{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T14:10:45Z","timestamp":1789827045271,"version":"4.0.1"},"reference-count":163,"publisher":"The Association of Faculties of Medicine of Canada","issue":"4","license":[{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can. Med. Ed. J"],"abstract":"<jats:p>Background: Longitudinal measurements of medical student wellbeing are needed to evaluate the impacts of training and potential interventions, but the psychometric evidence underlying commonly used wellbeing scales is unclear, impairing selection decisions. We therefore synthesized the psychometric evidence of the most common scales employed to measure self-reported medical student wellbeing longitudinally.\nMethods: We conducted a psychometric systematic review based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. We searched seven databases and gray literature in March 2023 for psychometric studies in medical students of 53 scales. Two independent reviewers completed screening and data extraction and resolved conflicts via discussion. We assessed study quality and psychometrics using COSMIN methodology and pooled results for internal consistency and test-retest reliability when there were \u22652 studies per scale.\nResults: Of 2374 abstracts, we included 133 studies. Over a quarter (26.4%) of study scales lacked psychometric evidence in medical students. Internal consistency was the most studied property (118 studies), while there were no studies on measurement error. There was sufficient evidence of internal consistency for 30 scales and construct validity for 34 scales. However, there were only 1-6 scales with sufficient evidence for each of the remaining properties. Study quality varied widely and only 20 of them reported participant ethno-racial identity.\nConclusions: Many scales commonly used to measure medical student wellbeing longitudinally lack medical student-specific psychometric evidence. Among those that do, few have any evidence beyond internal consistency and construct validity. Future psychometric studies are needed in diverse populations to better inform scale selection.<\/jats:p>","DOI":"10.36834\/cmej.82091","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T16:45:27Z","timestamp":1764175527000},"page":"41-67","source":"Crossref","is-referenced-by-count":1,"title":["Measuring medical student wellbeing longitudinally: a psychometric systematic review of commonly used scales","Mesure longitudinale du bien-\u00eatre des \u00e9tudiants en m\u00e9decine : revue syst\u00e9matique psychom\u00e9trique des \u00e9chelles couramment utilis\u00e9es"],"prefix":"10.36834","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1594-347X","authenticated-orcid":false,"given":"Henry","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youri","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Do","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliya","family":"Kassam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Chankasingh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Lewis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"22580","published-online":{"date-parts":[[2025,11,25]]},"reference":[{"key":"97430","doi-asserted-by":"crossref","unstructured":"1. Brazeau CMLR, Shanafelt T, Durning SJ, et al. Distress among matriculating medical students relative to the general population. Acad Med. 2014;89(11):1520-1525. https:\/\/doi.org\/10.1097\/ACM.0000000000000482","DOI":"10.1097\/ACM.0000000000000482"},{"key":"97431","doi-asserted-by":"crossref","unstructured":"2. Maser B, Danilewitz M, Gu\u00e9rin E, Findlay L, Frank E. Medical Student Psychological Distress and Mental Illness Relative to the General Population: A Canadian Cross-Sectional Survey. Acad Med. 2019;94(11):1781-1791. https:\/\/doi.org\/10.1097\/ACM.0000000000002958","DOI":"10.1097\/ACM.0000000000002958"},{"key":"97432","doi-asserted-by":"crossref","unstructured":"3. Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016;316(21):2214. https:\/\/doi.org\/10.1001\/jama.2016.17324","DOI":"10.1001\/jama.2016.17324"},{"key":"97433","doi-asserted-by":"crossref","unstructured":"4. Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. 2016;50(1):132-149. https:\/\/doi.org\/10.1111\/medu.12927","DOI":"10.1111\/medu.12927"},{"key":"97434","doi-asserted-by":"crossref","unstructured":"5. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Acad Med. 2006;81(4):354-373.","DOI":"10.1097\/00001888-200604000-00009"},{"key":"97435","doi-asserted-by":"crossref","unstructured":"6. Dyrbye LN, Harper W, Moutier C, et al. A multi-institutional study exploring the impact of positive mental health on medical students\u2019 professionalism in an era of high burnout: Acad Med. 2012;87(8):1024-1031. https:\/\/doi.org\/10.1097\/ACM.0b013e31825cfa35","DOI":"10.1097\/ACM.0b013e31825cfa35"},{"key":"97436","doi-asserted-by":"crossref","unstructured":"7. Dyrbye LN, Thomas MR, Shanafelt TD, et al. Burnout and serious thoughts of dropping out of medical school: a multi-institutional study. Acad Med. 2010;85(1):94-102. https:\/\/doi.org\/10.1097\/ACM.0b013e3181c46aad","DOI":"10.1097\/ACM.0b013e3181c46aad"},{"key":"97437","doi-asserted-by":"crossref","unstructured":"8. Brazeau CMLR, Schroeder R, Rovi S, Boyd L. Relationships between medical student burnout, empathy, and professionalism climate. Acad Med. 2010;85:S33-S36. https:\/\/doi.org\/10.1097\/ACM.0b013e3181ed4c47","DOI":"10.1097\/ACM.0b013e3181ed4c47"},{"key":"97438","doi-asserted-by":"crossref","unstructured":"9. Charles ST, Piazza JR, Mogle J, Sliwinski MJ, Almeida DM. The wear and tear of daily stressors on mental health. Psychol Sci. 2013;24(5):733-741. https:\/\/doi.org\/10.1177\/0956797612462222","DOI":"10.1177\/0956797612462222"},{"key":"97439","doi-asserted-by":"crossref","unstructured":"10. Herr R, Barrech A, Riedel N, et al. Long-term effectiveness of stress management at work: effects of the changes in perceived stress reactivity on mental health and sleep problems seven years later. Int J Environ Res Public Health. 2018;15(2):255. https:\/\/doi.org\/10.3390\/ijerph15020255","DOI":"10.3390\/ijerph15020255"},{"key":"97440","doi-asserted-by":"crossref","unstructured":"11. Dyrbye LN, Lipscomb W, Thibault G. Redesigning the learning environment to promote learner well-being and professional development. Acad Med. 2020;95(5):674-678. https:\/\/doi.org\/10.1097\/ACM.0000000000003094","DOI":"10.1097\/ACM.0000000000003094"},{"key":"97441","doi-asserted-by":"crossref","unstructured":"12. Li H, Upreti T, Do V, et al. Measuring wellbeing: ascoping review of metrics and studies measuring medical student wellbeing across multiple timepoints. Med Teach. Published online July 5, 2023:1-20. https:\/\/doi.org\/10.1080\/0142159X.2023.2231625","DOI":"10.1080\/0142159X.2023.2231625"},{"key":"97442","doi-asserted-by":"crossref","unstructured":"13. Li H, Do V, Kassam A. The Need to Understand Medical Student-Specific Validity of Well-Being Scales. Acad Med. 2024 Dec 1;99(12):1319. https:\/\/doi.org\/10.1097\/ACM.0000000000005880. Epub 2024 Sep 17.","DOI":"10.1097\/ACM.0000000000005880"},{"key":"97443","doi-asserted-by":"crossref","unstructured":"14. Dyrbye LN, Meyers D, Ripp Jet al. A