International Journal of Psychology, 2022
Vol. 57, No. 3, 401–410, DOI: 10.1002/ijop.12825
A longitudinal examination of the relation between
academic stress and anxiety symptoms among
adolescents in India: The role of physiological
hyperarousal and social acceptance
Mackenzie Trevethan1 , Anjali T. Jain1 , Anuradha Shatiyaseelan2 ,
Aaron M. Luebbe1 , and Vaishali V. Raval1
1
Department of Psychology, Miami University, Oxford, Ohio, USA
2 Christ University, Bengaluru, Karnataka, India
A
cademic stress is a critical aspect of adolescent experience around the world, but particularly in countries with dense
populations that lead to highly competitive college admissions. With a population of over one billion people, the
competition for higher education in India is significantly high. Although research has shown that academic pressures
are associated with anxiety in adolescents, this work is primarily cross-sectional. The current study examined academic
stress and anxiety symptoms over time and assessed physiological hyperarousal as a mediator and social acceptance as
a moderator of this relation in a sample of adolescents from India (N = 282, 13–18 years, 84% female). Adolescents
completed measures of academic stress, physiological hyperarousal, social acceptance and anxiety symptoms at two-time
points, 5 months apart. Findings demonstrate direct effects of academic stress on changes in symptoms of generalised
anxiety and panic, as well as indirect effects through physiological hyperarousal. Social acceptance did not moderate
the relation, although it uniquely predicted changes in panic disorder symptoms over time. The findings of this study
contribute to the scientific understanding of a potential mechanism through which academic stress leads to anxiety among
adolescents in India.
Keywords: Academic stress; Anxiety; Physiological hyperarousal; Social acceptance.
Adolescents around the world experience stress associated with their academic work, which may have negative
health effects (Casuso-Holgado et al., 2019). Particularly for students in countries with dense populations
and restricted higher education prospects, academic
competition is exceedingly difficult (Sun et al., 2012).
High school students in India and other Asian countries
encounter state examinations that determine acceptance
into universities and open the door for desired careers.
Therefore, these exams are incredibly competitive and
stressful (Verma et al., 2002). For some of these adolescents, challenging competition can lead to experiences
of anxiety (Sun et al., 2012; Verma et al., 2002). While
some cross-sectional research has shown that academic
stress is associated with anxiety (Deb et al., 2014),
assessments of stress and anxiety over time are limited.
Thus, in the current study, we examined the association
between academic stress and anxiety longitudinally in
a sample of adolescents from India, a country with a
population of over one billion people. Beyond demonstrating a cross-sectional association between academic
stress and anxiety, there has been little research attention
devoted to examining potential mechanisms that may
explain this association or factors that may buffer the
negative effects of stress on anxiety. Thus, we examined
physiological hyperarousal as a potential mediator of this
association, and social acceptance as a potential moderator. Such examinations have implications for informing
intervention approaches for adolescent anxiety.
Academic stress and anxiety in India
As the second-most populous country in the world,
India is home to 22% of the world’s adolescent
Correspondence should be addressed to Mackenzie Trevethan, Department of Psychology, Miami University, 90 N Patterson Avenue, Oxford, OH
45056, USA. (E-mail: trevetma@miamioh.edu)
Mackenzie Trevethan contributed to conception, analysis, drafting the article, revising; Anjali T. Jain contributed to analysis, drafting the article,
revising; Anuradha Shatiyaseelan contributed to design, collection; Aaron M. Luebbe contributed to drafting the article, revising; Vaishali V. Raval
contributed to conception, drafting the article, revising.
© 2021 International Union of Psychological Science.
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TREVETHAN ET AL.
population. Adolescents in India experience highly
competitive state-wide exams that determine their access
to higher education (Verma et al., 2002). Academic
success is important because it determines future occupational success and upward social and economic mobility.
