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Cheah YK, Kee CC, Lim KK, Cheong YL. Demographic, lifestyle, social, and psychological factors associated with worry-related sleep problems among school-going adolescents in Timor-Leste. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2024; 37:e12468. [PMID: 38654575 DOI: 10.1111/jcap.12468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Adolescent sleep problems are a worldwide public health issue. The present study examines factors associated with worry-related sleep problems among school-going adolescents. The country of interest is Timor-Leste, a low-income country, where studies pertaining to adolescent sleep problems are lacking. DESIGN AND MEASURES Data were analysed from the Global School-Based Student Health Survey Timor-Leste (n = 3455). An ordered probit model was used to assess the effects of demographic, lifestyle, social, and psychological factors on different levels of worry-related sleep problems (i.e., no, mild and severe sleep problems). RESULTS School-going adolescents were more likely to face mild or severe worry-related sleep problems if they were older, passive smokers, alcohol drinkers and moderately active. School-going adolescents who sometimes or always went hungry were more likely to experience worry-related sleep problems than those who did not. Involvement in physical fights, being bullied, and loneliness were positively associated with the probability of having modest or severe worry-related sleep problems. CONCLUSION Age, exposure to second-hand smoke, alcohol consumption, physical activity, going hungry, physical fights, being bullied and loneliness are the important determining factors of adolescent worry-related sleep problems. Policymakers should pay special attention to these factors when formulating intervention measures.
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Affiliation(s)
- Yong Kang Cheah
- School of Economics, Finance and Banking, College of Business, Universiti Utara Malaysia, Sintok, Malaysia
| | - Chee Cheong Kee
- Sector for Biostatistics and Data Repository, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Kuang Kuay Lim
- Centre for Occupational Health Research, Institute for Public Health, Ministry of Health Malaysia, Shah Alam, Malaysia
| | - Yoon Ling Cheong
- Special Research Centre, Institute for Medical Research, Ministry of Health Malaysia, Jalan Pahang, Malaysia
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Baena D, Toor B, Ray LB, Smith D, Kong P, Lopez J, Hoffmann R, Bertram H, Robillard R, Armitage R, Fogel SM. Sleep spindles in adolescents with major depressive disorder. J Affect Disord 2024; 344:535-545. [PMID: 37827259 DOI: 10.1016/j.jad.2023.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/26/2023] [Accepted: 10/08/2023] [Indexed: 10/14/2023]
Abstract
Sleep spindle differences in adolescents with major depressive disorder (MDD) compared to healthy adolescents is an ongoing debate. Results mostly indicate decreased sleep spindle activity in adolescents with MDD. Given that sleep spindles predominate NREM and that acutely delaying the sleep period via a "sleep delay challenge" (SDC) increases non-rapid eye movement (NREM) sleep duration, it may be possible to increase spindle density in adolescents with MDD, which may provide a therapeutic benefit to depression symptoms. Here, we examined the impact of a SDC on spindle density and depression symptomology in adolescents with MDD (n = 66) and healthy controls (n = 62) tested across three nights: adaptation, normal sleep, and a SDC night which delayed bedtime by three hours. The results showed that; (1) there was no difference in spindle density between groups on the normal sleep night, (2) following the SDC, both males and females with MDD had a decrease in the frequency of slow spindles, while only females with MDD had an increase in the frequency of fast spindles, (3) acute SDC reduced depression symptoms in both groups, and (4) light sleep on the normal sleep night and slow spindle frequency at SDC predicted an 8 % improvement in depression symptoms, regardless of sex or MDD diagnosis. Taken together, these results suggest that; (a) spindles may be a useful biological marker of depression symptomatology regardless of clinical MDD diagnosis, and (b) that acute SDC may help alleviate depression symptoms in adolescents with MDD.
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Affiliation(s)
- D Baena
- School of Psychology, University of Ottawa, Ottawa K1N 6N5, Canada; Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa K1Z 7K4, Canada
| | - B Toor
- School of Psychology, University of Ottawa, Ottawa K1N 6N5, Canada; Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa K1Z 7K4, Canada
| | - L B Ray
- School of Psychology, University of Ottawa, Ottawa K1N 6N5, Canada
| | - D Smith
- School of Psychology, University of Ottawa, Ottawa K1N 6N5, Canada; Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa K1Z 7K4, Canada
| | - P Kong
- School of Psychology, University of Ottawa, Ottawa K1N 6N5, Canada
| | - J Lopez
- Department of Psychiatry, University of Michigan, MI 48109, USA; Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham 35294, USA
| | - R Hoffmann
- Department of Psychiatry, University of Michigan, MI 48109, USA
| | - H Bertram
- Department of Psychiatry, University of Michigan, MI 48109, USA
| | - R Robillard
- School of Psychology, University of Ottawa, Ottawa K1N 6N5, Canada; Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa K1Z 7K4, Canada
| | - R Armitage
- Department of Psychiatry, University of Michigan, MI 48109, USA
| | - S M Fogel
- School of Psychology, University of Ottawa, Ottawa K1N 6N5, Canada; Sleep Research Unit, The Royal's Institute of Mental Health Research, Ottawa K1Z 7K4, Canada; University of Ottawa Brain & Mind Research Institute, Ottawa K1H 8M5, Canada.
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Wingerson MJ, Baugh CM, Provance AJ, Armento A, Walker GA, Howell DR. Changes in Quality of Life, Sleep, and Physical Activity During COVID-19: A Longitudinal Study of Adolescent Athletes. J Athl Train 2023; 58:887-894. [PMID: 36827615 PMCID: PMC11215709 DOI: 10.4085/1062-6050-0529.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
CONTEXT The abrupt cessation of school and sport participation during the COVID-19 pandemic may have negative implications for adolescent mental health. OBJECTIVES To (1) compare mental, physical, and social health and behaviors during pandemic-related stay-at-home mandates with the same measures collected 1 to 2 years earlier and (2) evaluate the relationships between physical activity and sleep during the pandemic and changes in anxiety, fatigue, and peer relationships between assessment times. DESIGN Cohort study. SETTING Pediatric sports medicine center. PATIENTS OR OTHER PARTICIPANTS A total of 39 high school athletes (25 adolescent girls, 14 adolescent boys; age = 16.2 ± 0.9 years). MAIN OUTCOME MEASURE(S) Patient-Reported Outcome Measurement System anxiety, fatigue, and peer relationships short forms and the Pittsburgh Sleep Quality Index were completed twice (initial assessment in May 2018 or 2019, follow-up assessment in May or June 2020). Frequency and duration of physical activity and frequency of interaction with other individuals (family, peers, sport coaches, etc) were self-reported at follow-up assessment for the 2 weeks before school or sport closure and the 2 weeks before questionnaire completion. RESULTS Higher levels of anxiety (5.5 ± 4.0 versus 3.6 ± 3.4 points; P = .003) and fatigue (5.4 ± 3.7 versus 2.3 ± 2.5 points; P < .001) and worse sleep quality (6.6 ± 2.9 versus 4.3 ± 2.3 points; P < .001) were observed during the pandemic compared with previous assessments. Reductions in physical activity were noted between assessments (exercise duration: 86.4 ± 41.0 versus 53.8 ± 30.0 minutes; P < .001). Sleep quality but not physical activity during the pandemic predicted changes in fatigue (P = .03, β = 0.44 [95% CI = 0.06, 0.83]) and peer relationships (P = .01, β = -0.65 [95% CI = -1.16, -0.15]) from initial to follow-up assessment. CONCLUSIONS Mental and physical health declined during stay-at-home mandates compared with assessments 1 to 2 years earlier. Physical activity behaviors and sources of social interaction underwent changes after school and sport cessation. Sleep quality may have provided some protection against declining adolescent mental health during the pandemic, although this relationship requires further investigation.
