Association between insufficient sleep and suicidal ideation among adolescents

24-Hour Movement Behaviors of LGBTQA+ Young People: A Systematic Review

BACKGROUND

The movement behaviors of LGBTQA+ young people, who encounter specific health, and other, challenges are not well understood. This systematic review examines the 24-hour movement behaviors of LGBTQA+ young people compared with population estimates of meeting the 24-hour movement guidelines.

METHODS

Seven electronic databases were searched from inception to January 2024. Observational studies published in English and reporting quantitative data for physical activity, sedentary behavior, or sleep duration for LGBTQA+ individuals <24 years old were included. Data were narratively synthesized for children/adolescents (<18 years) and young adults (18-24 years), guided by the Cochrane Synthesis Without Meta-analysis guidelines.

RESULTS

Fifty-six studies were included; 46 were of "fair" quality and 37 were conducted in the United States. Physical activity, sedentary behavior, and sleep outcomes were reported in 46, 11, and 14 studies, respectively. Ninety unique LGBTQA+ terms were identified. Based on outcomes reported in ≥1 study, and compared to population estimates, LGBTQA+ young people were less likely to meet aerobic physical activity and strength/resistance training guidelines. LGBTQA+ children/adolescents were less likely to meet the sleep guidelines. Young adults demonstrated similar adherence to sleep guidelines as population estimates.

CONCLUSIONS

Overall, our results suggest that LGBTQA+ young people have suboptimal 24-hour movement behaviors; in some cases, worse than population estimates. Utilization of more robust measures of exposure and outcome variables is recommended, with a focus on sleep and sedentary behavior.

Association between sleep duration, suicidal ideation, suicidal attempt and suicidal behavior among Chinese adolescents

BACKGROUND

A relatively small number of studies have researched the relationship between sleep duration and suicidal ideation, attempts, and behavior. This research aims to investigate the link between sleep duration and suicide in Chinese adolescents, and to examine the role of depression as a mediating factor.

METHOD

Data were collected from 3315 students using a multi-stage random cluster sampling method and self-administered questionnaires. The study applied logistic regression to investigate the relationship between sleep duration and various forms of suicidal behavior, and mediation analysis to understand how depression might influence this relationship.

RESULTS

The average sleep duration among the adolescents was 7.25 h (±0.20), with 59.67 % reporting insufficient sleep. The logistic regression analysis showed that longer sleep duration is linked with lower risks of suicidal ideation (OR: 0.753, 95%CI: 0.696 to 0.814), suicidal attempts (OR: 0.830, 95%CI: 0.748 to 0.922), and suicidal behavior (OR: 0.841, 95%CI: 0.713 to 0.992). Analysis using restricted cubic spline plots indicated the connection between sleep duration and these suicidal factors was not linear. The study found that depression plays a partial mediating role between sleep duration and suicidal ideation, with an effect of 52.29 %.

LIMITATIONS

The cross-sectional study design could not prove causation.

CONCLUSIONS

There is a clear non-linear association between sleep duration and suicidal tendencies in adolescents, with depression acting as a mediator. This suggests that future research could focus on sleep and mood management as ways to address suicide risk in this age group.

Insufficient Sleep is Associated With Increasing Trends in Adolescent Suicidal Behaviors

PURPOSE

Youth suicide has been increasing and became a public health concern worldwide. Identifying insufficient sleep as the potential risk factor is critical to reducing suicide risk and increasing trends. This study aimed to determine whether insufficient sleep is associated with increasing trends in suicidal behaviors and disparities by sex, age, and race/ethnicity among school adolescents.

METHODS

The present study used biennial data from the US nationally representative Youth Risk Behavior Survey from 2007 to 2019. Joinpoint regression models were used to estimate biennial percent changes (BPCs) and average BPCs (ABPCs) of suicidal behaviors by sleep duration. Logistic regression models were used to examine the association between insufficient sleep and suicidal behaviors.

RESULTS

Of 73,356 adolescent students included (mean [standard deviation] age, 16.11 [1.23] years), 50.03% were female. Suicidal ideation and suicide plan among insufficient sleep group increased from 2007 to 2019 (BPC = 2.88% [95% confidence interval {CI}: 1.65%, 4.13%]; BPC = 3.42% [95% CI: 2.09%, 4.77%]), but were nonsignificant among sufficient sleep group. Trends in suicidal ideation (ABPC = 3.03% [95% CI: 1.35%, 4.73%]) and suicide plan (ABPC = 4.03% [95% CI: 2.47%, 5.62%]) among female adolescents with insufficient sleep increased, but nonsignificant among male adolescents with insufficient sleep. Suicidal ideation (ABPC = 1.73% [95% CI: 0.51%, 2.97%]) and suicide plan (ABPC = 2.31% [95% CI: 0.70%, 3.95%]) increased among younger adolescents only with insufficient sleep, whereas suicide trends by sleep duration were similar among older adolescents. Suicide plan among insufficient sleep group increased across the four racial groups, with BPC highest for the White (BPC = 3.48% [95% CI: 1.31%, 5.69%]), and lowest for the Hispanic/Latino (BPC = 1.18% [95% CI: 0.15%, 2.23%]), but were nonsignificant among sufficient sleep group except for the White (BPC = 2.83% [95% CI: 0.62%, 5.09%]).

DISCUSSION

Insufficient sleep was disproportionately associated with increasing trends in suicidal behaviors among female, younger, and non-White adolescent students. Ensuring sufficient sleep can potentially reduce suicide among school adolescents.

Associations between multiple sleep dimensions and suicide and non-suicidal self-injury: a cross-sectional study of 3828 Chinese young people

PURPOSE

Suicide and non-suicidal self-injury (NSSI) are preventable concerns in young people. Suicidal ideation (SI), suicidal plans (SP) and suicidal attempt (SA) are closely related to death. Sleep problems are known risk factors for suicide and NSSI. This study aimed to explore the relationship between sleep, suicidality and NSSI.

METHODS

Participants were 3,828 middle school and college students aged 11-23 years from urban and rural areas of Henan Province. Sleep, suicidal phenomena and NSSI were assessed by applying self-reported questionnaires. Chi-squared tests were utilized to demonstrate the demographic data and sleep variables. The correlation between sleep, suicidality and NSSI were explored by using binary logistic regression, while adjusting socio-demographic characteristics with multivariate models.

