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Role of sleep quality in mediating the relationship between sexual minority status and suicidal behavior among Chinese adolescents

Authors Huang Y, Li P, Lai Z, Jia X, Xiao D, Wang T, Guo L, Lu C

Received 5 September 2018

Accepted for publication 9 November 2018

Published 7 December 2018 Volume 2018:11 Pages 607—615

DOI https://doi.org/10.2147/PRBM.S186586

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Professor Igor Elman


Yeen Huang,1,* Pengsheng Li,1,* Zhisheng Lai,2 Xiaofei Jia,3 Di Xiao,1 Tian Wang,1 Lan Guo,2,* Ciyong Lu1,4,*

1Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China; 2Department of HIV/AIDS Prevention and Control, Yuexiu District Center for Disease Control and Prevention, Guangzhou, Guangdong, People’s Republic of China; 3Department of HIV/AIDS Prevention and Control, Tianhe District Center for Disease Control and Prevention, Guangzhou, Guangdong, People’s Republic of China; 4Guangdong Provincial Key Laboratory of Food, Guangdong Engineering Technology Research Center of Nutrition Translation, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China

*These authors contributed equally to this work

Background: Studies suggest that sexual minority adolescents experience higher rates of sleep disturbance than their heterosexual peers, and disturbed sleep is a well-known risk factor for suicidality. This study aimed to explore whether sleep quality had mediating effects on the relationship between sexual minority status and suicidal behavior in Chinese adolescents.
Methods: We analyzed data collected from 7th to 12th graders from seven randomly selected provinces of People’s Republic of China in the 2015 School-Based Chinese Adolescents Health Survey. The 123,459 students who completed questionnaires regarding sexual attraction, the Pittsburgh Sleep Quality Index, past-year suicidal ideation, and past-year suicide attempts were included in our study (response rate: 95.9%).
Results: After adjustment for covariates, sexual minority status was associated with suicidal ideation (adjusted odds ratio =1.82, 95% CI=1.69–1.95) and suicide attempts (adjusted odds ratio =2.16, 95% CI=1.82–2.56). Sleep quality partially mediated the effects of sexual minority status on suicidal ideation (standardized β estimate=0.009, 95% CI=0.007–0.012) and suicide attempts (standardized β estimate=0.004, 95% CI=0.003–0.005).
Conclusion: Poor sleep quality partially explained the increased risk of suicidality for Chinese sexual minority adolescents. To prevent subsequent suicidality, suicide interventions targeting sexual minorities should be made, with a focus on their disparities in sleep disturbance and sleep health promotion.

Keywords: sexual minority, suicidal behavior, adolescents, sleep quality, mediating effect

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