citing research articles in text

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APA Style (7th Edition) Citation Guide: Journal Articles

• Introduction
• Journal Articles
• Magazine/Newspaper Articles
• Books & Ebooks
• Government & Legal Documents
• Biblical Sources
• Secondary Sources
• Films/Videos/TV Shows
• How to Cite: Other
• Additional Help

Table of Contents

Journal article from library database with doi - one author, journal article from library database with doi - multiple authors, journal article from a website - one author.

Journal Article- No DOI

Note: All citations should be double spaced and have a hanging indent in a Reference List.

A "hanging indent" means that each subsequent line after the first line of your citation should be indented by 0.5 inches.

This Microsoft support page contains instructions about how to format a hanging indent in a paper.

• APA 7th. ed. Journal Article Reference Checklist

If an item has no author, start the citation with the article title.

When an article has one to twenty authors, all authors' names are cited in the References List entry. When an article has twenty-one or more authors list the first nineteen authors followed by three spaced ellipse points (. . .) , and then the last author's name. Rules are different for in-text citations; please see the examples provided.

Cite author names in the order in which they appear on the source, not in alphabetical order (the first author is usually the person who contributed the most work to the publication).

Italicize titles of journals, magazines and newspapers. Do not italicize or use quotation marks for the titles of articles.

Capitalize only the first letter of the first word of the article title. If there is a colon in the article title, also capitalize the first letter of the first word after the colon.

If an item has no date, use the short form n.d. where you would normally put the date.

Volume and Issue Numbers

Italicize volume numbers but not issue numbers.

Retrieval Dates

Most articles will not need these in the citation. Only use them for online articles from places where content may change often, like a free website or a wiki.

Page Numbers

If an article doesn't appear on continuous pages, list all the page numbers the article is on, separated by commas. For example (4, 6, 12-14)

Library Database

Do not include the name of a database for works obtained from most academic research databases (e.g. APA PsycInfo, CINAHL) because works in these resources are widely available. Exceptions are Cochrane Database of Systematic Reviews, ERIC, ProQuest Dissertations, and UpToDate.

Include the DOI (formatted as a URL: https://doi.org/...) if it is available. If you do not have a DOI, include a URL if the full text of the article is available online (not as part of a library database). If the full text is from a library database, do not include a DOI, URL, or database name.

In the Body of a Paper

Books, Journals, Reports, Webpages, etc.: When you refer to titles of a “stand-alone work,” as the APA calls them on their APA Style website, such as books, journals, reports, and webpages, you should italicize them. Capitalize words as you would for an article title in a reference, e.g., In the book Crying in H Mart: A memoir , author Michelle Zauner (2021) describes her biracial origin and its impact on her identity.

Article or Chapter: When you refer to the title of a part of a work, such as an article or a chapter, put quotation marks around the title and capitalize it as you would for a journal title in a reference, e.g., In the chapter “Where’s the Wine,” Zauner (2021) describes how she decided to become a musician.

The APA Sample Paper below has more information about formatting your paper.

• APA 7th ed. Sample Paper

Author's Last Name, First Initial. Second Initial if Given. (Year of Publication). Title of article: Subtitle if any. Name of Journal, Volume Number (Issue Number), first page number-last page number. https://doi.org/doi number

Smith, K. F. (2022). The public and private dialogue about the American family on television: A second look. Journal of Media Communication, 50 (4), 79-110. https://doi.org/10.1152/j.1460-2466.2000.tb02864.x

Note: The DOI number is formatted as a URL: https://doi.org/10.1152/j.1460-2466.2000.tb02864.xIf

In-Text Paraphrase:

(Author's Last Name, Year)

Example: (Smith, 2000)

In-Text Quote:

(Author's Last Name, Year, p. Page Number)

Example: (Smith, 2000, p. 80)

Author's Last Name, First Initial. Second Initial if Given., & Last Name of Second Author, First Initial. Second Initial if Given. (Year of Publication). Title of article: Subtitle if any. Name of Journal, Volume Number (Issue Number), first page number-last page number. https://doi.org/doi number

Note: Separate the authors' names by putting a comma between them. For the final author listed add an ampersand (&) after the comma and before the final author's last name.

Note: In the reference list invert all authors' names; give last names and initials for only up to and including 20 authors. When a source has 21 or more authors, include the first 19 authors’ names, then three ellipses (…), and add the last author’s name. Don't include an ampersand (&) between the ellipsis and final author.

Note : For works with three or more authors, the first in-text citation is shortened to include the first author's surname followed by "et al."

Reference List Examples

Two to 20 Authors

Case, T. A., Daristotle, Y. A., Hayek, S. L., Smith, R. R., & Raash, L. I. (2011). College students' social networking experiences on Facebook. Journal of Applied Developmental Psychology, 3 (2), 227-238. https://doi.org/10.1016/j.appdev.2008.12.010

21 or more authors

Kalnay, E., Kanamitsu, M., Kistler, R., Collins, W., Deaven, D., Gandin, L., Iredell, M., Saha, J., Mo, K. C., Ropelewski, C., Wang, J., Leetma, A., . . . Joseph, D. (1996). The NCEP/NCAR 40-year reanalysis project. Bulletin of the American Meteorological Society , 77 (3), 437-471. https://doi.org/10.1175/1520-0477(1996)077<0437:TNYRP>2.0.CO;2

In-Text Citations

Two Authors/Editors

(Case & Daristotle, 2011)

Direct Quote: (Case & Daristotle, 2011, p. 57)

Three or more Authors/Editors

(Case et al., 2011)

Direct Quote: (Case et al., 2011, p. 57)

Author's Last Name, First Initial. Second Initial if Given. (Year of Publication). Title of article: Subtitle if any.  Name of Journal, Volume Number (Issue Number if given). URL

Flachs, A. (2010). Food for thought: The social impact of community gardens in the Greater Cleveland Area.  Electronic Green Journal, 1 (30). http://escholarship.org/uc/item/6bh7j4z4

Example: (Flachs, 2010)

Example: (Flachs, 2010, Conclusion section, para. 3)

Note: In this example there were no visible page numbers or paragraph numbers; in this case you can cite the section heading and the number of the paragraph in that section to identify where your quote came from. If there are no page or paragraph numbers and no marked section, leave this information out.

