Stressful Life Events among College Student: Direct and Indirect Relationships with Insomnia, Depression, Self-Esteem, and Suicide Ideation

Suicide is a serious public health problem and is the fourth leading cause of death among adolescents. Suicide ideation is the most significant predictor of suicide. However, few empirical studies have examined the relationship between stressful life events, insomnia, depression symptoms, self-esteem, and suicide ideation among college students. This study builds on O'Connor's The integrated motivational-volitional model of suicidal behavior theory will verify the relationship between these five factors through a large data study among college students, and further reveal the mechanisms and interventions of suicide ideation among college students. A total of 2717 (mean age = 19.81 years, 22.49% male) college students from South China participated in this behavioral and health survey. Using self-reported questionnaires which were Adolescent Self Rating Life Events Check-list, MINI-C, Insomnia Severity Index, PHQ-9, and Self-Esteem Scale to assess the subjects' demographic information, suicide ideation, stressful life events, insomnia, depressive symptoms, and self-esteem levels as comprehensively as possible. A moderated chain mediation model was used to validate their relationship. The results showed that stressful life events significant positively predicted insomnia symptoms, depressive symptoms, and suicide ideation. The mediating effect of depression between stressful life events and suicide ideation was significant. The chain mediating effect of insomnia and depression between stressful life events and suicide ideation was significant. However, the mediating effect of insomnia between stressful life events and suicide ideation was not significant. Also, the positive prediction of stressful life events and depression on suicide ideation was weaker when the individual's self-esteem level was higher, and the moderated chain mediating effect was significant. This study developed a moderated chain mediation model, and proposes a new integrated stress coping-self-perception model of suicide ideation to discover the important role of self-esteem levels in adolescent suicide prevention.