Daily Associations Between Adolescent Sleep and Socioemotional Experiences During an Ongoing Stressor

Using the Person-Based Approach to Co-Create and Optimize an App-Based Intervention to Support Better Sleep for Adolescents in the United Kingdom: Mixed Methods Study

BACKGROUND

Poor sleep is a common problem in adolescents aged 14 to 18 years. Difficulties with sleep have been found to have a bidirectional link to mental health problems.

OBJECTIVE

This new research sought to involve young people in the co-creation of a new app, particularly those from underserved communities. The Sleep Solved app uses science-based advice to improve sleep-related behaviors and well-being. The app was developed using the person-based approach, underpinned by the social cognitive theory and the social-ecological model of sleep health.

METHODS

Young people (aged 14-18 y) were recruited from across the United Kingdom to contribute to patient and public involvement (PPI) activities. In partnership with our peer researcher (MHJ), we used a multitude of methods to engage with PPI contributors, including web-based workshops, surveys, think-aloud interviews, focus groups, and app beta testing.

RESULTS

A total of 85 young people provided PPI feedback: 54 (64%) young women, 27 (32%) young men, 2 (2%) genderfluid people, 1 (1%) nonbinary person, and 1 (1%) who reported "prefer not to say." Their levels of deprivation ranged from among the 40% most deprived to the 20% least deprived areas. Most had self-identified sleep problems, ranging from 2 to 3 times per week to >4 times per week. Attitudes toward the app were positive, with praise for its usability and use of science-based yet accessible information. Think-aloud interviews and a focus group identified a range of elements that may influence the use of the app, including the need to pay attention to language choices and readability. User experiences in the form of narrated audio clips were used to normalize sleep problems and provide examples of how the app had helped these users.

CONCLUSIONS

Young people were interested in using an app to better support their sleep and mental health. The app was co-created with strong links to theory- and evidence-based sleep hygiene behaviors. Future work to establish the effectiveness of the intervention, perhaps in a randomized controlled trial, would provide support for potential UK-wide rollout.

Interpersonal Loneliness Predicts the Frequency and Intensity of Nightmares: An Examination of Theoretic Mechanisms

The evolutionary theory of loneliness (ETL) argues that human belongingness is essential to survival and failing to meet belongingness needs constitutes a threat to viability. In two separate studies (total N = 1,609), links between loneliness and nightmares were examined as a test of ETL postulates. As hypothesized, loneliness predicted nightmare frequency (both studies) and nightmare intensity (Study Two only). Although stress mediated the relationship between loneliness and nightmare frequency in Study One, stress was not a significant mediator of this relationship in Study Two. As predicted, in Study Two both hyperarousal and rumination mediated the relationships between loneliness and nightmare frequency and between loneliness and nightmare intensity. Theoretical implications include support for both the aversive signaling and implicit vigilance postulates of ETL.

The relationships between insomnia, nightmares, and dreams: A systematic review

Insomnia and nightmares are both prevalent and debilitating sleep difficulties. The present systematic review aims to document the relationships between insomnia and nightmares in individuals without a concomitant psychopathology. The relationships between insomnia and dreams are also addressed. PsycINFO and Medline were searched for papers published in English or French from 1970 to March 2023. Sixty-seven articles were included for review. Most results support positive relationships between insomnia variables and nightmare variables in individuals with insomnia, individuals with nightmares, the general population, students, children and older adults, and military personnel and veterans. These positive relationships were also apparent in the context of the COVID-19 pandemic. Some psychological interventions, such as Imagery Rehearsal Therapy, might be effective in alleviating both nightmares and insomnia symptoms. Regarding the relationships between insomnia and dreams, compared with controls, the dreams of individuals with insomnia are characterized by more negative contents and affects. The results show that insomnia and nightmares are connected and may be mutually aggravating. A model is proposed to explain how insomnia might increase the likelihood of experiencing nightmares, and how nightmares can in turn lead to sleep loss and nonrestorative sleep.

