REVIEW ARTICLE

https://doi.org/10.1057/s41599-025-04484-w OPEN

Theoretical underpinnings and future research on

academic stress in biological and educational
perspectives
Wasis Wuyung Wisnu Brata1,2, Hendra Susanto1 ✉ & Siti Zubaidah1
1234567890():,;

Academic stress, which is a frequent experience for university students, has been demon-
strated to have a considerable effect on their academic performance. However, the con-
ceptual basis linking the biological mechanism of stress with educational outcomes remains
fragmented. This systematic literature review seeks to synthesize current knowledge on the
biological and educational perspectives of academic stress and its impact on student per-
formance. Using the PRISMA framework, a comprehensive search was conducted in the
Scopus database, yielding an initial pool of 4054 articles. After applying predefined inclusion
and exclusion criteria focused on academic stress in university students, 31 articles were
selected for detailed analysis. The review identifies four key theoretical foundations: the
neurocognitive aspects of stress and performance, the neurophysiology of stress, epigenetic
regulation of stress, and stress and genetic variations. Based on these insights, the study
proposes three main directions for subsequent studies: enhancing the understanding of stress
mechanisms, developing effective educational interventions, and employing interdisciplinary
approaches in subsequent studies. These findings aim to provide a comprehensive framework
for optimizing academic performance by deepening our understanding of the biological and
educational dimensions of stress.

A
Introduction
cademic stress is a physiological, emotional, cognitive, and behavioral response to stimuli
that can influence students’ capacity to adjust to the educational setting (Pozos‐Radillo et
al. 2016). This multifaceted nature of academic stress aligns with the bio-psycho-social
paradigm (WHO, 2001), which highlights the integration of biological, psychological, and social
components in understanding stress. Stress is also defined as an adaptive systemic process that
consists of three stages: perceiving a stressor, experiencing systemic imbalance manifested as
symptoms, and responding to restore equilibrium. Three components identified in this systemic
process are the stimuli that trigger stress, the symptoms indicating imbalance, and coping
strategies (Castillo-Navarrete et al. 2024). Academic stress among university students can be
caused by factors such as academic workload, poor peer relationships, inadequate facilities, and

1 Department of Biology, Faculty of Mathematics and Natural Sciences, Universitas Negeri Malang, Malang, Indonesia. 2 Department of Biology, Faculty of

Mathematics and Natural Sciences, Universitas Negeri Medan, Medan, Indonesia. ✉email: hendrabio@um.ac.id

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academic demands that exceed students’ adaptive capacities Research has investigated the interaction between BDNF and
(Bedewy and Gabriel, 2015; Reddy et al. 2018). This phenomenon cortisol during acute stress, revealing that serum BDNF levels are
is particularly common among students, especially those studying responsive to stress and that there is an antagonistic relationship
in fields with extensive content, and can significantly impact their between BDNF dynamics and cortisol (Linz et al. 2019).
overall development during their education (Briones et al. 2024). A variety of biological parameters have been extensively used
Various studies have measured the levels of academic stress to detect psychological stress; however, the current literature lacks
experienced by students and identified its triggers through sur- a thorough examination of the relationship between these bio-
veys and rating scales (Mayya et al. 2022; Špiljak et al. 2022). A logical markers and academic performance. For instance, studies
survey of university students found an academic stress prevalence indicate that levels of BDNF and cortisol are crucial for under-
of 51.1%, with workload, time constraints, and academic diffi- standing stress (Ballestar-Tarín et al. 2024), but their direct
culties being the main stressors (Zamroni et al. 2018). Several impact on academic achievement is underexplored. Similarly,
studies confirm a significant correlation between academic stress heart rate variability and sAA have been identified as significant
and students’ mental well-being (Córdova Olivera et al. 2023; indicators of stress (Armario et al. 2020; Brodersen and Lorenz,
Barbayannis et al. 2022; Ojewale, 2020). High-stress levels among 2020), yet knowledge of how these physiological responses cor-
university students are associated with persistent mental health relate with students’ academic outcomes is limited. Existing stu-
issues and can affect their academic performance (Stirparo et al. dies primarily focus on the acute and chronic effects of
2024). psychosocial stress on these biological parameters (Hermann
Academic-related stress can lead to decreased academic et al. 2021; Castillo-Navarrete et al. 2023), but the specific bio-
achievement, reduced motivation, and an increased risk of mental logical mechanisms explaining how academic stress affects aca-
health problems, such as depression, anxiety, sleep disorders, and demic performance remain poorly understood. This gap indicates
substance abuse (Córdova Olivera et al. 2023; Pascoe et al. 2020; the need for further research to elucidate the biological basis of
Wyatt and Oswalt, 2013). Stress levels are found to be a sig- academic stress and its direct consequences on academic
nificant predictor of academic performance, with perceived stress achievement.
negatively impacting both mental health and academic perfor- Several systematic reviews have explored stress in academic
mance (Amhare et al. 2021; Javaid et al. 2024). In another study settings with various focuses and approaches. Jiménez-Mijangos
(Almarzouki, 2024), stress negatively affects cognitive functions et al. (2023) examined stress and anxiety detection methods in
such as working memory, which is crucial for academic skills, universities using psychological instruments and biological sig-
potentially reducing academic performance. nals. They analyzed advancements, limitations, challenges, and
Understanding the biological response to stress is crucial for potential research pathways for detecting stress in classrooms.
comprehending the mechanisms and impacts of stress and mental This study provided valuable insights, although it focused more
health (Nadal et al. 2021). Analysis at the micro level provides on psychological and biological aspects without directly linking
precise information about the biochemical, psychophysiological, them to academic performance. Conversely, Shanbhog and
and neurological processes underlying behavior. This level of Medikonda (2023) emphasized the detrimental effects of stress on
analysis is critical for developing models and insights related to students’ sleep quality, which can, in turn, influence their aca-
neuropsychological and neurophysiological disorders (de la demic performance. Nevertheless, the connection between stress
Fuente et al. 2019). Physiological parameters, such as heart rate and academic performance, especially within a biological frame-
variability and hormone levels, can be used as biological markers work, is still not well comprehended.
to objectively measure stress and its intensity (Armario et al. Although these two systematic reviews have made significant
2020). Studies reveal that academic stress has a significant impact contributions to the understanding of stress detection and its
on the cardiovascular system, leading to increased heart rate, effects on mental health and sleep quality, there is still a paucity
blood pressure, and reduced heart rate variability, indicating of research in this area that requires further investigation. One
sympathetic autonomic stress dominance (La Rovere et al. 2022; such gap is the lack of studies that directly link the biological
Seipäjärvi et al. 2022). parameters of stress in research with academic performance. The
A number of studies have shown that salivary alpha-amylase existing studies tend to focus more on stress detection meth-
(sAA) levels increase in response to psychological stress, such as odologies and their impact on specific health aspects, rather than
during exams or high-risk situations (Brodersen and Lorenz, comprehensively integrating biological and psychological per-
2020). sAA has been used to assess autonomic nervous system spectives. Secondly, a review of the literature on the use of various
function in clinical populations and shows secretion patterns that methodologies to detect stress reveals a lack of emphasis on the
could be valuable indicators of autonomic nervous system dys- theoretical framework that bridges the biological and psycholo-
function typically occurring in chronic stress-related pathologies gical parameters used to specifically influence academic perfor-
(Ali and Nater, 2020). These studies found a positive relationship mance. This highlights the necessity for a literature review that
between sAA and sympathetic nervous system activity during integrates biological and psychological perspectives to gain a
stress, indicating its sensitivity to psychosocial stress and potential deeper understanding of the mechanisms of academic stress and
use as a non-invasive measure of stress in clinical and research its impact on academic performance. To this end, this systematic
settings (Rashkova et al. 2012). literature review study was guided by several research questions
In addition to salivary alpha-amylase (sAA), other biological (RQs), namely:
markers, such as brain-derived neurotrophic factor (BDNF) and RQ1: What are the principal elements of research on the
cortisol, are essential for understanding the body’s stress relationship between stress and academic performance?
response. Levels of BDNF and cortisol are key indicators in stress RQ2: What are the theoretical or conceptual foundations
research (Jiang et al. 2017; Hermann et al. 2021; Castillo- employed in the stress and academic performance literature?
Navarrete et al. 2023). Harb et al. (2017) found that BDNF RQ3: What are some prospective avenues of inquiry in the field
protein levels were negatively correlated with hair cortisol and of academic stress and academic performance?
somatic complaints, while hair cortisol showed a positive corre- By identifying and analyzing limitations in previous studies,
lation with mental disorders. Acute and chronic psychosocial this study seeks to provide evidence-based recommendations for
stress, such as academic stress, can affect peripheral BDNF and future subsequent studies. These include new approaches to
cortisol levels (Myint et al. 2021; Castillo-Navarrete et al. 2023). measuring and analyzing academic stress, as well as interventions

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that can help college students manage stress and improve their related to academic performance, (2) The study population
academic performance. consists of university students, (3) The article is an original
research article, not a review, (4) Only open access articles, and
Methods (5) Articles are published in English.
The study employs a systematic literature review (SLR) approach, A comprehensive search of electronic databases was conducted
a desk-based research method characterized by its rigorous, using Scopus, resulting in a total of 4054 articles related to
standardized, and verifiable methodology. This ensures the review academic stress, depression, and anxiety. The articles were then
is replicable, transparent, objective, unbiased, and thorough filtered to focus on those emphasizing academic stress, depres-
(Višić, 2022; Boell and Cecez-Kecmanovic, 2015). The SLR sion, and anxiety, narrowing the selection to 1116 articles. At this
approach helps researchers systematically map the current state stage, 293 articles were excluded because their primary focus was
of the literature, providing a structured exploration of topics and not on stress, depression, or anxiety within the academic context
findings, and serves as a foundation for further investigations of university students.
(Pati and Lorusso, 2018). The subsequent criterion applied was the study population,
which had to be comprised of university students. This resulted in
the exclusion of 501 articles. Consequently, 615 articles were
Search strategy. The search for relevant literature was conducted excluded on the grounds that the population under consideration
using the Scopus database. Scopus is a prominent citation and included school students, university staff, professionals, or
indexing database that provides access to global peer-reviewed patients at a university hospital. Subsequently, the articles were
literature across a wide range of subject areas (Renjith and further screened to include only those published in English,
Pradeepkumar, 2021). Automated screening with user-friendly resulting in a total of 456 articles. This step excluded 45 articles
operations can save time and costs while enhancing search that were reviews, conference papers, letters, books, or articles not
accuracy with specific keywords (Van Dinter et al. 2021). in the English language. In the subsequent phase, the focus was
Leveraging advanced features in Scopus enables researchers to narrowed to include only open-access articles, reducing the
narrow their search to the most pertinent and current articles number to 222 articles. At this point, 234 articles were excluded
within their field of study. because they were not open access.
In order to obtain relevant data, this study utilized specific A manual screening process was conducted to ensure
keywords within the “search” menu of the Scopus database, eligibility, resulting in the final inclusion of 31 articles. During
employing Boolean conjunction operators to achieve a more this step, 190 articles were excluded for reasons such as being
focused result set. The key search comprised (TITLE (“academic related to pandemic-related stress, lacking biological measure-
stress” OR “academic-related stress” OR “exam stress” OR ments, not being related to academic performance, involving
“examination stress” OR “task stress” OR “work-load stress” unhealthy samples, not focusing on university students, or being
OR “perceived stress” OR “psychological stress” OR anxiety OR review articles. This process concluded with a total of 31 studies
depression) AND TITLE-ABS-KEY (biomarker OR molecular included in the review, following the stringent criteria outlined in
OR physiology OR physiological OR biology OR biological OR the PRISMA guidelines.
salivary OR saliva OR cortisol OR hormone OR genetic OR
epigenetic OR methylation OR bdnf OR neuron OR bmi OR
“body mass index”) AND TITLE-ABS-KEY (“academic perfor- Data extraction and analysis. The data and information from the
mance” OR “academic achievement” OR “academic success” OR collected 31 articles were tabulated using Microsoft Excel. The
grade* OR gpa OR cgpa OR score OR “academic attainment” OR extraction table contains information on the authors, year of
“academic outcome*“) AND TITLE-ABS-KEY (student* OR publication, research methodology, sample size, theoretical or
university OR college OR undergraduate OR graduate OR conceptual framework, biological parameters, psychological
postgraduate OR pre-service) AND NOT TITLE-ABS-KEY instruments, main results, and limitations of the study. The table
(school OR pupil* OR staff OR professionals OR patients)) proved invaluable in the recording of pertinent information
AND (LIMIT-TO (DOCTYPE, “ar”)) AND (LIMIT-TO (LAN- during the content analysis and synthesis phases. The data
GUAGE, “English”)) AND (LIMIT-TO (OA, “all”)). obtained from the reviewed articles were organized and subjected
A comprehensive selection technique was employed to identify to analysis. Subsequently, a textual narrative synthesis was con-
relevant articles, following the Preferred Reporting Items for ducted. Narrative synthesis is a method for combining and
Systematic Reviews and Meta-Analyses (PRISMA) guidelines, as summarizing data from multiple studies, relying on the use of
illustrated in Fig. 1. Using these search terms and patterns, we words and literature to describe the synthesis findings (Jahan
conducted the search on June 6, 2024, identifying 4054 articles et al. 2022).
related to academic stress, depression, and anxiety mentioned in
titles, abstracts, and keywords. To focus the analysis on this Results
theme, the first search was refined to include only articles where A systematic review was conducted using the Scopus database,
the keywords appeared in the title. which identified a large pool of studies related to academic stress,
depression, and anxiety. Through a rigorous multi-step screening
Inclusion and exclusion criteria. We applied the Preferred process, articles were filtered based on specific inclusion criteria
Reporting Items for Systematic Reviews and Meta-Analyses such as relevance to academic stress among university students,
(PRISMA) model to guide the inclusion and exclusion processes, availability in English, and open-access status. Additional manual
aiming to identify articles that strictly met the criteria. The screening ensured that only studies aligning with the review’s
PRISMA guidelines were developed to facilitate transparent and focus on academic stress, biological measurements, and academic
comprehensive reporting of systematic reviews, ensuring that the performance were included. This thorough process resulted in the
methods and results are detailed enough for users to assess the final selection of 31 articles. The detailed decision-making process
reliability and applicability of the review’s findings (Page et al. is presented in Fig. 1.
2021). The following key points formed the basis of the inclusion
criteria used in this systematic literature review (SLR): (1) The Key aspects of research. The analysis identified 31 relevant stu-
primary focus of the article is on stress, depression, or anxiety dies within the scope of research conducted across 19 countries.

