Insomnia May Mediate the Relationship Between Stress and Anxiety: A Cross-Sectional Study in University Students
Received 26 August 2020
Accepted for publication 25 November 2020
Published 8 January 2021 Volume 2021:13 Pages 31—38
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Steven A Shea
Md Dilshad Manzar,1 Mohammed Salahuddin,2,3 Seithikurippu R Pandi-Perumal,4 Ahmed S Bahammam5,6
1Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia; 2Department of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University (Mizan Campus), Mizan-Aman, Ethiopia; 3Pharmacology Division, Department of BioMolecular Sciences, University of Mississippi, Oxford, MS, USA; 4Somnogen Canada Inc, Toronto, ON, Canada; 5The University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh 11324, Saudi Arabia; 6National Plan for Science and Technology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
Correspondence: Md Dilshad Manzar
Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
Background: High perceived stress and anxiety disorders are usually comorbid with each other, with stress often sequentially preceding the development of anxiety. While prior findings showed a causal role of sleep problems in anxiety, no study has assessed the role of insomnia as a mediator in the relationship between stress and anxiety.
Methods: A cross-sectional study on university students (n = 475, age = 21.1+2.6 years) was conducted over 3 months. Participants completed self-report measures of Leeds Sleep Evaluation Questionnaire-Mizan (LSEQ-M), Perceived Stress Scale-10 (PSS-10), generalized anxiety disorder-7 scale (GAD-7), and a sociodemographic tool. The mediation effect model given by Baron and Kelly was used to determine the relationship.
Results: The prevalence of insomnia and anxiety disorder was 43.6% and 21.9%, respectively. Stress was significantly associated with LSEQ-M (insomnia measure) (b = − .44, SE = 0.16, p< 0.01), and high levels of anxiety (b = 0.25, SE = 0.03, p < 0.01). The indirect effect of stress on anxiety through LSEQ-M (insomnia measure) was significant (95% confidence interval [0.01, 0.04]). However, the indirect effect of anxiety on stress through LSEQ-M (insomnia measure) was non-significant (95% confidence interval [− .01, 0.04]).
Conclusions: Students having higher perceived stress levels and comorbid insomnia were also likely to have a higher anxiety level.
Keywords: stress, anxiety, insomnia, mediator