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BMC Public Health

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Open Access 01.12.2024 | Research

The relationship between COVID-19 stress and test anxiety in art students: the chain mediating roles of intolerance of uncertainty and sleep quality

verfasst von: Ruiying Liu, Qing Qiu, Baojuan Ye

Erschienen in: BMC Public Health | Ausgabe 1/2024

Abstract

Background

The global spread of COVID-19 has brought immense physiological and psychological distress to students, such as test anxiety and poor sleep quality. This study aims to explore the relationship between COVID-19 stress and test anxiety and the mediating roles of intolerance of uncertainty and sleep quality between them.

Methods

A study was conducted in China during the late stage of the pandemic. A total of 936 Chinese art students (age M = 18.51, SD = 2.11, 46.6% female) completed the Coronavirus Stress Measure (CSM), the 12-item Intolerance of Uncertainty (IUS-12), the Brief Version of the Pittsburgh Sleep Quality Index (B-PSQI), and the Test Anxiety Inventory (TAI). A chain mediation model analysis was conducted to examine the mediating effects of intolerance of uncertainty and sleep quality on the association with COVID-19 stress and test anxiety.

Results

COVID-19 stress was positively associated with test anxiety (β = 0.50, p < 0.001). The intolerance of uncertainty and sleep quality partially and serially mediated the relationship between COVID-19 stress and test anxiety (β = 0.01, 95% CI = 0.01 to 0.02).

Conclusion

These findings suggest that art students’ intolerance of uncertainty and sleep quality partially and serially mediate the relation between COVID-19 stress and test anxiety. The results have significant implications for the intervention and prevention of test anxiety, providing additional evidence for the relationship between COVID-19 stress and test anxiety.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Introduction

COVID-19 has emerged as a significant health threat, posing a vital threat to the mental and physical well-being of individuals worldwide [1‐3]. COVID-19 stress can lead to various physical and psychological problems in individuals such as depression, anxiety, poor sleep quality, and other problems [4, 5]. For the students, the negative effects of COVID-19 stress are mainly related to academic stress and anxiety [6]. The COVID-19 pandemic has brought significant changes to the lives and studies of adolescents. Campus lockdowns, online teaching, and reduced social support have greatly increased students’ academic stress and anxiety [7‐9].

Art students refer to specific groups of students defined by the characteristics of their chosen majors. For art students, the admission requirement for the college entrance examination is that they can pass both professional and cultural courses at the same time [10]. Compared to regular academic students, art students in high school have to study more subjects and bear a heavier workload during their three years of high school [11]. In 2014, China began the reform of art college entrance examination, and in recent years, the scores of art students in cultural courses have increased year by year [11]. The Ministry of Education has put forward a series of reform requirements for college art major enrollment in 2019. The admission cultural score line for art-related majors of central colleges and universities cannot be lower than the admission line for the cultural score of the general majors [11]. In addition, the new policy for art college admissions has been gradually implemented since 2021. Universities preferentially admit art students based on the total scores of cultural courses and professional courses, of which cultural scores account for not less than 50% in principle. Compared to previous admission policies, the minimum cultural exam score for art students will be raised [12]. With the reform of China’s art college entrance examination, the admission scores of art students in cultural courses are increasing year by year. The changes in this policy have brought about increased psychological pressure and anxiety among art students who struggle with cultural courses during their studies and exam preparations [11]. Previous studies have also shown that art students report more stress and time spent on academic work than non-art students [10]. In addition, the test anxiety among high school students is more widespread and severe under the pressure of the pandemic [13]. But excessive anxiety not only affects test performance but also harms mental health [14, 15]. Moreover, there are few studies on text anxiety of art student. Given the negative impact of test anxiety on both test performance and mental health, it is essential to understand and focus on test anxiety so that art students can reach their academic potential.

According to Pressure-Cognitive Interaction Theory, individuals make a primary and secondary assessment of stress to assess whether the individual has the ability and resources to cope with the stress. If individuals adapt and can effectively cope with stress, there is no stress response; otherwise, there is a stress response [16]. Therefore, in the face of COVID-19 stress, individuals make a preliminary assessment and secondary assessment. Individuals with high intolerance of uncertainty make negative cognitive interpretation for the COVID-19 stress [17]. When individuals assess that they cannot effectively cope with COVID-19 stress, they may produce physiological and psychological reactions such as poor sleep quality and anxiety. This study examines the impact of COVID-19 stress on test anxiety and explores the serially mediating role of intolerance of uncertainty and sleep quality for this special group of art students.

The influence of COVID-19 stress on test anxiety

The COVID-19 pandemic has an important impact on an individual’s mental health and well-being, and previous studies have mentioned that COVID-19 stress can increase anxiety, causing various negative effects [18]. COVID-19 stress is defined the degree to which individuals find that life in the COVID-19 pandemic is unpredictable, uncontrollable, or overloaded (that is stressful) [19]. Studies have shown that COVID-19 stress is positively associated with individuals’ levels of anxiety [5, 20]. Test anxiety is a particular form of anxiety characterized by two main components: emotionality and worry [21]. Worry primarily refers to concerns about upcoming evaluations, expectations, and the resulting worries and unease, which involve more cognitive components; and emotionality mainly refers to the accompanying emotional experiences and physical reactions, such as palpitation, nervousness, and other physical symptoms related to autonomic neurological disorders [22].

In the context of the COVID-19 pandemic, the influence of external factors such as COVID-19 stress may exacerbate students’ test anxiety [13]. On the one hand, the COVID-19 pandemic has led to changes in learning styles, resulting in poor learning outcomes for students [9]. In particular, for art students, the study of specialized courses requires a lot of operational exercises, and online learning is not conducive to the study of professional knowledge. In addition, with the change of the policy, the proportion of academic courses in the art exam has increased, which has also increased the academic burden on art students. The culture examination and art examination are life-changing opportunities for many art students. Consequently, art students may experience heightened worries and uneasiness about the culture examination and art examination, which to some extent affects their test anxiety levels. On the other hand, the stress caused by COVID-19 may make individuals feel nervous and anxious [4]. Art students have higher stress levels and poorer mental health than non-art students [10]. And these negative emotional experiences also affect the individual’s test anxiety [23]. For art students, the stress and anxiety caused by COVID-19 may also affect their test anxiety.

The mediating role of intolerance of uncertainty

Intolerance of uncertainty (IU) is conceptualized as a cognitive bias that influences how individuals perceive, interpret, and respond to uncertain situations at cognitive, emotional, and behavioral levels [17]. During the period of epidemic liberalization, the chance of getting sick with COVID-19 is greatly increased, bringing a lot of uncertainty to the individual’s life, learning and own health [24]. Study have found that the uncertainty and perceived stress of the COVID-19 pandemic are positively correlated with intolerance of uncertainty [25].

