Sleep quality and associated factors among undergraduate medical students during Covid-19 confinement

Efficacy of a Personalized Mobile Health Intervention (BedTime) to Increase Sleep Duration Among Short-Sleeping Patients With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

A strong association exists between sleep duration and glycemic control in patients with type 2 diabetes (T2D), yet convincing evidence of a causal link remains lacking. Improving sleep is increasingly emphasized in clinical T2D treatment guidance, highlighting the need for effective, scalable sleep interventions that can affordably serve large populations through mobile health (mHealth).

OBJECTIVE

This study aims to pilot an intervention that extends sleep duration by modifying bedtime behavior, assessing its efficacy among short-sleeping (≤6 hours per night) patients with T2D, and establishing robust evidence that extending sleep improves glycemic control.

METHODS

This randomized, single-blinded, multicenter study targets 70 patients with T2D from 9 institutions in Japan over a 12-week intervention period. The sleep extension intervention, BedTime, is developed using the Theory of Planned Behavior (TPB) and focuses on TPB's constructs of perceived and actual behavioral control (ABC). The pilot intervention combines wearable actigraphy devices with SMS text messaging managed by human operators. Both the intervention and control groups will use an actigraphy device to record bedtime, sleep duration, and step count, while time in bed (TIB) will be assessed via sleep diaries. In addition, the intervention group will receive weekly bedtime goals, daily feedback on their bedtime performance relative to those goals, identify personal barriers to an earlier bedtime, and select strategies to overcome these barriers. The 12-week intervention period will be followed by a 12-week observational period to assess the sustainability of the intervention's effects. The primary outcome is the between-group difference in the change in hemoglobin A1c (HbA1c) at 12 weeks. Secondary outcomes include other health measures, sleep metrics (bedtime, TIB, sleep duration, total sleep time, and sleep quality), behavioral changes, and assessments of the intervention's usability. The trial commenced on February 8, 2024, and is expected to conclude in February 2025.

RESULTS

Patient recruitment ended on August 29, 2024, with 70 participants enrolled. The intervention period concluded on December 6, 2024, and the observation period ended on February 26, 2025, with 70 participants completing the observation period. The data analysis is currently underway, and results are expected to be published in July 2025.

CONCLUSIONS

This trial will provide important evidence on the causal link between increased sleep duration and improved glycemic control in short-sleeping patients with T2D. It will also evaluate the efficacy of our bedtime behavior change intervention in extending sleep duration, initially piloted with human operators, with the goal of future implementation via an mHealth smartphone app. If proven effective, this intervention could be a key step toward integrating sleep-focused mHealth into the standard treatment for patients with T2D in Japan.

TRIAL REGISTRATION

Japan Registry of Clinical Trials jRCT1030230650; https://jrct.niph.go.jp/latest-detail/jRCT1030230650.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/64023.

Association between restless legs syndrome and sleep quality in Peruvian medical students

OBJECTIVE

To evaluate the association between restless legs syndrome (RLS) and sleep quality in Peruvian medical students.

METHODS

Cross sectional study with a secondary data analysis. The study included Peruvian medical students surveyed in 2020. The outcome was sleep quality evaluated using the Pittsburgh Sleep Quality Index (PSQI), and the exposure variable was RLS assessed with the International Restless Legs Syndrome Study Group (IRLSSG) scale. To address the research question, we employed Poisson regression models with robust variance.

RESULTS

We analyzed information from 3139 medical students (61.1% female, median age 22.3 years). 15.3% experienced symptoms of Restless Legs Syndrome (RLS), and 77.2% had poor sleep quality. The prevalence of poor sleep quality was higher in female participants (80.0%) and those with symptoms of anxiety (92.8%), depression (91.6%), and severe nomophobia (86.3%). In the multivariable model, the presence of RLS symptoms was associated with poor sleep quality (prevalence ratio: 1.05, 95% CI 1.01 - 1.09, p < 0.013).

CONCLUSION

We found a high prevalence of poor sleep quality, notably associated with RLS. Other factors associated with poor sleep quality were the academic year of study, anxiety, depression, and nomophobia.

