This study examined how different combinations of psychosocial risks (e.g. negative life events, anxiety) and protective resources (e.g. resilience) are associated with adolescents’ sleep quality over time. Mixture models using data from two assessment points (Spring 2023, Spring 2024) from adolescents in Liling and Zibo, China (N = 723; 45.09% male, 54.91% female; Time 1 mean age = 14.45 ± 1.52) identified three distinct patterns. Vulnerable and Distressed (17.43%)—showed high levels of risk and limited resources. Resilient and Well-Adapted (47.44%)—exhibited moderate levels of both risk and resilience. Protected and Thriving (35.13%)—was marked by strong protective factors and low risk exposure. Adolescents in the high-risk profile reported significantly poor sleep quality (p < 0.001). Girls and left-behind adolescents (whose one or both parents work away from home for extended periods) were more likely to belong to risk-dominated profiles. These findings underscore the need for tailored interventions to support at-risk youth.
AfifiM (2007) Gender differences in mental health. Singapore Medical Journal48(5): 385–391.
2.
AsparouhovTMuthénB (2014) Auxiliary variables in mixture modeling: Using the BCH method in Mplus to estimate a distal outcome model and an arbitrary secondary model. Mplus web notes21(2): 1–22.
3.
BabsonKATrainorCDBunaciuL, et al. (2008) An examination of anxiety sensitivity as a moderator of the relation between sleep anticipatory anxiety and sleep onset latency. Journal of Cognitive Psychotherapy22(3): 258–270.
4.
BauerDJCurranPJ (2003) Overextraction of latent trajectory classes: Much ado about nothing? Reply to Rindskopf (2003), Muthén (2003), and Cudeck and Henly (2003). Psychological Methods8: 384–393.
5.
BensonPLScalesPCSyvertsenAK (2011) The contribution of the developmental assets framework to positive youth development theory and practice. Advances in Child Development and Behavior41: 197–230.
6.
BerlinKSWilliamsNAParraGR (2014) An introduction to latent variable mixture modeling (part 1): Overview and cross-sectional latent class and latent profile analyses. Journal of Pediatric Psychology39(2): 174–187.
7.
BoguschLMFeketeEMSkintaMD (2016) Anxiety and depressive symptoms as mediators of trait mindfulness and sleep quality in emerging adults. Mindfulness7: 962–970.
8.
BonnetMHArandDL (2010) Hyperarousal and insomnia: State of the science. Sleep Medicine Reviews14(1): 9–15.
9.
BuysseDJReynoldsCF3rdMonkTH, et al. (1989) The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research28(2): 193–213.
10.
CapelliniIMcNamaraPPrestonBT, et al. (2009) Does sleep play a role in memory consolidation? A comparative test. PLoS One4(2): e4609.
11.
ChaplinTMHongKBergquistK, et al. (2008) Gender differences in response to emotional stress: An assessment across subjective, behavioral, and physiological domains and relations to alcohol craving. Alcoholism Clinical and Experimental Research32(7): 1242–1250.
12.
ChengJPengCRongF, et al. (2024) Mobile phone addiction and suicide behaviors among Chinese adolescents: The mediation of poor sleep quality. Journal of Behavioral Addictions13(1): 88–101.
13.
Chinese Academy of Social Sciences (2022) Chinese Sleep Research Report 2022. Social Sciences Literature Press.
14.
ConnorKMDavidsonJR (2003) Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC). Depression and Anxiety18(2): 76–82.
15.
CroneEADahlRE (2012) Understanding adolescence as a period of social-affective engagement and goal flexibility. Nature Reviews Neuroscience13(9): 636–650.
16.
FavoleIDavicoCMarcotulliD, et al. (2023) Sleep disturbances and emotional dysregulation in young children with autism spectrum, intellectual disability, or global developmental delay. Sleep Medicine105: 45–52.
17.
FergusonKM (2006) Social capital and children’s wellbeing: A critical synthesis of the international social capital literature. International Journal of Social Welfare15(1): 2–18.
18.
FergusSZimmermanMA (2005) Adolescent resilience: A framework for understanding healthy development in the face of risk. Annual Review of Public Health26: 399–419.
19.
GellmanMD (2020) Behavioral medicine. In: GellmanMD (ed) Encyclopedia of Behavioral Medicine. Springer International Publishing, pp.223–226.
20.
GibsonPABakerEHMilnerAN (2016) The role of sex, gender, and education on depressive symptoms among young adults in the United States. Journal of Affective Disorders189: 306–313.
21.
GregoryAMCaspiAMoffittTE, et al. (2006) Family conflict in childhood: A predictor of later insomnia. Sleep29(8): 1063–1067.
22.
GreyIAroraTThomasJ, et al. (2020) The role of perceived social support on depression and sleep during the COVID-19 pandemic. Psychiatry Research293: 113452.
23.
GuangYFengZYangG, et al. (2017) Depressive symptoms and negative life events: What psycho-social factors protect or harm left-behind children in China?BMC Psychiatry17(1): 402.
24.
HarrisKMGohMT (2017) Is suicide assessment harmful to participants? Findings from a randomized controlled trial. International Journal of Mental Health Nursing26(2): 181–190.