In addition, according to the intolerance of uncertainty model, intolerance of uncertainty appears to be an important cognitive element that affects test anxiety [26, 27]. Intolerance of uncertainty is likened to a cognitive bias in which uncertainty and ambiguity are viewed as threatening, and it is proposed to directly lead to worry and anxiety [26]. When faced with uncertain situations, high IU individuals may engage in risky cognitive explanations and experience increased worry and anxiety, which can contribute to heightened test anxiety among students [17, 28, 29]. And previous studies have demonstrated that intolerance of uncertainty is a direct predictor of test anxiety [30, 31]. Studies have shown that student athletes’ intolerance of uncertainty is a significant predictor of test anxiety [32]. Art students, similar to student athletes, face the double pressure of academic and professional courses. Art students report more mental stress and spent more time on academic work than non-art students [10]. Therefore, this study speculates that there is a positive correlation between art students’ intolerance of uncertainty and test anxiety.

The mediating role of sleep quality

Additionally, sleep quality may serve as another mediating variable worth considering. The COVID-19 pandemic has introduced many unprecedented stressors that negatively affect sleep quality [33, 34]. A larger proportion of the population reported sleep disturbances and poor sleep quality after the COVID-19 outbreak compared to pre-pandemic levels [35, 36]. In addition, compared to older individuals, adolescents with high COVID-19 stress have poorer sleep quality [37]. Art students report increased sleep disturbance and daytime dysfunction, and later chronotype, compared with the non-art students [38]. Studies have shown a positive correlation between COVID-19 stress and sleep quality [34, 37]. Under the influence of COVID-19 stress, art students may experience poor sleep quality.

Based on the transdiagnostic cognitive theory of sleep posits, poor sleep quality can impair individuals’ cognitive functioning such as working memory, concentration, etc., and reduce their ability to manage emotions [39‐41]. Individuals with poor sleep quality tend to experience more worry and anxiety in test situations, which may affect their level of test anxiety [42]. Physiologically, sleep-deprived individuals would experience some physical discomfort (increased blood pressure, increased neuro-immunological functioning, increased sympathetic tone) [39]. These physiological discomforts caused by the lack of sleep further exacerbate panic symptoms, nervousness and autonomic dysfunction in individuals and may increase their level of test anxiety [14, 43]. Previous studies have shown a positive correlation between sleep deprivation and higher test anxiety [14].

The chain mediation effect intolerance of uncertainty and sleep quality

Intolerance of uncertainty is an important factor that affects adolescent mental health, especially regarding sleep problems. Studies have found that adolescents with high intolerance of uncertainty scores have negative cognition in the face of uncertain situations. This increases the arousal of negative emotions which subsequently triggers problems related to sleep [44]. The social uncertainty caused by COVID-19 has disrupted people’s normal sleep time and the quality of sleep has deteriorated [24]. A study conducted during the early COVID-19 pandemic found that uncertainty intolerance plays a crucial role in the relationship between COVID-19 uncertainty and sleep outcomes [24]. Previous studies have shown that intolerance of uncertainty is positively related to sleep quality [44, 45]. Based on these findings, the study further speculates that the intolerance of uncertainty is positively related to sleep quality.

The current study

Current research on test anxiety mainly focuses on the general student population, with less attention given to the test anxiety of art students. In addition, most studies on the influencing factors of test anxiety focus on family factors and individual internal factors such as coping style and personality characteristics [46, 47]. Few studies explore the effect of COVID-19 stress on individual test anxiety. The epidemic has led to changes in the academic environment and methods, causing anxiety and depression among students [8, 9]. Therefore, the degree and causes of students’ test anxiety during the epidemic period may be different from those in the past. Based on the Pressure-Cognitive Interaction Theory [16], whether COVID-19 stress may affect the art students’ test anxiety depends on the individual’s assessment of COVID-19 stress. Therefore, this study explores the effects of COVID-19 stress on test anxiety of art students from cognitive and physiological perspectives. It enriches the research object of test anxiety and its possible influencing factors.

Based on the literature review mentioned above and the Pressure-Cognitive Interaction Theory. We conducted a chain mediation model to examine the mediating effects of intolerance of uncertainty and sleep quality on the association with COVID-19 stress and test anxiety. Based on the literature review, we constructed a chain mediation model and proposed the following hypotheses, as shown in Fig. 1

Hypothesis 1

COVID-19 stress is positively related to test anxiety of art students.

Hypothesis 2

COVID-19 stress can indirectly predict test anxiety of art students through the mediating role of intolerance of uncertainty.

Hypothesis 3

COVID-19 stress can indirectly predict test anxiety of art students through the mediating role of sleep quality.

Hypothesis 4

COVID-19 stress can indirectly predict test anxiety of art students through the chain mediation role of intolerance of uncertainty and sleep quality.

Materials and methods

Participants

A total of 936 senior-year art students who are about to take the Art exam (age M = 18.51, SD = 2.11, 46.6% female) in China participated in this study. Table 1 shows the detailed demographic characteristics of this study. The consent of the participant was obtained, and the principles of voluntary completion, strict confidentiality and anonymity were emphasized. This study was approved by the Research Ethics Review Committee of Jiangxi Normal University’s School of Psychology.

Table 1

Demographic information (N = 936)

Characteristics	Categories	N	Percentage (%)
Gender	Male	436	46.6
	Female	500	53.4
Only child	Only child	216	23.1
	Non-only child	720	76.9
Father’s level of education	Primary and below	103	11.0
	Junior high school	369	39.4
	Senior high school	261	27.9
	Junior college	90	9.6
	Undergraduate	92	9.8
	Master and above	21	2.2
Mother’s level of education	Primary and below	172	18.4
	Junior high school	371	39.6
	Senior high school	204	21.8
	Junior college	80	8.5
	Undergraduate	89	9.5
	Master and above	20	2.1

Measures

COVID-19 stress

The Chinese version of Coronavirus Stress Measure (CSM) was used to measure COVID-19 stress [20], which was adapted from Arslan et al. [48]. The scale has 5 items (e.g., “How often have you been upset because of the COVID-19 pandemic?”) and each item is rated on a 5-point scale (0 = never, 4 = always). The higher scores indicate higher levels of coronavirus stress. This scale has shown good reliability and validity among Chinese participants [20]. In this study, the α coefficient of the scale was 0.94. Confirmatory factor analysis (CFA) in this study suggested that the one-factor model fit the data well: χ²/df = 1.084, RMSEA = 0.009, CFI = 1.000, TLI = 1.000, SRMR = 0.003.

Intolerance of uncertainty

The Chinese version of the 12-item Intolerance of Uncertainty Scale (IUS-12) [49], adapted from Carleton et al. [50], was utilized to measure Intolerance of uncertainty. The scale consists of 12 items (e.g., “Unforeseen events upset me greatly”) and each item is rated on a 5-point scale (1 = completely inconsistent, 5 = completely consistent). The IUS-12 demonstrated a stable two-factor structure, representing both anxious and avoidance components of intolerance of uncertainty. This scale has demonstrated good reliability and validity among Chinese participants [49]. Higher overall scores indicate higher intolerance of uncertainty. In this study, the α coefficient of the scale was 0.93. Confirmatory factor analysis (CFA) in this study suggested that the two-factor model fit the data well: χ²/df = 9.610, RMSEA = 0.087, CFI = 0.955, TLI = 0.937, SRMR = 0.043.

