Prevalence of Anxiety and Insomnia Symptoms and Their Association with Academic Performance among Medical Students at Medical Universities in Kabul, Afghanistan: A Cross-Sectional Analytical Study

Abstract

Background: Anxiety and insomnia are common problems among medical students and may be associated with academic performance. This study aimed to determine the prevalence of anxiety and insomnia symptoms and to examine their association with academic performance among general medicine and stomatology students at medical universities in Kabul.

Methods: This analytical cross-sectional study was conducted from Saratan to Hoot 1404 among 353 male students at medical universities in Kabul using multi-site convenience sampling and an online questionnaire. Anxiety symptoms were assessed using the GAD-7, and insomnia symptoms were assessed using the ISI. A GAD-7 score ≥ 5 and an ISI score ≥8 was considered indicative of symptoms. Academic performance was assessed based on self-reported GPA from the previous semester, and data were analyzed using jamovi version 2.7.

Results: The mean anxiety and insomnia scores were 8.10±5.34 and 8.28±5.14, respectively. Anxiety symptoms were observed in 71.1% (n=251) and insomnia symptoms in 178 of students. Anxiety and insomnia were significantly and inversely associated with GPA. A significant positive association was also observed between anxiety and insomnia. In multiple linear regression, after adjustment for age, academic year, residence, and employment status, anxiety was significantly and inversely associated with GPA, whereas insomnia was not significantly associated with GPA. The model explained 12.1% of the variance in GPA.

Conclusion: Anxiety and insomnia symptoms were relatively common among male medical students in Kabul and both were inversely associated with GPA. After adjustment for the variables included in the model, anxiety remained significantly associated with GPA, although the overall explanatory power of the model was limited. Given the cross-sectional analytical design, causal relationships cannot be inferred. Early identification of anxiety and sleep-related symptoms and access to psychological counseling services at medical universities are recommended.