| Original Full Text | Frontiers in PsychiatryOPEN ACCESSEDITED BYDagmara Dimitriou,University College London, United KingdomREVIEWED BYMohammedamin Hajure Jarso,Madda Walabu University, EthiopiaGregory Siy Ching,National Chengchi University, Taiwan*CORRESPONDENCEMastewal Aschale Walemastieaschalew@gmail.comRECEIVED 07 December 2023ACCEPTED 09 July 2024PUBLISHED 15 August 2024CITATIONAschale Wale M, Reta Y, Addis H, Tarekegn R,Tafese M and Tsega Chekol A (2024)Predictors of insomnia amongundergraduate students at HawassaUniversity Sidama, Ethiopia, 2023:a facility-based cross-sectional study.Front. Psychiatry 15:1352291.doi: 10.3389/fpsyt.2024.1352291COPYRIGHT© 2024 Aschale Wale, Reta, Addis, Tarekegn,Tafese and Tsega Chekol. This is an open-access article distributed under the terms ofthe Creative Commons Attribution License(CC BY). The use, distribution or reproductionin other forums is permitted, provided theoriginal author(s) and the copyright owner(s)are credited and that the original publicationin this journal is cited, in accordance withaccepted academic practice. No use,distribution or reproduction is permittedwhich does not comply with these terms.TYPE Original ResearchPUBLISHED 15 August 2024DOI 10.3389/fpsyt.2024.1352291Predictors of insomnia amongundergraduate students atHawassa University Sidama,Ethiopia, 2023: a facility-basedcross-sectional studyMastewal Aschale Wale*, Yared Reta, Haymanot Addis,Rahel Tarekegn, Mintesnot Tafese and Aklile Tsega ChekolFaculty of Health Sciences, College of Medicine and Health Sciences, Hawassa University,Hawassa, EthiopiaBackground: Insomnia is a sleep disorder characterized by difficulty fallingasleep, staying asleep, or experiencing poor-quality sleep. People with thisproblem often have trouble falling asleep at night, wake up frequently duringthe night, and may wake up too early in the morning and feel tired and notrefreshed. This can lead to daytime fatigue, irritability, difficulty concentrating,and impaired functioning in their day-to-day activities. Study is scarce inresource-limited countries such as Ethiopia, particularly concerning the studysetting. As a result, this study aimed to assess the prevalence of insomnia and itsassociated factors among undergraduate students at Hawassa University.Methods: An institution-based cross-sectional study design was used. Astratified simple random sampling method was used among 398 studyparticipants. The data were collected using a structured self-administeredquestionnaire. The outcome variable was assessed by the insomnia severityindex (ISI). The data were then gathered by using the Kobo toolbox online andthen exported into the Statistical Package for Social Sciences version 27 toanalyze the data. Data cleaning and screening were conducted exclusively by theinvestigators. Descriptive statistics like frequency, percentages, and mean wereused. Bivariate and multivariate binary regression were performed. In multivariatebinary logistic regression, a p-value of<0.05 was identified as a significantlyassociated factor with the dependent variable.Results: Among 398 students who participated in the study, 81 (20.4%)experienced insomnia. Being female [adjusted odds ratio (AOR) = 2.98; 95%confidence interval (CI) 1.56–5.69], age (AOR = 3.06; 95% CI 1.11–8.45), mildanxiety symptom (AOR = 4.89; 95% CI 1.56–15.37), and mobile device use ≥30min just before going to sleep (AOR = 7.81; 95% CI 2.34–26.12) were significantlyassociated with insomnia.Conclusion: In this study, the prevalence of insomnia was one-fifth amonguniversity students, which is high when compared to another study at thenational level. There were significant associations between being female, age,frontiersin.org01Aschale Wale et al. 10.3389/fpsyt.2024.1352291Frontiers in Psychiatryanxiety symptoms, and mobile device use before going to sleep with insomnia.This indicates that there is a need to treat and prevent insomnia in collegestudents, emphasizing the necessity for mental healthcare and ethicaltechnology use.KEYWORDSsleep problem, prevalence, social media, Hawassa, undergraduate studentsBackgroundInsomnia is defined as difficulty initiating or maintaining sleepthat is associated with consequences of daytime activities and is notattributable to environmental circumstances or inadequateopportunity to sleep (1). It is characterized by chronicdissatisfaction with sleep quantity or quality that is associatedwith difficulty initiating and maintaining