Mental Health, Sleep, and Eating Patterns Among Saudi Adults During Ramadan Fasting – A Cross-Sectional Study

Summary

This study examined mental health, sleep, and eating behavior changes among Saudi adults during Ramadan fasting, identifying women, middle-aged adults, and Eastern region residents as more vulnerable to psychological distress and lifestyle disruptions.

Abstract

Ramadan fasting involves marked shifts in sleep–wake cycles, dietary habits, and daily routines, all of which may influence psychological well-being. Although Ramadan represents a naturalistic model of structured, time-restricted fasting, limited research in Saudi Arabia has explored how sociodemographic factors shape mental health, sleep, and eating behaviors during this period. This study examined these outcomes in adults across multiple regions of the country. A descriptive cross-sectional survey was conducted in March 2025 among adults aged 18–60 years residing in Saudi Arabia who observed daytime fasting during Ramadan. A total of 464 participants were recruited through convenience sampling. Data were collected using a validated, culturally adapted questionnaire that assessed psychological well-being, sleep patterns, and eating behaviors. Analyses included descriptive statistics, chi-square tests, and multivariable logistic regression, with p < 0.05 as the significance threshold. Most respondents were female (56.5%) and aged 18–40 years (77.1%). Female sex was significantly associated with depressive feelings and reduced interest (p < 0.05) and independently predicted psychological distress (AOR = 1.35, 95% CI: 1.08–1.72). Adults aged 26–39 and 40–60 years showed higher odds of sleep disturbance and altered eating behaviors (p < 0.05). Participants from the Eastern region demonstrated elevated odds of psychological distress (AOR = 1.80), sleep disturbances (AOR = 2.05), and changes in eating patterns (AOR = 1.50). Employment status was associated with daytime fatigue and non-hunger-driven eating patterns. Ramadan-related lifestyle changes are associated with measurable variations in psychological well-being, sleep quality, and eating behavior. Women, middle-aged adults, and residents of the eastern region appeared to be more vulnerable to these effects. Tailored public health strategies promoting mental health, sleep hygiene, and healthy eating during altered daily routines may help mitigate these impacts.

Introduction

Ramadan fasting is an annually recurring period of time-restricted daytime fasting accompanied by marked modifications in daily routines, sleep–wake timing, and meal patterns^1,2. These lifestyle and circadian changes represent naturalistic behavioral exposures that may influence psychological well-being, sleep quality, and eating behaviors. Alterations in sleep duration, meal timing, and daily activity schedules are known to affect mood regulation, cognitive performance, and emotional stability^3,4.

A growing body of research has explored the effects of Ramadan fasting on sleep patterns, reporting delayed bedtimes, reduced nocturnal sleep, increased daytime sleepiness, and altered melatonin secretion^4,5. These physiological disruptions can have downstream consequences for emotional regulation and stress reactivity. Similarly, dietary changes during Ramadan, such as increased caloric intake during evening meals, changes in appetite, and social eating practices, may influence energy levels, mood, and behavioral patterns^6,7. Despite these insights, studies examining fasting-related lifestyle changes have reported mixed findings regarding psychological well-being. Some studies suggest potential improvements in mood and emotional regulation^8,9, whereas others^10,11 report increased fatigue, stress, and mood disturbances, particularly among women and working adults. These inconsistencies may be attributed to variability in sleep disruption, workload, and individual adaptation to altered daily schedules^6,12,13.

In Saudi Arabia, Ramadan is associated with predictable large-scale lifestyle modifications, including changes in daily schedules, meal timing, and sleep–wake patterns. However, empirical studies examining how sociodemographic factors intersect with mental health, sleep, and eating behaviors during this period are limited. Most available research has focused on physiological or metabolic outcomes, or general sleep alterations, while fewer studies have examined behavioral and psychological responses across population subgroups^6,12,14. This study stands out from previous research on Ramadan and behavior due to its comprehensive, multi-regional approach within Saudi Arabia, which enhances the representativeness and geographic diversity of the findings. Unlike many earlier studies that focused on single cities or limited populations, this investigation included adults from the Western, Central, and other regions, providing a broader perspective on how sociodemographic factors influence mental health, sleep, and eating behaviors during Ramadan. Additionally, the study employed a rigorously adapted and culturally sensitive questionnaire, ensuring relevance and validity across diverse Saudi populations. The integration of multivariable logistic regression to identify independent predictors of psychological distress, sleep disturbances, and changes in eating behavior further strengthens the analytical depth. Moreover, this research uniquely highlights the vulnerability of specific subgroups—women, middle-aged adults, and residents of the Eastern region—thereby offering targeted insights for tailored public health interventions during Ramadan fasting.

By examining psychological, sleep-related, and eating-behavior outcomes within a behavior-focused framework, this study aimed to identify demographic predictors of behavioral and mental health changes during a structured fasting period. These findings may inform evidence-based public health strategies targeting sleep hygiene, mental well-being, and nutritional behaviors during periods of substantial lifestyle modification.

Protocol

Ethical approval was granted by the Ethical Committee of Batterjee Medical College, Jeddah, Saudi Arabia (Reference No. RES-2025-0032). Participants received an online information sheet detailing the study’s aims, procedures, and confidentiality measures. Electronic informed consent was obtained prior to participation in the study. All responses were anonymized, securely stored, and accessible only to the research team. This study adhered to the principles of the Declaration of Helsinki and applicable data protection regulations.

