OBJECTIVE Mental health problems among medical students have been widely reported, but the predisposing and perpetuating factors and biological concomitants are poorly understood. Adopting a biopsychosocial approach, we studied well-being in a group of Australian medical students, focusing on sleep, autonomic and immune mechanisms, as well as mental, social and physical well-being, health-related behaviours, and daily functioning. METHODS Fourth-year medical students (N = 151) completed comprehensive assessments, including laboratory-based and nocturnal autonomic monitoring via ambulatory bioharness, a psychiatric diagnostic interview, and questionnaires assessing sleep quality and psychosocial and physical well-being. A blood sample was taken to quantify the inflammatory marker C-reactive protein. Sleep, mood and activity was additionally monitored daily for 7 days. RESULTS A sizable minority of students reported diminished physical, mental and psychosocial well-being. We also found concerning levels of sleep disturbance and social and occupational impairment in a subset of students. The strong co-occurrence of problems across symptom domains supported a biopsychosocial interdependence of health and well-being states. Maladaptive coping behaviours were apparent, notably hazardous alcohol consumption, which was associated with a clinically significant elevation in C-reactive protein levels (> 3 mg/L). We documented, for the first time, significantly diminished nocturnal heart rate variability in medical students with a mental health diagnosis. Nocturnal heart rate variability was strongly associated with sleep quality, daytime autonomic stress reactivity, as well as occupational and social functioning. CONCLUSION Well-being is a multifaceted phenomenon firmly interlinked with sleep, autonomic and immune function, health behaviours and functional outcomes. Our novel findings supported a key role for nocturnal autonomic function in promoting sleep quality and mental well-being. Interventions could focus on sleep hygiene and health behaviours as a buffer for well-being and teach more adaptive strategies for coping with the stresses of medical training.

中文翻译：

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医学生的福祉：一种生物心理社会方法。

目的医学生的心理健康问题已被广泛报道，但对其诱发和持续因素以及生物学伴随的了解甚少。我们采用生物心理社会方法，研究了一组澳大利亚医学生的幸福感，重点关注睡眠、自主神经和免疫机制，以及心理、社会和身体健康、与健康相关的行为和日常功能。方法四年级医学生（N = 151）完成了综合评估，包括通过动态生物安全装置进行的实验室和夜间自主神经监测、精神科诊断访谈，以及评估睡眠质量、社会心理和身体健康的问卷调查。采集血液样本以量化炎症标志物 C 反应蛋白。睡觉，另外每天监测情绪和活动，持续 7 天。结果 相当多的学生报告身体、心理和社会心理健康状况下降。我们还发现了一部分学生的睡眠障碍以及社交和职业障碍的程度。跨症状领域问题的强烈同时发生支持了健康和幸福状态的生物心理社会相互依赖。适应不良的应对行为很明显，尤其是危险的饮酒，这与临床上显着的 C 反应蛋白水平升高 (> 3 mg/L) 相关。我们首次记录了精神健康诊断的医学生夜间心率变异性显着降低的情况。夜间心率变异性与睡眠质量密切相关，白天自主神经应激反应，以及职业和社会功能。结论 幸福是一个多方面的现象，与睡眠、自主神经和免疫功能、健康行为和功能结果密切相关。我们的新发现支持夜间自主神经功能在促进睡眠质量和心理健康方面的关键作用。干预措施可以侧重于睡眠卫生和健康行为，作为幸福的缓冲，并教授更多适应性策略来应对医疗培训的压力。我们的新发现支持夜间自主神经功能在促进睡眠质量和心理健康方面的关键作用。干预措施可以侧重于睡眠卫生和健康行为，作为幸福的缓冲，并教授更多适应性策略来应对医疗培训的压力。我们的新发现支持夜间自主神经功能在促进睡眠质量和心理健康方面的关键作用。干预措施可以侧重于睡眠卫生和健康行为，作为幸福的缓冲，并教授更多适应性策略来应对医疗培训的压力。