关键词: 睡眠, 睡眠质量, 被欺凌经历, 初中生, 学生, 校园欺凌

Abstract: Background　Sleep quality is closely related to psychosomatic health in junior high school students. Previous studies suggest that bullying may be associated with sleep quality，but the association between the two in junior high school students has been rarely studied. Objective　To explore the association between sleep quality and bullying victimization experiences in junior high school students in Sanya City. Methods　An online，cross-sectional questionnaire survey was conducted from 2020-03-18 to 2020-04-18 in Sanya City to collect information on demographic characteristics，Pittsburgh Sleep Quality Index（PSQI）score，Insomnia Severity Index （ISI）score，clinical insomnia diagnosis，bullying victimization experiences，and related distresses and injuries. Students from nine public junior high schools in three most populated districts participated in this study：five schools in Tianya District，three schools in Jiyang District and one school in Yazhou District. Descriptive data were presented as two groups：one group with bullying victimization experiences and the other group without. Logistic regression was used to analyze the association between sleep quality and bullying victimization experiences. Results　Among the 3 050 students who participated in the survey，2 727 submitted questionnaires，and 2 167 of them were eligible respondents，including 125 with self-reported bullying victimization experience and 2 042 without，indicating that the survey response rate was 79.5%. Students with and without bullying victimization experiences differed significantly in mean age，gender ratio，grade distribution，and distribution of anxiety and depression levels（P<0.05）. Male students had higher rate of having self-reported bullying victimization experiences than female students（P<0.05）. Higher percentage of grade eight or nine students reported bullying victimization experiences than grade seven students（P<0.05）. Those with anxiety and/or depression had higher rate of experiencing bullying victimization than those without （P<0.05）. There were significant differences in prevalence of poor sleep outcomes，global PSQI score and subscale PSQI scores of subjective sleep quality，sleep latency，sleep duration，sleep disturbances，use of sleeping medication，and daytime dysfunction，ISI total score，prevalence of insomnia symptoms，and prevalence of clinical diagnosed insomnia between students with and without bullying victimization experiences（P<0.05）. Self-perceived bullying severity was positively correlated with global PSQI score（rs=0.166，P<0.001）） and ISI total score （rs=0.151，P<0.001）. After adjusted for age，gender，BMI，grade，ethnic group，being an only child or having siblings，resident status （on/off campus），paternal education，maternal education，and educational performance，bullying victimization experiences remained significantly associated with poor sleep outcomes（global PSQI score >7） （OR=3.54，P<0.001），poor subjective sleep quality（OR=3.47，P<0.001），longer sleep latency（OR=2.28，P<0.001），shorter sleep duration（OR= 1.88，P<0.001），sleep disturbances（OR=2.93，P<0.001），more frequent use of sleeping medication（OR=10.49，P<0.001），worse daytime dysfunction（OR=4.31，P<0.001），insomnia symptoms（OR=4.95，P<0.001），and being diagnosed with insomnia（OR=2.76，P<0.001）. Furthermore，after anxiety and depression being added as cofounders in model 2，bullying victimization experiences remained significantly associated with poor sleep outcomes（global PSQI score >7） （OR=2.45，P=0.001），poor subjective sleep quality（OR=2.71，P<0.001），longer sleep latency（OR=1.92，P=0.002），shorter sleep duration（OR=1.59，P=0.025），sleep disturbances（OR=2.27，P<0.001），more frequent use of sleeping medication（OR=4.75，P=0.039），worse daytime dysfunction（OR=3.19，P<0.001），and or insomnia symptoms （ISI≥8）（OR=3.18，P<0.001）. Conclusion　Bullying victimization experiences might be a risk factor of poor sleep outcomes among junior high school students.

Key words: Sleep, Sleep quality, Bullying victimization experiences, Junior school students, Students, School bullying victimization experiences