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Affiliation(s)
- Mathew J. Wingerson
- Department of Orthopedics, Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora
| | - Christine M. Baugh
- Division of General Internal Medicine, Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora
| | - Aaron J. Provance
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City
| | - Aubrey Armento
- Department of Orthopedics, Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora
- Sports Medicine Center, Children’s Hospital Colorado, Aurora
| | - Gregory A. Walker
- Department of Orthopedics, Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora
- Sports Medicine Center, Children’s Hospital Colorado, Aurora
| | - David R. Howell
- Department of Orthopedics, Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora
- Sports Medicine Center, Children’s Hospital Colorado, Aurora
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Domingues SF, Diniz da Silva C, Faria FR, de Sá Souza H, dos Santos Amorim PR. Sleep, sedentary behavior, and physical activity in Brazilian adolescents: Achievement recommendations and BMI associations through compositional data analysis. PLoS One 2022; 17:e0266926. [PMID: 35404979 PMCID: PMC9000056 DOI: 10.1371/journal.pone.0266926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/29/2022] [Indexed: 11/18/2022] Open
Abstract
Physical activity, sedentary behavior (SB), and sleep are habitual human behaviors (HHB) which are modifiable throughout the different life phases. Therefore, it is necessary to analyze how the time distribution throughout the day among HHB may be associated with body mass index (BMI). These results could provide inferences which can guide interventions that trigger changes in adolescent behaviors in favor of their health. The objective of this study was to verify the proportion of adolescents who meet the recommendation of sleep, moderate to vigorous physical activity (MVPA), and screen time (ST); to analyze the associations between HHB and BMI, and to determine possible changes in BMI associated with time reallocation between different HHB. Daily HHB recommendations (yes/no) were analyzed by frequency distribution. Compositional data analyses were used to examine the association between HHB and the BMI z-score (zBMI) with covariates (sex, age, and socioeconomic status). Compositional isotemporal substitution models estimated the change in zBMI associated with HHB reallocations from 15 to 120 minutes. A total of 185 adolescents were included (15 to 18 years, 50.8% boys). Thus, total sleep time, SB, light physical activity (LPA) and MVPA were measured by 24-hour accelerometry for seven consecutive days. ST, demographic characteristics, and socioeconomic status were assessed using a questionnaire. Sleep, MVPA, and ST recommendations were achieved by 32.97%, 8.10%, and 1.08% of the sample, respectively. No adolescent was able to achieve all of the daily recommendations. Age was significantly and positively associated with zBMI (p<0.001). Simply replacing 75, 90, and 120 minutes of MVPA by LPA led to an estimated significant increase in zBMI (95CI% z-value, 0.01 to 1.49). The HHB relocation estimates in 24h did not show positive effects on zBMI, nor did it increase the time engaged in MVPA, which may raise the hypothesis that other parameters related to obesity and their related interactions need to be better understood.
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Affiliation(s)
| | - Cristiano Diniz da Silva
- Department of Physical Education, Federal University of Juiz de Fora—Advanced Campus Governador Valadares, Governador Valadares, Minas Gerais, Brazil
| | - Fernanda Rocha Faria
- Federal Institute of Education, Science and Technology of Triângulo Mineiro, Ituiutaba, Minas Gerais, Brazil
| | - Helton de Sá Souza
- Department of Physical Education, Federal University of Viçosa, Viçosa, Minas Gerais, Brazil
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Krempel R, Schleicher D, Jarvers I, Ecker A, Brunner R, Kandsperger S. Sleep quality and neurohormonal and psychophysiological accompanying factors in adolescents with depressive disorders: study protocol. BJPsych Open 2022; 8:e57. [PMID: 35236539 PMCID: PMC8935910 DOI: 10.1192/bjo.2022.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Depressive disorders are common mental health problems during adolescence. Many adolescents with depression describe difficulties with sleeping. Findings of previous studies regarding changes in objective sleep quality in adolescents with depressive disorders are heterogeneous. AIMS This study aims to investigate differences in objective and subjective sleep quality between adolescents with depressive disorders and healthy peers, and to evaluate if potential changes in sleep occur concurrently with changes in the release of cortisol and alpha-amylase after awakening. METHOD This non-interventional parallel study examines correlations between depressive disorders, sleep quality and release of stress hormones. Sleep quality in the past 2 weeks, severity of depressive symptoms, psychiatric comorbidities and stress response of 30 adolescents with depressive disorders and 30 healthy controls (N = 60) are assessed via questionnaires. In participants' home environments, the objective sleep quality of seven consecutive nights is measured by sleep accelerometry. After awakening, participants answer sleep questionnaires to examine the subjective sleep quality of those nights. Furthermore, salivary cortisol and alpha-amylase are measured three times after awakening (+0 min, +30 min and +45 min after awakening). CONCLUSIONS Sleep is an important factor for prognosis and well-being in adolescents with depression. The results of this study can be highly valuable to integrate a more detailed examination of sleep quality and sleeping impairments in the treatment of adolescent depressive disorders.
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Affiliation(s)
- Rebekka Krempel
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Germany
| | - Daniel Schleicher
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Germany
| | - Irina Jarvers
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Germany
| | - Angelika Ecker
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Germany
| | - Romuald Brunner
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Germany
| | - Stephanie Kandsperger
- Clinic of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Germany
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Bowen AE, Staggs S, Kaar J, Nokoff N, Simon SL. Short sleep, insomnia symptoms, and evening chronotype are correlated with poorer mood and quality of life in adolescent transgender males. Sleep Health 2021; 7:445-450. [PMID: 33875385 PMCID: PMC8384662 DOI: 10.1016/j.sleh.2021.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/31/2021] [Accepted: 03/11/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Poor sleep is common among adolescents and associated with impaired mood and health-related quality of life (HRQOL). Transgender individuals are at increased risk of mood problems hypothesized to be due to minority stress; however, no research has investigated associations between sleep and mood in this population. We aimed to examine sleep, mood, and HRQOL in transgender adolescent males. DESIGN & SETTING Transgender males age 13-16 were recruited from a U.S. gender diversity clinic. MEASUREMENTS Participants completed one week of home actigraphy monitoring. Questionnaires assessed insomnia symptoms, chronotype, mood, and HRQOL. Pearson correlations between sleep, mood, and HRQOL were examined. RESULTS A total of 10 participants completed study measures during the school year. Participants obtained less than the recommended 8-10 hours of sleep per night, and half of participants endorsed insomnia symptoms. Greater insomnia symptoms were correlated with higher anxiety (P = .04) and depression (P = .04) symptoms, and poorer Psychosocial HRQOL (P = .03). Earlier weekday and weekend bed and wake times and earlier weekday sleep midpoint were associated with better Wellbeing HRQOL. No other significant correlations between sleep and mood or HRQOL variables were found. CONCLUSIONS Anxiety and depression symptoms were associated with self-reported insomnia symptoms, while HRQOL was associated with both insomnia symptoms and objective sleep timing in this sample of adolescent transgender males. Clinicians should assess both sleep and mood symptoms in this population and future research should evaluate the impact of improved sleep and gender-affirming care on mood and HRQOL for transgender adolescents.
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Affiliation(s)
- Anne E Bowen
- Children's Hospital Colorado, Aurora, Colorado, USA
| | - Syd Staggs
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jill Kaar
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Natalie Nokoff
- Children's Hospital Colorado, Aurora, Colorado, USA; University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stacey L Simon
- Children's Hospital Colorado, Aurora, Colorado, USA; University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
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Leung CY, Torres R. Sleep duration does not mediate the association between screen time and adolescent depression and anxiety: findings from the 2018 National Survey of Children's Health. Sleep Med 2021; 81:227-234. [PMID: 33721600 PMCID: PMC8499699 DOI: 10.1016/j.sleep.2021.02.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE/BACKGROUND Adolescence is a crucial time period in which individuals are at high risk for depression and anxiety. Associations between screen time and adolescent depression and anxiety have been inconclusive. We examined 1) the associations of screen time with adolescent depression and anxiety and 2) whether sleep duration mediates these relationships. METHODS This study utilized data from the 2018 US. National Survey of Children's Health, a large cross-sectional population representative dataset with parent/caregiver responses. Multivariable logistic regression was used to estimate the associations between screen time and depression and anxiety in separate models. Path models were used to test the mediating role of sleep duration. Confounders, as sex, age, and sociodemographic variables were included in our adjusted models. RESULTS Data of 10,907 adolescents aged 13 to 17 were included in this study. The average screen time was 3.76 h daily. Compared to no screen time, adolescents who used over 4 h of screen time per day had higher odds of depression (OR = 2.23, 95% CI:1.27-3.91) and anxiety (OR = 1.85, 95% CI: 1.26-2.72). Sleep duration did not mediate the associations between screen time and depression and anxiety. CONCLUSIONS Further research is necessary to examine the associations of screen time content with depression and anxiety, as well as the effects of sleep quality in conjunction with sleep duration on the relationships of screen time and depression and anxiety.