Thus, it is common for students from urban, middle-class
families in India to attend after-school tutoring sessions to
be more academically competitive. These high academic
demands and pressures to succeed can be experienced
as stressful for some adolescents. According to Lazarus
and Folkman (1984), stress is experienced when external
demands are appraised as exceeding beyond the individual’s capabilities. Given the salience of academic success
for adolescents in India, stress experienced in academic
situations is likely to have health consequences, including implications for mental health (Deb et al., 2014). In
particular, anxiety may be relevant to examine given its
prevalence and associations with academic stress.
Anxiety is the second most common mental health
condition (after depression) worldwide with current global prevalence estimates of 5–10% (Baxter
et al., 2013). In India, anxiety symptoms have been
found to be just as prevalent, if not more (e.g., 20% as
per Deb et al., 2010), and anxiety symptoms are more
common among adolescents compared to children (Deb
et al., 2010). As children get older, academic demands
increase, which may contribute to greater stress related to
those demands, making them more prone to developing
anxiety (Verma et al., 2002).
Academic stress has been associated with anxiety and
depression in samples from around the world (e.g., see
American Psychological Association, 2018, USA; Deb
et al., 2014, India; Casuso-Holgado et al., 2019, Spain).
In a study of adolescents from high SES families in India,
Bhasin et al. (2010) found that the extreme pressure to
perform well on board exams was correlated with stress,
depression and anxiety. Whether this pressure is from parents or the individual perceived pressure, the stress of performance expectations may be contributing to students’
experience of anxiety and depression. In another study,
the more time these students spent on school-related activities outside of the classroom (e.g., tutoring or homework)
the more likely they were to experience anxiety according
to their mothers (Verma et al., 2002). While there are some
studies that demonstrate an association between academic
stress and anxiety, this work is primarily cross-sectional.
Examining academic stress and anxiety over time can
help establish the direction of effect. Furthermore, mechanisms that explain this relation and factors that may buffer
the negative effects of stress on anxiety are understudied.
Physiological hyperarousal as a mediator
Selye’s (1978) stress response theory suggests that the
experience of stress evokes bodily processes that signal an “alarm” response through multiple systems (i.e.,
cardiovascular, endocrine and nervous systems) that prepares the body to respond to the stressor. Consistent
with this theory, research with White American samples has documented an association between perceived
stress and physiological stress responses (i.e., heightened autonomic nervous system response, cortisol levels
and hypothalamic–pituitary–adrenal axis activity) (Oldehinkel et al., 2011; Van Praag et al., 2004). PH, defined
as the overarousal experienced by the autonomic nervous
system, specifically the sympathetic branch (Anderson
& Hope, 2008) captures this bodily response to stress.
Although researchers have not specifically examined the
relation between academic stress and PH, PH may be
a promising candidate to examine as a potential mediator given its established associations with anxiety. Conceptually, it makes sense that the psychological experience of stress related to academic performance may
contribute to increased arousal at a physiological level
(Marker et al., 2017).
Substantial research has indicated that PH is associated with anxiety and symptoms of panic in White
middle-class Americans (Anderson & Hope, 2008).
Although researchers have used both objective measures
and self-reports of PH, in predicting the subjective state
of anxiety, one’s perception of PH, rather than an objective measure of arousal, might be more relevant. The
studies that have documented an association between
PH and anxiety have utilised self-reports of both constructs (Anderson & Hope, 2008), assessing participants’
perceptions of their physiological and psychological
states.
Given the cross-sectional relation between academic
stress and anxiety, along with a broader association
between perceived stress and physiological responses, PH
may be one potential mediator between academic stress
and anxiety. Although the research supporting the potential mediating role of PH is based on studies with White,
middle-class Americans, we expect these associations to
hold for adolescents from urban, middle-class families in
India.
