European Child & Adolescent Psychiatry

, Volume 26, Issue 3, pp 271–279 | Cite as

Poor sleep quality and nightmares are associated with non-suicidal self-injury in adolescents

  • Xianchen Liu
  • Hua Chen
  • Qi-Gui Bo
  • Fang Fan
  • Cun-Xian Jia
Original Contribution


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.


Sleep Nightmares Self-injury Adolescents 



This work was funded by Shandong Scientific Technique Development Plan (Grant No. 2014GSF118163) and National Natural Science Foundation of China (Grant No. 81573233).

Compliance with ethical standards

This study has been approved by the research ethics committee of Shandong University, and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Conflict of interest

All authors have no conflict of interest to disclose.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Epidemiology, Shandong University School of Public Health and Shandong University Center for Suicide Prevention ResearchShandong UniversityJinanChina
  2. 2.The University of Tennessee Health Science CenterMemphisUSA
  3. 3.Center for Disease Control and Prevention of Lijin CountyLijinChina
  4. 4.School of PsychologySouth China Normal UniversityGuangzhouChina

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