Prospective relationships between sleep problems and substance use, internalizing and externalizing problems

Emotion dysregulation mediates the relationship between sleep problems and externalizing symptoms in early adolescents: A four-wave longitudinal study

BACKGROUND

Despite the growing body of longitudinal research linking sleep problems and externalizing symptoms, regarding the direction of the effects of both variables, the results have been inconsistent. Given the mixed findings and inconsistent results in the literature, we propose that emotion dysregulation may link sleep problems and externalizing symptoms.

METHODS

The participants (N = 1281, 49.65 % female; M = 12.73 years at time 1, SD = 0.68) were middle school students who completed assessments for sleep problems, externalizing symptoms, and emotion dysregulation. The interval between each wave was six months, for two consecutive years. Autoregressive mediation models using longitudinal data and cross-sectional mediation models using baseline data were evaluated and compared through structural equation modeling.

RESULTS

The results revealed that severe sleep problems (at T1, T2, or T3) were associated with higher levels of externalizing symptoms later in adolescence (at T2, T3, or T4), but not vice versa. In addition, analyses of indirect effects indicated that emotion dysregulation mediated this link, such that greater sleep problems led to more emotion dysregulation, which, in turn, led to more externalizing symptoms.

CONCLUSION

The findings highlight the critical role that emotional regulation plays in the link between sleep problems and externalizing symptoms and emphasize the need for students as well as middle school administration to pay close attention to both the sleep and externalizing symptoms of early adolescents.

The impact of sleep problems during late childhood on internalizing problems in early-mid adolescence

OBJECTIVES

Sleep and internalizing problems escalate during adolescence and can negatively impact long-term health. However, the directionality of this risk-relationship remains poorly understood within a developmental context. The current study aimed to determine the directionality of this relationship in adolescents with no history of psychiatric disorder and whether sex at birth played a role in this relationship.

METHODS

We used data from the Adolescent Brain Cognitive Development, an ongoing multisite longitudinal US study, that covered four waves (W1:9-11 years; W2:10-12 years; W3:11-13 years; W4:12-14 years). Analyses included 3,128 youth (50.99%girls) with no past or current psychiatric disorders at W1. The Sleep Disturbance Scale for Children and the Child Behavior Checklist were used to measure sleep and internalizing problems. Cross-lagged panel models were used to evaluate the cross-lagged relationships across waves.

RESULTS

The sleep-internalizing cross-lagged relationship was unidirectional, with medium-large effect sizes: greater total sleep problems were associated with more severe internalizing problems at later waves (W2➔W3, coefficient = 0.052, p = .021; W3➔W4, coefficient = 0.091, p < .001), with problems in initiating and maintaining sleep predicting internalizing problems early on. Girls showed greater sleep-internalizing risk than boys.

CONCLUSIONS

Sleep-internalizing relationships change across adolescence, becoming significant and more specific from early to mid-adolescence. Sleep interventions delivered in early adolescence, to girls in particular, may have a positive short and long-term impact on internalizing outcomes.

Associations Between Multiple Dimensions of Sleep and Mood During Early Adolescence: A Longitudinal Daily Diary Study

Prior research has observed reciprocal associations between sleep and mood. However, these findings are primarily based on the examination of one or two aspects of sleep behaviors (e.g., duration, quality), neglecting how multiple dimensions of sleep (particularly indicators pertinent to adolescence, e.g., sleep variability) are linked to adolescent mood both daily and longitudinally. Drawing on a multidimensional framework for sleep, this study addressed the knowledge gap by examining the directionality of and differential effects for associations between multiple dimensions of sleep and mood during early adolescence. Participants were 273 Chinese early adolescents (34.39% girls; Mage = 11.57, SD = 1.31), who filled out a pre-survey on demographics (T1) and 7-day diaries on sleep (i.e., duration, quality, disturbance, and latency) and mood (i.e., positive and negative mood). Adolescents completed another wave of diary reports 1 year later (T2). Findings revealed both bidirectional and unidirectional, within-person effects depending on specific sleep parameters, suggesting differential associations between multiple dimensions of sleep and mood. Specifically, on days when adolescents had longer sleep latency and greater disturbance than usual, they reported higher negative mood the next day, whereas higher negative mood was linked to poorer sleep quality the next day. The longitudinal investigation found that greater variability in sleep quality at T1 was associated with higher negative mood at T2. These findings underscore the importance of understanding the complex interplay between sleep and mood by examining the directionality of and differential effects for the daily and longer-term associations between multiple dimensions of sleep and mood among early adolescents.

Trajectories of sleep problems and the longitudinal associations with mental health difficulties among Chinese adolescents

OBJECTIVE

Growing research highlights the negative impact of sleep problems on adolescent mental health. However, the developmental trajectory of sleep problems during adolescence and their relationship with mental health difficulties, including both internalizing and externalizing symptoms, remain unclear. Additionally, the direction of the effects between sleep problems and mental health difficulties is not well established. This study aims to identify the developmental trajectories of sleep problems and examine their association with mental health difficulties in both internalizing and externalizing domains.

METHOD

The study involved 1,281 Chinese middle school students (645 males, mean age at initial assessment = 12.73, SD = 0.68). Data were collected at four time points (T1, T2, T3, T4) over approximately 6-month intervals, spanning from the first semester of seventh grade to the second semester of 8th grade.

RESULTS

Latent growth modeling revealed an overall increasing trend in sleep problems. Parallel latent growth modeling indicated that trajectories of sleep problems were positively related to the developmental trends of mental health difficulties, as shown by intercept-intercept and slope-slope associations. The cross-lagged panel model demonstrated significant bidirectional associations between sleep problems and internalizing symptoms. In contrast, we observed unidirectional associations between sleep problems and externalizing symptoms. Hence, sleep problems were a significant predictor of subsequent externalizing symptoms, with no significant reverse effect observed.

CONCLUSION

These findings suggest that future research should explore whether interventions targeting sleep problems can reduce the incidence of both internalizing and externalizing symptoms. Additionally, interventions aimed at internalizing symptoms may potentially improve adolescent sleep, while those targeting externalizing symptoms may not have the same effect.

Adolescent Sleep Quality and Alcohol Use: An Initial Examination of the Serial Indirect Effects of Anxiety Symptoms and Coping Motives for Alcohol Use

Background: Insufficient sleep and insomnia are associated with alcohol use as well as anxiety during adolescence and young adulthood. A negative reinforcement path to explain the association between sleep difficulties and alcohol misuse has been proposed. Within this pathway, it is speculated that while sober, insomnia and insufficient sleep lead to increased anxiety as well as anxiolytic responses to alcohol, thereby increasing the risk for both alcohol use and alcohol use problems. No work to date has examined the negative reinforcement path to alcohol use among adolescents who have consumed alcohol. Objectives: The current study aims to address this gap in the literature by examining if sleep quality is related to adolescent alcohol use problems and frequency through serial indirect effects of adolescent anxiety symptoms and coping motives for alcohol use. A total of 147 adolescents between the ages of 13 and 18 years (Mage = 16.31; SD = 0.96) from all geographic regions in the US were recruited using social media platforms (i.e., Facebook and Instagram). Participants who reported having tried alcohol at least once completed self-report measures to examine sleep quality, anxiety symptoms, alcohol use problems, alcohol use frequency, and coping motives for alcohol use. Results: Adolescent sleep quality was found to be associated with higher levels of both alcohol use problems and alcohol use frequency through the serial indirect effect of anxiety symptoms and coping motives for alcohol use. Conclusions: Overall, these findings represent a step towards understanding the complex relationship between sleep quality, alcohol, anxiety, and coping motives among adolescents.

