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Al Doori L, Zaki PG, Joshi V. Impact of USMLE Step 1 transition to pass/fail scoring system on medical students' anxiety, sleep quality, and burnout. Ir J Med Sci 2024; 193:2155-2160. [PMID: 38954326 PMCID: PMC11450038 DOI: 10.1007/s11845-024-03738-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION Originally designed to evaluate the application of foundational scientific knowledge in clinical contexts, the United States Medical License Exam (USMLE) Step 1 evolved into a comparative tool for assessing candidates with similar educational foundations. This transition heightened the pressure on medical students to excel in the exam. In response, collaborative efforts involving the National Board of Medical Examiners prompted a change from reporting scores to a pass/fail system. The true impact of this shift remains insufficiently explored. This study aims to assess the emotional toll - encompassing burnout, anxiety, depression, and sleep quality - experienced prior to taking the Step 1 exam. Additionally, it aims to uncover potential gender-based disparities in perceived anxiety and depression. METHODS The study encompasses the entirety of third-year medical students at Drexel University College of Medicine, who were invited to participate in a comprehensive survey. Drawing from retrospection, the survey relies on self-reported data regarding anxiety, depression, sleep quality, and burnout. Data compilation was anonymized and executed via Qualtrics platform. RESULTS A total of 102 medical students completed the survey, with a 97% pass rate for the USMLE Step 1. Despite their excellent performance, 75% of students reported inadequate sleep quality, and 68% exhibited mild to moderate anxiety levels. Among them, a higher percentage of females (83%) experienced anxiety compared to their male counterparts (50%). Furthermore, 66% of students felt that their commitment to education exceeded what was reasonable for their well-being. CONCLUSIONS The transition from traditional scoring to a pass/fail system was ostensibly intended to enhance the mental well-being of medical students. Nevertheless, our findings underscore that students continue to endure heightened levels of stress, anxiety, and burnout during the pivotal month leading up to the Step 1 examination.
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Affiliation(s)
- Lana Al Doori
- Drexel University College of Medicine at Tower Health, Drexel University, West Reading, Wyomissing, PA, 19610, USA
| | - Peter G Zaki
- Drexel University College of Medicine at Tower Health, Drexel University, West Reading, Wyomissing, PA, 19610, USA
| | - Vivek Joshi
- Drexel University College of Medicine at Tower Health, Drexel University, West Reading, Wyomissing, PA, 19610, USA.
- Department of Biochemistry, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Ding Y, Zhang H, Hu Z, Sun Y, Wang Y, Ding B, Yue G, He Y. Perceived Social Support and Health-Related Quality of Life Among Hypertensive Patients: A Latent Profile Analysis and the Role of Delay Discounting and Living Alone. Risk Manag Healthc Policy 2024; 17:2125-2139. [PMID: 39246592 PMCID: PMC11380862 DOI: 10.2147/rmhp.s476633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 08/27/2024] [Indexed: 09/10/2024] Open
Abstract
Background Improving health-related quality of life (HRQoL) among hypertensive individuals has emerged as a significant public health issue. However, current research has ignored the individual heterogeneity of perceived social support (PSS) among hypertensive patients. The potential mechanism of delay discounting (DD), living alone, and PSS on HRQoL remains unclear, and further exploration is required. Aim This study aimed to ascertain PSS profiles among hypertensive patients and examine the hypotheses that DD mediates the relationship between PSS and HRQoL and that this mediating process is moderated by living alone in hypertensive patients. Methods A cross-sectional study was carried out in Jiangsu, China. In total, 1815 hypertensive patients completed socio-demographic and HRQoL questionnaires, a PSS scale, and a DD task. Data analyses included a latent profile analysis, χ2-test, Spearman correlation analysis, and PROCESS macro for regression analysis. Results Four potential PSS profiles were identified: lowest (3.2%), moderate-low (26.6%), moderate-high (42.4%), and highest (27.8%). DD mediated the association between PSS and HRQoL. The first half of this mediating process was moderated by living alone. Conclusion Our findings indicated that PSS, DD, and living alone significantly influence the HRQoL of individuals with hypertension. Healthcare professionals should consider variations in PSS among hypertensive patients and implement interventions to reduce DD by enhancing PSS, in order to improve the HRQoL of this population.
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Affiliation(s)
- Yueming Ding
- Institute of Medical Humanities, School of Marxism, Nanjing Medical University, Nanjing, People's Republic of China
| | - Huiying Zhang
- Institute of Medical Humanities, School of Marxism, Nanjing Medical University, Nanjing, People's Republic of China
| | - Zhiqing Hu
- Institute of Medical Humanities, School of Marxism, Nanjing Medical University, Nanjing, People's Republic of China
| | - Yanjun Sun
- Institute of Medical Humanities, School of Marxism, Nanjing Medical University, Nanjing, People's Republic of China
| | - Yiping Wang
- School of Nursing, Nanjing Medical University, Nanjing, People's Republic of China
| | - Baolong Ding
- School of Pharmacy, Nanjing Medical University, Nanjing, People's Republic of China
| | - Guofeng Yue
- School of Health Policy and Management, Nanjing Medical University, Nanjing, People's Republic of China
| | - Yuan He
- Institute of Medical Humanities, School of Marxism, Nanjing Medical University, Nanjing, People's Republic of China
- Research Center for Social Risk Management of Major Public Health Events (Key Research Base of Philosophy and Social Sciences of Universities in Jiangsu), Nanjing Medical University, Nanjing, People's Republic of China
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Zhang X, Feng S, Yang X, Peng Y, Du M, Zhang R, Sima J, Zou F, Wu X, Wang Y, Gao X, Luo Y, Zhang M. Neuroelectrophysiological alteration associated with cognitive flexibility after 24 h sleep deprivation in adolescents. Conscious Cogn 2024; 124:103734. [PMID: 39096822 DOI: 10.1016/j.concog.2024.103734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 07/28/2024] [Accepted: 07/30/2024] [Indexed: 08/05/2024]
Abstract
The cognitive neural mechanisms by which sleep deprivation affects cognitive flexibility are poorly understood. Therefore, the study investigated the neuroelectrophysiological basis of the effect of 24 h sleep deprivation on cognitive flexibility in adolescents. 72 participants (36 females, mean age ± SD=20.46 ± 2.385 years old) participated in the study and were randomly assigned to the sleep deprivation group and control group. They were instructed to complete a task switch paradigm, during which participants' behavioral and electroencephalographic data were recorded. Behaviorally, there were significant between-group differences in accuracy. The results of event-related potential showed that the P2, N2 and P3 components had significant group effects or interaction effects. At the time-frequency level, there were statistically significant differences between the delta and theta bands. These results suggested that 24 h sleep deprivation affected problem-solving effectiveness rather than efficiency, mainly because it systematically impaired cognitive processing associated with cognitive flexibility.
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Affiliation(s)
- Xirui Zhang
- The First Affiliated Hospital of Xinxiang Medical University, Henan 453003, China
| | - Shuqing Feng
- Department of Psychology, Xinxiang Medical University, Henan 453003, China; Mental Illness and Cognitive Neuroscience Key Laboratory of Xinxiang (Xinxiang Medical University), Xinxiang 453003, Henan Province, China
| | - Xiaochen Yang
- The First Affiliated Hospital of Xinxiang Medical University, Henan 453003, China
| | - Yunwen Peng
- Department of Psychology, Xinxiang Medical University, Henan 453003, China; Mental Illness and Cognitive Neuroscience Key Laboratory of Xinxiang (Xinxiang Medical University), Xinxiang 453003, Henan Province, China
| | - Mei Du
- Department of Psychology, Xinxiang Medical University, Henan 453003, China; Mental Illness and Cognitive Neuroscience Key Laboratory of Xinxiang (Xinxiang Medical University), Xinxiang 453003, Henan Province, China
| | - Rui Zhang
- Department of Psychology, Xinxiang Medical University, Henan 453003, China; Mental Illness and Cognitive Neuroscience Key Laboratory of Xinxiang (Xinxiang Medical University), Xinxiang 453003, Henan Province, China
| | - Jiashan Sima
- Department of Psychology, Xinxiang Medical University, Henan 453003, China; Mental Illness and Cognitive Neuroscience Key Laboratory of Xinxiang (Xinxiang Medical University), Xinxiang 453003, Henan Province, China
| | - Feng Zou
- Department of Psychology, Xinxiang Medical University, Henan 453003, China; Mental Illness and Cognitive Neuroscience Key Laboratory of Xinxiang (Xinxiang Medical University), Xinxiang 453003, Henan Province, China
| | - Xin Wu
- Department of Psychology, Xinxiang Medical University, Henan 453003, China; Mental Illness and Cognitive Neuroscience Key Laboratory of Xinxiang (Xinxiang Medical University), Xinxiang 453003, Henan Province, China
| | - Yufeng Wang
- Department of Psychology, Xinxiang Medical University, Henan 453003, China; Mental Illness and Cognitive Neuroscience Key Laboratory of Xinxiang (Xinxiang Medical University), Xinxiang 453003, Henan Province, China
| | - Xiaomeng Gao
- Department of Psychology, Xinxiang Medical University, Henan 453003, China; Mental Illness and Cognitive Neuroscience Key Laboratory of Xinxiang (Xinxiang Medical University), Xinxiang 453003, Henan Province, China.
| | - Yanyan Luo
- School of Nursing, Xinxiang Medical University, Henan 453003, China.
| | - Meng Zhang
- Department of Psychology, Xinxiang Medical University, Henan 453003, China; Mental Illness and Cognitive Neuroscience Key Laboratory of Xinxiang (Xinxiang Medical University), Xinxiang 453003, Henan Province, China.
