Determinants of Severe Stress in University Students: The Mediating Role of Physical and Psychological Symptoms in a Brazilian Cross-Sectional Study

Objective:This study aimed to evaluate the association between severe stress, its phases, and types of symptoms among undergraduate and graduate students at a Brazilian public university.Methods:A cross-sectional, comparative study was conducted in July 2023 using the Lipp Stress Symptom Inventory (LSSI) and a sociodemographic questionnaire. A total of 1,049 students participated (undergraduate group [UG]: 688; graduate group [GG]: 361). Statistical analyses included chi-square tests, Spearman’s correlation, and binary logistic regression, adjusted for sociodemographic variables associated with stress.Results:Both groups exhibited high stress levels, with undergraduate students (UG) showing a higher prevalence of severe stress (27.7%) compared to graduate students (GG) (22.7%). Psychological symptoms were more frequent and predictive of severe stress in both groups in the categorical analysis, which was not observed for physical symptoms. Binary logistic regression indicated consistent odds for severe stress in both groups, with GG standing out for both physical symptoms (OR=2.67) and psychological symptoms (OR = 2.23). In this group, stress was predominantly mediated by the exhaustion phase (OR=3.34), whereas in UG, it was mainly mediated by the resistance phase (OR=3.59).Conclusions:Psychological symptoms were more frequent than physical symptoms in both groups; however, the GG appeared to be more affected, although both types of symptoms were determinants of severe stress. The exhaustion phase was the main predictor of severe stress in the GG, whereas the resistance phase mediated stress in the UG. Institutions should prioritize structural and psychosocial support policies to mitigate academic stress and promote mental well-being across diverse student populations. <br>