Teens’ mental health, body mass index (BMI), and screen time are significantly associated with sleep quality, according to a new paper published June 10, 2026 in an open access journal. Pro Swan By Jianying Li et al. of Shanxi University, China. The study also found that girls and adolescents living in rural areas tended to have poorer sleep quality.
Sleep quality is increasingly recognized as an important lifestyle determinant of physical and mental health during adolescence, and poor sleep quality in adolescents is a growing public health concern. Factors such as screen use, sedentary behavior and mental health problems have been linked to poor sleep in young people, but there has been little systematic evaluation of how these factors interact with place of residence and gender. In China in particular, improving sleep quality and mental health has become a mainstream government focus, with programs like Healthy China 2030 prioritizing sleep time and the National Health Commission designating 2025-2027 as the Year of Child and Mental Health Services.
In the new study, researchers surveyed 5,713 adolescents between the ages of 13 and 18 in six Chinese cities: Shanghai, Suzhou, Taiyuan, Wuyuan, Xingyi, and Urumqi. They collected data on sleep quality using the Pittsburgh Sleep Quality Index (PSQI), as well as data on BMI, physical fitness, sedentary time, screen time, and mental health. Data on each participant’s place of residence (urban or rural) and gender were also available.
Overall, 33.71% of participants reported poor sleep quality. Mental health emerged as the strongest protective factor, with higher mental health scores associated with lower risk of poor prognosis across all sleep measures. The higher your BMI, the more time you spend sitting and looking at screens, the more likely you are to have poor sleep outcomes.
The researchers also found significant differences by place of residence and gender. Rural adolescents had a higher proportion of poor sleep quality than urban adolescents (35.78% vs. 31.90%, p<0.001) and had worse sleep onset latency, sleep duration, and sleep disturbances. Female adolescents performed worse than males on almost all sleep measures, with 38.40% of girls classified as having poor sleep quality compared to 29.20% of boys (p<0.001). Rurality and gender also moderate the effects of behavioral and health factors on sleep. The negative impact of high BMI on sleep was more pronounced in girls, while the protective effect of good mental health was stronger in rural adolescents.
This study is limited by its cross-sectional design, which does not allow for causal conclusions. Sleep quality and behavioral measures were assessed by self-report, which may have introduced bias, and nuances in daily sleep time, screen time, and sedentary time were not available.
The researchers conclude that Chinese adolescents and female adolescents living in rural areas may experience a greater burden from poor sleep quality, and that addressing screen time, BMI, and mental health may be key to improving sleep for adolescents overall.
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Reference magazines:
Kang, X, Others. (2026) Gender and residence differences in sleep quality among Chinese adolescents aged 13–18 years. Pro Swan. DOI: 10.1371/journal.pone.0349681. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0349681
