Sleep Quality and Mental Health of Medical Students in Greece During the COVID-19 Pandemic

Background-Aim: Medical students have been greatly affected by the COVID-19 pandemic due to their educational program, which comprises theoretical knowledge and also clinical duties, making them vulnerable to viral exposures and possibly affecting their everyday life. The aim of this study was to explore changes in sleep and mental health parameters among medical students in Greece during the second year of the pandemic.Methods: This cross-sectional study comprised students of all medical schools in Greece (n = 7), using an anonymous online survey. Participants completed the following questionnaires: Pittsburgh Sleep Quality Index (PSQI), Athens Insomnia Scale (AIS), Fatigue Severity Scale (FSS), General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9). Statistical analysis was conducted with the use of SPSS v.26 (IBM SPSS, Armonk NY, USA).Results: Out of the 562 received responses, 559 met the inclusion criteria. The largest proportion of the respondents came from 4th-year (27.8%) and the majority of the sample were females (69.8%). Only 5.9% of the participants reported having been infected by SARS-COV-2. Most of the respondents experienced insomnia (65.9%, mean AIS score: 7.59 ± 4.24), poor sleep quality (52.4%, mean PSQI score: 6.6 ± 3.25) and increased fatigue (48.5%, mean 35.82 ± 11.74). Moderate to severe symptoms of anxiety (mean 9.04 ± 5.66) and depression (mean 9.36 ± 6.15) were noted. Suicidal ideation was found in 16.7% of the sample, while use of sleeping pills in the previous month was reported by 8.8% (n = 47). Further analysis revealed independent associations between sleep and mental health parameters. Higher AIS score was associated with greater FSS score; higher PSQI scores with higher GAD-7 and PHQ-9 scores. Additionally, female students were found to be significantly more affected than males by the COVID-19 pandemic, displaying higher levels of insomnia, sleep disturbances, anxiety and depression. In addition, those with a history of COVID-19 infection or in close proximity with a positive case reported significantly more significant post-traumatic symptoms in IES-COVID-19 questionnaire.Conclusions: In the aftermath of the COVID-19 pandemic, prevalence of sleep and mental health disorders among Greek medical students is significant, highlighting the need for better surveillance of students' wellbeing and subsequent counseling, with special focus on female students and other affected groups.

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Association between Sleep Quality and Gastroesophageal Reflux in Medical Students

Middle East Journal of Digestive Diseases ◽

10.34172/mejdd.2021.217 ◽

2021 ◽

Vol 13 (2) ◽

pp. 139-144

Author(s):

Azam Teimouri ◽

Babak Amra

Keyword(s):

Medical Students ◽

Gastroesophageal Reflux ◽

Sleep Quality ◽

Sleep Disturbances ◽

Gastrointestinal Symptoms ◽

Cross Sectional Study ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Cross Sectional ◽

Increased Risk

BACKGROUND Due to stressful occupational conditions, irregular dietary and sleep schedules, medical students are at increased risk of developing gastrointestinal disorders, gastroesophageal reflux (GERD) in particular, as well as sleep disturbances. Therefore, for the first time, we aimed to assess the correlation between GERD and sleep disturbances among medical students. METHODS The current cross-sectional study was done on 290 medical students at different study periods in Iran during 2018-2019. Age, sex, stage of studying, residence, and body mass index were gathered. The frequency scale for the symptoms of gastroesophageal reflux (FSSG) was utilized to assess gastrointestinal symptoms among them and the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. Eventually, the association of sleep disturbances with demographic factors and gastrointestinal symptoms was evaluated. RESULTS Living in the dormitory (p = 0.048; OR: 1.73; 95%CI: 1.01-2.99) and being overweight (p < 0.001; OR: 3.09; 95%CI: 1.58-6.06) were independently correlated with impaired sleep quality. GERD presented either by heartburn (p < 0.001) or regurgitation (p < 0.001) was associated with a lower quality of life. CONCLUSION GERD was correlated with poor sleep quality among medical students. In addition, residence in dormitory and being overweight were correlated with poor sleep quality.

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Poor Sleep Quality among Medical Students in International Islamic University Malaysia (IIUM) and Its Association with Mental Health and other Factors

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v19i2.1564 ◽

2020 ◽

Vol 19 (2) ◽

Author(s):

Said AH ◽

Yusof MZ ◽

Mohd FN ◽

Azmi MANH ◽

Mohd Hanapiah H ◽

...

