How to cite this article: Vernaza P, Chavarria J, Dueñas R, Niño V, Ávila G, Klínger J, Londoño J. Relationship between perceived academic

stress and Interleukin 6 levels in health students. Ciencia e Innovación en Salud. 2020. e68:31-44 DOI 10.17081/innosa. 68

Relationship between perceived academic stress and Interleukin 6 levels in

health students

Relación entre el estrés académico percibido y los niveles de Interleucina 6

en estudiantes de salud

Paola Vernaza

*, Jayson Chavarria

, Rosa Dueñas Cuellar

, Victoria Niño

, Gloria Ávila González

, Julio Klínger Hernández

, Jerónimo Londoño

Universidad del Cauca, Popayán, Colombia

*Address correspondence to: pvernaza@unicauca.edu.co

ABSTRACT

Background: Academic stress is an important research topic due to the effect it has on the quality of life of

students, future professionals and therefore, adult contributors in a society. It has been shown that students in

the health field face additional stressors specific from their careers, and suffer greater stress than the general

population of the same age. Methods: 52 students, 23 from Physiotherapy and 29 from Medicine programs

were surveyed with Academic Stressors Academic Scale (SAS) to know academic stress level and IL-6 was

quantified in serum. Results: It was found that students who perceive the academic semester as stressful “fairly

often” and “many times”, increases in 50%, 75% and 76.9% during the semester; while “anxiety/distress” feeling

was predominant. The most frequent SAS scale factors were “methodological deficiencies”, “student overload”,

“beliefs about performance”, “lack of content value”, “participation” and “exams” Conclusion: The study

revealed an IL-6 increment, and their association with “Methodological Deficiencies” at 1st moment. This study

showed the importance of academic stressors identification at same time that it is a call to construct strategies

to reduce stressors in University context.

Article History

Submitted: 18 09 19

Accepted: 29 10 19

Published: 20 01 20

Keywords: Academic stress; IL-6; Physiotherapy; Psychoneuroimmunology.

I. INTRODUCTION

Academic stress is an important research topic due to the effect it has on

the quality of life of students, future professionals and therefore, adult

contributors in a society. It has been shown that students in the health field

face additional stressors specific from their careers, and suffer greater

stress than the general population of the same age (1, 2). Among these

stressors have been mainly identified, the awareness of having in their

hands people’s health and life, extended work hours, difficult work places

(emergency rooms or intensive care) and continuous assessment of large

volumes of knowledge. In response to these stress circumstances,

students can develop depression (3) drug dependence (4), suicidal

tendencies (5), difficulty in establishing interpersonal relationships (6), as

well as associated pathologies such as musculoskeletal disorders (7),

infections (8), oral diseases (9), and autoimmune disorders (10), among

others. Research on the association between stress and students in health

areas is extensive (11-13). Survey-type tools to elucidate the problem

qualitatively, have noted that time available to perform academic activities,

fear of failure, interactions within the classroom, economic problems and

social and global problems, are the most frequent stressors within this

population, while the consequences are associated with these factors: high

burnout index, fatigue and depersonalization, emotional exhaustion,

depression and suicidal ideation (14)

DOI 10.17081/innosa.68

Vernaza

et al.

Of these studies, few inquire students’ health status through their own biological indicators for

this purpose. In this sense, the relationship between stress and the immune system has been

explored; for example, it has been shown that in situations of acute stress, health science

undergraduate students have an increase in the concentration of cortisol in their blood (15),

leukotriene in nasal fluids (16). It is also related to an increase of the adrenocorticotropic

hormone (ACTH), which in turn generates an increase in the IL-4, IL-10 and IL-13 cytokines

that have anti-inflammatory effects, and a decrease in the pro-inflammatory IL-1β, IL-6, TNF-α,

IFN-γ, IL-2 and IL-12 cytokines (17). On the other hand, when stress is chronic, fatigue of the

hypothalamus-adrenal pituitary axis occurs, which attenuates the response of cortisol, causing

resistance to glucocorticoids due to the low expression of its receptors; therefore, the effect of

cortisol on the inflammatory response loses its effect and increases IL-6, TNF-α and IFN-γ

levels (18), so that chronic stress is related to a pro-inflammatory profile (19), which can become

an etiological factor of pathologies of an inflammatory nature.