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Affiliation(s)
- Cherry Y Leung
- University of California, San Francisco, School of Nursing, Dept. of Community Health Systems, 5th Floor, Box 0608, 2 Koret Way, San Francisco, CA, 94143, USA.
| | - Rosamar Torres
- The University of Texas at Austin, School of Nursing, 1710 Red River St., Austin, TX, 78701, USA.
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An Exploratory Study on Sleep Procrastination: Bedtime vs. While-in-Bed Procrastination. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165892. [PMID: 32823762 PMCID: PMC7460337 DOI: 10.3390/ijerph17165892] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/05/2020] [Accepted: 08/12/2020] [Indexed: 12/02/2022]
Abstract
Sleep Procrastination literature has focused on the behaviors individuals engage in before going to bed (Bedtime Procrastination) but not on the behaviors individuals engage in after going to bed (While-in-Bed Procrastination). The main goal of this study is to explore whether this While-in-Bed procrastination is a novel phenomenon that adds to the Sleep Procrastination literature. The study was conducted online with 400 high school students (Mage = 16.56; 139 males) recruited through personal contacts and social media. The Bedtime procrastination scale was adapted and validated for this sample, whereas the While-in-Bed Procrastination scale was developed for this study. Data show a low correlation (r = 0.158 **) between Bedtime and While-in-Bed Procrastination scales, suggesting that Sleep Procrastination may be composed of the two facets. Additionally, results showed that more Bedtime Procrastination was related to later waking time and later dinnertime hours, whereas more While-in-Bed Procrastination was linked to being male, later desired time to sleep, and earlier dinnertime hour. Findings indicate that solely assessing Bedtime Procrastination as representing the procrastination of Sleep is limited and overlooks a significant part of this behavior. This exploratory study adds a new perspective to the literature by stressing the role of While-in-Bed Procrastination, thus opening new research pathways.
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Yip T, Cham H, Wang Y, El-Sheikh M. Discrimination and Sleep Mediate Ethnic/Racial Identity and Adolescent Adjustment: Uncovering Change Processes With Slope-as-Mediator Mediation. Child Dev 2020; 91:1021-1043. [PMID: 31317537 PMCID: PMC6980173 DOI: 10.1111/cdev.13276] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study employs slope-as-mediator techniques to explore how the daily association between ethnic/racial discrimination and sleep disturbances serves as an intermediary link between ethnic/racial identity (ERI) and psychological adjustment. In a diverse sample of 264 adolescents (Mage = 14.3 years old, 70% female, 76% United States born, 25% African American, 32% Asian American, 43% Latinx), discrimination was associated with sleep disturbance. Furthermore, ERI commitment buffered the impact of discrimination on sleep, whereas ERI exploration exacerbated the impact of discrimination. Finally, the daily level association between discrimination and sleep (i.e., daily slope) mediated the association between ERI and adolescent adjustment. Substantive links between discrimination and sleep are discussed as well as broader applications of slope-as-mediator techniques.
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Abstract
Chronic sleep deprivation is a common, treatable condition among adolescents. Growing literature supports a myriad consequences that impact overall health, behavior, mood, and academic performance in this vulnerable age group during a time when there are rapid changes in physical development and emotional regulation. This article reviews the epidemiology and health effects of sleep deprivation in adolescents as well as common disorders leading to sleep loss and evidence to support treatment. Although a variety of important sleep disorders may disrupt quality of sleep in adolescents, such as obstructive sleep apnea, restless leg syndrome, and narcolepsy, this article will focus on common disorders that affect the quantity of sleep, such as poor sleep hygiene, circadian rhythm disorders, and insomnia.
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Do sleep disturbances in depressed adolescents improve following psychological treatment for depression? J Affect Disord 2020; 262:205-210. [PMID: 31679753 DOI: 10.1016/j.jad.2019.10.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/28/2019] [Accepted: 10/19/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Persistent sleep disturbances are one of the most common symptoms of Major Depressive Disorder (MDD) in adolescence. These are not typically targeted in psychological treatments and it is not known if psychological treatment for depression improves sleep. METHODS Secondary analyses were conducted using data from a large, multi-centre, randomised controlled trial (Goodyer et al., 2017b). Young people aged 12-18 years (N = 465; 75% female) met diagnostic criteria for Major Depressive Disorder, based on the Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS). They were randomised to one of three psychological treatments. Sleep difficulties were assessed at baseline, post-treatment (36 weeks) and one year follow up (86 weeks) with the K-SADS, and the Mood and Feelings Questionnaire (MFQ). RESULTS At baseline, 92% of young people exhibited clinically significant sleep difficulties. Exploratory analyses suggest that sleep difficulties significantly decreased from baseline to end of treatment on self-report and interview-based measures, and this decrease was maintained at follow up. Reduction in sleep difficulties did not differ between the psychological treatments. Approximately, half of young people reported residual sleep difficulties at the end of treatment and at follow-up. LIMITATIONS This paper reports secondary data analyses and findings are exploratory. CONCLUSIONS Tentative results suggest that psychological treatments for depression reduced sleep problems for some participants. However, young people with treatment-resistant sleep problems may benefit from adjunctive sleep interventions. Future work with a range of sleep measures is needed to determine those who have residual sleep problems at the end of treatment and post-treatment follow-up.
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Hamann C, Rusterholz T, Studer M, Kaess M, Tarokh L. Association between depressive symptoms and sleep neurophysiology in early adolescence. J Child Psychol Psychiatry 2019; 60:1334-1342. [PMID: 31512761 DOI: 10.1111/jcpp.13088] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Depression is highly prevalent among adolescents, and depressive symptoms rise rapidly during early adolescence. Depression is often accompanied by subjective sleep complaints and alterations in sleep neurophysiology. In this study, we examine whether depressive symptoms, measured on a continuum, are associated with subjective and objective (sleep architecture and neurophysiology) measures of sleep in early adolescence. METHODS High-density sleep EEG, actigraphy, and self-reported sleep were measured in 52 early adolescents (12.31 years; SD: 1.121; 25 female). Depressive symptoms were measured on a continuum using the Center for Epidemiological Studies Depression Scale (CES-D). The association between depressive symptoms and 2 weeks of actigraphy, self-reported sleep, sleep architecture, and sleep neurophysiology (slow wave activity and sigma power) was determined via multiple linear regression with factors age, sex, and pubertal status. RESULTS Despite no association between polysomnography measures of sleep quality and depressive symptoms, individuals with more depressive symptoms manifested worse actigraphically measured sleep. Less sleep spindle activity, as reflected in nonrapid eye movement sleep sigma power, was associated with more depressive symptoms over a large cluster encompassing temporal, parietal, and occipital regions. Furthermore, worse subjectively reported sleep quality was also associated with less sigma power over these same areas. Puberty, age, and sex did not impact this association. CONCLUSIONS Sleep spindles have been hypothesized to protect sleep against environmental disturbances. Thus, diminished spindle power may be a subtle sign of disrupted sleep and its association with depressive symptoms in early adolescence may signal vulnerability for depression.
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Affiliation(s)
- Christoph Hamann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Rusterholz
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - Martina Studer
- Department of Neurology, University Hospital, Inselspital, Bern, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Section for Translational Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Leila Tarokh
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Gupta P, Sagar R, Mehta M. Subjective sleep problems and sleep hygiene among adolescents having depression: A case-control study. Asian J Psychiatr 2019; 44:150-155. [PMID: 31376799 DOI: 10.1016/j.ajp.2019.07.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/03/2019] [Accepted: 07/23/2019] [Indexed: 11/29/2022]
Abstract
Sleep research has often focussed heavily on polysomnography while ignoring subjective sleep complaints of individuals, especially the young ones. Discordance has been seen between objective and subjective parameters of sleep among children and adolescents. There has been a trend towards worsening of sleep hygiene among adolescents, which may predispose to psychiatric disorders like depression. So, we compared the subjective sleep quality and sleep hygiene among depressed and normal adolescents. A sample of 31 depressed adolescents and 32 healthy controls were compared on sleep parameters using Adolescent Sleep Wake Scale (ASWS), Adolescent Sleep Hygiene Scale (ASHS) and School Sleep Habits Survey. Depressed adolescents were found to have significantly worse sleep quality [ASWS score 3.72 ± 0.952 vs 4.79 ± 0.552, p < 0.001], longer sleep onset latency [68.23 ± 62.98 vs 19.53 ± 19.48 minutes, p < 0.001], and shorter sleep duration [414.19 ± 110.78 vs 498.28 ± 56.86 minutes, p < 0.001]. Sleep quality significantly correlated with depression severity (measured on Children's Depression Rating Scale- revised), i.e., higher the severity of depression, poorer was the sleep quality (r = -0.605, p < 0.01). But sleep hygiene was statistically similar between the two groups [ASHS score 3.21 ± 0.60 vs 3.36 ± 0.51, p = 0.293], and was inadequate (< 3.8) among all adolescents irrespective of depression. Hence, despite the lack of evidence from objective sleep measures, there seem to be subjective sleep impairments among adolescents having depression. Future research needs to address the underlying etiological factors and causal directions for depression and sleep impairments among adolescents. Sleep hygiene education must be a part of broader primary prevention strategies for psychiatric disorders.
