大学生睡眠问题与非自杀性自伤行为关系的追踪研究

廖文娜; 孙永鹏; 孔繁旭; 罗向晗

doi:10.16835/j.cnki.1000-9817.2025303

大学生睡眠问题与非自杀性自伤行为关系的追踪研究

doi: 10.16835/j.cnki.1000-9817.2025303

1.
广东开放大学公共课教学部，广州 510091
2.
广州中医药大学第三附属医院党政办公室

基金项目:

广东省哲学社会科学规划项目 GD24CXL08

广东省教育科学规划课题(高等教育专项)项目 2023GXJK655

国家心理健康和精神卫生防治中心、中国教育发展基金会、教育部学生服务与素质发展中心“向阳花学生心理健康促进行动”支持项目 GX25B008

详细信息

作者简介:
廖文娜(1984-)，女，广东梅州人，硕士，副教授，主要研究方向为大学生心理危机筛查和干预

通讯作者:
罗向晗，E-mail：50196656@qq.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 C913.5 Q428
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- 被引次数: 0
出版历程
- 收稿日期: 2025-05-06
- 修回日期: 2025-09-08
- 刊出日期: 2025-10-25

Longitudinal study on the associations between sleep problems and non-suicidal self-injury behaviors in college students

1.
Public Teaching Department, Guangdong Open University, Guangzhou 510091, Guangdong Province, China

摘要

摘要: 目的探讨大学生睡眠问题与非自杀性自伤(NSSI)行为的纵向关系，为预防和干预大学生NSSI提供参考依据。方法 2023年10月(T1)，采用方便抽样与分层整群随机抽样相结合的方法选取广东2所省属高校1 009名大学生进行为期1年的追踪调查(2024年10月，T2)，采用失眠严重程度指数量表(ISI)、非恢复性睡眠量表(NRSS)、爱泼沃斯嗜睡量表(ESS)和青少年非自杀性自伤行为评定问卷(ANSAQ)等对大学生进行追踪测查，并采用McNemar's检验和Logistic回归进行数据分析。结果 T1时大学生NSSI行为检出率为18.83%，T2时检出率下降为7.73%，差异有统计学意义(χ²=66.24，P < 0.01)。NSSI行为的变化轨迹分为持续组(4.06%)、新发组(3.67%)、消退组(14.77%)和免疫组(77.50%)。Logistic回归分析结果显示，T1夜间睡眠 < 7 h/d、失眠(轻度、中度及以上)、非恢复性睡眠(中度、重度)、嗜睡及每周噩梦次数(1~2，≥3次)为T1大学生NSSI行为的相关因素(OR值分别为5.02，2.39，5.51，3.47，9.70，2.36，2.63，4.74，P值均 < 0.01)；T1失眠(轻度、中度及以上)、重度非恢复性睡眠、嗜睡和每周≥3次噩梦均会增加T2时大学生NSSI行为的风险(OR值分别为1.76，4.15，4.05，1.88，5.63，P值均 < 0.05)；T1中度及以上失眠、重度非恢复性睡眠、嗜睡以及每周≥3次噩梦会增加个体进入NSSI行为新发组的风险(OR值分别为5.05，3.37，2.08，5.86，P值均 < 0.05)。结论失眠、非恢复性睡眠、嗜睡和频繁噩梦是大学生NSSI行为的重要风险因素，对睡眠问题进行早期评估和干预是防治NSSI的重要策略。
- 睡眠 /
- 自我伤害行为 /
- 精神卫生 /
- 回归分析 /
- 学生
Abstract: Objective To explore the longitudinal relationships between sleep problems and non-suicidal self-injury (NSSI) behaviors in college students, so as to provide a theoretical basis for the prevention and intervention of NSSI. Methods In October 2023 (T1), a total of 1 009 college students from two provincial colleges in Guangdong were selected by using a combination of convenience sampling and stratified cluster random sampling for a 1-year follow-up survey (October 2024, T2). The students were assessed by using the Insomnia Severity Index(ISI), Non-restorative Sleep Scale(NRSS), Epworth Sleepiness Scale (ESS), and Adolescent Non-suicidal Self-injury Assessment Questionnaire(ANSAQ). Data analysis was performed using McNemar's test and Logistic regression. Results The detection rate of NSSI behaviors was 18.83% at T1 and decreased to 7.73% at T2, with a statistically significant difference (χ²=66.24, P < 0.01). The trajectories of NSSI behaviors were divided into persistent group (4.06%), new-onset group (3.67%), remission group (14.77%), and resistance group (77.50%). Logistic regression analysis showed that sleep less than 7 hours per day at night, insomnia (mild, moderate-to-severe), non-restorative sleep (moderate, severe), daytime sleepiness, and weekly nightmare frequency (1-2, ≥3 times) were associated with NSSI behaviors at T1 (OR=5.02, 2.39, 5.51, 3.47, 9.70, 2.36, 2.63, 4.74, all P < 0.01). Insomnia (mild, moderate-to-severe), severe non-restorative sleep, daytime sleepiness, and weekly nightmares ≥3 times at T1 all increased the risk of NSSI behaviors at T2 (OR=1.76, 4.15, 4.05, 1.88, 5.63, all P < 0.05). Moderate-to-severe insomnia, severe non-restorative sleep, daytime sleepiness, and weekly nightmares ≥3 times at T1 increased the risk of belong to the new-onset NSSI group (OR=5.05, 3.37, 2.08, 5.86, all P < 0.05). Conclusions Insomnia, non-restorative sleep, daytime sleepiness, and frequent nightmares are important risk factors for NSSI behaviors among college students. Early assessment and intervention of sleep problems may be an important strategy for the prevention and treatment of NSSI.
- Sleep /
- Self-injurious behavior /
- Mental health /
- Regression analysis /
- Students
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表 1 不同人口学特征大学生NSSI行为检出率比较

