Prevalence and correlates of sleep disturbance among adolescents in the eastern seaboard of China

doi:10.21203/rs.3.rs-3346583/v1

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Research Article

Prevalence and correlates of sleep disturbance among adolescents in the eastern seaboard of China

https://doi.org/10.21203/rs.3.rs-3346583/v1

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published 10 Apr, 2024

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Background

Sleep disturbances are serious public health issues that warrant increased attention, especially in adolescents. The aim of this study was to investigate the prevalence and factors associated with sleep disorders among urban adolescents in China.

Methods

This study utilized an online survey to assess the demographic characteristics and mental health status of secondary school students in Lianyungang City. The Patient Health Questionnaire-9 (PHQ-9) was used to evaluate suicidal ideation and sleep disturbances in adolescents. The seven-item Generalized Anxiety Disorder (GAD-7) assessed anxiety symptoms, and the Perceived Social Support Scale (PSSS) was used to measure perceived social support.

Results

Among 3443 adolescents, the prevalence of sleep disorders were 10.8%, with significantly higher proportions of sleep disorders (13.7% VS 8.3%, χ² = 26.559, P < 0.001) among female adolescents when compared to males. Binary regression analysis revealed that suicidal ideation (OR = 2.558, 95% CI: 1.897–3.450, P < 0.001) and anxiety symptoms (OR = 9.899, 95% CI: 7.317–13.393, P < 0.001) were risk factors for sleep disturbances, and significant other support (OR = 0.940, 95% CI: 0.894–0.989, P = 0.016) and good annual household income (OR = 0.661, 95% CI: 0.396–0.943, P = 0.026) were protective factors. Furthermore, multinomial logistic regression analysis showed that sex, suicidal ideation, anxiety symptoms, and parental relationship were associated with an elevated risk of experiencing more frequent sleep disturbances (all P < 0.05).

Conclusions

We have found that 10.8% of adolescents experience sleep disorders, and it is evident that various factors can influence healthy sleeping. These results underscore the significance of addressing these factors to enhance sleep health among this population.

Sleep disturbance

suicidal ideation

adolescents

PHQ-9

GAD-7

PSSS

Adolescence is a critical developmental period during which significant challenges related to mental health issues due to physical, psychological, and social factors are faced [1, 2]. Sleep plays a critical role in maintaining optimal cognitive and emotional functioning [3]. Sleep insufficiency can lead to a variety of issues, including difficulty concentrating, reduced academic performance, obesity, heightened suicidal thoughts, and in some cases, an elevated risk of car accidents, workplace injuries, and sports-related injuries [4, 5]. Regrettably, sleep disturbances have been increasingly prevalent among adolescents worldwide [6].

Sleep disturbances are a prominent concern affecting the mental health of adolescents, alongside symptoms of depression and anxiety [7, 8]. Changes in circadian rhythms during adolescence have a detrimental effect on the development of depressive symptoms in adolescents and this has been demonstrated in animal models, wherein animal models with disrupted circadian rhythms are more likely to exhibit depressive-like behaviors [9]. A previous study reported that individuals with any type of sleep disorder such as hypersomnia, excessive daytime sleepiness, insufficient sleep duration, or disruption in circadian rhythms have an increased likelihood of developing a mood or psychiatric disorders in adolescence and early adulthood [10]. A recent systematic review and meta-analysis revealed that sleep disorders greatly impacted children and adolescents during the COVID-19 pandemic, making them the second most vulnerable population, with an overall combined prevalence of 45.96% [11]. A cohort study conducted in Germany, focusing on adolescents aged 10–17 years, found that approximately 20% of the participants exhibited sleep-related problems [12].

