
Yashwanth G Naik, Skanda A G., Meghana A T. et al.· International journal of res...· 0 citations
Academic stress has been associated with psychological distress, unhealthy behaviors, and poorer academic functioning among university students, particularly in health sciences programs. This study examined the association between academic stress and perceived academic impairment, considering five eating behavior phenotypes as parallel indirect pathways. A quantitative cross-sectional study was conducted with 225 undergraduate health sciences students from a public university in southeastern Mexico. Academic stress was assessed using the SISCO Academic Stress Inventory, eating behavior phenotypes using the Eating Behavior Phenotypes Scale, and perceived academic impairment using the recoded University Academic Performance Scale. Parallel multiple-mediator path analysis with bootstrap confidence intervals was performed, adjusting for relevant sociodemographic and academic covariates. Academic stress was positively associated with all five eating behavior phenotypes, which were, in turn, positively associated with perceived academic impairment. The total indirect effect was significant, and all specific indirect pathways were supported by bootstrap confidence intervals excluding zero. The direct association between academic stress and perceived academic impairment also remained significant. These findings suggest that multidimensional eating behavior may represent an important mechanism linking academic stress with perceived academic impairment. Given the cross-sectional design, the findings should be interpreted as indirect associations rather than evidence of causal or temporal mediation.
N. Torres-Soto, Brandon Pérez-Zepeda, Yann Alfredo Aguilar-Navarro et al.· Psychology International· 0 citations
Abstract Introduction Depression and occupational burnout are prevalent mental health challenges in working-age populations and are linked to adverse health behaviors, with these concerns particularly relevant among individuals with obesity. Although prior research suggests associations with eating behaviors and physical activity, most studies rely on cross-sectional designs, leaving the temporal and potentially bidirectional relationships between mental health and health behaviors unclear. Methods This longitudinal study examined bidirectional associations between depressive and burnout symptoms, eating behavior, and physical activity among occupational health clients with obesity (N = 110; BMI 30–40 kg/m2) participating in a 12-month behavioral intervention. At baseline, the mean age was 50.8 years and mean BMI 34.2 kg/m2; 17% were male and most were white-collar workers. Assessments at baseline, 6, and 12 months included depression (BDI-21), burnout (BBI-15), eating competence (ecSI 2.0), dietary behaviors (TFEQ-R18), and physical activity (BHPAQ). A random-intercept cross-lagged panel model (RI-CLPM) was used to examine within-person longitudinal associations. Results Higher depressive symptoms predicted subsequent decreases in eating competence and increases in emotional eating, although the depression–emotional eating association was derived from a traditional CLPM rather than an RI-CLPM model due to convergence issues. Elevated burnout symptoms predicted subsequent increases in emotional eating and decreases in physical activity. In addition, emotional eating predicted later burnout symptoms. No longitudinal associations were observed between depression and physical activity, or between depression or burnout and uncontrolled eating. Discussion Elevated depressive and burnout symptoms may predispose individuals to less healthy behaviors, potentially limiting the effectiveness of health interventions. These findings highlight the interplay between mental health, eating, and physical activity, suggesting that addressing psychological distress in behavior change programs may improve outcomes for individuals with elevated depression and burnout. Clinical trials gov NCT04785586; RR2-10.1016/j.conctc.2020.100638.
Siniriikka A. Männistö, Joona Muotka, L. Suojanen et al.· Health Psychology and Behavi...· 0 citations
BACKGROUND
Psychological distress among university students is a pressing public health concern. Emerging research in nutritional psychology links eating patterns to mental health outcomes, while emotion regulation processes shape individual stress responses. Female university students in Pakistan are particularly vulnerable due to compounding sociocultural pressures, rigorous academic demands, and limited mental health resources. This cross-sectional study investigates the association between eating patterns and psychological distress in this demographic, specifically examining whether cognitive reappraisal (an adaptive emotion regulation strategy) moderates this relationship.