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Affiliation(s)
- Prashant Gupta
- All India Institute of Medical Sciences, New Delhi, 110005, India.
| | - Rajesh Sagar
- All India Institute of Medical Sciences, New Delhi, 110005, India
| | - Manju Mehta
- All India Institute of Medical Sciences, New Delhi, 110005, India
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Hosker DK, Elkins RM, Potter MP. Promoting Mental Health and Wellness in Youth Through Physical Activity, Nutrition, and Sleep. Child Adolesc Psychiatr Clin N Am 2019; 28:171-193. [PMID: 30832951 DOI: 10.1016/j.chc.2018.11.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The medical benefits to youth conferred by physical activity, balanced nutrition, and quality sleep have been increasingly encouraged by medical and mental health providers. Emerging evidence continues to reveal benefits for youth mental health and well-being, including for youth with psychiatric disorders. This evidence seems multifactorial through both neurobiological and psychosocial systems, with common mechanisms present between physical activity, nutrition, and sleep. This article reviews the benefits of optimizing physical activity, nutrition, and sleep; how to assess these lifestyle domains with patients and their parents; and appropriate interventions to optimize well-being in youth.
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Affiliation(s)
- Daniel K Hosker
- Psychiatry, Massachusetts General Hospital, 32 Fruit Street, Boston, MA 02114, USA.
| | - R Meredith Elkins
- McLean Anxiety Mastery Program, McLean Hospital, 799 Concord Avenue, Cambridge, MA 02138, USA; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Cambridge, MA 02115, USA
| | - Mona P Potter
- Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Cambridge, MA 02115, USA; McLean Child and Adolescent Psychiatry Outpatient Services, McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA
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15
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Li X, Buxton OM, Lee S, Chang AM, Berger LM, Hale L. Sleep mediates the association between adolescent screen time and depressive symptoms. Sleep Med 2019; 57:51-60. [PMID: 30897456 DOI: 10.1016/j.sleep.2019.01.029] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study examined the associations between four types of screen-based activities and depressive symptoms among adolescents. We further investigated whether sleep characteristics (ie, insomnia symptoms and sleep duration) mediate these associations. METHODS Data come from 2865 U.S. adolescents (mean age = 15.53, SD = 0.73, 51.8% male) in the age 15 follow-up of the Fragile Families and Child Wellbeing Study. Adolescents completed surveys regarding sleep duration and insomnia symptoms, typical daily duration of four screen activities (social messaging, web surfing, TV/movie watching, and gaming), and depressive symptoms. We constructed a multiple mediation model to elucidate the associations between age 15 screen time, sleep and depressive symptoms, while adjusting for age 9 depressive symptoms. RESULTS Structural Equation Modeling analyses revealed that the association between screen time and depressive symptoms is partially or fully mediated by sleep. For social messaging, web surfing and TV/movie watching, the three sleep variables fully mediated the positive association between screen time and depressive symptoms. For gaming, the three sleep variables acted as partial mediators in the model, accounting for 38.5% of the association between gaming and depressive symptoms. CONCLUSIONS Our results highlight both screen-based activities and sleep behaviors as potential intervention targets to reduce depressive symptoms among adolescents.
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Affiliation(s)
- Xian Li
- Program in Public Health, Department of Family, Population and Preventive Medicine, Stony Brook University, USA.
| | - Orfeu M Buxton
- Department of Biobehavioral Health, Pennsylvania State University, USA; Division of Sleep Medicine, Harvard Medical School, USA; Sleep Health Institute, Departments of Medicine and Neurology, Brigham and Women's Hospital, USA; Department of Social and Behavioral Sciences, Harvard Chan School of Public Health, USA
| | - Soomi Lee
- School of Aging Studies, University of South Florida, USA
| | - Anne-Marie Chang
- Department of Biobehavioral Health, Pennsylvania State University, USA; College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Lawrence M Berger
- Institute for Research on Poverty and School of Social Work, University of Wisconsin-Madison, USA
| | - Lauren Hale
- Program in Public Health, Department of Family, Population and Preventive Medicine, Stony Brook University, USA
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The Role of Sleep Quality in Associations between Peer Victimization and Internalizing Symptoms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2018. [DOI: 10.1007/s10862-018-9700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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17
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Schnatschmidt M, Schlarb A. Review: Schlafprobleme und psychische Störungen im Kindes- und Jugendalter. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2018; 46:368-381. [DOI: 10.1024/1422-4917/a000605] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Schlafprobleme und -störungen sind in Kindheit und Jugendalter weitverbreitet. Dieser Review beleuchtet den Zusammenhang zwischen Schlafproblemen und psychischen Störungen im Kindes- und Jugendalter. Schlafprobleme und -störungen gelten zum einen als Risikofaktoren für die Entwicklung psychischer Störungen, aber auch als Symptom und Auswirkung psychischer Störungen. Oft stehen Schlafverhalten und Psychopathologie in einer Wechselwirkung, sodass Schlafprobleme zur Intensität und Aufrechterhaltung psychischer Störungen beitragen. Dieser bidirektionale Zusammenhang ist sowohl in der frühen Kindheit als auch im Schulalter und bei Jugendlichen zu beobachten. Viele Studien konnten zeigen, dass es einen langfristigen Zusammenhang über die kindliche Entwicklung hinweg gibt. Sowohl Umweltfaktoren als auch genetische Faktoren scheinen bei der Entwicklung und Aufrechterhaltung dieses Zusammenhangs eine Rolle zu spielen. Diverse Forschungsergebnisse zeigen, dass die Behandlung von psychischen Störungen und die Behandlung von Schlafproblemen sich wechselseitig positiv beeinflussen. Daher ist die Berücksichtigung von Schlafproblemen in der Diagnostik und Behandlung, aber auch in der Prävention von psychischen Störungen dringend anzuraten.
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Affiliation(s)
- Marisa Schnatschmidt
- Fakultät für Psychologie und Sportwissenschaft, Abteilung für Psychologie, Universität Bielefeld
| | - Angelika Schlarb
- Fakultät für Psychologie und Sportwissenschaft, Abteilung für Psychologie, Universität Bielefeld
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Sleep Disturbances in Child and Adolescent Mental Health Disorders: A Review of the Variability of Objective Sleep Markers. Med Sci (Basel) 2018; 6:medsci6020046. [PMID: 29867064 PMCID: PMC6024884 DOI: 10.3390/medsci6020046] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022] Open
Abstract
Sleep disturbances are often observed in child and adolescent mental health disorders. Although previous research has identified consistent subjective reports of sleep disturbances, specific objective sleep markers have not yet been identified. We evaluated the current research on subjective and objective sleep markers in relation to attention deficit hyperactivity disorders, autism spectrum disorders, anxiety and depressive disorders. Subjective sleep markers are more consistent than objective markers of actigraphy, polysomnography, and circadian measures. We discuss the causes of variability in objective sleep findings and suggest future directions for research.
