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Objectives  The aim of this study was to examine the association between health literacy (HL) and sleep problems with mental health of Chinese students in combined junior and senior high school.    Methods  A cross-sectional study was conducted among seven hundred and seventy-five students from a combined junior and senior high school in Shenyang on December 16, 2016. HL, sleep problems, anxiety symptoms and depressive symptoms were measured by self-reported validated instruments. Multiple logistic regression models were used to examine the association of HL and sleep problems with mental health problems.    Results  The prevalence of anxiety symptoms and depressive symptoms was 24.6% and 45.2%, respectively. Low HL was significantly associated with anxiety symptoms ( OR  = 2.457,  95%CI : 1.493–4.045) and depressive symptoms ( OR  = 5.164,  95%CI : 3.233–8.250). Sleep problems were significantly positively correlated with anxiety symptoms ( OR  = 4.237,  95%CI : 2.831–6.341) and depressive symptoms ( OR  = 3.170,  95%CI : 2.084–4.823). The students who had sleep problems with low HL had the highest risks of anxiety symptoms ( OR  = 11.440,  95%CI : 5.564–23.520) and depressive symptoms ( OR  = 19.470,  95%CI : 8.143–46.558).    Conclusion  Our findings suggest that Chinese students in combined junior and senior high school who had sleep problems with low HL are at risk of exhibiting anxiety symptoms and depressive symptoms. Intervention programs of mental health problems should enhance HL level and improve sleep quality.

Association of health literacy and sleep problems with mental health of Chinese students in combined junior and senior high school