sleep, frequent nighttimeawakenings with difficulty returning to sleep, not getting anyrestorative or reviving sleep, and awakening earlier in themorning than desired. In the general community, it is the mostfrequent sleep problem. It affects 33% to 50% of the adultpopulation and 5% to 10% of the general population (2).Sleep disturbances are a common complaint among collegestudents worldwide, likely as a result of stress due to increasedacademic demands. Moreover, busy schedules, new socialopportunities, and a sudden change in the sleeping environmentcan be additional contributing factors (3). The transition from highschool to university presents many challenges, including leavinghome, increased independence, changes in peer groups, new socialsituations, maintenance of academic responsibilities, and increasedaccess to alcohol and drugs. Some students may cope more effectivelywith these stressors than others, and the latter may be at increasedrisk of developing insomnia. While recent research has helped toincrease the public understanding of the importance of good sleepbehaviors in young adults, a thorough investigation of insomnia andits correlation to university students is still lacking (4).People with poor sleep quality are more likely to experiencephysical and psychosocial health problems, as well as lack ofconcentration, fatigue, irritability, anxiety, and depression (5).People with insomnia often report having difficulties withinitiating and maintaining sleep, early morning awakenings, andsleep that is not refreshing. The high incidence of the condition isnot helped by a prevailing attitude among many patients thatinsomnia is only one of the many challenges of life and istherefore not a “real” health problem that necessitatesconsultation with medical professionals (6).Insomnia has notable consequences with regard to learningability and academic success in higher education. It is associatedwith a higher risk of failed examinations and experiencing delayedstudy progress (5). Up to 60% of all college students suffer from02poor sleep quality, and 7.7% meet all criteria of an insomniadisorder. Sleep problems have a great impact on the student’sdaily life such as the student’s grades, regular daytime routines,chronotype changes, side jobs, and exam periods (7). Inadequatesleep leads to increased drowsiness and daytime sleepiness, whichsubsequently decreases mental alertness and concentration. Thiscan affect the ability to deal with tasks involving problem-solving,memory, and attention to detail. Thus, students who suffer fromsleep disorders are at a higher risk of failing academically, withlower grade point averages (GPAs) of<2.0 (8).On the one hand, physiological factors, schooling, and workschedules affect sleep quality. On the other hand, poor sleep qualityaffects human cognitive functions, such as information processing,learning, and the integration of intellectual records. Poor sleepquality is highly correlated with poor academic performance andreduced learning ability to perform basic activities, such as solving amathematical problem. Other detrimental effects of poor sleepquality include reduced memory, reduced cognitive ability, risk ofsuicide, mental problems, and poor sleep hygiene practices (3).The prevalence of insomnia in various countries was found tobe 40.8% among medical students in Pakistan (9), 12.1% atuniversities in the Netherlands (10), 19.3% at Jazan University(11), 32.5% at universities in Nigeria (12), and 61.6% at DebreBerhan University (3).The purpose of this study is to assess the prevalence of insomniaand its associated factors among undergraduate students at HawassaUniversity by answering the following questions: What is theprevalence of insomnia in university students? Is there anassociation between the outcome variable and explanatory variables?Materials and methodsStudy area, period, and designAn institution-based cross-sectional study was conducted fromJuly to August 2023 at Hawassa University located in Hawassa City,Sidama region, Ethiopia. The city is 285 km away from AddisAbaba, the capital city of the country. Hawassa University has sevencampuses, namely, the main campus, the Institute of Technology,the College of Agriculture, the College of Medicine and Healthfrontiersin.orgAschale Wale et al. 10.3389/fpsyt.2024.1352291Sciences, the Daye Campus, the Wondo Genet College of Forestryand Natural Resources, and the Awada Campus. Data werecollected from three