Considering the above, this research aimed to identify the circumstances of academic stress in

a population of Physiotherapy and Medicine students of the Faculty of Health Sciences of the

University, through the application of the Academic Stressors Scale SAS and the pro-

inflammatory cytokine IL-6 quantification.

II. METHODS

Study population. An observational, longitudinal and descriptive study was carried out. The

selected population was obtained from the students of the Faculty of Health Sciences of the

University, enrolled in the seventh semester of the Medicine Program and from the sixth

semester of the Physiotherapy Program; who were chosen due to their higher academic load

according to their study plans. The following aspects were taken into account as inclusion

criteria: Academic enrollment with 100% of the academic credits required for the corresponding

semester, signature of the informed consent, presence in the three moments of the survey

administration and in peripheral blood samples collection, students who were not consuming

any type of drugs or hallucinogenic substances, and as an indication of the peripheral blood

samples collection, who had followed a minimum fast of 8 hours. 52 students participated, 23

students from the Physiotherapy Program and 29 students from the Medicine Program;

however, the quantification analysis of IL-6 was performed on 51 students given the dispersion

of 1 case between the first and the second moment. All the procedures were approved by the

Ethics Committee of the University, the project was registered with ID 4624 in the Research

System of the University.

Measurement of stressors. The stressors were measured through a survey of

sociodemographic characteristics and the academic stressors questionnaire, which was

formulated and validated in 2016 by Cabanach and collaborators (reliability of a=0.96) (20).

From this questionnaire, the Stressors Academic Scale (SAS) was used, consisting of 54

questions with Likert-type answers (Never =1, Sometimes= 2, Fairly Often =3, Many times =4

and Always =5). The survey was first administered on the first week of the semester (“1

Moment”), where the survey of sociodemographic characteristics (age, gender, socioeconomic

status, marital status, economic stability and academic program) was also administered. The

survey was administered again in week 13, where the 70% evaluation of the academic content

takes place, and in week 16, where final exams are taken, defined as the “2

Moment” and the

“3

Moment”, respectively. The SAS was entirely assessed and grouped into 8 factors:

teacher’s methodological deficiencies (12 items); student’s overload (10 items); public

interventions (5 items); bad social relationships in the academic context (6 items); lack of control

over one's academic performance (5 items); lack of content value (4 items); low academic

esteem (5 items); exams (4 items); inability to participate in decisions regarding one's own

academic work (3 items).

IL-6 determination in serum of peripheral blood. IL-6 determination in serum of peripheral

blood was performed by means of peripheral venous blood samples, which were obtained by

direct venipuncture with the Venoject system (Terumo Europe NV Eschborn Germany), using

Vacutainer® tubes without additives (BD Franklin Lakes red cap tubes, NJ, USA). 6 mL of blood

was collected from each person in the established times (1

, 2

and 3

moments). The serum

was separated by centrifugation and the samples were labeled and stored at -70°C until the

cytokine IL-6 was quantified. The cytokine IL-6 was quantified from peripheral blood serum by

the sandwich ELISA method using the Human IL-6 ELISA MAX™ kit (Biolegend), the procedure

was performed according to the manufacturer's instructions.

Data analysis. The data from the SAS and the Cytokine IL-6 quantification were included in an

Excel-type electronic sheet in which each student was assigned a code; once the data were

entered, the electronic sheet was exported to the statistical program SPSS.19 for its

corresponding analysis. The sociodemographic variables were analyzed using frequency and

percentage tables, as well as the variables of the academic stressor questionnaire, which were

analyzed first by question and then by groups or factors, comparing the average behavior by

factor in each of the programs. To classify the results by average, it was decided to group them

in ranks to facilitate the interpretation of the final results: 0 to 0.9 “Never”, 1 to 1.9 “Sometimes”,

2 to 2.9 “Fairly often”, 3 to 3.9 “Many times” and 4 to 5 “Always”. Finally, the questionnaire

questions which presented the highest response rate represented in the final average were

selected; as a selection criterion, it was taken into account that the question obtained a

frequency greater than or equal to 20 in the answers, except for the ones answered as "never",

and that it would be repeated in the results of each moment of the questionnaire administration.