The network analysis of learning burnout and sleep quality among medical students during online learning in China

Previous studies had identified the significant issue of burnout and sleep quality in medical students. However, no studies have explored the interactions between learning burnout and sleep quality on a symptom level. This study used network analysis to explore the interaction and construct the network structure of learning burnout and sleep quality among medical students in China. We recruited 553 medical students to participate in our study. Learning Burnout of Undergraduates and Scale (LBUS) and the Pittsburgh Sleep Quality Index (PSQI) were used to measure learning burnout and sleep quality. Expected influence and bridge expected influence were used to identify the central and bridge symptoms. Results showed 'B9' (Tired of learning) and 'B17' (I want to learn but feel bored with it) had the highest expected influence. 'B12' (I often fall asleep while studying) and 'P_DD' (Daytime dysfunction) had the highest bridge expected influence. Our findings revealed the characteristics of learning burnout and sleep quality in online learning and provided information to further understand the difference in the influence of mental health between online and offline learning.

Sleep quality and associated factors in Latin American medical students: a cross-sectional and multicenter study

BACKGROUND

Existing literature has not stablished the factors associated with sleep quality, which requires further research in the context of the mental health of future medical professionals. This study aimed to determine the prevalence and factors related to sleep quality in Latin American medical students during the COVID-19 pandemic.

METHODS

Cross-sectional multicenter analytic study of secondary data analysis in Latin American medical students. The sampling was non-probabilistic snowball sampling. Sleep quality (Pittsburgh questionnaire) and its association with psychosocial-academic variables, depressive symptoms (PHQ-9 questionnaire), anxious symptoms (GAD-7 questionnaire), resilience (abbreviated CD-RISC questionnaire), eating disorder (EAT-26 questionnaire), physical activity (IPAQ questionnaire-short version), tobacco and alcohol consumption (ASSIST questionnaire) and burnout syndrome (Maslash questionnaire) were assessed. Prevalence ratios and 95% confidence intervals were estimated.

RESULTS

Of 2019 medical students, the prevalence of poor sleep quality was 62.2% (95%CI: 60.00%-64.28%). In the multiple regression model, factors that were positively associated with poorer sleep quality were female sex (PR: 1.13), moderate risk of smoking (PR: 1.08), the presence of moderate to severe depressive symptoms (PR: 2.19 and PR: 2.14, respectively), as well as moderate and severe anxiety symptoms (PR: 1.21 and PR: 1.22, respectively). On the other hand, factors that were negatively associated with poorer sleep quality were having received training on COVID-19 (PR: 0.95), having a history of COVID-19 (PR: 0.80), and having a high level of resilience (PR: 0.86).

CONCLUSION

It was found that 62.2% of students had poor sleep quality. Factors such as female sex, moderate risk of smoking, and depressive and anxious symptoms were associated with poor sleep quality, while COVID-19 training, history of the disease, and a high level of resilience were linked to better quality. These findings are key for public health, as poor sleep quality affects physical and mental health and academic performance, underscoring the importance of intervening on these factors to improve student well-being.

Impact of sleep quality on academic achievements of undergraduate medical students: a cross-sectional study from Saudi Arabia

BACKGROUND

Sleep is an active process that affects human health and quality of life. Sleep is essential for learning and memory consolidation. Good sleep is required for good academic performance. Sleep disorders are common among medical students, due to the high academic load, stressful life, and hectic schedule. Therefore, this study aims to assess sleep quality among medical students.

METHODS

A cross-sectional study was conducted among medical students at King Khalid University by using the Pittsburgh sleep quality index (PSQI) to assess sleep duration, sleep efficiency, sleep latency, and global PSQI score. Participants were enrolled from second to sixth year. Bivariate and multivariate logistic regression were used to predict factors related to poor sleep quality.

RESULTS

Out of 514 medical students, 453 (88.1%) of students exhibited poor sleep quality. Fourth year students were less likely to have poor sleep quality (AOR, 0.381; CI, 0.158-0.934) p = 0.035 and students with regular sleep schedule were more likely to be good sleepers (AOR,0.349; CI, 0.129-0.940) p = 0.037. Additionally, students who had more than five courses per semester more frequently had daytime sleepiness p = 0.03. However, Insufficient sleep was not significantly affected by factors like gender, different age groups, number of courses per semester, daytime sleeping, and students with varying Grade Point Averages (GPA).