Table 1. Comparison of the detection rates of NSSI behaviors among college students with different demographic characteristics

人口学指标	选项	人数	T1			T2
人口学指标	选项	人数	检出人数	χ²值	P值	检出人数	χ²值	P值
性别	男	431	79(18.33)	0.12	0.73	46(10.67)	9.13	< 0.01
	女	578	111(19.20)			32(5.54)
年级	大一	409	74(18.09)	0.80	0.67	29(7.09)	1.04	0.59
	大二	323	66(20.43)			29(8.98)
	大三	277	50(18.05)			20(7.22)
专业	文科	389	87(22.37)	5.17	0.02	26(6.68)	0.97	0.32
	理科	620	103(16.61)			52(8.39)
家庭居住地	农村	705	132(18.72)	0.02	0.90	58(8.23)	0.81	0.37
	城镇	304	58(19.08)			20(6.58)
独生子女	否	868	159(18.32)	1.07	0.30	67(7.72)	< 0.01	0.97
	是	141	31(21.99)			11(7.80)
留守经历	无	716	128(17.88)	1.47	0.23	48(6.70)	3.64	0.06
	有	293	62(21.16)			30(10.24)
注： ()内数字为检出率/%。

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表 2 大学生NSSI行为的Logistic回归分析[OR值(95%CI)，n=1 009]

Table 2. Logistic regression analysis of NSSI behaviors among college students[OR(95%CI), n=1 009]

T1睡眠状况	T1时NSSI		T2时NSSI
T1睡眠状况	模型1	模型2	模型3	模型4
每天夜间睡眠时长/h
>8	1.00	1.00	1.00	1.00
8	0.92(0.49~1.73)	0.94(0.50~1.77)	0.99(0.39~2.55)	1.11(0.42~2.97)
7	1.33(0.74~2.39)	1.33(0.73~2.40)	1.39(0.58~3.33)	1.39(0.56~3.49)
< 7	5.02(2.09~12.07)^**	4.93(2.03~11.99)^**	2.05(0.54~7.76)	1.34(0.33~5.50)
失眠
无	1.00	1.00	1.00	1.00
轻度	2.39(1.71~3.34)^**	2.36(1.69~3.32)^**	1.76(1.08~2.88)^*	1.42(0.84~2.39)
中度及以上	5.51(2.92~10.39)^**	5.43(2.86~10.33)^**	4.15(1.85~9.32)^**	2.18(0.91~5.24)
非恢复性睡眠
轻度	1.00	1.00	1.00	1.00
中度	3.47(1.72~6.98)^**	3.56(1.76~7.22)^**	1.92(0.81~4.56)	1.69(0.69~4.15)
重度	9.70(4.58~20.55)^**	9.76(4.57~20.82)^**	4.05(1.58~10.34)^**	2.60(0.96~7.05)
嗜睡
否	1.00	1.00	1.00	1.00
是	2.36(1.71~3.26)^**	2.38(1.71~3.32)^**	1.88(1.18~3.01)^**	1.53(0.93~2.54)
每周噩梦次数
< 1	1.00	1.00	1.00	1.00
1~2	2.63(1.37~5.06)^**	2.52(1.30~4.88)^**	1.77(0.68~4.67)	1.50(0.54~4.18)
≥3	4.74(1.94~11.57)^**	5.08(2.06~12.53)^**	5.63(2.10~15.12)^**	3.57(1.17~10.93)^*
注： ^P < 0.05，^*P < 0.01；模型1未调整变量，模型2调整了性别、年龄、专业、家庭居住地、独生子女状况和留守经历等人口学指标，模型3未调整变量，模型4调整了T1时NSSI行为及人口学指标；因变量分别以T1和T2时无NSSI行为作为参照。

