Sleep Quality as a Predictor of Depression in Preclinical Medical Students

Authors

  • Auriza Nabila Atiqah Universitas Negeri Surabaya
  • Ariesta Dewi Ciptorini Universitas Negeri Surabaya
  • Haifa Hasna Putri Universitas Negeri Surabaya
  • Reynhard Alfado Randalabi Universitas Negeri Surabaya
  • Tedy Nurnizam Universitas Negeri Surabaya

DOI:

https://doi.org/10.58344/ihj.v5i2.871

Keywords:

Sleep Quality, Depression, Medical Students, Preclinical

Abstract

Sleep quality has emerged as a critical determinant of mental health among medical students worldwide. Poor sleep patterns are frequently associated with increased depressive symptoms, particularly in preclinical medical students who face intense academic pressure and limited recovery time. This study aims to examine the relationship between sleep quality and depression and to analyze its psychological implications among preclinical medical students. A literature review approach was employed using articles indexed in PubMed, Scopus, and ScienceDirect published between 2022 and 2026. A total of 13 eligible studies were analyzed based on predefined inclusion criteria focusing on validated instruments such as the Pittsburgh Sleep Quality Index (PSQI) and Patient Health Questionnaire-9 (PHQ-9). The results indicate a consistent and significant association between poor sleep quality and higher levels of depression, with odds ratios ranging from 1.50 to 3.99 across studies. Psychological factors such as anxiety and academic stress were identified as major mediators in this relationship, while behavioral factors such as screen time further exacerbated sleep disturbances. The discussion highlights that sleep quality is not merely a symptom but a significant predictive factor of depression in this population. In conclusion, poor sleep quality significantly increases the risk of depression among preclinical medical students, emphasizing the need for early screening, sleep hygiene interventions, and institutional mental health support programs.

References

Acar, R. C., Acan, E., Konak, O. K., & Basoglu, O. K. (2026). Sleep quality in medical students: Any relationship with fatigue severity? Sleep Epidemiology, 6. https://doi.org/10.1016/j.sleepe.2025.100126

Aldabbour, B., Jaradat, R., Aljbour, O., Abdo, M., Aljbour, J., Dayya, A. A., Dabbour Asad, M., & Abuabada, A. (2025). Depression, anxiety, stress, sleep quality, and life satisfaction among undergraduate medical students in the Gaza Strip: a cross-sectional survey. Middle East Current Psychiatry, 32(1). https://doi.org/10.1186/s43045-025-00507-z

Alrashed, F. A., Alsubiheen, A. M., Alshammari, H., Mazi, S. I., Al-Saud, S. A., Alayoubi, S., Kachanathu, S. J., Albarrati, A., Aldaihan, M. M., Ahmad, T., Sattar, K., Khan, S., & Dhiman, G. (2022). Stress, Anxiety, and Depression in Pre-Clinical Medical Students: Prevalence and Association with Sleep Disorders. Sustainability (Switzerland), 14(18). https://doi.org/10.3390/su141811320

Brzostowski, B., Bozeyeh, H., Ishchenko, M., Dulak, D., Szwed, A., ?abu?, D., Mysera, M., Shabai, A., Zawadzka, M., Oleszczak, P. E., Czaja, W., Chudecka, K., Piech, B., Ryczek, M., Bekier, M., Khalavchuk, Y., Wierzbicka, A., Pola?ska-Szczap, A., Mielnik, C., … Pu?uk, P. (n.d.). Sleep Quality, Perceived Stress, And Symptoms Of Anxiety And Depression Among Medical Students. J. Biomed. Res, 29(1s). https://doi.org/10.53555/AJBR.v29i1S.9217

Campbell, F., Blank, L., Cantrell, A., Baxter, S., Blackmore, C., Dixon, J., & Goyder, E. (2022). Factors that influence mental health of university and college students in the UK: a systematic review. BMC Public Health, 22(1). https://doi.org/10.1186/s12889-022-13943-x

Chen, J., Tuersun, Y., Yang, J., Xiong, M., Wang, Y., Rao, X., & Jiang, S. (2022). Association of depression symptoms and sleep quality with state-trait anxiety in medical university students in Anhui Province, China: a mediation analysis. BMC Medical Education, 22(1). https://doi.org/10.1186/s12909-022-03683-2

Dudo, K., Ehring, E., Fuchs, S., Herget, S., Watzke, S., Unverzagt, S., & Frese, T. (2022). The association of sleep patterns and depressive symptoms in medical students: a cross-sectional study. BMC Research Notes, 15(1). https://doi.org/10.1186/s13104-022-05975-8

Dutta, G., Rajendran, N., Kumar, T., Varthya, S. B., & Rajendran, V. (2023). Prevalence of Depression Among Undergraduate Medical Students in India: A Systemic Review and Meta-Analysis. Cureus. https://doi.org/10.7759/cureus.33590