Sleep quality

Sleep quality was measured by the Brief Version of the Pittsburgh Sleep Quality Index (B-PSQI) [51]. The Brief Version of the Pittsburgh Sleep Quality Index is a brief form of the Pittsburgh Sleep Quality. The Chinese Version of the Pittsburgh Sleep Quality Scale was adapted from Liu et al. [52]. The scale has 6 items (e.g., “When have you usually gone to bed at night?”). Because bedtime and rise time are used to calculate sleep efficiency, the six questions of the B-PSQI yield five scored items. These five items provide a global score ranging from 0 to 15, where higher scores indicate worse sleep quality. This scale has shown good reliability and validity [51]. In this study, the α coefficient of the scale was 0.71. Confirmatory factor analysis (CFA) in this study suggested that the one-factor model fit the data well: χ²/df = 2.928, RMSEA = 0.045, CFI = 0.991, TLI = 0.971, SRMR = 0.015.

Test anxiety

Test Anxiety was measured by the Chinese version of Test Anxiety Inventory (TAI) [53]. The scale has 20 items (e.g., “I felt anxious during the exam”) and each item is rated on a 4-point scale (1 = never, 4 = always). The scale comprises two dimensions: emotionality and worry. Higher overall scores indicate higher levels of test anxiety. This scale has shown good reliability and validity among Chinese participants [54]. In this study, the α coefficient of the scale was 0.95. Confirmatory factor analysis (CFA) in this study suggested that the two-factor model fit the data well: χ²/df = 9.610, RMSEA = 0.096, CFI = 0.932, TLI = 0.917, SRMR = 0.038.

Data analysis

First, we used MPLUS 8.3 to conduct confirmatory factor analysis in order to examine the adequacy of the measurement model for the scales. Model fit was evaluated based on the CFI and TLI values (≥ 0.90), as well as the RMSEA and SRMR values (≤ 0.08) [55]. Second, the descriptive statistics and Pearson correlation were calculated among the study variables using SPSS 25. Finally, the PROCESS macro (Model 6) was applied to examine the mediating effect of intolerance of uncertainty and sleep quality on the relationship between COVID-19 stress and test anxiety. The bootstrap confidence intervals (CIs) were used to determine whether the effects in Model 6 is significantly based on 5000 random samples [56]. An effect is regarded as significant if the CIs do not include zero. All study variables were standardized in Model 6 before data analyses.

Results

Common method bias

All data were based on the self-reports of parents on questionnaires. We addressed potential common method bias with Harman’s single-factor analysis [57]. The exploratory factor analysis results showed that there were total of 7 factors with characteristic roots greater than 1. The largest factor explained 37.99% of the variance, with the critical value being less than 40%. Therefore, there are no serious common method biases in this study.

Descriptive statistics and correlation analysis

Table 2 shows the means, standard deviations, and correlations of the variables. Correlation analysis revealed that COVID-19 stress, intolerance of uncertainty, sleep quality and test anxiety were positively correlated (p < 0.001). Most importantly, COVID-19 stress was positively correlated with test anxiety, providing support for Hypothesis 1.

Table 2

Means, standard deviations, and correlations of the main study variables

Variables	M	SD	1	2	3
1.COVID-19 Stress	7.62	4.71	-
2. Intolerance of uncertainty	32.03	9.60	0.42^***	-
3. Sleep quality	3.35	2.46	0.25^***	0.25^***	-
4. Test anxiety	43.66	11.82	0.51^***	0.55^***	0.32^***

N = 936, ^*p < 0.05, ^**p < 0.01, ^***p < 0.001, M = Mean, SD = Standard Deviation

The mediating effects of intolerance of uncertainty and sleep quality

The results of the serial mediation model are shown in Fig. 2; Table 3. Figure 2 shows the standardized regression coefficients for each path in the model. COVID-19 stress exhibited a significant positive path to intolerance of uncertainty (β = 0.42, t = 14.22, p < 0.001), which in turn had a significant positive path to test anxiety (β = 0.39, t = 13.65, p < 0.001). COVID-19 stress also had a significant positive path to sleep quality (β = 0.17, t = 4.86, p < 0.001), which had a significant positive path to test anxiety (β = 0.15, t = 5.59, p < 0.001). Finally, intolerance of uncertainty had a significant positive path to sleep quality (β = 0.18, t = 5.26, p < 0.001).

Table 3

Regression paths of the conceptual model

Variables	Model 1 IU		Model 2 SQ		Model 3 TA
	β	SE	β	SE	β	SE
Gender	-0.05	0.06	0.00	0.06	-0.02	0.05
Only child	-0.05	0.07	0.02	0.08	0.02	0.06
Father’s level of education	0.10	0.04^*	-0.09	0.04	-0.01	0.03
Mother’s level of education	-0.02	0.03	0.13^*	0.04	-0.00	0.03
COVID-19 stress	0.42^***	0.03	0.17^***	0.03	0.31^***	0.03
Intolerance of uncertianty			0.18^***	0.04	0.39^***	0.03
Sleep quality					0.15^***	0.03
R²	0.19		0.09		0.42
F	44.66^***		16.10^***		94.96^***

Notes IU = intolerance of uncertainty, SQ = sleep quality, TA = test anxiety N = 936, ^*p < 0.05, ^**p < 0.01, ^***p < 0.001

Table 4 showed the direct and indirect effects of the model. The direct effect of COVID-19 stress on text anxiety was significant (β = 0.31, 95% CI = 0.25 to 0.36). The mediation effect of intolerance of uncertainty on test anxiety was significant (supporting Hypothesis 2) (β = 0.16, 95% CI = 0.12 to 0.20). Additionally, the mediation effect of sleep quality on test anxiety was significant (supporting Hypothesis 3) (β = 0.02, 95% CI = 0.01 to 0.04). Finally, acting as serial mediators, the indirect effects of intolerance of uncertainty and sleep quality in the relationship between COVID-19 stress and test anxiety were significant (supporting Hypothesis 4) (β = 0.01, 95% CI = 0.01 to 0.02). The total indirect effect accounted for 39.05%, with the mediating effect of intolerance of uncertainty at 31.96%, the mediating effect of sleep quality at 4.86%, and the chain mediating effect of intolerance of uncertainty and sleep quality at 2.23%.

