Abstract
Household financial hardship primarily affects the mental and physical health of children, with adolescence being a particularly vulnerable period for emotional and sleep-related issues. This study aimed to investigate the associations between economic difficulties experienced by families during the coronavirus disease (COVID-19) pandemic and adolescents' sleep patterns, specifically sleep duration and sleep satisfaction as a proxy of sleep quality. Data from the 2020 and 2021 Korea Youth Risk Behavior Surveys, comprising a final sample of 95,816 students, were analyzed. Financial hardship was measured using self-reported perceptions of household financial difficulties, whereas sleep duration was assessed through open-ended questions. The association between financial hardship and sleep duration was examined using multinomial logistic regression analysis conducted in SAS version 9.4. Students who perceived their households as financially strained were more likely to experience both reduced and increased sleep durations (males < 7 h, odds ratio [OR]: 1.10, 95% confidence interval [CI]: 1.00-1.22; females < 7 h, OR: 1.14, 95% CI: 1.01-1.29; females ≥ 9 h, OR: 1.52, 95% CI: 1.16-1.99). These associations were more pronounced among female students and remained statistically significant after adjusting for demographic characteristics, health behaviors, and mental health factors. Severe financial stress was also associated with decreased sleep satisfaction, suggesting an impact on both sleep quantity and perceived quality. These findings suggest that abnormal sleep patterns may be an overlooked manifestation of adolescent stress under economic pressure and highlight the urgent need for targeted mental health and sleep-related interventions during times of crisis.