Hydrotherapy as a complementary intervention for academic stress in higher education: A public health perspective

Introduction

The global public health landscape is increasingly dominated by the burden of non-communicable diseases (NCDs), including cardiovascular conditions, diabetes, and mental health disorders.^1,2 Chronic psychological stress plays a key role as a modifiable risk factor in the development of NCDs.³ Research indicates that experiencing stressful life events can elevate the risk of developing various non-communicable diseases, such as depression, anxiety, type 2 diabetes, and heart-related conditions.⁴ Workplace environments present convenient opportunities for implementing preventive health measures. Higher education institutions, typically viewed as upholders of intellectual growth, harbor high levels of chronic stress, especially among faculty members.^5–7 This perspective shifts the narrative surrounding faculty stress from a personal inadequacy to a widespread occupational health issue with noteworthy public health ramifications. We argue that the persistent neglect of faculty wellbeing contributes to a higher population risk for NCDs and diminished institutional vitality. Therefore, we advocate for hydrotherapy not merely as a wellness activity but as a scientifically grounded, non-pharmacological, and scalable upstream intervention to mitigate the physiological consequences of academic stress.

Main body

Academic stress is increasingly acknowledged as a widespread yet under-addressed health issue within higher education institutions worldwide.⁸ Faculty members endure chronic psychological stress due to overwhelming workloads, elevated performance expectations, administrative responsibilities, and strict deadlines.^9,10 Unlike students, whose mental health often receives institutional attention, the wellbeing of faculty is frequently neglected, despite research indicating that prolonged stress among academics can lead to fatigue, insomnia, anxiety, cardiovascular issues, and reduced cognitive abilities, which may either be precursors or direct manifestations of NCDs.¹¹ According to Cordaro, Howard¹¹ and Roos and Borkoski,¹² these consequences not only harm individual well-being but also affect academic productivity and the quality of education provided. A growing body of evidence confirms that psychological stress in academia is not merely an occupational inconvenience but a public health concern with direct links to the rising burden of NCDs.¹³ Studies reveal that over 70% of faculty experience high levels of job stress, with burnout rates continuing to rise globally.^7,13,14 The cumulative nature of stress, often unmitigated by institutional support, necessitates the exploration of innovative, low-risk strategies that are accessible, evidence-based, and sustainable.¹⁵ It is time for the higher education sector to seriously consider the therapeutic potential of non-pharmacological interventions.¹⁵ Among these, hydrotherapy is notable for its physiological and psychophysiological benefits.¹⁶

Although “treatment-resistant stress” is not a clinical term, it effectively captures the situation which many faculty members encounter when typical stress-relief methods, such as short vacations, mindfulness applications, or workplace workshops, fail to yield lasting benefits.¹⁷ Like Treatment-Resistant Depression (TRD), which describes depression unresponsive to standard treatments, a comparable trend is observed in persistent academic stress.¹⁸ Juruena, Bourne¹⁹ state that continuous exposure to work-related stressors results in maladaptive changes in the hypothalamic-pituitary-adrenal (HPA) axis, the central system responsible for managing stress, and a key mechanism in the development of many NCDs which delays the ability to recover from stress.¹⁹ In this scenario, non-invasive treatments such as hydrotherapy warrant consideration.^19,20 Unlike temporary coping strategies, hydrotherapy can potentially reset physiological responses and restore balance by affecting the autonomic nervous system.²¹ Given the limited success of generic wellness programs, it is crucial to assess hydrotherapy as a personalized, supplementary method for those dealing with ongoing academic stress

Gaining insight into the molecular and physiological processes that drive chronic stress enhances the ability to identify effective interventions for managing this condition. Academic stress leads to an increase in cortisol secretion,²² the primary hormone associated with stress.²³ Persistently high cortisol levels are linked to immune system suppression, poor sleep quality, and memory issues, which are frequently observed in faculty members experiencing prolonged stress and are risk factors for NCDs.²² Hydrotherapy stimulates the parasympathetic nervous system, triggering the body’s relaxation response and promoting digestive processes, thereby modulating the stress reaction.^22,23 For instance, immersing in cold water stimulates the vagus nerve and decreases inflammatory markers like interleukin-6 and C-reactive protein.²² Warm water therapies improve circulation, reduce muscle tension, and increase serotonin levels, indicating that hydrotherapy functions in addition to being a relaxation technique, as a biologically active intervention capable of counteracting stress-induced physiological changes.¹⁶ By influencing both the nervous and endocrine systems, hydrotherapy presents a holistic approach to managing stress. The thematic issue on depression emphasizes the importance of interventions grounded in pathophysiological understanding.¹⁸

