Abstract
OBJECTIVE: The COVID-19 pandemic has profoundly disrupted global mental health. Medical students, already vulnerable to high stress, experience heightened psychological distress. This study aimed to investigate the association between acute COVID-19 infection and the development of psychological symptoms in medical students, exploring the role of specific COVID-19 symptoms and lifestyle factors. METHODS: A longitudinal study of 2359 medical students assessed psychological symptoms (depression, anxiety, insomnia) before and after COVID-19 infection. Logistic regression models, adjusted for confounders, examined the relationship between COVID-19 status (with or without infection), and the onset of psychological symptoms. The study also explored acute COVID-19 symptoms and lifestyle factors associated with psychological symptoms in the COVID-19 infected (COVID+) group. FINDINGS: The COVID + group exhibited significantly greater increases in depression and insomnia compared to non-infected group. COVID-19 infection was significantly associated with the onset of insomnia post-infection (OR [95 % CI] 1.83 [1.05-3.21]). Moderate to severe acute symptoms, including sleep disturbances (2.20 [1.17-4.14]), decreased attention/memory (2.47 [1.02-6.00]), and breathlessness (2.05 [1.08-3.85]), were identified as risk factors for onset of insomnia. Regular exercise was found to be negatively associated with the onset of insomnia (0.54 [0.33-0.88]). CONCLUSION: Early intervention targeting these acute-phase risk symptoms is crucial for preventing long-term insomnia. Regular exercise is effective in preventing the development of insomnia in medical students following COVID-19 infection. These findings will assist in formulating targeted interventions to address recurrent infections in the post-pandemic era.