The biologic era and pregnancy in rheumatoid arthritis: a prospective multicenter study from the Norwegian RevNatus registry.

Adolescence is a critical developmental stage during which adolescents undergo major physical, psychological, social, and interpersonal changes []. This transitional phase renders them vulnerable to emotional and behavioral problems (e.g., emotional symptoms, hyperactivity, conduct problems, and peer relationship issues) [], with an overall prevalence of 19% across all types of such problems []. Growing evidence has shown that emotional and behavioral problems in adolescence may compromise long-term mental health [], and even lead to severe adverse outcomes such as school dropout [, ], delinquency [], and suicide []. Without being addressed promptly, these problems are likely to endure and exacerbate the cumulative burden on both society and the economy. Therefore, there is an urgent need to identify risk factors for emotional and behavioral problems in adolescents in order to develop targeted and effective prevention programs. Sleep problems are highly prevalent among adolescents []. Multiple biological, social, psychological, cultural, and familial factors contribute to their emergence ([]; Sadeh []), , manifesting as insufficient sleep duration, poor subjective sleep quality, and daytime dysfunction []. Especially in China, limited educational resources and rising educational demands have resulted in fierce enrollment competition []. This competition exposes Chinese adolescents to greater academic pressure, potentially increasing their likelihood of sleep problems [, ]. Accumulating evidence has demonstrated that sleep problems are strongly associated with emotional and behavioral problems in adolescents [, , ]. Sleep problems should be regarded as a multidimensional construct [, ]. Although existing evidence has established their association with emotional and behavioral problems, most studies have focused only on a single aspect or used a composite score to represent overall sleep problems. Therefore, it is necessary to further investigate this relationship by simultaneously considering multiple aspects of sleep problems. Moreover, most prior studies that explored the relationship between the two relied on regression analysis [, ], which failed to account for the multicollinearity of multiple sleep problems []. Meanwhile, they have not distinguished which sleep problem is most closely related to emotional and behavioral problems. In contrast, relative weight analysis can eliminate multicollinearity and identify the sleep problems that contribute most significantly to emotional and behavioral problems [], thereby providing the most prioritized intervention target especially when resources are limited.