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Journal of Behavior, Health & Social Issues 8 (2017) 1–7
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Monographic article
Does stress and university adjustment relate to health in peru?夽
¿Se relacionan el estrés y el ajuste universitario con la salud en Perú?
Cecilia Chau ∗,1 , Juan Carlos Saravia 1
Universidad Católica de Perú, Departamento de Psicología, Lima, Perú
Received 10 November 2015; accepted 12 October 2016

Abstract
The aim of this study was to assess the relationship between university adaptation, perceived stress and mental and physical health. We also
evaluated if perceived stress mediated the relationship between university adaptation and health. A cross-sectional study was carried out among
general studies undergraduate students of one private university in Lima, Peru. The sample was composed of 200 students with an average of 18.13
years old (SD = 1.41). Multiple regression and mediation analyses were assessed to understand the relationship between university adaptation and
health. Multiple linear regression estimations had the following results for mental and physical health. Interpersonal relationships in university
better related to mental health. This model was composed by interpersonal relationships (Interpersonal), dedication to study and future career plans,
which accounted for 23% of the whole model. Physical health model was composed of perceived stress and study which accounted for 22% of
the whole model of physical health. Mediation analysis showed that perceived stress fully mediated the relationship between study and physical
health. Our findings could help further understand how college students are adjusting in order to have a better health. These findings have important
implications on assessing interventions for students that are struggling to adapt to college demands.
© 2017 Universidad Nacional Autónoma de México, Asociación Mexicana de Comportamiento y Salud. This is an open access article under the
CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Keywords: Peru; Health perception; University adaptation; Adolescent

Resumen
El objetivo de este estudio fue evaluar la relación entre adaptación universitaria, estrés percibido, salud mental y física. Además, se evaluó si el
estrés percibido mediaba la relación entre adaptación y salud. Se realizó una investigación transeccional con estudiantes de estudios generales de
una universidad de Lima, Perú. La muestra estuvo compuesta por 200 estudianes con un promedio de edad de 18.13 años (DE = 1.41). Un análisis
de regresión múltiple y otro de mediación fueron utilizados para evaluar la relación entre adaptación y salud. La regresión múltiple arrojó que
las relaciones interpersonales fueron las que mejor predecían la salud mental. Este modelo fue compuesto por las relaciones interpersonales, la
dedicación hacia el estudio y las expectativas futuras de carrera, el cual explicó el 23% de la varianza. El modelo de salud física estuvo compuesto
por las relaciones interpersonales y el estrés percibido, el cual explicó el 22% de la varianza. El estrés percibido mediaba completamente la
relación entre dedicación hacia el estudio y salud física. Nuestros hallazgos podrían ayudar a enteder cómo los estudiantes se están adaptando para
mantener una adecuada salud. Estos resultados tienen implicaciones importantes en la evaluación de las intervenciones para los estudiantes que
están luchando para adaptarse a las demandas de la universidad.
© 2017 Universidad Nacional Autónoma de México, Asociación Mexicana de Comportamiento y Salud. Este es un artículo Open Access bajo la
licencia CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Palabras clave: Perú; Percepción de la salud; Adaptación a la universidad; Adolescentes

∗ Corresponding author.
E-mail address: [email protected] (C. Chau).
1 Each author contributed in the same proportion to each section of the paper.
夽 Peer review under the responsibility of Asociación Mexicana de Comportamiento y Salud.

https://doi.org/10.1016/j.jbhsi.2017.08.002
2007-0780/© 2017 Universidad Nacional Autónoma de México, Asociación Mexicana de Comportamiento y Salud. This is an open access article under the CC
BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
2 C. Chau, J.C. Saravia / Journal of Behavior, Health & Social Issues 8 (2017) 1–7

