Abstract
INTRODUCTION: Perceived academic and non-academic stress have been associated with the presence of somatic symptoms in university students; however, the cognitive mechanism underlying this relationship, particularly the role of reactive worry, has been scarcely examined using Ecological Momentary Assessment (EMA) designs. OBJECTIVE: To analyze the longitudinal relationship between academic stress, non-academic stress, and somatic symptoms, considering the mediation role of reactive worry and gender differences. METHOD: A total of 238 university students participated. A quantitative, correlational, and longitudinal design was employed, combining standardized questionnaires and EMA over one week. Descriptive, correlational, linear regression, path analysis, and robust mediation analyses were conducted. RESULTS: Women reported higher levels of trait worry, academic stress, reactive worry, and somatic symptoms. In the linear regression analyses, academic stress, non-academic stress, and reactive worry were associated with greater somatic symptoms. In the mediation analyses conducted separately by stress source, an indirect effect of non-academic stress on somatic symptoms through reactive worry was observed, whereas no such effect was found for academic stress. CONCLUSIONS: Considering the brief follow-up period, the findings reveal complex relationships among stress, reactive worry, and changes in somatic symptoms, highlighting the need to consider the source of stress.
References
Alfons, A., Ateş, N. Y. y Groenen, P. J. F. (2022). A robust bootstrap test for mediation analysis. Organizational Research Methods, 25(3), 591-617. https://doi.org/10.1177/1094428121999096
Alsaleem, M. A., Alsaleem, S. A., Al Shehri, S., Awadalla, N. J., Mirdad, T. M., Abbag, F. I. y Mahfouz, A. A. (2021). Prevalence and correlates of university students' perceived stress in southwestern Saudi Arabia. Medicine, 100(38), e27295. https://doi.org/10.1097/MD.0000000000027295
Arbel, R., Shapiro, L. S., Timmons, A. C., Moss, I. K. y Margolin, G. (2017). Adolescents' daily worry, morning cortisol, and health symptoms. Journal of Adolescent Helath, 60(6), 667-673. https://doi.org/10.1016/j.jadohealth.2017.01.007
Atasoy, S., Hausteiner-Wiehle, C., Sattel, H., Johar, H., Roenneberg, C., Peters, A., Ladwig, K.-H. y Henningsen, P. (2022). Gender specific somatic symptom burden and mortality risk in the general population. Scientific Reports, 12(1). https://doi.org/10.1038/s41598-022-18814-4
Atif, S., Mustafa, N. y Ghafoor, S. (2025). Perceived stress and coping strategies used by undergraduate dental students: An observational study. PLoS One, 20(1), e0318152. https://doi.org/10.1371/journal.pone.0318152
Ballering, A. V., Olde Hartman, T. C., Verheij, R. y Rosmalen, J. G. M. (2023). Sex and gender differences in primary care help-seeking for common somatic symptoms: a longitudinal study. Scandinavian Journal of Primary Health Care, 41(2), 132-139. https://doi.org/10.1080/02813432.2023.2191653
Barrera-Hererra, A. y San Martín, Y. (2021). Prevalencia de sintomatología de salud mental y hábitos de salud en una muestra de universitarios chilenos. Psykhe, 30(1), 1-16. https://doi.org/10.7764/psykhe.2019.21813
Borkovec, T. D., Robinson, E., Prunzinsky, T. y DePree, J. A. (1983). Preliminary exploration of worry: some characteristics and processes Behaviour Research and Therapy, 21(1), 9-16. https://doi.org/10.1016/0005-7967(83)90121-3
Bottesi, G. y Spoto, A. (2025). Should we worry about how we measure worry? Insights from an updated version of the Italian Penn State Worry Questionnaire. International Journal of Clinical and Health Psychology, 25(2). https://doi.org/10.1016/j.ijchp.2025.100579
Brambila-Tapia, A., Meda-Lara, R., Palomera-Chavez, A., De Santos-Ávila, F., Hernandez-Rivas, M., Borquez-Hernandez, P. y Juarez-Rodriguez, P. (2019). Association between personal, medical and positive psychological variables with somatization in university health sciences students. Psychology, Health & Medicine, 25(7), 879-886. https://doi.org/10.1080/13548506.2019.1683869
