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We examined associations between sleep characteristics and moderate\/severe daytime functional impairment in depressed adolescent outpatients with NSSI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this cross-sectional study, depressed adolescent outpatients with NSSI completed self-report measures of sleep over the past month. Daytime functional impairment was assessed using item 8 of the sleep questionnaire. For group comparisons, impairment was dichotomized as no\/mild versus moderate\/severe. For multivariable analyses, impairment was modeled as an ordinal outcome (none\/mild, moderate, severe) using ordinal logistic regression, adjusting for age, sex, sleep duration, and depressive (BDI) and anxiety (BAI) symptom severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among participants with available impairment data (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200999), 74.7% reported moderate\/severe daytime impairment. The moderate\/severe group reported shorter sleep duration and greater insomnia symptom burden than the no\/mild impairment group. In multivariable analyses including both insomnia symptom burden and sleep duration, greater insomnia symptom burden was independently associated with higher odds of being in a more severe category of daytime functional impairment (OR\u2009=\u20091.83, 95% CI 1.42\u20132.36;\n                      <jats:italic>p<\/jats:italic>\n                      &lt;.001), whereas sleep duration was not independently associated. Other sleep metrics were not independently associated after adjustment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Daytime functional impairment is highly prevalent in this high-risk adolescent population. The findings suggest that the subjective burden of insomnia symptoms\u2014rather than sleep quantity alone\u2014may be more strongly associated with functional impairment, independent of depressive and anxiety symptom severity. Targeted screening and intervention for insomnia symptoms may be important for improving daytime functioning and quality of life in adolescents with depression and NSSI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12888-026-07993-3","type":"journal-article","created":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T01:38:11Z","timestamp":1774489091000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sleep disturbance and daytime functional impairment among adolescent outpatients with depression and non-suicidal self-injury"],"prefix":"10.1186","volume":"26","author":[{"given":"Ting","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Hong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caihong","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaqi","family":"Mo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanqiu","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiyang","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyan","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,26]]},"reference":[{"issue":"3","key":"7993_CR1","doi-asserted-by":"publisher","first-page":"e921","DOI":"10.1542\/peds.2014-1696","volume":"134","author":"J Owens","year":"2014","unstructured":"Owens J, Au R, Carskadon M, Millman R, Wolfson A, Braverman PK, Adelman WP, Breuner CC, Levine DA, Marcell AV, et al. 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All procedures were conducted in accordance with the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Individual, de-identified participant data that underlie the results reported in this article (including a data dictionary) will be made available upon reasonable request to the corresponding author. Requests will be reviewed by the study team in accordance with participant consent and institutional policies. Data will be available beginning 3 months after publication and ending 24 months after publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data sharing"}},{"value":"The authors did not use generative AI to generate scientific content, data, results, or conclusions. An AI-assisted language tool was used solely for language editing. All content was reviewed and approved by the authors, who take full responsibility for the manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Use of generative AI and AI-assisted technologies in the writing process"}},{"value":"Written informed consent was obtained from all participants and their legal guardians prior to participation. A copy of the consent form is available for review by the editor of this journal .All authors have read and approved the final version of the manuscript for submission to BMC Psychiatry, and agree with the authorship and the order of authors listed in the paper. Any future changes, extensions, or supplements to the paper will be handled by all parties involved in accordance with the journal\u2019s policies and with the necessary approvals obtained.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"365"}}