Current Status and Influencing Factors of Insomnia Severity in Adolescents: A Cross-Sectional Study

To investigate the status and influencing factors of insomnia severity among Chinese urban adolescents and to develop a predictive model for early identification.

A multi-center cross-sectional study.

A survey was conducted with 4288 secondary school students from Wuhan, China. A nested case-control sampling method was used within the cross-sectional survey to enhance statistical power for predictive modeling. Data were collected using standardized scales including the Insomnia Severity Index (ISI), the Three-dimensional Psychological Pain Scale (TDPPS), and the Patient Health Questionnaire-9 (PHQ-9). Statistical analyses included univariate analysis, correlation analysis, and multivariable binary logistic regression to identify independent predictors and construct a prediction model.

Psychological pain was the strongest risk factor (OR=1.444), followed by depression (OR=1.292) and parental absence >3 months (OR=1.290). Increasing age (OR=0.361) and higher paternal education (OR=0.644) were protective. The final optimized prediction model demonstrated excellent goodness-of-fit (Nagelkerke R² = 0.761), with an overall correct classification rate of 88.6% and a sensitivity of 87.2%.

This study identifies psychological pain as the strongest predictor of adolescent insomnia, exceeding the influence of depression and anxiety. We developed a streamlined 9-variable prediction model with high accuracy (88.6%), offering a practical tool for efficient, large-scale insomnia screening in school settings. This enables early identification and paves the way for targeted, preventive interventions.

Clinical assessments for adolescent insomnia should incorporate the evaluation of psychological pain. The model enables school nurses and mental health professionals to efficiently identify at-risk adolescents, promoting precision-based preventive care.

This study addresses the multifactorial nature of adolescent insomnia and the lack of practical screening tools. Findings will benefit school health systems and mental health practitioners.

This study was reported in accordance with the STROBE guidelines for cross-sectional studies.

Patients or the public were not involved in the design, conduct, analysis, interpretation, or preparation of the manuscript for this study.