Journal Article - No DOI

Author's Last Name, First Initial. Second Initial if Given. (Year of Publication). Title of article: Subtitle if any.  Name of Journal, Volume Number (Issue Number), first page number-last page number. URL [if article is available online, not as part of a library database]

Full-Text Available Online (Not as Part of a Library Database):

Steinberg, M. P., & Lacoe, J. (2017). What do we know about school discipline reform? Assessing the alternatives to suspensions and expulsions.  Education Next, 17 (1), 44–52.  https://www.educationnext.org/what-do-we-know-about-school-discipline-reform-suspensions-expulsions/

Example: (Steinberg & Lacoe, 2017)

(Author's Last Name, Year, p. Page number)

Example: (Steinberg & Lacoe, 2017, p. 47)

Full-Text Available in Library Database:

Jungers, W. L. (2010). Biomechanics: Barefoot running strikes back.  Nature, 463 (2), 433-434.

Example: (Jungers, 2010)

Example: (Jungers, 2010, p. 433)

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Apa quick citation guide.

• In-text Citation
• Citing Generative AI
• Citing Web Pages and Social Media
• Citing Articles
• Citing Books
• Citing Business Reports
• Other Formats
• APA Style Quiz

Using In-text Citation

Include an in-text citation when you refer to, summarize, paraphrase, or quote from another source. For every in-text citation in your paper, there must be a corresponding entry in your reference list.

APA in-text citation style uses the author's last name and the year of publication, for example: (Field, 2005). For direct quotations, include the page number as well, for example: (Field, 2005, p. 14). For sources such as websites and e-books that have no page numbers , use a paragraph number, for example: (Field, 2005, para. 1). More information on direct quotation of sources without pagination is given on the APA Style and Grammar Guidelines web page.

Example paragraph with in-text citation

A few researchers in the linguistics field have developed training programs designed to improve native speakers' ability to understand accented speech (Derwing et al., 2002; Thomas, 2004). Their training techniques are based on the research described above indicating that comprehension improves with exposure to non-native speech.   Derwing et al. (2002) conducted their training with students preparing to be social workers, but note that other professionals who work with non-native speakers could benefit from a similar program.

Derwing, T. M., Rossiter, M. J., & Munro, M. J. (2002). Teaching native speakers to listen to foreign-accented speech.  Journal of Multilingual and Multicultural Development , 23 (4), 245-259.

Thomas, H. K. (2004).  Training strategies for improving listeners' comprehension of foreign-accented speech  (Doctoral dissertation). University of Colorado, Boulder.

Citing Web Pages In Text

Cite web pages in text as you would any other source, using the author and date if known. Keep in mind that the author may be an organization rather than a person. For sources with no author, use the title in place of an author.

For sources with no date use n.d. (for no date) in place of the year: (Smith, n.d.). For more information on citations for sources with no date or other missing information see the page on missing reference information on the APA Style and Grammar Guidelines web page. 

Below are examples of using in-text citation with web pages.

Web page with author:

In-text citation

Heavy social media use can be linked to depression and other mental disorders in teens (Asmelash, 2019).

Reference entry

Asmelash, L. (2019, August 14). Social media use may harm teens' mental health by disrupting positive activities, study says . CNN. https://www.cnn.com/2019/08/13/health/social-media-mental-health-trnd/index.html

Web page with organizational author:

More than 300 million people worldwide are affected by depression (World Health Organization, 2018).

World Health Organization. (2018, March 22).  Depression . https://www.who.int/en/news-room/fact-sheets/detail/depression

Web page with no date:

Establishing regular routines, such as exercise, can help survivors of disasters recover from trauma (American Psychological Association [APA], n.d.).

American Psychological Association. (n.d.). Recovering emotionally from disaste r. http://www.apa.org/helpcenter/recovering-disasters.aspx

General Guidelines

In-text references should immediately follow the title, word, or phrase to which they are directly relevant, rather than appearing at the end of long clauses or sentences. In-text references should always precede punctuation marks. Below are examples of using in-text citation.

Author's name in parentheses:

One study found that the most important element in comprehending non-native speech is familiarity with the topic (Gass & Varonis, 1984).

Author's name part of narrative:

Gass and Varonis (1984) found that the most important element in comprehending non-native speech is familiarity with the topic.

Group as author: First citation: (American Psychological Association [APA], 2015) Subsequent citation: (APA, 2015)

Multiple works: (separate each work with semi-colons)

Research shows that listening to a particular accent improves comprehension of accented speech in general (Gass & Varonis, 1984; Krech Thomas, 2004).

Direct quote: (include page number and place quotation marks around the direct quote)

One study found that “the listener's familiarity with the topic of discourse greatly facilitates the interpretation of the entire message” (Gass & Varonis, 1984, p. 85).

Gass and Varonis (1984) found that “the listener’s familiarity with the topic of discourse greatly facilitates the interpretation of the entire message” (p. 85).

Note:  For direct quotations of more than 40 words , display the quote as an indented block of text without quotation marks and include the authors’ names, year, and page number in parentheses at the end of the quote. For example:

This suggests that familiarity with nonnative speech in general, although it is clearly not as important a variable as topic familiarity, may indeed have some effect. That is, prior experience with nonnative speech, such as that gained by listening to the reading, facilitates comprehension. (Gass & Varonis, 1984, p. 77)

Works by Multiple Authors

APA style has specific rules for citing works by multiple authors. Use the following guidelines to determine how to correctly cite works by multiple authors in text. For more information on citing works by multiple authors see the APA Style and Grammar Guidelines page on in-text citation .

Note: When using multiple authors' names as part of your narrative, rather than in parentheses, always spell out the word and. For multiple authors' names within a parenthetic citation, use &.

One author: (Field, 2005)

Two authors: (Gass & Varonis, 1984)

Three or more authors:   (Tremblay et al., 2010)

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APA Style 7th Edition: Citing Your Sources

• Basics of APA Formatting
• In Text Quick View
• Block Quotes
• Books & eBooks

Standard Format

Formatting rules, various examples.

• Thesis/Dissertation
• Audiovisual
• Conference Presentations
• Social Media
• Legal References
• Reports and Gray Literature
• Academic Integrity and Plagiarism
• Additional Resources
• Reference Page

Adapted from American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed).  https://doi.org/10.1037/0000165-000

The following formats apply to all journals, periodicals, magazines, newspapers, etc. whether you found them in an online database, search engine, or in print.