Furthermore, several factors may be associated with sleep disturbances among adolescents, including family or academic pressures and problematic internet use [13, 14]. Previous research has demonstrated that unstable home environments and conflicts within the family have a detrimental impact on sleep quality in adolescents [15]. Academic and social pressures from peers have also been found to be strongly linked to sleep disturbances and an elevated risk of experiencing suicidal thoughts [16, 17]. Previous studies have consistently demonstrated a noteworthy correlation between sleep disturbances and suicidal ideation. For example, Nguyen et al. revealed that sleep disturbances were independently associated with a higher risk of self-harming behaviors [18]. A meta-analysis of longitudinal studies showed that while sleep disturbance had a weak association with suicidal thoughts and suicidal behavior, insomnia emerged as a significant predictor of suicidal ideation, and nightmares were strongly linked to suicide attempts [19]. Individually and in combination, these factors have a profound impact on the mental health of adolescents. It is crucial to comprehend their intricate interactions to effectively address and minimize the risks associated with sleep disorders.

Understanding the prevalence and factors related to sleep disturbances among adolescents is vital for the development of effective preventive interventions. Therefore, the primary objective of the present study was to investigate (1) the prevalence of sleep disturbances and suicidal ideation among adolescents and (2) identify potential risk factors associated with varying severity of sleep disturbances. We hypothesized that there is an increased prevalence of sleep disturbances among adolescents. Furthermore, we postulated that differing severity of sleep disturbances may be linked to various sociodemographic and behavioral factors.

To the best of our knowledge, there is currently little research regarding the prevalence and risk factors associated with different severity of sleep disturbances among adolescents in China.

Procedures and Subjects

We conducted a cross-sectional survey between May and June 2023, selecting secondary school students at random from five schools in the city of Lianyungang, Jiangsu Province, China. The participants were drawn from various grades, spanning from 7th grade to 3rd year of high school. The survey was administered online using the Wenjuanxing platform (https://www.wjx.cn/app/survey.aspx) and the study received approval from the Ethics Committee of Lianyungang Fourth People’s Hospital. The survey was conducted with the consent of the school, parents, and students. Prior to the survey, the students were given comprehensive information about the purpose, process, data confidentiality, and anonymity of the survey. Their participation was entirely voluntary, and they had the option to discontinue completion of the questionnaire at any time.

Socio-demographic information

The research team designed a semi-structured questionnaire to gather sociodemographic data, which included information on age, gender, single-parent households (yes/no), parental relationships (harmonious/moderate/troubled), and annual household income (better/good/fair/poor). An annual household income of less than CNY 50,000 is categorized as “poor”, between CNY 50,000 and CNY 100,000 as “fair”, between CNY 100,000 and CNY 200,000 as “good”, and an income of CNY 200,000 or more is considered “better”.

Measurements

Sleep disturbances and suicidal ideation

The 9-item Patient Health Questionnaire (PHQ-9) is a commonly used self-assessment questionnaire in which participants respond to nine questions to assess their individual mental health status over the past two weeks, often in primary care clinical settings [20]. The PHQ-9 consists of nine items, with each item rated on a scale of 0 to 3. The scoring scale is as follows: 0 for “not at all”, 1 for “several days”, 2 for “more than half the days”, and 3 for “nearly every day”. We assessed the presence of a sleep disturbance by utilizing the third item “Trouble falling or staying asleep, or sleep too much” of the PHQ-9 questionnaire, respectively. A cut-off score of 0–1 signifies no sleep disorders, while a cutoff score of 2–3 indicates their presence [21]. Suicidal ideation was evaluated using item nine on the “Thoughts that you would be better off dead or of hurting yourself in some way” scale, whereby a score of ≥ 1 indicated the presence of suicidal thoughts [22].

Anxiety symptoms

The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a widely used self-assessment scale consisting of seven items. It helps evaluate an individual’s anxiety symptoms experienced within the last two weeks [23, 24]. A 4-point scale ranging from 0 to 3 was utilized to score each item on the GAD-7. The total score ranges from 0 to 27, where higher scores indicate more severe anxiety symptoms. On the GAD-7 scale, the ratings 0, 1, 2, and 3 correspond to the following descriptions: “not at all”, “several days”, “more than half the days”, and “almost every day”, respectively [23]. These ratings are used to assess the frequency of anxiety symptoms experienced by an individual. Spitzer et al. found that the sensitivity and specificity of the GAD-7 scale were 89.0% and 82.0% at a cut-off score of 10, respectively, making it suitable for detecting anxiety symptoms [23].