RESULTS

Sleep variables except mid-sleep time were related to suicidal phenomena (P < 0.05). Greater social jet lag (SJL) [≥ 2 h (h)] was associated with increased risk of SI [Odds ratios (OR) = 1.72, 95% confidence intervals (CI):1.40-2.11], SP (OR = 2.10, 95%CI:1.59-2.79) and SA (OR = 1.50, 95%CI:1.00-2.26). Non-only child participants with SJL (≥ 2 h) had significantly increased odds of SI (OR = 1.75, 95%CI: 1.41-2.18) and SP (OR = 2.25, 95%CI: 1.66-3.05). Eveningness chronotype had the strongest correlation with SI (OR = 3.87, 95%CI:2.78-5.38), SP (OR = 4.72, 95%CI:2.97-7.50), SA (OR = 6.69, 95%CI:3.08-14.52) and NSSI (OR = 1.39, 95%CI:1.02-1.90).

CONCLUSION

Overlong or short sleep duration, SJL, eveningness chronotype and other sleep abnormalities (e.g., daytime dysfunction, low sleep efficiency) were associated with a higher prevalence of SI, SP and SA. Additionally, eveningness was significantly correlated with NSSI among young people. These findings suggested the importance of assessing and intervening in sleep habits to prevent suicide and NSSI in young people.

The Association between Cyberbullying Victimization and Depression among Children: A Moderated Mediation Model

Cyberbullying victimization is becoming more prevalent and adversely affects mental health. This research explores the relationship between the two variables and the underlying mechanism, especially for children, as the impact of mental health in childhood might last a lifetime. Primary school students (N = 344; Mage = 9.90; 43.90% girls) completed self-report questionnaires regarding cyberbullying victimization, self-perceived social competence, optimism, and depression at school. Gender and grade were controlled as covariates. Depression was positively predicted by cyberbullying victimization, while self-perceived social competence played a partially mediating role. In addition, optimism directly and indirectly moderated the effects of cyberbullying victimization on depression. Specifically, the effects were stronger for children with low levels of optimism. Therefore, efforts to enhance children's self-perceived social competence and optimism may reduce their depression resulting from cyberbullying victimization.

Associations between Sleep Disturbances, Personality Traits and Self-Regulation in a Sample of Healthy Adults

Background: Scientific evidence and everyday experience show that sleep disturbances and self-regulation as a proxy of stress reactivity are linked. Particular personality traits such as neuroticism, internalizing and externalizing problems are also associated with sleep disturbances. Here, we combined self-regulation and personality traits and associated these variables with subjective sleep disturbances. Methods: A total of 846 adults (mean age: 33.7 years; 78.7% females) completed questionnaires covering sleep disturbances, self-regulation and personality traits. Results: Higher scores for sleep disturbances were associated with higher scores for externalization, internalization, and instability and with lower scores for stability (all trait variables) and with poorer self-regulation (state variable). The regression model showed that higher scores for externalization and internalization (traits), and lower scores for self-regulation (state) predicted higher scores for sleep disturbance. Next, self-regulation had both a direct effect on sleep disturbance, and an indirect effect via personality traits. Conclusions: Sleep disturbances were related to both state (i.e., self-regulation) and trait (e.g., internalization and instability) dimensions. The current data analysis leapfrogs the state-trait dichotomy discussion and reconciles the state-and-trait approach in the prediction of poor sleep, though self-regulation appeared to have both direct and indirect effects on sleep disturbances.

How to survive the long night? Longitudinal relationship between sleep problems and suicidal behavior among adolescents: The serial mediating roles of negative emotion, self-control, and nonsuicidal self-injury

OBJECTIVE

Sleep problems are a significant risk factor for identifying and preventing suicidal involvement among adolescents. However, there is limited evidence to assess the underlying mechanisms between them. This study investigated the longitudinal relationship between sleep problems and suicidal behavior and examined whether this relationship was moderated by negative emotions, low self-control, and nonsuicidal self-injury (NSSI).

METHODS

From December 2020 onward, we assessed 1214 Chinese secondary school adolescents (60.7% were boys, aged 13-19 years) three times, 6 months apart.

RESULTS

In the direct effects model, sleep problems were found to have a positive impact on adolescent suicidal behavior. In the indirect effects model, we observed that sleep problems were associated with an elevated risk of suicidal behavior through several pathways: one-mediator path of negative emotions, low self-control, and NSSI, respectively; two-mediator path of negative emotions via low self-control, negative emotions via NSSI, and low self-control via NSSI, and three-mediator path from negative emotions to NSSI via low self-control.

CONCLUSIONS

This longitudinal study provides evidence that sleep problems in adolescents may increase suicidal behavior by exacerbating negative emotions, weakening self-control, and promoting NSSI. The findings suggest sleep problems should be addressed in suicide prevention and intervention efforts for adolescents.

Social zeitgeber and sleep loss as risk factors for suicide in American Indian adolescents

American Indians / Alaska Natives (AI/AN) bear a high burden of suicide, the reasons for which are not completely understood, and rates can vary by tribal group and location. This article aims to identify circumstances reported by a community group of American Indian adolescent participants to be associated with their depression and/or suicide. American Indian adolescents (n  =  360) were recruited from contiguous reservations and were assessed with a semi-structured diagnostic interview. Twenty percent of the adolescents reported suicidal thoughts (ideation, plans), an additional 8% reported a history of suicide attempts, and three deaths due to suicide were reported. Suicidal behaviors and major depressive disorder (MDD) co-occurred and were more common among female adolescents. The distressing events that adolescents most often reported were: death in the family, family disruption, peer relationship problems, and school problems. All of these events were significantly associated with suicidal behaviors, however those with suicidal acts were more likely to report death in the family. Those with MDD but no suicidal behaviors were more likely to report disruptions in the family. Disruptions in falling asleep were also associated with suicidal behaviors and having experienced a death in the family. Disruptions in important relationships, particularly through death or divorce, may be interpreted as a loss or disruption in "social zeitgebers" that may in turn disturb biological rhythms, such as sleep, thus potentially increase the risk for MDD and/or suicide. Prevention programs aimed at ameliorating the impact of disruptions in important relationships may potentially reduce suicidal behaviors in AI/AN adolescents.

Prediction of suicidal ideation with associated risk factors among university students in the southern part of Bangladesh: Machine learning approach

BACKGROUND

The prevalence of suicidal ideation has become an urgent issue, particularly among adolescents. The primary objective of this research is to determine the prevalence of suicidal ideation among students in the southern region of Bangladesh and to predict this phenomenon using machine learning (ML) models.