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Oliveira JLDC, Carvalho Neta OJD, Athayde RABD. Fear of Missing Out Syndrome and its Impact on Sleep Quality in Medical Students: A Cross-sectional Study. Sleep Sci 2024; 17:e227-e234. [PMID: 39268334 PMCID: PMC11390167 DOI: 10.1055/s-0044-1780499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/22/2023] [Indexed: 09/15/2024] Open
Abstract
Objective Fear of missing out (FOMO) is a type of social anxiety defined as "intense concern that others may be experiencing rewarding experiences without one's presence," which can lead to illness. Excessive smartphone use is often associated with FOMO. This study aimed to investigate FOMO among medical university students, as well as factors associated with sleep quality, anxiety, depression, and excessive smartphone use. Materials and Methods A cross-sectional observational study was conducted using electronic questionnaires and the following scales: FOMO scale/score, Pittsburgh Sleep Quality Index (PSQI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Smartphone Addiction Scale Short Version (SAS SV). Results Participants included 142 individuals (mean age 23.73 ± 4.98 years, 97 [68.3% female]). All participants were smartphone users. Fear of missing out was present (FOMO score 22.08 ± 6.71) along with poorer sleep quality (PSQI 7.26 ± 3.08) and excessive smartphone use (SAS SV 30.21 ± 10.20). Moderate/severe anxiety (BAI) was reported by 35.2% of participants, while 16.9% had moderate/severe depression (BDI). Positive correlations were found between PSQI and FOMO ( p < 0.05), as well as between SAS SV and FOMO ( p < 0.001), PSQI ( p < 0.001), BAI ( p < 0.001), and BDI ( p < 0.001). Discussion High levels of FOMO, poorer sleep quality, symptoms of depression, anxiety, and excessive smartphone use were found among medical students. Furthermore, a positive correlation was demonstrated between these factors, which can directly impact the physical and mental health, as well as the academic performance of these young individuals.
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Younes A, Point C, Wacquier B, Lanquart JP, Hein M. Excessive Daytime Sleepiness in Hypertensive Patients: The Role of Major Depressive Disorder. Diagnostics (Basel) 2024; 14:1854. [PMID: 39272639 PMCID: PMC11394253 DOI: 10.3390/diagnostics14171854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/19/2024] [Accepted: 08/23/2024] [Indexed: 09/15/2024] Open
Abstract
There is a special relationship between major depressive disorder and excessive daytime sleepiness. However, given the negative impact of excessive daytime sleepiness on life quality and cardiovascular outcome in hypertensive patients, the objective of this study was to investigate the potential role played by major depressive disorder in the occurrence of this complaint for this particular subpopulation. Data from 1404 hypertensive patients recruited from the Sleep Unit's polysomnographic recordings database were analyzed. A score >10 on the Epworth Sleepiness Scale was used to define excessive daytime sleepiness in this study. Logistic regression analyses were performed to investigate the risk of excessive daytime sleepiness associated with major depressive disorder in hypertensive patients. Excessive daytime sleepiness was frequent (40.0%) in our sample of hypertensive patients. After adjustments for major confounding factors, multivariate logistic regression analyses demonstrated that unlike remitted major depressive disorder, only current major depressive disorder was associated with a higher risk of excessive daytime sleepiness in hypertensive patients. Given this potential implication of current major depressive disorder in the occurrence of excessive daytime sleepiness for hypertensive patients, it is therefore essential to achieve the complete remission of this psychiatric disorder to avoid negative consequences associated with this complaint in this particular subpopulation.
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Affiliation(s)
- Alexandre Younes
- Faculté de Médecine, Université Libre de Bruxelles, ULB, 1070 Bruxelles, Belgium
| | - Camille Point
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Bruxelles, Belgium
| | - Benjamin Wacquier
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Bruxelles, Belgium
| | - Jean-Pol Lanquart
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Bruxelles, Belgium
| | - Matthieu Hein
- Hôpital Universitaire de Bruxelles, Service de Psychiatrie et Laboratoire du Sommeil, Université Libre de Bruxelles, ULB, 1070 Bruxelles, Belgium
- Laboratoire de Psychologie Médicale et Addictologie (ULB312), Université Libre de Bruxelles, ULB, 1020 Bruxelles, Belgium
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Khandalavala B, Emig S, Yousef M, Geske J. Diet quality in medical trainees: a cross-sectional assessment comparing medical students and primary care residents using the Rapid Eating Assessment for Participants-shortened version. BMC Nutr 2024; 10:106. [PMID: 39054563 PMCID: PMC11271206 DOI: 10.1186/s40795-024-00899-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 06/19/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The diet quality of the US population is significantly unhealthy, with critical long-term implications for the nation's health. A few studies have explored diet quality in the future primary care workforce. This cross-sectional study quantifies the diet quality of medical students and primary care residents at a Midwestern college of medicine in the United States. METHODS 250 medical students and 148 primary care residents were surveyed electronically utilizing the Rapid Eating Assessment for Participants-Shortened Version (REAP-S). The survey consists of 13 questions that can be scored on a scale from 1 to 3, along with 3 questions that are not scored. The average REAP-S score for a US omnivorous diet is 32 (range 13 to 39) with higher scores indicating a higher quality diet. We obtained average REAP-S scores for all respondents and descriptive summary statistics for individual REAP-S items. Students' REAP-S total scores were compared to those of residents and the interaction between student/resident status and BMI category on REAP-S total scores were analyzed using analyses of variance. Differences between students and residents on BMI categories and other outcomes (individual REAP-S items, pandemic dietary and weight changes) were analyzed using Chi-Square Tests of Independence or Fisher's Exact Tests. RESULTS Medical students (n = 99; 39.6% response rate) had a significantly higher mean REAP-S score (30.5, SD = 3.9) than primary care residents (n = 72; 49% response rate) (mean = 28.6, SD = 3.9; p = 0.006). Total mean REAP-S scores were significantly higher for those with BMI < 25 (mean = 30.8, SD = 3.7) than for those with BMI > = 25 (mean = 28.3, SD = 4.0; p < 0.001). There was not a statistically significant interaction between role (student vs. resident) and BMI category on total REAP-S scores (p = 0.39). Most respondents (89.3%) indicated that they were willing to improve their diet. CONCLUSION Our data suggest that the diet quality of surveyed medical students and primary care residents, as quantified by the REAP-S, is suboptimal. Early detection and improvement of diet quality may be necessary for our medical profession trainees to avert potential long-term adverse cardiometabolic health outcomes, and to optimize the health of our future primary care workforce.
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Affiliation(s)
- Birgit Khandalavala
- University of Nebraska Medical Center, Omaha, NE, USA.
- Nebraska Medicine, Omaha, NE, USA.
| | - Stephanie Emig
- University of Nebraska Medical Center, Omaha, NE, USA
- Nebraska Medicine, Omaha, NE, USA
| | - Mira Yousef
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Jenenne Geske
- University of Nebraska Medical Center, Omaha, NE, USA
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Meng R, Ying Y, Luo Y, Huang M, Miller CB, Xie Y, Jia Y, Fan L, Chen W, Yi J, Yang N, Xu J, Jiang C, Lu L, Ma H, Spruyt K, Lau EYY. A longitudinal examination of the measurement properties and invariance of the Sleep Condition Indicator in Chinese healthcare students. BMC Psychiatry 2024; 24:518. [PMID: 39039484 PMCID: PMC11264982 DOI: 10.1186/s12888-024-05844-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/13/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND The Sleep Condition Indicator (SCI), an insomnia measurement tool based on the updated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria with sound psychometric properties when applied in various populations, was evaluated here among healthcare students longitudinally, to demonstrate its measurement properties and invariance in this particularly high-risk population. METHODS Healthcare students of a Chinese university were recruited into this two-wave longitudinal study, completing the simplified Chinese version of the SCI (SCI-SC), Chinese Regularity, Satisfaction, Alertness, Timing, Efficiency, Duration (RU_SATED-C) scale, Chinese Patient Health Questionnaire-4 (PHQ-4-C), and sociodemographic variables questionnaire (Q-SV) between September and November 2022. Structural validity, measurement invariance (MI), convergent and discriminant validity, internal consistency, and test-retest reliability of the SCI-SC were examined. Subgroups of gender, age, home location, part-time job, physical exercise, and stress-coping strategy were surveyed twice to test cross-sectional and longitudinal MI. RESULTS We identified 343 valid responses (62.9% female, mean age = 19.650 ± 1.414 years) with a time interval of seven days. The two-factor structure was considered satisfactory (comparative fit index = 0.953-0.989, Tucker-Lewis index = 0.931-0.984, root means square error of approximation = 0.040-0.092, standardized root mean square residual = 0.039-0.054), which mostly endorsed strict invariance except for part-time job subgroups, hence establishing longitudinal invariance. The SCI-SC presented acceptable convergent validity with the RU_SATED-C scale (r ≥ 0.500), discriminant validity with the PHQ-4-C (0.300 ≤ r < 0.500), internal consistency (Cronbach's alpha = 0.811-0.835, McDonald's omega = 0.805-0.832), and test-retest reliability (intraclass correlation coefficient = 0.829). CONCLUSION The SCI-SC is an appropriate screening instrument available for assessing insomnia symptoms among healthcare students, and the promising measurement properties provide additional evidence about validity and reliability for detecting insomnia in healthcare students.
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Affiliation(s)
- Runtang Meng
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China.