Esubalew, D., Delie, A. M., Limenh, L. W., Worku, N. K., Fenta, E. T., Hailu, M., Abie, A., Mehari, M. G., Dagnaw, T. E., & Melese, M. (2024). Poor sleep quality among bedtime smartphone user medical students in Ethiopia, 2024. Sleep Medicine: X, 8. https://doi.org/10.1016/j.sleepx.2024.100134

Feng, Z., Diao, Y., Ma, H., Liu, M., Long, M., Zhao, S., Wu, H., & Wang, Y. (2022). Mobile phone addiction and depression among Chinese medical students: the mediating role of sleep quality and the moderating role of peer relationships. BMC Psychiatry, 22(1). https://doi.org/10.1186/s12888-022-04183-9

Garmabi, M., Andishmand, Z., Naderi, F., Sharifnezhad, A., Darrudi, F., Malekzadeh, R., Amini, A., & Gholami, A. (2024). The Prevalence of Depression and Anxiety and Its Association with Sleep Quality in the First-Year Medical Science Students. Depression Research and Treatment, 2024. https://doi.org/10.1155/2024/7102081

Gosadi, I. M., & Shnaimer, J. A. (2025). Association Between Depression, Anxiety, and Stress and Sleep Quality Among University Students from Saudi Arabia: A Cross-Sectional Study. Psychology Research and Behavior Management, 18, 2287–2298. https://doi.org/10.2147/PRBM.S562798

He, H., Zeng, Y., Chen, Z., Wu, M., & Wang, Y. (2025). Associations Between Sleep Duration, Sleep Quality, and Depressive Symptoms: Evidence from Medical Graduate Students in China. Nature and Science of Sleep, 17, 1853–1862. https://doi.org/10.2147/NSS.S536854

Huang, W., Wen, X., Li, Y., & Luo, C. (2024). Association of perceived stress and sleep quality among medical students: the mediating role of anxiety and depression symptoms during COVID-19. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1272486

Li, M., Jin, X. Y., Li, H., Chu, M. D., & Su, Z. F. (2025). Sleep quality and its correlates among medical undergraduates in Anhui Province: A cross-sectional study on academic stress, mental health, and lifestyle factors. Sleep Epidemiology, 5. https://doi.org/10.1016/j.sleepe.2025.100109

Liyanage, G., Rajapakshe, D. P. R. W., Wijayaratna, D. R., Jayakody, J. A. I. P., Gunaratne, K. A. M. C., & Alagiyawanna, A. M. A. D. K. (2024). Psychological distress and sleep quality among Sri Lankan medical students during an economic crisis. PLoS ONE, 19(6 June). https://doi.org/10.1371/journal.pone.0304338

McKinley, B., Daines, B., Allen, M., Pulsipher, K., Zapata, I., & Wilde, B. (2022). Mental health and sleep habits during preclinical years of medical school. Sleep Medicine, 100, 291–297. https://doi.org/10.1016/j.sleep.2022.09.001

Mekonnen, C. K., Abate, H. K., Beko, Z. W., Zegeye, A. F., & Azagew, A. W. (2024). Prevalence of depression among medical students in Africa: Systematic review and meta-analysis. PLoS ONE, 19(12). https://doi.org/10.1371/journal.pone.0312281

Mishra, J., Panigrahi, A., Samanta, P., Dash, K., Mahapatra, P., & Behera, M. R. (2022). Sleep quality and associated factors among undergraduate medical students during Covid-19 confinement. Clinical Epidemiology and Global Health, 15. https://doi.org/10.1016/j.cegh.2022.101004

Muyeed, A., Rahman, R., Suchi, S. I., Ahmed, K., & Tithi, T. A. (2026). Sleep quality and psychological distress among Bangladeshi medical students: Prevalence, predictors, and sex-institutional differences. Global Epidemiology, 11. https://doi.org/10.1016/j.gloepi.2026.100243

Nguyen, C. T., Dam, V. A. T., Nguyen, L. H., Phung, D., Vu, T. S., Do, H. P., Vu, T. M. T., Latkin, C., Ho, R. C. M., & Ho, C. S. H. (2025). Factors associated with sleep quality among medical students in Vietnam: A national cross-sectional study. BMJ Open, 15(3). https://doi.org/10.1136/bmjopen-2023-083168

Nikolic, A., Bukurov, B., Kocic, I., Vukovic, M., Ladjevic, N., Vrhovac, M., Pavlovi?, Z., Grujicic, J., Kisic, D., & Sipetic, S. (2023). Smartphone addiction, sleep quality, depression, anxiety, and stress among medical students. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1252371

