The university years represent the most difficult period of training characterized by significant academic workload of students. It is not always easy for the student’s body to adapt when switching from school to the completely different level of complexity, which entails effects on the students’ health and psychological status. The levels of stress are directly related to the individual’s mental performance: stress contributes to cognitive decline in humans [1–4].

The process of adaptation of first-year students seriously hampers the radical change in the training conditions in the higher education institutions. A small school is replaced by multiple separate buildings of the university that are often located at a rather large distance from each other. The familiar schoolteachers are replaced by the university teachers, and the group consists of complete strangers. Unfortunately, not all first-year students adapt fairly quickly and successfully, the adaptation process usually stretches to the next academic year and sometimes continues for longer [5–7].

The university applicants and the forward-thinking first-year students bear a huge responsibility for the selection of their future profession, with which they will spend the rest of their lives. It is essential that the student makes the choice on his/her own in accordance with his/her aspirations and abilities, without any pressure from parents or consideration of various benefits that could come from the further employment. Furthermore, students themselves note that difficulties they face on their way to higher education are complexity of mastering various academic disciplines and excessive academic workload they experience during the learning process [:lit_;8–10].

The combined effects of various negative factors entail multiple negative consequences having an adverse effect on the health of immature students and increasing the risk of different disorders. Since the regulatory framework essential to ensure the training conditions for students is incomplete, the institutional capacity of higher education institutions is reduced [11].

Psychological health is very important for students of all specialties, since the constantly high levels of stress and anxiety cause a negative response to training and further work in the profession, as well as professional burnout [12, 13].

This is especially important for medical students, who will become doctors in their nearest future and have to be strong, including psychologically strong, in order to work as hard as possible in the field of healthcare. The population of our country is interested in the qualified human resources capable of working most effectively when being in the state of psychological harmony [14].

High workload experienced by students when coming to universities after school also adversely affects the status of their nervous system and the quality of life. This is particularly true for first-year students, who cope with a large amount of information they have to master due to the lack of experience. In addition, year by year computer technologies are being introduced more and more intensively, and the reading rooms are gradually replaced by electronic libraries. This, in turn, results in the fact that it is necessary to spend much time on gadgets to go through the literature and successfully prepare for classes [15–18].

The study was aimed to perform comparative analysis of psychological health of the students attending the medical university and to determine the indicators most strongly affecting the students’ quality of life and health.

METHODS

The randomized study was performed at the Center for Public Health and Preventive Healthcare of the Burdenko Voronezh State Medical University in 2022–2023. A total of 1050 students of the medical university were enrolled: first-year, third-year, and sixth-year students studying at the faculties of general medicine and pediatrics.

Each subject was offered to voluntarily pass different tests (sensorimotor test to determine the functional reserve of the central nervous system (CNS) and performance; color test to assess anxiety level and emotional stability; nonspecific adaptation test to calculate the resistance level) in the Origins of Health Valeometer program (Breath Technologies; Russia).

Statistical analysis of the results was performed using the MyOffice 2022 software package (New Cloud Technologies; Russia); the descriptive statistics, Student's t-test, and Spearman’s rank correlation were used. The differences were considered significant at p < 0.05.

RESULTS

After passing the sensorimotor test, the functional reserve of the CNS that showed the body’s reserve capacity and determined its capacity to work was defined for each student as a percentage. Furthermore, software assessed performance of each respondent based on these data.

Comparison of the first-year, third-year, and sixth-year students revealed no significant differences. The worst performers were third-year students of the medical university. Among them almost a half (48%) showed decreased body’s performance. The lowest functional reserves of the CNS (below 50%) were also reported for the third-year students (38%).

Significant differences were revealed when comparing the scores of the test of visual-motor response in students of different genders and students studying at different faculties (tab. 1). The levels of functional reserve of the CNS below 50% were more often found in girls, than in boys. Decreased performance also prevailed in females: the test results showed that almost every second girl demonstrated decreased performance. Both of these scores showed smaller deviation from the norm in boys.

Comparison of the scores of students studying at two different faculties of the Burdenko Voronezh State Medical University showed that the students of the faculty of general medicine with the score of functional reserve of the CNS exceeding 74% predominated over students of the other faculty, i.e. students of the faculty of pediatrics had lower functional reserve of the CNS. Moreover, it should be noted that every second student of pediatric faculty has decreased performance, which may subsequently have an impact on the state of his/her nervous system, result in impaired functional state of the body and eventually in disorders affecting various organs and systems.