- Engineering Research Center of Mobile Health Management System, Ministry of Education, Hangzhou, Zhejiang, China.
| | - Yiwei Ying
- School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yi Luo
- School of Nursing, Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | - Mengyi Huang
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | | | - Yuhuan Xie
- School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Yuxin Jia
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Lianxia Fan
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Wukang Chen
- School of Clinical Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Jiayu Yi
- School of Nursing, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Nongnong Yang
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Jiale Xu
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Chen Jiang
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Liping Lu
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
| | - Haiyan Ma
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, Zhejiang, China
- Engineering Research Center of Mobile Health Management System, Ministry of Education, Hangzhou, Zhejiang, China
| | - Karen Spruyt
- Université Paris Cité, NeuroDiderot, INSERM, Paris, France
| | - Esther Yuet Ying Lau
- Sleep Laboratory, Department of Psychology, The Education University of Hong Kong, Hong Kong, China
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong, China
- Centre for Religious and Spirituality Education, The Education University of Hong Kong, Hong Kong, China
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Sharma A, Austerlitz J, Najjar F, McDermott J, Matalon J, Varma M. Measuring Sleep Quality Among Medical Students Using the Epworth Sleepiness Scale. Cureus 2024; 16:e63319. [PMID: 39070409 PMCID: PMC11283370 DOI: 10.7759/cureus.63319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/30/2024] Open
Abstract
Introduction While existing literature establishes the positive impact of sleep on test performance among medical students and its correlation with better outcomes among physicians, there is a notable gap in the quantitative understanding of how the transition from preclinical to clinical training affects sleep quality. Methods Our survey was sent to all medical students attending the California University of Science and Medicine between April 2023 and January 2024. The relative risks for having an Epworth sleepiness scale (ESS) greater than 10 were calculated and compared for various subgroups in our sample. Univariate logistic regression analysis was also carried out to assess the effect of covariates on our primary outcome. Results In total, our sample consisted of 124 medical students. Only 11.3% (n=14) were somewhat dissatisfied or very dissatisfied with their medical school experience. The relative risk of having an ESS > 10 when on clinical rotations was 2.06 (95% CI: 1.22-3.49). Conclusion This study demonstrates that the risk of medical students experiencing excessive sleepiness, defined by an ESS > 10, doubles when students are on clinical rotations. Despite being limited by information bias and a smaller sample size, this study provides interesting pilot data on the quantitative examination of sleepiness among medical students and may be used to guide areas for future work.
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Affiliation(s)
- Arjun Sharma
- School of Medicine, California University of Science and Medicine, Colton, USA
| | - Joaquin Austerlitz
- School of Medicine, California University of Science and Medicine, Colton, USA
| | - Fabian Najjar
- School of Medicine, California University of Science and Medicine, Colton, USA
| | - James McDermott
- School of Medicine, California University of Science and Medicine, Colton, USA
| | - Jacob Matalon
- School of Medicine, California University of Science and Medicine, Colton, USA
| | - Madhu Varma
- School of Medicine, California University of Science and Medicine, Colton, USA
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Souza AKR, Sandes RS, Vasco RFV, Albuquerque EVDA. Quality of sleep and excessive daytime sleepiness among medical students in a Brazilian private university. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231141. [PMID: 38656002 DOI: 10.1590/1806-9282.20231141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 04/26/2024]
Abstract
OBJECTIVE The aim of this study was to assess medical students' quality of sleep and excessive daytime sleepiness in different graduation cycles. METHODS A cross-sectional study was carried out at a private university in Maceió, Brazil, from August 2021 to March 2022. The sample was composed of medical students aged 18 years and above from years 1-2 (basic cycle), 3-4 (clinical cycle), and 5-6 (internship) of Medical School who were invited to answer two validated questionnaires: the Pittsburgh Sleeping Quality Index and the Epworth Sleepiness Scale. RESULTS A total of 179 students participated; most of them were female (78.2%), aged 19-25 years (73.7%), and with a body mass index<25 kg/m2 (73.7%), with smaller participation from students from the basic cycle (21.2%). Analyzing the Pittsburgh Sleeping Quality Index, 55.9% of the students were classified as having poor sleep quality, with no difference in sleep category between gender, age, body mass index, and graduation cycle. Students with a body mass index of ≥25 kg/m2 had longer sleep latency (p=0.016) and shorter sleep duration (p=0.027). The Epworth Sleepiness Scale assessment showed that 44.1% of the students exhibit daytime sleepiness. Women had more daytime sleepiness than men (p=0.017), with no difference between age, body mass index, and graduation cycle. CONCLUSION About half of the medical students experience poor sleep quality and daytime sleepiness, regardless of the graduation cycle. This should trigger a targeted institutional intervention to promote better mental and physical health, as well as sleep hygiene, to reduce future health issues.
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Zhang N, Gao X, Li D, Xu L, Zhou G, Xu M, Peng L, Sun G, Pan F, Li Y, Ren R, Huang R, Yang Y, Wang Z. Sleep deprivation-induced anxiety-like behaviors are associated with alterations in the gut microbiota and metabolites. Microbiol Spectr 2024; 12:e0143723. [PMID: 38421192 PMCID: PMC10986621 DOI: 10.1128/spectrum.01437-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 02/03/2024] [Indexed: 03/02/2024] Open
Abstract
The present study aimed to characterize the gut microbiota and serum metabolome changes associated with sleep deprivation (SD) as well as to explore the potential benefits of multi-probiotic supplementation in alleviating SD-related mental health disorders. Rats were subjected to 7 days of SD, followed by 14 days of multi-probiotics or saline administration. Open-field tests were conducted at baseline, end of SD (day 7), and after 14 days of saline or multi-probiotic gavage (day 21). Metagenomic sequencing was conducted on fecal samples, and serum metabolites were measured by untargeted liquid chromatography tandem-mass spectrometry. At day 7, anxiety-like behaviors, including significant decreases in total movement distance (P = 0.0002) and staying time in the central zone (P = 0.021), were observed. In addition, increased levels of lipopolysaccharide (LPS; P = 0.028) and decreased levels of uridine (P = 0.018) and tryptophan (P = 0.01) were detected in rats after 7 days of SD. After SD, the richness of the gut bacterial community increased, and the levels of Akkermansia muciniphila, Muribaculum intestinale, and Bacteroides caecimuris decreased. The changes in the host metabolism and gut microbiota composition were strongly associated with the anxiety-like behaviors caused by SD. In addition, multi-probiotic supplementation for 14 days modestly improved the anxiety-like behaviors in SD rats but significantly reduced the serum level of LPS (P = 0.045). In conclusion, SD induces changes in the gut microbiota and serum metabolites, which may contribute to the development of chronic inflammatory responses and affect the gut-brain axis, causing anxiety-like behaviors. Probiotic supplementation significantly reduces serum LPS, which may alleviate the influence of chronic inflammation. IMPORTANCE The disturbance in the gut microbiome and serum metabolome induced by SD may be involved in anxiety-like behaviors. Probiotic supplementation decreases serum levels of LPS, but this reduction may be insufficient for alleviating SD-induced anxiety-like behaviors.
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Affiliation(s)
- Nana Zhang
- Medical School of Chinese PLA, Beijing, China
- Department of Gastroenterology and Hepatology, The First Centre of Chinese PLA General Hospital, Beijing, China
| | - Xuefeng Gao
- Shenzhen Key Laboratory of Gastrointestinal Microbiota and Disease, Integrative Microecology Clinical Center, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China
- Shenzhen Clinical Research Center for Digestive Disease, Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China
- The Clinical Innovation & Research Center, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Donghao Li
- Department of Gastroenterology and Hepatology, The First Centre of Chinese PLA General Hospital, Beijing, China
| | - Lijuan Xu
- Department of Gastroenterology and Hepatology, The First Centre of Chinese PLA General Hospital, Beijing, China
| | - Guanzhou Zhou
- Department of Gastroenterology and Hepatology, The First Centre of Chinese PLA General Hospital, Beijing, China
| | - Mengqi Xu
- Medical School of Chinese PLA, Beijing, China
- Department of Gastroenterology and Hepatology, The First Centre of Chinese PLA General Hospital, Beijing, China
| | - Lihua Peng
- Medical School of Chinese PLA, Beijing, China
- Department of Gastroenterology and Hepatology, The First Centre of Chinese PLA General Hospital, Beijing, China
| | - Gang Sun
- Medical School of Chinese PLA, Beijing, China
- Department of Gastroenterology and Hepatology, The First Centre of Chinese PLA General Hospital, Beijing, China
| | - Fei Pan
- Medical School of Chinese PLA, Beijing, China
- Department of Gastroenterology and Hepatology, The First Centre of Chinese PLA General Hospital, Beijing, China
| | - Yan Li
- Medical School of Chinese PLA, Beijing, China
- Department of Gastroenterology and Hepatology, The First Centre of Chinese PLA General Hospital, Beijing, China
| | - Rongrong Ren
- Medical School of Chinese PLA, Beijing, China
- Department of Gastroenterology and Hepatology, The First Centre of Chinese PLA General Hospital, Beijing, China
| | - Ruolan Huang
- Department of Neurology, Shenzhen University Clinical Research Center for Neurological Diseases, Shenzhen University General Hospital, Shenzhen, China
| | - Yunsheng Yang
- Medical School of Chinese PLA, Beijing, China
- Department of Gastroenterology and Hepatology, The First Centre of Chinese PLA General Hospital, Beijing, China
| | - Zikai Wang
- Medical School of Chinese PLA, Beijing, China
- Department of Gastroenterology and Hepatology, The First Centre of Chinese PLA General Hospital, Beijing, China
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Aderinto N, Olatunji G, Afolabi S, Muili A, Olaniyi P, Edun M, Olakanmi D. Sleep patterns and quality among Nigerian medical students: A cross-sectional study. Medicine (Baltimore) 2024; 103:e37556. [PMID: 38518024 PMCID: PMC10956952 DOI: 10.1097/md.0000000000037556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/19/2024] [Indexed: 03/24/2024] Open
Abstract
Adequate sleep is crucial for individuals' well-being and cognitive functioning. However, medical students face unique challenges that disrupt their sleep patterns, such as a rigorous curriculum, long study hours, and high-stress levels. Understanding the sleep patterns and quality among medical students in Nigeria is important to develop targeted interventions and support their overall well-being. This study involved 802 medical students from 3 medical schools in Southwest Nigeria. Participants completed an online questionnaire that collected data on their demographic characteristics, sleep patterns and self-reported sleep quality. Descriptive statistics and correlation analysis were used to analyze the data and identify patterns and associations. Most participants were female (56.9%), with the highest representation from the UNILORIN (65.5%). The average reported sleep duration was 5.74 hours per night, indicating insufficient sleep. Irregular bedtimes and wake-up times were commonly reported. A significant proportion of students consumed coffee late at night (27.1%) and used medication to induce sleep (24.3%). Sleep patterns and behaviors, such as snoring (36.1%) and nocturnal eating (57.6%), were reported. Overall, participants reported satisfactory (28.3%) or poor (29.7%) sleep quality. Correlation analysis revealed significant associations between sleep patterns, sleep quality, academic performance, and other sleep-related factors. The study identified insufficient sleep duration, irregular bedtimes, late-night coffee consumption, and poor sleep quality. These findings emphasize the need for interventions and strategies to promote healthy sleep habits among medical students, which can positively impact their overall health and academic performance.
