Sanitas

Revista arbitrada de ciencias de la salud

Vol. 4(3), 1-9, 2025

https://doi.org/10.62574/cqqvm718

Relationship between academic stress, anxiety, and depression in university

students studying Public Health

Relación entre estrés académico, ansiedad y depresión en estudiantes

universitarios de Salud Pública

Freddy Alexander Cuadrado-Quishpe

alexander.cuadrado@espoch.edu.ec

Escuela Superior Politécnica de Chimborazo, Riobamba, Chimborazo, Ecuador

https://orcid.org/0009-0006-9162-2199

Emily Domenick Moreno-Carvajal

emily.moreno@espoch.edu.ec

Chimborazo Polytechnic University, Riobamba, Chimborazo, Ecuador

https://orcid.org/0009-0002-3939-2489

María Bernarda Robalino-Silva

bernarda.rodriguez@espoch.edu.ec

Chimborazo Polytechnic University, Riobamba, Chimborazo, Ecuador

https://orcid.org/0009-0007-8522-9304

Daniel Sebastián Tene-Guamán

daniels.tene@espoch.edu.ec

Chimborazo Polytechnic University, Riobamba, Chimborazo, Ecuador

https://orcid.org/0009-0009-4520-772X

ABSTRACT

Objective: To analyze the relationship between academic stress and anxiety-depression symptoms in public

health university students. Method: Cross-sectional observational study of 241 sixth-semester students at

ESPOCH (2024-2025 academic year). The SISCO Inventory and the HADS Scale were used. The analysis

included Chi-square and Cramer's V coefficient to evaluate associations between categorical variables. Results

and conclusion: 45.6% presented high stress. Statistically significant relationships were identified between

academic stress and anxiety (χ²=32.15, p<0.0001, V=0.258), as well as with depression (χ²=28.47, p<0.001,

V=0.243), both of moderate magnitude. Females showed greater vulnerability (p=0.040). The results confirm the

urgency of implementing institutional programs that include emotional education, stress management

techniques, and early detection, addressing academic stress as a public health problem in universities.

Descriptors: psychological stress; anxiety; depression. (Source, DeCS).

RESUMEN

Objetivo: Analizar la relación entre estrés académico y sintomatología ansioso-depresiva en

estudiantes universitarios de Salud Pública. Método: Estudio observacional transversal en 241

estudiantes de sexto semestre de la ESPOCH (período 2024-2025). Se emplearon el Inventario

SISCO y la Escala HADS. El análisis incluyó Chi cuadrado y coeficiente V de Cramér para evaluar

asociaciones entre variables categóricas. Resultados y conclusión: El 45.6% presentó estrés alto.

Se identificaron relaciones estadísticamente significativas entre estrés académico y ansiedad

(χ²=32.15, p<0.0001, V=0.258), así como con depresión (χ²=28.47, p<0.001, V=0.243), ambas de

magnitud moderada. El sexo femenino mostró mayor vulnerabilidad (p=0.040). Los resultados

confirman la urgencia de implementar programas institucionales que incluyan educación emocional,

técnicas de manejo del estrés y detección temprana, abordando el estrés académico como problema

de salud pública universitaria.

Descriptores: estrés psicológico; ansiedad; depresión. (Fuente, DeCS).

Received: 06/10/2025. Reviewed: 06/15/2025. Approved: 07/15/2025. Published: 09/01/2025.

Short original

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 4(3), 1-9, 2025

Relación entre estrés académico, ansiedad y depresión en estudiantes universitarios de Salud Pública

Relationship between academic stress, anxiety and depression in university students studying Public

Health

Freddy Alexander Cuadrado-Quishpe

Emily Domenick Moreno-Carvajal

María Bernarda Robalino-Silva

Daniel Sebastián Tene-Guamán

INTRODUCTION

Stress represents an adaptive response of the organism to demands that exceed its

capacity for homeostatic balance (1). From a physiological perspective, this reaction

branches into two modalities: eustress, characterized by its stimulating effect on

individual performance, and distress, whose prolonged manifestation can lead to

multiple alterations in physical and psychological health (2). Although it does not

constitute a nosological entity per se, its chronicity represents a significant risk factor

for the development of various pathologies.

In the context of higher education, stress arises from the mismatch between

perceived academic demands and the personal resources available to meet them

(3). This condition, called academic stress, emerges when students experience

distress in the face of educational, social, and economic demands that act as specific

stressors. Previous research on medical students at the University of Buenos Aires

reported prevalences close to 98.4%, highlighting the magnitude of the phenomenon

(1,4).

Associated symptoms include physical manifestations such as chronic fatigue and

insomnia, along with emotional disturbances including persistent restlessness,

difficulty concentrating, and impaired academic performance (5). Of particular

relevance is the accumulated evidence linking sustained exposure to academic

stress with a substantial increase in the likelihood of developing anxiety and

depressive disorders, especially in health science-related disciplines (6,7). The

World Health Organization has recognized the educational environment as a priority

area for preventive mental health interventions (8).

