Resumen
INTRODUCCIÓN: La percepción de estrés académico y no académico se ha asociado con la presencia de síntomas somáticos en estudiantes universitarios; sin embargo, los mecanismos cognitivos implicados, particularmente el rol de la preocupación reactiva, han sido escasamente estudiados desde diseños con Evaluación Ecológica Momentánea (EMA). OBJETIVO: analizar la relación entre el estrés académico y no académico y síntomas somáticos, considerando el rol mediador de la preocupación reactiva. MÉTODO: Participaron 238 estudiantes universitarios. Se empleó un diseño cuantitativo, correlacional prospectivo, combinando cuestionarios estandarizados y EMA durante una semana, con análisis descriptivos e inferenciales con mediación. RESULTADOS: Las mujeres presentaron mayores niveles de preocupación rasgo, estrés académico, preocupación reactiva y síntomas somáticos. En las regresiones lineales, el estrés académico y no académico, así como la preocupación reactiva, se asociaron con mayores síntomas somáticos. En los análisis de mediación separados por fuente de estrés, se observó un efecto indirecto del estrés no académico sobre los síntomas somáticos a través de la preocupación reactiva, pero no para el estrés académico. CONCLUSIONES: Teniendo en cuenta la brevedad del seguimiento, los resultados evidencian relaciones complejas entre el estrés, la preocupación reactiva y la variación de los síntomas somáticos, lo que subraya la necesidad de considerar la fuente de estrés.
Referencias
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