Although hydrotherapy is commonly used in rehabilitation and spa settings, its application in academic settings is unconfirmed.²⁴ Yet, preliminary studies show promising results.²⁵ For example, a small clinical trial in Japan found that university staff who took daily warm footbaths experienced reduced anxiety and better sleep within two weeks.²⁶ Another study revealed that soaking in mineral baths improved stress biomarkers in professionals who faced high job stress.²⁷ Additionally, A comparison between South African and Hong Kong professionals showed that South Africans reported higher job demands and control but less job support and stress than their Hong Kong counterparts.²⁸ However, these individual findings need to be integrated into a cohesive framework.²⁵ A dedicated exploration of hydrotherapy’s potential in managing academic stress could bridge an important gap in academic wellness research. This interdisciplinary focus would bring together insights from psychologists, occupational health specialists, and educational leaders, addressing a significant oversight into current stress management initiatives within academia.

Typical pharmacological strategies for addressing stress-related symptoms include the use of anxiolytics and sleep aids. However, these downstream treatments are not ideal for faculty members due to the risk of dependency, adverse side effects, and their limited overall effectiveness.^29,30 Furthermore, wellness programs at educational institutions often rely on superficial engagement techniques, such as motivational talks or self-help webinars, which fail to adequately address the core physiological effects of stress.³¹ Conversely, hydrotherapy presents a non-addictive, affordable, and scientifically validated upstream option.²⁰ Its physiological benefits are parallel to those of mindfulness meditation and aerobic exercise, both of which receive support from health authorities.¹⁶ With minimal investment, such as installing hydrotherapy footbaths, contrast showers in faculty gyms, or forming partnerships for access to nearby hydro-wellness centers, it can be seamlessly integrated into campus settings.³² Essentially, while pharmacological methods focus on symptom suppression, hydrotherapy seeks to restore systemic equilibrium.³³ Therefore, it should be incorporated not as a replacement but as an enhancement to current wellness strategies.

New therapeutic models highlight the importance of addressing mental health and stress through a range of strategies.²⁵ Institutions can initiate hydrotherapy programs through interdisciplinary research efforts.³⁴ Faculty members might participate in a 6–12-week program³⁵ that includes regular hydrotherapy sessions (such as cold plunges, hot baths, or hydro-massage), with both psychological and physiological outcomes, including biomarkers for NCDs risk, and monitored over time. Interdisciplinary collaborations involving physiology, psychology, and occupational health departments can enhance the methodological rigor of research.²⁹ Furthermore, institutional policies that incorporate wellness interventions into faculty workload frameworks can strengthen organizational support.³⁶

Conclusion

The higher education sector faces a critical decision regarding faculty stress, which has significant public health implications. The current approach relies on reactive, downstream measures that fail to address the fundamental causes of burnout and its associated risks NCDs. An alternative strategy involves adopting a proactive, public health-oriented paradigm that emphasizes preventive care. Hydrotherapy, with its deep historical roots and modern scientific validation, is more than a supplementary wellness benefit³⁴; it is an evidence-based, upstream intervention that targets the physiological mechanisms of stress, thereby mitigating the risk factors for stress-related NCDs. This shift in intervention patterns represents a key change from treating faculty as disposable assets to recognizing them as the enduring foundation of academic pursuits. The focus extends beyond burnout prevention, emphasizing long-term investment in human capital crucial for institutional excellence and community well-being. Higher education institutions face a clear imperative: to fulfil their 21st-century mission, they must prioritize community health stewardship, transforming campuses from stress-inducing environments into exemplars of sustainable well-being.³⁷