Volume 9, Issue 11, November – 2024 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

To Investigate the Association between Sleep Quality

and Mental Health among Students of the University
of Hyderabad: A Cross-Sectional Study
Sarbasree Bhattacharjeeab, Dr. Vara Lakshmi Manchanaa , Dr. Gaurav Kumar Royab
a
University of Hyderabad, Telangana
b
Department of Community Medicine, Manipal Tata Medical College Jamshedpur, Jharkhand

Abstract:- approach to support student well-being and academic

success.
 Introduction:
Sleep is vital for various brain functions and overall Keywords:- Mental Health, Sleep Quality, Anxiety, Stress,
well-being, yet its biological purpose remains elusive. Depression
Sleep disorders are prevalent, particularly among
university students, impacting academic success and I. INTRODUCTION
emotional well-being. This study explores the relationship
between sleep quality and mental health among Sleep plays a vital role in cognitive function, emotional
University of Hyderabad students, aiming to inform regulation and overall well-being. Sleep affects the quality of
interventions for improved well-being and academic life and health, which is also perceived as an important
success. variable (Engin E et al.,2004). Poor sleep quality, especially
among University students, has been linked to increased risks
 Methods: of mental health issues such as anxiety, depression and stress.
The study was conducted at the University of In 2019, 1 in every 8 people, or 970 million people around the
Hyderabad campus in Telangana, India, from February world were living with a mental disorder, with anxiety and
1st, 2024, to March 31st, 2024. Employing a cross- depressive disorders the most common. Sleep quality and
sectional design, data collection involved administering psychological wellbeing, more psychological diseases are
validated questionnaires to assess sleep quality and observed among university students with low sleep quality
mental health among students. The sample size was (Liu et al., 2008). This study aims to explore the association
determined using the formula n = z^2 * p * q / d^2, with between sleep quality and mental health among students at
a confidence level of 95% and a margin of error of 6%, the University of Hyderabad, focusing on anxiety, depression,
resulting in 267 participants. Three validated and stress levels.
questionnaires were utilized: the DASS-21, PSQI, and
PHQ-9. Convenient sampling ensured representation II. METHODS
from both male and female students.
A. Study Design and Population
 Results: A cross-sectional study was conducted from February to
The mean PSQI score was 6.52 ± 2.75, indicating March, 2024 among students who were enrolled at the
variability in sleep quality. The mean anxiety score was University of Hyderabad. A total of 267 students were
approximately 9.77, with a significant proportion recruited using convenient sampling. All students across
experiencing moderate to severe anxiety. Significant different academic programs were included.
associations were observed between poor sleep quality
and higher anxiety levels. Prevalence of depression varied, B. Inclusion Criteria:
with 71.43% experiencing mild depression, 41.35%
moderate, 22.18% moderately severe, and 12.41% severe  The participants must be currently enrolled students at the
depression. Loneliness was significantly correlated with University of Hyderabad
moderate to severe depression. Students living with  Participants should provide informed consent to
roommates were more likely to experience sleep voluntarily participant in the study.
disturbances.  Participants should not have a known history of diagnosed
sleep disorders or medical conditions that significantly
 Conclusion: affect sleep patterns.
The study highlights the complex relationship  Participants should not have a current diagnosis of any
between sleep quality, anxiety, and mental health severe mental health disorder that could significantly
outcomes among University of Hyderabad students. confound the study results.
Tailored interventions are necessary to address these
challenges comprehensively, emphasizing a holistic

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Volume 9, Issue 11, November – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