Table 4

Direct and indirect effects of COVID-19 stress on test anxiety via intolerance of uncertainty and sleep quality

Effect Types	Path	Effect	95% CI
			Lower	Upper	Effect size
Direct effect	COVID-19 stress→TA	0.3062	0.25	0.36	60.97%
Indirect effect	COVID-19 Stress→IU→TA	0.1605	0.12	0.20	31.96%
	COVID-19 Stress→SQ→TA	0.0244	0.01	0.04	4.86%
	CS→IU→SQ→TA	0.0112	0.01	0.02	2.23%
Total indirect effect		0.1961	0.15	0.24	39.05%
Total effect		0.5022	0.45	0.56

Notes CS = COVID-19 stress, IU = intolerance of uncertainty, SQ = sleep quality, TA = test anxiety, N = 936, ^*p < 0.05, ^**p < 0.01, ^***p < 0.001

Discussion

Although the relationship between COVID-19 stress and anxiety has been extensively studied in recent years, there has been less research on test anxiety for this particular group of art students. According to the norm of TAI scale, a group score greater than 40 points is considered to have a higher score of test anxiety [58]. The results of this study showed that the average score of art students’ test anxiety is 43.66, indicating that art students have a high level of test anxiety. According to TAI assessment standards, 25.4% of the individuals in this study scored more than 50 points and had test anxiety, which was higher than the 14.6% test anxiety detection rate of senior three students in previous study [59]. And previous studies have shown that the level of test anxiety of art students is slightly higher than that of non-art students [60]. According to the results of previous studies, the test anxiety level and test anxiety detection rate of art students are higher than that of non-art students. Therefore, it is necessary to pay attention to the test anxiety of art students.

In this study, these findings suggest that art students’ intolerance of uncertainty and sleep quality partially and serially mediate the relation between COVID-19 stress and test anxiety. The resulting chain mediation model presented here facilitates a better understanding of the relationship between COVID-19 stress and text anxiety of art students. According to the cognitive-phenomenological-transactional model (CPT), stress is caused by both external environment and personal factor [16]. In the face of COVID-19 stress, individuals conduct primary and secondary evaluations, and then make corresponding physiological and psychological responses. Art students with high intolerance of uncertainty tend to give higher evaluations of the harm caused by COVID-19 stress, believing that they are unable to cope COVID-19 stress and the uncertainty of exams. After assessment, individuals may experience physiological reactions such as poor sleep quality, as well as psychological reactions like test anxiety.

COVID-19 stress and test anxiety

The results showed that COVID-19 stress was positively associated with test anxiety, which is consistent with previous studies [7, 13]. It can be seen that COVID-19 stress, as an external stimulus, has a negative impact on art students’ test anxiety. According to the cognitive-phenomenological-transactional model (CPT), the generation of anxiety emotions depends on an individual’s initial assessment of the event [61]. When art students face COVID-19 stress, they make a preliminary assessment of COVID-19 stress and its risks. If an individual feels unable to handle COVID-19 stress and the examination arrangements, they may experience test anxiety. In addition, China’s college entrance examination is a crucial exam for students. Under the epidemic environment, changes in learning style and reduced social support may also increase test anxiety among art students [8, 9].

The mediating role of intolerance of uncertainty

The results showed that COVID-19 stress was positively associated with intolerance of uncertainty, and intolerance of uncertainty was positively associated with test anxiety. These results are consistent with previous studies [25, 31]. During data collection, there are still many uncertainties and challenges in the management and control of COVID-19 [25]. And the fear of COVID-19 can also increase an individual’s intolerance of uncertainty [62]. The instability of the epidemic may lead to changes in the timing and location important exams, bringing many uncertain factors to students’ study and life, which contributes to higher levels of COVID-19 stress among individuals and increases their intolerance of uncertainty.

While art students face the dual pressure of the coming cultural examination and professional skill assessments, individuals with high intolerance of uncertainty are more likely to make catastrophic explanations for uncertain events and stressful events. Individuals with high intolerance of uncertainty think that they cannot cope with the possible uncertain events, leading to worry and unease which further intensifies test anxiety [32]. The results found that intolerance of uncertainty played an important mediating role between COVID-19 stress and test anxiety. Cognitive Behavioral Therapy (CBT) can be employed as an effective approach for enhancing individuals’ tolerance for uncertainty [63], thereby effectively reducing test anxiety.

The mediating role of sleep quality

The results showed that COVID-19 stress was positively associated with sleep quality, and sleep quality was positively associated with test anxiety. These results are consistent with previous studies [14, 36, 64]. The COVID-19 pandemic has exposed people to unpredictable stress, and prior research have shown that perceived stress is a major cause of poorer sleep quality [65]. Stress has been shown to increase the heart rate and increase metabolism, which contributes to lower sleep quality [66]. Therefore, high levels of COVID-19 stress can lead to lower sleep quality and longer sleep latency [34, 67].

Poor sleep quality can affect individuals’ learning ability, memory, concentration and neurobehavioral functioning, and then lead to poor academic performance, and increase individual test anxiety [39, 68]. In addition, poor and inadequate sleep quality is related to reduced positive emotions, cognitive as well as emotional disorders. And individuals with poor sleep quality have weaker emotional regulation ability and are more prone to experiencing anxiety during exams [40, 69]. Relaxation therapy and cognitive-behavioral therapy for insomnia (CBTI) can be used to reduce an individual’s stress level, improve their sleep quality, and help alleviate the production of test anxiety [14, 70].

Intolerance of uncertainty and sleep quality as serial mediators

Our results showed that intolerance of uncertainty was positively associated with sleep quality, which is consistent with previous studies [24, 42]. Intolerance of uncertainty has been extensively studied in relation to mental health problems among adolescents, but less research has been conducted on its relationship with sleep quality. Adolescents with higher intolerance of uncertainty showed negative beliefs about uncertain situations and experienced increased arousal of negative emotions [71], which can lead to sleep-related problems [42]. Studies had shown that individuals with high intolerance of uncertainty tend to experience more sleep problems, such as longer sleep latency, decreased sleep duration, and poorer sleep quality [42]. During the COVID-19 pandemic, the chain mediators found here may contribute to reducing art students’ test anxiety from the perspective of intolerance of uncertainty and sleep quality.

This study examined the role of intolerance of uncertainty and sleep quality as a chain mediator between COVID-19 stress and test anxiety. The results showed that the mediating effect of intolerance of uncertainty was the largest, reaching 31.96%, which meant that COVID-19 stress mainly affected test anxiety of art students through intolerance of uncertainty. The mediating effect size of sleep quality was 4.86%, although its mediating effect was not as large as the mediating effect value of intolerant uncertainty, its mediating effect was still significant, indicating that the role of sleep quality in it cannot be ignored.

