Anxiety and poor sleep quality in medical students. Is there a relationship with anemia?

Authors

  • Raisa Espinoza-Henriquez Universidad Nacional del Santa, Escuela Profesional de Medicina Humana. Ancash.
  • Erika Diaz-Mejia Universidad Nacional del Santa, Escuela Profesional de Medicina Humana. Ancash.
  • Ángel J Quincho-Estares Universidad Nacional del Centro del Perú, Facultad de Medicina Humana. Huancayo.
  • Carlos Jesus Toro-Huamanchumo Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud. Lima. Association for the Study of Medical Education (ASME). Edinburgh, United Kingdom.

Keywords:

Anxiety, Sleep, Anemia, Medical education, Medical students

Abstract

Introduction: Medical students are often vulnerable to mental health disorders such as anxiety and poor sleep quality. Both can have a negative impact on their eating behavior, which could generate middle- and long-term anemia-related problems during their studies.

Objective: To identify the prevalence of anxiety and poor sleep quality and to evaluate the association with anemia in medical students of a Peruvian public university.

Material and Methods: We conducted a cross-sectional analytical study in 80 medical students from the first to the fourth year. We used the Beck Anxiety Inventory (BAI) and the Pittsburgh Sleep Quality Index (PSQI) to assess anxiety symptoms and sleep quality, respectively. We also included sociodemographic, academic, and behavioral data. Likewise, we determined the presence of anemia by obtaining hemoglobin results, following the procedures stipulated by the Peruvian Ministry of Health.

Results: We found a percentage of anxiety and poor sleep quality of 62.5% and 63,7%, respectively. To be female (RPa: 1,39; 95 % CI: 1,01-1,91) and to have moderate anemia (PRa: 1,31; 95 % CI: 1,06-1,64) were associated with anxiety. On the other hand, the factors associated with poor sleep quality were to be located in Clinics (PRa: 1,54, 95 % CI: 1,17-2,02) and to have moderate anemia (PRa: 1,52, CI95 %: 1,09-2,11).

Conclusion: Anxiety and sleep quality were frequent problems in the medical students studied.  Moderate anemia was an associated factor for both cases.

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References

1. Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness. The Lancet Psychiatry. 2016;3(2):171-8.

2. Ludwig AB, Burton W, Weingarten J, Milan F, Myers DC, Kligler B. Depression and stress amongst undergraduate medical students. BMC Medical Education. 2015;15(1):141.

3. Achata-Espinoza M, Muñoz-Dueñas CR, Cabrejos-Llontop S, Toro-Huamanchumo CJ, Achata-Espinoza M, Muñoz-Dueñas CR, et al. Spare the rod, spoil the child: Bullying during medical internship in three Peruvian hospitals. Revista de la Facultad de Medicina. 2017;65(1):169-70.

4. Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016;316(21):2214-36.

5. Pacheco JP, Giacomin HT, Tam WW, Ribeiro TB, Arab C, Bezerra IM, et al. Mental health problems among medical students in Brazil: a systematic review and meta-analysis. Rev Bras Psiquiatr. 2017;39(4):369-78.

6. Mahroon ZA, Borgan SM, Kamel C, Maddison W, Royston M, Donnellan C. Factors Associated with Depression and Anxiety Symptoms Among Medical Students in Bahrain. Acad Psychiatry. 2018;42(1):31-40.

7. Sánchez-Marín C, Chichón-Peralta J, Leon-Jimenez F, Alipazaga-Pérez P. Trastornos mentales en estudiantes de medicina humana en tres universidades de Lambayeque, Perú. Revista de Neuro-Psiquiatría. 2016;79(4):197-206.

8. Legua-Flores M, Arroyo-Hernandez CH. Prevalencia y factores asociados a sintomatología depresiva en estudiantes de medicina de la provincia de Ica, Perú. Rev Med Panacea. 2011;1(2):28-33.

9. Muñoz-Dueñas CR, Burgos-Muñoz SJ, Novoa-Sandoval P, Toro-Huamanchumo CJ. Adicción a Internet: ¿cuál es la realidad en estudiantes de medicina de Latinoamérica? Educación Médica. 2017;18(3):222-4.

10. Brenneisen Mayer F, Souza Santos I, Silveira PSP, Itaqui Lopes MH, de Souza ARND, Campos EP, et al. Factors associated to depression and anxiety in medical students: a multicenter study. BMC Medical Education. 2016;16(1):282.

11. Ngin C, Pal K, Tuot S, Chhoun P, Yi R, Yi S. Social and behavioural factors associated with depressive symptoms among university students in Cambodia: a cross-sectional study. BMJ Open. 2018;8(9):e019918.

12. Vilchez-Cornejo J, Quiñones-Laveriano D, Failoc-Rojas V, Acevedo-Villar T, Larico-Calla G, Mucching-Toscano S, et al. Salud mental y calidad de sueño en estudiantes de ocho facultades de medicina humana del Perú. Revista chilena de neuro-psiquiatría. 2016;54(4):272-81.

