The study, conducted by Richard Armah Danyi of Teesside University in the United Kingdom and Patrick Kwame Akwaboah of the University of Lethbridge in Canada, analyzed primary survey data collected between October and December 2024. Participants were recruited through the Ghana Physician Assistant Association via email, WhatsApp, and QR-coded posters displayed at the association’s annual conference. Anxiety symptoms were measured using the Hospital Anxiety and Depression Scale (HADS), a validated seven-item instrument with demonstrated sensitivity and specificity, and a score of eight or higher was used to indicate the presence of anxiety symptoms. The subscale showed very good internal consistency in this sample, with a Cronbach’s alpha of 0.84.

Sleep duration was self-reported, with participants asked to state their average nightly hours of sleep. Following the Canadian 24-hour Movement Guidelines for adults, those reporting seven to nine hours per night were classified as meeting the recommended sleep guideline, while those reporting fewer than seven hours were classified as not meeting it. Notably, no participant reported sleeping more than nine hours per night, suggesting that insufficient sleep, rather than oversleeping, was the dominant pattern in this population.

The results revealed a striking picture of sleep deprivation among Ghana’s frontline clinicians. Only 31.9 percent of participants met the recommended sleep duration guideline, meaning more than two-thirds routinely slept fewer than seven hours per night. Meanwhile, 23.5 percent of respondents reported anxiety symptoms at the clinical threshold. Sex differences emerged in sleep behavior, with 39.3 percent of female physician assistants meeting the sleep guideline compared to just 28.0 percent of males, a statistically significant difference. Age also played a role in mental health outcomes, with younger participants aged 24 to 40 years showing a significantly higher prevalence of anxiety symptoms (26.2 percent) than their older colleagues aged 41 to 67 years (15.7 percent).

To examine the association between sleep and anxiety while accounting for potential confounding factors, the researchers employed multivariable logistic regression. The models adjusted for a broad range of covariates, including sociodemographic variables such as age, sex, educational attainment, monthly income, and marital status, as well as behavioral factors like alcohol intake and moderate-to-vigorous physical activity. Uniquely, the analysis also incorporated environmental and climatic variables, including urban versus rural practice location, sidewalk availability along the commute, and satellite-derived regional data on rainfall, temperature, and relative humidity obtained from the Ghana Meteorological Agency.

After adjustment, meeting the recommended sleep guideline was associated with 55 percent lower odds of anxiety symptoms (adjusted odds ratio = 0.45, 95 percent confidence interval: 0.26–0.78). This finding was corroborated by a sensitivity analysis treating both sleep duration and anxiety symptom scores as continuous variables, which showed that each additional hour of daily sleep was associated with a 0.69-point decrease in anxiety symptom score (β = −0.69, 95 percent CI: −1.01, −0.38). The consistency of results across both binary and continuous analytical approaches strengthens the robustness of the observed association.

Beyond sleep, the study uncovered intriguing environmental correlates of mental health. Physician assistants practicing in urban settings had more than twice the odds of experiencing anxiety symptoms compared to their rural counterparts (aOR = 2.17, 95 percent CI: 1.13–4.16). Conversely, the availability of sidewalks along the route to work was associated with 41 percent lower odds of anxiety symptoms (aOR = 0.59, 95 percent CI: 0.35–0.99), although the researchers cautioned that this finding should be interpreted carefully given that the confidence interval lies close to the null value. These results suggest that the built environment may play a meaningful role in shaping psychological wellbeing among healthcare workers, potentially through mechanisms involving walkability, green space exposure, and relief from urban stressors such as traffic congestion and noise.

The neurobiological plausibility of the sleep-anxiety link is well established in the scientific literature. Experimental evidence indicates that sleep deprivation is associated with increased amygdala reactivity and impaired prefrontal cortical regulation, two mechanisms closely tied to anxiety symptoms. Epidemiological studies have consistently reinforced this relationship; a large analysis of 13,476 adults from the U.S. National Health and Nutrition Examination Survey found that very short sleep duration (under five hours) was associated with a 40 percent higher risk of anxiety symptoms, while short sleep (five to less than seven hours) carried a 17 percent higher risk. Meta-analytic evidence further suggests that approximately 47 percent of healthcare professionals experience insufficient sleep and are more than twice as likely to report anxiety symptoms.

The prevalence of anxiety symptoms observed in this Ghanaian cohort, while substantial, was lower than the 57.6 percent reported among healthcare workers in Ethiopia but falls within the range documented across sub-Saharan Africa. The higher prevalence among younger physician assistants may reflect the occupational stress associated with career establishment, professional uncertainty, and heavy workload demands during the early stages of clinical practice. Physician assistants in Ghana serve as critical frontline providers in municipal and district hospitals, health centers, and clinics, often working in resource-constrained environments with high patient loads. As of 2021, over 3,000 physician assistants were registered with the Medical and Dental Council of Ghana, making their mental health a matter of significant public health and health system concern.

The authors acknowledge several limitations that warrant cautious interpretation. The cross-sectional design precludes causal inference, and reverse causation remains plausible, as anxiety symptoms may themselves disrupt sleep duration just as inadequate sleep may exacerbate anxiety. Sleep was self-reported and subject to recall and social desirability bias, and the study captured only duration rather than other important dimensions such as sleep quality, insomnia symptoms, or sleep timing. Unmeasured factors including workload, shift patterns, burnout, and social support may also have influenced the observed associations. Nevertheless, the findings position adequate sleep as a potentially modifiable factor in safeguarding the mental health of frontline healthcare providers. The authors call for future longitudinal research incorporating objective sleep measures such as actigraphy, broader representation of healthcare professional cadres, and a 24-hour movement behavior framework that considers the combined contributions of sleep, physical activity, and sedentary behavior to mental health outcomes.

Subject of Research: Association between sleep guideline adherence and anxiety symptoms among physician assistants in Ghana

Article Title: Association between meeting sleep guidelines and anxiety symptoms among Physician assistants in Ghana: a cross-sectional study

Article References: Danyi, R. A., & Akwaboah, P. K. (2026). Association between meeting sleep guidelines and anxiety symptoms among Physician assistants in Ghana: a cross-sectional study. Frontiers in Sleep, 5, Article 1928518. https://doi.org/10.3389/frsle.2026.1928518

Image Credits: AI Generated

DOI: 10.3389/frsle.2026.1928518

Keywords: sleep duration, anxiety symptoms, physician assistants, Ghana, mental health, healthcare workers, cross-sectional study, HADS, sleep guidelines, urban practice, sub-Saharan Africa, occupational health