• Volume, issue and page numbers in periodicals:  Continuous pagination throughout a volume: only cite the volume number (in italics), followed by a comma and then the page numbers: 20 , 344-367.
•   Do Not copy and paste URLS from library databases or other platforms that restrict public access.

See Ch. 10 pp. 313-352 of APA Manual for more examples and formatting rules

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• Knowledge Base
• Referencing
• Harvard In-Text Citation | A Complete Guide & Examples

Harvard In-Text Citation | A Complete Guide & Examples

Published on 30 April 2020 by Jack Caulfield . Revised on 5 May 2022.

An in-text citation should appear wherever you quote or paraphrase a source in your writing, pointing your reader to the full reference .

In Harvard style , citations appear in brackets in the text. An in-text citation consists of the last name of the author,  the year of publication, and a page number if relevant.

Up to three authors are included in Harvard in-text citations. If there are four or more authors, the citation is shortened with et al .

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Table of contents

Including page numbers in citations, where to place harvard in-text citations, citing sources with missing information, frequently asked questions about harvard in-text citations.

When you quote directly from a source or paraphrase a specific passage, your in-text citation must include a page number to specify where the relevant passage is located.

Use ‘p.’ for a single page and ‘pp.’ for a page range:

• Meanwhile, another commentator asserts that the economy is ‘on the downturn’ (Singh, 2015, p. 13 ).
• Wilson (2015, pp. 12–14 ) makes an argument for the efficacy of the technique.

If you are summarising the general argument of a source or paraphrasing ideas that recur throughout the text, no page number is needed.

Prevent plagiarism, run a free check.

When incorporating citations into your text, you can either name the author directly in the text or only include the author’s name in brackets.

Naming the author in the text

When you name the author in the sentence itself, the year and (if relevant) page number are typically given in brackets straight after the name:

Naming the author directly in your sentence is the best approach when you want to critique or comment on the source.

Naming the author in brackets

When you  you haven’t mentioned the author’s name in your sentence, include it inside the brackets. The citation is generally placed after the relevant quote or paraphrase, or at the end of the sentence, before the full stop:

Multiple citations can be included in one place, listed in order of publication year and separated by semicolons:

This type of citation is useful when you want to support a claim or summarise the overall findings of sources.

Common mistakes with in-text citations

In-text citations in brackets should not appear as the subject of your sentences. Anything that’s essential to the meaning of a sentence should be written outside the brackets:

• (Smith, 2019) argues that…
• Smith (2019) argues that…

Similarly, don’t repeat the author’s name in the bracketed citation and in the sentence itself:

• As Caulfield (Caulfield, 2020) writes…
• As Caulfield (2020) writes…

Sometimes you won’t have access to all the source information you need for an in-text citation. Here’s what to do if you’re missing the publication date, author’s name, or page numbers for a source.

If a source doesn’t list a clear publication date, as is sometimes the case with online sources or historical documents, replace the date with the words ‘no date’:

When it’s not clear who the author of a source is, you’ll sometimes be able to substitute a corporate author – the group or organisation responsible for the publication:

When there’s no corporate author to cite, you can use the title of the source in place of the author’s name:

No page numbers

If you quote from a source without page numbers, such as a website, you can just omit this information if it’s a short text – it should be easy enough to find the quote without it.

If you quote from a longer source without page numbers, it’s best to find an alternate location marker, such as a paragraph number or subheading, and include that:

A Harvard in-text citation should appear in brackets every time you quote, paraphrase, or refer to information from a source.

The citation can appear immediately after the quotation or paraphrase, or at the end of the sentence. If you’re quoting, place the citation outside of the quotation marks but before any other punctuation like a comma or full stop.

In Harvard referencing, up to three author names are included in an in-text citation or reference list entry. When there are four or more authors, include only the first, followed by ‘ et al. ’

In Harvard style , when you quote directly from a source that includes page numbers, your in-text citation must include a page number. For example: (Smith, 2014, p. 33).

You can also include page numbers to point the reader towards a passage that you paraphrased . If you refer to the general ideas or findings of the source as a whole, you don’t need to include a page number.

When you want to use a quote but can’t access the original source, you can cite it indirectly. In the in-text citation , first mention the source you want to refer to, and then the source in which you found it. For example:

It’s advisable to avoid indirect citations wherever possible, because they suggest you don’t have full knowledge of the sources you’re citing. Only use an indirect citation if you can’t reasonably gain access to the original source.

In Harvard style referencing , to distinguish between two sources by the same author that were published in the same year, you add a different letter after the year for each source:

• (Smith, 2019a)
• (Smith, 2019b)

Add ‘a’ to the first one you cite, ‘b’ to the second, and so on. Do the same in your bibliography or reference list .

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the ‘Cite this Scribbr article’ button to automatically add the citation to our free Reference Generator.

Caulfield, J. (2022, May 05). Harvard In-Text Citation | A Complete Guide & Examples. Scribbr. Retrieved 14 May 2024, from https://www.scribbr.co.uk/referencing/harvard-in-text-citation/

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Home / Guides / Citation Guides / Harvard Referencing / Harvard Referencing Style Examples / How to reference an article in Harvard referencing style

How to reference an article in Harvard referencing style

What is an article.

Almost all writers and academics reference other people’s writing in their works. Referencing demonstrates that you have researched your topic, are well versed in its arguments and theories, and it also helps avoid charges of plagiarism.  

The Harvard citation system is just one of many referencing styles – and which style you choose is normally guided by the institution or publication you are writing for.

In this article, you will learn how to use the Harvard citation system to reference the following types of articles:

• journal article
• newspaper article
• magazine article

Properly citing article details in the reference list will help the readers to locate your source material if they wish to read more about a particular area or topic.

Information you need:

• Author name
• (Year published)  
• ‘Article title’  
• Journal/newspaper/magazine name  
• Day and month published, if available
• Volume number, if available
• (Issue) number, if available
• Page number(s), if available

If accessed online:

• Available at: URL or DOI  
• (Accessed: date).

