Symptoms of anxiety and depression in Estonian medical students with sleep problems

Poor Health Behaviour in Medical Students at a South African University: A Cross-Sectional Survey Study

BACKGROUND

Personal health behaviours and lifestyle habits of health professionals influence their counselling practices related to non-communicable diseases (NCDs). There are limited data on the prevalence of unhealthy lifestyle habits among medical students and the impact of acquired health knowledge throughout the curriculum. The aim of this study was to determine and compare the prevalence of modifiable behavioural NCD risk factors of medical students in different academic years at a South African tertiary institution.

METHODS

A cross-sectional observational study of 532 consenting medical students was conducted. Participants completed five online questionnaires regarding lifestyle behaviours (physical activity, dietary habits, smoking, alcohol consumption and sleep).

RESULTS

Lifestyle-related risk factors with the highest prevalence were poor sleep quality (66.0%), low levels of habitual physical activity (55.8%) and low-to-moderate diet quality (54.5%). There were no differences between academic years for all risk factors measured. Over 60% of the cohort had two or more NCD risk factors and this prevalence did not differ across the degree program with the acquisition of more health knowledge.

CONCLUSION

Medical students have a high prevalence of poor sleep quality, low levels of physical activity and low-to-moderate diet quality, which does not appear to change over the course of their academic career. Sleep hygiene, regular physical activity and healthy nutrition should be targeted in intervention programmes and be more prevalent in the medical curriculum.

Moderated moderation modelling of subjective social status, pocket money and depressive symptoms of university students in Ghana

Introduction

Although the relationship between subjective social status and depression in university students has been well-established, this association could be seen as a spurious one. Previous studies have shown that key variables like financial resources and age could play key roles in explaining the variances in social status and mental health outcomes. In this research, we assessed the complex interrelationships between subjective social status, financial resources at their disposal and depressive symptoms among university students within their young and middle adulthood stages.

Methods

A cross-sectional survey was conducted in a university in Ghana to sample 1134 university students through accidental sampling. The McArthur Scale and WHO-5 Well-being measure were used for the data collection.

Results

The results revealed that higher levels of subjective social status were associated with lower levels of depression. It was further found that the interaction between students' pocket money and age played unique roles in the relationship between subjective social status and depression.

Conclusion

The study findings call on stakeholders in education to explore funding opportunities and to examine ways of empowering parents (financially) to adequately support the students. Health educationists and promoters, including psychologists, school counsellors and parents could compliment these efforts by helping to train and empower students through self-regulation or management skills to help improve their well-being. Continuous efforts are required to improve the financial status and mental health of students.

Anxiety and depression during post covid-19 lockdown period among medical students, and it's relation with stress and smartphone addiction in India

OBJECTIVES

Medical profession, a competitive and ever-updating field which requires great commitment, imposes a stressful environment for students. Our study aimed to find the prevalence and factors associated with psychological illness.

METHODS

A cross-sectional analytical study was done among medical students in Puducherry. A stratified random sampling strategy was incorporated to achieve a calculated sample size of 384. The presence of anxiety and depression, perceived stress and addiction to the phone were assessed using the Hospital Anxiety and Depression Scale, Perceived Stress Scale, and Smartphone Addiction Scale - short version. Prevalence of anxiety and depression was summarized as a proportion with a 95 % confidence interval (CI). The prevalence ratio (PR) for the factors associated was estimated using log-binomial regression.

RESULTS

With the response from 383 students, the prevalence of anxiety and depression was 39.4 % (95 %CI: 34.5-44.3 %) and 26.6 % (22.2-31.1 %). Perceived stress was moderate in 68.2 % and high in 14 % of students. Higher age (aPR=1.49), female gender (aPR=1.22), tobacco or alcohol use (aPR=1.24), smartphone addiction (aPR=2.09) and high stress (aPR=1.93) were the predictors of anxiety among medical students in our study. Use of tobacco or alcohol (aPR=2.07), smartphone addiction (aPR=1.96) and high stress (aPR=1.72) were the predictors of depression.

CONCLUSIONS

Anxiety was more prevalent than depression among the medical students. Use of tobacco or alcohol, smartphone addiction and stress increase the risk of psychological morbidity. Medical training should have a module on coping mechanisms to overcome psychological illness and have better mental well-being.

Sleep Patterns and Associated Insomnia in Junior and Senior Medical Students: A Questionnaire-Based Cross-Sectional Study

Introduction  Appropriate quality and quantity of sleep are critical for good mental health, optimal body functioning, memory consolidation, and other cognitive processes. Objectives  To evaluate the sleeping patterns of medical students in Saudi Arabia and their relationships with psychological distress. Methods  This was a cross-sectional, self-administered, questionnaire-based study. The study included medical students from a university in Jeddah, Saudi Arabia. The Pittsburgh Sleep Quality Index (PSQI) and the Athens Insomnia Scale (AIS) were used to evaluate the prevalence and burden of inadequate sleep quality and insomnia in the participants. Results  The majority of the participants was women (76.6%). Furthermore, most participants (96.2%) were aged between 18 and 24 years old, while 54.4% of the participants were in their senior year. According to the AIS scores (mean: 15.85 ± 4.52), 98.7% of the participants exhibited insomnia symptoms. The PSQI scores (mean: 9.53 ± 5.67) revealed that 70.5% of the participants had poor sleep quality. Students in their fundamental and junior years had significantly higher percentages of insomnia symptoms and poor sleep quality compared with students in their senior years. Conclusion  The prevalence of insomnia and poor sleep quality is high among medical students. Therefore, appropriate strategies for early detection and intervention are warranted.

Sleep quality and associated factors among university students in Africa: a systematic review and meta-analysis study

Background

Poor sleep quality significantly impacts academic performance in university students. However, inconsistent and inconclusive results were found in a study on sleep among university students in several African nations. Therefore, this study aimed to estimate the pooled prevalence and associated factors of poor sleep quality among university students in Africa.

Methods

The databases PubMed, Scopus, Cochrane Library, Science Direct, African Journal Online, and Google Scholar were searched to identify articles. A total of 35 primary articles from 11 African countries were assessed and included in this systematic review and meta-analysis. Data were extracted by using a Microsoft Excel spreadsheet and exported to STATA version 14 for analysis. The I2 test was used to assess the statistical heterogeneity. A random effect meta-analysis model was employed with 95% confidence intervals. Funnel plots analysis and Egger regression tests were used to check the presence of publication bias. A subgroup analysis and a sensitivity analysis were done.

Results

A total of 16,275 study participants from 35 studies were included in this meta-analysis and systematic review. The overall pooled prevalence of poor sleep quality among university students in Africa was 63.31% (95% CI: 56.91-65.71) I2 = 97.2. The subgroup analysis shows that the combined prevalence of poor sleep quality in East, North, West, and South Africa were 61.31 (95% CI: 56.91-65.71), 62.23 (95% CI: 54.07-70.39), 54.43 (95% CI: 47.39-61.48), and 69.59 (95% CI: 50.39-88.80) respectively. Being stressed (AOR= 2.39; 95% CI: 1.63 to 3.51), second academic year (AOR= 3.10; 95% CI: 2.30 to 4.19), use of the electronic device at bedtime (AOR= 3.97 95% CI: 2.38 to 6.61)) and having a comorbid chronic illness (AOR = 2.71; 95% CI: 1.08, 6.82) were factors significantly associated with poor sleep quality.

