From Digital Academic Stress to Systemic Inflammation: Neutrophil-to-Lymphocyte Ratio as a Potential Biomarker of Psychological Distress in Medical Students

Risti Graharti; Intanri  Kurniati; Putu  Ristyaning Ayu; Linda  Septiani; Terza  Aflika Happy

doi:10.58344/ihj.v5i3.925

Authors

Risti Graharti Universitas Lampung
Intanri Kurniati Universitas Lampung
Putu Ristyaning Ayu Universitas Lampung
Linda Septiani Universitas Lampung
Terza Aflika Happy Universitas Lampung

DOI:

https://doi.org/10.58344/ihj.v5i3.925

Keywords:

digital academic stress, psychological distress, medical students, neutrophil-to-lymphocyte ratio, systemic inflammation

Abstract

Digital learning has transformed medical education by improving access and flexibility; however, excessive screen exposure, information overload, and continuous online academic demands may adversely affect students’ psychological and physiological well-being. This study examined the associations among digital academic stress, psychological distress, and systemic inflammation, as measured by the neutrophil-to-lymphocyte ratio (NLR), among medical students. An analytical observational study with a cross-sectional design was conducted among 124 students at the Faculty of Medicine, Universitas Lampung, Indonesia. Participants completed questionnaires assessing digital academic stress and psychological distress using the Depression Anxiety Stress Scales–21 (DASS-21) and underwent complete blood count examinations. Associations were analyzed using correlation tests and multiple linear regression analysis. Digital academic stress was positively associated with psychological distress (p < 0.01). Students with moderate-to-high psychological distress had significantly higher NLR values than those with lower distress levels (p = 0.02). Digital academic stress was also positively correlated with NLR (r = 0.29, p = 0.003) and remained an independent predictor of elevated NLR after multivariable adjustment (? = 0.24, p = 0.01). These findings indicated that digital academic stress was associated with both psychological distress and low-grade systemic inflammation. Medical schools should optimize digital learning environments, promote balanced academic workloads, and strengthen psychological support systems to protect students’ mental and physiological health.

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