Study On The Relationship Between Sleep Disorders And Depression,Anxiety And Other Mental Health Problems In Primary And Middle School Students

Objective:Sleep is closely related to physical and mental health development of children and adolescents.Multiple mental health problems such as depression and anxiety of primary and secondary school students cannot be ignored.Early identification and intervention of sleep and mental health problems of children and adolescents need a comprehensive understanding of the relevant influencing factors.The questionnaire survey was conducted to investigate the prevalence of sleep disorders,emotional behavior problems,depression and anxiety symptoms and other mental health problems to explore the influencing factors of sleep disorders,verify longitudinal association between sleep disorders with depressive or anxiety symptoms,and provide scientific basis for improving sleep quality and mental health of children and adolescents.Methods:Convenient sampling was used to conduct cross-sectional and two follow-up questionnaire surveys.Students from grade 4 to grade 9 in Anhui province were selected in the cross-sectional survey,and students of grade 4 and grade 7 of them were selected in two follow-up surveys at intervals of 6 months.The survey was carried out by self-filled questionnaires,including personal and family information,left-behind experience,sleep quality,emotional behavior problems,school bullying,family functioning,psychological resilience,depressive symptoms and anxiety symptoms,etc.SPSS 23.0,PROCESS（macroprogram of SPSS）,and AMOS 24.0 were used to conducted statistical description,χ~2 test,variance analysis,non-parametric test,Logistic regression,path analysis and cross-lagged panel model construction.Results:A cross-sectional survey of 6363 primary and secondary school students showed that the detection rate of sleep disorders was 13.59%with PSQI score≥7 as the cut-off value,and 31.15%with PSQI score≥5 as the cut-off value.The detection rate of emotional behavior problems was 17.11%,and 33.48%for depressive symptoms,30.54%for anxiety symptoms.Variance analysis andχ~2 test showed that there was significant difference of age,gender,residence,experience of hospitalization in last year,only child,family economic conditions,parents’educational level,parent died,parent divorce,left-behind experience,guardians,school bullying,family function,emotional behavior problems,psychological resilience,anxiety and depression symptoms between students with and without sleep disorders.Logistic regression analysis showed that girls（OR=1.272,95%CI,1.069-1.514）,increasing age（OR=1.524,95%CI,1.438-1.615）,living in rural areas（OR=1.830,95%CI,1.498-2.236）,pretty poor（OR=3.492,95%CI,1.210-10.080）or very good family economic conditions（OR=3.616,95%CI,1.065-12.272）（compared with very poor）,school bullying（OR=1.443,95%CI,1.194-1.743）,emotional behavior problems（OR=1.999,95%CI,1.629-2.453）,depressive symptoms（OR=2.214,95%CI,1.784-2.748）,and anxiety symptoms（OR=2.343,95%CI,1.925-2.852）were risk factors for sleep disorders.The death of either parent（OR=0.188,95%CI,0.065-0.547）and good family function（OR=0.599,95%CI,0.502-0.716）were protective factors for sleep disorders,with statistical significance.Path analysis show that depression and anxiety symptoms had incomplete mediating effects in the relationship between emotional behavior problems and sleep disorders,accounted for 79.44%of the total effect.Cohort study of 1150 students from grade 4 and grade 9 showed that the detection rates of sleep disorders were 13.66%and 12.17%with PSQI score≥7 as the cut-off value in two follow-up surveys,and 35.22%and 33.04%with PSQI score≥5 in two follow-up surveys,respectively.The detection rate of emotional behavior problems was 20.79%and16.42%,school bullying was 29.33%and 21.15%,depressive symptoms was 32.16%and25.94%,anxiety symptoms was 27.06%and 21.22%,for two follow-up surveys,respectively.Cross-lagged panel analysis showed that the sleep disorder at earlier stage had a significant predictive effect on depressive symptoms or anxiety symptoms at later period,depressive symptoms or anxiety symptoms at earlier stage had a significant predictive effect on sleep disorder at later period as well.Conclusions:The detection rates of sleep disorders,emotional behavior problems,depressive symptoms and anxiety symptoms were pretty high among primary and middle school students in Anhui Province,China.Sleep disorders could be influenced by gender,age,residence,family economic conditions,family function,school bullying,emotional behavior problems,depression and anxiety symptoms.Sleep disorders had longitudinal mutual predictive effects with depressive and anxiety symptoms.It is urgent to carry out health education,joint prevention to reduce the occurrence of sleep disorders and mental health problems of primary and secondary school students.