ASSOCIATION OF INSOMNIA AND ANXIETY AMONG THE UNDERGRADUATE STUDENTS OF DOCTOR OF PHYSICAL THERAPY AFFILIATED WITH KHYBER MEDICAL UNIVERSITY IN HAYATABAD PESHAWAR: A CROSS-SECTIONAL STUDY

Abstract

Objective: This study aimed to determine the prevalence of insomnia and anxiety and to examine their association ‎among undergraduate Doctor of Physical Therapy (DPT) students affiliated with Khyber ‎Medical University, Peshawar.

Study Design: A cross-sectional study was conducted.

Place and duration of study: The study was conducted at the Institute of Physical Medicine and Rehabilitation (IPM&R), ‎Rehman Medical Institute (RMI), and Mehboob Medical Institute (MMI).‎

Material and Methods: A cross-sectional study was conducted among 258 DPT students selected through non-‎probability convenience sampling from the Institute of Physical Medicine and Rehabilitation ‎‎(IPM&R), Rehman Medical Institute (RMI), and Mehboob Medical Institute (MMI). Data ‎were analyzed to determine the distribution of insomnia and anxiety severity levels and to ‎assess their association.‎

Results: Of the 258 participants, 74 (28.7%) were male and 184 (71.3%) were female. Sub-threshold ‎insomnia was the most prevalent category (39.9%), followed by moderate clinical insomnia ‎‎(28.7%), no insomnia (27.1%), and severe insomnia (4.3%). Regarding anxiety, 28.7% of ‎participants reported moderate anxiety, 27.1% mild anxiety, 22.9% minimal anxiety, and ‎‎21.3% severe anxiety. A statistically significant linear association was observed between ‎insomnia severity and anxiety levels (p = .000), indicating that higher insomnia severity was ‎associated with greater anxiety severity. Female participants demonstrated higher ‎prevalence rates of both insomnia and anxiety across all severity categories. Institutional ‎analysis revealed that sub-threshold and moderate insomnia were more frequently reported ‎among students from IPM&R and RMI.‎

Conclusion: Insomnia and anxiety are highly prevalent among undergraduate DPT students, with sub-threshold insomnia being the most common form. The findings demonstrate a significant positive association between insomnia severity and anxiety levels. Early identification and targeted interventions are recommended to reduce the psychological burden and improve academic performance among university students.

Keywords: Anxiety, Insomnia, Undergraduate Students of Doctor of Physical Therapy

https://doi.org/10.37939/jnah.v4i01.234
PDF

References

‎1.‎ Riemann D, Benz F, Dressle RJ, Espie CA, Johann AF, Blanken TF, et al. Insomnia disorder: ‎State of the science and challenges for the ‎future. Journal of sleep research. 2022;31(4):e13604.‎

‎2.‎ ‎Hertenstein E, Benz F, Schneider CL, Baglioni C. Insomnia—A risk factor for mental ‎disorders. Journal of sleep research. ‎‎2023;32(6):e13930.‎

‎3.‎ ‎van Straten A, Weinreich KJ, Fábián B, Reesen J, Grigori S, Luik AI, et al. The ‎prevalence of insomnia disorder in the general population: A ‎meta‐analysis. Journal of Sleep ‎Research. 2025;34(5):e70089.‎

‎4.‎ ‎Chowdhury AI, Ghosh S, Hasan MF, Khandakar KAS, Azad F. Prevalence of insomnia ‎among university students in South Asian Region: ‎a systematic review of studies. Journal of ‎preventive medicine and hygiene. 2021;61(4):E525.‎

‎5.‎ ‎Kale H, Zhdanava M, Pilon D, Sheehan J, Drissen T, Boonmak P, et al. Economic and ‎clinical burden of major depressive disorder with ‎insomnia symptoms in commercially and ‎Medicaid-insured adults in the United States: A retrospective matched cohort study. Journal of ‎‎affective disorders. 2025;372:653-64.‎