Introduction The first one is appointed to the student domain, the third and
fourth to the course domain and finally, interpersonal and institu-
Late adolescents and emerging adults have an important role tional to the contextual domain (Almeida et al., 2001; Almeida,
in development of a nation because in the future they will become Soares, & Ferreira, 2002). If the person succeeds in these five
the main workforce of it. They will lead political, economi- domains then he/she has an adequate university adaptation.
cal and social movements. In particular, in Peru a population The university environment shows a variety of demands
between 15-29 years of age represents 27.2% of the whole pop- that can cause stress in young people. For example,
ulation of the state. Moreover it is possible that in the year 2021 lack of time to finish all academic tasks, oral presen-
this group will increase to 8,512764 people (INEI, 2013). tations, heavy academic workload and course evaluations
Therefore, the health states of late adolescents and emerging (García-Ros, Pérez-González, Pérez-Blasco & Natividad, 2012;
adults is very important for this country. The health ministry Pozos-Radillo, Preciado-Serrano, Acosta-Fernández, Aguilera-
has found out that in people between 18 and 29 years old, Velasco & Delgado-García, 2014). In a qualitative study, Sevinc
the most common diseases are the following: respiratory infec- and Gizir (2014) found out that perception of distant teachers
tions (26.2%), oral diseases (19.9%) and affections related to was related to the university adaptation process. Furthermore,
pregnancy (12.3%) (MINSA, 2011). peer relations, leisure time and participation in recreational
A national study with adolescents showed that these late ado- activities were positively related with a better social adaptation.
lescents and emerging adults have also suffered from changes Moreover, being shy, fear of being rejected by others and identity
in their sleep patterns (56.40%), feel tired or bored the major- were related to personal adaptation. Finally, sense of belonging
ity of the day (51.1%), suffer constant headache, neck and back to a group was also positively related to institutional adaptation.
pain (47.5%) and also an important group of people (44.0%) Furthermore, Pozos-Radillo et al., (2014) found in 527 Mexi-
suffer from depressive and anxiety symptoms such as feelings can university students that class participation, mandatory tasks
of sadness and listlessness (SENAJU, 2012). Overall, the prin- and exams predict chronic symptoms of stress. This could be
cipal need this population has is the access to higher education very important because high levels of stress are related to low
(Ministerior de salud del Perú (MINSA), 2011). According to a academic adaptation. In that case, adaptation is also related to
Peruvian national study with adolescents, 15.6% of young peo- health in late adolescents and emerging adults.
ple between 15-29 years have completed the first year of higher Self-perceived health is the subjective perception of how
education. Moreover, the majority of people that where able to healthy physically and mentally a person feels. The person could
pass this level are between 25 and 29 years and old (23.0%) and feel healthy but when he or she is evaluated by a doctor founds
20 to 24 years old (19.7%) (SENAJU, 2012). out that is not (Schwartzmann, 2003). Besides, a person could
Going to university is a big challenge for late adolescents and not feel any physical discomfort but regardless of that does not
emerging adults. In this path they have a lot of different chal- feel healthy (Ardila, 2003).
lenges from and developmental perspective and an academic Hussain, Guppy, Robertson and Temple (2013) found that
perspective. In the developmental level, this population has to stress has a negative relationship with a lower perception of
face difficult tasks as a result of maturation. Physical and emo- health in late adolescents. Therefore, they also found that late
tional changes transform the way they have to relate with peers adolescents that suffered higher levels of stress had more health
and family. Moreover, this period is marked by an increase in problems, more fatigue, which was related with a less class
psychological autonomy that is related to making own indepen- attendance, more feelings of dropping out from college and less
dent decisions, which could influence on their health (Currie enjoyment of university. Other studies have found out that late
et al., 2010). adolescents that perceive a better health also feel they have a
In an academic level they have to face the challenges that better academic achievement in comparison to the ones that
require adapting to new environment, with new rules and higher have a lower self-perceived health (Ansari & Stock, 2010).
academic workload, which show new stressors and high aca- Furthermore, late adolescents that have less physical health,
demic achievement (Leary & DeRosier, 2012). In other words, less well-being and little social support and lower satisfac-
these late adolescents have to develop an academic adaptation tion towards their courses tend to consider school dropout
towards university. (Hixenbaugh, Dewart & Towell, 2012).
To understand academic adaptation, Portuguese researchers As a result of all these, it is very important to study the rela-
used a psychosocial perspective and made questionnaires that tionship of university adaptation and health in late adolescents
measured three big domains: Student which is related to auton- and emerging adults. It appears that they have a strong bond with
omy, competence and well-being. Course, which is related each other, but we don’t know much of what specific domains
to academic achievement and how the person is succeeding are more related to health in late adolescents and emerging
in their academic career. Context which describes the institu- adults. Empirical research gives evidence that the developmen-
tional adaptation of the student with the academic environment tal level and academic level are important for late adolescents
(Almeida, Ferreira Soares, 2001; Soares, Almeida y Ferreira, and emerging adult’s health.
2006). Finally, these three big domains were divided into five Therefore, the aim of this study was to assess the relation-
subdomains: Personal (Personal or well being), Interpersonal ship between university adaptation, perceived stress and mental
(Interpersonal relationships), Career, Study and Institutional. and physical health. Moreover, we evaluated if perceived stress
 C. Chau, J.C. Saravia / Journal of Behavior, Health & Social Issues 8 (2017) 1–7 3