pragmatic approach for organizations to measure health care professional well-being. NAM Perspect. Published online Oct 1, 2018. https:\/\/doi.org\/10.31478\/201810b","DOI":"10.31478\/201810b"},{"key":"97444","doi-asserted-by":"crossref","unstructured":"15. Lall MD, Gaeta TJ, Chung AS, et al. Assessment of physician well-being, part two: beyond burnout. West J Emerg Med. 2019;20(2):291-304. https:\/\/doi.org\/10.5811\/westjem.2019.1.39666","DOI":"10.5811\/westjem.2019.1.39666"},{"key":"97445","doi-asserted-by":"crossref","unstructured":"16. Lall MD, Gaeta TJ, Chung AS, et al. Assessment of physician well-being, part one: burnout and other negative states. West J Emerg Med. 2019;20(2):278-290. https:\/\/doi.org\/10.5811\/westjem.2019.1.39665","DOI":"10.5811\/westjem.2019.1.39665"},{"key":"97446","doi-asserted-by":"crossref","unstructured":"17. Haykal KA, Pereira L, Power A, Fournier K. Medical student wellness assessment beyond anxiety and depression: a scoping review. PloS One. 2022;17(10):e0276894. https:\/\/doi.org\/10.1371\/journal.pone.0276894","DOI":"10.1371\/journal.pone.0276894"},{"key":"97447","doi-asserted-by":"crossref","unstructured":"18. Prinsen CAC, Mokkink LB, Bouter LM, et al. COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual Life Res. 2018;27(5):1147-1157. https:\/\/doi.org\/10.1007\/s11136-018-1798-3","DOI":"10.1007\/s11136-018-1798-3"},{"key":"97448","doi-asserted-by":"crossref","unstructured":"19. Mokkink LB, Terwee CB, Patrick DL, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. 2010;63(7):737-745. https:\/\/doi.org\/10.1016\/j.jclinepi.2010.02.006","DOI":"10.1016\/j.jclinepi.2010.02.006"},{"key":"97449","doi-asserted-by":"crossref","unstructured":"20. Terwee CB, Jansma EP, Riphagen II, de Vet HCW. Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments. Qual Life Res. 2009;18(8):1115-1123. https:\/\/doi.org\/10.1007\/s11136-009-9528-5","DOI":"10.1007\/s11136-009-9528-5"},{"key":"97450","doi-asserted-by":"crossref","unstructured":"21. Mokkink LB, de Vet HCW, Prinsen C a. C, et al. COSMIN Risk of Bias checklist for systematic reviews of patient-reported outcome measures. Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 2018;27(5):1171-1179. https:\/\/doi.org\/10.1007\/s11136-017-1765-4","DOI":"10.1007\/s11136-017-1765-4"},{"key":"97451","unstructured":"22. American Educational Research Association, American Psychological Association, National Council on Measurement in Education, Joint Committee on Standards for Educational and Psychological Testing. Standards for educational and psychological testing. Washington, DC: American Educational Research Association; 2014."},{"key":"97452","unstructured":"23. Li H. Review of measurement properties for common metrics used to measure medical student wellbeing over multiple timepoints. Published online Oct 23, 2023. Available from https:\/\/osf.io\/s8qfg [Accessed Oct 24, 2025]."},{"key":"97453","doi-asserted-by":"crossref","unstructured":"24. Elsman EBM, Mokkink LB, Terwee CB, et al. Guideline for reporting systematic reviews of outcome measurement instruments (OMIs): PRISMA-COSMIN for OMIs 2024. J Clin Epidemiol. 2024;173:111422. https:\/\/doi.org\/10.1016\/j.jclinepi.2024.111422","DOI":"10.1016\/j.jclinepi.2024.111422"},{"key":"97454","doi-asserted-by":"crossref","unstructured":"25. Brady KJS, Trockel MT, Khan CT, et al. What do we mean by physician wellness? a systematic review of its definition and measurement. Acad Psychiatry. 2018;42(1):94-108. https:\/\/doi.org\/10.1007\/s40596-017-0781-6","DOI":"10.1007\/s40596-017-0781-6"},{"key":"97455","doi-asserted-by":"crossref","unstructured":"26. Bramer WM, Rethlefsen ML, Kleijnen J, Franco OH. Optimal database combinations for literature searches in systematic reviews: a prospective exploratory study. Syst Rev. 2017;6(1):245. https:\/\/doi.org\/10.1186\/s13643-017-0644-y","DOI":"10.1186\/s13643-017-0644-y"},{"key":"97456","doi-asserted-by":"crossref","unstructured":"27. McKeown S, Mir ZM. Considerations for conducting systematic reviews: evaluating the performance of different methods for de-duplicating references. Syst Rev. 2021;10(1):38. https:\/\/doi.org\/10.1186\/s13643-021-01583-y","DOI":"10.1186\/s13643-021-01583-y"},{"key":"97457","unstructured":"28. R Core Team. R: A language and environment for statistical computing. Published online 2021. https:\/\/www.R-project.org\/"},{"key":"97458","doi-asserted-by":"crossref","unstructured":"29. Krieglstein F, Beege M, Rey GD, et al. A systematic meta-analysis of the reliability and validity of subjective cognitive load questionnaires in experimental multimedia learning research. Educ Psychol Rev. 2022;34(4):2485-2541. https:\/\/doi.org\/10.1007\/s10648-022-09683-4","DOI":"10.1007\/s10648-022-09683-4"},{"key":"97459","doi-asserted-by":"crossref","unstructured":"30. Pharasi S, Patra S. Burnout in medical students of a tertiary care Indian medical center: how much protection does resilience confer? Indian J Psych. 2020;62(4):407-412. https:\/\/doi.org\/10.4103\/psychiatry.IndianJPsychiatry_681_19","DOI":"10.4103\/psychiatry.IndianJPsychiatry_681_19"},{"key":"97460","doi-asserted-by":"crossref","unstructured":"31. Z\u00fa\u00f1iga D, Torres-Sahli M, Rigotti A, et al. Dispositional mindfulness reduces burnout and promotes flourishing in medical students: a two-wave latent change score model. Mindfulness. 2022;13(1):112-122. https:\/\/doi.org\/10.1007\/s12671-021-01774-7","DOI":"10.1007\/s12671-021-01774-7"},{"key":"97461","doi-asserted-by":"crossref","unstructured":"32. Paro HBMS, Silveira PSP, Perotta B, et al. Empathy among medical students: is there a relation with quality of life and burnout? PloS One. 2014;9(4):e94133. https:\/\/doi.org\/10.1371\/journal.pone.0094133","DOI":"10.1371\/journal.pone.0094133"},{"key":"97462","doi-asserted-by":"crossref","unstructured":"33. Lapinski J, Yost M, Sexton P, LaBaere RJ. Factors modifying burnout in osteopathic medical students. Acad Psychiatry J Am Assoc Dir Psychiatr Resid Train Assoc Acad Psychiatry. 2016;40(1):55-62. https:\/\/doi.org\/10.1007\/s40596-015-0375-0","DOI":"10.1007\/s40596-015-0375-0"},{"key":"97463","doi-asserted-by":"crossref","unstructured":"34. Sanchez DJ, Strauman TJ, Compton S. Impact of student perceptions of the educational program on burnout in medical school. Med Sci Educ. 2019;29(4):1077-1087. https:\/\/doi.org\/10.1007\/s40670-019-00812-3","DOI":"10.1007\/s40670-019-00812-3"},{"key":"97464","doi-asserted-by":"crossref","unstructured":"35. Miguel A de QC, Tempski P, Kobayasi R, Mayer FB, Martins MA. Predictive factors of quality of life among medical students: results from a multicentric study. BMC Psychol. 2021;9(1):36. https:\/\/doi.org\/10.1186\/s40359-021-00534-5","DOI":"10.1186\/s40359-021-00534-5"},{"key":"97465","doi-asserted-by":"crossref","unstructured":"36. Shi Y, Gugiu PC, Crowe RP, Way DP. A Rasch analysis validation of the Maslach Burnout Inventory-Student Survey with preclinical medical students. Teach Learn Med. 2019;31(2):154-169. https:\/\/doi.org\/10.1080\/10401334.2018.1523010","DOI":"10.1080\/10401334.2018.1523010"},{"key":"97466","doi-asserted-by":"crossref","unstructured":"37. Obregon M, Luo J, Shelton J, Blevins T, MacDowell M. Assessment of burnout in medical students using the Maslach Burnout Inventory-Student Survey: a cross-sectional data analysis. BMC Med Educ. 2020;20(1):376. https:\/\/doi.org\/10.1186\/s12909-020-02274-3","DOI":"10.1186\/s12909-020-02274-3"},{"key":"97467","unstructured":"38. Periasamy P, Suganthi V, Sukala PM, et al. Burnout among medical students and correlation with academic performance, sleep quality during covid19 pandemic online class in erode district. Pharmacologyonline. Published online 2021:962-971."