METHODS

The data collection process involved using a simple random sampling technique to gather information from university students located in the southern region of Bangladesh during the period spreading from April 2022 to June 2022. Upon accounting for missing values and non-response rates, the ultimate sample size was determined to be 584, with 51.5 % of participants identifying as male and 48.5 % female.

RESULTS

A significant proportion of students, precisely 19.9 %, reported experiencing suicidal ideation. Most participants were female (77 %) and unmarried (78 %). Within the machine learning (ML) framework, KNN exhibited the highest accuracy score of 91.45 %. In addition, the Random Forest (RF), and Categorical Boosting (CatBoost) algorithms exhibited comparable levels of accuracy, achieving scores of 90.60 and 90.59 respectively.

LIMITATIONS

Using a cross-sectional design in research limits the ability to establish causal relationships.

CONCLUSION

Mental health practitioners can employ the KNN model alongside patients' medical histories to detect those who may be at a higher risk of attempting suicide. This approach enables healthcare professionals to take appropriate measures, such as counselling, encouraging regular sleep patterns, and addressing depression and anxiety, to prevent suicide attempts.

Sleep disturbance and suicidal ideation mediated by psychotic-like experiences in adolescents: a two-wave longitudinal study

STUDY OBJECTIVES

Sleep disturbance may cause suicidal ideation (SI). This study aimed to examine their co-occurrence rate among adolescents and investigate whether psychotic-like experiences (PLEs) mediate this association.

METHODS

A total of 17 722 Chinese adolescents were included in this two-wave longitudinal study. The baseline survey (time 1, T1) was conducted between April 21 and May 12, 2021, and the follow-up survey (time 2, T2) was implemented between December 17 and 26, 2021. At T1, participants completed questionnaires to assess their sleep disturbance, sleep duration, PLEs, SI, depressive symptoms, and sociodemographic characteristics. At T2, participants reported their PLEs, SI, and negative life events.

RESULTS

The SI prevalence decreased from 20.2% (T1) to 18.4% (T2). Participants with SI showed significantly higher prevalence of sleep disturbance and short sleep duration compared to those without SI. Baseline sleep disturbance and short sleep duration were both associated with the increased risk of SI 6 months later. These longitudinal links were mediated by PLEs, independent of baseline covariates and negative life events.

CONCLUSIONS

These findings provide a novel insight into the mechanism linking sleep problems and suicidality, and stress the significance of assessing and addressing sleep problems and PLEs for adolescent suicide prevention and intervention.

When Night Falls Fast: Sleep and Suicidal Behavior Among Adolescents and Young Adults

Sleep disturbances have been linked to suicidal ideation and behaviors in adolescents. Specifically, insomnia and nightmares are associated with current suicide risk and predict future ideation. Associations between hypersomnia, sleep apnea, and suicide remain inconclusive. Potential biological mechanisms underlying these relationships include executive functioning deficits and hyperarousal. Related psychological factors may include thwarted belongingness, perceived burdensomeness, and negative appraisals. Assessing suicide risk in patients with sleep disturbances, and vice versa, is needed. Therapeutic interventions such as cognitive behavior therapy for insomnia and imagery rehearsal treatment, as well as pharmacologic treatments, show promise in treating sleep disorders and suicidal behavior.

The Associations between the Number of School Sports Teams That a Student Regularly Participates in and Factors Such as Perceived Stress, Loneliness, and Sleep Satisfaction among Korean Adolescents Who Have Attempted Suicide

Adolescents who have attempted suicide are more likely to experience a recurrence of suicidal behavior, thus necessitating systematic follow-ups and management. We aimed to investigate the association between the number of school sports teams that a student regularly participates in and psychological factors such as perceived stress, loneliness, and sleep satisfaction among 1393 Korean adolescents who have attempted suicide by using data from the 2022 Korea Youth Risk Behavior Survey. Frequency analyses were performed to evaluate participant characteristics. Chi-square analyses were used to examine the differences in participant characteristics according to the number of teams. Multivariate logistic regression analysis was used to examine the associations between the number of teams and perceived stress, loneliness, and sleep satisfaction. Our results indicated that participating in a greater number of sports teams at school was more strongly associated with reduced perceived stress, reduced loneliness, and increased sleep satisfaction. Specifically, the odds ratio (OR) for feeling very much stressed was 0.613 (range: 0.387-0.969; p = 0.036) among the participants who belonged to one team. Among those who belonged to two teams, the OR for feeling very much stressed was 0.482 (range: 0.281-0.286; p = 0.008). Among those who belonged to two teams, the OR for feeling a lot of stress was 0.514 (range: 0.304-0.870; p = 0.013), and that for not feeling much stress was 2.663 (range: 1.103-6.426; p = 0.029). The OR for not feeling much stress was 4.697 for those who belonged to three teams (range: 1.531-14.408; p = 0.007) and 6.671 for those who belonged to four or more teams (range: 1.858-23.953; p = 0.004). The OR for feeling no stress at all was 11.629 (range: 2.229-60.661; p = 0.004) for those who belonged to three teams and 93.531 (range: 19.260-454.207; p < 0.001) for those who belonged to four or more teams. In terms of loneliness, the OR for rarely feeling lonely was 2.651 (range: 1.148-6.123; p = 0.022) among those who belonged to one team. The OR for feeling lonely all the time was 0.370 (range: 0.155-0.884; p = 0.025) among those who belonged to two teams. In terms of sleep satisfaction, the OR for having very sufficient sleep was 4.371 (range: 1.627-11.742; p = 0.003) for those who belonged to four or more teams. These results suggest that school sports are an advantageous tool for suicide prevention, given their low costs, absence of side effects, and ease of participation.

Longitude-based time zone partitions and rates of suicide

BACKGROUND

Increasing evidence suggests that conditions with decreased morning and increased evening light exposure, including shift work, daylight-saving time, and eveningness, are associated with elevated mortality and suicide risk. Given that the alignment between the astronomical, biological, and social time varies across a time zone, with later-shifted daylight exposure in the western partition, we hypothesized that western time zone partitions would have higher suicide rates than eastern partitions.

METHODS

United States (U.S.) county-level suicide and demographic data, from 2010 to 2018, were obtained from a Centers for Disease Control database. Using longitude and latitude, counties were sorted into the western, middle, or eastern partition of their respective time zones, as well as the northern and southern halves of the U.S. Linear regressions were used to estimate the associations between suicide rates and time zone partitions, adjusting for gender, race, ethnicity, age group, and unemployment rates.

RESULTS

Data were available for 2872 counties. Across the U.S., western partitions had statistically significantly higher rates of suicide compared to eastern partitions and averaged up to two additional yearly deaths per 100,000 people (p < .001).