mediated the relationship between university adaptation vari- used to measure university adaptation. This questionnaire has
ables and mental and physical health. 60 items for 5 subscales and uses a Likert scale from 1 to 5.
(Almeida, Soares, Ferreira & Tavares, 2004). The five subscales
Method are: “Personal” which measures well-being, “Interpersonal” that
is related to interpersonal relationships; “Study”, which evalu-
Participants ates academic achievement, “Career” that measures future career
perspective and “Institutional” which evaluates the familirty the
A cross-sectional study was carried out among general studies student has with the facilities in his institution. Scoring for
undergraduate students of one private university in Lima, the higher scores mean better adaptation (Márques, Ortiz & Rendón,
capital of Peru. The sampling frame consisted of undergraduate 2009), these subscales showed an adequate Cronbach alpha,
students studying in Peru which studied Basic general studies (n which ranged between .71 (“Institutional) and .97 “Career”. Fur-
= 200). Students were not selected randomly. Ethical permission thermore, the total explained variance between each subscale
for the study was issued by the Commission on research ethics ranged between 5.4% (“Institutional”) and 10.6% (“Personal”)
for basic general studies. For this study, we used the Peruvian version of the QVAr (Chau
Of the 200 students, 67 were male (33.5%) and 133 female & Saravia, 2014a).
(66.5%). Mean age was 18.13 years old (SD = 1.41) and ranged
between 16 – 27 years old. The majority of cases were born in Statistical Methods
Lima (77.8%) and 22.2% were born in other places. 72.5% of
the people have never failed a course and 27.5% had failed one Questionnaires were coded for each participant. Data was
course. collected by using paper-based questionnaires.
For all variables total scores were calculated and used for
Instruments analysis. Two models were made for each variable. Variables
highly correlated were not included in order to avoid multi-
Mental and physical health collinearity. Kurtosis and Skewness lower than 1 criterion were
Self-perceived health was measured using the SF-36 scale, used to test for normality and justify the use of multiple linear
which has 36 items and 8 scales organized into 2 big components, regressions (Tabachnick & Fidell, 2013). Finally, significance
Physical Health and Mental Health. Higher scores indicate better level was set at 0.05.
physical and mental health (Ware, Snow, Kosinski & Gandek,
1993). Salazar and Bernabé (2012) validated the SF-36 scale for
Procedure
Peru and reached an internal consistency of .88. The eights scales
(Emotional role, Social Functioning, Vitality, Mental Health
The instruments were administered in 30 minutes sessions
(well-being), Physical functioning, Physical role, Bodily pain
and participation was voluntary. Data analysis techniques are
and General health) ranged a Cronbach alpha between .66 and
described in the Results Section.
.92. A CFA model showed an adequate goodness of fit in CFI,
TLI, RMSEA and SRMR for an 8 eight subscale separated in two
high order latent variables (mental and physical health). Men- Results
tal health was comprised in emotional role, social functioning,
vitality and mental health. Meanwhile, Physical health consisted We situate for each scale the mean score on the possible range
on Physical functioning, Physical role, Bodily pain and General of scores, we see the following pattern:
Health.
• Mental health scores are just above the midpoint (50). Further-
Perceived stress more, all subscales of mental health (general) were hire the
mid-point of the scale (50). Vitality and emotional role were
Perceived stress was measured by using the Spanish version the lowest scales and were nearest to the mid-point. Social
of the Perceived stress scale (PSS). This scale has 14 questions functioning was the highest subscale and is well higher from
and uses a Likert scale from 1 to 5. Items, 4, 5, 6, 7, 9, 10 and the mid-point.
13 has reversed scoring. Higher scores mean bigger amounts of • Meanwhile, in Physical health the mean scores are much
perceived stress in the last month. The PSS showed and adequate higher than the midpoint (50). General health is the lowest
internal consistency of .82 and a high test-retest correlation .73. subscale of physical health. In spite of this, it is above the mid-
Furthermore, the PSS also showed concurrent validaty with a point of the scale (50). Physical role and bodily pain were also
distress (r = .71) and anxiety test (r = .64) (HADS-T and HADS- above the mid-point of the scale which means a better physi-
A) (Remor, 2006; Gonzalez & Landero, 2007). cal health. Finally, physical function was the highest subscale
and was well over the mid-point and had almost the highest
University adaptation possible score of the whole scale.

