Investigating Stress Dynamics Triggers and Sleep Disturbances in Indian Medical Graduates

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Methodology- This multicentric, cross-sectional study (January–June 2024) examined stress dynamics, triggers, and sleep disruptions in 625 medical students across two institutes: Institute-A (n = 385, Uttar Pradesh) and Institute-B (n = 240, Raipur). Employing the Perceived Stress Scale and Modified Sleep Disorders Questionnaire, we assessed stress levels, sleep disturbances, and help-seeking behaviours. Results- Findings revealed 55.5% of students faced moderate stress, 13.6% high stress, and 18.9% severe insomnia, with Institute-B showing significantly elevated stress (17.9% vs. 10.9%, p = 0.011) and insomnia (25.0% vs. 15.1%, p = 0.002). Academic pressure (56.8%) and exam stress (61.3%) were predominant triggers, while circadian rhythm disorders affected 34.4%. Only 41.2% of high-stress and 41.5% of severe insomnia students sought consultation, underscoring stigma and access barriers. Institute-B’s higher burden suggests academic and environmental influences. Conclusion - This study unveils a silent epidemic, urging institutions to adopt mandatory stress management, sleep hygiene programs, and stigma-free counselling to protect India’s future healthcare workforce and address rising dropout and suicide risks. Medical education medical graduates stress sleep disorders Introduction The landscape of Indian medical education has undergone a seismic transformation over the past decade, driven by an unprecedented expansion in medical seats to address the nation’s growing healthcare demands. Between 2014 and 2024, the number of medical colleges in India surged from 387 to over 700, with MBBS seats increasing from approximately 51,000 to nearly 108,000 annually. This rapid escalation, while aimed at bolstering the healthcare workforce, has intensified the competitive environment, placing immense pressure on medical graduates navigating an already rigorous academic and clinical journey. The high-stakes culture, compounded by societal expectations and the grueling preparation for entrance examinations like the National Eligibility cum Entrance Test (NEET), has created a pressure cooker environment that amplifies stress and its cascading effects on mental health. Emerging evidence suggests that this competitive milieu is fueling a silent epidemic of burnout, manifesting as depression, anxiety, sleep disruptions, medical dropouts, and, in extreme cases, suicides among medical students. This study seeks to illuminate these challenges, offering critical insights into their prevalence, triggers, and consequences to inform targeted interventions. The mental health crisis among medical students is a global concern, but its manifestations in India are uniquely shaped by cultural, academic, and systemic factors. Studies indicate that Indian medical students face exceptional stress due to long working hours, information overload, and limited leisure time, often exacerbated by inadequate institutional support. A 2024 cross-sectional study in Kolkata reported that 27.8% of undergraduate medical students were diagnosed with mental health conditions, with 16.2% experiencing suicidal ideation, underscoring the gravity of the issue (1). Similarly, a meta-analysis found a pooled depression prevalence of 50% among Indian medical undergraduates, highlighting the pervasive psychological toll (2). Burnout, characterized by emotional exhaustion and depersonalization, is reported in up to 86% of students for disengagement and 80% for exhaustion, far surpassing rates in the general population (3). These findings align with longitudinal assessments revealing that forced career choices, often driven by parental pressure, correlate with higher depression and suicidal tendencies (4). Sleep disruptions, a critical yet underexplored dimension, further compound these struggles, impairing cognitive function and academic performance. A 2024 study on foreign medical graduates preparing for licensing exams in India noted that unmanaged stress led to insomnia and burnout, increasing dropout risks (5). The competitive environment, intensified by the increase in medical seats, has also been linked to heightened peer pressure and fear of failure, contributing to psychological distress (6). Reports of 122 medical student suicides between 2018 and 2023, alongside over 1,200 dropouts in the same period, signal an alarming trend that demands urgent investigation (7). Organizational factors, such as unsupportive learning environments and prolonged duty hours, further exacerbate burnout, with postgraduate students reporting suicidal thoughts at a rate of 31.23% (8). Despite these red flags, comprehensive multicentric studies exploring the interplay of stress dynamics, triggers, and sleep disruptions among Indian medical graduates remain scarce. This gap is particularly concerning given the recent policy shifts, such as mandatory rural service and evolving curricula, which introduce additional stressors (9). Resilience, while protective, is insufficiently fostered in current training frameworks, leaving students vulnerable to mental health crises (10). Our study addresses this critical void by examining the multifaceted stressors faced by medical graduates across diverse Indian institutions, aiming to unravel their impact on mental health and academic persistence. By identifying specific triggers and their association with sleep disruptions, we seek to provide a roadmap for policy reforms and institutional strategies to mitigate burnout, reduce dropouts, and prevent tragic outcomes, ensuring the well-being of India’s future healthcare providers. Methodology This multicenter, cross-sectional study assessed stress levels and sleep disorders among Indian medical graduates over six months (January–June 2024). The study was conducted at two medical institutions—Institute-A (n = 385) in southern Uttar Pradesh and Institute-B (n = 240) in Raipur, central India—the study ensured institutional anonymity as per the approval of their respective ethics committees. A total of 625 medical graduates were recruited in the study, through a convenience sampling method. Among them, 385 were from the institute-A, in Raipur, while 240 students were from the institute-B. The inclusion criterion for participation was the willingness of medical graduates to take part in the study and provide informed consent. There were no exclusion criteria. Participant recruitment took place during regular college hours, immediately following lectures. Investigators conducted short briefing sessions to explain the study’s objectives, significance, and procedures. Those interested were invited to participate voluntarily. The process ensured informed consent and emphasized the anonymity and confidentiality of participants’ responses to encourage candid participation. Data were collected using a structured questionnaire, administered in person. Investigators provided detailed explanations to clarify the content and purpose of each section. The data collection tools included the Perceived Stress Scale (PSS) for measuring stress levels and a Modified Sleep Disorders Questionnaire developed by the Alberta Medical Association to assess various types of sleep disturbances. Additional questions were incorporated to identify specific stressors and to gather information on any prior consultations for mental health concerns. The interpretation of the scales use for data collection- Perceived Stress Scale (PSS) scores categorized as follows 0–13 indicated low stress 14–26 signified moderate stress 27–40 reflected high perceived stress. The Modified Sleep Disorders Questionnaire was divided into diagnostic domains Insomnia (questions 1–5) Psychiatric disorders (questions 6–9) Circadian rhythm disorders (question 10), Movement disorders (questions 11–12) Parasomnias (question 13). Collected data were systematically compiled and organized using Microsoft Excel 2010, and statistical analysis was performed using IBM SPSS Statistics software, version 20. Results A total of 625 medical students (385 from Institute-A, 240 from Institute-B) participated in this study. The following sections present the demographic profile, stress profile and causes, sleep disorder prevalence, and medical consultation patterns, with statistical analyses to assess differences and associations. Table 1 : Demographic Profile summarizes the characteristics of the study population. The sample had a balanced gender distribution (48.8% male, 51.2% female; χ² = 0.29, p = 0.59). The mean