Adolescent chronic sleep restriction promotes alcohol drinking in adulthood: evidence from epidemiological and preclinical data

Epidemiological investigations have indicated that insufficient sleep is prevalent among adolescents, posing a globally underestimated health risk. Sleep fragmentation and sleep loss during adolescence have been linked to concurrent emotional dysregulation and an increase in impulsive, risk-taking behaviors, including a higher likelihood of substance abuse. Among the most widely used substances, alcohol stands as the primary risk factor for deaths and disability among individuals aged 15-49 worldwide. While the association between sleep loss and alcohol consumption during adolescence is well documented, the extent to which prior exposure to sleep loss in adolescence contributes to heightened alcohol use later in adulthood remains less clearly delineated. Here, we analyzed longitudinal epidemiological data spanning 9 years, from adolescence to adulthood, including 5497 participants of the Avon Longitudinal Study of Parents And Children cohort. Sleep and alcohol measures collected from interviews and questionnaires at 15 and 24 years of age were analyzed with multivariable linear regression and a cross-lagged autoregressive path model. Additionally, we employed a controlled preclinical experimental setting to investigate the causal relationship underlying the associations found in the human study and to assess comorbid behavioral alterations. Preclinical data were collected by sleep restricting Marchigian Sardinian alcohol preferring rats (msP, n=40) during adolescence and measuring voluntary alcohol drinking concurrently and in adulthood. Polysomnography was used to validate the efficacy of the sleep restriction procedure. Behavioral tests were used to assess anxiety, risky behavior, and despair. In humans, after adjusting for covariates, we found a cross-sectional association between all sleep parameters and alcohol consumption at 15 years of age but not at 24 years. Notably, alcohol consumption (Alcohol Use Disorder Identification Test for Consumption) at 24 years was predicted by insufficient sleep at 15 years whilst alcohol drinking at 15 years could not predict sleep problems at 24. In msP rats, adolescent chronic sleep restriction escalated alcohol consumption and led to increased propensity for risk-taking behavior in adolescence and adulthood. Our findings demonstrate that adolescent insufficient sleep causally contributes to higher adult alcohol consumption, potentially by promoting risky behavior.

Sleep-Related Predictors of Risk for Alcohol Use and Related Problems in Adolescents and Young Adults

PURPOSE

Growing evidence supports sleep and circadian rhythms as influencing alcohol use and the course of alcohol use disorder (AUD). Studying sleep/circadian-alcohol associations during adolescence and young adulthood may be valuable for identifying sleep/circadian-related approaches to preventing and/or treating AUD. This paper reviews current evidence for prospective associations between sleep/circadian factors and alcohol involvement during adolescence and young adulthood with an emphasis on the effects of sleep/circadian factors on alcohol use.

SEARCH METHODS

The authors conducted a literature search in PsycInfo, PubMed, and Web of Science using the search terms "sleep" and "alcohol" paired with "adolescent" or "adolescence" or "young adult" or "emerging adult," focusing on the title/abstract fields, and restricting to English-language articles. Next, the search was narrowed to articles with a prospective/longitudinal or experimental design, a sleep-related measure as a predictor, an alcohol-related measure as an outcome, and confirming a primarily adolescent and/or young adult sample. This step was completed by a joint review of candidate article abstracts by two of the authors.

SEARCH RESULTS

The initial search resulted in 720 articles. After review of the abstracts, the list was narrowed to 27 articles reporting on observational longitudinal studies and three articles reporting on intervention trials. Noted for potential inclusion were 35 additional articles that reported on studies with alcohol-related predictors and sleep-related outcomes, and/or reported on candidate moderators or mediators of sleep-alcohol associations. Additional articles were identified via review of relevant article reference lists and prior exposure based on the authors' previous work in this area.

DISCUSSION AND CONCLUSIONS

Overall, the review supports a range of sleep/circadian characteristics during adolescence and young adulthood predicting the development of alcohol use and/or alcohol-related problems. Although sleep treatment studies in adolescents and young adults engaging in regular and/or heavy drinking show that sleep can be improved in those individuals, as well as potentially reducing alcohol craving and alcohol-related consequences, no studies in any age group have yet demonstrated that improving sleep reduces drinking behavior. Notable limitations include relatively few longitudinal studies and only two experimental studies, insufficient consideration of different assessment timescales (e.g., day-to-day vs. years), insufficient consideration of the multidimensional nature of sleep, a paucity of objective measures of sleep and circadian rhythms, and insufficient consideration of how demographic variables may influence sleep/circadian-alcohol associations. Examining such moderators, particularly those related to minoritized identities, as well as further investigation of putative mechanistic pathways linking sleep/circadian characteristics to alcohol outcomes, are important next steps.

Childhood sleep: physical, cognitive, and behavioral consequences and implications

BACKGROUND

Sleep problems in children have been increasingly recognized as a major public health issue. Previous research has extensively studied and presented many risk factors and potential mechanisms for children's sleep problems. In this paper, we aimed to identify and summarize the consequences and implications of child sleep problems.

DATA SOURCES

A comprehensive search for relevant English language full-text, peer-reviewed publications was performed focusing on pediatric sleep studies from prenatal to childhood and adolescence in a variety of indexes in PubMed, SCOPUS, and Psych Info published in the past two decades. Both relevant data-based articles and systematic reviews are included.

RESULTS

Many adverse consequences are associated with child sleep deficiency and other sleep problems, including physical outcomes (e.g., obesity), neurocognitive outcomes (e.g., memory and attention, intelligence, academic performance), and emotional and behavioral outcomes (e.g., internalizing/externalizing behaviors, behavioral disorders). Current prevention and intervention approaches to address childhood sleep problems include nutrition, exercise, cognitive-behavioral therapy for insomnia, aromatherapy, acupressure, and mindfulness. These interventions may be particularly important in the context of coronavirus disease 2019. Specific research and policy strategies can target the risk factors of child sleep as well as the efficacy and accessibility of treatments.

CONCLUSIONS

Given the increasing prevalence of child sleep problems, which have been shown to affect children's physical and neurobehavioral wellbeing, understanding the multi-aspect consequences and intervention programs for childhood sleep is important to inform future research direction as well as a public health practice for sleep screening and intervention, thus improving sleep-related child development and health.

Disruption of circadian rhythms promotes alcohol use: a systematic review

This systematic review investigates the bidirectional relationship between alcohol consumption and disrupted circadian rhythms. The goal of this study was to identify (i) the types of circadian rhythm disruptors (i.e. social jet lag, extreme chronotypes, and night shift work) associated with altered alcohol use and (ii) whether sex differences in the consequences of circadian disruption exist. We conducted a search of PubMed, Embase, and PsycINFO exclusively on human research. We identified 177 articles that met the inclusion criteria. Our analyses revealed that social jet lag and the extreme chronotype referred to as eveningness were consistently associated with increased alcohol consumption. Relationships between night shift work and alcohol consumption were variable; half of articles reported no effect of night shift work on alcohol consumption. Both sexes were included as participants in the majority of the chronotype and social jet lag papers, with no sex difference apparent in alcohol consumption. The night shift research, however, contained fewer studies that included both sexes. Not all forms of circadian disruption are associated with comparable patterns of alcohol use. The most at-risk individuals for increased alcohol consumption are those with social jet lag or those of an eveningness chronotype. Direct testing of the associations in this review should be conducted to evaluate the relationships among circadian disruption, alcohol intake, and sex differences to provide insight into temporal risk factors associated with development of alcohol use disorder.

A meta-analysis of longitudinal studies on the interplay between sleep, mental health, and positive well-being in adolescents

Objective

This review aimed to summarize longitudinal research about the interplay between sleep, mental health, and positive well-being in adolescents.

Method

Multiple search strategies were applied until 28th January 2023 to identify relevant research published in peer-reviewed journal articles or available grey literature. A final set of 63 studies were included in the systematic review and 42 in the meta-analysis.

Results

Results highlighted that long sleep duration, good sleep quality, and low insomnia symptoms were bidirectionally related to lower internalizing (Sleep T1 → Internalizing symptoms T2: r = -.20, p < .001; Internalizing symptoms T1 → Sleep T2: r = -.21, p < .001) and externalizing (Sleep T1 → Externalizing symptoms T2: r = -.15, p < .001; Externalizing symptoms T1→ Sleep T2: r = -.17, p < .001) symptoms, and to higher levels of psychological well-being (Sleep T1 → Psychological well-being T2: r = .15, p < .001; Psychological well-being T1 → Sleep T2: r = .15, p < .05). Moreover, good sleep was positively related to higher subjective well-being at a later time point (r = .18, p < .001).

Conclusions

Overall, these findings suggest a bidirectional relation between different aspects of sleep, mental health, and positive well-being.

Latent Profiles of Sleep Patterns in Early Adolescence: Associations With Behavioral Health Risk

PURPOSE

The present study characterized sleep profiles in a national longitudinal sample of early adolescents and examined whether profiles predicted later behavioral problems.

