Abstract
Background: University students are exposed to academic, social, financial, and personal stressors that may adversely affect psychological well-being and self-evaluation, with female students potentially experiencing additional contextual pressures. Objective: To determine the association between perceived stress and self-esteem among female university students in Peshawar, Pakistan. Methods: This analytical cross-sectional study included 400 female students recruited from selected public and private universities in Peshawar between January and March 2025. Perceived stress was assessed using the 10-item Perceived Stress Scale, and self-esteem using the 10-item Rosenberg Self-Esteem Scale. Descriptive statistics summarized score distributions, while Pearson’s chi-square test examined the association between categorized perceived stress and self-esteem; Cramér’s V quantified association magnitude. Results: The mean perceived-stress score was 17.05 ± 6.25; 59.0% of students had low, 28.0% moderate, and 13.0% high perceived stress. Mean self-esteem was 16.76 ± 6.36; 41.3% had low, 40.3% normal, and 18.5% high self-esteem. Low self-esteem occurred in 22.9% of students with low stress, 68.8% with moderate stress, and 65.4% with high stress. Perceived-stress category was significantly associated with self-esteem category, χ²(4)=88.40, p<0.001, with a moderate effect size (Cramér’s V=0.332). Conclusion: Perceived stress and self-esteem were significantly associated among female university students. Students with moderate or high perceived stress showed a substantially greater prevalence of low self-esteem than those with low stress. These findings support university-based psychological support, stress-management, and student well-being initiatives and future preventive planning locally while longitudinal research is needed to clarify temporal relationships