AbstractMethodsStudy design and measuresAnalysis planResultsSampleMultilevel model resultsCommentLimitationsConclusionsAcknowledgmentsConflict of interest disclosureFundingReferencesFull Terms & Conditions of access and use can be found athttp://www.tandfonline.com/action/journalInformation?journalCode=vach20Download by: [University of Illinois at Urbana-Champaign] Date: 09 November 2017, At: 08:10Journal of American College HealthISSN: 0744-8481 (Print) 1940-3208 (Online) Journal homepage: http://www.tandfonline.com/loi/vach20Multilevel analysis exploring the links betweenstress, depression, and sleep problems amongtwo-year college studentsDeshira D. Wallace, Marcella H. Boynton & Leslie A. LytleTo cite this article: Deshira D. Wallace, Marcella H. Boynton & Leslie A. Lytle (2017)Multilevel analysis exploring the links between stress, depression, and sleep problemsamong two-year college students, Journal of American College Health, 65:3, 187-196, DOI:10.1080/07448481.2016.1269111To link to this article: http://dx.doi.org/10.1080/07448481.2016.1269111Accepted author version posted online: 12Dec 2016.Published online: 12 Dec 2016.Submit your article to this journal Article views: 1318View related articles View Crossmark dataMAJOR ARTICLEMultilevel analysis exploring the links between stress, depression, and sleepproblems among two-year college studentsDeshira D. Wallace, MSPHa, Marcella H. Boynton, PhDa,b, and Leslie A. Lytle, PhDaaDepartment of Health Behavior, School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;bLineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USAARTICLE HISTORYReceived 8 September 2015Revised 4 August 2016Accepted 15 November 2016ABSTRACTObjective: This study explored the association of stress and depression with a multidimensionalsleep problems construct in a sample of 2-year college students. Participants: The sample consistedof 440 students enrolled in 2-year study from Fall 2011 to Fall 2013. Methods: Participants in anobesity prevention study completed surveys assessing sleep, stress, and depression at baseline, 4,12, and 24 months. Multilevel models predicting sleep problems were conducted to distinguishepisodic from chronic reports of stress and depression. Results: Participants were primarily women(68%), white (73%), young adults (M age D 22.8), with an average of 8.4 hours of sleep per night.Neither stress nor depression was predictive of sleep quantity; however, they were predictive ofsleep quality. Conclusions: Results show that sleep quality rather than sleep quantity may be thegreater health concern for young adults, suggesting that intervention programs targetingdepression, stress management, and healthy sleep patterns are warranted.KEYWORDSDepression; mental health;sleep problems; stress; youngadultsA plethora of evidence affirms the importance of suffi-cient sleep quantity and quality as critical determinantsof health and well-being.1,2Approximately 25% of USadults report insufficient sleep or rest at least half of thetime,3and the US government recently added sleephealth as a Healthy People 2020 objective. Insufficientsleep is associated with numerous health conditions,including increased risk of heart disease, high bloodpressure, diabetes, and adverse mental health status.4–8Evidence suggests that there is a correlation betweensleep quantity and body mass index (BMI); individualswho report fewer hours of sleep are more likely to beoverweight or obese.5,9However, causality remains inquestion due to the cross-sectional nature of the majorityof these studies.10Young adults appear to be particularly at risk forinsufficient sleep with evidence indicating that a largemajority of college students garner less than 8 hours ofsleep per night.11In 2011, one-third of young adultsreported insufficient sleep.3Poor sleep quality is also asalient health issue for college students12with a recentreport finding 70% of 4-year college students reportinginsufficient sleep.13Young adults may be particularlyvulnerable to both external and intrinsic factors that mayhinder both the quantity and quality of sleep.11Excessivealcohol use, caffeine use, and use of electronic mediabefore going to bed are all behaviors common in youngadults that have been implicated in negatively influenc-ing sleep.14,15Many young adults are living indepen-dently from their families for the first time and arelearning how to juggle time demands from school andwork, developing relationships, and taking on moreresponsibility.16These new stressors may influence over-all sleep quantity as well as quality.11,17Young adults are also vulnerable to negative affect andother emotional issues as they go through this importantlife stage transition, specifically depression and stress haverepeatedly been shown to have a strong correlation withboth sleep quantity and quality.8,18–23Based on NationalHealth Interview Surveys, reports of depressive symptomsamong young adults have been largely stable between 1998and 2011.24In 2011, 4% of young adults aged 18–24 yearsold, and 5% of 25-to 29-year olds reported two or moredepressive symptoms in the past month.24However, exam-ining young adults in a 2- and 4-year college context thatsame year revealed that 30% of college students reportedfeeling so depressed it was “difficult to function at sometime in the past year” (p. 11).25Risk factors for depressionamong young adults include poverty, stressful life events,maltreatment, and family dysfunction.26Studies amongcollege students have reported that sleep problemsincreased the risk of developing depressive symptoms, andCONTACT Deshira D., Wallace [email protected] Department of Health Behavior, University of North Carolina at Chapel Hill, 302 Rosenau Hall 135Dauer Drive CB7440, Chapel Hill, NC 27599, USA.© 2017 Taylor & FrancisJOURNAL OF AMERICAN COLLEGE HEALTH2017, VOL. 65, NO. 3, 187–196http://dx.doi.org/10.1080/074 48481.2016.1269111Downloaded by [University of Illinois at Urbana-Champaign] at 08:10 09 November 2017that depressed students are more likely to report sleepproblems than nondepressed individuals.18Stress has also been shown to be an important factorin predicting sleep quality.11A study by Lund et al11con-ducted with 4-year college students found that 64% oftheir participants reported that academic or emotionalstress adversely affected their sleep.