Associations of sleep quality and physical activity with anxiety and depressive symptoms among university students: a cross-sectional study

Sleep disturbances and insufficient physical activity are common in university populations and have been associated with adverse mental health outcomes; however, evidence integrating these factors in Latin American student populations remains limited. This study examined the associations of sleep quality and physical activity with anxiety and depressive symptoms among university students and assessed whether physical activity moderates the association between sleep quality and mood symptoms. This cross-sectional analysis was conducted within the EpiHealth-UCEVA project and included 1,125 undergraduate students from a Colombian public university. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS), sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and physical activity using the International Physical Activity Questionnaire (IPAQ). Multivariable linear regression models, along with moderation analyses using PROCESS (Model 1), were conducted. In adjusted regression models, poorer sleep quality was associated with higher anxiety ( B = 0.59) and depressive symptoms ( B = 0.10). Moderate physical activity was associated with lower anxiety, whereas high physical activity was associated with lower depressive symptoms. In moderation analyses, the overall sleep × physical activity interaction was not statistically significant. These findings suggest complementary roles of sleep quality and physical activity in students’ mental health and highlight the potential value of integrated lifestyle-based strategies to support mental well-being in university settings.