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 4(3), 1-9, 2025

Relación entre estrés académico, ansiedad y depresión en estudiantes universitarios de Salud Pública

Relationship between academic stress, anxiety and depression in university students studying Public

Health

Freddy Alexander Cuadrado-Quishpe

Emily Domenick Moreno-Carvajal

María Bernarda Robalino-Silva

Daniel Sebastián Tene-Guamán

Validated psychometric instruments are used to quantify these variables. The SISCO

Inventory, developed by Barraza Macías, allows for the identification of stress levels,

relevant stressors, physical and emotional symptoms, and coping strategies in their

cognitive, physiological, and behavioral dimensions (9). Similarly, the HADS Scale

is a self-administered questionnaire with 14 items distributed across two subscales,

anxiety (HADS-A) and depression (HADS-D), which has demonstrated high

reliability in student populations for the detection of anxiety and depression

symptoms (10).

The aim of this study is to analyze the relationship between academic stress levels

and the presence of anxiety and depression symptoms in public health university

students.

METHOD

An observational, descriptive, and analytical cross-sectional study was conducted

during the 2024-2025 academic year. The target population comprised sixth-

semester students from the Faculty of Public Health at the Escuela Superior

Politécnica de Chimborazo (ESPOCH), located in Riobamba, Chimborazo province,

Ecuador, specifically in the fields of gastronomy, medicine, nutrition and dietetics,

and health promotion (N=250). The final sample included 241 participants who

voluntarily responded to the online survey using the Forms platform.

Two standardized and validated scales were used:

SISCO Academic Stress Inventory (11): Measures the frequency and intensity of

academic stressors and reactions to stress, classifying them into Low (≤16 points),

Moderate (17-22 points), and High (≥23 points) levels.

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 4(3), 1-9, 2025

Relación entre estrés académico, ansiedad y depresión en estudiantes universitarios de Salud Pública

Relationship between academic stress, anxiety and depression in university students studying Public

Health

Freddy Alexander Cuadrado-Quishpe

Emily Domenick Moreno-Carvajal

María Bernarda Robalino-Silva

Daniel Sebastián Tene-Guamán

Hospital Anxiety and Depression Scale (HADS) (12): Assesses anxiety and

depressive symptoms using 14 items with ranges Normal (≤14), Mild (15-21), and

Moderate-Severe (≥22).

Responses were coded numerically (scale 0-5) and total scores were calculated for

each dimension. A Global Classification was established considering: Low (all

domains at Low-Normal level), Medium (one domain at Moderate-Mild level), High

(one domain at High-Moderate-Severe level), and Very High (two or more domains

at High-Moderate-Severe level).

Descriptive statistics were used in the form of frequencies and percentages. Chi-

square independence tests were used to evaluate associations between categorical

variables. Comparisons of total scores by gender and career were performed using

Mann-Whitney U and Kruskal-Wallis tests. The strength of association was

determined using Cramér's V coefficient (13), interpreting values of 0.1 as weak

association, 0.3 as moderate, and 0.5 as strong. Processing was performed with

Python 3.10, using pandas and scipy.stats libraries.

Anonymity, confidentiality, and informed consent were guaranteed for all

participants. The protocol was approved by the institutional ethics committee.

RESULTS

Prevalence of academic stress

Of the 241 students evaluated, 42 (17.4%) had low levels of academic stress, 89

(36.9%) had moderate levels, and 110 (45.6%) had high levels.

Relationship between stress and anxiety

Chi-square analysis revealed a statistically significant relationship between

academic stress level and anxiety level (χ²=32.15, p<0.0001). r Cramér's V

coefficient was 0.258, indicating a moderate association. In the high-stress group,

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 4(3), 1-9, 2025

Relación entre estrés académico, ansiedad y depresión en estudiantes universitarios de Salud Pública

Relationship between academic stress, anxiety and depression in university students studying Public

Health

Freddy Alexander Cuadrado-Quishpe

Emily Domenick Moreno-Carvajal

María Bernarda Robalino-Silva

Daniel Sebastián Tene-Guamán

41.8% (46 students) presented moderate-severe anxiety, compared to 16.7% (7

students) in the low-stress group.

Relationship between stress and depression

Similarly, a significant relationship was identified between academic stress and

depressive symptoms (χ²=28.47, p<0.001, Cramér's V=0.243). Among students with

high stress, 29.1% reported moderate-severe depression, while in the low stress

group this proportion was 9.5%.

Differences by degree program

The analysis by degree program showed that medical students had a higher

proportion of high stressors (40% of the group) compared to gastronomy students

(10%). Statistical analysis confirmed a significant association (p<0.0001) with

moderate magnitude.

Differences by gender

Females showed a higher prevalence of Very High overall classification (30% vs.

