The associations between self-reported sleep duration and adolescent health outcomes: what is the role of time spent on Internet use?

The association between internet addiction and sleep quality among medical students in Saudi Arabia

BACKGROUND

Sleep is one of the fundamental human needs, essential for maintaining a high quality of life and mental and physical well-being across all age groups. Poor sleep quality often stems from negative lifestyle habits, including excessive internet usage. Therefore, it is important to determine the prevalence of internet gaming disorder among youth in Saudi Arabia and to examine the relationship between internet addiction levels and sleep quality.

METHODS

Data were collected from 338 medical students in the southern region of Saudi Arabia (mean age = 21.2 years, standard deviation = 3.29 years). Participants completed an online questionnaire comprising the Internet Addiction Test (IAT) and the Pittsburgh Sleep Quality Index (PSQI). Data analysis employed iterations, chi-square tests, Pearson correlation coefficients, and ANOVA.

RESULTS

The results revealed that 21% of the participants exhibited severe internet addiction, while 31% displayed moderate internet addiction. Furthermore, the findings indicated a positive correlation between sleep quality and the severity of internet addiction. Sleep quality symptoms explained 75% of the variance in Internet addiction scores, even after controlling for demographic variables. Additional bivariate analyses revealed that individuals who spent six or more hours online daily were more likely to experience symptoms of poor sleep quality and exhibit a higher severity of internet addiction. Additionally, Men were more susceptible to developing internet addiction compared to women. Moreover, students with internet addiction tended to have lower academic achievements.

CONCLUSION

These findings, while exploratory, offer valuable insights into potential interventions, strategies, and programs for mitigating internet addiction and enhancing sleep quality among medical college students.

Social Media Posts from Friends during Late Adolescence as Predictors of Young Adult Physical Health

Although an increasing body of literature has linked social experiences to physical health, research has yet to consider how specific aspects of social experiences taking place on social media during late adolescence may predict future physical health outcomes. This study thus examined qualities of social media posts received from peers at age 21 as predictors of participants' physical health (e.g., Interleukin-6 (inflammation), sleep problems, problems with physical functioning, and BMI) at age 28. Participants included 138 youth (59 men and 79 women); 57% of participants identified as White, 30% as Black/African American, and 13% as from other or mixed racial/ethnic groups. Posts from friends and participants at age 21 characterized by social ties predicted lower levels of future physical health problems, whereas socially inappropriate "faux pas" posts that deviated from peer norms by friends predicted higher levels of physical health problems at age 28. These associations were found after accounting for factors typically associated with physical health outcomes, including participants' baseline social competence, internalizing and externalizing symptoms, alcohol use, observed physical attractiveness, and history of prior hospitalizations. The results of this study suggest the importance of both achieving social integration with peers online and adhering to peer norms in the online domain as key predictors of future physical health.

Examining the Bidirectional Associations Between Sleep Duration, Screen Time, and Internalizing Symptoms in the ABCD Study

PURPOSE

The likelihood of meeting sleep duration and screen time guidelines decreases as children develop toward adolescence. Simultaneously, the prevalence of internalizing symptoms increases. The purpose of this paper was to examine the bidirectional associations between sleep duration and screen time with internalizing symptoms in a one-year longitudinal study starting in late childhood.

METHODS

Participants were 10,828 youth (47.8% female) enrolled in the Adolescent Brain Cognitive Development Study. At baseline (mean age 9.9 years) and one-year follow-up (mean age 10.9 years), youth self-reported screen time for weekdays and weekend days. Responses were separately dichotomized as >2 versus ≤2 hours/day (meeting behavioral guidelines). Caregiver-reported youth sleep duration was dichotomized as <9 versus 9-11 hours/night (meeting behavioral guidelines). Caregivers reported internalizing symptoms via the child behavior checklist. The withdrawn/depressed, anxious/depressed, and somatic symptom child behavior checklist subscale t-scores were separately dichotomized as ≥65 (borderline clinical levels of symptoms and above) versus <65. Analyses were gender-stratified.

RESULTS

In females, longer baseline sleep duration was protective against withdrawn/depressed symptoms (odds ratio [OR] 0.6, 95% confidence interval [CI] 0.4-0.8) and somatic complaints (OR 0.8, 95% CI 0.6-0.97) one year later. In females, greater baseline weekend screen time was associated with increased risk of withdrawn/depressed symptoms (OR 1.6, 95% CI 1.1-2.2) one year later. No other significant associations were observed.

