Silent refractoriness in epilepsy care: cross-sectoral analysis of prescribing patterns, referrals and workforce capacity in Saxony.

Graduate education in China’s elite universities offers an exceptional opportunity but also imposes intense psychological demands. Students navigate professional specialization, financial semi-dependence, identity consolidation, and often geographic dislocation within a compressed period, under the sustained pressure of publication deadlines, uncertain career prospects, and the cultural weight of family expectation (). The mental health consequences of these pressures have been documented extensively. What has received far less attention is how the structural inequalities students carried with them before enrollment, in other words, the inequalities rooted in China’s persistent urban–rural divide, continue to shape their well-being once they are inside the gates of a top-tier institution. For a student from a rural county or small town, admission to a Double First-Class university is a genuine achievement of educational mobility. But arrival does not erase the past. The transition can activate acculturative stress, for example, unfamiliar metropolitan environments, different social norms around leisure and networking, and often real financial constraint (). Sociological research has documented the cultural mismatch, social isolation, and impostor syndrome that rural-origin students frequently experience (). These are not transient adjustment difficulties; they reflect durable inequalities that the system and decades of differential state investment have produced (, ). Poverty alleviation policies have raised absolute material conditions in rural China, but psychosocial and cultural gaps close more slowly (). At the same time, health behaviors, including sleep, physical activity, and substance use, are not distributed evenly across social groups. The Health Lifestyle Theory, as developed by Cockerham (, ), frames health practices as products of both structural conditions or life chances and individual agency or life choices. For a rural-origin graduate student, life chances may include having grown up with limited access to recreational sports facilities or with different norms around sleep and study. The choices that students make about exercise or sleep are then exercised within a new environment that may feel unsupportive (, ). Insomnia occupies a particularly consequential position, as it can be both a manifestation of distress and a driver of its worsening (, , ). Physical activity is among the most reliable behavioral correlates of mental health in student populations (), yet it tends to be deprioritized under academic pressure.