Conclusion

This study shows that there is a high prevalence of poor sleep quality among university students in Africa. Being stressed, in the second year, using electronic devices at bedtime, and having chronic illness were factors associated with poor sleep quality. Therefore, addressing contributing factors and implementing routine screenings are essential to reduce the burden of poor sleep quality.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023493140.

Quality of life and quality of education among physiotherapy students in Europe

Background

The study of physiotherapy is challenging and can affect the students' well-being and quality of life. The aim of this study was to describe and compare factors that could affect well-being among students across Europe.

Methods

In this descriptive cross-sectional study using an online questionnaire survey, students of bachelor's physiotherapy programs from 23 European faculties, from 8 countries, were interviewed on mental health and stress burden, sleep quality, dietary habits, and physical activity.

Results

Although 75% of students rated their quality of life positively and 47% were satisfied with their mental health, 65% showed higher levels of stress and 51% described impaired sleep quality. The minimum physical activity of 150 min weekly was described by 79% of students, within which 67% engaged in strengthening twice a week. Students with a higher stress load/worse psychological health also showed worse sleep quality and lower amount of physical activity, women were significantly worse off. In terms of physical activity and sleep quality, students from Finland and Kosovo achieved the best results, while students from Italy, Greece, and Portugal achieved the worst. Students from Italy indicated the greatest dissatisfaction with the organisation of the study system and communication with teachers, while in Kosovo students rated the communication and study organisation the highest. All students had a problem with adhering to nutritional habits. Students from Italy and Spain, with the lowest body mass indexes and weight averages, were closest to the nutrition recommendations.

Conclusion

We demonstrated that physiotherapy students are burdened with stress, suffer from sleep disorders, and do not follow the recommendations regarding nutrition nor physical activity. There are significant differences between universities and countries in some aspects.

Do anxiety sensitivity cognitive concerns and/or depression symptoms independently explain sleep disturbances in a high anxiety sensitive treatment-seeking sample?

Cognitive models of insomnia posit a role for anxiety sensitivity (AS) in sleep difficulties. While sleep disturbances have been linked to AS, particularly AS cognitive concerns, prior studies have rarely accounted for the correlated construct of depression. We used pre-treatment intervention trial data from 128 high AS, treatment-seeking adults with a DSM-5 diagnosis of an anxiety, depressive, or posttraumatic stress disorder to determine whether AS cognitive concerns and/or depression are independently associated with sleep impairment domains (e.g., sleep quality, latency, daytime dysfunction). Participants provided data on AS, depressive symptoms, and sleep impairments. AS cognitive concerns (but not other AS dimensions) were correlated with four of five sleep impairment domains; depression was correlated with all five. Multiple regressions revealed four of five sleep impairment domains were predicted by depression with no independent contribution of AS cognitive concerns. In contrast, AS cognitive concerns and depression were independently associated with daytime dysfunction. Results suggest previous findings linking AS cognitive concerns to sleep impairments may have been largely secondary to the overlap of cognitive concerns with depression. Findings demonstrate the importance of incorporating depression into the cognitive model of insomnia. Both AS cognitive concerns and depression may be useful targets for reducing daytime dysfunction.

A systematic review and meta-analysis of studies exploring prevalence of non-specific anxiety in undergraduate university students

BACKGROUND

Anxiety is a common mental health problem in the general population, and is associated with functional impairment and negative impacts upon quality of life. There has been increased concern about university students' mental health in recent years, with a wide range of non-specific anxiety rates reported worldwide in undergraduate university students. We aimed to explore prevalence of non-specific anxiety in undergraduate university student populations.

METHODS

Four databases were searched to identify studies published between 1980 and 2020 which investigated prevalence of non-specific anxiety in undergraduate university students. Each study's quality was appraised using a checklist. Sub-analyses were undertaken reflecting outcome measure utilized, course of study, location of study, and whether study was before or during the COVID-19 pandemic.

RESULTS

A total of 89 studies - representing approx. 130,090 students-met inclusion criteria. Eighty-three were included in meta-analysis, calculating a weighted mean prevalence of 39.65% (95% CI: 35.72%-43.58%) for non-specific anxiety. Prevalence from diagnostic interview studies ranged from 0.3%-20.8% 12-month prevalence. Prevalence varied by outcome measure used to assess non-specific anxiety, the type of course studied by sample, and by study location. In half the studies, being female was associated with being more likely to have higher non-specific anxiety scores and/or screening above thresholds. Few of the included studies met all quality appraisal criteria.

CONCLUSION

The results suggest that approximately a third of undergraduate students are experiencing elevated levels of non-specific anxiety. Results from sub-analyses have identified some methodological issues that need consideration in appraising prevalence in this population.

Prevalence of mental health symptoms in children and adolescents during the COVID-19 pandemic: A meta-analysis

The COVID-19 pandemic and its accompanying infection control measures introduced sudden and significant disruptions to the lives of children and adolescents around the world. Given the potential for negative impacts on the mental health of youths as a result of these changes, we conducted a systematic review and meta-analysis to examine the prevalence of depressive symptoms, anxiety symptoms, and sleep disturbances in children and adolescents during the pandemic. We searched major literature databases for relevant cross-sectional or longitudinal studies that included primary and secondary school students or children and adolescents ≤18 years of age. Prevalence values were extracted, logit-transformed, and pooled. Based on 191 included studies with 1,389,447 children and adolescents, we found the pooled prevalence of depressive symptoms, anxiety symptoms, and sleep disturbances to be 31%, 31%, and 42%, respectively. Age, grade levels, education levels, gender, geographical regions, and electronics use were correlated with the prevalence of mental health symptoms. The prevalence of mental health symptoms also increased with time, although signs of recovery and stabilization were also observed. Overall, the results from this review demonstrate the need for increased mental health research, monitoring, and intervention for children and adolescents during the current and future pandemics.

The Mediating Role of Sleep Quality in the Relationship between Negative Emotional States and Health-Related Quality of Life among Italian Medical Students

Sleep problems have been shown to be related to adverse outcomes concerning physical and mental well-being. Furthermore, mental health issues and sleep problems were reported to be highly prevalent among medical students and physicians, and were found to be associated with worse academic and clinical performance in these populations. This study aims to investigate the prevalence of poor sleep to examine the associations between sleep quality and health-related quality of life (HRQoL), and to explore the possible mediating role of sleep in the relationship between psychological distress and HRQoL itself in a sample of medical and dental students attending a large Italian university. Participants (n = 407, mean age: 24.2 ± 2.4) answered an online questionnaire comprising the 21-item Depression Anxiety Stress Scale, the Pittsburgh Sleep Quality Index, and the Short Form-12 health survey. Up to 62% of the participants reported poor sleep quality. Controlling for psychological distress, sleep quality components were found to be associated with physical and mental HRQoL. Mediation analysis showed that overall sleep quality mediated all the single associations between anxiety, depression, and stress and HRQoL. These preliminary findings suggest that the quality of sleep is important for the well-being of medical students and that targeting sleep issues in this academic population may be beneficial.

Sleep Management Strategies Among Medical Students At the University of Otago

OBJECTIVES

We aim to investigate factors which might affect the sleep of medical students, and how they currently manage their sleep.

METHODS

An online survey was sent to medical students at the University of Otago.