DISCUSSION

Longitudinal associations between sleep duration, weekend screen time, and internalizing symptoms were unidirectional (behavior preceding internalizing symptoms), among females only, and specific to withdrawn/depressed and somatic symptoms. These prospective study findings warrant attention and inform future research in this cohort.

Cross-sectional and prospective associations between children's 24-h time use and their health-related quality of life: a compositional isotemporal substitution approach

Background

Promoting active, balanced lifestyles among children may be an important approach to optimising their health-related quality of life (HRQoL). However, the relationships between children's movement behaviours and HRQoL remain unclear.

Methods

We examined the associations between movement behaviours (sleep, inactivity, light and moderate-to-vigorous intensity physical activity) assessed using accelerometers at ages 8 and 10 years and self-reported HRQoL scores (overall, and physical and emotional well-being, self-esteem, relationship with family and friends, and school functioning domains) at age 10 years among 370 children in a local birth cohort using compositional isotemporal substitution techniques.

Findings

Cross-sectionally, light and moderate-to-vigorous intensity physical activities were associated with better self-esteem (β = 15.94 [2.71, 29.18]) and relationship with friends (β = 10.28 [3.81, 16.74]) scores respectively. Prospectively, inactivity was associated with lower overall HRQoL (β = -10.00 [-19.13, -0.87]), relationship with friends (β = -16.41 [-31.60, -1.23]) and school functioning (β = -15.30 [-29.16, -1.44]) scores, while sleep showed a positive trend with overall HRQoL (β = 10.76 [-1.09, 22.61]) and school functioning (β = 17.12 [-0.87, 35.10]) scores. Children's movement behaviours were not associated with their physical and emotional well-being, or relationship with family scores. The isotemporal substitution analyses suggest that increasing time spent in physical activity and/or sleep at the expense of inactivity may benefit children's HRQoL.

Interpretation

Our findings suggest that sleep and physical activity may be associated with better HRQoL, with the inverse for inactivity. However, the relationship between children's movement behaviours and HRQoL is complex and warrants further research.

Funding

Singapore National Research Foundation, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research.

Investigation of the correlation between internet addiction, obesity risk and sleep disorder in children

AIM

This study was performed with the aim of investigating the correlation and the effective factors between internet addiction, obesity risk and sleep disorders in children.

MATERIAL AND METHOD

The sample for this descriptive and relational search type study comprised the parents of 458 children aged 7-10 years attending a primary school in Turkey. Data were collected the Parent and Child Descriptive Information Form, Family Child Internet Addiction Scale (FCIAS), Family Nutrition and Physical Activity Tool (FNPAT) and Sleep Disturbance Scale for Children (SDSC).

RESULTS

There was a statistically significant, positive and weak correlation between the Body Mass Index (BMI) and FCIAS scores of children (p < 0.001). There was a statistically significant, negative and very weak correlation between FNPAT total score with FCIAS total score (p = 0.007). There was a statistically significant, positive and moderate correlation between SDSC total score and FCIAS total score (p < 0.001). According to regression analysis, FCIAS was a determinant at significant levels for FNPAT and SDSC (p < 0.05).

CONCLUSION

There was a relationship between internet addiction and obesity and sleep quality. As a result of the study, the increase in internet use was determined to negatively impact physical activity and health nutrition behavior, and to increase sleep disturbance.

IMPLICATIONS FOR PRACTICE

Pediatric nurses are recommended to give counseling to children and families about preventing obesity and the risk of sleep disorders by identifying children at risk in terms of internet addiction in the early period.

Internet Addiction and Sleep Disorders among Medical Students

Background

Considering the increasing use of the Internet in Iranian society, especially among students, and the importance of sleep quality, the present study investigated the relationship between sleep quality and Internet addiction among medical students in Shiraz.

Methods

In this descriptive-analytical study, the sample included students of the Shiraz University of Medical Sciences who were selected by a multistage sampling method in 2018. Each faculty was considered to be stratified, and the samples were selected from all strata by simple random sampling. A total of 400 student questionnaires were eligible for analysis. The level of sleep disturbance was measured using the Pittsburgh Sleep Quality Index (PSQI), and Young's Internet Addiction Test (IAT) was used to evaluate Internet addiction. Cronbach's alpha for PSQI and IAT was 0.77 and 0.93, respectively.