Social acceptance as a moderator
In addition to potential mediators, there may be conditions that intensify or reduce the negative effects of
academic stress on anxiety such that in some situations
academic stress is more likely to contribute to anxiety
than in others. According to the stress-buffering model,
interpersonal resources or individual characteristics can
reduce the negative effects of stress on individuals’ health
(Wheaton, 1985). Social acceptance is one such resource
(DeWall & Bushman, 2011). Defined as an indication
from others (e.g., parents or peers) that they understand or
support the individual and want to include them in their
relationships or activities (DeWall & Bushman, 2011),
© 2021 International Union of Psychological Science.
ACADEMIC STRESS AND ANXIETY
social acceptance may buffer the negative effects of academic stress on anxiety. Social acceptance may be particularly relevant for adolescents in India due to the
salience of interdependence and inclusion of others in
one’s self-construal (Roland, 1988). Despite processes of
modernization, adolescents in urban-middle-class families in India define themselves in the context of others,
and cognitions about others’ expectations guide social
behaviour (Patole, 2018). Given this pattern, acceptance
from others may be a critical factor in understanding the
relation between academic stress and anxiety.
Studies have shown that academic stress and social
acceptance may interact to contribute to anxiety. For
example, social acceptance and support from parents
interacted with academic stress to predict anxiety among
school children in Hong Kong, such that the association between academic stress and anxiety was weaker
when emotional support from parents was high (Leung
et al., 2010). In another study, McMahon et al. (2008)
argued that social resources from a school (e.g., empathy and support from counsellors and teachers) can have
buffering effects on academic stress. They found that
social acceptance and belonging within the school was
associated with lower academic stress and lower anxiety
in a low-income racially diverse sample from the USA
(McMahon et al., 2008). Furthermore, although they did
not specifically assess social acceptance as a moderator,
Renk and Smith (2007) showed a positive association
between academic stress and anxiety, and a negative association between support from significant others and anxiety among college students in the USA.
For adolescents in urban, middle-class families in India
who experience high levels of academic stress due to
the familial emphasis on academic achievement, social
acceptance may serve a protective function. When adolescents feel accepted by their family members, peers
and teachers, high academic stress may be unrelated
or weakly related to anxiety (McMahon et al., 2008).
However, high levels of academic stress combined with
low acceptance from others may be particularly distressing for the adolescent. In such a condition, academic
stress may be strongly associated with the experience of
anxiety.
Current study
In the current study, our first aim was to examine the
association between academic stress and anxiety symptoms cross-sectionally and longitudinally in a sample of
adolescents from India. For a comprehensive assessment
of anxiety, we included generalised anxiety, panic symptoms and symptoms of social phobia. For the prospective tests, we examined change in anxiety symptoms from
time 1 to 2 to account for anxiety symptomatology at
time 1. Based on the existing cross-sectional literature,
© 2021 International Union of Psychological Science.
403
we expected academic stress to be associated with higher
anxiety symptoms concurrently and over time. Our second aim was to examine the mediating role of PH. We
expected significant direct effects of academic stress on
anxiety symptoms, as well as significant indirect effects
through PH. We expected PH to explain some of the variance in the association (i.e., partial mediation) given that
there may be other potential mediators that we have not
examined. Our third aim was to examine the buffering role
of social acceptance. Based on the stress-buffering model
(Wheaton, 1985), the main effect of social acceptance on
anxiety symptoms was expected, along with an interaction between academic stress and social acceptance in
predicting anxiety such that the association between academic stress and anxiety would be weaker under the condition of high social acceptance.
METHOD
Participants
The participants were 282 adolescents from Bengaluru,
India, the third-most populous city in India that represents
the religious and regional diversity of the country (City
Bengaluru, 2021). The adolescents ranged in age from
13 to 18 years (84% female; M age = 15.00, SD = 1.20).
Most parents of the participants reported that they were
Hindu (63.5%) and married (85.1%) and had a bachelor’s degree (45.4%). The reported monthly household
incomes varied: 13.9% of the sample reported income
above INR 61,000, 24.2% between INR 41,000–60,000,
37.3% between INR 21,000–40,000 and 24.6% less than
INR 20,000. Household incomes were higher for most
participants than the per capita income for the state where
the high schools were located (monthly INR 13,321; Government of Karnataka, 2017).