25.
HarveyCJGehrmanPEspieCA (2014) Who is predisposed to insomnia: A review of familial aggregation, stress-reactivity, personality and coping style. Sleep Medicine Reviews18(3): 237–247.
26.
HeBFanJLiuN, et al. (2012) Depression risk of ‘left-behind children’ in rural China. Psychiatry Research200(2-3): 306–312.
27.
HerrmanHStewartDEDiaz-GranadosN, et al. (2011) What is resilience?Canadian Journal of Psychiatry56(5): 258–265.
28.
HirschfeldRM (2001) The comorbidity of major depression and anxiety disorders: Recognition and management in primary care. Primary Care Companion to the Journal of Clinical Psychiatry3(6): 244–254.
29.
HouFBiFJiaoR, et al. (2020) Gender differences of depression and anxiety among social media users during the COVID-19 outbreak in China: A cross-sectional study. BMC Public Health20(1): 11.
30.
HowardMCHoffmanME (2018) Variable-centered, person-centered, and person-specific approaches: Where theory meets the method. Organizational Research Methods21(4): 846–876.
31.
HuangYZhengRXiongX, et al. (2025) The heterogeneity of insomnia symptoms for emerging workers in the digital economy: Latent profile and network analysis. Journal of Health Psychology30(5): 976–988.
32.
HuHLuSHuangCC (2014) The psychological and behavioral outcomes of migrant and left-behind children in China. Children and Youth Services Review46: 1–10.
KangHJBaeKYKimSW, et al. (2017) Impact of anxiety and depression on physical health condition and disability in an elderly Korean population. Psychiatry Investigation14(3): 240.
35.
KhanMAAl-JahdaliH (2023) The consequences of sleep deprivation on cognitive performance. Neuroscience Journal28(2): 91–99.
36.
KidwellKMBrockRLTomasoC, et al. (2025) Adolescent health behavior profiles and associations with mental health in a longitudinal study. Journal of Health Psychology30(9): 2232–2249.
37.
KishidaKTsudaMTakahashiF, et al. (2022) Irritability and mental health profiles among children and adolescents: A result of latent profile analysis. Journal of Affective Disorders300: 76–83.
38.
KlineRB (2023) Principles and Practice of Structural Equation Modeling. Guilford publications.
39.
KohnNEickhoffSBSchellerM, et al. (2014) Neural network of cognitive emotion regulation–an ALE meta-analysis and MACM analysis. NeuroImage87: 345–355.
40.
LenzoVSardellaAMusettiA, et al. (2022) The relationship between resilience and sleep quality during the second wave of the COVID-19 pandemic: A longitudinal study. Nature and Science of Sleep14: 41–51.
41.
LiQYeXLiZ, et al. (2025) Association between stressful life events and sleep quality in Chinese university students: Mediating and moderating roles of emotion regulation. Journal of Health Psychology30(5): 909–920.
42.
LiuX (1996) Reliability and validity of the Pittsburgh sleep quality index. Chinese Journal of Psychiatry29: 103.
43.
LiuXLiuCTianX, et al. (2016) Associations of perceived stress, resilience and social support with sleep disturbance among community-dwelling adults. Stress and Health32(5): 578–586.
44.
LiuXLiuLYangJ, et al. (1997) Reliability and validity test of adolescent life events scale. Chinese Journal of Clinical Psychology5(1): 34–36.
45.
LiYGuSWangZ, et al. (2019) Relationship between stressful life events and sleep quality: Rumination as a mediator and resilience as a moderator. Frontiers in Psychiatry10: 348.
46.
LubkeGMuthénBO (2007) Performance of factor mixture models as a function of model size, covariate effects, and class-specific parameters. Structural Equation Modeling A Multidisciplinary Journal14(1): 26–47.
47.
LundHGReiderBDWhitingAB, et al. (2010) Sleep patterns and predictors of disturbed sleep in a large population of college students. Journal of Adolescent Health46(2): 124–132.
48.
LundhLGBromanJE (2000) Insomnia as an interaction between sleep-interfering and sleep-interpreting processes. Journal of Psychosomatic Research49(5): 299–310.
49.
MastenAS (2001) Ordinary magic: Resilience processes in development. American Psychologist56(3): 227–238.
50.
MezickEJMatthewsKAHallM, et al. (2009) Intra-individual variability in sleep duration and fragmentation: Associations with stress. Psychoneuroendocrinology34(9): 1346–1354.
51.
MohamedNAMohamedYAEraslanA, et al. (2023) The impact of perceived social support on sleep quality in a sample of patients undergoing hemodialysis in Somalia. Frontiers in Psychiatry14: 1108749.
52.
NylundKLAsparouhovTMuthénBO (2007) Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Structural Equation Modeling A Multidisciplinary Journal14(4): 535–569.
53.
PalaginiLBaglioniCCiapparelliA, et al. (2013) REM sleep dysregulation in depression: State of the art. Sleep Medicine Reviews17(5): 377–390.
54.
RadloffLS (1977) A self-report depression scale for research in the general population. Applied psychol Measurements1: 385–401.
