Sleep problems and depression in adolescence: results from a large population-based study of Norwegian adolescents aged 16-18 years

Gender identity and symptoms of anxiety and depression and their relationship with sleep disorders among Polish adolescents during the Covid-19 pandemic and the outbreak of war in the Ukraine

INTRODUCTION

For most people, gender identity is consistent with biological sex and such people are called cisgender. People in whom such a relationship does not occur or occurs to a lesser extent are referred to as gender non-conforming-and these include transgender, non-binary, agender and gender-fluid people. These individuals are usually affected by minority stress, which, combined with the circumstances of the pandemic and Russian aggression against Ukraine, may have led to mental disorders and sleep disorders in this population. The aim of the study was to analyze the symptoms of anxiety, depression and insomnia in a group of Polish youth during the Covid-19 pandemic and the outbreak of the war in Ukraine, taking into consideration gender differences, including non-binary gender.

METHODS

The study involved 1621 secondary school students aged 14 to 19, the average age was 16.73 ± 1.35, including 857 girls, 690 boys and 74 people who defined their gender as non-binary. A set of questionnaires for the Diagnosis of Depression in Children (CDI 2), the State-Trait Anxiety Inventory (STAI), the X-1 subscale, The Athens Insomnia Scale (AIS) and an original questionnaire of sociodemographic data were used in research.

RESULTS

Analyzing the results obtained in the study group, the respondents scored an average of 17.99 ± 9.55 points in the assessment of depressive symptoms. After division into groups taking into account gender, the corresponding score was 19.69 ± 9.40 points for girls, 15.03 ± 8.68 for boys and 25.86 ± 9.91 for non-binary people. The difference was statistically significant (p = 0.000) in all three study groups. In the anxiety symptoms assessment, the respondents scored an average of 46.92 ± 11.67 points. After division into gender groups, the corresponding score was 49.21 ± 11.12 points for girls, 43.39 ± 11.47 for boys and 53.39 ± 10.41 for non-binary people. The difference was statistically significant (p = 0.000) in all three study groups. Analyzing the results obtained in The Athens Insomnia Scale (AIS), the average score was 8.31 ± 4.58 points, which allows to evaluate sleep onset as a norm. After dividing into groups, the results were 8.95 ± 4.55 points, respectively for girls, 7.19 ± 4.21 points for boys and 11.35 ± 5.43 for non-binary people, the difference was significant in terms of comparisons between all statistically tested groups. The analysis of the relationships between the studied variables was presented for each gender separately. Statistically significant positive correlations were found between the results obtained on the scale assessing depressive symptoms (CDI-2) and anxiety symptoms (STAI-X1) and the results obtained on the AIS scale.

CONCLUSIONS

Among the studied group of teenagers, the highest intensity of depressive symptoms is demonstrated by non-binary people, followed by females, and finally by males. Similar results were obtained in the assessment of anxiety symptoms. The non-binary group achieved results indicating sleep disorders, while the cisgender group's results of sleep onset were borderline normal. Whatsmore, the greater the severity of depressive and anxiety disorders, the greater the sleep disorders in all study groups, regardless of gender.

Sleep Problems and Autism Impairments in a Large Community Sample of Children and Adolescents

Sleep problems are common in individuals with autism spectrum disorder (ASD). How sleep problems reflect specific ASD phenotypes is unclear. We studied whether sleep problems indexed functional impairment in a heterogeneous community sample of individuals with ASD. We analyzed 977 probands (233 females; age = 11.27 ± 4.13 years) from the Rhode Island Consortium for Autism Research and Treatment dataset, a unique public-private-academic collaboration involving all major points of service for families in Rhode Island. We found that individuals with a confirmed diagnosis of ASD were more likely to have sleep problems. However, across the whole sample and above and beyond a formal diagnosis, sleep problems were dimensionally associated with worse social impairment and poorer adaptive functioning. By using a large dataset reflective of the diversity of presentations in the community, this study underscores the importance of considering sleep problems in clinical practice to improve adaptive functioning in individuals with ASD.

Depression and suicidal ideation among Chinese college students during the COVID-19 pandemic: the mediating roles of chronotype and sleep quality

BACKGROUND

This study was intended to investigate the correlation between depression and suicidal ideation among Chinese college students during the COVID-19 pandemic and the potential mediating roles of chronotype and sleep quality in this relationship .

METHODS

A sample of 4,768 college students was selected from four institutions in Anhui Province, China, and the study was conducted during the COVID-19 pandemic (November to December 2020) using a stratified, cluster, multi-stage sampling method. This study used the two-item Patient Health Questionnaire (PHQ-2) to assess depressive symptoms, the Morningness-Eveningness Questionnaire 19 (MEQ-19) to determine individual sleep chronotypes (i.e., morning or evening preference), and the Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality. Participants were asked about suicidal ideation. MPLUS 8.3 software was used to analyze the mediating effect of chronotype and sleep quality on the relationship between depression and suicidal ideation.

RESULTS

During the COVID-19 pandemic, the prevalence of suicidal ideation among Chinese college students was 5.4%. Depression was inversely correlated with chronotype (beta = - 0.346, P < 0.01) and positively correlated with sleep quality (beta = 0.846, P < 0.001), indicating that students experiencing depressive symptoms were more likely to have a later chronotype and poor sleep quality. A later chronotype (beta = - 0.019, P < 0.05) and poor sleep quality (beta = 0.066, P < 0.01) predicted suicidal ideation. Depression emerged as a direct and significant risk factor for suicidal ideation (effect value = 0.535, 95% confidence interval: 0.449 ~ 0.622). Chronotype and sleep quality were found to have potential mediating effects on the relationship between depression and suicidal ideation; however, the chain-mediating effect of chronotype and sleep quality was not statistically significant.

CONCLUSIONS

Our findings suggest that during the COVID-19 pandemic, depression can precipitate suicidal ideation through its influence on sleep chronotype and quality. These compelling findings highlight the urgency of early intervention strategies intended to mitigate suicidal thoughts, particularly among students exhibiting depressive symptoms, who experience disrupted sleep patterns and poor sleep quality.

Sleep quality and the cortisol and alpha-amylase awakening responses in adolescents with depressive disorders

BACKGROUND

Depressive disorders in adolescents affect all aspects of life and impose a very large burden of disease. Sleep is frequently affected by depression and is crucial for facing challenges during development. One of the postulated reasons for depression-induced sleep disruption is dysregulation of the physiological stress system.

AIMS

To investigate the links of adolescent depressive disorders with subjective sleep quality, objective sleep quality, and the course of cortisol and alpha-amylase after awakening.

METHOD

We compared subjective sleep quality (via daily questionnaires) and objective sleep quality (via actigraphy measurement) of 35 adolescents with depressive disorders and 29 healthy controls over 7 consecutive days. In addition, saliva samples were collected on 3 days to examine cortisol and alpha-amylase patterns after awakening.

RESULTS

No significant differences in cortisol or alpha-amylase awakening responses were observed between participants with depressive disorders and healthy controls. We found severe reductions in subjective sleep quality in the depression group (Z = -5.19, P < 0.001, d = 1.80) and a prolonged actigraphy-measured sleep onset latency (Z = -2.42, P = 0.015, d = 0.64) compared with controls. Reductions in subjective sleep quality were partially correlated with objective sleep measures (sleep onset latency: r = -0.270, P = 0.004, sleep efficiency: r = 0.215, P = 0.017).

CONCLUSIONS

Sleep onset latency seems to aggravate depressive symptoms and to have an important role in perception of sleep quality. Adolescents with depressive disorders should be supported regarding the establishment of good sleep hygiene and avoiding activities that may impede falling asleep.

Sleep measures as a predictor of suicidal ideation among high-risk adolescents

Suicide is the second leading cause of death among youth aged 15-24 years. Identifying modifiable risk factors relevant to adolescents is crucial for suicide prevention. Sleep patterns have been linked to suicidality in adults, but lack sufficient study in youth. This ecological momentary assessment (EMA) study aimed to explore the relationship between objectively and subjectively measured sleep characteristics and next-day suicidal ideation in high-risk youth. We included 29 adolescents (12-18 years old) admitted to the inpatient psychiatric ward post-suicide attempt or due to suicidal intent within the previous month. We conducted objective (actigraphy) and subjective (sleep diary) sleep pattern assessments over ten consecutive days. Daily suicidal ideation was evaluated using a questionnaire based on the validated C-SSRS interview. A significant positive association was observed between sleep onset latency (SOL) and expressing a "death wish" the following day (OR = 1.06, 95% CI [1-1.11], p = .04), with each minute of longer SOL increased the risk for a death wish the following day by 6%. In addition, a marginally significant negative association was observed between total sleep time (TST) and expressing a "death wish" the following day (OR = 0.57, 95% CI [0.3-1.11], p = 0.1), with each one-hour decrease in objectively measured TST increasing the odds of a death wish by 43%. Our study highlights the interplay between sleep patterns and suicidal ideation, with SOL and TST playing a significant role that may function as proximal risk factors for suicidality and as a target for intervention while treating suicidal youth.