The decrease in performance and functional reserve of the CNS puts a lot of strain on the entire nervous system of the body, thereby increasing the risk of various adverse psychological conditions capable of causing persistent mental disorders in the future.

The color test demonstrated the anxiety levels and emotional stability of medical students, as well as the advantageous method to overcome stressful situations. The data obtained show that on average about 30% of students have medium to high anxiety levels, which is indicative of increased anxiety during the training process. No fundamental differences between boys and girls or students of different faculties were revealed. Significant differences were reported only when comparing the first-year and sixth-year students (tab. 2). Among first-year students, low anxiety levels were reported only for 69%, while the anxiety levels of sixth-year students were about 75%. Such results indicate the decreased adaptability of first-year students, as well as the increased levels of stress and anxiety during training. These score decreases considerably by the end of training.

When assessing emotional stability, all scores were divided into four groups: normal, moderate, increased, and high emotional stability. Based on the results, it is important to emphasize that 55% of boys and 52% of girls had the increased scores that were outside the normal range. This means that every second student, regardless of gender, was not emotionally stable. tab. 3 reflects the dynamic changes in the emotional stability scores, from junior students to senior ones. If among first-year students the indicators exceeding the norm were noted in 58%, and among third-year students in 51%, then by the 6th year these dropped to 48%. Such results suggest better students’ adaptation to training at senior courses. Unfortunately, the process of the first-year students’ adaptation to the medical university is slow, which can adversely affect their psychological status.

The levels of body’s resistance to environmental factors show the extent, to which the nervous system is resistant to various changing environmental conditions. Assessment of this parameter revealed statistically significant differences (p < 0.005) between boys and girls, who had decreased resistance in 31 and 38% of cases, respectively. Comparative analysis by courses of training showed that the resistance levels of first-year students were much better than that of third-year students, and the differences were significant (tab. 4).

Furthermore, the results of first-year students turned out to be more upbeat compared to graduate students. The sixth-year students had very low resistance levels 10% more often than first-year students. The scores of third-year and graduate students were almost the same and showed no significant differences.

DISCUSSION

In recent years, insufficient attention is paid to psychological status of students, however, a comprehensive approach to the issue is needed when assessing the students’ bodies and morbidity. The decrease in performance and the increase in anxiety levels can result in depression and later transform into stress [19].

When comparing emotional stability of university students with the results of adolescents, it should be noted, that schoolchildren demonstrate better results compared to first-year students of the medical university, whose scores are almost 2-fold decreased (31% and 58%, respectively). Unfortunately, the emotional stability score significantly decreases by the time of entering the higher education institution; the influence of the higher education institution itself and the specifics of training on the former applicants also become evident. The decrease in emotional stability score associated with the effects of some stressful situation can result in the development of various psychological conditions adversely affecting the body’s health and the quality of life [20].

The functional reserve of the CNS often represents the essential energy reserve that helps the body overcome various stressful situations, furthermore, it contributes to mobilization of all organs and systems, as well as to increased performance of the individual [21, 22]. On average, the drop of functional reserve of the CNS to the level below 50% is observed in 30% of students of the medical university, while the decreased performance is reported for a half of students studying at the faculty of pediatrics. These two scores are directly related to processing new information and the students’ academic success.

When assessing anxiety in all students, medical students show not the worst results. In total, 7.3% have increased anxiety levels, and the highest anxiety scores are reported for first-year students (9%). The rate of high anxiety levels is higher in the students of humanitarian university, than in medical students, and constitute 10% [23]. We can say that students of different universities usually demonstrate standard anxiety levels, except for a small number of people. Medical students from Tajikistan showed high anxiety levels in 33% of cases, which 3-fold exceeded the anxiety levels observed in the Russian students. Such results suggest reduced adaptability, lower quality of life of the residents of Tajikistan, including students [24].

CONCLUSIONS

The first-year students of the medical university mostly have unstable psychological status, increased anxiety levels. They often demonstrate decreased performance, high emotional instability. All these characteristics cal later transform into various depressive disorders, and, therefore, finally transform into stress. It is necessary to pay more attention to the students’ adaptation and psychological status. This is particularly true for first-year students, who were recently applicants and came to universities to face a completely different from school education system. It is reasonable to engage tutors from among senior students or teachers, who will gradually facilitate systematic immersion of former schoolchildren into the student environment, in order to improve adaptation of first-year students.