Sleep quality and nonsuicidal self-injury: The mediating role of rumination and depression
【摘要】：Introduction: Nonsuicidal self-injury(NSSI), the direct and intentional destruction of one's own body tissue without suicidal intent, associated with increased risk of suicidal behavior, has become a significant public health concern among adolescents. In recognition of this high-risk behavior, NSSI has been added to the Diagnostic and Statistical Manual of Mental Disorders(DSM-5) as a 'condition for further study,' thus highlighting the importance of identifying additional risk factors and psychological correlates. Research has shown a positive association between sleep disturbances,(e.g., nightmares and insomnia), and suicidal behavior. However, the relation between NSSI and sleep quality has been less examined. Sleep disturbances have been found to have a causal role in problems with emotional dysfunction. This study examined the relationship between sleep variables(included sleep quality, habitual sleep efficiency, sleep disturbance, use of sleeping medications, and daytime dysfunction.) and NSSI in Chinese adolescents, and the mediating effect of both rumination and depression on this association. Methods: Participants were recruited from three public junior middle schools and a public high school(7 th, 8 th and 10 th students). 1991 students(From 11 years to 19 years; Mage = 14.00, SD = 1.50; 1105 females) participated, of them, 38.8% from the high school(n=772), completed self-report questionnaires assessing their demographic and family information, sleep problems, depression, rumination, emotional characteristics, and NSSI history. Results: A series of regression analyses were conducted to examine the associations between sleep, rumination, depression and NSSI. Findings showed that sleep quality were associated with NSSI while controlling for depressive symptoms. The results show that NSSI, rumination and depression have a significantly positive correlation with sleep quality. NSSI and depression had significantly positive relationship with rumination.Further, the relationship between sleep quality and NSSI was partially mediating effects by rumination and depression. Conclusion: The present research provides initial evidence that sleep quality are a temporally associated with an increased propensity for NSSI by contributing to rumination and symptoms of depression, and provides support for the emotion regulation function of sleep. Sleep quality can directly affect NSSI of adolescents but also can be influenced by rumination and symptoms of depression to indirectly affect their NSSI, namely the rumination and symptoms of depression in mediating between the sleep quality and NSSI. Sleep quality could positively predict aggressive NSSI of adolescents. While multiple sleep variables are associated with NSSI, provides support for the sleep quality, rumination and depression are risk factors of NSSI. Findings of this study may help to better understand the distinct mechanisms underlying the relationships from sleep to NSSI, and may have important implications for early detection and prevention of NSSI in adolescents.