Sleep Medicine and Psychophysiology (수면정신생리)

KOREAN ACADEMY OF SLEEP MEDICINE (대한수면의학회)
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Association Between Chronotype, Sleep Quality and Resilience as Well as Anxiety Among Medical Students

의과대학 학생들의 일주기 유형과 수면의 질 및 회복탄력성과 불안 증상의 관련성

  • Jeein Kim (Department of Psychiatry, Gyeongsang National University Hospital) ;
  • Bong-Jo Kim (Department of Psychiatry, Gyeongsang National University Hospital) ;
  • Chul-Soon Lee (Department of Psychiatry, Gyeongsang National University Changwon Hospital) ;
  • Boseok Cha (Department of Psychiatry, Gyeongsang National University Hospital) ;
  • So-Jin Lee (Department of Psychiatry, Gyeongsang National University Hospital) ;
  • Dongyun Lee (Department of Psychiatry, Gyeongsang National University Changwon Hospital) ;
  • Jiyeong Seo (Department of Psychiatry, Gyeongsang National University Changwon Hospital) ;
  • Jae-Won Choi (Department of Psychiatry, Gyeongsang National University Hospital) ;
  • Young-Ji Lee (Department of Psychiatry, Gyeongsang National University Changwon Hospital) ;
  • Eunji Lim (Department of Psychiatry, Gyeongsang National University Changwon Hospital)
  • 김지인 (경상국립대학교병원 정신건강의학과 ) ;
  • 김봉조 (경상국립대학교병원 정신건강의학과 ) ;
  • 이철순 (창원경상국립대학교병원 정신건강의학과) ;
  • 차보석 (경상국립대학교병원 정신건강의학과 ) ;
  • 이소진 (경상국립대학교병원 정신건강의학과 ) ;
  • 이동윤 (창원경상국립대학교병원 정신건강의학과) ;
  • 서지영 (창원경상국립대학교병원 정신건강의학과) ;
  • 최재원 (경상국립대학교병원 정신건강의학과 ) ;
  • 이영지 (창원경상국립대학교병원 정신건강의학과) ;
  • 임은지 (창원경상국립대학교병원 정신건강의학과)
  • Received : 2022.06.13
  • Accepted : 2022.06.20
  • Published : 2022.06.30
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Abstract

Objectives: Our study aimed to investigate the relationship between the anxiety at first year and chronotype and sleep quality at third year in medical students. We also investigated the association between sleep quality, chronotype, depression and resilience at third year. Methods: Fifty two medical students (36 males, 69%, aged 21 ± 0.93) in first year, and forty four medical students (31 males, 70.5%, aged 23.05 ± 0.99) at third year answered Beck Depression Inventory 2, Beck anxiety inventory, Insomnia severity index-K, Composite scale of morningness and Conner-Davidson Resilience scale-10. Multiple linear regression analysises were performed to identify predictors of chronotype, sleep quality and resilience. Results: Higher anxiety (β = -0.434, p = 0.006) at first year was significant predictor of eveningness at third year, while lower anxiety score (β = 0.606, p < 0.001) at first year was significant predictor of sleep quality at third year. Lower sleep quality (β = -0.314, p = 0.042) and eveningness (β = 0.315, p = 0.041) were associated with low resilience at third year. Also, Lesser depression (β = -0.717, p < 0.001) was associated with higher resilience at third year. Conclusion: Our study showed that higher anxiety in first year had significantly related with eveningness and poor sleep quality at third year. In addition, higher sleep quality, morningness and less depression had significantly associated with better resilience at third year.

목적: 의과대학생들은 많은 스트레스를 받으며 점점 불안감이 높아지고 수면시간의 부족과 함께 수면양상도 불규칙 해진다. 따라서 의과대학생들의 일주기 유형, 수면의 질, 회복탄력성 그리고 불안이 어떠한 연관이 있는지 알아보고자 하였다. 방법: 경상국립대학교 의과대학생 본과 1학년 52명과 2년 후, 44명의 본과3학년 학생들을 대상으로 했다. 벡 우울 척도, 벡 불안 척도, 불면증 심각성 척도, 아침활동형 척도 그리고 코너-데이비드슨 탄력성 척도를 자기 설문지로 사용하였다. 각각의 상호 연관성을 알아보기 위하여 다중회귀 분석을 시행하였다. 결과: 본과 1학년 때의 불안이 높은 것은 2년 뒤인 3학년때 저녁형을 예측했고 본과 1학년때의 불안이 낮을수록 본과 3학년의 수면의 질이 좋았다. 본과 3학년의 수면의 질이 낮은 것은 저녁형 그리고 낮은 회복탄력성과 연관이 있었다. 또한, 본과 3학년의 우울감이 적은 것은 높은 회복탄 력성과 유의한 연관성을 보였다. 결론: 본 연구에서 의과대학생 본과 1학년 때의 불안의 정도가 2년 후 3학년 때의 수면의 질과 저녁형을 예측했다. 앞으로 1학년 학생들의 불안을 낮출 수 있는 방안을 고안하여 학생들의 수면의 질을 높이고 삶의 질을 향상시킬 필요가 있다.

