Doctoral Thesis
Poor sleep among persons with a mental health condition in Australia: prevalence, associations with other health risk behaviours, and current provision of health care
Murdoch University
Doctor of Philosophy (PhD), Murdoch University
2025
DOI:
https://doi.org/10.60867/00000083
Abstract
Poor sleep and lifestyle risk behaviours—including smoking, poor nutrition, risky alcohol use, and inadequate physical activity (SNAP risks)—are common among people with mental health conditions and linked to poorer health outcomes. Although sleep is increasingly recognised as the third pillar of health, it remains overlooked in preventative care and absent from clinical guidelines addressing SNAP risks. Limited evidence exists on how sleep and SNAP risks are addressed in mental health services, or how they interact across the lifespan to influence mental health.
While SNAP risk effects on health are well documented, the role of sleep remains underrepresented. This thesis examined developmental trajectories and combined effects of poor sleep, SNAP risks, and mental health difficulties across development, and investigated the provision of sleep care in mental health services.
Using longitudinal Raine Study data (ages 8–27 years), poor sleep and SNAP risks increased across development, with poor sleep consistently linked to worse mental health. Interactions between poor sleep and greater adherence to a Western dietary pattern predicted poorer outcomes, highlighting cumulative burden. Cross-sectional data from the Sleep Improvement Study showed that higher cognitive performance and greater adherence to a healthy diet independently protected mental health among middle- and older-aged adults with poor sleep. Specific sleep dimensions—especially poorer sleep quality and greater daytime fatigue— were correlated with SNAP risks such as alcohol consumption, underscoring interconnections between cognition, lifestyle, and sleep health.
A systematic review and meta-analysis showed that preventative sleep care is rarely delivered in mental health services, with limited assessment, advice, or referral. Secondary survey analysis revealed that nearly half of Australian adults with mental health conditions met criteria for probable insomnia, yet only 16% accessed first-line cognitive behavioural therapy.
Collectively, these findings highlight sleep as a critical but neglected target for integrated mental health prevention and care.
Details
- Title
- Poor sleep among persons with a mental health condition in Australia: prevalence, associations with other health risk behaviours, and current provision of health care
- Authors/Creators
- Dan Russell
- Contributors
- Guillermo Campitelli (Supervisor) - Murdoch University, Centre for Biosecurity and One HealthStephanie Rainey-Smith (Supervisor) - Murdoch University, Centre for Healthy AgeingAlexandra Metse (Supervisor) - University of the Sunshine CoastHelen Correia (Supervisor)
- Awarding Institution
- Murdoch University; Doctor of Philosophy (PhD)
- Publisher
- Murdoch University
- Identifiers
- 991005871138407891
- Murdoch Affiliation
- College of Health and Education
- Resource Type
- Doctoral Thesis
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