Association Between Depression, Anxiety, and Stress and Sleep Quality Among University Students from Saudi Arabia: A Cross-Sectional Study

Introduction: Inadequate sleep is linked to increased mental distress, and mental disorders often impair sleep quality, suggesting a bidirectional relationship. University students are particularly vulnerable to mental health issues due to academic pressures and related personal experiences. This study assesses sleep quality among university students in Jazan, Saudi Arabia, and its association with depression, anxiety, and stress levels. Methods: A cross-sectional study was conducted among university students in online settings. The questionnaire collected demographic data, assessed anxiety, depression, and stress using the DASS-21, and measured sleep quality with the Pittsburgh Sleep Quality Index (PSQI). Statistical significance was tested using either Chi-squared tests or Fisher's exact tests and followed up by logistic regression to calculate the odds of poor sleep quality among the students according to the levels of depression, anxiety, and stress. Results: Of 508 participating students, 74% reported poor sleep quality. A statistically significant association was found between poor sleep quality and the presence of anxiety, depression, and stress (all P<0.001). Abnormal stress levels were associated with higher odds of poor sleep 4.68 [2.8-7.7], followed by higher odds of poor sleep quality among students with anxiety 3.62 [2.38-5.52] and higher odds of poor sleep quality among students with depression 3.31 [2.1-4.99]. All seven PSQI components were significantly associated with depression, anxiety, and stress (P<0.05), except for sleep duration and stress, as well as sleep duration and depression, which had a marginally significant association (P=0.065). Depression showed a higher association with subjective sleep quality, daytime dysfunction, and sleep disturbances compared to stress and anxiety. Conclusion: The majority of university students in this study experienced poor sleep quality, which was significantly associated with higher levels of depression, anxiety, and stress. The study highlights the critical importance of addressing poor mental health in university students and its strong correlation with sleep quality.