METHODS

Three waves of data (2016-2021) were obtained from the Adolescent Behavior and Cognitive Development study, including 3,326 participants with both weekday and weekend sleep data measured by Fitbit wearables (age range 10.58-13.67 years; 49.3% female). Latent profile analysis was utilized to identify sleep profiles using multiple sleep indicators (duration, latency, efficiency, wake minutes, wake counts, and midpoint). We then explored whether demographic predictors predicted profile membership and tested the latent sleep profiles' predictive utility of internalizing and externalizing symptoms.

RESULTS

Four profiles were identified: average sleep (40.39%), high duration & high wakefulness (28.58%), high efficiency, low duration &low wakefulness (16.86%), and low duration & low efficiency (14.17%). Participants with older age, males, higher body mass index, and advanced pubertal status were more likely to be classified in the low duration & low efficiency profile than the average group. Participants with lower income, minority identification, older age, and higher body mass index were more likely to be classified in the high efficiency, low duration &low wakefulness than the average group. Participants with lower parental education and males were more likely to be in the high sleep duration & high wakefulness than the average group. The low duration & low efficiency group had the highest attention problems, social problems, and rule-breaking behaviors.

DISCUSSION

Our findings highlight unique sleep patterns in early adolescence and their prospective links with internalizing and externalizing problems.

The relationship between alexithymia, emotion regulation, and sleep problems in school-aged children: A multicentric study

OBJECTIVES

Alexithymia, mood dysregulation, and sleep quality have complicated effects on children's development. The current study aimed to investigate the relationship between alexithymia, emotion regulation, psychiatric problems, and sleep problems among Egyptian school-aged children.

METHODS

A total of 564 Egyptian children, aged 6 to 14, were divided into two groups based on their total Children's Sleep Habits Questionnaire abbreviated score: group 1 (N = 300) with sleep problems and group 2 (N = 264) with non-sleep problems. Their parents completed the Strengths and Difficulties Questionnaire (SDQ) and subjectively assessed the children's emotions using the Children's Alexithymia Measure (CAM) and the Clinical Evaluation of Emotional Regulation-9 (CEER-9).

RESULTS

Males were more proportional in the sleep problems group than others. The sleep problem group was significantly younger and had a longer daily sleep duration than the non-sleep problem group. Alexithymia and emotion dysregulation had the highest mean in the sleep problem group. Furthermore, alexithymia, emotion dysregulation, emotion difficulty, conduct, and prosocial problems were the most significant contributing factors and risk factors for sleep problems in children.

CONCLUSION

Sleep problems in children were associated with younger male children with lengthy daily sleep duration and emotional, behavioural, and prosocial difficulties. Furthermore, alexithymia and emotion dysregulation are significant contributors and risk factors for sleep problems in school-aged children.

Insomnia as a Risk Factor for Substance Use Disorders in Women

Gender differences exist for both insomnia and substance use disorders. Women show a higher prevalence of insomnia and increased susceptibility to the effects of drugs than men. Importantly, a growing body of evidence suggests that insufficient sleep predicts and puts individuals at a higher risk for substance use and associated psychosocial problems. However, the role of insomnia in substance use disorders among women remains poorly understood. The present article discusses gender differences in insomnia and in substance use disorders and reviews evidence suggesting that an increased prevalence of insomnia may be a risk factor for substance use disorders in women.

Sleep, alcohol, and caffeine in financial traders

Alcohol and caffeine are two of the most commonly used substances for altering human consciousness. While their adverse effects on sleep have been separately examined in the laboratory and epidemiological levels, how they impact real-world night-to-night sleep, in isolation or together, remains unclear. This is especially true in occupations wherein the use of alcohol and caffeine is high (e.g., financial services sector). Using a six-week micro-longitudinal study, here we examined the real-world impact of alcohol, caffeine, and their combined consumption in a cohort of financial traders. We demonstrate that alcohol consumption significantly degrades the subjective quality of sleep (p < 0.001). Caffeine consumption led to a different phenotype of sleep impairment, resulting in a detrimental reduction in sleep quantity (p = 0.019), rather than a marked alteration in sleep quality. Contrary to our hypothesis, when consumed in combination, evening alcohol consumption interacted with ongoing caffeine consumption such that alcohol partially mitigated the impairments in sleep quantity associated with caffeine (p = 0.032). This finding suggests the sedating effects of alcohol and the psychoactive stimulant effects of caffeine obscure each other's impact on sleep quantity and sleep quality, respectively-potentially explaining their interdependent use in this cohort (i.e., "self-medication" of evening sedation with alcohol to combat the prior daytime ingestion of caffeine and vice versa). More generally, these results contribute to a unique understanding of the singular and combinatory impacts of two of the most commonly used substances for augmenting human consciousness under free-living, real-world conditions, the performance-impairing (and thus economic-cost) consequences of which may be important to the business sector and the society.

Associations between insomnia symptom trajectories with depression and self-harm behaviors in Chinese college students before and during the COVID-19 pandemic: A five-wave longitudinal investigation

BACKGROUND

Sleep problems are highly prevalent during COVID-19 pandemic. However, only very limited studies have examined the changing patterns of insomnia symptom before and during the COVID-19 pandemic, and most of these studies were limited to two-wave designs and the variable-centered approach.

METHODS

The data was taken from a large-scale health-related cohort among Chinese college students. This cohort was a five-wave design and 3834 participants who completed at least two waves were included in the present study. Growth mixture modeling (GMM) was used to estimate trajectory classes for insomnia symptoms, followed by binary logistic regression to explore the association between trajectory classes and subsequent mental health problems.

RESULTS

GMM analyses extracted four distinct trajectories of insomnia symptoms: stable-low pattern (n = 2897, 75.6 %), increasing pattern (n = 405, 10.6 %), decreasing pattern (n = 182, 4.7 %), and stable-high pattern (n = 350, 9.1 %). Additionally, we found that individuals in stable-high and increasing patterns were more likely to experience mental health problems after the COVID-19 pandemic even after adjusting significant covariates and outcomes at baseline.

CONCLUSIONS

Appreciable heterogeneity in insomnia symptoms among college students was revealed before and during the COVID-19 pandemic. About 20 % of college students were classified as high-risk patterns of insomnia symptoms. Psychological interventions should target such vulnerable groups to reduce the rates of mental health problems.

The associations between academic stress and depression among college students: A moderated chain mediation model of negative affect, sleep quality, and social support

BACKGROUND

Growing competition in tight job market and academic excellence as a social norm in Asian culture have made Chinese college students burdened with immense academic stress.

OBJECTIVES

This study aimed to explore the associations between academic stress and depression, and the mediating roles of negative affect and sleep quality, as well as the moderating role of social support in the relationship between negative affect and sleep quality.

METHODOLOGY

A convenience sample of 221 male and 479 female college students aged between 17 and 25 completed questionnaires on academic stress, depression, negative affect, sleep quality and social support.

RESULTS

Results indicated that academic stress could not only directly affect depression (b = 0.31, p < 001), but also affect depression through the mediation role of negative affect and sleep quality. The chain mediating effects includes three paths, namely, the mediating role of negative affect (indirect effect = 0.21, percentage of total effect = 69.58 %), the mediating role of sleep quality (indirect effect = 0.06, percentage of total effect = 21.03 %), and the chain mediating role of negative affect and sleep quality (indirect effect = 0.06, percentage of total effect = 19.86 %). Social support moderated the adverse influence of negative affect on sleep quality. Social support decreases the impact of negative affect on sleep quality. Specifically, the association between negative affect and sleep quality was stronger for college students with low (bsimple = 0.44, p < 0.001) social support than those with high (bsimple = 0.32, p < 0.001) social support.

IMPLICATIONS

The results advanced our understanding of how academic stress affects college students' depression. These findings provide implications on the cultivation of stress coping strategies, promotion of emotion regulation skills, exaltation of sleep quality, and improvement of the social support level aiming for future depression preventions and interventions. Specific measures include setting up psychological health courses, teaching emotion management strategies, and establishing web-based programme steming from acceptance and commitment therapy. It should be noted that the cross-sectional design means the causal associations among the variables could not be determined.

Associations of Changes in Sleep and Emotional and Behavioral Problems From Late Childhood to Early Adolescence

Importance

Sleep problems and psychopathology symptoms are highly comorbid and bidirectionally correlated across childhood and adolescence. Whether these associations are specific to discrete profiles of sleep problems and specific internalizing and externalizing phenomena is currently unclear.