For the analysis of the IL-6 quantification, the ANOVA test was performed for repeated samples

and the Dunn's multiple comparison test, with a value of p≤0.05. Finally, a Pearson correlation

was conducted between the higher frequency academic stressors by academic program and

the IL-6.

III. RESULTS

Analysis of socio-demographic variables. The average age of the surveyed students was

21.54 years, with a minimum age of 19 years and a maximum of 27 years; 38.5% (20/52) of

the respondents were men, while 61.5% (32/52) were women; regarding the socioeconomic

level classificated in Colombia by 5 strata, being stratum 1 the lowest income and stratum 5 the

highest income; 78.8% (41/52) belonged to 1, 2 and 3 strata. 73.1% (38/52) considered having

a good economic stability. Regarding marital status, 98.1% (51/52) reported being single.

Among the respondents, 44.2% (23/52) were enrolled in the Physiotherapy program and 55.8%

(29/52) in the Medicine program. Table 1 describes the socio-demographic characteristics.

Table 1. Bivariate analysis of the socio-demographic variables of Physiotherapy and Medicine

students.

VARIABLE

PHYSIOTERAPY

MEDICINE

n (%)

Age

21.54±v2.8

21±1.6

Gender

Male

6 (26.1)

14 (48.3)

Female

17 (73.9)

15 (51.7)

Socioeconomic stratum

One

6 (26.1)

0 (0)

Two

8 (34.8)

8 (27.6)

Three

6 (26.1)

13 (44.8)

Four

3 (13.0)

7 (24.1)

Five

0 (0)

1 (3.4)

Marital status

Single

22 (95.7)

29 (100)

Common law marriage

1 (4.3)

0 (0)

Economic stability

Regular

6 (26.1)

7 (24.1)

Good

16 (69.6)

22 (75.9)

Excellent

1 (4.3)

0 (0)

Source: own elaboration

Analysis of the survey on perceived academic stress

Regarding the level of perceived stress, it was found that at the 1

moment 48.1% (25/52)

perceive stress “sometimes”, however 50% (26/52) perceive it “fairly often” and “many times”.

When administering the survey at the 2

moment, the level of stress perceived by the students

was 75% (44/52) for a stress level between “fairly often” and “many times”, as well as the level

of stress perceived by students at the 3

moment with a percentage of 76.9% (27/56). Having

said that, regarding the predominant feeling, the “anxiety / distress” was the main emotion that

produced stress, this tendency was reiterative in the three moments of the study.

Concerning the factors of the SAS survey, it was found that in the studied population, 6 out of

8 factors, namely “methodological deficiencies”, “student’s overload”, “beliefs about one’s

academic performance”, “lack of content value”, “participation” and “exams”, presented a rising

variability, in the three moments of the study, going from experiencing stress manifestations

“sometimes” to “fairly often” (Table 2).

Table 2. Average of each SAS factor for academic programs

FACTOR

1st MOMENT

2nd MOMENT

3rd MOMENT

± DE

Methodological deficiencies

2.9 ± 0.8

3.0 ± 0.8

3.1± 0.9

Student overload

30 ± 0.8

3.3 ± 0.9

Beliefs about performance

2.7 ± 0.8

2.9 ± 0.9

3.1 ± 1.0

Public interventions

2.7 ± 0.9

2.6 ± 0.8

2.7 ± 0.8

Negative social climate

2.1 ± 0.9

2.0 ± 0.8

2.2 ± 0.9

Lack of content value

2.4 ± 0.9

2.6 ± 0.9

2.8 ± 1.0

Participation

2.0 ± 0.7

2.2 ± 0.9

2.6 ± 0.9

Exams

3.0 ± 0.9

3.1 ± 0.8

3.4 ± 0.9

Quantitative and qualitative values of academic stressors according to the SAS. 0-0.9 = never;

