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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 4  |  Page : 530-533

Association between sleep quality and stress among medical students of a rural indian tertiary care setting


1 Department of Medical Physiology, Vinayaka Mission’s Research Foundation (Deemed to be University), Salem, India
2 Department of Physiology, Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital, Salem, India
3 Government Erode Medical College Hospital, Perundurai, India
4 Yoga and Naturopathy Lifestyle Clinic, Government Hospital, Udumalpet, India
5 Department of Sports Physiotherapy, Nandha College of Physiotherapy, Erode, Tamil Nadu, India

Date of Submission22-Aug-2022
Date of Acceptance22-Nov-2022
Date of Web Publication29-Dec-2022

Correspondence Address:
Dr. Panneerselvam Periasamy
Department of Medical Physiology, Vinayaka Mission’s Research Foundation (Deemed to be University), Salem 636308, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mgmj.mgmj_141_22

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  Abstract 

Background: Due to the rigorous academic standards and demanding professionals, the medical field is thought to be a stressful subject of study. This has a negative impact on the student’s mental and physical health. The long-term effects of this study will have an impact on identifying major issues that our students are facing, which will ultimately improve the level of medical treatment offered by future doctors. Materials and Methods: This cross-sectional study was conducted from October to December 2020 at a tertiary care institution in Tamil Nadu, India for three months. After getting the necessary ethical permissions from the institution with reference number GEMC/2020/002, the undergraduate students from the first year to the internship were included in the study. Results: The educational status of the students indicated that around 147 (31.1%) of respondents belonged in the first year. The mean + Pittsburgh Sleep Quality Index (PSQI) was observed to be 6.33 + 2.13, where undesirable sleep quality was predominant among 370 (78.3%) of the respondents with a p-value of less than 0.0001. The majority of the students (70.1%) have normal levels of stress which were significant with a p-value of 0.0027. Conclusion: Medical students experience poor sleep and ongoing stress, which can result in harmful behaviors like overindulging in junk food and a reduced likelihood of exercising. They are undeniably more prone to developing chronic illnesses. If these issues are not addressed, they will affect the medical care that is given to their incoming patients.

Keywords: Medical students, mental health, sleep, stress


How to cite this article:
Periasamy P, Vajiravelu S, Gunasekaran S, Balakrishnan R, Manivannan J. Association between sleep quality and stress among medical students of a rural indian tertiary care setting. MGM J Med Sci 2022;9:530-3

How to cite this URL:
Periasamy P, Vajiravelu S, Gunasekaran S, Balakrishnan R, Manivannan J. Association between sleep quality and stress among medical students of a rural indian tertiary care setting. MGM J Med Sci [serial online] 2022 [cited 2023 Feb 7];9:530-3. Available from: http://www.mgmjms.com/text.asp?2022/9/4/530/365969




  Introduction Top


Due to the rigorous academic standards and demanding professionals, the medical field is thought to be a stressful subject of study. This has a negative impact on the student’s mental and physical health.[1],[2] The predicament is a result of several variables, including academic overload, exposure to illnesses and fatalities, frequent exams, and an extensive curriculum. Additionally, many students are dealing with a variety of stressors outside of their medical school, including family, social, emotional, and physical issues.[3],[4] Maintaining healthy physical, mental, and emotional health depends on getting enough sleep, which is also one of the most crucial aspects of life.[5] Sleep quality is a hard-to-define phenomenon that can be evaluated on both quantitative and qualitative grounds. The quantity and timing of sleep also affect cognitive function.[6] The timing of sleep is influenced by the period of previous wakefulness as well as circadian clock regulation. Poor sleep hygiene can be a common health issue for medical students as well as a sign of many chronic physical and mental diseases.[7] Poor sleep hygiene is very common in both high-income and developing nations. According to a WHO (World Health Organization) survey, roughly 27% of individuals globally experience sleep disorders. The study also revealed that 50 to 70 million individuals experience persistent sleep difficulties.[8] Both mental and physical health is negatively impacted by the increasing levels of poor sleep quality and psychological anxiety.[9] Numerous studies conducted in the United States, Australia, and other nations have revealed that students with bad sleep habits perform worse on tests and are sadder than their peers.[10] The long-term effects of this study will have an impact on identifying major issues that our students are facing, which will ultimately improve the level of medical treatment offered by future doctors. To improve students’ quality of life, it is crucial in our opinion to assess the degree of mental and physical health among our students and pinpoint any gaps.[11],[12] This study’s goal is to ascertain the incidence and relationships between stress and sleep quality among medical students in a rural tertiary care setting.