Microaggressions, perceptions of campus climate, mental health, and alcohol use among first-year college students of color

Depressive and anxiety symptoms are increasingly common, and problematic alcohol use remains prevalent in college. To expand on prior research on mostly white samples, we surveyed first-year students of color from our predominately white university (Southeastern US) to identify risk factors for mental health symptoms and potentially co-occurring problematic alcohol use. Results showed significant associations between microaggressions and poor campus climate (hypothetical predictors) with depressive, anxiety, somatic symptoms (hypothetical outcomes) that were indirectly linked through perceived stress, poor sleep, and academic burnout (hypothetical mediators). Poor campus climate, academic burnout, and using alcohol to cope were the most relevant to alcohol use disorder symptoms. Results support efforts to address and reduce racial microaggressions and promote a positive campus climate for all.

Problematic internet use and suicide ideation among Chinese adolescents: The indirect effects of insomnia, nightmares, and social jetlag

BACKGROUND

Problematic Internet use (PIU) is related to suicide ideation (SI) in adolescents, but little is known about the potential mechanisms between them. This study aimed to examine the mediation roles of insomnia, nightmares, and social jetlag in the association of PIU with SI in adolescents.

METHODS

A total of 39,731 adolescents (mean age = 13.49 ± 0.76 years, 54.4 % males) from Shenzhen, China, participated in a cross-sectional survey. SI was assessed using the ninth item of the Patient Health Questionnaire-9. PIU was measured by the Revised Chinese Internet Addiction Scale. A self-administered questionnaire was used to assess insomnia symptoms, nightmare frequency, social jetlag, sleep duration, psychological distress, and social-demographical characteristics. Logistic regression and path analyses were performed to examine the associations between PIU, insomnia symptoms, nightmares, social jetlag, and SI.

RESULTS

The prevalence of PIU and SI were 14.9 % and 18.6 %, respectively. PIU, insomnia symptoms, frequent nightmares, and social jetlag were significantly associated with SI. Path analyses showed that the indirect effects of PIU on SI through insomnia symptoms, frequent nightmares, and social jetlag were significant. Conversely, social jetlag significantly mediated the pathway from SI to PIU. The mediation effect sizes of these sleep and circadian problems were slightly larger in females than in males.

LIMITATIONS

Cross-sectional design limited the capacity to infer causal relationships.

CONCLUSIONS

The associations between PIU and SI were mediated by sleep and circadian problems. These findings underscore the importance of assessing and intervening in sleep and circadian problems among adolescents with PIU or SI.

Children's Sleep and Mental Health During the COVID-19 Pandemic

PURPOSE OF REVIEW

The COVID-19 pandemic and protracted home confinement required adjustments to schedules and routines generating concern about children's sleep. This review describes general considerations regarding children's sleep, changes and disturbances in their sleep during the pandemic, and the association of sleep measures with health and psychological outcomes in general and in the context of the pandemic.

RECENT FINDINGS

A number of studies found an increase in the duration of children's sleep with later bedtimes and waketimes for some children. The research also documented sleep disturbances and associations between children's sleep and psychological outcomes. The extent to which increased sleep duration and changed sleep behaviors translated into improved sleep quality and/or a change in sleep disturbances remains unclear. This review suggests the importance of considering children's sleep in other mass trauma situations including, for example, natural and man-made disasters, as well as pandemics.

Associations between COVID-19 sleep patterns, depressive symptoms, loneliness, and academic engagement: a latent profile analysis

Background: The COVID-19 pandemic has had important implications for college students' socioemotional and academic well-being. Sleep problems were common during this time, which may have further impacted well-being. Methods: Five hundred and fifty-two college students (Mage = 19.81; 58% female; 42% White) completed a survey in Fall 2021 reflecting on behaviors/emotions (sleep, depressive symptoms, loneliness, academic engagement) experienced during the first peak of COVID-19 and over the past month. Latent profile analysis was conducted to identify subgroups of sleepers during peak-COVID in relation to well-being during and after the initial peak. Results: Four sleep profiles were identified: Optimal (49%), High Latency/Medicated (23%), Average/Fair (16%), Low-Duration (12%). During peak-COVID, depression and loneliness were highest in High Latency/Medicated and Low-Duration subgroups; academic engagement was highest for Optimal sleepers. Following peak-COVID, academic engagement was highest for Average/Fair sleepers. Conclusions: Findings highlight heterogeneity in students' sleep patterns during the initial peak of COVID-19 and their relation to well-being during and post-peak-pandemic.

