Date Published: June 7, 2019
Publisher: Public Library of Science
Author(s): Shi-chen Zhang, Rong Yang, Dan-lin Li, Yu-hui Wan, Fang-biao Tao, Jun Fang, Laura Zamarian.
The aim of this study was to examine the association between health literacy (HL) and sleep problems with mental health of Chinese students in combined junior and senior high school.
A cross-sectional study was conducted among seven hundred and seventy-five students from a combined junior and senior high school in Shenyang on December 16, 2016. HL, sleep problems, anxiety symptoms and depressive symptoms were measured by self-reported validated instruments. Multiple logistic regression models were used to examine the association of HL and sleep problems with mental health problems.
The prevalence of anxiety symptoms and depressive symptoms was 24.6% and 45.2%, respectively. Low HL was significantly associated with anxiety symptoms (OR = 2.457, 95%CI: 1.493–4.045) and depressive symptoms (OR = 5.164, 95%CI: 3.233–8.250). Sleep problems were significantly positively correlated with anxiety symptoms (OR = 4.237, 95%CI: 2.831–6.341) and depressive symptoms (OR = 3.170, 95%CI: 2.084–4.823). The students who had sleep problems with low HL had the highest risks of anxiety symptoms (OR = 11.440, 95%CI: 5.564–23.520) and depressive symptoms (OR = 19.470, 95%CI: 8.143–46.558).
Our findings suggest that Chinese students in combined junior and senior high school who had sleep problems with low HL are at risk of exhibiting anxiety symptoms and depressive symptoms. Intervention programs of mental health problems should enhance HL level and improve sleep quality.
From a social-emotional developmental perspective, adolescence is a period of life that maybe specially vulnerable to physiological and psychological impact factors, for instance confusion and greater psychological pressure. It could even be the peak period for the onset of mental health problems [1–2]. Because emotion regulation mechanisms have not yet fully developed in adolescence, such as the ability to cope with negative emotions, adolescents are prone to many mental and behavioural problems . Worldwide 10% to 20% of children and adolescents experience mental health problems, such as schizophrenia, depression, anxiety and intellectual disabilities, accounting for a large portion of the global burden of disease . Anxiety and depression are the two most common psychological problems that can threaten adolescents’ mental health and academic performance . Anxiety refers to the brain response to dangerous stimuli that an organism will actively attempt to avoid, which is not typically pathological as it is adaptive in many scenarios when it facilitates avoidance of danger . Depression refers to the occasional sadness and gloom which accompanies the ups and downs of everyday life . Childhood and adolescence are the core risk phase for the development of mental symptoms and syndromes, ranging from transient mild symptoms to full-blown mental disorders . For example, depressive symptoms are known to escalate during adolescence, and adolescents who experience depressive disorder have an increased risk of mental illness in adulthood . Thus, these conditions severely influence adolescents’ development, their educational achievement and their quality of life. However, these conditions could be contained efficiently or even reversed by improving level of mental health literacy (MHL) [9–10].
In the present study, we found that HL and sleep problems are associated with mental health problems. Namely, low HL and sleep problems are correlated with the increased prevalence of anxiety symptoms and depressive symptoms.
Although there are above limitations, the present study demonstrates the importance of associations of HL and sleep problems with mental health in Chinese junior and high school students. Our results suggest that low HL and sleep problems can cause anxiety symptoms and depressive symptoms gradually. Our findings may suggest that interventions are needed to enhance HL and sleep quality in junior and high school students. Further research is needed to measure the impacts of interventions to clarify the potential consequences on HL, sleep and mental health.