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Fig. 1 PRISMA flowchart for the search strategy and selection procedure. The selection process resulted in 31 articles that met the criteria for further
analysis.

Two studies were conducted in African countries, namely Uganda We identified 12 studies that used 10 specific markers to
and South Africa. Eight studies were conducted in Europe, cov- discuss how academic stress biologically affects academic
ering Finland, the UK, Croatia, Germany, and Italy. Six studies performance. Some of these parameters utilized neurophysiolo-
were carried out in the US and Canada. Nine studies were con- gical, genetic, and epigenetic frameworks, linked to cognitive
ducted in Asian countries, including Hong Kong, Pakistan, psychology and educational concepts. Table 2 presents the types
Lebanon, Saudi Arabia, Iran, Japan, and India. Finally, six articles of parameters, the sample sizes used, and a discussion based on
were from South America, covering Chile, Brazil, and Mexico. All their findings, which contribute to understanding the relationship
articles reported research examining stress, anxiety, and depres- between stress and academic performance.
sion among university students. Each study used biological and
psychological approaches to identify stress and develop discus- Psychological instruments of stress measurement. All the studies
sions on the impact of stress on academic performance (Table 1). analyzed employed psychological instruments to detect psychoso-
cial stress related to academics. These tools allowed researchers to
Biological parameters. Thirty-four biological parameters were gather data on various aspects of mental health and behavior. The
used across the 31 studies analyzed. Some of these studies uti- most frequently used instrument was the State-Trait Anxiety
lized biological parameters to identify stress, depression, or Inventory (STAI), which appeared in 12 articles. The Abbreviated
anxiety status without necessarily explaining their interactions Mathematics Anxiety Scale (AMAS) was utilized in two articles to
with academic performance. For example, several studies assess mathematics anxiety. Other anxiety instruments, such as the
employed salivary proteins to detect the body’s response to Test Anxiety Inventory (TAI), Hamilton Anxiety Rating Scale
academic stress (Zallocco et al. 2021; Cai et al. 2018; Špiljak (HAM-A), and Generalized Anxiety Disorder Scale (GAD-7), were
et al. 2024). Cardiovascular parameters were also widely used also used, demonstrating validity and reliability across different
for detecting stress, depression, and anxiety across various populations. The Perceived Stress Scale (PSS) appeared in three
studies (Nakamura et al. 2010; Abromavičius et al. 2023; Cronje articles to measure perceived stress levels. The SISCO Inventory of
et al. 2024). A portion of these studies used biological para- Academic Stress (SISCO) was employed in two articles to evaluate
meters to evaluate the impact of interventions aimed at reducing academic stress among university students, focusing on stressors,
stress, anxiety, and depression (Harris et al. 2019; Mäkelä et al. symptoms, and coping strategies. The Visual Analog Scale (VAS)
2023; Usichenko et al. 2020). Cortisol, one of the most fre- was used in four articles to gauge the intensity of various subjective
quently used parameters, was found to be associated with stu- experiences, including academic stress, depression, and anxiety.
dents’ academic stress levels (Anjum et al. 2021; Jamieson et al. Additionally, the Depression Anxiety Stress Scale (DASS-21) was
2021). However, not all researchers explored how these biolo- employed in three articles to simultaneously measure depression,
gical parameters are related to and can explain their implica- anxiety, and stress. Lastly, the Beck Depression Inventory (BDI),
tions for academic achievement. used in three articles, assessed the severity of depression (Table 3).

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 Table 1 key aspects in the literature on stress and academic performance.

Authors (Year) Country Journal Biological parameters Psychological Research focus

instruments
Cronje et al. South Africa NeuroRegulation qEEG, HRV, BP, BVP, EDA, DASS-21 Stress biomarkers through
(2024) neopterin neurophysiological and
inflammatory parameters.
Špiljak et al. Croatia Behavioral science Salivary Cortisol Perceived Stress Scale Relationship between stress levels,
(2024) (PSS) cortisol and test scores.
Cardozo et al. Brazil Frontiers in Cortisol, α-amylase State-Trait Anxiety The effect of active learning on
(2023) Psychology Inventory (STAI) academic anxiety.
Abromavičius US Technology and Electrodermal activity – The effectiveness of physiological
et al. (2023) Health Care measurements (EDA), stress signals in value prediction
photoplethysmography, heart by evaluating models and feature
rate. selection techniques.
Castillo-Navarrete Chile PeerJ Plasma BDNF, Global DNA SISCO-II Inventory of Relationship between academic
et al. (2023) Methylation Academic Stress, Beck stress and BDNF and G-DNA-M.
Depression Inventory
(BDI)
Mäkelä et al. Finland Brain, Behavior & Cortisol STAI-state; sleep Investigating the effect of Lpc-37
(2023) Immunity- Health quality index (PSQI); in reducing stress in a chronic
VAS; DASS-21; HADS- exam stress model of college
14; Perceived Stress students.
Scale
Wong et al. Hongkong PlosOne Heart Rate Variability (HRV) State-Trait Anxiety Investigating the impact of stress
(2023) Inventory (STAI) on college students’ performance
and developing stress
management interventions.
Mujinya et al. Uganda Frontiers in Psychiatry Visual reaction time (VRT), audio Perceived Stress Scale; Effect of stress on VRT, ART, and
(2022) reaction time (ART), dan tacticle coping scale TRT in the somatosensory cortex.
reaction time (TRT)
Peter et al. (2023) Germany Gene, Brain dan Polygenic gene NPS dan NPSR1; Hospital Anxiety and Relationship between chronic
Behavior Cortisol Awakening Response Depression Scale stress response and overall
(CAR) (HADS); Ambulatory genetic variability of the
Assessment stress neuropeptide S system (NPS),
scale which consists of genes for NPS
and its receptor (NPSR1).
Tripathi et al. Saudi Arabia Journal of Applied Body Mass Index DASS-21 Stress affects academic
(2022) Pharmaceutical performance and BMI.
Science
Anjum et al. Pakistan European Journal of Cortisol, tiroid (T3&T4), – Effect of academic stress on
(2021) Inflammation antropometri, arylesterase dan academic performance.

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paraoxonase
Márquez-Morales Mexico Nutriens Gut microbiota composition SISCO academic stress Effect of fermented beverages in
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et al. (2021) reducing stress in college students

Zallocco et al. Italy International Journal Heart rate, salivary proteins State-Trait Anxiety Salivary Proteome Biomarkers of
(2021) of Molecular Science Inventory (STAI-Y2) College Students in Academic
Stress
Ibrahim and Audi Lebanon Journal of Health Vitamin D Hamilton Anxiety Prevalence of Academic Anxiety
(2021) Science Rating Scale (HAM-A) Symptoms and Its Relationship
with Vitamin D Status
Jamieson et al. U.S. Journal of Educational Cortisol, testosteron Abbreviated Relationships Between
(2021) Psychology Mathematics Anxiety Mathematics Anxiety, Affective
Scale (AMAS), Stress and Biological Responses, and
appraisal Academic Achievement
Brodersen and U.S. International Journal Salivary cortisol (sC) and salivary Stressor Appraisal Relationships Between Perceived
Lorenz (2020) of Nursing Education alpha amylase (sAA). Scale (SAS); Visual Stress, Physiological Stress
Scholarship Analog Scales (VAS) Responses, and Final Exam
Performance

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Table 1 (continued)
Authors (Year) Country Journal Biological parameters Psychological Research focus
instruments
Cardozo et al. Brazil Advance in Psy Edu Cortisol dan alpha-amylase saliva State-Trait Anxiety Active Learning and Academic
(2020) Inventory (STAI) Stress
Ferreira et al. Brazil BMC Medical Edu Salivary cortisol State-Trait Anxiety Relationship between physiological
(2020) Inventory (STAI) stress, test anxiety, self-efficacy,
and meaning that students
attribute to the experience
Malanchini et al. U.K. Translational Genetic similarity Abbreviated Math Relationship between math anxiety
(2020) Psychiatry Anxiety and low math self-confidence,
REVIEW ARTICLE

Scale (AMAS); interest, and ability and genetic

Generalized Anxiety factors.
Disorder Scale (GAD-7)
Pizzie et al. U.S. Social Cognitif and fMRI (Brain activity) Math Anxiety, State- Cognitive reappraisal to manage
(2020) Afective Neuroscience Trait Anxiety Inventory math anxiety and improve
performance
Usichenko et al. Germany PLoS ONE Salivary alpha-amylase (sAA), State-Trait-Anxiety Cognitive behavioral therapy and
(2020) blood pressure, heart rate Inventory (STAI) auricular stimulation
Cipra and Muller- Germany PLoS ONE Cortisol STAI-T, STAI-S, The Correlation between anxiety and
Hilke (2019) Approaches and Study students’ learning approaches
Skills Inventory for
Students
(ASSIST)
Harris et al. U.S. CBE-life sciences Heart rate Trait-based test anxiety Interventions to reduce test
(2019) education anxiety can improve test
performance in STEM students
Ringeisen et al. Germany Anxiety, Stress & Cortisol State anxiety; Academic Relationship between self-efficacy,
(2019) Coping self-efficacy anxiety, cortisol levels, threat
appraisal, and exam performance
Cai et al. (2018) Germany BMC Psychiatry Salivary alpha-amylase (sAA) Visual Analog Scale Attention bias modification (ABM)
(VAS) in stressed college students
Bedard et al. Canada Frontiers in Profile BDNF gene BDI; General Self- Relationship between BDNF gene
(2017) Psychology Efficacy Scale variation and loneliness and
depression
Tavakoli et al. Iran Asian Biomedicine BDNF (brain-derived neurotrophic Beck Depression Investigating the relationship
(2017) factor), trigliserid, colesterol, HDL, Inventory (BDI) between depression, BDNF, and
and LDL lipid levels that may increase the
risk of cardiovascular disease
Kabrita and Lebanon Nature and Science of Sleep quality Pittsburg Sleep Quality Analyzing the relationship
Hajjar-Muça Sleep Index (PSQI), CES between sleep habits, depression,
(2016) Depression Scale and psychoacademic status of
(CES-D) college students
Kato-Kataoka Japan Aplied and Leukocyte DNA microarray, gut STAI (State-Trait Effect of probiotic Lactobacillus
et al. (2016) Environmental Biology microbiota composition, salivary Anxiety Inventory), casei strain Shirota on stress-
cortisol Skala Analog Visual induced abdominal dysfunction in
(VAS) college students
Pradhan et al. India Journal of clinical and Pulse rate (PR), systolic-diastolic Student stress scale Measuring cardiovascular
(2014) diagnostic research: blood pressure (SBP/DBP) parameters, stress scores, and
JCDR cognitive functions.
Nakamura et al. Japan Journal of Brain activity, HRV State-Trait Anxiety Effect of hydrolyzed casein
(2010) Physiological Inventory (STAI) beverage derived from cow’s milk
Anthropology on relaxation and brain activity

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Table 2 Biological parameters of stress and their association with academic performance.