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Affiliation(s)
- Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Gbolahan Olatunji
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Samson Afolabi
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Abdulbasit Muili
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Peter Olaniyi
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Mariam Edun
- Department of Medicine and Surgery, University of Ilorin, Ilorin, Nigeria
| | - Damilare Olakanmi
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
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Yu C, Liu Z, Su T, Li Z, Jiang Z, Zhong W, Xiao Z. The effect of anxiety on sleep disorders in medical students: a moderated mediation model. Front Psychol 2024; 15:1338796. [PMID: 38529089 PMCID: PMC10961465 DOI: 10.3389/fpsyg.2024.1338796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/19/2024] [Indexed: 03/27/2024] Open
Abstract
The relationship between anxiety and sleep disorders is a key research topic in the academic community. However, evidence on the mechanism through which anxiety influences sleep disorders remains limited. The purpose of this study was to investigate the roles of flourishing and neuroticism in the mechanism through which anxiety influences sleep disorders in medical students. We constructed a moderated mediation model and tested the mediating role of flourishing and the moderating role of neuroticism in medical college students. The results showed that: (1) anxiety was significantly and positively related to sleep disorders and significantly and negatively related to flourishing; flourishing was significantly and negatively related to sleep disorders; neuroticism was significantly and positively related to sleep disorders; (2) flourishing had a mediation effect on the relationship between anxiety and sleep disorders; (3) neuroticism moderated the process through which flourishing mediated the effect of anxiety on sleep disorders. Our research expands the literature on the mechanism underlying the effects of anxiety on sleep disorders and provides insights into the potential prevention and intervention of sleep and emotional problems in medical students.
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Affiliation(s)
- Chuang Yu
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
- Department of Physiology, School of Basic Medical Sciences, Key Laboratory of Psychiatric Disorders of Guangdong Province, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Zhiyi Liu
- Department of Physiology, School of Basic Medical Sciences, Key Laboratory of Psychiatric Disorders of Guangdong Province, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Tiehong Su
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
- Department of Physiology, School of Basic Medical Sciences, Key Laboratory of Psychiatric Disorders of Guangdong Province, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Zhongyu Li
- Department of Physiology, School of Basic Medical Sciences, Key Laboratory of Psychiatric Disorders of Guangdong Province, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Zinan Jiang
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
- Department of Physiology, School of Basic Medical Sciences, Key Laboratory of Psychiatric Disorders of Guangdong Province, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
| | - Wen Zhong
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Zhongju Xiao
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
- Department of Physiology, School of Basic Medical Sciences, Key Laboratory of Psychiatric Disorders of Guangdong Province, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Key Laboratory of Mental Health of the Ministry of Education, Southern Medical University, Guangzhou, China
- General Practice Center, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
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Zaffanello M, Pietrobelli A, Cavarzere P, Guzzo A, Antoniazzi F. Complex relationship between growth hormone and sleep in children: insights, discrepancies, and implications. Front Endocrinol (Lausanne) 2024; 14:1332114. [PMID: 38327902 PMCID: PMC10847528 DOI: 10.3389/fendo.2023.1332114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/04/2023] [Indexed: 02/09/2024] Open
Abstract
Growth hormone (GH) is crucial to growth and development. GH secretion is regulated by a complex feedback system involving the pituitary gland, hypothalamus, and other organs, and predominantly occurs during deep sleep. Isolated and idiopathic growth hormone deficiency (GHD) is a condition characterized by GHD without any other signs or symptoms associated with a specific syndrome or disease. The aim of this narrative review was to evaluate the relationship between GH and sleep in children using published data. Various databases (Medline/PubMed, Scopus, and Web of Science) were systematically searched for relevant English language articles published up to April 2023. Search strategies included the terms 'children/pediatric', 'growth hormone', 'growth hormone deficiency' and 'sleep'. Data were extracted by two independent reviewers; 185 papers were identified of which 58 were duplicates and 118 were excluded (unrelated n=83, syndromic/genetic GHD n=17, non-English n=13, abstract n=1, case report n=1). Overall, nine studies (six clinical studies, two case series, and one survey) were included. GHD appears to have an adverse effect on sleep in children, and GH therapy has only been shown to have a beneficial effect on sleep parameters in some individuals. Notably, identified data were limited, old/poor quality, and heterogenous/inconsistent. Further research of GHD in pediatric populations is necessary to improve the understanding of GHD impact on sleep and its underlying mechanisms, and to determine the specific impacts of GH therapy on sleep in children.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Angelo Pietrobelli
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Paolo Cavarzere
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Alessandra Guzzo
- Department of Pathology and Diagnostics, School of Medicine, University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
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Sagun S, DeCicco D, Badami V, Mittal A, Thompson J, Pham C, Stansbury R, Wen S, Sharma S. iSleepFirst: burnout, fatigue, and wearable-tracked sleep deprivation among residents staffing the medical intensive care unit. Sleep Breath 2023; 27:2491-2497. [PMID: 37243855 PMCID: PMC10224664 DOI: 10.1007/s11325-023-02839-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE This study aimed to evaluate the relationship between sleep, burnout, and psychomotor vigilance in residents working in the medical intensive care unit (ICU). METHODS A prospective cohort study of residents was implemented during a consecutive 4-week. Residents were recruited to wear a sleep tracker for 2 weeks before and 2 weeks during their medical ICU rotation. Data collected included wearable-tracked sleep minutes, Oldenburg burnout inventory (OBI) score, Epworth sleepiness scale (ESS), psychomotor vigilance testing, and American Academy of Sleep Medicine sleep diary. The primary outcome was sleep duration tracked by the wearable. The secondary outcomes were burnout, psychomotor vigilance (PVT), and perceived sleepiness. RESULTS A total of 40 residents completed the study. The age range was 26-34 years with 19 males. Total sleep minutes measured by the wearable decreased from 402 min (95% CI: 377-427) before ICU to 389 (95% CI: 360-418) during ICU (p < 0.05). Residents overestimated sleep, logging 464 min (95% CI: 452-476) before and 442 (95% CI: 430-454) during ICU. ESS scores increased from 5.93 (95% CI: 4.89, 7.07) to 8.33 (95% CI: 7.09,9.58) during ICU (p < 0.001). OBI scores increased from 34.5 (95% CI: 32.9-36.2) to 42.8 (95% CI: 40.7-45.0) (p < 0.001). PVT scores worsened with increased reaction time while on ICU rotation (348.5 ms pre-ICU, 370.9 ms post-ICU, p < 0.001). CONCLUSIONS Resident ICU rotations are associated with decreased objective sleep and self-reported sleep. Residents overestimate sleep duration. Burnout and sleepiness increase and associated PVT scores worsen while working in the ICU. Institutions should ensure resident sleep and wellness checks during ICU rotation.
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Affiliation(s)
- Steven Sagun
- Department of Medicine, West Virginia University Hospitals, Morgantown, WV, 26506, USA
| | - Danielle DeCicco
- Department of Medicine, West Virginia University Hospitals, Morgantown, WV, 26506, USA
| | - Varun Badami
- Department of Medicine, West Virginia University Hospitals, Morgantown, WV, 26506, USA
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Health Science Center North, West Virginia University Hospitals, Room 4075A, PO Box 9166, Morgantown, WV, 26506, USA
| | - Abhinav Mittal
- Section of Interventional Pulmonology, Division of Thoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
- Department of Pulmonary & Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Jesse Thompson
- Department of Medicine, West Virginia University Hospitals, Morgantown, WV, 26506, USA
| | - Christopher Pham
- Department of Medicine, West Virginia University Hospitals, Morgantown, WV, 26506, USA
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Health Science Center North, West Virginia University Hospitals, Room 4075A, PO Box 9166, Morgantown, WV, 26506, USA
| | - Robert Stansbury
- Department of Medicine, West Virginia University Hospitals, Morgantown, WV, 26506, USA
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Health Science Center North, West Virginia University Hospitals, Room 4075A, PO Box 9166, Morgantown, WV, 26506, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburg, 15213, USA
| | - Sijin Wen
- Department of Biostatistics in the School of Public Health at West Virginia University, Morgantown, WV, 26506, USA
| | - Sunil Sharma
- Department of Medicine, West Virginia University Hospitals, Morgantown, WV, 26506, USA.
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Health Science Center North, West Virginia University Hospitals, Room 4075A, PO Box 9166, Morgantown, WV, 26506, USA.
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Wang S, Luo G, Zhang X, Jing Y, Zaimina, Yao C, Li M, Chen H, Li J. Prevalence and influencing factors of sleep disturbance among medical students under the COVID-19 pandemic. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01707-6. [PMID: 38007404 DOI: 10.1007/s00406-023-01707-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/15/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Medical students may feel severe psychological stress during COVID-19, which might impair their ability to sleep. This research aimed to look at the risk factors for sleep disturbance and the prevalence of sleep disturbance among medical students. METHODS 538 medical students in total were recruited for this research. Anxiety, depression, and sleep disturbance were assessed using the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI). To evaluate the possible risk variables, we computed descriptive statistics for each assessment item and ran univariate and logistic regression analyses. RESULTS Medical students had a 63.6% prevalence of sleep disturbance (n = 342). According to logistic regression, introverted students are 1.77 times more likely than extroverted students to have sleep disturbance (OR = 1.77, 95% CI 1.08-2.91). Medical students with depression had a 5.6-times higher risk of sleep disturbance than those without depression (OR = 5.60, 95% CI 3.43-9.15). Additionally, medical students with anxiety were 3.95 times more likely than those without anxiety to have sleep disturbance (OR = 3.95, 95% CI 2.04-7.64). CONCLUSIONS According to this research, the COVID-19 pandemic caused significant sleep disturbance among medical students. Additionally, among medical students, introversion, anxiety, and depression were risk factors for sleep disturbance.
