Sleep quality among undergraduate students of a medical college in Nepal during COVID-19 pandemic: an online survey

Determining the Mental Status, Sleep Quality, and Eating Behaviors of University Students During the COVID-19 Pandemic: A Cross-Sectional Study

BACKGROUND

The COVID-19 pandemic has resulted in adverse effects on individuals' physical and mental health worldwide, with university students also being adversely affected by this process.

OBJECTIVES

This research aimed to determine the mental condition, sleep quality, and eating behaviors of university students during the COVID-19 process.

METHOD

This cross-sectional study was conducted with 1,065 university students. Study data were collected with an online questionnaire including a personal information form, the Depression Anxiety Stress Scale, the Pittsburgh Sleep Quality Index, and the Dutch Eating Behavior Scale.

RESULTS

Students' poor sleep quality was determined to be 69.5%. It was also determined that students' depression and stress levels were moderate that their anxiety levels were low, their eating behaviors were generally problematic, and more than half had poor sleep quality. In addition, eating disorders and poor sleep quality increased as depression, anxiety, and stress levels increased, and eating disorders increased as poor sleep quality increased (p < .05).

CONCLUSIONS

The results emphasize the importance of the strengthening of students' mental health, particularly by improving their sleep quality and eating habits. Evidence-based interventions regarding the effects of the pandemic should be made for students under the leadership of a psychiatric nurse, and effective strategies must be developed accordingly.

The Effect of Physical Activity on Sleep Quality Among Chinese College Students: The Chain Mediating Role of Stress and Smartphone Addiction During the COVID-19 Pandemic

Purpose

During the period of COVID-19 pandemic, the social restrictions and isolation exerted a significant impact on the sleep quality of Chinese college students. This study aims to delve into the influence of physical activity on the sleep quality of college students as well as the mediating roles of stress and smartphone addiction.

Materials and Methods

A cohort of 274 eligible college students (146 males and 128 females) were selected for the investigation. The International Physical Activity Questionnaire Short Form, Stress Perception Scale, Smartphone Addiction Scale, and Pittsburgh Sleep Quality Index were employed to assess the levels of physical activity, stress, smartphone addiction, and sleep quality among college students. For data analysis, descriptive statistics, correlation analysis, and chained mediation effect tests were performed sequentially.

Results

The findings revealed: (1) a significant negative correlation between physical activity and stress, smartphone addiction, and sleep quality among college students (r = -0.216, p < 0.001; r = -0.224, p < 0.001; r = -0.259, p < 0.001); (2) independent mediating roles of stress and smartphone addiction in the relationship between physical activity and sleep quality; and (3) chained mediating effects of stress and smartphone addiction in the association between physical activity and sleep quality.

Conclusion

This study deepens our comprehension of how physical activity augments the quality of slumber, concurrently emphasizing that mitigating stress levels and alleviating smartphone addiction constitute effective strategies for preventing sleep issues among college students.

Psychological dynamics of pandemic resilience: a tale of two cultures

The present work endeavours to explore the experiences of university-level students from Pakistan and Nepal after the COVID-19 outbreak. A comprehensive electronic survey was carried out utilising a meticulous cluster sampling technique encompassing two distinct populations, i.e. Pakistan and Nepal, during the period extending from September 2022 to January 2023. A total of 2496 participants completed the questionnaire (Pakistani population: 55.45% and Nepalese population: 44.55%). We utilised the Mental Health Continuum-Short Form (MHC-SF), Pittsburgh Sleep Quality Index (PSQI), feeling of loneliness (UCLA), interdependent happy scale (IHS), and fear of COVID-19 scale (FCV-19S). Notably, a significant intercultural disparity was observed, particularly concerning the level of COVID-19 fear which was higher among the Nepalese population. However, this particular variable did not demonstrate any significant associations with other variables, except for the social dimension of MHC-SF. There was a negative correlation observed between this variable and IHS within the Pakistani population. Irrespective of the varying degrees of apprehension towards COVID-19 within the two distinct cultural contexts, there exists a significant positive correlation between the assessed psychological assets and individual well-being, as well as the resumption of regular activities after the outbreak.

Chronotypes and their association with sleep quality among Chinese college students of Anhui Province: a cross-sectional study

OBJECTIVES

To describe the prevalence of chronotype and sleep quality among Chinese college students and explore the relationship between chronotype and sleep quality.

DESIGN

A cross-sectional study.

SETTING

Four colleges and universities in Anhui, China, between November and December 2020.

PARTICIPANTS

A total of 4768 college students were recruited using a stratified, multistage, cluster sampling survey.

OUTCOME MEASURES

Morningness-Eveningness Questionnaire 19 was used to determine the chronotype of the students and the Pittsburgh Sleep Quality Index (PSQI) was used to measure their sleep quality. The multiple logistic regression model was used to explore the potential association between chronotype and sleep quality.