The Connection between Sleep Patterns and Mental Health: Insights from Rural Chinese Students

BACKGROUND

The association between sleep patterns and young students' mental health, which is crucial for their development, remains understudied in rural China. Therefore, the relationship between sleep patterns and mental health among primary and junior high school students in rural China was examined.

METHOD

A total of 1592 primary and junior high school students from rural areas of Gansu Province were surveyed, and the Depression Anxiety and Stress Scale (DASS) was utilized to assess mental health, alongside self-reported data on their daily sleep patterns.

RESULTS

Significant sleep inadequacies were identified: 28% of students received less than 8 h of sleep on weekdays, and 19% went to bed later than recommended. On weekends, 38% of students had delayed bedtimes, though only 7.2% received less than 8 h of sleep. Notably, a "U-shaped" relationship was uncovered between sleep duration and mental health for students on weekends, with optimal mental health correlated with receiving 10-11 h of sleep, while both shorter and longer sleep durations on weekends worsened outcomes. This pattern is absent on weekdays. Additionally, adequate sleep and an earlier bedtime was linked to a 6-8% decrease in mental health risks.

CONCLUSIONS

These findings provide valuable insights for policymakers seeking to enhance student mental well-being in rural settings, emphasizing the importance of implementing measures that promote balanced sleep habits among young students.

Predictors of early adulthood insomnia following exposure to a single mass violence attack during adolescence: 7-13 year follow-up from the Utøya and HUNT studies

Background: The long-term impact of mass violence attacks is practically unknown, especially in children and adolescents. In a previous study, we found that 8.5 years after a terror attack targeting mainly adolescents, nearly half of the survivors met diagnostic criteria for insomnia.Objectives: The aims of this study were to investigate: (1) whether exposure to a single mass violence event during adolescence increases the risk of insomnia almost a decade later above that expected for a non-exposed population; and (2) whether prior interpersonal violence exposure and early post-traumatic reactions predict later insomnia.Method: Participants were survivors of the 2011 Utøya Island terrorist attack (n = 279) and controls from the HUNT Norwegian general population study (n = 35,664). Early adulthood insomnia was assessed using four items from the Karolinska Sleep Questionnaire 8.5 years after the attack. Participants who had also completed earlier data collection waves for both studies (n = 116 and 2382, respectively) were included in logistic regression models testing the associations between predictors during adolescence and later insomnia.Results: Nearly a decade after the Utøya attack, 38.4% (n = 56) of the survivors reported symptoms of insomnia indicative of probable insomnia compared to 20.5% (n = 5771) of controls. Terror exposure during adolescence was a significant predictor of later insomnia [odds ratio (OR) = 3.18, 95% confidence interval (CI) = 2.05-4.87, p < .001]. Early post-trauma symptoms of anxiety and depression (OR = 1.34, 95% CI = 1.02-1.76, p = .033) and weekly headaches (OR = 1.64, 95% CI = 1.08-2.47, p = .018) were also significant predictors while controlling for background factors and other predictors.Conclusion: Long-term assessment and treatment are needed for survivors of mass violence to improve resilience and recovery.

Associations between social loneliness trajectories and chronotype among adolescents

Late chronotype during adolescence is a critical risk factor for poor physical and mental health among adolescents. While social loneliness is confirmed to negatively influence sleep behaviors, the long-term effect of social loneliness on chronotype remains unknown. This study aims to investigate whether social loneliness trajectories from middle childhood to adolescence are associated with chronotype in late adolescence and examine the potential sex differences in these associations. Data were obtained from 2398 adolescents who participated in the Child and Adolescent Behaviors in Long-Term Evolution project. Chronotype was calculated as the midpoint of sleep on free days adjusted for sleep debt. Group-based trajectory modeling and multiple linear regression were employed to establish social loneliness trajectories and determine their associations with chronotype. Social loneliness trajectories were significantly associated with chronotype and varied by sex. Specifically, boys following a high-decreasing trajectory had earlier chronotype during late adolescence than did those following a low-decreasing trajectory (B =  - 0.07; p < 0.05). By contrast, girls following a low-to-moderate-increasing trajectory exhibited later chronotype than did those following a low-stable trajectory (B = 0.07; p < 0.01). Social loneliness trajectories, especially those displaying significant fluctuations over time, are critical indicators influencing chronotype among adolescents. Furthermore, these trajectories and their associations with chronotype display sex differences. These findings highlight the need for early interventions for psychological factors such as social loneliness to ensure that the late chronotype can be prevented. In addition, sex variations must be considered.

Common Issues for General Practitioners in the Medical Management of Child and Adolescent Psychiatric Care

With a limited number of child and adolescent psychiatrists available to see youth patients, many common psychiatric problems in youth are managed by other providers. Clinical pearls from experts in child and adolescent psychiatry can help general practitioners with this management. Some common issues are discussed here for which practical guidance is offered, ranging from approaches to assessment and how to start and titrate medications for the treatment of attention deficit hyperactivity disorder, depression, and sleep problems.

A bibliometric analysis of insomnia in adolescent

Background

The negative effects of insomnia on adolescents' development, academic performance, and quality of life place a burden on families, schools, and society. As one of the most important research directions for insomnia, adolescent insomnia has significant research value, social value, and practical significance. Unfortunately, there is no bibliometric analysis in this field of study. This study aims to analyze published articles using bibliometrics, summarize the current research progress and hot topics in this field systematically and exhaustively, and predict the future direction and trend of research.

Methods

For this study, the Web of Science Core Collection (WoSCC) database was searched between 2002 and 2022 for publications related to adolescent insomnia. The R-bibliometrix, VOSViewer, and CiteSpace software were utilized for bibliometric analysis.

Results

This investigation included 2468 publications from 3102 institutions in 87 countries, led by China and the United States. This field of research has entered a period of rapid development since 2017. The journal with the most publications on adolescent insomnia is Sleep, which is also the most co-cited journal. American Journal of Psychology has the highest impact factor among the top 10 journals. These papers were written by 10605 authors; notably, Liu Xianchen emerged as the author with the highest frequency of publications, while Mary A. Carskadon was the most frequently co-cited author. Mental health and comorbid diseases were the main research directions in this field. "Depression," "anxiety," "mental health," "COVID-19," "stress," "quality of life," "heart rate variability," and "attention-deficit hyperactivity disorder" were hot spots and trends in this field at the current moment.

Conclusion

The research on adolescent insomnia has social value, research value, and research potential; its development is accelerating, and an increasing number of researchers are focusing on it. This study summarized and analyzed the development process, hot spots, and trends of adolescent insomnia research using bibliometric analysis, which identified the current hot topics in this field and predicted the development trend for the future.

Using Nightly Sleep Guidelines to Address Links Between Adolescents' Self-Reported Weekly Sleep Patterns and Anxiety and Depression Symptoms

Short and long nightly sleep durations are associated with anxiety and depression symptoms among adolescents. However, studies have not used recommended hours of nightly sleep or focused on sleep patterns across weekdays and weekends in examining links with anxiety and depression symptoms. The present study included 709 adolescents in Grade 11 (402 females; 307 males) who self-reported hours of sleep on weeknights and weekends and anxiety and depression symptoms. Using the recommended 8-10 h to define average nightly sleep for adolescents, sleep patterns across weekdays and weekends were categorised into seven classes: short stable, short increasing, average decreasing, average stable, average increasing, long decreasing, and long stable. Relative to average stable sleepers, short stable, short increasing, and long stable sleepers had significantly higher anxiety and depression. Adolescents require 8-10 h of sleep on weeknights, regardless of weekends, for optimal emotional wellbeing.

Sleep Deprivation and Insomnia in Adolescence: Implications for Mental Health

Sleep changes significantly throughout the human lifespan. Physiological modifications in sleep regulation, in common with many mammals (especially in the circadian rhythms), predispose adolescents to sleep loss until early adulthood. Adolescents are one-sixth of all human beings and are at high risk for mental diseases (particularly mood disorders) and self-injury. This has been attributed to the incredible number of changes occurring in a limited time window that encompasses rapid biological and psychosocial modifications, which predispose teens to at-risk behaviors. Adolescents’ sleep patterns have been investigated as a biunivocal cause for potential damaging conditions, in which insufficient sleep may be both a cause and a consequence of mental health problems. The recent COVID-19 pandemic in particular has made a detrimental contribution to many adolescents’ mental health and sleep quality. In this review, we aim to summarize the knowledge in the field and to explore implications for adolescents’ (and future adults’) mental and physical health, as well as to outline potential strategies of prevention.

