# University Exams and Psychosocial Stress: Effects on Cortisol Rhythmicity in Students

## TL;DR

This study explores how university exams affect stress levels in students by measuring cortisol, a stress-related hormone, over time.

## Contribution

The study introduces a combined use of hair and salivary cortisol to assess both acute and cumulative stress responses during exams.

## Key findings

- Hair cortisol levels were significantly higher during the exam month compared to a non-exam month.
- Salivary cortisol showed a consistent diurnal pattern and cortisol awakening response during the exam week.
- Daily cortisol output remained stable despite increased cumulative cortisol exposure during exams.

## Abstract

University exams are recognised as naturalistic stressors that may elicit psychosocial and physiological responses in students. This pilot study investigated the short‐ and long‐term effects of exam‐related stress on hypothalamic–pituitary–adrenal (HPA) axis activity, focusing on cortisol production and rhythmicity.

Twenty‐seven undergraduate students (aged 18–24 years) from a biological sciences programme participated. Hair cortisol concentrations were analysed for October (non‐exam month) and November (exam month), while salivary cortisol was collected during 3 consecutive exam weekdays (Monday to Wednesday) at five daily time points to assess diurnal variation and the cortisol awakening response (CAR).

Hair cortisol levels were significantly higher in November than in October, suggesting greater cumulative HPA activation during the exam period. Salivary cortisol displayed a general diurnal pattern and CAR across the week. Morning cortisol values showed a nonsignificant numerical increase across days, though overall daily cortisol output (AUC) remained stable.

Exam periods may be accompanied by elevated cumulative cortisol exposure while short‐term HPA rhythmicity remains preserved. The combined use of hair and salivary biomarkers offers a multidimensional and feasible approach to investigating acute and cumulative stress responses in students. Larger longitudinal studies incorporating behavioural measures are warranted to confirm these findings.