Abstract
OBJECTIVES: Non-suicidal self-injury (NSSI) often coexists with depressive and anxiety symptoms in adolescents, jointly impairing their mental health. However, the interplay between NSSI and symptoms of depression, anxiety, and sleep problems remain unclear. This study aims to explore the association patterns among insomnia, anxiety, depression, and NSSI behaviors in adolescents. METHODS: A total of 4 319 students from three secondary schools in southern Hunan Province were assessed using the Insomnia Severity Index (ISI), Generalized Anxiety Disorder-7 items (GAD), Patient Health Questionaire-9 items (PHQ), and the Adolescent Self-Injury Scale (ASIS) to evaluate insomnia symptoms, depressive symptoms, and NSSI behaviors, respectively. Network analysis was then conducted to examine the interrelationships among these symptom domains. RESULTS: Network analysis indicated that suicidal ideation within depressive symptoms was closely associated with NSSI (edge weight=0.15). Among the symptoms, ISI6 (sleep problems noticed by others, an insomnia symptom), GAD2 (difficulty controlling worries, an anxiety symptom), and PHQ2 (low mood, a depressive symptom) exhibited high strength centrality in the disease network (strength values: 0.88, 0.80, and 0.76, respectively). Additionally, anxiety symptoms including GAD5 (restlessness), GAD6 (irritability), GAD7 (feeling afraid), and depressive symptoms including PHQ2 (low mood), PHQ3 (sleep problems), and PHQ8 (psychomotor retardation/agitation) were identified as bridge symptoms in the network structure (bridge strength values=0.95, 1.32, 1.23, 1.21, 1.32, and 1.27, respectively). CONCLUSIONS: Restlessness, irritability, feeling afraid, feeling down, sleep problems, and psychomotor agitation/retardation may serve as key target symptoms for effective interventions addressing insomnia, anxiety, depression, and NSSI among adolescents.