Objective

To characterize individual changes in profiles of sleep problems and their prospective associations with psychopathology symptoms across the transition from childhood to adolescence.

Design, Setting, and Participants

This observational cohort study used baseline data (participant age of 9 to 11 years) and 2-year follow-up data (participant age of 11 to 13 years) from the community-setting, multicenter Adolescent Brain Cognitive Development (ABCD) study. Individuals were assessed for a range of sleep problems at both waves and categorized into profiles via latent profile analysis. The stability and change in these profiles over time was assessed via latent transition analysis. Logistic regression models examined whether psychopathology symptoms were cross-sectionally associated with profile membership and whether transitions between profiles were associated with changes psychopathology symptoms over time. Data were collected from September 2016 to January 2020, and data were analyzed from August 2021 to July 2022.

Exposures

Sleep problems were assessed at both baseline and follow-up via the parent-reported Sleep Disturbance Scale for Children (SDSC).

Main Outcomes and Measures

Psychopathology symptoms at both baseline and follow-up were assessed using the internalizing and externalizing dimension scores derived from the parent-reported Child Behavior Checklist.

Results

A total of 10 313 individuals (4913 [47.6%] were female) were categorized into 4 latent profiles of sleep problems at both baseline and follow-up: a low disturbance profile, a sleep onset/maintenance problems profile, a moderate and nonspecific disturbance profile (termed mixed disturbance), and a high disturbance profile. Individuals in the 3 more severe problem profiles displayed greater risk of concurrent internalizing symptoms (sleep onset/maintenance problems: odds ratio [OR], 1.30; 95% CI, 1.25-1.35; P < .001; mixed disturbance: OR, 1.29; 95% CI, 1.25-1.33; P < .001; high disturbance: OR, 1.44; 95% CI, 1.40-1.49; P < .001) and externalizing symptoms (sleep onset/maintenance problems: OR, 1.20; 95% CI, 1.16-1.23; P < .001; mixed disturbance: OR, 1.17; 95% CI, 1.14-1.20; P < .001; high disturbance: OR, 1.24; 95% CI, 1.21-1.28; P < .001). Transitions between sleep profiles over time were associated with prospective internalizing and externalizing symptoms, but not vice versa.

Conclusions and Relevance

There are substantial changes in sleep problems across the transition to adolescence that are associated with later internalizing and externalizing symptoms. Sleep profiles could be targeted in future intervention and treatment programs to improve sleep-related and mental health-related outcomes across development.

Bullying victimization and internalizing and externalizing problems in school-aged children: The mediating role of sleep disturbance and the moderating role of parental attachment

BACKGROUND

Studies have shown that bullying victimization may be related to internalizing and externalizing problems; however, the mechanism underlying this relationship remains unknown. This study explored the mediating role of sleep disturbance and the moderating role of parental attachment.

METHODS

A total of 1543 Chinese primary school students (M age = 8.92 years, SD1.7 years; range, 6-12) completed bullying victimization, sleep disturbance, and parental attachment measures, and provided information on their parents' occupations. The parents or guardians (n = 1995) also completed ratings on their children's internalizing and externalizing problems.

RESULTS

It was found that bullying victimization directly affected internalizing and externalizing problems and also influenced sleep disturbance. Regardless of the parent's socioeconomic status, parental attachment was found to moderate the relationship between bullying victimization and internalizing problems.

CONCLUSIONS

These findings contribute to understanding the partial mediating mechanism of sleep disturbance in the association between bullying victimization and internalizing and externalizing problems. The protective role of parental attachment proved central to preventing internalizing problems in bullied children. Intervention programs that enhance parental attachment and improve sleep quality could assist in mitigating the impact of bullying victimization on internalizing or externalizing problems.

Sleep quality, physical activity, screen time, and substance use in children with obesity: associations with obstructive sleep apnea

STUDY OBJECTIVES

The association between obstructive sleep apnea (OSA) and lifestyle habits in children with obesity is largely unknown. This study aimed to determine whether there was an association between lifestyle patterns (sleep quality, physical activity, recreational screen time, and substance use) and OSA presence and severity in children with obesity.

METHODS

This cross-sectional study recruited children with obesity, aged 8-17 years, who were referred to undergo polysomnography. Children completed questionnaires on sleep quality, physical activity, recreational screen time, and substance use. Children also had a diagnostic polysomnography. The association between questionnaire scores and OSA severity, after adjusting for body mass index z-score, age, and sex, was evaluated using negative binomial multiple regression. Correlations were conducted between sleep quality, physical activity, screen time, substance use, and OSA severity.

RESULTS

A total of 100 children were included in the analysis (mean age: 14.3 ± 2.6 years; 44% female; mean body mass index z-score: 2.5 ± 0.4; 65% with OSA). In the adjusted regression analysis, each additional substance-use behavior was associated with a 17% (95% confidence interval: 1%, 36%) increase in OSA severity. Correlations were identified between poorer sleep quality and lower physical activity (r = -.42), poorer sleep quality and more substance-use behaviors (r = .40), and greater physical activity and less substance-use behaviors (r = -.26).

CONCLUSIONS

In children with obesity, more substance-use behaviors were independently associated with greater OSA severity. As there are complex, bidirectional relationships between lifestyle behaviors and OSA severity, interventions need to be comprehensive and multifactorial to ensure successful treatment of OSA and its sequelae in children.

CITATION

Blinder H, Narang I, Chaput J-P, Katz SL; on behalf of the Canadian Sleep and Circadian Network. Sleep quality, physical activity, screen time, and substance use in children with obesity: associations with obstructive sleep apnea. J Clin Sleep Med. 2023;19(3):511-518.

Perceived sleep quality predicts aggressive offending in adolescence and young adulthood

BACKGROUND

There are profound consequences when developing youth do not get adequate sleep. Adolescents who experience poor sleep may be more likely to engage in offending behavior. While there is a documented association between the number of hours youth sleep and their likelihood of offending, it is unclear how youths' perceptions of their sleep quality contribute to offending. Further, scholars have yet to rigorously examine the relation between sleep problems and offending in young adulthood, a developmental stage, which is both critical for desistance and in which sleep may play an important role.

METHODS

Using a sample of 1,216 justice-involved male youth, this study uses within-individual longitudinal methods (fixed-effects Poisson regression models) to examine the relation between changes in perceptions of sleep quality and changes in offending behavior from ages 13 to 24.

RESULTS

Increases in sleep problems are associated with increases in offending, particularly aggressive/person-related offenses, for both adolescents and young adults. This holds true even after controlling for time-varying anxiety, substance use, and violence exposure.

CONCLUSIONS

Improving sleep quality may be critical for reducing aggressive behavior in at-risk adolescents and young adults. Interventions that address sleep quality, and not just quantity, may be particularly beneficial.

Longitudinal Associations Between Cybervictimization and Adolescent Sleep Problems: The Role of Anxiety and Depressive Symptoms

Adolescents who have experienced cybervictimization are at risk for sleep problems. However, there is a gap in knowledge about the mechanism that would explain this link. The study used a longitudinal design to test if cybervictimization predicted adolescents' sleep problems 6 and 12 months later, and whether these patterns could be explained in part by emotional distress in response to the victimization. Participants were 1987 Chinese adolescents (56.1% males) ages 10 to 14 (M = 12.32, SD = 0.53) at baseline. Data were collected over the course of 1 year, in three waves 6 months apart. The adolescents completed questionnaires regarding cybervictimization, sleep problems, depressive symptoms, and anxiety symptoms at all three time points. Autoregressive cross-lagged models showed that cybervictimization predicted later sleep problems after controlling for traditional peer victimization, and anxiety and depressive symptoms mediated this link. Multivariate latent growth models showed that the developmental trajectories of cybervictimization, sleep problems, anxiety symptoms, and depressive symptoms were related in complex ways over time. Measures of study variables were self-reported, and generalizability may be limited by a sample of adolescents from school in China. These results are important because of their implications for prevention and treatment of adolescents' sleep problems evoked by cybervictimization.

Associations between insomnia symptoms and prescription opioid and benzodiazepine misuse in a nationally representative sample

BACKGROUND

There are complex associations between insomnia symptoms and misuse of prescription drugs. The aim of this study was to examine prospective associations between insomnia symptoms and prescription opioid and benzodiazepine misuse among a nationally representative sample of adults.