},{"key":"97468","doi-asserted-by":"crossref","unstructured":"39. Calcatin S, Sinval J, Neto LL, et al. Burnout and dropout intention in medical students: the protective role of academic engagement -BMC Med Ed. 2022 Feb 7;22(1):83. https:\/\/doi.org\/10.1186\/s12909-021-03094-9.","DOI":"10.1186\/s12909-021-03094-9"},{"key":"97469","doi-asserted-by":"crossref","unstructured":"40. Gal\u00e1n F, Sanmart\u00edn A, Polo J, Giner L. Burnout risk in medical students in Spain using the Maslach Burnout Inventory-Student Survey. Int Arch Occup Environ Health. 2011;84(4):453-459. https:\/\/doi.org\/10.1007\/s00420-011-0623-x","DOI":"10.1007\/s00420-011-0623-x"},{"key":"97470","doi-asserted-by":"crossref","unstructured":"41. Ilic M, Todorovic Z, Jovanovic M, Ilic I. Burnout syndrome among medical students at one university in serbia: validity and reliability of the Maslach Burnout Inventory-Student Survey. Behav Med Wash DC. 2017;43(4):323-328. https:\/\/doi.org\/10.1080\/08964289.2016.1170662","DOI":"10.1080\/08964289.2016.1170662"},{"key":"97471","doi-asserted-by":"crossref","unstructured":"42. Rudinskait\u0117 I, Ma\u010di\u016bt\u0117 E, Gud\u017ei\u016bnait\u0117 G, Gerulaityt\u0117 G. Burnout syndrome amongst medicine students in Lithuania and Germany. Acta Medica Litu. 2020;27(2):53-60. https:\/\/doi.org\/10.15388\/Amed.2020.27.2.2","DOI":"10.15388\/Amed.2020.27.2.2"},{"key":"97472","unstructured":"43. Does mental toughness buffer the relationship between perceived stress, depression, burnout, anxiety, and sleep? Available from https:\/\/psycnet.apa.org\/record\/2018-34737-001 [Accessed Fev 4, 2024]."},{"key":"97473","doi-asserted-by":"crossref","unstructured":"44. Puranitee P, Saetang S, Sumrithe S, Busari JO, van Mook WNKA, Heeneman S. Exploring burnout and depression of Thai medical students: the psychometric properties of the Maslach Burnout Inventory. Int J Med Educ. 2019;10:223-229. https:\/\/doi.org\/10.5116\/ijme.5dc6.8228","DOI":"10.5116\/ijme.5dc6.8228"},{"key":"97474","doi-asserted-by":"crossref","unstructured":"45. Pagnin D, de Queiroz V. Influence of burnout and sleep difficulties on the quality of life among medical students. SpringerPlus. 2015;4:676. https:\/\/doi.org\/10.1186\/s40064-015-1477-6","DOI":"10.1186\/s40064-015-1477-6"},{"key":"97475","doi-asserted-by":"crossref","unstructured":"46. Al-Alawi M, Al-Sinawi H, Al-Qubtan A, et al. Prevalence and determinants of burnout Syndrome and Depression among medical students at Sultan Qaboos University: a cross-sectional analytical study from Oman. Arch Environ Occup Health. 2019;74(3):130-139. https:\/\/doi.org\/10.1080\/19338244.2017.1400941","DOI":"10.1080\/19338244.2017.1400941"},{"key":"97476","unstructured":"47. Whistle C. Resilience and Burnout in Second- and Third-Year Medical Students. USF Tampa Grad Theses Diss. Published online January 26, 2021. Available from https:\/\/digitalcommons.usf.edu\/etd\/8887 [Accessed on Nov 17, 2025]."},{"key":"97477","doi-asserted-by":"crossref","unstructured":"48. Lee SJ, Choi YJ, Chae H. The effects of personality traits on academic burnout in Korean medical students. Integr Med Res. 2017;6(2):207-213. https:\/\/doi.org\/10.1016\/j.imr.2017.03.005","DOI":"10.1016\/j.imr.2017.03.005"},{"key":"97478","doi-asserted-by":"crossref","unstructured":"49. Shin HS, Park H, Lee YM. The relationship between medical students\u2019 empathy and burnout levels by gender and study years. Patient Educ Couns. 2022;105(2):432-439. https:\/\/doi.org\/10.1016\/j.pec.2021.05.036","DOI":"10.1016\/j.pec.2021.05.036"},{"key":"97479","doi-asserted-by":"crossref","unstructured":"50. Dyrbye LN, Satele D, West CP. Association of characteristics of the learning environment and US medical student burnout, empathy, and career regret. JAMA Netw Open. 2021;4(8):e2119110. https:\/\/doi.org\/10.1001\/jamanetworkopen.2021.19110","DOI":"10.1001\/jamanetworkopen.2021.19110"},{"key":"97480","doi-asserted-by":"crossref","unstructured":"51. Shad R, Thawani R, Goel A. Burnout and sleep quality: a cross-sectional questionnaire-based study of medical and non-medical students in India. Cureus. 2015;7(10):e361. https:\/\/doi.org\/10.7759\/cureus.361","DOI":"10.7759\/cureus.361"},{"key":"97481","doi-asserted-by":"crossref","unstructured":"52. Njim T, Mbanga CM, Tindong M, et al. Burnout as a correlate of depression among medical students in Cameroon: a cross-sectional study. BMJ Open. 2019;9(5):e027709. https:\/\/doi.org\/10.1136\/bmjopen-2018-027709","DOI":"10.1136\/bmjopen-2018-027709"},{"key":"97482","doi-asserted-by":"crossref","unstructured":"53. Njim T, Makebe H, Toukam L, et al. Burnout syndrome amongst medical students in Cameroon: a cross-sectional analysis of the determinants in preclinical and clinical students. Psychiatry J. 2019;2019:4157574. https:\/\/doi.org\/10.1155\/2019\/4157574","DOI":"10.1155\/2019\/4157574"},{"key":"97483","doi-asserted-by":"crossref","unstructured":"54. Babenko O, Mosewich A, Abraham J, Lai H. Contributions of psychological needs, self-compassion, leisure-time exercise, and achievement goals to academic engagement and exhaustion in Canadian medical students. J Educ Eval Health Prof. 2018;15:2. https:\/\/doi.org\/10.3352\/jeehp.2018.15.2","DOI":"10.3352\/jeehp.2018.15.2"},{"key":"97484","doi-asserted-by":"crossref","unstructured":"55. Runyon CR, Paniagua MA, Dyrbye LN. Exploring the validity based on internal structure of the Oldenburg Burnout Inventory - Medical Student (OLBI-MS). Teach Learn Med. 2023;35(1):37-51. https:\/\/doi.org\/10.1080\/10401334.2021.2018695","DOI":"10.1080\/10401334.2021.2018695"},{"key":"97485","doi-asserted-by":"crossref","unstructured":"56. Greenmyer JR, Montgomery M, Hosford C, et al. Guilt and burnout in medical students. Teach Learn Med. 2022;34(1):69-77. https:\/\/doi.org\/10.1080\/10401334.2021.1891544","DOI":"10.1080\/10401334.2021.1891544"},{"key":"97486","doi-asserted-by":"crossref","unstructured":"57. School of Medical Sciences, Universiti Sains Malaysia, Kelantan, MALAYSIA, et al. Malay Language translation and validation of the Oldenburg Burnout Inventory Measuring Burnout. Educ Med J. 2018;10(2):27-40. https:\/\/doi.org\/10.21315\/eimj2018.10.2.4","DOI":"10.21315\/eimj2018.10.2.4"},{"key":"97487","doi-asserted-by":"crossref","unstructured":"58. Dahlin M, Joneborg N, Runeson B. Performance-based self-esteem and burnout in a cross-sectional study of medical students. Med Teach. 