CONCLUSION

Poor sleep quality is common among medical students, which may affect academic performance and general health. It is essential to educate them about good sleep hygiene and time management skills.

Perceived stress and burnout syndrome in chiropractic students at a South African university during the COVID-19 pandemic: A cross-sectional study

OBJECTIVE

Higher stress levels may be associated with decreased academic success and physical and psychological well-being in chiropractic students. This study aimed to determine the perceived stress and burnout of chiropractic students at the University of Johannesburg during the COVID-19 pandemic.

METHODS

This was a quantitative, exploratory study utilizing a self-administered online questionnaire distributed to chiropractic students (n = 246) at the university. The questionnaire consisted of 3 main components: demographics, the Perceived Stress Scale (PSS-10), and the Maslach Burnout Inventory-Student Survey (MBI-SS). Data were analyzed utilizing exploratory factor analysis, Cronbach alpha for reliabilities, and descriptive statistics for mean scores being interpreted using subscales pertaining to the 2 survey tools.

RESULTS

The response rate was 63.82% (n = 157) with the PSS-10 indicating participants obtained a total mean score of 25.08 (average stress). For the MBI-SS categories, participants scored 18.96 out of 30 for exhaustion, 10.31 out of 30 for cynicism, and 22.46 out of 36 for professional efficiency; higher scores of exhaustion and cynicism and lower scores of professional efficiency are indicative of higher degrees of burnout. Statistically significant differences for both tools were noted in relation to age and academic year with higher values indicated with increased age and progression in the program.

CONCLUSION

The results indicate that chiropractic students experienced moderate levels of stress but higher burnout than other health sciences student populations when compared to current literature. Age and progression in the program appear to have a negative influence on both these factors.

Sleep Disturbances in Health Professional Students During the COVID-19 Pandemic: A Concept Analysis

AIM

The aim is to delineate the concept of sleep disturbances in health professional students during the COVID-19 pandemic.

DESIGN

A concept analysis was conducted.

METHODS

A systematic search was conducted for relevant articles published and performed from inception to July 5, 2024. Electronic databases searched included PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and Web of Science. Rodgers' method of evolutionary concept analysis was used.

RESULTS

A total of 50 pertinent articles were included in our analysis. Utilising inductive thematic analysis, this study identified attributes, antecedents and consequences of sleep disturbances. Important attributes included insomnia, disrupted sleep patterns, altered sleep duration/nocturnal sleep duration and poor sleep quality. Antecedents encompassed factors such as gender, age/grade levels, physical activity, screen time of digital production, mental health issues, COVID-19-related stressors, financial strain and academic stress. Consequences included both mental and physical health implications. By addressing sleep disturbances and promoting better sleep health among students, we can enhance their learning and performance, which could translate to improved patient care outcomes. Additionally, understanding and mitigating sleep disturbances can contribute to the development of a more resilient and effective health care workforce, capable of providing high-quality care even during crises like the COVID-19 pandemic.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Sleep Quality, Daytime Sleepiness and Sleep Hygiene Among Youth in a Rural District in South India: A Cross-Sectional Study