LIMITATIONS

Ecological design and limited adjustment for socioeconomic factors.

CONCLUSIONS

To our knowledge, this is the first study of the relationship between longitude-based time zone partitions and suicide. The results were consistent with the hypothesized elevated suicide rates in the western partitions, and concordant with previous reports on cancer mortality and transportation fatalities. The next step is to retest the hypothesis with individual-level data, accounting for latitude, photoperiodic changes, daylight-saving time, geoclimatic variables, physical and mental health indicators, as well as socioeconomic adversity and protection.

Sleep deprivation and suicide risk among minoritized US adolescents

OBJECTIVES

To assess (1) the prevalence of suicide ideation/behavior among adolescents with short sleep by race/ethnicity and (2) the association between sleep duration and suicidal ideation and behavior among American youth by race/ethnicity from 2007 to 2019.

METHODS

Data were drawn from the Youth Risk Behavior Surveillance System (YRBSS). Logistic regression analyses were used to assess the relationship between sleep duration and suicidal ideation/behavior.

RESULTS

Overall, suicide ideation/behavior increased among U.S. adolescents of all racial groups from 2007 to 2019. Adjusting for race/ethnicity, sexual identity, age, sex, substance use, trauma, and bullying, those with short sleep had approximately twice the odds [OR: 1.92 (95% CI: 1.65, 2.23)] of suicide ideation/consideration compared to those with long sleep. Stratified analyses indicated that Black students with short sleep had higher odds of making a suicide plan (OR = 1.51, 95% C.I.: 1.27, 1.79) compared with Black students with long sleep. A similar pattern was observed across other racial/ethnic groups (e.g., Hispanic: (OR = 1.74, 95% C.I.: 1.53, 1.97).

CONCLUSION

Emphasis on suicide interventions is of the essence, especially with increasing rates. Sleep duration significantly predicts suicide risk among all adolescents. Additional research is needed to assess factors that predict suicide among minoritized adolescents, specifically Black and Hispanic adolescents.

Association Between Insufficient Sleep, Depressive Symptoms, and Suicidality Among Florida High School Students

INTRODUCTION

Emerging research suggests insufficient sleep can heighten the risk of poor mental health among adolescents. We examined the relationship between sleep, depressive symptoms, and suicidal thoughts and behaviors among Florida high school students.

METHODS

Data were from the 2021 Florida High School Youth Risk Behavior Survey, a statewide representative sample of students in grades 9 to 12. We estimated prevalence of 1 indicator of depressive symptoms - feeling sad or hopeless for 2 or more weeks - and 2 indicators of suicidality - having considered attempting suicide and making a suicide plan - by insufficient sleep status (<8 h of sleep on an average school night). Multivariate logistic regressions were used to calculate odds ratios measuring the association between insufficient sleep, poor mental health, and suicidality.

RESULTS

Compared with students reporting sufficient sleep, those with insufficient sleep were more likely to feel sad or hopeless (42.7% vs 28.1%), have considered suicide (19.1% vs 12.5%), or have made a suicide plan (14.8% vs 9.6%). In adjusted multivariate models, compared with students with sufficient sleep, students with insufficient sleep had higher odds of feeling sad or hopeless (adjusted odds ratio [AOR] = 1.83; 95% CI 1.54-2.17), and having made a plan about how they would attempt suicide (AOR = 1.32; 95% CI, 1.00-1.74), but did not have significantly higher odds of having seriously considered suicide.

CONCLUSION

Increased attention to sleep as a modifiable risk factor for mental health among adolescents is particularly important because of the many less modifiable factors that contribute to mental health difficulties in this population. Adolescent mental health programs should consider sleep an important factor in suicide prevention.

"I need to be alert at night to provide care": Factors associated with problematic sleep among young Australian caregivers

OBJECTIVES

There is increased recognition that young people (<25 years) may occupy a carer role for family or others with health conditions or disability. This is often in addition to study and social activities. This means competing demands on time, and insufficient sleep. Our aim was to determine the contribution of caring duties to problematic sleep in young carers.

METHODS

A survey of Australian carers was conducted, including questions on demographics, characteristics of the carer and care recipient, and sleep quality and quantity. Participants were eligible if they reported sleep time <7 hr or dissatisfaction with their sleep, and were aged 15-24 years.

RESULTS

A total of 110 participants (71.8%_female = 79, 15-17 years = 62, 18-24 years = 48) were included in analysis; 55.5% (n= 61) reporting dissatisfaction with their sleep and 62.7% (n= 69) reporting typically less than 7 hr sleep per night. Sleep duration was significantly shorter for those who reported 1-2 or ≥3 awakenings to provide care, compared with no awakenings (p_< .05). Sleep quality, as described by scores on the Pittsburgh Sleep Quality Index (PSQI) was also significantly worse for those who were frequently awoken by their care recipient (p < .05). Worrying about the care recipient, being woken by the care recipient, and listening out for the care recipient were the most frequently identified factors impacting on sleep.

CONCLUSION

Young carers experience reduced sleep duration and poor sleep quality. Strategies to alleviate the burden of care work on young carer's sleep would benefit the health and safety of this group.

Physical Activity Patterns, Circadian Rhythms, and Aggressive and Suicidal Behavior among a Larger Sample of the General Population Aged 15 to 34 Years

BACKGROUND

From a psychological perspective, aggressive behavior, non-suicidal self-injury and suicidal behavior could be considered dysfunctional coping strategies. Poor sleep patterns may further increase such dysfunctional coping. In contrast, regular physical activity may have the power to counteract such dysfunctional coping. Given this background, the aim of the present study was to combine categories of circadian rhythms as a proxy of normative sleep patterns and categories of physical activity patterns, and to associate these categories with aggressive behavior, non-suicidal self-injury and suicidal behavior among a larger sample of adolescents and young adults, aged 15 to 34 years.

METHOD

A total of 2991 (55.6% females) individuals aged 15 to 34 years of the so-called Ravansar non-communicable disease cohort study (RaNCD) took part in this study. Participants completed self-rating questionnaires covering circadian-related sleep patterns, regular physical activity, socio-demographic information and dimensions of aggression, non-suicidal self-injury and suicidal behavior.

