{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:26:37Z","timestamp":1791347197290,"version":"4.3.1"},"reference-count":88,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2020,8,11]],"date-time":"2020-08-11T00:00:00Z","timestamp":1597104000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005825","name":"National Institute of Food and Agriculture","doi-asserted-by":"publisher","award":["1012976"],"award-info":[{"award-number":["1012976"]}],"id":[{"id":"10.13039\/100005825","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011138","name":"AgBioResearch, Michigan State University","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/100011138","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Indiana University of Pennsylvania Faculty Incidental Research Support award","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clocks &amp; Sleep"],"abstract":"<jats:p>High levels of perceived stress and anxiety among university students are a global concern and are known to negatively influence sleep. However, few studies have explored how stress response styles, like psychological resilience and rumination, might alter these relationships. Using validated tools, perceived stress, anxiety, stress response styles, and sleep behaviors of undergraduate and graduate students from seven countries during the height of the COVID-19 pandemic were characterized in order to examine the relationships between these factors using mediation and moderation analyses. Students enrolled in universities in China, Ireland, Malaysia, Taiwan, South Korea, the Netherlands, and the United States were recruited in May 2020. A total of 2254 students completed this cross-sectional study. Perceived stress and anxiety were negatively associated with sleep quality through the mediation of rumination. Increased psychological resilience weakened the relationships between perceived stress and anxiety on sleep quality. The majority of students reported that COVID-19 negatively influenced their mental health and sleep quality but not sleep duration. Based on these results, university students would likely benefit from sleep education and mental health promotion programs that include trainings to increase psychological resilience and reduce rumination, particularly during times of increased stress.<\/jats:p>","DOI":"10.3390\/clockssleep2030025","type":"journal-article","created":{"date-parts":[[2020,8,11]],"date-time":"2020-08-11T09:28:57Z","timestamp":1597138137000},"page":"334-353","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":65,"title":["Increased Resilience Weakens the Relationship between Perceived Stress and Anxiety on Sleep Quality: A Moderated Mediation Analysis of Higher Education Students from 7 Countries"],"prefix":"10.3390","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0671-7817","authenticated-orcid":false,"given":"Chen","family":"Du","sequence":"first","affiliation":[{"name":"Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan Chong Hueh","family":"Zan","sequence":"additional","affiliation":[{"name":"Division of Nutrition and Dietetics, International Medical University, Kuala Lumpur 57000, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2456-1307","authenticated-orcid":false,"given":"Min Jung","family":"Cho","sequence":"additional","affiliation":[{"name":"Global Public Health, Leiden University College, 2595 DG The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8875-3239","authenticated-orcid":false,"given":"Jenifer I.","family":"Fenton","sequence":"additional","affiliation":[{"name":"Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pao Ying","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Food and Nutrition, Indiana University of Pennsylvania, Indiana, PA 15705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, Health, and Sport Science, Indiana University of Pennsylvania, Indiana, PA 15705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1369-5035","authenticated-orcid":false,"given":"Laura","family":"Keaver","sequence":"additional","affiliation":[{"name":"Department of Health and Nutritional Science, Institute of Technology Sligo, F91 YW50 Sligo, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0453-1207","authenticated-orcid":false,"given":"Chang-Chi","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Exercise and Health Sciences, University of Taipei, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4254-5247","authenticated-orcid":false,"given":"HeeSoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Human Services, Bowling Green State University, Bowling Green, OH 43403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7887-255X","authenticated-orcid":false,"given":"Mary-Jon","family":"Ludy","sequence":"additional","affiliation":[{"name":"Department of Public &amp; Allied Health, Bowling Green State University, Bowling Green, OH 43403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9137-3245","authenticated-orcid":false,"given":"Wan","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Public &amp; Allied Health, Bowling Green State University, Bowling Green, OH 43403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3424-3943","authenticated-orcid":false,"given":"Winnie Chee Siew","family":"Swee","sequence":"additional","affiliation":[{"name":"Division of Nutrition and Dietetics, International Medical University, Kuala Lumpur 57000, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4040-7529","authenticated-orcid":false,"given":"Jyothi","family":"Thrivikraman","sequence":"additional","affiliation":[{"name":"Global Public Health, Leiden University College, 2595 DG The Hague, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuo-Wei","family":"Tseng","sequence":"additional","affiliation":[{"name":"Department of Exercise and Health Sciences, University of Taipei, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Chin","family":"Tseng","sequence":"additional","affiliation":[{"name":"Department of Exercise and Health Sciences, University of Taipei, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6838-0105","authenticated-orcid":false,"given":"Robin M.","family":"Tucker","sequence":"additional","affiliation":[{"name":"Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI 48824, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,11]]},"reference":[{"key":"ref_1","first-page":"15","article-title":"Perceived stress and self efficacy among college students: A global review","volume":"5","author":"Varghese","year":"2015","journal-title":"Psychology"},{"key":"ref_2","first-page":"296","article-title":"Socio-demographic determinants and prevalence of depression, anxiety, and stress among Malaysian university students","volume":"43","author":"Talwar","year":"2017","journal-title":"J. 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