Study design

The study employed a multidimensional assessment approach encompassing three distinct yet interrelated domains: psychological well-being, sleep patterns, and eating behaviors. Each domain was evaluated using validated, culturally adapted questionnaire items specifically designed to capture constructs such as mental health symptoms, sleep disturbances, and changes in eating behavior during Ramadan fasting. This integrated framework facilitates a comprehensive evaluation of behavioral and psychological adaptations, offering insights beyond unidimensional assessments. This study employed a descriptive cross-sectional design to assess psychological well-being, sleep disturbances, and changes in eating behavior during Ramadan among adults in Saudi Arabia. The survey was conducted in March 2025, during the fasting month of Ramadan. This design is commonly used to explore health-related patterns linked to fasting and lifestyle modifications.

Study area and population

Unlike many previous studies that focused on single cities, this study targeted adults across multiple regions of Saudi Arabia, enhancing the representativeness and geographic diversity. Participants were recruited from the Western, Central, and other regions of the Kingdom. Eligible participants were Muslim adults aged 18–60 years residing in Saudi Arabia who actively fasted during the month of Ramadan. The exclusion criteria were refusal to participate, not fasting, residence outside Saudi Arabia, and age outside the specified range (Figure 1). Participants with chronic illnesses or acute diseases were not specifically excluded; however, medical history was not collected. The questionnaire also did not include items to identify pregnant or lactating women; hence, their participation status in the study sample is unknown.

Sampling method and sample size

A convenience sampling technique was used to recruit participants from across the country through online platforms and social media networks. The sample size was calculated based on an assumed prevalence of 50%, 95% confidence level, and 5% margin of error^14,15. Using these parameters, the minimum required sample size was 384. This method was chosen for its practicality and feasibility within the study context, enabling efficient data collection from readily accessible participants. The survey introduction clearly explained the research objectives and specified the target population as Muslim adults aged 18 to 60 years residing in Saudi Arabia and fasting during Ramadan. Only participants who met these inclusion criteria and provided informed consent by clicking the "Consent" button were able to proceed with the survey. The first section of the questionnaire collected demographic information, including age group, place of residence, and other relevant variables, allowing verification of participant eligibility and assessment of sample diversity. This approach relied on self-selection based on clearly stated eligibility criteria and informed consent, which helped to target the intended population despite the open online distribution via Google Forms. A total of 464 participants from Saudi Arabia completed the survey, exceeding the required sample size and improving statistical precision.

Data collection tool and instrument adaptation

Data were collected using a structured questionnaire adapted from the instrument developed by Sulaiman et al.¹⁶. To address the substantial cultural and contextual differences between the original Nigerian population during COVID-19 and the current Saudi adult population fasting during Ramadan, a comprehensive adaptation process was undertaken. The original instrument was translated into Arabic and then back-translated into English (Forward–Backward Translation) by independent bilingual experts to ensure linguistic and conceptual equivalence across Arabic-speaking participants from various Saudi regions. The contextual modifications were adjusted to reflect culturally relevant behaviors and experiences specific to Ramadan fasting in Saudi Arabia, while preserving the original instrument’s constructs and domains. Also, two experts specializing in behavioral sciences and public health reviewed the adapted instrument to assess cultural appropriateness, clarity, and content relevance. Besides, a pilot study was conducted with 20 participants from diverse Saudi regions to evaluate clarity, cultural relevance, and comprehension. Feedback from this pilot led to minor revisions to improve the instrument’s suitability. The questionnaire consisted of closed-ended items with categorical and frequency-based response options assessing sociodemographic variables, psychological well-being, sleep patterns, and eating behaviors during Ramadan. Eating behaviors were self-reported based on frequency of overeating, eating without hunger, and snacking. No dietary normalization or control was applied. The questionnaire was distributed online using Google Forms. Participation was voluntary, anonymous, and based on informed consent obtained from the participants.

Construct validity

Although formal psychometric revalidation (e.g., factor analysis) was not performed for the adapted instrument, the rigorous adaptation process emphasized maintaining the original instrument’s conceptual framework. The combined expert review and pilot testing provided preliminary evidence supporting the instrument’s construct validity and suitability for assessing psychological well-being, sleep disturbances, and eating behaviors in the Saudi Ramadan fasting context.

Statistical analysis

Data were exported from Google Forms, cleaned, coded, and analyzed using IBM SPSS Statistics (version 26). Descriptive statistics (frequencies, percentages, means, and SDs) were used to summarize the participant characteristics and outcome measures. Chi-square tests were used to examine associations between sociodemographic factors and changes in psychological, sleep, and eating behaviors. T-tests and ANOVA were applied where relevant to compare group means. Multivariate logistic regression was used to identify the independent predictors of psychological distress, sleep disturbances, and altered eating patterns. A p-value <0.05 was considered statistically significant.

Results

Participant characteristics

A total of 464 individuals completed the survey. Table 1 presents a summary of the participants’ demographic profiles. Most participants were relatively young, with 77.1% aged ≤40 years. Females comprised 56.5% of respondents. Most participants were single (60.1%) and lived in urban areas (93.8%). Students accounted for 47.2% of the sample, and 40.5% were employed. Over half of the participants (54.9%) held an undergraduate degree. ...

Discussion

This study investigated the associations between Ramadan fasting and changes in mental health, sleep patterns, and eating behaviors among Saudi adults, emphasizing the influence of sociodemographic factors such as sex, age, region of residence, and employment status. Our findings indicate that female participants reported significantly higher levels of psychological distress, including depressive feelings and reduced interest in activities, consistent with the regression analysis identifying female sex as an independent ...

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Google forms	Google	NA	NA
IBM SPSS Statistics	IBM Corp., Armonk, NY, USA	version 26	NA