  Materials and methods Top


This cross-sectional study was conducted from October to December 2020 at a tertiary care institution in Tamil Nadu, India for three months. After getting the necessary ethical permissions from the institution with reference number GEMC/2020/002, the undergraduate students from the first year to the internship were included in the study. Individuals who were denied participation in the study were excluded. The data forms consisted of Socio-demographic characteristics, the Kessler psychological distress scale, and the Pittsburgh Sleep quality index. Socio-demographic characteristics included age, gender, year of the study, and the average marks scored by the individual in previous examinations. Pittsburgh Sleep Quality Index (PSQI) was used to assess Sleep quality, which was validated among college students by Aloba et al.[13] The PSQI is composed of 19 questions comprising seven components that evaluate sleep during the past month. Each component is given a value between 0 and 3, with 3 denoting the most dysfunction, while the overall score is between 0 and 21. Poor sleep quality is indicated by a PSQI score greater than 5, whereas excellent sleep quality is indicated by a PSQI score less than or equal to 5. The Kessler Psychological Distress Scale (K10), which consists of ten items concerning emotional states with a five-point Likert scale ranging from “none of the time” to “all of the time” and was scored from 1 to 5, is used to gauge how much stress pupils have encountered over the past four weeks.[14] The overall score goes from 10 to 50, with 20–24 representing mild stress and 25–29 representing moderate stress, 30–50 representing severe stress.

Statistical analysis

The survey results of the questionnaire were extracted and recorded using MS Excel and then imported and analyzed using SPSS version 25. Univariate descriptive analyses such as frequency and percentage were done for sociodemographic and categorical (nominal and ordinal) demographic variables and dependent variables. Descriptive statistical measures were calculated for numeric scale variables. Chi-squared test was used to study the significant associations between categorical sociodemographic variables versus categorical dependent variables. P value <0.05 is considered statistically significant.


  Results Top


A total of 472 participants were included in the study, where the mean age ±SD of the respondents was 21.4 ± 2.6, with ages ranging from 18 to 26 years and about 286 (60.6%) of the respondents were within ≤ 21 years and about 278 (58.9%) of the respondents were females. The educational status of the students indicated that around 147 (31.1%) of respondents belonged in the first year [Table 1]. The mean+ PSQI was observed to be 6.33+2.13, where undesirable sleep quality was predominant among 370 (78.3%) of the respondents with a p-value of less than 0.0001. The majority of the students (70.1%) have normal levels of stress which were significant with a p-value of 0.0027[Table 2].
Table 1: Socio-demographic characteristics of the participants

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Table 2: Sleep Quality and Stress levels among the respondents

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  Discussion Top


This study demonstrates the typical prevalence of psychological discomfort (70,1%) and poor sleep (78,5%) among medical students in a rural, tertiary care environment in India. In contrast to past research that demonstrated higher levels of psychological discomfort, the findings of the current investigation show a normal prevalence of stress. The normal levels of stress were observed because the majority of the study participants belonged to first years and they have a feeling of highness due to their recent pursuit of MBBS seats and less exposure to the clinics. It is well known that students in medical school face several pressures and difficulties and that medical school is thought to increase the chance of developing depressive symptoms, which may account for the students’ elevated stress levels.[15],[16] The current study supports previous research by Yazdi et al. and Brick et al. that shows a rising prevalence of poor sleep quality among medical students.[17],[18] This result can be explained by a variety of variables, including the fact that medical students are involved in a variety of activities and are managing many stressors, both of which may cause them to study or work late into the night.[19] In this study, there was no discernible relationship between gender and sleep quality; however, in some other investigations, being a female medical student was found to be a major predictor of worse sleep.[20] Furthermore, there is no evidence of a connection between stress and poor sleep quality in this study. The prior research’ concentration on preclinical students may be the cause, which has been linked to the heavy lecture and homework loads in the early preclinical years. The failure of individuals to adjust to their surroundings may also be a factor.[21],[22]


  Conclusion Top


Medical students experience poor sleep and ongoing stress, which can result in harmful behaviors like overindulging in junk food and a reduced likelihood of exercising. They are undeniably more prone to developing chronic illnesses. If these issues are not addressed, they will affect the medical care that is given to their incoming patients. The goal of basic healthcare is to identify and prevent illness risk factors. For this reason, we advise offering undergraduate students enough assistance, counseling, direction, and mental health prevention programs as a part of their clinical rotations.