Biological parameters Authors (Year) Sample (n) Contribution to the concept of academic performance and stress
Brain wave (qEEG) Cronje et al. (2024) 158 Stress and anxiety are associated with decreased alpha waves and
increased delta waves in the left temporal lobe, which are associated
with learning and memory. This condition is thought to affect academic
performance.
Cortisol Cardozo et al. (2023) 139 High cortisol can impair memory, attention, and executive function, all of
which are important for academic performance. Stress hormones
indirectly affect learning circuits by impacting intermediate brain regions
like the hippocampus, amygdala, and tegmental nucleus of the striatum.
This leads to interference with the creation of strong memories.
Brodersen and Lorenz 43 It is possible that chronic stress due to frequent exams promotes HPAA
(2020) adaptation and reduces cortisol responses despite sympathetic nervous
system (SNS) responses and perceived stress.
Ferreira et al (2020) & 32 Self-efficacy might shield students from the adverse impacts of stress
Ringeisen et al. (2019) 92 and anxiety on their performance. The findings support the transactional
model of test anxiety, where self-efficacy is crucial in mitigating the
stress response (cortisol) and enhancing test performance.
Cipra and Muller-Hilke 98 There was a positive correlation between test anxiety and cortisol levels.
(2019) Additionally, surface learning approaches were associated with lower
test anxiety and improved learning outcomes, while strategic
approaches were linked to the least anxiety and the highest academic
success.
BDNF Castillo-Navarrete et al. 91 There may be a relationship between academic stress and BDNF levels.
(2024) BDNF is vital for dendritic branching, synaptic plasticity, and long-term
potentiation (LTP), influencing memory, learning, and, consequently,
learning outcomes.
Global DNA Methylation Castillo-Navarrete et al. 91 At the final assessment, the global DNA methylation percentage
(5-mC) (2024) increased from the baseline as stress levels rose. Psychosocial stress
can alter global DNA methylation patterns, impacting how individuals
perceive and physiologically respond to stressors. The rise in DNA
methylation may potentially lead to a reduction in BDNF levels. Further
research is needed to examine the methylation of specific BDNF genes
and related genes to clarify this relationship.
Heart Rate Variability (HRV) Wong et al. 2023 90 Students who experience higher stress and have lower HRV levels tend
to perform better academically. This could be because elevated stress,
up to an optimal point, may enhance their focus and improve their
performance. However, the precise optimal level of stress for peak
performance remains unclear. Additionally, high-achieving students with
lower HRV do not necessarily experience greater stress, as indicated by
non-significant STAI results. This might be due to their effective coping
strategies or other factors that require further investigation.
Visual and Auditory Reaction Pradhan et al. (2014) 100 The results of this study support the Execution Focus Model: Anxiety
Time (VRT, ART) affects performance by changing how a person focuses and uses
attentional resources, not simply because of resource limitations. Stress
affects how a person makes decisions and focuses attention via the
sympathetic nervous system and the HPAA.
Vitamin D Ibrahim and Audi (2021) 157 College students with anxiety symptoms had significantly lower levels of
Vitamin D. Vitamin D plays a key role in proliferation, differentiation,
neurotropism, neuroprotection, neurotransmission, and neuroplasticity.
It is not yet known how vitamin D plays a role in mental pathology.
However, Vitamin D deficiency may have an impact on academic
performance.
Genetic similarity Malanchini et al. (2020) 3410 twin Research suggests that genetic variants associated with math anxiety,
couples attitudes toward math, and math achievement are likely unrelated to
variations in general anxiety. This suggests that genetic factors
influencing specific aspects of math may be different from genetic
factors influencing general academic performance.
Brain activity (fMRI) Pizzie et al. (2020) 74 Academic performance in math may be influenced by certain genetic
variants that are specific to math and different from genes that regulate
general academic performance.
SNP Val66Met BDNF Bedard et al. (2017) 252 Individuals with high self-efficacy are better able to cope with the
negative effects of loneliness, regardless of their genotype.

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Table 3 Psychological instruments used together with employed in different studies. Wong et al. (2023) conducted a
biological parameters. correlational study to identify associations between several stress
and anxiety indicators and exam competence. Peter et al. (2023)
used Ambulatory Assessment, Anjum et al. (2021) utilized a
Psychological instruments Acronym n
comparative study, Malanchini et al. (2020) conducted a twin
State-Trait Anxiety Inventory STAI 12 study, Jamieson et al. (2021) employed a multilevel design, and
Perceived Stress Scale PSS 3 Bedard et al. (2017) used a case-control study.
Visual Analog Scale VAS 4
Beck Depression Inventory BDI 3
SISCO Inventory of Academic Stress SISCO 2
Depression Anxiety Stress Scale DASS-21 3 Conceptual framework of stress and performance. A variety of
Pittsburgh Sleep Quality Index PSQI 2 theoretical frameworks from different research areas, such as
Abbreviated Mathematics Anxiety Scale AMAS 2 learning methods, neurophysiology, psychology, genetics, and
Center for Epidemiological Studies Depression Scale CES-D 2 epigenetics in studies of stress and academic performance, are
Generalized Anxiety Disorder Scale GAD 1 illustrated in Table 5. We classified these theories based on the
Stressor Appraisal Scale SAS 1 identified research clusters and categorized them according to the
Test Anxiety Inventory TAI 1 foundational theories or concepts associated with each cluster. In
Math Anxiety Rating Scale MARS 1 this way, we demonstrate that the association between stress and
Ambulatory Assessment Stress Scale AASS 1 academic performance can be depicted from various theoretical
Hamilton Anxiety Rating Scale HAM-A 1 perspectives. Furthermore, Fig. 2 illustrates a conceptual frame-
Student Stress Scale 1
work of stress and academic performance developed based on the
analysis of scientific articles, providing a clear visualization of
how different theories and concepts interact within the context of
Approaches to data gathering. In analyzing the data collection this research.
methods used across the 31 articles reviewed, it is evident that Of the 31 articles, only 74.18% (n = 23) discussed the theories
various study designs were employed, reflecting diverse approa- they employed. The remaining 25.81% (n = 8) did not specifically
ches to investigating academic stress and performance in biolo- mention the underlying theories of their research, possibly
gical contexts. The methods can be broadly categorized into because the focus was not on forming a hypothesis-driven
experimental, observational, and mixed-method research. Table 4 argument based on the relationship between stress, anxiety,
summarizes the research designs, authors, and years of depression and academic performance. The focus of these articles
publication. was on the detection or intervention to reduce academic-related
The crossover study design emerged as one of the most stress, depression, or anxiety (Abromavičius et al. 2023; Anjum
common approaches in experimental methods, accounting for et al. 2021; Ibrahim and Audi, 2021; Kabrita and Hajjar-Muça,
9.7% of all studies. This type of study, as conducted by Cardozo 2016; Nakamura et al. 2010; Tripathi et al. 2022; Usichenko et al.
et al. (2023), Nakamura et al. (2010), and Usichenko et al. (2020), 2020; Zallocco et al. 2021).
involves administering multiple interventions sequentially to
participants. Blinded trial designs also accounted for 9.7% of all Neurocognitive stress and performance. Wong et al. (2023) found
studies and were included in the research by Mäkelä et al. (2023), that students who experienced higher stress levels with lower
Márquez-Morales et al. (2021), and Kato-Kataoka et al. (2016). heart rate variability (HRV) actually had better academic per-
Within-subject and between-subject designs were used in studies formance. This finding suggests that when stress increases to an
by Zallocco et al. (2021), Brodersen and Lorenz (2020), and Pizzie optimal level, students may become more focused on their tasks,
et al. (2020), also comprising 9.7%. Quasi-experimental designs, thereby enhancing their performance. However, the anxiety
as seen in Harris et al. (2019) and Cardozo et al. (2020), assessment results in this study were not significant, indicating
accounted for 6.4% of all studies. Špiljak et al. (2024) employed a that students with high academic scores and lower HRV did not
prospective and interventional method, which was the only study necessarily experience higher levels of stress. These students
of this type reviewed. Cai et al. (2018) was also the only study might possess effective coping strategies that help them manage
using randomized controlled trials (RCTs), considered the gold stress despite having low HRV.
standard in experimental research due to their ability to minimize The study by Brodersen and Lorenz (2020) showed that
bias through randomization. Lastly, Abromavičius et al. (2023) perceived stress and salivary alpha-amylase were higher during
applied measurement and modeling techniques, accounting for exams compared to homework conditions, but there was no
3.2% of all studies. All articles employing interventions with this significant increase in cortisol levels. This indicates that exams
method are classified under the 1st level of prevention, focusing trigger a high-stress response and activation of the sympathetic
on programs aimed at mitigating academic stress before it nervous system but do not activate the hypothalamic-pituitary-
escalates into a significant issue. adrenal axis (HPAA) response. Ringeisen et al. (2019) found that
Observational study designs are a significant component of the anxiety and cortisol levels increased on exam days compared to
reviewed articles, highlighting the importance of non- control days. Self-efficacy was found to be negatively correlated
interventional approaches in understanding symptoms and the with anxiety and positively correlated with exam scores,
relationships between variables in natural conditions. Cross- suggesting that students with high self-efficacy perceive exams
sectional studies, including those by Cronje et al. (2024), Mujinya as challenges that can be overcome rather than threats.
(2022), Tripathi et al. (2022), Ibrahim and Audi (2021), Tavakoli Cai et al. (2018) found that the group receiving attention bias
et al. (2017), and Kabrita and Hajjar-Muça (2016), are the most modification intervention showed a significant change in
common observational design in the reviewed articles. Long- attention bias scores after training, but there was no significant
itudinal studies, such as those conducted by Castillo-Navarrete change in salivary alpha-amylase levels. These findings suggest a
et al. (2023), Cipra and Muller-Hilke (2019), Ringeisen et al. reduction in attention towards stressors following training,
(2019), and Pradhan et al. (2014), involve repeated observations although the lack of a well-validated psychosocial stressor may
of the same variables over a period of time. Various observational have contributed to the absence of significant changes in
designs, besides cross-sectional and longitudinal, were also biological responses. Pradhan et al. (2014) reported that stress,

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 Table 4 Summary of research designs.

