Too stressed to cope? A multiple mediation analysis of social bonds, sleep quality, and sleep disturbances in relation to prescription drug use among Chinese high school seniors

Amid rising concerns about stress and pharmacological coping among adolescents, this study investigated whether perceived stress is associated with the prescription drug use among Chinese high school seniors (CHS), and whether this association is mediated by social bonds, perceived sleep quality, and sleep disturbances. Drawing on general strain theory and social bond theory, a multiple mediation model integrating psychosocial and sleep-related mechanisms was proposed. A cross-sectional survey was conducted among 2140 CHS from six high schools in mainland China. Participants completed validated self-report measures assessing perceived stress, social bonds, perceived sleep quality, sleep disturbances, and prescription drug use. Structural equation modeling revealed no significant direct effect of stress on prescription drug use. Instead, the relationship was fully mediated through multiple indirect paths. The strongest indirect effects were observed via perceived sleep quality and sleep disturbances, both independently and sequentially. Social bonds also served as an upstream protective factor by enhancing sleep quality and indirectly reducing prescription drug use. These findings suggest that frequent short-term prescription drug use may reflect early behavioral responses to unmanaged stress and impaired sleep. Addressing sleep problems and reinforcing social connectedness may reduce adolescents’ reliance on pharmacological coping strategies. These results underscore the importance of integrated school-based mental health interventions and regulatory safeguards to ensure medically supervised access to prescription drugs and to prevent informal or inappropriate use in academically high-pressure environments.