RESULTS

The self-reported proportions of evening-type (E-type), neutral-type and morning-type among college students were 51.17%, 45.14% and 3.69%, respectively. The mean PSQI score was 4.97±2.82 and the prevalence of poor sleep quality was 18.2%. After adjusting the covariates by multiple logistic regression analysis, E-type was positively associated with subjective sleep quality (OR=1.671, 95% CI 1.414 to 1.975), sleep latency (OR=1.436, 95% CI 1.252 to 1.647), sleep duration (OR=2.149, 95% CI 1.506 to 3.067), habitual sleep efficiency (OR=1.702, 95% CI 1.329 to 2.180), daytime dysfunction (OR=1.602, 95% CI 1.412 to 1.818) and overall poor sleep quality (OR=1.866, 95% CI 1.586 to 2.196).

CONCLUSIONS

College students mainly exhibited E-type, and an elevated prevalence of poor sleep quality existed among these students. The E-type was positively associated with poor sleep quality.

Sleep Quality of Undergraduate Medical Students during and Post-Lockdown: A Cross-Sectional Research

Background

The COVID-19 and associated lockdowns have significantly impacted the lives of undergraduate medical students, including their sleep quality. This study attempts to investigate how sleep patterns, sleep quality, and associated factors altered during and post-lockdown.

Material and Methods

In this cross-sectional study, 171 medical students from colleges registered under the National Medical Council participated. The study used a validated PSQI questionnaire. The data collected through Google forms were analyzed using SPSS v2021.

Result

Among 171 study participants, 9.4% had bad sleep quality during lockdown which reduced to 4.7% post-lockdown significantly. Sleep latency and sleep duration were also significantly affected by the lockdown. There was a weak correlation between PSQI score during and post-lockdown, suggesting that individuals with poor sleep quality during lockdown also had poor sleep post-lockdown. According to the study, poor sleep quality decreased after lockdown as opposed to lockdown, with improvements in sleep latency and decreased use of sleep duration.

Conclusion

However, there was a weak correlation between PSQI score during and post-lockdown. Increased screen time during lockdown negatively affected sleep quality, emphasizing the importance of practicing sleep hygiene and promoting outdoor activities to reduce stress levels and improve mental health.

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

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.

Examining bedtime procrastination, study engagement, and studyholism in undergraduate students, and their association with insomnia

Introduction

Compulsive overstudying, known as studyholism, is an emerging behavioral addiction. In this study, we examine the prevalence of, and the relationships between, insomnia, study engagement, studyholism, bedtime procrastination among undergraduate students.

Methods

The Studyholism (SI-10), Athens Insomnia (AIS), and bedtime procrastination scales were administered to a convenience sample of 495 university students.

Results

Our findings indicate that the prevalence of insomnia was 75.31%, high studyholism was found in 15.31% of the sample, and increased study engagement was detected in 16.94%. Gender differences analysis revealed that females reported higher studyholism and bedtime procrastination than males. Fifth-year students had higher levels of studyholism than internship (p < 0.001), first-year (p < 0.01), and sixth-year students (p < 0.05). Insomnia was positively related to studyholism and bedtime procrastination. Furthermore, insomnia can be positively predicted by studyholism and bedtime procrastination. Participants with a medium level of studyholism were twice as likely to experience insomnia as those with a low level. Studyholics were six times more susceptible to insomnia than students with low studyholism levels. Compared to individuals with low bedtime procrastination levels, those with medium and high bedtime procrastination were twice as likely to report insomnia.

Conclusion

Our study highlights the interplay between insomnia, studyholism, and bedtime procrastination. Further, the findings indicate the need to increase awareness of insomnia.

The prevalence and risk factors of mental problems in medical students during COVID-19 pandemic: A systematic review and meta-analysis

BACKGROUND

This meta-analysis and systematic review aimed to evaluate the global prevalence and risk factors of mental problems (i.e., depression, anxiety, stress, sleep disorder, posttraumatic stress disorder (PTSD), burnout, psychological distress, and suicidal ideation) among medical students during the COVID-19 pandemic.

METHOD

We searched PubMed, Embase, Web of Science, psycARTICLES, PsycINFO, CNKI, and Wan Fang for studies on the prevalence of mental problems among medical students from January 1, 2020, to April 1, 2022. The pooled prevalence was calculated by random-effect models. We performed a narrative review to identify the risk factors.

