A Network Analysis of the Interrelationships Between Depression, Anxiety, Insomnia and Non-Suicidal Self-Injury in Middle School Students.

PURPOSE: Depression, anxiety and Insomnia are common among middle school students. Non-suicidal self-injury (NSSI) has become an important mental health issue in this group. This study explores the comorbid relationship between depression, anxiety, and insomnia symptoms among junior high school students from a network perspective and investigates the associations between these symptoms and NSSI.

PATIENTS AND

METHODS

This study was a cross-sectional design with convenience sampling, and students from junior high schools in Wuhan, China, were selected in October 2023 (N=8244) as survey respondents. An online questionnaire was used to collect data. The Patient Health Questionnaire, Generalized Anxiety Disorder Scale and Insomnia Severity Index were used to assess depression, anxiety and insomnia. Whether NSSI behaviors occurred in the last 1 year was obtained by self-report. Network analysis was used to assess core and bridge symptoms of the depression, anxiety and insomnia co-morbidity network and associations with NSSI.

RESULTS

The results revealed that GAD2 "Control Worry", GAD3 "Excessive Worry" (EI = 1.040), ISI2 "SleepMaint" (EI=1.025) and PHQ2 "Hopeless" (EI=1.018) were the central symptoms of the network, exhibiting the highest expected influence values. GAD5 "restlessness" (BEI=0.376) and PHQ4 "Lack of Energy" (BEI=0.351), PHQ6 "self feeling" (BEI=0.325) and GAD1 "Nervous" (BEI=0.296) were the bridge symptoms. PHQ9 "Suicidal Ideation" (edge weight = 0.33) showed the strongest connection to NSSI. The network comparison test results indicated a more densely connected symptom network in the NSH group than in the NSSI group.

CONCLUSION

Symptoms related to worry are core factors in the network of depression, anxiety, and insomnia among junior high school students. Suicidal ideation is directly and closely associated with NSSI. These symptoms may serve as key targets for early screening and intervention, while the strong link between suicidal ideation and NSSI underscores the need for timely prevention efforts in this vulnerable population.