METHODS

Utilizing data from the National Longitudinal Study of Adolescent to Adult Health (N = 10,685), we conducted log-binomial regression to examine associations of insomnia symptoms at Wave IV (2008-2009; 24-32 years) with prescription opioid and benzodiazepine misuse at Wave V (2016-2018; 33-43 years). We adjusted analyses for prior insomnia symptoms and substance misuse, as well as potential demographic and health-related confounders.

RESULTS

Each unit increase in insomnia symptoms at Wave IV was associated with a small increase in the likelihood of prescription opioid (RR = 1.08, 95 % CI 1.01, 1.15) but not benzodiazepine (RR = 1.09, 95 % CI 0.99, 1.21) use at Wave V. Both prescription opioid (β = 0.20, 95 % CI 0.09, 0.031) and benzodiazepine (β = 0.21, 95 % CI 0.10, 0.33) misuse at Wave IV had small associations with elevated insomnia symptoms at Wave V.

CONCLUSIONS

Results support associations between prescription opioid and benzodiazepine misuse and later insomnia symptoms. There was a small association between insomnia symptoms and later prescription opioid misuse worthy of future study. These results fit within a broad line of research suggesting that insomnia symptoms are associated with future substance use and vice versa. Future research is needed explore mechanisms (e.g., mental health, pain) underlying these associations.

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.

The trajectories and associations of insomnia symptoms with addictive behaviours in adolescents: A two-year longitudinal study

Insomnia displays heterogeneous trajectories across adolescence, which may induce addictive behaviours, including internet gaming disorder and substance use. This study aimed to investigate the latent trajectory classes of insomnia symptoms over 2 years and to examine the associations between insomnia trajectories and these addictive behaviours. Participants were 910 adolescents from six middle schools in Shanghai, China (52.7% males; mean age = 13.17 years). The three-wave survey measured insomnia symptoms, internet gaming disorder, substance use, depressive symptoms, and sociodemographic characteristics from 7th to 9th grade. Latent class growth modelling was performed to identify the latent trajectory classes of insomnia symptoms. Then multivariable logistic regressions were conducted within the best-fitting latent class growth model to examine the associations of insomnia trajectories with internet gaming disorder and substance use. Two latent trajectory classes of insomnia symptoms were recognised: the non-insomnia group (71.8%) and the insomnia group (28.2%). In the multivariable analysis controlling for baseline demographic variables and depressive symptoms, the insomnia group had a higher risk of developing internet gaming disorder (OR = 2.203 [95% CI: 1.258-3.858]) and substance use (OR = 2.215 [95% CI: 1.324-3.705]) compared with the non-insomnia group. These findings add to a growing body of research on heterogeneous trajectories of insomnia symptoms during adolescence, suggesting that intervention strategies are needed to target the characteristics or developmental patterns of different insomnia subgroups. The ultimate goal is to mitigate the impact of insomnia symptoms on adolescent addictive behaviours.

The bidirectional relationship between sleep and externalizing behavior: A systematic review

It is well-established that sleep and behavior are interrelated. Although studies have investigated this association, not many have evaluated the bidirectional relationship between the two. To our knowledge this is the first systematic review providing a comprehensive analysis of a reciprocal relationship between sleep and externalizing behavior. Five databases (PsycINFO, PubMed, Web of Science, Scopus, and Google Scholar) were utilized to yield a total of 3,762 studies of which 20 eligible studies, empirical articles examining bidirectionality of sleep and externalizing behavior, were selected for analysis. According to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis, the varying methodological approaches used in these studies were analyzed and synthesized, including examining differences and similarities in outcomes between distinct study designs (longitudinal vs cross-sectional), sleep measures (objective vs subjective vs a combination of both), informants (parents, self-report, teachers), and recruited participants (clinical, subclinical and typical populations). The assessment of risk of bias and quality of studies was guided by the instruments employed in research on sleep and behavior in the past. This review establishes that a bidirectional relationship between sleep problems and externalizing behavior clearly exists, and identifies limitations in the existing literature. Furthermore, the importance of early interventions that target both externalizing behaviors and sleep problems is highlighted as a potentially effective way of breaking the sleep-externalizing behavior relationship. Nonetheless, causality cannot be claimed until more trials that manipulate sleep and evaluate changes in externalizing behavior are conducted.

Energy Drinks and Sleep among Adolescents

Many adolescents worldwide have the problem of meeting recommended nightly sleep hours. The causes of sleep disturbance are multifactorial, but interest in food’s effect on sleep has dramatically increased lately. In this study, we investigated the association between regular energy drink (ED) intake (weekly or more frequent) and sufficient sleep (SS) (≥8 h) in adolescents. Additional objectives were to examine the relationship between health-related behaviors and SS, stratified by gender. A population-based cross-sectional study was conducted during the 2019/2020 school year from 12 schools in Belgrade. There were 1287 students aged 15 to 19 who participated (37.4% male). We used a modified version of the food frequency questionnaire adapted for Serbian adolescents. Logistic regression revealed that regular ED consumption was an independent risk factor negatively related to SS in both sexes. Additionally, daily vegetable and water intake (≥2 L) showed a positive correlation with SS in boys, while in girls, the odds of realizing SS decreased with statements of sedative use. In conclusion, we show that ED intake is negatively associated with SS in both sexes; daily vegetable and water intake (≥2 L) may raise the odds of SS in boys, while sedative use may decrease the chances of SS in girls.

Family Socioeconomic Status and Internalizing Problem Behavior Among Chinese Adolescents: The Chain Mediation Effect of Academic Performance and Peer Conflict

This study aims to provide a new perspective on the relationship between family socioeconomic status (SES) and internalizing problem behavior (IPB) among adolescents. Many studies have focused on the relationship between family SES and IPB among adolescents; however, research on the underlying mechanism is still insufficient, and peer conflict has been ignored as a crucial social relationship factor for adolescents. This study identifies two new mediating variables and a chain mediating mechanism model between them. Using national longitudinal data from 2,467 adolescents aged 10–15 published in the China Family Panel Studies of wave 2018, this study found the following: (1) higher family SES can significantly reduce peer conflict and IPB among adolescents; (2) adolescents with better academic performance were less likely to be involved in peer conflict; (3) peer conflict mediated 30.41% of the relationship between family SES and adolescent’s IPB; and (4) there was a chain mediating mechanism, and the mediating effect of peer conflict was much stronger than the mediating effect of both academic performance and the chain mediation pathways. This is the first study to develop a chain mediation model to examine the roles of academic achievement and peer conflict in the relationship between family SES and IPB. These findings are significant in that they highlight the importance of providing adolescents with proper emotional de-escalation and peer conflict resolution strategies, contributing to the management of adolescent mental health in urban governance and rural development.

Dimensions of emotional distress among Brazilian workers in a COVID-19 reference hospital: A factor analytical study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for public health and has caused the loss of millions of lives worldwide. Hospital workers play a key role in averting the collapse of the health system, but the mental health of many has deteriorated during the pandemic. Few studies have been devoted to identifying the needs of workers on frontline duty.

AIM

To investigate dimensions of common emotional symptoms and associated predictors among Brazilian workers in a COVID-19 reference hospital.

METHODS

This is an observational study of the mental health of professionals in a COVID-19 hospital in the city of São Paulo. We invited all hospital employees to respond to an online survey between July and August 2020, during the first peak of the pandemic. Data of 1000 participants who completed the survey were analyzed (83.9% were women and 34.3% were aged 30 to 40). Hospital workers self-reported the presence of symptoms of depression, anxiety, trauma-related stress, and burnout through the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Impact of Event Scale-Revised and the Mini-Z Burnout Assessment respectively. Responses were assembled and subjected to exploratory factor analysis to reveal workers’ core emotional distress. Multiple linear regression models were subsequently carried out to estimate the likelihood of dimensions of distress using questions on personal motivation, threatening events, and institutional support.

RESULTS

Around one in three participants in our sample scored above the threshold of depression, anxiety, post-traumatic stress disorder, and burnout. The factor analysis revealed a three-factor structure that explained 58% of the total data variance. Core distressing emotional domains were avoidance and re-experience, depression-anxiety, and sleep changes. Regression analysis revealed that institutional support was a significant protective factor for each of these dimensions (β range = -0.41 to -0.20, P < 0.001). However, participants’ personal motivation to work in healthcare service was not associated with these emotional domains. Moreover, the likelihood of presenting the avoidance and re-experience dimension was associated with having a family member or close friend be hospitalized or die due to COVID-19 and having faced an ethical conflict.