RESULTS

The meta-analysis included 201 studies (N = 198,000). The prevalence of depression (41 %, 95 % CI, 37-45 %,), anxiety (38 %,95 % CI, 34 %-42 %), stress (34 %, 95 % CI, 27 %-42 %), sleep disorder (52 %, 95 % CI, 44 %-60 %), psychological distress (58 %, 95 % CI, 51 %-65 %), PTSD (34 %, 95 % CI, 22 %-46 %), suicidal ideation (15 %, 95 % CI, 11 %-18 %) and burnout (38 %, 95 % CI, 25 %-50 %) was high. The major risk factors were being female, being junior or preclinical students, exposure to COVID-19, academic stress, psychiatric or physical disorders history, economic trouble, fear of education impairment, online learning trouble, fear of infection, loneliness, low physical activity, low social support, problematic internet or smartphone use, and young age.

LIMITATIONS

Most studies were cross-sectional. Few studies provided a reasonable response rate, suggesting potential selection bias.

CONCLUSIONS

The study demonstrated a high prevalence and risk factors for mental problems during COVID-19, calling for mental health services. Our findings are valuable for college and health authorities to identify high-risk students and provide targeted intervention.

Subjective sleep alterations in healthy subjects worldwide during COVID-19 pandemic: A systematic review, meta-analysis and meta-regression

OBJECTIVE

We conducted a systematic review and meta-analysis to provide an update on sleep quality in different world areas and better characterize subjective sleep alterations during the COVID-19 pandemic. Considering gender distribution and specific pandemic-related parameters, we also intend to identify significant predictors of sleep problems.

METHODS

Six electronic databases were searched from December 2019 to November 2021 for studies investigating sleep during COVID-19 employing the Pittsburgh Sleep Quality Index, the Medical Outcomes Study Sleep, the Insomnia Severity Index or the Epworth Sleepiness Scale. Random-effects models were implemented to estimate the pooled raw means of subjective sleep alterations. Also, we considered the role of several pandemic-related parameters (i.e., days from the first COVID-19 case, government stringency index, new cases for a million people, new deaths for a million people) by means of meta-regression analyses.

RESULTS

A total of 139 studies were selected. The pooled mean of the global Pittsburgh Sleep Quality Index score (PSQIgen) was 6.73 (95% CI, 6.61-6.85). The insomnia severity index score was reported from 50 studies with a pooled mean of 8.44 (95% CI, 7.53-9.26). Subgroup analyses confirmed that most subcategories had poor sleep quality and subclinical insomnia. Meta-regressions showed that PSQIgen was predicted by days from the first COVID-19 case and government restrictions with a negative slope and by female gender with a positive slope. The government stringency index was positively correlated with the direct subjective evaluation of sleep quality.

CONCLUSIONS

We found an overall impaired sleep and widespread subthreshold insomnia during the COVID-19 pandemic. The female percentage seems to be the best predictor of impaired sleep quality, consistently to the available literature. Noteworthy, sleep alterations were inversely associated with governmental restrictions and decreased during the pandemic. Our results give a contribution to critically orienting further studies on sleep since COVID-19 pandemic.

Sleep Disorders and Their Associated Factors during the COVID-19 Pandemic: Data from Peruvian Medical Students

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.

Sleep quality and its correlates among undergraduate medical students in Nepal: A cross-sectional study

Poor sleep quality has been found to affect students' learning abilities, academic performance, and interpersonal relationships. However, little is known about this issue in Nepal. This study aimed to identify the factors associated with poor sleep quality among undergraduate medical students in Nepal. A web-based survey was conducted in March 2021 among 212 undergraduate medical students at the Institute of Medicine, Kathmandu, Nepal. Sleep quality was measured using a 19-item Pittsburgh Sleep Quality Index (PSQI). Multivariable logistic regression analysis was done to assess the factors associated with sleep quality. In the study participants, 38.2% of the students were identified as poor sleepers. Factors like being depressed (AOR = 4.5, 95% CI; 1.2-5.4), current alcohol use (AOR = 2.5, 95% CI; 1.8-10.8), poor academic achievement (AOR = 3.4, 95% CI; 1.1-10.9), and being a fourth-year student (AOR = 3.6, 95% CI; 1.1-11.8) were significantly associated with poor sleep quality. Poor sleep quality was common among undergraduate medical students. Routine screening of sleep quality and depressive symptoms is necessary to mitigate their impact among medical students. Medical students of the fourth year, current alcohol users, and those who did not have good academic achievement had poor sleep quality. Special attention on these population subgroups is thus needed to enhance sleep quality.