2007;29(1):43-48. https:\/\/doi.org\/10.1080\/01421590601175309","DOI":"10.1080\/01421590601175309"},{"key":"97488","doi-asserted-by":"crossref","unstructured":"59. Masri R, Kadhum M, Farrell SM, et al. Wellbeing and mental health amongst medical students in Jordan: a descriptive study. Int Rev Psychiatry Abingdon Engl. 2019;31(7-8):619-625. https:\/\/doi.org\/10.1080\/09540261.2019.1670402","DOI":"10.1080\/09540261.2019.1670402"},{"key":"97489","unstructured":"60. Akhtar M, Herwig BK, Faize FA. Depression and anxiety among International medical students in Germany: the predictive role of coping styles. JPMA J Pak Med Assoc. 2019;69(2):230-234."},{"key":"97490","doi-asserted-by":"crossref","unstructured":"61. Vasegh S, Mohammadi MR. Religiosity, anxiety, and depression among a sample of Iranian medical students. Int J Psychiatry Med. 2007;37(2):213-227. https:\/\/doi.org\/10.2190\/J3V5-L316-0U13-7000","DOI":"10.2190\/J3V5-L316-0U13-7000"},{"key":"97491","doi-asserted-by":"crossref","unstructured":"62. Mendes TB, Souza KC de, Fran\u00e7a CN, et al. Physical activity and symptoms of anxiety and depression among medical students during a pandemic. Rev Bras Med Esporte. 2021;27:582-587. https:\/\/doi.org\/10.1590\/1517-8692202127062021_0059","DOI":"10.1590\/1517-8692202127062021_0059"},{"key":"97492","doi-asserted-by":"crossref","unstructured":"63. Yoon S, Lee Y, Han C, et al. Usefulness of the Patient Health Questionnaire-9 for Korean medical students. Acad Psychiatry J Am Assoc Dir Psychiatr Resid Train Assoc Acad Psychiatry. 2014;38(6):661-667. https:\/\/doi.org\/10.1007\/s40596-014-0140-9","DOI":"10.1007\/s40596-014-0140-9"},{"key":"97493","unstructured":"64. Bilgel N, Oz\u00e7ak\u0131r A. Depression and anxiety among medical students: examining scores of the Beck Depression and Anxiety Inventory and the Depression Anxiety and Stress Scale with student characteristics. 2017. Available from: https:\/\/www.academia.edu\/31343781\/Depression_and_anxiety_among_medical_students_Examining_scores_of_the_beck_depression_and_anxiety_inventory_and_the_depression_anxiety_and_stress_scale_with_student_characteristics. [Accessed on Feb 4, 2024]."},{"key":"97494","doi-asserted-by":"crossref","unstructured":"65. Ernst J, Jordan KD, Weilenmann S, et al. Burnout, depression and anxiety among Swiss medical students - A network analysis. J Psychiatr Res. 2021;143:196-201. https:\/\/doi.org\/10.1016\/j.jpsychires.2021.09.017","DOI":"10.1016\/j.jpsychires.2021.09.017"},{"key":"97495","doi-asserted-by":"crossref","unstructured":"66. Peng L, Hu X, Lan L, Xu C, Li M. The moderating role of resilience in the relationship between state and trait anxiety and post-traumatic growth of medical freshmen. Acta Psychol (Amst). Oct 2022. https:\/\/doi.org\/10.1016\/j.actpsy.2022.103741","DOI":"10.1016\/j.actpsy.2022.103741"},{"key":"97496","doi-asserted-by":"crossref","unstructured":"67. Jiang N, Sato T, Hara T, et al. Correlations between trait anxiety, personality and fatigue: study based on the Temperament and Character Inventory. J Psychosom Res. 2003;55(6):493-500. https:\/\/doi.org\/10.1016\/s0022-3999(03)00021-7","DOI":"10.1016\/S0022-3999(03)00021-7"},{"key":"97497","doi-asserted-by":"crossref","unstructured":"68. Wongpakaran T, Wongpakaran N, Ruktrakul R. Reliability and validity of the Multidimensional Scale of Perceived Social Support (MSPSS): Thai Version. Clin Pract Epidemiol Ment Health CP EMH. 2011;7:161-166. https:\/\/doi.org\/10.2174\/1745017901107010161","DOI":"10.2174\/1745017901107010161"},{"key":"97498","doi-asserted-by":"crossref","unstructured":"69. Hendryx MS, Haviland MG, Shaw DG. Dimensions of alexithymia and their relationships to anxiety and depression. J Pers Assess. 1991;56(2):227-237. https:\/\/doi.org\/10.1207\/s15327752jpa5602_4","DOI":"10.1207\/s15327752jpa5602_4"},{"key":"97499","doi-asserted-by":"crossref","unstructured":"70. Fino E, Martoni M, Russo PM. Specific mindfulness traits protect against negative effects of trait anxiety on medical student wellbeing during high-pressure periods. Adv Health Sci Educ Theory Pract. 2021;26(3):1095-1111. https:\/\/doi.org\/10.1007\/s10459-021-10039-w","DOI":"10.1007\/s10459-021-10039-w"},{"key":"97500","doi-asserted-by":"crossref","unstructured":"71. Concerto C, Rodolico A, La Rosa VL, et al. Flourishing or languishing? predictors of positive mental health in medical students during the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(23):15814. https:\/\/doi.org\/10.3390\/ijerph192315814","DOI":"10.3390\/ijerph192315814"},{"key":"97501","doi-asserted-by":"crossref","unstructured":"72. Jafari P, Nozari F, Ahrari F, Bagheri Z. Measurement invariance of the Depression Anxiety Stress Scales-21 across medical student genders. Int J Med Educ. 2017;8:116-122. https:\/\/doi.org\/10.5116\/ijme.58ba.7d8b","DOI":"10.5116\/ijme.58ba.7d8b"},{"key":"97502","doi-asserted-by":"crossref","unstructured":"73. Ramadianto AS, Kusumadewi I, Agiananda F, Raharjanti NW. Symptoms of depression and anxiety in Indonesian medical students: association with coping strategy and resilience. BMC Psych. 2022;22(1):92. https:\/\/doi.org\/10.1186\/s12888-022-03745-1","DOI":"10.1186\/s12888-022-03745-1"},{"key":"97503","doi-asserted-by":"crossref","unstructured":"74. Tee KR, Ismail AS, Ang YH, et al. Prevalence of anxiety and burnout, and coping mechanisms among clinical year medical undergraduate students in Universiti Kebangsaan Malaysia amidst the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(20):13010. https:\/\/doi.org\/10.3390\/ijerph192013010","DOI":"10.3390\/ijerph192013010"},{"key":"97504","doi-asserted-by":"crossref","unstructured":"75. Kumar S, Samal A, Dwivedi S. Sleep quality, daytime sleepiness and mental health in undergraduate medical students: a cross-sectional descriptive study. J Clin Diagn Res. Published online 2023. https:\/\/doi.org\/10.7860\/JCDR\/2023\/60633.17524","DOI":"10.7860\/JCDR\/2023\/60633.17524"},{"key":"97505","doi-asserted-by":"crossref","unstructured":"76. Phang CK, Mukhtar F, Ibrahim N, Sidik SM. Mindful Attention Awareness Scale (MAAS): factorial validity and psychometric properties in a sample of medical students in Malaysia. J Ment Health Train Educ Pract. 2016;11 (5): 305\u2013316. https:\/\/doi.org\/10.1108\/JMHTEP-02-2015-0011","DOI":"10.1108\/JMHTEP-02-2015-0011"},{"key":"97506","doi-asserted-by":"crossref","unstructured":"77. Yusoff MSB, Yaacob MJ, Naing NN, Esa AR. Psychometric properties of the Medical Student Well-Being Index among medical students in a Malaysian medical school. Asian J Psychiatry. 2013;6(1):60-65. https:\/\/doi.org\/10.1016\/j.ajp.2012.09.001","DOI":"10.1016\/j.ajp.2012.09.001"},{"key":"97507","unstructured":"78. Al-Dubai S, Barua A, Ganasegeran K, Ali Jadoo S, Rampal KG. Concurrent validity of the Malay version of Perceived Stress Scale (PSS-10). ASEAN J Psychiatry. 2014;15:8-13."},{"key":"97508","unstructured":"79. Karao\u011flu N, Bat\u0131 A. Medical students\u2019 loneliness, anxiety and depression at the beginning of their studies. Int J Psychiatry Clin Pract. 2012;16:33-34."},{"key":"97509","doi-asserted-by":"crossref","unstructured":"80. Mumford DB, Tareen IA, Bajwa MA, Bhatti MR, Karim R. The translation and evaluation of an Urdu version of the Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1991;83(2):81-85. https:\/\/doi.org\/10.1111\/j.1600-0447.1991.tb07370.x","DOI":"10.1111\/j.1600-0447.1991.tb07370.x"},{"key":"97510","doi-asserted-by":"crossref","unstructured":"81. Voltmer E, K\u00f6tter T, Spahn C. Perceived medical school stress and the development of behavior and experience patterns in German medical students. Med Teach. 