Increased Resilience Weakens the Relationship between Perceived Stress and Anxiety on Sleep Quality: A Moderated Mediation Analysis of Higher Education Students from 7 Countries
Abstract
:1. Introduction
- (1)
- Higher levels of perceived stress would be associated with decreased sleep quality and duration through increased rumination.
- (2)
- Higher levels of anxiety would be associated with decreased sleep quality and duration through increased rumination.
- (3)
- Students with higher levels of resilience were likely to be protected from the negative impact of perceived stress and anxiety on sleep quality and sleep duration.
2. Results
2.1. Participant Characteristics
2.2. Mental Health and Sleep Behaviors Influenced by COVID-19
2.3. Mediation and Moderation Analyses
2.3.1. Correlations between Examined Variables
2.3.2. Model 1 Moderated Mediation Model of Perceived Stress on Sleep Quality
2.3.3. Model 2 Moderated Mediation Model of Perceived Stress on Sleep Duration
2.3.4. Model 3 Moderated Mediation Model of Perceived Stress on Sleep Quality
2.3.5. Model 4 Moderated Mediation Model of Perceived Stress on Sleep Quality
3. Discussion
4. Materials and Methods
4.1. Study Design
4.2. Demographics
4.3. Assessment of Perceived Stress and Anxiety
4.4. Assessment of Psychological Resilience and Rumination
4.5. Assessment of Sleep Duration and Quality
4.6. Assessment of How COVID-19 Impacted the Factors Described Above
4.7. Statistical Analysis
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Location | Social Restriction Measures in Place | Sex n (%) | Undergraduate vs. Graduate n (%) | Domestic vs. International n (%) |
---|---|---|---|---|
China | Some online classes and some in-person classes resumed | M = 36 (32.4) F = 75 (67.6) Other = 0 | U = 94 (84.7) G = 17 (15.3) | D = 106 (95.5) I = 5 (4.5) |
Ireland | Online classes only | M = 53 (27.6) F = 138 (71.9) Other = 1 (0.5) | U = 154 (80.2) G = 38 (19.8) | D = 179 (93.2) I = 13 (6.8) |
Malaysia | Online classes only | M = 19 (20.9) F = 72 (79.1) Other = 0 | U = 88 (96.7) G = 3 (3.3) | D = 74 (81.3) I = 17 (18.7) |
South Korea | Some online classes and some in-person classes resumed | M = 54 (60.7) F = 35 (39.3) Other = 0 | U = 41(46.1) G = 48 (53.9) | D = 84 (94.4) I = 5 (5.6) |
Taiwan | Some online classes and some in-person classes resumed | M = 202 (53.6) F = 155 (41.1) Other = 20 (5.3) | U = 360 (95.5) G = 17 (4.5) | D = 360 (95.5) I = 17 (4.5) |
The Netherlands | Online classes only | M = 22 (19.3) F = 92 (80.7) Other = 0 | U = 114 (100) G = 0 | D = 46 (40.4) I = 68 (59.6) |
United States | Online classes only | M = 308 (24.1) F = 935 (73.0) Other = 37 (2.0) | U = 951 (74.3) G = 327 (25.7) | D = 1113 (87.0) I = 167 (13) |
Total | M = 694 (30.8) F = 1502 (66.7) Other = 58 (2.5) Total = 2254 | U = 1802 (79.9) G = 452 (20.1) | D = 1962 (87.0) I = 292 (13.0) |
