title: Poor sleep quality and nightmares are associated with non-suicidal self-injury in adolescents.
abstract: Non-suicidal self-injury (NSSI) is prevalent and is associated with increased risk of suicidal behavior in adolescents. This study examined which sleep variables are associated with NSSI, independently from demographics and mental health problems in Chinese adolescents. Participants consisted of 2090 students sampled from three high schools in Shandong, China and had a mean age of 15.49 years. Participants completed a sleep and health questionnaire to report their demographic and family information, sleep duration and sleep problems, impulsiveness, hopelessness, internalizing and externalizing problems, and NSSI. A series of regression analyses were conducted to examine the associations between sleep variables and NSSI. Of the sample, 12.6 % reported having ever engaged in NSSI and 8.8 % engaged during the last year. Univariate logistic analyses demonstrated that multiple sleep variables including short sleep duration, insomnia symptoms, poor sleep quality, sleep insufficiency, unrefreshed sleep, sleep dissatisfaction, daytime sleepiness, fatigue, snoring, and nightmares were associated with increased risk of NSSI. After adjusting for demographic and mental health variables, NSSI was significantly associated with sleeping <6 h per night, poor sleep quality, sleep dissatisfaction, daytime sleepiness, and frequent nightmares. Stepwise logistic regression model demonstrated that poor sleep quality (OR = 2.18, 95 % CI = 1.37-3.47) and frequent nightmares (OR = 2.88, 95 % CI = 1.45-5.70) were significantly independently associated with NSSI. In conclusion, while multiple sleep variables are associated with NSSI, poor sleep quality and frequent nightmares are independent risk factors of NSSI. These findings may have important implications for further research of sleep self-harm mechanisms and early detection and prevention of NSSI in adolescents.
authors.affiliation: Department of Epidemiology, Shandong University School of Public Health and Shandong University Center for Suicide Prevention Research, Shandong University, No. 44, Wenhuaxi Rd, Lixia Dist, Jinan, 250012, China. xliu69@uthsc.edu.|The University of Tennessee Health Science Center, Memphis, TN, 38163, USA. xliu69@uthsc.edu.
authors.forename: Xianchen
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Epidemiology, Shandong University School of Public Health and Shandong University Center for Suicide Prevention Research, Shandong University, No. 44, Wenhuaxi Rd, Lixia Dist, Jinan, 250012, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Chen
authors.affiliation: Center for Disease Control and Prevention of Lijin County, Lijin, 257400, China.
authors.forename: Qi-Gui
authors.initials: QG
authors.lastname: Bo
authors.affiliation: School of Psychology, South China Normal University, Shipai, Guangzhou, 510631, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Fan
authors.affiliation: Department of Epidemiology, Shandong University School of Public Health and Shandong University Center for Suicide Prevention Research, Shandong University, No. 44, Wenhuaxi Rd, Lixia Dist, Jinan, 250012, China. jiacunxian@sdu.edu.cn.
authors.forename: Cun-Xian
authors.initials: CX
authors.lastname: Jia
mesh_terms: D000293:Adolescent; D044466:Asian People / Q000523:psychology* / Q000706:statistics & numerical data; D002681:China / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D004325:Dreams; D004644:Emotions; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000453:epidemiology / Q000523:psychology*; D007319:Sleep Initiation and Maintenance Disorders; D013334:Students / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires
keywords: Adolescents; Nightmares; Self-injury; Sleep