Article

Psychological Reports
0(0) 1–16
Examining the ! The Author(s) 2021
Article reuse guidelines:
Moderator Role of Sleep sagepub.com/journals-permissions
DOI: 10.1177/00332941211025268
Quality in the journals.sagepub.com/home/prx

Relationship Among
Test Anxiety, Academic
Success and Mood
Highlighting Key:
Green: Parts of an IMRaD
Sue K Adams paper
Department of Human Development and Family Science, Yellow: Ideas
The University of Rhode Island, Kingston, RI, USA Pink: Links between
current study and previous
literature
Zoe Mushkat Blue (might look green
Department of Psychology, The University of Rhode over the yellow highlights):
Island, Kingston, RI, USA Language and
Metadiscourse
Jared Minkel
Department of Psychology, The University of Rhode
Island, Kingston, RI, USA

Abstract
This study explored associations among test anxiety, GPA, sleep quality, and mood in
college students. Data were collected from undergraduate students (N ¼ 316).
Results revealed that higher levels of test anxiety and sleep impairment predicted
negative mood in undergraduates. Findings suggest that prioritizing sleep could help
improve overall mood among students with test anxiety. Future studies should work
toward clarifying the complex and reciprocal relationship between sleep and test
anxiety.

Corresponding Author:
Sue K Adams, Department of Human Development and Family Science, The University of Rhode Island,
Transition Center 112, 2 Lower College Road, Kingston, RI 02881, USA.
Email: suekadams@uri.edu
2 Psychological Reports 0(0)

Keywords
Test anxiety, sleep, mood, college students

Introduction
Academic stressors among college students
College students experience a number of unique and normative stressors that
impact their physical and mental health status. For instance, many college
students have high expectations for achievement that begin in grade school
and persist through college. These expectations can lead to general internalized
worry over academic performance and increased test anxiety (Derakshan &
Eysenck, 2009). Additional stressors also emerge during college, including
actual and perceived impact on future educational and employment opportuni-
ties (Abdollahi et al., 2018; Pryor et al., 2010). The complexity of various stres-
sors in the lives of college students contribute to rates of anxiety disorders as
high as 27.9% for females and 12.6% for males according to the 2019 National
College Health Assessment (American College Health Association, 2019).
Furthermore, females experience higher rates of test anxiety compared to
males at all grade levels (von der Embse et al., 2018).

Test anxiety and mental health

A unique stressor for college students is stress and worry about performance on
tests, exams and other evaluative measures. Test anxiety is “perceived arousal,
reported worry, self-denigrating thoughts, tension, and reports of somatic symp-
toms in exams or similar evaluative situations” (Zeidner, 2010). Students with
high test anxiety may experience increased sympathetic nervous system
responses while preparing for exams and when taking exams. This anxious
response may cause physical and emotional discomfort, as well as the use of
maladaptive coping strategies which could impact their potential to maximize
their test score and fully represent the full breadth of their knowledge (Shobe et
al., 2005). One common coping strategy used to manage test anxiety is avoidance
coping (Burcaş & Creţu, 2020; von der Embse et al., 2018). However, when
avoidance coping leads students to ignore or escape the source of their distress
(Vanstone & Hicks, 2019), they likely spend less time preparing for exams which
can result in decreased performance. They may also spend more time ruminating
about their avoidance which can decrease sleep quality (Tousignant et al., 2019).
The complexity of factors that influence test anxiety are also reflected in the
interventions that have been shown to be effective at treating test anxiety. For
example, a meta-analysis of 56 test anxiety interventions found that the most
Adams et al. 3

effective interventions included a combination of strategies such as skill building

(e.g., study and test taking skills), behavioral approaches (e.g., relaxation train-
ing, biofeedback, anxiety induction and systematic desensitization), and cogni-
tive strategies (e.g., cognitive restructuring skills) (Ergene, 2003). One example is
Damer and Melendreses (2011) four-week group intervention based on the strat-
egies described above. Results revealed positive results, with students reporting
that they were better able to manage their anxiety symptoms and that they
found significant value in the intervention.

Academic stress and sleep

Sleep issues are among the most prevalent physical health complaints in college
students, with students reporting increased rates of insomnia and decreased
sleep quality and quantity (Adams & Kisler, 2013). The average adolescent
receives 7.4 hours of sleep per night but requires approximately nine hours
(Perlus et al., 2018). Poor sleep diminishes a number of physical and mental
health capacities, including a person’s ability to effectively cope with daily stress
and worries, and performance across multiple domains such as academic per-
formance (de Bruin et al., 2017; Short & Louca, 2015). Emotional and academic
stress, as well as frequent environmental changes, can negatively impact sleep
(Kim & Suh, 2017; Lund et al., 2010). Moreover, the stressors of college life can
result in fewer hours of sleep, more sleep disturbances, and later waking times
(Galambos et al., 2013). College students report that multiple factors impact
sleep including technological influences, a desire to maintain old relationships
and foster new relationships, and housing (e.g., noisy residence halls) (Adams et
al., 2017). Sleep issues and anxiety are complex and highly reciprocal in nature,
with daytime stress leading to shorter sleep duration, which in turn leads to
increased anxiety symptoms the following day (Fuligni & Hardway, 2006). A
clear gender disparity also exists, with females scoring worse than males on
measures of test anxiety and sleep quality (Dinis & Bragança, 2018; Kim &
Suh, 2017; Ziyar et al., 2016).