Brambila-Tapia, A. J. L., Macias-Espinoza, F., Reyes-Dominguez, Y. A., Ramirez-Garcia, M. L., Miranda-Lavastida, A. J., Rios-Gonzalez, B. E., Saldana-Cruz, A. M., Esparza-Guerrero, Y., Mora-Moreno, F. F. y Davalos-Rodriguez, I. P. (2022). Association of depression, anxiety, stress and stress-coping strategies with somatization and number of diseases according to sex in the mexican general population. Healthcare, 10(6). https://doi.org/10.3390/healthcare10061048
Brosschot, J. F., Gerin, W. y Thayer, J. F. (2006). The perseverative cognition hypothesis: a review of worry, prolonged stress-related physiological activation, and health. Journal of Psychosomatic Research, 60(2), 113-124. https://doi.org/10.1016/j.jpsychores.2005.06.074
Cabanach, R. G., Fariña, F., Freire, C., González, P. y del Mar Ferradas, M. (2013). Diferencias en el afrontamiento del estrés en estudiantes universitarios hombres y mujeres. European Journal of Education and Psychology, 6(1), 19-32. https://www.redalyc.org/articulo.oa?id=129327497002
Cassaretto, M., Vilela, P. y Gamarra, L. (2021). Estrés académico en universitarios peruanos: importancia de las conductas de salud, características sociodemográficas y académicas. Liberabit, 27(2). https://doi.org/10.24265/liberabit.2021.v27n2.07
Castillo Avila, I. Y., Barrios Cantillo, A. y Alvis Estrada, L. R. (2018). Estrés académico en estudiantes de enfermería de Cartagena, Colombia. Investigación en Enfermería: Imagen y Desarrollo, 20(2). https://dialnet.unirioja.es/servlet/articulo?codigo=10118942
Casuso-Holgado, M. J., Moreno-Morales, N., Labajos-Manzanares, M. T. y Montero-Bancalero, F. J. (2019). The association between perceived health symptoms and academic stress in Spanish Higher Education students. European Journal of Education and Psychology, 12(2), 109-123. https://doi.org/10.30552/ejep.v12i2.277
Cranford, J. A., Shrout, P. E. y Bolger, N. (2006). A procedura for evaluating sensitivity to within-person change: can mood in diary studies detect change reliably. Personality and Social Psychology Bulletin, 32(7). https://doi.org/10.1177/0146167206287721
Davey, G. C. L., Meeten, F. y Field, A. P. (2022). What's worrying our students? increasing worry levels over two decades and a new measure of student worry frequency and domains. Cognitive Therapy and Research, 46(2), 406-419. https://doi.org/10.1007/s10608-021-10270-0
Emran, M. G. I., Mahmud, S., Khan, A. H., Bristy, N. N., Das, A. K., Barma, R., Taru, A., Mita, M. H., Bosunia, L., Rahman, M. y Roy, M. (2024). Factors influencing stress levels among students: A virtual exploration. European Journal of Medical and Health Sciences, 6(6). https://doi.org/10.24018/ejmed.2024.6.6.2203
Feussner, O., Rehnisch, C., Rabkow, N. y Watzke, S. (2022). Somatization symptoms-prevalence and risk, stress and resilience factors among medical and dental students at a mid-sized German university. PeerJ, 10, e13803. https://doi.org/10.7717/peerj.13803
Folkman, S., Lazarus, R. S., Dunkel-Schetter, C., DeLongis, A. y Gruen, R. J. (1986). Dynamics of a stressful encounter: cognitive appraisal, coping, and encounter outcomes. Journal of Personality and Social Psychology, 50(5), 992-1003. https://doi.org/10.1037//0022-3514.50.5.992
Gempp Fuentealba, R. y Avendaño Bravo, C. (2008). Datos normativos y propiedades psicométricas del SCL-90-R en estudiantes universitarios chilenos. Sociedad Chilena de Psicología Clinica, 26(1), 39-58. https://doi.org/10.4067/S0718-48082008000100004
Graves, B. S., Hall, M. E., Dias-Karch, C., Haischer, M. H. y Apter, C. (2021). Gender differences in perceived stress and coping among college students. PLoS One, 16(8), e0255634. https://doi.org/10.1371/journal.pone.0255634
Heim, C., Ehlert, U. y Hellhammer, D. (2000). The potential role of hypocortisolism in the pathophysiology of stress-related bodily disorders. Psychoneuroendocrinology, 25(1), 1-35. https://doi.org/10.1016/s0306-4530(99)00035-9
