Longitudinal relationships among perceived stress, suicidal ideation and sleep quality in Chinese undergraduates: A cross-lagged model

Background: Sleep quality is an important indicator of quality of life. It is of importance to investigate the risk factors and potential consequences of poor sleep quality, such as perceived stress and suicidal ideation. We therefore investigated the longitudinal and reciprocal relationships among perceived stress, suicidal ideation, and sleep quality. Methods: A three-wave longitudinal survey was conducted from June 2019 to June 2020 at six-month intervals in undergraduate students (N = 197, 58.9% female) in China. The participants completed self-report questionnaires in classroom settings. Results: While the levels of perceived stress were stable, levels of suicidal ideation and sleep quality fluctuated significantly over time. There were significant reciprocal relationships between perceived stress and suicidal ideation from T1 to T3. In addition, the reciprocal relationships between suicidal ideation and sleep quality from T1 to T2 were also significant. Suicidal ideation at T2 partially mediated the relationship between perceived stress at T1 and sleep quality at T3 (indirect effect: beta=0.06, 95% CI: 0.04 to 0.10, p<0.001), and suicidal ideation at T2 fully mediated the relationship between sleep quality at T1 and perceived stress at T3 (indirect effect: beta=0.48, 95% CI: 0.30, 0.70, p<0.001). Limitations: The subjects' educational background is single, and the measurement method is self-report measures. Conclusions: Suicidal ideation may play a significant role in explaining the longitudinal relationships between perceived stress and sleep quality. And suggest the importance of early identification and treatment of suicidal ideation among Chinese undergraduates.