1.0-1.9 = Sometimes; 2.0-2.9 = Fairly often; 3.0-3.9 = Many times; 4.0-5 = Always

Source: own elaboration

The comparison of means for each factor in the Physiotherapy and Medicine academic

programs is described in Figure 1; it was found that the “academic overload” is a prevalent

factor with greater response to stress in the Medicine students than in the Physiotherapy

students, another factor affected through the academic semester is the one corresponding to

“exams”, being higher the frequency of stressors in Medicine students. Figure 1 shows the

perception of the different stressors in the students by academic program, where it is evident

that the Medicine students exhibit greater perception in the SAS academic stressors. The

“activity overload”, “exams”, “beliefs about performance” and “methodological deficiencies”

means values are the three factors with the highest stress load perceived by Medicine students

with a “fairly often” value above 3, while the factor perceived as the most stressful in the

Physiotherapy program was “exams”.

Levels of IL-6 in serum in physiotherapy and medicine students

When performing the descriptive analysis of the IL-6 concentration behavior in the serum of

students, it was observed that the data median increased progressively at each moment (Table

3).

Figure 1. Averages comparison for each SAS factor by academic program.

Source: Own elaboration

The data represent the means by factors relating to: 1. Methodological deficiencies; 2. Student

Overload; 3. Beliefs About Performance; 4. Public Interventions; 5. Negative Social Climate; 6. Lack of

Content Value; 7. Participation; 8. Exams. The values were represented as 0-0.9 = never; 1.0-1.9 =

Sometimes; 2.0-2.9 = Fairly often; 3.0-3.9 = Many times; 4.0-5 = Always.

Table 3. Descriptive values of the IL-6 quantification in Medicine and Physiotherapy students

during the academic semester

1st Moment

2nd Moment

3rd Moment

Sample size

Minimum value

0.0

0.05

1.9

Percentile 25

1.15

2.15

5.25

Median

3.8

5.1

Percentile 75

6.9

9.9

14.6

Maximum value

37.05

44.9

54.4

Source: Own elaboration

When the ANOVA test for repeated samples and the Dunn's multiple comparison test were

performed, a significant difference was shown in the IL-6 production between the 1

moment

and the 3

moment. Likewise, a significant difference was shown between the 2

moment and

the 3

moment (Figure 2). The above shows that, at a general level, the students of the

Physiotherapy and Medicine programs suffered an increase of this pro-inflammatory cytokine

during the academic semester.

Figure 2. IL-6 quantification (pg/mL) in serum of Physiotherapy and Medicine students

throughout the academic semester.

Source: own elaboration

The figure shows the pooled values of the cytokine IL-6 quantification during three moments of

the academic semester. The 1

Moment (black circles) corresponding to the beginning of the

semester; The 2

Moment (black squares) corresponding to the 70% grading period of the

academic semester; The 3

Moment (black triangles) corresponding to the end of the semester.

The data represent each individual in the study and the horizontal line represents the data

median, which were analyzed by the ANOVA test for repeated samples and the Dunn's multiple

comparison test, p <0.001 (***) and p <0.01 (**).

Figure 3. IL-6 levels (pg / mL) in serum of Physiotherapy and Medicine students throughout the

academic semester

Source: own elaboration

The figure shows the quantification of the Cytokine IL-6 in students of the Physiotherapy

program (A) and the Medicine program (B) during three moments of the academic semester.

The 1

Moment (black circles) corresponding to the beginning of the semester; the 2

Moment

(black squares) corresponding to the 70% grading period of the academic semester; the 3

Moment (black triangles) corresponding to the end of the semester. The data represent each

individual in the study and the horizontal line represents the data median, which were analyzed

by the ANOVA test for repeated samples and the Dunn's multiple comparison test, p <0.001

(***) and p <0.01 (**).