2012;34(10):840-847. https:\/\/doi.org\/10.3109\/0142159X.2012.706339","DOI":"10.3109\/0142159X.2012.706339"},{"key":"97511","doi-asserted-by":"crossref","unstructured":"82. Francis B, Gill JS, Yit Han N, et al. Religious coping, religiosity, depression and anxiety among medical students in a multi-religious setting. Int J Environ Res Public Health. 2019;16(2):259. https:\/\/doi.org\/10.3390\/ijerph16020259","DOI":"10.3390\/ijerph16020259"},{"key":"97512","doi-asserted-by":"crossref","unstructured":"83. Vitaliano PP, Maiuro RD, Russo J, Mitchell ES, Carr JE, Van Citters RL. A biopsychosocial model of medical student distress. J Behav Med. 1988;11(4):311-331. https:\/\/doi.org\/10.1007\/BF00844933","DOI":"10.1007\/BF00844933"},{"key":"97513","doi-asserted-by":"crossref","unstructured":"84. Swami V, Chamorro-Premuzic T, Sinniah D, et al. General health mediates the relationship between loneliness, life satisfaction and depression. A study with Malaysian medical students. Soc Psychiatry Psychiatr Epidemiol. 2007;42(2):161-166. https:\/\/doi.org\/10.1007\/s00127-006-0140-5","DOI":"10.1007\/s00127-006-0140-5"},{"key":"97514","doi-asserted-by":"crossref","unstructured":"85. Shim EJ, Jeon HJ, Kim H, et al. Measuring stress in medical education: validation of the Korean version of the higher education stress inventory with medical students. BMC Med Educ. 2016;16(1):302. https:\/\/doi.org\/10.1186\/s12909-016-0824-9","DOI":"10.1186\/s12909-016-0824-9"},{"key":"97515","doi-asserted-by":"crossref","unstructured":"86. Ng CG, Amer Siddiq AN, Aida SA, Zainal NZ, Koh OH. Validation of the Malay version of the Multidimensional Scale of Perceived Social Support (MSPSS-M) among a group of medical students in Faculty of Medicine, University Malaya. Asian J Psych. 2010;3(1):3-6. https:\/\/doi.org\/10.1016\/j.ajp.2009.12.001","DOI":"10.1016\/j.ajp.2009.12.001"},{"key":"97516","doi-asserted-by":"crossref","unstructured":"87. Ghassab-Abdollahi N, Shakouri SK, Aghdam AT, et al. Association of quality of life with physical activity, depression, and demographic characteristics and its predictors among medical students. J Educ Health Promot. 2020;9:147. https:\/\/doi.org\/10.4103\/jehp.jehp_91_20","DOI":"10.4103\/jehp.jehp_91_20"},{"key":"97517","unstructured":"88. Ongel K, Mergen H, Tan S, et al. Psychometric properties of depression in university students of Turkey. Biomed Res. 2010;21(3). Available from https:\/\/www.alliedacademies.org\/abstract\/psychometric-properties-of-depression-in-university-students-of-turkey-1316.html. [Accessed Feb 4, 2024]."},{"key":"97518","doi-asserted-by":"crossref","unstructured":"89. Solibieda A, Rotsaert M, Loas G. Relationship between recent change of anhedonia and suicidal ideation taking into account the severity and the acuteness of suicidal ideation as well as the specific roles of loss of pleasure and loss of interest in people: a study on medical students. Omega. 2023;87(4):1280-1292. https:\/\/doi.org\/10.1177\/00302228211037300","DOI":"10.1177\/00302228211037300"},{"key":"97519","doi-asserted-by":"crossref","unstructured":"90. Gomes-Oliveira MH, Gorenstein C, Lotufo Neto F, Andrade LH, Wang YP. Validation of the Brazilian Portuguese version of the Beck Depression Inventory-II in a community sample. Rev Bras Psiquiatr Sao Paulo Braz 1999. 2012;34(4):389-394. https:\/\/doi.org\/10.1016\/j.rbp.2012.03.005","DOI":"10.1016\/j.rbp.2012.03.005"},{"key":"97520","doi-asserted-by":"crossref","unstructured":"91. Flaherty J, Richman J. Gender differences in the perception and utilization of social support: theoretical perspectives and an empirical test. Soc Sci Med 1982. 1989;28(12):1221-1228. https:\/\/doi.org\/10.1016\/0277-9536(89)90340-7","DOI":"10.1016\/0277-9536(89)90340-7"},{"key":"97521","doi-asserted-by":"crossref","unstructured":"92. Ghubash R, Daradkeh TK, Al Naseri KS, Al Bloushi NB, Al Daheri AM. The performance of the Center for Epidemiologic Study Depression Scale (CES-D) in an Arab female community. Int J Soc Psychiatry. 2000;46(4):241-249. https:\/\/doi.org\/10.1177\/002076400004600402","DOI":"10.1177\/002076400004600402"},{"key":"97522","doi-asserted-by":"crossref","unstructured":"93. Valencia J, Christian F. The relationship between neuroticism, emotion regulation, and academic stress with depression symptoms in Indonesian medical student. Open Access Maced J Med Sci. 2022 Feb. 15. https:\/\/doi.org\/10.3889\/oamjms.2022.8322","DOI":"10.3889\/oamjms.2022.8322"},{"key":"97523","doi-asserted-by":"crossref","unstructured":"94. Renn D, Pfaffenberger N, Platter M, et al. International Well-being Index: the Austrian version. Soc Indic Res. 2009;90:243-256. https:\/\/doi.org\/10.1007\/s11205-008-9255-2","DOI":"10.1007\/s11205-008-9255-2"},{"key":"97524","doi-asserted-by":"crossref","unstructured":"95. Baptista T, Vargas O, Colmenares R, et al. Positive and Negative Affect Schedule (PANAS): psychometric properties of a Venezuelan Spanish version in medical students. Investig Cl\u00ednica. 2020;61(4):301-315. https:\/\/doi.org\/10.22209\/ic.v61n4a01","DOI":"10.22209\/IC.v61n4a01"},{"key":"97525","doi-asserted-by":"crossref","unstructured":"96. Asif M, Idrees M, Ghazal S, Ishaq G. Relationship of emotional intelligence and life satisfaction: mediating role of affectivity in medical students. ASEAN J Psychiatry. Feb 2022;23:1-8.","DOI":"10.54615\/2231-7805.47278"},{"key":"97526","doi-asserted-by":"crossref","unstructured":"97. Karawekpanyawong N, Wongpakaran T, Wongpakaran N, et al. Impact of perceived social support on the relationship between ADHD and depressive symptoms among first year medical students: a structural equation model approach. Child Basel Switz. 2021;8(5):401. https:\/\/doi.org\/10.3390\/children8050401","DOI":"10.3390\/children8050401"},{"key":"97527","doi-asserted-by":"crossref","unstructured":"98. Zhao FF, Yang L, Ma JP, Qin ZJ. Path analysis of the association between self-compassion and depressive symptoms among nursing and medical students: a cross-sectional survey. BMC Nurs. 2022;21(1):67. https:\/\/doi.org\/10.1186\/s12912-022-00835-z","DOI":"10.1186\/s12912-022-00835-z"},{"key":"97528","doi-asserted-by":"crossref","unstructured":"99. Alzahrani AM, Hakami A, AlHadi A, et al. The interplay between mindfulness, depression, stress and academic performance in medical students: a Saudi perspective. PloS One. 2020;15(4):e0231088. https:\/\/doi.org\/10.1371\/journal.pone.0231088","DOI":"10.1371\/journal.pone.0231088"},{"key":"97529","doi-asserted-by":"crossref","unstructured":"100. Dian CN, Effendy E, Amin MM. The Validation of Indonesian Version of Patient Health Questionnaire-9. Open Access Maced J Med Sci. https:\/\/doi.org\/10.3889\/oamjms.2022.9293","DOI":"10.3889\/oamjms.2022.9293"},{"key":"97530","doi-asserted-by":"crossref","unstructured":"101. Rosenthal TL, Rosenthal RH, Edwards NB. Students\u2019 self-ratings of stress in medical school: a replication across 20 months. Behav Res Ther. 1990;28(2):171-173. https:\/\/doi.org\/10.1016\/0005-7967(90)90030-m","DOI":"10.1016\/0005-7967(90)90030-M"},{"key":"97531","unstructured":"102. Chia T, Oyeniran OI, Oraebosi MI, Dane S. Study of stressors in a cohort of undergraduate medical students: implications for student support. J Res Med Dent Sci, 2021, 9 (2): 23-29."