Sleep and Mental Health Problems in Children and Adolescents

Previous reviews have described the links between sleep and mental health extensively. In this narrative review, we focus on literature published during the last decade investigating the links between sleep and mental health difficulties in childhood and adolescence. More specifically, we focus on the mental health disorders listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders. We also discuss possible mechanisms underlying these associations. The review ends with a discussion of possible future lines of enquiry.

Negative social media-related experiences and lower general self-efficacy are associated with depressive symptoms in adolescents

Social media are an integral part of adolescents' daily lives, and reviews have suggested an overall small association between more social media use and mental health problems. However, researchers have commonly investigated social media use in a time use perspective, rendering nuances in adolescents' social media experience less well explored. Thus, studies of relationships between social media use and mental health problems need also examine the nature of the events taking place on social media. This study aimed to examine depressive symptoms in adolescents in relationship to time spent on social media, negative social media-related experiences, and general self-efficacy. Data collected in a national survey, Ungdata 2021 (n = 139,841), was used. Multivariate linear regression analyses showed that time spent on social media was associated with depressive symptoms (β = 0.09, p < 0.001). However, negative social media-related experiences were more strongly associated with depressive symptoms (β ranging 0.09-0.22, all p < 0.001), and their inclusion weakened the initial association between time on social media and depressive symptoms. General self-efficacy was directly associated with lower symptom levels (β = -0.29, p < 0.001) but did not change the associations between social media use and depressive symptoms. The findings imply that not only time spent on social media, but in particular negative social media-related experiences, are related to depressive symptoms in Norwegian adolescents. General self-efficacy is an important resource for adolescents' mental health.

Sleep-Related Drug Therapy in Special Conditions: Children

Pharmacologic treatment of the most common pediatric sleep disorders lacks evidence, and alternative methods, which have been proved to alleviate the symptoms, are preferred in most cases. The implementation of specific guidelines is of great importance because sleep disorders in children are not rare and they can negatively affect children's development and their cognitive and social skills. This article summarizes the current therapeutic management of sleep disorders in children, bearing in mind the absence of evidence-based guidelines on this topic.

Investigating the prevalence of and factors associated with depressive symptoms among urban and semi-urban school adolescents in Bangladesh: a pilot study

BACKGROUND

Adolescent depression is an alarming issue for Bangladesh since a large number of Bangladeshi adolescents suffer from depression but cannot get proper treatment. This study aimed to investigate the prevalence of depression and factors associated with this psychological health hazard among urban and semi-urban adolescents of the Dhaka region in Bangladesh.

METHODS

A cross-sectional pilot study was performed among 311 adolescents, grades 8-10, in Dhaka city and Savar Upazila, adjacent to the city, in 2018. Data were collected using a questionnaire consisting of items on sociodemographics, lifestyle information, screen-based sedentary behaviour (SBSB) and mental health.

RESULTS

A total of 36.6% of the adolescents reported depressive symptoms, with a greater prevalence among females (42.9%) than males (25.7%). Sociodemographic factors including being female, residence and grade in school were significantly associated with depression. Logistic regression analysis showed that SBSBs, such as the use of social media (odds ratio [OR] 2.06 [95% confidence interval {CI} 1.27-3.35]), high screen time (>120 min/day; OR 2.35 [95% CI 1.30-4.25]) and sleep disturbance (OR 3.93 [95% CI 2.37-6.50]) were significantly linked with depressive symptoms.

CONCLUSIONS

Depressive symptoms are prevalent among urban and semi-urban adolescents of Dhaka, Bangladesh. Therefore, urgent initiatives should be taken to curb the spread of depression among Bangladeshi adolescents.

Association of self-reported sleep problems with morbidities and multimorbidities according to sex: National Health Survey 2019

OBJECTIVE

To evaluate the association between self-reported sleep problems and the presence of non-communicable diseases (NCDs) and multimorbidity, and whether these associations differ by sex.

METHODS

This is a cross sectional study performed with data from the Brazilian National Health Survey, 2019. Prevalence ratios between morbidities, the number of NCDs, and the self-report of sleep problems were estimated by Poisson regression with robust variance, according to sex.

RESULTS

This study analysed data from 85,531 Brazilians age ≥ 18 years. The self-reported sleep problems were associated with all the herein studied morbidities and multimorbidities. The prevalence of sleep problems was higher in those who stated one or two (PR = 2.37; 95%CI 2.22;2.54) and three or more NCDs (PR = 4.73; 95%CI 4.37;5.11). Prevalence ratios of the association with diabetes, lung disease, mental disease, renal disease and multimorbidities were higher among males.

CONCLUSION

NCDs significantly impacted sleep quality, with a particularly stronger association in both, males and females.

Insomnia, sleep loss, and circadian sleep disturbances in mood disorders: a pathway toward neurodegeneration and neuroprogression? A theoretical review

The present paper aims at reviewing and commenting on the relationships between sleep and circadian phasing alterations and neurodegenerative/neuroprogressive processes in mood disorder. We carried out a systematic review, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, in PubMed, PsycINFO, and Embase electronic databases for literature related to mood disorders, sleep disturbances, and neurodegenerative/neuroprogressive processes in relation to (1) neuroinflammation, (2) activation of the stress system, (3) oxidative stress, (4) accumulation of neurotoxic proteins, and (5) neuroprotection deficit. Seventy articles were collectively selected and analyzed. Experimental and clinical studies revealed that insomnia, conditions of sleep loss, and altered circadian sleep may favor neurodegeneration and neuroprogression in mood disorders. These sleep disturbances may induce a state of chronic inflammation by enhancing neuroinflammation, both directly and indirectly, via microglia and astrocytes activation. They may act as neurobiological stressors that by over-activating the stress system may negatively influence neural plasticity causing neuronal damage. In addition, sleep disturbances may favor the accumulation of neurotoxic proteins, favor oxidative stress, and a deficit in neuroprotection hence contributing to neurodegeneration and neuroprogression. Targeting sleep disturbances in the clinical practice may hold a neuroprotective value for mood disorders.

Sleep duration, depressive symptoms, and digital self-harm among adolescents

BACKGROUND

This study examines the relationship between sleep duration, depression, and engagement in a novel cyber behavior, digital self-harm, among adolescents.

METHOD

Logistic regression analyses were conducted using cross-sectional data from the 2019 Florida Youth Substance Abuse Survey (N = 9,819; 48% male; avg. grade level = 9th grade [SD = 1.9]) to analyze the association between sleep duration and digital self-harm. A Karlson-Holm-Breen (KHB) analysis was used to assess whether depressive symptoms attenuate this association.

RESULTS

Bivariate results indicated that longer sleep duration was associated with lower incidence of digital self-harm. Multivariate results showed that sleep duration was inversely associated with engaging in digital self-harm, net of all covariates. Depressive symptoms attenuated the influence of sleep duration on digital self-harm by 50.72%.

CONCLUSIONS

Both insufficient sleep and depressive symptoms were associated with engagement in digital self-harm among adolescents. Prospective research is needed, however, to confirm this pathway. Practitioners and clinicians should consider discussing digital self-harm with adolescents and parents, especially if adolescents are experiencing poor sleep and depressive symptoms.

Factors influencing health-related quality of life in adolescent girls: a path analysis using a multi-mediation model

BACKGROUND

Recent studies have reported gender differences in adolescents' health-related quality of life (HRQOL), with females scoring significantly lower than males. Researchers have identified the female puberty process as one of the causes of the differences in HRQOL between male and female adolescents. This study examines mechanisms of how social support, dietary habits, sleep quality, and depression contribute to predicting HRQOL in relation to menstrual health among adolescent girls.

METHODS

A cross-sectional study was conducted with 295 students recruited from middle and high schools in Korea using a self-report questionnaire. A multi-mediation model was constructed based on previous literature and tested using path analysis with AMOS, version 21.0.

RESULTS

The study results showed that menstrual health, social support, sleep quality, dietary habits, and depression had significant effects on HRQOL. Both sleep quality and depression had significant direct effects on menstrual health. Dietary habits, social support, sleep quality, and depression had significant indirect effects on HRQOL, mediated through menstrual health. According to serial mediation analysis, the path from social support to HRQOL via dietary habits → sleep quality → depression → menstrual health → HRQOL was significant. However, mediation models including the path of dietary habits → depression were not supported. The study variables explained 57% of the total variance for HRQOL.

CONCLUSIONS

The findings suggest menstrual health is an important factor that mediates the effects of eating, sleeping, psychological health, and social support on HRQOL. Early complaints about sleep disorders and depressive symptoms with poor dietary habits could be an ominous sign for adolescent girls at high risk of menstrual problems and lower HRQOL. Empirical evidence from this study suggests the need to develop and test interventions addressing multiple modifiable behavioral and psychosocial factors to improve HRQOL in adolescent girls. Interventions or supportive systems that aim to improve eating habits and sleep quality thereby achieving a healthier lifestyle need to be developed and incorporated into school health services.