CONCLUSION

Distressing emotional domains among hospital workers were avoidance and re-experience, depression and anxiety, and sleep changes. Improving working conditions through institutional support could protect hospital workers' mental health during devastating public health crises.

Poor Sleep in Community-Dwelling Polysubstance Users: Association With Khat Dependence, Metacognition, and Socio-Demographic Factors

Purpose

Poor sleep and cognitive deficits are often associated with increased drug use. However, no study has addressed the relationship between poor sleep, substance dependence, and metacognitive deficit in polysubstance users.

Methods

This was a cross-sectional study with a simple random sampling involving community-dwelling polysubstance users (n = 326, age = 18-43 years) in Mizan, Ethiopia. Participants completed a brief sleep questionnaire, severity of dependence on khat (SDS-Khat), a brief meta-cognition questionnaire, and a socio-demographic survey.

Results

Majority (56.4%) of the polysubstance users had sleep disturbance. Chronic health conditions [adjusted odds ratio (AOR) = 2.52, 95% confidence interval (CI) 1.31-4.85], chronic conditions in the family (AOR = 2.69, 95% CI 1.40-5.20), illiterate-primary level of educational status (AOR = 2.40, 95% CI 1.30-4.04), higher SDS-Khat score (AOR = 1.39, 95% CI 1.13-1.72), and lower meta-cognition score (AOR = 0.90, 95% CI 0.84-0.97) predicted poor sleep in the polysubstance users. Moreover, low metacognition score and high SDS score also predicted additional sleep disturbances like chronic sleep insufficiency, lethargy and restlessness after nighttime sleep, socio-occupational dysfunctions, and daytime disturbances in polysubstance users.

Conclusion

Poor sleep, severe khat dependence, and metacognitive deficits are common in community polysubstance users. Moreover, poor sleep is associated with higher khat dependence, lower metacognitive ability, lower educational status, and the presence of chronic conditions in polysubstance users or their families.

Adolescents' sleep and adjustment: Reciprocal effects

Reciprocal relations between sleep and adjustment were investigated. Participants included 246 adolescents (M = 15.80 years; 67.5% White, 32.5% Black/African American; 53% female, 47% male) at Time 1 (data collected 2012-2013), 227 at Time 2 (M = 16.78 years) and 215 at Time 3 (M = 17.70 years). Sleep-wake variables were measured with self-reports (sleepiness) and actigraphy (average sleep minutes and efficiency, variability in sleep minutes and efficiency). Adolescents reported on depression and anxiety symptoms, and parents reported on externalizing problems. Greater variability in sleep duration and efficiency as well as sleepiness predicted adjustment problems (range of R² : 36%-60%). Reciprocal relations were supported mostly for sleepiness (range of R² : 16%-32%). Results help understand bidirectional relations between sleep and adjustment.

Out-of-home placement, sleep problems, and later mental health and crime: A prospective investigation

Previous research suggests that out-of-home placement experiences increase the risk for mental health problems and criminal involvement. However, few studies have examined the mechanisms whereby out-of-home placement increases the risk for these outcomes. The present study examines whether sleep problems in part explain the relationship between childhood placement experiences and depression and anxiety and criminal arrests in adulthood. Data are from a prospective longitudinal study of 531 children with documented cases of childhood maltreatment (14% with no out-of-home placement, 68% placed solely for abuse and/or neglect, and 18% placed for maltreatment and delinquency) who were followed up into adulthood. Cases are from 1967 to 1971 from a metropolitan county in the Midwest. Sleep problems were assessed in young adulthood (M_age = 29 years). Depression and anxiety symptoms and arrest records were assessed in middle adulthood (M_age = 40 years). Structural equation modeling was used to test hypotheses. Both types of out-of-home placement experiences (for maltreatment only and for maltreatment and delinquency) predicted more sleep problems in adulthood across all models. Sleep problems in young adulthood predicted higher levels of anxiety and depression in middle adulthood, but not criminal arrests. Sleep problems mediated the relationship between placement only and internalizing symptoms and results differed for male, female, White, and Black individuals examined separately. Using court-substantiated cases of childhood abuse and neglect, this study demonstrates the long-term negative consequences of out-of-home placement experiences for sleep problems and anxiety and depression in adulthood. More attention is needed to insure adequate sleep for maltreated children. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Inadequate sleep moderates effects of interparental conflict appraisals on adolescent adjustment

OBJECTIVES

Previous research and theory suggest that interparental conflict that is perceived by youth as frequent/intense, threatening, and/or the responsibility of the youth is predictive of adjustment problems. In contrast, sleep, an important precursor to emotion regulation, is likely a protective factor for youth experiencing interparental conflict. The goal of the current study was to investigate the extent to which adolescents who maintain better and/or longer sleep are buffered from the adjustment problems associated with greater interparental conflict.

METHODS

One-hundred and fifty adolescents completed questionnaires assessing interparental conflict (frequency/intensity perceptions as well as threat and self-blame appraisals) as well as internalizing and externalizing behaviors. Participants also wore an actigraph over 1 week to objectively measure sleep quantity and quality; 123 participants had valid actigraphy data.

RESULTS

Results of structural equation modeling analyses revealed that greater sleep quality weakened the association between interparental conflict and adjustment problems, particularly internalizing behaviors. However, sleep quantity was not a moderator.

CONCLUSION

These results suggest that higher quality sleep may protect adolescents from the negative effects of interparental conflict.

Childhood Maltreatment, Sleep Disturbances, and Anxiety and Depression: A Prospective Longitudinal Investigation

This research sought to determine whether inadequate sleep conditions in childhood and sleep problems in young adulthood in part explain the relationship between childhood abuse and neglect and anxiety and depression later in life. Children with documented histories of abuse and neglect and matched controls were followed up and assessed in young and middle adulthood. Abused and neglected children were more likely to report experiencing inadequate sleep conditions in childhood, sleep problems in young adulthood, and higher levels of depression and anxiety later in middle adulthood. Results revealed significant indirect paths from childhood maltreatment to anxiety and depression in middle adulthood through inadequate sleep conditions in childhood and sleep problems in young adulthood. This longitudinal follow-up of children with documented cases of maltreatment reveals the important role of sleep disturbances in the lives of maltreated children and adults and sleep disturbances in the development of subsequent anxiety and depression.

Internet use and its impact on internalizing disorder symptoms and sleep in adolescents with an evening circadian preference

STUDY OBJECTIVES

This study sought to examine the relationship between internet use, sleep, and internalizing disorder symptoms in adolescents with an evening circadian preference.

METHODS

One hundred seventy-two adolescents aged 10-18 years with an evening circadian preference completed a week of sleep diaries and questionnaires about internet use and internalizing disorder symptoms.

RESULTS

Adolescents reported internet use for 3.81 hours on weekdays and 5.44 hours on weekends, with > 90% having access to both a computer with internet and a personal cell phone. A majority of adolescents used the internet from 4-8 pm (71%) and from 9-11 pm (62%). Common online activities included listening to music (77%), watching videos (64%), communicating with others (64%), and doing homework (58%). Late-night internet use (9-11 pm) was associated with more internalizing disorder symptoms. Middle-of-the-night internet use (midnight-5 am) was associated with a later bedtime, shorter total sleep time, and more internalizing disorder symptoms. Adolescents used the internet to fulfill social needs, to avoid or combat boredom, or for maladaptive activities. Using the internet for social interaction or avoidance/boredom was associated with higher internalizing disorder symptoms. Using the internet for maladaptive reasons was associated with more late-night and middle-of-the-night use.

CONCLUSIONS

Adolescent internet use late at night and in the middle of the night is common. Internet use may be motivated by desires for social connection, by boredom/avoidance, or for maladaptive behaviors. Because middle-of-the-night internet use was associated with higher internalizing disorder symptoms and worse sleep, it presents as a potential target for intervention.

CITATION

Asarnow LD, Gasperetti CE, Gumport NB, Harvey AG. Internet use and its impact on internalizing disorder symptoms and sleep in adolescents with an evening circadian preference. J Clin Sleep Med. 2021;17(10):2019-2027.