13. Eller T, Aluoja A, Vasar V, Veldi M. Symptoms of anxiety and depression in Estonian medical students with sleep problems. Depress Anxiety. 2006;23(4):250-6.

14. Velten J, Bieda A, Scholten S, Wannemüller A, Margraf J. Lifestyle choices and mental health: a longitudinal survey with German and Chinese students. BMC Public Health. 2018;18(1):632.

15. Ponce Torres C, Turpo Espinoza K, Salazar Pérez C, Viteri-Condori L, Carhuancho Aguilar J, Taype Rondan Á. Trastornos de la conducta alimentaria en estudiantes de medicina de una universidad de Perú. Rev cub salud pública. 2017;43:551-61.

16. Ghodasara SL, Davidson MA, Reich MS, Savoie CV, Rodgers SM. Assessing student mental health at the Vanderbilt University School of Medicine. Acad Med. 2011;86(1):116-21.

17. Al-Alimi AA, Bashanfer S, Morish MA. Prevalence of Iron Deficiency Anemia among University Students in Hodeida Province, Yemen. Anemia. 2018;2018:4157876.

18. Azma RZ, Ainoon O, Azlin I, Hamenuddin H, Hadi NA, Tatt WK, et al. Prevalence of iron deficiency anaemia and thalassaemia trait among undergraduate medical students. Clin Ter. 2012;163(4):287-91.

19. Jawed S, Tariq S, Tariq S, Kamal A. Frequency of nutritional anemia among female medical students of Faisalabad. Pak J Med Sci. 2017;33(2):398-403.

20. Saxena Y, Shrivastava A, Saxena V. Effect of gender on correlation of anaemia with body mass index in medical students. Indian J Physiol Pharmacol. 2011;55(4):364-9.

21. Sanz J. Recomendaciones para la utilización de la adaptación española del Inventario de Ansiedad de Beck (BAI) en la práctica clínica. Clínica y Salud. 2014;25(1):39-48.

22. Wang L, Qin P, Zhao Y, Duan S, Zhang Q, Liu Y, et al. Prevalence and risk factors of poor sleep quality among Inner Mongolia Medical University students: A cross-sectional survey. Psychiatry Res. 2016;244:243-8.

23. Brick CA, Seely DL, Palermo TM. Association between sleep hygiene and sleep quality in medical students. Behav Sleep Med. 2010;8(2):113-21.

24. Jiménez-Genchi A, Monteverde-Maldonado E, Nenclares-Portocarrero N, Esquivel-Adame G, de la Vega-Pacheco A. Confiabilidad y análisis factorial de la versión en español del índice de calidad de sueño de Pittsburgh en pacientes psiquiátricos. Gac Med Méx. 2008;144(6):491-6.

25. Lemma S, Gelaye B, Berhane Y, Worku A, Williams MA. Sleep quality and its psychological correlates among university students in Ethiopia: a cross-sectional study. BMC Psychiatry. 2012;12(1):237.

26. Ministerio de Salud. Norma Técnica de Salud para el manejo terapéutico y preventivo de la anemia en niños, adolescentes, mujeres gestantes y puérperas. Resolución Ministerial N° 250-2017/MINSA. Lima: MINSA; 2017.

27. Zwart A, van Assendelft OW, Bull BS, England JM, Lewis SM, Zijlstra WG. Recommendations for reference method for haemoglobinometry in human blood (ICSH standard 1995) and specifications for international haemiglobinocyanide standard (4th edition). J Clin Pathol. 1996;49(4):271-4.

28. Ministerio de Salud, Instituto Nacional de Salud. Guía Técnica: procedimiento para la determinación de hemoglobina mediante hemoglobinómetro portátil. Lima: MINSA, INS; 2013.

29. Ediz B, Ozcakir A, Bilgel N. Depression and anxiety among medical students: Examining scores of the beck depression and anxiety inventory and the depression anxiety and stress scale with student characteristics. Cogent Psychology. 2017;4(1):1283829.

30. Fawzy M, Hamed SA. Prevalence of psychological stress, depression and anxiety among medical students in Egypt. Psychiatry Res. 2017;255:186-94.

31. Zochil ML, Thorsteinsson EB. Exploring poor sleep, mental health, and help-seeking intention in university students. Australian Journal of Psychology. 2018;70(1):41-7.

32. Cardona-Arias JA, Pérez-Restrepo D, Rivera-Ocampo S, Gómez-Martínez J, Reyes Á. Prevalence of anxiety in universitary students. Diversitas. 2015;11(1):79-89.

33. Pedraz-Petrozzi B, Pilco-Inga J, Vizcarra-Pasapera J, Osada-Liy J, Ruiz-Grosso P, Vizcarra-Escobar D. Ansiedad,síndrome de piernas inquietas y onicofagia en estudiantes de medicina. Revista de Neuro-Psiquiatría. 2015;78(4):195-202.

34. Oro P, Esquerda M, Viñas J, Yuguero O, Pifarre J. Síntomas psicopatológicos, estrés y burnout en estudiantes de medicina. Educ Med. 2017.

