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940, 95% confidence interval [CI] 3.124-11.292), anxiety (aOR 4.233, 95% CI 2.138-8.381), stress (aOR 2.880, 95% CI 1.915-4.33 and social support (aOR 0.959, 95% CI 0.939-0.98 have a significant effect on sleep quality after adjusted by sex, age, smoking status, drinking status, caffeine intake, past shift working and circadian rhythm type. Conclusions Depression, anxiety, stress and social support were associated with sleep quality among pre-employed firefighters. Repeated follow-up studies of pre-employed firefighters are needed to further ass