Anxiety-induced sleep disturbance among Malaysian adolescents: findings from the 2022 National Adolescent Health Survey

Mental health problems among adolescents are an increasing public health concern, with anxiety frequently accompanied by sleep disturbance. However, nationally representative evidence on anxiety-induced sleep disturbance (AISD) among Malaysian adolescents remains limited. This study aimed to estimate the prevalence of AISD and identify its associated factors among Malaysian secondary school adolescents. Data were obtained from the 2022 National Health and Morbidity Survey (NHMS): Adolescent Health Survey, a nationwide cross-sectional survey employing a multistage stratified cluster sampling design. A total of 33,523 secondary school adolescents aged 13–17 years participated. Data were collected using a validated, self-administered questionnaire adapted from the World Health Organization Global School-based Health Survey (GSHS). AISD was assessed using the GSHS Sleep Loss Over Worry (SLOW) item. Adolescents who reported being unable to sleep because of worry “most of the time” or “always” during the previous 12 months were classified as having AISD. Factors associated with AISD were identified using complex sample multiple logistic regression. The prevalence of AISD was 12.9% (95% CI: 12.26–13.54). The prevalence was highest among Form Five students (16.3%) and Bumiputera Sabah adolescents (18.7%). In the multivariable analysis, depressive symptoms (aOR = 4.95, 95% CI: 4.42–5.54), loneliness (aOR = 2.96, 95% CI: 2.67–3.27), suicide attempts (aOR = 1.59, 95% CI: 1.39–1.81), verbal abuse at home (aOR = 1.42, 95% CI: 1.29–1.55), physical attacks (aOR = 1.33, 95% CI: 1.18–1.50), female sex (aOR = 1.26, 95% CI: 1.12–1.41), higher school grade, Bumiputera Sabah ethnicity, and lifetime drug use were independently associated with AISD. AISD is a common mental health concern among Malaysian secondary school adolescents. The findings highlight the importance of strengthening school-based mental health promotion, early identification, and psychosocial support, particularly for adolescents experiencing psychological distress and other associated risk factors. Future longitudinal studies are warranted to better understand the temporal relationships between AISD and its associated factors.