Rahman, M. A., Dhira, T. A., Sarker, A. R., & Mehareen, J. (2022). Validity and reliability of the Patient Health Questionnaire scale (PHQ-9) among university students of Bangladesh. PLoS ONE, 17(6 June). https://doi.org/10.1371/journal.pone.0269634

Rahman, M., Tuli, S. S., Saha, T., Raquib, O. I., Shimu, A. T., Ikram, S. M., & Ashworth, E. (2025). A Systematic Review and Meta-analysis Protocol on Depressive Symptoms Among Medical Students in South Asia Using Patient-reported Validated Assessment Tools: Prevalence and Associated Factors. PLOS ONE, 20(8 August). https://doi.org/10.1371/journal.pone.0331033

Regli, J., Sadeghi-Bahmani, D., Rigotti, V., Stanga, Z., Ülgür, I. I., Fichter, C., Lang, U. E., Brühl, A. B., & Brand, S. (2024). Psychiatric Characteristics, Symptoms of Insomnia and Depression, Emotion Regulation, and Social Activity among Swiss Medical Students. Journal of Clinical Medicine, 13(15). https://doi.org/10.3390/jcm13154372

Selim, M. Y., Shaaban, S. F., Shoma, N. A., ElLeithi, A. A., Shahin, R. Y., & Ibrahim, I. M. A. (2026). A cross-sectional study of sleep quality and its association with academic performance and psychological distress among medical students in Mansoura University, Egypt. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 62(1). https://doi.org/10.1186/s41983-026-01070-y

Shadzi, M. R., Rahmanian, M., Heydari, A., & Salehi, A. (2024). Structural validity of the Pittsburgh Sleep Quality Index among medical students in Iran. Scientific Reports, 14(1). https://doi.org/10.1038/s41598-024-51379-y

Stankovi?, M., & Neši?, M. (2022). Association of internet addiction with depression, anxiety, stress, and the quality of sleep: Mediation analysis approach in Serbian medical students. Current Research in Behavioral Sciences, 3. https://doi.org/10.1016/j.crbeha.2022.100071

Sun, Y., Wang, H., Jin, T., Qiu, F., & Wang, X. (2022). Prevalence of Sleep Problems Among Chinese Medical Students: A Systematic Review and Meta-Analysis. In Frontiers in Psychiatry (Vol. 13). Frontiers Media S.A. https://doi.org/10.3389/fpsyt.2022.753419

Truong, N., Nguyen, H., Pham, T., Chu, D., & Bui, L. (2025). Sleep quality by clinical training status among medical students and its associated factors: a cross-sectional study in Da Nang, Vietnam. Scientific Reports, 15(1). https://doi.org/10.1038/s41598-025-18256-8

Valladares-Garrido, M. J., Morocho-Alburqueque, N., Zila-Velasque, J. P., Solis, L. A. Z., Saldaña-Cumpa, H. M., Rueda, D. A., Chiguala, C. I. P., Jiménez-Mozo, F., Valdiviezo-Morales, C. G., Alburqueque, E. S. B., Núñez, E. C. P., Dominguez-Troncos, H., Vera-Ponce, V. J., Valladares-Garrido, D., Failoc-Rojas, V. E., Pereira-Victorio, C. J., & Culquichicón, C. (2025). Sleep quality and associated factors in Latin American medical students: a cross-sectional and multicenter study. BMC Public Health, 25(1). https://doi.org/10.1186/s12889-025-21569-y

Vidovi?, S., Raki?, N., Kraštek, S., Pešikan, A., Degme?i?, D., Zibar, L., Labak, I., Heffer, M., & Pogoreli?, Z. (2025). Sleep Quality and Mental Health Among Medical Students: A Cross-Sectional Study. Journal of Clinical Medicine, 14(7). https://doi.org/10.3390/jcm14072274

Whitehead, J. P., & Horton, C. L. (2025). Relationships Between Sleep Quality, Anxiety and Depression in University Students: Stable Trends over Time and a Pronounced Concern for Sleep Initiation. Brain Sciences, 15(11). https://doi.org/10.3390/brainsci15111142

Wiguna, T., Dirjayanto, V. J., Maharani, Z. S., Faisal, E. G., Teh, S. D., & Kinzie, E. (2024). Mental health disturbance in preclinical medical students and its association with screen time, sleep quality, and depression during the COVID-19 pandemic. BMC Psychiatry, 24(1). https://doi.org/10.1186/s12888-024-05512-w

Xu, C., Pan, H., Huang, X., Liu, J., Bao, Y., Song, X., & Fang, L. (2026). Pathways from AI-assisted learning experience to psychological resilience: The role of stress perception in medical students. Acta Psychologica. https://doi.org/10.1016/j.actpsy.2026.106658

Downloads

Published

2026-06-30