Perceived social support

Perceived social support was assessed using the Chinese version of the Perceived Social Support Scale (PSSS), which comprises 12 items categorized into three subscales: family (items 3, 4, 8, and 11), friends (items 6, 7, 9, and 12), and significant other (items 1, 2, 5, and 10) [25, 26]. Each item was rated on a 7-point scale, ranging from “very strongly disagree” to “very strongly agree,” with higher scores indicating a greater level of perceived social support for the individual [27]. The Cronbach’s alpha coefficients for the subscales of family, friends, and significant other, as measured by Zimet et al., were 0.87, 0.85, and 0.91, respectively [27]. The scale has demonstrated robust psychometric properties and has been validated in Chinese populations, indicating its reliability and validity [28].

Statistical analyses

For continuous variables, such as age, comparisons were performed using either the Student’s t-test or independent samples t-test, with mean and standard deviation (SD) as measures of central tendency and dispersion, respectively. Categorical variables, such as percentages or frequencies, were compared using descriptive statistics and the chi-square test. Univariate analyses were performed to identify the risk factors associated with sleep disturbance, incorporating binary logistic regression. We categorized the presence of sleep disorders as a dichotomous variable and employed binary logistic regression analyses to assess the relationship between sleep disorders and other variables to analyze associated risk factors. We conducted multinomial logistic regression analyses to assess the risk factors for sleep disturbances. Sleep disturbances were categorized into mild (1 point), moderate (2 points), and severe (3 points) based on the scores. We used these categorizations to evaluate the risk factors that might be linked to the severity of sleep disturbances. All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) software, version 23.0. A two-sided P-value of less than 0.05 was considered statistically significant.

Sociodemographic characteristics of participants

A total of 3532 questionnaires were collected, with 89 (2.52%) excluded due to incomplete information on age, sex, grade, and other required fields. Ultimately, a total of 3443 valid questionnaires were obtained. The age range of the adolescents who participated in the survey was from 12 to 18 years old, with an average age of 14.88 (1.59) years. The average total score on PSSS was 65.0 (15.18) and the overall prevalence rates among the surveyed population were 10.8% (n = 373) for sleep disturbances. Overall, 10.2% (n = 351) of adolescents experienced anxiety symptoms. according to the self-assessment reports, and the percentages for parental relationships were 72.0% (n = 2479), 24.2% (n = 832), and 3.8% (n = 132) for harmonious, moderate, and troubled, respectively. Single-parent households accounted for 10.0% (n = 346) of the total. For annual household incomes, the percentages were 25.4% (n = 876), 20.1% (n = 20.1), 51.9% (n = 1786), and 2.6% (n = 89) for better, good, fair, and poor, respectively.

Comparison of adolescent characteristics with or without sleep disturbances

The results of the self-report indicated that there were a higher proportion of female adolescents with sleep disorders than males (χ2 = 26.599, P < 0.001). Adolescents with suicidal ideation demonstrated a higher prevalence of sleep disorders when compared to those without such ideation (χ2 = 439.024, P < 0.001). Additionally, a significant difference was found between individuals with and without anxiety symptoms in individuals of sleep disturbances (χ2 = 893.818, P < 0.001). Adolescents without sleep disorders reported significantly higher PSSS scores in terms of family, friends, and significant other when compared to those with sleep disorders (all P < 0.001). Adolescents from single-parent families showed a higher prevalence of sleep disorders when compared to those from non-single-parent families (χ2 = 14.0, P < 0.001). Moreover, adolescents from families with harmonious parental relationships exhibited lower rates of sleep disorders in contrast to those from families with troubled parental relationships (χ2 = 133.748, P < 0.001). The prevalence of sleep disorders among adolescents from families with higher annual incomes was significantly lower when compared to adolescents from families with lower annual incomes (χ2 = 35.889, P < 0.001), as shown in Table 1.