Journal articles

Academic or scholarly journals are periodical publications about a specific discipline. No matter what your field is, if you are writing an academic paper, you will inevitably have to cite a journal article in your research. Journal articles often have multiple authors, so make sure you know when to use et al. in Harvard style . The method for referencing a journal article in the reference list is as follows:

Reference list (print) structure:

Last name, F. (Year published) ‘Article title’, Journal name , Volume(Issue), Page(s).

Shepherd, V. (2020) ‘An exploration around peer support for secondary pupils in Scotland with experience of self-harm’, Educational Psychology in Practice, 36(3), pp. 297-312.

Note that the article title uses sentence case. However, the title of the journal uses title case. Additionally, the volume number comes immediately after the journal title followed by the issue number in round brackets.

If the original material you are referencing was accessed online, then the method for citing it in the reference list will be the same as that in print, but with an additional line at the end.  

Reference list (online) structure:

Last name, F. (Year published) ‘Article title’, Journal Name , Volume(Issue), Page(s). Available at: URL or DOI (Accessed: date).  

Shepherd, V. (2020) ‘An exploration around peer support for secondary pupils in Scotland with experience of self-harm’, Educational Psychology in Practice, 36(3), pp. 297-312. Available at: https://www.tandfonline.com/doi/full/10.1080/02667363.2020.1772726 (Accessed: 08 October 2020).

In-text citation (print or online) structure:

In-text citations are written within round brackets and start with the last name of the author followed by the year published, both separated by a comma.

You can also mention the author within the text and only include the publication year in round brackets.

Examples:  

In this article (Shepherd, 2020) deals with…  

According to Shepherd (2020), when peer support is available…  

Talking about the secondary education system, Shepherd (2020, p.299) suggests that…

Newspaper articles

Even if you are referring to an incident which is public knowledge, you still need to cite the source.  

The name of the author in a newspaper article is referred to as a byline. Below are examples for citing an article both with and without a byline.  

Reference list (print) structure:  

Last name, F. (Year published). ‘Article title’, Newspaper name , Day Month, Page(s).

Hamilton, J. (2018). ‘Massive fire at local department store’, The Daily Local, 10 August, p. 1.

Last name, F. (Year published). ‘Article title’, Newspaper name , Day Month, Page(s). Available at: URL (Accessed: Day Month Year).

Gambino, L. (2020) ‘Kamala Harris and Mike Pence clash over coronavirus response in vice-presidential debate,’ The Guardian, 8 October. Available at: https://www.theguardian.com/us-news/2020/oct/07/debate-kamala-harris-mike-pence-latest-news (Accessed: 8 October 2020).

Reference list structure, no byline:

The basic reference list structure for the reference is the same for both print and online articles. If information isn’t available, simply omit it from the reference.

Newspaper name (Year published) ‘Article Title’, Day Month, Page(s). Available at: URL (Accessed: Day Month Year).

The Chronicler (2016) ‘Local man wins lottery jackpot twice in one year’, 30 May, p. 14. Available at: https://thechroniclerpaper.com/local-man-wins-lottery-twice (Accessed: 1 October 2020).

In-text citation structure (print or online):

The last name of the author and date are written in round brackets, separated by a comma. The method is similar to referencing journal articles in in-text citations.

(Hamilton, 2018)

In his paper, Gambino (2020) mentioned that…

For articles accessed online which do not have an author, the name of the publication is mentioned in place of the author’s name and is italicized.

( The Chronicler , 2016)

Magazine articles  

The structure of magazine articles is similar to that of a journal article.

Last name, F. (Year published) ‘Article title’, Magazine Name , Volume(Issue), Page(s).

Ornes, S. (2020). “To save Appalachia’s endangered mussels, scientists hatched a bold plan”, ScienceNews, (198), p.2.

Last name, F. (Year published) ‘Article title’, Magazine name , Volume(Issue), Page(s). Available at: URL (Accessed: Date).

Ornes, S. (2020) ‘To save Appalachia’s endangered mussels, scientists hatched a bold plan’, ScienceNews, (198), p.2. Available at: https://www.sciencenews.org/article/endangered-mussels-appalachia-rivers-biologists-conservation-plan (Accessed: 3 October 2020).

  In-text citation (print or online) structure:

(Author last name, Year published)

(Ornes, 2020)

Published October 29, 2020.

Harvard Formatting Guide

Harvard Formatting

• et al Usage
• Direct Quotes
• In-text Citations
• Multiple Authors
• Page Numbers
• Writing an Outline
• View Harvard Guide

Reference Examples

• View all Harvard Examples

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APA 7th Edition Citation Examples

• Volume and Issue Numbers
• Page Numbers
• Undated Sources
• Citing a Source Within a Source

Citing a Source within a Source

• In-Text Citations
• Academic Journals
• Encyclopedia Articles
• Book, Film, and Product Reviews
• Online Classroom Materials
• Conference Papers
• Technical + Research Reports
• Court Decisions
• Treaties and Other International Agreements
• Federal Regulations: I. The Code of Federal Regulations
• Federal Regulations: II. The Federal Register
• Executive Orders
• Charter of the United Nations
• Federal Statutes
• Dissertations and Theses
• Interviews, E-mail Messages + Other Personal Communications
• Social Media
• Business Sources
• PowerPoints
• AI: ChatGPT, etc.

Scenario: You read a 2007 article by Linhares and Brum that cites an earlier article, by Klein. You want to cite Klein's article, but you have not read Klein's article itself.

Reference list citation

Linhares, A., & Brum, P. (2007). Understanding our understanding of strategic scenarios: What role do chunks play? Cognitive Science , 31 (6), 989-1007. https://doi.org/10.1080/03640210701703725

Your Reference list will contain the article you read, by Linhares and Brum. Your Reference list will NOT contain a citation for Klein's article.

In-text citation

Klein's study (as cited in Linhares & Brum, 2007) found that...

Your in-text citation gives credit to Klein and shows the source in which you found Klein's ideas.

See  Publication Manual , p. 258.

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Prevalence of Cardiovascular-Kidney-Metabolic Syndrome Stages in US Adults, 2011-2020

• 1 Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts

Cardiovascular, kidney, and metabolic (CKM) diseases are pathophysiologically interrelated, 1 have affected more than 25% of US adults between 2015-2020, 2 and were the leading causes of death in 2021. 3 In 2023, the American Heart Association introduced a novel staging construct, termed CKM syndrome , 1 to enhance multidisciplinary approaches to prevention, risk stratification, and management of these disorders. Based on risk factors and established disease, the stages range from 0 (no risk factors) to 4 (established cardiovascular disease [CVD]).