Keywords

References

  1. Abdulghani HM, Alrowais NA, Bin-Saad NS, Al-Subaie NM, Haji AM, Alhaqwi AI. Sleep disorder among medical students: relationship to their academic performance. Med Teach 2012;34 Suppl 1:S37-S41. https://doi.org/10.3109/0142159X.2012.656749
  2. Al-Khani AM, Sarhandi MI, Zaghloul MS, Ewid M, Saquib N. A cross-sectional survey on sleep quality, mental health, and academic performance among medical students in Saudi Arabia. BMC Research Notes 2019;12:1-5. https://doi.org/10.1186/s13104-018-4038-6
  3. Alsaggaf MA, Wali SO, Merdad RA, Merdad LA. Sleep quantity, quality, and insomnia symptoms of medical students during clinical years. Relationship with stress and academic performance. Saudi Med J 2016;37:173-182. https://doi.org/10.15537/smj.2016.2.14288
  4. Antunez JM, Navarro JF, Adan A. Circadian typology is related to resilience and optimism in healthy adults. Chronobiology International 2015;32:524-530. https://doi.org/10.3109/07420528.2015.1008700
  5. Antypa N, Vogelzangs N, Meesters Y, Schoevers R, Penninx BW. Chronotype associations with depression and anxiety disorders in a large cohort study. Depression and Anxiety 2016;33:75-83. https://doi.org/10.1002/da.22422
  6. Bacchi S, Licinio J. Resilience and psychological distress in psychology and medical students. Acad Psychiatry 2017;41:185-188. https://doi.org/10.1007/s40596-016-0488-0
  7. Baek HS, Lee KU, Joo EJ, Lee MY, Choi KS. Reliability and validity of the Korean version of the Connor-Davidson Resilience Scale. Psychiatry Investigation 2010;7:109.
  8. Boni R, Paiva CE, de Oliveira MA, Lucchetti G, Fregnani J, Paiva BSR. Burnout among medical students during the first years of undergraduate school: prevalence and associated factors. PLoS One 2018;13:e0191746.
  9. Breedon JR, Huang L. Resilience training and medical student wellbeing. Clin Teach 2019;16:428-429. https://doi.org/10.1111/tct.13025
  10. Campbell-Sills L, Stein MB. Psychometric analysis and refinement of the connor-davidson resilience scale (CD-RISC): validation of a 10-item measure of resilience. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies 2007;20:1019-1028. https://doi.org/10.1002/jts.20271
  11. Chatburn A, Coussens S, Kohler MJ. Resiliency as a mediator of the impact of sleep on child and adolescent behavior. Nature and Science of Sleep 2014;6:1.
  12. Cho YW, Song ML, Morin CM. Validation of a Korean version of the insomnia severity index. J Clin Neurol 2014;10:210-215. https://doi.org/10.3988/jcn.2014.10.3.210
  13. Connor KM, Davidson JR. Development of a new resilience scale: the connor-davidson resilience scale (CD-RISC). Depression and Anxiety 2003;18:76-82. https://doi.org/10.1002/da.10113
  14. Costa EF, Santos SA, Santos AT, Melo EV, Andrade TM. Burnout syndrome and associated factors among medical students: a cross-sectional study. Clinics 2012;67:573-580. https://doi.org/10.6061/clinics/2012(06)05
  15. Cox RC, Olatunji BO. Differential associations between chronotype, anxiety, and negative affect: a structural equation modeling approach. Journal of Affective Disorders 2019;257:321-330. https://doi.org/10.1016/j.jad.2019.07.012
  16. Di Milia L, Adan A, Natale V, Randler C. Reviewing the psychometric properties of contemporary circadian typology measures. Chronobiology International 2013;30:1261-1271. https://doi.org/10.3109/07420528.2013.817415
  17. Fawzy M, Hamed SA. Psychological stress among medical students in Assiut University, Egypt. Psychiatry Research 2017;255(10.1016).
  18. Feng G, Chen J, Yang X. Study on the status and quality of sleep-related influencing factors in medical college students. Zhonghua Liu Xing Bing Xue Za Zhi 2005;26:328-331.
  19. Gishen F, Lynch S, Gill D, Jawad S, Peters D. Medical student resilience: a symposium approach. Clin Teach 2018;15:425-427. https://doi.org/10.1111/tct.12761
  20. Haraden DA, Mullin BC, Hankin BL. Internalizing symptoms and chronotype in youth: a longitudinal assessment of anxiety, depression and tripartite model. Psychiatry Research 2019;272: 797-805. https://doi.org/10.1016/j.psychres.2018.12.117
  21. Kang HS, Lee SJ, Kim BJ, Lee CS, Cha BS, Lee DY, et al. Sleep quality as a predictor of post-clerkship anxiety in Korean medical students: a preliminary report. Chronobiology in Medicine 2020;2:78-81. https://doi.org/10.33069/cim.2020.0014