Furthermore, the chain mediating effect of the intolerance of uncertainty and sleep quality was 2.23%, indicating a significant mediating effect. It is worth noting that the chain mediating effect accounted for a relatively small proportion of the total effect, but this does not mean that the chain mediating effect in this study is meaningless. First, small effect sizes may still have important theoretical implications. Many phenomena in social science are often affected by multiple factors, and social science theories usually only predict whether a certain factor has an impact, but less predict the absolute size of the role played by a certain factor. In this case, if small effects can support the tested theory, then small effects are also of great significance [72, 73]. Secondly, small effect sizes may also have important practical significance, methodologists believe that when small effects may directly or indirectly lead to major results, small effects may accumulate into large effects over time. Even small effects need to be taken seriously [74, 75]. Long-term intolerance of uncertainty and poor sleep quality can affect test anxiety in art students. Therefore, small effects also need to be paid attention to.

Implication

It is worth noting that our findings have important academic implications and practical implications. The results showed that the COVID-19 stress positively affected test anxiety of art students, and intolerance of uncertainty and sleep quality played a chain mediating role. It promotes the in-depth understanding of the relationship between COVID-19 stress and test anxiety of art students, and provides important theoretical guidance for schools to carry out students’ mental health education. Schools’ mental health educators can use Cognitive Behavioral Therapy (CBT) to reduce students’ intolerance of uncertainty and improve their sleep quality. This can reduce students’ test anxiety, improve the mental health level of art students, and promote academic development.

Limitations and further research

Several limitations of the current study need to be considered. Firstly, this study used a cross-sectional design to explore the relationship between COVID-19 stress and test anxiety, which could not explain the causal relationship. Future studies could incorporate longitudinal designs and physiological measurements for in-depth discussion. Secondly, all data in this study were measured by the self-report method, which are subject to socially desirable responding bias. Future studies should collect data from objective sources or multiple informants (e.g., friends, teachers, and family members). Finally, the sample used in this study consisted of Chinese art students, thereby limiting the generalizability of findings across diverse cultures.

Conclusion

The present study found that COVID-19 stress can aggravate the test anxiety of art students. This effect was partially and serially mediated by intolerance of uncertainty and sleep quality. This study enables us to understand the mechanisms between COVID-19 stress and test anxiety, guiding intervention programs aimed at improving sleep quality and reducing test anxiety.

Acknowledgements

The authors would like to acknowledge all study participants.

Declarations

Ethical approval

The present study was approved by the Research Ethics Review Committee of Jiangxi Normal University’s School of Psychology. Informed consents were obtained from the participants prior to the survey.

Not applicable.

Competing interests

The authors declare no competing interests.

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Jakovljevic M, Bjedov S, Jaksic N, Jakovljevic I. COVID-19 pandemia and public and global mental health from the perspective of global health security. Psychiatria Danubina. 2020;32(1):6–14. https://doi.org/10.24869/psyd.2020.6.CrossRefPubMed

Sun S, Goldberg SB, Lin D, Qiao S, Operario D. vol 17, 15,. Psychiatric symptoms, risk, and protective factors among university students in quarantine during the COVID-19 pandemic in China (2021). Globalization and Health. 2021; 17(1). https://doi.org/10.1186/s12992-021-00701-8.

Wang C, Tripp C, Sears SF, Xu L, Tan Y, Zhou D, et al. The impact of the COVID-19 pandemic on physical and mental health in the two largest economies in the world: a comparison between the United States and China. J Behav Med. 2021;44(6):741–59. https://doi.org/10.1007/s10865-021-00237-7.CrossRefPubMedPubMedCentral

Monnig MA, Clark SE, Avila JC, Sokolovsky AW, Padovano HT, Goodyear K, et al. COVID-19-Related stressors and Clinical Mental Health Symptoms in a Northe-Ast US Sample. Int J Environ Res Public Health. 2023;20(2). https://doi.org/10.3390/ijerph20021367.

Wang D-k, Liu X-h, Xiao J-h, Chen J, Li X, Yu C, et al. Hope during the COVID-19 epidemic decreased anxiety and depression symptoms mediated by perceived stress: coping style differences among patients with COVID-19. Curr Med Sci. 2022;42(4):885–94. https://doi.org/10.1007/s11596-022-2624-2.CrossRefPubMedPubMedCentral

Gomez-Garcia G, Ramos-Navas-Parejo M, de la Cruz-Campos J-C, Rodriguez- Jimenez C. Impact of COVID-19 on University students: an analysis of its influence on psychological and academic factors. Int J Environ Res Public Health. 2022;19(16). https://doi.org/10.3390/ijerph191610433.

Sun MQ. The Relationship between Social Support and Test Anxiety of Junior High School Students: the Mediating Role of Resilience. [Masters Thesis]. 2021. https://link.cnki.net/doi/10.27859/d.cnki.gxhsf.2021.000194.

Camargo CP, Tempski PZ, Busnardo FF, Martins MA, Gemperli R. Online learning and COVID-19: a meta-synthesis analysis. Clinics. 2020;75. https://doi.org/10.6061/clinics/2020/e2286.

She R, Wong K, Lin J, Leung K, Zhang Y, Yang X. How COVID-19 stress related to schooling and online learning affects adolescent depression and internet gaming disorder: testing conservation of resources theory with sex difference. J Behav Addictions. 2021;10(4):953–66. https://doi.org/10.1556/2006.2021.00069.CrossRef

10.

Lee FMM, Koch JMM, Ramakrishnan N. Fine arts students: Mental Health, stress, and Time on Academic Work. J Coll Student Psychother. 2023. https://doi.org/10.1080/87568225.2023.2175755.CrossRef

11.

Ye LX. The relationship between time management tendency and learning devotion in high school art students:mediating role of academic self-efficacy. [Masters Thesis]. Sichuan Normal University; 2018. https://kns.cnki.net/kcms2/article/abstract?v=SDjqx_HoHgv4f78XLaVMgo1ak8kTNZZK4i-gXkxYhKHyh8vjtsNjk6lhD3dZU9P8zYmLDZ5yE78QMgPw4Vel4btpJB4U19ts6IciYLN4xlpauWkwdz_KXRZtbHWWnXSt-7C3N6SOCCA=&uniplatform=NZKPT&language=CHS

12.

Zhang XD, Cao HF. Thinking on art education under the new college entrance examination policy. (C). Educational practice and research. 2022(Z1): 41 – 2 + 57. https://doi.org/10.14160/j.cnki.13-1259/g4-c.2022.z1.036.

13.

Huang CB, Wei YJ. The moderating effect of school atmosphere on the relationship between COVID-19 stress and test anxiety in high school students. Teaching quality management research network forum -- Culture and art innovation subforum. 2023; 410–4. https://sci-hub.se/https://doi.org/10.26914/c.cnkihy.2023.038249.

14.

Adams SK, Mushkat Z, Minkel J. Examining the moderator role of Sleep Quality in the relationship among test anxiety, Academic Success and Mood. Psychol Rep. 2022;125(5):2400–15. https://doi.org/10.1177/00332941211025268.CrossRefPubMed

15.

von der Embse N, Jester D, Roy D, Post J. Test anxiety effects, predictors, and correlates: a 30-year meta-analytic review. J Affect Disord. 2018;227:483–93. https://doi.org/10.1016/j.jad.2017.11.048.CrossRefPubMed

16.