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表 3 大学生睡眠问题对NSSI行为变化的预测作用[OR值(95%CI)，n=1 009]

Table 3. Predictive effects of sleep problems on changes in NSSI behaviors among college students[OR(95%CI), n=1 009]

T1睡眠状况	新发组		持续组
T1睡眠状况	模型1	模型2	模型1	模型2
每天夜间睡眠时长/h
>8	1.00	1.00	1.00	1.00
8	1.64(0.36~7.57)	1.63(0.35~7.56)	0.65(0.17~2.53)	0.79(0.19~3.32)
7	2.00(0.46~8.70)	2.11(0.48~9.25)	0.83(0.24~2.83)	1.00(0.27~3.68)
< 7	5.20(0.68~39.85)	6.09(0.77~48.18)	0.39(0.06~2.55)	0.42(0.06~3.01)
失眠
无	1.00	1.00	1.00	1.00
轻度	1.45(0.71~2.93)	1.56(0.76~3.18)	1.17(0.56~2.46)	1.15(0.52~2.54)
中度及以上	5.05(1.58~16.17)^**	5.10(1.54~16.89)^**	1.36(0.43~4.32)	1.03(0.29~3.58)
非恢复性睡眠
轻度	1.00	1.00	1.00	1.00
中度	1.10(0.41~2.96)	1.33(0.49~3.64)	2.42(0.29~20.13)	2.22(0.25~19.65)
重度	3.37(1.11~10.21)^*	4.03(1.31~12.43)^*	1.96(0.22~17.31)	1.84(0.19~17.71)
嗜睡
否	1.00	1.00	1.00	1.00
是	2.08(1.06~4.05)^*	2.53(1.26~5.09)^**	0.95(0.47~1.90)	0.98(0.47~2.03)
每周噩梦次数
< 1	1.00	1.00	1.00	1.00
1~2	2.93(0.84~10.24)	3.24(0.91~11.61)	0.57(0.12~2.65)	0.72(0.15~3.48)
≥3	5.86(1.20~28.71)^*	6.86(1.33~35.37)^*	2.48(0.66~9.26)	2.33(0.55~9.80)
注： ^P < 0.05，^*P < 0.01；新发组以免疫组为参照，持续组以消退组为参照；模型1未调整变量，模型2调整了性别、年龄、专业、家庭居住地、独生子女状况和留守经历等人口学指标。

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参考文献(28)