Academic stress and mood

College students experience academic stress related to course demands, taking
tests, or time management (Macan et al., 1990; Misra & McKean, 2000). During
times of greater academic stress, students are more likely to experience lower
mood, anxiety, depressive symptoms, and poorer sleep (Beiter et al., 2015; Lee et
al., 2013). Previous research using the Positive and Negative Affect Schedule
(PANAS) has demonstrated a relationship between academic stress and reduced
positive affect, particularly during times of greater academic stress, such as the
end of the semester (Wunsch et al., 2017). A recent meta-analysis also revealed
that 20 out of the 36 studies identified a negative relation between test anxiety
4 Psychological Reports 0(0)

and GPA. In a college sample, as test anxiety increased student GPA decreased,
demonstrating a link between test anxiety and academic performance (von der
Embse et al., 2018).
The association between academic stress and mood has important impli-
cations for the well-being of college students, as negative emotions have a
role in poor mental health outcomes and occurrences of insomnia (Short &
Schmidt, 2018). When sleep quality is poor, frustration, irritability, and dis-
tress have been shown to increase, with links to lower academic achievement
and low GPA (Steinmayr et al., 2016). A systematic review examining the
bidirectionality between sleep disturbances and anxiety suggest that there is
support for the bidirectionality theory (Alvaro et al., 2013). Specifically,
researchers determined that insomnia and sleep quality both predict and
are predicted by anxiety. Anxiety has long been known to interfere with
sleep and recent studies in neurobiology have even provided insight into
the specific circuits that make this possible (see (Goldstein et al., 2013)). In
addition, neuroimaging experiments have shown that top-down inhibitory
control of emotion circuitry appears to be compromised after sleep depriva-
tion (Yoo et al., 2007).

Poor sleep and mood

There is evidence that anxiety has deleterious effects on mood by disrupting
sleep. Sleep deprivation has been shown to reduce positive mood and emotion
(see Goldstein & Walker, 2014 for review) and sleep fragmentation has been
shown to have even more profound effects on emotional states. Pre-sleep worry
has been shown to delay sleep onset (Harvey, 2000) and reduce perceived sleep
quality. Later school start times have been shown to be associated with
improved test scores and better mental health outcomes (Owens et al., 2010).
Therefore, we hypothesized an interaction effect between primary study varia-
bles, such that poor sleep and high rates of test anxiety would be significantly H
related to negative mood and decreased GPA.

The current study

The current study explores the associations among test anxiety, GPA, sleep Aim
quality, and mood in college students to further help understand the impact
of test anxiety on academic and physical health outcomes. Based on the litera-
ture reviewed above, it was hypothesized that (1) the associations between test Hi
anxiety and GPA would be moderated by two measures of sleep quality (insom-
nia severity and sleep impairment), and 2) that sleep would significantly mod-
erate the association between test anxiety and mood.
Hz
Adams et al. 5

Method
Sample and procedure
Survey data were collected from a sample of 316 college undergraduate students
enrolled at a large Northeastern university during the 2017–2018 academic year
(N ¼ 316). Two participants were excluded from this study because they were
under the age of 18. Two methods of recruitment were used, both in compliance
with the requirements of the Institutional Review Board at the university. The
majority of students were voluntarily recruited from classes within the College
of Health Sciences and received extra credit for participation in the present
study. Students who preferred not to participate in the study were offered an
alternative extra credit opportunity. Participants were also recruited via a flyer
that invited students to participate in a laboratory experiment (results not
reported here), which included the research questionnaire used in this study.

Measures
Test anxiety
Test anxiety was measured with the Test Anxiety subscale of the Adult Manifest
Anxiety Scale – College Version (AMAS-C), which measures self-reported anx-
iety related to test taking. The AMAS-C is a 49-item self-report measure of
chronic anxiety among college students (Reynolds et al., 2003). The AMAS-C
Test Anxiety subscale consists of 15 ‘yes/no’ items. Previous validation testing
with the standardization sample revealed adequate reliability (a ¼ 0.72–0.95) for
the AMAS-C Total Anxiety scale scores (Reynolds et al., 2003). Validation of
the AMAS-C Test Anxiety subscale revealed good to excellent temporal stability
(a ¼ 0.89 to 0.90) in a sample of college students (Lowe, 2007). Results of Lowe
(2007) support external validity, in which the AMAS-C Test Anxiety subscale
was significantly correlated to the BASC-2-SRP measure of test anxiety
(r ¼ 0.60, p < .005). In the present sample, AMAS-C Test Anxiety scores
showed good reliability (a ¼ 0.84).

