Cited by 1,094Sleep and related disordersMindfulness and Compassion InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

The DOI matches its Crossref record; 186 of the 194 references it cites were found in a registry or an index; none of the 36 sources its claims cite is checked for support yet.

Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials

Open access
Scott, Alexander J., Webb, Thomas L., Martyn-St James, Marrissa, Rowse, Georgina, Weich, Scott·2021·Sleep Medicine Reviews

Published version of a preprint

Abstract

The extent to which sleep is causally related to mental health is unclear. One way to test the causal link is to evaluate the extent to which interventions that improve sleep quality also improve mental health. We conducted a meta-analysis of randomised controlled trials that reported the effects of an intervention that improved sleep on composite mental health, as well as on seven specific mental health difficulties. 65 trials comprising 72 interventions and N = 8608 participants were included. Improving sleep led to a significant medium-sized effect on composite mental health (g+ = -0.53), depression (g+ = -0.63), anxiety (g+ = -0.51), and rumination (g+ = -0.49), as well as significant small-to-medium sized effects on stress (g+ = -0.42), and finally small significant effects on positive psychosis symptoms (g+ = -0.26). We also found a dose response relationship, in that greater improvements in sleep quality led to greater improvements in mental health. Our findings suggest that sleep is causally related to the experience of mental health difficulties. Future research might consider how interventions that improve sleep could be incorporated into mental health services, as well as the mechanisms of action that explain how sleep exerts an effect on mental health.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This meta-analysis of randomised controlled trials found that interventions which successfully improved sleep quality produced significant improvements in subsequent mental health, with a medium-sized effect on composite mental health. The findings support a causal role for sleep in mental health difficulties and suggest sleep as a transdiagnostic treatment target.

Key findings

  • Across 65 trials, 72 interventions, and N = 8608 participants, improving sleep led to a significant medium-sized effect on composite mental health (g+ = −0.53, 95% CI −0.68 to −0.38), depression (g+ = −0.63), anxiety (g+ = −0.51), and rumination (g+ = −0.49), plus smaller effects on stress (g+ = −0.42) and positive psychosis symptoms (g+ = −0.26).
  • A dose–response relationship was found: greater improvements in sleep quality were associated with greater improvements in mental health (B = 0.77, 95% CI 0.52 to 1.02, p < 0.001).
  • Studies with a significant effect on sleep quality showed larger mental health effects (g = −0.53) than those without (g = −0.12; Q = 17.59, p < 0.001); effects were larger at shorter follow-up (<6 months, g+ = −0.60) than longer follow-up (≥6 months, g+ = −0.18; Q = 10.75, p < 0.01), and larger for clinician-delivered (g+ = −0.63) than self-administered interventions (g+ = −0.34; Q = 4.50, p < 0.05).
  • Publication bias was indicated by funnel plot asymmetry (Egger’s regression = −1.09, p < 0.05); trim-and-fill adjustment reduced the composite effect to g+ = −0.35, and Orwin’s fail-safe n was 4101.

Methods

  • Systematic review and meta-analysis of RCTs that tested an intervention designed to improve sleep, produced a statistically significant improvement in sleep quality versus control, and measured mental health at a later follow-up; studies were excluded if the intervention specifically targeted mental health or recruited participants under 18 years.
  • Searches covered MEDLINE, Embase, PsycINFO, and The Cochrane Library, plus reference lists and trial registries, originally in May 2019 and updated in February 2021; PRISMA selection yielded 65 studies and 72 comparisons.
  • Random-effects meta-analysis in R used Hedges g, I² for heterogeneity, moderation/subgroup analyses and meta-regression, Cochrane risk-of-bias assessment, and publication-bias checks including funnel plot, Egger’s test, trim-and-fill, and Orwin’s fail-safe n.

