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

High levels of perceived stress and anxiety among university students are a global concern and are known to negatively influence sleep. However, few studies have explored how stress response styles, like psychological resilience and rumination, might alter these relationships. Using validated tools, perceived stress, anxiety, stress response styles, and sleep behaviors of undergraduate and graduate students from seven countries during the height of the COVID-19 pandemic were characterized in order to examine the relationships between these factors using mediation and moderation analyses. Students enrolled in universities in China, Ireland, Malaysia, Taiwan, South Korea, the Netherlands, and the United States were recruited in May 2020. A total of 2254 students completed this cross-sectional study. Perceived stress and anxiety were negatively associated with sleep quality through the mediation of rumination. Increased psychological resilience weakened the relationships between perceived stress and anxiety on sleep quality. The majority of students reported that COVID-19 negatively influenced their mental health and sleep quality but not sleep duration. Based on these results, university students would likely benefit from sleep education and mental health promotion programs that include trainings to increase psychological resilience and reduce rumination, particularly during times of increased stress.

Health Behaviors of Higher Education Students from 7 Countries: Poorer Sleep Quality during the COVID-19 Pandemic Predicts Higher Dietary Risk

“…While sleeping adequately is important for health, enhancing sleep quality is also critical; yet, improving higher education students’ sleep quality has received little attention [ 117 , 118 ]. Higher education students in all countries studied suffered from poor sleep quality, which has been associated with lower grades, impaired learning ability, worse mood, greater stress, more risk-taking behaviors and poorer overall health [ 10 , 108 , 119 , 120 , 121 ]. One study of over 55,000 students reported that stress, binge drinking and drug use had similar, or even smaller, associations with academic success compared to sleep disturbance; yet these risk factors received far more attention by university administrators compared to sleep problems [ 121 ].…”

“…These high levels of perceived stress are a global phenomenon; for example, prior to the pandemic more than three-quarters of Malaysian students reported experiencing moderate stress [ 7 ] while nearly 40% of USA students reported high levels of perceived stress [ 8 ]. Stress plays an important role in health behaviors, like insufficient sleep [ 6 , 9 , 10 ] and increased alcohol consumption [ 11 , 12 , 13 ], which can lead to negative health outcomes such as cardiovascular disease [ 14 , 15 ], diabetes [ 16 , 17 ] and cancers [ 18 , 19 , 20 , 21 ]. An improved understanding of the health behaviors of young adults, especially under conditions of heightened stress, is needed to assist public health practitioners in designing programming to promote the development of lifelong healthy habits.…”

Concerns of College Students during the COVID-19 Pandemic: Thematic Perspectives from the United States, Asia, and Europe

“…This abrupt shift from face-to-face learning to online instruction has led to negative mental health consequences for higher education students (AlAteeq et al, 2020;Baloran, 2020;Hasan & Bao, 2020;Ramos-Morcillo et al, 2020). The disruption of normality that students experienced through lockdowns and quarantines also exacerbated symptoms of mental disorders in the student population (Du et al, 2020;Patsali et al, 2020;Son et al, 2020). While not solely focused on university students, Dubey et al (2020) found that COVID-19 has caused global social impacts such as job loss, financial and political uncertainty, and relationship challenges, as well as confusion due to the proliferation of information through social media.…”

“…Institutes of higher education and their students face significant and unprecedented challenges from COVID-19 (Du et al, 2020;Cao et al, 2020;Maddumapatabandi & Grange, 2020). Researchers have reviewed many aspects of the higher education experience in the time of COVID-19, both qualitatively and quantitatively .…”

Locus of control moderates the association of COVID-19 stress and general mental distress: Results of a cross-sectional survey in two large samples from Norway, Germany, and Austria

“…Until now, several factors were found to serve as resources buffering the effects of stressors, stressful experiences or risk factors on mental health or protective health promoting behaviour during the first year of the pandemic. Among these moderating factors are higher self-esteem [18], greater psychological flexibility and acceptance of difficult experience [19], higher meaning in life and self-control [12], less digital emotion contagion [20], higher age [21], male gender and lower COVID-19 stress [22], emotion regulation by cognitive reappraisal strategies [23], increased resilience [24], trust in the healthcare system [25], identifying positive over negative aspects of COVID-19 lockdown [26], as well as utilizing prenatal care services [27].…”