RESULTS

After adjusting for gender, ethnicity and age, depressive symptoms (Mild: odds ratio (OR) = 6.3; Moderate: OR = 18.1; Severe: OR = 15.6), and sleep hygiene (OR = 1.07) were associated with insomnia symptoms. Commonly endorsed strategies for sleep management by students were undertaking regular exercise (80.1%), having consistent sleep-wake time (71.3%), and limiting caffeine intake (70.3%). Few were willing to see a clinician (23.4%) or take medication (22.3%). Participants with insomnia symptoms were more likely to prefer limiting their alcohol intake (OR = 1.8), limiting daytime naps (OR = 1.5), seeing clinicians (OR = 1.9), and taking sleep medication (OR = 4.0), but less likely to prefer avoiding intense work (OR = .71) or minimizing using electronics (OR = .60) close to bedtime than those without insomnia symptoms. High sleep self-efficacy was associated with lower odds for having insomnia symptoms (OR = .74 (.70, .77)).

CONCLUSIONS

Increased awareness and greater resources are needed to support the sleep health of medical students.

Prevalence and risk factors of depressive symptoms among 140,259 college students during the COVID-19 epidemic normalization in China: A cross-sectional survey

Objective

College students are one of the most vulnerable populations to the COVID-19 pandemic's mental health effects. During the coronavirus disease 2019 (COVID-19) outbreak, we wanted to see how common depressive symptoms were among college students and what factors contributed to that.

Methods

Between 21 and 27 May 2021, 140,259 college students from three cities in Henan Province, China, were involved. The Patient Health Questionnaire-9 was used to determine depressive symptoms (PHQ-9). Multiple logistic regression analysis was used to calculate odds ratios (ORs) and 95% CIs for potential depressive symptom factors.

Results

Mild depressive symptoms and above are present in 21.12% of college students. Women had a higher prevalence of mild depressive symptoms than men (61.38 vs. 59.75%), and depressive symptoms were most prevalent among rural students and least prevalent among city students (21.44 vs. 20.29%). Participants with depressive symptoms are also more likely to have a poor-behavioral status. From none-to-severe depressive symptoms, 78.88, 15.78, 2.80, 1.67, and 0.88% had them. Gender, residential location, and behavioral status were found to be associated with depressive symptoms after adjusting for potential confounders.

Conclusion

This cross-sectional study identified the factors that influence the prevalence of depression in college students. It found that the government should pay more attention to mental health issues affecting college students in combating the COVID-19 epidemic normalization.

Behavioral and psychosocial predictors of depression in Bangladeshi medical students: a cross-sectional study

BACKGROUND

Depression, stress, and anxiety were found in a large number of medical undergraduate students, indicating a neglected aspect of their psychology that required immediate attention. The goal of this study was to find out the prevalence of depression among medical students, as well as potential psychosocial and behavioral predictors for depression.

METHODS

This cross-sectional study was conducted from July to November 2021 among 840 randomly selected medical students from four medical colleges using stratified random sampling. Data were collected using a semi-structured, self-administered questionnaire and were analyzed through the SPSS v.23 software. Multiple regression was performed to assess the effect of several behavioral and psychosocial factors on depression.

RESULTS

Among the 840 study participants, 55.7% (n= 468) were female and 44.3% (n= 372) were male. According to the data, the prevalence of depression, anxiety, perceived stress among medical students was found to be 28.8%, 65% and 85% respectively. A strong link was found between depression and anxiety, stress, poor sleep quality, poor academic performance, and a negative social and romantic relationship status.

CONCLUSIONS

A significant number of medical students are depressed. In order to prevent and treat depression, medical students should be screened for depression and its associated factors.

Hierarchical Structure of Depression Knowledge Network and Co-word Analysis of Focus Areas

Contemporarily, depression has become a common psychiatric disorder that influences people's life quality and mental state. This study presents a systematic review analysis of depression based on a hierarchical structure approach. This research provides a rich theoretical foundation for understanding the hot spots, evolutionary trends, and future related research directions and offers further guidance for practice. This investigation contributes to knowledge by combining robust methodological software for analysis, including Citespace, Ucinet, and Pajek. This paper employed the bibliometric methodology to analyze 5,000 research articles concerning depression. This current research also employed the BibExcel software to bibliometrically measure the keywords of the selected articles and further conducted a co-word matrix analysis. Additionally, Pajek software was used to conduct a co-word network analysis to obtain a co-word network diagram of depression. Further, Ucinet software was utilized to calculate K-core values, degree centrality, and mediated centrality to better present the research hotspots, sort out the current status and reveal the research characteristics in the field of depression with valuable information and support for subsequent research. This research indicates that major depressive disorder, anxiety, and mental health had a high occurrence among adolescents and the aged. This present study provides policy recommendations for the government, non-governmental organizations and other philanthropic agencies to help furnish resources for treating and controlling depression orders.

Regulatory emotional self-efficacy and psychological distress among medical students: multiple mediating roles of interpersonal adaptation and self-acceptance

BACKGROUND

Psychological distress (depression, anxiety and stress) is more common among medical students than in the general population, and is an important cause of insomnia, internet addiction, substance abuse, decreased academic performance and increased suicidality in medical students.

METHODS

To examine the mechanism by which regulatory emotional self-efficacy affects medical students' psychological distress, a questionnaire of 539 medical students using an interpersonal adaptability scale, regulatory emotional self-efficacy scale, self-acceptance scale and depression-anxiety-stress scale was conducted.

RESULTS

① Regulatory emotional self-efficacy, interpersonal adaptability and self-acceptance are positively correlated, but they are negatively correlated with psychological distress. ② The mediation model shows that interpersonal adaptation and self-acceptance are the mediation variables of the effect of regulatory emotional self-efficacy on psychological distress, and the total mediation effect value is -0.37, accounting for 86.05% of the total effect (-0.43). Specifically, the effect involves three paths: first, regulatory emotional self-efficacy indirectly affects psychological distress through interpersonal adaptation (effect value-0.24); second, regulatory emotional self-efficacy indirectly affects psychological distress through interpersonal adaptation and self-acceptance (effect value-0.08); and third, regulatory emotional self-efficacy indirectly affects psychological distress through self-acceptance (effect value -0.05).

CONCLUSIONS

Interpersonal adaptation and self-acceptance have a significant mediating effect between regulatory emotional self-efficacy and psychological distress, and the chain mediating effect of interpersonal adaptation and self-acceptance is also significant.

The effect of auditory stimulation using delta binaural beat for a better sleep and post-sleep mood: A pilot study

Background

Although previous evidence confirms the effects of sleep deprivation on mental health and wellbeing, due to the interaction effects of sleep and mood on each other, the influence of sleep improvement has received less attention.

Objective

This study aimed to find whether binaural beat technology can enhance sleep quality and thus post-sleep mood.

Methods

Twenty healthy students participated in this pilot study. All subjects were investigated for two weeks (a baseline week and an experimental week). In the first week, there was no intervention, but in the second week, all subjects were exposed to a 90 min binaural beat in the delta frequency range. The individuals’ sleep was monitored for two weeks using a sleep diary form, and a Profile of Mood State questionnaire was employed to assess their mood at the end of the first and second weeks.

Results

Auditory stimulation with delta binaural beat enhanced sleep parameters such as sleep failure, the number of awakenings, real duration of sleep, sleep quality, and feeling following the waking of the individuals. Finally, students’ moods improved by reducing anxiety and anger, but other mood parameters did not indicate a significant difference.

Conclusion

The findings of this study confirmed that auditory stimulation with a delta binaural beat seems to be a low-cost and alternative method for medicine and other treatment methods with side effects.