Lazarus RS, Folkman S. Stress, appraisal, and coping. Springer publishing company; 1984.

17.

Dugas MJ, Hedayati M, Karavidas A, Buhr K, Francis K, Phillips NA. Intolerance of uncertainty and information processing: evidence of biased recall and interpretations. Cogn Therapy Res. 2005;29(1):57–70. https://doi.org/10.1007/s10608-005-1648-9.CrossRef

18.

Salari N, Khazaie H, Hosseinian-Far A, Khaledi-Paveh B, Kazeminia M, Mohammadi M, et al. The prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients: a systematic review and meta-regression. Hum Resour Health. 2020;18(1). https://doi.org/10.1186/s12960-020-00544-1.

19.

Ye B, Chen X, Zhang Y, Yang Q. Psychological flexibility and COVID-19 burnout in Chinese college students: a moderated mediation model. J Context Behav Sci. 2022;24:126–33. https://doi.org/10.1016/j.jcbs.2022.04.003.CrossRef

20.

Hu Y, Ye B, Tan J. Stress of COVID-19, anxiety, Economic Insecurity, and Mental Health literacy: a structural equation modeling Approach. Front Psychol. 2021;12. https://doi.org/10.3389/fpsyg.2021.707079.

21.

Liebert RM, Morris LW. Cognitive and emotional components of test anxiety: a distinction and some initial data. Psychol Rep. 1967;20(3):975–8. https://doi.org/10.2466/pr0.1967.20.3.975.CrossRefPubMed

22.

Morris LW, Engle WB. Assessing various coping strategies and their effects on test performance and anxiety. J Clin Psychol. 1981;37(1):165–71. https://doi.org/10.1002/1097-4679(198101)37:1%3C165::aid-jclp2270370133%3E3.0.co;2-8.CrossRefPubMed

23.

Chin ECH, Williams MW, Taylor JE, Harvey ST. The influence of negative affect on test anxiety and academic performance: an examination of the tripartite model of emotions. Learn Individual Differences. 2017;54:1–8. https://doi.org/10.1016/j.lindif.2017.01.002.CrossRef

24.

Gu S, He Z, Sun L, Jiang Y, Xu M, Feng G, et al. Effects of Coronavirus-19 Induced loneliness on Mental Health: Sleep Quality and Intolerance for uncertainty as mediators. Front Psychiatry. 2021;12. https://doi.org/10.3389/fpsyt.2021.738003.

25.

Wu D, Yang T, Hall DL, Jiao G, Huang L, Jiao C. COVID-19 uncertainty and sleep: the roles of perceived stress and intolerance of uncertainty during the early stage of the COVID-19 outbreak. BMC Psychiatry. 2021;21(1). https://doi.org/10.1186/s12888-021-03310-2.

26.

Dugas MJ, Gagnon F, Ladouceur R, Freeston MH. Generalized anxiety disorder: a preliminary test of a conceptual model. Behav Res Ther. 1998;36(2):215–26. https://doi.org/10.1016/s0005-7967(97)00070-3.CrossRefPubMed

27.

Hebert EA, Dugas MJ. Behavioral experiments for intolerance of uncertainty: challenging the unknown in the treatment of generalized anxiety disorder. Cogn Behav Pract. 2019;26(2):421–36. https://doi.org/10.1016/j.cbpra.2018.07.007.CrossRef

28.

Oglesby ME, Stentz LA, Portero AK, Kin SL, Schmidt NB. Exaggerated interpretation bias for uncertain information as a predictor of anxiety-related symptoms: a new method of assessment for IU. J Behav Ther Exp Psychiatry. 2019;64:64–71. https://doi.org/10.1016/j.jbtep.2019.02.010.CrossRefPubMed

29.

Ranney RM, Behar E, Bartoszek G. Individuals intolerant of uncertainty: the maintenance of worry and distress despite reduced uncertainty. Behav Ther. 2019;50(3):489–503. https://doi.org/10.1016/j.beth.2018.08.006.CrossRefPubMed

30.

Hong CJ, Wu SM. Mechanisms of mindfulness on test anxiety and evaluation of intervention effect on college students with anxiety tendency. Chin J Health Psychol. 2020;05780–4. https://doi.org/10.13342/j.cnki.cjhp.2020.05.034. https://sci-hub.se/.

31.

Huntley C, Young B, Tudur Smith C, Jha V, Fisher P. Testing times: the association of intolerance of uncertainty and metacognitive beliefs to test anxiety in college students. BMC Psychol. 2022;10(1). https://doi.org/10.1186/s40359-021-00710-7.

32.

Li G, Zhou J, Yang G, Li B, Deng Q, Guo L. The impact of intolerance of uncertainty on test anxiety: student athletes during the COVID-19 pandemic. Front Psychol. 2021;12. https://doi.org/10.3389/fpsyg.2021.658106.

33.

Lin L-y, Wang J, Ou-yang X-y, Miao Q, Chen R, Liang F-x, et al. The immediate impact of the 2019 novel coronavirus (COVID-19) outbreak on subjective sleep status. Sleep Med. 2021;77:348–54. https://doi.org/10.1016/j.sleep.2020.05.018.CrossRefPubMed

34.

Ye B, Wu D, Wang P, Im H, Liu M, Wang X, et al. COVID-19 stressors and poor sleep quality: the mediating role of rumination and the moderating role of emotion regulation strategies. Int J Behav Med. 2022;29(4):416–25. https://doi.org/10.1007/s12529-021-10026-w.CrossRefPubMed

35.

Dongol E, Shaker K, Abbas A, Assar A, Abdelraoof M, Saady E, et al. Sleep quality, stress level and COVID-19 in university students; the forgotten dimension. Sleep Sci. 2022;15:347–54. https://doi.org/10.5935/1984-0063.20210011.CrossRefPubMedPubMedCentral

36.

Jahrami H, BaHammam AS, Bragazzi NL, Saif Z, Faris M, Vitiello MV. Sleep problems during the COVID-19 pandemic by population: a systematic review and meta-analysis. J Clin Sleep Med. 2021;17(2):299–313. https://doi.org/10.5664/jcsm.8930.CrossRefPubMedPubMedCentral

37.

Lee K, Sayre B, Martin S, James TA, Duarte A. Covid-19-Stress Associated with worse sleep quality, particularly with increasing age. Journals of Gerontology Series B-Psychological sciences and Social sciences. 2023; 78(7): 1163–8. https://doi.org/10.1093/geronb/gbac173.

38.

Ram-Vlasov N, Tzischinsky O, Green A, Shochat T, Creativity, Habitual Sleep Patterns Among Art and Social Sciences Undergraduate Students. Psychol Aesthet Creativity Arts. 2016;10(3):270–7. https://doi.org/10.1037/aca0000062.CrossRef

39.

de Bruin EJ, van Run C, Staaks J, Meijer AM. Effects of sleep manipulation on cognitive functioning of adolescents: a systematic review. Sleep Med Rev. 2017;32:45–57. https://doi.org/10.1016/j.smrv.2016.02.006.CrossRefPubMed

40.

