Wang Yanzhe, Wang Qingyu, Gong Weijie, Shang Xingchen, Ruan Jiayin, Liang Wei, Lin Zheng, Li Sha
School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning, Nanjing, 211166, Jiangsu, China.
South China Hospital, Shenzhen University Medical School, 1 Fuxin Road, Shenzhen, 518111, Guangdong, China.
BMC Public Health. 2025 Aug 27;25(1):2949. doi: 10.1186/s12889-025-23840-8.
Previous studies showed that nonrestorative sleep (NRS) was associated with various adverse outcomes. This study aimed to explore whether NRS was associated with self-injury behavior, suicidal ideation, and suicide attempts.
Adolescents attending Grades 7-12 in Nanjing, China, were invited to participate in this longitudinal school-based survey from January 11 to 23, 2024 (T1) and from May 16 to 26, 2024 (T2). The Nonrestorative Sleep Scale (NRSS), Perceived Stress Scale, Center for Epidemiologic Studies Depression-10, and Family APGAR Index were employed to assess NRS, stress, depression, and family function at T1, respectively. The self-injury behavior, suicidal ideation, and suicide attempts during the last four months were measured at T2. Multivariable logistic regressions were applied to investigate the associations of NRS with self-injury behavior, suicidal ideation, and suicide attempts. Stratified analyses were conducted to explore gender-specific effects, and the area under curve was calculated to explore the predictive ability of NRS.
Totally, 322 adolescents (57.1% male, mean age 15.4 ± 1.86 years) completed the two-wave surveys. The prevalence of self-injury behavior, suicidal ideation, and suicide attempts in adolescents was 9.3%, 12.7%, and 5.9%, respectively. Reduced NRS symptoms (higher scores of NRSS) were associated with a decreased likelihood of self-injury (odds ratio, OR = 0.89, P < 0.001), suicidal ideation (OR = 0.90, P < 0.001), and suicide attempts (OR = 0.93, P = 0.015). After accounting for sociodemographics, stress, depression, and family function, reduced NRS symptoms significantly decreased the odds of self-injury behavior (adjusted odds ratio, AOR = 0.88, P = 0.002) and suicidal ideation (AOR = 0.92, P = 0.009) but not suicide attempts (AOR = 0.93, P = 0.082). Subgroup analysis showed that the associations of NRS symptoms reached statistical significance exclusively in female participants. The optimal risk-screening threshold of NRSS was 36.5.
Reduced NRS symptoms might decrease the risk of self-injury and suicidal ideation. Relieving NRS symptoms with appropriate interventions would be advantageous for adolescents' health.
先前的研究表明，非恢复性睡眠（NRS）与各种不良后果相关。本研究旨在探讨NRS是否与自我伤害行为、自杀意念和自杀未遂有关。
邀请中国南京7至12年级的青少年参加这项基于学校的纵向调查，调查时间为2024年1月11日至23日（T1）和2024年5月16日至26日（T2）。分别采用非恢复性睡眠量表（NRSS）、感知压力量表、流行病学研究中心抑郁量表-10和家庭APGAR指数在T1时评估NRS、压力、抑郁和家庭功能。在T2时测量过去四个月内的自我伤害行为、自杀意念和自杀未遂情况。应用多变量逻辑回归分析来研究NRS与自我伤害行为、自杀意念和自杀未遂之间的关联。进行分层分析以探讨性别特异性影响，并计算曲线下面积以探索NRS的预测能力。
共有322名青少年（57.1%为男性，平均年龄15.4±1.86岁）完成了两波调查。青少年中自我伤害行为、自杀意念和自杀未遂的患病率分别为9.3%、12.7%和5.9%。NRS症状减轻（NRSS得分较高）与自我伤害（优势比，OR = 0.89，P < 0.001）、自杀意念（OR = 0.90，P < 0.001）和自杀未遂（OR = 0.93，P = 0.015）的可能性降低相关。在考虑了社会人口统计学、压力、抑郁和家庭功能因素后，NRS症状减轻显著降低了自我伤害行为（调整后的优势比，AOR = 0.88，P = 0.002）和自杀意念（AOR = 0.92，P = 0.009）的几率，但未降低自杀未遂的几率（AOR = 0.93，P = 0.082）。亚组分析表明，NRS症状的关联仅在女性参与者中达到统计学意义。NRSS的最佳风险筛查阈值为36.5。
NRS症状减轻可能会降低自我伤害和自杀意念的风险。通过适当干预缓解NRS症状对青少年健康有益。