All procedures performed in the study that involved
human participants was in accordance with the ethical standards of the Institutional Review Board at
Miami University and with the 1964 Helsinki Declaration and its later amendments or comparable ethical
standards.
Informed consent was obtained from all the parents of
the participants, and assent was obtained from all of the
adolescents.
Procedure
The institutional review board at Miami University
approved the study. A packet of information was sent
home with adolescents enrolled in standards 9 through 12
at two high schools that represented demographic diversity in Bengaluru towards the beginning of the school
year (August 2016). The information packets included
a recruitment letter explaining that the study was about
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TREVETHAN ET AL.
adolescents’ feelings, thoughts and mood states, a consent
form and a demographic questionnaire for the parents to
complete. Parents who agreed to the participation of their
child and themselves signed the consent form, completed
the questionnaire, and enclosed the forms in the provided
sealed envelope delivered to the child’s school. Their
children were invited to group sessions at school. In the
group sessions, the adolescents gave their assent and then
completed four questionnaires. Five months later, these
adolescents completed questionnaires for time 2 (93%
were sustained at time 2). Families who participated were
compensated with educational supplies worth INR 150
(US $2.29).
Measures
as if I cannot breathe when there is no reason for this).
All the items are rated on a 4-point Likert scale ranging
from 0 (never) to 3 (always) to assess the frequency
of each item occurring in the participant’s life. Mean
composite scores of each of the three subscales were
calculated. The RCADS has established high convergent
and discriminant validity, good internal consistency and
an adequate factor structure in samples of children and
adolescents in community and clinical settings (Chorpita
et al., 2000; Chorpita et al., 2005). In this sample, the three
subscales from the RCADS-C demonstrated good internal
consistency (𝛼 = .79 and .80 for GAD, 𝛼 = .83 and .83 for
social phobia and 𝛼 = .81 and .83 for panic disorder, at
times 1 and 2, respectively. Across time, rates of anxiety
symptoms ranged from 1.5% for GAD to 18.5% for panic
disorder for adolescents.
Demographics questionnaire
The demographics information questionnaire asked
questions about adolescent age, gender, family religion,
family income, parents’ education and occupation and
their marital status.
Adolescent academic stress
The Adolescent Stress Questionnaire (ASQ; Byrne
et al., 2007) consists of 56 items and 10 subscales. Adolescent participants record the extent to which each item has
caused them stress throughout the previous year. All items
were rated on a 5-point scale ranging from 0 (not at all
stressful) to 5 (very stressful). The present study utilised
three of the subscales: school/leisure conflict (five items;
e.g., “Not having enough time for fun”), school performance (seven items; e.g., “Keeping up with schoolwork”)
and future uncertainty (three items; e.g., “Concern about
your future”). In order to evaluate academic stress, a mean
composite score of the three subscales was calculated.
Adolescents completed the three subscales at both time
points. The ASQ has been positively associated with anxiety and depression measures. In addition, this questionnaire has been established as having both good internal
consistency and test–retest reliability (Byrne et al., 2007).
In this sample, the ASQ demonstrated good internal consistency (𝛼 = .85, 𝛼 = .88 for the composite score at time
1 and 2, respectively).