randomly selected campuses: the maincampus, the College of Agriculture, and the College of Medicineand Health Sciences.Study populationAll undergraduate students currently enrolled at HawassaUniversity were the source population. All randomly selectedundergraduate students during the data collection period were thestudy population.Inclusion and exclusion criteriaAll regular undergraduate students who enrolled in the secondsemester at Hawassa University at the selected campuses and whoare available during the data collection period were included in thestudy, while students who are on an annual break, practice, andstudents who have no smartphones to complete the questionnairewere excluded from the study.Sample size determination and procedureThe sample size was determined by using a single proportionalformula under the following assumptions: a proportion of 61.6%from a previous study in Ethiopia at Debre Berhan University (3)with a 5% margin of error at 95% confidence interval (CI).n =(za=2)2p(1 − p)d2, n =(1:96)2½0:62(1 − 0:62)(0:05)2= 362The final sample size was 398 after adding a 10% non-response rate.A stratified sampling technique was employed. First, threecolleges were chosen using a simple random sampling techniqueusing 40%. The registrar of each college provided an updatedsampling frame of students in each department. The frameworkcontained student names, sexes, departments, and student IDs.According to the information obtained from the registrar’s office,there were a total of 27,146 students on three campuses (23,062students were from the main campus, 2,714 students were from theCollege of Medicine and Health Sciences, and 1,370 students werefrom the College of Agriculture). Proportional allocation was donefor the three campuses (the main campus, the College of Medicineand Health Sciences, and the College of Agriculture) using a simplerandom sampling method based on the sample size. Then, weselected a proportional number of students from each stratum, inwhich we first made several lists of all units (sampling frame); a totalof 27,146 students (23,062 from the main campus, 2,714 from thereferral campus, and 1,370 from the agriculture campus) and 398participants will be selected by using the lottery method (338students from the main campus, 40 students from the referralFrontiers in Psychiatry 03campus, and 20 students from the agriculture campus byproportional allocation).Data collection toolThe data were collected by three BSc Psychiatry nursingprofessionals using a semi-structured self-administeredquestionnaire through the Kobo toolbox. The questionnaire hasfive sections. The first part included the socio-demographiccharacteristics of the study participants. The second part is theinsomnia severity index, which is a brief screening assessment tooldesigned to evaluate insomnia. The insomnia severity index is aseven-item self-report tool used to evaluate the type, severity, andeffects of insomnia (13, 14). The dimensions assessed the severity ofsleep onset, maintenance, early morning awakening problems, sleepdissatisfaction, and interference of sleep difficulties with the sevenitems. The ISI is a self-report tool used to evaluate the type, severity,and effects of insomnia. Each question is rated on a five-point Likertscale (0 = no difficulty; 4 = extremely severe problem). Items areadded together to get the final score, which can range from 0 to 28.The interpretation of the total score is as follows: 0–7 indicates noinsomnia; 8–14 indicates sub-threshold insomnia; 15–21 indicatesmoderate insomnia; and 22–28 indicates severe insomnia (13, 15).This survey can be used for both screening and evaluating theeffectiveness of treatments in clinical trials (13). Higher scorescorrespond to a more severe feeling of sleeplessness. It is valid inthe Ethiopian adult population with moderate to significant item-total ISI score correlations (r = 0.47), as well as internal homogeneityand consistency (Cronbach’s alpha = 0.68 and 0.78) (16).The third section contains the Hospital Anxiety and DepressionScale (HADS). It is a 14-item scale with seven items for each anxietyand depression subscale. HADS is validated and used in Ethiopia(17, 18). Scoring for each item ranges from 0 to 21. A subscale >8denotes anxiety or depression (19, 20). Mobile-related sleep riskfactors (MRSRF) are questionnaire items that focus on the totalduration of mobile use per day, using a mobile device while in bedwhen the lights have been