Influence of medical education on student mental health

A recent study, published on preprint server medRxiv*, examined the impact of medical school on students’ mental health and sleep habits.

Medical students need to rethink and prioritize their activities in order to be available for the long lecture periods and daily lab sessions and to prepare well for their school and national exams.

Study: Effects of medical school on mental health and sleep habits. Credit: Maridav/Shutterstock

Before they join a medical school, their life is different and they have to adapt to the competitive and increased demands of medical education; In addition, medical students report burnout and mental illnesses more frequently than other students. Some students take up additional activities such as volunteering, work, or research experience in order to register for a residency.

Therefore, it is important to identify the risk factors for declining mental health in college students and to understand what is likely to impact medical professionals and physicians.

The study

In the present study, changes in depression and anxiety in the first two years of medical school students were evaluated. The authors assessed the association between sleep habits and other risk factors (chronic disease, year of medical school, class year, exercise habits). The study also focused on the effects of the coronavirus disease 2019 (COVID-19) on medical students.

The survey of students born in 2023 and 2024 was carried out on a voluntary basis. Sleep was quantified as average hours of sleep per night, and changes in sleep quality (SQ-3) were assessed using three questions. As a supplemental assessment of sleep quality, the Pittsburg Sleep Quality Index (PSQI) was included in the Summer 2020 survey. Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to assess levels of anxiety and depression, respectively. In the second year of the study, additional questions about the COVID-19 pandemic were included in the survey to examine whether the pandemic had an impact on sleep levels, anxiety, and depression among medical students.

Using generalized linear mixed models (GLMMs), the response data from SQ-3, PSQI, GAD-7, PHQ-9 were statistically analyzed. The present analysis was stratified into three cohorts. In the first cohort, participants from both classes, i.e. 2023 and 2024, were analyzed without COVID-19 specific questions. The second cohort analysis was the same as the first but included the COVID-19 specific questionnaire. The final cohort included only the students in Class 2023.


A total of 197 students were surveyed, of whom 85 were from the 2023 class and the remainder enrolled in the 2024 class (2021), average sleep hours, total exposure, COVID-19 period, and chronic illness. The authors observed significant differences between time points in the individual analysis of SQ-3, PHQ-9, PSQI and GAD-7. Differences between time points, less sleep, and a chronic diagnosis increased SQ-3, PHQ-9, and PSQI levels. Time differences and chronic diseases significantly increased the GAD-7 score.

In the second cohort, three additional variables of self-reported changes in anxiety, depression, and sleep quality were included. The COVID-19 pandemic had not caused significant changes in depression, anxiety, and sleep quality, but the pandemic had significant impacts on self-reported responses to these factors.

The third cohort showed that chronic illness and average hours of sleep had a significant impact on SQ-3, PSQI, PHQ-9, and GAD-7 responses. Timing differences had significant effects on the SQ-3, GAD-7, and PHQ-9 scores. The study found that other variables had no significant impact.


The authors found that the COVID-19 pandemic had no significant impact on the mental health of medical students. The class year and exercise also had no effect on their mental health, according to the observations. Medical student life is filled with stress and poor sleep times during the academic year, leading to increased anxiety, depression and sleep quality.

Observations made in this study showed that the first two years of medical education are associated with increased levels of anxiety and depression and poor sleep quality, which are conditioned by the academic cycle. Chronic disorders and reduced amount of sleep have been identified as risk factors for poor mental health in medical students. To counteract this, medical schools need to implement changes and policies to achieve healthy well-being and improved academic performance of medical students.

*Important NOTE

medRxiv publishes preliminary scientific reports that are not peer-reviewed and therefore should not be relied upon as conclusive, guide clinical practice/health behavior, or be treated as established information.

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