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

Abstract

Emotional and behavioral problems in adolescents are associated with suicidal ideation, but different dimensions of problems may be associated with different levels of suicidal ideation. The aim of this large-scale study was to explore the relationship between different dimensions of emotional and behavioral problems and suicidal ideation in Chinese adolescents and to determine whether sleep disorders play a mediating role in the relationship. In total, 20,475 students completed the questionnaire regarding emotional and behavioral problems, sleep quality and suicidal ideation. After adjustment for covariates, total emotional and behavioral difficulties (adjusted odds ratios (AOR) = 1.22, 95% confidence interval (CI) = 1.21–1.23) and sleep disorders (AOR = 4.17, 95% CI = 3.82–4.54) increased the risk of suicidal ideation, while prosocial problems (AOR = 0.91, 95% CI = 0.90–0.93) decreased the risk of suicidal ideation. Sleep quality partially mediated the relationship between emotional and behavioral problems and suicidal ideation. The standardized indirect effects of emotional and behavioral difficulties on suicidal ideation (standardized β estimate = 0.031, 95% CI = 0.020, 0.044) and the effects of prosocial problems on suicidal ideation (standardized β estimate = −0.039, 95% CI = −0.045, −0.035) mediated by sleep quality were statistically significant (p < 0.001). Our study indicates that emotional and behavioral problems increase the risk of suicidal ideation. Additionally, sleep quality plays a mediating role in the association between emotional and behavioral problems and suicidal ideation.