Lindahl · Acta paediatrica (Oslo, Norway : 1992) 2005 · Cross-sectional experimental study · n=46

Test performance and self-esteem in relation to experienced stress in Swedish sixth and ninth graders--saliva cortisol levels and psychological reactions to demands.

Cited 42 times in the scientific literature.

Level 4 - case-series / case-control

Cross-sectional correlational study assessing biological and psychological markers during a test

PubMed 16092465 · doi:10.1111/j.1651-2227.2005.tb01922.x · record verified 2026-08-26

What was done

46 randomly selected Swedish 6th and 9th graders voluntarily took an experimental school test evaluating reading and mathematics skills. Salivary cortisol was collected at awakening, 30 minutes post-awakening, immediately before the test, and after the test. Students also completed a visual analogue scale (VAS) for perceived stress, a standardized self-esteem questionnaire, and questions assessing psychological coping reactions to school testing demands.

What was found

The abstract reports no numerical values, correlation coefficients, or p-values. Experienced stress during testing was correlated with poorer test performance, lower self-rated self-esteem, and higher increases in salivary cortisol during the test. Self-reported positive self-talk ('I can solve this task') was correlated with a lower morning cortisol increase, whereas worry-based reactions ('I get worried and will have problems solving other tasks too') correlated with increased cortisol levels during testing.

Why it matters

This study links biological HPA-axis activation (salivary cortisol) to subjective stress, self-esteem, and cognitive appraisal strategies during standard academic performance situations in children.

Limits

The sample size is very small (n = 46) across only two grade cohorts. The design is correlational, preventing causal inference. The abstract omits all statistical effect sizes, confidence intervals, and p-values.

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