A strong association between sleep problems and suicidal thoughts and behaviors (STBs) has been demonstrated in high-income countries. The sleep-STB relationship, however, is minimally understood among youth in low and middle-incomes countries. There also is a limited understanding of how individual- (i.e., age, sex) and country-level (i.e., economic inequality, economic quality) factors may moderate the magnitude of the sleep-STB association among youth. Data were analyzed from the cross-national Global School-based Health Survey 2003–2017, which assessed a range of health behaviors among school-enrolled adolescents aged 11–18 years from 88 low-, lower-middle, upper-middle, and high-income countries. Multilevel models were used to examine the influence of individual- and country-level factors on the association between past-year worry-related sleep problems and past-year suicide ideation, suicide plans, and suicide attempts. Worry-related sleep problems were significantly associated with suicide ideation, plans, and attempts. Adolescent sex, country economic quality (income group designation), and country economic inequality moderated the sleep-STB association, but age did not. The sleep-STB relationship was stronger for males and across macroeconomic indices, the relationship was generally strongest among upper-middle income countries (economic quality) and countries with a big income gap (economic inequality). When examining how individual-level factors differentially affected the sleep-STB relationship within economic quality (income group designation), the effects were driven by older adolescents in high-income countries for suicide ideation and suicide plans. Study findings suggest an important role for global macroeconomic factors, for males, and older adolescents in high-income countries in the sleep-STB relationship. Future directions include expanding worldwide coverage of countries, assessing a wider range of sleep problems, and longitudinal work to understand potential mechanisms in the sleep-STB relationship.

睡眠问题与自杀念头和行为 (STB) 之间的密切关联已在高收入国家得到证实。然而，低收入和中等收入国家的年轻人对睡眠与机顶盒的关系知之甚少。对于个人（即年龄、性别）和国家层面（即经济不平等、经济质量）因素如何调节青少年睡眠-STB 关联的程度，人们也知之甚少。数据来自 2003-2017 年跨国全球校本健康调查，该调查评估了 88 名低、中低、中高和高中 11-18 岁在校青少年的一系列健康行为- 收入国家。多层次模型用于检验个人和国家层面的因素对过去一年与忧虑相关的睡眠问题与过去一年的自杀意念、自杀计划和自杀未遂之间关联的影响。忧虑相关的睡眠问题与自杀意念、计划和企图显着相关。青少年性别、国家经济质量（收入组指定）和国家经济不平等缓和了睡眠-STB 关联，但年龄没有。睡眠与机顶盒的关系在男性和宏观经济指数中更强，这种关系在中高收入国家（经济质量）和收入差距较大的国家（经济不平等）中普遍最强。在研究个体层面的因素如何在经济质量（收入组指定）内对睡眠-STB 关系产生不同影响时，这些影响是由高收入国家中年龄较大的青少年的自杀意念和自杀计划驱动的。研究结果表明，全球宏观经济因素、高收入国家的男性和年龄较大的青少年在睡眠与 STB 关系中发挥着重要作用。未来的方向包括扩大全球范围内的国家，评估更广泛的睡眠问题，以及纵向工作以了解睡眠-STB 关系中的潜在机制。和高收入国家中年龄较大的青少年的睡眠-STB 关系。未来的方向包括扩大全球范围内的国家，评估更广泛的睡眠问题，以及纵向工作以了解睡眠-STB 关系中的潜在机制。和高收入国家中年龄较大的青少年的睡眠-STB 关系。未来的方向包括扩大全球范围内的国家，评估更广泛的睡眠问题，以及纵向工作以了解睡眠-STB 关系中的潜在机制。