RESULTS

In a first step, both sleep patterns (circadian rhythm disorder: yes vs. no) and physical activity patterns (high vs. low) were dichotomized. Next, participants were assigned to one of four prototypical clusters: No circadian sleep disorders and high physical activity ("Hi-Sleep-Hi-PA"); no circadian sleep disorders and low physical activity ("Hi-Sleep-Lo-PA"); circadian sleep disorders and high physical activity ("Lo-Sleep-Hi-PA"); circadian sleep disorders and low physical activity ("Lo-Sleep-Lo-PA"). Projecting these four clusters on dimensions of aggressive behavior, non-suicidal self-injury and suicidal behavior, the following findings were observed: Participants of the "Hi-Sleep-Hi-PA" reported the lowest scores for aggressive behavior, self-injury and suicidal behavior, compared to participants of the "Lo-Sleep-Lo-PA" cluster. No differences for aggressive behavior, self-injury and suicidal behavior were observed among participants of the "Hi-Sleep-Lo-PA" and the "Lo-Sleep-Hi-PA" clusters.

CONCLUSIONS

It appeared that the combination of favorable circadian sleep patterns and high physical activity patterns was associated with lower aggressive behavior, lower self-injury and suicidal behavior as proxies of favorable psychological functioning. In contrast, persons reporting high circadian sleep disorders and low physical activity patterns appeared to demand particular attention and counseling for both their lifestyle issues (sleep and physical activity) and their dysfunctional coping strategies.

Association between Sexual Violence Victimization and Electronic Vaping Product Use among Adolescents: Findings from a Population-based Study

BACKGROUND

Although studies have investigated the association between sexual violence (SV) victimization and substance use, few studies have examined the association between SV victimization and electronic vaping product (EVP) use among adolescents in the United States. The objective of this study was to examine the cross-sectional association between SV victimization and EVP use among adolescents.

METHODS

Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 28,135 adolescents (51.2% female) was analyzed using binary logistic regression. The outcome variable investigated was EVP use, and the main explanatory variable was SV victimization.

RESULTS

Of the 28,135 adolescents, the prevalence of past 30-day EVP use and SV victimization was 22.7% and 10.8%, respectively. Controlling for other factors, adolescents who experienced SV had 1.52 times higher odds of being EVP users when compared to their counterparts who did not experience SV (AOR = 1.52, p < .001, 95% CI = 1.27-1.82). Other factors associated with EVP use included cyberbullying victimization, symptoms of depression, and current use of cigarettes, alcohol, and marijuana.

CONCLUSIONS

Experiencing SV was associated with EVP use. Future studies that employ longitudinal designs may offer more insight into the mechanisms underlying the association between SV victimization and EVP use. In addition, school-based interventions that focus on sexual violence prevention and reducing substance use among adolescents are warranted.

Association between Suicidal Behaviors in Adolescence and Negative Emotions, the Level of Stress, Stress Coping Strategies and the Quality of Sleep

Suicidal behaviors in adolescents stem from complex processes deeply rooted in various spheres of life and functioning. The study was aimed at assessing the relationship between selected negative emotions, the quality of sleep, the level of perceived stress as well as stress coping strategies and suicidal ideation and attempts among high school students. The examined group consisted of adolescents aged 16-18 recruited by social-media groups in Poland. The study was based on a diagnostic survey with the application of CAWI method. The other research tools applied in the study included: Hospital Anxiety and Depression Scale-Modified, Perceived Stress Scale-10, How do you cope?-Questionnaire, Athens Insomnia Scale as well as the authors' own questionnaire on suicidal ideation and suicide attempts. Anxiety, depression, aggression and insomnia as well as a high level of stress were statistically more common in girls than in boys (p < 0.001). The high level of negative emotions and insomnia, in turn, increased the risk of suicidal ideation (OR = 3.59, 95% CI: 2.13-6.06 and OR = 2.35, 95% CI: 1.60-3.46), as well as suicide attempts (OR = 6.29, 95% CI: 2.93-14.80 and OR = 3.29, 95% CI: 2.07-5.35). Additionally, high level of stress was associated with more than twice larger odds of suicidal ideation (OR = 2.26, 95% CI: 1.13-4.63). Significantly higher prevalence of suicidal ideation (p = 0.017) and suicide attempts (p = 0.016) was observed in girls. A high level of negative emotions and stress accompanied by a low quality of sleep are factors predisposing people to suicidal ideation and attempted suicide.

Association between use of electronic vaping products and insufficient sleep among adolescents: Findings from the 2017 and 2019 YRBS

BACKGROUND AND OBJECTIVE

Although studies have investigated the association between cigarette smoking and sleep outcomes among adolescents in the United States, few studies have examined the association between electronic vaping products (EVPs) use and insufficient sleep among adolescents. The objective of this study was to investigate the cross-sectional association between the use of EVPs and insufficient sleep among adolescents.

METHODS

Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 28,135 adolescents (51.2% female) was analyzed using binary logistic regression. The dependent variable investigated was insufficient sleep, and the main independent variable was the use of EVPs.

RESULTS

Of the 28,135 adolescents, 22.6%, 19.2%, and 58.2% were current, former, and never users of EVPs, respectively. More than three in four adolescents (76.5%) did not obtain the recommended 8 h of sleep on an average school night. Controlling for demographic factors and other covariates, adolescents who currently used EVPs had 1.33 times higher odds of having insufficient sleep (AOR = 1.33, p < .001, 95% CI = 1.16-1.52), and adolescents who previously used EVPs had 1.29 times higher odds of having insufficient sleep (AOR = 1.29, p < .001, 95% CI = 1.15-1.44) when compared to adolescents who had never used EVPs. Adolescents were more likely to get insufficient sleep if they were older, non-Hispanic Black, had symptoms of depression, experienced suicidal ideation, engaged in excessive screen-time behaviors, or currently used alcohol. Physical activity had a protective effect on insufficient sleep.

CONCLUSION

This study found that EVPs use was associated with insufficient sleep among adolescents over and above demographic and other covariates. As EVP use increases among adolescents, it is important to consider the potential impact on multiple domains, including sleep. Future studies that employ longitudinal designs may offer additional insight into the mechanisms underlying the association between EVPs use and insufficient sleep.

You Hurt Me, so I Hurt Myself and Others: How Does Childhood Emotional Maltreatment Affect Adolescent Violent Behavior and Suicidal Ideation?