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Affiliation(s)
- Shuo Wang
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China
| | - Guoshuai Luo
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China
| | - Xue Zhang
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China
| | - Yifan Jing
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China
| | - Zaimina
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China
| | - Cong Yao
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China
| | - Meijuan Li
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China
| | - Hongli Chen
- State Key Laboratory of Separation Membrane and Membrane Process, Tiangong University, Tianjin, 300387, China
| | - Jie Li
- Institute of Mental Health, Tianjin Anding Hospital, Mental Health Center of Tianjin Medical University, 13 Liulin Road, Tianjin, 300222, China.
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Wang Y, Guang Z, Zhang J, Han L, Zhang R, Chen Y, Chen Q, Liu Z, Gao Y, Wu R, Wang S. Effect of Sleep Quality on Anxiety and Depression Symptoms among College Students in China's Xizang Region: The Mediating Effect of Cognitive Emotion Regulation. Behav Sci (Basel) 2023; 13:861. [PMID: 37887511 PMCID: PMC10603987 DOI: 10.3390/bs13100861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND While the exact mechanisms are not fully understood, there are significant links between sleep quality, anxiety, depressive symptoms, and cognitive emotion regulation. This research examines how sleep quality affects anxiety and depressive symptoms, as well as the potential of cognitive emotion regulation strategies (CERS) to moderate the impact of sleep quality on these symptoms. METHODS The Chinese version of the Pittsburgh Sleep Quality Index (CPSQI), the Cognitive Emotion Regulation Questionnaire (CERQ), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder Scale-7 (GAD-7) were all completed online by students from two colleges in China's Xizang region. RESULTS The study included 4325 subjects. The prevalence of poor sleep quality, anxiety symptoms, and depression symptoms was 45.69%, 36.81%, and 51.86%, respectively. We observed significant direct effects on poor sleep and severity of anxiety/depression: c'1 = 0.586 (0. 544-0.628), and c'2 = 0.728 (0.683-0.773). Adaptive CERS only had a mediating effect on the relationship between sleep quality and depression symptoms, with a1b3 = -0.005 (-0.011--0.001). The link between poor sleep quality and the intensity of anxiety and depression was significantly affected by the indirect effects of maladaptive CERS: effect a2b2 = 0.126 (0.106-0.147), and effect a2b4 = 0.145 (0.123-0.167). CONCLUSIONS Individuals who experience poor sleep quality are more likely to have increased levels of anxiety and depression. However, enhancing sleep quality led to a decrease in anxiety and depression levels. Adaptive CERS did not predict anxiety, but they did predict depression. Multiple maladaptive CERS could increase levels of anxiety and depression. To prevent mental stress, it is crucial to examine sleep problems among college students, understand their cognitive strategies, promote the adoption of adaptive CERS, and reduce the reliance on maladaptive CERS.
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Affiliation(s)
- Yingting Wang
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang 712082, China
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, Xianyang 712082, China
| | - Zixuan Guang
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang 712082, China
| | - Jinjing Zhang
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, Xianyang 712082, China
| | - Lixin Han
- School of Public Health, Xi’an Jiaotong University Health Science Center, No.76 Yanta West Road, Xi’an 710049, China
- Disease Control and Prevention Division, Shaanxi Provincial Health Commission, No.112 Lianhu Road, Xi’an 710003, China
| | - Rongqiang Zhang
- School of Public Health, Shaanxi University of Chinese Medicine, Xianyang 712046, China
| | - Yichun Chen
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, Xianyang 712082, China
| | - Qi Chen
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang 712082, China
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China
| | - Zhenjia Liu
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang 712082, China
| | - Yuan Gao
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang 712082, China
| | - Ruipeng Wu
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang 712082, China
- Key Laboratory of High Altitude Hypoxia Environment and Life Health, School of Medicine, Xizang Minzu University, Xianyang 712082, China
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China
| | - Shaokang Wang
- Key Laboratory for Molecular Genetic Mechanisms and Intervention Research on High Altitude Disease of Tibet Autonomous Region, School of Medicine, Xizang Minzu University, Xianyang 712082, China
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, Nanjing 210009, China
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Alesci RS, Hecking C, Weissmann MV. Identification of an Unmet Medical Need: Height of Depression, Hypersomnia, and Sleep Apnea Positively Correlate With the Level of Fatigue in Patients With Immune Thrombocytopenia. Cureus 2023; 15:e47003. [PMID: 37965409 PMCID: PMC10641264 DOI: 10.7759/cureus.47003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Immune thrombocytopenia (ITP) is a rare chronic disease, frequently accompanied by fatigue, which is an important comorbidity associated with this disease. Patients experience difficulties in managing their daily activities and a reduction in their overall quality of life (QoL). The causes of fatigue in ITP are not clarified yet, and underlying causes seem to be multifactorial. The development of fatigue may not solely be influenced by a decrease in platelet count but also by unknown factors as well as psychological reasons. METHODS This prospective, multicenter, exploratory, pilot study aimed to investigate which parameters contribute to the occurrence of fatigue in patients with ITP. Adult patients with ITP and with or without fatigue who visited the study center for their regular appointments were asked to complete questionnaires pertaining to patient-reported outcome measures regarding bleeding symptoms, depression, sleep apnea, and hypersomnia. Blood tests included platelet count as well as different parameters like vitamin D. RESULTS A total of 36 patients (100%; 27 females (75%) and nine males (25%)) with primary ITP, with a median age of 46.5 years (range 19‑83 years) were analyzed. The median duration of ITP was 4.5 years (min‑max 0-21). Approximately one-third of patients (29.4%; 10/34 patients) had no comorbidities. The two most frequently used current treatment options were "watch-and-wait" (38.9%; 14/36 patients) and "avatrombopag" (30.6%; 11/36 patients); eight patients (22.2%; 8/36 patients) needed rescue therapy with corticosteroids. There was a statistically negative correlation between fatigue and year of diagnosis (r=-0.41, p=0.014). Results indicated no statistically significant relationship between fatigue and age or differences in fatigue between the genders. Ferritin predicted fatigue with statistical significance. Platelet count was not correlated with the level of fatigue. A significant correlation was obvious between fatigue, depression, and obstructive sleep apnea syndrome (OSAS) as well as sleep-related problems (p<0.01). DISCUSSION Patient characteristics were comparable to that of other studies. The level of fatigue negatively impacts the lives of patients with ITP. Age and gender were not correlated with fatigue in ITP, which is in line with other reports. Interestingly, the fatigue level was higher in patients presenting with additional depression and poor sleeping quality due to, e.g., hypersomnia, which seems common. Fatigue levels seem independent from thrombocyte levels, which were reported elsewhere. CONCLUSION Patients diagnosed with ITP several years ago cope with their condition better than patients with a more recent diagnosis, who have higher levels of fatigue. Concurrent depression, hypersomnia, and sleep apnea are important underestimated factors, which do have a negative effect on the QoL of patients with ITP. We were able to show that patients with ITP might face an unmet medical need in terms of delayed diagnosis and supportive therapy. To our knowledge, this is the first report on combined findings of depression, hypersomnia, and sleep apnea in patients with ITP.
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Affiliation(s)
- Rosa S Alesci
- Blood Coagulation Centre, Medizinisches Versorgungszentrum (MVZ) Institut für Medizinische Diagnostik (IMD) GmbH, Bad Homburg, DEU
| | - Carola Hecking
- Blood Coagulation Centre, Medizinisches Versorgungszentrum (MVZ) Institut für Medizinische Diagnostik (IMD) GmbH, Bad Homburg, DEU
| | - Maike V Weissmann
- Blood Coagulation Centre, Medizinisches Versorgungszentrum (MVZ) Institut für Medizinische Diagnostik (IMD) GmbH, Mannheim, DEU
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O'Hora KP, Schleifer CH, Bearden CE. Sleep in 22q11.2 Deletion Syndrome: Current Findings, Challenges, and Future Directions. Curr Psychiatry Rep 2023; 25:479-491. [PMID: 37721640 PMCID: PMC10627929 DOI: 10.1007/s11920-023-01444-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE OF REVIEW To summarize current literature available on sleep in 22q11.2 Deletion Syndrome (22q11.2DS; Velocardiofacial or DiGeorge Syndrome), a neurogenetic disorder caused by a hemizygous deletion in a genomic region critical for neurodevelopment. Due to the greatly increased risk of developmental psychiatric disorders (e.g., autism and schizophrenia) in 22q11.2DS, this review focuses on clinical correlates of sleep disturbances and potential neurobiological underpinnings of these relationships. RECENT FINDINGS Sleep disturbances are widely prevalent in 22q11.2DS and are associated with worse behavioral, psychiatric, and physical health outcomes. There are reports of sleep architecture and sleep neurophysiology differences, but the literature is limited by logistical challenges posed by objective sleep measures, resulting in small study samples to date. Sleep disturbances in 22q11.2DS are prevalent and have a substantial impact on well-being. Further investigation of sleep in 22q11.2DS utilizing multimodal sleep assessments has the potential to provide new insight into neurobiological mechanisms and a potential trans-diagnostic treatment target in 22q11.2DS.
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Affiliation(s)
- Kathleen P O'Hora
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
- Neuroscience Interdepartmental Program, University of California, Los Angeles, CA, USA
| | - Charles H Schleifer
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
- Neuroscience Interdepartmental Program, University of California, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, 760 Westwood Plaza, Los Angeles, CA, 90095, USA.