Effectiveness of Digital Cognitive Behavioral Therapy for Insomnia in Young People: Preliminary Findings from Systematic Review and Meta-Analysis

Various forms of cognitive behavioral therapy for insomnia (CBT-i) have been developed to improve its scalability and accessibility for insomnia management in young people, but the efficacy of digitally-delivered cognitive behavioral therapy for insomnia (dCBT-i) remains uncertain. This study systematically reviewed and evaluated the effectiveness of dCBT-i among young individuals with insomnia. We conducted comprehensive searches using four electronic databases (PubMed, Cochrane Library, PsycINFO, and Embase; until October 2021) and examined eligible records. The search strategy comprised the following three main concepts: (1) participants were adolescents or active college students; (2) dCBT-I was employed; (3) standardized tools were used for outcome measurement. Four randomized controlled trials qualified for meta-analysis. A significant improvement in self-reported sleep quality with a medium-to-large effect size after treatment (Hedges’s g = −0.58~−0.80) was noted. However, a limited effect was detected regarding objective sleep quality improvement (total sleep time and sleep efficiency measured using actigraphy). These preliminary findings from the meta-analysis suggest that dCBT-i is a moderately effective treatment in managing insomnia in younger age groups, and CBT-i delivered through the web or a mobile application is an acceptable approach for promoting sleep health in young people.

A Comprehensive Review of the Literature on Sleep Difficulties and Suicidality in Youth to Inform an Integrative Developmental Model and Future Directions

Purpose of Review

Suicide is currently the second leading cause of death among youth. Identification of modifiable near-term risk factors can inform suicide prevention strategies. One promising, readily assessed factor is sleep. We critically review the literature on sleep and suicidal thoughts and behaviors among youth.

Recent Findings

Most studies examining the youth sleep-suicidality relationship are from epidemiological samples in which both sleep problems and suicidality were assessed over variable timeframes using limited items from scales not designed to measure these constructs. Nonetheless, these data overwhelmingly support an association between suicidality and a range of sleep difficulties (e.g., insomnia, short/long sleep, weekend oversleep), above and beyond depressive symptoms. Limited studies include clinical samples or prospective designs. We review potential mechanisms and present a developmentally-informed integrative model.

Summary

Literature supports a clear association between sleep difficulties and youth suicidality. Future directions include prospective longitudinal studies and targeted prevention efforts.

Sleep and mental health in childhood: a multi-method study in the general pediatric population

BACKGROUND

Sleep problems, altered sleep patterns and mental health difficulties often co-occur in the pediatric population. Different assessment methods for sleep exist, however, many studies only use one measure of sleep or focus on one specific mental health problem. In this population-based study, we assessed different aspects of sleep and mother-reported mental health to provide a broad overview of the associations between reported and actigraphic sleep characteristics and mental health.

METHODS

This cross-sectional study included 788 children 10-11-year-old children (52.5% girls) and 344 13-14-year-old children (55.2% girls). Mothers and children reported on the sleep of the child and wrist actigraphy was used to assess the child's sleep patterns and 24 h activity rhythm. Mental health was assessed via mother-report and covered internalizing, externalizing and a combined phenotype of internalizing and externalizing symptoms, the dysregulation profile.

RESULTS

Higher reported sleep problems were related to more symptoms of mental health problems in 10-11- and 13-14-year-old adolescents, with standardized ß-estimates ranging between 0.11 and 0.35. There was no association between actigraphy-estimated sleep and most mental health problems, but earlier sleep onset was associated with more internalizing problems (ß = - 0.09, SE = 0.03, p-value = 0.002), and higher intra-daily variability of the 24 h activity rhythm was associated with more dysregulation profile symptoms at age 10-11 (ß = 0.11, SE = 0.04, p-value = 0.002).

DISCUSSION

Reported sleep problems across informants were related to all domains of mental health problems, providing evidence that sleep can be an important topic to discuss for clinicians seeing children with mental health problems. Actigraphy-estimated sleep characteristics were not associated with most mental health problems. The discrepancy between reported and actigraphic sleep measures strengthens the idea that these two measures tap into distinct constructs of sleep.

Association between the CLOCK gene polymorphism and depressive symptom mediated by sleep quality among non-clinical Chinese Han population

BACKGROUND

Depression is a common mental disorder associated with sleep problems and the circadian clock genes may underlie the relationship between the two in clinical samples. However, little is known about whether poor sleep quality is associated with depressive symptom in healthy individuals and whether is mediated by specific single-nucleotide polymorphisms (SNPs).

METHODS

Using a cross-sectional design, 444 university staff members were randomly recruited in Beijing. We used the Pittsburgh Sleep Quality Index (PSQI) to measure sleep quality, the Zung's Self-rating Depression Scale (SDS) to measure depressive symptom, and the Work Stress Scale to measure job stress. The CLOCK gene rs12649507 polymorphism was genotyped in 289 blood samples.

RESULTS

There were positive inter-correlations between job stress, PSQI and SDS (almost ps < 0.05). GG homozygotes of the SNP had higher PSQI and its sleep duration and daytime dysfunction scores than AA homozygotes (all Bonferroni corrected ps0.05). The SNP had no main effect on the SDS and did not interact with job stress to affect SDS, PSQI and its dimensions (all ps > 0.05). Interestingly, after controlling for job stress and covariates, the significant effect size of the SNP on the SDS mediated by the PSQI was 0.68 (95% CI [0.24, 1.35]).

LIMITATIONS

Some limitations included single professional background, cross-sectional study design, small sample size and potential confounding factors, which could be amended by future research.

CONCLUSIONS

Non-clinical Chinese carrying CLOCK gene rs12649507 G-allele may lead to poor sleep quality and further depression symptoms.

Emerging mental health problems during the COVID-19 pandemic among presumably resilient youth -a 9-month follow-up

BACKGROUND

The COVID-19 pandemic may have multifarious adverse effects on the mental health of some youth. To our knowledge, no study has followed young people beyond the first 6 months of the pandemic outbreak. The aim of this study was to examine 1) Change in internalizing, externalizing, and total mental health problems over two time-points with a nine-month interval during the COVID-19 outbreak and 2) Whether contextual and COVID-19-related factors contribute to change in mental health problems.

METHODS

Youth within the municipality of Bergen aged 11-19 years were invited via SMS to participate in an online survey in April and again in December 2020. A total of 2997 (40% response rate) youth participated at baseline in the present study, and 1598 (53.3%) completed the second survey. At baseline, the mean age was 16.0 (standard deviations 1.7) years, about 60% were girls, and 93% were born in Norway. Comparison across time was approached using inferential statistics and mixed linear models with maximum likelihood estimation and mixed-effects logistic regression models.

RESULTS

There was an overall increase in total mental health problems from the first weeks into lockdown to 9 months after the pandemic outbreak. The overall increase seems to be exclusively driven by internalizing difficulties, i.e., increases in emotional problems and peer problems. The level of externalizing difficulties, i.e., conduct problems and hyperactivity/inattention remained stable between the two time-points.

CONCLUSIONS

Our results imply that in the wake of the pandemic, one should be aware of emerging mental health problems among presumably resilient youth, in addition to the more expected and pronounced mental health needs of vulnerable groups. Efforts to reach out to the general youth population with preventive measures in schools may be important actions to normalize the situation for young people, and to identify those in need of more targeted mental health interventions.

The relationship between sleep and depression and bipolar disorder in children and young people

BACKGROUND

Sleep difficulties are often reported in practice, and are part of the diagnostic criteria for depression and bipolar disorder.

AIMS

To inform the understanding of the relationship between sleep and both depression and bipolar disorder.

METHOD

We conducted a narrative literature review of affective disorders and sleep difficulties in children and young people.

RESULTS

Specific sleep disorders, such as parasomnias, narcolepsy and sleep-related movement disorders, are associated with depression, whereas insomnia, obstructive sleep apnoea and circadian rhythm disorders are associated with both depression and bipolar disorder in children and young people. Conversely, children and young people with depression can present with a number of sleep difficulties, and these are associated with higher depression severity and greater fatigue, suicidal ideation, physical complaints, pain and decreased concentration. Sleep disturbances among adolescents with bipolar disorder can affect the severity of depressive and manic symptoms, are a poor prognostic indicator and have been associated with social and academic impairment. Antidepressants and antipsychotics can directly affect sleep architecture, which clinicians need to be aware of. Non-pharmacological interventions for sleep problems could prevent and/or minimise the risk of relapse in affective disorders.