Self and parent-reported sleep problems of adolescents with childhood conduct problems and comorbid psychological problems

INTRODUCTION

Childhood conduct problems (CP) are characterized by maladaptive externalizing behaviors and are linked with poor sleep. CP are highly comorbid with other psychological problems, including attention deficit/hyperactivity disorder and depression, which are also associated with disturbed sleep. The present study examined if childhood CP and comorbid depressive and/or attentional-hyperactivity problems were prospectively associated with parent and self-reported sleep difficulties in adolescence.

METHODS

Participants (N = 744; 53% boys) from an ongoing longitudinal study in Québec, Canada were assessed for CP and comorbidities when they were between 6 and 9 years old. Participants were classified as without CP, CP only, CP and depressive symptoms, CP and attention-hyperactivity problems, or CP, depressive symptoms, and attention-hyperactivity problems. Regressions were conducted to examine the associations between comorbidity groups, parent, and self-reported sleep problems 7 years later (Median age = 15.33 years), controlling for sex, age, family income, primary caregiver education and medication.

RESULTS

Adolescents in all CP groups had higher self and parent-reported sleep problems compared to adolescents without histories of CP. Adolescents with histories of CP, depressive symptoms and attention-hyperactivity problems had more sleep problems than all other groups according to self-reports, but not parent-reports.

CONCLUSION

Childhood CP was prospectively linked to sleep problems in adolescence, and comorbid conditions exacerbated these problems, according to youth but not parents.

Longitudinal bidirectional association between sleep and behavior problems at age 6 and 11 years

BACKGROUND

Although a growing number of longitudinal studies have found that sleep problems precede behavior problems, few have examined potential bidirectional relationships longitudinally. The present study examined prospective associations between sleep problems and internalizing, externalizing, and attention problems over the course of childhood.

METHODS

Participants included 775 children from the China Jintan Cohort Study. Sleep problems were rated by mothers at ages six and 11.5, as well as self-reported by children at age 11.5. Behavior problems were rated by mothers and teachers at ages six and 11.5, and self-reported by children at age 11.5.

RESULTS

At age six, 15.0% of children were reported to have sleep problems as rated by mothers. At age 11, this prevalence was 12% as rated by mothers and 20% as rated by youth. Bidirectional relationships between sleep problems and behavior problems were observed. Mother-reported sleep problems at age six were predictive of self-reported internalizing and attention problems at age 11.5, even after controlling for baseline behavioral problems. At age six, teacher-reported externalizing, internalizing, and attention problems, and mother-rated internalizing and externalizing problems were all related to sleep problems at age 11.5, even after controlling for baseline sleep problems. Other sociodemographic covariates including child sex, age, and parental education were controlled for.

CONCLUSIONS

Findings provide further support for the reciprocal relationship between sleep problems and behavior problems. Early interventions that target both types of problems may be especially effective in preventing this aggravating health-behavior cycle.

Daytime sleepiness underlies the link between adverse parenting and youth psychopathology among adolescent girls

INTRODUCTION

Adverse parenting is associated with sleep problems in adolescence, including sleep quality, inadequate sleep, and daytime sleepiness. Adolescents who experience sleep problems are at greater risk for developing internalizing and externalizing problems. However, research on the intervening role of sleep in the link between adverse parenting and youth psychopathology remains limited. The present study aimed to examine the indirect effects of adverse parenting on youth internalizing and externalizing psychopathology via sleep problems, and to examine the moderating role of gender in associations between parenting and sleep.

METHODS

Participants were 101 low-income youth aged 9-12 (52.5% female; 75.2% African-American) and their primary caregivers. Families were from a non-metropolitan region in the Southeastern United States. Data were collected at two time points (T1; Mage = 10.28, SD = 1.2; T2; Mage = 12.08, SD = 1.2). Adverse parenting was measured at T1, youth-reported sleep problems (inadequacy, disturbance) and daytime sleepiness were assessed at T2, and parent-reported internalizing and externalizing symptoms were measured at T2.

RESULTS

Daytime sleepiness served as an intervening variable in associations between adverse parenting and internalizing and externalizing problems, but sleep problems did not. This indirect association was moderated by gender, such that the association between adverse parenting and daytime sleepiness only emerged as significant for girls.

CONCLUSIONS

These findings suggest that daytime-related sleep behaviors may serve as a mechanism through which harsh or neglectful parenting is related to internalizing and externalizing psychopathology in adolescence, particularly for adolescent girls.

Linking RDoC and HiTOP: A new interface for advancing psychiatric nosology and neuroscience

The Research Domain Criteria (RDoC) and the Hierarchical Taxonomy of Psychopathology (HiTOP) represent major dimensional frameworks proposing two alternative approaches to accelerate progress in the way psychopathology is studied, classified, and treated. RDoC is a research framework rooted in neuroscience aiming to further the understanding of transdiagnostic biobehavioral systems underlying psychopathology and ultimately inform future classifications. HiTOP is a dimensional classification system, derived from the observed covariation among symptoms of psychopathology and maladaptive traits, which seeks to provide more informative research and treatment targets (i.e., dimensional constructs and clinical assessments) than traditional diagnostic categories. This article argues that the complementary strengths of RDoC and HiTOP can be leveraged in order to achieve their respective goals. RDoC's biobehavioral framework may help elucidate the underpinnings of the clinical dimensions included in HiTOP, whereas HiTOP may provide psychometrically robust clinical targets for RDoC-informed research. We present a comprehensive mapping between dimensions included in RDoC (constructs and subconstructs) and HiTOP (spectra and subfactors) based on narrative review of the empirical literature. The resulting RDoC-HiTOP interface sheds light on the biobehavioral correlates of clinical dimensions and provides a broad set of dimensional clinical targets for etiological and neuroscientific research. We conclude with future directions and practical recommendations for using this interface to advance clinical neuroscience and psychiatric nosology. Ultimately, we envision that this RDoC-HiTOP interface has the potential to inform the development of a unified, dimensional, and biobehaviorally-grounded psychiatric nosology.

The association of sleep quality and aggression: A systematic review and meta-analysis of observational studies

Poor sleep quality is closely related to aggression, but despite the promise of new therapeutic possibilities, a systematic synthesis of observational research on the association between sleep quality and aggression is lacking. This systematic review and meta-analysis examined the association between sleep quality and aggression, using the academic databases PubMed and PsycINFO. Subjective and objective measures of sleep quality were included, as well as multiple measures of aggression, assessing aggressive and externalizing behavior, anger, hostility and irritability. Ninety-two observational articles, containing 96 studies, encompassing a total of 58.154 children, adolescents and adults were sourced out of 7161 references identified. Methodological quality was moderate or strong in 76% of studies. Data for meta-analysis was available from 74 studies. Poorer sleep quality was associated with higher aggression in 80.8% of studies. Pooled results showed a correlation of 0.28 (95%CI 0.25-0.31; I² = 90.1%) and odds ratio of 3.61 (95%CI 1.13-11.51; I² = 88.3%). Effect estimates and heterogeneity varied according to population type and measurement instruments, but not according to article quality or age group. Our findings confirm that poor sleep quality is consistently associated with higher aggression. As most evidence is cross-sectional, more prospective and high-quality experimental evidence is required to elucidate cause-effect and optimize prevention and treatment of aggression.

Cognitive behavioral therapy for insomnia among young adults who are actively drinking: a randomized pilot trial

STUDY OBJECTIVES

More than half of young adults at risk for alcohol-related harm report symptoms of insomnia. Insomnia symptoms, in turn, have been associated with alcohol-related problems. Yet one of the first-line treatments for insomnia (Cognitive Behavioral Therapy for Insomnia or CBT-I) has not been tested among individuals who are actively drinking. This study tested (1) the feasibility and short-term efficacy of CBT-I among binge-drinking young adults with insomnia and (2) improvement in insomnia as a predictor of improvement in alcohol use outcomes.

METHODS

Young adults (ages 18-30 years, 75% female, 73% college students) who met criteria for Insomnia Disorder and reported 1+ binge drinking episode (4/5+ drinks for women/men) in the past month were randomly assigned to 5 weekly sessions of CBT-I (n = 28) or single-session sleep hygiene (SH, n = 28). All participants wore wrist actigraphy and completed daily sleep surveys for 7+ days at baseline, posttreatment, and 1-month follow-up.