Keyword(s):

Mental Health ◽

Logistic Regression ◽

Medical Students ◽

Sleep Quality ◽

Multiple Logistic Regression Analysis ◽

Cross Sectional Study ◽

Poor Sleep ◽

Multiple Logistic Regression ◽

Poor Sleep Quality ◽

Cross Sectional

INTRODUCTION: Poor sleep quality is a common problem experienced by medical students worldwide. Therefore, this study aimed to measure the prevalence of poor sleep quality among medical students in International Islamic University Malaysia (IIUM) and its association with mental health and other factors. MATERIALS AND METHODS: A cross-sectional study using convenience sampling was conducted among 500 medical students in IIUM Kuantan. A validated self-reported questionnaire including sociodemographic, socioeconomic, lifestyle, Pittsburgh Sleep Quality Index and Depression Anxiety Stress Score 21 was distributed from 15th July to 31st August 2019. Descriptive statistics were used to measure the prevalence of poor sleep quality. Chi- square test, Fisher’s exact test, independent sample T-test, and multiple logistic regression were used to measure the association between risk factors and sleep quality. RESULT: The response rate was 91.2%. The prevalence of poor sleep quality was 59.6%. Multiple logistic regression analysis revealed level of study (clinical year (AOR=0.44, 95% CI: 0.29 - 0.66) and depression (yes (AOR: 1.71, 95% CI 1.03-2.83) contributed independently on poor sleep quality among medical students. There was no significant relationship between tahajjud practice and poor sleep quality. CONCLUSION: More than half of IIUM medical students have poor sleep quality. Those students who were in the pre-clinical year and had depression were independently associated with the occurrence of poor sleep quality. Early intervention is compulsory to overcome this problem among medical students in IIUM.

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

F1000Research ◽

10.12688/f1000research.53904.2 ◽

2021 ◽

Vol 10 ◽

pp. 505

Author(s):

Dhan Shrestha ◽

Suman Prasad Adhikari ◽

Namrata Rawal ◽

Pravash Budhathoki ◽

Subashchandra Pokharel ◽

...

Keyword(s):

Medical Students ◽

Sleep Quality ◽

Online Survey ◽

Sampling Technique ◽

Well Being ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Cross Sectional ◽

Diverse Range ◽

Medical College

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.

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Burnout among medical students in Cyprus: A cross-sectional study

PLoS ONE ◽

10.1371/journal.pone.0241335 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241335 ◽

Cited By ~ 1

Author(s):

Antonios Nteveros ◽

Marios Kyprianou ◽

Artemios Artemiadis ◽

Antrianthi Charalampous ◽

Kallistheni Christoforaki ◽

...

Keyword(s):

Mental Health ◽

Medical Students ◽

Sleep Quality ◽

Short Form ◽

Maslach Burnout Inventory ◽

Healthcare Sector ◽

Poor Sleep ◽

Student Survey ◽

Cross Sectional ◽

Linear Effect

Objectives The primary aim was to estimate the burnout prevalence among all medical students at the Medical School of the University of Cyprus. Secondary aims were to ascertain the predictors of burnout and its relationship with lifestyle habits, sleep quality and mental health. Background Burnout in the healthcare sector has drawn significant scientific attention over the last few years. Recent research underscored the large burden of profession-related burnout among medical students. Materials and methods An anonymous questionnaire was administered to all 189 eligible candidates. This included demographic and lifestyle characteristics. Sleep quality was assessed via the Pittsburg Sleep Quality Index, mental health was assessed via the mental health (MH) domain of the 36-item Short Form Health Survey (SF-36) and burnout with the Maslach Burnout Inventory–Student Survey (MBI-SS). Results Overall response rate was 96.3%. The burnout prevalence was 18.1%. There was a significant linear effect of between the year of studies and the burnout frequency [F(1) = 5.09, p = 0.024], implying that with increasing academic year there were more students with burnout, especially after the 4th year of education which signifies the beginning of clinical education. Students with burnout were more likely to have poor sleep quality (90.9% vs. 60.8%, odds ratio 4.33, p = 0.023) and worse mental health (MH score 40.2 ± 17.7 vs 62.9 ± 20.3, p<0.001). Alcohol consumers had more symptoms of cynicism and less feelings of efficacy than non-alcohol consumers. Moreover, less feelings of efficacy were significantly associated with more alcohol consumption among alcohol consumers. Conclusions Burnout is prevalent in medical students and increases significantly during the clinical years. Students with burnout have worse sleep and mental health and might use alcohol as a coping mechanism. Implementing prevention strategies of burnout may be beneficial.

