The Mediating Effect of Sleep Quality on the Relationship between Emotional and Behavioral Problems and Suicidal Ideation

Mindfulness mediates the relationship between positive parenting and aggression, depression, and suicidal ideation: A longitudinal study in middle school students

Previous research has indicated that parenting factors affect the risk of maladaptive psychological outcomes (e.g., aggression, depression, or suicidal ideation), and that positive parenting is a prospective risk factor for maladaptive psychological outcomes. However, the mechanisms underlying the relationships between positive parenting, mindfulness, and maladaptive psychological outcomes remain unknown, as do the processes that mediate the effect of positive parenting on maladaptive psychological outcomes in adolescents. The objective of the present study was to investigate the longitudinal relationship between positive parenting, mindfulness, and maladaptive psychological outcomes in middle school students, as well as the mediating effect of mindfulness in the relationships between positive parenting and depression, aggression, and suicidal ideation. In this study, 386 middle school children (aged 12–16) were tested three times over a period of 6 months. Positive parenting was assessed at Time 1, mindfulness at Time 2, and depression, aggression, and suicidal ideation at Time 3. Using structural equation modeling, positive parenting was revealed to be longitudinally associated with mindfulness and negatively associated with maladaptive psychological outcomes. More crucially, mindfulness mediated the relationship between positive parenting and maladaptive psychological outcomes. This research provides important insights into how to effectively decrease adolescent maladaptive psychological outcomes and highlights the importance of teaching mindfulness to youths.

Associations of parent-adolescent relationship and self-esteem with emotional and behavioral problems among Chinese adolescents

BACKGROUND

This study aimed at exploring the associations of parent-adolescent relationship and self-esteem with emotional and behavioral problems (EBPs) among Chinese adolescents using a large-scale nationally questionnaire survey data from China.

METHODS

Obtained from China Family Panel Studies (CFPS) 2018, the research data involved 2400 adolescents aged 10-15. Multiple linear regression analysis and the PROCESS macro were used for examining the mediating effect of self-esteem on the associations of parent-adolescent relationship with EBPs.

RESULTS

After controlling the potential confounding factors, parent-adolescent relationship and self-esteem were significantly associated with EBPs (P < 0.01). Correlation analysis results showed that parent-adolescent relationship (r = -0.116, P < 0.01) and self-esteem (r = -0.209, P < 0.01) were negatively correlated with EBPs. Self-esteem partially mediated the associations of parent-adolescent relationship with EBPs among Chinese adolescents.

LIMITATIONS

The cross-sectional design limited the ability to make causal inferences.

CONCLUSIONS

Positive parent-adolescent relationship and high self-esteem contributed to fewer EBPs of adolescents. Parent-adolescent relationship predicted EBPs partially mediated by self-esteem. Establishing positive parent-adolescent relationship and improving individual self-esteem may thus be promising targets for intervention in adolescents with EBPs.

A Comprehensive Review of the Literature on Sleep Difficulties and Suicidality in Youth to Inform an Integrative Developmental Model and Future Directions

Purpose of Review

Suicide is currently the second leading cause of death among youth. Identification of modifiable near-term risk factors can inform suicide prevention strategies. One promising, readily assessed factor is sleep. We critically review the literature on sleep and suicidal thoughts and behaviors among youth.

Recent Findings

Most studies examining the youth sleep-suicidality relationship are from epidemiological samples in which both sleep problems and suicidality were assessed over variable timeframes using limited items from scales not designed to measure these constructs. Nonetheless, these data overwhelmingly support an association between suicidality and a range of sleep difficulties (e.g., insomnia, short/long sleep, weekend oversleep), above and beyond depressive symptoms. Limited studies include clinical samples or prospective designs. We review potential mechanisms and present a developmentally-informed integrative model.

Summary

Literature supports a clear association between sleep difficulties and youth suicidality. Future directions include prospective longitudinal studies and targeted prevention efforts.

