The relationship between quality of life, sleep quality, mental health, and physical activity in an international sample of college students: a structural equation modeling approach

ObjectiveWe assessed the direct and indirect relationships between sleep quality, mental health, and physical activity with quality of life (QOL) in college and university students.MethodsIn a cross-sectional design, 3,380 college students (60% females; age = 22.7 ± 5.4) from four continents (Africa: 32%; America: 5%; Asia: 46%; and Europe: 15%; others: 2%) completed the Pittsburgh Sleep Quality Index (PSQI); Insomnia Severity Index (ISI); Epworth Sleepiness Scale (ESS); the Depression, Anxiety, and Stress Scale 21 (DASS); the International Physical Activity Questionnaire short-form (IPAQ); and the World Health Organization Quality of Life-BREF (WHOQOL-Brief).ResultsWe showed that sleep quality, insomnia, and depression had direct negative effects on the physical domain of QOL (β = −0.22, −0.19, −0.31, respectively, p