Background Adequate sleep is crucial for youth cognitive function, academic performance, and mental health. However, various factors, including academic pressure, technology use, and socio-cultural norms can significantly impact sleep patterns, particularly in rural settings. This cross-sectional study assessed sleep quality, daytime sleepiness prevalence, and sleep hygiene practices among youth in a rural South Indian district. We also investigated factors associated with these sleep parameters in this understudied population Methods This was a cross-sectional study among 852 young subjects who were assessed with a self-reported proforma of socio-demographic details, behavioural factors, Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. Regression model was created to analyse the predictor for sleep quality and daytime sleepiness with respect to sociodemographic variables, behavioural factors and sleep hygiene practices. Results Our study revealed that 49.4% (n=421) of participants exhibited poor sleep quality, while 29.5% (n=251) reported abnormal daytime sleepiness. The most prevalent sleep hygiene practices were reading in bed (68.5%, n=584) and pre-bedtime eating (56.22%, n=479). Multivariate analysis indicated that sleep quality was significantly associated with accommodation type, with increased odds for those in private accommodation (adjusted odds ratio (AOR) 1.29, 95% CI: 1.14-1.62) and hostels (AOR 3.79, 95% CI: 1.79-8.06). Additionally, eating in bed (AOR 1.42, 95% CI: 1.03-1.95) and pre-bedtime eating (AOR 1.41, 95% CI: 1.07-1.88) were also associated with poor sleep quality. Factors significantly associated with daytime sleepiness included younger age (AOR 0.84, 95% CI: 0.75-0.94), non-medical academic streams (AOR 1.94, 95% CI: 1.33-2.83), extensive internet usage (three or more hours) (AOR 1.87, 95% CI: 1.15-3.13), watching TV in bed (AOR 1.46, 95% CI: 1.06-1.99), writing (AOR 1.45, 95% CI: 1.02-2.06), and eating in bed (AOR 1.55, 95% CI: 1.09-2.21). Conclusion This study reveals a significant incidence of poor sleep quality and daytime drowsiness among young individuals residing in rural areas of South India. The results of our study emphasize significant connections between sleep disturbances and several modifiable aspects, such as the kind of accommodation, eating habits, and use of technology. The impact of eating behaviours, both in bed and before bedtime, on sleep quality and daytime sleepiness underscores the importance of proper sleep hygiene education. Furthermore, the relationship between extensive internet usage and daytime sleepiness points to the growing influence of digital technology on youth sleep patterns. These findings emphasize the need for comprehensive sleep health programs tailored to rural youth. Such initiatives should address environmental factors, promote healthy sleep hygiene practices, and provide guidance on balanced technology use. Additionally, the varying impact of academic streams on sleep parameters suggests that sleep health strategies may need to be customized for different educational contexts.

Global prevalence of anxiety and depression among medical students during the COVID-19 pandemic: a systematic review and meta-analysis

PURPOSE

As future physicians, medical students have experienced tremendous pressure during the ongoing COVID-19 pandemic, which is associated with a high risk of depression and anxiety. We aimed to investigate an overview of the prevalence of anxiety and depression among medical students in various countries during the global COVID-19 pandemic, and discuss associated stressors.

METHODS

We systematically searched CINAHL, EMBASE, MEDLINE, PubMed, and Web of Science for relevant articles from December 1, 2019 to March 15, 2023. We performed meta-analysis using a random-effects model with REML method to calculate the pooled prevalence of anxiety and depression. Begg's and Egger's tests were used to identify the potential risk of publication bias. Meta-regression was used to explore potential sources of heterogeneity.

RESULTS

We identified 130 studies reporting anxiety and depression among 132,068 medical students during the COVID-19 pandemic. Eight screening tools were identified for anxiety and six for depression. The pooled prevalence of mental health outcomes for anxiety and depression was 45% (95% confidence interval [CI], 40%-49%) and 48% (95% CI, 43%-52%), respectively. The pooled prevalence of mental health outcomes for moderate and severe anxiety and moderate and severe depression was 28% (95% CI, 24%-32%) and 30% (95% CI, 26%-35%), respectively. There was high heterogeneity between studies, with I2 ranging from 99.58%-99.66%. Continent and survey date were included in the meta-regression model. The results of meta-regression revealed that medical students in Asia had a lower prevalence of anxiety, and depression than those in other regions. The survey date (from February to June, 2020) showed a significantly positive correlation with the prevalence of anxiety and depression.

CONCLUSIONS

We demonstrated the global prevalence of anxiety and depression among medical students during the COVID-19 pandemic. The data highlight that medical students worldwide are at high risk of experiencing anxiety and depression. The reported stressors can be categorized into personal, academic, environmental and cultural, and pandemic factors. Schools and institutions should ensure optimal alternative learning environments for uninterrupted provision of medical education. The appropriate authorities should prioritize the provision of adequate protection for medical students and establish policies to promote new methods of training and education during a disaster, such as via distance learning.