Insomnia severity
Insomnia severity was quantified with the Insomnia Severity Index (ISI), a brief
self-report measure of subjective insomnia and distress related to sleep difficul-
ties (Bastien et al., 2001). The ISI contains seven items that evaluate difficulties
with sleep onset, maintenance, and satisfaction with one’s sleep patterns
(Bastien et al., 2001). Scores range from 0–28. Scores in the 0–7 range represent
no clinically significant insomnia, 8–14 represent subthreshold insomnia, 15–21
represents clinical insomnia (moderately severe) and 22–28 represents clinical
insomnia (severe). Previous validation testing showed good internal consistency
6 Psychological Reports 0(0)

(a ¼ 0.74) and was significantly correlated to objective sleep diaries (Bastien et

al., 2001). In the present sample, ISI scores showed good internal consistency
(a ¼ 0.88).

Sleep impairment
Sleep impairment was measured with the 8-Item Patient-Reported Outcomes
Measurement Information System (PROMIS) Sleep-Related Impairment
Short Form. The PROMIS Sleep Impairment sub-scale includes eight items
that evaluate self-reported impairment due to daytime sleepiness, such as diffi-
culty concentrating or irritability (Yu et al., 2012). To comprehensively evaluate
sleep problems in the present sample, the PROMIS Sleep Impairment form was
used in conjunction with the Insomnia Severity Index to measure both distress
about sleep (ISI) and the extent to which sleep problems cause daytime inter-
ference in functioning (PROMIS Sleep Impairment). Results of measure devel-
opment showed a strong correlation between the short form and long form
measures of sleep-related impairment (Yu et al., 2012). Previous validation test-
ing of the PROMIS Long Form measures of Sleep Impairment showed moder-
ate to high correlations with existing scales, including the Pittsburgh Sleep
Quality Index (Buysse et al., 2010). In the present sample, PROMIS Sleep
Impairment scores showed good internal consistency (a ¼ 0.91).

Positive and negative affect

Positive and negative mood was measured with the Positive and Negative Affect
Schedule (PANAS) (Watson et al., 1988). The PANAS scale measures self-
reported positive and negative affect across 20 items, with 10 items measuring
positive affect and 10 items measuring negative affect. Higher scores represent
higher levels of positive or negative mood. The PANAS measure has sound
psychometric properties, with strong reliability for both positive affect
(a ¼ 0.86–0.90) and negative affect (a ¼ 0.84–0.87), as well as stability over
time (Watson et al., 1988). In the current sample, internal consistency was
good for both positive affect (a ¼ 0.89) and negative affect (a ¼ 0.87).

Academic achievement
Academic achievement was measured by grade point average (GPA) of students
who provided consent for the investigators to access their college transcripts
(n ¼ 249). GPA was measured on a 4 point scale, with 4.0 representing the
highest academic achievement.
Adams et al. 7

Statistical analyses
Descriptive statistics were used to report the following sample demographics:
gender, age, racial-ethnic identity, sexual identity, class year, and GPA. Pearson
correlations were conducted to examine associations between primary study
variables, which included test anxiety, insomnia severity, sleep impairment, pos-
itive affect, negative affect, and GPA. Linear regression analyses were con-
ducted to test whether two measures of sleep, insomnia severity and sleep
impairment, moderated the relationship between test anxiety (IV) and three
separate dependent variables (DVs): GPA, positive mood, and negative mood
(PANAS) (Hayes, 2018). Interaction terms were calculated to analyze interac-
tions of moderator and independent variables (insomnia severity X test anxiety,
sleep impairment X test anxiety). Additional moderator analyses were con-
ducted to control for gender and age effects. All analyses were conducted
using IBM SPSS Statistics 26.0.

Results
Participants’ ages ranged from 18 to 62 (M ¼ 20.7, SD ¼ 3.29), and participants
were mostly women (n ¼ 242; 76.6%). The majority of participants identified as
White (75%), followed by Latino/a (9.2%), African American (6%), multiracial
(4.4%), and Asian (4.1%). The majority of the students identified as heterosex-
ual (n ¼ 229, 72.5%). The sample represented all class years, with 40.5% in the
senior year of college (n ¼ 128), 29.4% junior year (n ¼ 93), 4.4% sophomore
year (n ¼ 14), and 20.6% first year (n ¼ 65). GPAs of student participants ranged
from 1.43 to 4.0 (M ¼ 3.13, SD ¼ 0.51) (see Table 1).

Test anxiety
In the present sample, test anxiety scores ranged from 0 to 21 (M ¼ 8.13,
SD ¼ 4.27). Test anxiety scores were considered elevated in t-scores of 60 or
greater, which is one standard deviation above the mean. Elevated test anxiety
was detected among 33.5% of the sample (n ¼ 104), while 13.6% would be
expected in the general population. This suggests that our sample had a some-
what higher prevalence of test anxiety than the general population of college
students (see Table 2).