Application

This study demonstrates the use of technology with a neuroergonomics approach to improve sleep and mood disorders.

Validity and reliability of the Generalized Anxiety Disorder-7 (GAD-7) among university students of Bangladesh

This study investigated the reliability and factorial validity of General Anxiety Disorder-7 (GAD-7) in the context of university students in Bangladesh. The research aimed to assess whether the original one-dimensional model or a model containing both somatic and cognitive-emotional factors is appropriate. A repeated cross-sectional survey design based on convenience sampling was used to collect data from 677 university students. The factor structure of the GAD-7 was assessed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and its convergent validity was determined by investigating its correlations with Patient Health Questionnaire-9 (PHQ-9) and Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS). Results showed excellent reliability of GAD-7 as measured by Cronbach's α. CFA suggested that a modified one-factor model is appropriate for the sample. This model provided high values of comparative fit index (CFI), goodness of fit index (GFI), and Tucker Lewis Index (TLI), low value of standardized root mean square residual (SRMR) and a non-significant root mean square error of approximation (RMSEA). Correlation between GAD-7 and PHQ-9 was 0.751 and 0.934 between GAD-7 and PHQ-ADS. Overall, the study provided support for modified unidimensional structure for GAD-7 and showed high internal consistency along with good convergent validity.

Bedtime Procrastination Partially Mediates the Impact of Personality Characteristics on Daytime Fatigue Resulting From Sleep Deficiency

Getting good and sufficiently long sleep at night is important for health, effective functioning, and well-being. However, insufficient or delayed sleep are important and growing social problems that can lead to fatigue, poor performance, deterioration of well-being, circadian rhythm disturbances, and health problems. One of the significant determinants of sleep deprivation is bedtime procrastination, which is understood as the individual tendency to postpone going to bed in the absence of any external circumstances that force one to do so. Nowadays, this phenomenon is widespread in various social groups, especially among students. Despite the high prevalence of bedtime procrastination, its relationship with personality characteristics has not yet been thoroughly studied. The presented research aimed to identify the possible impact of the basic dispositional personality traits and trait-like personality characteristics on bedtime procrastination and daytime fatigue resulting from a deficiency of sleep at night. The responses from 399 university students who voluntarily took part in an internet survey were analyzed. The severity of bedtime procrastination was assessed using the Bedtime Procrastination Scale. Five basic dispositional personality traits (extraversion, neuroticism, conscientiousness, agreeableness, and openness/intellect) and their components (aspects) were measured using the International Personality Item Pool - Big Five Aspects Scale. Self-esteem and general self-efficacy were assessed using the Rosenberg Self-Esteem Scale and the General Self-Efficacy Scale. Perceived locus of control was measured using the Delta Questionnaire. The direct and indirect relationships between personality variables and daytime fatigue were investigated using linear regression models with bedtime procrastination as a mediator variable. Industriousness and orderliness, both of which are aspects of conscientiousness, were found to be indirectly associated with daytime fatigue as a consequence of their impact on bedtime procrastination. Volatility and withdrawal, both of which are aspects of neuroticism, were found to be directly related to daytime fatigue without the intermediary impact of bedtime procrastination. Self-esteem was shown to be associated with experiencing daytime fatigue, both directly and indirectly through bedtime procrastination. General self-efficacy and external locus of control were associated with daytime fatigue only directly, without the intermediary role of bedtime procrastination. The results of our research indicate that personality factors may not only play an important role in shaping sleep-related health behaviors, but they also affect well-being during the day.

Prevalence and associated factors of depression among Bangladeshi university students: A cross-sectional study

The study aimed to assess the prevalence of depression and its associated factors among university students in Bangladesh. Participants: A total of 403 undergraduate students from Patuakhali Science and Technology University, and Barisal University participated in the study. Method: A cross-sectional study was conducted using Beck's Depression Inventory (BDI). Result: The prevalence of depression (BDI ≥ 14) was 47.14%. Depression was 3.4 times (95% CI: 1.6-7.1), 3.8 times (95% CI: 1.7-8.6), and 3.9 times (95% CI: 1.5-8.9) higher among 2nd, 3rd, and 4th-year students, respectively than 1st-year students. Students with a history of stressful life events (aOR = 2.7, 95% CI: 1.7-4.4), suicidal attempts (aOR = 3.0, 95% CI: 1.2-7.9), and who received inadequate monthly allowance from their family (aOR = 0.53 95% CI: 0.3-0.9) were more likely to develop depressive symptoms. Conclusion: This study reports a high level of depression among university students which needs further discussion, exploration, and calls for designing appropriate interventions.

Stigmatizing Attitudes Toward Depression Among Male and Female, Medical and Non-medical Major College Students

Background: Stigma is often reported to be a barrier to the treatment and rehabilitation of depression. However, little is known about stigma toward people with depression among college students in China.

Methods: Using a questionnaire with a case vignette describing depression, a total of 1,056 students from nine colleges/universities in Hunan Province of China were included in this study. The questionnaire addressed the attitudes toward depression and the desire for keeping a distance from depressed individuals. The current study explored the stigma attitudes of college students toward people with depression and the desire for social distancing, as well as the gender (male and female) and major (medical and non-medical) differences.

Results: Over half of the respondents agreed that people described in the vignette were “dangerous” (60.7%) and “could snap out of the problem” (58.7%). Compared with female students, males were more likely to agree that “If I had this problem, I would not tell anyone” (7.0 vs. 13.2%, p = 0.001); compared with non-medical students, medical students were more likely to agree that “The problem is a sign of personal weakness” (38.0 vs. 50.0%, p < 0.001). A lot of respondents would be unwilling to “marry into the family of people with depression” (71.1%) or “work closely with them” (45.1%). Compared with male students, females were more unwilling to “work closely with them” (40.3 vs. 47.5%, p = 0.026).

Conclusion: This study found that a high proportion of Chinese college students showed stigma toward and desire for social distancing from people with depression, male students and medical major students showed higher stigma in some subscale items toward people with depression. The present results suggest that more anti-stigma interventions should be applied for Chinese college students to help prevent or reduce stigma attitudes toward people with depression.

Prevalence of Depression in Iranian College Students: A Systematic Review and Meta-analysis

Context: Depression is a common problem in students. The current study aimed to determine the prevalence of depression in Iranian college students. Evidence Acquisition: The study was conducted using preferred reporting items for systematic reviews and meta-analysis (PRISMA). We searched both international (i.e. PubMed, Scopus, Science Direct, Web of Science, Embase, and Google Scholar) and national (i.e. SID, Magiran, Iranmedex, and IranDoc) databases from 1991 to June 2019 to identify relevant studies. Cochran’s Q test, I2 index, and τ2 index were used to assess the heterogeneity. A random-effects model was employed to combine the results using comparative meta-analysis software version 2.2. Results: Overall, 89 studies dealing with a total of 33,564 Iranian students were included. The prevalence of depression was estimated at 48.0% [95% confidence interval (CI): 43.6 - 52.5%]. The prevalence of depression was 51.3% (95% CI: 41.1 - 61.4%) and 48.9% (95% CI: 41.0 - 54.8%) in males and females, respectively. The prevalence of mild, moderate, and severe depression was estimated at 26.1% (95% CI: 23.8 - 28.6%), 15.5% (95% CI: 13.1 - 18.3%), and 6.4% (95% CI: 5.1 - 8%), respectively. The Beck-I Questionnaire and the GHQ-28 Questionnaire indicated the highest and the lowest prevalence of depression [68.4% (95% CI: 38.8 - 88.1%) vs. 39.2% (95% CI: 24.6 - 56.1%)], respectively. It was proved that the prevalence of depression among Iranian college students has significantly increased during the study period (P < 0.001). Interest in the field was significantly correlated with depression (P < 0.001). Conclusions: Given the high prevalence of depression among Iranian college students, prevention and treatment programs are strongly recommended.