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P152 Poor sleep quality, individual experiences and increased risk of self-harm – A multi-method study

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.192 ◽

2021 ◽

Vol 2 (Supplement_1) ◽

pp. A71-A71

Author(s):

P Varma ◽

M Burge ◽

H Meaklim ◽

M Junge ◽

M Jackson

Keyword(s):

Sleep Quality ◽

Sleep Disturbances ◽

Online Survey ◽

Suicide Ideation ◽

Poor Sleep ◽

Free Text ◽

Poor Sleep Quality ◽

Cross Sectional ◽

Increased Risk ◽

Self Harm

Abstract Introduction The COVID-19 pandemic has caused significant psychological distress to many people across the globe. Poor sleep quality may be linked to poor mental health and increased suicide ideation. To contextualise the risk factors associated with self-harm or suicidal ideation during the COVID-19 pandemic, this cross-sectional study examined links between poor sleep quality, individual experiences and self-harm risk. Methods N=1544 (Mage=44.3y) from 63 countries completed an online survey in March-April 2020. Participants reported their pandemic experiences as free text responses, which were examined quantitatively for frequent word usage using Linguist Inquiry and Word Count software. Pittsburgh Sleep Quality Index assessed poor sleep quality (cut-off score >8). Item-9 of Patient Health Questionnaire-9 measured the risk of self-harm. Results Individuals with poor sleep quality (45%) used more negative emotional tone and had greater use of anxiety or money-related words in their comments than good sleepers (all ps<.05). Additionally, 19% of respondents (n=295) reported thoughts of self-harm at least several days a week (3.4% nearly every day). Logistic regression indicated that younger individuals, males, and those feeling isolated or less resilient had 1.2 to 1.5 times greater risk of self-harm (all ps<.001). Poor sleep quality was associated with a two-fold increased risk of self-harm (95%CI=1.5–2.7, p<.0001) after controlling for demographic variables. Discussion Poor sleep quality is linked to negative emotionality and increased risk of self-harm during the COVID-19 pandemic. Sleep is a modifiable factor; therefore interventions aimed at addressing sleep disturbances may improve resilience and reduce the risk of self-harm in vulnerable individuals.

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Effect of COVID-19 Quarantine on the Sleep Quality and the Depressive Symptom Levels of University Students in Jordan During the Spring of 2020

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.605676 ◽

2021 ◽

Vol 12 ◽

Author(s):

Heba Saadeh ◽

Maha Saadeh ◽

Wesam Almobaideen ◽

Assem Al Refaei ◽

Nour Shewaikani ◽

...

Keyword(s):

Mental Health ◽

Depressive Symptoms ◽

University Students ◽

Sleep Quality ◽

Sleep Disturbances ◽

Depression Scale ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Online Questionnaire ◽

Cross Sectional

Objectives: This study was designed to assess the effect of COVID-19 home quarantine and its lifestyle challenges on the sleep quality and mental health of a large sample of undergraduate University students in Jordan. It is the first study applied to the Jordanian population. The aim was to investigate how quarantine for several weeks changed the students' habits and affected their mental health.Methods: A cross-sectional study was conducted using a random representative sample of 6,157 undergraduate students (mean age 19.79 ± 1.67 years, males 28.7%) from the University of Jordan through voluntarily filling an online questionnaire. The Pittsburgh Sleep Quality Index (PSQI) and the Center for Epidemiologic Studies-Depression Scale (CES-D) were used to assess sleep quality and depressive symptoms, respectively.Results: The PSQI mean score for the study participants was 8.1 ± 3.6. The sleep quality of three-quarters of the participants was negatively affected by the extended quarantine. Nearly half of the participants reported poor sleep quality. The prevalence of poor sleep quality among participants was 76% (males: 71.5% and females: 77.8%). Similarly, the prevalence of the depressive symptoms was 71% (34% for moderate and 37% for high depressive symptoms), with females showing higher prevalence than males. The overall mean CES-D score for the group with low depressive symptoms is 9.3, for the moderate group is 19.8, while it is 34.3 for the high depressive symptoms group. More than half of the students (62.5%) reported that the quarantine had a negative effect on their mental health. Finally, females, smokers, and students with decreased income levels during the extended quarantine were the common exposures that are significantly associated with a higher risk of developing sleep disturbances and depressive symptoms.Conclusions: Mass and extended quarantine succeeded in controlling the spread of the COVID-19 virus; however, it comes with a high cost of potential psychological impacts. Most of the students reported that they suffer from sleeping disorders and had a degree of depressive symptoms. Officials should provide psychological support and clear guidance to help the general public to reduce these potential effects and overcome the quarantine period with minimum negative impacts.

