Exploring sex, residence type, and psychosomatic factors in the association between insomnia symptoms and stress-related outcomes among university students in Ghana

Insomnia has been associated with adverse stress-related outcomes among university students. However, evidence from Sub-Saharan Africa remains limited, and the factors underlying these associations are poorly understood. This study examined the associations between insomnia symptoms and stress-related outcomes among undergraduate students in Ghana and explored potential effect modification and mediating factors. We analyzed data from a cross-sectional survey of 1,047 students aged ≥ 18 years in Ghana. Insomnia symptoms were assessed using the Insomnia Severity Index, while perceived stress and academic stress were measured using validated scales. Parallel mediation and multivariable OLS regression models evaluated the associations. After full adjustment, insomnia symptoms were positively associated with higher perceived stress (B = 0.05, 95% CI: 0.03-0.08) and academic stress (B = 0.21, 95% CI: 0.18-0.24) scores. These associations varied by sex and place of residence, with significant associations observed for perceived stress among female students and students residing in urban areas. In the mediation models, self-rated health and physical inactivity statistically accounted for approximately 20% and 26% of the association between insomnia symptoms and perceived stress, and approximately 4% and 26% of the association with academic stress, respectively. Addressing stress-related issues among university students in Ghana may benefit from attention to insomnia symptoms, health status, and lifestyle behaviors.