Research method Design Authors Article (n, %)

2010–2014 2015–2019 2020–2024
Experimental Crossover Cardozo et al. (2023), Nakamura et al. (2010), Usichenko 1 (3.23) 2 (6.45)
et al. (2020)
Blinded trials Mäkelä et al. (2023), Márquez-Morales et al. (2021), 1 (3.23) 2 (6.45)
Kato-Kataoka et al. (2016)
Prospective and Špiljak et al. (2024) 1 (3.23)
Interventional Study
Within-subjects and Zallocco et al. (2021), Brodersen and Lorenz (2020), 3 (9.68)
between-subjects design Pizzie et al. (2020)
Quasi-experimental Harris et al. (2019), Cardozo et al. (2020), 1 (3.23) 1 (3.23)
a randomized-controlled Cai et al. (2018) 1 (3.23)
trials
Measurement and Abromavičius et al. (2023) 1 (3.23)
modeling
Observational Cross-sectional Cronje et al. (2024), Mujinya (2022), Tripathi et al. 2 (6.45) 4
(2022) Ibrahim and Audi (2021), Tavakoli et al. (2017), (12.90)
Kabrita and Hajjar-Muça (2016)
Longitudinal Castillo-Navarrete et al. (2023), Cipra and Muller-Hilke 1 (3.23) 1 (3.23) 2 (6.45)
(2019), Ringeisen et al. (2019), Pradhan et al. (2014)
Correlational Wong et al. (2023) 1 (3.23)
Ambulatory Assessment Peter et al. (2023) 1 (3.23)
(AA)
Comparative Anjum et al. (2021) 1 (3.23)
Twin study Malanchini et al. (2020) 1 (3.23)
Multilevel (multi-situs 2 Jamieson et al. 2021 1 (3.23)
tingkat)
Case-control study Bedard et al. (2017) 1 (3.23)
Mix-method Concurrent mixed methods Ferreira et al. (2020) 1 (3.23)

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measured through increased pulse rate, blood pressure, and processes. Studies also found a correlation between concentration,
reaction time, significantly affected students’ cognitive function brain waves, and exam results, indicating that students who focus
before exams. Students with higher stress levels showed longer longer tend to achieve better grades or show significant
touch and audio reaction times, as well as faster visual reaction improvement between exams (Kokubo and Shoji, 2017). Addi-
times, indicating that stress impacts the somatosensory cortex tionally, brain activity scans using fMRI evaluated activity in the
areas that process touch and visual stimuli. prefrontal cortex (PFC). The cognitive reappraisal process
involves the PFC, a brain area responsible for executive functions
Neurophysiology stress and performance. EEG analysis shows that like planning, decision-making, and cognitive control. Increased
stress and anxiety are associated with decreased alpha waves and activity in the PFC can enhance the ability to focus, solve pro-
increased delta waves in the left temporal lobe, which plays a blems, and think critically, which are all essential for solving
crucial role in learning and memory processes (Cronje et al. mathematical tasks (Pizzie et al. 2020).
2024). This condition could potentially affect academic perfor- The hypothalamic-pituitary-adrenal axis (HPAA) is involved
mance, where a decrease in alpha waves might indicate a reduced in the systemic effects of stress, depression, and anxiety, which
capacity for relaxation and focus, while an increase in delta waves also play a role in the neurophysiology of cognition. Cortisol, as
may suggest disruption or inhibition in learning and memory the primary stress hormone in the HPA axis, is one of the most
widely used biomarkers in research related to academic stress
(Anjum et al. 2021; Cardozo et al. 2020; Ringeisen et al. 2019;
Table 5 Mapping of articles on theory clusters and Kato-kataoka et al. 2016; Špiljak et al. 2024; Cardozo et al. 2023;
keywords. Mäkelä et al. 2023; Peter et al. 2023; Jamieson et al. 2021;
Brodersen and Lorenz, 2020; Ferreira et al. 2020; Cipra and
Muller-Hilke, 2019). In stressful situations such as exam stress,
Cluster of theory Keywords Article (n) Percentage
serotonin, acetylcholine, and inflammatory cytokines are
Neurocognitive stress Transactional 8 25.80 released as stress signals that activate the HPA axis (Hall et al.
and performance theory
2012). Stress signals also activate the sympathetic nervous
Attention bias
theory
system response, causing a positive feedback loop and a
Execution focus continuous cycle between the HPAA and the sympathetic
model nervous system (Hong et al. 2022). When the HPA axis is
Self-efficacy activated, stress hormones are released, including corticotropic
Neurophysiology stress Brain activity 8 25.80 releasing hormone (CRH) from the hypothalamus (Contoreggi,
and performance HPAA 2015), which then stimulates the anterior pituitary to release
Stress and epigenetic DNA methylation 2 6.45 adrenocorticotropic hormone (ACTH) (Fukuoka et al. 2020).
regulations BDNF ACTH, in turn, regulates the production of glucocorticoids,
Genetic variations and SNP Val66Met of 3 9.68 such as cortisol, from the adrenal glands (Lightman et al. 2020).
stress BDNF gene Elevated cortisol levels can negatively impact memory, atten-
Math-related gene tion, and executive functions, all of which are essential for
Polygenic gene
academic performance (Ouanes and Popp, 2019). Stress
NPS and NPSR1
Total 21 67.74
hormones affect learning circuits through intermediary brain
regions like the hippocampus, amygdala, and striatum

Fig. 2 Conceptual framework of academic stress and performance based on the analyzed studies (Source: Author's own elaboration). The framework
illustrates the theoretical scope and keywords representing the current research developments.

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tegmental nuclei, causing disruptions in the formation of strong targeted approach to assessing academic stress among university
memories (Cardozo et al. 2023). students (Castillo-Navarrete et al. 2024). This instrument, along
with others, contributes to a nuanced understanding of academic
Stress and epigenetic regulations. Stress can trigger epigenetic stress and supports the development of targeted interventions to
changes that affect gene expression and modulate the psycho- improve student well-being and academic performance.
biological response to stress (Stoffel et al. 2022). These changes The findings of this review underscore the multidimensional
involve DNA methylation of genes involved in the stress response nature of academic stress, as evidenced by the significant inter-
and development (Unternaehrer and Meinlschmidt, 2016). Aca- actions between biological markers, psychological coping strate-
demic stress is believed to cause epigenetic changes that affect gies, and social influences identified across the studies analyzed.
gene expression related to learning and memory, such as the This aligns with the Bio-Psycho-Social paradigm (WHO, 2001),
BDNF gene (Castillo-Navarrete et al. 2023). Some studies use which emphasizes the integration of biological, psychological, and
brain-derived neurotrophic factor (BDNF) as a biomarker of social factors in understanding stress and wellbeing. Key results
neuronal plasticity, linking explanations between academic per- reveal that markers such as BDNF and cortisol are highly sensi-
formance and epigenetic regulation influenced by stress. BDNF tive to stress but show variability depending on psychological
plays a significant role in memory formation and processing states and social contexts, such as peer support and institutional
through the regulation of synaptic plasticity, including synapto- environment. These findings resonate with recent theoretical
genesis and long-term potentiation (LTP), the primary cellular advancements, such as the conceptual model for managing stress
mechanisms underlying learning and memory (Soliman et al. and promoting wellbeing (de la Fuente et al. 2024), which inte-
2010; Karpova, 2014). Castillo-Navarrete et al. (2023) observed grates these dimensions into a cohesive framework.
that academic stress could increase global DNA methylation The analysis of research designs employed across the reviewed
percentage and decrease BDNF levels in blood plasma. Tavakoli studies provides significant insights into the methodologies used
et al. (2017) reported that male students with higher depression to explore academic stress and performance within biological
scores had lower BDNF levels. contexts. Each design offers unique advantages and limitations,
contributing to the overall understanding of the field. Despite the
Genetic variations and stress. Genetic variation, particularly the richness of insights provided by these designs, there remains a
Val66Met polymorphism in the BDNF gene, can affect individual notable scarcity of mixed-method approaches in the literature.
cognition and emotions (Al-Hatamleh et al. 2019; He et al. 2018). Mixed-methods research, which combines qualitative and quan-
Bedard et al. (2017) found that individuals with low self-efficacy titative techniques, has the potential to offer a more compre-
were more likely to have high depression compared to those with hensive perspective by integrating detailed numerical data with
high self-efficacy, regardless of their BDNF genotype. The study contextual understanding. Its underrepresentation suggests a
also showed that individuals with the Val/Val genotype might missed opportunity to explore academic stress from both statis-
have poor neurocognitive vulnerability to experiences of lone- tical and narrative perspectives, which could enrich our under-
liness. Malanchini et al. (2020) observed 3410 pairs of identical standing of complex phenomena and lead to more nuanced
and fraternal twins to separate the influence of genetic and interventions. Addressing this gap could enhance future research
environmental factors on traits related to attitudes and mathe- and provide a more holistic view of the interplay between aca-
matical abilities. The study’s findings suggest that academic per- demic stress and performance.
formance in mathematics is influenced by specific genetic variants
for mathematics and is different from the genes regulating general
academic performance. Theoretical underpinnings. The findings provide insights into
how academic stress, measured through various biological para-
meters, can affect students’ academic performance and cognitive
Discussion function. The findings by Wong et al. (2023) support the concept
Certain parameters in the context of genetics and epigenetics can that stress at an optimal level can enhance academic performance
serve as potential biomarkers for understanding the complexity of by increasing focus, although the exact optimal level remains
academic performance. A polygenic analysis study of the NPS unclear. However, this also highlights that effective coping stra-
and NPSR1 genes found that neuroticism genetics can predict tegies play a crucial role in mitigating the negative impacts of
stress in high-pressure situations, such as academic exams (Peter stress, as seen in students with low HRV but high academic
et al. 2023). Tavakoli et al. (2017) utilized brain-derived neuro- performance. These findings can be explained by the transac-
trophic factor (BDNF), a crucial neurotrophic factor involved in tional theory of stress and coping by Lazarus and Folkman
the growth and maintenance of nerve cells in the brain. However, (1984).
this study did not explain the implications of stress on learning The transactional theory of stress focuses on how individuals
and memory, which could affect academic performance. Simi- appraise and manage stress (Zhao et al. 2020; Spătaru et al. 2024).
larly, studies examining gut microbiota diversity (Marquez- According to this theory, stress is not merely the result of external
Morales et al. 2021; Kato-Kataoka et al. 2016) did not provide situations or stimuli, but also arises from an individual’s
detailed explanations of how the gut–brain axis connection under perception of the situation and their ability to cope with it.
stress conditions could influence academic performance. Several studies (Brodersen and Lorenz, 2020; Ringeisen et al.
The use of psychological instruments in these studies allowed 2019) within the scope of this review have utilized this theoretical
researchers to collect comprehensive data on various aspects of framework to explain the relationship between stress and
mental health and behavior, facilitating the development of more academic performance, supported by evidence from biological
effective interventions to address academic-related psychosocial parameters.
stress. By assessing different dimensions of stress, anxiety, and Brodersen and Lorenz (2020) underscore the role of HPAA
depression, research has provided deeper insights into how these adaptation in response to chronic stress, such as frequent exams,
factors interact and impact individuals in both biological and which may reduce cortisol response despite the activation of the
academic contexts. Although the SISCO Inventory of Academic sympathetic nervous system. This finding aligns with the concept
Stress is not the most widely used scale, its focus on stressors, of appraisal in transactional theory, where an individual’s
symptoms, and coping strategies offers a comprehensive and perception of a situation influences their stress response. The