When analyzing the IL-6 production in each program, it was observed that the Physiotherapy

program students do not show significant changes in the IL-6 production between the first and

the second moment, even though the values show a relative increase. However, between the

moment and the 3

moment a significant increase is shown (Figure 3.A). Regarding the

Medicine program students, a significant increase was observed between the 1

moment and

the 3

moment (Figure 3.B). These results reflect that the IL-6 values increase progressively

throughout the semester, both in the Physiotherapy program and in the Medicine program,

according to the behavior of the grouped data.

Correlation between the SAS survey results and the IL-6 production

When analyzing the overall correlation between SAS factors and the IL-6 quantification for each

moment, an association was found in the Methodological Deficiencies factor with a 0.78 value

at the 1

moment, in the other factors there was no correlation among the variables (Table 4).

Table 4. Correlation for each factor of the SAS survey and the cytokine IL-6 quantification in

the students of the Physiotherapy and Medicine academic programs

Factor

IL-6

1st Moment

2nd Moment

3rd Moment

Methodological deficiencies

0.78

-0.58

-0.123

Student overload

-0.52

-0.15

-0.127

Beliefs about performance

0.006

0.086

-0.128

Public interventions

-0.145

-0.104

-0.114

Negative social climate

0.15

0.124

-0.136

Lack of content value

0.151

-0.05

-0.113

Participation

0.29

0.019

-0.106

Exams

-0.136

-0.103

-0.257

* A correlation of ≥ 0.3 with p value ≤ 0.05 is considered significant

Source: own elaboration

The situational stimuli that the students rated as more threatening for each of the 3 moments

were correlated with the IL-6 production and no significant relationship was found (data not

shown).

IV. DISCUSIÓN

The students who participated in the study share similar sociodemographic characteristics and

are enrolled in the semester with the highest number of academic credits of each program.

When investigating the level of perceived stress in the population, it was observed that as

academic semester progresses, the level of perceived stress by the students was higher,

characterized by an anxiety and distress feeling; however, a scale was not applied to determine

such levels of anxiety (21).

Regarding the SAS survey factors, it was found that in studied population (6 out of 8), factors

such as: “methodological deficiencies”, “student overload”, “beliefs about performance”, “lack

of content value”, “participation” and “exams”, presented variability in the three moments of the

survey administration. Though, Medicine students showed greater stressors in the “Academic

overload”, “Methodological deficiencies” and “Exams” factors; similar to what was found in the

study by Taboada et al., 2015 (22) who found that university students are “fairly often” stressed

by situations related to the factors corresponding to “methodological deficiencies”, “academic

overload” and “exams”, which, corresponds to the results obtained by this investigation.

Meanwhile, in Physiotherapy students the factors with the most frequent stressors were:

“Academic overload” and “exams”. The results presented in this study agree upon the results

obtained by Toribio et al., 2016, who studied a population of undergraduate nursing students

at the University of Papaloapan (Mexico), where he found that the most affecting stressors in

this population were: “exams”, “academic overload”, “short delivery period” and “teacher’s

personality / character” (23).

Regarding the “exams” factor, which is perceived as an important stressor and is related both,

to its preparation and its proximity or administration of the exam, it has been determined that is

the one that produces greater anxiety and tension, for this reason it is assigned an important

role as a trigger for a state of emotional stress associated with the action of taking exam. The

result of this study, just like that of Hernández et al., 2011 (24), show that anxiety about exams

not only affects academic performance, but is also related to the emotional state and students’

health. The obtained results were corroborated with the results of other investigations (25, 26)

and are coherent with the related studies in the corresponding subject. That is, “exams” and

“academic overload” are among the most frequent academic stressors in the life of a university

student.