CONCLUSIONS

Sleep difficulties can occur before, during and after an episode of depression or bipolar disorder, and have a higher prevalence in affective disorders compared with the general population. A multi-modal approach would include the treatment of both the affective and specific sleep disorder. Further research is needed in this field to understand the impact of combined interventions on clinical outcomes.

Sleep disorders mediate the link between childhood trauma and depression severity in children and adolescents with depression

BACKGROUND

Childhood trauma is closely related to the onset of depression and more severe depressive symptoms; however, the specific mechanisms are unclear. We aimed to examine the relationship between childhood trauma and sleep disorders in children and adolescents with depression and to explore further the role of sleep disorders in the relationship between childhood trauma and depression severity.

METHODS

A total of 285 children and adolescents with depression completed all scale assessments, including the Childhood Trauma Questionnaire, Self-Reported Insomnia Severity Index and Epworth Sleepiness Scale, and the Center for Epidemiologic Studies Depression Scale. A simple mediation model was used as a theoretical model to examine whether sleep disorders could mediate the relationship between childhood trauma and depression severity.

RESULTS

Among children and adolescents with depression, childhood trauma is about 78.9%. Compared with patients without childhood trauma, patients with childhood trauma had a higher incidence of sleep disorders (Z = 17.59, P < 0.001), which were characterized by insomnia (Z = 14.45, P < 0.001), not hypersomnia (Z = 2.77, P = 0.096). Different childhood trauma subtypes significantly affected sleep disorders and insomnia (all P < 0.05). Insomnia partially mediated the relationship between childhood trauma and depression severity, and the mediating effect accounted for 35.90%.

CONCLUSION

This study found a high rate of concurrent childhood trauma and insomnia among children and adolescents with depression. Insomnia, as a mediator between childhood trauma and depression severity, partially mediates the relationship.

Insomnia in survivors 8.5 years after the Utøya Island terrorist attack: transition from late adolescence to early adulthood - the Utøya study

BACKGROUND

Insomnia is a global health concern, associated with many mental and physical health conditions. Prevalence of insomnia is reported to increase during adolescence and early adulthood. High levels of insomnia are also reported in adolescents up to 2.5 years after a traumatic event. What is less well understood is the prevalence of insomnia in a trauma exposed population transitioning from adolescence to adulthood.

OBJECTIVE

To assess insomnia in the survivors in the 2011 Utøya Island terrorist attack, 2.5 years and 8.5 years after the attack when the majority of survivors were transitioning from late adolescence to early adulthood.

METHOD

Participants were 336 survivors of the Utøya Island attack who completed the Utøya Study 2.5 years (T3) and 8.5 years (T4) after the attack. Participants completed a face-to-face interview including the Bergen Insomnia Scale (BIS), which was used to assess insomnia symptoms and prevalence of meeting diagnostic criteria for insomnia.

RESULTS

Insomnia was indicated in 47.7% of survivors 8.5 years after the attack. Insomnia prevalence did not significantly change from 2.5 to 8.5 years after the attack, though insomnia symptoms (BIS sum score) were found to increase. Age was negatively associated with insomnia at T4, with older age being associated with less insomnia. No significant sex difference was found in insomnia prevalence at T4.

CONCLUSION

Almost a decade after the Utøya Island terrorist attack, nearly a half of the young survivors in our study reported insomnia and typical age- and sex-related differences in sleep were not always seen. This rate is almost double what is reported in the general population (20-30%) indicating a high level of unmet need in this population. The implications of such sleep disruption during a critical time for physical, mental, social and cognitive development are far reaching.

Family stress during the pandemic worsens the effect of adverse parenting on adolescent sleep quality

BACKGROUND

Adverse parenting is consistently associated with increased sleep problems among adolescents. Shelter-in-Place restrictions and the uncertainty linked to the Covid-19 pandemic have introduced new stressors on parents and families, adding to the risk for youth's sleep problems.

OBJECTIVE

Using multidimensional assessments of child maltreatment (CM; threat vs. deprivation), the present study examined whether parent-report and child-report of Covid-19 related stress potentiated the effect of CM on sleep problems among boys and girls.

PARTICIPANTS AND SETTING

The study focused on a sample of 124 dyads of adolescents (Mage = 12.89, SD = 0.79; 52% female) and their primary caregivers (93% mothers) assessed before and during the pandemic (May to October 2020).

METHOD

Data were obtained from both youth and their parents. Structural equation modeling (SEM) was used to test all study hypotheses. Simple slopes and Johnson-Neyman plots were generated to probe significant interaction effects.

RESULTS

Deprivation, but not threat, directly predicted increased sleep problems among boys during the pandemic. Additionally, elevation in Covid-19 stress (both parent and child report) intensified the link between CM (threat and deprivation) and sleep problems among boys.

CONCLUSION

Our findings inform prevention and intervention efforts that aim to reduce sleep problems among boys during stressful contexts, such as the Covid-19 pandemic.

Preexisting Depression and Daytime Sleepiness in Women and Men

BACKGROUND

Sleep problems can persist following the treatment of depression and remission of symptoms. The extent to which having a previous history of depression may be associated with current daytime sleepiness is largely unknown.

METHODS

Data were obtained from the spring 2017 American College Health Association-National College Health Assessment (ACHA-NCHA) survey (92 institutions) which assessed self-reported health in U.S. college students (n = 41,670). Among the sample, 93.5% were 18-24 year of age, and 69.6% women. Logistic regression estimated the association between reported prior lifetime diagnosis of depression and daytime sleepiness from the past 7 days, while adjusting for depressive symptoms and antidepressant use from the past year. Unadjusted and adjusted logistic regression models stratified by gender were performed.

RESULTS

Among those who reported problems with sleepiness, 31.6% women and 19.4% men had a preexisting depression diagnosis. Individuals with preexisting depression were more likely than those without this diagnosis to report sleepiness problems (women: OR = 1.4, CI = 1.3-1.6, p < .001; men: OR = 1.2, CI = 1.0-1.4, p < .01). However, this association differed significantly by gender, with women with a preexisting depression diagnosis having a 13.0% greater likelihood of sleepiness compared to men.

CONCLUSIONS

Those with a preexisting depression diagnosis, and specifically women, may be at risk for daytime sleepiness even in the absence of current depressive mood-related symptoms. Given that many individuals are at risk for daytime sleepiness, mental health initiatives, including those on college campuses, should incorporate sleep hygiene within their programming.

Sleep patterns and insomnia among adolescents receiving child welfare services: A population-based study

OBJECTIVES

Sleep problems are common in adolescence. We aimed to investigate sleep patterns and insomnia in Norwegian adolescents who have been in contact with child welfare services (CWS), both adolescents living in foster care (FC) and adolescents receiving in-home-services (IHS). Both groups were compared to youth who reported they were not receiving child welfare interventions.

DESIGN

Cross-sectional.

SETTING

The population-based study youth@hordaland from 2012 in Hordaland, Norway.

PARTICIPANTS

About 9421 adolescents (53.8% girls), age range 16-19 years, were divided into 3 groups; IHS group (n = 123), FC group (n = 132), and control group (n = 9166).

MEASUREMENTS

Self-reported information about demographics, detailed sleep patterns, sleep problems, and adverse life events.

RESULTS

Adolescents receiving IHS (vs. controls) had significantly shorter sleep duration, lower sleep efficiency, longer sleep onset latency (SOL), wake after sleep onset (WASO), and higher prevalence of insomnia. They had increased odds of insomnia (adjusted odds ratio [AOR] = 1.77, 95% confidence interval [CI] = 1.19-2.62) and SOL ≥ 30 minutes (AOR = 1.95, CI = 1.32-2.87). Adolescents in FC (vs. controls) reported lower sleep efficiency and longer WASO. When adjusting for sex and age, the associations did not substantially change. When additionally adjusting for adverse life events, the associations were considerably attenuated for both groups, and were no longer significant for the FC group.

CONCLUSION

Our results indicate a higher rate of sleep problems among adolescents receiving interventions from CWS, particularly those receiving IHS. Adverse life events accounted for a substantial part of the increased risk of sleep problems.

Association of Nighttime Sleep Duration with Depressive Symptoms and Its Interaction with Regular Physical Activity among Chinese Adolescent Girls

Depression has become a major mental health concern among adolescents globally, and the relationship between depressive symptoms and nighttime sleep duration among adolescent girls remains unclear. This study aimed to examine the association between nighttime sleep duration and depressive symptoms among Chinese adolescent girls. This cross-sectional study, conducted in 2018, included 4952 girls aged 10-19 years from the eastern, central, and western regions of China. Depressive symptoms were assessed by the Patient Health Questionnaire-9, and categorized into depressive symptoms and non-depressive symptoms. Logistic regression models were used to estimate the odds ratios (ORs) of depressive symptoms. After adjustment for covariates, adolescent girls with a nighttime sleep duration of <7 h/night (OR = 2.28, 95% CI: 1.76-2.95) and 7 h/night (OR = 1.82, 95% CI: 1.48-2.24) were associated with increased risk of depressive symptoms, compared to those with a sleep duration of 8 h/night. An interaction between nighttime sleep duration and regular physical activity on the risk of depressive symptoms was observed (p for interaction = 0.036). Among both girls with and without regular physical activity, a sleep duration of <7 h/night was associated with increased odds of depressive symptoms, and the magnitude of the ORs among girls with regular physical activity was lower than those without regular physical activity. This study found a significant association of short nighttime sleep duration with increased risk of depressive symptoms, and demonstrates the importance of maintaining adequate nighttime sleep duration and ensuring regular physical activity in improving depressive symptoms among adolescent girls.