Furthermore, of the 3,443 adolescents, the percentages of self-reported sleep disorders with scores of 0, 1, 2, and 3 were 63.6%, 25.5%, 6.2%, and 4.7%, respectively.

Table 1

Socio-demographic profile of participants (n = 3443).
Variable	With (n = 373)	Without (n = 3070)	χ2/t	P
Age (years), mean (SD)	14.63 (1.50)	14.91 (1.60)	3.234	0.001
Sex, n (%)			26.599	< 0.001
Male	150 (8.3)	1668 (91.7)
Female	223 (13.7)	1402 (86.3)
Suicidal ideation, n (%)			439.024	< 0.001
Yes	241 (31.7)	520 (68.3)
No	132 (4.9)	2550 (95.1)
GAD, n (%)			893.818	< 0.001
Yes	203 (57.8)	148 (42.2)
No	170 (5.5)	2922 (94.5)
PSSS, mean (SD)
Family	17.10 (5.97)	22.32 (5.30)	16.165	< 0.001
Friends	18.46 (5.82)	21.98 (5.11)	11.155	< 0.001
Significant other	17.48 (5.70)	22.15 (5.06)	15.096	< 0.001
Single-parent households, n (%)			14.000	< 0.001
Yes	58 (16.8)	288 (83.2)
No	315 (10.2)	2782 (89.8)
Parental relationship, n (%)			133.748	< 0.001
Harmonious	189 (7.6)	2290 (92.4)
Moderate	138 (16.6)	694 (83.4)
Troubled	46 (34.8)	86 (65.2)
Annual household income, n (%)			35.889	< 0.001
Better	79 (9.0)	797 (91.0)
Good	49 (7.1)	643 (92.9)
Fair	223 (12.5)	1563 (87.5)
Poor	22 (24.7)	67 (75.3)

SD, standard deviation; GAD, Generalized Anxiety Disorder-7; PSSS, Perceived Social Support Scale.

Correlation analysis of the prevalence of sleep disturbances in adolescents

Significant relationships were observed between age, sex, suicidal ideation, anxiety symptoms, single-parent families, parental relationships, and annual household income, and sleep disturbances according to univariate analyses (all P < 0.05). Consequently, to account for these findings, the aforementioned variables were included in the binary logistic regressions. The results reveal suicidal ideation (OR = 2.558, 95% CI: 1.897–3.450, P < 0.001) and anxiety symptoms (OR = 9.899, 95% CI: 7.317–13.393, P < 0.001) to be risk factors for sleep disturbances in adolescents. Significant other support and good annual household income were protective factors for sleep disturbances (OR = 0.940, 95% CI: 0.894–0.989, P = 0.016; OR = 0.611, 95% CI: 0.396–0.943, P = 0.026), respectively. However, age, sex, family, and friend support, single-parent households, and parental relationship were not risk factors for sleep disturbances (all P > 0.05), as shown in Table 2.

Table 2

Risk factors associated with the prevalence of sleep disturbances.
Variables	B	OR	95%CI	P
Age	-0.037	0.964	0.886–1.048	0.387
Sex	0.256	1.291	0.993–1.679	0.057
Suicidal ideation	0.939	2.558	1.897–3.450	< 0.001
GAD	2.292	9.899	7.317–13.393	< 0.001
PSSS
Family	− 0.021	0.979	0.942–1.018	0.293
Friends	0.022	1.022	0.984–1.062	0.253
Significant other	− 0.061	0.940	0.894–0.989	0.016
Single-parent households	0.101	1.106	0.726–1.686	0.638
Parental relationship
Harmonious		1
Moderate	0.175	1.192	0.876–1.620	0.263
Troubled	0.450	1.568	0.880–2.792	0.127
Annual household income
Better		1
Good	− 0.492	0.611	0.396–0.943	0.026
Fair	− 0.049	0.952	0.687–1.319	0.769
Poor	0.098	1.103	0.544–2.236	0.785

GAD, Generalized Anxiety Disorder-7; PSSS, Perceived Social Support Scale.