18% in males), with a statistically significant difference (p=0.040, Cramér's V=0.187).

Stress reactions did not show significant differences by gender (p=0.149, Cramér's

V=0.127).

Overall classification

The distribution of the overall classification was: 90 students (37.3%) at the Low

level, 85 (35.3%) at the Medium level, 78 (32.4%) at the High level, and 79 (32.8%)

at the Very High level.

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 4(3), 1-9, 2025

Relación entre estrés académico, ansiedad y depresión en estudiantes universitarios de Salud Pública

Relationship between academic stress, anxiety and depression in university students studying Public

Health

Freddy Alexander Cuadrado-Quishpe

Emily Domenick Moreno-Carvajal

María Bernarda Robalino-Silva

Daniel Sebastián Tene-Guamán

DISCUSSION

The data obtained confirm the existence of significant relationships between

academic stress and anxiety-depressive symptoms in the university population of

Public Health . The moderate magnitude of these associations, measured using

Cramér's V, suggests the involvement of additional contextual and personal factors

that modulate the individual response to stress (14,15).

The greater vulnerability observed in females is consistent with previous research

that has documented differences in emotional reactivity, perception of self-efficacy,

and coping strategies between genders (16,17). This pattern could be explained by

the confluence of biopsychosocial factors, including differentiated social pressures,

family expectations, and self-imposed demands that intensify emotional responses

(18).

With regard to differences by degree program, health sciences disciplines have

particular characteristics that increase exposure to stressors: high academic

workload, demanding practical requirements, and early exposure to situations of

professional responsibility (19,20). This phenomenon justifies the development of

specific interventions tailored to the curricular particularities of each discipline.

CONCLUSION

The existence of significant relationships between academic stress and anxiety-

depressive symptoms in the public health university population is confirmed.

Females tended to report higher levels of stress and anxiety more frequently, which

is consistent with recent evidence describing greater emotional vulnerability and

psychosocial burden in female university students.

Among the limitations of the study is its cross-sectional design, which prevents the

establishment of temporal causal relationships. Likewise, the exclusive use of self-

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 4(3), 1-9, 2025

Relación entre estrés académico, ansiedad y depresión en estudiantes universitarios de Salud Pública

Relationship between academic stress, anxiety and depression in university students studying Public

Health

Freddy Alexander Cuadrado-Quishpe

Emily Domenick Moreno-Carvajal

María Bernarda Robalino-Silva

Daniel Sebastián Tene-Guamán

report instruments may introduce social desirability biases. However, the sample

robustness and psychometric validation of the instruments used strengthen the

reliability of the results.

The implementation of institutional programs is recommended, including: emotional

education workshops, training in stress management techniques, strengthening peer

support networks, and teacher training for early detection of symptoms. Future

research with a longitudinal design would allow for the identification of critical periods

of vulnerability throughout the academic career, as well as the evaluation of the

effectiveness of specific interventions. The inclusion of variables such as perceived

social support, resilience, and sleep quality would contribute to a more

comprehensive understanding of the phenomenon.

The results emphasize the urgency of addressing academic stress as a public health

problem in university settings, requiring comprehensive institutional policies that

promote healthy and equitable academic environments.

FUNDING

Non-monetary

CONFLICT OF INTEREST

There is no conflict of interest with individuals or institutions linked to the research.

ACKNOWLEDGMENTS

To the Faculty of Public Health of the Escuela Superior Politécnica de Chimborazo

for facilitating access to the student population and to all participants who voluntarily

responded to the assessment instruments.

Sanitas

Revista arbitrada de ciencias de la salud

Vol. 4(3), 1-9, 2025

Relación entre estrés académico, ansiedad y depresión en estudiantes universitarios de Salud Pública

Relationship between academic stress, anxiety and depression in university students studying Public

Health

Freddy Alexander Cuadrado-Quishpe

Emily Domenick Moreno-Carvajal

María Bernarda Robalino-Silva

Daniel Sebastián Tene-Guamán

AUTHORS' CONTRIBUTIONS

Freddy Alexander Cuadrado-Quishpe: Conceptualization, methodology, statistical

analysis, writing of the original manuscript. Emily Domenick Moreno-Carvajal:

Data collection, information processing, manuscript review. María Bernarda

Robalino-Silva: Data analysis, interpretation of results, analytical review of content.

Daniel Sebastián Tene-Guamán: Literature search, methodological design, final

review of the manuscript.

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Sanitas

Revista arbitrada de ciencias de la salud

Vol. 4(3), 1-9, 2025

Relación entre estrés académico, ansiedad y depresión en estudiantes universitarios de Salud Pública

Relationship between academic stress, anxiety and depression in university students studying Public

Health

Freddy Alexander Cuadrado-Quishpe

Emily Domenick Moreno-Carvajal

María Bernarda Robalino-Silva

Daniel Sebastián Tene-Guamán

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