The mediating role of sleep quality and the moderating role of gender and grade in the association between academic stress and psychological health among adolescents in county-level areas of Liaoning Province, China

This study examined how academic stress is associated with psychological health among adolescents in county-level areas of Liaoning Province, China, and tested whether sleep quality mediates this association while gender and grade moderate key pathways. A total of 449 students from Grades 7-9 completed validated measures of academic stress, sleep quality (PSQI), and psychological health. Mediation and moderated mediation analyses were conducted using PROCESS (Model 4 and Model 22) with 5,000 bootstrap samples. Academic stress was positively associated with sleep problems (<i>r</i> = 0.446, <i>p</i> < 0.01) and psychological health problems (<i>r</i> = 0.584, <i>p</i> < 0.01), while sleep quality showed a strong association with psychological health (<i>r</i> = 0.699, <i>p</i> < 0.01). Sleep quality partially mediated the association between academic stress and psychological health [<i>β</i> = 0.55, <i>p</i> < 0.001; 95% CI (0.506, 0.920)]. Grade significantly moderated the stress-health link, with stronger associations observed in Grades 8 and 9 than in Grade 7 (<i>B</i> = -0.60, <i>p</i> < 0.05). Gender moderated the relationship between sleep quality and psychological health (<i>B</i> = -1.59, <i>p</i> < 0.05), indicating a stronger association for females.