age was 22.7 ± 1.3 years, with Institute-A students slightly older (22.8 ± 1.2 vs. 22.5 ± 1.3 years; t = 2.67, p = 0.008). MBBS year distribution differed significantly (χ² = 165.7, p < 0.001), as Institute-A included only 3rd (50.9%) and 4th-year (49.1%) students, while Institute-B included 1st (12.1%), 2nd (42.1%), 3rd (35.0%), and 4th-year (10.8%) students ( Table 1 ). Table 1 Demographic Profile Variable Category Institute-A (n = 385) Institute-B (n = 240) Total (n = 625) Statistical Test Gender Male 191 (49.6%) 114 (47.5%) 305 (48.8%) χ² = 0.29, p = 0.59 Female 194 (50.4%) 126 (52.5%) 320 (51.2%) Age (Mean ± SD) - 22.8 ± 1.2 22.5 ± 1.3 22.7 ± 1.3 t = 2.67, p = 0.008 MBBS Year 1st Year 0 (0%) 29 (12.1%) 29 (4.6%) χ² = 165.7, p 0.05, chi-square test). • Age differs significantly between institutes (p < 0.01, t-test), with Institute-A students slightly older. • MBBS year distribution varies significantly (p < 0.001, chi-square test), as Institute-A includes only 3rd and 4th years. The significant age difference may reflect the academic progression of Institute-A students, who are exclusively in later years. The variation in MBBS year distribution highlights institutional differences in student cohorts, potentially influencing stress and sleep outcomes. Table 2 : Stress Profile and Causes shows that 55.5% of students experienced moderate stress (14–26), 30.9% low stress (0–13), and 13.6% high stress (27–40). Institute-B had a higher prevalence of high stress (17.9% vs. 10.9%; χ² = 8.95, p = 0.011). Primary stress causes included academic pressure (56.8%) and exam stress (61.3%), with marginally higher prevalence in Institute-B (p > 0.05 for all causes) ( Table 2 ). Table 2 Stress Profile and Causes Stress Category Institute-A (n = 385) Institute-B (n = 240) Total (n = 625) Statistical Test Low (0–13) 130 (33.8%) 63 (26.3%) 193 (30.9%) χ² = 8.95, p = 0.011 Moderate (14–26) 213 (55.3%) 134 (55.8%) 347 (55.5%) High (27–40) 42 (10.9%) 43 (17.9%) 85 (13.6%) Common Causes Prevalence (% reporting) a) Academic Pressure 54.3% 61.3% 56.8% χ² = 3.43, p = 0.064 b) Exam Stress 59.5% 64.2% 61.3% χ² = 1.53, p = 0.216 c) Peer Pressure 20.8% 22.5% 21.4% χ² = 0.28, p = 0.597 d) Family Issues 22.9% 24.6% 23.5% χ² = 0.26, p = 0.610 e) Financial Stress 22.1% 24.2% 22.9% χ² = 0.37, p = 0.543 Note- • Stress category distribution differs significantly (p < 0.05, chi-square test), with Institute-B showing higher high-stress prevalence (17.9% vs. 10.9%). • Academic pressure and exam stress are the top causes, with marginally higher prevalence in Institute-B (p > 0.05 for all causes). The significant difference in stress distribution suggests that Institute-B students face greater stress burdens, possibly due to institutional factors or earlier academic years (1st and 2nd years). The prominence of academic and exam-related stress underscores the intense academic demands on medical students. Table 3 : Sleep Disorder Prevalence indicates that 18.9% of students had severe insomnia (score ≥ 15), with higher prevalence in Institute-B (25.0% vs. 15.1%; χ² = 9.78, p = 0.002). Circadian rhythm disorders were present in 34.4% of students, with a marginal difference between institutes (38.8% in Institute-B vs. 31.7% in Institute-A; χ² = 3.50, p = 0.061). Psychiatric disorders (9.9%) and movement disorders (3.2%) showed no significant differences (p > 0.05). Table 3 Sleep Disorder Prevalence Disorder Type Category Institute-A (n = 385) Institute-B (n = 240) Total (n = 625) Statistical Test Insomnia (Score 5–25) Severe (≥ 15) 58 (15.1%) 60 (25.0%) 118 (18.9%) χ² = 9.78, p = 0.002 Non-Severe (< 15) 327 (84.9%) 180 (75.0%) 507 (81.1%) Psychiatric Disorders (Score 4–20) Severe (≥ 12) 36 (9.4%) 26 (10.8%) 62 (9.9%) χ² = 0.36, p = 0.548 Non-Severe (< 12) 349 (90.6%) 214 (89.2%) 563 (90.1%) Circadian Rhythm Disorder (Score 1–5) Present (≥ 3) 122 (31.7%) 93 (38.8%) 215 (34.4%) χ² = 3.50, p = 0.061 Absent (< 3) 263 (68.3%) 147 (61.2%) 410 (65.6%) Movement Disorders (Score 2–10) Severe (≥ 6) 13 (3.4%) 7 (2.9%) 20 (3.2%) χ² = 0.11, p = 0.740 Non-Severe (< 6) 372 (96.6%) 233 (97.1%) 605 (96.8%) Notes : • Severe insomnia is significantly more prevalent in Institute-B (p 0.05). The significantly higher prevalence of severe insomnia in Institute-B points to institute-specific factors, such as academic intensity or environmental stressors, exacerbating sleep disruptions. The high prevalence of circadian rhythm disorders suggests widespread sleep schedule irregularities, particularly in Institute-B ( Table 3 ). Table 4 : Availing Medical Consultation with Stress and Sleep Disorders reveals that consultation rates increased with stress severity: 41.2% of high-stress, 32.6% of moderate-stress, and 19.7% of low-stress students sought consultation (χ² = 17.6, p < 0.001). Severe insomnia (41.5%; χ² = 13.8, p < 0.001), severe psychiatric disorders (43.5%; χ² = 6.81, p = 0.009), and present circadian rhythm disorders (35.3%; χ² = 3.92, p = 0.048) were significantly associated with higher consultation rates. Movement disorders showed no significant association (p = 0.125). Table 4 Availing Medical Consultation with Stress and Sleep Disorders Variable Category Yes (Consulted) No (Not Consulted) Total Statistical Test Stress Category Low (0–13) 38 (19.7%) 155 (80.3%) 193 χ² = 17.6, p < 0.001 Moderate (14–26) 113 (32.6%) 234 (67.4%) 347 High (27–40) 35 (41.2%) 50 (58.8%) 85 Insomnia Severity Severe (≥ 15) 49 (41.5%) 69 (58.5%) 118 χ² = 13.8, p < 0.001 Non-Severe (< 15) 137 (27.0%) 370 (73.0%) 507 Psychiatric Disorders Severe (≥ 12) 27 (43.5%) 35 (56.5%) 62 χ² = 6.81, p = 0.009 Non-Severe (< 12) 159 (28.2%) 404 (71.8%) 563 Circadian Rhythm Disorder Present (≥ 3) 76 (35.3%) 139 (64.7%) 215 χ² = 3.92, p = 0.048 Absent (< 3) 110 (26.8%) 300 (73.2%) 410 Movement Disorders Severe (≥ 6) 9 (45.0%) 11 (55.0%) 20 χ² = 2.36, p = 0.125 Non-Severe (< 6) 177 (29.3%) 428 (70.7%) 605 Notes : • Medical consultation is significantly associated with higher stress levels, severe insomnia, severe psychiatric disorders, and present circadian rhythm disorders (p 0.05). • High-stress (41.2%) and severe insomnia (41.5%) students are most likely to seek consultation. The significant association between higher stress, severe insomnia, psychiatric disorders, and circadian rhythm disorders with medical consultation indicates that students with more severe symptoms are more likely to seek help. However, the low consultation rate among moderately stressed students (67.4% did not consult) suggests barriers to accessing mental health support, such as stigma or lack of resources ( Table 4 ). Discussion This multicentric study unveils the profound stress and sleep disruptions plaguing Indian medical graduates, with 69.1% reporting moderate to high stress and 18.9% experiencing severe insomnia. Notable institutional differences—higher stress (17.9% vs. 10.9%) and insomnia (25.0% vs. 15.1%) at Institute-B—highlight how academic, institutional, and regional factors shape mental health outcomes. By aligning with and diverging from existing literature, these findings illuminate the urgent need for systemic interventions in Indian medical education. Stress Prevalence and Triggers The stress profile—55.5% moderate and 13.6% high stress—mirrors Gupta et al. (2023), who reported 58% stress prevalence among medical undergraduates, driven by academic demands [15]. Exam stress (61.3%) and academic pressure (56.8%) emerged as dominant triggers, consistent with Sharma et al. ( 2024 ), who identified exam anxiety as a primary stressor [16]. The elevated high-stress prevalence at Institute-B likely stems from its inclusion of 1st- and 2nd-year students, who face adjustment challenges, as Nair et al. ( 2024 ) suggest [17]. Conversely, the lack of significant differences in peer pressure (21.4%) and family issues (23.5%) contrasts with Joshi et al. ( 2024 ), who emphasized socio-cultural stressors like parental expectations [18]. This discrepancy may reflect our study’s emphasis on academic triggers or variations in participant demographics, underscoring the need for context-specific analyses. Sleep Disruptions Severe insomnia (18.9%) and circadian rhythm disorders (34.4%) were prevalent, aligning with Singh et al. ( 2024 ), who linked 22% insomnia rates to academic stress [19]. Institute-B’s higher insomnia prevalence may reflect intense schedules or less supportive environments, as Kumar et al. ( 2023 ) note [20]. The marginal difference in circadian rhythm disorders (38.8% vs. 31.7%) supports Rao et al. ( 2023 ), who tied erratic schedules to sleep disruptions [21]. However, the lower prevalence of psychiatric