The association between anxiety symptoms and sleep quality in people living with HIV/AIDS: the mediating effect of social support, psychological resilience and coping strategies.

OBJECTIVE: This cross-sectional observational study aimed to investigate the relationship between anxiety symptoms and sleep quality among people living with HIV/AIDS (PLWHA), and to examine the parallel mediating roles of social support, psychological resilience, and positive coping style in this association. METHODS: From October 2024 to February 2025, 241 PLWHA were recruited via convenience sampling. Participants completed standardized measures including the Athens Insomnia Scale, Generalized Anxiety Disorder Scale, and scales for depression, perceived social support, coping style, and psychological resilience. All basic demographic statistical analysis, correlation analysis and descriptive statistics were performed using SPSS 23.0. The parallel mediation analysis was performed using R software (version 4.4.2). RESULTS: The insomnia and non-insomnia groups differed significantly by age, educational level, employment status, and CD4+ T cell count (p < 0.05). Sleep quality scores were negatively correlated with social support scores (r=-0.299), positive coping scores (r=-0.313), and resilience scores (r=-0.411),and positively correlated with depressive symptom scores (r=0.693) and anxiety symptom scores (r=0.631), all p-values < 0.001. Depressive symptom scores were positively correlated with anxiety symptom scores (r=0.848) and negatively correlated with social support scores (r=-0.322), positive coping scores (r=-0.308), and resilience assessment scores (r=-0.393), all p-values < 0.001. Social support (effect size=0.037,95% CI: 0.010-0.080), positive coping style (effect size=0.050,95%CI:0.018-00.090), and psychological resilience (effect size=0.069,95%CI:0.035-0.110) partially mediated the relationship between anxiety symptoms and sleep quality, accounting for 7.2%,9.6%, and 13.3% of the total effect respectively. CONCLUSION: Social support, psychological resilience and positive coping style partially mediate the statistical association between anxiety symptoms and sleep quality among PLWHA. These three psychosocial protective factors are promising intervention targets for alleviating the adverse correlates of anxiety symptoms on sleep quality in this population.