The hidden burden of college life: Stress, sleep, and salivary biomarkers in students-A cross-sectional study
Abstract
Globally, university students face substantial psychological pressures, and stress-related mental health disorders are recognized as major public health concerns. While biomarkers such as cortisol have been extensively studied, integrated analyses of neuroendocrine-immune-circadian interactions remain limited. In this cross-sectional study with two complementary components, psychometric assessments of 637 undergraduates revealed that 90.4% experienced moderate-to-high perceived stress. These stress levels correlated with fatigue (r = 0.41, p < 0.01) and poor sleep quality (r = 0.35, p < 0.01). A second component involved laboratory-based diurnal biomarker profiling of 33 high-stress and low-stress participants, revealing stress-dependent physiological patterns. Specifically, high stress was associated with sympathetic activation (α-amylase↑), HPA axis dysregulation (altered diurnal cortisol patterns), circadian disruption (melatonin↑), and mucosal immune activation (IgA ↑ , lysozyme↑). The coupling of α-amylase and lysozyme suggested neuro-immune coordination (r = 0.52, p < 0.001). These findings indicate that salivary biomarker profiles are associated with perceived stress. Sleep quality and fatigue warrant further investigation as potential intervention targets in future longitudinal studies.
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause.
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