Health Parameters | Category | n (%) |
---|---|---|
Anxiety | Minimal anxiety | 711 (31.6) |
Mild anxiety | 722 (32.0) | |
Moderate anxiety | 456 (20.2) | |
Severe anxiety | 364 (16.2) | |
Perceived stress | Low stress | 337 (15.0) |
Moderate stress | 1425 (63.2) | |
High stress | 492 (21.8) | |
Sleep quality * | Good sleeper | 890 (39.7) |
Poor sleeper | 1352 (60.3) | |
Sleep duration | Met ≥ 7 h of sleep per day | 1628 (72.2) |
Did not meet the above sleep duration recommendation | 626 (27.8) |
n | Greater Perceived Stress (%) | Greater Financial Stress (%) | Reduced Resilience to Stress (%) | Greater Repetitive Negative Thinking (%) | Greater Negative Mood (%) | Greater * Anxiety (%) | Reduced Sleep Duration (%) | Increased Sleep Duration (%) | Reduced Sleep Quality (%) | |
---|---|---|---|---|---|---|---|---|---|---|
Total | 2254 | 60.2 | 41.7 | 29.5 | 50.1 | 50.9 | 63.9 | 17.1 | 44.6 | 32.1 |
Undergraduate | 1802 | 59.3 | 41.6 | 29.9 | 50.0 | 50.6 | 64.3 | 17.5 | 44.9 | 32.2 |
Graduate | 452 | 63.7 | 42.0 | 28.1 | 50.4 | 52.2 | 62.8 | 15.5 | 44.0 | 31.6 |
Domestic | 1962 | 60.2 | 40.9 | 29.3 | 49.3 | 51.0 | 64.0 | 16.8 | 44.2 | 31.3 |
International | 292 | 59.6 | 46.9 | 30.8 | 55.1 | 50.0 | 62.9 | 19.2 | 47.3 | 37.3 |
Measures a | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 |
---|---|---|---|---|---|---|---|---|
(1) Sleep quality (PSQI) b | - | −0.33 * | −0.28 * | 0.41 * | 0.43 * | −0.50 * | 0.04 | 0.19 * |
(2) Sleep duration (hours) | - | 0.05 | −0.05 | −0.05 | −0.08 * | −0.11 * | −0.07 * | |
(3) Resilience | - | −0.47 * | −0.50 * | −0.42 * | 0.09 * | −0.27 | ||
(4) Rumination | - | 0.62 * | 0.67 * | −0.09 * | 0.09 * | |||
(5) Perceived stress | - | 0.69 * | −0.12 * | 0.10 * | ||||
(6) Anxiety | − | −0.05 | 0.16 * | |||||
(7) Age (years) | - | 0.19 * | ||||||
(8) BMI (Kg/m2) | - | |||||||
Mean ± SD | 6.8 ± 3.5 | 7.5 ± 1.2 | 3.2 ± 0.7 | 82.9 ± 23.0 | 20.6 ± 6.8 | 8.2 ± 5.8 | 22.5 ± 5.5 | 24.4 ± 5.6 |
Variables | B | SE | t | p Value |
---|---|---|---|---|
Perceived stress → rumination | 2.04 | 0.05 | 37.90 | <0.001 |
Rumination → sleep quality | 0.01 | 0.02 | 0.75 | 0.46 |
Perceived stress → sleep quality | 0.35 | 0.06 | 5.91 | <0.001 |
Bootstrap | Effect | SE | LL 95% CI | UL 95% CI |
Rumination | 0.06 | 0.01 | 0.05 | 0.08 |
Variables | B | SE | t | p Value |
---|---|---|---|---|
Resilience → sleep quality | 0.69 | 0.36 | 1.89 | 0.06 |
Interaction 1 → sleep quality | −0.06 | 0.02 | −3.68 | <0.001 |
Interaction 2 → sleep quality | 0.01 | 0.01 | 1.03 | 0.30 |
Conditional indirect effect of resilience | Resilience scores | Indirect effect (SE) | LL 95% CI | UL 95% CI |
2.46 | 0.19 (0.02) | 0.15 | 0.23 | |
3.18 | 0.14 (0.01) | 0.12 | 0.17 | |
3.90 | 0.10 (0.02) | 0.06 | 0.13 | |