The “Cuestionario de Vivencias académicas” (QVA-r) or Perceived stress: the mean score is below the midpoint of 22.
in English Questionnaire of Academic Experience (QAE) was We do now the same for the University adaptation variables.
4 C. Chau, J.C. Saravia / Journal of Behavior, Health & Social Issues 8 (2017) 1–7

Table 1
Mean score, standard deviation, alpha’s and possible range for each of the health measures.
Variables Cronbach ␣ Coding(* ) M SD Possible range

Mental Health (General) .88 + 63.32 19.62 0 – 100

Emotional role .77 + 56.95 40.69 0 - 100
Social Functioning .81 + 73.75 21.78 0 - 100
Vitality .79 + 55.96 40.69 0 - 100
Mental health (well-being) .86 + 66.50 17.56 0 - 100
Physical Health .85 + 75.79 15.70 0 – 100
Physical functioning .80 + 91.01 12.26 0 - 100
Physical role .76 + 74.63 32.53 0 - 100
Bodily pain .80 + 74.74 21.05 0 - 100
General health .78 + 62.28 17.14 0 - 100
Perceived stress .92 - 20.21 7.94 0 - 44
University Adaptation
Personal* .93 + 27.92 10.23 0 – 48
Interpersonal* .91 + 31.51 9.81 0 – 52
Institutional* .74 + 23.93 4.64 0 – 32
Study* .88 + 35.49 8.52 0 – 56
Career* .89 + 27.71 7.74 0 - 40

+ = the higher, the healthier; - = the lower, the healthier

* Personal (Well being), Interpersonal (Interpersonal relationships), Institutional (Familiarity to institutional facilities), Study (academic achievement) and Career

(future career perspective).

Table 2
Models for the estimation of mental and physical health.
B (coeff) 95% CI ␤ t P value
Mental health Interpersonal 0.50 0.21 – 0.78 .25 3.46 <0.001
Study 0.46 0.12 – 0.79 .20 2.64 <0.01
Career 0.44 0.09 – 0.79 .18 2.50 <0.01
Physical health Perceived stress -0.76 -1.06 – -0.47 -.39 -5.10 <0.001
Study 0.26 -0.02 – 0.53 .14 1.85 =0.07

Note: Mental health: R2 = .23 (N = 186, p < .001). CI = Confidence interval for B.
Physical health: R2 = .22 (N = 189, p < .001). CI = Confidence interval for B.

Personal: the mean score is above the midpoint 24 of the perceived health and Study which accounted for 22% of the
scale. Interpersonal: the means score is above the midpoint 26 whole model of physical health.
of the scale. Institutional: the mean score is very much above the Mediation analysis was performed for the physical health
midpoint 16 of the scale. Study: the mean score is much above model. The Sobel test proved to be significant (z = 4.34, p <
the midpoint 28 of the scale. Career: the mean score is above the 0.001) with an indirect effect of 0.38. Study was not signifi-
midpoint 20 of this scale. Table 1 Table 2 cant when perceived stress was added to the model, therefore
this variable fully mediated the relationship between study and
physical health. A mediation analysis for mental health wasnt́
Models for predicting mental and physical health on conducted due to the similarities between mental health and
students perceived stress causing the model to be biased. Figure 1

Regression models to estimate mental and physical health Discussion

were performed including all the variables that correlated with
that variable. The aim of this study was to assess the relationship between
Multiple linear regression estimations had the following university adaptation, perceived stress and mental and physical
results for mental health. According to our findings, interper- health. Moreover, we evaluated if perceived stress mediated the
sonal relationships in university better related to mental health. relationship between university adaptation variables and mental
Furthermore, this model was composed by three variables (Inter- and physical health.
personal, Study and Career), which accounted for 23% of the Interpersonal, had the strongest relationship with a better
whole model. Career was the variable that least explained mental mental health. This could be due to the following: Social sup-
health. port under stressful situations is associated with positive effects
On the other hand, perceived stress better explained the rela- and reduces mental and physical health disorders. Furthermore,
tionship with physical health. This model was composed of affiliation with other or “befriending” is vital for health and
 C. Chau, J.C. Saravia / Journal of Behavior, Health & Social Issues 8 (2017) 1–7 5

