The mediating role of anxiety in poor sleep quality and passive coping among adolescents

Abstract Background The increasing prevalence of poor sleep quality in children and adolescents highlights the essential role of quality sleep in promoting growth and development. Coping styles are associated with cognitive and behavioral adaptations to stress. However, their connection to sleep quality remains unclear. Methods In the summer of 2023, a cross-sectional survey was carried out among middle school students in Henan Province, China. The students were randomly chosen from five cities within the province, each representing varying economic levels, using a stratified random sampling approach. The questionnaire comprised inquiries regarding participants’ demographic details, along with assessments of sleep quality, anxiety levels, and coping styles. The Pittsburgh Sleep Quality Index (PSQI) was employed to gauge the sleep quality of middle school students. The Self-Rating Anxiety Scale (SAS) was used to evaluate the anxiety levels of participants. Additionally, coping styles were assessed using the Simplified Coping Style Questionnaire (SCSQ). The correlation coefficients among these three variables were calculated. The significance of the mediation effect was obtained using a bootstrap approach with SPSS PROCESS macro. Results This study included 592 middle school students, 76 (12.8%) had a poor sleep quality, while 23.0% showed signs of anxiety. Additionally, 54.6% of students employed passive coping styles in their daily lives. Spearman correlations analysis showed that poor sleep quality was positively correlated with anxiety (r = 0.583, P  < 0.01) and passive coping (r = 0.175, P  < 0.01). Anxiety was positively correlated with passive coping (r = 0.206, P  < 0.01). We validated the significance of the indirect effect of sleep quality mediated through anxiety(95% bootstrap CI  = 0.048, 0.112). The percentage of indirect effect was calculated to be 84.4%. The mediating role of anxiety in passive coping and poor sleep quality was established and was fully mediated. Conclusions The mediating effect of anxiety on passive coping and poor sleep quality was confirmed and found to be fully mediated. Passive coping style is associated with inadequate sleep quality and the occurrence of anxiety symptoms. Assessing the correlation between sleep quality and coping style among middle school students is crucial for developing effective health promotion strategies to improve students’ health.