turned off, using blue light filters onmobile phones, keeping the mobile device under the pillow, keepingthe mobile device 2 m away from the bed, and putting the mobiledevice on airplane mode while sleeping (21). These have been usedin previous studies (22–25). The fourth section contains theAlcohol, Smoking, and Substance Involvement Screening Test(ASSIST), which was developed under the auspices of the WorldHealth Organization (WHO) by an international group of addictionresearchers and clinicians in response to the overwhelming publichealth burden associated with psychoactive substance useworldwide. It is an eight-item questionnaire and a risk score isdetermined for each substance by discussion with clients about theirsubstance use. The score obtained for each substance falls into a“lower”, “moderate”, or “high” risk category, which determines themost appropriate intervention for that level of use (“no treatment”,“brief intervention”, or “referral to specialist assessment andtreatment”, respectively) (26). It is utilized in Ethiopia (27).frontiersin.orgAschale Wale et al. 10.3389/fpsyt.2024.1352291Data quality measureTo ensure the quality of the data, special attention was taken byensuring that the students clearly understood the instructions aboutanswering the questionnaire and written informed consent wasgiven to the study participants. The participants were also informedthat they would not be forced to do anything against their choiceand that their information was kept completely secret. Moreover,before and throughout data processing, the information waschecked for completeness, accuracy, and clarity as well as forcorrect collection and recording. The questionnaire was pre-testedamong 5% of graduate students at the IOT campus 2 weeks beforethe actual data collection period. The internal consistency(Cronbach’s alpha) of the tool in this study was 0.886.Data processing and analysisThe data were checked for completeness and consistency andthen coded. The coded data were loaded into the Statistical Packagefor Social Sciences version 25 and analyzed using it. Bivariate andmultivariate binary regression were performed. In binary logisticregression, variables with p-value< 0.25 were candidates formultivariate logistic regression. Statistical significance wasdeclared at a 95% CI when variables have a p-value< 0.05 in themultivariate analysis with premenstrual dysphoric disorder. Finally,a compiled result was presented in the form of text, tables, andgraphs of the characteristics of the study subjects.Operational definitionInsomnia: Students who scored >15 on the insomnia severityindex have insomnia (28).Common mental illness: using HADS, students who scored ≥8have depression and anxiety (19).Substance use: using ASSIST, students who scored 0–3 (0–4 forcannabis) need brief education, those who scored 4–26 (5–26 forcannabis) need brief intervention, and those who scored 27+ needbrief intervention offer options that include treatment (29).ResultsSocio-demographic characteristicsof respondentsFrom the total number of 398 distributed questionnaires forstudy participants, all were filled out completely and consistentlywith a response rate of 100%. Out of this, more than half of theparticipants (216, 54.3%) were men. The minimum and maximumage of the participants was 18 and 28, respectively, with a mean ageof 22.22. More than one-third of the participants (158, 39.7%) wereorthodox religious followers. Nearly three-fourths (283, 71.1%) ofthe participants were single (Table 1).Frontiers in Psychiatry 04Common mental illness-related factorsFrom the 398 participants, more than two-thirds (271, 68.1%)had depression symptoms and 281 (70.6%) of them had anxietysymptoms (Table 2).Social media-related factorsMore than three-fourths of the participants (356, 89.4%) usetheir mobile device just before going to sleep, and from theseparticipants, 198 (49.7%) use their mobile device for ≥30 min justTABLE 1 Socio-demographic characteristics of undergraduate studentsat Hawassa University Hawassa, Southern Ethiopia, 2023 (n = 398).Variables Categories Frequency Percentage(%)Sex Male 216 54.3Female 182 45.7Age 18–22 320 80.423–28 78 19.6Religion Orthodox 158 39.7Muslim 68 17.1Protestant 122 30.7Catholic 41 10.3Other* 9 2.3Studentmarital statusSingle 283 71.1In a relationship 106 26.6Married 9 2.3Parentalmarital statusLiving together 246 61.8Divorced 74 18.6Widowed 61 15.3Both lostin death17 4.3Residency Dormitory 241 60.6Home 