Abstract
Sleep is essential for the physical and mental health of adolescents. Previous international studies have indicated a strong association between adverse childhood experiences (ACEs) and insomnia, although relevant reports focusing on Chinese adolescents remain limited. This online cross-sectional study ultimately included 6670 adolescents aged 12-18 years. Childhood adversity and insomnia symptoms were assessed using the Adverse Childhood Experiences Questionnaire and the Insomnia Severity Index (ISI), respectively. Statistical analyses included chi-square tests to compare ACE prevalence between groups, binary logistic regression to identify risk factors for insomnia symptoms, and Network analysis explored interrelationships among specific ACEs and insomnia symptoms, using centrality indices (strength, closeness, betweenness) to evaluate symptom influence. The prevalence of ACEs was 47.6% and insomnia symptoms was 20.6%. ACEs showed a cumulative dose-effect relationship with insomnia. Adolescents with ACEs had a significantly higher incidence of insomnia than those without. Physical abuse (OR = 1.41), emotional neglect (OR = 1.32), social isolation or exclusion (OR = 2.52), and witnessing community violence (OR = 1.57) were identified as significant risk factors for insomnia symptoms. Network analysis showed that ACE10 (family crime, strength z = 2.084) and ACE12 (Isolated or excluded, betweenness z = 3.594) were the most central ACE nodes. The strongest cross-domain connections were ISI4 (sleep dissatisfaction) and ACE12 (edge weights = 0.081), and between ISI1 (difficulty falling asleep) and ACE12 (edge weights = 0.077). ACEs and insomnia symptoms are prevalent and closely interrelated among Chinese adolescents. These findings highlight the need to strengthen the assessment of ACEs in this population and implement timely interventions to reduce the incidence of insomnia. However, as this is a cross-sectional study from a single province, further research is needed in terms of its generalizability.