Read More About

Aggarwal R , Ostrominski JW , Vaduganathan M. Prevalence of Cardiovascular-Kidney-Metabolic Syndrome Stages in US Adults, 2011-2020. JAMA. Published online May 08, 2024. doi:10.1001/jama.2024.6892

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• Published: 08 May 2024

The relationship between childhood adversity and sleep quality among rural older adults in China: the mediating role of anxiety and negative coping

• Yuqin Zhang 1 ,
• Chengwei Lin 2 ,
• Hongwei Li 1 ,
• Xueyan Zhou 4 ,
• Ying Xiong 5 ,
• Jin Yan 1 ,
• Mengxue Xie 1 ,
• Xueli Zhang 6 ,
• Chengchao Zhou 7 &
• Lian Yang 1  

BMC Psychiatry volume  24 , Article number:  346 ( 2024 ) Cite this article

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Metrics details

Studies have revealed the effects of childhood adversity, anxiety, and negative coping on sleep quality in older adults, but few studies have focused on the association between childhood adversity and sleep quality in rural older adults and the potential mechanisms of this influence. In this study, we aim to evaluate sleep quality in rural older adults, analyze the impact of adverse early experiences on their sleep quality, and explore whether anxiety and negative coping mediate this relationship.

Data were derived from a large cross-sectional study conducted in Deyang City, China, which recruited 6,318 people aged 65 years and older. After excluding non-agricultural household registration and lack of key information, a total of 3,873 rural older adults were included in the analysis. Structural equation modelling (SEM) was used to analyze the relationship between childhood adversity and sleep quality, and the mediating role of anxiety and negative coping.

Approximately 48.15% of rural older adults had poor sleep quality, and older adults who were women, less educated, widowed, or living alone or had chronic illnesses had poorer sleep quality. Through structural equation model fitting, the total effect value of childhood adversity on sleep quality was 0.208 (95% CI: 0.146, 0.270), with a direct effect value of 0.066 (95% CI: 0.006, 0.130), accounting for 31.73% of the total effect; the total indirect effect value was 0.142 (95% CI: 0.119, 0.170), accounting for 68.27% of the total effect. The mediating effects of childhood adversity on sleep quality through anxiety and negative coping were significant, with effect values of 0.096 (95% CI: 0.078, 0.119) and 0.024 (95% CI: 0.014, 0.037), respectively. The chain mediating effect of anxiety and negative coping between childhood adversity and sleep quality was also significant, with an effect value of 0.022 (95% CI: 0.017, 0.028).

Conclusions

Anxiety and negative coping were important mediating factors for rural older adult’s childhood adversity and sleep quality. This suggests that managing anxiety and negative coping in older adults may mitigate the negative effects of childhood adversity on sleep quality.

Peer Review reports

The global population is entering an aging stage, and China has the fastest rate of population aging in the world. According to China’s seventh national census, in 2020, 191 million individuals were aged 65 years and older, accounting for 13.50% of the total population [ 1 ], and the proportion of people aged 65 and above in rural is 6.6% higher than in urban [ 2 ]. In addition, China’s long-standing urban-rural dual structure has resulted in inequality in economic, medical, and educational development, leading to significant differences in the health status of China’s urban and rural older populations [ 3 , 4 ]. Relevant studies have found that, urban residents have a higher survival rate [ 5 ], better self-assessed health status and better self-assessed self-care ability than rural dwellers [ 6 ]. Therefore, to reduce health inequalities among older adults, the health status of rural older adults is an important focus.

Good quality sleep has been found to be essential for health [ 7 , 8 , 9 ]. However, sleep problems are prevalent among the older population [ 10 , 11 ]. Gulia and Tatineny have reported that the current prevalence of sleep disorders in the global older population is 30–40% [ 12 , 13 ]. In a systematic review, Lu reported that the overall prevalence of poor sleep among the older population in China had reached 35.9% [ 14 ]. In the rural older adults, the prevalence of sleep disorders is more than 40% [ 15 ], even as high as 58.40% [ 16 ].There are various factors that affect sleep quality [ 17 , 18 ]. Adverse childhood experiences (ACEs) are stressful and/or traumatic experiences that occur during childhood [ 19 ]. There is growing evidence that ACEs may lead to sleep problems in adulthood [ 20 , 21 ] and that the influence can last up to 50 years [ 22 ]. For example, emotional abuse and neglect experienced early in life impede the development of individuals’ social relationships later in life and negatively affect the subjective sleep quality of older adults [ 23 ]. A study by Dorji. found that older adults with multiple (≥ 7) ACEs had a higher incidence of insomnia [ 24 ]. Although previous investigations have indicated the relationship between childhood adversity and sleep quality in older adults, they have ignored possible potential mechanisms for this relationship.

Previous studies have found that anxiety negatively affects sleep quality in older adults [ 25 ], whereas a good mental state can improve their sleep quality. Notably, childhood adversity may be associated with increased anxiety symptoms in late adulthood [ 26 ]. Raposo have reported that older adults who experienced childhood adversity were more likely to suffer from anxiety (OR = 1.48; 95%CI = 1.20–1.83) [ 27 ]. Considering the relationships among anxiety, childhood adversity, and sleep quality, one aim of this study was to verify whether anxiety mediates the relationship between childhood adversity and sleep quality.

A coping style refers to a psychological and behavioral strategy adopted by an individual in response to changes in the internal and external environment [ 28 ]. Negative coping is usually positively associated with sleep disorders [ 29 , 30 ]. Coping style usually evolves over time and may be influenced by exposure to childhood adversity; for instance, people exposed to early adverse experiences show predominantly emotion-focused and avoidance coping styles, such as denial and disengagement [ 31 , 32 ]. In addition to childhood adversity, negative emotions or psychological states also can influence individuals’ coping strategies [ 33 ]. For example, Orgeta reported that older adults with high levels of anxiety were more likely to adopt dysfunctional coping [ 34 ]. Therefore, we hypothesized that anxiety affects coping styles in older adults and that negative coping may be a potential mediator between childhood adversity and sleep quality.