RESULTS

Of those randomized, 43 (77%) completed posttreatment (19 CBT-I, 24 SH) and 48 (86%) completed 1-month follow-up (23 CBT-I, 25 SH). CBT-I participants reported greater posttreatment decreases in insomnia severity than those in SH (56% vs. 32% reduction in symptoms). CBT-I did not have a direct effect on alcohol use outcomes; however, mediation models indicated that CBT-I influenced change in alcohol-related consequences indirectly through its influence on posttreatment insomnia severity.

CONCLUSIONS

CBT-I is a viable intervention among individuals who are actively drinking. Research examining improvement in insomnia as a mechanism for improvement in alcohol-related consequences is warranted.

TRIAL REGISTRATION

U.S. National Library of Medicine, https://clinicaltrials.gov/ct2/show/NCT03627832, registration #NCT03627832.

The Relationship Between Family Functioning and Internalizing Problems in Chinese Adolescents: A Moderated Mediation Model

Research has consistently found that poor family functioning is a risk factor for adolescents' internalizing problems. However, studies of the mediating and moderating mechanisms underlying this relation are insufficient. In this study, we explore the association between family functioning and adolescents' internalizing problems by testing the mediating roles of positive youth development (PYD) attributes and the moderating role of migrant status. A large cross-sectional sample of 11,865 Chinese adolescents (mean age = 14.45 years, standard deviation = 1.55 years) were used to measure internalizing problems, family functioning, PYD, migrant status, and other demographic information. After controlling for covariates (age, gender, grade, and socioeconomic status), the results revealed that PYD mediated the relation between family functioning and internalizing problems. Moreover, migrant status moderated the relationship between family functioning and internalizing problems. Specifically, the effects of family functioning on internalizing problems were stronger among local-born adolescents than among migrant adolescents. The findings indicate that improving family functioning and PYD attributes may be promising approaches to prevent/reduce adolescent internalizing problems.

The influence of intensity and timing of daily light exposure on subjective and objective sleep in adolescents with an evening circadian preference

STUDY OBJECTIVES

The aim of the present study is to examine the relationship between light and sleep, in adolescents with an evening circadian preference.

METHODS

For a period of seven days, ninety-nine adolescents wore a wrist actigraph to assess light exposure and objective sleep and completed a sleep diary to assess subjective sleep.

RESULTS

Lower average light intensity across the preceding 24 h was associated with a later sleep onset (p < 0.01) and a later next-day sleep offset (p < 0.05). A later time of last exposure to more than 10 lux was associated with a later sleep onset (p < 0.001) and a shorter objective total sleep time (p < 0.001), as well as a later bedtime (p < 0.001) and a shorter subjective total sleep time (p < 0.001). Furthermore, exploratory analyses found that lower average early morning light exposure (between 4 and 9 AM) was associated with later sleep onset (p < 0.05), a later next-day sleep offset (p < 0.05), and a later next-day waketime (p < 0.01), lower average afternoon light exposure (between 2 and 7 PM) was associated with a later next-day sleep offset (p < 0.05), and lower average evening light exposure (between 7 PM and 12 AM) was associated with longer subjective total sleep time (p < 0.01).

CONCLUSION

This study highlights the importance of light exposure, particularly the timing of light exposure, for establishing healthy patterns of sleep among adolescents with a propensity for a delayed bedtime and waketime. These findings provide additional evidence for targeting light exposure when designing interventions to improve adolescent sleep.

Associations of sleep with psychological problems and well-being in adolescence: causality or common genetic predispositions?

BACKGROUND

Whereas short and problematic sleep are associated with psychological problems in adolescence, causality remains to be elucidated. This study therefore utilized the discordant monozygotic cotwin design and cross-lagged models to investigate how short and problematic sleep affect psychological functioning.

METHODS

Adolescent twins (N = 12,803, 13-20 years, 42% male) completed questionnaires on sleep and psychological functioning repeatedly over a two-year interval. Monozygotic twin pairs were classified as concordant or discordant for sleep duration and trouble sleeping. Resulting subgroups were compared regarding internalizing problems, externalizing problems, and subjective well-being.

RESULTS

Cross-sectional analyses indicated associations of worse psychological functioning with both short sleep and problematic sleep, and cross-lagged models indicate bidirectional associations. Longitudinal analyses showed that an increase in sleep problems experienced selectively by one individual of an identical twin pair was accompanied by an increase of 52% in internalizing problem scores and 25% in externalizing problem scores. These changes were significantly different from the within-subject changes in cotwins with unchanged sleep quality (respectively, 3% increase and 5% decrease). Psychological functioning did, however, not worsen with decreasing sleep duration.

CONCLUSIONS

The findings suggest that sleep quality, rather than sleep duration, should be the primary target for prevention and intervention, with possible effect on psychological functioning in adolescents.

Understanding the Relationship Between Sleep Problems in Early Childhood and Borderline Personality Disorder: A Narrative Review

OBJECTIVE

Recent research indicates that sleep problems in childhood precede the development of borderline personality disorder (BPD) symptoms, but the mechanisms by which sleep problems associate with BPD are still unknown. This narrative review aims to provide some potential explanations for how early sleep problems might associate with BPD.

METHODS

We used the biosocial developmental model of BPD as a framework to discuss how sleep problems may associate with BPD. Articles were identified via PubMed and Embase, and papers published between January 1991 and April 2021 were extracted. Authors made a series of literature searches using the following keywords: Sleep problems, Insomnia, Nightmares, Hypothalamic-Pituitary-Adrenal Axis (HPA), Prefrontal Cortex, Family Psychopathology, Disrupted Attachment, Child Maltreatment, Impulsivity, Emotion Regulation, Internalizing, Externalizing, Rumination, Childhood, Adolescence, Young people. The inclusion criteria were published in peer-reviewed journals; human studies or reviews; published in English. The exclusion criteria were commentaries; abstracts from conferences; studies with animal samples. A total of 96 articles were included for the purpose of this review.

RESULTS

The evidence from this review suggests that some biological factors and core features of BPD act as potential mechanisms mediating the associations between early sleep and subsequent BPD, while some family-related factors might constitute common risk factors for sleep problems and BPD.

CONCLUSION

The biosocial developmental model of BPD provides a plausible characterization of how sleep disruption might lead to subsequent BPD. Further research on new developmental and early intervention approaches to understand how sleep in early stages associates with BPD could have significant clinical impact on these patients and could inform targeted therapeutic interventions.

Circadian Functioning and Quality of Life in Substance Use Disorder Patients With and Without Comorbid Major Depressive Disorder

Aim: Although a relationship between circadian disruption and development of several psychiatric disorders, such as major depressive disorder (MDD) and substance use disorder (SUD), has been observed, knowledge on this area is scarce yet. Therefore, this study aims to analyze the circadian functioning and quality of life (QOL) in SUD patients with and without comorbid MDD, two highly prevalent clinical entities with difficult therapeutic management. Methods: One hundred sixty-three male patients under treatment, 81 with SUD and 82 with SUD comorbid major depressive disorder (SUD + MDD), were evaluated. For the circadian functioning assessment, we calculated Social Jet Lag (SJL) and used the reduced Morningness-Eveningness Questionnaire (rMEQ) and the Pittsburgh Sleep Quality Index (PSQI). QOL was measured using the shortened version of the World Health Organization's Quality of Life Questionnaire (WHOQOL-BREF). We collected sociodemographic and clinical variables to evaluate their possible influence on the circadian functioning. Intergroup differences among the variables were examined by different analyses of covariance (ANCOVA and MANCOVA). The possible relationships of quantitative clinical variables with rMEQ, PSQI, and WHOQOL-BREF were explored using bivariate correlation analysis. Results: Lower SJL appears in the SUD + MDD group compared with SUD. The intermediate-type was more prevalent in the SUD group, while a higher percentage of morning-type patients was found in the SUD + MDD. Sleep quality (including latency and daytime dysfunction) was worse for SUD + MDD patients than for SUD even after controlling age and age of SUD onset variables. Last, QOL was poorer in patients with SUD + MDD and, for them, psychological health had a negative relationship with SJL and severity of depression. Conclusions: Our data support and extend previous findings indicating that SUD + MDD is associated with worse clinical characteristics, more sleep problems, and poorer QOL than SUD patients. These results underline the importance of a precise assessment of these measurements in future studies conducted in SUD patients with/without MDD comorbidity that could be considered from a therapeutic point of view.