Study on the association between sleep quality and anxiety-depression symptoms in school-aged children

Front Public Health. 2026 Oct 20;14:1927475. doi: 10.3389/fpubh.2026.1927475. eCollection 2026.

ABSTRACT

BACKGROUND: To analyze the short-term longitudinal associations between sleep-related problems and anxiety, depression and the coexistence of anxiety and depression in school-aged children, and to provide the epidemiological evidence for mental health surveillance and risk assessment.

METHODS: This study was part of a child and adolescent growth and development cohort in an urban district of Chongqing. Participants were recruited from grade 1-3 at three local primary schools. A total of 1,529 children (782 boys and 747 girls; average age = 8.00 ± 1.0 years) were included who completed two surveys. Sleep, anxiety, and depressive symptoms were assessed using the PSQI-5, GAD-7, and CDI-S, respectively. Binary logistic regression and multiple linear regression were used to examine the associations between baseline sleep levels, sleep change values (ΔPSQI), and follow-up emotional outcomes. Missing covariates were handled via multiple imputation.

RESULTS: The total scores of PSQI-5, GAD-7, and CDI-S at the follow-up were all lower than those at the baseline (p < 0.001). After adjusting for confounding factors and baseline emotional levels, a higher baseline PSQI independently predicted subsequent anxiety (OR = 1.144, p < 0.001), depression (OR = 1.097, p = 0.013), and coexisting symptoms (OR = 1.146, p = 0.003). The increases in ΔPSQI was positively associated with the aggravation of emotional symptoms (all p < 0.001).

CONCLUSION: Long-term poor sleep and decreased sleep quality may increase the risk of internalizing problems in school-aged children.

PMID:42978638 | PMC:PMC13727519 | DOI:10.3389/fpubh.2026.1927475