Revisiting sleep duration and mental distress among US high school students: National YRBS, 2011–2023

BACKGROUND: Adolescent mental distress is a prevalent global public health concern. Aligning with the goals of Healthy People 2030, this study aimed to characterize the sleep duration associated with the lowest prevalence of mental distress among US high school students. METHODS: This study pooled and examined cross-sectional data from 7 waves of the national Youth Risk Behavior Survey (YRBS) in 2011-2023. All data analyses were sex-stratified. We estimated the prevalence of mental symptoms and suicidal behaviors across sleep duration, and examined both linear and quadratic associations. We also calculated adjusted odds ratios (AORs) with 95% CIs and compared the prevalence of mental distress indicators among sleep duration categories. RESULTS: Overall, 24.39% of adolescents reported 8-9 h of sleep (female: 22.51%; male: 26.21%). Compared with 8-9 h, insufficient sleep (< 8 h) was associated with significantly higher odds of all five mental distress indicators among female students: current bad mental health (AOR, 1.93; 95% CI, 1.61-2.30), feeling sad/hopeless (AOR, 1.59; 95% CI, 1.40-1.80), suicidal thoughts (AOR, 1.68; 95% CI, 1.49-1.91), suicide plan (AOR, 1.41; 95% CI, 1.25-1.59), and attempted suicide (AOR, 1.41; 95% CI, 1.20-1.66). Results were similar among male students. Across all five indicators in both sexes, the lowest prevalence was observed at 8-9 h; however, most comparisons at ≥ 10 h were not statistically significant. CONCLUSIONS: The lowest prevalence of mental distress across all indicators and both sexes was observed at 8-9 h of sleep; however, most ≥ 10-hour comparisons were not significant, likely reflecting the small proportion of adolescents in this category.