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findings from Ringeisen et al. (2019) emphasize the importance of academic potential. It is suggested that different academic
self-efficacy in managing stress and improving academic potentials in individuals may be influenced by different genes
performance. High self-efficacy can change the perception of (Rimfeld et al. 2015). Understanding how genetic variability can
exams from threats to manageable challenges, thereby reducing affect stress responses could lead to the development of more
anxiety and enhancing performance. tailored and personalized interventions to help individuals
Within the context of attention bias theory, the results from manage stress more effectively, particularly in high-pressure
Cai et al. (2018) indicate that attention bias modification environments like exams (Peter et al. 2023).
interventions can reduce attention toward stressors, although Overall, the findings from these studies support the importance
effects on biological parameters like alpha-amylase may require of biological parameters in measuring stress responses and
clearer and more validated stress conditions to demonstrate suggest that academic stress can affect performance in complex,
significant changes. This suggests that the effectiveness of context-dependent ways. This emphasizes the need for a multi-
interventions depends on the validity and intensity of the dimensional approach to understanding the impact of academic
stressors used. stress on student performance. To provide a comprehensive
The execution focus model employed by Pradhan et al. (2014) understanding of the intricate relationships among various factors
also confirms that stress affects how the brain processes influencing academic stress and performance, a conceptual
information, reflected in changes in reaction times. While there framework is illustrated in Fig. 2. This framework synthesizes
is general support for the role of reaction time in academic findings from the analyzed studies, highlighting the intercon-
performance, the differing results in this study may reflect nected roles of neurophysiological mechanisms, epigenetic
variations in coping strategies or optimal stress levels that have regulations, genetic variations, and other psychological factors
not been fully explained, indicating a need for further research to in shaping academic outcomes.
understand these complex relationships.
The results from EEG and fMRI analyses indicate the
importance of brain regions like the left temporal lobe and Future research directions. Research on the association between
prefrontal cortex in academic performance under stress. The stress, anxiety, and depression with academic performance has
decrease in alpha waves and increase in delta waves observed in evolved rapidly and has been examined from various perspectives.
the EEG studies (Cronje et al. 2024) suggest that stress can From our review, however, we argue that several areas require
interfere with brain functions associated with learning and further exploration to enhance our understanding of the com-
memory, potentially reducing students’ ability to perform plexity of academic performance as an outcome of various
academically. Furthermore, the increased activity in the pre- interrelated factors and study contexts. To provide recommen-
frontal cortex during cognitive reappraisal (Pizzie et al. 2020) dations for forthcoming research, we evaluated the limitations
highlights the role of executive functions in managing stress and and explored the potential and gaps from studies over the past
performing complex cognitive tasks, such as mathematics. This three years included in our analysis. This procedure resulted in
suggests that training students in cognitive strategies that enhance three major potential research agendas, as discussed below.
PFC activity could potentially improve their academic outcomes.
The findings on HPAA’s role in stress response highlight its Academic performance and stress mechanism. Efforts to uncover
significance in academic settings where stress levels are often the influence of stress on academic performance have been the
high. Although there is strong evidence of cortisol’s negative focus of many studies. Various biomarkers have been used to
impact on cognitive function (Ouanes and Popp, 2019), the identify changes in the body’s biological functions when an
inconsistencies in findings regarding cortisol’s relationship with individual experiences stress. Nonetheless, our understanding of
exam performance (Ferreira et al. 2020; Ringeisen et al. 2019) the biological mechanisms linking stress to academic perfor-
suggest that cortisol alone may not be a definitive predictor of mance remains incomplete. Future studies need to investigate the
academic outcomes. Factors such as different cortisol measure- biological processes influencing academic performance and use
ment methods, individual differences in stress responses, and biomarkers that can more closely explain the relationship
variations in exam environments could contribute to these between stress mechanisms and academic performance (Cronje
inconsistencies. Understanding how the HPAA and sympathetic et al. 2024; Castillo-Navarrete et al. 2023; Peter et al. 2023).
nervous system influence academic performance has important The use of cardiovascular parameters as markers of stress
implications for education. Providing adequate resources for presence is widespread in research (Anjum et al. 2021; Usichenko
counseling units and training students on stress management et al. 2020; Zallocco et al. 2021). However, cardiovascular
strategies have been recommended to address high levels of parameters cannot directly explain how stress, whether acute or
academic stress among students (Munyaradzi and Addae, 2018). chronic, affects academic performance. While stress can trigger
Implementing strategies to foster a more conducive academic cardiovascular responses, its effects on memory, concentration,
environment has been suggested based on the predictive and cognitive abilities are more influenced by how stress interacts
relationship between stress coping, self-efficacy, and academic with the central nervous system and involves various hormones
satisfaction (Estrada-Araoz et al. 2024). (Lindau et al. 2016; Vogel and Schwabe, 2016). Cardiovascular
The discussion on epigenetic changes driven by stress under- parameters are part of a series of processes initiated in the brain,
scores the complexity of how academic stress impacts cognitive impacting the body’s readiness for a ‘fight or flight’ response to
functions at the molecular level. Epigenetic regulation, such as pressure (Shah et al. 2019).
BDNF gene methylation, suggests that the effects of stress on The detection of neurophysiological signals, such as electro-
students are not only evident in their psychological and dermal activity (Abromavičius et al. 2023), electroencephalogram
physiological responses but also at a deeper molecular level, (EEG) (Cronje et al. 2024), and functional magnetic resonance
ultimately influencing academic performance and cognitive imaging (fMRI) (Pizzie et al. 2020), has also been used in several
abilities. Understanding these epigenetic mechanisms is crucial studies analyzed and contributes to the understanding of the
for explaining how stress can impact learning and memory relationship between stress and central and autonomic nervous
abilities in students. system activities. Measurement techniques using such parameters
The research on genetic variations and academic performance have drawbacks; they are time-consuming and can introduce bias
extends the scope of studies on the genetic factors influencing due to the potential stress caused by sensor placement or

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participation in experiments (Jiménez-Mijangos et al. 2023). To educational interventions that not only focus on cognitive aspects
obtain accurate and comprehensive results, we suggest using non- but also consider individual biological aspects in supporting
invasive biomarkers in more natural settings. optimal academic performance.
Cortisol, the primary stress hormone involved in mechanisms
in the central nervous system, is the most widely used parameter Research on educational interventions. Cardozo et al. (2023)
in the analyzed studies. Cortisol levels are known to be found that implementing active learning methods combined with
associated with student stress (Anjum et al. 2021; Cardozo formative assessments can reduce exam stress and anxiety and
et al. 2020; Ringeisen et al. 2019). The advantage of this improve students’ academic performance compared to traditional
parameter is its ability to be measured non-invasively from lecture methods. These results indicate that more interactive and
urine (Borghi et al. 2021), saliva (Kato-Kataoka et al. 2016), and student-centered approaches have the potential to create a more
hair (van den Heuvel et al. 2022; Heming et al. 2023; Romero- conducive learning environment and support better academic
Romero et al. 2023). However, inconsistencies in study results achievement (Angraini, et al. 2023). For instance, learning that
regarding the effects of stress on cortisol levels and academic uses the joyful-inquiry interactive demonstration model assisted
performance necessitate further research (Brodersen and by Android games has been shown to improve students’ cognitive
Lorenz, 2020; Ferreira et al. 2020; Ringeisen et al. 2019; Cipra learning outcomes by engaging them more actively in the learning
and Muller-Hilke, 2019). Recognizing the complexity of process (Mustikasari et al. 2020). Additionally, Dou et al. (2018)
academic performance as a result of interactions among various and Muntholib et al. (2024) argue that students’ self-efficacy is
factors, not just physiological but also psychological and social, influenced by the learning strategies or models implemented.
we suggest that upcoming studies consider an interdisciplinary Specifically, learning models that accommodate active student
approach. participation in investigating topics can enhance self-efficacy.
Based on the analysis of existing studies, brain-derived This investigative process allows students to build confidence
neurotrophic factor (BDNF) emerges as a promising biomarker through active class discussions and presenting their findings to
in elucidating the influences of psychological factors and peers, fostering strong problem-solving skills (Fitriani et al. 2020).
educational strategies on academic performance. BDNF is a Furthermore, self-efficacy has become a trending variable in
neurotrophin abundantly expressed in the brain and plays a the application of collaborative science learning over the past
critical role in the survival, growth, and cognitive function of decade. It is frequently associated with motivation, learning
neurons under normal and neuropathological conditions systems, and e-learning. These findings indicate that integrating
(Ismail et al. 2020). This marker can also be measured non- self-efficacy into various learning models, especially in STEM
invasively through urine (Olivas-Martinez et al. 2023) and fields, holds significant promise for enhancing students’ engage-
saliva (Ballestar-Tarín et al. 2024), making it more comfortable ment and performance in the classroom (Marlina et al. 2024).
for participants and reducing the risk of stress bias due to However, further research is needed, especially longitudinal
plasma sampling procedures. Additionally, it facilitates studies, to observe the long-term impact of these active
repeated sampling in longitudinal study designs or ambulatory methods. Additionally, it is essential to explore various
assessment. variations of active learning methods and evaluate their
In the context of academic stress, peripheral BDNF levels may effectiveness, including integration with technology, to identify
fluctuate, with the potential for significant decreases in students the most effective approaches for application in different
facing chronic academic pressure (Castillo-Navarrete et al. 2023; educational contexts. Developing and evaluating these methods
Tavakoli et al. 2017). In other studies, acute stress induced by is crucial to help students manage stress and improve their
academic exams increased BDNF production (Myint et al. 2021). academic performance (Cardozo et al. 2023; Wong et al. 2023).
These varied findings present opportunities to explore BDNF as a The crucial role of self-efficacy in student success and its
potential biomarker in understanding how effective management connections to psychological, physiological, and educational
strategies and assessments can mitigate the negative impacts of aspects, highlights the need for further interdisciplinary
academic stress on academic performance. research into this area.
Given the potential of BDNF as a biomarker for academic Several studies suggest that the impact of stress on academic
performance, it is essential to conduct in-depth studies on the achievement may vary and may be influenced by various factors
genetic and epigenetic regulation that influences BDNF synthesis. (Brodersen and Lorenz, 2020; Ferreira et al. 2020; Wong et al.
Polymorphisms in the BDNF gene have been associated with 2023). The influence of stress on academic performance is not
variations in cognitive performance, particularly in tasks invol- linear and can be affected by other factors such as self-efficacy,
ving psychomotor speed, working memory, and executive motivation, individual learning approaches, and emotional
function (Dowlati et al. 2020; Wiłkość et al. 2016). The BDNF intelligence (Ferreira et al. 2020; Ringeisen et al. 2019; Wong
Val66Met gene polymorphism is also linked to mental health, et al. 2023; Cipra and Muller-Hilke, 2019; MacCann et al. 2022).
which can affect academic performance (Bedard et al. 2017). These findings suggest that subsequent studies should consider
These genetic factors can provide insights into how individuals these variables to obtain a more comprehensive understanding of
respond differently to academic stress, which in turn can the relationship between stress and academic performance. Thus,
influence optimal learning strategies and curriculum adjustments a holistic approach to examining the interaction between stress
to enhance academic outcomes. and other psychological factors can provide deeper insights into
Beyond genetic regulation, epigenetic aspects also play a crucial efforts to improve student academic achievement.
role in BDNF expression and could be an area for further Another approach to reducing the negative impact of stress
exploration in educational research. Epigenetic regulation, such as and enhancing students’ well-being is through the development of
global DNA methylation, MeCP2, and various non-coding RNAs, educational programs that encourage students’ connection to
has been shown to influence BDNF expression (Castillo- nature and their knowledge of environmental issues (Sulfa et al.
Navarrete et al. 2023; Lee et al. 2019; Lipovich et al. 2012; 2024). These programs have the potential to benefit not only
Modarresi et al. 2021). Research in this area could provide new students’ mental health but also increase their awareness and
insights into how educational environments and social experi- responsibility toward the environment. Continued inquiry could
ences interact with biological factors to shape students’ academic explore the potential of this intervention in learning practices,
performance. This has implications for developing more effective particularly in the natural sciences, to assess its impact on