Limitations

  • The paper states that relatively few studies examined long-term effects, and longer follow-ups generally showed smaller effects, likely due to diminishing intervention effects on sleep quality over time.
  • The paper states that few primary studies existed for outcomes other than depression and anxiety, limiting inferences for other mental health difficulties, and that most analyses were based on CBT for insomnia; the focus on sleep quality may also have excluded studies of sleep disorders with different improvement definitions.
  • Evident from the text: most included studies were at high (29, 45%) or unclear (26, 40%) risk of bias, with only 10 (15%) at low risk; main analyses showed substantial heterogeneity (I² = 76–82% for composite, depression, and anxiety), and publication bias was present, with trim-and-fill reducing the composite effect.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.smrv.2021.101556

Cites

186 of 186 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Fig. 1 PRISMA diagram showing the flow of studies through the review.
Fig. 1 PRISMA diagram showing the flow of studies through the review.CC BY · PubMed Central
Fig. 2 Forest plot showing the effect of improving sleep on composite mental health outcomes.
Fig. 2 Forest plot showing the effect of improving sleep on composite mental health outcomes.CC BY · PubMed Central
Fig. 3 Forest plot showing the effect of improving sleep on depression.
Fig. 3 Forest plot showing the effect of improving sleep on depression.CC BY · PubMed Central
Fig. 4 Forest plot showing the effect of improving sleep on anxiety.
Fig. 4 Forest plot showing the effect of improving sleep on anxiety.CC BY · PubMed Central
Fig. 5 Forest Plot Showing the Effect of Improving Sleep on Stress, Suicidal Ideation, PTSD, and rumination.
Fig. 5 Forest Plot Showing the Effect of Improving Sleep on Stress, Suicidal Ideation, PTSD, and rumination.CC BY · PubMed Central
Fig. 6 Forest plot showing the effect of improving sleep on psychosis spectrum outcomes.
Fig. 6 Forest plot showing the effect of improving sleep on psychosis spectrum outcomes.CC BY · PubMed Central
Fig. 7 Weighted risk of bias summary plot.
Fig. 7 Weighted risk of bias summary plot.CC BY · PubMed Central
Fig. 8 Contrast enhanced funnel plot for the effect of improving sleep on composite mental health (solid grey markers) with imputed studies (hollow markers).
Fig. 8 Contrast enhanced funnel plot for the effect of improving sleep on composite mental health (solid grey markers) with imputed studies (hollow markers).CC BY · PubMed Central

Verification

Claims the paper makes

52 Own result · 25 Not checked yet · 16 Own interpretation · 13 No basis given · 5 Own method

Verify all 36 references — free account

Show all 75 claims

  • It may state two separate claims as one. 18
  • Probably not a substantial claim. 20
36 of 36
  • The paper relies on this without support.

    The interventions that successfully improved sleep quality did not improve mental health through mechanisms other than improved sleep.

    “To better isolate the effect of improved sleep on mental health, we excluded interventions that included specific elements targeting mental health (e.g., CBT elements for depression).”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

4 of 4

Citations

Cites

Show all 194 references

Cited by

Sorted by citations

Items 801–900 of 1,000

Metadata

Authors
Scott, A. J., Webb, T. L., Martyn-St James, M., Rowse, G., & Weich, S.
Affiliations
  • Keele University (GB)
  • University of Sheffield (GB)
Corresponding author
Scott, Alexander J.
Venue
Sleep Medicine Reviews
Publisher
Elsevier BV
Published
2021-12
Volume
60
Pages
101556
ISSN
1087-0792 (ISSN-L)
OpenAlex
W3203364067
Cited by
1,094
References
194
Citations by year
2026: 226 · 2025: 349 · 2024: 275 · 2023: 190 · 2022: 51 · 2021: 3
FWCI
21.13
Type
journal article
Language
en
Open access
Locations
  • Sleep Medicine Reviews (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • Keele Research Repository (Keele University) (submittedVersion, cc-by)
  • PsyArXiv (OSF Preprints) (submittedVersion, cc-by)
  • PsyArXiv (OSF Preprints) (submittedVersion)
Funders
  • Research for Patient Benefit Programme (PB-PG- 0817-20027)
  • National Institute for Health Research
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
sleep quality, mental health, sleep interventions, depression, anxiety, rumination, stress, psychotic symptoms, dose-response relationship
MeSH terms
Sleep Quality, Anxiety, Humans, Mental Health, Psychotic Disorders, Sleep, Randomized Controlled Trials as Topic

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-10-09, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-09 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review