Prevalence of sleep disorders among medical students of Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia

Background: Sleep disorders are a common medical problem and can affect health and quality of life. There are multiple types of sleep disorders such as obstructive sleep apnea, insomnia, narcolepsy, restless legs/periodic limb movement disorder, circadian rhythm disorders, sleepwalking and nightmares. Medical students appear to be more liable to develop sleep disorders due to their high academic load. Design and Methods: This study seeks to estimate the prevalence of sleep disorders among Umm Al-Qura University medical students and associated risk factors. This cross-sectional study was conducted at the Faculty of Medicine of Umm Al-Qura University in Makkah, Saudi Arabia. A self administrated questionnaire was used to collect the data including socio-demographic data and sleep-50 questionnaire. Four hundred and thirty-eight (438) medical students from the second year to the sixth year were recruited to the study Results: Three hundred and twenty-three participants (73.8%) complained of at least one sleep disorder. The most prevalent sleep disorder among students was narcolepsy at 226 (51.6%). Female students, second year students and students spending significant time watching television or on smartphones were more affected than others with p values of 0.001, 0.005, and 0.004 respectively. Conclusions: Sleep disorders are common among medical students. It is essential to detect and address them before their condition deteriorates.

Effectiveness of Music Interventions to Reduce Test Anxiety in Pharmacy Students

BACKGROUND

The main objective of this pilot study was to evaluate the impact of a classroom activity involving music on anxiety associated with preparing for and taking an assessment.

METHODS

Two hundred and two (202) pharmacy students were randomly assigned to one of two conditions of the experimental study: active music playing (n = 103) versus passive music listening (n = 99). All students completed a pre-test, a mid-test, and a post-test including: an "Attitudes and Perceptions" survey, State-Trait Anxiety Inventory for Adults (STAI Survey), and a knowledge assessment. Data were analyzed to determine the impact each of the music interventions had on students' test anxiety.

RESULTS

Both types of musical interventions produced similar results in terms of anxiety reduction. Faced with an upcoming test prior to the musical intervention, average state-trait anxiety scores increased; after the musical intervention, state-trait anxiety scores decreased.

CONCLUSIONS

The use of music helped to reduce test anxiety, even after one brief musical intervention, regardless of whether students passively listened to music or actively played music.

Association Between Pittsburgh Sleep Quality Index and Depressive Symptoms in Chinese Resident Physicians

Background: Previous studies have suggested that sleep quality is associated with depressive symptoms. However, associations between overall sleep quality and depressive symptoms in Chinese resident physicians remain unclear. Therefore, we aimed to determine whether overall sleep quality is associated with depressive symptoms in Chinese resident physicians. Methods: This cross-sectional study included 1,230 resident physicians. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Logistic regression analysis was applied to estimate the associations between the PSQI and PHQ-9. Results: Among all participants, the prevalence of mild (PHQ-9 ≥ 5) and moderate or severe (PHQ-9 ≥ 10) depressive symptoms were 48.28 and 12.93%, respectively. PSQI score was positively associated with PHQ-9 score before and after adjustments of socio-demographic, behavioral, and psychologic confounding factors (all P < 0.0001). After adjustments, the regression coefficients (standard error) between PSQI scores and PHQ-9 scores were 0.95 (0.04), 0.88 (0.09), and 0.96 (0.05) in all participants, men, and women, respectively. Compared to physicians with good sleep quality (PSQI scores ≤ 5), the adjusted odds ratios (ORs) [95% confidence intervals (CIs)] for mild (PHQ-9 ≥ 5) and moderate or severe (PHQ-9 ≥ 10) depressive symptoms in physicians with poor sleep quality were 7.15 (5.44, 9.46) and 6.17 (4.03, 9.71) in all participants, respectively. Conclusions: Our findings suggest that poor sleep quality was associated with a higher prevalence of depressive symptoms in Chinese resident physicians.

Using bodily postures to reduce anxiety and improve interoception: A comparison between powerful and neutral poses

BACKGROUND

Previous research has shown that anxiety syndromes are highly prevalent among university students. Effective treatments are needed to reduce the burden of anxiety in this population. Powerful postures have been found to impact affective states, as well as interoception (i.e. the ability to perceive inner bodily signals). However, no previous study has compared the effects of powerful- and neutral postures in regards to anxiety and interoceptive ability.

METHODS

The first part of the study measured the single-session effect of adopting powerful- vs. neutral postures on students' (n = 57) interoceptive ability and state anxiety. The second part of the study measured the effect of adopting powerful or neutral postures twice daily for two weeks, on individuals' interoceptive ability and trait anxiety.

RESULTS

State anxiety decreased in both conditions whereas interoceptive accuracy only increased in the power posing condition after a single session. Interoceptive accuracy increased in both groups after two weeks of training.

LIMITATIONS

The study included no comparison to a condition where individuals adopted their natural (i.e. usual) bodily posture.

CONCLUSIONS

Embodiment interventions that include elements of adopting an open or expansive bodily posture whilst maintaining a self-focus, can help to reduce state anxiety and improve interoceptive accuracy in student populations. Power posing does not seem to be superior to holding a neutral posture to improve interoceptive accuracy or anxiety. One reason therefore could be that both conditions include the manipulation of self-focus and a postural change that diverges from individuals' normal posture.

Depression Severity and Depression Stigma Among Students: A Survey of Universities in Five Countries

In the university setting, mental disorders have come under greater scrutiny and more attention has been given toward addressing the social stigmas associated with mental illness in an effort to promote mental well-being and improve mental health care delivery on-campus. Depression has been previously linked to a reduction in quality of life, suicidal ideation, and poor academic performance. However, few studies have directly compared the burden of depression or stigmatized views between multiple universities. As a result, this cross-sectional study of university students from five countries was performed to determine the burden of depressive disorders, the stigmatizations of beliefs related to depression, and international variation. A questionnaire consisting of a sociodemographic survey, Patient Health Questionnaire-9 (PHQ-9), and Depression Stigma Scale (DSS) was distributed via multiple routes to undergraduate and graduate students at institutions in the United States, Taiwan, United Arab Emirates, Egypt, and Czech Republic. The point prevalence of depression was determined by using the algorithm scoring method of the PHQ-9. Depression severity was determined according to the summed-item scoring method of the PHQ-9. The degree of stigmatization of beliefs was determined by continuous scores on the DSS subscales for personal and perceived stigma. Differences in depression severity, personal stigma, and perceived stigma were determined according to analysis of variance and further studied using post hoc Tukey's tests. Responses were collected from students in the United States (n = 593), United Arab Emirates (n = 134), Taiwan (n = 217), Egypt (n = 105), and Czech Republic (n = 238). Of 1287 responses, 30.7% (n = 396) screened positive for a depressive disorder: 18.0% (n = 232) for major depressive disorder and 12.7% (n = 164) for another depressive disorder. Depression severity differed internationally (p < 0.001). Emirati students significantly exhibited most depression followed by Czech, American, and Taiwanese students (all ps < 0.001). There was also a difference between students of different countries in terms of personal stigma (p < 0.001), with Emirati students holding more stigmatized personal views than Czech, American, Egyptian, and Taiwanese students (all ps < 0.001). Students similarly demonstrated differences in terms of personal stigma (p < 0.001). Egyptian students exhibited the most perceived stigma followed by Emirati, Taiwanese, American, and Czech students (all ps < 0.001). These findings suggest a high point prevalence of depression among university students and differences in the severity of depression, which has implications for the delivery of mental health care in this population. There were significant differences in terms of personal and perceived stigma between university students, indicating resource allocation for university-based campaigns to reduce depression stigma may need to be tailored to the population. After implementation of stigma reduction programs, future follow-up surveys can be done to compare degrees of stigma before and after the intervention.

