Sleep Disturbance in Chinese College Students with Mental Health Problems: A Moderated Mediation Model
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Measures
2.2.1. Self-Designed Sociodemographic Questionnaire
2.2.2. Chinese College Students’ Mental Health Screening Scale (CCSMHSS)
2.3. Statistical Analyses
3. Results
3.1. Demographic Characteristics
3.2. Correlation of Key Internalizing Problem Factors, Externalizing Problem Factors and Sleep Disturbance
3.3. Association between Internalizing/Externalizing Problems Indicators and Sleep Disturbance
3.4. Mediating Effect of Somatic Symptoms on the Relationship between Hostility and Sleep Disturbance
3.5. Moderating Effect of OCS on the Mediator Effect
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Zhang, J.; Xu, Z.; Zhao, K.; Chen, T.; Ye, X.; Shen, Z.; Wu, Z.; Zhang, J.; Shen, X.; Li, S. Sleep Habits, Sleep Problems, Sleep Hygiene, and Their Associations with Mental Health Problems Among Adolescents. J. Am. Psychiatr. Nurses Assoc. 2018, 24, 223–234. [Google Scholar] [CrossRef] [PubMed]
- Sadeghi Bahmani, D.; Esmaeili, L.; Shaygannejad, V.; Gerber, M.; Kesselring, J.; Lang, U.E.; Holsboer-Trachsler, E.; Brand, S. Stability of Mental Toughness, Sleep Disturbances, and Physical Activity in Patients with Multiple Sclerosis (MS)—A Longitudinal and Pilot Study. Front. Psychiatry 2018, 9, 182. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Léger, D.; Scheuermaier, K.; Philip, P.; Paillard, M.; Guilleminault, C. SF-36: Evaluation of Quality of Life in Severe and Mild Insomniacs Compared With Good Sleepers. Psychosom. Med. 2001, 63, 49–55. [Google Scholar] [CrossRef] [PubMed]
- McMakin, D.L.; Alfano, C.A. Sleep and anxiety in late childhood and early adolescence. Curr. Opin. Psychiatry 2015, 28, 483–489. [Google Scholar] [CrossRef] [Green Version]
- Brower, K.J.; Perron, B.E. Sleep disturbance as a universal risk factor for relapse in addictions to psychoactive substances. Med. Hypotheses 2010, 74, 928–933. [Google Scholar] [CrossRef] [Green Version]
- Chen, W.-L.; Chen, J.-H. Consequences of inadequate sleep during the college years: Sleep deprivation, grade point average, and college graduation. Prev. Med. 2019, 124, 23–28. [Google Scholar] [CrossRef]
- Alvaro, P.K.; Roberts, R.; Harris, J.K. A Systematic Review Assessing Bidirectionality between Sleep Disturbances, Anxiety, and Depression. Sleep 2013, 36, 1059–1068. [Google Scholar] [CrossRef]
- Lopes, E.; Milheiro, I.; Maia, A. Sleep quality in college students: A study about the contribution of lifestyle, academic performance and general well-being. Sleep Med. 2013, 14 (Suppl. S1), e185. [Google Scholar] [CrossRef]
- Lohsoonthorn, V.; Khidir, H.; Casillas, G.; Lertmaharit, S.; Tadesse, M.G.; Pensuksan, W.C.; Rattananupong, T.; Gelaye, B.; Williams, M.A. Sleep quality and sleep patterns in relation to consumption of energy drinks, caffeinated beverages, and other stimulants among Thai college students. Sleep Breath. 2013, 17, 1017–1028. [Google Scholar] [CrossRef]
- Wang, J.X.; Zhang, Y.; Liu, Y.Y. Annual Sleep Report of China 2022; Social Sciences Academic Press: Beijing, China, 2022; pp. 81–95. [Google Scholar]