Insomnia severity index

On average, the sample reported insomnia severity scores that fell within the
range of subthreshold insomnia (M ¼ 9.87, SD ¼ 5.79). Scores ranged from
0–26. Across participants, 65 students reported sleep difficulties indicative of
clinical insomnia (20.9%). Notably, 50% of students reported moderate to
severe difficulty falling asleep (n ¼ 158), 46.8% reported difficulty waking up
8 Psychological Reports 0(0)

Table 1. Participant demographics.

Baseline demographics Mean n %

Gender
Female 242 76.6%
Male 74 23.4%
Race
White 237 75%
Latino/a 29 9.2%
African American 19 6%
Multiracial 14 4.4%
Asian 13 4.1%
Class
First years 65 20.6%
Sophomores 14 4.4%
Juniors 93 29.4%
Seniors 128 40.5%
Age 20.7 (18–62)
GPA (out of 4.0) 3.13 (1.43–4.0)

Table 2. Descriptive statistics of primary study variables.

Minimum Maximum Standard

Measure score score Mean deviation

Test anxiety 0 21 8.13 4.27

Insomnia severity index 0 26 9.87 5.79
Sleep impairment 0 28 22.48 7.04
Mood
Positive 10 50 26.79 8.66
Negative 7 45 17.12 6.87

too early (n ¼ 147), and 41.5% were dissatisfied with their sleep patterns
(n ¼ 131). Fifty-six percent of the sample reported a mild to severe interference
in daily functioning due to sleep problems (n ¼ 177).

Sleep impairment
Sleep impairment scores ranged from 0 to 28 (M ¼ 22.48, SD ¼ 7.04).
Among participants, 16.7% reported elevated levels of subjective
impairment due to sleepiness (t " 60, n ¼ 51). The majority of student partic-
ipants appeared to experience typical levels of alertness and sleepiness through-
out the day.
Adams et al. 9

Table 3. Descriptive statistics and correlations among study variables.

1. 2. 3. 4. 5. 6. M SD

1. GPA – 3.13 0.51

2. Test anxiety #.18** – 8.13 4.27
3. Negative mood #.06 .27** – 17.12 6.87
4. Positive mood #.02 #.13* .05 – 26.79 8.66
5. Insomnia severity #.12 .40** .33** #.12* – 9.87 5.79
6. Sleep impairment #.09 .36** .38** #.16** .63** – 22.48 7.04
Note. *Correlation is significant at the 0.05 level (2-tailed). **Correlation is significant at the 0.01 level
(2-tailed).

Mood
Participants’ self-reported positive affect on the PANAS ranged from 10 to 50
(M ¼ 26.79, SD ¼ 8.66). Measures of negative affect ranged from 7–45 across
participants (M ¼ 17.12, SD ¼ 6.87).

Correlations among primary study variables

Pearson correlations were conducted to examine associations between primary
study variables. Correlations are presented in Table 3. Test anxiety was found to
be significantly correlated with GPA, sleep quality, and mood. The relationship
between GPA and test anxiety revealed a small negative correlation (r ¼ #0.18,
p < .01). Significant correlations were detected among the two sleep variables, in
which insomnia severity was strongly correlated with sleep impairment (r ¼ 0.63,
p < .001). Greater test anxiety was significantly associated with poorer sleep
when measured as insomnia severity (r ¼ 0.40, p < .001) and sleep impairment
(r ¼ 0.36, p < .001). Test anxiety was also associated with lower mood, demon-
strated by significant associations with negative mood (r ¼ 0.27, p < .001) and
was negatively related to positive mood (r ¼ #0.13, p < .05). Results showed that
poorer sleep quality was associated with greater negative mood. Negative affect
was positively correlated with sleep impairment (r ¼ 0.38, p < .001) as well as
insomnia severity (r ¼ 0.32, p < .001). Small correlations were detected between
positive affect and insomnia severity (r ¼ #0.12, p < .05), as well as positive
affect and sleep impairment (r ¼ -0.16, p < .01).

Moderator analyses
Linear regression analyses were utilized to test moderating effects of sleep var-
iables on the relationship between test anxiety and GPA, positive mood, and
negative mood. The model in Figure 1 illustrates a significant association in
which the relationship between test anxiety and negative mood was moderated
by severity of sleep impairment, which accounted for 18.9% of the relationship
10 Psychological Reports 0(0)

Figure 1. Sleep impairment moderates the relationship between test anxiety and negative
mood. Note. Linear regression model demonstrating the moderating effects of sleep impair-
ment on the relationship between test anxiety and mood.