- Department of Psychology, University of California, Los Angeles, CA, USA.
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Wang J, Liu M, Bai J, Chen Y, Xia J, Liang B, Wei R, Lin J, Wu J, Xiong P. Prevalence of common mental disorders among medical students in China: a systematic review and meta-analysis. Front Public Health 2023; 11:1116616. [PMID: 37719741 PMCID: PMC10501456 DOI: 10.3389/fpubh.2023.1116616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/04/2023] [Indexed: 09/19/2023] Open
Abstract
Background The prevalence of mental distress is common for medical students in China due to factors such as the long duration of schooling, stressful doctor-patient relationship, numerous patient population, and limited medical resources. However, previous studies have failed to provide a comprehensive prevalence of these mental disorders in this population. This meta-analysis aimed to estimate the prevalence of common mental disorders (CMDs), including depression, anxiety, and suicidal behaviors, among medical students in China. Methods We conducted a systematic search for empirical studies on the prevalence of depression, anxiety, suicide attempt, suicide ideation, and suicide plan in Chinese medical students published from January 2000 to December 2020. All data were collected pre-COVID-19. The prevalence and heterogeneity estimations were computed by using a random-effects model and univariate meta-regression analyses. Results A total of 197 studies conducted in 23 provinces in China were included in the final meta-analysis. The prevalence data of depression, anxiety, suicide attempt, suicide ideation, and suicide plan were extracted from 129, 80, 21, 53, and 14 studies, respectively. The overall pooled crude prevalence for depression was 29% [38,309/132,343; 95% confidence interval (CI): 26%-32%]; anxiety, 18% (19,479/105,397; 95% CI: 15%-20%); suicide ideation, 13% (15,546/119,069; 95% CI: 11%-15%); suicide attempt, 3% (1,730/69,786; 95% CI: 1%-4%); and suicide plan, 4% (1,188/27,025; 95% CI: 3%-6%). Conclusion This meta-analysis demonstrated the high prevalence of CMDs among Chinese medical students. Further research is needed to identify targeted strategies to improve the mental health of this population.
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Affiliation(s)
- Jinxingyi Wang
- The Second Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Min Liu
- Zhuhai Center for Maternal and Child Health Care, Zhuhai Women and Children's Hospital, Zhuhai, China
| | - Jian Bai
- School of Medicine, Jinan University, Guangzhou, China
| | - Yuhan Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Jie Xia
- The Second Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Baolin Liang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Ruixuan Wei
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Jiayin Lin
- School of Stomatology, Jinan University, Guangzhou, China
| | - Jiajun Wu
- School of Nursing, Jinan University, Guangzhou, China
| | - Peng Xiong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
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Hamvai C, Kiss H, Vörös H, Fitzpatrick KM, Vargha A, Pikó BF. Association between impulsivity and cognitive capacity decrease is mediated by smartphone addiction, academic procrastination, bedtime procrastination, sleep insufficiency and daytime fatigue among medical students: a path analysis. BMC MEDICAL EDUCATION 2023; 23:537. [PMID: 37501113 PMCID: PMC10375684 DOI: 10.1186/s12909-023-04522-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Medical students are at high risk for sleep disturbance. One possible cause of their sleeping problem is impulsivity. We aim to investigate the possible mediators between medical students' impulsivity and sleep outcomes. Thus, we developed and investigated a model where the predictors were attentional, non-planning, and motor impulsivity subtraits. In the final model, subjective cognitive capacity decrease was the outcome variable. In light of previous findings, academic procrastination, smartphone addiction, and bedtime procrastination were considered important mediators as well as two variables of poor sleep, sleeping insufficiency, and daytime fatigue. METHODS Medical students (N = 211; ageM = 22.15 years; ageSD = 3.47 years; 71.6% women) were recruited to complete an online survey comprised of demographics (age, gender), self-administered scales (Abbreviated Impulsiveness Scale, Bedtime Procrastination Scale, Abbreviated Impulsiveness Scale, Academic Procrastination Scale-Short Form) and questions on tiredness, daily fatigue and subjective cognitive capacity decrease. Correlation and path analyses were implemented to examine hypothesized relationships between the variables. RESULTS Both attentional impulsivity (β = 0.33, p < .001) and non-planning impulsivity (β = -0.19, p < .01) had a direct relationship with cognitive capacity decrease. Attentional impulsivity was also associated with decreased cognitive capacity with a serial mediation effect via smartphone addiction, academic procrastination, bedtime procrastination, sleep insufficiency and fatigue (estimate = 0.017, p < .01). The indirect link between non-planning impulsivity and cognitive capacity decrease was mediated by academic procrastination, bedtime procrastination, sleep insufficiency and fatigue (estimate = 0.011, p < .01). CONCLUSIONS Inability to stay focused and plan tasks effectively (directly and indirectly) predicts poor sleep outcomes. This relationship is mediated by excessive smartphone use, academic procrastination, and bedtime procrastination. Our findings are relevant in light of self-regulatory learning, which is crucial in medical education. This is a recursive cycle of planning, emotion regulation, proper strategy selection and self-monitoring. Future interventions addressing attentional and non-planning impulsivity, problematic smartphone use, academic procrastination, and in turn, bedtime procrastination might make this routine more effective. In the conclusion section, practical implications of the results are discussed.
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Affiliation(s)
- Csaba Hamvai
- Department of Behavioral Sciences, University of Szeged, Mars tér 20, 6722, Szeged, Hungary.
| | - Hedvig Kiss
- Department of Behavioral Sciences, University of Szeged, Mars tér 20, 6722, Szeged, Hungary
| | - Henrietta Vörös
- Department of Behavioral Sciences, University of Szeged, Mars tér 20, 6722, Szeged, Hungary
| | - Kevin M Fitzpatrick
- Department of Sociology & Criminology, University of Arkansas, Fayetteville, AR, USA
| | - András Vargha
- Institute of Psychology, Károli Gáspár Reformed Church University, Budapest, Hungary
- Institute of Psychology, Eötvös Loránad University, Budapest, Hungary
| | - Bettina F Pikó
- Department of Behavioral Sciences, University of Szeged, Mars tér 20, 6722, Szeged, Hungary
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Binjabr MA, Alalawi IS, Alzahrani RA, Albalawi OS, Hamzah RH, Ibrahim YS, Buali F, Husni M, BaHammam AS, Vitiello MV, Jahrami H. The Worldwide Prevalence of Sleep Problems Among Medical Students by Problem, Country, and COVID-19 Status: a Systematic Review, Meta-analysis, and Meta-regression of 109 Studies Involving 59427 Participants. CURRENT SLEEP MEDICINE REPORTS 2023; 9:1-19. [PMID: 37359215 PMCID: PMC10238781 DOI: 10.1007/s40675-023-00258-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/28/2023]
Abstract
Abstract Purpose of Review Several studies have found that medical students have a significant prevalence of sleep issues, such as poor sleep quality, excessive daytime sleepiness, and inadequate sleep duration. The purpose of this review is to carefully evaluate the current research on sleep problems among medical students and, as a result, estimate the prevalence of these disturbances. The EMBASE, PsychINFO, PubMed/MEDLINE, ScienceDirect, Scopus, and Web of Science and retrieved article reference lists were rigorously searched and rated for quality. Random effects meta-analysis was performed to compute estimates. Recent Findings The current meta-analysis revealed an alarming estimated pooled prevalence of poor sleep quality (K = 95, N = 54894) of 55.64% [95%CI 51.45%; 59.74%]. A total of 33.32% [95%CI 26.52%; 40.91%] of the students (K = 28, N = 10122) experienced excessive sleepiness during the day. The average sleep duration for medical students (K = 35, N = 18052) is only 6.5 h per night [95%CI 6.24; 6.64], which suggests that at least 30% of them get less sleep than the recommended 7-9 h per night. Summary Sleep issues are common among medical students, making them a genuine problem. Future research should focus on prevention and intervention initiatives aimed at these groups. Supplementary Information The online version contains supplementary material available at 10.1007/s40675-023-00258-5.
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Affiliation(s)
- Mohammed A. Binjabr
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Idrees S. Alalawi
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Rayan A. Alzahrani
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Othub S. Albalawi
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Rakan H. Hamzah
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Yazed S. Ibrahim
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Fatima Buali
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Mariwan Husni
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Ahmed S. BaHammam
- Department of Medicine, University Sleep Disorders Center and Pulmonary Service, King Saud University, KSA, Riyadh, Saudi Arabia
- The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
| | - Michael V. Vitiello
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, USA
| | - Haitham Jahrami
- Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
- Government Hospitals, Manama, Bahrain
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Maxwell RA, Reisinger‐Kindle KM, Rackett TM, Yaklic JL, Czerwinski SA, Lee M. Perceived quality of sleep across the menopausal transition: A retrospective cohort study. Health Sci Rep 2023; 6:e1250. [PMID: 37283881 PMCID: PMC10240097 DOI: 10.1002/hsr2.1250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 06/08/2023] Open
Abstract
Background and Aims To compare sleep quality among naturally and surgically post-menopausal women, and to identify lifestyle factors that predict sleep quality in pre, peri, and postmenopausal women. Methods This is a retrospective cohort study of data collected from 429 women who participated in Fels Longitudinal Study data. Sleep quality, based on the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale, demographics, medical history, depression, quality of life, and physical activity levels were included in the analysis. Results The four study groups did not differ on overall sleep quality with either scale (p = 0.61). Both Post-M groups were more likely to have a major sleep problem than the Peri-M and Pre-M groups (p < 0.001), and to have a history of restless leg syndrome (p = 0.016), but the two Post-M groups did not differ on these problems. Predictors of sleep quality included depression, bodily pain, vitality, and surgical menopause (p<0.001). Conclusion Menopause is associated with sleep disrupting conditions. This study did not find any significant differences in sleep quality among the three reproductive stages or for natural versus surgical menopause. Women may benefit from addressing other lifestyle factors associated with poor sleep quality including mental health factors.
