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 is a preview of subscription content, log in to check access.
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.
Hawton K et al (2015) Interventions for self-harm in children and adolescents. Cochrane Database Syst Rev 12:CD012013Google Scholar
Hawton K et al (2012) Repetition of self-harm and suicide following self-harm in children and adolescents: findings from the multicentre study of self-harm in England. J Child Psychol Psychiatry 53(12):1212–1219CrossRefPubMedGoogle Scholar
Swannell SV et al (2014) Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression. Suicide Life Threat Behav 44(3):273–303CrossRefPubMedGoogle Scholar
Giletta M et al (2012) Adolescent non-suicidal self-injury: a cross-national study of community samples from Italy, the Netherlands and the United States. Psychiatry Res 197(1–2):66–72CrossRefPubMedPubMedCentralGoogle Scholar
Brent DA et al (1999) Age- and sex-related risk factors for adolescent suicide. J Am Acad Child Adolesc Psychiatry 38(12):1497–1505CrossRefPubMedGoogle Scholar
Guan K, Fox KR, Prinstein MJ (2012) Nonsuicidal self-injury as a time-invariant predictor of adolescent suicide ideation and attempts in a diverse community sample. J Consult Clin Psychol 80(5):842–849CrossRefPubMedPubMedCentralGoogle Scholar
Wilkinson P et al (2011) Clinical and psychosocial predictors of suicide attempts and nonsuicidal self-injury in the adolescent depression antidepressants and psychotherapy trial (ADAPT). Am J Psychiatry 168(5):495–501CrossRefPubMedGoogle Scholar
Maciejewski DF et al (2014) Overlapping genetic and environmental influences on nonsuicidal self-injury and suicidal ideation: different outcomes, same etiology? JAMA Psychiatry 71(6):699–705CrossRefPubMedPubMedCentralGoogle Scholar
Brent DA et al (2013) Protecting adolescents from self-harm: a critical review of intervention studies. J Am Acad Child Adolesc Psychiatry 52(12):1260–1271CrossRefPubMedGoogle Scholar
Owens J (2014) Insufficient sleep in adolescents and young adults: an update on causes and consequences. Pediatrics 134(3):e921–e932CrossRefPubMedGoogle Scholar
Roberts RE, Roberts CR, Chen IG (2001) Functioning of adolescents with symptoms of disturbed sleep. J Youth Adolesc 30:1–18CrossRefGoogle Scholar
Roberts RE, Roberts CR, Duong HT (2008) Chronic insomnia and its negative consequences for health and functioning of adolescents: a 12-month prospective study. J Adolesc Health 42(3):294–302CrossRefPubMedGoogle Scholar
Liu X, Zhao Z, Jia C (2015) Insomnia symptoms, behavioral/emotional problems, and suicidality among adolescents of insomniac and non-insomniac parents. Psychiatry Res 228(3):797–802CrossRefPubMedGoogle Scholar
Liu X, Tein JY (2005) Life events, psychopathology, and suicidal behavior in Chinese adolescents. J Affect Disord 86(2–3):195–203CrossRefPubMedGoogle Scholar
Levin R, Fireman G (2002) Nightmare prevalence, nightmare distress, and self-reported psychological disturbance. Sleep 25(2):205–212PubMedGoogle Scholar
Duval M, McDuff P, Zadra A (2013) Nightmare frequency, nightmare distress, and psychopathology in female victims of childhood maltreatment. J Nerv Ment Dis 201(9):767–772CrossRefPubMedGoogle Scholar
Achenbach TM (1991) Manual for the youth self-report and 1991 profile. Department of Psychiatry. University of Vermont, BurlingtonGoogle Scholar
Liu X (1997) Reliability and validity of the youth self-report (YSR) of achenbach’s child behavior checklist (CBCL) (in Chinese). Chin Ment Health J 11(4):200–203Google Scholar
Martin G et al (2004) Sexual abuse and suicidality: gender differences in a large community sample of adolescents. Child Abus Negl 28(5):491–503CrossRefGoogle Scholar
Zhang J, Lamis DA, Yuanyuan K (2012) Measuring Chinese psychological traits and social support with western developed instruments in psychological autopsy studies. J Clin Psychol 68(12):1313–1321CrossRefPubMedGoogle Scholar
Eysenck SBG et al (1985) Age norms for impulsiveness, venturesomeness and empathy in adults. Pers Individ Differ 6(5):613–619CrossRefGoogle Scholar
Agargun MY et al (1998) Repetitive and frightening dreams and suicidal behavior in patients with major depression. Compr Psychiatry 39(4):198–202CrossRefPubMedGoogle Scholar
Tanskanen A et al (2001) Nightmares as predictors of suicide. Sleep 24(7):844–847PubMedGoogle Scholar
Matamura M et al (2014) Associations between sleep habits and mental health status and suicidality in a longitudinal survey of monozygotic twin adolescents. J Sleep Res 23(3):290–294CrossRefGoogle Scholar
Pigeon WR, Pinquart M, Conner K (2012) Meta-analysis of sleep disturbance and suicidal thoughts and behaviors. J Clin Psychiatry 73(9):e1160–e1167CrossRefPubMedGoogle Scholar
Wong MM, Brower KJ (2012) The prospective relationship between sleep problems and suicidal behavior in the national longitudinal study of adolescent health. J Psychiatr Res 46(7):953–959CrossRefPubMedPubMedCentralGoogle Scholar
Lundh L-G, Bjärehed J, Wångby-Lundh M (2012) Poor sleep as a risk factor for nonsuicidal self-injury in adolescent girls. J Psychopathol Behav Assess 35(1):85–92CrossRefGoogle Scholar
Buysse DJ et al (1989) The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213CrossRefPubMedGoogle Scholar
Harvey AG et al (2008) The subjective meaning of sleep quality: a comparison of individuals with and without insomnia. Sleep 31(3):383–393PubMedPubMedCentralGoogle Scholar
Choquet M, Menke H (1990) Suicidal thoughts during early adolescence: prevalence, associated troubles and help-seeking behavior. Acta Psychiatr Scand 81(2):170–177CrossRefPubMedGoogle Scholar
Owens C et al (2016) Needs and fears of young people presenting at accident and emergency department following an act of self-harm: secondary analysis of qualitative data. Br J Psychiatr 208(3):286–291CrossRefPubMedPubMedCentralGoogle Scholar