Adolescent anxiety
Three subscales from The Revised Children’s Anxiety
and Depression Scale (RCADS; Chorpita et al., 2000)
were utilised to evaluate anxiety in adolescents. These
included Generalised Anxiety Disorder (GAD) (six items;
e.g., I worry about what is going to happen), Social
Phobia (nine items; e.g., I worry what other people think
of me) and Panic Disorder (nine items; e.g., I suddenly feel
Adolescent social acceptance
The current study used the social acceptance subscale
of The Self-Worth Contingency Questionnaire (SWCQ;
Burwell & Shirk, 2003). The social acceptance subscale
has eight items (e.g., “If other people’s feelings about me
change, my feelings of self-worth change as well”) that
are rated on a scale from 1 (not at all true for me) to
5 (extremely true for me), indicating the extent to which
they agree with eight items in each domain. We also used
an additional item (i.e., “People’s feelings about you”)
rated from 1 (not at all important) to 4 (extremely important). The items were summed, and a mean composite
score was calculated. The SWCQ has established good
reliability and validity, good internal consistency and an
adequate factor structure in past research (Burwell &
Shirk, 2003; Burwell & Shirk, 2006). In the current sample, the internal consistency of the social acceptance subscale was adequate (𝛼s = .76 and .77 for times 1 and 2,
respectively).
Adolescent PH
The Physiological Hyperarousal subscale of the Affect
and Arousal Scale (AAS; Chorpita et al., 2000) contains
nine self-report items (e.g., “I have trouble breathing”
and “Often I feel sick in my stomach”) in which adolescents indicate how true each item is in their lives. The
PH subscale is rated using a 4-point Likert scale ranging
from 0 (never true) to 3 (always true). The items were
summed, and a mean composite score of the subscale
was calculated. Adolescents completed the PH subscale
at both time points. The full-scale AAS and the PH subscale have established good internal consistency (Chorpita et al., 2000). In this sample, the PH subscale had good
internal consistency (𝛼s = .80 and .86 for times 1 and 2,
respectively).
© 2021 International Union of Psychological Science.
ACADEMIC STRESS AND ANXIETY
RESULTS
Data management
All primary variables of interest were approximately normally distributed (skew < 2.00|.
and kurtosis < |4.00|) and had an acceptable range of
values. Collinearity index <15 indicated no problems of
multicollinearity, and Harmon’s one-factor test of common method bias also supported this conclusion (i.e., percent of variance explained by a common factor was only
45.02%). Overall, 9.6% of data were missing at time 1
and 10.1% were missing at time 2. Variables with the
highest amounts of missingness were time 2 scores for
adolescent GAD, social phobia, panic disorder symptoms.
Total mean item scores for analyses were only calculated
if participants completed 75% of the items. At times 1
and 2, Little’s MCAR test (χ2 (763) 835.990, p = .37) and
(χ 2 (742) 858.99, p = .06), respectively, suggested data
were missing in a pattern consistent with missing completely at random. For bivariate analyses, missing data
were handled with the recommended multiple imputations (n = 40 imputed datasets using all primary variables
and demographic variables in estimating algorithm; Graham, 2009). Bivariate correlations were derived from the
“pooled” results of the combined 40 datasets. For path
analyses estimated in Mplus, the full-information maximum likelihood was used.
Table 1 presents intercorrelations among all study variables displayed separately by time point. Demographic
variables (adolescent age, adolescent gender, parent age,
parent gender and monthly income) were examined as
possible covariates. Adolescent gender and grade were
each associated with at least one dependent variable of
interest. Primary models with and without these covariates included produced the same results. For parsimony,
neither were included as covariates in the analyses presented here.
Analyses for aim one: Association between
academic stress and anxiety symptoms within
and across time
Bivariate correlations were examined among key study
variables. Specifically, we examined if academic stress
was positively correlated with PH, as well as if PH
was positively correlated with adolescent anxiety. Within
time, academic stress at times 1 and 2 was positively correlated with GAD, social phobia and panic disorder (see
Table 1). There were positive correlations between academic stress and PH at times 1 and 2. In addition, there
were positive correlations between PH with GAD and
panic disorder, but not social phobia, at times 1 and 2.
Several important bivariate relations warrant mention
(see Table 1). Within both times 1 and 2, all adolescent
© 2021 International Union of Psychological Science.