Violent behavior and suicidal ideation are two major public health problems, with the former representing outward attack and the latter characterizing inward attack. The effects of emotional maltreatment in childhood will continue into adolescence. This study explores the impact of childhood emotional maltreatment on adolescent violent behavior/suicidal ideation and its mechanism. Participants were 3,600 adolescents (average age is 16.21 ± 0.99) from the middle east of China. They completed questionnaires measuring emotional maltreatment in childhood, deviant peer affiliation, depression, violent behavior, and suicidal ideation in adolescence. After controlling for demographic variables, we found that deviant peer affiliation and depression mediated between childhood emotional maltreatment and adolescent violent behavior/suicidal ideation. Multi-group analysis results showed that males' deviant peer affiliation would contribute to their violent behaviors. Among female groups, deviant peer affiliation and depression were risk factors for violent behavior and suicidal ideation. a) cross-sectional design was used in this study; b) all the measures were self-reported. Preventing emotional maltreatment in childhood can help reduce violent behavior and suicidal ideation by reducing deviant peer affiliation and depression in adolescence. Males who experienced emotional maltreatment in childhood are more likely to show violent behaviors shaped by external factors such as deviant peer affiliation. In contrast, females' interpersonal orientation and internalizing factors both influence their external and internal aggressive behaviors.

The Link between Sleep Insufficiency and Self-Injury among In-School Adolescents: Findings from a Cross-Sectional Survey of Multi-Type Schools in Huangpu District of Shanghai, China

Both insufficient sleep and self-injury are rising public health issues among middle school students. Understanding their relationship may guide the intervention and policy making to help youths gain a healthy life. Thus, we analysed the data collected from the Shanghai Students Health Risk Behavior Surveillance (2015) in the Huangpu District. Self-injury was self-reported and categorized into ever or never. Sleep duration was classified as sufficient and insufficient according to the Health China 2030 Plan and the National Sleep Foundation's updated sleep duration recommendations. Crude OR and adjusted OR of sleep duration and covariates were estimated for self-injury using the logistic regression models with standard error clustered on school types. Results showed that 8.42% of the participants had conducted self-injury, with girls more than boys and ordinary school students more than key school students. After full adjustment, sleep insufficiency increased the odds of conducting self-injury by approximately two folds (AOR = 2.08, 95%CI = 1.40-3.07). The odds of self-injury were higher among students studying at ordinary schools (AOR = 3.58, 95%CI = 1.25-10.27) or vocational schools (AOR = 2.00, 95%CI = 1.77-2.26), with comparison to those at key schools. Interventions seeking to solve insufficient sleep need to be multifaceted, with consideration of changing the school environment and multiple social contexts, which create stressful burdens for adolescents' development.

Association of sleep with mental health in Chinese high school students: a cross-sectional study

Adolescents' sleep problems and their association with mental health is an important public health concern. This study aimed to investigate sleep and mental health status and the association of sleep with mental health in Chinese high school students. Data came from a cross-sectional study in Guangdong province which included 42,077 high school students. Sleep quality and sleep duration were obtained through self-report. The Depression Anxiety and Stress Scale (DASS-21) was used to measure mental health. The association between sleep quality, sleep duration, and mental health was analysed using logistic regression. The prevalence of depression, anxiety, and stress symptoms were 35.27%, 42.32%, and 21.87% in high school students, respectively. And only 17.71% and 34.41% of the high school students had very good sleep quality and ≥8 h sleep duration, respectively. Poorer sleep quality and shorter sleep duration were risk factors for mental health problems in high school students. Compared to high school students with very good sleep quality and ≥8 h sleep duration, the high school students with poor or very poor sleep quality and <6 h sleep duration had the highest risk of depression symptoms (odds ratio [OR] 5.02, 95% confidence interval [CI] 4.40-5.72), anxiety symptoms (OR 6.02, 95% CI5.25-6.89), and stress symptoms (OR 6.12, 95% CI5.30-7.06). Considering the combined association of sleep quality and sleep duration on mental health, it is important not only to ensure that high school students have sufficient sleep duration, but also to improve their sleep quality.

Misuse of Prescription Opioids and Suicidal Behaviors Among Black Adolescents: Findings from the 2017 and 2019 Youth Risk Behavior Survey

PURPOSE

Although some studies have examined the association between prescription opioid misuse and mental health outcomes, few have investigated the effects of prescription opioid misuse on suicidal behaviors among Black adolescents. The objective of this study was to investigate the cross-sectional association between prescription opioid misuse and suicidal ideation, suicide plan, and suicide attempt among Black adolescents.

METHODS

Data for this study came from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 4798 Black adolescents aged 14-18 years (51.2% female) was analyzed using binary logistic regression. The outcome variables investigated were suicidal ideation, suicide plan, and suicide attempt, and the main explanatory variable was prescription opioid misuse.

RESULTS

Of the 4798 Black adolescents, 15% reported ever misusing prescription opioids; 16.2% experienced suicidal ideation; 14% made a suicide plan; and 11.3% attempted suicide during the past 12 months. In the multivariate logistic regression models, Black adolescents who misused prescription opioids had 1.39 times higher odds of making a suicide plan and 1.65 times higher odds of making a suicide attempt during the past 12 months when compared to their counterparts who did not misuse prescription opioids. Other significant factors associated with suicidal behaviors include female sex, school bullying, cyberbullying, depressive symptoms, and illicit drug use. In addition, physical activity had a protective effect on suicide attempt.

CONCLUSION

The findings of the present study demonstrate the effects of prescription opioid misuse and its association with suicidal behaviors among Black adolescents.

Predictors of Sleep-Problem Trajectories Across Adolescence

Stress and sleep problems are significantly correlated in adolescents. Few longitudinal studies, however, have evaluated possible correlates and predictors of sleep problems at multiple points across adolescence. The current study examined the relation between stress and sleep problems across four years in a sample of adolescents who varied in risk for psychopathology. Participants included 223 adolescents (55% female) and 223 mothers (77% with a history of a mood disorder during their child's life). Youth were evaluated in grade 7 (M = 12.69 years, SD = 0.61) and again in grades 8, 9, and 11. Sleep problems were assessed as part of a clinical interview, and weekly stressful events were measured with the Life Events Interview for Adolescents. Multi-group latent growth curve analyses were conducted. Among youth whose mothers had a history of depression (high-risk), sleep problems significantly increased over time (p < .001). Second, among high-risk youth, at each time point, higher stress levels during the prior three months significantly predicted higher levels of sleep problems (p < .001). Finally, across the entire sample, at each time point a greater level of sleep problems predicted higher stress ratings a year later (p ≤ .001). Thus, stress was a significant predictor of sleep problems across multiple years of adolescence, particularly among offspring of mothers with a history of depression. Results highlight targets for preventive interventions for sleep problems in youth.