C. Exclusion Criteria:  Patient Health Questionnaire -9 (PHQ-9)

The PHQ-9 is the 9-item depression module from the
 Participants with a known history of diagnosed sleep full PHQ. Major depression is diagnosed if 5 or more of the 9
disorders or medical conditions that significantly affect depressive symptom criteria have been present at least “more
sleep patterns. than half the days” in the past 2 weeks, and 1 of the symptoms
 Participants with a current diagnosis of severe mental is depressed mood or anhedonia. Other depression is
health disorders. diagnosed if 2, 3, or 4 depressive symptoms have been present
 Participants who provide incomplete or inaccurate data in at least “more than half the days” in the past 2 weeks, and 1
the survey responses may be excluded from the final of the symptoms is depressed mood or anhedonia. One of the
analysis. 9 symptom criteria (“thoughts that you would be better off
dead or of hurting yourself in some way”) counts if present at
D. Data Collection Instruments all, regardless of duration. As with the original PRIME-MD,
before making a final diagnosis, the clinician is expected to
 Pittsburgh Sleep Quality Index (PSQI) rule out physical causes of depression, normal bereavement,
The Pittsburgh Sleep Quality Index (PSQI) is a self- and history of a manic episode.As a severity measure, the
rated questionnaire which assesses sleep quality and PHQ-9 score can range from 0 to 27, since each of the 9 items
disturbances over a 1-month time interval. Nineteen can be scored from 0 (not at all) to 3 (nearly every day). An
individual items generate seven "component" scores: item was also added to the end of the diagnostic portion of the
subjective sleep quality, sleep latency, sleep duration, habitual PHQ-9 asking patients who checked off any problems on the
sleep efficiency, sleep disturbances, use of sleeping questionnaire: “How difficult have these problems made it for
medication, and daytime dysfunction. The sum of scores for you to do your work, take care of things at home, or get along
these seven components yields one global score. Clinical and with other people?” (Spitzer, 1999)
clinimetric properties of the PSQI were assessed over an 18-
month period with "good" sleepers (healthy subjects, n = 52) E. Statistical Analysis
and "poor" sleepers (depressed patients, n = 54; sleep- Data was analysed using Excel 2021 and IBM® SPSS®
disorder patients, n = 62). Acceptable measures of internal software (Free Trial Version). Chi-Square tests was employed
homogeneity, consistency (test-retest reliability), and validity to assess the relationship between sleep quality and mental
were obtained. A global PSQI score greater than 5 yielded a health outcomes. A p-value of <0.05 was considered
diagnostic sensitivity of 89.6% and specificity of 86.5% statistically significant.
(kappa = 0.75, p less than 0.001) in distinguishing good and
poor sleepers. The clinimetric and clinical properties of the III. RESULTS
PSQI suggest its utility both in psychiatric clinical practice
and research activities. (Buysse et al., 1989). A. Demographics:
Of the 267 total participants, 99 were female (37.1%),
 Depression Anxiety Stress -21 (DASS-21) 167 were male (62.5%), and one (0.4%) individual chose not
Lovibond and Lovibond developed the DASS to disclose their identity distributed across Bachelor’s ,
questionnaire to assess key symptoms of depression, anxiety, Master’s and Doctoral programs.
and stress and it also has been used to evaluate patient
reaction to treatment. The questionnaire has been proven to B. Sleep Quality:
have adequate psychometric properties and is equivalent to Based on the Global PSQI score data provided, the sleep
other accurate scales. The DASS-21 is the short form and quality of students at the University of Hyderabad appears to
findings from studies support its validity as an approved be moderately average, with a mean score of 6.52. This
instrument for measuring adverse mental states and suggests that, on average, students experience a moderate
depression, anxiety, and stress in adults (patients and non- level of sleep disturbance across various components
patients). The 21 items on the questionnaire comprise a set of assessed by the PSQI. However, there is notable variability in
3 self-reported scales designed to assess DASS. The 7 sleep quality among students, as indicated by a standard
elements on the scales are graded on a Likert scale from 0 to deviation of approximately 2.75. The distribution of scores is
3 (0: “Did not apply to me at all,” 1:“Applied to me to some slightly right-skewed with moderately heavy tails, implying
degree or some of the time,” 2: “Applied to me to a that while most students may have moderate sleep quality,
considerable degree or a good part of the time,” and 3: there are outliers with either notably poor or exceptionally
“Applied to me very much or most of the time”). Depression, good sleep quality.
anxiety, and stress scores are measured by summarizing the
scores of the related items. Because the DASS-21 is a shorter
version of the 42-item original DASS, the score for each
subscale must be multiplied by 2 to calculate the final score.
According to the manual, the resulting ratings then are
classified as: “normal, mild, moderate, severe, or extremely
severe” (Marijanović et al., 2021).

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Volume 9, Issue 11, November – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

Table 1: Mental Health Outcomes

Serial No. Anxiety Female Male Total
1 Normal 45(45.4%) 79(47.3%) 124(46.4%)
2 Mild 8(8.0%) 19(11.3%) 27(10.1%)
3 Moderate 20(20.2%) 37(22.1%) 57(21.3%)
4 Severe 9(9.0%) 10(6.0%) 19(7.1%)
5 Extremely Severe 17(17.1%) 22(13.1%) 39(14.6%)

Grand Total 99 167 266(99.8%)

Serial No. Depression (PHQ-9) Female Male Total
1 Minimal Depression 28(28.2%) 51(30.5%) 79(29.6%)
2 Mild Depression 33(33.3%) 54(32.3%) 87(32.7%)
3 Moderate Depression 19(19.1%) 36(21.5%) 55(20.6%)
4 Moderately Severe 11(11.1%) 18(10.7%) 29(10.9%)
Depression
5 Severe Depression 8(8.0%) 8(4.7%) 16(6.0%)
99 167 266