Stress is defined as the process of adaptive and coping responses when an individual faces or perceives threatening or challenging environmental changes [ 35 ]. People respond to stress with either problem-focused coping or emotion-focused coping [ 36 ]. Stress can be caused by many factors, such as early adversities, and the result of stress is adaptive or maladaptive psychosomatic responses. Based on the above, we constructed a structural equation model of a large cross-sectional dataset to explore the effects of childhood adversity on sleep quality, with childhood adversity as the stressor and anxiety and negative coping as mediators.

Research methods

Research population.

The data were sourced from a large-scale cross-sectional study conducted in 2022 that recruited older adults aged 65 years and older living in 6 districts and counties in Deyang City, Sichuan Province. Using a multistage stratified random cluster sampling method, townships (streets) were randomly selected from six county (districts), administrative villages (communities) were randomly selected from each sample township (streets), finally, people over 65 years old were selected randomly in each chosen village or community. The inclusion criteria were as follows: (1) individuals aged ≥ 65 years; (2) permanent residents in the survey area (those who have lived in the area for 6 months or more); (3) those who signed an informed consent form and agreed to take the questionnaire survey. The exclusion criteria were as follows: (1) unwilling to participate in research; (2) individuals identified by local village doctors who are unable to answer questions independently and have a history of dementia;3) other reasons for not participating in the study. The household registration system is a very important factor affecting the unequal social welfare rights and privileges of urban and rural residents in China [ 37 ], which is associated with poor health [ 38 ]. In this study, rural means that residents with agricultural household registration. A total of 6318 respondents were recruited, excluding non-agricultural household registration (2345) and missing main information (100), and finally included 3873 for analysis. The study was approved by the Medical Ethics Committee of the Affiliated Hospital of Chengdu University of Chinese Medicine, and all participants signed an informed consent form before taking the survey.

Measurement tools

General information.

This includes the age, gender, education level, marital status, chronic disease status, and exercise status of the participating older adults.

Childhood adversity

Childhood adversity was measured using the Adverse Childhood Experiences Scale developed by the Centers for Disease Control and Prevention (USA). The scale contains three major dimensions (abuse, neglect, and household dysfunction) and ten subdimensions including emotional abuse, physical abuse, sexual abuse, and emotional neglect. Higher ACE scores indicate more severe ACE exposure [ 19 , 39 ]. The internal consistency coefficients of the abuse, neglect, and household dysfunction subscales in this study were 0.790, 0.732, and 0.778, respectively.

• Sleep quality

Sleep quality was evaluated using the revised Chinese-version Pittsburgh Sleep Quality Index (PSQI). The scale consists of seven dimensions including subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction. A PSQI score of ≥ 7 is generally considered to indicate poor sleep quality [ 15 , 40 , 41 ]. The internal consistency coefficient of the scale in this study was 0.754.

Anxiety in older adults was measured using the Self-Rating Anxiety Scale (SAS). The scale consists of 20 items and is rated on a 4-point scale. An SAS score of 50 or more is considered to be indicative of anxiety symptoms [ 42 ]. The internal consistency coefficient of this scale in this study was 0.831.

Trait coping style

Negative coping was measured using the Trait Coping Style Questionnaire (TCSQ). The scale consists of 20 questions in 2 dimensions—negative coping and positive coping—and is rated on a 5-point scale. The negative coping and positive coping scores are the sum of the scores for each item in the corresponding dimensions. A positive total score indicates a predominantly positive attitude toward coping with events, whereas a negative score indicates a predominantly negative coping style [ 43 , 44 ]. Only the negative coping dimension of the scale, which has an internal consistency coefficient of 0.929, was selected in this study.

Statistical analysis

The variables in the study were descriptively analyzed using the mean, standard deviation, frequency (n), and constituent ratio (%), and difference tests were conducted using t-tests and the Kruskal-Wallis H test. Spearman’s correlation was used to analyze whether there were correlations between sleep quality and the variables. Finally, a multiple-mediator structural equation model was constructed to analyze the effects of anxiety and negative coping on the relationship between sleep quality and childhood adversity, and the bootstrap method was applied to verify the mediating effect. After the initial establishment of the model, we evaluated the fit degree of the structural equation model and adjusted the model via calculating indicators such as standardized root-mean-square residual (SRMR ≤ 0.08), root-mean-square error of approximation (RMSEA ≤ 0.08), goodness of fit index (GFI ≥ 0.90), comparative fit index (CFI ≥ 0.90), normed fit index (NFI ≥ 0.90) according to the studies by Wen and Kang [ 45 , 46 ]. Data were analyzed using SPSS 25.0 and AMOS 24.0 software, and a P value < 0.05 was considered to be statistically significant. The bootstrap CI was set to 95%, and the bootstrap sample size was 5000. If the 95% CI interval does not contain 0, it indicates a significant mediating effect.

Research results

Comparison of the general information and sleep quality scores of the study participants.

A total of 3,873 older adults were included in this study. The mean participant age was 72.84 ± 6.13 years, ranging from a minimum of 65 years to a maximum of 99 years. The mean PISQ score was 6.94 ± 3.88, and older adults with poor sleep quality (PSQI score ≥ 7) accounted for 48.15%. The mean ACE score was 2.09 ± 1.16, the mean SAS score was 44.13 ± 9.84, and the mean TCSQ negative coping score was 21.88 ± 8.23.

The results of univariate analysis showed that among the different gender populations, women had poorer sleep quality and a statistically significantly higher PSQI score than men at 7.44 ± 3.98 (t = 8.845, p  < 0.001). The PSQI score increased with age: that of adults aged 80 years and older was 7.32 ± 4.01, and the difference was statistically significant (H = 11.125, p  = 0.004). Regarding the groups with different educational levels, the highest PSQI score was found among illiteracy individuals (7.39 ± 4.01), with a statistically significant difference (H = 39.885, p  < 0.001). Sleep quality varied among older adults with different marital statuses, and the worst sleep quality was found in widowed older adults, with a PSQI score of 7.52 ± 4.00, which presented a statistically significant difference (H = 39.582, p  < 0.001). Older adults living alone had the worst sleep quality with a statistically significantly different PSQI score of 7.46 ± 3.90 (H = 20.904, p  < 0.001). Older adults with chronic diseases had poor sleep quality with a statistically significantly different PSQI score of 7.4 ± 3.95 (t=-8.83, p  < 0.001) (Table  1 ).