Longitudinal relationships among perceived stress, suicidal ideation and sleep quality in Chinese undergraduates: A cross-lagged model

BACKGROUND

Sleep quality is an important indicator of quality of life. It is of importance to investigate the risk factors and potential consequences of poor sleep quality, such as perceived stress and suicidal ideation. We therefore investigated the longitudinal and reciprocal relationships among perceived stress, suicidal ideation, and sleep quality.

METHODS

A three-wave longitudinal survey was conducted from June 2019 to June 2020 at six-month intervals in undergraduate students (N = 197, 58.9% female) in China. The participants completed self-report questionnaires in classroom settings.

RESULTS

While the levels of perceived stress were stable, levels of suicidal ideation and sleep quality fluctuated significantly over time. There were significant reciprocal relationships between perceived stress and suicidal ideation from T1 to T3. In addition, the reciprocal relationships between suicidal ideation and sleep quality from T1 to T2 were also significant. Suicidal ideation at T2 partially mediated the relationship between perceived stress at T1 and sleep quality at T3 (indirect effect: β=0.06, 95% CI: 0.04 to 0.10, p<0.001), and suicidal ideation at T2 fully mediated the relationship between sleep quality at T1 and perceived stress at T3 (indirect effect: β=0.48, 95% CI: 0.30, 0.70, p<0.001).

LIMITATIONS

The subjects' educational background is single, and the measurement method is self-report measures.

CONCLUSIONS

Suicidal ideation may play a significant role in explaining the longitudinal relationships between perceived stress and sleep quality. And suggest the importance of early identification and treatment of suicidal ideation among Chinese undergraduates.

Sleep disturbances and correlates among a sample of preschool children in rural China

This study aimed to explore the prevalence of sleep disturbances among preschool children in rural areas of China and identify the underlying associated factors. A cross-sectional study was conducted in rural areas of Anhui Province, China, from September 2019 to January 2020. The caregivers of children from 26 kindergartens completed the demographic questionnaire, the Children's Sleep Habits Questionnaire (CSHQ), the Strengths and Difficulties Questionnaire (SDQ), the Self-rating Anxiety Scale (SAS), and the adapted Identification and Management of Feeding Difficulties (IMFeD) tool. One-way analysis of variance, independent-samples t-test, and hierarchical multiple linear regression were conducted to explore the potential influencing factors of sleep disturbances in preschool children. For the specific sleep disturbances based on each subscale of the CSHQ, bedtime resistance (54.9%) and sleep anxiety (47.9%) were the most common types of sleep disturbances, followed by daytime sleepiness (21.3%), sleep duration (20.8%), parasomnias (16.5%), sleep-onset delay (12.6%), night wakings (12.2%) and sleep-disordered breathing (10.3%). The ages of children, children's emotional/behavioral problems, children's feeding difficulties, inconsistent parenting attitudes of parents, poor parenting styles, non-parent caregivers, and caregiver anxiety contributed significantly to the CSHQ total score, accounting for approximately 27.1% (R2 = 0.271) of the variance. Our study indicates that the prevalence of sleep disturbances among preschool children in rural areas of China is quite high. Furthermore, the potential risk factors are complicated, including factors related to both children and their caregivers.

Associations of depressive and anxiety symptoms with non-suicidal self-injury and suicidal attempt among Chinese adolescents: The mediation role of sleep quality

BACKGROUND

Associations of depressive and anxiety symptoms with non-suicidal self-injury (NSSI) and suicide attempt (SA) are not well understood. We aimed to examine these associations among Chinese adolescents, and whether any potential association is mediated through sleep quality.

METHODS

We conducted a cross-sectional study among 1,771 (994 boys [56.1%] and 777 girls [43.9%], mean [SD] age was 12.9 [0.6] years) adolescents who participated in the baseline survey of the Chinese Adolescent Health Growth Cohort (CAHGC) study. Depressive symptoms, anxiety symptoms, NSSI, SA and sleep quality were measured by validated questionnaire. Logistic regression models were employed to estimate the associations of depression and anxiety with NSSI and SA. Mediation analyses were conducted to explore the mediate effect of sleep quality.

