Investigation of the Relationship Between Perceived Stress and Sleep Hygiene in High School Students
Article information
Abstract
Background and Objective
This study aimed to conduct a descriptive study to examine the relationship between perceived stress and sleep hygiene in high school students.
Methods
The data required for the research were collected online between December 16, 2022 and March 10, 2023. The study group of the research consisted of high school students. An online survey method, a socio-demographic data collection form, Perceived Stress Scale (PSS), and Sleep Hygiene Index (SHI) were obtained from 219 high school students living in Hakkari, Turkey, who were selected by the convenience sampling method, one of the nonprobability sampling methods. The independent sample t-test, ANOVA analysis, and Pearson correlation test were used to analyze the data.
Results
A total of 51.1% of the participating high school students were boys, and 48.9% were girls. A total of 35.6% of the participating high school students were 16 years old, 27.4% were 17 years old, 21.5% were 15 years old, and 15.5% were 18 years old. It was found that there was no significant difference (p > 0.05) between the PSS subdimensions and the SHI scores of high school students according to the variables, such as age, high school type, and class status. It was found that there was a significant relationship among the gender variable, the PSS subdimensions, and the SHI scale (p < 0.05).
Conclusions
It can be concluded that factors, such as age, high school type, and class status, did not affect the relationship between perceived stress and sleep hygiene in high school students and that the gender variable had an effect on the relationship between perceived stress and sleep hygiene. It is recommended that research to examine the relationship between perceived stress and sleep hygiene should be performed by expanding the samples.
INTRODUCTION
Stress, anxiety, and depression are observed in people of developed and developing countries in different age groups and dimensions. Rapid changes in living conditions in modern societies have increased the risk level for adolescents (the 12–18 age group), and high school students also fall in the adolescent group, whom we consider as “healthy individuals.” There are studies in which professionals from many fields have contributed to developing strategies for coping with stress [1-4].
In a period when the roles of adolescents (the 12–18 age group) in the family, social, academic, and professional life are rapidly evolving, many factors, directly and indirectly, affect the process of being exposed to stress and coping with stress. The increase in competitive attitude over the years in education, work, and even social life puts the individual in a compulsory adaptation process. In cases where self-management and coping skills are inadequate, the emergence of anxiety, depression, and psychosomatic disorders is inevitable [5]. Environmental risk factors, inactivity, and musculoskeletal problems increase the perceived stress level and negatively affect sleep quality [6,7].
On the other hand, sleep is a multidimensional regeneration process, including physiological, psychological, and social factors. For this reason, sleep is affected by the positive/negative changes in the dimensions it covers. It has been observed that there is a decrease in the sleep duration due to environmental factors, especially in industrial societies. In a study, the rate of 5–6 hour sleep, classified as short sleep, was 18% [8]. In adolescents (the 12–18 age group), the inefficient use of time in social life and experience restricts sleep, which is a physiological need, consciously or unconsciously. With anxiety and stress accompanying this picture, a significant decrease in the sleep quality can be observed even if the sleep duration is sufficient [9]. Some studies have developed protective and preventive approaches for stress and sleep problems that adolescents (12–18 age group) frequently encounter, but these studies are lacking [10,11]. Since studies in the related field in the literature were generally performed in the adult and elderly groups, it was concluded that few studies have been conducted in adolescents.
This study was conducted to measure the perceived stress and sleep hygiene levels in high school students and to examine whether there is a relationship between them.
METHODS
A descriptive study was conducted to examine the relationship between perceived stress and sleep hygiene in high school students. The research data were collected using an online questionnaire (Google Form) between December 16, 2022 and March 10, 2023.
The research population comprised high school students. However, since reaching high school students living in Turkey is nearly impossible, this study was performed online. Students who were in secondary school and had access to the internet were included in the study. A questionnaire was used as a data collection technique in the research. The online questionnaire (Google Forms) was circulated over social networks and social media, and an attempt was made to reach many segments. The study’s sample size was calculated based on the number of variables used in multivariate data analysis. In this context, the sample of the research was selected from high school students living in Turkey by the convenience sampling method, one of the nonprobability sampling methods. The research was carried out in 219 students who met the conditions of study participation.
Ethical Approval
Permission was obtained from the Hakkari University Scientific Research and Publication Ethics Committee (IRB: 2022/106-1) for the research. Identity information was not obtained or shared in any way by the parents. Informed consent was obtained from the parents so as not to cause ethical violations within the scope of the research.
Inclusion/Exclusion Criteria for the Study
High school students who have received parental consent and have completed the consent forms are included in the study. However, other student groups, such as those who were not high school students, did not receive parental consent, or did not fill out the consent forms, have not been included.
Measures
Research data were collected using the socio-demographic data collection form, Perceived Stress Scale (PSS), and Sleep Hygiene Index (SHI).
Socio-demographic data collection form
This form consisted of 3 questions about the age, gender, and class status of adolescents studying in high school.