35. Hantsoo L, Epperson CN. Anxiety Disorders Among Women: A Female Lifespan Approach. Focus (Am Psychiatr Publ). 2017;15(2):162-72.

36. Seeman MV. Psychopathology in women and men: focus on female hormones. Am J Psychiatry. 1997;154(12):1641-7.

37. Chen M-H, Su T-P, Chen Y-S, Hsu J-W, Huang K-L, Chang W-H, et al. Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study. BMC Psychiatry. 2013;13:161.

38. Zhang L, Kleiman-Weiner M, Luo R, Shi Y, Martorell R, Medina A, et al. Multiple micronutrient supplementation reduces anemia and anxiety in rural China’s elementary school children. J Nutr. 2013;143(5):640-7.

39. Pamuk GE, Top MŞ, Uyanık MŞ, Köker H, Akker M, Ak R, et al. Is iron-deficiency anemia associated with migraine? Is there a role for anxiety and depression? Wien Klin Wochenschr. 2016;128(Suppl 8):576-80.

40. Vallée L. Fer et neurodéveloppement. Archives de Pédiatrie. 2017;24(5, Supplement):5S18-22.

41. Dziembowska I, Kwapisz J, Izdebski P, Żekanowska E. Mild iron deficiency may affect female endurance and behavior. Physiol Behav. 2018;205:44-50.

42. Robinson SL, Marín C, Oliveros H, Mora-Plazas M, Richards BJ, Lozoff B, et al. Iron Deficiency, Anemia, and Low Vitamin B-12 Serostatus in Middle Childhood are Associated with Behavior Problems in Adolescent Boys: Results from the Bogotá School Children Cohort. J Nutr. 2018;148(5):760-70.

43. Wenger MJ, DellaValle DM, Murray-Kolb LE, Haas JD. Effect of iron deficiency on simultaneous measures of behavior, brain activity, and energy expenditure in the performance of a cognitive task. Nutr Neurosci. 2017;1-10.

44. East P, Delker E, Lozoff B, Delva J, Castillo M, Gahagan S. Associations Among Infant Iron Deficiency, Childhood Emotion and Attention Regulation, and Adolescent Problem Behaviors. Child Dev. 2018;89(2):593-608.

45. Yien YY, Paw BH. A role for iron deficiency in dopaminergic neurodegeneration. Proc Natl Acad Sci USA. 2016;113(13):3417-8.

46. Georgieff MK. Long-term brain and behavioral consequences of early iron deficiency. Nutr Rev. 2011;69(Suppl 1):S43-48.

47. Becker SP, Jarrett MA, Luebbe AM, Garner AA, Burns GL, Kofler MJ. Sleep in a large, multi-university sample of college students: sleep problem prevalence, sex differences, and mental health correlates. Sleep Health. 2018;4(2):174-81.

48. 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(3):169-74.

49. Mohammadbeigi A, Absari R, Valizadeh F, Saadati M, Sharifimoghadam S, Ahmadi A, et al. Sleep Quality in Medical Students; the Impact of Over-Use of Mobile Cell-Phone and Social Networks. J Res Health Sci. 2016;16(1):46-50.

50. Mokros Ł, Witusik A, Michalska J, Łężak W, Panek M, Nowakowska-Domagała K, et al. Sleep quality, chronotype, temperament and bipolar features as predictors of depressive symptoms among medical students. Chronobiol Int. 2017;34(6):708-20.

51. Castro AM, Caamaño LU, Julio SC. Calidad del dormir, insomnio y rendimiento académico en estudiantes de medicina. Duazary. 2014;11(2):2:85-97.

52. Durán Agüero S, Rosales Soto G, Moya Cantillana C, García Milla P, Durán Agüero S, Rosales Soto G, et al. Insomnia, sleep latency and quantity of sleep in chilean university students during a periods of classes and exam. Revista Salud Uninorte. 2017;33(2):75-85.

53. Cuttilan AN, Sayampanathan AA, Ho RC-M. Mental health issues amongst medical students in Asia: a systematic review [2000-2015]. Ann Transl Med. 2016;4(4):72.

54. Ibrahim N, Badawi F, Mansouri Y, Ainousa A, Jambi S. Sleep Quality among Medical Students at King Abdulaziz University: A Cross-sectional Study. J Community Med Health Educ. 2017;7(5):1000561.

55. Murat S, Ali U, Serdal K, Süleyman D, İlknur P, Mehmet S, et al. Assessment of subjective sleep quality in iron deficiency anaemia. Afr Health Sci. 2015;15(2):621-7.

Published

2019-12-07

How to Cite

1.
Espinoza-Henriquez R, Diaz-Mejia E, Quincho-Estares Ángel J, Toro-Huamanchumo CJ. Anxiety and poor sleep quality in medical students. Is there a relationship with anemia?. Rev haban cienc méd [Internet]. 2019 Dec. 7 [cited 2025 Jul. 7];18(6):942-56. Available from: https://revhabanera.sld.cu/index.php/rhab/article/view/2790

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Section

Social Sciences