title: Effects of a selective educational system on fatigue, sleep problems, daytime sleepiness, and depression among senior high school adolescents in Taiwan.
abstract: OBJECTIVE
  The aim of the study reported here was to clarify the effects of academic pressure on fatigue, sleep problems, daytime sleepiness, and depression among senior high school adolescents in Taiwan.
  
  
  METHODS
  This cross-sectional study enrolled 757 senior high school adolescents who were classified into four groups: Grade 1 (n=261), Grade 2 (n=228), Grade 3T (n=199; Grade 3 students who had another college entrance test to take), and Grade 3S (n=69; Grade 3 students who had succeeded in their college application). Fatigue, sleep quality, daytime sleepiness, and depression were assessed using the Chinese version of the Multidimensional Fatigue Symptom Inventory - Short Form, Pittsburgh Sleep Quality Index-Taiwan Form, the Chinese version of the Epworth Sleepiness Scale, and the Chinese version of the Beck Depression Inventory(®)-II (BDI-II), respectively.
  
  
  RESULTS
  Physical, emotional, and mental fatigue scores were all higher in higher-grade groups. The Grade 3T (test) students had the worst fatigue severity, and the Grade 3S (success) students had the least fatigue severity. More than half of the students (60.9%) went to bed after 12 am, and they had on average 6.0 hours of sleep per night. More than 30% of the students in Grade 2 (37.3%) and Grades 3T/S (30.2%/30.4%) possibly had daily sleepiness problems. The students in Grade 3T had the worst BDI-II score (13.27±9.24), and the Grade 3S students had a much lower BDI-II score (7.91±6.13).
  