Association between Depressed Mood and Sleep Duration among Various Ethnic Groups-The Helius Study

Background: We examined the association between depressed mood (DM) and sleep duration in a multi-ethnic population in Amsterdam, and the extent to which DM accounts for both short and long sleep. Methods: Cross-sectional data using 21,072 participants (aged 18–71 years) from the HELIUS study were analyzed. Sleep duration was classified as: short, healthy, and long (<7, 7–8, and ≥9 h/night). A Patient Health Questionnaire (PHQ-9 sum score ≥10) was used to measure DM. The association between DM and sleep duration was assessed using logistic regression. The extent to which DM accounted for short and long sleep was assessed using a population attributable fraction (PAF). Results: DM was significantly associated with short sleep in all ethnic groups after adjustment for other covariates (OR 1.9 (1.5–2.7) in Ghanaians to 2.5 (1.9–32) in the Dutch). DM was not associated with long sleep except in the Dutch (OR 1.9; 1.3–2.8). DM partly accounted for the prevalence of short sleep with PAF ranging from 3.5% in Ghanaians to 15.5% in Turkish. For long sleep, this was 7.1% in the Dutch. Conclusions: DM was associated with short sleep in all ethnic groups, except in Dutch. If confirmed in longitudinal analyses, strategies to reduce depression may reduce the prevalence of short sleep in concerned groups.

Prevalence of depressive symptoms among older children and young adolescents: a longitudinal population-based study

Introduction

This paper investigates levels of depressive symptoms among older children and young adolescents, 11-14 years of age. The population-based sample was assessed twice during a 12-month period. Point-prevalence, 12-month prevalence, and 12-month incidence were measured by a validated self-reported scale (SFMQ) and are presented in this paper.

Methods

A total of 2148 pupils were invited to participate in this study, and 1748 pupils and at least one parent/guardian provided informed consent. The population was assessed twice within one 12-month period resulting in 1439 participants at both data collection points. Depressive symptoms were measured by a validated self-reported scale, The Short Mood and Feelings Questionnaire (SMFQ).

Results

The results indicate that the point-prevalence was just under 10% in 6^th to 10^th grade with a 12-month prevalence at almost 3%. The results also indicate an incidence rate of 4.5% over 12-months. This study confirms that girls report a higher range of point prevalence, 12- month-prevalence, and 12-month incidence compared to boys.

Conclusions

The results indicate that depressive symptoms among children and young adolescents is a serious health challenge. The results demonstrate substantial gender differences even at an early age (11-14 years), where girls report significantly higher point prevalence, 12-month-prevalence, and 12-month incidence compared to boys. Results from this study suggest that depressive symptoms are an important problem that young adolescents face, and the study underlines the need for more intervention tailored to gender at the middle-school level, especially with respect to those children and adolescents who experience persistent depressive symptoms.

Elevated risk of depression among adolescents presenting with sleep disorders

STUDY OBJECTIVES

Depression is prevalent among patients with sleep disorders, and studies show associations between suicidal ideation and insufficient sleep. Using retrospective clinic records, we examined positive depression screening rates among adolescent sleep clinic patients relative to other subspecialty clinic patients. We also examined relationships between sleep diagnoses and positive depression screening rate in adolescent sleep clinic patients.

METHODS

Data were analyzed from patients ages 12-18 (n = 12,520) who were screened for depression using the Patient Health Questionnaire-2 (PHQ-2). Those who screened positive were administered the PHQ-9. Logistic regression was used to examine effects of age, sex, race, ethnicity, and clinic on likelihood of a positive depression screen. Within sleep clinic patients (n = 308), demographic factors, sleep disorder diagnosis, and body mass index percentile were examined using logistic and linear regression.

RESULTS

Among all patients screened, older age and female sex predicted positive depression screens. Sleep clinic patients were more likely to screen positive than patients in 9 other clinics [odds ratios 2.03-6.83]. Results were similar even when the PHQ-9 sleep item was excluded [odds ratios 2.18-6.41]. Within sleep clinic patients, sleep disorder diagnosis (eg, insomnia, obstructive sleep apnea) was predictive of a positive depression screen (χ²(1) = 10.88, P = .004): insomnia patients were most likely to be experiencing depression.

CONCLUSIONS

Adolescent sleep clinic patients are at increased risk for depressive symptoms. Among insomnia patients, risk was independent of age, sex, and obesity, suggesting a unique relationship between insomnia and affective distress, as has been found in adults. Assessing adolescents for sleep disorders should be prioritized, given the strong association with depression.

Prevalence of depression, anxiety and associated factors among school going adolescents in Bangladesh: Findings from a cross-sectional study

BACKGROUND

Common mental disorders in early life represent a major concern as they become more complex and intense with transition into adolescence. Despite global recognition of the significance of adolescent mental health, it remains a neglected area in research and health policy in Bangladesh. This study aimed to investigate the prevalence and factors associated with depression and anxiety among school going adolescents in Bangladesh.

METHODS

A cross-sectional survey was conducted among 563 students aged 13-18 years at selected schools (secondary and higher secondary) in Dhaka City. After providing written informed consent, participants completed a survey examining socio-demographic variables, along with the PHQ-9 and GAD-7 scales. Logistic regression was used to examine associations between variables under examination.

RESULTS

The prevalence rates of moderate to severe levels of depression and anxiety were 26.5% and 18.1%, respectively. Based on multivariable analyses, unsatisfactory sleep (AOR = 3.17; 95% CI = 1.81-5.53, p < .001), cigarette smoking (AOR = 2.00; 95% CI = 1.01-3.97, p = .048), and anxiety (AOR = 10.47; 95% CI = 6.11-17.95, p < .001) were associated with depression. Anxiety was associated with being 15-16 years (AOR = 2.66; 95% CI = 1.18-6.00, p = .018), not having good perceived relationships with friends (AOR = 2.10; 95% CI = 1.24-3.56, p = .006) and depression (AOR = 10.22; 95% CI = 6.01-17.38, p < .001).

CONCLUSIONS

Depression and anxiety were prevalent among school going adolescents in Bangladesh. The findings suggest epidemiological data can direct policy-level decisions regarding evaluation, prevention, and intervention of mental health conditions among school going adolescents in Bangladesh.

Sleep Duration and Insomnia in Adolescents Seeking Treatment for Anxiety in Primary Health Care

There is limited knowledge about sleep in adolescents with elevated levels of anxiety treated within primary health care settings, potentially resulting in sleep problems not being sufficiently addressed by primary health care workers. In the current study self-reported anxiety, insomnia, sleep onset latency, sleep duration, and depressive symptoms were assessed in 313 adolescents (12–16 years; mean age 14.0, SD = 0.84, 84.0% girls) referred to treatment for anxiety within primary health care. Results showed that 38.1% of the adolescents met criteria for insomnia, 34.8% reported short sleep duration (<7 h), and 83.1% reported long sleep onset latency (≥30 min). Total anxiety symptoms were related to all sleep variables after controlling for age and sex. Furthermore, all anxiety symptom sub-types were associated with insomnia and sleep onset latency, whereas most anxiety subtypes were associated with sleep duration. Adolescents’ depressive symptoms accounted for most of the anxiety-sleep associations, emphasizing the importance of depressive symptoms for sleep. However, anxiety was associated with insomnia and sleep onset latency also among youth with low levels of depressive symptoms. The findings suggests that primary health care workers should assess sleep duration, sleep onset latency, and insomnia in help-seeking adolescents with anxiety.

Sleep problems in children and adolescents following traumatic life events

Rates of childhood trauma exposure are extremely high, with approximately 70% of children and adolescents experiencing at least one traumatic event. Among the most common non-specific consequences of stress and trauma are disruptions of sleep. Sleep problems, such as shorter sleep duration, difficulty falling asleep, frequent awakenings, nightmares, sleepless nights, and early-morning wakefulness appear to have a higher prevalence among children and adolescents following traumatic events. This review will illustrate the role of sleep problems in traumatized children and adolescents, and emphasize the need to consider a wide range of etiological mechanisms for these symptoms. However, the relationship of trauma exposure to sleep problems among children and adolescents needs further investigation in future research. Moreover, in view of the adverse consequences of long-term disrupted sleep on mental health outcomes following trauma, the need to effectively address sleep disturbances in traumatized children and adolescents is crucial.

