Sleep Problems and Non-Suicidal Self-Injury in Adolescents: A Systematic Review and Meta-Analysis of Longitudinal Studies.

Sleep problems and non-suicidal self-injury (NSSI) represent critical public health concerns during adolescence. While cross-sectional research suggests an association, prospective longitudinal evidence remains limited. This systematic review and meta-analysis evaluated the prospective relationship between sleep problems and subsequent NSSI risk among adolescents. PubMed, Embase, Web of Science, Cochrane Library, and CINAHL were searched from inception to January 2026. Twenty longitudinal studies comprising 62,467 adolescents were included. Pooled analysis revealed that sleep problems significantly increased NSSI risk (OR = 1.60; 95% CI: 1.32-1.95). Subgroup analyses showed generally consistent associations across regions, study populations, sample sizes, measurement tools, and follow-up durations. The type of sleep problem appeared to moderate the association. Evidence of publication bias was mixed, with Begg's test suggesting possible bias whereas Egger's test was not statistically significant. These findings underscore sleep problem as a prospective risk factor for adolescent NSSI, with important implications for early prevention strategies.