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Predicting Fatigue 12 Months after Child Traumatic Brain Injury: Child Factors and Postinjury Symptoms. J Int Neuropsychol Soc 2018; 24:224-236. [PMID: 28974281 DOI: 10.1017/s1355617717000893] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Fatigue is a common and persisting symptom after childhood brain injury. This study examined whether child characteristics and symptomatology preinjury or 6 months postinjury (pain, sleep, and mood, inattention) predicted fatigue at 12months postinjury. METHODS Parents of 79 children (0-18 years) rated fatigue at 12 months after injury on a multidimensional scale (general, sleep/rest, and cognitive). Demographic and clinical data were collected at injury. Parents rated child sleep, pain, physical/motor function, mood, and inattention at injury (preinjury description), and 6 months postinjury. Children were divided into two traumatic brain injury severity groups: mild TBI (n=57) and moderate/severe TBI (n=27). Hierarchical regression models were used to examine (i) preinjury factors and (ii) symptoms 6 months postinjury predictive of fatigue (general, sleep/rest, and cognitive) at 12 months postinjury. RESULTS Sleep/rest fatigue was predicted by preinjury fatigue (7% of variance) and psychological symptoms preinjury (10% of variance). General fatigue was predicted by physical/motor symptoms (27%), sleep (10%) and mood symptoms (9%) 6 months postinjury. Sleep/rest fatigue was predicted by physical/motor symptoms (10%), sleep symptoms (13%) and mood symptoms (9%) 6 months postinjury. Cognitive fatigue was predicted by physical/motor symptoms (17%) 6 months postinjury. CONCLUSIONS Preinjury fatigue and psychological functioning identified those at greatest risk of fatigue 12 months post-TBI. Predictors of specific fatigue domains at 12 months differed across each of the domains, although consistently included physical/motor function as well as sleep and mood symptoms postinjury. (JINS, 2018, 24, 224-236).
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Carbone T. Pediatric Sleep Medicine. Pediatr Ann 2017; 46:e319-e320. [PMID: 28892545 DOI: 10.3928/19382359-20170815-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Insufficient sleep duration and poor sleep quality are common among adolescents. The multidimensional causes of insufficient sleep duration and poor sleep quality include biological, health-related, environmental, and lifestyle factors. The most common direct consequence of insufficient and/or poor sleep quality is excessive daytime sleepiness, which may contribute to poor academic performance, behavioral health problems, substance use, and drowsy driving. Evaluation of sleepiness includes a detailed sleep history and sleep diary, with polysomnography only required for the assessment of specific sleep disorders. Management involves encouraging healthy sleep practices such as having consistent bed and wake times, limiting caffeine and electronics at night before bed, and eliminating napping, in addition to treating any existing sleep or medical disorders. [Pediatr Ann. 2017;46(9):e340-e344.].
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Yang B, Choe K, Park Y, Kang Y. Associations among daytime sleepiness, depression and suicidal ideation in Korean adolescents. Int J Adolesc Med Health 2017; 31:/j/ijamh.ahead-of-print/ijamh-2016-0161/ijamh-2016-0161.xml. [PMID: 28598800 DOI: 10.1515/ijamh-2016-0161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 02/21/2017] [Indexed: 06/07/2023]
Abstract
The aim of this study was to examine the effects of daytime sleepiness on depression and suicidal ideation in adolescent high-school students. A survey of 538 high school students aged 16-17 years attending two academic schools was conducted. The Epworth Sleepiness Scale (ESS), the Beck Depression Inventory and the Scale for Suicide Ideation were used to assess subjects' daytime sleepiness, depression and suicidal ideation. The mean score for daytime sleepiness was 8.52, which indicates a sleep deficit. Significant positive correlations were found between daytime sleepiness and depression, between daytime sleepiness and suicidal ideation and between depression and suicidal ideation. Gender and depression were significant predictors of suicidal ideation, accounting for 48% of the variance in this measure. Depression acts as a mediator of the relationship between daytime sleepiness and suicidal ideation. High school students in Korea generally have insufficient sleep time and feel sleepy during the day; insufficient sleep during adolescence may be associated with depression and suicidal ideation.
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Affiliation(s)
- Boksun Yang
- College of Nursing, Jesus University, Jeonju, Jeonbuk,Republic of Korea
| | - Kwisoon Choe
- Department of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Youngrye Park
- Department of Nursing, Kunsan National University, Jeonbuk,Gusan, Republic of Korea
| | - Youngmi Kang
- East-West Nursing Research Institute, College of Nursing Science, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 130-701, Republic of Korea, Phone: +82-2-961-9175, Fax: +82-02-961-9398
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Radcliff Z, Baylor A, Rybarczyk B. Adopted youth and sleep difficulties. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2016; 7:165-175. [PMID: 29388635 PMCID: PMC5683292 DOI: 10.2147/phmt.s119958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Sleep is a critical component of healthy development for youth, with cascading effects on youth’s biological growth, psychological well-being, and overall functioning. Increased sleep difficulties are one of many disruptions that adopted youth may face throughout the adoption process. Sleep difficulties have been frequently cited as a major concern by adoptive parents and hypothesized in the literature as a problem that may affect multiple areas of development and functioning in adopted youth. However, there is limited research exploring this relationship. Using a biopsychosocial framework, this paper reviews the extant literature to explore the development, maintenance, and impact of sleep difficulties in adopted youth. Finally, implications for future research and clinical interventions are outlined.
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Affiliation(s)
- Zach Radcliff
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Allison Baylor
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Bruce Rybarczyk
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
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Dean S, Britt E, Bell E, Stanley J, Collings S. Motivational interviewing to enhance adolescent mental health treatment engagement: a randomized clinical trial. Psychol Med 2016; 46:1961-1969. [PMID: 27045520 DOI: 10.1017/s0033291716000568] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The prevalence of anxiety and mood disorders in adolescents is a growing public health concern worldwide. Given the high rates of drop-out and limited resources available in psychiatric settings, the importance of engaging adolescents in evidence-based treatments cannot be understated. The aim of the study was to determine the efficacy of motivational interviewing (MI), as a brief pre-treatment intervention, to enhance treatment engagement in a standard therapy setting (group cognitive behavioral therapy; gCBT) for adolescents with anxiety and mood disorders. METHOD Ninety-six adolescents (13-18 years) with a principal diagnosis of an anxiety or mood disorder participated in a trial conducted at two publicly funded outpatient services. Participants were randomly assigned to individual MI for treatment engagement prior to gCBT (MI + gCBT), or to an individually administered active control (befriending) prior to gCBT (befriending + gCBT). Eight pairs of gCBT were run in parallel. Outcome measures were the mean number of gCBT sessions attended, treatment initiation, and ratings of readiness for treatment. RESULTS Participants randomized to MI as a pretreatment intervention attended significantly more group therapy sessions compared to those in the active control condition. The MI group also demonstrated greater treatment initiation, and ratings of treatment readiness were significantly higher for those randomized to MI. CONCLUSIONS MI, used as a pre-treatment intervention, enhanced group treatment engagement in adolescents diagnosed with anxiety and mood disorders compared to the active control condition. MI is a promising intervention to facilitate engagement in adolescent mental health settings.
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Affiliation(s)
- S Dean
- Social Psychiatry & Population Mental Health Research Unit,University of Otago,Wellington,New Zealand
| | - E Britt
- Department of Psychology,University of Canterbury,Christchurch,New Zealand
| | - E Bell
- Department of Psychological Medicine,University of Otago,Wellington,New Zealand
| | - J Stanley
- Department of Public Health,University of Otago,Wellington,New Zealand
| | - S Collings
- Social Psychiatry & Population Mental Health Research Unit,University of Otago,Wellington,New Zealand
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Abstract
BACKGROUND AND OBJECTIVES Screen media overuse is associated with negative physical and mental health effects in children. The American Academy of Pediatrics recommends limiting screen media use at home; however, there are no similar guidelines for children's hospitals. This study was conducted to explore caregiver (parent or other guardian) perceptions about screen media use, compare at-home with in-hospital screen media use, and measure screen use among hospitalized children. METHODS We obtained data from a convenience cohort of hospitalized children at a single, comprehensive tertiary care children's hospital over 3 periods of 2 weeks each from 2013 to 2014. Home and hospital screen media use was measured through survey and study personnel directly observed hospital screen use. Descriptive statistics are reported and generalized estimating equation was used to identify characteristics associated with screen media use. RESULTS Observation (n = 1490 observations) revealed screen media on 80.3% of the time the hospitalized child was in the room and awake, and 47.8% of observations with direct attention to a screen. Surveyed caregivers reported their child engaging in significantly more screen media use in the hospital setting as compared with home, and 42% of caregivers reported the amount of screen time used by their child in the hospital was more than they would have liked. CONCLUSIONS Hospitalized children have access to a variety of screen media, and this media is used at rates far higher than recommended by the American Academy of Pediatrics. Children's hospitals should consider developing guidelines for screen media use.