  
  CONCLUSIONS
  Relatively high proportions of fatigue, sleep problems, daytime sleepiness, and depression among senior high school adolescents were found in our study. The severities of fatigue, sleep problems, and depression were significantly diminished in the group under less academic stress (Grade 3S). Our findings may increase the understanding of the mental health of senior high school students under academic pressure in Taiwan. Further large sample size and population-based study should be done for better understanding about this topic.
authors.affiliation: Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Tien-Yu
authors.initials: TY
authors.lastname: Chen
authors.affiliation: School of Public Health, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Yu-Ching
authors.initials: YC
authors.lastname: Chou
authors.affiliation: Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China ; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Nian-Sheng
authors.initials: NS
authors.lastname: Tzeng
authors.affiliation: Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China ; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Hsin-An
authors.initials: HA
authors.lastname: Chang
authors.affiliation: Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China ; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Shin-Chang
authors.initials: SC
authors.lastname: Kuo
authors.affiliation: Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Pei-Yin
authors.initials: PY
authors.lastname: Pan
authors.affiliation: Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China ; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Yi-Wei
authors.initials: YW
authors.lastname: Yeh
authors.affiliation: Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Chin-Bin
authors.initials: CB
authors.lastname: Yeh
authors.affiliation: Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan, Republic of China ; School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China ; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan, Republic of China.
authors.forename: Wei-Chung
authors.initials: WC
authors.lastname: Mao
keywords: academic stress; hours of sleep; mental health; school performance; students
references.citation: Behav Med. 2010 Apr-Jun;36(2):53-62
references.pmid: 20497943
references.citation: Sleep. 1995 Oct;18(8):667-73
references.pmid: 8560133
references.citation: Cochrane Database Syst Rev. 2004;(1):CD003380
references.pmid: 14974014
references.citation: Arch Intern Med. 2005 Apr 25;165(8):910-5
references.pmid: 15851643
references.citation: Psychiatry Res. 2011 Aug 30;189(1):128-34
references.pmid: 21196050
references.citation: Pediatrics. 2005 Jan;115(1 Suppl):241-9
references.pmid: 15866858
references.citation: Sleep. 1980;2(4):453-60
references.pmid: 7403744
references.citation: Respirology. 2014 May;19(4):570-5
references.pmid: 24661455
references.citation: BMC Public Health. 2006 May 02;6:116
references.pmid: 16670019
references.citation: Arch Pediatr Adolesc Med. 2004 Aug;158(8):797-803
references.pmid: 15289254
references.citation: Neuropsychiatr Dis Treat. 2013;9:289-94
references.pmid: 23459616
references.citation: Sleep. 1991 Dec;14(6):540-5
references.pmid: 1798888
references.citation: Arch Pediatr Adolesc Med. 2010 Jul;164(7):608-14
references.pmid: 20603459
references.citation: Qual Life Res. 2002 Dec;11(8):817-21
references.pmid: 12482165
references.citation: Neurosci Lett. 2010 Nov 19;485(2):89-93
references.pmid: 20813159
references.citation: Adolescence. 1990 Summer;25(98):357-62
references.pmid: 2375263
references.citation: Adolesc Med State Art Rev. 2010 Dec;21(3):401-17, vii
references.pmid: 21302851
references.citation: Sleep Med. 2008 Jul;9(5):555-63
references.pmid: 17761453
references.citation: J Pediatr Adolesc Gynecol. 2013 Oct;26(5):252-6
references.pmid: 22475885
references.citation: Sleep Med. 2013 Feb;14(2):195-200
references.pmid: 23068781
references.citation: J Psychosom Res. 1993;37(2):147-53
references.pmid: 8463991
references.citation: Sleep Med. 2010 Oct;11(9):907-16
references.pmid: 20817554
references.citation: Cancer Pract. 1998 May-Jun;6(3):143-52
references.pmid: 9652245
references.citation: J Adolesc. 2009 Oct;32(5):1225-37
references.pmid: 19232705
references.citation: BMC Public Health. 2009 Jul 19;9:248
references.pmid: 19615098
references.citation: Tohoku J Exp Med. 2008 Sep;216(1):95-8
references.pmid: 18719343
references.citation: Int J Pediatr. 2010;2010:null
references.pmid: 20886027
references.citation: J Epidemiol Community Health. 1992 Apr;46(2):92-7
references.pmid: 1583440
references.citation: Child Dev. 1995 Aug;66(4):1214-34
references.pmid: 7671657
references.citation: J Pain Symptom Manage. 2004 Jan;27(1):14-23
references.pmid: 14711465
references.citation: BMC Med. 2010 Oct 18;8:61
references.pmid: 20955578
references.citation: Pediatrics. 2006 Jun;117(6):e1078-86
references.pmid: 16740810
references.citation: Arch Gen Psychiatry. 2003 Aug;60(8):837-44
references.pmid: 12912767
references.citation: J Adolesc Health. 2011 Mar;48(3):289-94
references.pmid: 21338901
references.citation: J Clin Nurs. 2011 Aug;20(15-16):2224-32
references.pmid: 21615574
references.citation: Neuropsychiatr Dis Treat. 2013;9:1087-94
references.pmid: 23976855
references.citation: Neuropsychiatr Dis Treat. 2012;8:369-73
references.pmid: 22977304
references.citation: Int J Nurs Stud. 2012 Jan;49(1):102-8
references.pmid: 21924421
references.citation: Sleep. 1993 Apr;16(3):258-62
references.pmid: 8506460
references.citation: Psychol Bull. 2009 Sep;135(5):731-48
references.pmid: 19702380
references.citation: J Adolesc Health. 1998 Nov;23(5):259-63
references.pmid: 9814385
references.citation: Sleep Med. 2014 Feb;15(2):248-54
references.pmid: 24424101
references.citation: J Adolesc Health. 2002 Dec;31(6 Suppl):175-84
references.pmid: 12470913
references.citation: Pediatrician. 1990;17(1):5-12
references.pmid: 2315238
references.citation: Addict Behav. 2014 Mar;39(3):744-7
references.pmid: 24388433
references.citation: J Intellect Disabil Res. 2014 May;58(5):421-9
references.pmid: 23517422
references.citation: BJU Int. 2002 Dec;90(9):912-7
references.pmid: 12460356
references.citation: J Pediatr. 2009 Mar;154(3):426-30, 430.e1
references.pmid: 18849051
references.citation: Adolesc Med State Art Rev. 2010 Dec;21(3):430-45, vii-viii
references.pmid: 21302853
references.citation: Child Psychiatry Hum Dev. 2007 Jun;38(1):73-87
references.pmid: 17131177
references.citation: Arch Pediatr Adolesc Med. 2008 May;162(5):469-75
references.pmid: 18458194
references.citation: Epilepsy Behav. 2014 Jun;35:50-3
references.pmid: 24802904
references.citation: Sleep Med. 2006 Jun;7(4):357-61
references.pmid: 16713341
references.citation: Clin Psychol Rev. 2011 Feb;31(1):104-12
references.pmid: 20817371
references.citation: Psychiatry Res. 1989 May;28(2):193-213
references.pmid: 2748771
references.citation: Support Care Cancer. 1998 Mar;6(2):94-100
references.pmid: 9540166
references.citation: J Pain Symptom Manage. 2007 Jan;33(1):32-9
references.pmid: 17196905
references.citation: J Sleep Res. 1997 Sep;6(3):189-98
references.pmid: 9358397
references.citation: Neuropsychiatr Dis Treat. 2013;9:437-43
references.pmid: 23579788
references.citation: J Child Psychol Psychiatry. 1994 May;35(4):663-76
references.pmid: 8040219
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2005 Feb;40(2):126-32
references.pmid: 15685404
references.citation: Pediatr Clin North Am. 2011 Jun;58(3):621-35
references.pmid: 21600345
references.citation: J Adolesc Health. 2010 Mar;46(3):284-91
references.pmid: 20159507
references.citation: Pediatrics. 2007 Mar;119(3):e603-9
references.pmid: 17332180
references.citation: Minerva Pediatr. 2011 Apr;63(2):99-104
references.pmid: 21487372
references.citation: J Affect Disord. 1995 Aug 18;34(4):283-9
references.pmid: 8550954