405
anxiety symptoms were positively correlated with one
another. The strongest associations appear between the
adolescent anxiety symptoms within time. When focusing
on academic stress, GAD has the highest association
at both time points. In addition, PH was most strongly
associated with panic disorder at both time points.
Analyses for aim two: Mediating role
of physiological hyperarousal
The mediation model was assessed using the path analyses via Mplus across time. Path analyses analysed the
covariance matrices, and models were just identified so no
fit indices are reported. To test the mediation model longitudinally (see Figure 1), rather than control for all-time
1 forms of psychopathology, time 2 GAD, social phobia
and panic disorder symptoms were individually regressed
on their time 1 counterpart. For example, time 2 GAD
was regressed on time 1 GAD. Then, the unstandardized
residuals of these regressions were used as endogenous
variables to account for changes in symptoms for each
symptom cluster (GAD, panic disorder, social phobia).
These residuals were then regressed on time 1 academic
stress and changes in PH.
Results of the mediation model across time can be
found in Figure 1. T1 academic stress significantly predicted changes in PH (path a), and changes in PH significantly predicted GAD and panic disorder symptoms, but
not social anxiety (b paths). The direct relation between
T1 academic stress and changes in GAD and panic disorder symptoms were statistically significant (path c);
however, academic stress did not significantly predict
changes in social phobia symptoms. The indirect effects
were significant (as evidenced by zero not in the confidence interval) for changes in PH mediating the relation between time 1 academic stress and changes in
GAD and panic disorder symptoms. However, the indirect
effect was non-significant for PH mediating the relation
between time 1 academic stress and changes in social phobia symptoms (see Figure 1).
Analyses for aim three: Moderating role
of social acceptance
The moderation model was also assessed through the use
of Mplus. The predictors were time 1 academic stress,
time 1 social acceptance and the interaction between time
1 academic stress and time 1 social acceptance and the
outcome variables were changes in GAD, panic disorder and social phobia symptoms over time. To avoid
potentially problematic high multicollinearity with the
interaction term, each of the predictor variables was
mean-centred and interaction terms between academic
stress and social acceptance were created.
.51**
.29**
.06
.42**
.31**
.40**
9.40 (2.42)
.15*
.09
.02
.16**
.19**
.15*
.14*
.13
.03
.15*
.10
.12
.87 (.33)
−.08
.10
.01
.16**
.09
.17**
.01
.10
.05
.02
.06
−.06
9.98 (1.13)
.26**
.66**
.04
.34**
.29**
.49**
.61 (.57)
—
.13*
.32**
.31**
.59**
4
.16*
.11
.42**
.20**
.30**
.06
3.25 (1.15)
—
.30**
.45**
.30**
5
.33**
.30**
.22**
.58**
.41**
.28**
6.42 (3.80)
—
.69**
.55**
6
.33**
.29**
.32**
.54**
.56**
.32**
11.35 (5.48)
—
.55**
7
.28**
.46**
.12
.43**
.38**
.49**
5.81 (4.97)
—
8
—
.26**
.12
.50**
.45**
.37**
9.43 (2.56)
9
—
.11
.40**
.32**
.57**
.71 (.64)
10
—
.23**
.32**
.09
3.25 (1.07)
11
—
.71**
.58**
6.32 (3.92)
12
—
.50**
10.95 (5.56)
13
—
6.37 (4.98)
14
Note: Displays the Pearson Correlation coefficients between the variables. AAS PH = The Physiological Hyperarousal subscale of the Affect and Arousal Scale; ASQ = Adolescent Stress Questionnaire;
GAD = Generalised Anxiety Disorder; PD: Panic Disorder. RCADS = Revised Children’s Anxiety and Depression Scale; SA = Social Acceptance Subscale of Self-Worth Contingency Questionnaire;
SOC = Social Phobia; *p < .05, **p < .01.