55.
RenZZhangXShenY, et al. (2021) Associations of negative life events and coping styles with sleep quality among Chinese adolescents: A cross-sectional study. Environmental Health and Preventive Medicine26(1): 85.
56.
Ribeiro da SilvaDSalekinRTRijoD (2019) Psychopathic severity profiles: A latent profile analysis in youth samples with implications for the diagnosis of conduct disorder. Journal of Crime and Justice60: 74–83.
57.
RichardsonGE (2002) The metatheory of resilience and resiliency. Journal of Clinical Psychology58(3): 307–321.
58.
Riecher-RösslerA (2017) Sex and gender differences in mental disorders. Lancet Psychiatry4(1): 8–9.
59.
RiemannDSpiegelhalderKFeigeB, et al. (2010) The hyperarousal model of insomnia: A review of the concept and its evidence. Sleep Medicine Reviews14(1): 19–31.
60.
RoohafzaHRAfsharHKeshteliAH, et al. (2014) What’s the role of perceived social support and coping styles in depression and anxiety?Journal of Research in Medical Sciences19(10): 944–949.
61.
Salmela-AroKTangXUpadyayaK (2022) Study demands-resources model of student engagement and burnout. In: ReschlyALChristensonSL (eds) Handbook of research on student engagement. Springer International Publishing, pp.77–93.
62.
SawyerSMAzzopardiPSWickremarathneD, et al. (2018) The age of adolescence. The lancet child & adolescent health2(3): 223–228.
63.
SchulzHSalzaruloP (2012) Forerunners of REM sleep. Sleep Medicine Reviews16(1): 95–108.
64.
ShiYBaiYZhangL, et al. (2022) Psychological resilience mediates the association of the middle frontal gyrus functional connectivity with sleep quality. Brain Imaging and Behavior16(6): 2735–2743.
65.
SnyderCRLopezSJ (Eds.)(2001) Handbook of Positive Psychology. Oxford university press.
66.
SongSYangXYangH, et al. (2020) Psychological resilience as a protective factor for depression and anxiety among the public during the outbreak of COVID-19. Frontiers in Psychology11: 618509.
67.
SunXTianYZhangY, et al. (2015) Psychological development and educational problems of left-behind children in rural China. School Psychology International36(3): 227–252.
68.
UrsinHEriksenHR (2010) Cognitive activation theory of stress (CATS). Neuroscience and Biobehavioral Reviews34(6): 877–881.
69.
VermuntJK (2010) Latent class modeling with covariates: Two improved three-step approaches. Political Analysis18(4): 450–469.
70.
WalkerM (2017) Why We Sleep: Unlocking the Power of Sleep and Dreams. Simon and Schuster.
71.
WangWZhuYYuH, et al. (2024) The impact of sleep quality on emotion regulation difficulties in adolescents: A chained mediation model involving daytime dysfunction, social exclusion, and self-control. BMC Public Health24(1): 1862.
72.
WangZChiY (1984) Chinese version of Zung’s self-rating anxiety scale. J Shanghai Psychiatry2(2): 73–74.
73.
WilliamsPBarclayLSchmiedV (2004) Defining social support in context: A necessary step in improving research, intervention, and practice. Qualitative Health Research14(7): 942–960.
74.
WuDChenSChenY, et al. (2023) The impact of peer victimization on Chinese left-behind adolescent suicidal ideation: The mediating role of psychological suzhi and the moderating role of family cohesion. Child Abuse & Neglect141: 106235.
75.
XiongWLiuHGongP, et al. (2019) Relationships of coping styles and sleep quality with anxiety symptoms among Chinese adolescents: A cross-sectional study. Journal of Affective Disorders257: 108–115.
76.
Yalcin-SiedentopfNPichlerTWelteAS, et al. (2021) Sex matters: Stress perception and the relevance of resilience and perceived social support in emerging adults. Archives of Women’s Mental Health24: 403–411.
77.
YangTLeiXAndersonM (2016) Decreased inhibitory control of negative information in directed forgetting. International Journal of Psychophysiology100: 44–51.
78.
YaoZFHsiehS (2019) Neurocognitive mechanism of human resilience: A conceptual framework and empirical review. International Journal of Environmental Research and Public Health16(24): 5123.
79.
YuXZhangJ (2007) Factor analysis and psychometric evaluation of the Connor-Davidson Resilience Scale (CD-RISC) with Chinese people. Social Behavior and Personality35(1): 19–30.
80.
ZakiNFWSpenceDWBaHammamAS, et al. (2018) Chronobiological theories of mood disorder. European Archives of Psychiatry and Clinical Neuroscience268: 107–118.
81.
ZengHYanRWangS, et al. (2018) The predict factors and generative mechanism of psychological crisis for adolescents. Psychological Exploration38(6): 539–545.
82.
ZimetGDDahlemNWZimetSG, et al. (1988) The multidimensional scale of perceived social support. Journal of Personality Assessment52(1): 30–41.
83.
ZungWWK (1971) A rating instrument for anxiety disorders. Psychosomatics12: 371–379.
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