Gender moderation in the association between academic stress, sleep quality, and adolescent mental health

Adolescent mental health has become a growing concern in China, with academic stress identified as a prominent risk factor. This cross-sectional study examined the associations among academic stress, sleep quality, and mental health in county-level areas of Liaoning Province, with particular attention to the mediating role of sleep quality and the stage-specific moderating effect of gender. A total of 2150 junior and senior middle school students completed standardized questionnaires measuring academic stress, sleep quality, and mental health. The findings revealed that academic stress was significantly associated with poorer mental health across both educational stages. However, the mediating role of sleep quality differed by stage. Sleep quality significantly mediated the association between academic stress and mental health among senior middle school students, but not among junior middle school students. Gender demonstrated stage-specific moderating patterns. Among senior middle school students, gender moderated the association between academic stress and sleep quality, with girls showing stronger stress-related sleep disruptions. Among junior middle school students, gender moderated the association between sleep quality and mental health, with girls being more vulnerable to the psychological effects of poor sleep.