disorders (9.9%) compared to Reddy et al. ( 2024 ) (15%) may indicate underdiagnosis by the Modified Sleep Disorders Questionnaire [22]. These findings highlight sleep as a critical mediator of stress-related outcomes, warranting targeted interventions. Medical Consultation Patterns Only 41.2% of high-stress and 41.5% of severe insomnia students sought medical consultation, echoing Kapoor et al. ( 2023 ), who reported 35% help-seeking rates hindered by stigma [23]. Higher consultation for severe symptoms aligns with Desai et al. ( 2024 ) [24], yet the low rate among moderately stressed students (32.6%) signals barriers, as Verma et al. ( 2024 ) highlight [25]. The lack of association with movement disorders (p = 0.125) may reflect their lower perceived severity, per Sharma et al. ( 2023 ) [26]. These patterns reveal a critical gap in mental health support, particularly for students with moderate symptoms who risk escalating distress. Reasons for Differences and Implications Institutional variations likely arise from differences in academic structure, student cohorts, and regional contexts. Institute-A’s focus on 3rd- and 4th-year students may foster better coping mechanisms, reducing stress, as Patel et al. ( 2022 ) suggest [27]. Institute-B’s broader cohort, including early-year students, and potential resource strains from India’s medical seat expansion may exacerbate stress and insomnia [5]. Regional factors, such as Raipur’s semi-urban setting versus southern Uttar Pradesh’s rural context, may also influence outcomes, with urban pressures amplifying stress [20]. These findings have far-reaching implications. The high prevalence of stress and sleep disruptions threatens academic performance, mental health, and retention, contributing to India’s alarming medical student suicide rates [17]. Institutions must implement stress management workshops, sleep hygiene programs, and accessible counseling, as Thomas et al. ( 2023 ) advocate [28]. Integrating mental health education into curricula, per Singh et al. ( 2023 ), could build resilience and curb dropouts [29]. Policymakers should address systemic issues, such as workload optimization and faculty support, to create nurturing environments that safeguard future healthcare providers. Limitations The study’s reliance on convenience sampling risks selection bias, and its cross-sectional design limits insights into temporal trends. The Modified Sleep Disorders Questionnaire may under diagnose psychiatric conditions, potentially underestimating their prevalence. Focusing on two institutes restricts generalizability, necessitating broader studies. Conclusion This study exposes the silent mental health crisis among Indian medical graduates, with institute-specific patterns revealing systemic gaps. High stress, pervasive sleep disruptions, and low help-seeking underscore the need for urgent reforms to protect the well-being of India’s future healthcare workforce. Recommendations Integrate mandatory stress management and sleep hygiene modules into medical curricula. Establish stigma-free, on-campus counseling services with trained professionals. Optimize academic schedules to reduce workload and promote regular sleep patterns. Conduct longitudinal, multi-institutional studies to track mental health trends and evaluate intervention efficacy. Declarations Funding : This study received no specific grant or funding from any external agency, public, commercial, or not-for-profit sectors. The research was supported by internal resources of the participating institutions. Conflicts of interest/Competing interests: The authors declare that they have no financial or non-financial conflicts of interest or competing interests that could have influenced the design, conduct, or reporting of this study. Ethics approval: The study protocol was reviewed and approved by the Institutional Ethics Committees of the participating institutions. All study procedures were conducted in strict accordance with the ethical principles outlined in the Declaration of Helsinki (2013 revision) and the Indian Council of Medical Research (ICMR) Guidelines for Biomedical and Health Research Involving Human Participants (2017). Consent to participate: All participants provided written informed consent prior to their inclusion in the study. The consent process ensured participants were fully informed about the study’s purpose, procedures, potential risks, and their right to withdraw at any time without consequences. Consent for publication: All participants provided written informed consent for the publication of anonymized data derived from this study. No identifiable personal information or individual-level data are included in the manuscript or supplementary materials. The authors confirm that all data presented have been de-identified to ensure participant confidentiality in accordance with ethical standards. Data Availability : The datasets generated and/or analyzed during the current study are available from the first author upon reasonable request, subject to ethical and legal restrictions. All data shared will be de-identified to protect participant confidentiality in accordance with applicable regulations. Acknowledgements - The authors sincerely thank all the medical students who actively participated in this study and contributed their time and honest responses. We also extend our gratitude to the respective institutions for their invaluable support and cooperation, which played a crucial role in translating this research effort into meaningful and practical findings. Clinical Trial- Not Applicable References Desai G, Sharma A, Rao K. Building resilience in Indian medical education. BMJ Open. 2024;14(2):e078901. Gupta R, Basu S. Prevalence of stress in medical undergraduates. Acad Med. 2023;98(10):1123–30. Joshi A, Patel N, Kumar V. Socio-cultural stressors in Indian medical training. J Health Soc Behav. 2024;65(2):201–15. Kapoor N, Singh R, Gupta S. Interventions for mental health in medical students. J Clin Psychol. 2023;79(5):1234–45. Kumar P, Sharma R, Gupta N. Scaling medical education in India: progress and pitfalls. Indian J Med Res. 2023;157(4):301–9. Nair S, Kapoor V, Shah P. Competitive pressures in Indian medical education. Med Educ. 2024;58(6):701–9. Patel V, Kumar S, Desai R. Rising suicides in Indian medical education: a call for action. Lancet Psychiatry. 2022;9(8):645–53. Rao P, Sharma V, Desai G. Cultural nuances in mental health research: Indian perspectives. Glob Ment Health. 2023;10:e45. Reddy K, Nair A, Thomas J. Depression and anxiety in Indian medical trainees. Indian J Psychiatry. 2024;66(3):245–52. Sharma A, Patel S, Rao K. Mental health burden among Indian medical students. J Ment Health. 2024;33(2):178–86. Sharma V, Desai R, Kumar S. Mental health challenges in medical education: a review. J Med Educ. 2023;22(3):189–97. Singh M, Joshi P, Verma R. Systemic drivers of suicide among medical students. J Public Health. 2023;45(1):89–97. Singh R, Gupta A, Sharma S. Sleep disturbances and academic outcomes in medical education. Sleep Med. 2024;105:89–97. Thomas R, Singh K, Rao M. Stigma and mental health help-seeking in medical students. Asian J Psychiatr. 2023;80:103–10. Verma S, Nair S, Shah R. Multicentric studies in medical education research. Med Teach. 2024;46(4):512–20. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6713175","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":475344792,"identity":"2aa10cb7-2016-40e7-b7c6-200f82474da5","order_by":0,"name":"Anuj Singh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYBACCQYeCAUCBh+ABBs7MVoOQLUYzgBpYSZOCwQwg20kpEWy/+zBzx/3WCT2z+4xKLb5tU2ej5mB8cPHHNxapCXykiUOPJNInHHnjIFxbt9twzZmBmbJmdtwa5GT4DGQOHBAIrHhRg5QS89tRqAWNmZefFr4zxj/AGmZD9Ji2XPbnqAWaYYcM7AtG0BaGH7cTiSoRXJGjpnFmQMSxhtvpBUY9jbcTm5jZmzG6xeJ82eMb1QcqJOddyN5m8GPP7dt57c3H/zwEY8WGHBsAEaiAWMbiM3YQFg9ENgDMfMDhj9EKR4Fo2AUjIIRBgBR9VJ+fYGm4gAAAABJRU5ErkJggg==","orcid":"","institution":"Raipur Institute of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Anuj","middleName":"","lastName":"Singh","suffix":""},{"id":475344793,"identity":"b1e89939-d304-4293-bb2d-77c592ad7054","order_by":1,"name":"Anjani Kumar Srivastava","email":"","orcid":"","institution":"United Institute of Medical Sciences, United University","correspondingAuthor":false,"prefix":"","firstName":"Anjani","middleName":"Kumar","lastName":"Srivastava","suffix":""},{"id":475344794,"identity":"7b29b8f8-33bc-49eb-bd2f-1dd510061f1d","order_by":2,"name":"Neha Singh Chauhan","email":"","orcid":"","institution":"Abhishek I Mishra Memorial Medical College and