[Network analysis of insomnia, anxiety, depression, and non-suicidal self-injury in adolescents].

Jan 6, 2026Zhong nan da xue xue bao. Yi xue ban = Journal of Central South University. Medical sciences

How Insomnia, Anxiety, Depression, and Self-Harm Are Connected in Teenagers

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Abstract

A total of 4,319 adolescents were assessed for associations between insomnia, anxiety, depression, and non-suicidal self-injury (NSSI).

Suicidal ideation within depressive symptoms showed a strong connection to NSSI, with an edge weight of 0.15.
Symptoms of insomnia, anxiety, and depression exhibited significant centrality within the disease network, with key symptoms having strength values of 0.88, 0.80, and 0.76, respectively.
Anxiety symptoms like restlessness, irritability, and fear, along with depressive symptoms such as low mood and sleep problems, were identified as important bridge symptoms connecting different mental health issues.
The analysis highlights specific symptoms that may be targeted for interventions to address the interconnectedness of insomnia, anxiety, depression, and NSSI.

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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.

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[Network analysis of insomnia, anxiety, depression, and non-suicidal self-injury in adolescents].

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