Prevalence and risk factors of sleep disturbances among adolescents with non-suicidal self-injury: a systematic review and meta-analysis

To estimate the pooled prevalence of sleep disturbances and identify associated risk factor among adolescent with non-suicidal self-injury (NSSI). A systematic search of PubMed, Web of Science, Embase, PsycINFO, CNKI, and SinoMed was conducted up to March 2026. Eligible studies included adolescents aged 11–19 years with NSSI that reported the prevalence or risk factors of sleep disturbances. Cross-sectional and longitudinal studies were included. Two reviewers independently conducted study selection, data extraction, and quality assessment. Pooled estimates were calculated using random-effects models. A total of 23 studies were included in the review. The pooled prevalence of sleep disturbances across 13 studies was 41% (95%CI: 39%–44%; I²= 76.8%). Overall, 11 risk factors were identified across 15 studies, of which four factors were eligible for meta-analysis, including female sex, depression, emotional neglect, and externalizing problems. Significant associations were observed for depression (OR = 1.05, 95%CI: 1.03–1.07; I²= 69.1%) and female sex (OR = 1.74, 95%CI: 1.31–2.18; I²= 78.8%), whereas emotional neglect and externalizing problems were not significantly associated with sleep disturbances. Sleep disturbances are highly prevalent among adolescents engaging in NSSI, particularly among females and those with depression. These findings underscore the need for routine sleep assessment within adolescent mental health screening. Nurses can play a key role in early identification, sleep-health education, and timely referral, supporting nurse-led models of early detection and prevention.