Identifying patterns of movement behaviours in relation to depressive symptoms during adolescence: A latent profile analysis approach

Movement behaviour guideline adherence has been associated with lower depressive symptoms during adolescence, yet no studies have used person-centered approaches to examine this relationship. The purpose of the present study was to identify whether unique adolescent movement behaviour profiles exist, evaluate predictors of profile membership, and determine whether profile membership was associated with differences in depressive symptoms cross sectionally and longitudinally. This study involved secondary analysis of the public-use data from Wave 1 and Wave 2 of the National Study of Adolescent Health. Adolescents (N = 6436; 48% male) in grades 7 to 12 (M_age = 16.03 ± 1.75) completed measures to assess moderate-to-vigorous physical activity (MVPA), recreational screen time (ST), and sleep - collectively known as movement behaviours - and depressive symptoms. Latent profile analysis identified four profiles that had similar sleep patterns and were thus characterized by different levels of MVPA and ST: high MVPA/low ST (29%), high MVPA/high ST (4%), low MVPA/low ST (53%), and low MVPA/high ST (14%). Several socio-demographic variables were found to influence profile membership. After adjusting for covariates, findings revealed depressive symptoms were lowest among the high MVPA/low ST profile and this trend was evident one year later. Engaging in high levels of either MVPA or ST alone did not provide additive benefits for depressive symptoms compared to those who engaged in low levels of both MVPA and ST. These findings suggest intervention efforts should take an integrative approach to improve mental health outcomes among adolescents by considering each of the movement behaviours concurrently.

Chronic Sleep Reduction in Childhood and Adolescence

BACKGROUND

Habitually shortened nighttime sleep is a common phenomenon in childhood and adolescence, sometimes associated with chronic sleep reduction (CSR). CSR is associated with impairments of performance ability and emotional well-being. The extent to which children and adolescents in Germany suffer from CSR is unclear; it is also unclear what factors are predictive of CSR.

METHODS

In the present study, we carried out a telephone survey in a representative sample of 998 children and adolescents aged 12 to 17, asking them about their sleep behavior, sleep disturbances, and mental well-being. A standardized method was used.

RESULTS

The point prevalence of CSR was found to be 12.5% (95% confidence interval, [10.5; 14.6]). Children and adolescents affected by CSR reported a significantly higher frequency of insomnia, delayed sleep-phase syndrome, restless legs syndrome, and obstructive sleep apnea. Female sex, pro - longed absence from school or vocational training, emotional and behavioral disturbances, age over 15 years, bedtimes after 10:38 pm on nights before school (or vocational training), getting up after 10:04 on days off, and reported insomnia were all associated with CSR, with odds ratios (OR) ranging from 2.2 to 21.1 (R2 = 0.32 in a logistic regression model).

CONCLUSION

One in eight persons aged 12 to 17 in Germany, particularly girls, meets the criteria for CSR. CSR is associated with sleep disturbances and significantly impaired mental health and should, therefore, always be kept in mind in routine clinical practice. We provide a set of indicators for possible CSR that patients can easily be asked about.

A meta-analysis of the relationship between subjective sleep and depressive symptoms in adolescence

BACKGROUND

Adolescence is a risk period for the development of mental illness, as well as a time for pronounced change in sleep behaviour. While prior studies, including several meta-analyses show a relationship between sleep and depressive symptoms, there were many inconsistences found in the literature.

OBJECTIVE

To investigate the relationship between subjective sleep and depressive symptoms.

METHODS

Following PRISMA guidelines, we conducted a literature search that yielded forty-nine recent studies (2014-2020) with adolescent samples aged 9 to 25-year-olds, and more than double the sample size of previous meta-analyses (N = 318,256).

RESULTS

In a series of meta-analyses, we show that while several common categories of subjective sleep are associated with depressive symptoms in adolescents, the strength of this relationship varies. Measures of sleep perception: poor sleep quality (r = 0.41), insomnia (r = 0.37), sleep disturbances (r = 0.36), wake after sleep onset (r = 0.31), and daytime sleepiness (r = 0.30) correlated more strongly with depressive symptoms, than measures of sleep behaviour: sleep latency (r = 0.22), and sleep duration (r = -0.19).

CONCLUSIONS

These findings suggest that in studies of depressive symptoms it may be important to assess an adolescent's perception about their sleep, in addition to their sleep/wake behaviours.

Sex-Specific Moderation Effect of Age on the Associations Between Insomnia Symptoms and Various Psychological Distresses

BACKGROUND

Insomnia is closely related to psychological distress. This study aims to examine the role of age and sex in the association between various psychological distresses and insomnia symptoms.

PARTICIPANTS AND METHODS

This population-based study used data provided by cumulative respondents of the annual survey of the Taiwan Suicide Prevention Center between 2006 and 2019. Potential respondents were aged ≥15 years and were selected by a stratified proportional randomization method according to the distribution of population size, sex, and age in different geographic areas of Taiwan. The Five-Item Brief Symptom Rating Scale was used to measure insomnia symptoms and four psychological distresses: depression, anxiety, hostility, and inferiority. The independent relationship between insomnia symptoms with depression, anxiety, hostility, and inferiority was further examined according to age and sex.

RESULTS

A total of 28,649 participants were included (women, 50.2%). The four types of psychological distress correlated differentially with insomnia symptoms. Concerning interaction effects, sex moderated the interaction effects between age with depression, anxiety, and hostility. In men, and not in women, age moderated the relationship between insomnia symptoms and all four psychological distresses. Specifically, the effect sizes of the associations between insomnia symptoms and depression, anxiety, and hostility showed an age-dependent decreasing trend in men.

CONCLUSION

The associations between psychological distresses and insomnia symptoms varied in strength and according to age in a sex-specific manner.

Associations Between Transgender Identity, Sleep, Mental Health and Suicidality Among a North American Cohort of College Students

PURPOSE

The purpose of this study is to examine the associations between transgender identity, sleep, and mental health among a North American cohort of cisgender and transgender college students.

PARTICIPANTS AND METHODS

This cross-sectional study surveyed 221,549 North American college students from the 2016-2017 American College Health Association-National College Health Assessment II. Bivariate and multivariable analysis examined associations among transgender identity and outcomes of insomnia symptoms, daytime sleepiness, sleep disorder diagnoses and treatments. Mental health outcomes included mood symptoms, suicidal behaviors, anxiety and depression diagnoses and treatments.

RESULTS

Transgender identity was reported by 1.6% (n=3471) of United States (US) and 1.7% (n=717) Canadian students, respectively. Mean age was 22.5 ±6. Transgender college students have an increased prevalence of daytime sleepiness, insomnia symptoms, diagnoses and/or treatment of insomnia and other sleep disorders as compared to cisgender college students. Mental Health symptoms are more prevalent with a 2-fold increase in depression and anxiety and nearly a 4-fold increase in suicide attempts among transgender students. A higher burden of mood symptoms exists among transgender college students in the US in comparison to Canadian students.

CONCLUSION

Transgender college students have an alarmingly high rate of mood, sleep disturbances and sleep diagnoses, and suicidality. Colleges and universities must provide sufficient resources to address the sleep and mental health needs of transgender students. Institutions must adopt gender affirming policies that promote an inclusive environment. Increased allocation of resources and adoption of policies that enhance the physical and mental health of transgender students could improve sleep, mood, and potentially lower the suicide risk among a population that often experiences health inequities.

What types of insomnia relate to anxiety and depressive symptoms in late life?

Background

Symptoms of insomnia are associated with symptoms of depression and anxiety in older adults, yet less is known about the relation of specific forms of insomnia (i.e., onset, maintenance, and terminal insomnia) with these symptoms. This study explored how insomnia types related to symptoms of anxiety and depression in older adults. It was hypothesized that onset and maintenance insomnia would have stronger relations to anxiety and depressive symptoms than terminal insomnia.

Methods

One-hundred thirty-three older adults (mean age 69, age range 65–89) were recruited using Amazon's Mechanical Turk. Participants completed the Insomnia Severity Index, Geriatric Depression Scale-Short Form, and Geriatric Anxiety Inventory-Short Form.

Results

Regression analyses that controlled for the comorbidity between anxiety and depressive symptoms indicated that onset insomnia was the only independent predictor of anxiety symptoms, and maintenance insomnia was the only independent predictor of depressive symptoms, each of which had medium to large effect sizes.

Limitations

Our findings are limited by an online, primarily Caucasian, and non-clinical sample as well as the cross-sectional design of the study.

