European Journal of Cardiovascular Medicine

Mental health, sleep quality, and quality of life (QOL) are critical determinants of academic success and overall well-being among undergraduate students. The transition to higher education, coupled with academic pressures, can exacerbate stress, anxiety, and depression, particularly in diverse academic disciplines such as medical, paramedical, and arts and science programs [1]. In India, where cultural and socioeconomic factors significantly influence student experiences, understanding these parameters is essential for developing effective support systems [2].

This study, conducted at Nandha Medical College and Hospital, Erode, Tamil Nadu, from August to December 2023, aimed to assess QOL, sleep quality, and mental health among 619 undergraduate students using standardized scales: WHO Quality of Life-BREF (WHOQOL-BREF), Pittsburgh Sleep Quality Index (PSQI), Depression Anxiety and Stress Scale (DASS-42), and Subjective Well-Being Inventory (SUBI). We also explored correlations between these parameters and compared outcomes across academic disciplines to inform targeted interventions.

Study Design and Population

This cross-sectional study was conducted at the Departments of Psychiatry and Pharmacology, Nandha Medical College and Hospital, Erode, Tamil Nadu, India, from August 2023 to December 2023. A total of 619 undergraduate students from medical (56.54%), paramedical (30.53%), and arts and science (12.92%) disciplines participated. Inclusion criteria included full-time enrolment and willingness to sign informed consent. Exclusion criteria included incomplete survey responses or diagnosed psychiatric conditions requiring ongoing treatment.

Data Collection Tools

• WHOQOL-BREF: A 26-item scale assessing four domains (physical, psychological, social, environmental) of QOL, with scores transformed to a 0–100 scale [3].
• PSQI: A 19-item self-rated questionnaire evaluating sleep quality over the past month, with a global score > 5 indicating poor sleep quality [4].
• DASS-42: A 42-item scale measuring depression, anxiety, and stress, with severity categorized as normal, mild, moderate, severe, and extremely severe [5].
• SUBI: A 40-item inventory assessing subjective well-being across life satisfaction, positive affect, and negative affect domains [6].

Statistical Analysis

Descriptive statistics (mean, standard deviation, percentages) were calculated for demographic variables, QOL, sleep quality, and mental health outcomes. Chi-square tests assessed associations between demographic variables and outcome measures. Pearson’s correlation analyzed relationships between QOL, sleep quality, and mental health parameters. Statistical significance was set at p < 0.05. Data were analyzed using SPSS version 25.

Ethical Considerations

The study was approved by the Institutional Ethics Committee of Nandha Medical College and Hospital. Informed consent was obtained from all participants, and anonymity was maintained.

RESULTS

Demographic Characteristics

The study included 619 students (66.07% female, 33.93% male), with a mean age of 19.6 years (Table 1). Most students were Hindu (81.91%), from nuclear families (77.87%), and lived in urban areas (35.38%). Medical students constituted the largest group (56.54%), followed by paramedical (30.53%) and arts and science (12.92%) students.

Table 1: Demographic Variables of Undergraduate Students (N = 619)

Quality of Life (WHOQOL-BREF)

The mean overall QOL score was 63.89 (SD = 12.12), with domain-specific means of 68.90 (physical), 61.58 (psychological), 61.34 (social), and 63.74 (environmental) (Table 2). Most students (69.79%) reported moderate QOL, while 14.05% had poor QOL and 16.16% had good QOL. Significant associations were found between QOL and age (p = 0.001), number of siblings (p = 0.001), place of living (p = 0.001), faculty (p = 0.001), year of study (p = 0.01), and family income (p = 0001).

Table 2: Overall Quality of Life Scores (WHOQOL-BREF)

Sleep Quality (PSQI)

Poor sleep quality (PSQI > 5) was reported by 67.53% of students, with a mean global PSQI score of 7.01 (SD = 2.07) (Table 3). Significant associations were observed with sex (p = 0.05), place of living (p = 0.05), and faculty (p = 0.001), with female, paramedical, and rural students reporting better sleep scores.

Table 3: Levels of Pittsburgh Sleep Quality Index (PSQI) Scores

Mental Health (DASS-42)

Normal stress levels were reported by 70.44% of students, followed by normal depression (59.61%) and anxiety (62.04%) levels (Table 4). Mean scores were 9.29 (depression), 7.57 (anxiety), and 9.20 (stress). Significant associations with depression were found for sex (p = 0.001), age (p = 0.001), birth order (p = 0.001), number of siblings (p = 0.001), weight (p = 0.01), height (p = 0.001), faculty (p = 0.001), and family income (p = 0.001).

Table 4: Levels of Depression, Anxiety, and Stress (DASS-42)

Subjective Well-Being (SUBI)

The mean SUBI score was 81.43 (SD = 9.76), with 47.66% of students reporting poor well-being, 44.43% moderate, and 7.92% good (Table 5). Significant associations were found with sex (p = 0.01), birth order (p = 0.01), number of siblings (p = 0.001), place of living (p = 0.001), weight (p = 0.001), height (p = 0.001), and year of study (p = 0.01).

