The Association Between Tuberculosis-Related Stigma and Sleep Quality Among Hospitalized Tuberculosis Patients: The Indirect Role of Anxiety.

BACKGROUND

To investigate the relationship between perceived stigma and sleep quality among hospitalized tuberculosis patients, and to examine the indirect role of anxiety in this relationship.

METHODS

A cross-sectional study design was employed. A convenience sample of 2179 tuberculosis patients was selected and assessed using the TB-Related Stigma Scale (TSS), the Self-Rating Anxiety Scale (SAS), and the Pittsburgh Sleep Quality Index (PSQI). The indirect effect of anxiety was examined using the PROCESS macro (Model 4; Hayes, 2018) with 5000 bootstrap resamples to generate 95% bias-corrected confidence intervals for indirect effects.

RESULTS

Perceived stigma was positively associated with PSQI scores (r = 0.143, p < 0.01), indicating that higher perceived stigma was associated with poorer sleep quality. Perceived stigma was also positively correlated with anxiety (r = 0.180, p < 0.01), and anxiety was positively associated with PSQI scores (r = 0.446, p < 0.01), suggesting that higher anxiety was also associated with poorer sleep quality.

CONCLUSION

Perceived stigma was indirectly associated with sleep quality through anxiety. These findings suggest that perceived stigma and anxiety may be potential contributing factors related to sleep quality in this population. Given the cross-sectional design, they should be interpreted as hypotheses-generating rather than evidence of causal intervention effects; future intervention studies may consider combined approaches-such as cognitive behavioral therapy together with social support and anxiety-management interventions-to examine whether targeting perceived stigma and anxiety improves sleep outcomes.