(F(1, 292) ¼ 22.62, p < .001, R2 ¼ 0.19). When controlled for age, severity of
sleep accounted for 19.3% of the relationship between test anxiety and negative
mood (F(1, 289) ¼ 17.29, p < .001, R2 ¼ .19). When controlled for gender, sever-
ity of sleep accounted for 19.2% of this relationship (F(1, 291) ¼ 17.27, p < .001,
R2 ¼ .19).
Linear regression analysis revealed a significant relationship between GPA
and test anxiety (F(2, 226) ¼ 4.24, p < .05, R2 ¼ 0.04), however, no moderating
effects were detected for sleep impairment (F(3,231) ¼ 3.15, p ¼ .79, R2 ¼ .03) or
insomnia severity (F(3, 236) ¼ 3.78, p ¼.68, R2 ¼ 0.03).
Linear regression models also revealed a significant association between pos-
itive mood and test anxiety (F(2,287) ¼ 7.0, p < .01, R2 ¼ 0.04). However, no
moderating effects were detected for insomnia severity (F(3,298) ¼ 2.59,
p < .05, R2 ¼ 0.02) or sleep impairment (F(3,292) ¼ 3.37, p < .05, R2 ¼ 0.02).

Discussion
Test anxiety has been shown to impair mood and interfere with academic per-
formance in college students (Chin et al., 2017; von der Embse et al., 2018). The
purpose of this study was to explore whether or not poor sleep could be involved Restate
in these relationships. We observed a relatively small but significant correlation Aim
between lower GPA and higher test anxiety and a moderate correlation between
higher test anxiety and more negative mood.
The key findings from this study were related to the relationship between test
anxiety and negative mood. Our key findings were that poor sleep and higher
test anxiety interacted to predict increased negative mood. This result indicated
Adams et al. 11

that the relationship between test anxiety and negative mood was moderated by
sleep. Specifically, college students with higher rates of test anxiety and sleep
impairment reported higher levels of negative affect than those with lower levels
of sleep impairment. Two important aspects of sleep were measured in this
study, sleep disturbance and daytime impairment related to poor sleep.
Although these were strongly correlated in our study, they represent different
aspects of sleep difficulties that could have different relationships with test anx-
iety and academic performance.
The interaction, however, between test anxiety and sleep impairment did not
significantly predict academic performance as measured by GPA. In fact, GPA
was not strongly correlated with any of our measures of mood, sleep or anxiety
in this study. Other studies have demonstrated relationships between both sleep
and test anxiety (see Hamilton et al., 2021), but GPA may be too gross of an
indicator of performance. GPA is also a variable that is highly dependent on a
combination or internal and external factors such as time management, class
atmosphere, learning style, a lack of motivation and gaming addiction (Sarmita,
2018). It is possible that these other factors account for more variance in GPA
than sleep. In addition, contrary to other research (e.g., von der Embse et al.,
2018) that have identified a negative association between GPA and test anxiety,
our findings supported that students who experienced more test anxiety had
higher GPAs. It is possible that students’ desires to do well on exams resulted
in better academic performance, particularly in a sample of advanced under-
graduates who have experience with the pressures of test taking. Future studies
may be more effective if they limit the scope to performance on a specific test or
control for ways in which students manage their GPA (such as dropping courses
or asking instructors for higher grades).
Due to the correlational design of this study, we are unable to make strong
causal claims about the observed relationship between test anxiety and sleep.
Based on previous studies we propose that when test anxiety leads to sleep
impairment, college students are less able to regulate their mood. For example,
students with significant test anxiety likely experience anticipatory anxiety about
their ability to study and their expected performance on exams. These students
may spend more time studying to compensate for their worries resulting in sleep
dysregulation. They may also experience acute sleep impairment resulting from
the stress of exams, which could also be heightened by the common practice of
having multiple exams during the same week of the semester. Given that sleep
problems, mood and anxiety have complex and reciprocal impacts on each
other, sleep problems can increase mood dysregulation which in turn magnifies
anxiety (Talbot et al., 2010).
Sleep impairment was also found to be a more robust moderator between test
anxiety and negative mood than the measure of insomnia severity. Although
directionality cannot be determined, it is plausible that college students experi-
ence more significant mood changes when test anxiety leads to acute sleep
12 Psychological Reports 0(0)

impairment rather than chronic sleep issues. Sleep impairment could also lead to
difficulties managing anxiety, which could heighten negative mood. Conversely,
the results also suggest that sleep may be a protective factor against elevated test
anxiety and negative mood. Although test anxiety is a common emotional,
physiological and behavioral response to academic evaluations, encouraging
students to receive adequate sleep during stressful academic periods could
help to improve overall well-being. Because interventions for sleep problems
are often very effective (e.g., Friedrich & Schlarb, 2018) this would represent
an important potential target for improving academic performance and mood.