Conditional direct effect of resilience Johnson-Neyman test | Resilience scores | Direct effect (SE) | LL 95% CI | UL 95% CI |
1.00 | 0.29 (0.04) | 0.05 | 0.08 | |
1.80 | 0.23 (0.03) | 0.18 | 0.29 | |
2.60 | 0.18 (0.02) | 0.15 | 0.22 | |
3.40 | 0.13 (0.01) | 0.10 | 0.16 | |
4.20 | 0.08 (0.02) | 0.04 | 0.12 | |
4.40 | 0.07 (0.02) | 0.02 | 0.11 | |
4.61 | 0.05 (0.03) | 0.00 | 0.10 | |
4.80 | 0.04 (0.03) | −0.02 | 0.10 | |
5.00 | 0.03 (0.03) | −0.04 | 0.09 |
Variables | B | SE | t | p Value |
---|---|---|---|---|
Perceived stress → rumination | 2.04 | 0.05 | 37.90 | <0.001 |
Rumination → sleep duration | 0.01 | 0.01 | 1.14 | 0.25 |
Perceived stress → sleep duration | −0.03 | 0.02 | −1.08 | 0.28 |
Bootstrap | Effect | SE | LL 95% CI | UL 95% CI |
Rumination | −0.002 | 0.003 | −0.01 | 0.001 |
Variables | B | SE | t | p Value |
---|---|---|---|---|
Resilience → sleep duration | 0.21 | 0.16 | 1.34 | 0.18 |
Interaction 1 → sleep duration | 0.01 | 0.01 | 0.83 | 0.40 |
Interaction 2 → sleep duration | −0.003 | 0.002 | −1.38 | 0.17 |
Conditional indirect effect of resilience | Resilience scores | Indirect effect (SE) | LL 95% CI | UL 95% CI |
2.46 | 0.002 (0.005) | −0.008 | 0.012 | |
3.18 | −0.002 (0.003) | −0.008 | 0.004 | |
3.90 | −0.007 (0.004) | −0.015 | 0.001 | |
Conditional direct effect of resilience | Resilience scores | Direct effect (SE) | LL 95% CI | UL 95% CI |
2.46 | −0.011 (0.008) | −0.027 | 0.004 | |
3.18 | −0.007 (0.005) | −0.017 | 0.003 | |
3.90 | −0.003 (0.007) | −0.016 | 0.011 |
Variables | B | SE | t | p Value |
---|---|---|---|---|
Anxiety → rumination | 2.60 | 0.06 | 41.23 | <0.001 |
Rumination → sleep quality | 0.01 | 0.02 | 0.78 | 0.43 |
Anxiety → sleep quality | 0.35 | 0.07 | 5.03 | <0.001 |
Bootstrap | Effect | SE | LL 95% CI | UL 95% CI |
Rumination | 0.05 | 0.01 | 0.03 | 0.07 |
Variables | B | SE | t | p Value |
---|---|---|---|---|
Resilience → sleep quality | −0.13 | 0.36 | −0.36 | 0.72 |
Interaction 1 → sleep quality | −0.04 | 0.02 | −1.88 | 0.06 |
Interaction 2 → sleep quality | 0.002 | 0.005 | −1.88 | 0.73 |
Conditional indirect effect of resilience | Resilience scores | Indirect effect (SE) | LL 95% CI | UL 95% CI |
2.46 | 0.05 (0.01) | 0.02 | 0.07 | |
3.18 | 0.05 (0.01) | 0.03 | 0.07 | |
3.90 | 0.05 (0.01) | 0.03 | 0.08 | |
Conditional direct effect of resilience | Resilience scores | Direct effect (SE) | LL 95% CI | UL 95% CI |
2.46 | 0.25 (0.02) | 0.21 | 0.29 | |
3.18 | 0.22 (0.02) | 0.19 | 0.25 | |
3.90 | 0.19 (0.02) | 0.15 | 0.24 | |
Conditional direct effect of resilience Johnson-Neyman test | Resilience scores | Direct effect (SE) | LL 95% CI | UL 95% CI |
1.00 | 0.31 (0.05) | 0.21 | 0.40 | |
1.80 | 0.28 (0.03) | 0.21 | 0.34 | |
2.60 | 0.24 (0.02) | 0.21 | 0.28 | |
3.40 | 0.21 (0.02) | 0.18 | 0.24 | |
4.20 | 0.18 (0.03) | 0.14 | 0.23 | |
4.40 | 0.17 (0.03) | 0.11 | 0.23 | |