Results

109 (%28.9) and 58 (%14.4) of all the people under study were at risk of Internet addiction or poor sleep quality, respectively. The highest percentage of poor sleep quality was in those who were addicted to the Internet (60%), but the lowest percentage was observed in the group without addiction (27%). In addition, there was a significant correlation between Internet addiction and subjective sleep quality (r = 0.191, p = 0.05), sleep latency (r = 0.129, p = 0.01), sleep duration (r = 0.119, p = 0.01), habitual sleep efficiency (r = 0.186, p = 0.05), sleep disturbances (r = 0.169, p = 0.01), use of sleeping medication (r = 0.203, p = 0.05), and daytime dysfunction (r = 0.188, p = 0.05).

Conclusion

These findings help national health officials and planners in Iran to design appropriate and effective interventions to improve students' health and prevent Internet addiction.

Separating the influences of means and daily variations of sleep on the stress-induced salivary cortisol response

BACKGROUND

Previous research regarding the effects of sleep quality and quantity on the acute stress response has yielded inconsistent findings. This may be attributed to various factors, including composite sleep components (i.e., means and daily variations) and mixed cortisol stress response (i.e., reactivity and recovery). Thus, this study aimed to separate the effects of means and daily variations of sleep on the reactivity and recovery of cortisol responses to psychological challenges.

METHODS

In study 1, we recruited 41 healthy participants (24 women; age range, 18-23 years), monitored their sleep during seven consecutive days via wrist actigraphy and sleep diaries, and adopted the Trier Social Stress Test (TSST) paradigm to induce acute stress. Study 2 consisted of a validation experiment using the ScanSTRESS paradigm, which included 77 additional healthy individuals (35 women; age range, 18-26 years). Similarly to the TSST, the ScanSTRESS induces acute stress using uncontrollability and social evaluation. In both studies, saliva samples from the participants were collected before, during, and after the acute stress task.

RESULTS

Using residual dynamic structural equation modeling, both study 1 and study 2 demonstrated that higher means of objective sleep efficiency, and longer means of objective sleep duration were related to greater cortisol recovery. In addition, fewer daily variations in objective sleep duration were associated with greater cortisol recovery. However, there was no correlation between sleep variables and cortisol reactivity, except for the daily variations in objective sleep duration in study 2. No correlation was observed between subjective sleep and cortisol response to stress.

CONCLUSIONS

The present study separated two features of multi-day sleep patterns and two components of cortisol stress response, providing a more comprehensive picture of the effect of sleep on the stress-induced salivary cortisol response, and contributing to the future development of targeted interventions for stress-related disorders.

Association between Physical Activity, Sedentary Behavior, Satisfaction with Sleep Fatigue Recovery and Smartphone Dependency among Korean Adolescents: An Age- and Gender-Matched Study

The purpose of this study was to identify the association between physical activity (PA), sedentary behavior (SB), satisfaction with sleep fatigue recovery (SSFR), and smartphone dependency in South Korean adults. We analyzed data from the National Health and Nutrition Examination Survey 2020 data. We selected participants who answered Internet addiction-related questions as “Very much” (n = 241) and answered Internet addiction-related questions as “Not at all” (n = 241) in the questionnaire. The participants were matched by age and gender, then divided into two groups. Between the two groups, there were considerable differences in the number of days participating in moderate to vigorous PA (5 days or more, p = 0.01), the number of strength training days (1 day, p = 0.02), the number of light PA days for more than 60 min (every day for the last 7 days, p = 0.01), and the SSFR over the past 7 days (p < 0.05). Additionally, the mean smartphone usage time and mean sedentary behavior time between the two groups showed significant differences. The study demonstrated that there were significant associations between PA, SB, SSFR, and smartphone dependency among Korean adolescents matched by age and gender. Additionally, this study highlights the importance of increasing overall PA and number of days participating in MVPA, decreasing SB time and smartphone usage time could reduce the incidence of smartphone overdependence.

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

Purpose of Review

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

Recent Findings

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

Summary

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

Sleep Difficulties among Mexican Adolescents: Subjective and Objective Assessments of Sleep

OBJECTIVE/BACKGROUND

Self-reported sleep difficulties, such as insomnia symptoms, have been reported among adolescents. Yet, studies of their prevalence and correlates are scarce among Latin Americans. This study sought (1) to describe associations between sociodemographic and lifestyle factors with self-reported sleep difficulties and (2) to examine associations between self-reported sleep difficulties and actigraphy-based sleep.