Association of sleep quality with childhood adversity, anxiety, and negative coping in rural older adults

The relevant analysis results indicated that the PSQI score was positively correlated with the ACE score ( r  = 0.092, P  < 0.01). The PSQI score was positively correlated with the SAS score and negative coping score ( r  = 0.279 and r  = 0.239, respectively; both P  < 0.01). The ACE score was positively correlated with the SAS score and negative coping score ( r  = 0.217 and r  = 0.133, respectively; both P  < 0.01). There was also a positive correlation between the SAS score and negative coping score ( r  = 0.351, P  < 0.01) (Table  2 ).

Analysis of mediating effects

Goodness-of-fit indices and path coefficients for the theoretical model of older adults’ sleep quality.

Based on the results of the above analyses, a structural equation model was constructed with childhood adversity as the independent variable, anxiety and negative coping as the mediating variables, and sleep quality as the dependent variable. The final model was screened according to the following model fitting indices: SRMR = 0.05, RMSEA = 0.06, GFI = 0.97, CFI = 0.90 and NFI = 0.89. The results of the fitting indices indicated that the model was well fitted. The differences in each of the standardized path coefficients in the model were statistically significant (all P  < 0.05) (Fig.  1 ).

Serial mediation models for childhood adversity, anxiety, negative coping and sleep quality

Bootstrap test of the theoretical model of older adults’ sleep quality

Table  3 demonstrates the results of structural modeling: (1) The total effect value of childhood adversity on sleep quality was 0.208 (95% CI: 0.146, 0.270), with a direct effect value of 0.066 (95% CI: 0.006, 0.130), accounting for 31.73% of the total effect, and a total indirect effect value of 0.142 (95% CI: 0.119, 0.170), accounting for 68.27% of the total effect. (2) The mediating effect of anxiety on the association between childhood adversity and sleep quality was significant, with a path effect value of 0.096 (95% CI: 0.078, 0.119), accounting for 46.15% of the total effect. (3) The mediating effect of negative coping on the association between childhood adversity on sleep quality was significant, with a path effect value of 0.024 (95% CI: 0.014, 0.037), accounting for 11.54% of the total effect. (4) The multiple mediating effects of anxiety and negative coping on the association between childhood adversity on sleep quality were also significant, with a pathway effect value of 0.022 (95% CI: 0.017, 0.028), accounting for 10.58% of the total effect (Table  3 ).

Current status and influencing factors of sleep quality in older adults

The proportion of older adults with poor sleep quality (PSQI score ≥ 7) was 48.15%, which is similar to the results of previous studies [ 15 , 16 ]. Due to gradual aging, the sleep-wake cycle of the older adults is disordered, and the efficiency of the circadian rhythm mechanism is reduced, which leads to changes in their sleep duration, sleep architecture, and sleep depth [ 12 ]. Furthermore, the occurrence of a variety of sleep problems such as sleep disruption, early sleep onset, and early awakening [ 47 , 48 , 49 ], result in a general decline in the sleep quality of older adults. We also found that gender, educational level, marital status, residency status, and chronic diseases were influencing factors of sleep quality. First, women have poorer sleep quality than men, which is in accordance with the established viewpoint [ 50 , 51 ]. Poor sleep quality and an increased risk of sleep disorders in older women may be due to the following reasons: (1) women are at a disadvantage in terms of socioeconomic factors, such as education and personal income [ 52 ]; (2) women are more susceptible to somatic [ 53 ] and psychiatric [ 54 , 55 ] disorders than men; and (3) women experience changes in secreted reproductive hormones [ 56 ]. Second, differences in sleep quality among older adults with different educational levels may be due to the fact that well-educated older adults have a higher sense of wellness and are more likely to access healthcare knowledge, which in turn leads to a better sleep state [ 57 ]. Third, the poorer sleep quality in widowed older adults and those living alone than in others may be related to loneliness and lack of social support leading to mood disorders, which in turn may cause reduced sleep efficiency and quality [ 58 ]. Finally, having a chronic disease is also a risk factor for poor sleep quality in older adults, which may be related to the physical discomfort caused by chronic diseases, the side effects of medications, and the associated financial pressure and psychological burden [ 59 ].

Direct effect of childhood adversity on sleep quality in older adults

The present study found that childhood adversity had a direct effect on sleep quality. Early life experiences, such as abuse, poverty, or the death of a parent, can affect sleep not only in childhood and adolescence but also in adulthood [ 60 , 61 ]. Childhood is an important phase for significant development of the hypothalamic-pituitary-adrenal (HPA) axis and the brain [ 58 ], and adverse events experienced during childhood can lead to long-term changes in the HPA axis response to stress (e.g., hyperactivity) and interfere with normal neurodevelopment in childhood and adolescence [ 62 ], increasing the risk of developing psychiatric disorders such as depression and post-traumatic stress disorder, which indirectly affect sleep in adulthood [ 63 ]. In addition, people exposed to ACEs are more likely to adopt unhealthy lifestyles and behaviors [ 64 , 65 ], and these changes may directly affect the sleep-wake cycle and lead to sleep problems.

Mediating effect of anxiety between childhood adversity and sleep quality in older adults

Sleep problems are not only a precursor but also a consequence of mental illness [ 66 , 67 ]. Our study found that anxiety could partially explain the relationship between childhood adversity and sleep disorders. Extensive studies have confirmed that exposure to adverse experiences in early life can increase an individual’s risk of developing psychiatric disorders such as anxiety and depression [ 68 , 69 ]. Anxiety is thus associated with a variety of sleep problems, with higher levels of anxiety corresponding to more severe sleep disorders [ 25 , 70 , 71 ]. Furthermore, anxiety has been found to mediate the effects of childhood adversity on sleep quality. For example, Amarneh found that elevated levels of anxiety sensitivity may explain the relationship between child maltreatment and adult sleep disorders among psychiatric hospitalizations [ 72 ]. Haimov found that COVID-19-related anxiety mediated the association between the number of childhood adversities and adult sleep quality [ 73 ]. The findings of our study further support the mediating role of anxiety on the effects of childhood adversity on sleep quality in older adults, suggesting that actively intervening in older adults’ anxiety states may mitigate the effects of childhood adversity on their sleep quality.