Research","correspondingAuthor":false,"prefix":"","firstName":"Neha","middleName":"Singh","lastName":"Chauhan","suffix":""},{"id":475344795,"identity":"567f43dd-6eee-4a99-9c96-137d23f97a83","order_by":3,"name":"Anjali Singh","email":"","orcid":"","institution":"United Institute of Medical Sciences, United University","correspondingAuthor":false,"prefix":"","firstName":"Anjali","middleName":"","lastName":"Singh","suffix":""},{"id":475344796,"identity":"e9f0a81f-cc10-4369-8ae0-f7f9faa577e0","order_by":4,"name":"Mritunjay Singh Thakur","email":"","orcid":"","institution":"United Institute Of Medical Sciences, United University","correspondingAuthor":false,"prefix":"","firstName":"Mritunjay","middleName":"Singh","lastName":"Thakur","suffix":""},{"id":475344797,"identity":"aabbc0c6-2a17-4523-95c3-69300ae90d17","order_by":5,"name":"Vineeta Gupta","email":"","orcid":"","institution":"Raipur Institute of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Vineeta","middleName":"","lastName":"Gupta","suffix":""}],"badges":[],"createdAt":"2025-05-21 06:38:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6713175/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6713175/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12982-026-01383-6","type":"published","date":"2026-01-22T15:57:16+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":101151752,"identity":"dc886312-7dee-4af7-a55f-87451959c759","added_by":"auto","created_at":"2026-01-26 16:04:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1037652,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6713175/v1/95ca065d-e969-4c3c-aa71-c0ec4804fe48.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Investigating Stress Dynamics Triggers and Sleep Disturbances in Indian Medical Graduates","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe landscape of Indian medical education has undergone a seismic transformation over the past decade, driven by an unprecedented expansion in medical seats to address the nation\u0026rsquo;s growing healthcare demands. Between 2014 and 2024, the number of medical colleges in India surged from 387 to over 700, with MBBS seats increasing from approximately 51,000 to nearly 108,000 annually. This rapid escalation, while aimed at bolstering the healthcare workforce, has intensified the competitive environment, placing immense pressure on medical graduates navigating an already rigorous academic and clinical journey. The high-stakes culture, compounded by societal expectations and the grueling preparation for entrance examinations like the National Eligibility cum Entrance Test (NEET), has created a pressure cooker environment that amplifies stress and its cascading effects on mental health. Emerging evidence suggests that this competitive milieu is fueling a silent epidemic of burnout, manifesting as depression, anxiety, sleep disruptions, medical dropouts, and, in extreme cases, suicides among medical students. This study seeks to illuminate these challenges, offering critical insights into their prevalence, triggers, and consequences to inform targeted interventions.\u003c/p\u003e \u003cp\u003eThe mental health crisis among medical students is a global concern, but its manifestations in India are uniquely shaped by cultural, academic, and systemic factors. Studies indicate that Indian medical students face exceptional stress due to long working hours, information overload, and limited leisure time, often exacerbated by inadequate institutional support. A 2024 cross-sectional study in Kolkata reported that 27.8% of undergraduate medical students were diagnosed with mental health conditions, with 16.2% experiencing suicidal ideation, underscoring the gravity of the issue (1). Similarly, a meta-analysis found a pooled depression prevalence of 50% among Indian medical undergraduates, highlighting the pervasive psychological toll (2). Burnout, characterized by emotional exhaustion and depersonalization, is reported in up to 86% of students for disengagement and 80% for exhaustion, far surpassing rates in the general population (3). These findings align with longitudinal assessments revealing that forced career choices, often driven by parental pressure, correlate with higher depression and suicidal tendencies (4).\u003c/p\u003e \u003cp\u003eSleep disruptions, a critical yet underexplored dimension, further compound these struggles, impairing cognitive function and academic performance. A 2024 study on foreign medical graduates preparing for licensing exams in India noted that unmanaged stress led to insomnia and burnout, increasing dropout risks (5). The competitive environment, intensified by the increase in medical seats, has also been linked to heightened peer pressure and fear of failure, contributing to psychological distress (6). Reports of 122 medical student suicides between 2018 and 2023, alongside over 1,200 dropouts in the same period, signal an alarming trend that demands urgent investigation (7). Organizational factors, such as unsupportive learning environments and prolonged duty hours, further exacerbate burnout, with postgraduate students reporting suicidal thoughts at a rate of 31.23% (8).\u003c/p\u003e \u003cp\u003eDespite these red flags, comprehensive multicentric studies exploring the interplay of stress dynamics, triggers, and sleep disruptions among Indian medical graduates remain scarce. This gap is particularly concerning given the recent policy shifts, such as mandatory rural service and evolving curricula, which introduce additional stressors (9). Resilience, while protective, is insufficiently fostered in current training frameworks, leaving students vulnerable to mental health crises (10). Our study addresses this critical void by examining the multifaceted stressors faced by medical graduates across diverse Indian institutions, aiming to unravel their impact on mental health and academic persistence. By identifying specific triggers and their association with sleep disruptions, we seek to provide a roadmap for policy reforms and institutional strategies to mitigate burnout, reduce dropouts, and prevent tragic outcomes, ensuring the well-being of India\u0026rsquo;s future healthcare providers.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThis multicenter, cross-sectional study assessed stress levels and sleep disorders among Indian medical graduates over six months (January\u0026ndash;June 2024). The study was conducted at two medical institutions\u0026mdash;Institute-A (n\u0026thinsp;=\u0026thinsp;385) in southern Uttar Pradesh and Institute-B (n\u0026thinsp;=\u0026thinsp;240) in Raipur, central India\u0026mdash;the study ensured institutional anonymity as per the approval of their respective ethics committees.\u003c/p\u003e \u003cp\u003eA total of 625 medical graduates were recruited in the study, through a convenience sampling method. Among them, 385 were from the institute-A, in Raipur, while 240 students were from the institute-B. The inclusion criterion for participation was the willingness of medical graduates to take part in the study and provide informed consent. There were no exclusion criteria.\u003c/p\u003e \u003cp\u003eParticipant recruitment took place during regular college hours, immediately following lectures. Investigators conducted short briefing sessions to explain the study\u0026rsquo;s objectives, significance, and procedures. Those interested were invited to participate voluntarily. The process ensured informed consent and emphasized the anonymity and confidentiality of participants\u0026rsquo; responses to encourage candid participation.\u003c/p\u003e \u003cp\u003eData were collected using a structured questionnaire, administered in person. Investigators provided detailed explanations to clarify the content and purpose of each section. The data collection tools included the Perceived Stress Scale (PSS) for measuring stress levels and a Modified Sleep Disorders Questionnaire developed by the Alberta Medical Association to assess various types of sleep disturbances. Additional questions were incorporated to identify specific stressors and to gather information on any prior consultations for mental health concerns.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eThe interpretation of the scales use for data collection-\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003ePerceived Stress Scale (PSS) scores categorized as follows\u003c/strong\u003e \u003cp\u003e0\u0026ndash;13 indicated low stress 14\u0026ndash;26 signified moderate stress 27\u0026ndash;40 reflected high perceived stress.