Bedtime Procrastination and Psychological Distress in University Students: A Systematic Review and Meta-Analysis of Their Association

Obaid AzeemFatma SulaimanZhu Haidong^*

• Shihezi University, Shihezi, China

ABSTRACT Bedtime procrastination (BP), the voluntary delay of sleep despite the opportunity and intention to sleep, is prevalent among university students, a population particularly vulnerable to both sleep problems and psychological distress. While theoretically linked to mental health, the magnitude and consistency of its associations with depression, anxiety, and stress remain unclear. This systematic review and meta-analysis aimed to quantify these associations and explore potential moderators. We systematically searched PubMed, Web of Science, EBSCOhost, ScienceDirect, WanFang Data, and ProQuest from inception to 2025. Observational studies reporting correlations between BP and depression, anxiety, or perceived stress in university students were included. Study quality was assessed using the Joanna Briggs Institute checklists. Random-effects meta-analyses were conducted to synthesize Pearson correlation coefficients (r). Moderator analyses examined geographic region, gender, and measurement tool. Eighteen studies (N = 35,097) were included. Meta-analyses revealed significant, positive associations between BP and overall psychological distress (k = 14, r = .34, 95% CI [.23, .43]), depressive symptoms (k = 11, r = .28, [.22, .34]), anxiety symptoms (k = 8, r = .30, [.22, .37]), and perceived stress (k = 9, r = .38, [.30, .46]). Effect sizes were moderate, with the strongest association observed for stress. Substantial heterogeneity was present (I² > 90%). Moderator analyses indicated significantly stronger associations in samples from Asian regions compared to the non-asian areas for overall distress and depression. Neither gender distribution nor the specific BP measurement tool significantly moderated the effects. Bedtime procrastination is a robust, transdiagnostic behavioral correlate of psychological distress in university students, showing a powerful link to perceived stress. Findings support theoretical models framing BP as a stress-contingent self-regulation failure. The association appears robust across methodological variations but is culturally contextualized. Targeting bedtime procrastination in interventions may offer a viable pathway for improving sleep and mental well-being in this population.