METHODS
Data were collected via purposive sampling from 354 female university students in Lahore, Pakistan. Assessments utilized the Healthy Eating Index (HEI) for dietary patterns, the Emotion Regulation Questionnaire (ERQ) for cognitive reappraisal, and the Depression Anxiety Stress Scales-21 (DASS-21) for psychological distress. Data were analyzed using Pearson correlations, linear regression, and hierarchical moderation.
RESULTS
Healthier eating patterns were significantly associated with reduced levels of depression (r = - .233, p < .001), anxiety (r = - .174, p < .05), and stress (r = - .192, p < .05). Cognitive reappraisal correlated positively with healthier eating (r = .215, p < .05) and negatively correlated with depression (r = - .412, p < .01), anxiety (r = - .367, p < .01), and stress (r = - .389, p < .01). Regression models confirmed that eating patterns significantly predicted depression (β = - 0.23, p < .01), anxiety (β = - 0.17, p < .05), and stress (β = - 0.19, p < .01). Moderation analyses indicated that cognitive reappraisal significantly moderated the relationship between eating patterns and psychological distress (interaction β range = - 0.12 to - 0.17), explaining an additional 2-3% of variance. Specifically, higher cognitive reappraisal strengthened the protective association between healthier eating patterns and lower psychological distress while attenuating distress associated with unhealthy eating patterns.
CONCLUSION
Healthier eating patterns and higher levels of cognitive reappraisal were associated with lower psychological distress among young women in academic settings. Cognitive reappraisal appeared to play a protective moderating role by strengthening the beneficial association between healthier eating patterns and lower levels of depression, anxiety, and stress while reducing psychological vulnerability associated with poorer eating habits. These findings highlight the importance of holistic university mental health initiatives that integrate nutritional awareness with adaptive emotion-regulation training to promote psychological well-being among female students.
A. Qamar, Ayesha Sarfaraz, A. Khalid et al.· BMC Women's Health· 0 citations
Excess body weight, low PA, and low F/V consumption were associated with poorer mental health indicators, highlighting the importance of integrated health-promotion strategies among university students.
INTRODUCTION
Adolescent-onset type 2 diabetes (T2D) has increased in prevalence in recent decades. However, the efficacy of preventative interventions targeting health behaviours is limited, and key developmental factors that may influence effectiveness, such as executive functioning (EF) and stress, are often overlooked. Within-person fluctuations in EF and stress are linked to the adoption and maintenance of physical activity, a critical component of T2D prevention, yet little is known about the between- and within-person temporal variability of these constructs or their relationship with physical activity in adolescents at risk for T2D. Ecological momentary assessment (EMA) is ideal to capture these processes in real-time to inform intervention development and personalisation.
METHODS AND ANALYSES
We will enrol a subset of participants from a larger intervention study involving assigned-female-at-birth adolescents aged 12-17 years, with elevated depression symptoms (CES-D≥21) and T2D risk (BMI≥85th percentile) and diabetes family history. Prior to the intervention, a minimum of 50 participants will complete a 7-day EMA protocol consisting of repeated daily gamified EF assessments and brief surveys about EF, stress and physical activity. Participants will simultaneously wear an activity monitor to provide objective measures of physical activity. Recruitment began in Spring 2024 and is ongoing. Multilevel models will be used to separate between- and within-person variability and to estimate short-term lagged within-person associations between EF/stress and subsequent physical activity across 15-60 min windows. Primary analyses are planned for Winter 2026.
ETHICS AND DISSEMINATION
The Colorado Multiple Institutional Review Board approved this study (COMIRB#22-0180). Findings will be disseminated in peer-reviewed journals and conference presentations.
TRIAL REGISTRATION NUMBER
NCT05543083.
Ana M. Gutierrez-Colina, Abigail Neiser, Stephen R. Aichele et al.· BMJ Open· 0 citations