Effectiveness of physical activity programs in enhancing sleep outcomes among adolescents: a systematic review

BACKGROUND

Adolescence is a developmental period characterised by rapid physical and psychological changes that heighten the risk for inadequate sleep. Fortunately, physical activity programs (PAPs) are an easy-to-do intervention that has been associated with improved sleep outcomes in different population groups. This systematic review aimed to provide evidence to support the effects of PAPs on sleep outcomes among apparently healthy adolescents.

METHODS

A systematic literature search was performed in online databases of PubMed, Cochrane Library, and PEDro for all dates up to April 2022. All relevant clinical trials reporting on the effects of PAPs on sleep among adolescents were included using a pre-defined inclusion/exclusion criterion (PROSPERO: CRD42020171852). The methodological quality of the included studies was assessed using 'specific checklists per design' (RCTs) provided by the Dutch Cochrane Centre. Qualitative synthesis was used to report the results of the review.

RESULTS

Two RCTs were included and analysed in the review. Both studies were of good methodological quality but lacked blinding. The PAPs in the reviewed studies included mainly aerobic exercises in the form of cross-country running in the mornings, SMS-delivered motivational messages to increase daily step counts, and use of a pedometer and step diaries. Sleep was measured both subjectively by means of sleep questionnaires and objectively using sleep electroencephalographic recordings. Nevertheless, qualitative synthesis is suggestive of an overall positive effect of PAPs on some sleep outcomes in adolescents, albeit with limited to moderate evidence.

CONCLUSION

PAPs appear to have a beneficial effect on some sleep outcomes among apparently healthy adolescents. Nevertheless, the body of evidence is currently scanty, thus warranting the need for more high-quality RCTs.

Sports- and physical activity-related concussion and mental health among adolescents: Findings from the 2017 and 2019 Youth Risk Behavior Survey

This study examined the association between self-reported sports- or physical activity-related concussion and symptoms of depression and suicidal behaviors (suicidal ideation, having a suicide plan, and suicide attempts). This study used data from the 2017 and 2019 Youth Risk Behavior Survey (YRBS), a biennial, school-based, nationally representative survey of U.S. students in grade levels 9 to 12 (N = 14,496). Multivariate logistical regression models assessed the association between self-reported sports-or physical activity-related concussions and suicidal behaviors among students, controlling for a range of demographic and psychosocial variables. Altogether, 13.6% of students reported a sports-or physical activity related concussion in the past 12 months. Among youth, sports-or physical activity related concussions were significantly associated with greater odds of symptoms of depression, suicidal ideation, making a suicide plan, and suicide attempts compared to other youth who did not experience sports- or physical activity-related concussion. Findings highlight increased risk for adverse mental health outcomes among students with sports-or physical activity related concussions. Providing resources for students to engage in physical activity and sports teams may help prevent the onset of depression and suicidal behaviors; however, resources must also be available to monitor any concussions related to these activities to provide support for student emotional well-being.

Latent profile analysis to identify subgroups of Chinese sexual minority adolescents at risk of suicidality

BACKGROUND

This study aimed to identify latent class profiles of sexual minority adolescents (Men Sexually attracted to Men, Women Sexually attracted to Women, and Bisexual) with elevated suicidal ideation.

METHODS

Data were collected from 18 secondary schools in China. Sub-group classifications were identified using variables associated with suicidal ideation in sexual minority adolescents, including parental relationship quality, electronic equipment time, school bullying, and sleep quality using the Chinese version of the Pittsburgh Sleep Quality Index to measure sleep. Anxiety was measured using the Generalized Anxiety Disorder 7 (GAD-7), depression was measured using the Patient Health Questionnaire 9 (PHQ-9), hypomania using the Hypomanic Checklist-32 (HCL-32), positive coping style was identified using the Trait Coping Style Questionnaire, and self-efficacy was measured by the General Self-Efficacy Scale.

RESULTS

Four distinctive profiles were derived from the data. Compared to "low-risk" group (Class 3), the "adolescent with mood problems" group (Class 2) had a 9.81 times higher risk of suicidal ideation; the those who classified as "severe bullied adolescent" (Class 4) had a 9.26 times higher risk of suicidal ideation. and the "adolescents with low self-efficacy" group (Class 1) had a 4.48 times higher risk of suicidal ideation.

CONCLUSIONS

Sexual minority adolescents with mood problems have the highest risk of suicidal ideation, followed by adolescents frequently being bullied at school. Interventions aimed at reducing suicide risk among sexual minority adolescents may benefit from attending to such profile factors identified in this study to develop targeted clinical care.

Lifestyle Behaviors and Suicide-Related Behaviors in Adolescents: Cross-Sectional Study Using the 2019 YRBS Data

Objective: The purpose of this research was to investigate the prevalence of lifestyle behaviors and suicide-related behaviors and the association between them using a nationally representative sample of adolescents from the USA. Methods: 13,677 high school students aged 14-18 years were included in this cross-sectional study. The research data were retrieved from the Youth Risk Behavior Surveillance System Survey in 2019. All data on age, sex, grade, race, physical activity, television time, fruit intake, and suicide-related behavior were self-reported by students. Logistic regression models were adopted to examine the association between lifestyle behaviors and the suicide-related behaviors. Results: Students who played video/computer games for ≥2 h had higher risk of suicide attempt (OR = 1.55, 95%CI: 1.30-1.85). Daily sleep duration of ≤8 h was positively associated with considering a suicide attempt (OR = 1.99, 95%CI: 1.62-2.43). In addition, participants who did not engage in any sport team were more likely to report considering a suicide attempt (OR = 1.50, 95%CI: 1.24-1.81). Conclusion: This research suggests that some lifestyle behaviors (e.g., time for video or computer use, sleep duration, sports team participation, regular breakfast intake, and substance use) are associated with increased risk of suicidal behavior and ideation in high school students. To identify the specific effect of multiple lifestyle factors in influencing the risk of suicide-related behaviors in high school students, longitudinal studies are warranted in future.

Nonlinear relationship between sleep duration and non-suicidal self-injurious behaviour among Chinese adolescents

BACKGROUND

Previous studies have shown a positive association between sleep deprivation and non-suicidal self-injury (NSSI) among adolescents, but few studies have described the effects of oversleeping and weekend catch-up sleep on NSSI. The present study aimed to explore the nonlinear relationship between sleep duration and NSSI among Chinese adolescents.

