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Peer-reviewedCC BY 4.0PLOS Mental Health

The hidden burden of college life: Stress, sleep, and salivary biomarkers in students—A cross-sectional study

  • Hongyu Xu1
  • Zhiqiang Yan2
  • Xinyi Kong3
  • Shuang Wu4
  • Fei Shi5
  • Qiong Ye
  • Zijin Li
  • Jia Lu
  • Juan Fang
  • Kexin Chen
  • Jiajun Bao
  • Yiyao Huang
5 affiliations
  1. 1College of Science and Technology, Wenzhou-Kean University, Wenzhou, Zhejiang, China
  2. 2Dorothy and George Hennings College of Science, Mathematics and Technology, Kean University, Union, New Jersey, United States of America
  3. 3Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
  4. 4The Key Laboratory of Aerospace Medicine, Ministry of Education, Fourth Military Medical University, Xi'an, Shaanxi, China
  5. 5Department of Neurosurgery, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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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.

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Cite

BibTeXRIS
BibTeX
@article{xu2026hidden,
  title = {{The hidden burden of college life: Stress, sleep, and salivary biomarkers in students—A cross-sectional study}},
  author = {Hongyu Xu and Zhiqiang Yan and Xinyi Kong and Shuang Wu and Fei Shi and Qiong Ye and Zijin Li and Jia Lu and Juan Fang and Kexin Chen and Jiajun Bao and Yiyao Huang},
  journal = {PLOS Mental Health},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pmen.0000717},
  url = {https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000717},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - The hidden burden of college life: Stress, sleep, and salivary biomarkers in students—A cross-sectional study
AU  - Hongyu Xu
AU  - Zhiqiang Yan
AU  - Xinyi Kong
AU  - Shuang Wu
AU  - Fei Shi
AU  - Qiong Ye
AU  - Zijin Li
AU  - Jia Lu
AU  - Juan Fang
AU  - Kexin Chen
AU  - Jiajun Bao
AU  - Yiyao Huang
PY  - 2026
DA  - 2026/09/15
JO  - PLOS Mental Health
DO  - 10.1371/journal.pmen.0000717
UR  - https://journals.plos.org/mentalhealth/article?id=10.1371/journal.pmen.0000717
AB  - 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.
SN  - 2837-8156
ER  -