Prevalence and factors associated with depressive and anxiety symptoms among Palestinian medical students

BACKGROUND

Co-existence of depression and anxiety can be associated with severe detrimental consequences to the physical, mental and social wellbeing of the affected populations. This study was conducted to determine prevalence of depressive and anxiety symptoms among Palestinian medical students and to investigate associations between sociodemographic factors of the students with depressive and anxiety symptoms.

METHODS

This study was conducted in a cross-sectional observational design using a questionnaire in the period between September 2018 and April 2019 in a major university in the West Bank of Palestine. Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II) and anxiety symptoms were assessed using the Beck Anxiety Inventory (BAI). The questionnaire also collected the sociodemographic characteristics of the students. Reliability of the questionnaire was tested using the test re-test method. A total of 425 medical students were invited to participate in the study.

RESULTS

Of those invited, 286 students completed the questionnaire, giving a response rate of 67.3%. More than half (56.6%) of the students had minimal depression, 20.3% had mild depression, 14.0% had moderate depression, 9.1% had severe depression, 23.4% had no anxiety, 29.7% had mild to moderate anxiety, 25.5% had moderate to severe anxiety, and 21.3% had severe anxiety. Multiple linear regression analysis showed that academic stage (p-value < 0.01), Grade Point Average (p-value < 0.01), mental health status (p-value < 0.001), ever attempted suicide (p-value < 0.05), and religious commitment (p-value < 0.01) were predictors of BDI-II scores. Multiple linear regression analysis showed that academic stage (p-value < 0.05) and mental health status (p-value < 0.001) were predictors of BAI scores.

CONCLUSIONS

Depressive and anxiety symptoms were prevalent among Palestinian medical students in a major university in the West Bank of Palestine. Interventions might be designed to improve self-rated mental health of medical students in their academic years, ameliorate study conditions, and provision of counseling services to improve spirituality might be effective in reducing symptoms of depression and anxiety among medical students in Palestine. Future studies are still needed to investigate if these interventions could be useful in reducing depressive and anxiety symptoms among Palestinian medical students.

Sleep quality in medical students: a comprehensive meta-analysis of observational studies

PURPOSE

Poor sleep quality is common in medical students and is associated with a number of negative health outcomes. However, the prevalence estimates of poor sleep quality in medical students vary widely across studies. We thus conducted a meta-analysis of the prevalence of poor sleep quality and its mediating factors in medical students.

METHODS

A systematic literature search of PubMed, EMBASE, Web of Science, PsycINFO, and Medline Complete was performed. The random-effects model was used to analyze the pooled prevalence of poor sleep quality and its 95% confidence intervals (CIs).

RESULTS

A total of 57 studies with 25,735 medical students were included. The pooled prevalence of poor sleep quality was 52.7% (95% CI: 45.3% to 60.1%) using the Pittsburgh Sleep Quality Index (PSQI). The pooled mean total PSQI score across 41 studies with available data was 6.1 (95% CI: 5.6 to 6.5). Subgroup analyses found that PSQI cutoff value and study region were associated with the prevalence of poor sleep quality (P = 0.0003 VS. P = 0.005). Across the continents, poor sleep quality was most common in Europe, followed by the Americas, Africa, Asia, and Oceania. Meta-regression analyses found that smaller sample size (slope = - 0.0001, P = 0.009) was significantly associated with higher prevalence of poor sleep quality.

CONCLUSIONS

Poor sleep quality is common among medical students, especially in Europe and the Americas continets. Due to the negative health outcomes, regular screening of poor sleep quality and effective interventions are needed for medical students.

The Role of Campus Data in Representing Depression Among College Students: Exploratory Research

BACKGROUND

Depression is a predominant feature of many psychological problems leading to extreme behaviors and, in some cases, suicide. Campus information systems keep detailed and reliable student behavioral data; however, whether these data can reflect depression and we know the differences in behavior between depressive and nondepressive students are still research problems.

OBJECTIVE

The purpose of this paper is to investigate the behavioral patterns of depressed students by using multisource campus data and exploring the link between behavioral preferences and depressive symptoms. The campus data described in this paper include basic personal information, academic performance, poverty subsidy, consumption habit, daily routine, library behavior, and meal habit, totaling 121 features.

METHODS

To identify potentially depressive students, we developed an online questionnaire system based on a standard psychometric instrument, the Zung Self-Rating Depression Scale (SDS). To explore the differences in behavior of depressive and nondepressive students, the Mann-Whitney U test was applied. In order to investigate the behavioral features of different depressive symptoms, factor analysis was used to divide the questionnaire items into different symptom groups and then correlation analysis was employed to study the extrinsic characteristics of each depressive symptom.

RESULTS

The correlation between these factors and the features were computed. The results indicated that there were 25 features correlated with either 4 factors or SDS score. The statistical results indicated that depressive students were more likely to fail exams, have poor meal habits, have increased night activities and decreased morning activities, and engage less in social activities (eg, avoiding meal times with friends). Correlation analysis showed that the somatic factor 2 (F4) was negatively correlated with the number of library visits (r=-.179, P<.001), and, compared with other factors, had the greatest impact on students' daily schedule, eating and social habits. The biggest influencing factor to poor academic performance was cognitive factor F1, and its score was found to be significantly positively correlated with fail rate (r=.185, P=.02).

CONCLUSIONS

The results presented in this study indicate that campus data can reflect depression and its symptoms. By collecting a large amount of questionnaire data and combining machine learning algorithms, it is possible to realize an identification method of depression and depressive symptoms based on campus data.

Exploring the relationship between medical student basic psychological need satisfaction, resilience, and well-being: a quantitative study

BACKGROUND

There is increasing acknowledgment that medical training is stressful for students and can impact their well-being. An important aspect of this is self-determination and basic psychological need satisfaction. A better understanding of how medical student perceptions of the learning environment impacts their basic psychological needs for motivation, resilience, and well-being may help to create learning environments that support the needs of medical students and help them become better healthier physicians. We aim to add to the literature on this topic by examining this relationship through the lens of Self-Determination Theory.

METHODS

A total of 400 students from all 4 years of the medical program at our institution were invited to complete an anonymous online survey, measuring basic need satisfaction/frustration (autonomy, competence, relatedness) within the learning environment, resilience, and psychological well-being. We used analysis of variance to assess the effect of gender, age, and year on all variables, with t-tests to compare subgroups. Structural equation modelling was performed to test a hypothesized model in which support of medical students' basic needs would positively relate to their resilience and well-being.

