Impact of Sleep Quality on the Quality of Life of Medical Students: A Study on the Mediating Role of Depression

<p>Bin Wang<sup>1,2</sup>, Yuehan Zhu<sup>1,2</sup>, Dawei Liu<sup>1,2</sup>, Leyi Xie<sup>1,2</sup>, Jia Liu<sup>1,2</sup>, Yuting Wei<sup>1,2</sup>, Yuan Yang<sup>1,2</sup>, Jiansheng Cai<sup>1,2</sup>, Liang Cao<sup>1,3</sup>, You Li<sup>1,2</sup></p>

doi:10.25236/IJFM.2026.080213

International Journal of Frontiers in Medicine, 2026, 8(2); doi: 10.25236/IJFM.2026.080213.

Impact of Sleep Quality on the Quality of Life of Medical Students: A Study on the Mediating Role of Depression

Author(s)

Bin Wang^1,2, Yuehan Zhu^1,2, Dawei Liu^1,2, Leyi Xie^1,2, Jia Liu^1,2, Yuting Wei^1,2, Yuan Yang^1,2, Jiansheng Cai^1,2, Liang Cao^1,3, You Li^1,2

Corresponding Author:

You Li

Affiliation(s)

¹Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guilin, 541199, China

²Guangxi Health Commission Key Laboratory of Entire Lifecycle Health and Care, Guilin Medical University, Guilin, 541199, China

³Department of Experimental Teaching Center, School of Public Health, Guilin Medical University, Guilin, 541199, China

Download PDF
|
Download: 2
|
View: 119

Abstract

To examine the relationships among sleep quality, depression, and quality of life (physical and mental health) in medical students, and to explore the mediating role of depression, a cross-sectional survey of 857 medical students was conducted using the SF-36, PSQI, and CES-D. Correlation and mediation analyses (PROCESS v4.1) were performed. Sleep quality was negatively correlated with physical health (r = -0.233) and mental health (r = -0.432); depression was negatively correlated with physical health (r = -0.134) and mental health (r = -0.554); sleep quality was positively correlated with depression (r = 0.485) (P < 0.01). Depression partially mediated the relationship between sleep quality and mental health (B = -0.656, 95% CI: -0.778 to -0.538), with an indirect effect accounting for 51.5% of the total effect. Good sleep quality benefits both physical and mental health. Depression partially mediated the effect of sleep quality on mental health.

Keywords

Medical students, Quality of life, Sleep quality, Depression, Mediation analysis

Cite This Paper

Bin Wang, Yuehan Zhu, Dawei Liu, Leyi Xie, Jia Liu, Yuting Wei, Yuan Yang, Jiansheng Cai, Liang Cao, You Li. Impact of Sleep Quality on the Quality of Life of Medical Students: A Study on the Mediating Role of Depression. International Journal of Frontiers in Medicine (2026), Vol. 8, Issue 2: 104-115. https://doi.org/10.25236/IJFM.2026.080213.

References

[1] Ghrouz AK, Noohu MM, Dilshad Manzar M, et al. Physical activity and sleep quality in relation to mental health among college students. Sleep Breath. 2019;23(2):627–634.

[2] Haykal K-A, Pereira L, Power A, et al. Medical student wellness assessment beyond anxiety and depression: A scoping review. PLoS One. 2022;17(10):e0276894.

[3] Freitas PHB de, Meireles AL, Ribeiro IK da S, et al. Symptoms of depression, anxiety and stress in health students and impact on quality of life. Rev Lat Am Enfermagem. 2023;31:e3884.

[4] Noreen A, Iqbal N, Hassan B, et al. Relationship between psychological distress, quality of life and resilience among medical and non-medical students. J Pak Med Assoc. 2021;71(9):2181–2185.

[5] Seo EH, Kim S-G, Lee J-H, et al. Psychosocial Factors Influencing Quality of Life Among Medical Students. Psychiatry Investig. 2023;20(11):1077–1085.

[6] Li L, Feng X, Luo S, et al. Internet addiction and health-related quality of life in adolescents: The mediating role of sleep disturbance. Sleep Medicine. 2024;117:53–59.

[7] Paro HBMS, Morales NMO, Silva CHM, et al. Health-related quality of life of medical students. Med Educ. 2010;44(3):227–235.