- Lund, H.G.; Reider, B.D.; Whiting, A.B.; Prichard, J.R. Sleep Patterns and Predictors of Disturbed Sleep in a Large Population of College Students. J. Adolesc. Health 2010, 46, 124–132. [Google Scholar] [CrossRef]
- Zhu, X.; Haegele, J.; Liu, H.; Yu, F. Academic Stress, Physical Activity, Sleep, and Mental Health among Chinese Adolescents. Int. J. Environ. Res. Public Health 2021, 18, 7257. [Google Scholar] [CrossRef] [PubMed]
- Nordin, G.; Sundqvist, R.; Nordin, S.; Gruber, M. Somatic symptoms in sleep disturbance. Psychol. Health Med. 2021, 1–11. [Google Scholar] [CrossRef] [PubMed]
- Tsuchiyama, K.; Terao, T.; Wang, Y.; Hoaki, N.; Goto, S. Relationship between hostility and subjective sleep quality. Psychiatry Res. 2013, 209, 545–548. [Google Scholar] [CrossRef] [PubMed]
- Ren, J.; Zhang, J.H.; Zhang, X.Q.; Lu, X.Y.; Zhang, K.X.; Wang, T.L.; Wei, H.Y.; Zhang, Z.H. The relationship between internet addiction and sleep disorder among adolescents: A moderated mediation model. China J. Health Psychol. Chin. 2022, 30, 1381–1385. [Google Scholar]
- Li, S.C.; Kong, J.H. Review on the functional mechanism of obsessive-compulsive disorder which leads to insomnia. World J. Sleep Med. Chin. 2017, 4, 401–404. [Google Scholar]
- Achenbach, T.M.; Ivanova, M.Y.; Rescorla, L.A.; Turner, L.V.; Althoff, R.R. Internalizing/Externalizing Problems: Review and Recommendations for Clinical and Research Applications. J. Am. Acad. Child Adolesc. Psychiatry 2016, 55, 647–656. [Google Scholar] [CrossRef]
- Kundu, K.; Joshi, T.; Gupta, R. Somatic Symptom Disorder and Sleep. In Sleep and Neuropsychiatric Disorders, 1st ed.; Gupta, R., Neubauer, D.N., Pandi-Perumal, S.R., Eds.; Springer Nature Singapore Pte Ltd.: Singapore, 2022; pp. 483–491. [Google Scholar] [CrossRef]
- Ionescu, C.G.; Popa-Velea, O.; Mihăilescu, A.I.; Talaşman, A.A.; Bădărău, I.A. Somatic Symptoms and Sleep Disorders: A Literature Review of Their Relationship, Comorbidities and Treatment. Healthcare 2021, 9, 1128. [Google Scholar] [CrossRef]
- Taylor, N.D.; Fireman, G.D.; Levin, R. Trait Hostility, Perceived Stress, and Sleep Quality in a Sample of Normal Sleepers. Sleep Disord. 2013, 2013, 1–8. [Google Scholar] [CrossRef] [Green Version]
- Timpano, K.R.; Carbonella, J.Y.; Bernert, R.A.; Schmidt, N.B. Obsessive compulsive symptoms and sleep difficulties: Exploring the unique relationship between insomnia and obsessions. J. Psychiatr. Res. 2014, 57, 101–107. [Google Scholar] [CrossRef]
- Zhang, J.; Lam, S.-P.; Li, S.X.; Tang, N.L.; Yu, M.W.; Li, A.M.; Wing, Y.-K. Insomnia, sleep quality, pain, and somatic symptoms: Sex differences and shared genetic components. Pain 2012, 153, 666–673. [Google Scholar] [CrossRef]
- Hartz, A.; Ross, J.J.; Noyes, R.; Williams, P. Somatic symptoms and psychological characteristics associated with insomnia in postmenopausal women. Sleep Med. 2013, 14, 71–78. [Google Scholar] [CrossRef] [PubMed]
- Johnson, K.A.; Gordon, C.J.; Grunstein, R.R. Somatic symptoms are associated with Insomnia disorder but not Obstructive Sleep Apnoea or Hypersomnolence in traumatic brain injury. NeuroRehabilitation 2019, 45, 409–418. [Google Scholar] [CrossRef]
- Kim, K.; Uchiyama, M.; Liu, X.; Shibui, K.; Ohida, T.; Ogihara, R.; Okawa, M. Somatic and Psychological Complaints and Their Correlates with Insomnia in the Japanese General Population. Psychosom. Med. 2001, 63, 441–446. [Google Scholar] [CrossRef] [Green Version]
