Cumulative ecological risk, dysfunctional beliefs and attitudes about sleep, and sleep quality among Chinese adolescents: the indirect association of psychological distress

Background Adolescent sleep problems have gained increasing attention; however, systematic research integrating both external environmental and internal cognitive factors is still lacking. This study focuses on Chinese adolescents and investigates the associations among cumulative ecological risk, dysfunctional beliefs and attitudes about sleep, psychological distress, and sleep quality. The goal is to examine the potential indirect associations involving psychological distress within the context of cognitive and environmental factors. Methods This study employed a random sampling method to survey 793 Chinese middle and high school students. Standardized instruments were employed to assess students’ cumulative ecological risk, dysfunctional beliefs and attitudes about sleep, psychological distress, and sleep quality. Results An indirect association model was constructed and tested. Both cumulative ecological risk and dysfunctional beliefs and attitudes about sleep were negatively associated with sleep quality, and psychological distress was statistically involved in the indirect associations between each risk factor and sleep quality. The estimated indirect association involving psychological distress represented 52.27% of the overall association between cumulative ecological risk and sleep quality and 36.79% of the overall association between dysfunctional beliefs and attitudes about sleep quality. Discussion This study incorporates both cumulative ecological risk and dysfunctional beliefs and attitudes about sleep into a unified model, indicating a significant indirect association involving psychological distress. It highlights meaningful connections among environmental risks, cognitive biases, psychological distress, and sleep quality. These outcomes broaden our comprehension of the elements relating to teenage sleep issues, while simultaneously offering both theoretical backing and practical guidance for psychological services in schools, family-based intervention efforts, and the formulation of relevant policies.