A Cross-Sectional Survey Assessing Mental Health, Fatigue and Sleep Among Male Medical Students in Western Saudi Arabia During and After Examination Periods

Academic examination periods are a significant source of stress, particularly for medical students, yet few studies explore how these periods affect mental health and sleep in specific cultural contexts like Saudi Arabia. This study aimed to assess whether exam periods exacerbate depression, anxiety, stress, sleepiness, insomnia and fatigue among male undergraduate medical students at a university in Western Saudi Arabia, compared to post-exam periods. Using a convenience sample (n = 109), we administered electronic surveys during and after exams in April-May 2024, employing validated scales: Depression Anxiety Stress Scale-21 (DASS-21), Epworth Sleepiness Scale, Fatigue Severity Scale and Insomnia Severity Index. Results revealed significantly higher depression (M = 7.67 vs. M = 4.89; p<0.001) and anxiety (M = 7.10 vs. M = 4.30; p<0.001) during exams, with moderate effect sizes (Cohen’s d = 0.346 and 0.422), alongside elevated stress, sleepiness, fatigue and insomnia and reduced sleep time (6.76 vs. 7.28 hours). These findings underscore how academic stress impairs mental well-being and sleep, potentially affecting academic performance. Post-exam recovery was partial, with lingering performance concerns prolonging psychological strain. Given the all-male sample and potential cultural influences, generalizability is limited. Universities should implement targeted interventions-such as stress management workshops, sleep education and flexible exam scheduling-to mitigate these effects. Future longitudinal studies are needed to explore long-term impacts and evaluate intervention efficacy, enhancing support for student mental health in high-stress academic settings.