Ethical consideration

Institutional Ethics Committee of Government Erode Medical College Hospital, Perundurai, Tamil Nadu, India had reviewed the research project and approved the study protocol vide letter no. IEC/001/GEMCand H/2020 on 31.07.2020.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest



 
  References Top

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Sethia R, Sharma G, Shekhawat K, Aacharya A, Acharya R, Meena RR Study of perceived stress and stressors among undergraduate medical students. Int J Community Med Public Health 2019;6:1690-4.  Back to cited text no. 1
    
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Shaikh BT, Kahloon A, Kazmi M, Khalid H, Nawaz K, Khan N, et al. Students, stress and coping strategies: A case of pakistani medical school. Educ Health (Abingdon) 2004;17:346-53.  Back to cited text no. 2
    
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Wong JG, Patil NG, Beh SL, Cheung EP, Wong V, Chan LC, et al. Cultivating psychological well-being in hong kong’s future doctors. Med Teach 2005;27:715-9.  Back to cited text no. 3
    
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Behere SP, Yadav R, Behere PB A comparative study of stress among students of medicine, engineering, and nursing. Indian J Psychol Med 2011;33:145-8.  Back to cited text no. 4
    
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Ezquiaga A, Vas C, Nieto G, Blanco S, Schwemler M, Roca L, et al. Sleep quality evaluation in medical students. J Neurol Sci 2015;357:e435. https://doi.org/10.1016/j.jns.2015.09.063  Back to cited text no. 5
    
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Preišegolavičiūtė E, Leskauskas D, Adomaitienė V Associations of quality of sleep with lifestyle factors and profile of studies among lithuanian students. Medicina (Kaunas) 2010;46:482-9.  Back to cited text no. 6
    
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Foster RG, Peirson SN, Wulff K, Winnebeck E, Vetter C, Roenneberg T Sleep and circadian rhythm disruption in social jetlag and mental illness. Prog Mol Biol Transl Sci 2013;119:325-46.  Back to cited text no. 7
    
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Yang CM, Wu CH, Hsieh MH, Liu MH, Lu FH Coping with sleep disturbances among young adults: A survey of first-year college students in taiwan. Behav Med 2003;29:133-8.  Back to cited text no. 8
    
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Azad MC, Fraser K, Rumana N, Abdullah AF, Shahana N, Hanly PJ, et al. Sleep disturbances among medical students: A global perspective. J Clin Sleep Med 2015;11:69-74.  Back to cited text no. 9
    
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Satti MZ, Khan TM, Qurat-Ul-Ain QU, Azhar MJ, Javed H, Yaseen M, et al. Association of physical activity and sleep quality with academic performance among fourth-year Mbbs students of rawalpindi medical university. Cureus 2019;11:e5086.  Back to cited text no. 10
    
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Gupta S, Choudhury S, Das M, Mondol A, Pradhan R Factors causing stress among students of a medical college in kolkata, india. Educ Health (Abingdon) 2015;28:92-5.  Back to cited text no. 11
    
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Abdel Rahman AG, Al Hashim BN, Al Hiji NK, Al-Abbad Z Stress among medical saudi students at college of medicine, king faisal university. J Prev Med Hyg 2013;54:195-9.  Back to cited text no. 12
    
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Abiola T, Udofia O, Zakari M Psychometric properties of the 3-item Oslo social support scale among clinical students of Bayero University Kano, Nigeria. Malays J Psychiatry 2013;22:32-41.  Back to cited text no. 13
    
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Easton SD, Safadi NS, Wang Y, Hasson RG 3rd. The kessler psychological distress scale: Translation and validation of an arabic version. Health Qual Life Outcomes 2017;15:215.  Back to cited text no. 14
    
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Almojali AI, Almalki SA, Alothman AS, Masuadi EM, Alaqeel MK The prevalence and association of stress with sleep quality among medical students. J Epidemiol Glob Health 2017;7:169-74.  Back to cited text no. 15
    
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Jeon HJ, Roh MS, Kim KH, Lee JR, Lee D, Yoon SC, et al. Early trauma and lifetime suicidal behavior in a nationwide sample of korean medical students. J Affect Disord 2009;119:210-4.  Back to cited text no. 16
    
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Yazdi Z, Loukzadeh Z, Moghaddam P, Jalilolghadr S Sleep hygiene practices and their relation to sleep quality in medical students of qazvin university of medical sciences. J Caring Sci 2016;5:153-60.  Back to cited text no. 17
    
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Brick CA, Seely DL, Palermo TM Association between sleep hygiene and sleep quality in medical students. Behav Sleep Med 2010;8:113-21.  Back to cited text no. 18
    
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Berhanu H, Mossie A, Tadesse S, Geleta D Prevalence and associated factors of sleep quality among adults in jimma town, southwest ethiopia: A community-based cross-sectional study. Sleep Disord 2018;2018:8342328.  Back to cited text no. 19
    
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Waqas A, Khan S, Sharif W, Khalid U, Ali A Association of academic stress with sleeping difficulties in medical students of a pakistani medical school: A cross sectional survey. Peerj 2015;3:e840.  Back to cited text no. 20
    
21.
Bahammam AS, Alaseem AM, Alzakri AA, Almeneessier AS, Sharif MM The relationship between sleep and wake habits and academic performance in medical students: A cross-sectional study. Bmc Med Educ 2012;12:61.  Back to cited text no. 21
    
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    Tables

  [Table 1], [Table 2]



 

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