PSS
The PSS enquired about what the individuals thought and felt over the last month, and it consists of 10 items and measures their stress levels [12]. In the scale’s Turkish validity and reliability results [13], confirmatory factor analysis showed that a single-factor model did not fit the data. In contrast, a two-factor correlated model better fits the model and data. Significant moderate correlations were found between stress-related self-efficacy beliefs and stress-related feelings of helplessness and depression, anxiety, academic difficulties, relationship problems, and health problems. The internal consistency reliability coefficients for stress-related self-efficacy beliefs and stress-related feelings of helplessness were 0.68 and 0.85, respectively.
SHI
Mastin et al. [14] developed the SHI in 2006. Its Turkish validity and reliability were performed by Ozdemir et al. [15] in 2015. The survey consists of 13 questions. The questions are rated on a 5-point Likert scale (none: 1, rarely: 2, sometimes: 3, often: 4, and always: 5). The scale enables the evaluation of sleep behaviors that constitute sleep hygiene of the participants. Scores range from 13 to 65, with higher scores indicating poorer sleep hygiene in the participants. The Cronbach alpha value of the SHI was calculated to be 0.70, and it was found to be valid and reliable [15,16]. In our study, the Cronbach alpha value was found to be 0.52.
Variables of the Study
Age, gender, high school type and class status are dependent variables of the study. The relationship between perceived stress levels and sleep hygiene levels are independent variables of the study.
Statistics, SPSS 26.0 (IBM Corp., Armonk, NY, USA) package program was used to analyze the data. Independent sample t-test, ANOVA analysis, and Pearson correlation were used to examine the relationship between perceived stress and sleep hygiene in high school students.
RESULTS
High school students were included in the research; 51.1% of the high school students were boys, and 48.9% were girls. In terms of age distribution, 35.6% of the students were 16 years old, 27.4% were 17 years old, 21.5% were 15 years old, and 15.5% were 18 years old. In terms of the high school type, 38.8% of the students were in Anatolian high schools, 29.7% were in vocational high schools, 18.7% were in other schools, and 12.8% were in science high schools. In terms of the class, 33.8% of the students were in the 12th class, 23.3% were in the 10th class, 20.5% were in the 11th class, 11.4% were in the preparatory class, and 11.0% were in the 9th class (Table 1).
Distribution of demographic characteristics of high school students
The average score of the responses given to the PSS subdimension, stress-related self-efficacy beliefs, ranged from 0 to 16 points, with an average score of 9.92 ± 4.49 points. The average score of the responses to feelings of helplessness related to stress, which is the subdimension of the PSS, ranged from 3 to 21 points, with an average score of 12.03 ± 3.80 points. The average score of the responses to the SHI scale ranged from 13 to 65 points, with an average score of 37.67 ± 14.61 points (Table 2).
Distribution of Perceived Stress Scale subdimensions and sleep hygiene index scores
There was a significant difference among the gender factor of high school students’ PSS subdimensions, stress-related selfefficacy beliefs, feelings of helplessness related to stress, and SHI scores (p < 0.05) (Table 3).
Comparison of high school students’ Perceived Stress Scale subdimensions by the gender and Sleep Hygiene Index scores
There was no significant difference among the age groups of high school students’ PSS subdimensions, stress-related self-efficacy beliefs, feelings of helplessness related to stress, and SHI scores (p > 0.05) (Table 4).
Comparison of high school students’ Perceived Stress Scale subdimensions by the age and Sleep Hygiene Index scores
There was no significant difference among the high school students’ PSS subdimensions of stress-related self-efficacy beliefs, feelings of helplessness related to stress, and SHI scores compared to the high school types (p > 0.05) (Table 5).
Comparison of high school students’ Perceived Stress Scale subdimensions by the high school type and Sleep Hygiene Index scores
There was no significant difference among the high school students’ classroom situation and PSS subdimensions, stress-related self-efficacy beliefs, feelings of helplessness related to stress, and SHI scores (p > 0.05) (Table 6).
Comparison of high school students’ Perceived Stress Scale subdimensions by the class status and Sleep Hygiene Index scores
There was a significant relationship among the PSS subdimensions, stress-related self-efficacy beliefs, feelings of helplessness related to stress, and SHI. The SHI was significant compared to the other scale (p < 0.05) (Table 7).
Investigation of the relationship (r) between the Perceived Stress Scale subdimensions and the Sleep Hygiene Index scale
DISCUSSION
On examining the relationship between perceived stress and sleep hygiene in high school students, variables, such as age, gender, high school type, and class status, are essential. It was determined that the participating high school students were mostly male, and the age distribution was 16 years old and more students were studying in Anatolian high schools and 12th grade. According to the results of the study by Léger et al. [8] on the distribution of demographic characteristics of 12–18 year-old high school students, the prevalence and clinical definition of a short sleep study in a representative sample of 1004 adolescents (the 12–18 age group) from France and the socio-demographic information of young individuals in the study of sleep difficulty in young people were found to be similar [9].