[1]	ANGELOTTA C. Defining and refining self-harm: a historical perspective on nonsuicidal self-injury[J]. J Nerv Ment Dis, 2015, 203(2): 75-80. doi: 10.1097/NMD.0000000000000243
[2]	石绪亮, 朱亚, 马晓辉, 等. 大学生睡眠问题与非自杀性自伤行为的关系[J]. 中国学校卫生, 2020, 41(6): 918-921. doi: 10.16835/j.cnki.1000-9817.2020.06.032 SHI X L, ZHU Y, MA X H, et al. Relationship between sleep problems and non-suicidal self-injury behavior among college students[J]. Chin J Sch Health, 2020, 41(6): 918-921. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2020.06.032
[3]	李陆. 蒙古族高校学生非自杀性自伤行为与抑郁焦虑的关联[J]. 中国学校卫生, 2022, 43(1): 96-99. doi: 10.16835/j.cnki.1000-9817.2022.01.021 LI L. Non-suicidal self-injury behavior and its relationship with depression and anxiety in Mongolian college students[J]. Chin J Sch Health, 2022, 43(1): 96-99. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2022.01.021
[4]	潘婵, 刘晓容, 石相孜, 等. 基于机器学习构建贵州省大学生非自杀性自伤行为的预测模型[J]. 中国学校卫生, 2023, 44(8): 1198-1202, 1206. doi: 10.16835/j.cnki.1000-9817.2023.08.018 PAN C, LIU X R, SHI X Z, et al. A machine learning-based predictive model of non-suicidal self-injurious behavior among college students in Guizhou Province[J]. Chin J Sch Health, 2023, 44(8): 1198-1202, 1206. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2023.08.018
[5]	赵文欣, 田萌, 陈思远, 等. 贵州中学生非自杀性自伤相关因素的网络分析[J]. 中国学校卫生, 2025, 46(1): 92-95, 101. doi: 10.16835/j.cnki.1000-9817.2025022 ZHAO W X, TIAN M, CHEN S Y, et al. Network analysis of factors related to non-suicidal self-injury among middle school students in Guizhou Province[J]. Chin J Sch Health, 2025, 46(1): 92-95, 101. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2025022
[6]	徐慧琼, 万宇辉, 许韶君, 等. 中学生非自杀性自伤行为与自杀意念和自杀未遂的关联[J]. 中国心理卫生杂志, 2019, 33(10): 774-778. XU H Q, WAN Y H, XU S J, et al. Associations of non-suicidal self-injury with suicidal ideation and suicide attempt among middle school students[J]. Chin Ment Health J, 2019, 33(10): 774-778. (in Chinese)
[7]	高媛媛, 王冉, 李娜, 等. 童年期创伤和心理弹性与青少年非自杀性自伤关联性研究[J]. 中国神经精神疾病杂志, 2024, 50(8): 483-488. GAO Y Y, WANG R, LI N, et al. A study on the correlation between childhood trauma, resilience and non-suicidal self-injury in adolescents[J]. Chin J Nerv Ment Dis, 2024, 50(8): 483-488. (in Chinese)
[8]	曾灿, 余超, 蒲唯丹, 等. 亲子疏离对青少年非自杀性自伤行为的影响: 有调节的中介模型[J]. 中国临床心理学杂志, 2024, 32(3): 498, 566-570. ZENG C, YU C, PU W D, et al. The impact of parent-child alienation on adolescents' non-suicidal self-injury: a moderated mediating model[J]. Chin J Clin Psychol, 2024, 32(3): 498, 566-570. (in Chinese)
[9]	熊庆, 申秀云, 阳红, 等. 述情障碍与青少年非自杀性自伤: 非适应性情绪调节和抑郁的链式中介作用[J]. 中国临床心理学杂志, 2023, 31(3): 574-577, 582. XIONG Q, SHEN X Y, YANG H, et al. Alexithymia and adolescents' non-suicidal self-injury: the chain mediating of maladaptive emotion regulation and depression[J]. Chin J Clin Psychol, 2023, 31(3): 574-577, 582. (in Chinese)
[10]	林琳, 莫娟婵, 王晨旭, 等. 冲动性和大学生自伤行为的关系: 一个有调节的中介模型[J]. 心理与行为研究, 2017, 15(6): 824-832. LIN L, MO J C, WANG C X, et al. The relationship between impulsivity and self-injury: a moderated mediation model[J]. Stud Psychol Behav, 2017, 15(6): 824-832. (in Chinese)
[11]	朱亚, 蔡炎, 石绪亮. 青少年失眠与自伤行为的关系: 情绪调节困难和抑郁症状的中介作用[J]. 中国健康心理学杂志, 2023, 31(4): 610-614. ZHU Y, CAI Y, SHI X L. Relationship between insomnia and non-suicidal self-injury: a multiple mediation model[J]. China J Health Psychol, 2023, 31(4): 610-614. (in Chinese)
[12]	张鹏程, 李喜, 韩午阳, 等. 睡眠不足对中小学生负性情绪的影响: 一个链式中介模型[J]. 心理发展与教育, 2023, 39(3): 402-409. ZHANG P C, LI X, HAN W Y, et al. The effect of lack of sleep on negative emotion in primary and secondary school students: a chain mediation model[J]. Psychol Dev Educ, 2023, 39(3): 402-409. (in Chinese)
[13]	CHAPMAN A L, GRATZ K L, BROWN M Z. Solving the puzzle of deliberate self-harm: the experiential avoidance model[J]. Behav Res Ther, 2006, 44(3): 371-394. doi: 10.1016/j.brat.2005.03.005