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Internet addiction and sleep quality among medical students during the COVID-19 pandemic: A multinational cross-sectional survey

PLoS ONE ◽

10.1371/journal.pone.0259594 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259594

Author(s):

Muhammad Junaid Tahir ◽

Najma Iqbal Malik ◽

Irfan Ullah ◽

Hamza Rafique Khan ◽

Shahida Perveen ◽

...

Keyword(s):

Medical Students ◽

Sleep Quality ◽

Internet Addiction ◽

Online Survey ◽

Medical Training ◽

Negative Impact ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Cross Sectional ◽

Patient Reported

Background The emergence of the COVID-19 pandemic has affected the lives of many people, including medical students. The present study explored internet addiction and changes in sleep patterns among medical students during the pandemic and assessed the relationship between them. Methods A cross-sectional study was carried out in seven countries, the Dominican Republic, Egypt, Guyana, India, Mexico, Pakistan, and Sudan, using a convenience sampling technique, an online survey comprising demographic details, information regarding COVID-19, the Pittsburgh Sleep Quality Index (PSQI), and the Internet Addiction Test (IAT). Results In total, 2749 participants completed the questionnaire. Of the total, 67.6% scored above 30 in the IAT, suggesting the presence of an Internet addiction, and 73.5% scored equal and above 5 in the PSQI, suggesting poor sleep quality. Internet addiction was found to be significant predictors of poor sleep quality, causing 13.2% of the variance in poor sleep quality. Participants who reported COVID-19 related symptoms had disturbed sleep and higher internet addiction levels when compared with those who did not. Participants who reported a diagnosis of COVID-19 reported poor sleep quality. Those living with a COVID-19 diagnosed patient reported higher internet addiction and worse sleep quality compared with those who did not have any COVID-19 patients in their surroundings. Conclusion The results of this study suggest that internet addiction and poor sleep quality are two issues that require addressing amongst medical students. Medical training institutions should do their best to minimize their negative impact, particularly during the current COVID-19 pandemic.

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A cross-sectional survey on sleep quality, mental health, and academic performance among medical students in Saudi Arabia

BMC Research Notes ◽

10.1186/s13104-019-4713-2 ◽

2019 ◽

Vol 12 (1) ◽

Cited By ~ 6

Author(s):

Abdullah Murhaf Al-Khani ◽

Muhammad Ishaque Sarhandi ◽

Mohamed Saddik Zaghloul ◽

Mohammed Ewid ◽

Nazmus Saquib

Keyword(s):

Mental Health ◽

Academic Performance ◽

Medical Students ◽

Sleep Quality ◽

Screen Time ◽

Pittsburgh Sleep Quality Index ◽

Poor Sleep ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Prevalence Of Depression

Abstract Objective Adequate sleep is integral to better mental health and facilitates students’ learning. We aimed to assess sleep quality among medical students and to see whether it was associated with their mental health (e.g., depression, anxiety, and stress) and academic performance. Results A total of 206 responded, and 95 of them had complete data on demography, lifestyle, academic performance, sleep quality (Pittsburgh Sleep Quality Index), and mental health (Depression Anxiety Stress Scales). The prevalence of poor sleep was 63.2%; it was higher among students who were physically inactive and had more screen time. Poor sleepers demonstrated higher academic performance than sufficient sleepers (p = 0.04). The prevalence of depression, anxiety, and stress were 42%, 53%, and 31% respectively. Sleep quality was significantly associated with depression (p = 0. 03), anxiety (p = 0.007), and stress (p = 0.01).

