Aberrant salience associated with menstrual cycle, mood, and sleep alterations - A cross-sectional study in female medical students during the COVID-19 pandemic

Background: The SARS-CoV-2 pandemic represented an unprecedented global context. Alterations in subjective distress and in psychological processes such as aberrant attribution of meaning - defined as aberrant salience, that is, the tendency to assign excessive or inappropriate significance to otherwise neutral internal or external stimuli - have been described in vulnerable populations. Methods: In a cross-sectional survey administered in March 2021, 293 female medical students completed the Aberrant Salience Inventory (ASI), Beck Depression Inventory (BDI), Impact of Event Scale-Revised (IES-R; event-related distress symptoms), and a questionnaire on perceived menstrual changes. Sleep complaints were examined using dedicated items (BDI sleep items and IES-R sleep-related items). Analyses treated ASI as a continuous variable (correlation and regression analyses), with secondary descriptive comparisons using the published ASI cut-off (ASI ≤ 13 vs ASI ≥ 14). Results: Higher ASI scores were associated with higher depressive symptoms and greater event-related distress. ASI was also associated with more frequent sleep complaints (e.g., nightmares and sleep maintenance problems). Associations between ASI and perceived menstrual outcomes were weaker overall; perceived changes in menstrual flow showed the most consistent association, whereas self-reported menstrual irregularities were not robustly related to ASI. All results are reported as associations consistent with the cross-sectional design. Conclusions: In female medical students assessed during the COVID-19 period, aberrant salience was associated with depressive symptoms and sleep complaints. Perceived menstrual changes showed limited associations. Longitudinal studies with objective sleep and menstrual-cycle measures are needed to clarify temporal ordering and underlying mechanisms.