RESULTS

The 12-month prevalence of NSSI and SA was 17.1 and 8.3%, respectively. Depressive and anxiety symptoms were significantly associated with NSSI (the adjusted odds ratio [aOR] was 1.89 [95% CI 1.34-2.65] for depressive symptoms and 2.84 [95% CI 2.05-3.94] for anxiety symptoms) and SA (the aOR was 3.20 [95% CI 2.03-5.05] for depressive symptoms and 2.98 [95% CI 1.84-4.84] for anxiety symptoms). No significant gender differences were found in the associations. The mediation proportion of sleep quality on the association of depressive and anxiety symptoms with NSSI, as well as depressive and anxiety symptoms with SA were 21.1, 13.9, 13.6, and 14.7, respectively.

CONCLUSION

Independent associations of depressive and anxiety symptoms with NSSI and SA were observed in Chinese adolescents, and there were no significant gender differences in the associations. Moreover, these associations were partially mediated through sleep quality. Targeted interventions for adolescents' NSSI and SA should focus on those who have depressive and anxiety symptoms, and poor sleep quality.

Association between problematic internet use and behavioral/emotional problems among Chinese adolescents: the mediating role of sleep disorders

Background

Studies that focus on the relationships of problematic Internet use (PIU), sleep disorders, and behavioral/emotional problems were limited. This study aimed to explore (1) the relationship between PIU and behavioral/emotional problems among Chinese adolescents and (2) whether sleep disorders mediate the relationship between PIU and behavioral/emotional problems.

Methods

A total of 1,976 adolescents were recruited by cluster sampling from ten secondary schools in Guangzhou between January and April 2019, and 1,956 of them provided valid information (response rate: 98.9% ). Among them, 50.8% were males and the mean age was 13.6±1.5 years, ranging from 11 to 18 years. Data on behavioral/emotional problems, sleep disorders, and PIU were collected using a self-reported questionnaire. Linear regression models and mediation analyses were performed.

Results

Of the participants, 14.5% (284/1,956) reported moderate to severe PIU, and their average score for total difficulties was significantly higher than the score for average users (14.9±5.5 Vs 9.8±4.7). After adjusting for controlled variables, PIU was further proven to be positively related to elevated levels of behavioral/emotional problems (unstandardized β = 0.16, p < 0.05). In addition, sleep disorders partially mediated the forgoing associations.

Conclusions

Adolescents with problematic Internet habits were at higher risk of developing behavioral and emotional problems than their normal-use peers, and sleep disorders partially mediated the effect. Close attention and effective guidance for adolescents with PIU and behavioral/emotional problems were recommended for parents and schools.

Family and School Context: Effects on the Mental Health of Brazilian Students

Mental health during adolescence can affect an individual’s long-term quality of life. However, the effects of family and school contexts on students’ mental health have been little explored. This study aims to analyze the relationships between family and school life and feelings of loneliness and trouble sleeping owing to worries in adolescents. The data from this cross-sectional study were obtained from Brazil’s National School Health Survey (PeNSE), which obtained its data through questionnaires. This study’s sample consisted of 102,072 ninth-grade students aged between 11 and 19 years, 52,782 (51.7%) of whom were female, enrolled in public and private schools throughout Brazil. The methodology consisted of an analysis using the Poisson regression model. Regarding the family context, mental health issues were associated with hunger, distant relationships with parents, and family violence. Regarding the school context, feelings of loneliness and trouble sleeping were associated with poor peer relationships, insecurity at school, and schools in more violent areas. This study contributes to the elaboration of public policies aimed at bringing awareness to family members and school bodies that indicators of mental health in adolescents are influenced by the quality of bonds established within these environments.