Factors related to sleep disturbance severity

Having failed the parallel test, a multinomial logistic regression analysis was conducted to examine the risk factors associated with varying severities of sleep disorders. We used a sleep disturbance score of 1 as a control. As shown in Table 3, compared to adolescents with rare sleep disorders (score of 1), females who experienced sleep disorders almost every day (score of 3) had a 1.456-fold increased risk of sleep disorders when compared to males (OR = 1.456, 95% CI: 1.010–2.099, P = 0.044), 2.81-fold increased risk of sleep disorders among those with suicidal ideation (OR = 2.81, 95% CI: 1.898–4.159, P < 0.001), 2.441-fold increased risk among those with anxiety symptoms compared to those with no anxiety symptoms (OR = 2.441, 95% CI: 1.623–3.671, P < 0.001), and 2.823-fold increased risk among those with a troubled parental relationship compared to those with a harmonious interparental relationship (OR = 2.823, 95% CI: 1.373–5.804, P = 0.005). In comparison. adolescents experiencing sleep disorders more than half of the days over a 2-week period (score of 2) had a 1.693-fold increased risk of sleep disorders among those with suicidal ideation (OR = 1.693, 95% CI: 1.228–2.336, P = 0.001) and 2.256-fold increased risk among those with anxiety symptoms compared to those with no anxiety symptoms (OR = 2.256, 95% CI: 1.573–3.236, P < 0.001). Individuals with a moderate parental relationship had a 1.578-fold increased risk of sleep disorders compared to those with a harmonious parental relationship (OR = 1.578, 95% CI: 1.118–2.228, P = 0.010). However, our findings indicate that age, PSSS subscale, and single-parent household were not significant factors for the determination of sleep disturbance severity (all P > 0.05).

Table 3

Risk factor associated with sleep disturbance severity.
Dependent variable	Variables	B	P	Exp(B)	95%CI
3 points	Age	− 0.105	0.073	0.900	0.802–1.010
	Sex	0.375	0.044	1.456	1.010–2.099
	Suicidal ideation	1.033	< 0.001	2.810	1.898–4.159
	GAD	0.892	< 0.001	2.441	1.623–3.671
	Family	− 0.032	0.206	0.968	0.921–1.018
	Friends	− 0.040	0.131	0.961	0.913–1.012
	Significant other	− 0.078	0.053	1.022	0.965–1.157
	Troubled parental relationship	1.038	0.005	2.823	1.373–5.804
	Moderate parental relationship	0.398	0.057	1.490	0.989–2.244
	Single-parent households	− 0.085	0.775	0.918	0.824–1.002
2 points	Age	− 0.096	0.056	0.909	0.994–1.858
	Sex	0.291	0.070	1.337	0.977–1.830
	Suicidal ideation	0.527	0.001	1.693	1.228–2.336
	GAD	0.814	< 0.001	2.256	1.573–3.236
	Family	0.007	0.771	1.007	0.961–1.055
	Friends	− 0.037	0.121	0.964	0.920–1.010
	Significant other	0.044	0.161	1.045	0.983–1.112
	Troubled parental relationship	− 0.472	0.310	0.624	0.251–1.552
	Moderate parental relationship	0.456	0.010	1.578	1.118–2.228
	Single-parent households	− 0.175	0.529	0.839	0.487–1.448

GAD, Generalized Anxiety Disorder-7.

We found that the prevalence of sleep disturbances in Chinese adolescents was 10.8%, and suicidal ideation, anxiety symptoms, lower significant other support, and poor annual household income were risk factors for sleep disturbances. Furthermore, female sex, suicidal ideation, anxiety symptoms, and parental relationships were found to be associated with an elevated risk of experiencing more frequent sleep disturbances.