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Affiliation(s)
- Gitanjli Arora
- Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, California;
| | - Neelkamal Soares
- Department of Pediatrics, Janet Weis Children's Hospital, Danville, Pennsylvania
| | - Ning Li
- Department of Biomathematics, University of California Los Angeles, Los Angeles, California
| | - Frederick J Zimmerman
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
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Gregory AM, Sadeh A. Annual Research Review: Sleep problems in childhood psychiatric disorders--a review of the latest science. J Child Psychol Psychiatry 2016; 57:296-317. [PMID: 26412255 DOI: 10.1111/jcpp.12469] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hippocrates flagged the value of sleep for good health. Nonetheless, historically, researchers with an interest in developmental psychopathology have largely ignored a possible role for atypical sleep. Recently, however, there has been a surge of interest in this area, perhaps reflecting increased evidence that disturbed or insufficient sleep can result in poor functioning in numerous domains. This review outlines what is known about sleep in the psychiatric diagnoses most relevant to children and for which associations with sleep are beginning to be understood. While based on a comprehensive survey of the literature, the focus of the current review is on the latest science (largely from 2010). There is a description of both concurrent and longitudinal links as well as possible mechanisms underlying associations. Preliminary treatment research is also considered which suggests that treating sleep difficulties may result in improvements in behavioural areas beyond sleep quality. FINDINGS To maximise progress in this field, there now needs to be: (a) greater attention to the assessment of sleep in children; (b) sleep research on a wider range of psychiatric disorders; (c) a greater focus on and examination of mechanisms underlying associations; (d) a clearer consideration of developmental questions and (e) large-scale well-designed treatment studies. CONCLUSIONS While sleep problems may sometimes be missed by parents and healthcare providers; hence constituting a hidden risk for other psychopathologies - knowing about these difficulties creates unique opportunities. The current excitement in this field from experts in diverse areas including developmental psychology, clinical psychology, genetics and neuropsychology should make these opportunities a reality.
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Affiliation(s)
- Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, New Cross, London, UK
| | - Avi Sadeh
- School of Psychological Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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Bogen S, Legenbauer T, Gest S, Holtmann M. Lighting the mood of depressed youth: Feasibility and efficacy of a 2 week-placebo controlled bright light treatment for juvenile inpatients. J Affect Disord 2016; 190:450-456. [PMID: 26551404 DOI: 10.1016/j.jad.2015.09.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/06/2015] [Accepted: 09/15/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Sarah Bogen
- LWL University Hospital of the Ruhr University Bochum, Hospital for Child and Adolescent Psychiatry, Heithofer Allee 64, 59071 Hamm, Germany
| | - Tanja Legenbauer
- LWL University Hospital of the Ruhr University Bochum, Hospital for Child and Adolescent Psychiatry, Heithofer Allee 64, 59071 Hamm, Germany.
| | - Stephanie Gest
- LWL University Hospital of the Ruhr University Bochum, Hospital for Child and Adolescent Psychiatry, Heithofer Allee 64, 59071 Hamm, Germany
| | - Martin Holtmann
- LWL University Hospital of the Ruhr University Bochum, Hospital for Child and Adolescent Psychiatry, Heithofer Allee 64, 59071 Hamm, Germany
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Abstract
Sleep disturbances are common in pediatric psychiatric disorders and constitute key elements in diagnostic symptomatology of various primary psychiatric disorders including bipolar disorder, depression, and anxiety disorder. Although sleep is not included in key defining criteria of some impairing illnesses such as obsessive-compulsive disorder and schizophrenia, these disorders present with a very high prevalence of sleep disturbances. The interaction between sleep and psychopathology is very complex with significant interrelationship in development, severity, and prognosis of psychiatric disorders and comorbid sleep disturbances. The research ranging from small intervention case series to large epidemiologic studies have demonstrated the role of specific sleep complaints in specific psychiatric diagnoses. However, the research using objective instruments such as polysomnography and actigraphy remains limited in youth with psychiatric disorders. The intervention studies using pharmaceutical treatment specifically focusing on sleep disturbances in psychiatric disorders are also sparse in the pediatric literature. Early identification of sleep disturbances and behavioral management using cognitive behavior therapy-based tools appear to be the most effective approach for treatment. The use of psychotropic medications such as selective serotonin reuptake inhibitors for the treatment of primary psychiatric disorder often alleviate the psychological barriers for sleep but may lead to emergence of other sleep issues such as restless leg syndrome. The safety and efficacy data of hypnotics for primary sleep disorders are limited in pediatrics and should be avoided or used with extreme caution in children with comorbid sleep and psychiatric problems.
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Affiliation(s)
- Ujjwal Ramtekkar
- Department of Psychiatry, Mercy Children׳s Hospital, St Louis, MO.
| | - Anna Ivanenko
- Department of Psychiatry, Northwestern University, Chicago, IL
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Murphy PJ, Frei MG, Papolos D. Alterations in skin temperature and sleep in the fear of harm phenotype of pediatric bipolar disorder. J Clin Med 2014; 3:959-71. [PMID: 25530872 PMCID: PMC4270265 DOI: 10.3390/jcm3030959] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In children diagnosed with pediatric bipolar disorder (PBD), disturbances in the quality of sleep and wakefulness are prominent. A novel phenotype of PBD called Fear of Harm (FOH) associated with separation anxiety and aggressive obsessions is associated with sleep onset insomnia, parasomnias (nightmares, night-terrors, enuresis), REM sleep-related problems, and morning sleep inertia. Children with FOH often experience thermal discomfort (e.g., feeling hot, excessive sweating) in neutral ambient temperature conditions, as well as no discomfort during exposure to the extreme cold, and alternate noticeably between being excessively hot in the evening and cold in the morning. We hypothesized that these sleep- and temperature-related symptoms were overt symptoms of an impaired ability to dissipate heat, particularly in the evening hours near the time of sleep onset. We measured sleep/wake variables using actigraphy, and nocturnal skin temperature variables using thermal patches and a wireless device, and compared these data between children with PBD/FOH and a control sample of healthy children. The results are suggestive of a thermoregulatory dysfunction that is associated with sleep onset difficulties. Further, they are consistent with our hypothesis that alterations in neural circuitry common to thermoregulation and emotion regulation underlie affective and behavioral symptoms of the FOH phenotype.
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Affiliation(s)
- Patricia J. Murphy
- Parallax Innovations LLC, 22 Crescent Rd., Westport, CT 06880, USA; E-Mails: (P.J.M.); (M.G.F.)
| | - Mark G. Frei
- Parallax Innovations LLC, 22 Crescent Rd., Westport, CT 06880, USA; E-Mails: (P.J.M.); (M.G.F.)
| | - Demitri Papolos
- Parallax Innovations LLC, 22 Crescent Rd., Westport, CT 06880, USA; E-Mails: (P.J.M.); (M.G.F.)
- The Juvenile Bipolar Research Foundation, 277 Martine Avenue, White Plains, NY 10601, USA
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-203-246-1939; Fax: +1-203-842-2180
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Abstract
Chronic sleep loss and associated sleepiness and daytime impairments in adolescence are a serious threat to the academic success, health, and safety of our nation's youth and an important public health issue. Understanding the extent and potential short- and long-term repercussions of sleep restriction, as well as the unhealthy sleep practices and environmental factors that contribute to sleep loss in adolescents, is key in setting public policies to mitigate these effects and in counseling patients and families in the clinical setting. This report reviews the current literature on sleep patterns in adolescents, factors contributing to chronic sleep loss (ie, electronic media use, caffeine consumption), and health-related consequences, such as depression, increased obesity risk, and higher rates of drowsy driving accidents. The report also discusses the potential role of later school start times as a means of reducing adolescent sleepiness.
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Abstract
The American Academy of Pediatrics recognizes insufficient sleep in adolescents as an important public health issue that significantly affects the health and safety, as well as the academic success, of our nation's middle and high school students. Although a number of factors, including biological changes in sleep associated with puberty, lifestyle choices, and academic demands, negatively affect middle and high school students' ability to obtain sufficient sleep, the evidence strongly implicates earlier school start times (ie, before 8:30 am) as a key modifiable contributor to insufficient sleep, as well as circadian rhythm disruption, in this population. Furthermore, a substantial body of research has now demonstrated that delaying school start times is an effective countermeasure to chronic sleep loss and has a wide range of potential benefits to students with regard to physical and mental health, safety, and academic achievement. The American Academy of Pediatrics strongly supports the efforts of school districts to optimize sleep in students and urges high schools and middle schools to aim for start times that allow students the opportunity to achieve optimal levels of sleep (8.5-9.5 hours) and to improve physical (eg, reduced obesity risk) and mental (eg, lower rates of depression) health, safety (eg, drowsy driving crashes), academic performance, and quality of life.