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Affiliation(s)
- Rose A. Maxwell
- Department of Obstetrics and GynecologyWright State UniversityDaytonOhioUSA
| | | | - Traci M. Rackett
- Department of Obstetrics and GynecologyWright State UniversityDaytonOhioUSA
| | - Jerome L. Yaklic
- Department of Obstetrics and GynecologyThe University of Texas Medical Branch at GalvestonGalvestonTexasUSA
| | | | - Miryoung Lee
- School of Public Health Health Science Center at Houston (UTHealth)The University of TexasHoustonTexasUSA
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23
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Mello DRB, Ortega F, Müller MR, Apratto Júnior PC. [Reflexive groups with medical students from the mental health league as a strategy for change]. CIENCIA & SAUDE COLETIVA 2023; 28:887-896. [PMID: 36888871 DOI: 10.1590/1413-81232023283.10962022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/01/2022] [Indexed: 03/08/2023] Open
Abstract
This paper set out to present the outcomes of qualitative research conducted with medical students of a Mental Health and Psychiatry League (LASMP). Its objectives were to sensitize them to perceive themselves as people and provide them with other rationales different from biomedical ways of thinking. The reflexive groups, within the culture circle, provided an opportunity for an exchange of ideas, time for reflection and sharing of fully formed daily experiences. They were configured as a strategy of change and awakening to rethink models of health more focused on healthcare than on diseases. Participant observation enabled revealing, through the narratives, particularities of the experiences, discourses and culture of the group itself. The analyses were carried out using the reflexivity method (Bourdieu, 2001; 2004), as it permits the systematic deepening of the contents of the narratives. Without any pretension of synthesis, the reflexive course on the narratives started from the assumptions of thought and actions to arrive at the constructed and shared meanings. They offered possibilities of transforming the way of perceiving the world of work, themselves, and the people around them; of changing the understanding of mental health beyond the individual level.
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Affiliation(s)
| | - Francisco Ortega
- Institució Catalana de Recerca i Estudis Avançats. Barcelona Espanha
| | - Manuela Rodrigues Müller
- Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro. Rio de Janeiro RJ Brasil
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Kong LN, Yao Y, Chen SZ, Zhu JL. Prevalence and associated factors of burnout among nursing students: A systematic review and meta-analysis. NURSE EDUCATION TODAY 2023; 121:105706. [PMID: 36577286 DOI: 10.1016/j.nedt.2022.105706] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To systematically estimate the global prevalence of burnout among nursing students, and examine the associated factors of burnout in this population. DESIGN A systematic review and meta-analysis. REVIEW METHODS AND DATA SOURCES PubMed, Embase, Web of Science, and CINAHL were searched from inception to June 30th, 2022. Two researchers independently screened studies, extracted data and assessed the quality of included studies. The random-effects model was used to estimate the global prevalence of burnout among nursing students. Subgroup analysis, meta-regression analysis, publication bias, and sensitivity analysis were also conducted. RESULTS A total of 21 studies were included, involving 10,861 nursing students. In the random-effects model, the pooled prevalence of burnout was 23.0 % (95 % CI = 15.6-30.5 %) in nursing students. The pooled prevalence of emotional exhaustion, depersonalization, and reduced personal accomplishment was 47.1 %, 32.2 %, and 43.5 %, respectively. Main associated factors of burnout included demographic (e.g., age and grade), educational (e.g., workload, academic satisfaction, and incivility experience), physical (e.g., sleep quality and physical activity), and psychological (e.g., self-efficacy and personality traits) factors. CONCLUSIONS Burnout is common in nursing students, with demographic, educational, physical, and psychological factors affecting their burnout. Early screening of burnout and interventions to prevent and reduce burnout should be considered for nursing students.
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Affiliation(s)
- Ling-Na Kong
- School of Nursing, Chongqing Medical University, Chongqing, China.
| | - Yu Yao
- School of Nursing, Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Shuo-Zhen Chen
- Clinical Nursing Teaching and Research Section, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jia-Lu Zhu
- Nursing Department, The Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Insomnia, Daytime Sleepiness, and Quality of Life among 20,139 College Students in 60 Countries around the World-A 2016-2021 Study. J Clin Med 2023; 12:jcm12020692. [PMID: 36675621 PMCID: PMC9866097 DOI: 10.3390/jcm12020692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 12/30/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Background: Sleep disorders are a widespread phenomenon, and the number of individuals suffering from them is increasing every year, especially among young adults. Currently, the literature lacks studies that cover both countries with different levels of development and a period before the announcement of the ongoing COVID-19 pandemic. Therefore, this study aims to globally assess the prevalence of insomnia and daytime sleepiness among students and assess their quality of life. Methods: For this purpose, our own questionnaire was distributed online via Facebook.com. In addition to the questions that assessed socioeconomic status, the survey included psychometric tools, such as the Athens insomnia scale (AIS), the Epworth sleepiness scale (ESS), and the Manchester short assessment of the quality of life (MANSA). The survey distribution period covered 31 January 2016 to 30 April 2021. Results: The survey involved 20,139 students from 60 countries around the world. The vast majority of the students were women (78.2%) and also those residing in countries with very high levels of development and/or high GDP (gross domestic product) per capita at 90.4% and 87.9%, respectively. More than half (50.6%) of the respondents (10,187) took the survey before the COVID-19 pandemic was announced. In the group analyzed, 11,597 (57.6%) students obtained a score indicative of insomnia and 5442 (27.0%) a score indicative of daytime sleepiness. Women, low-income residents, and nonmedical students were significantly more likely to have scores indicating the presence of insomnia. Individuals experiencing both sleepiness (B = −3.142; p < 0.001) and daytime sleepiness (B = −1.331; p < 0.001) rated their quality of life significantly lower. Conclusions: Insomnia and excessive daytime sleepiness are common conditions among students worldwide and are closely related. The COVID-19 pandemic significantly altered students’ diurnal rhythms, which contributed to an increase in insomnia. Students in countries with a high GDP per capita index are significantly less likely to develop insomnia compared to the residents of countries with a low GDP per capita index. Sleep disorders definitely reduce the quality of life of students.
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Babicki M. Use of Alcohol, Cannabinoids, Psychostimulants, and Sedatives before and during the COVID-19 Pandemic among Students in 40 European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14879. [PMID: 36429598 PMCID: PMC9690623 DOI: 10.3390/ijerph192214879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 06/16/2023]
Abstract
In March 2020, the WHO announced the COVID-19 pandemic, which has been ongoing for over 2 years. To stop the spread of the virus, the governments of many countries decided to introduce reasonable social restrictions that were suitable for pandemic waves. This led to radical changes in people's lives, especially among students, who are very active in society. Before COVID-19, being of student age was associated with the highest frequency of stimulants use. It is important to note that drugs are taken disparately in various areas. Therefore, using the Computer-Assisted Web Interview type of study, the impact of the pandemic on the use of alcohol, cannabinoids, psychostimulants (e.g., amphetamine, methamphetamine, ecstasy) and sedatives (e.g., zolpidem, zopiclone, alprazolam, lorazepam, etc.) was assessed among students from European countries. The questionnaire included single- and multiple-answer questions. The first part concerned sociodemographic questions, while the second included questions about the use of stimulants in the last 3 months prior to participation in the study. Distribution of the survey covered the period from 31 January 2016 to 30 April 2021. A total of 17,594 European students participated in the study. The vast majority of participants were women (80.4%) and students of non-medical universities (77.2%) living in Eastern European countries (86.1%). Of all students, 15,613 (89.6%) reported alcohol drinking, 2538 (14.1%) the use of cannabinoids, 650 (3.6%) psychostimulants, and 2252 (12.5%) sedatives in the past three months. It has been shown that women are far less likely to use alcohol (OR 0.81), psychostimulants (OR 0.44) and cannabinoids (OR 0.49), while they are more likely to use sedatives (OR 1.41). During the COVID-19 pandemic, the consumption of alcohol (OR 0.55) and psychostimulants (OR 0.72) decreased and that of sleep medications increased (OR 1.17). To conclude, the COVID-19 pandemic influenced the pattern of stimulants used by students in European countries. The restriction of social interactions contributed to the decrease in the consumption of alcohol and psychostimulants but increased the use of sedatives and the frequency of their use. Women were found to use sedatives more often, while men preferred to drink alcohol and use cannabinoids or psychostimulants. It has also been shown that students of Central and Eastern Europe more often use alcohol and sedatives, while in Southern European countries psychostimulants and cannabinoids are preferred.
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Affiliation(s)
- Mateusz Babicki
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland
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Lankrew Ayalew T, Wale BG, Haile KE. Prevalence and associated factors of sleep deprivation among Haramaya University students, Ethiopia, 2021: cross-sectional study. SLEEP SCIENCE AND PRACTICE 2022. [DOI: 10.1186/s41606-022-00080-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Sleep deprivation is the lack of sleep that is associated with an increased risk of cardiovascular illness, diabetes, obesity, cognitive impairment, vehicle accidents, and workplace accidents, as well as being a direct source of daily dysfunction. Despite the fact that some studies have been undertaken, there is a shortage of data on the incidence of sleep deprivation and associated factors among university students in Africa, particularly in Ethiopia, where the study area is located. As a result, the purpose of this study was to determine the incidence of sleep deprivation and its associated factors among Haramaya University students in Eastern Ethiopia.
Methods
A cross-sectional study design was employed among Haramaya University students. A total of 624 students participated in this study. A multistage sampling technique was used to select the participants. A pretested structured self-administered questionnaire was used to collect data. Using Epi Data Version 3.1, the data was checked, coded, entered, and cleaned before being exported to SPSS Version 20 for analysis. Bivariate and multivariate logistic regression analysis was undertaken. For statistical significance, P ≤ 0.001 was used as the cutoff point.