Our findings also revealed that the prevalence of sleep disorders among adolescents was 10.8%, which was inconsistent with the results of previous studies. For example, a systematic review and meta-analysis reported that sleep disorders among Chinese adolescents had an overall pooled prevalence of 26% [29], and another cross-sectional survey revealed that the prevalence of sleep disorders among adolescents aged 12–18 years was 26.9% [30]. A large sample conducted in the Netherlands found that less than 20% of adolescents reported experiencing sleep disturbances within a month [31], while in Brazil 53% of adolescents were reported to have poor sleep quality [32]. These studies were conducted in different countries and at times, including before and during the COVID-19 pandemic [33]. Our study found a lower prevalence of sleep disorders in adolescents when compared to previous studies, which was potentially attributed to the use of a different survey questionnaire and the post-COVID-19 period. Nevertheless, these consistent findings highlight the significance of addressing the prevalence of sleep disorders in adolescents and emphasizes the need for further investigation in the future.

Our results align with previous research highlighting the impact of psychological factors on sleep disturbances [34, 35]. Suicidal ideation and anxiety symptoms were found to be significant risk factors and adolescents aged 14–18 who do not obtain sufficient sleep are 1.35 times more likely to experience suicidal ideation when compared to those who do get enough sleep [36]. After conducting a nearly 7-year investigation into sleep disorders and suicidal ideation, it was found that 94.9% of individuals who reported suicidal ideation also experienced sleep problems [37]. Adolescents who had poor sleep quality were 3.558 times more likely to experience anxiety symptoms when compared to individuals with good sleep quality [38]. Moreover, higher levels of negative coping styles in adolescents with sleep disorders were found to increase the prevalence of anxiety symptoms, whereas higher levels of positive coping styles were associated with a lower prevalence of anxiety symptoms [38]. These findings are consistent with previous research highlighting the bidirectional relationship between sleep disturbances and psychological factors.

Moreover, suicidal ideation and anxiety symptoms may contribute to the more frequent occurrence of sleep disturbances. A clinical randomized controlled trial demonstrated that the treatment of insomnia resulted in a reduction in suicidal ideation [39]. Dolsen et al. reported that the inflammatory factor interleukin (IL)-6 plays a moderating role in the relationship between sleep disorders and suicidal ideation [40], suggesting IL-6’s influence on the relationship between sleep disorders and suicidal thoughts improves our understanding of the physiological mechanisms. Also, a prior study utilizing a two-sample Mendelian randomized design demonstrated a robust association between sleep disorders and anxiety symptoms [41]. Bian et al. also reported similar findings, further supporting the association between sleep disorders and anxiety symptoms [42]. The relationship between suicidal ideation, anxiety symptoms, and sleep disorders is intricate and multifaceted, and further research is needed to understand the underlying mechanisms.

Lower significant other support and lower household income were also risk factors for sleep disturbances among adolescents. In line with previous research, it was clear that perceived social support plays an important role on the development of depressive symptoms, anxiety symptoms, and sleep disorders [43, 44]. A study found that support from friends negatively correlated with sleep duration, while support from family seemed to positively contribute to sleep quality, and the presence of other significant forms of support mitigated the negative impact on sleep duration [45]. Similarly, family economic crises, such as unemployment and financial constraints, have a significant impact on the mental health of adolescents [46]. However, a study conducted in South Korea revealed that adolescents residing in urban areas, as well as those from high-income families, experienced shorter sleep durations and later bedtimes [47]. These findings suggest the importance of social support networks and socioeconomic factors affecting sleep.

In line with previous studies, our results indicate that females are at a higher risk of experiencing more frequent sleep disturbances [48]. This gender difference may be attributed to various biological, psychological, and sociocultural factors. Previous reviews have indicated that pubertal development, hormonal changes, genetic mechanisms, gestational period, and mode of birth, as well as behavioral and social environments, contribute to this increased susceptibility [49, 50]. However, the exact mechanisms underlying this association remain unclear.