RESULTS

The response rate was 183/400 (46%). After data cleaning, 160 remained: 67 males (42%) and 93 females (58%). There were 67 first years (42%), 35 second years (22%), 30 third years (19%), and 28 fourth years (18%). The sample mean age was 25.8 years (SD = 4.1). A well-fitting model was confirmed to fit the data, χ² = 3.15, df = 3, p = 0.369, RMSEA = 0.018, SRMR = 0.022, CFI = 0.999. Autonomy and relatedness satisfaction exerted direct effects on well-being. Competence satisfaction did so indirectly, through its direct effect on resilience. Female medical students had lower resilience scores compared to their male peers.

CONCLUSIONS

When medical students perceived their learning environment as supportive to their basic needs, it was associated with an increase in their psychological well-being. Satisfaction of competence, but not autonomy or relatedness, predicted an increase in their resilience. Fostering medical students' basic needs for motivation, especially competence, is recommended to support their resilience and well-being. Further research is required to generalize these results further.

Sleep hygiene awareness: Its relation to sleep quality among medical students in King Saud University, Riyadh, Saudi Arabia

Background/Objective:

Sleep hygiene (SH) is considered to be an effective method to treat sleep disturbances, especially among adolescents and young adults. This study aimed to find out the relationship of SH awareness and its importance in overall sleep quality among medical students and to assess the prevalence of sleep disturbance among them.

Methodology:

This was a cross-sectional study conducted in the College of Medicine, King Saud University during the period between April and July 2016. A total of 225 students participated in this study and were recruited by a convenience sampling method. Two validated questionnaires were used, Pittsburg Sleep Quality Index (PSQI) to assess sleep quality and the Sleep Beliefs Scale (SBS) to assess the awareness of students about SH. Data were entered into, and analyzed by SPSS Version 20.

Results:

Overall, more than half of the participants, 113 (56.5%), had a poor sleep quality. Sixty one (30.5%) students got excellent score in SH awareness and the rest of the participants (n = 139; 69.5%) scored poor/intermediate. Thirty-five (57.4%) poor sleepers and 42.6% of good sleepers scored excellent in SH awareness.

Conclusion:

This study showed a higher prevalence of sleep disturbance among medical students and no significant correlation between SH awareness and good sleep quality, which means that SH awareness may not necessarily ensure a good sleep quality.

Bedtime Procrastination, Sleep-Related Behaviors, and Demographic Factors in an Online Survey on a Polish Sample

The sufficient length and good quality of night sleep play a vital role in maintaining health, well-being and effective functioning. Nevertheless, an increase in the prevalence of sleep deprivation can be observed recently. The concept of bedtime procrastination, defined as going to bed later than intended, has been proposed to explain one of the psychological determinants of sleep deficiency. To investigate the prevalence of bedtime procrastination among Poles we carried out a Polish adaptation of the Bedtime Procrastination Scale (BPS), a self-report questionnaire for measuring the tendency to voluntarily postpone going to bed in the absence of any external circumstances for doing so. The aim of the research was to determine the main psychometric properties of the Polish version of the BPS. We also aimed to identify the relationships between bedtime procrastination and selected demographic variables in the Polish sample, and to examine the impact of bedtime procrastination on self-reported sleep outcomes. The data obtained from online surveys conducted on two Polish samples were analyzed, including demographic factors, self-reported sleep outcomes, and responses to items of the BPS. The Polish version of the BPS has a unifactorial structure like the original version. It also exhibits satisfactory internal consistency and moderate temporal stability in a 10-week retest study. BPS scores were not significantly related to the place of residence, the highest completed level of education, living with a spouse or partner, and living with children. Scores in BPS slightly decreased with age and females scored higher on BPS than males. Higher BPS scores were obtained for a group of students in comparison to a group of subjects who were not students, and lower BPS scores were found in working respondents in comparison to respondents who were not working. BPS scores correlate negatively with sleep length on workdays and a feeling of sleep sufficiency, and positively with sleep length on weekdays relative to workdays, sleeping later than one would like, and a feeling of fatigue. Several relationships between self-reported sleep outcomes and demographic variables were also identified.

The Global Prevalence of Anxiety Among Medical Students: A Meta-Analysis

Anxiety, although as common and arguably as debilitating as depression, has garnered less attention, and is often undetected and undertreated in the general population. Similarly, anxiety among medical students warrants greater attention due to its significant implications. We aimed to study the global prevalence of anxiety among medical students and the associated factors predisposing medical students to anxiety. In February 2019, we carried out a systematic search for cross-sectional studies that examined the prevalence of anxiety among medical students. We computed the aggregate prevalence and pooled odds ratio (OR) using the random-effects model and used meta-regression analyses to explore the sources of heterogeneity. We pooled and analyzed data from sixty-nine studies comprising 40,348 medical students. The global prevalence rate of anxiety among medical students was 33.8% (95% Confidence Interval: 29.2–38.7%). Anxiety was most prevalent among medical students from the Middle East and Asia. Subgroup analyses by gender and year of study found no statistically significant differences in the prevalence of anxiety. About one in three medical students globally have anxiety—a prevalence rate which is substantially higher than the general population. Administrators and leaders of medical schools should take the lead in destigmatizing mental illnesses and promoting help-seeking behaviors when students are stressed and anxious. Further research is needed to identify risk factors of anxiety unique to medical students.

Evaluation of Sleep Patterns and Self-Reported Academic Performance among Medical Students at the University of Ghana School of Medicine and Dentistry

Background

Sleep habits and problems play a vital role in determining sleep quality. We describe sleep habits and problems among medical students and assess their possible effect on self-reported academic performance.

Methods

We conducted a cross-sectional study among medical students at the University of Ghana during the 2014/2015 academic year. Data was collected using the Pittsburgh Sleep Quality Index (PSQI), a self-report questionnaire that assesses sleep quality over a 1-month time interval.

Results

153 medical students were recruited comprising 83 (54.2%) females and 70 (45.8%) males with a mean age of 23.1 ± 2.4 years. The mean duration of night sleep was 5.7 ± 1.2 hours; 88 (57.5%) students had sleep latency of 10-30 minutes while 18 (11.8%) woke up nightly. 23 (15%) students experienced nightmares, 13 (8.5%) snored at night, and only one student reported coffee intake of 2-3 times daily. Sleep quality was poor in 86 (56.2%) and was significantly associated with sleep latency, morning tiredness, daytime sleepiness during lectures, academic performance, living conditions, leisure time, frequency of nocturnal awakenings, waking up due to noise, sleep walking, and nocturnal awakening to use washroom. There was also a significant positive relation between sleep quality and academic performance (X² = 10.004 p = 0.019).

Conclusion

Poor sleep quality and daytime dysfunction are widespread among medical students in Ghana. There was a significant positive relation between sleep quality and self-reported academic performance.

Depression in health college students: relationship factors and sleep quality

This research was conducted to determine depression symptom frequency in health sciences students (n = 445), to investigate sleep quality and some related factors. In this study of the students approximately one fifth of the students showed depressive symptom. Students with poor academic performance, poor economic status, smoking or alcohol use, chronic illness or mental problems are more likely to experience depression. As sleep quality deteriorates, the level of depression also increases. The risk of depressive symptoms in students with poor sleep quality was 3.28 times.