Regarding the “participation” factor, this study shows that what affects students the most is

giving an oral presentation about their work, or expressing themselves to others during a certain

period of time, as well as answering questions, expressing opinions or explaining their point of

view to the audience. These stress situations may have their origin in the quality of the

academic preparation to be presented, or in a personal insecurity. Thus, it can be concluded

that students perceive as stressful, any situation in which they are evaluated through

participation, these findings are similar to those reported by García et al., 2014 (26). In our

study, the “participation” factor is classified as a stressor that can have a negative impact on

the health of university students. The participation situations that affect students the most are

giving an oral presentation about their work or expressing themselves to others. In the “negative

social climate” factor, students perceive an uncomfortable environment within their respective

classrooms, which hinders peer support and collaboration. This factor can be explained related

to the natural grouping constituted by the classroom and the interactions taking place in it

through cooperation, competition or leadership, and which configure what we know as social

climate, which can be explained with the time students spend throughout their academic

40 
 
training in both, theoretical, and practical activities; these academic stressors were assessed 
with a “many times” occurrence, but in spite of this, no significant differences were found, similar 
to what was found in the study by García et al., 2014, where the least stressful factor was “the 
negative social climate” perceived by students in Health programs (26).  
Cytokine profiles are immune-biochemical markers frequently used in stress situations. Studies 
have  shown  relationship  between  problems  associated  with  stress  with  pro-inflammatory 
cytokines increase in patients, for example in the meta-analysis conducted by Segerstrom & 
Miller  (2004)  (27),  it  was  found  that  in  patients  with  psychological  stress,  there  is  a  high 
concentration of cytokines such as IFN-γ and IL-6. This increase in pro-inflammatory cytokines 
has also been documented in studies where circumstances of academic stress were evaluated 
in students of Health Sciences programs (28). Our results show an increase of the cytokine IL-
6  when  analyzing  the  grouped  data  of  the  students  of  the  Physiotherapy  and  Medicine 
programs; this increase appears when comparing three moments of the academic semester, 
being significant the difference between the first and the third moment, and between the second 
and the third moment. These data correlate with the ones reported by different authors (29, 30). 
Likewise, Marshall et al., 1998 analyzed the IFN-γ and IL-10 levels, four weeks before and 48 
hours after a partial exam in 16 Medicine students at the University of Texas; results showed 
higher IFN-γ values before the test, which decreased after 48 hours, while the IL-10 values 
increased. These data suggest that “exams” situation is psychologically stressful, and changes 
the  balance  of  Th1/Th2  type  cytokines,  causing  the  Th2  type  content  to  increase,  which 
produces  an  immunological  dysregulation  (31).  Similarly,  Lester  et  al.,  2010,  analyzed  the 
concentrations of various cytokines, including IL-6, in saliva samples from 36 Anatomy students 
from different programs in the health area one day before the 3 evaluations of the semester, 
the  results  showed  that  IL-6  concentrations  as  well  as  other  pro-inflammatory  cytokines 
increased gradually from the first evaluation to the third one (32).  
Increase of the IL-6 in Physiotherapy and Medicine students should be taken into account as a 
starting point to conduct new studies to evaluate the immune status of students, since it has 
been suggested that the changes evidenced in the balance between Th1/Th2 responses, could 
lead to a decrease in cell-mediated immunity, which would increase the risk of susceptibility to 
viral, mycotic and bacterial infections (33, 34); at the same time, chronic increase of the cytokine 
IL-6 could be related to short, medium or long term development of diseases of inflammatory 
etiology, such as cardiovascular diseases, diabetes, obesity, periodontal diseases, even cancer 
(35, 36). 
In addition, the chronic inflammatory condition, not only would be related to the physical health 
of  students,  but  also  to  their  mental  health,  since  the  inflammation  affects  several 
neurotransmitter  systems  in  the  brain,  including  the  serotonin,  dopamine  and  glutamate 
pathways, as well as to the kynurenine pathway, which generates quinolinic acid, a neurotoxic 
metabolite. Neuroimaging studies have shown that disruption of neurotransmitter pathways is 
associated with inflammation-induced alterations in brain circuits that mediate motivation and 
motor activity, as well as anxiety, activation and alarm  (37), so that eventually this chronic 
inflammatory process caused by academic stress could converge in depression (38).  
Regarding  the  correlation  between  SAS  factors  and  the  cytokine  IL-6,  it  was  only  found 
correlation in the “1
st
 Moment”, specifically in the “methodological deficiencies” factor (0.78) In 
this  regard,  authors  such  as  Taboada  2015,  express  a  relationship  between  academic 
performance and stress expressed by students, with the disparity between what the teacher 
teaches and how he/she evaluates (22). Several studies have addressed the teaching-learning 