},{"key":"97532","doi-asserted-by":"crossref","unstructured":"103. Yusoff MSB. A confirmatory factor analysis study on the medical student stressor questionnaire among Malaysian medical students. Educ Med J. 2011;3(1). https:\/\/doi.org\/10.5959\/eimj.v3i1.95","DOI":"10.5959\/eimj.v3i1.95"},{"key":"97533","unstructured":"104. Yusoff MSB. A multicenter study on validity of the Medical Student Stressor Questionnaire (MSSQ). Internat Med J. Mar 1, 2011. Available at https:\/\/openurl.ebsco.com\/contentitem\/gcd:59688789?sid=ebsco:plink:crawler&id=ebsco:gcd:59688789. [Accessed on Feb 4, 2024]."},{"key":"97534","doi-asserted-by":"crossref","unstructured":"105. Gupta S, Choudhury S, Das M, Mondol A, Pradhan R. Factors causing stress among students of a medical college in Kolkata, India. Educ Health Abingdon Engl. 2015;28(1):92-95. https:\/\/doi.org\/10.4103\/1357-6283.161924","DOI":"10.4103\/1357-6283.161924"},{"key":"97535","doi-asserted-by":"crossref","unstructured":"106. Itagi ABH, Dharmalingam A, Dipankar S, et al. Influence of stress on quality of sleep and QT interval variables among young adult medical students- a cross-sectional study. J Clin Diagn Res. Published online 2021. https:\/\/doi.org\/10.7860\/JCDR\/2021\/50023.15386","DOI":"10.7860\/JCDR\/2021\/50023.15386"},{"key":"97536","unstructured":"107. Saiful M, Yusoff B, Rahim AF, Jamil M. The development and validity of the medical student stress questionnaire (MSSQ). In: 2010. Available from https:\/\/www.semanticscholar.org\/paper\/THE-DEVELOPMENT-AND-VALIDITY-OF-THE-MEDICAL-STUDENT-Saiful-Yusoff\/4c7e3c6a2948bd424adec12e067eb1b9cd4d8f58. [Accessed Feb 4, 2024]."},{"key":"97537","unstructured":"108. Yusoff MSB. The stability of MSSQ to measure stressors among medical students. Int Med J 1994. 2013;20:1-3."},{"key":"97538","doi-asserted-by":"crossref","unstructured":"109. Dagani J, Buizza C, Ferrari C, Ghilardi A. Psychometric validation and cultural adaptation of the Italian medical student stressor questionnaire. Curr Psychol. 2022;41(6):4132-4140. https:\/\/doi.org\/10.1007\/s12144-020-00922-x","DOI":"10.1007\/s12144-020-00922-x"},{"key":"97539","doi-asserted-by":"crossref","unstructured":"110. Jayarajah U, Lakmal K, Athapathu A, Jayawardena AJ, de Silva V. Validating the Medical Students\u2019 Stressor Questionnaire (MSSQ) from a Sri Lankan medical faculty. J Taibah Univ Med Sci. 2020;15(5):344-350. https:\/\/doi.org\/10.1016\/j.jtumed.2020.08.003","DOI":"10.1016\/j.jtumed.2020.08.003"},{"key":"97540","unstructured":"111. K\u00f6tter T, Voltmer E. Measurement of specific medical school stress: translation of the \u201cPerceived Medical School Stress Instrument\u201d to the German language. GMS Z Med Ausbild. 2013;30(2):Doc22. https:\/\/doi.org\/10.3205\/zma000865"},{"key":"97541","unstructured":"112. Marchewka W, Loster Z, Marchewka J, Olszewska-Turek K, Kope\u0107 G. Stress associated with undergraduate medical courses: a translation and validation of the Perceived Medical School Stress Instrument into Polish and its adaptation to the Polish environment. Folia Med Cracov. 2020;60(2):55-66. https:\/\/doi.org\/10.24425\/fmc.2020.135013"},{"key":"97542","doi-asserted-by":"crossref","unstructured":"113. Chakraborti A, Ray P, Sanyal D, et al. Assessing perceived stress in medical personnel: in search of an appropriate scale for the Bengali population. Indian J Psychol Med. 2013;35(1):29-33. https:\/\/doi.org\/10.4103\/0253-7176.112197","DOI":"10.4103\/0253-7176.112197"},{"key":"97543","unstructured":"114. Al-Dubai SAR, Alshagga MA, Rampal KG, Sulaiman NA. Factor structure and reliability of the Malay version of the Perceived Stress Scale among Malaysian Medical Students. Malays J Med Sci MJMS. 2012;19(3):43-49."},{"key":"97544","doi-asserted-by":"crossref","unstructured":"115. Badura-Brzoza K, D\u0119bski P, G\u0142\u00f3wczy\u0144ski P, D\u0119bska-Janus M, Gorczyca P. Life satisfaction and perceived stress versus health promoting behavior among medical students during the COVID-19 pandemic. Int J Environ Res Public Health. 2022;19(11):6706. https:\/\/doi.org\/10.3390\/ijerph19116706","DOI":"10.3390\/ijerph19116706"},{"key":"97545","doi-asserted-by":"crossref","unstructured":"116. Gupta R, Singh N, Kumar R. Longitudinal predictive validity of emotional intelligence on first year medical students perceived stress. BMC Med Educ. 2017;17(1):139. https:\/\/doi.org\/10.1186\/s12909-017-0979-z","DOI":"10.1186\/s12909-017-0979-z"},{"key":"97546","doi-asserted-by":"crossref","unstructured":"117. Boyd A, Mealand K, Briggs Early K, Oestreich E. Perceived stress, grit, and self-care behaviors in first-year medical students. Amer J Lifestyle Med. 2022;17(6):803-812. https:\/\/doi.org\/10.1177\/15598276221124576","DOI":"10.1177\/15598276221124576"},{"key":"97547","doi-asserted-by":"crossref","unstructured":"118. Li Z, Yi X, Zhong M, et al. psychological distress, social support, coping style, and perceived stress among medical staff and medical students in the early stages of the COVID-19 epidemic in China. Front Psychiatry. 2021;12:664808. https:\/\/doi.org\/10.3389\/fpsyt.2021.664808","DOI":"10.3389\/fpsyt.2021.664808"},{"key":"97548","doi-asserted-by":"crossref","unstructured":"119. Shi M, Wang X, Bian Y, Wang L. The mediating role of resilience in the relationship between stress and life satisfaction among Chinese medical students: a cross-sectional study. BMC Med Educ. 2015;15:16. https:\/\/doi.org\/10.1186\/s12909-015-0297-2","DOI":"10.1186\/s12909-015-0297-2"},{"key":"97549","doi-asserted-by":"crossref","unstructured":"120. Agarwal G, Mosquera M, Ring M, Victorson D. Work engagement in medical students: an exploratory analysis of the relationship between engagement, burnout, perceived stress, lifestyle factors, and medical student attitudes. Med Teach. 2020;42(3):299-305. https:\/\/doi.org\/10.1080\/0142159X.2019.1679746","DOI":"10.1080\/0142159X.2019.1679746"},{"key":"97550","doi-asserted-by":"crossref","unstructured":"121. Wang Q, Wu H. Associations between maladaptive perfectionism and life satisfaction among Chinese undergraduate medical students: the mediating role of academic burnout and the moderating role of self-esteem. Front Psychol. 2021;12:774622. https:\/\/doi.org\/10.3389\/fpsyg.2021.774622","DOI":"10.3389\/fpsyg.2021.774622"},{"key":"97551","doi-asserted-by":"crossref","unstructured":"122. Wang Q, Wang L, Shi M, et al. Empathy, burnout, life satisfaction, correlations and associated socio-demographic factors among Chinese undergraduate medical students: an exploratory cross-sectional study. BMC Med Educ. 2019;19(1):341. https:\/\/doi.org\/10.1186\/s12909-019-1788-3","DOI":"10.1186\/s12909-019-1788-3"},{"key":"97552","doi-asserted-by":"crossref","unstructured":"123. Y\u0131ld\u0131r\u0131m M, Ozaslan A. Love of Life Scale: psychometric analysis of a Turkish adaptation and exploration of its relationship with well-being and personality. Gazi Med J. 2022;33(2). Available from https:\/\/medicaljournal.gazi.edu.tr\/index.php\/GMJ\/article\/view\/3359. [Accessed Feb 4, 2024].","DOI":"10.12996\/gmj.2022.36"},{"key":"97553","doi-asserted-by":"crossref","unstructured":"124. Dev V, Fernando AT, Consedine NS. Self-compassion as a stress moderator: a cross-sectional study of 1700 doctors, nurses, and medical students. Mindfulness. 