‎6.‎ ‎Li W, Liu Y, Tao R, Chen L, Liu Y, Mo D, et al. Association of insomnia with suicide ‎attempts in Chinese chronic schizophrenia patients ‎with and without autistic symptoms. BMC ‎psychiatry. 2025;25(1):604.‎

‎7.‎ ‎Jansson-Fröjmark M, Lindblom K. A bidirectional relationship between anxiety and ‎depression, and insomnia? A prospective study in the ‎general population. Journal of ‎psychosomatic research. 2008;64(4):443-9.‎

‎8.‎ ‎Casares MÁ, Díez-Gómez A, Pérez-Albéniz A, Lucas-Molina B, Fonseca-Pedrero E. ‎Screening for anxiety in adolescents: Validation of the ‎Generalized Anxiety Disorder ‎Assessment-7 in a representative sample of adolescents. Journal of Affective Disorders. ‎‎2024;354:331-8.‎

‎9.‎ ‎Errazuriz A, Avello-Vega D, Passi-Solar A, Torres R, Bacigalupo F, Crossley NA, et al. ‎Prevalence of anxiety disorders in Latin America: a ‎systematic review and meta-analysis. The ‎Lancet Regional Health–Americas. 2025;45.‎

‎10.‎ ‎Bauducco SV, Tillfors M, Özdemir M, Flink IK, Linton SJ. Too tired for school? The ‎effects of insomnia on absenteeism in adolescence. ‎Sleep Health. 2015;1(3):205-10.‎

‎11.‎ ‎Surani AA, Zahid S, Surani A, Ali S, Mubeen M, Khan RH. Sleep quality among ‎medical students of Karachi, Pakistan. J Pak Med Assoc. ‎‎2015;65(4):380-2.‎

‎12.‎ ‎Lemma S, Gelaye B, Berhane Y, Worku A, Williams MA. Sleep quality and its ‎psychological correlates among university students in ‎Ethiopia: a cross-sectional study. BMC ‎psychiatry. 2012;12(1):237.‎

‎13.‎ ‎Schlarb AA, Claßen M, Grünwald J, Vögele C. Sleep disturbances and mental strain in ‎university students: results from an online survey in ‎Luxembourg and Germany. International ‎journal of mental health systems. 2017;11(1):24.‎

‎14.‎ ‎Bayram N, Bilgel N. The prevalence and socio-demographic correlations of depression, ‎anxiety and stress among a group of university ‎students. Social psychiatry and psychiatric ‎epidemiology. 2008;43(8):667-72.‎

‎15.‎ ‎‎Manzar MD, Salahuddin M, Pandi-Perumal SR, Bahammam AS. Insomnia may mediate ‎the relationship between stress and anxiety: a cross-‎sectional study in university students. ‎Nature and Science of Sleep. 2021:31-8.‎

‎16.‎ ‎Mahmood-ul-Hassan AH, Sannan A, Nooz N, Ramay A, Huzaifa M, Zaidi SMJ, et al. ‎Prevalence of insomnia and anxiety in university ‎students during the COVID-19 lockdown: A ‎cross-sectional study. Journal of Fatima Jinnah Medical University. 2021;15(1):9-12.‎

‎17.‎ ‎Baklola M, Terra M, Al-barqi M, AbdulHusain YH, Asiri SA, Jadaan NS, et al. ‎Prevalence of insomnia among university students in Saudi ‎Arabia: a systematic review and ‎meta‑analysis. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. ‎‎2024;60(1):138.‎

‎18.‎ ‎Rangel TC, Raposo MCF, Rocha-Filho PAS. The prevalence and severity of insomnia in ‎university students and their associations with ‎migraine, tension-type headache, anxiety and ‎depression disorders: a cross-sectional study. Sleep Medicine. 2021;88:241-6.‎

‎19.‎ ‎Albikawi ZF, editor Fear related to COVID-19, mental health issues, and predictors of ‎insomnia among female nursing college students ‎during the pandemic. Healthcare; 2023: MDPI.‎ ‎

Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Copyright (c) 2026 Journal of Nursing and Allied Health