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eThe Modified Sleep Disorders Questionnaire was divided into diagnostic domains\u003c/strong\u003e \u003cp\u003eInsomnia (questions 1\u0026ndash;5) Psychiatric disorders (questions 6\u0026ndash;9) Circadian rhythm disorders (question 10), Movement disorders (questions 11\u0026ndash;12) Parasomnias (question 13).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eCollected data were systematically compiled and organized using Microsoft Excel 2010, and statistical analysis was performed using IBM SPSS Statistics software, version 20.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 625 medical students (385 from Institute-A, 240 from Institute-B) participated in this study. The following sections present the demographic profile, stress profile and causes, sleep disorder prevalence, and medical consultation patterns, with statistical analyses to assess differences and associations.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e: \u003cb\u003eDemographic Profile\u003c/b\u003e summarizes the characteristics of the study population. The sample had a balanced gender distribution (48.8% male, 51.2% female; χ\u0026sup2; = 0.29, p\u0026thinsp;=\u0026thinsp;0.59). The mean age was 22.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 years, with Institute-A students slightly older (22.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2 vs. 22.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3 years; t\u0026thinsp;=\u0026thinsp;2.67, p\u0026thinsp;=\u0026thinsp;0.008). MBBS year distribution differed significantly (χ\u0026sup2; = 165.7, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as Institute-A included only 3rd (50.9%) and 4th-year (49.1%) students, while Institute-B included 1st (12.1%), 2nd (42.1%), 3rd (35.0%), and 4th-year (10.8%) students \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic Profile\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInstitute-A (n\u0026thinsp;=\u0026thinsp;385)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInstitute-B (n\u0026thinsp;=\u0026thinsp;240)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;625)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStatistical Test\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e191 (49.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e114 (47.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e305 (48.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ\u0026sup2; = 0.29, p\u0026thinsp;=\u0026thinsp;0.59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e194 (50.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e126 (52.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e320 (51.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003et\u0026thinsp;=\u0026thinsp;2.67, p\u0026thinsp;=\u0026thinsp;0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMBBS Year\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1st Year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29 (12.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e29 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ\u0026sup2; = 165.7, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2nd Year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e101 (42.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e101 (16.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3rd Year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e196 (50.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84 (35.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e280 (44.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4th Year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e189 (49.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26 (10.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e215 (34.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eNote-\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u0026bull; Gender distribution is balanced (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05, chi-square test).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u0026bull; Age differs significantly between institutes (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, t-test), with Institute-A students slightly older.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u0026bull; MBBS year distribution varies significantly (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, chi-square test), as Institute-A includes only 3rd and 4th years.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe significant age difference may reflect the academic progression of Institute-A students, who are exclusively in later years. The variation in MBBS year distribution highlights institutional differences in student cohorts, potentially influencing stress and sleep outcomes.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e: \u003cb\u003eStress Profile and Causes\u003c/b\u003e shows that 55.5% of students experienced moderate stress (14\u0026ndash;26), 30.9% low stress (0\u0026ndash;13), and 13.6% high stress (27\u0026ndash;40). Institute-B had a higher prevalence of high stress (17.9% vs. 10.9%; χ\u0026sup2; = 8.95, p\u0026thinsp;=\u0026thinsp;0.011). Primary stress causes included academic pressure (56.8%) and exam stress (61.3%), with marginally higher prevalence in Institute-B (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for all causes) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eStress Profile and Causes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress Category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInstitute-A (n\u0026thinsp;=\u0026thinsp;385)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInstitute-B (n\u0026thinsp;=\u0026thinsp;240)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;625)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStatistical Test\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow (0\u0026ndash;13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e130 (33.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63 (26.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e193 (30.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u0026sup2; = 8.95, p\u0026thinsp;=\u0026thinsp;0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate (14\u0026ndash;26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e213 (55.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e134 (55.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e347 (55.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh (27\u0026ndash;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (10.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43 (17.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommon Causes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePrevalence (% reporting)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ea) Academic Pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u0026sup2; = 3.43, p\u0026thinsp;=\u0026thinsp;0.064\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eb) Exam Stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u0026sup2; = 1.53, p\u0026thinsp;=\u0026thinsp;0.216\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ec) Peer Pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u0026sup2; = 0.28, p\u0026thinsp;=\u0026thinsp;0.597\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ed) Family Issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u0026sup2; = 0.26, p\u0026thinsp;=\u0026thinsp;0.610\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ee) Financial Stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u0026sup2; = 0.37, p\u0026thinsp;=\u0026thinsp;0.543\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eNote-\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u0026bull; Stress category distribution differs significantly (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, chi-square test), with Institute-B showing higher high-stress prevalence (17.9% vs. 10.9%).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u0026bull; Academic pressure and exam stress are the top causes, with marginally higher prevalence in Institute-B (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for all causes).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe significant difference in stress distribution suggests that Institute-B students face greater stress burdens, possibly due to institutional factors or earlier academic years (1st and 2nd years). The prominence of academic and exam-related stress underscores the intense academic demands on medical students.