Association of depression symptoms and sleep quality with state-trait anxiety in medical university students in Anhui Province, China: a mediation analysis

Abstract

Background The prevalence of depression symptoms among medical students is particularly high, and it has increased during the COVID-19 epidemic. Sleep quality and state-trait anxiety are risk factors for depression, but no study has yet investigated the mediating role of state-trait anxiety in the relationship between poor sleep quality and depression symptoms in medical students. This study aims to investigate the relationship among depression symptoms, sleep quality and state-trait anxiety in medical university students in Anhui Province. Methods This was a cross-sectional survey of 1227 students’ online questionnaires collected from four medical universities in Anhui Province using a convenience sampling method. We measured respondents’ sleep quality, state-trait anxiety, and depression symptoms using three scales: the Pittsburgh Sleep Quality Index (PSQI), the State-Trait Anxiety Inventory (STAI) and the Self-rating Depression Scale (SDS). We analysed the mediating role of STAI scores on the association between PSQI scores and SDS scores through the Sobel-Goodman Mediation Test while controlling for covariates. P < 0.05 was considered statistically significant. Results A total of 74.33% (912) and 41.40% (518) of the respondents reported suffering from poor sleep quality and depression symptoms. Sleep quality, state-trait anxiety, and depression symptoms were positively associated with each other (β = 0.381 ~ 0.775, P < 0.001). State-trait anxiety partially mediated the association between sleep quality and depression symptoms (Sobel test Z = 15.090, P < 0.001), and this mediating variable accounted for 83.79% of the association when adjusting for potential confounders. Subgroup analysis further revealed that STAI scores partially mediated the association between PSQI scores and SDS scores in females and rural students and fully mediated the association between PSQI scores and SDS scores in males and urban students. Conclusions This study found that sleep quality and state-trait anxiety have a significant predictive effect on depression symptoms. State-trait anxiety mediated the relationship between sleep quality and depression symptoms, with a more complex mechanism observed among rural and female medical students. Multiple pathways of intervention should be adopted, such as encouraging students to self-adjust, providing professional psychological intervention and timely monitoring, enriching extracurricular activities, and making changes in policies regarding long shifts and working hours.

Psychometric properties of the Brief Version of Pittsburgh Sleep Quality Index (B-PSQI) among Chinese male sailors on 18-hr rotating shift schedule.

“…With reference to the concurrent and predictive validity, the correlation results indicated that the sleep quality of sailors was related to depression and anxiety, which was in accord with the results of recent studies on the relationship between sleep disturbance and mental health among shift workers (J. Chen et al, 2022; Dai et al, 2019; Demirkol et al, 2021; Hwang et al, 2022; Yao et al, 2022).…”

How is family health related to health‐related quality of life among middle‐aged and older adults in rural China? A cross‐sectional study

“…Our results showed that the association was not significant. A potential reason is that the occurrence of anxiety/depression is complex and affected by many factors, including social participation (Ding et al., 2022), physical health (Almhdawi et al., 2021) and sleep quality (Chen et al., 2022). The non‐significant effect of family health on anxiety/depression may be related to the decomposition of other factors.…”

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

“…Recent studies have found that medical students are more likely to experience sleep deprivation than their peers in other fields, due to the intense academic and clinical demands of medical school [ 61 , 79 ]. This lack of sleep can profoundly impact medical students’ physical and mental health, leading to various negative effects [ 80 ]. The most obvious consequence of insufficient sleep is decreased alertness and focus [ 58 , 81 ].…”