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

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          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.

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          Most cited references36

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          Suicide, Suicide Attempts, and Suicidal Ideation

          Suicidal behavior is a leading cause of death and disability worldwide. Fortunately, recent developments in suicide theory and research promise to meaningfully advance knowledge and prevention. One key development is the ideation-to-action framework, which stipulates that (a) the development of suicidal ideation and (b) the progression from ideation to suicide attempts are distinct phenomena with distinct explanations and predictors. A second key development is a growing body of research distinguishing factors that predict ideation from those that predict suicide attempts. For example, it is becoming clear that depression, hopelessness, most mental disorders, and even impulsivity predict ideation, but these factors struggle to distinguish those who have attempted suicide from those who have only considered suicide. Means restriction is also emerging as a highly effective way to block progression from ideation to attempt. A third key development is the proliferation of theories of suicide that are positioned within the ideation-to-action framework. These include the interpersonal theory, the integrated motivational-volitional model, and the three-step theory. These perspectives can and should inform the next generation of suicide research and prevention.
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            The human emotional brain without sleep--a prefrontal amygdala disconnect.

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              Depression and hopelessness as risk factors for suicide ideation, attempts and death: meta-analysis of longitudinal studies.

              Many studies have documented robust relationships between depression and hopelessness and subsequent suicidal thoughts and behaviours; however, much weaker and non-significant effects have also been reported. These inconsistencies raise questions about whether and to what degree these factors confer risk for suicidal thoughts and behaviours.AimsThis study aimed to evaluate the magnitude and clinical utility of depression and hopelessness as risk factors for suicide ideation, attempts and death.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                06 December 2019
                December 2019
                : 16
                : 24
                : 4963
                Affiliations
                Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; xiaoly25@ 123456mail2.sysu.edu.cn (L.X.); zhangsh46@ 123456mail2.sysu.edu.cn (S.Z.); liwy23@ 123456mail2.sysu.edu.cn (W.L.); wurp5@ 123456mail2.sysu.edu.cn (R.W.); wgg0808@ 123456163.com (W.W.); wangt97@ 123456mail2.sysu.edu.cn (T.W.)
                Author notes
                [* ]Correspondence: guolan3@ 123456mail.sysu.edu.cn (L.G.); luciyong@ 123456mail.sysu.edu.cn (C.L.); Tel.: +86-020-8733-2477 (C.L.)
                [†]

                These authors contributed equally to this work.

                Article
                ijerph-16-04963
                10.3390/ijerph16244963
                6949910
                31817688
                ee39f516-6db4-4679-9f5e-1ac893fadbb3
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 14 November 2019
                : 04 December 2019
                Categories
                Article

                Public health
                emotional and behavioral problems,suicidal ideation,sleep quality,mediating effect,adolescents

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