C. Relationship Between Sleep Quality and Anxiety Levels 0.674) confirmed no statistically significant association
The crosstabulation of sleep quality and anxiety levels between gender and anxiety, indicating that gender was not a
reveals significant findings. Participants were divided into predictor of anxiety severity in this sample.
two categories: "Good Sleepers" and "Poor Sleepers," and
their anxiety levels were assessed from "Normal" to G. Association Between Gender and Stress Levels
"Extremely Severe." The results indicate that most good Similarly, stress levels were assessed across genders.
sleepers exhibited normal anxiety levels, while poor sleepers While males and females exhibited varying counts across
showed a more varied distribution, with a significant number stress categories, the chi-square test (χ² = 3.846, p = 0.427)
falling into higher anxiety categories, including "Extremely showed no significant association between gender and stress
Severe" and "Severe." A chi-square test confirmed a levels. Therefore, gender does not appear to be a significant
statistically significant association between sleep quality and factor in predicting stress severity.
anxiety levels (p < 0.05), suggesting that poorer sleep is
linked to increased anxiety. H. Association Between Loneliness and Depression
A strong relationship was identified between feelings of
D. Association Between Gender and Sleep Quality loneliness and depression severity among University of
The crosstabulation between gender and sleep quality Hyderabad students. The chi-square test (χ² = 126.921, p <
showed that of the 99 female participants, 30 were good 0.001) indicated a statistically significant association between
sleepers and 69 were poor sleepers. Among the 167 male these variables, with students reporting frequent loneliness
participants, 73 were good sleepers and 94 were poor more likely to experience moderate to severe depression. This
sleepers. The chi-square test yielded a value of 4.710 with a suggests a dose-response relationship, where increasing
significance level of 0.030, indicating a statistically loneliness correlates with higher levels of depression.
significant association between gender and sleep quality. This
suggests that sleep quality differs significantly between males I. Association Between Living Conditions and Sleep Quality
and females, with females showing a higher proportion of Living conditions were significantly associated with
poor sleepers. sleep quality (p = 0.039). Students living with roommates had
the highest proportion of poor sleepers (101 out of 180),
E. Association Between Gender and Depression Severity compared to those living alone (35 out of 50) or with family
Depression severity, categorized as "Normal," "Mild," (27 out of 36). This suggests that living with roommates may
"Moderate," "Severe," and "Extremely Severe," was contribute to sleep disturbances.
examined across genders. Female participants displayed a
more balanced distribution across the severity levels, while J. Prevalence of Depression (PHQ-9)
male participants exhibited higher counts in the "Moderate" The prevalence of depression severity, based on PHQ-9
and "Normal" categories. However, the chi-square test (χ² = scores, showed that 71.43% of students experienced mild
5.386, p = 0.250) indicated no significant association between depression. A considerable proportion (41.35%) fell into the
gender and depression severity, suggesting that depression moderate depression category, while 22.18% reported
levels were not influenced by gender. moderately severe depression. Severe depression was noted
in 12.41% of students, indicating the need for targeted mental
F. Association Between Gender and Anxiety Levels health interventions within this population.
Anxiety levels were also compared across gender, but
no significant differences were observed. Both male and
female participants showed similar distributions across
anxiety severity levels. The chi-square test (χ² = 2.337, p =

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Volume 9, Issue 11, November – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