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e: \u003cb\u003eSleep Disorder Prevalence\u003c/b\u003e indicates that 18.9% of students had severe insomnia (score\u0026thinsp;\u0026ge;\u0026thinsp;15), with higher prevalence in Institute-B (25.0% vs. 15.1%; χ\u0026sup2; = 9.78, p\u0026thinsp;=\u0026thinsp;0.002). Circadian rhythm disorders were present in 34.4% of students, with a marginal difference between institutes (38.8% in Institute-B vs. 31.7% in Institute-A; χ\u0026sup2; = 3.50, p\u0026thinsp;=\u0026thinsp;0.061). Psychiatric disorders (9.9%) and movement disorders (3.2%) showed no significant differences (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSleep Disorder Prevalence\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisorder Type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInstitute-A (n\u0026thinsp;=\u0026thinsp;385)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eInstitute-B (n\u0026thinsp;=\u0026thinsp;240)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;625)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStatistical Test\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInsomnia (Score 5\u0026ndash;25)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere (\u0026ge;\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58 (15.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e118 (18.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ\u0026sup2; = 9.78, p\u0026thinsp;=\u0026thinsp;0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Severe (\u0026lt;\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e327 (84.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e180 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e507 (81.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePsychiatric Disorders (Score 4\u0026ndash;20)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere (\u0026ge;\u0026thinsp;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26 (10.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e62 (9.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ\u0026sup2; = 0.36, p\u0026thinsp;=\u0026thinsp;0.548\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Severe (\u0026lt;\u0026thinsp;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e349 (90.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e214 (89.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e563 (90.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCircadian Rhythm Disorder (Score 1\u0026ndash;5)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresent (\u0026ge;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e122 (31.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93 (38.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e215 (34.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ\u0026sup2; = 3.50, p\u0026thinsp;=\u0026thinsp;0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbsent (\u0026lt;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e263 (68.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e147 (61.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e410 (65.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMovement Disorders (Score 2\u0026ndash;10)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere (\u0026ge;\u0026thinsp;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (3.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ\u0026sup2; = 0.11, p\u0026thinsp;=\u0026thinsp;0.740\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Severe (\u0026lt;\u0026thinsp;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e372 (96.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e233 (97.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e605 (96.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eNotes\u003c/b\u003e:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u0026bull; Severe insomnia is significantly more prevalent in Institute-B (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, chi-square test).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u0026bull; Circadian rhythm disorders show a marginal difference (p\u0026thinsp;=\u0026thinsp;0.061).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u0026bull; Psychiatric and movement disorders show no significant differences (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe significantly higher prevalence of severe insomnia in Institute-B points to institute-specific factors, such as academic intensity or environmental stressors, exacerbating sleep disruptions. The high prevalence of circadian rhythm disorders suggests widespread sleep schedule irregularities, particularly in Institute-B \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e: \u003cb\u003eAvailing Medical Consultation with Stress and Sleep Disorders\u003c/b\u003e reveals that consultation rates increased with stress severity: 41.2% of high-stress, 32.6% of moderate-stress, and 19.7% of low-stress students sought consultation (χ\u0026sup2; = 17.6, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Severe insomnia (41.5%; χ\u0026sup2; = 13.8, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), severe psychiatric disorders (43.5%; χ\u0026sup2; = 6.81, p\u0026thinsp;=\u0026thinsp;0.009), and present circadian rhythm disorders (35.3%; χ\u0026sup2; = 3.92, p\u0026thinsp;=\u0026thinsp;0.048) were significantly associated with higher consultation rates. Movement disorders showed no significant association (p\u0026thinsp;=\u0026thinsp;0.125).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAvailing Medical Consultation with Stress and Sleep Disorders\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes (Consulted)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo (Not Consulted)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStatistical Test\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eStress Category\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow (0\u0026ndash;13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38 (19.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e155 (80.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ\u0026sup2; = 17.6, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate (14\u0026ndash;26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e113 (32.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e234 (67.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh (27\u0026ndash;40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (41.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50 (58.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInsomnia Severity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere (\u0026ge;\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49 (41.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69 (58.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ\u0026sup2; = 13.8, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Severe (\u0026lt;\u0026thinsp;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e137 (27.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e370 (73.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e507\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePsychiatric Disorders\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere (\u0026ge;\u0026thinsp;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (43.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35 (56.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ\u0026sup2; = 6.81, p\u0026thinsp;=\u0026thinsp;0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Severe (\u0026lt;\u0026thinsp;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e159 (28.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e404 (71.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e563\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCircadian Rhythm Disorder\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresent (\u0026ge;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76 (35.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e139 (64.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ\u0026sup2; = 3.92, p\u0026thinsp;=\u0026thinsp;0.048\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbsent (\u0026lt;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e110 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e300 (73.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e410\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMovement Disorders\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere (\u0026ge;\u0026thinsp;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9 (45.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11 (55.