125 31.4Rent house 32 8Field of study Natural andcomputationalscience188 47.2Law 81 20.3Otherhealth science25 6.2Agriculturalscience20 5.02Medicine 15 3.5Other** 69 17.58*Jehovah’s witness and atheist; **Journalism, hotel management, special needs, and sociology.frontiersin.orgAschale Wale et al. 10.3389/fpsyt.2024.1352291before going to sleep. More than three-fourths of the participants(355, 89.2%) keep their mobile device on their bed near their pillow.Nearly two-thirds of the participants (259, 65.1%) use a blue lightfilter or night mode on their mobile device. Three-fourths of theparticipants (305, 76.6%) do not put their mobile device on airplanemode while sleeping (Table 3).Substance-related factorsOf the total participants, more than half (231, 58%) never usedany substance in their lifetime while more than one-fifth (89, 22.4%)of the participants used alcohol (Table 4).Prevalence of insomniaAmong 398 students who participated in the study, 20.4% [95%CI 16.3–24.1] experienced insomnia. Psychoeducation about goodsleep hygiene was given to those students experiencing such aproblem (Figure 1).Factors associated with insomniaTo investigate the association of independent variables withinsomnia, both bivariate and multivariate binary analyses wereused. In the bivariate binary logistic regression analysis, sex, age,parental marital status, depression, anxiety, use of mobile phonejust before going to sleep when the lights have been turned off,duration of mobile phone use just before going to sleep, and usingFrontiers in Psychiatry 05blue light filters or night mode were the candidates for multivariatelogistic regression to adjust the possible confounders with a p-valueof ≤0.25. However, sex, age, anxiety, and duration of mobile phoneuse just before going to sleep had a p-value of<0.05 in multivariateb i n a r y l o g i s t i c r e g r e s s i on and we r e f ound t o b estatistically significant.Female students were three times more likely to developinsomnia than male students [adjusted odds ratio (AOR) = 3.09;95% CI 1.62–5.89]. Students who belong to the 18–22 age group areapproximately two times more likely to develop insomnia ascompared to those who are in the older age group (AOR = 2.93;95% CI 1.08–7.93). Students who had anxiety symptoms were 10times more likely to develop insomnia as compared to students whohad no anxiety (AOR = 10.60; 95% CI 2.84–39.56). Students whouse their mobile device for ≥30 min just before going to sleep whenthe lights have been turned off are six times (AOR = 6.085; 95% CI1.077–34.73) more likely to develop insomnia as compared tostudents who do not use their mobile device just before going tosleep when the lights have been turned off (Table 5).DiscussionGood emotional and social functioning, as well as one’s physicaland mental health, depend on getting enough sleep, and insomniacan have several negative effects. One of the most prevalent sleepdisorders, insomnia can hurt a person’s emotional and generalwellbeing. It is also linked to several health issues, including a higherrisk of obesity, diabetes, heart disease, and stroke. The definition ofinsomnia, the screening instrument used to assess it, and thepopulation under study all affect how common insomnia is. ATABLE 2 Hospital anxiety and depression scale among undergraduate students at Hawassa University, Hawassa, Southern Ethiopia, 2023 (n = 398).Depression YesDefinitelyYesSometimesNo, not much No, not at allI wake up early and then sleep badly for the rest of the night. 36 (6%) 166 (41.7%) 142 (35.7%) 54 (13.6%)I feel miserable and sad. 12 (3%) 159 (39.9%) 147 (36.9%) 80 (20.1%)I have lost interest in things. 21 (5.3) 143 (35.9%) 153 (38,4%) 81 (20.4%)I have a good appetite. 142 (35.7%) 106 (26.6%) 127 (31.9%) 23 (5.8%)I feel life is not worth living. 15 (3.8%) 129 (32.4%) 156 (39.2) 98 (24.6%)I still enjoy the things I used to. 100 (25.1) 159 (39.9%) 109 (27.4%) 30 (7.5%)I feel as if I have slowed down. 16 (4%) 135 (33.9%) 156 (39.2%) 91 (22.9%)AnxietyI get very frightened or have panic feelings for apparently no reason at all. 26 (6.5%) 154 (38.7%) 140 (35.2%) 78 (19.6%)I feel anxious when I go out of the house on my own. 31 (7.8%) 147 (36.9%) 141 (35.4%) 79 (19.8%)I get palpitations, or sensations of “butterflies” in my stomach or chest. 20 (5%) 127 (31.9%) 146 (36.7%) 105 (26.4%)I feel scared or frightened. 21 (5.3%) 142 (35.7%) 142 (35.7%) 93 (23.4%)I am restless and cannot keep still. 