[14]	贾存显, 刘珍珍. 关注睡眠问题, 预防青少年自伤[J]. 山东大学学报(医学版), 2022, 60(2): 1-7. JIA C X, LIU Z Z. Pay attention to sleep problems and prevent self-harm among adolescents[J]. J Shandong Univ (Health Sci), 2022, 60(2): 1-7. (in Chinese)
[15]	YU D S F. Insomnia Severity Index: psychometric properties with Chinese community-dwelling older people[J]. J Adv Nurs, 2010, 66(10): 2350-2359. doi: 10.1111/j.1365-2648.2010.05394.x
[16]	洪莹莹, 胡旭君. 正常听力青年噪声耐受性与非恢复性睡眠的相关性研究[J]. 听力学及言语疾病杂志, 2020, 28(3): 277-281. HONG Y Y, HU X J. Correlation between noise tolerance and non-restorative sleep in young people with normal hearing[J]. J Audiol Speech Pathol, 2020, 28(3): 277-281. (in Chinese)
[17]	彭莉莉, 李进让, 孙建军, 等. Epworth嗜睡量表简体中文版信度和效度评价[J]. 中华耳鼻咽喉头颈外科杂志, 2011, 46(1): 44-49. PENG L L, LI J R, SUN J J, et al. Reliability and validity of the simplified Chinese version of Epworth Sleepiness Scale[J]. Chin J Otorhinolaryngol Head Neck Surg, 2011, 46(1): 44-49. (in Chinese)
[18]	万宇辉, 刘婉, 郝加虎, 等. 青少年非自杀性自伤行为评定问卷的编制及其信效度评价[J]. 中国学校卫生, 2018, 39(2): 170-173. doi: 10.16835/j.cnki.1000-9817.2018.02.005 WAN Y H, LIU W, HAO J H, et al. Development and evaluation on reliability and validity of Adolescent Non-suicidal Self-injury Assessment Questionnaire[J]. Chin J Sch Health, 2018, 39(2): 170-173. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2018.02.005
[19]	韩杨, 王连花, 李秋硕, 等. 中职生节食暴食行为与非自杀性自伤行为的关系[J]. 中国学校卫生, 2024, 45(12): 1761-1765. doi: 10.16835/j.cnki.1000-9817.2024380 HAN Y, WANG L H, LI Q S, et al. Association of dieting and binge eating with non-suicidal self-injury among secondary vocational school students[J]. Chin J Sch Health, 2024, 45(12): 1761-1765. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2024380
[20]	潘珍, 毛绍菊, 唐寒梅, 等. 中国大学生非自杀性自伤检出率的Meta分析[J]. 中国学校卫生, 2016, 37(6): 878-881. doi: 10.16835/j.cnki.1000-9817.2016.06.020 PAN Z, MAO S J, TANG H M, et al. Meta-analysis on non-suicidal self-injury among college students in China[J]. Chin J Sch Health, 2016, 37(6): 878-881. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2016.06.020
[21]	DE LUCA L, PASTORE M, PALLADINO B E, et al. The development of non-suicidal self-injury (NSSI) during adolescence: a systematic review and Bayesian Meta-analysis[J]. J Affect Disord, 2023, 339: 648-659. doi: 10.1016/j.jad.2023.07.091
[22]	KHAZAIE H, ZAKIEI A, MCCALL W V, et al. Relationship between sleep problems and self-injury: a systematic review[J]. Behav Sleep Med, 2021, 19(5): 689-704. doi: 10.1080/15402002.2020.1822360
[23]	YOO S S, GUJAR N, HU P, et al. The human emotional brain without sleep: a prefrontal amygdala disconnect[J]. Curr Biol, 2007, 17(20): R877-R878. doi: 10.1016/j.cub.2007.08.007
[24]	LIU X, LIU Z, CHEN R, et al. Nightmares predict future non-suicidal self-injury in adolescents: SABHC cohort study[J]. Sleep, 2018, 41(Suppl 1): A317.
[25]	NIELSEN T, LEVIN R. Nightmares: a new neurocognitive model[J]. Sleep Med Rev, 2007, 11(4): 295-310. doi: 10.1016/j.smrv.2007.03.004
[26]	HOCHARD K D, HEYM N, TOWNSEND E. The unidirectional relationship of nightmares on self-harmful thoughts and behaviors[J]. Dreaming, 2015, 25(1): 44-58. doi: 10.1037/a0038617
[27]	YANG Q, XIE R, WANG D, et al. How to survive the long night? Longitudinal relationship between sleep problems and suicidal behavior among adolescents: the serial mediating roles of negative emotion, self-control, and nonsuicidal self-injury[J]. Suicide Life Threat Behav, 2024, 54(2): 349-360. doi: 10.1111/sltb.13046
[28]	BENTLEY K H, NOCK M K, BARLOW D H. The four-function model of nonsuicidal self-injury: key directions for future research[J]. Clin Psychol Sci, 2014, 2(5): 638-656. doi: 10.1177/2167702613514563