Around six in 10 people with schizophrenia attending outpatient treatment in Northwest Ethiopia experience poor sleep quality, with poor social support, younger age, poor medication adherence, and family history of mental illness identified as significant determinants.
Key Findings
Results
The overall prevalence of poor sleep quality in people with schizophrenia was 58.3%.
Prevalence was 58.3% with a 95% CI of 53.38 to 63%
This translates to approximately 'six in 10 people with schizophrenia' experiencing poor sleep quality
405 people with schizophrenia attending outpatient treatment at University of Gondar, Comprehensive and Specialized Hospital were recruited
Data were collected from 1 April to 30 May 2024 using systematic random sampling
Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI)
Results
Poor social support was the strongest factor associated with poor sleep quality, with poor support showing a tenfold increase in odds compared to good support.
Poor social support: AOR=10, 95% CI 5.7 to 17.8, p<0.05
Moderate social support: AOR=4.7, 95% CI 2.5 to 8.8, p<0.05
Social support was measured using the Oslo Social Support Scale
Both poor and moderate social support were independently and significantly associated with poor sleep quality
Results
Age less than 45 years was significantly associated with poor sleep quality in people with schizophrenia.
AOR=2.1, 95% CI 1.2 to 3.7, p<0.05
Younger patients (under 45 years) had approximately twice the odds of poor sleep quality compared to those 45 and older
Age was identified as an independent predictor after adjusting for other variables in binary logistic regression
Results
Poor medication adherence was significantly associated with poor sleep quality in people with schizophrenia.
AOR=1.9, 95% CI 1.8 to 3.1, p<0.05
Medication adherence was measured using the Medication Adherence Report Scale
Poor adherers had approximately 1.9 times the odds of poor sleep quality compared to those with good adherence
Results
A family history of mental illness was significantly associated with poor sleep quality in people with schizophrenia.
AOR=1.9, 95% CI 1.2 to 3.3, p<0.05
Having a family history of mental illness was associated with approximately 1.9 times the odds of poor sleep quality
This finding suggests a possible genetic or familial environmental contribution to sleep disturbances in schizophrenia
Methods
The study employed multiple validated instruments to assess sleep quality and its determinants in people with schizophrenia.
Pittsburgh Sleep Quality Index was used to measure sleep quality
Clinical Global Impression-Schizophrenia Scale was used to assess illness severity
Glasgow Antipsychotic Side-Effects Scale was used to measure antipsychotic side effects
Medication Adherence Report Scale and Oslo Social Support Scale were also administered
Data were collected via interviewer-administered questionnaire and chart review
What This Means
This research suggests that poor sleep is extremely common among people living with schizophrenia in Northwest Ethiopia, with nearly 6 out of every 10 patients in outpatient care experiencing poor sleep quality. The study surveyed 405 patients at a major hospital and used established questionnaires to measure sleep quality alongside factors like social support, medication adherence, and illness severity. This is notable because sleep problems are often overlooked in schizophrenia care, even though they can significantly worsen a person's quality of life and overall mental health.
The research identified several factors that were strongly linked to poor sleep. Patients who had little or no social support were dramatically more likely to sleep poorly — those with poor social support had ten times the odds of poor sleep compared to those with good support. Being younger than 45, not taking medications as prescribed, and having a family history of mental illness were also independently associated with worse sleep quality. These findings point to both social and clinical factors that could be targeted to improve sleep in this population.
This research suggests that healthcare providers treating people with schizophrenia should routinely screen their patients for sleep problems rather than treating sleep issues as a secondary concern. The particularly strong association with social support highlights that addressing social isolation and strengthening community connections may be a meaningful way to improve sleep outcomes. Improving medication adherence also appears important, reinforcing the need for patient education and support systems that help people stay on their treatment plans.
Rtbey G, Kelebie M, Kibralew G, Aderaw M, Endeshaw W, Fentahun S, et al.. (2026). Sleep quality and associated factors in people with schizophrenia in Northwest Ethiopia: a cross-sectional study.. BMJ open. https://doi.org/10.1136/bmjopen-2025-110820