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Alfano CA, Reynolds K, Scott N, Dahl RE, Mellman TA. Polysomnographic sleep patterns of non-depressed, non-medicated children with generalized anxiety disorder. J Affect Disord 2013; 147:379-84. [PMID: 23026127 PMCID: PMC3985749 DOI: 10.1016/j.jad.2012.08.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 08/16/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Polysomnographic (PSG) studies of children with psychiatric illness have primarily focused on depressed samples. Children with generalized anxiety disorder (GAD) report high rates of sleep problems yet investigation of objective sleep patterns in non-depressed children with GAD are unavailable. Identification of unique clinical features linking early GAD with sleep disturbance, including possible HPA activation during the pre-sleep period, is needed to inform effective treatments. METHOD Thirty non-medicated, pre-pubescent children (ages 7-11 years) were assessed including 15 children with GAD and 15 matched healthy controls. Anxious children had GAD as their primary diagnosis and did not meet criteria for secondary mood disorders. All participants underwent structured diagnostic assessment and laboratory-based polysomnography (PSG). State anxiety and salivary cortisol were assessed prior to light out on the PSG night. RESULTS Children with GAD showed significantly increased sleep onset latency and reduced latency to rapid eye movement (REM) sleep compared to controls. Marginal differences in the form of reduced sleep efficiency and increased total REM sleep also were found in the GAD group. Pre-sleep anxiety and cortisol levels did not differ between the two groups. LIMITATIONS A small sample size, time-limited assessment of cortisol, and possible first night effects should be considered. CONCLUSIONS Results of this study provide initial evidence of PSG-based differences in children with GAD compared to controls. Follow-up studies are needed to explore the course of sleep alterations and whether targeting sleep problems early in the course of GAD might improve clinical outcomes.
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Affiliation(s)
- Candice A Alfano
- Department of Psychology, University of Houston, Houston, TX 77204, USA.
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Gander M, Buchheim A. [Internalizing symptoms in depressive adolescents - manifestations and methods of identification in schools]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2013; 41:11-22. [PMID: 23258434 DOI: 10.1024/1422-4917/a000206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In order to improve teacher-training programs it is important to analyze the different manifestations of depressive symptoms in adolescent students. This study examined the severity and frequency of internalizing symptoms in adolescents with depressive symptoms and the relationship thereof to an increased risk of suicide. METHOD 403 students (212 girls and 191 boys) at Austrian secondary schools aged between 16 and 18 years completed the Reynolds Adolescent Depression Scale-2, the Youth Self-Report, and the Suicide Probability Scale. RESULTS 35 %, and thus more than one third, of the students with depressive symptoms showed high scores on the internalizing scale while being in the normal range on the externalizing scale. Using regression analysis we found that adolescents with internalizing problems show higher levels of physical complaints, anxiety, and depression. Furthermore, attention problems and thought problems are predictors of depression. In addition to depression, anxiety and thought problems, social problems, and aggressive behavior are predictive of a higher suicide risk. CONCLUSIONS These results are discussed with respect to existing studies concerning how to recognize behavioral problems in school. The integration of these results into teachers' education and training serves to raise their awareness of depressive students with internalizing problems and thus helps them when taking appropriate steps to facilitate treatment.
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Affiliation(s)
- Manuela Gander
- Institut für Psychologie, Universität Innsbruck, Innsbruck, Österreich.
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Shahid A, Khairandish A, Gladanac B, Shapiro C. Peeking into the minds of troubled adolescents: the utility of polysomnography sleep studies in an inpatient psychiatric unit. J Affect Disord 2012; 139:66-74. [PMID: 22410505 DOI: 10.1016/j.jad.2012.01.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 01/20/2012] [Accepted: 01/30/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sleep problems are commonly associated with the primary diagnostic criteria for many psychiatric disorders. Evidence suggests sleep disturbances may precede development of psychiatric disorders and the severity of psychopathology reflects the severity of sleep problems. Polysomnography (PSG) sleep studies in child and adolescent psychiatric populations, a particularly at risk group, has considerable value but has been more elusive requiring further investigation. METHODS We performed a retrospective chart review of PSG sleep studies and psychiatrist evaluations of 106 adolescents aged 7-16 admitted to an involuntary adolescent psychiatric inpatient facility. RESULTS Less than 5% of cases had mild/no sleep problems. Hyperarousal hallmarked this population, and severity of sleep disturbances trends with the severity of psychopathology. Inpatients with multiple psychiatric disorders had greater frequencies of insomnia, decreased sleep efficiency, and arousals from SWS (p<0.05). Inpatient's with self-harm behavior more frequently had elevated sleep onset latency (SOL), reduced efficiency, reduced SWS (p<0.05), increased REM, and reduced REM latency compared to inpatients with dysthymia and/or depression. LIMITATIONS Lacking an a priori hypothesis, this study was explorative and uncontrolled for factors such as medications. This notwithstanding however, analysis indicates the majority of inpatients were taking cocktails that "should" alleviate sleep symptoms suggesting greater associations may prevail in unmedicated populations. CONCLUSIONS This study attests to the potential clinical utility of PSG sleep studies in the management of adolescent psychiatric disorders and contributes to the body of evidence reputing the intimate connection between sleep problems and the development and perpetuation of psychopathology with public health implications.
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Affiliation(s)
- Azmeh Shahid
- Youthdale Child and Adolescent Sleep Centre, Canada
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Hatzinger M, Brand S, Perren S, von Wyl A, Stadelmann S, von Klitzing K, Holsboer-Trachsler E. Pre-schoolers suffering from psychiatric disorders show increased cortisol secretion and poor sleep compared to healthy controls. J Psychiatr Res 2012; 46:590-9. [PMID: 22316640 DOI: 10.1016/j.jpsychires.2012.01.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 01/15/2012] [Accepted: 01/17/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Various studies of child cortisol secretion and sleep show a close association between poor sleep, deterioration of the HPA axis and unfavorable psychological functioning. However, there is little evidence as to whether these associations are clearly present in pre-school children suffering from psychiatric disorders. METHOD A total of 30 pre-schoolers suffering from psychiatric disorders (anxiety, adjustment disorders, emotional and attachment disorder; hyperactivity or oppositional disorder) and 35 healthy controls took part in the study. Saliva cortisol secretion was assessed both at baseline and under challenge conditions. Sleep was assessed via activity monitoring for seven consecutive days and nights, using a digital movement-measuring instrument. Parents and teachers completed questionnaires assessing children's cognitive, emotional and social functioning. The Berkeley Puppet Interview provided child-based reports of cognitive-emotional processes. RESULTS Compared to healthy controls, children suffering from psychiatric disorders had much higher cortisol secretion both at baseline and under challenge conditions. Sleep was also more disturbed, and parents and teachers rated children suffering from psychiatric disorders as cognitively, emotionally and behaviorally more impaired, relative to healthy controls. Children with psychiatric disorders reported being more bullied and victimized. CONCLUSIONS In five-year old children the presence of psychiatric disorders is reflected not only at psychological, social and behavioral, but also at neuroendocrine and sleep-related levels. It is likely that these children remain at increased risk for suffering from psychiatric difficulties later in life.
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Affiliation(s)
- Martin Hatzinger
- Psychiatric Services Solothurn, Department of Adult Psychiatry, Solothurn, Switzerland.