Furthermore, parental relationships were found to be associated with an increased risk of severe sleep disturbances among adolescents. According to a longitudinal study, there is an indirect association between greater parental warmth and improved sleep among adolescents, while adolescent sleep disturbances may have a negative impact on parental warmth [51]. A recent editorial concluded that marital conflict within the family and impaired parent-child relationships contribute to increased vigilance and arousal states in children, which in turn leads to feelings of insecurity and anxiety that negatively impact sleep [52] and our findings are comparable to those of Peltz et al. [53]. Dysfunctional relationships between parents also contribute to increased insecurity among adolescents, leading to anxiety and a higher likelihood of experiencing sleep disturbances.

Recognizing the importance of addressing sleep disturbances among adolescents, healthcare professionals and policymakers should emphasize early identification and intervention strategies. By understanding the underlying mechanisms that link risk factors and sleep disturbances, targeted interventions can be developed to improve the mental well-being and overall health of this vulnerable population. Future research should focus on examining these mechanisms and developing effective strategies to enhance sleep quality.

Despite the significant findings and contributions derived from our study, there were several limitations that should be acknowledged. First, cross-sectional design limits establishing causality between risk factors and sleep disturbances; longitudinal studies are needed to unravel temporal relationships. Second, reliance on self-reported measurements introduces response bias. Third, the study sample focused exclusively on adolescents in one area, limiting generalizability; therefore, research in diverse populations is needed to determine the complex interplay between cultural and individual factors.

In summary, our study provided valuable insights into the prevalence and risk factors associated with sleep disturbances among adolescents, where suicidal ideation, anxiety symptoms, lower significant other support, and annual household income were identified as risk factors. Furthermore, female sex, suicidal ideation, anxiety symptoms, and parental relationships were found to be associated with an elevated risk of severe sleep disturbances. These findings highlight the need for comprehensive strategies to address sleep disturbances in adolescents, focusing on early detection, mental health support, and promoting positive social and familial relationships.

Acknowledgements

We would like to express our sincere gratitude to all study participants and colleagues involved in data collection.

Authors’ contributions

Haidong Yang and Xiaobin Zhang wrote the manuscript; Xiaobin Zhang and Xiaowei Tang were responsible for study design; Haidong Yang performed the statistical analysis; Linshu Luan, Jiuli Xu, and Xingran Xu were responsible for collecting the data, coordinating with schools, maintaining the online survey platform. All authors have contributed to and have approved the final manuscript.

Funding

The study was supported by the Youth Talent Support Project of Jiangsu Provincial 333 Project ((2022)3-29-052); Research Project of Jiangsu Commission of Health (M2020031); Elderly Health Research Project of Jiangsu Commission of Health (LR2022015, LKZ2023020); Suzhou clinical Medical Center for mood disorders (No. Szlcyxzx202109); Lianyungang Science and Technology Bureau of Social Development Key R&D Projects (SF2208). The funding sources of this study had no role in study design, data collection and analysis, decision to publish, or preparation of the article.

Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

All experimental protocols were approved by the Ethics Committee of the Fourth People’s Hospital of Lianyungang. Informed consent was obtained from all subjects. All methods were carried out in accordance with the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors have no conflict of interest.

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No competing interests reported.

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Prevalence and correlates of sleep disturbance among adolescents in the eastern seaboard of China

Status:

Journal Publication

Version 1

Abstract

Background

Methods

Results

Conclusions

Introduction

Methods

Procedures and Subjects

Socio-demographic information

Measurements

Sleep disturbances and suicidal ideation

Anxiety symptoms

Perceived social support

Statistical analyses

Results

Sociodemographic characteristics of participants

Comparison of adolescent characteristics with or without sleep disturbances

Correlation analysis of the prevalence of sleep disturbances in adolescents

Factors related to sleep disturbance severity

Discussion

Declarations

References

Additional Declarations

Status:

Journal Publication

Version 1