Results
In this study, 586 study participants were participated, with a response rate of 96.2%. Among participants, the majority of 324(55.3%) were males, and the majority of 311(53.1%) were in the age range of 17–20 years with a median age of 19. Most of the study participants were single 561(95.7%). The overall prevalence of sleep deprivation was 68.4% (95% CI: 64.8–72.4). Coffee/tea drinkers (AOR = 2.83, 95% CI:1.17–6.86), Khat chewers (AOR = 2.33, 95%CI: 1.20–4.50), participants with stress (AOR = 3.49,95% CI: 1.22–9.95), participants exposed to moderate stage of anxiety (AOR = 2.87,95% CI:1.14–7.18), and being in the third and fourth study years (AOR = 0.33,95% CI:0.13–0.85) were significantly associated factors with sleep deprivation.
Conclusion
The prevalence of sleep deprivation was found to be high in this study. Coffee/tea users, khat chewers, being stressed, exposed to moderate levels of anxiety, and being in the third and fourth study years were all found to be significantly associated with sleep deprivation.
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Sleep Disorders and Their Associated Factors during the COVID-19 Pandemic: Data from Peruvian Medical Students. Medicina (B Aires) 2022; 58:medicina58101325. [PMID: 36295486 PMCID: PMC9610973 DOI: 10.3390/medicina58101325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/31/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background and objectives: Sleep disorders are a common public health problem among college students. The objective of this study was to evaluate sleep quality and its associated factors in medical students during the COVID-19 pandemic. Materials and Methods: Cross-sectional analytical study—we conducted a secondary analysis of the survey “Nomophobia in medical students in Peru” database between 2020 and 2021. Sleep disturbances were assessed using the Pittsburgh Sleep Quality Index (PSQI). To evaluate associated factors, crude and adjusted prevalence ratios (aPR) and their 95% confidence intervals (95% CI) were calculated. Results: We analyzed data from 3139 participants from 18 cities in Peru (61.1% were women, median age: 22 years). 43.4% had a quality of sleep that could require medical attention; the PSQI dimension with the highest score was daytime dysfunction. The poor sleep quality was associated with symptoms of anxiety (aPR: 1.48; 95% CI: 1.27–1.72), depression (aPR: 2.03; 1.72–2.39), or nomophobia (aPR: 1.28; 1.09–1.51). Conclusions: Sleep disorders were a common problem among Peruvian medical students and were associated with anxiety, depression, or nomophobia symptoms.
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Fasanella NA, Custódio CG, do Cabo JS, Andrade GS, de Almeida FA, Pavan MV. Use of prescribed psychotropic drugs among medical students and associated factors: a cross-sectional study. SAO PAULO MED J 2022; 140:697-704. [PMID: 35976367 PMCID: PMC9514864 DOI: 10.1590/1516-3180.2021.0566.r2.05012022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The worldwide prevalences of anxiety and depressive disorders are 3.6% and 4.4%, respectively. Among medical students, many studies have indicated that the prevalences of these mental disorders vary between 19.7% and 47.1%, but there is a lack of information on psychotropic drug usage in this group of students. OBJECTIVE To evaluate the prevalence of psychotropic drug use, adherence to therapy and main clinical and diagnostic indications relating to psychotropic drug use among medical students. DESIGN AND SETTING Cross-sectional study at a Brazilian private university in the city of Sorocaba, state of São Paulo. METHODS Observational analytical cross-sectional study, conducted during the second semester of 2019, through a semi-structured online questionnaire, answered by first to sixth-year medical students. RESULTS Among the 263 participants (41.7% of the 630 enrolled students), the current prevalence of psychotropic drug usage was 30.4%. This prevalence increased over the course and 90.7% of the drugs were prescribed at regular medical consultations (85.5% by psychiatrists). The main indications for psychotropic drug usage were anxiety (30.0%), depression (22.8%), insomnia (7.2%), panic (5.3%) and attention deficit hyperactivity disorder (3.8%). Women were more likely to present diagnoses of depression and panic. Most of the participants used antidepressants and had good adherence to medications. Adequate sleep and regular physical activity were identified as protective factors against mental disorders. CONCLUSION The prevalence of mental disorders among medical students is high, which justifies the use of psychotropic drugs. This study provides valuable information and recommendations for institutional educational actions to improve students' mental health.
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Affiliation(s)
- Nicoli Abrão Fasanella
- MD. Professor, Department of Public Health, Faculdade de Ciências Médicas e da Saúde (FCMS), Pontifícia Universidade Católica de São Paulo (PUC-SP), Sorocaba (SP), Brazil
| | - Clarissa Garcia Custódio
- Undergraduate Medicine Student, Faculdade de Ciências Médicas e da Saúde (FCMS), Pontifícia Universidade Católica de São Paulo (PUC-SP), Sorocaba (SP), Brazil
| | - Júlia Santos do Cabo
- Undergraduate Medicine Student, Faculdade de Ciências Médicas e da Saúde (FCMS), Pontifícia Universidade Católica de São Paulo (PUC-SP), Sorocaba (SP), Brazil
| | | | - Fernando Antônio de Almeida
- MD, PhD. Full Professor, Department of Clinics, Faculdade de Ciências Médicas e da Saúde (FCMS), Pontifícia Universidade Católica de São Paulo (PUC-SP), Sorocaba (SP), Brazil
| | - Maria Valéria Pavan
- MD, MSc, PhD. Professor, Department of Public Health, Pontifícia Universidade Católica de São Paulo (PUC-SP), Sorocaba (SP), Brazil
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Babicki M, Piotrowski P, Mastalerz-Migas A. Assessment of Insomnia Symptoms, Quality of Life, Daytime Sleepiness, and Psychoactive Substance Use among Polish Students: A Cross-Sectional Online Survey for Years 2016–2021 before and during COVID-19 Pandemic. J Clin Med 2022; 11:jcm11082106. [PMID: 35456199 PMCID: PMC9026410 DOI: 10.3390/jcm11082106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/29/2022] [Accepted: 04/07/2022] [Indexed: 12/21/2022] Open
Abstract
Sleep disorders are a serious health problem worldwide, and insomnia is their most common manifestation. An increasing number of people have insomnia every year, young adults, especially. Due to the importance that sleep has in almost every aspect of our lives, the need to monitor disturbances in circadian rhythms has arisen. Therefore, this study aimed to assess the prevalence of sleep disorders among Polish students, including their quality of life (QOL) and drug use patterns. The study also investigated associations between sleep, QoL, and drug use. The study was conducted in 2016–2021 based on the self-made sociodemographic questionnaire, as well as standardized psychometric tools: Athens Insomnia Scale (AIS), Epworth Sleepiness Scale (ESS), and Manchester Short Assessment of quality of life (MANSA). A total of 14,844 students participated in the study. The majority were women (80.7%), of which 3425 (23.1%) were medical students, with the most numerous representing medical and dental faculties, 1884 (57.2%). Before the COVID-19 pandemic, 52.1% of the surveys were collected; 54.1% of respondents had insomnia as indicated by the AIS scores, and 26.1% displayed sleepiness during the day. Female students, the first-year college students, more often suffered from sleep disorders. Drug use was widespread among Polish students, correlating with sleep assessment results and QoL. In conclusion, sleep disorders are a significant clinical problem among Polish students. Female and junior students’ years are more prone to sleep deprivation. Insufficient sleep can be associated with a lower QoL score and psychoactive substance use. The effects of the COVID-19 pandemic on sleep are not conclusive, because there was decreasing quality for longer sleep durations. In order to analyze these associations, there is a need for further in-depth study.
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Affiliation(s)
- Mateusz Babicki
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland; (M.B.); (A.M.-M.)
| | - Patryk Piotrowski
- Section of Epidemiology and Social Psychiatry, Department and Clinic of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Correspondence: ; Tel.: +48-71-784-16-52
| | - Agnieszka Mastalerz-Migas
- Department of Family Medicine, Wroclaw Medical University, 51-141 Wroclaw, Poland; (M.B.); (A.M.-M.)
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Sun L, Li K, Zhang Y, Zhang L. Differentiating the associations between sleep quality and suicide behaviors: A population-based study in China. J Affect Disord 2022; 297:553-558. [PMID: 34728292 DOI: 10.1016/j.jad.2021.10.126] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/16/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the association between sleep problems and suicidal behaviors were found in many studies, their associations are not built until now. One of the reasons may be the identified differences among different suicide behaviors, which also implied that sleep quality may play different roles on these suicidal behaviors. However, absent study explores the possible distinguishing associations between sleep quality and different suicidal behaviors. METHODS This is a population-based study conducted in Hebei province, China. Totally, 21,376 valid questionnaires were analyzed in this study. Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality. Suicidal behaviors, living alone, and social-demographic variables were assessed for all the participants. RESULTS The prevalence of suicidal ideation, plan, and attempt were 1.4%, 0.3%, and 0.2%, respectively. The PSQI scores were separately associated with suicidal ideation (OR=1.25, p<0.001), plan (OR=1.19, p<0.001), and attempt (OR=1.18, p<0.001). The similar results were also supported when we compared conditional suicidal behaviors with general population without any suicidal behaviors. However, when we compared suicide attempters with suicidal ideators (with or without suicide plan), the associations between PSQI scores and suicide attempt were not supported (OR=1.93, P>0.05 or OR=1.02, p>0.05). LIMITATIONS The cross-sectional design made us cannot get any causal relationships. The self-reported sleep quality may also produce some influence on the results. CONCLUSION The results imply us that improving sleep quality may be not effective to control further suicidal behaviors, when people have considered or planned to suicide. The findings also can be translated into the clinical and preventive practice for suicide control.
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Affiliation(s)
- Long Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, China.; National Health Commission of China Key Lab for Health Economics and Policy Research (Shandong University), China
| | - Keqing Li
- Hebei Provincial Sixth People's Hospital, Hebei, China
| | - Yunshu Zhang
- Hebei Provincial Sixth People's Hospital, Hebei, China..
| | - Lili Zhang
- Hebei Provincial Sixth People's Hospital, Hebei, China
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