Psychological distress among undergraduate medical students: the influence of excessive daytime sleepiness and family functioning

Mental health problems among undergraduate medical students is a well-known issue; however, their associated risk factors have been poorly studied. We aimed to assess the hypothesis that medical students have a higher prevalence of psychological distress and to explain this prevalence considering common risk factors for mental disorders. This was a cross-sectional, questionnaire-based descriptive study conducted with 467 Colombian undergraduate medical students from different years of training. Validated and widely used self-report questionnaires of psychological distress, daytime sleepiness, and family functioning were included. In addition, measurements of smoking, alcohol, and caffeine intake were used. We found a prevalence of psychological distress, depressive symptoms and anxiety symptomatology of 65.9%, 75.3%, and 50.5%, respectively. Furthermore, 20.6% showed both psychological distress and excessive daytime sleepiness. Adjusted risk ratio analysis showed that poor family functioning, the presence of excessive daytime sleepiness, and caffeine consumption were significant risk factors for high levels of psychological distress. Additionally, psychological distress and daytime sleepiness were related to the year of training. Our results replicate in part previous findings of poor mental health among undergraduate medical students compared with mental health in general population and provide novel findings that family functioning plays a significant role as an important explanatory factor. The current study has high relevance for future research and interventions focused on prevention of medical errors, conflicts in the physician-patient relationship and the personal safety of undergraduate medical students.

Mean Scores of Depression, Anxiety and Stress in Iranian University Students Based on DASS-21: A Systematic Review and Meta-analysis

Background and aims: Depression is the most common psychiatric disorder, and students are more predisposed to depression than other populations. This meta-analysis was conducted to estimate the mean depression score in Iranian students based on DASS-21. Methods: The search was carried out using keywords Depression, Student, DASS-21 and Iran in domestic databases, including SID, Medlib, IranMedex, Irandoc, and Magiran. Data were analyzed using a meta-analysis (random effects model). The heterogeneity of studies was studied using the I2 index. Data were analyzed using the Stata software version 11. DASS-21 had been used in all reviewed studies. Results: The sample size was 3229 people included in 17 studies. The mean depression score in Iranian students based on DASS-21 was 9.30 (95% CI: 12.57-6.03), 8.90 in female students (95% CI: 4.50-13.29) and 8.45 in male students (95% CI: 4.03-12.86). The mean scores of anxiety and stress in students were 8.58 (95% CI: 5.95-12.86) and 9.91 (95% CI: 11.28-8.54), respectively. Conclusion: The mean depression score is higher in female students than in male students, and the mean score of stress is slightly higher than those of anxiety and depression.

Gender differences in the perception of quality of life during internal medicine training: a qualitative and quantitative analysis

BACKGROUND

The higher level of participation by women in medicine may impact this profession's evolution due to gender differences perceived during medical school, after graduation and during residency. Gender differences regarding quality of life are associated with higher states of anxiety and depression among female physicians. We aimed to assess gender differences in the perception of quality of life with quantitative methods and to understand further, from the female residents´ point of view, the reasons that may influence the perception of quality of life using qualitative method. Resilience, empathy and daytime sleepiness were also scored.

METHODS

We performed a cross-sectional study with first-year internal medicine residents to evaluate self-reported quality of life factors specific to medical residents (VERAS-Q), including empathy (Jefferson Scale of Empathy), resilience (Wagnild and Young Brief Resilience Scale) and daytime sleepiness (Epworth Scale). We explored, from the female residents´ view which factors may influence the perception of quality of life using a focus group method.

RESULTS

In our study, one hundred and nine residents completed the survey: 31 (28.4%) were female and 78 (71.6%) were male. Female residents exhibited significantly lower scores than those of male residents for quality of life in the domains of time management (30.3, females vs 41.1, males; p < 0.001), psychology (48.1, females vs 56.7, males; p < 0.01) and physical health (42.8, females vs 53.6, males; p < 0.05). Female residents also scored higher for daytime sleepiness (13.0, females vs 9.0, males; p < 0.001), with pathological scores for daytime sleepiness. No significant gender differences were found in the resilience or empathy scores. The focus group assessment revealed difficulty in concentration and knowledge acquisition, insecurity, feelings of loss, greater critical perception, self-doubt and difficulty in creating effective bonds to support the training period as the main factors involved in the lower perception of quality of life among the women.

CONCLUSIONS

In conclusion, female residents had lower scores for quality of life and higher scores for daytime sleepiness. Measures to improve quality of life among female residents during this critical period of medical training might include investing in mentoring to help them better manage their time and encouraging activities that facilitate relationship development.

Social and behavioural factors associated with depressive symptoms among university students in Cambodia: a cross-sectional study

OBJECTIVE

To explore social and behavioural factors associated with depressive symptoms among university students in Cambodia.

DESIGN

Cross-sectional study.

SETTINGS

Two public universities-one in the capital city of Phnom Penh and another in Battambang provincial town.

PARTICIPANTS

This study included 1359 students randomly selected from all departments in the two universities using a multistage cluster sampling method for a self-administered questionnaire survey in 2015.

PRIMARY OUTCOME MEASURE

Depressive symptoms measured by using the Center for Epidemiologic Studies Depression scale. All measures in the study were self-reported.

RESULTS

The proportion of students with depressive symptoms and severe depressive symptoms were 50.6% and 19.6%, respectively. After adjustment in multivariate logistic regression analysis, depressive symptoms remained significantly associated with poor academic performance (adjusted OR (AOR)=7.31, 95% CI 2.24 to 23.86), higher consumption of unhealthy food (AOR=1.72, 95% CI 1.08 to 2.76), a negative self-perception about body shape (AOR=0.54, 95% CI 0.29 to 0.99) and general health status (AOR=2.99, 95% CI 1.28 to 7.00), and limited physical activeness (AOR=0.30, 95% CI 0.16 to 0.58). Depressive symptoms also remained significantly associated with adverse childhood experiences including physical violence (AOR=1.39, 95% CI 1.04 to 1.86), psychological abuse (AOR=1.82, 95% CI 1.37 to 2.42) and lack of general and medical care (AOR=0.51, 95% CI 0.30 to 0.86) by family during childhood.

CONCLUSIONS

The key factors associated with depressive symptoms were family related and individual behaviours and attitudes. Thus, efforts should be invested in comprehensive screening and intervention programmes to diagnose those vulnerable students early, offer immediate treatment and cater appropriate support.

The Relationship between Personality Traits with Depressive Symptoms and Suicidal Ideation among Medical Students: A Cross-Sectional Study at One Medical School in Germany

Medical students are at increased risk of experiencing mental health problems. Certain personality traits may be associated with elevated vulnerability to study-related stress and poor mental health. This study aimed to investigate the relationship between such personality traits and mental health outcomes among medical students. We drew on cross-sectional data from 251 medical students who had been enrolled for one-year at a medical school in Germany. Depressive symptoms were measured using the Patient Health Questionnaire-8 (PHQ-8) and suicidal ideation was assessed by item 9 from the Patient Health Questionnaire-9 (PHQ-9). Personality traits were captured using the Business-Focused Inventory of Personality 6 Factors (BIP-6F). Multivariable logistic regression analyses were used to quantify the associations between work-related personality factors and mental health outcomes, controlling for demographic and social factors. Odds ratios (ORs) as outcome measures with 95% confidence intervals (CIs) were used. After controlling for important confounders, medical students who scored highly on Stability had lower odds of depressive symptoms (OR: 0.19, 95% CI: 0.09–0.42, p < 0.001) and suicidality (OR: 0.38, 95% CI: 0.16–0.87, p < 0.05) than those with high scores in other work-related personality factors. Findings also showed that those who scored highly on Dominance had greater odds of depressive symptoms (OR: 2.46, 95% CI: 1.22–4.97), p < 0.01). Work-related personality-informed interventions, which promote students’ mental well-being and reduce academic stress should be considered at various stages of their medical training.