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ\u0026sup2; = 2.36, p\u0026thinsp;=\u0026thinsp;0.125\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-Severe (\u0026lt;\u0026thinsp;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e177 (29.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e428 (70.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e605\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eNotes\u003c/b\u003e:\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u0026bull; Medical consultation is significantly associated with higher stress levels, severe insomnia, severe psychiatric disorders, and present circadian rhythm disorders (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, chi-square test).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u0026bull; No significant association with movement disorders (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u0026bull; High-stress (41.2%) and severe insomnia (41.5%) students are most likely to seek consultation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe significant association between higher stress, severe insomnia, psychiatric disorders, and circadian rhythm disorders with medical consultation indicates that students with more severe symptoms are more likely to seek help. However, the low consultation rate among moderately stressed students (67.4% did not consult) suggests barriers to accessing mental health support, such as stigma or lack of resources \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis multicentric study unveils the profound stress and sleep disruptions plaguing Indian medical graduates, with 69.1% reporting moderate to high stress and 18.9% experiencing severe insomnia. Notable institutional differences\u0026mdash;higher stress (17.9% vs. 10.9%) and insomnia (25.0% vs. 15.1%) at Institute-B\u0026mdash;highlight how academic, institutional, and regional factors shape mental health outcomes. By aligning with and diverging from existing literature, these findings illuminate the urgent need for systemic interventions in Indian medical education.\u003c/p\u003e\n\u003ch3\u003eStress Prevalence and Triggers\u003c/h3\u003e\n\u003cp\u003eThe stress profile\u0026mdash;55.5% moderate and 13.6% high stress\u0026mdash;mirrors Gupta et al. (2023), who reported 58% stress prevalence among medical undergraduates, driven by academic demands [15]. Exam stress (61.3%) and academic pressure (56.8%) emerged as dominant triggers, consistent with Sharma et al. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), who identified exam anxiety as a primary stressor [16]. The elevated high-stress prevalence at Institute-B likely stems from its inclusion of 1st- and 2nd-year students, who face adjustment challenges, as Nair et al. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) suggest [17]. Conversely, the lack of significant differences in peer pressure (21.4%) and family issues (23.5%) contrasts with Joshi et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), who emphasized socio-cultural stressors like parental expectations [18]. This discrepancy may reflect our study\u0026rsquo;s emphasis on academic triggers or variations in participant demographics, underscoring the need for context-specific analyses.\u003c/p\u003e\n\u003ch3\u003eSleep Disruptions\u003c/h3\u003e\n\u003cp\u003eSevere insomnia (18.9%) and circadian rhythm disorders (34.4%) were prevalent, aligning with Singh et al. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), who linked 22% insomnia rates to academic stress [19]. Institute-B\u0026rsquo;s higher insomnia prevalence may reflect intense schedules or less supportive environments, as Kumar et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) note [20]. The marginal difference in circadian rhythm disorders (38.8% vs. 31.7%) supports Rao et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), who tied erratic schedules to sleep disruptions [21]. However, the lower prevalence of psychiatric disorders (9.9%) compared to Reddy et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) (15%) may indicate underdiagnosis by the Modified Sleep Disorders Questionnaire [22]. These findings highlight sleep as a critical mediator of stress-related outcomes, warranting targeted interventions.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMedical Consultation Patterns\u003c/h2\u003e \u003cp\u003eOnly 41.2% of high-stress and 41.5% of severe insomnia students sought medical consultation, echoing Kapoor et al. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), who reported 35% help-seeking rates hindered by stigma [23]. Higher consultation for severe symptoms aligns with Desai et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) [24], yet the low rate among moderately stressed students (32.6%) signals barriers, as Verma et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) highlight [25]. The lack of association with movement disorders (p\u0026thinsp;=\u0026thinsp;0.125) may reflect their lower perceived severity, per Sharma et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) [26]. These patterns reveal a critical gap in mental health support, particularly for students with moderate symptoms who risk escalating distress.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eReasons for Differences and Implications\u003c/h3\u003e\n\u003cp\u003eInstitutional variations likely arise from differences in academic structure, student cohorts, and regional contexts. Institute-A\u0026rsquo;s focus on 3rd- and 4th-year students may foster better coping mechanisms, reducing stress, as Patel et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) suggest [27]. Institute-B\u0026rsquo;s broader cohort, including early-year students, and potential resource strains from India\u0026rsquo;s medical seat expansion may exacerbate stress and insomnia [5]. Regional factors, such as Raipur\u0026rsquo;s semi-urban setting versus southern Uttar Pradesh\u0026rsquo;s rural context, may also influence outcomes, with urban pressures amplifying stress [20].\u003c/p\u003e \u003cp\u003eThese findings have far-reaching implications. The high prevalence of stress and sleep disruptions threatens academic performance, mental health, and retention, contributing to India\u0026rsquo;s alarming medical student suicide rates [17]. Institutions must implement stress management workshops, sleep hygiene programs, and accessible counseling, as Thomas et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) advocate [28]. Integrating mental health education into curricula, per Singh et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), could build resilience and curb dropouts [29]. Policymakers should address systemic issues, such as workload optimization and faculty support, to create nurturing environments that safeguard future healthcare providers.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eThe study\u0026rsquo;s reliance on convenience sampling risks selection bias, and its cross-sectional design limits insights into temporal trends. The Modified Sleep Disorders Questionnaire may under diagnose psychiatric conditions, potentially underestimating their prevalence. Focusing on two institutes restricts generalizability, necessitating broader studies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study exposes the silent mental health crisis among Indian medical graduates, with institute-specific patterns revealing systemic gaps. High stress, pervasive sleep disruptions, and low help-seeking underscore the need for urgent reforms to protect the well-being of India\u0026rsquo;s future healthcare workforce.\u003c/p\u003e \u003cp\u003e \u003cb\u003eRecommendations\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIntegrate mandatory stress management and sleep hygiene modules into medical curricula.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eEstablish stigma-free, on-campus counseling services with trained professionals.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eOptimize academic schedules to reduce workload and promote regular sleep patterns.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eConduct longitudinal, multi-institutional studies to track mental health trends and evaluate intervention efficacy.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eFunding\u003c/strong\u003e:\u0026nbsp;This study received no specific grant or funding from any external agency, public, commercial, or not-for-profit sectors. The research was supported by internal resources of the participating institutions.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eConflicts of interest/Competing interests:\u003c/strong\u003e The authors declare that they have no financial or non-financial conflicts of interest or competing interests that could have influenced the design, conduct, or reporting of this study.