# Network Analysis and Mediation Effect Analysis of Anxiety Symptoms and Sleep Patterns for Adolescents

## TL;DR

This study explores how anxiety and sleep problems are connected in Chinese adolescents, finding that insomnia and fatigue play key roles in worsening daytime sleepiness.

## Contribution

The study introduces a novel network and mediation analysis framework to uncover symptom-level interactions between anxiety and sleep patterns in adolescents.

## Key findings

- 32.1% of adolescents showed anxiety symptoms, and 39.9% experienced insomnia.
- Insomnia and fatigue symptoms mediate the relationship between anxiety and daytime sleepiness.
- GAD2 and PSQI7 are core symptoms in the network, with fatigue having the highest expected impact.

## Abstract

The escalating prevalence of mental health issues and sleep disturbances among Chinese adolescents has become a pressing public health concern. Despite increasing recognition of this issue, there remains a paucity of research elucidating the intricate interplay between anxiety symptoms and sleep patterns. To address this critical gap, this study employs advanced network analysis to explore the complex relationships between these two domains, offering novel insights into their interconnectedness.

We conducted a large-scale, online, cross-sectional survey encompassing 48,074 adolescents. Anxiety symptoms were assessed using the Generalised Anxiety Disorder Scale-7 (GAD-7), while sleep quality was evaluated via the Pittsburgh Sleep Quality Index (PSQI). Daytime sleepiness and fatigue symptoms were measured using the Chinese Adolescent Daytime Sleepiness Scale and the Fatigue Symptom Scale (FSS). Demographic data were analysed using chi-square tests, and continuous variables were examined via t-tests. To investigate symptom-level relationships, we employed network and mediation effect analysis, providing a robust methodological framework.

Our findings reveal a concerning prevalence of anxiety and insomnia symptoms among adolescents, at rates of 32.1% and 39.9%, respectively. Adolescents exhibiting anxiety symptoms reported significantly higher levels of insomnia, fatigue, and daytime sleepiness. Mediation effect analysis uncovered a chain mediation pathway, whereby insomnia and fatigue symptoms sequentially mediated the relationship between anxiety and daytime sleepiness. Network analysis further identified GAD2 (uncontrollable worry) and PSQI7 (daytime function) as pivotal core symptoms, with FSS (fatigue symptoms) demonstrating the highest expected impact within the network.

This study underscores the persistent severity of anxiety and sleep pattern disturbances among adolescents. These findings highlight the importance of addressing core symptoms—particularly GAD2 and PSQI7—in therapeutic interventions. The results provide a solid foundation for developing more effective, symptom-specific strategies to improve adolescent mental health and sleep quality.