  22. Kim JH, Lee EH, Hwang ST, Hong SH. K-BDI-II manual. Korea Psychology Corporation 2015.
  23. Kim SM, Kim SJ. Psychometric properties of questionnaires for assessing chronotype. Chronobiology in Medicine 2020;2:16-20. https://doi.org/10.33069/cim.2020.0003
  24. Kook SH, Yoon JS, Lee HY. Cross Validation of the Korean Translation of Composite Scale (KtCS) to measure morningness-eveningness. J Korean Neuropsychiatr Assoc 1999;38:297-305.
  25. Koutsimani P, Montgomery A, Georganta K. The relationship between burnout, depression, and anxiety: a systematic review and meta-analysis. Frontiers in Psychology 2019;10:284.
  26. Lee SJ, Park CS, Kim BJ, Lee CS, Cha BS, Lee YJ, et al. Association between morningness and resilience in Korean college students. Chronobiology International 2016;33:1391-1399. https://doi.org/10.1080/07420528.2016.1220387
  27. Linn BS, Zeppa R. Stress in junior medical students: relationship to personality and performance. J Med Educ 1984;59:7-12.
  28. Mignot E, Taheri S, Nishino S. Sleeping with the hypothalamus: emerging therapeutic targets for sleep disorders. Nat Neurosci 2002;5 Suppl:1071-1075.
  29. Min SK, Shin WC, Kim KI, Chung JI, Kim DK. Comparison of quality of life between medical students and general college students. Journal of Korean Neuropsychiatric Association 2000: 1054-1060.
  30. Mirghani HO. The effect of chronotype (morningness/eveningness) on medical students' academic achievement in Sudan. J Taibah Univ Med Sci 2017;12:512-516.
  31. Niemi PM, Vainiomaki PT. Medical students' distress--quality, continuity and gender differences during a six-year medical programme. Med Teach 2006;28:136-141. https://doi.org/10.1080/01421590600607088
  32. Romo-Nava F, Tafoya SA, Gutierrez-Soriano J, Osorio Y, Carriedo P, Ocampo B, et al. The association between chronotype and perceived academic stress to depression in medical students. Chronobiol Int 2016;33:1359-1368. https://doi.org/10.1080/07420528.2016.1217230
  33. Silva VM, Magalhaes JEM, Duarte LL. Quality of sleep and anxiety are related to circadian preference in university students. PLoS One 2020;15:e0238514.
  34. Smith CS, Reilly C, Midkiff K. Evaluation of three circadian rhythm questionnaires with suggestions for an improved measure of morningness. Journal of Applied Psychology 1989;74:728.
  35. Southwick SM, Vythilingam M, Charney DS. The psychobiology of depression and resilience to stress: implications for prevention and treatment. Annu Rev Clin Psychol 2005;1:255-291. https://doi.org/10.1146/annurev.clinpsy.1.102803.143948
  36. Sung HM, Kim JB, Park YN, Bai DS, Lee SH, Ahn HN. A study on the reliability and the validity of Korean version of the Beck Depression Inventory-II (BDI-II). J Korean Soc Biol Ther Psychiatry 2008;14:201-212.
  37. Tafoya SA, Aldrete-Cortez V, Ortiz S, Fouilloux C, Flores F, Monterrosas AM. Resilience, sleep quality and morningness as mediators of vulnerability to depression in medical students with sleep pattern alterations. Chronobiol Int 2019;36:381-391. https://doi.org/10.1080/07420528.2018.1552290
  38. Tan MN, Mevsim V, Pozlu Cifci M, Sayan H, Ercan AE, Ergin OF, et al. Who is happier among preclinical medical students: the impact of chronotype preference. Chronobiol Int 2020;37:1163-1172. https://doi.org/10.1080/07420528.2020.1761373
  39. Tempski P, Santos IS, Mayer FB, Enns SC, Perotta B, Paro HB, et al. Relationship among medical student resilience, educational environment and quality of life. PLoS One 2015;10:e0131535.
  40. Wang J, Zhang X, Simons SR, Sun J, Shao D, Cao F. Exploring the bi-directional relationship between sleep and resilience in adolescence. Sleep Medicine 2020;73:63-69. https://doi.org/10.1016/j.sleep.2020.04.018
  41. Yook SP, Kim ZS. A clinical study on the Korean version of Beck Anxiety Inventory: comparative study of patient and non-patient. Korean J Clin Psychol 1997;16:185-197.
  42. Yoon JS, Shin SM, Kook SH, Lee HY. A preliminary study on the Korean translation of composite scale (KtCS) to measure morningness: eveningness. J Korean Neuropsychiatr Assoc 1997;36.
  43. Yu J, Rawtaer I, Fam J, Jiang MJ, Feng L, Kua EH, et al. Sleep correlates of depression and anxiety in an elderly a sian population. Psychogeriatrics 2016;16:191-195. https://doi.org/10.1111/psyg.12138