- A Schlarb, A.; Claßen, M.; Hellmann, S.M.; Vögele, C.; Gulewitsch, M.D. Sleep and somatic complaints in university students. J. Pain Res. 2017, 10, 1189–1199. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Granö, N.; Vahtera, J.; Virtanen, M.; Keltikangas-Järvinen, L.; Kivimaki, M. Association of hostility with sleep duration and sleep disturbances in an employee population. Int. J. Behav. Med. 2008, 15, 73–80. [Google Scholar] [CrossRef]
- Hyphantis, T.; Goulia, P.; Carvalho, A.F. Personality traits, defense mechanisms and hostility features associated with somatic symptom severity in both health and disease. J. Psychosom. Res. 2013, 75, 362–369. [Google Scholar] [CrossRef] [PubMed]
- Paterson, J.L.; Reynolds, A.C.; Ferguson, S.A.; Dawson, D. Sleep and obsessive-compulsive disorder (OCD). Sleep Med. Rev. 2013, 17, 465–474. [Google Scholar] [CrossRef]
- Lee, H.; Cashin, A.G.; Lamb, S.E.; Hopewell, S.; Vansteelandt, S.; VanderWeele, T.J.; MacKinnon, D.P.; Mansell, G.; Collins, G.S.; Golub, R.M.; et al. A Guideline for Reporting Mediation Analyses of Randomized Trials and Observational Studies: The AGReMA Statement. JAMA 2021, 326, 1045–1056. [Google Scholar] [CrossRef]
- Fang, X.Y.; Yuan, X.J.; Hu, W.; Deng, L.Y.; Lin, X.Y. The development of Chinese college students mental health screening scale. Stud. Psychol. Behav. Chin. 2018, 16, 111–118. [Google Scholar]
- Wang, J.; Liu, S.; Guo, J.; Xiao, R.; Yu, J.; Luo, X.; Xu, Y.; Zhao, Y.; Cui, Y.; Gu, Y.; et al. Chronotypes, Sleep and Mental Distress Among Chinese College Students: A Cross-Sectional Study. Front. Psychiatry 2022, 13, 883484. [Google Scholar] [CrossRef]
- Koh, K.B.; Park, J.K. The Relation between Anger Management Style and Organ System-Related Somatic Symptoms in Patients with Depressive Disorders and Somatoform Disorders. Yonsei Med. J. 2008, 49, 46–52. [Google Scholar] [CrossRef] [PubMed]
Level | Category | Indicators | Items | Internal Consistency Reliability | Criteria for Screening Participants |
---|---|---|---|---|---|
I: Severe Psychological problems | Hallucinations and delusions | 4 | 0.76 | Either standard score (ZI) > 1 | |
Suicidal thoughts | 4 | 0.86 | |||
II: General psychological problems | Internalizing problems | Anxiety | 4 | 0.79 | Any indicator standard score (ZII) > 2 |
Depression | 5 | 0.81 | |||
Paranoia | 4 | 0.82 | |||
Inferiority | 5 | 0.86 | |||
Sensitivity | 4 | 0.80 | |||
Social phobia | 4 | 0.82 | |||
Somatic symptoms | 4 | 0.78 | |||
Externalizing problems | Dependence | 4 | 0.83 | ||
Hostility | 4 | 0.77 | |||
Impulsivity | 4 | 0.79 | |||
Obsessive-compulsive symptoms | 4 | 0.78 | |||
Internet addiction | 5 | 0.88 | |||
Self-injurious behavior | 4 | 0.78 | |||
Eating problems | 4 | 0.59 | |||
III: Developmental disturbance problems or psychological problems source | School adaptation | 4 | 0.68 | Any indicator standard score (ZIII) > 3 | |
Interpersonal relationship | 4 | 0.82 | |||
Academic stress | 4 | 0.82 | |||
Employment stress | 4 | 0.88 | |||
Intimate relationships troubles | 4 | 0.65 | |||
Sleep disturbance | 4 | 0.72 | Standard score (Zsd) > 2 |
Variables | Total | Sleep Disturbance No. (Rate, %) | Permutation p-Value |