METHODS

Data from China's National Adolescent Health Surveillance for the years 2014 to 2015 were collected from 15,713 students located across four provinces in China. A self-report questionnaire was used to assess sleep duration and 12-month NSSI. Binomial logistic regression models were used to examine the association between NSSI and sleep duration. The locally estimated scatter plot smoothing (LOESS) method was used to explore the associations of total NSSI number with sleep duration, and binomial regression analysis was used to test this relationship.

RESULTS

About 68.5% of adolescents reported sleeping less than 8 h on weeknights, while 37.8% of adolescents slept more than 10 h per night during weekends. The 12-month prevalence rate of NSSI was 29.4%. Compared to adolescents who reported weekend catch-up sleep of 0-1 h, those who slept < 0 h (adjusted odds ratio [aOR] = 1.38, 95% Confidence Interval [95% CI]: 1.16-1.64) had a higher risk of NSSI. Males who reported ≥3 h of weekend catch-up sleep had significantly increased odds of NSSI (aOR = 1.20, 95%CI: 1.01-1.42). Notably, a positive U-shaped association was observed between the sleep duration and the total NSSI number.

CONCLUSIONS

The findings reveal a nonlinear relationship between sleep duration and NSSI among Chinese adolescents. Therefore, it is necessary to be vigilant and screen for sleep duration among adolescents in NSSI treatment or prevention.

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

STUDY OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CITATION

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

Age at first alcohol use and weapon carrying among adolescents: Findings from the 2019 Youth Risk Behavior Survey

BACKGROUND

Although studies have investigated the association between alcohol use and violent behaviors such as weapon carrying, few studies have examined the association between age at first alcohol use and weapon-carrying among adolescents. The objective of this study was to investigate the association between age at first alcohol use and weapon carrying among adolescents.

METHODS

Data for this study came from the 2019 Youth Risk Behavior Survey. An analytic sample of 13,442 adolescents aged 14-18 years old (51% female) was analyzed using binary logistic regression. The outcome variable investigated in this study was weapon carrying during the past 30 days, and the main explanatory variable investigated was age at first alcohol use.

RESULTS

Of the 13,442 adolescents, 13.5% carried a weapon during the past 30 days, and 15.4% reported having their first alcoholic drink before age 13. In the multivariable logistic regression, adolescents who reported having alcohol before age 13 had more than double the odds of carrying a weapon when compared to those who never had alcohol before age 13 (AOR = 2.32, p < .001, 95% CI = 1.87-2.89). Other significant factors associated with weapon carrying include male gender, victim of bullying, teen dating violence, sexual violence, suicidal ideation, and history of substance use. Adolescents who self-identified as Black/African American or Hispanic were significantly less likely to carry a weapon when compared to adolescents who self-identified as non-Hispanic White.

CONCLUSION

The findings of this study underscore the importance of developing age appropriate intervention strategies to curb early initiation of alcohol use and weapon carrying among adolescents.

Chronotype and social support among student athletes: impact on depressive symptoms

Previous studies have shown individuals with evening chronotype to have a greater likelihood for depression (self-reported and clinical ratings), especially in young adults. However, the mechanisms for this relationship remain unknown. Low levels of social support may be a plausible mechanism: young adults with evening chronotypes are awake when others are sleeping, which may lead to feelings of isolation or low support. This study examined links between chronotype, depression, and social support in relationship subtypes within a group of university student athletes. Data were obtained from 189 NCAA Division-I student athletes across all sports. Chronotype was assessed with the Circadian Energy Scale and ranged from -2 (definitely morning type) to +2 (definitely evening type). Depressive symptoms were assessed with Center for Epidemiological Studies Depression scale. Social support was assessed with the Multidimensional Scale of Perceived Social Support, which included subscales for Family, Friends, and Significant Other. A subscale for Team was created using the items from the Friends subscale (changing the word "friends" to "teammates"). Regression analyses adjusted for age, sex, and minority status. More evening chronotype was associated with higher reported depressive symptoms (p = .018), lower overall perceived social support (p = .001), and lower perceived social support specifically provided by family (p < .0001), friends (p < .0001), and teammates (p = .014). However, more evening chronotype was associated with higher depressive symptoms for higher, but not lower perceived social support from significant other. Moreover, chronotype-by-support interactions on depressive symptoms were observed; the statistical relationship between chronotype and depression was evident only in those with low (but not high) social support from friends and teammates. These data suggest that having a more evening chronotype may be associated with social isolation, and decreased opportunities for interactions with friends and teammates. This may contribute to the long-standing circadian association seen with depression in college student-athletes. Interventions aimed at increasing university support networks may reduce the impact of depression in students self-identifying with later chronotypes and sleep schedules.

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

STUDY OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

When Night Falls Fast: Sleep and Suicidal Behavior Among Adolescents and Young Adults

Sleep disturbances have been linked to suicidal ideation and behaviors in adolescents. Specifically, insomnia and nightmares are associated with current suicide risk and predict future ideation. Associations between hypersomnia, sleep apnea, and suicide remain inconclusive. Potential biological mechanisms underlying these relationships include executive functioning deficits and hyperarousal. Related psychological factors may include thwarted belongingness, perceived burdensomeness, and negative appraisals. Assessing suicide risk in patients with sleep disturbances, and vice versa, is needed. Therapeutic interventions such as cognitive behavior therapy for insomnia and imagery rehearsal treatment, as well as pharmacologic treatments, show promise in treating sleep disorders and suicidal behavior.

The association between excessive screen-time behaviors and insufficient sleep among adolescents: Findings from the 2017 youth risk behavior surveillance system

Although studies have examined the association between television viewing and poor sleep quality, few studies have considered the association between excessive screen-time behaviors and insufficient sleep among adolescents drawing on a large nationally representative sample. The objective of this study was to examine the association between excessive screen-time behaviors and insufficient sleep among adolescents. Data for this study came from the 2017 Youth Risk Behavior Survey. A sample of 14,603 adolescents aged 14-18 years (51.5% female) was analyzed using logistic regression with insufficient sleep as the outcome variable and excessive screen-time behaviors as the main explanatory variable. Of the 14,603 adolescents, almost three out of four (74.8%) had less than 8 h of sleep on an average school night, and about 43% engaged in excessive screen-time behaviors on an average school day. Controlling for all other predictors, odds were 1.34 times higher for adolescents who engaged in excessive screen-time behaviors to have insufficient sleep when compared to adolescents who did not engage in excessive screen-time behaviors (AOR = 1.34, p < .001, 95% CI = 1.22-1.48). School-based behavior interventions that focus on reduction in excessive screen-time and sedentary behaviors might be beneficial in reducing excessive screen-time behaviors and consequently improve sleep quality among adolescents.