In the Presence of a Sleep Disturbance, Stressful Life Events Increase Risk for Anxiety and Depression

Elderly man sitting on bed looking serious – Indoors
Researchers examined how the associations of life event stress with impulsivity, anxiety, and depressed mood change in the presence of sleep disturbance.

People who report high levels of stress throughout life are more likely to report impulsivity and depressed mood if they also have an underlying sleep disorder, a study in Psychiatry Investigation suggests.

In this study, a total of 214 healthy participants (mean age, 38.96±10.53 years) from South Korea were asked to complete the Life Experience Survey (LES), Pittsburgh Sleep Quality Index (PSQI), 23-item Barratt’s Impulsivity Scale (BIS), 21-item Beck Anxiety Inventory (BAI), and 21-item Beck Depression Inventory (BDI) self-reported questionnaires. The LES examined participants’ experiences with stress across 60 major life events.

A PSQI score of >5 was used to define the presence of a sleep disturbance. Based on the results from the self-reported questionnaires, the researchers identified 127 participants who presented to the study with a sleep disturbance. The remaining 87 participants did not have a sleep disturbance upon study entry.

Participants who were considered poor sleepers had significantly greater mean negative LES (5.68±5.18 vs 4.39±4.87; P <.001), PSQI (9.06±3.01 vs 6.94±3.52; P <.001), BAI (11.29±8.62 vs 8.79±8.39; P <.001), and BDI (11.48±8.78 vs 8.55±8.09; P <.001) scores. Higher levels of life stress as determined by negative LES scores significantly correlated with BIS (r=0.22, P =.001), BAI (r=0.46, P <.001), and BDI (r=0.51, P <.001) scores.

Additionally, PSQI scores significantly correlated with anxiety (r=0.49, P <.001) and depression (r=0.60, p< 0.001) scale scores. In the moderation analysis, the researchers found statistically significant interactions between negative LES scores and sleep disturbances on the BIS (P =.044) and BDI (P =.014).

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Limitations of the study included the lack of an objective measure for sleep quality and characteristics as well as the potential for unmeasured comorbidities that could have also had an impact on depression and anxiety.

The researchers suggest that additional studies may need to look at “whether improving sleep quality by medication or by cognitive-behavioral intervention is beneficial for reducing the mental health problems associated with life event stress.”


Park I, Oh SM, Lee KH, et al. The moderating effect of sleep disturbance on the association of stress with impulsivity and depressed mood [published online March 5, 2020]. Psychiatry Investig. doi: 10.30773/pi.2019.0181