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Chou Fund of the Zhejiang University Education Foundation","award":["grant number 419600-11107"],"award-info":[{"award-number":["grant number 419600-11107"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,8,25]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the association between sleep quality and psychological resilience in a Chinese community-based cohort and assess the consistency of this association across two sleep measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cross-sectional analysis of baseline data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Community-based cohort in Hangzhou, China (2016\u20132019).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>10\u2009268 adults aged 18\u201380 years enrolled via quota sampling stratified by sex and age group. After excluding participants with missing data, analytic samples were 9781 (single-item measure) and 9780 (Pittsburgh Sleep Quality Index (PSQI)), owing to one additional missing response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measure<\/jats:title>\n                    <jats:p>Low psychological resilience, defined by a median split on a 9-item scale adapted from the Brief Resilience Scale and Connor\u2013Davidson Resilience Scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Poor sleep quality was associated with higher odds of low resilience across both measures (single-item measure, adjusted OR=1.5, 95%\u2009CI 1.3 to 1.6; PSQI, adjusted OR=1.5, 95%\u2009CI 1.4 to 1.7), after adjustment for demographic factors, socio-economic factors, mental health indicators and health behaviours. Interaction tests showed no evidence of effect modification by sex, age group, loneliness or depression history for the single-item measure (p&gt;0.05). For the PSQI, the association differed by loneliness (p&lt;0.05), with a larger magnitude of association among lonely participants (adjusted OR=2.1, 95%\u2009CI 1.6 to 2.7) than non-lonely participants (adjusted OR=1.5, 95%\u2009CI 1.3 to 1.6).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Poor sleep quality was consistently associated with low resilience across both measures. Because the design was cross-sectional, temporal direction cannot be established. Longitudinal and interventional studies are needed to establish temporal ordering, and intervention studies are needed to determine whether improving sleep increases resilience.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-121573","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T13:57:57Z","timestamp":1788962277000},"page":"e121573","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Sleep quality and psychological resilience: a cross-sectional study of community-dwelling adults in China"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9936-8934","authenticated-orcid":false,"given":"Eunhye","family":"Lee","sequence":"first","affiliation":[{"name":"Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, 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