IV. DISCUSSION understanding these intricacies, public health practitioners

can develop targeted interventions and create supportive
Research conducted at King Saud Bin Abdul Aziz environments that promote holistic well-being and student
University for Health Sciences found strong positive success.
correlations between lower sleep quality and higher levels of
depression, stress, and anxiety.(Al-Khani et al., 2019) Current  Limitations:
study in University of Hyderabad also observed a moderate
level of sleep disturbance with a mean PSQI score of 6.52  Some participants were reluctant to spend 35 minutes
±2.75. Moreover, it was found that individuals with poor filling out the questionnaire due to its length.
sleep quality are more likely to experience higher levels of  The University of Hyderabad students as a study sample
anxiety, indicated by a mean anxiety score of 9.77. across multiple research projects this year have
contributed to participant disinterest, affecting the overall
In previous study findings showed that female students engagement and representation in this study.
showed significantly higher scores in psychological distress,
anxiety, stress scores and sleep quality, as compared to male V. CONCLUSION
students (Vuelvas-Olmos et al., 2022). In current study no
significant association between gender and depression, Based on the comprehensive assessment conducted on
anxiety, or stress levels. the sleep quality, anxiety levels, and mental health outcomes
among students at the University of Hyderabad, a deeper
The article "Social Network and Mental Health Among understanding of the challenges they face emerges. Sleep
Older Adults in Rural Uttar Pradesh, India: A Cross-Sectional quality among students appears to be moderately average,
Study" provides significant insights into the intricate with a mean PSQI score of 6.52, suggesting a moderate level
relationship between social networks and mental health of sleep disturbance. However, this moderate average masks
among older adults in rural India. (Singh et al., 2016) significant variability among students, as indicated by a
standard deviation of approximately 2.75. This variability
In a similar study investigating sleep quality and implies that while some students may experience relatively
psychological factors among Health Professions students or undisturbed sleep, others grapple with more severe sleep
the correlation between adolescent mental health and sleep disturbances. Particularly noteworthy is the influence of
quality during the COVID-19 pandemic in Indonesian rural living conditions on sleep quality, with students sharing
areas. (Moeis et al., 2023) accommodation with roommates reporting a higher
prevalence of poor sleep quality compared to those living
These studies collectively highlight the multifaceted alone or with family members. Anxiety levels among students
nature of mental health determinants, emphasizing the pivotal also present a complex picture. The mean anxiety score of
role of social connections, physical activity, and sleep quality approximately 9.77 indicates a prevalent experience of
in shaping mental well-being across diverse demographic anxiety, with a wide range of reported levels. While some
groups. While the findings underscore the importance of students report minimal anxiety, a significant proportion faces
addressing sleep disturbances and psychological issues to moderate to severe anxiety, suggesting varying degrees of
promote overall well-being, they also reveal the complexity psychological distress within the student population. This
of these relationships and the need for nuanced interventions variability underscores the need for tailored interventions to
tailored to specific populations and contextual factors. address individual needs effectively. The association between
Moreover, the limitations identified in these studies, such as sleep quality and anxiety levels further highlights the intricate
cross-sectional designs and reliance on self-reported data, interplay between these factors. Statistically significant
underscore the necessity for robust longitudinal research findings indicate that individuals with poor sleep quality are
methodologies to establish causal relationships and inform more likely to experience higher levels of anxiety,
targeted interventions effectively. Overall, these discussions emphasizing the importance of addressing both sleep
contribute to a deeper understanding of the interplay between disturbances and anxiety in promoting overall well-being.
social, environmental, and individual factors in shaping Mental health outcomes among University of Hyderabad
mental health outcomes, underscoring the imperative of students reveal a concerning prevalence of depression. The
comprehensive approaches to promote mental well-being majority of students report experiencing mild depression
across diverse populations. In this study ,the analysis of sleep (71.43%), with significant proportions also falling into the
quality distribution based on the Pittsburgh Sleep Quality categories of moderate
Index (PSQI) reveals a significant association between
gender and sleep quality, indicating potential gender-specific (41.35%) and moderately severe (22.18%) depression.
factors influencing sleep outcomes. However, the study finds Additionally, a notable subset of students faces severe
no statistically significant association between gender and depression (12.41%), indicating a considerable proportion
depression severity levels, as measured by the PHQ-9 scale, grappling with significant emotional distress that may impact
suggesting that other factors may play a more prominent role their academic performance and overall quality of life. The
in determining mental health outcomes. In summary, the observed association between feelings of loneliness and
study's findings offer valuable insights into the complex depression further underscores the complex nature of mental
interplay of demographic factors, sleep habits, and mental health challenges among students. Students reporting
health among University of Hyderabad students. By frequent feelings of loneliness tend to have higher counts in

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Volume 9, Issue 11, November – 2024 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

the moderate to severe depression categories, highlighting the [7]. Vuelvas-Olmos, C. R., Sánchez-Vidaña, D. I., &
importance of addressing social connectedness and support Cortés-Álvarez, N. Y. (2023). Gender-Based Analysis
networks as part of mental health initiatives. In conclusion, of the Association Between Mental Health, Sleep
these findings provide valuable insights into the multifaceted Quality, Aggression, and Physical Activity Among
nature of sleep quality, anxiety, and mental health outcomes University Students During the COVID-19 Outbreak.
among University of Hyderabad students. Effective Psychological reports, 126(5), 2212–2236.
interventions should adopt a holistic approach that considers https://doi.org/10.1177/00332941221086209
environmental, social, and psychological factors to promote [8]. Singh, L., Singh, P. K., & Arokiasamy, P. (2016).
overall well-being within the university community. By Social Network and Mental Health Among Older
prioritizing mental health resources and support services, the Adults in Rural Uttar Pradesh, India: A Cross-
university can create a nurturing environment that fosters Sectional Study. Journal of cross-cultural gerontology,
resilience and empowers students to thrive academically and 31(2), 173–192. https://doi.org/10.1007/s10823-016-
personally. 9286-0
[9]. Moeis, R. M., Kuswiyanto, R. B., Tarigan, R., Pandia,
ACKNOWLEDGEMENTS V., & Dhamayanti, M. (2023, July). Correlation
Between Adolescent Mental Health and Sleep Quality:
I would like to thank Md. Akula Mohammed Zunaid and A Study in Indonesian Rural Areas During the
few other friends from UoH who helped us during the data COVID-19 Pandemic. International Journal of
collection phase of the study in recruitment of participants. General Medicine, Volume 16, 3203–3210.
https://doi.org/10.2147/ijgm.s416076.
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