Limitations and future directions

Limitations of the current study should be noted. First, the data were collected
from a non-clinical sample and most participants did not reach clinical levels of
anxiety or insomnia. It is possible that study findings would be magnified in a
clinical sample. Second, the sample was homogenous in terms of race, sexual
orientation and gender. Therefore, findings may not be fully generalizable to
other populations of students experiencing anxiety, sleep, and mood difficulties.
Lastly, it is possible that GPA is not the most robust assessment of academic
performance, or it is a variable highly influenced by other factors. Future studies
should expand to include possible covariates that could impact GPA such as
access to disability services, accommodations, and extra credit.
Future studies should aim to discern the specific nature of the direction
between test anxiety and sleep impairment. The results of this study suggest
that college campuses could impact sleep and mood via a number of routes.
For instance, interventions could target students with extreme sleep impairment
as evidenced by the Insomnia Severity Index of other metrics. Conversely, col-
lege campuses could impact sleep and overall mood by implementing interven-
tions that alleviate test anxiety. Once identified, college campuses could tailor
interventions in first year classes that teach students cognitive behavioral strat-
egies to manage test anxiety and/or sleep problems depending on the student’s
area of readiness and motivation. For example, a multifaceted approach such as
that described by Damer and Melendres (2011) would help students to better
manage their anxiety across multiple domains. Evidence also exists that sending
students reappraisal messages while studying decreased worries and increased
performance on tests (Brady et al., 2018). A combination of interventions that
alter both the sleep habits, mood and/or test anxiety of college students could go
a long way in helping students to maximize their academic and social experience
in college, during both the day and the night.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.
Adams et al. 13

Funding
The author(s) received no financial support for the research, authorship, and/or publi-
cation of this article.

ORCID iD
Sue K Adams https://orcid.org/0000-0003-1682-2191

References
Abdollahi, A., Carlbring, P., Vaez, E., & Ghahfarokhi, S. A. (2018). Perfectionism and
test anxiety among high-school students: The moderating role of academic hardiness.
Current Psychology, 37(3), 632–639. https://doi.org/10.1007/s12144-016-9550-z
Adams, S. K., & Kisler, T. S. (2013). Sleep quality as a mediator between technology-
related sleep quality, depression, and anxiety. Cyberpsychology, Behavior, and Social
Networking, 16(1), 25–30. https://doi.org/10.1089/cyber.2012.0157
Adams, S. K., Williford, D. N., Vaccaro, A., Kisler, T. S., Francis, A., & Newman, B.
(2017). The young and the restless: Socializing trumps sleep, fear of missing out, and
technological distractions in first-year college students. International Journal of
Adolescence and Youth, 22(3), 337–348. https://doi.org/10.1080/02673843.2016.
1181557
Alvaro, P. K., Roberts, R. M., & Harris, J. K. (2013). A systematic review assessing
bidirectionality between sleep disturbances, anxiety, and depression. Sleep, 36(7),
1059–1068. https://doi.org/10.5665/sleep.2810
American College Health Association. (2019). National college health assessment II:
Undergraduate student executive summary Spring 2019. https://www.acha.org/docu
ments/ncha/NCHA-II_SPRING_2019_UNDERGRADUATE_REFERENCE%20_
GROUP_EXECUTIVE_SUMMARY.pdf
Bastien, C. H., Valli!eres, A., & Morin, C. M. (2001). Validation of the Insomnia Severity
Index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297–307.
https://doi.org/10.1016/s1389-9457(00)00065-4
Beiter, R., Nash, R., McCrady, M., Rhoades, D., Linscomb, M., Clarahan, M., &
Sammut, S. (2015). The prevalence and correlates of depression, anxiety, and stress
in a sample of college students. Journal of Affective Disorders, 173, 90–96. https://doi.
org/10.1016/j.jad.2014.10.054
Brady, S. T., Hard, B. M., & Gross, J. J. (2018). Reappraising test anxiety increases
academic performance of first-year college students. Journal of Educational
Psychology, 110(3), 395–406. https://doi.org/10.1037/edu0000219
Burcaş, S., & Creţu, R. Z. (2020). Multidimensional perfectionism and test anxiety: A
meta-analytic review of two decades of research. Educational Psychology Review, 3,
1–25. https://doi.org/10.1007/s10648-020-09531-3
Buysse, D. J., Yu, L., Moul, D. E., Germain, A., Stover, A., Dodds, N. E., Johnstonn,
K. L., Shablesky-Cade, M. A., & Pilkonis, P. A. (2010). Development and validation
of patient-reported outcome measures for sleep disturbance and sleep-related impair-
ments. Sleep, 33(6), 781–792. https://doi.org/10.1093/sleep/33.6.781
Chin, E. C., Williams, M. W., Taylor, J. E., & Harvey, S. T. (2017). The influence of
negative affect on test anxiety and academic performance: An examination of the
14 Psychological Reports 0(0)