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reducing academic stress and improving students’ well-being and approaches are needed to address the complexities of academic
academic performance. performance (Rodríguez-Torres et al. 2024; Vajaradul et al. 2021).
Prospective research should develop predictive models based Anticipated studies should focus not only on identifying stress
on individuals’ biological responses to stress, as suggested by within academic environments (Acevedo et al. 2021; Jiménez-
Abromavičius et al. (2023). Predictive models can help identify Mijangos et al. 2023; Shanbhog and Medikonda, 2023), but also
individuals more susceptible to stress and potentially experien- on evaluating the impact of interventions from a broader
cing declines in academic performance. Additionally, it is perspective (Špiljak et al. 2024; Mäkelä et al. 2023). This will
essential to develop interventions tailored to individual needs, pave the way for developing more effective and relevant
as proposed by Peter et al. (2023). A more personalized approach interventions tailored to the needs of students.
to intervention strategies is likely to yield more optimal results
because it can accommodate individual variations in response to
stress and their psychological needs. This approach requires a Limitations of the study
deep understanding of the biological and psychological factors Although this study successfully identified several significant
contributing to stress so that interventions are truly effective in findings regarding the relationship between stress, depression,
reducing the negative impact of stress on academic performance and anxiety with academic performance among university stu-
(Lee et al. 2019). dents, there are some limitations that should be noted. The
limitation of using only the Scopus database restricts the scope of
Interdisciplinary approach. From the eligibility analysis of the study. The diversity of articles on the Web of Science could
222 studies included in the topic analysis, only 31 studies com- offer different perspectives. It is recommended to incorporate
bined biological and psychological approaches in examining the additional databases in future directions to enhance the breadth
topic of stress and academic performance (Fig. 1). Further con- and accuracy of the findings. The restriction of the search to
tent analysis showed that only 12 of these studies genuinely English-language and open-access articles could potentially
integrated interdisciplinary approaches in the analysis and dis- overlook relevant studies published in other languages or hidden
cussion of their research findings (Table 2). This indicates a gap behind paywalls of subscription-based journals. Additionally, the
in more holistic approaches, considering that academic achieve- strict inclusion criteria, such as focusing solely on university
ment is highly likely influenced by interactions among various students, may limit the generalizability of the findings. Pro-
factors, including genetics, epigenetic regulation, and environ- spective research should explore academic stress across different
ment (Lee et al. 2019). Indeed, some reviewed studies focused educational levels to provide a more comprehensive under-
more on biological studies without comprehensively linking them standing. Nevertheless, the results of this analysis provide a strong
to psychological and social aspects (Abromavičius et al. 2023; foundation for further research on this topic.
Kabrita and Hajjar-Muça, 2016; Špiljak et al. 2024).
Most of the analyzed studies predominantly employed
quantitative methods, including both experimental and observa-
tional approaches (Table 4). Only one study adopted a mixed- Conclusion
method approach in its methodology (Ferreira et al. 2020). This This study reviewed literature exploring the relationship between
limitation may hinder the generation of findings that are more academic stress and academic performance through a structured
generalizable and relevant across various contexts. While literature review, employing content analysis techniques. From
quantitative approaches promise standardization, control, relia- this analysis, we identified three key aspects in the literature,
bility, and a stronger basis for making causal claims, qualitative encompassing biological parameters, psychological instruments,
approaches offer a broader context, phenomenological under- and research methodologies used. Commonly utilized biological
standing, and insights into behavioral complexities (Sockolow parameters include cardiovascular measures, cortisol hormone
et al. 2016). Therefore, the use of mixed methods is highly levels, and salivary α-amylase. We also found several psycholo-
recommended for ongoing explorations to achieve a broader gical instruments frequently used to measure stress, anxiety, and
perspective, a more in-depth analysis, and a better understanding depression among university students. In terms of methodology,
of the complexities of education and cognition (Poortinga and the research generally employed quantitative approaches and
Fontaine, 2022). For example, a comprehensive mixed-method rarely applied mixed-method approaches.
study that combined electrodermal activity (EDA) measurements As key findings, this study identifies two important points.
with qualitative analysis of video recordings of the learning First, there are four main theoretical foundations that can be used
process revealed that hands-on learning, which is generally to understand the interaction between stress and academic per-
assumed to foster higher student engagement, could actually formance in the context of biology and education: the neuro-
trigger more stress rather than productive involvement (Sung physiology of cognition and emotion, stress and the
et al. 2023). This serves as a concrete example of how mixed- hypothalamic-pituitary-adrenal axis, stress and epigenetic reg-
method research can enhance the understanding of academic ulation, and genetic variation and stress. Second, we recommend
stress. three future directions emphasizing the development of students’
A more comprehensive methodology can also minimize bias academic performance. Further studies should focus on under-
associated with self-report measurements in psychological standing the mechanisms of stress and academic performance,
instruments. Next step in the research should consider incorpor- educational interventions, and interdisciplinary research
ating more objective measures to complement self-reported data. approaches. These findings are expected to guide future studies in
In addition to objective measures such as physically or the fields of education and psychology to optimize students’
physiologically measured data, direct observations by researchers, academic performance through a deeper understanding of the
which are less influenced by respondents’ personal perceptions, impact of stress.
are also recommended.
Additionally, current interventions tend to be limited and are
not yet integrated with strategies aimed at holistically enhancing Data availability
academic performance. Hence, interdisciplinary studies that not All data is available in the published literature of the primary
only rely on quantitative data but also involve qualitative source.

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HUMANITIES AND SOCIAL SCIENCES COMMUNICATIONS | https://doi.org/10.1057/s41599-025-04484-w REVIEW ARTICLE

Received: 11 September 2024; Accepted: 23 January 2025; assessment, improved cardiac physiology knowledge and decreased pre-test
stress and anxiety. Front Physiol 14:1261199. https://doi.org/10.3389/fphys.
2023.1261199
Castillo-Navarrete J, Bustos C, Guzman-Castillo A, Vicente B (2023) Increased
academic stress is associated with decreased plasma BDNF in Chilean college
students. PeerJ 11:e16357. https://doi.org/10.7717/peerj.16357
References Castillo-Navarrete JL, Bustos C, Guzman-Castillo A, Zavala W (2024) Academic
Abromavičius V, Serackis A, Katkevičius A, Kazlauskas M, Sledevič T (2023) stress in college students: descriptive analyses and scoring of the SISCO-II
Prediction of exam scores using a multi-sensor approach for wearable exam inventory. PeerJ 12:e16980. https://doi.org/10.7717/peerj.16980
stress dataset with uniform preprocessing. Technol Health Care Cipra C, Müller-Hilke B (2019) Testing anxiety in undergraduate medical students
31(6):2499–2511. https://doi.org/10.3233/THC-235015 and its correlation with different learning approaches. PLoS ONE
Acevedo CMD, Gómez JKC, Rojas CAA (2021) Academic stress detection on 14(3):e0210130. https://doi.org/10.1371/journal.pone.0210130
university students during COVID-19 outbreak by using an electronic nose Contoreggi C (2015) Corticotropin releasing hormone and imaging, rethinking the
and the galvanic skin response. Biomed Signal Process Control 68:102756. stress axis. Nucl Med Biol 42(4):323–339
https://doi.org/10.1016/j.bspc.2021.102756 Córdova Olivera P, Gasser Gordillo P, Naranjo Mejía H, La Fuente Taborga I,
Al-Hatamleh MA, Hussin TM, Taib WR, Ismail I (2019) The brain-derived neu- Grajeda Chacón A, Sanjinés Unzueta A (2023) Academic stress as a predictor
rotrophic factor (BDNF) gene Val66Met (rs6265) polymorphism and stress of mental health in university students. Cogent Educ 10(2):2232686. https://
among preclinical medical students in Malaysia. J Taibah Univ Med Sci doi.org/10.1080/2331186X.2023.2232686
14(5):431–438. https://doi.org/10.1016/j.jtumed.2019.09.003 Cronje R, Beukes J, Masenge A, du Toit P, Bipath P (2024) Investigation of
Ali N, Nater UM (2020) Salivary alpha-amylase as a biomarker of stress in neopterin and neurophysiological measurements as biomarkers of anxiety
behavioral medicine. Int J Behav Med 27:337–342. https://doi.org/10.1007/ and stress. NeuroRegulation 11(1):25–25. https://doi.org/10.15540/nr.11.1.25
s12529-019-09843-x De la Fuente J, González-Torres MC, Aznárez-Sanado M, Martínez-Vicente JM,
Almarzouki AF (2024) Stress, working memory, and academic performance: a Peralta-Sánchez FJ, Vera MM (2019) Implications of unconnected micro,
neuroscience perspective. Stress 27(1):2364333. https://doi.org/10.1080/ molecular, and molar level research in psychology: the case of executive
10253890.2024.2364333 functions, self-regulation, and external regulation. Front Psychol 10:1919.
Amhare AF, Jian L, Wagaw LM, Qu C, Han J (2021) Magnitude and associated https://doi.org/10.3389/fpsyg.2019.01919
factors of perceived stress and its consequence among undergraduate stu- De la Fuente J, Martínez-Vicente JM (2024) Conceptual Utility Model for the
dents of Salale University, Ethiopia: cross-sectional study. Psychol Health Management of Stress and Psychological Wellbeing, CMMSPW™ in a uni-
Med 26(10):1230–1240. https://doi.org/10.1080/13548506.2020.1808234 versity environment: theoretical basis, structure and functionality. Front
Anjum A, Anwar H, Sohail MU, Ali Shah SM, Hussain G, Rasul A, Shahzad A Psychol 14:1299224. https://doi.org/10.3389/fpsyg.2023.1299224
(2021) The association between serum cortisol, thyroid profile, paraoxonase Dou R, Brewe E, Potvin G, Zwolak JP, Hazari Z (2018) Understanding the
activity, arylesterase activity and anthropometric parameters of under- development of interest and self-efficacy in active-learning undergraduate
graduate students under examination stress. Eur J Inflamm physics courses. Int J Sci Educ 40(13):1587–1605
19:20587392211000884. https://doi.org/10.1177/20587392211000884 Dowlati MA, Shayan A, Zar A (2020) The effect of brain-derived neurotrophic
Angraini E, Zubaidah S, Susanto H (2023) TPACK-based active learning to pro- factor single nucleotide polymorphism on cognitive factors. Middle East J
mote digital and scientific literacy in genetics. Pegem J Educ Instr Rehabil Health Stud. 7(3). https://doi.org/10.5812/mejrh.101559
13(2):50–61. https://doi.org/10.47750/pegegog.13.02.07 Estrada-Araoz EG, Larico-Uchamaco GR, Roman-Paredes NO, Ticona-Chayña E
Armario A, Labad J, Nadal R (2020) Focusing attention on biological markers of (2024) Coping with stress and self-efficacy as predictors of academic satis-
acute stressor intensity: empirical evidence and limitations. Neurosci Biobe- faction in a sample of university students. Salud Cienc Tecnol 4:840–840.
hav Rev 111:95–103. https://doi.org/10.1016/j.neubiorev.2020.01.013 https://doi.org/10.56294/saludcyt2024840
Ballestar-Tarín ML, Ibáñez-del Valle V, Mafla-España MA, Navarro-Martínez R, Ferreira ÉDMR, Pinto RZ, Arantes PMM, Vieira ÉLM, Teixeira AL, Ferreira FR,
Cauli O (2024) Salivary brain-derived neurotrophic factor and cortisol Vaz DV (2020) Stress, anxiety, self-efficacy, and the meanings that physical
associated with psychological alterations in University students. Diagnostics therapy students attribute to their experience with an objective structured
14(4):447. https://doi.org/10.3390/diagnostics14040447 clinical examination. BMC Med Educ 20:1–9. https://doi.org/10.1186/s12909-
Barbayannis G, Bandari M, Zheng X, Baquerizo H, Pecor KW, Ming X (2022) 020-02202-5
Academic stress and mental well-being in college students: correlations, Fitriani A, Zubaidah S, Susilo H, Al Muhdhar MHİ (2020) The effects of integrated
affected groups, and COVID-19. Front Psychol 13:886344. https://doi.org/10. problem-based learning, predict, observe, explain on problem-solving skills
3389/fpsyg.2022.886344 and self-efficacy. Eurasian J Educ Res 20(85):45–64
Bedard M, Woods R, Crump C, Anisman H (2017) Loneliness in relation to Fukuoka H, Shichi H, Yamamoto M, Takahashi Y (2020) The mechanisms
depression: the moderating influence of a polymorphism of the brain derived underlying autonomous adrenocorticotropic hormone secretion in Cushing’s
neurotrophic factor gene on self-efficacy and coping strategies. Front Psychol disease. Int J Mol Sci 21(23):9132
8:1224. https://doi.org/10.3389/fpsyg.2017.01224 Hall JM, Cruser D, Podawiltz A, Mummert DI, Jones H, Mummert ME (2012)
Bedewy D, Gabriel A (2015) Examining perceptions of academic stress and its Psychological stress and the cutaneous immune response: roles of the HPA
sources among university students: the Perception of Academic Stress Scale. axis and the sympathetic nervous system in atopic dermatitis and psoriasis.
Health Psychol Open 2(2):2055102915596714. https://doi.org/10.1177/ Dermatol Res Pract 2012(1):403908
2055102915596714 Harb H, Gonzalez-De-La-Vara M, Thalheimer L, Klein U, Renz H, Rose M, Peters
Boell SK, Cecez-Kecmanovic D (2015) On being ‘systematic’in literature reviews in EMJ (2017) Assessment of brain derived neurotrophic factor in hair to study
IS. J Inf Technol 30(2):161–173. https://doi.org/10.1057/jit.2014.26 stress responses: a pilot investigation. Psychoneuroendocrinology
Borghi F, da Silva PC, Canova F, Souza AL, Arouca AB, Grassi-Kassisse DM (2021) 86:134–143. https://doi.org/10.1016/j.psyneuen.2017.09.007
Acute and chronic effects of exams week on cortisol production in under- Harris RB, Grunspan DZ, Pelch MA, Fernandes G, Ramirez G, Freeman S (2019)
graduate students. Preprint at bioRxiv https://doi.org/10.1101/2021.02.23.432585 Can test anxiety interventions alleviate a gender gap in an undergraduate STEM
Briones NGP, Vázquez KR, Reyes BJL, Melasio DAG, Lara AR, Hernández PET course? CBE—Life Sci Educ 18(3):ar35. https://doi.org/10.1187/cbe.18-05-0083
(2024) Clinical practice stressors and anxiety in nursing students during He SC, Wu S, Wang C, Du XD, Yin G, Jia Q, Zhang XY (2018) Interaction between
COVID-19. Salud Mental 46(6):287–293. https://doi.org/10.17711/SM.0185- job stress and the BDNF Val66Met polymorphism affects depressive symp-
3325.2023.037 toms in Chinese healthcare workers. J Affect Disord 236:157–163. https://doi.
Brodersen L, Lorenz R (2020) Perceived stress, physiological stress reactivity, and org/10.1016/j.jad.2018.04.089
exit exam performance in a prelicensure Bachelor of Science nursing pro- Heming M, Angerer P, Apolinário-Hagen J et al. (2023) The association between study
gram. Int J Nurs Educ Scholarsh 17(1):20190121. https://doi.org/10.1515/ conditions and hair cortisol in medical students in Germany—a cross-sectional
ijnes-2019-0121 study. J Occup Med Toxicol 18:7. https://doi.org/10.1186/s12995-023-00373-7
Cai W, Pan Y, Chai H, Cui Y, Yan J, Dong W, Deng G (2018) Attentional bias Hermann R, Schaller A, Lay D, Bloch W, Albus C, Petrowski K (2021) Effect of
modification in reducing test anxiety vulnerability: a randomized controlled acute psychosocial stress on the brain-derived neurotrophic factor in humans
trial. BMC Psychiatry 18:1–9. https://doi.org/10.1186/s12888-017-1517-6 —a randomized cross within trial. Stress 24(4):442–449. https://doi.org/10.
Cardozo LT, Azevedo MARD, Carvalho MSM, Costa R, de Lima PO, Marcondes 1080/10253890.2020.1854218
FK (2020) Effect of an active learning methodology combined with formative Hong Y, Zhang L, Liu N, Xu X, Liu D, Tu J (2022) The central nervous mechanism
assessments on performance, test anxiety, and stress of university students. of stress-promoting cancer progression. Int J Mol Sci 23(20):12653
Adv Physiol Educ 44(4):744–751. https://doi.org/10.1152/advan.00075.2020 Ibrahim JN, Audi L (2021) Anxiety symptoms among Lebanese health-care stu-
Cardozo LT, Lima POD, Carvalho MSM, Casale KR, Bettioli AL, Azevedo MARD, dents: prevalence, risk factors, and relationship with vitamin D status. J
Marcondes FK (2023) Active learning methodology, associated to formative Health Sci 11(1):29–36. https://doi.org/10.17532/jhsci.2021.1191