Grima NA, Bei B, Mansfield D. Insomnia theory and assessment. Australian J Gen Pract. 2019;48(4):193–7. https://doi.org/10.31128/ajgp-12-18-4780.CrossRef

41.

Short MA, Louca M. Sleep deprivation leads to mood deficits in healthy adolescents. Sleep Med. 2015;16(8):987–93. https://doi.org/10.1016/j.sleep.2015.03.007.CrossRefPubMed

42.

Nguyen V, Zainal V, Newman NH. Why Sleep is Key: poor sleep quality is a mechanism for the bidirectional relationship between Major Depressive Disorder and generalized anxiety disorder across 18 years. J Anxiety Disord. 2022;90. https://doi.org/10.1016/j.janxdis.2022.102601.

43.

Talbot LS, McGlinchey EL, Kaplan KA, Dahl RE, Harvey AG. Sleep deprivation in adolescents and adults: changes in Affect. Emotion. 2010;10(6):831–41. https://doi.org/10.1037/a0020138.CrossRefPubMedPubMedCentral

44.

Lin R-M, Xie S-S, Yan Y-W, Yan W-J. Intolerance of uncertainty and adolescent sleep quality: the mediating role of worry. Pers Indiv Differ. 2017;108:168–73. https://doi.org/10.1016/j.paid.2016.12.025.CrossRef

45.

Liu QQ. The Relationship among Adolescents’ Neuroticism, Pre-test Sleep Quality and Irritable Bowel Syndrome.[ Masters Thesis]. 2018. https://kns.cnki.net/kcms2/article/abstract?v=aGn3Ey0ZxcBIccEdL_6Ap313_-jezL4hTPI5L4iMWS8UJ48Ur95owtxbwvf9x1sO79B8h6MDRe3JCJtMaJNeP6GiTM6LG0PSQQNCP2VJ5jJRINjlLHVJKo_NrtL6AJ7sf6sCxFWdhq4Ii8hAIV7IcA==&uniplatform=NZKPT&language=CHS.

46.

Xu X, Xia M, Pang W. Family socioeconomic status and Chinese high school students’ test anxiety: serial mediating role of parental psychological control, learning resources, and student academic self-efficacy. Scand J Psychol. 2021;62(5):689–98. https://doi.org/10.1111/sjop.12750.CrossRefPubMed

47.

Zhang RJ, An L. The Effect of personality traits on test anxiety: analysis of the multiple Mediating effects. Psychol Sci. 2016;39(03):614–20. https://doi.org/10.16719/j.cnki.1671-6981.20160316.CrossRef

48.

Arslan G, Yildirim M, Tanhan A, Bulus M, Allen K-A. Coronavirus stress, Optimism-Pessimism, psychological inflexibility, and Psychological Health: Psychometric properties of the coronavirus stress measure. Int J Mental Health Addict. 2021;19(6):2423–39. https://doi.org/10.1007/s11469-020-00337-6.CrossRef

49.

Wu LJ, Wang JN, Qi XD. Validity and reliability of the intolerance of uncertainty Scale-12 in middle school students. Chin Mental Health J. 2016;30:700–5. https://doi.org/10.3969/j.issn.1000-6729.2016.09.012.CrossRef

50.

Carleton RN, Norton PJ, Asmundson GJG. Fearing the unknown: a short version of the intolerance of uncertainty scale. J Anxiety Disord. 2007;21(1):105–17. https://doi.org/10.1016/j.janxdis.2006.03.014.CrossRefPubMed

51.

Sancho-Domingo C, Luis Carballo J, Coloma-Carmona A, Buysse DJ. Brief version of the Pittsburgh Sleep Quality Index (B-PSQI) and measurement invariance across gender and age in a Population-based sample. Psychol Assess. 2021;33(2):111–21. https://doi.org/10.1037/pas0000959.CrossRefPubMed

52.

Liu X, Tang M, Hu L, Wang A, Wu H, Zhao G, Gao C, Li W. Reliability and validity of the Pittsburgh sleep quality index. Chinese journal of psychiatry. 1996; 103–107. https://kns.cnki.net/kcms2/article/abstract?v=aGn3Ey0ZxcCRb9k_lAg2tGLxeKf8b56OZaIZqDneuNH3je65PYeQwTsJmpONrzLVvI0b3qgtQs4-jVEGNjDC14anfboVN7E7qnSmpWWD8ntQmQZD_zx62PJttHm6ZdEsm6fU4xqAGnE=&uniplatform=NZKPT&language=CHS

53.

Ye RM, Tom Rocklin. A cross-cultural study of test anxiety. Psychol Sci Bull. 1988;0327–31. https://doi.org/10.16719/j.cnki.1671-6981.1988.03.005.

54.

Wang C. The Reliability and Validation of Chinese Version Test Anxiety Inventory in College Students. Chinese Journal of Clinical Psychology. 2003; 69–70. https://kns.cnki.net/kcms2/article/abstract?v=aGn3Ey0ZxcBcEfuwkQFCQxmajOuVddtuJ8Qy1jBGvyHSodxaL7s9WOthFdMkkkrjITA5muDQm3HsnKbcmMGjKK3gdX4AV1LKNOasycBaE0QBVXv7s7NsyMHXuP8UunPk1SCpGPQ3fNo=&uniplatform=NZKPT&language=CHS.

55.

Lt H, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equation Modeling: Multidisciplinary J. 1999;6(1):1–55. https://doi.org/10.1080/10705519909540118.CrossRef

56.

Bolin JH. Introduction to Mediation, Moderation, and conditional process analysis: a regression-based Approach. J Educ Meas. 2014;51(3):335–7. https://doi.org/10.1111/jedm.12050.CrossRef

57.

Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP. Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol. 2003;88(5):879–903. https://doi.org/10.1037/0021-9010.88.5.879.CrossRefPubMed

58.

Fan XL, Peng CZ, Peng L, Study on TAI Assessment Standard and Its Reliability and Validity. Chinese Journal of Clinical Psychology. 2004(01): 58 – 9. https://kns.cnki.net/kcms2/article/abstract?v=Skeo7MzZydYCryTqTlE7TWJw27CWwJGo3B6vP3O_78eyKBgAKOaHYviKtvCzVASw0u0DF1MBHVpeBBdWbEG55Jhg2Ux6-L3ab31MlQ8MPr-_gQhKQBxc4Eoj3SreDfAAjGZqSWk3Xgw=&uniplatform=NZKPT&language=CHS.

59.

Liu LQ, Zhong Y, Chen YN, Wang N. The relationship among test anxiety, parental anxiety and parental consciousness of senior high school students. Mod Prim Secondary Educ. 2013;0663–6. https://doi.org/10.16165/j.cnki.22-1096/g4.2013.06.008.

