The mediating role of sleep quality and the moderating role of gender and grade in the association between academic stress and psychological health among adolescents in county-level areas of Liaoning Province, China

Overview

This study examined the pathways through which academic stress affects psychological health in adolescents from county-level areas in Liaoning Province, China. The research model tested sleep quality as a mediating mechanism and gender and grade as moderating factors in the stress-health relationship. The sample comprised 449 students in Grades 7-9 who completed validated instruments measuring academic stress, sleep quality using the Pittsburgh Sleep Quality Index, and psychological health outcomes.

Methods and approach

A cross-sectional design was employed with 449 adolescent participants from county-level regions. Participants completed validated self-report measures of academic stress, sleep quality, and psychological health. Statistical analysis utilized mediation and moderated mediation analyses through PROCESS macro (Model 4 and Model 22), with 5,000 bootstrap samples to generate confidence intervals and assess conditional indirect effects. Grade level and gender were examined as categorical moderators of key associations in the theoretical model.

Key Findings

Academic stress demonstrated significant positive associations with both sleep problems (r = 0.446, p < 0.01) and psychological health problems (r = 0.584, p < 0.01). Sleep quality exhibited a strong inverse association with psychological health difficulties (r = 0.699, p < 0.01). Sleep quality partially mediated the academic stress-psychological health pathway, with a standardized indirect effect of β = 0.55 (p < 0.001; 95% CI: 0.506-0.920). Grade significantly moderated the direct stress-health association (B = -0.60, p < 0.05), with Grades 8 and 9 demonstrating stronger associations than Grade 7. Gender moderated the sleep quality-psychological health relationship (B = -1.59, p < 0.05), with female adolescents showing stronger associations between sleep quality and psychological health outcomes.

Implications

Sleep quality represents a partially explanatory mechanism through which academic stress compromises psychological health in this adolescent population. The moderating effects of grade suggest that stress-health vulnerability increases across the middle secondary years, potentially reflecting cumulative academic and developmental pressures. The differential moderating effect of gender on the sleep-health pathway indicates that female adolescents may experience heightened psychological sensitivity to sleep disruption, warranting gender-differentiated intervention approaches. These findings suggest that sleep quality improvement may constitute an intervention target for mitigating psychological health consequences of academic stress, particularly in upper grades and for female students.