Reevaluating Sleep Quality During COVID-19 and Associations With Quarantine, Mental Health, Stress, and Screen Time in Young Adults: Results From a Cross-Sectional Online Survey

The COVID-19 pandemic affected individual sleep quality, especially with high-stress levels. We assessed sleep quality in young adults during COVID-19, and mental health, stress, and screen time (ST) use. An international cross-sectional study was conducted from September 2020 to January 2021. The surveys assessed sleep quality (PSQI), ST use, and mental health. 183 participants were eligible for analysis. The average global PSQI score was 7.29 (sd = 3.58, n = 99). Associations were found between global PSQI scores and Fear of COVID-19 (r (98) = .223, P = .027), anxiety scores (r (99) = -.541, P < .001), increased total stress scores (r (88) = .486, P < .001), and depression (r (97) = .628, P < .001). Those currently quarantining had statistically higher PSQI scores than those who quarantined in the past (F (2,175) = 3.397, P = .036), but not for those who did not quarantine. Differences were found between genders for global PSQI (F (4,94) = 2.865, P < .027) and poor vs good sleep (X2 (1,98) = 3.982, P = .046). There was also a relationship between ethnicity and poor vs good sleep quality (X2 (2,94) = 6.538, P = .038). We did not find associations between ST and sleep quality but found poor sleep quality significantly related to mental health during COVID-19. We found no direct evidence that quarantining itself results in poor sleep quality. Interventions need to maximize sleep quality in certain groups, like females and ethnic minorities.

A systematic review of studies on stress during the COVID-19 pandemic by visualizing their structure through COOC, VOS viewer, and Cite Space software

Background

The COVID-19 epidemic generated different forms of stress. From this period, there has been a remarkable increase in the quantity of studies on stress conducted by scholars. However, few used bibliometric analyses to focus on overall trends in the field.

Purpose

This study sought to understand the current status and trends in stress development during COVID-19, as well as the main research drives and themes in this field.

Methods

2719 publications from the Web of Science(WOS) core repository on stress during COVID-19 were analyzed by utilizing Co-Occurrence (COOC), VOS viewer, and Cite Space bibliometric software. The overall features of research on stress during COVID-19 were concluded by analyzing the quantity of publications, keywords, countries, and institutions.

Results

The results indicated that the United States had the largest number of publications and collaborated closely with other countries with each other. University of Toronto was the most prolific institution worldwide. Visualization and analysis demonstrated that the influence of stress during COVID-19 on the work, life, mental and spiritual dimensions is a hot research topic. Among other things, the frequency of each keyword in research on stress during COVID-19 increased from 2021 to 2022, and the researchers expanded their scope and study population; the range of subjects included children, nurses, and college students, as well as studies focusing on different types of stress, and emphasizing the handling of stress.

Conclusion

Our findings reveal that the heat of stress research during COVID-19 has declined, and the main research forces come from the United States and China. Additionally, subsequent research should concern more on coping methods with stress, while using more quantitative and qualitative studies in the future.

Associations between Stress, Anxiety, Depression and Sleep Quality among Healthcare Students

OBJECTIVES

Stress, anxiety, and depression among students have many negative health consequences and may predispose students to poor sleep quality; therefore, this research aimed to investigate the perceived stress, anxiety, and depression and their relation to the level of sleep quality among healthcare students.

METHODS

A cross-sectional study using a validated survey was conducted among Saudi healthcare students from different regions during the period from 26 September 2022 to 30 October 2022. The Pittsburgh Sleep Quality Index (PSQI) was utilized to assess sleep quality. PSPP Statistical Analysis Software version 1.2.0 was used for all statistical analyses.

RESULTS

701 respondents participated in this research; the response rate was 73.8%. About 60% of the study sample was female, and the average age was 20.9 years. 80.3% of students have poor sleep quality; the participants' mean sleeping hours per night was 6.81 ± 1.88 h. About three-quarters of students (72.9%) perceive themselves as stressed. A significant positive correlation was observed between sleep quality and perceived stress (r-value = 0.363), anxiety (r-value = 0.387), and depression (r-value = 0.347). Poor sleep quality was more likely among those with stress than those without stress (AOR = 1.79; 95% CI 1.07, 2.99) and two times more likely among students with cases of anxiety than those without anxiety (AOR = 2.07; 95% CI 1.10, 3.94).