60.

Qian NN. Research on Factors and Countermeasures of High School Students Test Anxiety. [Masters Thesis]. 2014. https://kns.cnki.net/kcms2/article/abstract?v=Skeo7MzZydYkjIGDMjaauEHBp0kRkQ6LIa__4R4anspAYsNPnNecdAUN8fQ64KADxLmsoFFLLxeZ4KW7fzHdPKvHMWdBN_7m55WhSKv2VaC0haO1RtxWMuGSuwMlhhVVgTZyL-mJTUwVmTcGQmYAPQ==&uniplatform=NZKPT&language=CHS.

61.

Lazarus RS. Psychological stress and the coping process. New York: McGraw-Hill; 1966.

62.

Deniz ME. Self-compassion, intolerance of uncertainty, fear of COVID-19, and well-being: a serial mediation investigation. Pers Indiv Differ. 2021;177. https://doi.org/10.1016/j.paid.2021.110824.

63.

Dugas MJ, Brillon P, Savard P, Turcotte J, Gaudet A, Ladouceur R, et al. A randomized clinical trial of cognitive-behavioral therapy and Applied Relaxation for adults with generalized anxiety disorder. Behav Ther. 2010;41(1):46–58. https://doi.org/10.1016/j.beth.2008.12.004.CrossRefPubMed

64.

Coiro MJ, Asraf K, Tzischinsky O, Hadar-Shoval D, Tannous-Haddad L, Wolfson AR. Sleep quality and COVID-19-related stress in relation to mental health symptoms among Israeli and U.S. adults. Sleep Health. 2021;7(2):127–33. https://doi.org/10.1016/j.sleh.2021.02.006.CrossRefPubMed

65.

Zhao X, Lan M, Li H, Yang J. Perceived stress and sleep quality among the non- diseased general public in China during the 2019 coronavirus disease: a moderated mediation model. Sleep Med. 2021;77:339–45. https://doi.org/10.1016/j.sleep.2020.05.021.CrossRefPubMed

66.

Kahn M, Sheppes G, Sadeh A. Sleep and emotions: bidirectional links and underlying mechanisms. Int J Psychophysiol. 2013;89(2):218–2. https://doi.org/10.1016/j.ijpsycho.2013.05.010.CrossRefPubMed

67.

Werner A, Kater M-J, Schlarb AA, Lohaus A. Sleep and stress in times of the COVID-19 pandemic: the role of personal resources. Appl Psychology-Health Well Being. 2021;13(4):935–51. https://doi.org/10.1111/aphw.12281.CrossRef

68.

Suardiaz-Muro M, Ortega-Moreno M, Morante-Ruiz M, Monroy M, Ruiz MA, Martin-Plasencia P, et al. Sleep quality and sleep deprivation: relationship with academic performance in university students during examination period. Sleep Biol Rhythms. 2023;21(3):377–83. https://doi.org/10.1007/s41105-023-00457-1.CrossRefPubMedPubMedCentral

69.

Goldstein AN, Walker MP. The Role of Sleep in Emotional Brain Function. In: Cannon TD, Widiger T, editors. Annual Review of Clinical Psychology, Vol 10. Annual Review of Clinical Psychology. 102014. pp. 679–708. https://doi.org/10.1146/annurev-clinpsy-032813-153716.

70.

Wu JQ, Appleman ER, Salazar RD, Ong JC. Cognitive behavioral therapy for Insomnia Comorbid with Psychiatric and Medical conditions a Meta-analysis. Jama Intern Med. 2015;175(9):1461–72. https://doi.org/10.1001/jamainternmed.2015.3006.CrossRefPubMed

71.

Meeten F, Dash SR, Scarlet ALS, Davey GCL. Investigating the effect of intolerance of uncertainty on catastrophic worrying and mood. Behav Res Ther. 2012;50(11):690–8. https://doi.org/10.1016/j.brat.2012.08.003.CrossRefPubMed

72.

Wainer H, Robinson DH. Shaping up the practice of null hypothesis significance testing. Educational Researcher. 2003;32(7):22–30. https://doi.org/10.3102/0013189x032007022.CrossRef

73.

Gall MD, Gall JP, Borg WR. Educational research: an introduction (8. utg.). AE Burvikovs, Red) USA: Pearson. 2007.

74.

Prentice DA, Miller DT. When small effects are impressive. Psychol Bull. 1992;112:160–4. https://doi.org/10.1037/0033-2909.112.1.160.CrossRef

75.

Ellis PD. The essential guide to effect sizes: statistical power, meta-analysis, and the interpretation of research results. Cambridge University Press; 2010.

Titel: The relationship between COVID-19 stress and test anxiety in art students: the chain mediating roles of intolerance of uncertainty and sleep quality
verfasst von: Ruiying Liu
Qing Qiu
Baojuan Ye
Publikationsdatum: 01.12.2024
Verlag: BioMed Central
Erschienen in: BMC Public Health / Ausgabe 1/2024
Elektronische ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-024-18684-7

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

The relationship between COVID-19 stress and test anxiety in art students: the chain mediating roles of intolerance of uncertainty and sleep quality

Abstract

Background

Methods

Results

Conclusion

Publisher’s Note

Introduction

The influence of COVID-19 stress on test anxiety

The mediating role of intolerance of uncertainty

The mediating role of sleep quality

The chain mediation effect intolerance of uncertainty and sleep quality

The current study

Materials and methods

Participants

Measures

COVID-19 stress

Intolerance of uncertainty

Sleep quality

Test anxiety

Data analysis

Results

Common method bias

Descriptive statistics and correlation analysis

The mediating effects of intolerance of uncertainty and sleep quality

Discussion

COVID-19 stress and test anxiety

The mediating role of intolerance of uncertainty

The mediating role of sleep quality

Intolerance of uncertainty and sleep quality as serial mediators

Implication

Limitations and further research

Conclusion

Acknowledgements

Declarations

Ethical approval

Competing interests

Publisher’s Note

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Background

Methods

Results

Conclusion

Publisher’s Note

Introduction

The influence of COVID-19 stress on test anxiety

The mediating role of intolerance of uncertainty

The mediating role of sleep quality

The chain mediation effect intolerance of uncertainty and sleep quality

The current study

Materials and methods

Participants

Measures

COVID-19 stress

Intolerance of uncertainty

Sleep quality

Test anxiety

Data analysis

Results

Common method bias

Descriptive statistics and correlation analysis

The mediating effects of intolerance of uncertainty and sleep quality

Discussion

COVID-19 stress and test anxiety

The mediating role of intolerance of uncertainty

The mediating role of sleep quality

Intolerance of uncertainty and sleep quality as serial mediators

Implication

Limitations and further research

Conclusion

Acknowledgements

Declarations

Ethical approval

Consent for publication

Competing interests

Publisher’s Note

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