—
.28**
.20**
.40**
.39**
.30**
—
—
.17**
3
1. Grade
2. Gender
Time 1
3. ASQ
4. AAS PH
5. SA
6. RCADS GAD
7. RCADS SOC
8. RCADS PD
Time 2
9. ASQ
10. AAS PH
11. SA
12. RCADS GAD
13. RCADS SOC
14. RCADS PD
M(SD)
2
1
Measure
TABLE 1
Bivariate correlations of academic stress, physiological hyperarousal, social acceptance, and anxiety variables
406
TREVETHAN ET AL.
© 2021 International Union of Psychological Science.
ACADEMIC STRESS AND ANXIETY
407
Figure 1. Path diagram of mediation analysis: Mediating role of changes in physiological hyperarousal. .Note: Light grey lines are non-significant
paths, and bold lines are significant paths. Unstandardized path coefficients and standard errors (in parentheses) are shown before the slash, with
standardised path coefficients shown after. Standardised covariances are shown. *p < .05, **p < .01. Effect size was calculated by dividing indirect
effect by total effect and multiplying with 100 to derive the percentage of the total effect accounted for by the indirect effect
Results revealed no significant interactions, although
there were main effects that warrant mention (see
Figure 2). Academic stress significantly predicted
increases in GAD and panic disorder, but not changes
in social phobia. Social acceptance uniquely predicted
higher panic disorder symptoms over time, over and
above academic stress.
DISCUSSION
Extending the literature that supports cross-sectional
association between academic stress and anxiety, our
findings demonstrated that academic stress predicted
changes in generalised anxiety and panic symptoms
over time. We also found that changes in PH mediated
the associations between academic stress and changes in
generalised anxiety and panic symptoms. However, social
acceptance was not found to moderate the relations.
Associations among anxiety symptoms
The three types of anxiety symptoms (GAD, panic, social
phobia) were highly correlated with one another within
time. This may suggest that the differing anxiety measures collectively measure adolescents’ overall anxiety in
urban, middle-class families in India. This finding is consistent with previous research with White American youth
that demonstrated that social anxiety and generalised anxiety were district factors that loaded on a second-order
latent general anxiety factor (Whitmore et al., 2014).
Within time, academic stress had the strongest associations with GAD symptoms, compared to social anxiety
© 2021 International Union of Psychological Science.
and panic symptoms. Previous research has not examined relations of academic stress with specific types
of anxiety, and thus, current findings are particularly
informative regarding the types of anxiety symptoms
most likely to be affected by academic stress. In addition,
PH was most strongly associated with panic disorder at
both time points. Previous studies with White American
samples have found similar associations between PH
and panic symptomology (Anderson & Hope, 2008),
suggesting PH to be particularly relevant for panic
symptomatology.
Concurrent and longitudinal association
between academic stress and anxiety
As predicted, academic stress was associated with each
of the anxiety symptom clusters both within and across
time. The concurrent associations are consistent with
previous findings from India supporting this relation
(Casuso-Holgado et al., 2019; Deb et al., 2014). Extending this literature, the current findings are the first to
show a longitudinal association at the bivariate level:
Adolescents who reported higher academic stress at
the beginning of the school year also reported higher
changes in generalised anxiety, panic and social phobia
symptoms 5 months later. Overall, these findings suggest
that the experience of academic stress may contribute
to anxiety in multiple forms (e.g., panic), and suggest
that reducing academic stress may be a critical goal for
psychosocial interventions for anxiety among Indian
adolescents.
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TREVETHAN ET AL.
Figure 2. Examination of academic stress, social acceptance in the prediction of changes in anxiety symptom clusters over time. Note: Light grey
lines are non-significant paths, and bold lines are significant paths. Unstandardized path coefficients and standard errors (in parentheses) are shown
before the slash, with standardised path coefficients shown after. Standardised covariances are shown. *p < .05, **p < .01.