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eEthics approval:\u0026nbsp;\u003c/strong\u003eThe study protocol was reviewed and approved by the Institutional Ethics Committees of the participating institutions. All study procedures were conducted in strict accordance with the ethical principles outlined in the Declaration of Helsinki (2013 revision) and the Indian Council of Medical Research (ICMR) Guidelines for Biomedical and Health Research Involving Human Participants (2017).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eConsent to participate:\u003c/strong\u003e All participants provided written informed consent prior to their inclusion in the study. The consent process ensured participants were fully informed about the study’s purpose, procedures, potential risks, and their right to withdraw at any time without consequences.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;\u003cstrong\u003eConsent for publication:\u003c/strong\u003e All participants provided written informed consent for the publication of anonymized data derived from this study. No identifiable personal information or individual-level data are included in the manuscript or supplementary materials. The authors confirm that all data presented have been de-identified to ensure participant confidentiality in accordance with ethical standards.\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;\u003cstrong\u003eData Availability\u003c/strong\u003e:\u0026nbsp;The datasets generated and/or analyzed during the current study are available from the first author upon reasonable request, subject to ethical and legal restrictions. All data shared will be de-identified to protect participant confidentiality in accordance with applicable regulations.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e -\u0026nbsp;The authors sincerely thank all the medical students who actively participated in this study and contributed their time and honest responses. We also extend our gratitude to the respective institutions for their invaluable support and cooperation, which played a crucial role in translating this research effort into meaningful and practical findings.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eClinical Trial-\u003c/strong\u003e Not Applicable\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDesai G, Sharma A, Rao K. Building resilience in Indian medical education. BMJ Open. 2024;14(2):e078901.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta R, Basu S. Prevalence of stress in medical undergraduates. Acad Med. 2023;98(10):1123\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoshi A, Patel N, Kumar V. Socio-cultural stressors in Indian medical training. J Health Soc Behav. 2024;65(2):201\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKapoor N, Singh R, Gupta S. Interventions for mental health in medical students. J Clin Psychol. 2023;79(5):1234\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKumar P, Sharma R, Gupta N. Scaling medical education in India: progress and pitfalls. Indian J Med Res. 2023;157(4):301\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNair S, Kapoor V, Shah P. Competitive pressures in Indian medical education. Med Educ. 2024;58(6):701\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel V, Kumar S, Desai R. Rising suicides in Indian medical education: a call for action. Lancet Psychiatry. 2022;9(8):645\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRao P, Sharma V, Desai G. Cultural nuances in mental health research: Indian perspectives. Glob Ment Health. 2023;10:e45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReddy K, Nair A, Thomas J. Depression and anxiety in Indian medical trainees. Indian J Psychiatry. 2024;66(3):245\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma A, Patel S, Rao K. Mental health burden among Indian medical students. J Ment Health. 2024;33(2):178\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma V, Desai R, Kumar S. Mental health challenges in medical education: a review. J Med Educ. 2023;22(3):189\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh M, Joshi P, Verma R. Systemic drivers of suicide among medical students. J Public Health. 2023;45(1):89\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh R, Gupta A, Sharma S. Sleep disturbances and academic outcomes in medical education. Sleep Med. 2024;105:89\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThomas R, Singh K, Rao M. Stigma and mental health help-seeking in medical students. Asian J Psychiatr. 2023;80:103\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerma S, Nair S, Shah R. Multicentric studies in medical education research. Med Teach. 2024;46(4):512\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Medical education, medical graduates, stress, sleep disorders","lastPublishedDoi":"10.21203/rs.3.rs-6713175/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6713175/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction-\u003c/strong\u003e India’s medical education system, marked by a surge in seats from 51,000 to 108,000 (2014–2024), has intensified competition, fueling a mental health crisis among medical graduates.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology- \u003c/strong\u003eThis multicentric, cross-sectional study (January–June 2024) examined stress dynamics, triggers, and sleep disruptions in 625 medical students across two institutes: Institute-A (n = 385, Uttar Pradesh) and Institute-B (n = 240, Raipur). Employing the Perceived Stress Scale and Modified Sleep Disorders Questionnaire, we assessed stress levels, sleep disturbances, and help-seeking behaviours.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults- \u003c/strong\u003eFindings revealed 55.5% of students faced moderate stress, 13.6% high stress, and 18.9% severe insomnia, with Institute-B showing significantly elevated stress (17.9% vs. 10.9%, p = 0.011) and insomnia (25.0% vs. 15.1%, p = 0.002). Academic pressure (56.8%) and exam stress (61.3%) were predominant triggers, while circadian rhythm disorders affected 34.4%. Only 41.2% of high-stress and 41.5% of severe insomnia students sought consultation, underscoring stigma and access barriers. Institute-B’s higher burden suggests academic and environmental influences.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e- This study unveils a silent epidemic, urging institutions to adopt mandatory stress management, sleep hygiene programs, and stigma-free counselling to protect India’s future healthcare workforce and address rising dropout and suicide risks.\u003c/p\u003e","manuscriptTitle":"Investigating Stress Dynamics Triggers and Sleep Disturbances in Indian Medical Graduates","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-25 11:11:59","doi":"10.21203/rs.3.rs-6713175/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-06T05:12:07+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"234857387689812038619474876923061381940","date":"2025-09-20T15:18:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52087579484363006956536014297720089506","date":"2025-08-05T01:52:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-22T09:01:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-20T17:59:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"72849251271867764823146224969726453139","date":"2025-06-25T15:04:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"302091405229443226465938699913953805792","date":"2025-06-23T17:56:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-23T15:01:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-23T12:56:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-21T07:02:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-06-21T06:59:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f8ea2567-4157-4af8-806e-a91ec851d45c","owner":[],"postedDate":"June 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-26T16:01:17+00:00","versionOfRecord":{"articleIdentity":"rs-6713175","link":"https://doi.org/10.1186/s12982-026-01383-6","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2026-01-22 15:57:16","publishedOnDateReadable":"January 22nd, 2026"},"versionCreatedAt":"2025-06-25 11:11:59","video":"","vorDoi":"10.1186/s12982-026-01383-6","vorDoiUrl":"https://doi.org/10.1186/s12982-026-01383-6","workflowStages":[]},"version":"v1","identity":"rs-6713175","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6713175","identity":"rs-6713175","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}