Study links adverse childhood experiences to insomnia among Chinese teenagers, spotlights social exclusion as a key factor

A large study in Shandong province reveals nearly half of adolescents have faced childhood adversity, significantly correlating with increased insomnia symptoms, especially social exclusion and community violence.

Adverse childhood experiences are common among Chinese teenagers and appear to be closely linked with insomnia symptoms, according to a large cross-sectional study published by Dove Medical Press. In a survey of 6,670 adolescents aged 12 to 18 in Shandong province, 47.6% reported at least one adverse childhood experience, while 20.7% met the study’s threshold for insomnia symptoms. The findings add to a growing body of evidence that early-life adversity is not only widespread, but also strongly associated with poorer sleep in young people.

The study’s results were consistent with wider international research showing that adverse childhood experiences are common across age groups and settings. A recent meta-analysis of adult populations found substantial global prevalence for individual adversity types, including emotional abuse, emotional neglect and physical abuse, while another review estimated that more than one in four adults had experienced at least four adverse events in childhood. Separate reviews of children and young people have also shown high exposure rates, underscoring that these are not rare or isolated experiences but a common public health issue. The Chinese study’s figure of nearly half of respondents reporting at least one adverse experience fits that broader pattern.

Within the Chinese sample, emotional abuse was the most frequently reported adversity, followed by physical abuse, emotional neglect and being isolated or excluded. The study found a clear dose-response pattern: the more types of adversity a teenager reported, the more likely they were to have insomnia symptoms. After accounting for demographic factors, adolescents with one adverse childhood experience had higher odds of insomnia, and those with four or more faced a sharply increased risk. Isolation or exclusion showed the strongest individual association with insomnia, followed by witnessing community violence, emotional abuse, physical abuse and emotional neglect.

The research also highlighted wider sleep and wellbeing differences. Girls, senior high school students, older adolescents and those with poorer academic performance were more likely to report insomnia symptoms. The authors noted that this mirrors earlier work showing that adolescents exposed to adverse experiences sleep less, experience greater social jet lag and report more insomnia than their peers. In the Chinese context, they argued, academic pressure, family separation and cultural acceptance of harsh discipline may all shape how adversity affects sleep.

A network analysis offered a more granular look at how specific adverse experiences and insomnia symptoms may be connected. In that model, being isolated or excluded emerged as a key bridge between childhood adversity and sleep problems, linking most directly with sleep dissatisfaction and difficulty falling asleep. The authors said this suggests social rejection may be especially important when thinking about sleep intervention in adolescents. Still, they stressed that the study was cross-sectional, meaning it can show association but not causation. They also noted limits linked to self-reported data, regional sampling and the absence of objective sleep measures. Even so, the findings suggest that screening for childhood adversity could be a useful part of efforts to identify teenagers at risk of insomnia and to guide future prevention work.