process itself as one of the most significant stressors, mainly related to teacher-student

relationships, so it is striking how this strong relationship appears at the beginning of the

academic semester before formally starting classes. Undeniably, the difficulties derived from

this poor teacher-student interaction are sources of instability, imbalance and academic

tensions (23, 26). Nevertheless, no significant correlations were found between SAS factors

and IL-6; this concurs with the study by Koh et al., 2012 (39) who analyzed effects of

psychological stress and pro-inflammatory and anti-inflammatory (IL-6, TNF-α) cytokines in

Medicine students. In this case, they did not find a significant relationship between the results

of survey and those of the cytokines; still, independently, significant data related to academic

stress circumstances were found.

Despite having a measurement scale of academic stressors such as SAS, an instrument that

allowed to evaluate specific factors to qualify the perception of students’ academic stressors,

when correlating them with the biological IL-6 measurements, it was observed an absence of

equivalence between scale and biological measure as expressed by Tangarife-Lujan and

Cardona Arias (40).

CONCLUSIONS

This study revealed that the greatest stressors perceived with the SAS survey administration in

the Medicine and Physiotherapy students were (6 out of 8): “methodological deficiencies”,

“student overload”, “beliefs about performance”, “lack of content value”, “participation” and

“exams”, these presented a rising stress variation, in the three moments of the study, going

from presenting stress manifestations “Sometimes” to “Fairly often”.

The study revealed an association between IL-6 values and methodological deficiencies in the

evaluation of academic stress level. There was no correlation between the other SAS factors

and the IL-6 quantification in students of the Faculty of Health Sciences of the University,

probably due to the absence of equivalence between the scale and the biological measure.

However, the obtained results show that, independently, there is an increase in the cytokine IL-

6 over time during the academic semester and that the SAS scale serves to identify the main

stressors of students.

This study showed the importance of academic stressors identification to mark a roadmap for

the close support of students who experience stress, at same time as it calls for strategies to

reduce stressors in University context.

In addition, this study shows the progressive increase of interleukin-6 during a state of chronic

academic stress, which correlates with the evidence of the relationship between inflammation

and psychiatric illness. Because there is also a relationship between inflammation and

progression of different diseases, knowing the inflammatory state of people who experience

stress is an interesting topic to explore and prevent diseases linked to chronic inflammatory

processes.

Authors contribution: "Conceptualization, Julio Klinger; methodology, Paola Vernaza,

Victoria Niño.; software, Jayson Chavarria; validation, Gloria Ávila González.; formal analysis,

Jerónimo Londoño, Paola Vernaza, Victoria Niño; research, Paola Vernaza; resources, Victoria

Niño.; data healing, Paola Vernaza. writing: preparation of original draft, Jayson Chavarria;

writing: review and editing, Paola Vernaza.; viewing, Jerónimo Londoño.; supervision, Rosa

Dueñas Cuellar.; project management, Paola Vernaza, Jerónimo Londoño, Rosa Dueñas,

42 
 
Victoria Niño.; fund acquisition, Victoria Niño, Rosa Dueñas Cuellar. All authors have read and 
accepted the published version of the manuscript." 
Funding details. This work was supported by the 07-2018 Semilleros de Investigación de 
Innovación Cauca and Universidad del Cauca.  
Acknowledgements. Authors are grateful with Vice-Chancellor for Research of the University 
of  Cauca  for  the  administrative  support;  also  with  Sarah  Burbano  Guerrero  from  the 
Immunology and Molecular Biology Laboratory of the University of Cauca for assist setting up 
the ELISA test for IL-6. 
Conflicts of interest.  The authors declare no conflict of interest. 
 
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