It was determined that there was a significant difference in the PSS (subdimensions: stress-related self-efficacy beliefs and feelings of helplessness related to stress) and SHI scores of high school students according to their gender. In other words, it was concluded that the gender variable affected the relationship between perceived stress and sleep quality. This finding is similar to the results of the study by the American Academy of Pediatrics [17], in which stress levels differed according to the gender variable and indirectly affected the sleep. Likewise, in the pilot study by Bei et al. [18] on a mindfulness-based, multicomponent, in-school group sleep intervention in adolescent girls, it was found that girls slept better than boys, and it had a positive effect on their sleep quality due to low stress experienced by them during the day. Burgard and Ailshire [19] reported a gender difference among American adolescents (the 12–18 age group) in the study of gender and bedtime, and they found that girls had more regular sleep routines than boys, and that their stress levels during the day were reduced.
It was found that there was no significant difference in the scores of high school students’ PSS (subdimensions: stress-related self-efficacy beliefs and feelings of helplessness related to stress) and SHI according to the variables, such as age, high school type, and class status. This result shows that the related variables did not affect the stress and sleep quality of the students. In the study by Dahl and Lewin [20], it was determined that factors, such as age and schooling period of adolescents, did not affect their stress and sleep, but rather, the negative situations that young people experience during the day negatively affect their stress and sleep. In the study by Drake et al. [21] of stress-related sleep disorder and vulnerability to hyperarousal, it was concluded that the socio-demographic data did not affect the stress levels, but rather, problems in sleep patterns increased the stress levels. The results of the study on monitoring the effects of adolescent sleep loss in the middle school years [22] and the study on the effect of school diary program on adolescent sleep [23] are consistent with our findings. Likewise, the sleep deprivation results for students in the previous study of longitudinal relationships between sleep quality, time spent in bed, and adolescent problem behavior are similar to our findings [24,25].
A significant relationship was found between the PSS (subdimensions: stress-related self-efficacy beliefs and feelings of helplessness related to stress) and the SHI. In a qualitative research study on adolescents’ perceptions of healthy sleep in Tucson, AZ, USA [26], the authors suggested that the more days adolescents spend without stress and discomfort regarding their quality sleep habits, the more comfortable and peaceful they sleep. The study by Sadeh et al. [27] showed a significant relationship between stress and sleep. In the study by Sanford et al. [28], it was concluded that stress directly affects the sleep and it is significantly related. In another study by Tanner [29], it was concluded that they do not get enough sleep due to the stress they experience, they become tense during the day, and they cannot carry out their daily life activities in a healthy way. In the analysis of the study by van der Schuur et al. [30], it was stated that they could not get quality sleep due to the frequent use of social media for a long time, and their academic and social success was inadequate. In the study on the relationship between sleep, school burnout, and academic performance, which is disrupted due to social media use, the authors concluded that students were unhappy and unsuccessful, and their stress levels were increased due to the decrease in sleep quality [31]. The data between stress and sleep quality in the studies by Pascoe et al. [32] and Wang and Yip [10] showed parallelism with our findings. As a result, studies have supported the claim that there is a relationship between perceived stress and sleep hygiene.
Weakness and Strength
This study does not reflect the general population of high school students and is limited to high school students who voluntarily participated in the study and in whom parental consent was obtained. There are studies that developed protective and preventive approaches for stress and sleep problems that high school students often encounter, but these studies are inadequate. This study will guide and contribute to the literature.
Conclusions
In conclusion, stress and sleep affect high school students’ bio-psychosocial health, social relationships, daily activities, and family interactions in all aspects. As a result, it was concluded that there is a relationship between perceived stress and sleep hygiene, but it differs according to the variables (age, gender, type of high school, and class status). It is recommended that training and practices should be conducted for high school students to increase the sleep hygiene and quality and reduce stress. In future studies, it will be helpful to assess using samples representing the perceived stress and other sleep hygiene teaching levels to generalize the results.
Notes
Availability of Data and Material
The datasets generated or analyzed during the study are available from the corresponding author on reasonable request.
Authors’ Contribution
Conceptualization: all authors. Data curation: Çiğdem Müge Haylı, Emrah Felek. Formal analysis: Çiğdem Müge Haylı, Emrah Felek. Funding acquisition: Çiğdem Müge Haylı, Dilek Demir Kösem. Investigation: Çiğdem Müge Haylı, Dilek Demir Kösem. Methodology: Çiğdem Müge Haylı, Dilek Demir Kösem. Project administration: Çiğdem Müge Haylı. Resources: Çiğdem Müge Haylı, Dilek Demir Kösem. Software: Çiğdem Müge Haylı, Emrah Felek. Supervision: Çiğdem Müge Haylı, Emrah Felek. Validation: Çiğdem Müge Haylı. Visualization: Çiğdem Müge Haylı. Writing—original draft: Çiğdem Müge Haylı. Writing—review & editing: Çiğdem Müge Haylı.
Conflicts of Interest
The authors have no potential conflicts of interest to disclose.
Funding Statement
None
Acknowledgements
Permission was obtained via e-mail for the Perceived Stress Scale, which was validated and reliable in Turkish by Kaya et al. (2019), and the Sleep Hygiene Index (SHI) was validated and reliable in Turkish by Güzel Özdemir et al. (2015).
We thank all authors for their contributions.