Why so slangry (sleepy and angry)? Shorter sleep duration and lower sleep efficiency predict worse next-day mood in adolescents

PURPOSE

The goal of this study was to evaluate the relationships of actigraphic nighttime sleep duration and quality with next-day mood among urban adolescents using a micro-longitudinal design.

METHODS

A subsample (N = 525) of participants from the Fragile Families & Child Wellbeing Study (mean age: 15.4 years; 53% female; 42% Black non-Hispanic, 24% Hispanic/Latino, 19% White non-Hispanic) in the United States between 2014 and 2016 concurrently wore a wrist actigraphic sleep monitor and rated their daily mood in electronic diaries for about 1 week. Multilevel models tested the within-person temporal associations of nightly sleep duration and sleep maintenance efficiency with next-day reports of happiness, anger, and loneliness. The models also tested the between-person associations of sleep variables and mood. Models adjusted for sociodemographic and household characteristics, weekend, and school year.

RESULTS

After nights when adolescents obtained longer sleep duration than their usual, they reported lower ratings of anger (B = -.03, p < .01) the next day. After nights when adolescents had higher sleep maintenance efficiency than their usual, they reported higher ratings of happiness (B = .02, p < .01) the next day. Adolescents who had longer average sleep duration reported lower ratings of anger (B = -.08, p < .01) and loneliness (B = -.08, p < .01) compared to others. There was no within-person association of sleep duration or efficiency with loneliness. Sleep duration was not associated with happiness between adolescents, and sleep maintenance efficiency was not associated with any mood measure between adolescents.

CONCLUSIONS

Improvements to nightly sleep may help increase happiness and decrease anger the following day in adolescents. Promoting sleep health is recommended to improve mood.

Sleep Deprivation and Insomnia in Adolescence: Implications for Mental Health

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

Adolescents' Time During the First Year of the COVID-19 Pandemic: Evidence From the American Time Use Survey

PURPOSE

The aim of this study is to examine where and with whom adolescents spent time during the first months of the COVID-19 pandemic compared to 2019.

METHODS

Time diary data from the May 2019 to December 2020 waves of the American Time Use Survey were used to examine trends in where and with whom a sample of individuals aged 15-18 years (N = 437) spent their time.

RESULTS

Only 13% of adolescents spent any time at school on a given day during the pandemic (May-December 2020), compared to 36% in the same period in 2019. Average time with friends decreased by 28%. Over the 7.5-month period, this amounts to an average of 204 fewer hours/34 fewer days in school and 86 fewer hours with friends. Time spent sleeping or sleepless did not change.

DISCUSSION

Time at school and with friends decreased substantially during the first months of the pandemic.

Loneliness and Well-Being in Children and Adolescents during the COVID-19 Pandemic: A Systematic Review

Concerns have been raised about the loneliness and well-being of children and adolescents during the COVID-19 pandemic. The extent to which the ongoing pandemic has impacted loneliness and the association between loneliness and well-being is unclear. Therefore, a systematic review of empirical studies on the COVID-19 pandemic was conducted to examine the (1) prevalence of loneliness in children and adolescents, (2) associations between loneliness and indicators of well-being, and (3) moderators of these associations. Five databases (MEDLINE, Embase, PsycInfo, Web of Science, ERIC) were searched from 1 January 2020 to 28 June 2022 and 41 studies met our inclusion criteria (cross-sectional: n = 30; longitudinal: n = 11; registered on PROSPERO: CRD42022337252). Cross-sectional prevalence rates of pandemic loneliness varied, with some finding that over half of children and adolescents experienced at least moderate levels of loneliness. Longitudinal results reflected significant mean increases in loneliness compared to pre-pandemic levels. Cross-sectional results indicated that higher levels of loneliness were significantly associated with poorer well-being, including higher depression symptoms, anxiety symptoms, gaming addiction, and sleep problems. Longitudinal associations between loneliness and well-being were more complex than cross-sectional associations, varying by assessment timing and factors in the statistical analyses. There was limited diversity in study designs and samples, preventing a thorough examination of moderating characteristics. Findings highlight a broader challenge with child and adolescent well-being that predates the pandemic and the need for future research to examine underrepresented populations across multiple timepoints.