Changes in psychological inflexibility as a potential mediator of longitudinal links between college students’ sleep problems and depressive symptoms

Abstract

BackgroundSleep problems and depressive symptoms, including suicidal ideation, are strongly associated among undergraduate students. Although upwards of 60% of college students report sleep problems, the mechanisms through which sleep might be linked with students' depressive symptoms, and suicidal ideation in particular, would benefit from further clarification. Drawing upon a contextual behavioral science perspective, the current study sought to examine how changes in psychological flexibility/inflexibility might act as potential mediators between changes in college students’ sleep quality and depressive symptoms, including suicidal ideation. MethodsThe longitudinal (baseline and 2-month follow-up) online sample of 385 undergraduates (M = 20.0, SD = 1.6) was collected through a multi-site study during the Spring semester of 2019. ResultsAnalyses using the PROCESS macro to examine potential mediation mechanisms suggested that residual increases in sleep disturbance (assessed with the Pittsburgh Sleep Quality Index) were associated with residual increases in global psychological inflexibility (assessed with the Multidimensional Psychological Flexibility Inventory), which, in turn, were associated with residual increases in both depressive symptoms and suicidal ideation (assessed with the Patient Health Questionnaire-9) over the two months of the study. Subsequent analyses (i.e., secondary models) examining specific dimensions of inflexibility as possible mechanisms of change in depressive symptoms suggested that residual change in self-as-content, fusion, lack of contact with values, and inaction each helped to explain the links between changes in sleep disturbance and depressive symptoms. In contrast, only changes in fusion helped to explain the association between changes in sleep disturbance and suicidal ideation. ConclusionsUndergraduates' sleep disturbance was a significant predictor of their depressive symptoms and suicidal ideation via changes in their levels of psychological inflexibility. In addition to addressing students' sleep problems directly, it appears to be advantageous to decrease students’ levels of psychological inflexibility to attenuate the potential association between mental health problems and sleep disturbances typically experienced during college.