tripartite model of emotions. Learning and Individual Differences, 54, 1–8. https://doi.
org/10.1016/j.lindif.2017.01.002
Damer, D. E., & Melendres, L. T. (2011). “Tackling test anxiety”: A group for college
students. The Journal for Specialists in Group Work, 36(3), 163–177. https://doi.org/10.
1080/01933922.2011.586016
de Bruin, E. J., van Run, C., Staaks, J., & Meijer, A. M. (2017). Effects of sleep manip-
ulation on cognitive functioning of adolescents: A systematic review. Sleep Medicine
Reviews, 32, 45–57. https://doi.org/10.1016/j.smrv.2016.02.006
Derakshan, N., & Eysenck, M. W. (2009). Anxiety, processing efficiency, and cognitive
performance: New developments from attentional control theory. European
Psychologist, 14(2), 168–176. https://doi.org/10.1027/1016-9040.14.2.168
Dinis, J., & Bragança, M. (2018). Quality of sleep and depression in college students: A
systematic review. Sleep Science, 11(4), 290–301. https://doi.org/10.5935/1984-0063.
20180045
Ergene, T. (2003). Effective interventions on test anxiety reduction: A meta-analysis.
School Psychology International, 24(3), 313–328. https://doi.org/10.1177/
01430343030243004
Friedrich, A., & Schlarb, A. A. (2018). Let’s talk about sleep: A systematic review of
psychological interventions to improve sleep in college students. Journal of Sleep
Research, 27(1), 4–22. https://doi.org/10.1111/jsr.12568
Fuligni, A. J., & Hardway, C. (2006). Daily variation in adolescents’ sleep, activities, and
psychological well-being. Journal of Research on Adolescence, 16(3), 353–378. https://
doi.org/10.1111/j.1532-7795.2006.00498.x
Galambos, N. L., Vargas Lascano, D. I., Howard, A. L., & Maggs, J. L. (2013). Who
sleeps best? Longitudinal patterns and covariates of change in sleep quantity, quality,
and timing across four university years. Behavioral Sleep Medicine, 11(1), 8–22.
https://doi.org/10.1080/15402002.2011.596234
Goldstein, A. N., Greer, S. M., Saletin, J. M., Harvey, A. G., Nitschke, J. B., & Walker,
M. P. (2013). Tired and apprehensive: Anxiety amplifies the impact of sleep loss on
aversive brain anticipation. The Journal of Neuroscience, 33(26), 10607–10615. https://
doi.org/10.1523/JNEUROSCI.5578-12.2013
Goldstein, A. N., & Walker, M. P. (2014). The role of sleep in emotional brain function.
Annual Review of Clinical Psychology, 10, 679–708. https://doi.org/10.1146/annurev-
clinpsy-032813-153716
Hamilton, N., Freche, R., Zhang, Y., Zeller, G., & Carroll, I. (2021). Test anxiety and
poor sleep: A vicious cycle. International Journal of Behavioral Medicine, 28, 250–258.
https://doi.org/10.1007/s12529-021-09973-1
Harvey, A. G. (2000). Pre-sleep cognitive activity: A comparison of sleep-onset insom-
niacs and good sleepers. British Journal of Clinical Psychology, 39(3), 275–286. https://
doi.org/10.1348/014466500163284
Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process anal-
ysis: A regression-based approach (2nd ed.). The Guilford Press.
Kim, S., & Suh, S. (2017). Social support as a mediator between insomnia and depression
in female undergraduate students. Behavioral Sleep Medicine, 17(4), 379–387. https://
doi.org/10.1080/15402002.2017.1363043
Adams et al. 15

