Associations Among Demographic Characteristics, Sleep Behaviors, Physical Activity, Health Status, and Quality of Life Among Undergraduate Students: A Structural Equation Modeling Study

Abstract

Background: Quality of life (QoL) among university students is an important indicator of overall health and academic success. Although these factors are interrelated, few studies have simultaneously examined their structural associations with QoL among university students in Saudi Arabia. This study investigated the associations among demographic characteristics, lifestyle behaviors, psychological distress, and quality of life using structural equation modeling (SEM). Methods: We conducted a cross-sectional study among undergraduate students enrolled in public universities in Riyadh, Saudi Arabia. The survey included demographic characteristics, the Depression Anxiety Stress Scale-21 (DASS-21), the World Health Organization Quality of Life-BREF (WHOQOL-BREF), and measures of sleep quality, sleep duration, and physical activity. Confirmatory factor analysis was performed to evaluate the measurement model. We fitted SEM to examine associations among demographic characteristics, lifestyle behaviors, health status, and quality of life. Results: A total of 198 undergraduate students were included in the analysis. The measurement model demonstrated satisfactory psychometric properties. The SEM demonstrated acceptable model fit (χ2/df = 2.00, Comparative Fit Index = 0.937, Tucker–Lewis Index = 0.914, Root Mean Square Error of Approximation = 0.071, Standardized Root Mean Square Residual = 0.070). Male students reported poorer sleep quality (β = −0.405, p < 0.001), shorter sleep duration (β = −0.208, p = 0.019), and lower physical activity (β = −0.299, p < 0.001) than female students. Students with a GPA of 4.50 or above reported higher physical activity than those with lower GPAs (β = 0.182, p = 0.027). Better sleep quality (β = 0.169, p = 0.024) and very good or excellent self-rated health (β = 0.492, p < 0.001) were positively associated with quality of life, whereas sleep duration was not significantly associated with quality of life (p = 0.225). Conclusions: Quality of life among undergraduate students was associated with multiple interconnected demographic and lifestyle factors. Our findings highlight the importance of integrated university health-promotion strategies that simultaneously address sleep health, healthy lifestyle behaviors, and psychological well-being to improve students’ overall quality of life. Longitudinal studies should be conducted to clarify the temporal relationships among these factors.