Liu Lewei, Tian Yinghan, Fan Haojie, Wang Jiawei, Chen Changhao, Liu Zhiwei, Geng Feng, Mo Daming, Luo Xiangfen, Wen Xiangwang, Zhao Xin, Hao Mingru, Xia Lei, Liu Huanzhong
Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000, Anhui Province, China.
Anhui Psychiatric Center, Anhui Medical University, Hefei, 238000, Anhui Province, China.
BMC Psychiatry. 2024 Dec 18;24(1):929. doi: 10.1186/s12888-024-06357-z.
Insomnia may mediate the association between internet addiction (IA) and suicidal ideation (SI). However, such association has not been thoroughly investigated in adolescents with major depressive disorder (MDD). Thus, our study aimed to explore whether insomnia significantly affects the association between IA and SI in adolescents with MDD, as well as any sex differences.
From January 2021 to September 2023, this cross-sectional study included 502 adolescents with MDD and 123 healthy controls (HCs). The Clinical Global Impression-Severity (CGI-S), the Internet Addiction Test (IAT), the Insomnia Severity Index Scale (ISI) and the Positive and Negative Suicidal Ideation Scale (PANSI) were used to assess subjects' severity of depression, IA, insomnia and SI. And we employed the PROCESS macro program to examine the mediating role of insomnia between IA and SI.
Compared to HCs, adolescents with MDD had significantly higher levels of SI and their prevalence of IA and insomnia were 50.0% and 35.7%. In patients, PANSI scores correlated negatively with age and age of onset, and positively with disease duration as well as the scores of the CGI-S, IAT, and ISI (all p < 0.01). Moreover, above-mentioned correlations were more significant in girls. Mediation analyses showed that insomnia mediated the effect of IA on SI, and the total, direct, and indirect effects were 0.197 (95% CI: 0.132-0.262), 0.157 (95% CI: 0.096-0.218) and 0.040 (95% CI: 0.014-0.068), respectively. In female patients, the total, direct, and indirect effects were 0.224 (95% CI: 0.151-0.296), 0.191 (95% CI: 0.124-0.257) and 0.033 (95% CI: 0.002-0.068), respectively. In male patients, insomnia acted as a fully mediated effect between IA and SI, with an effect value of 0.045 (95% CI: 0.008-0.093).
Depressed adolescents have higher suicide risk, and SI is significantly associated with IA and insomnia, especially in girls. Moreover, insomnia may mediate the association between IA and SI. However, given the small sample size of this study and the limitations of assessment tools used, the results need to be viewed with caution. Regardless, clinical interventions should be strengthened for IA and insomnia in adolescents with MDD to reduce suicide risk.
失眠可能介导网络成瘾（IA）与自杀意念（SI）之间的关联。然而，在患有重度抑郁症（MDD）的青少年中，这种关联尚未得到充分研究。因此，我们的研究旨在探讨失眠是否会显著影响患有MDD的青少年中IA与SI之间的关联，以及是否存在性别差异。
从2021年1月至2023年9月，这项横断面研究纳入了502名患有MDD的青少年和123名健康对照（HCs）。使用临床总体印象-严重程度（CGI-S）、网络成瘾测试（IAT）、失眠严重程度指数量表（ISI）和正负性自杀意念量表（PANSI）来评估受试者的抑郁严重程度、IA、失眠和SI。并且我们采用PROCESS宏程序来检验失眠在IA和SI之间的中介作用。
与HCs相比，患有MDD的青少年SI水平显著更高，他们的IA和失眠患病率分别为50.0%和35.7%。在患者中，PANSI评分与年龄和发病年龄呈负相关，与病程以及CGI-S、IAT和ISI评分呈正相关（均p < 0.01）。此外，上述相关性在女孩中更为显著。中介分析表明，失眠介导了IA对SI的影响，总效应、直接效应和间接效应分别为0.197（95%CI：0.132 - 0.262）、0.157（95%CI：0.096 - 0.218）和0.040（95%CI：0.014 - 0.068）。在女性患者中，总效应、直接效应和间接效应分别为0.224（95%CI：0.151 - 0.296）、0.191（95%CI：0.124 - 0.257）和0.033（95%CI：0.002 - 0.068）。在男性患者中，失眠在IA和SI之间起完全中介作用，效应值为0.045（95%CI：0.008 - 0.093）。
抑郁的青少年自杀风险更高，SI与IA和失眠显著相关，尤其是在女孩中。此外，失眠可能介导IA与SI之间的关联。然而，鉴于本研究样本量较小以及所使用评估工具的局限性，结果需谨慎看待。无论如何，应加强对患有MDD的青少年的IA和失眠的临床干预，以降低自杀风险。