---|---|---|---|
Number | 2134 | 78 (3.7) | |
Sex | 0.399 | ||
Men | 1285 (60.2) | 43 (55.1) | |
Women | 849 (39.8) | 35 (44.9) | |
Only child | 0.117 | ||
No | 1357 (63.6) | 43 (55.1) | |
Yes | 777 (36.4) | 35 (44.9) | |
Hometown | 0.102 | ||
Large cities | 202 (9.5) | 11 (14.1) | |
Small- and medium-sized cities | 506 (23.7) | 21 (26.9) | |
Small towns | 356 (16.7) | 18 (23.1) | |
Rural areas | 1070 (50.1) | 28 (35.9) | |
COVID-19 | 0.487 | ||
Before | 997 (46.7) | 33 (42.3) | |
During | 1137 (53.3) | 45 (57.7) |
Variables | No Sleep Disturbance (n = 2056) | Sleep Disturbance (n = 78) | Odds Ratio (95% Confidence Interval) |
---|---|---|---|
Hostility | 7.25 ± 1.96 | 9.45 ± 3.53 | 1.20 (1.06–1.36) *** |
somatic symptoms | 7.05 ± 2.18 | 9.33 ± 3.38 | 1.31 (1.17–1.48) *** |
OCS | 8.27 ± 2.19 | 10.97 ± 3.30 | 1.32 (1.18–1.48) *** |
Outcome Variables | Predictors | R-Squared | p | β | Standard Error | t |
---|---|---|---|---|---|---|
M: Somatic symptoms | X: Hostility | 0.30 | <0.001 | 0.55 | 0.02 | 25.88 *** |
Y: Sleep disturbance | X: Hostility | 0.17 | <0.001 | 0.16 | 0.03 | 5.85 *** |
M: Somatic symptoms | 0.31 | 0.03 | 12.20 *** |
Standardized Effect Size | Standard Error | 95% Confidence Interval (CI) | Relative Effect Size | |
---|---|---|---|---|
Total effects | 0.327 | 0.02 | 0.28–0.38 | |
Direct effects | 0.158 | 0.03 | 0.11–0.21 | 48.32% |
Mediating effects | 0.169 | 0.02 | 0.14–0.20 | 51.68% |
Outcome Variables | Predictors | R-Squared | p | β | Standard Error | t | p | 95% Confidence Interval |
---|---|---|---|---|---|---|---|---|
M: somatic symptoms | X: Hostility | 0.31 | <0.001 | 0.52 | 0.02 | 23.77 | <0.001 | 0.47–0.56 |
W: OCS | 0.09 | 0.02 | 3.86 | <0.001 | 0.04–0.13 | |||
X × W | 0.01 | 0.02 | 0.50 | 0.621 | −0.03–0.04 | |||
Y: Sleep disturbance | X: Hostility | 0.29 | <0.001 | 0.04 | 0.03 | 1.36 | 0.174 | −0.02–0.10 |
M: somatic symptoms | 0.26 | 0.03 | 9.36 | <0.001 | 0.20–0.31 | |||
W: OCS | 0.38 | 0.02 | 16.60 | <0.001 | 0.33–0.42 | |||
X × W | 0.01 | 0.02 | 0.17 | 0.867 | −0.04–0.05 | |||
M × W | 0.06 | 0.03 | 2.26 | <0.05 | 0.01–0.10 | |||
Conditional mediating effect on Y at values of the moderator | ||||||||
Low OCS | 0.10 | 0.02 | 4.22 | <0.001 | 0.06–0.15 | |||
Mean OCS | 0.13 | 0.02 | 8.31 | <0.001 | 0.10–0.16 | |||
High OCS | 0.16 | 0.02 | 9.57 | <0.001 | 0.13–0.20 | |||
Differences between high and low OCS | 0.06 | 0.03 | 2.273 | <0.05 | 0.01–0.12 |
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Sun, Y.; Wang, L.; Li, C.; Luo, W. Sleep Disturbance in Chinese College Students with Mental Health Problems: A Moderated Mediation Model. Int. J. Environ. Res. Public Health 2022, 19, 14570. https://doi.org/10.3390/ijerph192114570
Sun Y, Wang L, Li C, Luo W. Sleep Disturbance in Chinese College Students with Mental Health Problems: A Moderated Mediation Model. International Journal of Environmental Research and Public Health. 2022; 19(21):14570. https://doi.org/10.3390/ijerph192114570
Chicago/Turabian StyleSun, Yanping, Lin Wang, Chang Li, and Wanshu Luo. 2022. "Sleep Disturbance in Chinese College Students with Mental Health Problems: A Moderated Mediation Model" International Journal of Environmental Research and Public Health 19, no. 21: 14570. https://doi.org/10.3390/ijerph192114570