job selection represents a big part of their concerns (Seiffgge-

.64*** Krenke, 2001). This could be a possible explanation why we
Study Physical found out that variables regarding study workload and future
health
academic goals could be related to mental health. Furthermore,
findings have suggested that minor stressors such as academic
workload that are common in a college environment explain
more variance of psychological symptoms than critical life
-.49*** -.90***
events (Seifgge-Krenke, 1998). This could be another explana-
tion why Interpersonal, Study and Career which describes social
Perceived
stress
support, adaptation towards academic workload and future per-
spective of academic goals and career (Almeida, Ferreira &
Soares, 1999), is related to a better psychological health. Other
important topics related to health in adolescents are growing aca-
Figure 1. Mediation model for physical health.
demic expectations, changing social relationships with family
and peers, the physical and emotional change with matura-
for managing threating circumstances (Taylor & Master, 2011). tion and the considerable amount of change they have to face.
Social networks functions in health in different ways: First, they These changes, are regarding autonomy and independent deci-
serve as social support as a provision of care and aid in times sion making that could influence on their health (Currie et al.,
of need which reduces psychological distress. Second, these 2010).
networks provide enjoyable interactions. These relationships Perceived stress could have had a mediating effect on the
provide enjoyable activities, positive affect and stimulation. relationship of study and physical health due to the effects of
Meanwhile, less companionship could derive into negative affect stress in the body. As a result of heavy academic workload,
and reduce the possibility to develop psychological resources university students could be suffering from chronic stress and
to withstand life stressors (Rook, August & Sorkin, 2011). feel physical symptoms such as headaches or fatigue (Barraza,
Third, social relations could also function as social control, 2006). Furthermore, another study found that student’s most fre-
were the network members monitor, encourage and persuade quent and challenging concerns were regarding, stress and time
another person to adhere to positive health practices (Thoits, management (Reynolds, 2013), which are related to their abil-
2011). This could also be relevant because it is possible that ity to cope with stressful situations and university adjustment.
peer could encourage one another to study more, compare notes This condition could cause a malfunction in the negative loop
and have study groups in order to be better prepared for aca- which is designed to shut down the response to threating sit-
demic demands. This could be very important because if these uations and maintain homeostasis (Henderson & Baum, 2004)
coping skills such soliciting social support are used during ado- which consequently can promote biological damage and symp-
lescence it is highly probable that the person will keep using it toms of bodily pain and inevitably become stressors (Gatchel,
threw adulthood (Seiffge-Krenke & Beyers, 2005). Howard & Haggard, 2011). Moreover, other study findings were
Study was also related to mental health. In this case, find- also related to these results, were perceived stress measured
ings have shown that students of this college’s academic unit threw perceived pressure and demands were related to psychoso-
feel that they can cope with the academic demands. In spite of matic symptoms, headaches and upper respiratory infections and
this, these students feel that academic evaluations could be a musculo-skeletical pain (Wiklund, Malmgren-Olson, Ohman,
very difficult task to cope with and 38% of students have had Bergstrom & Fjellman-Wiklund, 2012).
some difficulties organizing themselves and dealing with daily This has important implications for these study findings; in
academic demands (DAA, 2012). As we found out, the abil- this case, physical health was measured by grouping physical
ity to cope with all these concerns could be related to a better functioning, physical role, bodily pain and general perception of
perception of mental health. Additionally, Boullosa (2013) also health measured physical health. Furthermore, in this study gen-
states that the most common reaction of student when they were eral health was the scale that had the least score, in this case there
feeling overwhelmed by academic demands was exhaustion and is the possibility that student’s perceived health is the variable
somnolence that is related to a lack of vitality. These findings that is affected the most from a heavy academic workload. These
are linked with the results from this study, were a less amount findings are very important not only for late adolescent’s health
of vitality also affects overall mental health. at this moment, but also for the future. Hoyt, Chase-Landsdale,
Career was also positively related to a better mental health. Mcdade & Adam, (2013), found that adolescent’s positive well-
Studies have shown that future oriented problems are more being was associated to better perceived health and fewer risky
stressful than even family problems and cause fear and worries behaviors during young adulthood.
of future unemployment or future occupation (Seiffge-Krenke, Some limitations were assessed for this study. This sample
1998). Likewise, other findings have shown that the principal was collected from just one college in a single providence of
reason for this student’s to go to college is to develop skills Peru. Future studies could also include other universities from
that could help them in their future jobs (Dirección de Estu- different cities of Peru and also several different universities
dios Académicos, 2012). Altogether, school and career issues in Lima. Furthermore, this sample included students that were
are highly important in adolescence, academic achievement and immigrants, this could have affected our findings because of the
6 C. Chau, J.C. Saravia / Journal of Behavior, Health & Social Issues 8 (2017) 1–7

challenges this people could face due to acculturation, which science: Biology, psychology and health. New York: Springer publishing
involves a process of adaptation to new norms and rules (Seiffge- company.
González, M., & Landero, R. (2007). Factor structure of the perceived stress
Krenke, 1998). Future studies could focus on the comparison
scale (PSS) in a sample from Mexico. The Spanish Journal of Psychology,
between immigrants’ students and non-immigrants in order to 10(1), 199–206. http://dx.doi.org/10.1017/S1138741600006466
assess if there are any difference in their college adaptation. Fur- Henderson, B. N., & Baum, A. (2004). Biological mechanism of health and
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