4.60 | 0.16 (0.03) | 0.10 | 0.23 | |
5.00 | 0.15 (0.04) | 0.06 | 0.23 |
Variables | B | SE | t | p Value |
---|---|---|---|---|
Anxiety → rumination | 2.61 | 0.06 | 41.24 | <0.001 |
Rumination → sleep duration | 0.01 | 0.01 | 1.00 | 0.32 |
Anxiety → sleep duration | −0.02 | 0.03 | −0.75 | 0.45 |
Bootstrap | Effect | SE | LL 95% CI | UL 95% CI |
Rumination | 0.001 | 0.004 | −0.007 | 0.009 |
Variables | B | SE | t | p Value |
---|---|---|---|---|
Resilience → sleep duration | 0.26 | 0.17 | 1.55 | 0.12 |
Interaction 1 → sleep duration | 0.002 | 0.010 | 0.19 | 0.85 |
Interaction 2 → sleep duration | −0.002 | 0.003 | −1.00 | 0.32 |
Conditional indirect effect of resilience | Resilience scores | Indirect effect (SE) | LL 95% CI | UL 95% CI |
2.46 | 0.006 (0.007) | −0.007 | 0.019 | |
3.18 | 0.001 (0.004) | −0.007 | 0.009 | |
3.90 | −0.004 (0.006) | −0.015 | 0.008 | |
Conditional direct effect of resilience | Resilience scores | Direct effect (SE) | LL 95% CI | UL 95% CI |
2.46 | −0.019 (0.009) | −0.036 | −0.001 | |
3.18 | −0.017 (0.006) | −0.029 | −0.005 | |
3.90 | −0.016 (0.010) | −0.035 | 0.003 |
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Du, C.; Zan, M.C.H.; Cho, M.J.; Fenton, J.I.; Hsiao, P.Y.; Hsiao, R.; Keaver, L.; Lai, C.-C.; Lee, H.; Ludy, M.-J.; et al. Increased Resilience Weakens the Relationship between Perceived Stress and Anxiety on Sleep Quality: A Moderated Mediation Analysis of Higher Education Students from 7 Countries. Clocks & Sleep 2020, 2, 334-353. https://doi.org/10.3390/clockssleep2030025
Du C, Zan MCH, Cho MJ, Fenton JI, Hsiao PY, Hsiao R, Keaver L, Lai C-C, Lee H, Ludy M-J, et al. Increased Resilience Weakens the Relationship between Perceived Stress and Anxiety on Sleep Quality: A Moderated Mediation Analysis of Higher Education Students from 7 Countries. Clocks & Sleep. 2020; 2(3):334-353. https://doi.org/10.3390/clockssleep2030025
Chicago/Turabian StyleDu, Chen, Megan Chong Hueh Zan, Min Jung Cho, Jenifer I. Fenton, Pao Ying Hsiao, Richard Hsiao, Laura Keaver, Chang-Chi Lai, HeeSoon Lee, Mary-Jon Ludy, and et al. 2020. "Increased Resilience Weakens the Relationship between Perceived Stress and Anxiety on Sleep Quality: A Moderated Mediation Analysis of Higher Education Students from 7 Countries" Clocks & Sleep 2, no. 3: 334-353. https://doi.org/10.3390/clockssleep2030025
APA StyleDu, C., Zan, M. C. H., Cho, M. J., Fenton, J. I., Hsiao, P. Y., Hsiao, R., Keaver, L., Lai, C. -C., Lee, H., Ludy, M. -J., Shen, W., Swee, W. C. S., Thrivikraman, J., Tseng, K. -W., Tseng, W. -C., & Tucker, R. M. (2020). Increased Resilience Weakens the Relationship between Perceived Stress and Anxiety on Sleep Quality: A Moderated Mediation Analysis of Higher Education Students from 7 Countries. Clocks & Sleep, 2(3), 334-353. https://doi.org/10.3390/clockssleep2030025