2020;11(5):1170-1181. https:\/\/doi.org\/10.1007\/s12671-020-01325-6","DOI":"10.1007\/s12671-020-01325-6"},{"key":"97554","doi-asserted-by":"crossref","unstructured":"125. Serinolli MI, Novaretti MCZ. A cross-sectional study of sociodemographic factors and their influence on quality of life in medical students at Sao Paulo, Brazil. PloS One. 2017;12(7):e0180009. https:\/\/doi.org\/10.1371\/journal.pone.0180009","DOI":"10.1371\/journal.pone.0180009"},{"key":"97555","doi-asserted-by":"crossref","unstructured":"126. Barreto FS, Carvalho GO de, Silva LCN da, et al. Electronic tools for physical activity and quality of life of medical students during COVID-19 pandemic social isolation. Mot Rev Educ F\u00edsica. Published online Jan 1, 2021. https:\/\/doi.org\/10.1590\/s1980-65742021002121","DOI":"10.1590\/s1980-65742021002121"},{"key":"97556","doi-asserted-by":"crossref","unstructured":"127. Mohd Salleh Sahimi H, Norzan MH, Nik Jaafar NR, et al. Excessive smartphone use and its correlations with social anxiety and quality of life among medical students in a public university in Malaysia: a cross-sectional study. Front Psychiatry. 2022;13:956168. https:\/\/doi.org\/10.3389\/fpsyt.2022.956168","DOI":"10.3389\/fpsyt.2022.956168"},{"key":"97557","doi-asserted-by":"crossref","unstructured":"128. Chawla B, Chawla S, Singh H, Jain R, Arora I. Is coronavirus lockdown taking a toll on mental health of medical students? A study using WHOQOL-BREF questionnaire. J Fam Med Prim Care. 2020;9(10):5261-5266. https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_715_20","DOI":"10.4103\/jfmpc.jfmpc_715_20"},{"key":"97558","doi-asserted-by":"crossref","unstructured":"129. Suhail H, Mousa AA, Waleed SM, Hussien YA. Predictors of quality of life (QoL) among Qadisiah medical student, Iraq. Int J Pharm Res. 2020;12(04). https:\/\/doi.org\/10.31838\/ijpr\/2020.12.04.047","DOI":"10.31838\/ijpr\/2020.12.04.047"},{"key":"97559","doi-asserted-by":"crossref","unstructured":"130. Ili\u0107 I, \u0160ipeti\u0107 S, Gruji\u010di\u0107 J, Ma\u010du\u017ei\u0107 I\u017d, Koci\u0107 S, Ili\u0107 M. Psychometric properties of the World Health Organization\u2019s Quality of Life (WHOQOL-BREF) questionnaire in medical students. Med Kaunas Lith. 2019;55(12):772. https:\/\/doi.org\/10.3390\/medicina55120772","DOI":"10.3390\/medicina55120772"},{"key":"97560","doi-asserted-by":"crossref","unstructured":"131. Malibary H, Zagzoog MM, Banjari MA, Bamashmous RO, Omer AR. Quality of Life (QoL) among medical students in Saudi Arabia: a study using the WHOQOL-BREF instrument. BMC Med Educ. 2019;19(1):344. https:\/\/doi.org\/10.1186\/s12909-019-1775-8","DOI":"10.1186\/s12909-019-1775-8"},{"key":"97561","doi-asserted-by":"crossref","unstructured":"132. Obad AS, Abdulwali FK, Alaidroos HAH, et al. Relationship between shortage of basic life needs and quality of life of medical students in Yemen: a study utilizing validity and reliability of WHOQOL-BREF questionnaire. J Fam Med Prim Care. 2021;10(3):1466-1472. https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_935_20","DOI":"10.4103\/jfmpc.jfmpc_935_20"},{"key":"97562","doi-asserted-by":"crossref","unstructured":"133. Shareef MA, AlAmodi AA, Al-Khateeb AA, et al. The interplay between academic performance and quality of life among preclinical students. BMC Med Educ. 2015;15:193. https:\/\/doi.org\/10.1186\/s12909-015-0476-1","DOI":"10.1186\/s12909-015-0476-1"},{"key":"97563","doi-asserted-by":"crossref","unstructured":"134. Kr\u00e4geloh CU, Henning MA, Hawken SJ, et al. Validation of the WHOQOL-BREF quality of life questionnaire for use with medical students. Educ Health Abingdon Engl. 2011;24(2):545.","DOI":"10.4103\/1357-6283.101436"},{"key":"97564","unstructured":"135. Mahaur R, Jain P, Jain A. Association of mental health to emotional intelligence in medical undergraduate students: are there gender differences? Indian J Physiol Pharmacol. 2017;61:383 391. Available from https:\/\/www.researchgate.net\/publication\/320414609_Association_of_Mental_health_to_Emotional_Intelligence_in_Medical_Undergraduate_Students_Are_there_Gender_Differences [Accessed Feb 4, 2024]."},{"key":"97565","unstructured":"136. Sahraian A, Javadpour A. Sleep disruption and its correlation to psychological distress among medical students. Shiraz E-Med J. 2009;11(1):20378. Available from https:\/\/brieflands.com\/articles\/semj-78485 [Accessed Feb 4, 2024]."},{"key":"97566","doi-asserted-by":"crossref","unstructured":"137. Yusoff MSB, Abdul Rahim A, Yaacob MJ. The sensitivity, specificity and reliability of the Malay version 12 Items General Health Questionnaire (GHQ 12) in detecting distressed medical students. ASEAN J Psychiatry. 2010;11(1):36\u201343","DOI":"10.5959\/eimj.2.1.2010.or2"},{"key":"97567","doi-asserted-by":"crossref","unstructured":"138. Rathner G, Rumpold G. Convergent validity of the eating disorder inventory and the anorexia nervosa inventory for self-rating in an Austrian nonclinical population. Int J Eat Disord. 1994;16(4):381-393. https:\/\/doi.org\/10.1002\/1098-108x(199412)16:4%3C381::aid-eat2260160407%3E3.0.co;2-q","DOI":"10.1002\/1098-108X(199412)16:4<381::AID-EAT2260160407>3.0.CO;2-Q"},{"key":"97568","unstructured":"139. Kaur J, Martin G. Non suicidal self injury in medical students. Suicidology. 2017;8:56 65. Available from https:\/\/espace.library.uq.edu.au\/view\/UQ:681910 [Accessed Feb 4, 2024]."},{"key":"97569","doi-asserted-by":"crossref","unstructured":"140. Sender R, Salamero M, Vall\u00e9s A, Vald\u00e9s M. Psychological variables for identifying susceptibility to mental disorders in medical students at the University of Barcelona. Med Educ Online. 2004;9(1):4350. https:\/\/doi.org\/10.3402\/meo.v9i.4350","DOI":"10.3402\/meo.v9i.4350"},{"key":"97570","doi-asserted-by":"crossref","unstructured":"141. Dyrbye LN, Szydlo DW, Downing SM, Sloan JA, Shanafelt TD. Development and preliminary psychometric properties of a well-being index for medical students. BMC Med Educ. 2010;10:8. https:\/\/doi.org\/10.1186\/1472-6920-10-8","DOI":"10.1186\/1472-6920-10-8"},{"key":"97571","doi-asserted-by":"crossref","unstructured":"142. Peng L, Zhang J, Li M, et al. Negative life events and mental health of Chinese medical students: the effect of resilience, personality and social support. Psychiatry Res. 2012;196(1):138-141. https:\/\/doi.org\/10.1016\/j.psychres.2011.12.006","DOI":"10.1016\/j.psychres.2011.12.006"},{"key":"97572","doi-asserted-by":"crossref","unstructured":"143. van Dijk I, Lucassen PLBJ, van Weel C, Speckens AEM. A cross-sectional examination of psychological distress, positive mental health and their predictors in medical students in their clinical clerkships. BMC Med Educ. 2017;17(1):219. https:\/\/doi.org\/10.1186\/s12909-017-1035-8","DOI":"10.1186\/s12909-017-1035-8"},{"key":"97573","doi-asserted-by":"crossref","unstructured":"144. Wu W, Ma X, Liu Y, et al. Empathy alleviates the learning burnout of medical college students through enhancing resilience. BMC Med Educ. 2022;22(1):481. https:\/\/doi.org\/10.1186\/s12909-022-03554-w","DOI":"10.1186\/s12909-022-03554-w"},{"key":"97574","doi-asserted-by":"crossref","unstructured":"145. Suh WW, Cho SH, Yoo JY, et al. Relationship between psychological correlates and empathy in medical students: a cross-sectional study. Psychiatry Investig. 