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BackgroundVocational education is an important part of high school education in China. However, there is little research on high school students' mental health. This study aimed to investigate the prevalence of suicidal behavior (SB) among this population and the mediating role of insomnia, depression, anxiety, and stress in the relationship between Internet addiction (IA) and SB using a structural equation model.MethodsA cross-sectional questionnaire survey was conducted among several vocational high school students in Hunan Province, and 7,968 valid questionnaires were obtained. General demographic data and data from the Dual-Mode Self-Control Scale, Athens Insomnia Scale, Depression Anxiety Stress scale-21, and Revised Chen Internet Addiction Scale were collected. A structural equation model was used to explore the different pathways from IA to SB.ResultsAmong the participants, 37.7, 15.7, and 21.8% reported suicidal ideation, plans, and attempts, respectively. The structural equation model confirmed that IA was indirectly related to SB and was mediated by insomnia and/or depression, anxiety, and stress.LimitationsFirst, we only recruited students from vocational schools in Hunan Province, therefore, the sample may not represent the entire population of vocational students in China. Second, self-report scales were used in this study, and clinical diagnosis required professional interviews. Third, since this study had a cross-sectional design, the causal relationship between the variables could not be determined.ConclusionsThe prevalence of SB among vocational high school students in China was significantly high. The prevention of SB related to IA can be attributed to the improvement of insomnia and emotional problems.

Additional file 1: Appendix S1. Survey questions used in the analysis. Appendix S2. Beta coefficients for business expansion. Appendix S3. Beta coefficients for business selling. Appendix S4. Variance inflation factor (VIF) values.

Additional file 1: Fig. S1. Quality control of single-cell RNA sequencing data. Fig. S2. Identification of venous endothelial cell as another EC subtypes significantly changed under MCAO condition. Fig. S3. The differentiation path and stemness of Healing-state endothelial cell. Fig. S4. Demonstration of 3D tomography from different planes. Fig. S5. Cellular communication analysis indicating the key roles of endothelial cells in the brain microenvironment. Fig. S6. Aberrantly changed cell communication under MCAO condition. (DOCX)