Lee, S. Y., Wuertz, C., Rogers, R., & Chen, Y. P. (2013). Stress and sleep disturbances in
female college students. American Journal of Health Behavior, 37(6), 851–858. https://
doi.org/10.5993/ajhb.37.6.14
Lowe, P. A. (2007). Examination of the psychometric properties of the Adult Manifest
Anxiety Scale-College Version (AMAS-C) scores among students in collegiate set-
tings. Individual Differences Research, 5(1), 59–72. https://doi.org/10.1177/
0013164405278563
Lund, H. G., Reider, B. D., Whiting, A. B., & Prichard, J. R. (2010). Sleep
patterns and predictors of disturbed sleep in a large population of college students.
Journal of Adolescent Health, 46(2), 124–132. https://doi.org/10.1016/j.jadohealth.
2009.06.016
Macan, T. H., Shahani, C., Dipboye, R. L., & Peek Phillips, A. (1990). College students’
time management: Correlations with academic performance and stress. Journal of
Educational Psychology, 82(4), 760–768. https://doi.org/10.1037/0022-0663.82.4.760
Misra, R., & McKean, M. (2000). College students’ academic stress and its relation to
their anxiety, time management, and leisure satisfaction. American Journal of Health
Studies, 16(1), 41–51.
Owens, J. A., Belon, K., & Moss, P. (2010). Impact of delaying school start time on
adolescent sleep, mood, and behavior. Archives of Pediatrics & Adolescent Medicine,
164(7), 608–614. https://doi.org/10.1001/archpediatrics.2010.96
Perlus, J. G., O’Brien, F., Haynie, D., & Simons-Morton, B. (2018). Adolescent sleep
insufficiency one year after high school. Journal of Adolescence, 68, 165–170. https://
doi.org/10.1016/j.adolescence.2018.07.016
Pryor, J. H., Hurtado, S., DeAngelo, L., Palucki Blake, L., & Tran, S. (2010). The
American freshman: National norms fall 2009. Higher Education Research Institute.
Reynolds, C. R., Richmond, B. O., & Lowe, P. A. (2003). The Adult Manifest Anxiety
Scale Manual. Western Psychological Services.
Sarmita, R.N. (2018). Contributing factors to the low grade point average (GPA) of
undergraduate students. International Journal of Economics, Business and
Management Research, 2(3), 1–27.
Shobe, E., Brewin, A., & Carmack, S. (2005). A simple visualization exercise for reducing
test anxiety and improving performance on difficult math tests. Journal of Worry and
Affective Experience, 1(1), 34–52.
Short, M. A., & Louca, M. (2015). Sleep deprivation leads to mood deficits in
healthy adolescents. Sleep Medicine, 16(8), 987–993. https://doi.org/10.1016/j.sleep.
2015.03.007
Short, N. A., & Schmidt, N. B. (2018). A multimethod examination of the effect of
insomnia symptoms on anxious responding to a social stressor. Behavior Therapy,
49(3), 323–330. https://doi.org/10.1016/j.beth.2017.11.001
Steinmayr, R., Crede, J., McElvany, N., & Wirthwein, L. (2016). Subjective well-being,
test anxiety, academic achievement: Testing for reciprocal effects. Frontiers in
Psychology, 6, 1–13. https://doi.org/10.3389/fpsyg.2015.01994
Talbot, L. S., McGlinchey, E. L., Kaplan, K. A., Dahl, R. E., & Harvey, A. G. (2010).
Sleep deprivation in adolescents and adults: Changes in affect. Emotion, 10(6),
831–841. https://doi.org/10.1037/a0020138
16 Psychological Reports 0(0)

Tousignant, O. H., Taylor, N. D., Suvak, M. K., & Fireman, G. D. (2019). Effects of
rumination and worry on sleep. Behavior Therapy, 50(3), 558–570. https://doi.org/10.
1016/j.beth.2018.09.005
Vanstone, D. M., & Hicks, R. E. (2019). Transitioning to university: Coping styles as
mediators between adaptive-maladaptive perfectionism and test anxiety. Personality
and Individual Differences, 141, 68–75. https://doi.org/10.1016/j.paid.2018.12.026
von der Embse, N., Jester, D., Roy, D., & Post, J. (2018). Test anxiety effects, predictors,
and correlates: A 30-year meta-analytic review. Journal of Affective Disorders, 227,
483–493. https://doi.org/10.1016/j.jad.2017.11.048
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief
measures of positive and negative affect: The PANAS scales. Journal of Personality
and Social Psychology, 54(6), 1063–1070. https://doi.org/10.1037/0022-3514.54.6.1063
Wunsch, K., Kasten, N., & Fuchs, R. (2017). The effect of physical activity on sleep
quality, well-being, and affect in academic stress periods. Nature and Science of Sleep,
9, 117–126. https://doi.org/10.2147/nss.s132078
Yoo, S. S., Gujar, N., Hu, P., Jolesz, F. A., & Walker, M. P. (2007). The human emo-
tional brain without sleep – a prefrontal amygdala disconnect. Current Biology,
17(20), R877–R878. https://doi.org/10.1016/j.cub.2007.08.007
Yu, L., Buysse, D. J., Germain, A., Moul, D. E., Stover, A., Dodds, N. E., Johnston,
K. L., & Pilkonis, P. A. (2012). Development of short forms from the PROMISTM
sleep disturbance and sleep-related impairment item banks. Behavioral Sleep Medicine,
10(1), 6–24. https://doi.org/10.1080/15402002.2012.636267
Zeidner, M. (2010). Test anxiety. In I. B. Weiner & W. E. Craighead (Eds.), The Corsini
encyclopedia of psychology (4th ed., Vol. 4, pp. 1766–1770). John Wiley & Sons, Inc.
https://doi.org/10.1002/9780470479216.corpsy0984
Ziyar, S. B., Karimi, Z., Massoumi, A., & Mohebi, S. (2016). Assessment sleep quality
and its relationship with test anxiety among high school students in Qom-Iran.
International Journal of Pediatrics, 4(10), 3719–3726. https://doi.org/10.22038/IJP.
2016.7475

Author Biographies
Sue K Adams is a Professor in the Department of Human Development and
Family Science at URI. She is also a licensed clinical psychologist and co-owner
of The New England Center for Anxiety.

Zoe Mushkat is a doctoral student in the URI Clinical Psychology Program. Her
main research and clinical interests are health disparities, model testing, and
medical decision-making on both the professional and patient-level.

Jared Minkel is a clinical psychologist and behavioral sleep medicine expert. He

is an adjunct professor of psychology and a clinical instructor at the University
of Rhode Island.