Relationship Between Stressful Life Events and Sleep Quality: Rumination as a Mediator and Resilience as a Moderator

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Abstract

Purpose: The aim of this study was to investigate the relationship between stressful life events and sleep quality and to probe the role of rumination and resilience in the relationship.

Method: The Adolescent Self-Rating Life Events Checklist, Ruminative Responses Scale, Connor–Davidson Resilience Scale, and Pittsburgh Sleep Quality Index were used among 1,065 college students. Statistical Product and Service Solutions (SPSS) 20.0 and the SPSS macro Process, which were specifically developed for assessing complex models including both mediators and moderators, were used to analyze the data.

Results: High scores of stressful life events predicted worse sleep quality. Rumination partially mediated the relations between stressful life events and sleep quality. Resilience moderated the direct and indirect paths leading from stressful life events to sleep quality.

Conclusions: The results demonstrate that stressful life events can directly affect the sleep quality of college students and indirectly through rumination. Additionally, increasing psychological resilience could decrease both the direct effect and the indirect effect of stressful life events affecting sleep quality. The results of this study may contribute to a better understanding of the effects, as well as the paths and conditions, of stressful life events on sleep quality in college students. Moreover, these findings can provide constructive suggestions for improving college students’ sleep quality.

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Most cited references 40

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Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC).

Kathryn M Connor, Jonathan Davidson (2003)

Resilience may be viewed as a measure of stress coping ability and, as such, could be an important target of treatment in anxiety, depression, and stress reactions. We describe a new rating scale to assess resilience. The Connor-Davidson Resilience scale (CD-RISC) comprises of 25 items, each rated on a 5-point scale (0-4), with higher scores reflecting greater resilience. The scale was administered to subjects in the following groups: community sample, primary care outpatients, general psychiatric outpatients, clinical trial of generalized anxiety disorder, and two clinical trials of PTSD. The reliability, validity, and factor analytic structure of the scale were evaluated, and reference scores for study samples were calculated. Sensitivity to treatment effects was examined in subjects from the PTSD clinical trials. The scale demonstrated good psychometric properties and factor analysis yielded five factors. A repeated measures ANOVA showed that an increase in CD-RISC score was associated with greater improvement during treatment. Improvement in CD-RISC score was noted in proportion to overall clinical global improvement, with greatest increase noted in subjects with the highest global improvement and deterioration in CD-RISC score in those with minimal or no global improvement. The CD-RISC has sound psychometric properties and distinguishes between those with greater and lesser resilience. The scale demonstrates that resilience is modifiable and can improve with treatment, with greater improvement corresponding to higher levels of global improvement. Copyright 2003 Wiley-Liss, Inc.

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Responses to depression and their effects on the duration of depressive episodes.

Susan Nolen-Hoeksema (1991)

I propose that the ways people respond to their own symptoms of depression influence the duration of these symptoms. People who engage in ruminative responses to depression, focusing on their symptoms and the possible causes and consequences of their symptoms, will show longer depressions than people who take action to distract themselves from their symptoms. Ruminative responses prolong depression because they allow the depressed mood to negatively bias thinking and interfere with instrumental behavior and problem-solving. Laboratory and field studies directly testing this theory have supported its predictions. I discuss how response styles can explain the greater likelihood of depression in women than men. Then I intergrate this response styles theory with studies of coping with discrete events. The response styles theory is compared to other theories of the duration of depression. Finally, I suggest what may help a depressed person to stop engaging in ruminative responses and how response styles for depression may develop.

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A cognitive model of insomnia.

A.G. Harvey (2002)

Insomnia is one of the most prevalent psychological disorders, causing sufferers severe distress as well as social, interpersonal, and occupational impairment. Drawing on well-validated cognitive models of the anxiety disorders as well as on theoretical and empirical work highlighting the contribution of cognitive processes to insomnia, this paper presents a new cognitive model of the maintenance of insomnia. It is suggested that individuals who suffer from insomnia tend to be overly worried about their sleep and about the daytime consequences of not getting enough sleep. This excessive negatively toned cognitive activity triggers both autonomic arousal and emotional distress. It is proposed that this anxious state triggers selective attention towards and monitoring of internal and external sleep-related threat cues. Together, the anxious state and the attentional processes triggered by it tricks the individual into overestimating the extent of the perceived deficit in sleep and daytime performance. It is suggested that the excessive negatively toned cognitive activity will be fuelled if a sleep-related threat is detected or a deficit perceived. Counterproductive safety behaviours (including thought control, imagery control, emotional inhibition, and difficulty problem solving) and erroneous beliefs about sleep and the benefits of worry are highlighted as exacerbating factors. The unfortunate consequence of this sequence of events is that the excessive and escalating anxiety may culminate in a real deficit in sleep and daytime functioning. The literature providing preliminary support for the model is reviewed and the clinical implications and limitations discussed.

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Author and article information

Contributors

Yukun Li: URI : https://loop.frontiersin.org/people/650975

Simeng Gu: URI : https://loop.frontiersin.org/people/570342

Zhutao Wang: URI : https://loop.frontiersin.org/people/728503

Hongfan Li: URI : https://loop.frontiersin.org/people/731208

Fushun Wang: URI : https://loop.frontiersin.org/people/231320

Jason H. Huang: URI : https://loop.frontiersin.org/people/236960

Journal

Journal ID (nlm-ta): Front Psychiatry

Journal ID (iso-abbrev): Front Psychiatry

Journal ID (publisher-id): Front. Psychiatry

Title: Frontiers in Psychiatry

Publisher: Frontiers Media S.A.

ISSN (Electronic): 1664-0640

Publication date (Electronic): 27 May 2019

Publication date Collection: 2019

Volume: 10

Electronic Location Identifier: 348

Affiliations

[1] ¹Department of Psychology, School of Medicine, Jiangsu University , Zhenjiang, China

[2] ²Department of Encephalopathy, Lianyungang Affiliated Hospital, Nanjing University of Chinese Medicine , Lianyungang, China

[3] ³School of Psychology, Institute of Emotional Studies, Nanjing University of Chinese Medicine , Nanjing, China

[4] ⁴Department of Neurosurgery, Baylor Scott & White Health , Temple, TX, United States

Author notes

Edited by: Baoman Li, China Medical University, China

Reviewed by: Huihua Deng, Southeast University, China; Jianhui Wu, Chinese Academy of Sciences, China

*Correspondence: Guangkui Feng, lygfgk@ 123456163.com ; Fushun Wang, 13814541138@ 123456163.com ; Simeng Gu, gsm_2007@ 123456126.com

This article was submitted to Psychopharmacology, a section of the journal Frontiers in Psychiatry

†These authors have contributed equally to this work.

Article

DOI: 10.3389/fpsyt.2019.00348

PMC ID: 6545794

PubMed ID: 31191370

SO-VID: 28b03b70-2667-4381-a796-883c821dee86

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 23 January 2019

Date accepted : 02 May 2019

Page count

Figures: 1, Tables: 4, Equations: 0, References: 55, Pages: 9, Words: 4097

Funding

Funded by: Natural Science Foundation of Jiangsu Province 10.13039/501100004608

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Relationship Between Stressful Life Events and Sleep Quality: Rumination as a Mediator and Resilience as a Moderator

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Most cited references 40

Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC).

Responses to depression and their effects on the duration of depressive episodes.

A cognitive model of insomnia.

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Cited by 37

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