HUMANITIES AND SOCIAL SCIENCES COMMUNICATIONS | (2025)12:146 | https://doi.org/10.1057/s41599-025-04484-w 15

REVIEW ARTICLE HUMANITIES AND SOCIAL SCIENCES COMMUNICATIONS | https://doi.org/10.1057/s41599-025-04484-w

Ismail NA, Leong Abdullah MFI, Hami R, Ahmad Yusof H (2020) A narrative Mexican beverage fermented with lactic acid bacteria on academic stress in
review of brain-derived neurotrophic factor (BDNF) on cognitive perfor- medical students. Nutrients 13(5):1551. https://doi.org/10.3390/nu13051551
mance in Alzheimer’s disease. Growth Factors 38(3-4):210–225. https://doi. Mayya SS, Martis M, Mayya A, Iyer VLR, Ramesh A (2022) Academic stress among
org/10.1080/08977194.2020.1864347 pre-university students of the commerce stream: a study in Karnataka. Per-
Jahan SS, Nerali JT, Parsa AD, Kabir R (2022) Exploring the association between tanika J Soc Sci Humanit 30(2). https://doi.org/10.47836/pjssh.30.2.10
emotional intelligence and academic performance and stress factors among Modarresi F, Fatemi RP, Razavipour SF, Ricciardi N, Makhmutova M, Khoury N,
dental students: a scoping review. Dent J 10(4):67. https://doi.org/10.3390/ Faghihi MA (2021) A novel knockout mouse model of the noncoding anti-
dj10040067 sense Brain-Derived Neurotrophic Factor (Bdnf) gene displays increased
Jamieson JP, Black AE, Pelaia LE, Reis HT (2021) The impact of mathematics endogenous Bdnf protein and improved memory function following exercise.
anxiety on stress appraisals, neuroendocrine responses, and academic per- Heliyon 7(7):e07570. https://doi.org/10.1016/j.heliyon.2021.e07570
formance in a community college sample. J Educ Psychol 113(6):1164. Mujinya R, Kalange M, Ochieng JJ, Ninsiima HI, Eze ED, Afodun AM, Kasozi KI
https://doi.org/10.1037/edu0000636 (2022) Cerebral cortical activity during academic stress amongst under-
Javaid ZK, Chen Z, Ramzan M (2024) Assessing stress causing factors and language graduate medical students at Kampala International University (Uganda).
related challenges among first year students in higher institutions in Pakistan. Front Psychiatry 13:551508. https://doi.org/10.3389/fpsyt.2022.551508
Acta Psychol 248:104356. https://doi.org/10.1016/j.actpsy.2024.104356 Muntholib M, Muhdhar MHIA, Zahro SM, Abdillah RR, Astuti L, Wardhani YS,
Jiang R, Babyak MA, Brummett BH, Siegler IC, Kuhn CM, Williams RB (2017) … & Achmad R (2024) The effect of inquiry social complexity (ISC)-based
Brain-derived neurotrophic factor (BDNF) Val66Met polymorphism interacts adiwiyata e-module on self-efficacy and environmental literacy. In: Habiddin
with gender to influence cortisol responses to mental stress. Psychoneur- H, Roncevic T (eds) AIP conference proceedings, vol 3106(1). AIP Publishing
oendocrinology 79:13–19. https://doi.org/10.1016/j.psyneuen.2017.02.005 Munyaradzi M, Addae D (2018) Effectiveness of student psychological support
Jiménez-Mijangos LP, Rodríguez-Arce J, Martínez-Méndez R et al. (2023) services at a technical and vocational education and training college in South
Advances and challenges in the detection of academic stress and anxiety in Africa. Community College J Res Practice 43(4):262–274. https://doi.org/10.
the classroom: a literature review and recommendations. Educ Inf Technol 1080/10668926.2018.1456379
28:3637–3666. https://doi.org/10.1007/s10639-022-11324-w Mustikasari VR, Suwono H, Farhania K (2020) Improving students’ science
Kabrita CS, Hajjar-Muça TA (2016) Sex-specific sleep patterns among university learning outcomes through joyful-inquiry interactive demonstration assisted
students in Lebanon: impact on depression and academic performance. Nat by game android. In: Habiddin H, Majid S, Ibnu S, Farida N, Dasna IW (eds)
Sci Sleep 8:189–196. https://doi.org/10.2147/NSS.S104383 AIP conference proceedings, vol 2215(1). AIP Publishing
Karpova NN (2014) Role of BDNF epigenetics in activity-dependent neuronal Myint K, Jacobs K, Myint AM, Lam SK, Henden L, Hoe SZ, Guillemin GJ (2021)
plasticity. Neuropharmacology 76(Part C):709–718. https://doi.org/10.1016/j. Effects of stress associated with academic examination on the kynurenine
neuropharm.2013.04.002 pathway profile in healthy students. PLoS ONE 16(6):e0252668
Kato-Kataoka A, Nishida K, Takada M, Kawai M, Kikuchi-Hayakawa H, Suda K, Nadal R, Gabriel-Salazar M, Sanchís-Ollé M, Gagliano H, Belda X, Armario A
Rokutan K (2016) Fermented milk containing Lactobacillus casei strain (2021) Individual differences in the neuroendocrine response of male rats to
Shirota preserves the diversity of the gut microbiota and relieves abdominal emotional stressors are not trait-like and strongly depend on the intensity of
dysfunction in healthy medical students exposed to academic stress. Appl the stressors. Psychoneuroendocrinology 125:105127. https://doi.org/10.
Environ Microbiol 82(12):3649–3658. https://doi.org/10.1128/AEM.04134-15 1016/j.psyneuen.2021.105127
Kokubo Y, Shoji Y (2017) Relationship between good grades and brain waves. In: Nakamura H, Iwamoto M, Washida K, Sekine K, Takase M, Park BJ, Miyazaki Y
Matsuo T, Fukuta N, Mori M, Hashimoto K, Hirokawa S (eds) 2017 6th IIAI (2010) Influences of casein hydrolysate ingestion on cerebral activity, auto-
International Congress on Advanced Applied Informatics (IIAI-AAI). IEEE, nomic nerve activity, and anxiety. J Physiol Anthropol 29(3):103–108. https://
Conference Publishing Services, pp. 687–690 doi.org/10.2114/jpa2.29.103
La Rovere MT, Gorini A, Schwartz PJ (2022) Stress, the autonomic nervous system, Ojewale LY (2020) Psychological state and family functioning of University of
and sudden death. Auton Neurosci 237:102921. https://doi.org/10.1016/j. Ibadan students during the COVID-19 lockdown. Preprint at MedRxiv
autneu.2021.102921 https://doi.org/10.1101/2020.07.09.20149997
Lazarus RS, Folkman S (1984) Stress appraisal, and coping. Springer Publishing Olivas-Martinez A, Suarez B, Salamanca-Fernandez E, Reina-Perez I, Rodriguez-
Company, New York Carrillo A, Mustieles V, Fernández MF (2023) Development and validation of
Lee LC, Su MT, Cho YC, Lee‐Chen GJ, Yeh TK, Chang CY (2019) Multiple brain-derived neurotrophic factor measurement in human urine samples as a
epigenetic biomarkers for evaluation of students’ academic performance. non-invasive effect biomarker. Front Mol Neurosci 15:1075613. https://doi.
Genes Brain Behav 18(5):e12559 org/10.3389/fnmol.2022.1075613
Lightman SL, Birnie MT, Conway-Campbell BL (2020) Dynamics of ACTH and Ouanes S, Popp J (2019) High cortisol and the risk of dementia and Alzheimer’s
cortisol secretion and implications for disease. Endocr Rev 41(3):bnaa002. disease: a review of the literature. Front Aging Neurosci 11:43. https://doi.org/
https://doi.org/10.1210/endrev/bnaa002 10.3389/fnagi.2019.00043
Lindau M, Almkvist O, Mohammed AH (2016) Effects of stress on learning and Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Moher
memory. In: Fink G (ed) Stress: concepts, cognition, emotion, and behavior. D (2021) Updating guidance for reporting systematic reviews: development
Academic Press, pp. 153–160 of the PRISMA 2020 statement. J Clin Epidemiol 134:103–112. https://doi.
Linz R, Puhlmann LMC, Apostolakou F, Mantzou E, Papassotiriou I, Chrousos GP, org/10.1016/j.jclinepi.2021.02.003
Singer T (2019) Acute psychosocial stress increases serum BDNF levels: an Pascoe MC, Hetrick SE, Parker AG (2020) The impact of stress on students in
antagonistic relation to cortisol but no group differences after mental train- secondary school and higher education. Int J Adolesc Youth 25(1):104–112.
ing. Neuropsychopharmacology 44(10):1797–1804. https://doi.org/10.1038/ https://doi.org/10.1080/02673843.2019.1596823
s41386-019-0391-y Pati D, Lorusso LN (2018) How to write a systematic review of the literature. Health
Lipovich L, Dachet F, Cai J, Bagla S, Balan K, Jia H, Loeb JA (2012) Activity- Environ Res Design J 11(1):15–30. https://doi.org/10.1177/1937586717747384
dependent human brain coding/noncoding gene regulatory networks. Peter HL, Giglberger M, Streit F, Frank J, Kreuzpointner L, Rietschel M, Wüst S
Genetics 192(3):1133–1148. https://doi.org/10.1534/genetics.112.145128 (2023) Association of polygenic scores for depression and neuroticism with
MacCann C, Double KS, Clarke IE (2022) Lower avoidant coping mediates the perceived stress in daily life during a long‐lasting stress period. Genes Brain
relationship of emotional intelligence with well-being and ill-being. Front Behav 22(6):e12872. https://doi.org/10.1111/gbb.12872
Psychol 13:835819. https://doi.org/10.3389/fpsyg.2022.835819 Pizzie RG, McDermott CL, Salem TG, Kraemer DJ (2020) Neural evidence for
Mäkelä SM, Griffin SM, Reimari J, Evans KC, Hibberd AA, Yeung N, Patterson E cognitive reappraisal as a strategy to alleviate the effects of math anxiety. Soc
(2023) Efficacy and safety of Lacticaseibacillus paracasei Lpc-37® in students Cogn Affect Neurosci 15(12):1271–1287. https://doi.org/10.1093/scan/nsaa161
facing examination stress: a randomized, triple-blind, placebo-controlled Poortinga YH, Fontaine JR (2022) Principles and practices of methodology and
clinical trial (the ChillEx study). Brain Behav Immun-Health 32:100673. methods in cross-cultural psychology. J Cross-Cult Psychol 53(7-8):847–859.
https://doi.org/10.1016/j.bbih.2023.100673 https://doi.org/10.1177/00220221221093811
Malanchini M, Rimfeld K, Wang Z, Petrill SA, Tucker-Drob EM, Plomin R, Kovas Pozos‐Radillo E, Preciado‐Serrano L, Plascencia‐Campos A, Valdez‐López R,
Y (2020) Genetic factors underlie the association between anxiety, attitudes Morales‐Fernández A (2016) Psychophysiological manifestations associated
and performance in mathematics. Transl Psychiatry 10(1):12. https://doi.org/ with stress in students of a public university in Mexico. J Child Adolesc
10.1038/s41398-020-0711-3 Psychiatr Nurs 29(2):79–84. https://doi.org/10.1111/jcap.12142
Marlina R, Suwono H, Ibrohim I, Yuenyong C, Husamah H, Hamdani H (2024) Pradhan G, Mendinca NL, Kar M (2014) Evaluation of examination stress and its
Theoretical frameworks of self-efficacy in collaborative science learning effect on cognitive function among first year medical students. J Clin Diagn
practices: a systematic literature review. J Pendidik Biol Res 8(8):BC05. https://doi.org/10.7860/JCDR/2014/9014.4680
Indones10(2):602–615 Rashkova MR, Ribagin LS, Toneva NG (2012) Correlation between salivary
Márquez-Morales L, El-Kassis EG, Cavazos-Arroyo J, Rocha-Rocha V, Martínez- [alpha]-amylase and stress-related anxiety. Folia Medica 54(2):46. https://doi.
Gutiérrez F, Pérez-Armendáriz B (2021) Effect of the intake of a traditional org/10.2478/v10153-011-0088-4