Physiological hyperarousal as a mediator
Consistent with the stress response theory (Selye, 1978)
and previous research (Anderson & Hope, 2008), academic stress was associated with PH (e.g., shortness of
breath, dryness, increased heart rate). Furthermore, there
were direct effects of academic stress on changes in GAD
and panic symptoms over time, and there were indirect
effects through PH. These findings support the mediating role of PH, suggesting that PH may be an underlying
mechanism that explains the relation between academic
stress and symptoms of anxiety and panic among adolescents in India.
It is important to highlight that although there was
a concurrent and longitudinal association between academic stress and social phobia symptoms at the bivariate level, this association did not hold in the model that
included generalised anxiety and panic symptoms. Thus,
academic stress does not uniquely predict changes in
social phobia symptoms, nor was there an indirect relationship through PH. The current findings suggest a separation between social and academic domains of functioning for adolescents in urban middle-class families in India
such that stress in the academic domain seems to not be
affecting social situations.
Social acceptance as a predictor of anxiety
symptoms
Contrary to the stress-buffering model (Wheaton, 1985)
and previous research (Leung et al., 2010), social acceptance did not moderate the relation between academic
stress and changes in any of the anxiety symptoms (i.e.,
GAD, panic, social phobia). Thus, social acceptance does
not buffer the negative effects of academic stress on anxiety. These findings further support the separation of academic and social domains for adolescents in India such
that social acceptance does not seem to mitigate the
effects of stress related to academics. Interestingly, social
acceptance uniquely inversely predicted changes in panic
disorder symptoms over time, over and above academic
stress. This finding suggests that social acceptance has a
stronger effect on panic symptomology in comparison to
other anxiety symptoms. The social acceptance measure
in this study assessed the extent to which others’ acceptance and approval matters to an individual, and thus, high
scores on this measure do not necessarily indicate higher
levels of social acceptance but instead that social acceptance matters to the respondent. In future work, it might
be helpful to include a measure that assesses perceived
levels of social acceptance.
Limitations and future directions
Our sample was recruited from urban, middle-class families residing in a metropolitan city in South India. Given
the diversity with respect to religion, region, languages,
cultural norms and lifestyles and social class across India,
our findings cannot be considered generalizable to the
entire country. We assessed all study variables based on
adolescent self-report, and shared method variance may
have led to an overestimation of effects. Future work
may consider including other reporters to assess academic
stress (i.e., parents or teachers) and objective measures of
PH. Subjective reports of PH may not align with objective
measures of PH (Hoehn-Saric & McLeod, 2000) because
bodily sensations can be modified by perceptual distortions created by psychological aspects (e.g., attention to
expectations and bodily states).
Given that adolescents in many communities around
the world experience academic stress, it is important to
examine academic stress and anxiety in other parts of
Asia, as well as densely populated regions such as Africa
and the Middle East. Furthermore, there may be additional moderators and mediators in the relation between
© 2021 International Union of Psychological Science.
ACADEMIC STRESS AND ANXIETY
academic stress and anxiety. PH was the only mediator
investigated in this study and social acceptance was the
only moderator investigated. Other variables that were not
examined (e.g., temperament-based characteristics) may
have an influence on this relation, which should be investigated in future work.
Conclusion
The current findings indicate that academic stress is associated with symptoms of generalised anxiety and panic
concurrently and over a 5-month period in a sample of
adolescents from India and that PH partially mediates this
relationship. Social acceptance uniquely predicted lower
panic symptoms over time. The current findings are the
first to demonstrate that academic stress contributes to
anxiety over time for Indian adolescents and that PH may
be a mechanism that explains the effects of academic
stress on anxiety. These findings contribute to theoretical frameworks of the development of anxiety symptoms
and have practical implications for interventions to reduce
anxiety. Specifically, both academic stress and PH may
be important targets for interventions aimed at reducing
anxiety among Indian adolescents. In addition, strengthening social acceptance may be a critical component of
interventions aimed at reducing panic symptoms.
Manuscript received March 2021
Revised manuscript accepted November 2021
First published online December 2021
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