2019;16(10):766-772. https:\/\/doi.org\/10.30773\/pi.2019.08.31","DOI":"10.30773\/pi.2019.08.31"},{"key":"97575","doi-asserted-by":"crossref","unstructured":"146. Rezaei AM, Naeim M, Asadi R, et al. The predictive role of emotional intelligence, resilience, and personality traits in addiction potential of students at Arak University of Medical Sciences. Addict Disord Their Treat. 2021;20(4):472 478. https:\/\/doi.org\/10.1097\/ADT.0000000000000276","DOI":"10.1097\/ADT.0000000000000276"},{"key":"97576","doi-asserted-by":"crossref","unstructured":"147. Vitaliano PP, Russo J, Carr JE, Maiuro RD, Becker J. The ways of coping checklist: revision and psychometric properties. Multivar Behav Res. 1985;20(1):3-26. https:\/\/doi.org\/10.1207\/s15327906mbr2001_1","DOI":"10.1207\/s15327906mbr2001_1"},{"key":"97577","doi-asserted-by":"crossref","unstructured":"148. Arima M, Takamiya Y, Furuta A, et al. Factors associated with the mental health status of medical students during the COVID-19 pandemic: a cross-sectional study in Japan. BMJ Open. 2020;10(12):e043728. https:\/\/doi.org\/10.1136\/bmjopen-2020-043728","DOI":"10.1136\/bmjopen-2020-043728"},{"key":"97578","unstructured":"149. Iqbal A, Nawaz H, Sikandar MZ, A M, Shah SIA. A cross-sectional study of happiness, self-esteem and optimism in medical students. Ann King Edw Med Univ Lahore Pak. 2019;25:1-4."},{"key":"97579","doi-asserted-by":"crossref","unstructured":"150. Chethana K, Nelliyanil M, Anil M. Prevalence of nomophobia and its association with loneliness, self happiness and self esteem among undergraduate medical students of a medical college in Coastal Karnataka. Indian J Public Health Res Dev. 2020;11(3):523-529. https:\/\/doi.org\/10.37506\/ijphrd.v11i3.1215","DOI":"10.37506\/ijphrd.v11i3.1215"},{"key":"97580","doi-asserted-by":"crossref","unstructured":"151. Satti MZ, Khan TM, Qurat-Ul-Ain QUA, et al. Association of physical activity and sleep quality with academic performance among fourth-year MBBS students of Rawalpindi Medical University. Cureus. 2019;11(7):e5086. https:\/\/doi.org\/10.7759\/cureus.5086","DOI":"10.7759\/cureus.5086"},{"key":"97581","unstructured":"152. James B, Omoaregba J, Igberase O. Prevalence and correlates of poor sleep quality among medical students at a Nigerian university. Annals Nigerian Med. 2011. Available from https:\/\/go.gale.com\/ps\/i.do?id=GALE%7CA265947083&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=03313131&p=AONE&sw=w&userGroupName=anon%7E143e4a34&aty=open-web-entry. [Accessed Feb 4, 2024]."},{"key":"97582","doi-asserted-by":"crossref","unstructured":"153. Anuradha R, Hemachandran S, Patil AB. Sleep quality and daytime sleepiness among medical undergraduate students in Tamil Nadu: a cross-sectional study. J Clin Diagn Res. Published online 2022. https:\/\/doi.org\/10.7860\/JCDR\/2022\/57499.16552","DOI":"10.7860\/JCDR\/2022\/57499.16552"},{"key":"97583","doi-asserted-by":"crossref","unstructured":"154. Arbabisarjou A, Hashemi SM, Sharif MR, et al. The relationship between sleep quality and social intimacy, and academic burn-out in students of medical sciences. Glob J Health Sci. 2015;8(5):231-238. https:\/\/doi.org\/10.5539\/gjhs.v8n5p231","DOI":"10.5539\/gjhs.v8n5p231"},{"key":"97584","doi-asserted-by":"crossref","unstructured":"155. Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep. 1992;15(4):376-381. https:\/\/doi.org\/10.1093\/sleep\/15.4.376","DOI":"10.1093\/sleep\/15.4.376"},{"key":"97585","doi-asserted-by":"crossref","unstructured":"156. Johns MW. Sleepiness in different situations measured by the Epworth Sleepiness Scale. Sleep. 1994;17(8):703-710. https:\/\/doi.org\/10.1093\/sleep\/17.8.703","DOI":"10.1093\/sleep\/17.8.703"},{"key":"97586","doi-asserted-by":"crossref","unstructured":"157. Attal BA, Al-Ammar FK, Bezdan M. Validation of the Arabic version of the Epworth Sleepiness Scale among the Yemeni medical students. Sleep Disord. 2020;2020:6760505. https:\/\/doi.org\/10.1155\/2020\/6760505","DOI":"10.1155\/2020\/6760505"},{"key":"97587","doi-asserted-by":"crossref","unstructured":"158. Wongpakaran N, Wongpakaran T. A revised Thai Multi-Dimensional Scale of Perceived Social Support. Span J Psychol. 2012;15(3):1503-1509. https:\/\/doi.org\/10.5209\/rev_sjop.2012.v15.n3.39434","DOI":"10.5209\/rev_SJOP.2012.v15.n3.39434"},{"key":"97588","doi-asserted-by":"crossref","unstructured":"159. Jordan KD, Foster PS. Medical student empathy: interpersonal distinctions and correlates. Adv Health Sci Educ Theory Pract. 2016;21(5):1009-1022. https:\/\/doi.org\/10.1007\/s10459-016-9675-8","DOI":"10.1007\/s10459-016-9675-8"},{"key":"97589","doi-asserted-by":"crossref","unstructured":"160. Lee J, Lee EH, Moon SH. Systematic review of the measurement properties of the Depression Anxiety Stress Scales-21 by applying updated COSMIN methodology. Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 2019;28(9):2325-2339. https:\/\/doi.org\/10.1007\/s11136-019-02177-x","DOI":"10.1007\/s11136-019-02177-x"},{"key":"97590","doi-asserted-by":"crossref","unstructured":"161. Sharif-Nia H, S\u00e1nchez-Teruel D, Sivarajan Froelicher E, et al. Connor-Davidson Resilience Scale: a systematic review psychometrics properties using the COSMIN. Ann Med Surg 2012. 2024;86(5):2976-2991. https:\/\/doi.org\/10.1097\/MS9.0000000000001968","DOI":"10.1097\/MS9.0000000000001968"},{"key":"97591","doi-asserted-by":"crossref","unstructured":"162. Shoman Y, Marca SC, Bianchi R, et al. Psychometric properties of burnout measures: a systematic review. Epidemiol Psychiatr Sci. 2021;30:e8. https:\/\/doi.org\/10.1017\/S2045796020001134","DOI":"10.1017\/S2045796020001134"},{"key":"97592","doi-asserted-by":"crossref","unstructured":"163. Brady KJS, Kazis LE, Sheldrick RC, Ni P, Trockel MT. Selecting physician well-being measures to assess health system performance and screen for distress: conceptual and methodological considerations. Curr Probl Pediatr Adolesc Health Care. 2019;49(12):100662. https:\/\/doi.org\/10.1016\/j.cppeds.2019.100662","DOI":"10.1016\/j.cppeds.2019.100662"}],"container-title":["Canadian Medical Education Journal"],"original-title":[],"link":[{"URL":"https:\/\/cmej.ca\/index.php\/cmej\/article\/download\/82091\/58656","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/cmej.ca\/index.php\/cmej\/article\/download\/82091\/58655","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T13:41:33Z","timestamp":1789825293000},"score":1,"resource":{"primary":{"URL":"https:\/\/cmej.ca\/index.php\/cmej\/article\/view\/82091"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,25]]},"references-count":163,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,8,31]]}},"URL":"https:\/\/doi.org\/10.36834\/cmej.82091","relation":{},"ISSN":["1923-1202"],"issn-type":[{"value":"1923-1202","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,25]]}}}