16 HUMANITIES AND SOCIAL SCIENCES COMMUNICATIONS | (2025)12:146 | https://doi.org/10.1057/s41599-025-04484-w

HUMANITIES AND SOCIAL SCIENCES COMMUNICATIONS | https://doi.org/10.1057/s41599-025-04484-w REVIEW ARTICLE

Reddy KJ, Menon KR, Thattil A (2018) Academic stress and its sources among Usichenko T, Wenzel A, Klausenitz C, Petersmann A, Hesse T, Neumann N,
university students. Biomed Pharmacol J 11(1):531–537. https://doi.org/10. Hahnenkamp K (2020) Auricular stimulation vs. expressive writing for exam
13005/bpj/1404 anxiety in medical students—a randomized crossover investigation. PLoS
Renjith VR, Pradeepkumar AP (2021) Citations of the top 100 most-cited papers of ONE 15(8):e0238307. https://doi.org/10.1371/journal.pone.0238307
the journal Scientometrics in Web of Science and its association and corre- Vajaradul Y, Aroonsrimorakot S, Laiphrakpam M, Paisantanakij W (2021) Key
lation with Scopus and Google Scholar citations. Libr Acad 4710. https:// steps and characteristics for successful interdisciplinary research: an analy-
digitalcommons.unl.edu/libphilprac/4710 tical review. J Behav Sci 16(2):73–85. https://so06.tci-thaijo.org/index.php/
Rimfeld K, Kovas Y, Dale PS, Plomin R (2015) Pleiotropy across academic subjects IJBS/article/view/245723
at the end of compulsory education. Sci Rep 5(1):11713. https://doi.org/10. van den Heuvel LL, Suliman S, Bröcker E, Kilian S, Stalder T, Kirschbaum C,
1038/srep11713 Seedat S (2022) The association between hair cortisol levels, inflammation
Ringeisen T, Lichtenfeld S, Becker S, Minkley N (2019) Stress experience and and cognitive functioning in females. Psychoneuroendocrinology 136:105619
performance during an oral exam: the role of self-efficacy, threat appraisals, Višić M (2022) Connecting puzzle pieces: systematic literature review method in
anxiety, and cortisol. Anxiety Stress Coping 32(1):50–66. https://doi.org/10. the social sciences. Sociologija 64(4):543–562. https://doi.org/10.1016/j.
1080/10615806.2018.1528528 psyneuen.2021.105619
Rodríguez-Torres ÁF, Garduño-Durán J, Carbajal-García SE, Marín-Marín JA Van Dinter R, Tekinerdogan B, Catal C (2021) Automation of systematic literature
(2024) Assessment of the perceived mastery of interdisciplinary competences reviews: a systematic literature review. Inf Softw Technol 136:106589. https://
of students in education degree programmes. Educ Sci 14(2):144. https://doi. doi.org/10.1016/j.infsof.2021.106589
org/10.3390/educsci14020144 Vogel S, Schwabe L (2016) Stress in the zoo: Tracking the impact of stress on
Romero-Romero E, De León EG, Morán-Pinzón J, Salado-Castillo R, Castillo- memory formation over time. Psychoneuroendocrinology 71:64–72. https://
Pimentel A (2023) Academic stress, hair and saliva cortisol, and their rela- doi.org/10.1016/j.psyneuen.2016.04.027
tionship with body mass index and fat percentage in first year medical stu- Wiłkość M, Szałkowska A, Skibińska M, Zając-Lamparska L, Maciukiewicz M, Ara-
dents. Physiol Int 110(3):277–290. https://doi.org/10.1556/2060.2023.00178 szkiewicz A (2016) BDNF gene polymorphisms and haplotypes in relation to
Seipäjärvi SM, Tuomola A, Juurakko J, Rottensteiner M, Rissanen APE, Kurkela JL, cognitive performance in Polish healthy subjects. Acta Neurobiol Exp 76(1):43–52
Wikgren J (2022) Measuring psychosocial stress with heart rate variability- Wong CL, Chien WT, Waye MMY, Szeto MWC, Li H (2023) Nursing students’
based methods in different health and age groups. Physiol Meas perceived anxiety and heart rate variability in mock skill competency assessment.
43(5):055002. https://doi.org/10.1088/1361-6579/ac6b7c PLoS ONE 18(10):e0293509. https://doi.org/10.1371/journal.pone.0293509
Shah A, Chen C, Campanella C, Kasher N, Evans S, Reiff C, Bremner JD (2019) World Health Organization (2001) International classification of functioning,
Brain correlates of stress‐induced peripheral vasoconstriction in patients with disability and health. World Health Organization, Geneva, Switzerland
cardiovascular disease. Psychophysiology 56(2):e13291. https://doi.org/10. Wyatt T, Oswalt SB (2013) Comparing mental health issues among undergraduate
1111/psyp.13291 and graduate students. Am J Health Educ 44(2):96–107. https://doi.org/10.
Shanbhog MS, Medikonda J (2023) A clinical and technical methodological review 1080/19325037.2013.764248
on stress detection and sleep quality prediction in an academic environment. Zallocco L, Giusti L, Ronci M, Mussini A, Trerotola M, Mazzoni MR, Sebastiani L
Comput Methods Programs Biomed 235:107521–107521. https://doi.org/10. (2021) Salivary proteome changes in response to acute psychological stress
1016/j.cmpb.2023.107521 due to an oral exam simulation in university students: Effect of an olfactory
Sockolow P, Dowding D, Randell R, Favela J (2016) Using mixed methods in health stimulus. Int J Mol Sci 22(9):4295. https://doi.org/10.3390/ijms22094295
information technology evaluation. In: Sermeus W, Procter PM, Weber P Zamroni Z, Hidayah N, Ramli M, Hambali IM(2018) Prevalence of academic stress
(eds) Nursing informatics 2016. Ios Press, pp. 83–87 among medical and pharmaceutical students Eur J Educ Stud 4(10):256–267.
Soliman F, Glatt CE, Bath KG et al. (2010) A genetic variant BDNF polymorphism https://doi.org/10.5281/zenodo.1321531
alters extinction learning in both mouse and human. Science Zhao X, Xia Q, Huang W (2020) Impact of technostress on productivity from the
327(5967):863–866. https://doi.org/10.1126/science.1181886 theoretical perspective of appraisal and coping processes. Inf Manag 57(8).
Spătaru B, Podină IR, Tulbure BT, Maricuțoiu LP (2024) A longitudinal exam- https://doi.org/10.1016/j.im.2020.103265
ination of appraisal, coping, stress, and mental health in students: a cross‐
lagged panel network analysis. Stress Health 40:e3450. https://doi.org/10.
1002/smi.3450 Acknowledgements
Špiljak B, Šimunović L, Vilibić M, Hanžek M, Crnković D, Lugović-Mihić L (2024) This research was funded by the Balai Pembiayaan Pendidikan Tinggi (BPPT) Kemen-
Perceived stress, salivary cortisol, and temperament traits among students of dikbudristek and Lembaga Pengelola Dana Pendidikan (LPDP) Republik Indonesia,
dental medicine: a Prospective and Interventional Study. Behav Sci 14(4):289. under Grant No. 01400/BPPT/BPI.06/9/2023. The authors are grateful for the financial
https://doi.org/10.3390/bs14040289 support that made this research possible.
Špiljak B, Vilibić M, Glavina A, Crnković M, Šešerko A, Lugović-Mihić L (2022) A
review of psychological stress among students and its assessment using Author contributions
salivary biomarkers. Behav Sci 12(10):400. https://doi.org/10.3390/ All three authors were actively involved in the processes of literature identification, screening,
bs12100400 and evaluation. The first author took primary responsibility for the review analysis, manu-
Stirparo G, Pireddu R, D’Angelo M, Bottignole D, Mazzoli R, Gambolò L (2024) Is script planning, drafting, and revisions. The second author oversaw the project and study
mental health worse in medical students than in the general population? A management and handled the writing as well as the final proofreading of the manuscript.
cross-sectional study. Medicina 60(6):863. https://doi.org/10.3390/ The third author contributed to the writing and revisions of the manuscript.
medicina60060863
Stoffel M, Gardini E, Ehrenthal JC, Abbruzzese E, Ditzen B (2022) Evaluation of
stress management and stress prevention using epigenetic markers. Verhal- Competing interests
tenstherapie 32(Suppl 1):5–13. https://doi.org/10.1159/000506323 The authors declare no competing interests.
Sulfa DM, Suwono H, Husamah H (2024) Human connection with nature
improves wellbeing and pro-environmental behavior: a literature review. J
Pendidik Biol Indonesia 10(2):698–713
Ethical approval
Ethics approval was not required for this study as it used data already published in the
Sung G, Bhinder H, Feng T, Schneider B (2023) Stressed or engaged? Addressing
scientific literature.
the mixed significance of physiological activity during constructivist learning.
Comput Educ 199. https://doi.org/10.1016/j.compedu.2023.104784
Tavakoli R, Yaghooti H, Daghagheleh R, Yousofi R, Rahimifar P (2017) Serum Informed consent
lipids and brain-derived neurotrophic factor in a cross-section of male stu- Informed consent was not required as the study did not involve human participants.
dents with symptoms of depression at a university in Iran: an observational
study. Asian Biomed 11(5):413–417. https://doi.org/10.1515/abm-2018-0016
Tripathi R, Alqahtani SS, Meraya AM, Makeen HA, Tripathi P, Pancholi SS (2022) Additional information
Evaluation of depression, anxiety, and stress among university healthcare Correspondence and requests for materials should be addressed to Hendra Susanto.
students. J Appl Pharm Sci 12(10):078–087. https://doi.org/10.7324/JAPS.
2022.121008 Reprints and permission information is available at http://www.nature.com/reprints
Unternaehrer E, Meinlschmidt G (2016) Psychosocial stress and DNA methylation.
In: Spengler D, Binder E (eds) Epigenetics and neuroendocrinology. Epige- Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in
netics and human health. Springer, Cham published maps and institutional affiliations.

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