The Association Between Changes in the University Educational Setting and Peer Relationships: Effects in Students' Depressive Symptoms During the COVID-19 Pandemic

Objective: Abrupt life changes imposed by the lockdown measures, with a direct impact on teaching methodology and social interactions, as well as sleeping patterns, harmed university students' mental health. This study aimed to analyze the relationship between satisfaction with online teaching, social interaction with depression, anxiety symptomatology, and to analyze the effects of the pandemic and the lockdown in mental care access. Methods: The online survey collected demographic data, satisfaction with online teaching, and social interaction. We evaluated the depression and anxiety symptomatology using the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder, respectively. For the PHQ-9, we used the cut-off 15 for moderately severe depressive symptoms, whereas for GAD-7, we recurred to the cut-off 10 for moderately severe anxiety symptoms. This study used three data points: October 2019, June 2020, and March 2021. Findings: The study included n = 366 participants from all university study fields, with a mean age of 21.71 (SD = 1.42) in the last survey, and 71.3% were women. Depressive symptoms increased significantly from October 2019 to June 2020, and the mean scores grew until March 2021. Anxiety symptoms also significantly increased from October 2019 to June 2020; however, from June 2020 to March 2021, there was a non-significant decrease in the proportion. Mean scores for satisfaction with online teaching were 38.23% in June 2020 and 34.25% in March 2021, a non-significant difference. Satisfaction with social interaction significantly decreased from 37.35% in 2020 to 24.41% in 2021. Participants with scores above the cut-off of moderately severe and severe depressive and anxiety symptoms showed significantly lower satisfaction with online teaching than students with lower depression and anxiety scores. Despite the significant increase in clinical symptomatology, help-seeking behaviors did not change accordingly, and more than 50% of the students with mild or severe depressive and anxiety symptomatology did not get treatment during the pandemic. Conclusion: The findings of this study suggest that most students are dissatisfied with online teaching and the type of social interaction they were forced to adopt because of the pandemic. The severity of depressive and anxiety symptomatology significantly increased between October 2019 and March 2021, but help-seeking behaviors did not increase accordingly.

Access to Mental Health Care during the First Wave of the COVID-19 Pandemic in Italy: Results from the COMET Multicentric Study

The COVID-19 pandemic represents an unprecedented public health emergency, with consequences at the political, social, and economic levels. Mental health services have been called to play a key role in facing the impact of the pandemic on the mental health of the general population. In the period March-May 2020, an online survey was implemented as part of the Covid Mental Health Trial (COMET), a multicentric collaborative study carried out in Italy, one of the Western countries most severely hit by the pandemic. The present study aims to investigate the use of mental health resources during the first wave of the pandemic. The final sample consisted of 20,712 participants, mainly females (N = 14,712, 71%) with a mean age of 40.4 ± 14.3 years. Access to mental health services was reported in 7.7% of cases. Among those referred to mental health services, in 93.9% of cases (N = 1503 subjects) a psychological assessment was requested and in 15.7% of cases (N = 252) a psychiatric consultation. People reporting higher levels of perceived loneliness (OR 1.079, 95% CI 1.056-1.101, p < 0.001), practicing smart-working (OR 1.122, 95% CI 0.980-1.285, p = 0.095), using avoidant (OR 1.586, 95% CI 1.458-1.725, p < 0.001) and approach (OR 1.215, 95% CI 1.138-1.299, p < 0.001) coping strategies more frequently accessed mental health services. On the other hand, having higher levels of perceived social support (OR 0.833, 95% CI 0.795-0.873, p < 0.001) was associated with a reduced probability to access mental health services. The COVID-19 pandemic represents a new threat to the mental health and well-being of the general population, therefore specific strategies should be implemented to promote access to mental healthcare during the pandemic and afterwards.

Sleep quality among undergraduate students of a medical college in Nepal during COVID-19 pandemic: an online survey

Background

Good sleep quality is associated with a diverse range of positive outcomes such as better health, less daytime sleepiness, well-being and proper psychological functioning. Sleep deprivation or poor sleep quality leads to many metabolic, endocrine, and immune changes. Many studies have shown changes in sleep schedule along with worsening of sleep quality during the COVID-19 pandemic.

Methods

This cross-sectional study was conducted among students of a medical college in Kathmandu, Nepal from January 13, 2021 to February 15, 2021. A stratified random sampling technique was used. Data were collected using the Pittsburgh Sleep Quality Index (PSQI). Questionnaires that were completely filled were included and analyzed using STATA vs. 15.

Results

168(n=190) medical students filled out the questionnaires with a response rate of 88.42%. Around 30% (n=51) of respondents had poor sleep quality (PSQI total score of > 5) with an average PSQI score of 4.24±2.19. Unadjusted logistic regression analysis showed significantly higher odds of poor sleep quality among females (OR, 2.25; CI, 1.14-4.43) compared with male and the relation persists even after adjusting with age and year in medical school (aOR, 2.81; CI, 1.35-5.86).  Adjusting with age and gender, 4 ^th-year MBBS students had 82% lesser odds of having poor sleep quality compared to 2 ^nd-year MBBS students (aOR, 0.18; CI, 0.04-0.76). Our study is suggestive of poor sleep quality common among medical students.

Conclusions

More than a quarter of medical students have a poor sleep quality as per our study. So, education and awareness should be raised among medical students regarding the detrimental effects of poor quality sleep on daily activities, physical and mental well-being, and the overall quality of life.