Mediating effect of negative coping between childhood adversity and sleep quality in older adults

Our results also identified a significant mediating effect of negative coping in the action of childhood adversity on sleep quality. Individuals’ exposure to environmental stressors early in life can compromise their adaptive coping strategies [ 74 ] and thus further affect sleep [ 75 ]. This result can be explained by the theory of stress. This theory states that when facing stressful events, people may take measures to disengage from threatening stimuli and generate associated thoughts and emotions (i.e., reducing activity and sleeping longer to minimize exposure to the stressor and the associated maladaptive emotions and thoughts) as well as adopt emotion-focused coping (i.e., regulating emotional responses to problems). However, such approaches may increase alertness and thus produce physiological arousal, disrupting or reducing sleep, which in turn affects sleep quality [ 76 ].

Finally, we founded that childhood adversity affected sleep quality in older adults through anxiety and negative coping. As mentioned above, stressful life events in childhood are associated with an increased risk of anxiety disorders in adulthood. Under the influence of such negative emotions, individuals are more inclined to adopt negative coping, which in turn affects the sleep quality in older adults. The above results facilitate a deeper understanding of the relationships among childhood adversity, anxiety, negative coping, and sleep quality and provide clues for exploring the potential mechanisms of how childhood adversity affects sleep quality in older adults.

Research limitations

In this study, the theoretical structural equation model fit the data well and provided an epidemiologic basis for the associations among childhood adversity, anxiety, negative coping, and sleep quality. However, there are several limitations. First, the results for the main variables in this study were obtained via self-report from the respondents and thus may be subject to unavoidable recall bias. Second, this study utilized a cross-sectional research design, which does not allow for a more precise determination of the causal relationship between variables. Third, this study explored the relationship between ACEs and PSQI scores but did not determine a dose-response relationship or whether different types of childhood adversities have different effects on sleep quality. Finally, the effects of drugs (such as antidepressants and anti-inflammatory drugs) on sleep quality were ignored in this study.

To sum up, anxiety and negative coping not only had direct effects on sleep quality but also played mediating roles in the association between childhood adversity and sleep quality, with a chained multiple mediating effect. These findings suggest that timely intervention for anxiety symptoms and negative coping states in older adults may mitigate the negative impact of childhood adversity on sleep quality.

Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

Adverse Childhood Experiences

the revised Chinese-version Pittsburgh Sleep Quality Index

Self-Rating Anxiety Scale

Trait Coping Style Questionnaire

Structural equation modelling

confidence interval

root mean square error of approximation

the hypo-thalamic pituitary adrenal axis

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Acknowledgements

We thank the responsible person of local health work, all participants and the staff of data reduction for their cooperation.

This work was funded by the research projects of “Investigation on health status and risk factors of the elderly over 65 years old in Deyang City” (No.301021062) of Chengdu University of Traditional Chinese Medicine.

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School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, Sichuan, China

Yuqin Zhang, Hongwei Li, Jin Yan, Mengxue Xie & Lian Yang

Sichuan Provincial Center for Disease Control and Prevention, No.6, Zhongxue Road, Wuhou District, Chengdu, 610041, China

Chengwei Lin

Hospital of Chengdu University of Traditional Chinese Medicine, Deyang Integrated Traditional Chinese and Western Medicine Hospital, Deyang, 618000, China

Centre for Aging Health Service of Deyang City, Deyang, 618000, China

Xueyan Zhou

Health Commission of Deyang City, Deyang, 618000, China

Sichuan Provincial Health Information Center, Chengdu, 610015, Sichuan, China

Xueli Zhang

Centre for Health Management and Policy Research,School of Public Health, Cheeloo College of Medicine,Shandong University, NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China

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YQ Z, CW L and HW L were responsible for conception and design of the study. L L, XY Z and Y X were involved in recruiting the participants. YQ Z and CW L did the statistical analysis and were involved in manuscript preparation and drafting the article.J Y , MX X, and XL Z were involved in editing and revising the manuscript. CC Z and L Y were responsible for the critical revision of the manuscript. All authors have contributed to and have approved the final manuscript.

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Zhang, Y., Lin, C., Li, H. et al. The relationship between childhood adversity and sleep quality among rural older adults in China: the mediating role of anxiety and negative coping. BMC Psychiatry 24 , 346 (2024). https://doi.org/10.1186/s12888-024-05792-2

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DOI : https://doi.org/10.1186/s12888-024-05792-2

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Virome Sequencing Identifies H5N1 Avian Influenza in Wastewater from Nine Cities

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Avian influenza (serotype H5N1) is a highly pathogenic virus that emerged in domestic waterfowl in 1996. Over the past decade, zoonotic transmission to mammals, including humans, has been reported. Although human to human transmission is rare, infection has been fatal in nearly half of patients who have contracted the virus in past outbreaks. The increasing presence of the virus in domesticated animals raises substantial concerns that viral adaptation to immunologically naïve humans may result in the next flu pandemic. Wastewater-based epidemiology (WBE) to track viruses was historically used to track polio and has recently been implemented for SARS-CoV2 monitoring during the COVID-19 pandemic. Here, using an agnostic, hybrid-capture sequencing approach, we report the detection of H5N1 in wastewater in nine Texas cities, with a total catchment area population in the millions, over a two-month period from March 4 th to April 25 th , 2024. Sequencing reads uniquely aligning to H5N1 covered all eight genome segments, with best alignments to clade 2.3.4.4b. Notably, 19 of 23 monitored sites had at least one detection event, and the H5N1 serotype became dominant over seasonal influenza over time. A variant analysis suggests avian or bovine origin but other potential sources, especially humans, could not be excluded. We report the value of wastewater sequencing to track avian influenza.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This work was supported by S.B. 1780, 87th Legislature, 2021 Reg. Sess. (Texas 2021) (E.B., A.W.M., and J.F.P.), NIH/NIAID (Grant number U19 AI44297) (A.W.M.), Baylor College of Medicine Melnick Seed (A.W.M) and Alkek Foundation Seed (J.F.P.), and Pandemic Threat Technology Center (P.A.P.).

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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All data produced are available online at https://zenodo.org/doi/10.5281/zenodo.11175923 and NCBI SRA BioProject: PRJNA966185

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