Background: This study aimed to investigate disparities in sleep quality between sexual minority and heterosexual college students, and to examine the serial multiple mediation effects of interpersonal relationships and depressive symptoms on sexual minority disparities in sleep quality. We also explored the sex differences in the mediating effects.
Methods: Data were drawn from the 2019 School-based Chinese College Students Health Survey using a multi-stage, stratified-cluster, random-sampling method to examine the risk factors of sleep disparities and the mediation effects. Measures included sexual orientation, perceived interpersonal relationships (i.e., family, teachers, and peer relationship), depressive symptoms, sleep quality, and other covariates.
Results: Of all the college students in the analysis, 95.8% were heterosexual, 4.2% were sexual minorities. In the adjusted model without mediation, sexual minority students were at a higher risk of poor sleep quality (P < 0.001). Serial multiple mediation analysis revealed that: both interpersonal relationships and depressive symptoms mediated the link between sexual orientation and sleep quality; a serial indirect pathway (i.e., sexual orientation → interpersonal relationships → depressive symptoms → sleep quality) existed. Moreover, the serial indirect pathway might be moderated by sex.
Limitations: Causal inference is limited due to the cross-sectional design.
Conclusions: Interventions to prevent or manage sleep disorders of sexual minority college students may yield better results if they consider the effects of improving interpersonal relationships and depression symptoms comprehensively than targeting sleep problems alone.
Keywords: College students; Depressive symptoms; Interpersonal relationships; Sexual orientation; Sleep quality.
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