Poor sleep quality was consistently associated with higher odds of low psychological resilience across both a single-item measure and the Pittsburgh Sleep Quality Index in a large Chinese community-based cohort, after adjustment for demographic, socioeconomic, mental health, and health behaviour factors.
Key Findings
Results
Poor sleep quality was associated with higher odds of low psychological resilience using a single-item sleep measure.
Adjusted OR = 1.5 (95% CI 1.3 to 1.6) for the single-item sleep measure
Analytic sample size was 9,781 participants
Adjustment included demographic factors, socioeconomic factors, mental health indicators, and health behaviours
Low psychological resilience was defined by a median split on a 9-item scale adapted from the Brief Resilience Scale and Connor-Davidson Resilience Scale
Results
Poor sleep quality was associated with higher odds of low psychological resilience using the Pittsburgh Sleep Quality Index (PSQI).
Adjusted OR = 1.5 (95% CI 1.4 to 1.7) for the PSQI measure
Analytic sample size was 9,780 participants
The association was consistent with that found using the single-item measure
The same covariates were applied in adjustment as with the single-item measure
Results
The association between poor sleep quality and low resilience measured by the PSQI differed by loneliness status.
Interaction test for loneliness was statistically significant for the PSQI (p < 0.05)
Among lonely participants, adjusted OR = 2.1 (95% CI 1.6 to 2.7)
Among non-lonely participants, adjusted OR = 1.5 (95% CI 1.3 to 1.6)
The magnitude of association was larger among lonely participants than non-lonely participants
Results
No evidence of effect modification by sex, age group, loneliness, or depression history was found for the single-item sleep measure.
All interaction tests for the single-item measure yielded p > 0.05
Subgroups tested included sex, age group, loneliness, and depression history
This contrasts with the PSQI, for which loneliness did show significant effect modification
Methods
The study enrolled 10,268 community-dwelling adults aged 18–80 years in Hangzhou, China using quota sampling stratified by sex and age group.
Data were collected from a community-based cohort in Hangzhou, China between 2016 and 2019
Quota sampling was stratified by sex and age group
After excluding participants with missing data, analytic samples were 9,781 (single-item measure) and 9,780 (PSQI)
This was a cross-sectional analysis of baseline data
Conclusions
The cross-sectional design of the study prevents establishing the temporal direction of the association between sleep quality and psychological resilience.
The authors explicitly note that 'because the design was cross-sectional, temporal direction cannot be established'
The authors call for longitudinal and interventional studies to establish temporal ordering
Intervention studies are identified as needed to determine whether improving sleep increases resilience
What This Means
This research suggests that people who sleep poorly are about 50% more likely to have low psychological resilience compared to people who sleep well, based on data from nearly 10,000 adults living in Hangzhou, China. The finding held up consistently across two different ways of measuring sleep quality — a simple single question and a more detailed standardized questionnaire called the Pittsburgh Sleep Quality Index — even after accounting for factors like age, income, mental health history, and lifestyle habits. This consistency across two measures strengthens confidence in the relationship.
One notable finding is that the link between poor sleep and low resilience appeared stronger among people who reported feeling lonely. For lonely individuals, poor sleep was associated with more than twice the odds of low resilience, compared to about 1.5 times the odds for those who were not lonely. This suggests that loneliness may amplify the relationship between sleep problems and reduced ability to cope with stress, though the reasons for this are not yet clear.
Because this was a cross-sectional study — meaning data were collected at a single point in time — it is not possible to determine whether poor sleep causes lower resilience, lower resilience causes poor sleep, or some other factor drives both. The researchers highlight the need for future studies that follow people over time or test sleep interventions to better understand the direction of this relationship and whether improving sleep might help people become more psychologically resilient.
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Lee E, Chang C, Wu Y, Hu E, Myers A, Delzell E, et al.. (2026). Sleep quality and psychological resilience: a cross-sectional study of community-dwelling adults in China.. BMJ open. https://doi.org/10.1136/bmjopen-2026-121573