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Association of severity of depressive symptoms with sleep quality, social support and stress among Pakistani medical and dental students: A cross-sectional study

Global Psychiatry ◽

10.2478/gp-2019-0019 ◽

2019 ◽

Vol 2 (2) ◽

pp. 211-220

Author(s):

Ahmed Waqas ◽

Aqsa Iftikhar ◽

Zahra Malik ◽

Kapil Kiran Aedma ◽

Hafsa Meraj ◽

...

Keyword(s):

Social Support ◽

Depressive Symptoms ◽

Medical Students ◽

Sleep Quality ◽

Severe Depression ◽

Dental Students ◽

Poor Sleep ◽

Poor Sleep Quality ◽

Cross Sectional ◽

Medical And Dental Students

AbstractObjectivesThis study has been designed to elucidate the prevalence of stress, depression and poor sleep among medical students in a Pakistani medical school. There is a paucity of data on social support among medical students in Pakistan; an important predictor of depressive symptoms. Therefore, this study was also aimed to demonstrate the direct and indirect impact of social support in alleviating depressive symptoms in the study sample.MethodsThis observational cross-sectional study was conducted in Lahore, Pakistan, where a total of 400 students at a medical school were approached between 1st January to 31st March 2018 to participate in the study. The study sample comprised of medical and dental students enrolled at a privately financed Pakistani medical and dental school. The participants responded to a self-administered survey comprising of five parts: a) demographics, b) Pittsburgh Sleep Quality Index (PSQI), c) Patient Health Questionnaire-9 (PHQ-9), d) Multidimensional Scale of Perceived Social Support (MSPSS) and e) Perceived Stress Scale-4 (PSS-4). All data were analysed using SPSS v. 20. Linear regression analysis was used to reveal the predictors of depression.ResultsIn total, 353 medical students participated, yielding a response rate of 88.25%. Overall, poor sleep quality was experienced by 205 (58.1%) students. Mild to severe depression was reported by 83% of the respondents: mild depression by 104 (29.5%), moderate depression by 104 (29.5%), moderately severe depression by 54 (15.3%) and severe depression by 31 (8.8%) respondents. Subjective sleep quality, sleep latency, daytime dysfunction and stress levels were significantly associated with depression symptoms. Social support was not significantly associated with depressive symptoms in the regression model (Beta = -0.08, P < 0.09); however, it acted as a significant mediator, reducing the strength of the relationship between depressive symptoms and sleep quality and stress.ConclusionsAccording to our study, a large proportion of healthcare (medical and dental) students were found to be suffering from mild to moderate depression and experienced poor sleep quality. It is concluded that social support is an important variable in predicting depressive symptomatology by ameliorating the effects of poor sleep quality and high stress levels.

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The Current Situation of Internet Addiction and Its Impact on Sleep Quality and Self-Injury Behavior in Chinese Medical Students

Psychiatry Investigation ◽

10.30773/pi.2019.0131 ◽

2020 ◽

Vol 17 (3) ◽

pp. 237-242

Author(s):

Yanqiu Wang ◽

Ying Zhao ◽

Ling Liu ◽

Yan Chen ◽

Dong Ai ◽

...

Keyword(s):

Medical Students ◽

Sleep Quality ◽

Internet Addiction ◽

Detection Rate ◽

Poor Sleep ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Self Injury ◽

Chinese Medical Students ◽

Self Harm

Objective The purpose of this cross-sectional survey is to explore the current state of Internet addiction (IA) in Chinese medical students and its connection with medical students’ sleep quality and self-injury behavior.Methods Respondents were came from Wannan Medical College, China. The Young’s Internet Addiction Test, Pittsburgh Sleep Quality Index (PSQI), Self-Harm Questionnaire were used in this cross-sectional survey. A total of 3,738 medical students were investigated, 1,552 (41.52%) males, 2,186 (58.48%) females. T-test, chi-square test and MANOVA were used for data analysis.Results Of the 3,738 medical students, 1,054 (28.2%) reported having IA, 1,126 (30.1%) reported having poor sleep quality, 563 (15.1%) having self-harm behaviors. IA tends to be more female, upper grade students. The sleep quality of IA was worse than that of non-IA (χ<sup>2</sup>=54.882, p<0.001), and the possibility of self-injury was higher than non-IA (χ<sup>2</sup>=107.990, p<0.001).Conclusion This survey shows that the IA detection rate of medical students was 28.2%. Females, higher grade students had a higher IA detection rate. The low sleep quality and self-injury behavior of medical students are associated with IA.

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