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Pullen SJ, Wall CA, Angstman ER, Munitz GE, Kotagal S. Psychiatric comorbidity in children and adolescents with restless legs syndrome: a retrospective study. J Clin Sleep Med 2012; 7:587-96. [PMID: 22171196 DOI: 10.5664/jcsm.1456] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Children and adolescents with restless legs syndrome (RLS) are commonly diagnosed with comorbid attention deficit hyperactivity disorder and behavioral disturbances. Uncertainty exists over the significance of other co-occurring psychiatric disorders and their pharmacologic management in children with RLS. The purpose of this study was to determine the prevalence and nature of psychiatric disorders in children with RLS and to describe the use of psychotropic medications in our study cohort. METHODS The electronic medical records of children younger than 18 years of age who had been diagnosed with RLS between January 1, 2003, and December 31, 2009, were reviewed. Only those patients whose findings were consistent with the 2003 NIH workshop diagnostic criteria for probable or definite restless legs syndrome were included in this study. The medical records were cross-referenced for encounters with a child psychiatrist or psychologist. Likewise, only psychiatric diagnoses whose medical records explicitly reflected DSM-IV diagnostic criteria for psychiatric disorder(s) were included. Demographic data, serum ferritin, psychotropic medications, and in some cases, the results of pharmacogenomic testing were included in the data analysis in an ad hoc fashion. RESULTS We found 374/922 patients who met diagnostic criteria for childhood onset RLS. The mean age of the subjects was 10.6 years (range 0 to 18) and the male to female ratio was approximately 1:1. Overall, 239/374 (64%) patients with RLS had one or more comorbid psychiatric disorders. Attention deficit hyperactivity disorder was found in 94/374 (25%) patients, mood disturbances were found in 109/374 (29.1%) patients, anxiety disorders in 43/374 (11.5%) patients, and behavioral disturbances in 40/374 (10.9%) patients. Attention deficit hyperactivity disorder and disruptive behavior disorders were more common in males (OR = 1.94 for both), whereas mood disturbances and anxiety disorders were more common in females (OR = 1.6 and 1.26, respectively). Mean serum ferritin levels derived from all patients without any psychiatric disorder were compared to all patients with one or more psychiatric disorder. No differences were found. The number of new psychotropic medication trials increased significantly with increase in patient age. Stimulants and antidepressant medications were the most commonly prescribed agents. As a part of clinical care, 15 of these patients underwent pharmacogenomic testing. Metabolic abnormalities were predicted by genotyping in 12/15 (80%) patients. CONCLUSION Comorbid psychiatric conditions occurred in two-thirds of children with RLS, underscoring the need for multidisciplinary management of this condition. An important relationship might exist between psychotropic medication, and possibly pharmacogenomic factors, in children and adolescents with symptoms of restless legs syndrome. These findings are consistent and build on those reported in the adult literature.
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Affiliation(s)
- Samuel J Pullen
- Department of Psychiatry and Psychology, Child and Adolescent Division, Mayo Clinic, Rochester, MN 55905, USA
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Abstract
Depressive illness beginning early in life can have serious developmental and functional consequences. Therefore, understanding its etiology and pathophysiology during this developmental stage is critical for developing effective prevention and intervention strategies. There is considerable evidence of sleep alterations in adult major depressive disorder. However, studies in children and adolescents have not found consistent changes in sleep architecture paralleling adult depression. This review article summarizes sleep polysomnography research in early-onset depression, highlighting the factors associated with variable findings across studies. In addition, potential avenues for future research will be suggested in order to develop more comprehensive theoretical models and interventions for pediatric depression.
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Affiliation(s)
- Uma Rao
- Center for Molecular and Behavioral Neuroscience, and the Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, TN, USADepartment of Psychiatry, Vanderbilt University School of Medicine, Nashville, TN, USA
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Soffer-Dudek N, Sadeh A, Dahl RE, Rosenblat-Stein S. Poor sleep quality predicts deficient emotion information processing over time in early adolescence. Sleep 2011; 34:1499-508. [PMID: 22043121 DOI: 10.5665/sleep.1386] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES There is deepening understanding of the effects of sleep on emotional information processing. Emotion information processing is a key aspect of social competence, which undergoes important maturational and developmental changes in adolescence; however, most research in this area has focused on adults. Our aim was to test the links between sleep and emotion information processing during early adolescence. DESIGN Sleep and facial information processing were assessed objectively during 3 assessment waves, separated by 1-year lags. SETTING Data were obtained in natural environments-sleep was assessed in home settings, and facial information processing was assessed at school. PARTICIPANTS 94 healthy children (53 girls, 41 boys), aged 10 years at Time 1. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Facial information processing was tested under neutral (gender identification) and emotional (emotional expression identification) conditions. Sleep was assessed in home settings using actigraphy for 7 nights at each assessment wave. Waking > 5 min was considered a night awakening. Using multilevel modeling, elevated night awakenings and decreased sleep efficiency significantly predicted poor performance only in the emotional information processing condition (e.g., b = -1.79, SD = 0.52, confidence interval: lower boundary = -2.82, upper boundary = -0.076, t(416.94) = -3.42, P = 0.001). CONCLUSIONS Poor sleep quality is associated with compromised emotional information processing during early adolescence, a sensitive period in socio-emotional development.
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Affiliation(s)
- Nirit Soffer-Dudek
- The Adler Center for Research in Child Development and Psychopathology, Department of Psychology, Tel Aviv University, Tel Aviv, Israel
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Hollway JA, Aman MG. Sleep correlates of pervasive developmental disorders: a review of the literature. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:1399-1421. [PMID: 21570809 DOI: 10.1016/j.ridd.2011.04.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 04/01/2011] [Accepted: 04/02/2011] [Indexed: 05/30/2023]
Abstract
Sleep disturbance is a significant problem in the general pediatric population, and it occurs even more frequently in children with pervasive developmental disorders (PDDs). Much time and energy have been spent examining the characteristics that predispose children to insomnia and it is likely that equivalent factors influence sleep in PDDs. Though similarly affected, it is the unique set of characteristics incumbent in a diagnosis of PDD that has additive effects and increases the likelihood for developing other predisposing factors and subsequent sleep loss. This review summarized research that has explored the behavioral, cognitive, and emotional correlates of sleep disturbance in children with PDDs. The literature provided 38 sleep studies that used either subjective or objective sleep measures. Of these, 17 met criteria for inclusion. Studies were evaluated for their attempts at matching their study samples and adjusting for possible confounding variables. The results revealed that the combined effects of autism symptom severity, internalizing behavior, and externalizing behavior, were the main predisposing factors for the development of insomnia. Other factors included medical conditions, epilepsy, and medication use (likely a proxy for behavior difficulty and even sleep disorder). A bidirectional theoretical framework for sleep disturbance in children with PDDs has been posited as a conceptual guide for future study. Recommendations for future study designs are included.
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Affiliation(s)
- Jill A Hollway
- The Nisonger Center, The Ohio State University, Columbus, OH 43210, United States.
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Gregory AM, Sadeh A. Sleep, emotional and behavioral difficulties in children and adolescents. Sleep Med Rev 2011; 16:129-36. [PMID: 21676633 DOI: 10.1016/j.smrv.2011.03.007] [Citation(s) in RCA: 426] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 03/08/2011] [Accepted: 03/23/2011] [Indexed: 10/18/2022]
Abstract
Links between sleep and psychopathology are complex and likely bidirectional. Sleep problems and alteration of normal sleep patterns have been identified in major forms of child psychopathology including anxiety, depression and attention disorders as well as symptoms of difficulties in the full range. This review summarizes some key findings with regard to the links between sleep and associated difficulties in childhood and adolescence. It then proposes a selection of possible mechanisms underlying some of these associations. Suggestions for future research include the need to 1) use multi-methods to assess sleep; 2) measure sleep in large-scale studies; 3) conduct controlled experiments to further establish the effects of sleep variations on emotional and behavioral difficulties; 4) take an interdisciplinary approach to further understand the links between sleep and associated difficulties.
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Affiliation(s)
- Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, UK.
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Brand S, Kirov R. Sleep and its importance in adolescence and in common adolescent somatic and psychiatric conditions. Int J Gen Med 2011; 4:425-42. [PMID: 21731894 PMCID: PMC3119585 DOI: 10.2147/ijgm.s11557] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Indexed: 02/05/2023] Open
Abstract
Restoring sleep is strongly associated with a better physical, cognitive, and psychological well-being. By contrast, poor or disordered sleep is related to impairment of cognitive and psychological functioning and worsened physical health. These associations are well documented not only in adults but also in children and adolescents. Importantly, adolescence is hallmarked by dramatic maturational changes in sleep and its neurobiological regulation, hormonal status, and many psychosocial and physical processes. Thus, the role of sleep in mental and physical health during adolescence and in adolescent patients is complex. However, it has so far received little attention. This review first presents contemporary views about the complex neurobiology of sleep and its functions with important implications for adolescence. Second, existing complex relationships between common adolescent somatic/organic, sleep-related, and psychiatric disorders and certain sleep alterations are discussed. It is concluded that poor or altered sleep in adolescent patients may trigger and maintain many psychiatric and physical disorders or combinations of these conditions, which presumably hinder recovery and may cross into later stages of life. Therefore, timely diagnosis and management of sleep problems appear critical for growth and development in adolescent patients.
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Affiliation(s)
- Serge Brand
- Depression and Sleep Research Unit, Psychiatric Hospital of the University of Basel, Basel, Switzerland
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