CONCLUSIONS

Our study highlights the high prevalence of poor sleep quality, anxiety, depression, and stress among healthcare students in Saudi Arabia. Students' reported stress, anxiety, and residence region were associated with poor sleep quality. These results imply the necessity of regular screening and appropriate intervention for sleep problems, stressors, and anxiety among healthcare students.

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.

A clinical and technical methodological review on stress detection and sleep quality prediction in an academic environment

BACKGROUND

Mental health in recent times is a much talked about topic and its effects on the sleep health of the students are said to result in long-term health issues if not identified and resolved. Students who are subjected to psychological stress have often been reported to have lower sleep quality which together has affected the academic performance of the students.

OBJECTIVE

While stress has its adverse effect on students'quality of sleep, an effort is also made to identify standard techniques and tools to automatically assess stress levels and sleep quality in a non-invasive environment among students only. This article mainly focuses on the Clinical and technical methodology employed in stress level detection and sleep quality prediction among students.

METHODS

This study was conducted by examining all research studies conducted in the past with respect to students in an academic setting from year 2000 to early 2022. The papers under study where finalised based on different methodologies involved in stress level detection and sleep quality prediction considering both in unimodal and multimodal measurements.

RESULTS

While questionnaires and physiological signals are used as a standard measuring tool, it is mostly used in a unimodal environment to measure students' mental stress or sleep quality in academic settings.

CONCLUSION

This paper describes in detail the clinical aspect of the association between mental stress, sleep quality, and academic performance in students followed by technical aspects to analyse the stress levels and sleep quality both qualitatively and quantitatively in an academic environment.

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.

Prevalence of Depression Among Undergraduate Medical Students in India: A Systemic Review and Meta-Analysis

BACKGROUND

Systematic reviews have proved that there is a high rate of depression among medical students when compared with their age-matched peers. Very few studies have evaluated the pooled prevalence of depression among medical students in India.

OBJECTIVES

To determine the pooled prevalence of depression among medical students in India.

MATERIALS AND METHODS

This review was done by searching databases like PubMed, Google Scholar, and Scopus for available original articles published between 2019 and 2022 on depression among Indian medical (MBBS) undergraduate students using PRISMA guidelines.

RESULTS

A total of 19 original research articles were included in this review, involving students at different medical colleges from various regions of India. The pooled prevalence of depression among 5944 medical students was 50.0% (95% CI: (31%-70%)) based on the random effect model. This meta-analysis also found that the pooled prevalence of depression among females (pooled prevalence: 38.0%, 95% CI: 20.0 to 58.0) was slightly higher than among males (pooled prevalence: 34.0%, 95% CI: 15.0 to 55.0).

CONCLUSION

 The high prevalence of depression among medical students demands regular screening for depression along with counselling services. It shows that there is a need to raise awareness among students and other stakeholders, such as parents and medical educators, concerning symptoms and signs of depression among medical students.

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

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

Lifestyle, Physical Activity and Dietary Habits of Medical Students of Wroclaw Medical University during the COVID-19 Pandemic

The new disease COVID-19, induced by SARS-CoV-2, causes acute respiratory infection. Many countries, including Poland, began to set a variety of different restrictions to reduce the spread of the virus. Most students had problems with online lessons. The study was conducted among second year medicine students of the Medical University of Wroclaw, and after the entire process of verification 200 respondents were accepted. The research consisted of completing the same anonymous online questionnaires twice in March and October 2020. This finally allowed for a critical assessment of the impact of the pandemic and its restrictions on the students’ daily lives. During the online classes, low levels of physical activity persisted (p = 0.718), whereas time spent sitting increased (p < 0.001). Despite positive changes in declared snacking (p = 0.061), we observed significant drops in the index of healthy diet (p = 0.001) and nutritional knowledge (p < 0.001) as well as an increase in the consumption of fast-food (p < 0.001) and energy drinks (p = 0.019). Reduced nutritional knowledge can cause a decrease in attention to healthy food preparation and much more frequent consumption of fast-food.