Table 5: Levels of Subjective Well-Being (SUBI)

Correlations

Significant negative correlations were observed between QOL and depression (r = -0.220, p = 0.023) and between QOL and PSQI scores (r = 0.256, p = 0.047). Strong positive correlations were found between depression and anxiety (r = 0.792, p < 0.001) and between depression and stress (r = 0.812, p < 0.001) (Table 6).

Table 6: Correlation Between QOL, PSQI, and Mental Health Parameters

*p < 0.05, ** p < 0.01 (2-tailed)

Mental Health Needs

Mental health needs were assessed using a 21-item scale, with a mean score of 9.69 (SD = 9.33) (Table 7). Common symptoms included fear of the worst happening (56.22% reporting some level) and nervousness (47.82%). Significant associations were found with age (p = 0.05), type of family (p = 0.001), place of living (p = 0.01), and faculty (p = 0.05).

Table 7: Percentage of Mental Health Need Scores

This study provides comprehensive insights into the QOL, sleep quality, and mental health of undergraduate students in Erode, Tamil Nadu. The mean QOL score (63.89) aligns with previous studies in Indian student populations, indicating moderate well-being [2]. Poor sleep quality in 67.53% of students highlights a significant public health concern, consistent with global trends among college students [7]. The higher prevalence of normal stress (70.44%) compared to depression (59.61%) and anxiety (62.04%) suggests that stress is a dominant mental health issue, possibly driven by academic pressures [8].

Significant associations between QOL, sleep quality, and demographic variables such as faculty, place of living, and family income underscore the role of socioeconomic and academic factors. Medical students reported better QOL and lower depression compared to arts and science students, possibly due to structured academic environments [9]. The strong correlation between depression and anxiety (r = 0.792) indicates overlapping mental health challenges, necessitating integrated interventions [5].

Limitations include the cross-sectional design, which limits causal inferences, and reliance on self-reported data, which may introduce bias. Future research should incorporate longitudinal designs and objective measures, such as actigraphy for sleep assessment.

Undergraduate students in Erode, Tamil Nadu, exhibit moderate QOL, significant sleep disturbances, and varying levels of mental health challenges, particularly among arts and science students. Targeted interventions, including sleep hygiene programs and mental health counseling, are essential, especially for rural and paramedical students. These findings provide a foundation for developing evidence-based support systems to enhance student well-being and academic success.

Acknowledgments

We thank the students of Nandha Medical College and Hospital for their participation and the Departments of Psychiatry and Pharmacology for their support.

Ethical approval:

This study was conducted in accordance with the Declaration of Helsinki‑Ethical principle for medical research involving human subjects. Accordingly, the ethical clearance was obtained from a joint ethical review committee intuitional ethical committee (IEC), Nandha Medical College and Hospital, Erode.

Financial support and sponsorship:

Nil

Conflicts of interest:

There are no conflicts of interest.

Author’s contribution:

Dr.Paramasivan: Conceptualization, Formal analysis, Project administration, Writing‑original draft, Validation, Investigation. Dr. Dr.Arul Mohan: Conceptualization, Writing‑review and editing, Formal analysis, Validation, Investigation, Visualization. Dr. Dr.S.Nagarajan: Conceptualization, Methodology, Writing‑review and editing, Validation, Resources. Dr.Panneerselvam Periasamy: Conceptualization, Investigation, Methodology, Project administration, Supervision, Writing – review & editing.  All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. All authors have read and agreed to the published version of the manuscript.

DATA AVAILABILITY:

All datasets generated or analyzed during this study are included in the manuscript.

INFORMED CONSENT:

Written informed consent was obtained from the participants before enrolling in the study

1. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Anxiety Inventory Manual. San Antonio, TX: Psychological Corporation.
2. Sahoo, S., & Khess, C. R. J. (2017). Prevalence of depression, anxiety, and stress among young male adults in India. Indian Journal of Psychiatry, 59(4), 445–450.
3. World Health Organization. (1996). WHOQOL-BREF: Introduction, administration, scoring and generic version of the assessment. Geneva: WHO.
4. Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193–213.
5. Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales. Sydney: Psychology Foundation.
6. Sell, H., & Nagpal, R. (1992). Assessment of Subjective Well-Being: The Subjective Well-Being Inventory (SUBI). New Delhi: WHO Regional Office for South-East Asia.
7. Becker, S. P., et al. (2018). Sleep in a large, multi-university sample of college students: Sleep problem prevalence, sex differences, and mental health correlates. Sleep Health, 4(2), 174–181.
8. Reddy, K. J., Menon, K. R., & Thattil, A. (2018). Academic stress and its sources among university students. Biomedical and Pharmacology Journal, 11(1), 531–537.
9. Kumar, H., et al. (2019). Quality of life and mental health among medical students in India: A cross-sectional study. Journal of Clinical and Diagnostic Research, 13(6), VC01–VC05.