[8] Wang Y, Guang Z, Zhang J, et al. Effect of Sleep Quality on Anxiety and Depression Symptoms among College Students in China’s Xizang Region: The Mediating Effect of Cognitive Emotion Regulation. Behav Sci (Basel). 2023;13(10):861.

[9] Palmer CA, Bower JL, Cho KW, et al. Sleep loss and emotion: A systematic review and meta-analysis of over 50 years of experimental research. Psychol Bull. 2024;150(4):440–463.

[10] Zhu B, Gao X-M, Zhou M, et al. The mediating roles of cognitive emotion regulation and resilience in the association between life events and sleep quality among medical students. Front Psychiatry. 2025;16:1466138.

[11] Buysse DJ, Reynolds CF, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.

[12] Ware JE, Gandek B. Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. J Clin Epidemiol. 1998;51(11):903–912.

[13] Roberts RE, Vernon SW. The Center for Epidemiologic Studies Depression Scale: its use in a community sample. Am J Psychiatry. 1983;140(1):41–46.

[14] Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016;316(21):2214–2236.

[15] He H, Zeng Y, Chen Z, et al. Associations Between Sleep Duration, Sleep Quality, and Depressive Symptoms: Evidence from Medical Graduate Students in China. NSS. 2025;Volume 17:1853–1862.

[16] Nagabhushan S, Kumar M, Ghosh S, et al. Impact of Sleep Quality, Sleep Disturbances on Quality of Life Among Medical Students Worldwide: A Narrative Review. Cureus. 2026;18(5):e108356.

[17] Vidović S, Rakić N, Kraštek S, et al. Sleep Quality and Mental Health Among Medical Students: A Cross-Sectional Study. Journal of Clinical Medicine. 2025;14(7):2274.

[18] Shen Z, Wang T, Zeng X, et al. Discrepant Associations Between Psychological Stress and Sleep Quality Among Medical and Non-Medical Students: A Nationwide Cross-Sectional Study in China. Behav Psychol [Internet]. 2025 [cited 2026 June 14];33(3).

[19] Altemus M, Sarvaiya N, Epperson CN. Sex differences in anxiety and depression clinical perspectives. Front Neuroendocrinol. 2014;35(3):320–330.

[20] Killgore W, Katz J, Henderson-Arredondo K, et al. 0225 Reconsidering the Human Emotional Brain Without Sleep: Is it a ‘Prefrontal-Amygdala Disconnect’ or Reorganization of Amygdala-Centric Networks? Sleep. 2026;49(Supplement_1):A98–A99.

[21] Pandi-Perumal SR, Monti JM, Burman D, et al. Clarifying the role of sleep in depression: A narrative review. Psychiatry Res. 2020;291:113239.

[22] Wang P, Xie C, Qian J, et al. Dysfunctional sleep beliefs and sleep quality among Chinese university students: the mediating roles of depression, anxiety, and stress. BMC Psychol. 2025;13(1):844.

[23] Katsikidou M, Anastasiadou S, Plakias S, et al. Sleep, Anxiety, and Depression Among Healthcare Students During COVID-19: A Systematic Review and Meta-analysis. Curr Sleep Medicine Rep. 2025;11(1):33.

[24] Sang D, Lin K, Yang Y, et al. Prolonged sleep deprivation induces a cytokine-storm-like syndrome in mammals. Cell. 2023;186(25):5500-5516.e21.

[25] Zhang L, Yang Q, Wu X, et al. The inverse association between skeletal muscle mass to visceral fat ratio (SVR) and sleep disturbance: the mediating role of inflammation and aging acceleration. BMC Psychiatry [Internet]. 2026 [cited 2026 June 14]; doi: 10.1186/s12888-026-08248-x.

[26] Mohamed NA, Mohamud RYH, Hassan MS, et al. Restless nights, demanding days: assessment of the prevalence and associated factors of poor sleep quality among medical students in Mogadishu, Somalia. BMC Med Educ. 2025;26(1):70.

[27] Karimi N, Pasyar N, Rambod M. Social relations and cellphone addiction mediate the relationship between sleep and quality of life in medical students residing in dormitories. Sci Rep. 2025;15(1):30980.

[28] Shadzi MR, Salehi A, Vardanjani HM. Problematic Internet Use, Mental Health, and Sleep Quality among Medical Students: A Path-Analytic Model. Indian J Psychol Med. 2020;42(2):128–135.