19 (4.8%) 113 (28.4%) 160 (40.2%) 106 (26.6%)I am more irritable than usual. 20 (5%) 158 (39.7%) 147 (36.9%) 73 (18.3%)Worrying thoughts constantly go through my mind. 63 (15.8%) 184 (46.2%) 99 (24.9%) 52 (13.1%)frontiersin.orgAschale Wale et al. 10.3389/fpsyt.2024.1352291clinical syndrome of insomnia is present in 5%–10% of individuals,and 30%–50% of individuals have one or more of the symptomsneeded to diagnose insomnia (30). The prevalence of insomniaamong regular undergraduate students at Hawassa was 20.4%. Inthe multivariate logistic regression analysis, being female, youngerage, having anxiety symptoms, and using a mobile phone device formore than 30 min were statically significant factors associatedwith insomnia.The results of this study indicate that 20.4% (95% CI 16.3–24.4)of respondents had insomnia. This study is consistent with aprevious study conducted at Jazan University, Southwestern SaudiArabia (where 19.3% of respondents had insomnia) (11). Bothstudies utilize similar tools to assess insomnia. In this study, theprevalence of insomnia was higher compared to a previous findingreported in the University of North Texas (9.5%) (5), CumhuriyetUniversity in Turkey (12.1%) (31), Iran (9.79%) (32), and USAFrontiers in Psychiatry 06(12%) (33). The difference might have occurred due to thedifference in methods used, such as sample size and assessmenttools. On the other hand, the prevalence of the current study waslower than that of studies involving Debre Berhan University(61.1%) (3), Pakistan Sheikh Zayed Medical College and Hospital(40.8%) (9), Omani University (79.3%) (34), Jordan University(60.6%) (35), Malaysian students (69%) (36), and NorwayUniversity (30.5%) (37). The difference might have occurred dueto the different measurement tools used to assess insomnia instudies. The possible rationale could be several variablescontributing to insomnia, involving psychological, social, cultural,and physical aspects (38–40).Students who were younger than 25 years old had a higherlikelihood of experiencing sleeplessness compared to those who wereolder than 25 (AOR = 2.93; 95% CI 1.08-7.93). This is supported bystudies conducted at Mizan Tepi University (6), Norway (37), andSaudi Arabia (41). Most young individuals experience insomnia whileattending college, likely as a result of the elevated stress levels that aretypical of college students (42, 43). Additionally, another possiblereason might be some circumstances may have contributed to thedevelopment of these illnesses. For instance, younger students whoare experiencing college life for the first time must adjust to somesignificant changes in their sleeping environment, an unfamiliar typeof housing, the anxiety of being away from home, a shift to higherperformance standards in the classroom, and pressure from peers andfamily to perform well academically. All of these elements have thepotential to cause people to experience ongoing stress, which can leadto complaints linked to insomnia and ongoing sleep loss. The otherTABLE 3 Social media-related respondents in Hawassa University,Hawassa, Southern Ethiopia, 2023 (n = 398).Variable Categories Frequency Percentage(%)For how manytotal hours/24 hdo you use amobile screen?<8 h 183 46%≥8 h 215 54%How many hoursdo you spendwatching videoson YouTube?<3 h 188 47.2%≥3 h 210 52.8%Do you use yourmobile justbefore going tosleep (while inbed, when thelights have beenturned off)?Yes 356 89.4%No 42 10.6%If yes to theabove question,for how manyhours do you use0 44 11.1%<30 min 156 39.2%≥30 min 198 49.7%Do you keepyour mobile onyour bed (nearyour pillow)while sleeping?Yes 355 89.2%No 43 10.8%Do you keepyour mobile awayfrom your bed(at least 2 maway)while sleeping?Yes 40 10.1%No 358 89.9%Do you put yourmobile onairplane modewhile sleeping?Yes 93 23.4%No 305 76.6%Do you use bluelight filters (nightmode) onyour mobile?Yes 259 65.1%No 139 34.9%TABLE 4 Substance-related questions of respondents in HawassaUniversity, Hawassa, Southern Ethiopia, 2023 (n = 398).In your life, which of thefollowing substanceshave you ever used?Response PercentageTobacco products (cigarettes,chewing tobacco, cigars, etc.)28 7%Alcoholic beverages (beer, wine,spirits, etc.)89 22.4%Cannabis (marijuana, pot, grass,hash, etc.)5 1.3%Amphetamine-type stimulants(speed, meth, ecstasy, etc.)30 7.5%Inhalants (nitrous, glue, petrol, paint thinner, etc.)Sedatives or sleeping pills(diazepam, alprazolam,flunitrazepam, midazolam, etc.)2 0.8%Hallucinogens (LSD, acid,mushrooms, trips, ketamine, etc.)1 0.3%Opioids (heroin, morphine,methadone, buprenorphine,codeine, etc.)9 2.3%Any other drugs 3 0.8%Never used any of theabove substance231 58%frontiersin.orgAschale Wale et al. 10.3389/fpsyt.2024.1352291possible rationale could be comparable patho-psychophysiologicalprocesses at work, the effects of which are visible despitesocioeconomic differences. Another explanation could be that thereare possibly contributing factors to the issue among younger pupils.For example, first-year university students have to adjust to severalFrontiers in Psychiatry 07big changes, like sudden changes in their sleeping schedules, a newtype of housing, the anxiety of being away from home, a move to ahigher level of academic performance, and pressure from family andfriends to do well in their studies (44). Regular screenings forinsomnia and psychoeducation regarding good sleep hygiene habits01020304050607080no insomnia insomniano insomniainsomniaFIGURE 1Prevalence of insomnia among Hawassa University undergraduate students, Hawassa, Southern Ethiopia, 2023 (n = 398).TABLE 5 Bivariate and multivariate binary logistic regression analysis of factors associated with insomnia among undergraduate students at HawassaUniversity, Hawassa, Southern Ethiopia, 2023 (n = 398).Variable Category Insomnia COR(95% CI)AOR(95% CI)p-valueYes NoSex Female 52 130 2.58 (1.55–4.28) 3.09 (1.62–5.89) <0.001**Male 29 187 1Age 18–22 75 245 3.67 (1.54–8.79) 2.93 (1.08–7.93) 0.034**23–28 6 72 1Parental marital status Living together 1 9 1Divorced 22 56 3.54 (0.423–29.58) 1.143(0.11–11.922)0.911Widowed 39 210 1.67 (0.21–13.57) 0.56 (0.56–5.64) 0.626Both lost in death 19 42 4.07 (0.48–34.46) 2.33 (0.22–24.72) 0.481Anxiety No 114 3 1Yes 203 78 14.60 (4.51–47.32) 10.60(2.84–39.56)<0.001**Depression No 117 10 1Yes 200 71 4.16 (2.06–8.37) 2.46 (0.99–6.14) 0.053Using a mobile device just beforegoing to sleep when the lights areturned offYes 78 278 3.65 (1.10–12.12) 0.69 (0.18–3.98) 0.64No 3 39 1Duration of mobile device use justbefore going to sleep0 3 41 1<30 min 6 150 0.55 (0.13–2.28) 0.26 (0.04–1.70) 0.159≥30 min 72 126 7.81 (2.34–26.12) 6.09 (1.08–34.37) 0.041**Using blue light filters or night mode Yes 58 201 1No 23 116 1.46 (0.85–2.48) 0.0.75 (0.37–1.53) 0.423AOR, adjusted odds ratio; COR, crude odds ratio; CI, confidence interval; 1, reference group; *p-value< 0.05.The single asterisk shows p-value less than 0.25 and the double asterisk shows p-value less than 0.05.frontiersin.orgAschale Wale et al. 10.3389/fpsyt.2024.1352291for college students should be conducted by the university healthcenters. More significantly, tailored approaches to managinginsomnia in this population may be aided by the modifiable riskfactors of insomnia, such as good sleep hygiene.On the other hand, the current study was contradicted by thestudy conducted in China (45). Students who belong to an older agegroup (>25) are more likely to develop insomnia than thosebelonging to a younger age group (45). The possible explanationmay be due to differences in the personality of students who find iteasy to adapt to new learning areas easily, the lifestyle of thestudents, and differences in geographical areas.In this study, female students are more likely to developinsomnia than male students (AOR = 3.09; 95% CI 1.62–5.89).This is consistent with studies done in (8, 9, 41, 46–49). The possibleexplanation for this finding is that women tend to be more affectedby sleep complaints compared to men; this has been attributed tothe increased frequency of other conditions affecting sleep, such asstress and anxiety, among women. There are gender disparities ininsomnia and sex-related psychological health, and women arereported to experience anxiety at a higher rate (50–52). Menregarded work-related causes as the most significant cause ofsleep disturbance, whereas women perceived psychological aspectsas the most significant cause, according to another study on self-evaluations of factors disrupting sleep. Another finding of thecurrent study was that those students with anxiety symptoms aremore likely to have insomnia when compared to students withoutthe symptom (AOR = 10.60; 95% CI 2.84–39.56). This is in line withsome studies (34, 53). The possible justification might be whensomeone is anxious, their mind races with unfavorable thoughtsand anxieties. In addition, since hypervigilance is the primarysymptom of anxiety, people who are anxious find it difficult