Conclusions

Our findings suggest that despite overlap between symptoms of depression and anxiety, insomnia may have different mechanisms of affecting each disorder. Thus, the type of insomnia is clinically relevant and should be assessed when symptoms of anxiety, depression, and/or sleep difficulties are reported.

Low-intensity sleep intervention in a youth mental health service: a case series analysis

BACKGROUND

There is increasing evidence of a strong association between sleep and mental health in both adolescents and adults. CBT for insomnia is being applied to good effect with adults with mental health difficulties but there are few studies examining its applicability to adolescents within mental health services.

METHOD

We carried out a case series analysis (n = 15) looking at the feasibility, accessibility and impact of a low-intensity sleep intervention for young people (14-25 years) being seen by a secondary care Youth Mental Health team in the UK. The intervention was based on cognitive behavioural therapy for insomnia (CBTi) and acceptance and commitment therapy (ACT) approaches and involved six individual sessions delivered on a weekly basis by a graduate psychologist. Routine outcome measures were used to monitor insomnia, psychological distress and functioning with assessments at baseline, session 3, session 6 and at 4 weeks after end of intervention. All participants scored in the clinical range for insomnia at the start of the study.

RESULTS

High uptake, attendance and measure completion rates were observed. Large effect sizes were observed for insomnia, psychological distress and functioning. Twelve of the fifteen participants (80%) no longer scored above threshold for insomnia at follow-up. All seven under-18s no longer met threshold for clinical 'caseness' on the Revised Child Anxiety and Depression Scale (RCADS) at follow-up.

DISCUSSION

The findings suggest that the intervention was well accepted by young people and feasible to apply within a secondary care setting. Strong effect sizes are encouraging but are probably inflated by the small sample size, uncontrolled design and unblinded assessments.

Association of Child and Adolescent Mental Health With Adolescent Health Behaviors in the UK Millennium Cohort

Importance

There is potential for mental health status to act as a determinant of an individual's ability to engage in healthful lifestyle behaviors.

Objective

To investigate the associations of parent-reported mental health problems during childhood and self-reported mental health problems in adolescence with health behaviors in adolescence.

Design, Setting, and Participants

This cohort study used data from wave 4 (collected in 2008) and wave 6 (collected in 2015) of the Millennium Cohort Study, a UK population-representative longitudinal study of young people born during 2000 to 2001. Wave 4 included data on parent-reported mental health issues for children at age 7 years. Wave 6 included data on self-reported mental health problems as well as health behaviors for the same children at age 14 years. Data were analyzed July 5, 2020.

Exposures

Mental health problems at age 7 years were parent-reported using Strengths and Difficulties Questionnaire. Mental health problems at age 14 years were self-reported using the Short Mood and Feelings Questionnaire.

Main Outcomes and Measures

Health behaviors at age 14 years were the main outcome of interest. Sleep duration; fruit, vegetable, and soft drink consumption; and social media use were self-reported using recall on a typical day. Regression models were calculated for each lifestyle variable, with mental health change from ages 7 to 14 years as the exposure variable. Data were weighted to account for the potential clustering of region of sampling and adjusted for nonresponse.

Results

A total of 9369 participants were included in waves 4 and 6 of the Millennium Cohort Study, including 4665 (48.1%) girls and 6014 participants (81.9%) who were born in England. Adolescents who self-reported mental health problems at age 14 years only were less likely to have at least 9 hours of sleep (odds ratio [OR], 0.39; 95% CI, 0.34-0.45) and to consume fruit (OR, 0.55; 95% CI, 0.46-0.65) and vegetables (OR, 0.66; 95% CI, 0.52-0.83) reported greater use of social media (b = 0.62; 95% CI, 0.49-0.75) compared with individuals who did not have mental health problems at both time points. Similarly, those with mental health problems at both time points were less likely to achieve 9 hours sleep (OR, 0.68; 95% CI, 0.51-0.90), consume fruit (OR, 0.39; 95% CI, 0.26-0.58) and vegetables (OR, 0.57; 95% CI, 0.35-0.91), and reported greater social media use (b = 0.63; 95% CI, 0.34-0.91).

Conclusions and Relevance

These findings suggest that the presence of depressive symptoms at ages 7 and 14 years and at age 14 years only were associated with some health behaviors in adolescence. These findings are particularly important given that independent health behaviors can deteriorate and become habitual during adolescence, and adolescence is a known time for the first emergence of mental health problems that continue into adulthood.

Sleep problems and depressive symptoms in toddlers and 8-year-old children: A longitudinal study

Sleep and depression are interlinked throughout the lifespan, but very few studies have examined the directionality of the sleep-depression link in children. The aim of the current study was to prospectively examine the bidirectional association between sleep problems and internalizing problems and depressive symptoms in toddlers and children aged 1.5 and 8 years. Data stem from the large ongoing population-based longitudinal study, the Norwegian Mother, Father and Child Cohort Study, recruited from October 1999 to July 2009. A total of 35,075 children were included. Information on sleep duration, nocturnal awakenings and internalizing problems (Child Behaviour Checklist) was provided by the mothers at 1.5 years, whereas data on sleep duration and depressive symptoms (Short Mood and Feelings Questionnaire) were provided by the mothers when the children were 8 years old. Odds ratios (ORs) were calculated using logistic regression analyses. After accounting for previous internalizing problems, short sleep duration (≤10 hr) and frequent (≥3) nightly awakenings at 1.5 years predicted the development of depressive symptoms at 8 years of age (adjusted OR = 1.28; 95% confidence interval [CI] 1.08-1.51, and adjusted OR = 1.27, 95% CI 1.08-1.50, respectively). Also, internalizing problems at 1.5 years predicted onset of later short sleep duration (adjusted OR = 1.83, 95% CI 1.32-2.54) after accounting for early sleep problems. This prospective study demonstrated a bidirectional association between sleep and internalizing/depressive symptoms from toddlerhood to middle childhood. Intervention studies are needed to examine whether targeting either of these problems at this early age may prevent onset of the other.

Changes in sleep and activity from age 15 to 17 in students with traditional and college-style school schedules

OBJECTIVES

Sleep duration and physical activity decline with age during adolescence. Earlier school schedules may contribute to these declines. The aim of this longitudinal study was to track changes in sleep and activity of Icelandic youth from primary to secondary school and compare students who enrolled in secondary schools with traditional and college-style schedules.

METHODS

We measured free-living sleep and activity with wrist actigraphy and body composition by dual-energy x-ray absorptiometry in 145 students at age 15 and age 17, when 58% attended schools with college-style scheduling. Differences from 15 to 17 and between students of different school structures were assessed with mixed-effect models.

RESULTS

Actigraphs were worn for 7.1 ± 0.4 nights at 15 and 6.9 ± 0.4 nights at 17. Overall, sleep duration decreased from 6.6 ± 0.7 h/night to 6.2 ± 0.7 h/night from age 15 to 17 (P < .001). Students with traditional schedules reduced school-night sleep duration 26 min/night at follow-up (P< .001), while sleep duration did not change for college-style students. All students went to bed later on school nights at follow-up, but only college-style students rose later. Sleep efficiency and awakenings did not differ by schedule-type. Neither sex changed body fat percentage, but average school-day activity decreased by 19% (P< .001) on follow-up and did not differ by schedule-type.

CONCLUSIONS

Over the 2-year period, adolescents decreased weekly sleep duration and activity, but only those continuing traditional schedules reduced school-night sleep. This suggests greater individual control of school schedule may preserve sleep duration in this age group, which may be beneficial during the transition into adulthood.

The Association Between Symptoms of Depression and School Absence in a Population-Based Study of Late Adolescents

OBJECTIVE

School attendance is an important functional marker in adolescence, and knowledge of the correlates of school absence is important to inform preventive efforts. The main aim of the present study was to investigate the association between symptoms of depression and school absence in late adolescence, adjusting for sociodemographic characteristics and externalizing problems.

METHODS

Data stem from the youth@hordaland-survey, a population-based survey of adolescents between 16 and 19 years old attending upper secondary education in Hordaland County, Norway, in spring 2012. Administrative data on school absence was provided for 8222 adolescents. In addition to days and hours absent the past semester, a variable of total absence was calculated and divided into quartiles of absence. Symptoms of mental health problems and sleep duration was based on adolescent self-reports.

RESULTS

Reports of depressive symptoms were significantly associated with school absence when investigated as continuous variables. The strength of the association attenuated but remained statistically significant when controlling for sociodemographic factors and externalizing problems. When investigating the association at different levels of school absence, adolescents in the second, third and fourth quartile of school absence reported significantly higher depression scores compared to adolescents in the first quartile. The association between reports of symptoms of depression and school absence was partially mediated by sleep duration.

CONCLUSION

The association between reported symptoms of depression and school absence was evident even at low levels of school absence, indicating a role for universal prevention strategies. The findings suggest both depression and sleep problems as possible targets for intervention in late adolescence.