Huang, W.-l., Liao, S.-C., Yang, C. C. H., Kuo, T. B. J., Chen, T.-T., Chen, I.-M. y Gau, S. S.-F. (2017). Measures of heart rate variability in individuals with somatic symptom disorder. Psychosomatic Medicine, 79(1), 34-42. https://doi.org/10.1097/PSY.0000000000000362
Inostroza, C., Bustos, C., Buhring, V., Gonzalez, L. y Cova, F. (2024). Stress, repetitive negative thinking, and mental health in Chilean university students: an ecological momentary assessment study. Frontiers in Psychology, 15, 1400013. https://doi.org/10.3389/fpsyg.2024.1400013
Jamil, S. D., Kaya, B., Ay, M. K., Gökmen, A. Y., Şensazli, B., Karaoğlan, M., Arusal, S., Hidiroğlu, S. y Karavuş, M. (2024). Somatisation status and associated variables in final-year medical students at a public university, in Istanbul, Türkiye. The New Zealand Medical Student Journal, 37, 16-20. https://doi.org/10.57129/001c.122991
Janssens, K. A., Oldehinkel, A. J., Verhulst, F. C., Hunfeld, J. A., Ormel, J. y Rosmalen, J. G. (2012). Symptom-specific associations between low cortisol responses and functional somatic symptoms: the TRAILS study. Psychoneuroendocrinology, 37(3), 332-340. https://doi.org/10.1016/j.psyneuen.2011.06.016
Jerez-Mendoza, M. y Oyarzo-Barría, C. (2015). Estrés académico en estudiantes del Departamento de Salud de la Universidad de Los Lagos Osorno. Revista Chilena de Neuro-Psiquiatría, 53(3), 149-157. https://doi.org/10.4067/S0717-92272015000300002
Lignier, B., Petot, J.-M., Canada, B., Nicolas, M., Courtois, R. y De Oliveira, P. (2024). The structure of the Symptom Checklist-90-Revised: global distress, somatization, hostility, and phobic anxiety scales are reliable and robust across community and clinical samples from four European countries. Psychiatry Research, 331, 115635. https://doi.org/10.1016/j.psychres.2023.115635
Meyer, T. J., Miller, M. L., Metzger, R. L. y Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28(6), 487-495. https://doi.org/10.1016/0005-7967(90)90135-6
Murray, A. L., Xiao, Z., Zhu, X., Speyer, L. G., Yang, Y., Brown, R. H., Katus, L., Eisner, M. y Ribeaud, D. (2023). Psychometric evaluation of an adapted version of the perceived stress scale for ecological momentary assessment research. Stress and Health, 39(4), 841-853. https://doi.org/10.1002/smi.3229
Pacheco Salles, F. L., Maciel Ferreira, D., da Silva Bozi, P., Furtado, M. A., Favalessa Mai, J., Vieira de Souza, J. S. y Matedi Bufon, P. (2022). Evaluation of the perception of stress in university students: implications for symptoms and health complaints and nutritional habits. Journal of Education, 202(3), 211-220. https://doi.org/10.1177/0022057420969427
Papousek, I., Schulter, G. y Premsberg, E. (2002). Dissociated autonomic regulation during stress and physical complaints. Journal of Psychosomatic Research, 52(4), 257-266. https://doi.org/10.1016/s0022-3999(02)00298-2.
Pieper, S., Brosschot, J. F., van der Leeden, R. y Thayer, J. F. (2010). Prolonged cardiac effects of momentary assessed stressful events and worry episodes. Psychosom Medicine, 72(6), 570-577. https://doi.org/10.1097/PSY.0b013e3181dbc0e9
Pimentel, M. y Cova, F. (2017). Efectos de la rumiación y la preocupación en el desarrollo de sintomatología depresiva y ansiosa en estudiantes universitarios de la ciudad de Concepción, Chile. Terapia Psicológica, 29(1), 43-52. https://teps.cl/index.php/teps/article/view/162
Pozos-Radillo, B. E., Preciado-Serrano, M. d. L., Plascencia-Campos, A. R., Acosta-Fernández, M. y Aguilera-Velasco, M. d. l. Á. (2015). Estrés académico y síntomas físicos, psicológicos y comportamentales en estudiantes mexicanos de una universidad pública. Ansiedad y Estrés, 21(1), 35-42. https://dialnet.unirioja.es/servlet/articulo?codigo=6850073
Ramirez, C. (2025). Estrés académico, estrés no académico, género y desarrollo de síntomas somáticos en estudiantes universitarios: El rol mediador de la preocupación [Tesis de magister, Universidad de Concepción]. Repositorio Institucional UdeC. https://repositorio.udec.cl/items/8e9318bc-c05d-406e-b05b-474bb0c8034e
Restrepo, J., Sánchez, O. y Castañeda Quirama, T. (2020). Estrés académico en estudiantes universitarios. Revista Psicoespacios, 14(24), 23-47. https://doi.org/10.25057/21452776.1331