torelax and go to sleep. Physical signs of anxiety include sweating,tense muscles, and a racing heartbeat (5).Students who spent more than 30 min of mobile device use justbefore going to sleep when the lights were turned off weresignificantly associated with the outcome variable (AOR = 6.09;95% CI 1.08–34.37). It is consistent with a study conducted in SaudiArabia (21). A possible explanation could be that students who wereoverburdened by their schoolwork stayed up late using theircomputers or cellphones, potentially disrupting their circadiancycle. Moreover, another rational explanation could be thatuniversity students use cellphones to read emails, accesseducational materials online, connect to various social mediasites, and access papers pertinent to their studies (54). All thingsconsidered, the drawbacks of smartphone use include energy loss,sleeplessness, and the adoption of unhealthy habits (55).Limitations of the studyThe study relies on self-reported data, which may be subject torecall bias or social desirability bias. The study does not exploreother potential risk factors for insomnia, such as lifestyle factors ormedical conditions.Frontiers in Psychiatry 08ConclusionIn this study, the prevalence of insomnia was one-fifth amonguniversity students, which is high when compared to another studyat the national level. There were significant associations betweenbeing female, age, anxiety symptoms, and mobile device use beforesleep with insomnia. To treat and prevent insomnia in collegestudents, these findings emphasize the necessity for mentalhealthcare and ethical technology use.RecommendationTo reduce anxiety and sleeplessness, it may be more effective toemploy student-centered counseling sessions that raise awarenessand teach about managing sleep hygiene practices and othermodifiable risk factors. This could potentially stop additionalunfavorable secondary consequences. To improve students’performance in their daily tasks, special attention should be paidto the following risky groups: female students, younger students,students who have anxiety symptoms, and students who use theirmobile devices more than 30 min before bedtime after the lightshave gone out.Data availability statementThe raw data supporting the conclusions of this article will bemade available by the authors, without undue reservation.Ethics statementEthical clearance was obtained from Hawassa UniversityCollege of Medicine and Health Sciences with a reference numberof 2117/16. Informed consent was obtained from participants. Allpersonnel information was kept entirely, and secret, andconfidentiality was assured throughout the study period. Theparticipants were informed about the purpose of the study andthe importance of their participation in it. Only volunteers wereinvolved, and study participants had the right to withdraw from thestudy at any time; confidentiality of the information was ensured byomitting the study subjects’ names. The studies were conducted inaccordance with the local legislation and institutional requirements.The participants provided their written informed consent toparticipate in this study.Author contributionsMA: Writing – review & editing, Writing – original draft,Conceptualization. AT: Writing – review & editing, Writing –original draft. YR: Writing – review & editing, Writing – originaldraft, Conceptualization. HA: Writing – review & editing, Datacuration, Investigation. RT: Writing – review & editing, Datafrontiersin.orgAschale Wale et al. 10.3389/fpsyt.2024.1352291curation, Investigation. MT: Writing – review & editing, Datacuration, Investigation.FundingThe author(s) declare that no financial support was received forthe research, authorship, and/or publication of this article.AcknowledgmentsThe authors would like to thank Hawassa University College ofMedicine and Health Sciences for giving us the chance to carry outthis research work. Our appreciation goes to data collectors,supervisors, and study participants for their time.Frontiers in Psychiatry 09Conflict of interestThe authors declare that the research was conducted in theabsence of any commercial or financial relationships that could beconstrued as a potential conflict of interest.Publisher’s noteAll claims expressed in this article are solely those of the authorsand do not necessarily represent those of their affiliatedorganizations, or those of the publisher, the editors and thereviewers. 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