Rosenkranz, T., Takano, K., Watkins, E. R. y Ehring, T. (2020). Assessing repetitive negative thinking in daily life: Development of an ecological momentary assessment paradigm. PLoS One, 15(4), e0231783. https://doi.org/10.1371/journal.pone.0231783
Royston, P. y White, I. R. (2011). Multiple imputation by chained equations (MICE): implementation in STATA. Journal of Statistical Software, 45(4), 1-20. https://doi.org/10.18637/jss.v045.i04
Rubin, D. B. (1987). Multiple imputation for nonresponse in surveys. John Wiley & Sons. https://doi.org/10.1002/9780470316696
Sandín, B., Chorot, P., Valiente, R. M. y Lostao, L. (2009). Validación española del cuestionario de preocupación PSWQ :estructura factorial y propiedades psicométricas. Revista de Psicopatología y Psicología Clínica, 14(2). https://doi.org/10.5944/rppc.vol.14.num.2.2009.4070
Schlotz, W., Hellhammer, J., Schulz, P. y Stone, A. A. (2004). Perceived work overload and chronic worrying predict weekend–weekday differences in the cortisol awakening response. Psychosomatic Medicine, 66(2), 207-214. https://doi.org/10.1097/01.psy.0000116715.78238.56
Schmaus, B. J., Laubmeier, K. K., Boquiren, V. M., Herzer, M. y Zakowski, S. G. (2008). Gender and stress: differential psychophysiological reactivity to stress reexposure in the laboratory. International Journal of Psychophysiology, 69(2), 101-106. https://doi.org/10.1016/j.ijpsycho.2008.03.006
Schulz, A., Larra, M. F., Vögele, C., Kölsch, M. y Schàchinger, H. (2023). The relationship between self-reported chronic stress, physiological stress axis dysregulation and medically-unexplained symptoms. Biological Psychology, 183. https://doi.org/10.1016/j.biopsycho.2023.108690
Seedhom, A. E., Kamel, E. G., Mohammed, E. S. y Raouf, N. R. (2019). Predictors of Perceived Stress among Medical and Nonmedical College Students, Minia, Egypt. International Journal of Preventive Medicine, 10. https://doi.org/10.4103/ijpvm.IJPVM_6_18
Shiffman, S., Stone, A. A. y Hufford, M. R. (2008). Ecological momentary assessment. Annual Review of Clinical Psychology, 4(1), 1-32. https://doi.org/10.1146/annurev.clinpsy.3.022806.091415
Slimmen, S., Timmermans, O., Mikolajczak-Degrauwe, K. y Oenema, A. (2022). How stress-related factors affect mental wellbeing of university students a cross-sectional study to explore the associations between stressors, perceived stress, and mental wellbeing. PLoS One, 17(11), e0275925. https://doi.org/10.1371/journal.pone.0275925
Smet, S., Ottaviani, C., Verkuil, B., Kappen, M., Baeken, C. y Vanderhasselt, M.-A. (2023). Effects of non-invasive vagus nerve stimulation on cognitive and autonomic correlates of perseverative cognition. Psychophysiology, 60(6), e14250. https://doi.org/10.1111/psyp.14250
Tak, L. M. y Rosmalen, J. G. (2010). Dysfunction of stress responsive systems as a risk factor for functional somatic syndromes. Journal of Psychosomatic Research, 68(5), 461-468. https://doi.org/10.1016/j.jpsychores.2009.12.004
Tharaldsen, K. B., Tvedt, M. S., Caravita, S. C. S. y Bru, E. (2023). Academic stress: links with emotional problems and motivational climate among upper secondary school students. Scandinavian Journal of Educational Research, 67(7), 1137-1150. https://doi.org/10.1080/00313831.2022.2116480
Verkuil, B., Brosschot, J. F., Meerman, E. E. y Thayer, J. F. (2012). Effects of momentary assessed stressful events and worry episodes on somatic health complaints. Psychology & Health, 27(2), 141-158. https://doi.org/10.1080/08870441003653470
Zlomke, K. R. y Hahn, k. S. (2010). Cognitive emotion regulation strategies: Gender differences and associations to worry. Personality and Individual Differences, 48(4), 408-419. https://doi.org/10.1016/j.paid.2009.11.007
Zunhammer, M., Eberle, H., Eichhammer, P. y Busch, V. (2013). Somatic symptoms evoked by exam stress in university students: the role of alexithymia, neuroticism, anxiety and depression. PLoS One, 8(12), e84911. https://doi.org/10.1371/journal.pone.0084911