PARTICIPANTS

Participants included 477 Mexican adolescents from the ELEMENT cohort.

METHODS

Over 7 days, self-reported sleep measures (hard time falling asleep, overall sleep difficulties, and specific types of sleep difficulties) were obtained from daily sleep diaries. Actigraphy-based sleep measures (duration, i.e. sleep onset to morning wake, midpoint, and fragmentation) were concurrently assessed using a wrist actigraph.

RESULTS

Mean (SD) age was 15.9 (2.2) years, and 53.5% were females. Mean (SD) sleep duration was 8.5 (1.2) h/night. Half reported a hard time falling asleep at least 3 days, and 25% had sleep difficulties at least 3 days over 7 days. The 3 types of sleep difficulties commonly reported among the entire cohort were insomnia/restlessness (29%), environmental (27%), and mental/emotional difficulties (19%). Female sex, smoking behavior, and socioeconomic indicators were among the most consistent factors associated with sleep difficulties. Subjective sleep difficulties were associated with shorter sleep duration (β = -20.8 [-35.3, -6.2] min), while subjective hard time falling asleep was associated with longer sleep duration (β = 11.3 [4.6, 27.2] min).

CONCLUSION

A high proportion of Mexican adolescents in the sample reported sleep difficulties. Findings demonstrate the importance of obtaining subjective and objective sleep measures for a more comprehensive assessment of adolescent sleep.

Internet Use and Quality of Life: The Multiple Mediating Effects of Risk Perception and Internet Addiction

The impact of internet use on quality of life (QoL) has become an increasing focus of academic research. This paper aims to explore the internal influencing mechanisms of internet use (i.e., leisure-oriented internet use (LIU); work-oriented internet use (WIU)) on QoL, with a focus on the multiple mediating effects of risk perception and internet addiction. We constructed a theoretical framework from a psychological perspective and tested the hypotheses using hierarchical regression analysis with a sample of 1535 participants. The results showed that: (1) LIU had a positive effect on QoL, while WIU did not have a significant impact on QoL; (2) both risk perception and internet addiction had a negative influence on QoL; (3) risk perception positively impacted internet addiction; (4) risk perception and internet addiction had multiple mediating effects on the relationship between internet use and QoL.

Association of Subjective Quality and Quantity of Sleep with Quality of Life among a General Population

This study aimed to determine whether both subjective sleep quality and sleep duration are directly associated with quality of life (QOL), as well as indirectly associated with QOL through insomnia symptoms. Individuals aged 20–69 years without mental illness (n = 9305) were enrolled in this web-based cross-sectional survey. The Short Form-8 was used to assess physical and mental QOL. We used the Pittsburgh Sleep Quality Index (PSQI) and extracted items related to subjective sleep quality and sleep duration. Insomnia symptoms were also extracted from the PSQI. The hypothesized models were tested using structural equation modeling. Worse sleep quality, but not shorter sleep duration, was related to worse physical QOL. Both worse sleep quality and shorter sleep duration were related to worse mental QOL. Insomnia symptoms mediated these relationships. Subgroup analyses revealed a U-shaped relationship between sleep duration and physical/mental QOL. However, the relationship between sleep quality and physical/mental QOL was consistent regardless of sleep duration. The results suggest that subjective sleep quality has a more coherent association with QOL than subjective sleep duration. Because of its high feasibility, a questionnaire on overall sleep quality could be a useful indicator in future epidemiological studies of strategies for improving QOL.

A Cross-Sectional Study of Evening Hyperphagia and Nocturnal Ingestion: Core Constituents of Night Eating Syndrome with Different Background Factors

This web-based cross-sectional survey aimed to elucidate the differences between the two core symptoms of night eating syndrome (NES): evening hyperphagia and nocturnal ingestion in the general Japanese population aged 16–79 years. Participants who consumed at least 25% of daily calories after dinner were defined as having evening hyperphagia. Those who consumed food after sleep initiation at least twice a week were determined to have nocturnal ingestion. Of the 8348 participants, 119 (1.5%) were categorized in the evening hyperphagia group, 208 (2.6%) in the nocturnal ingestion group, and 8024 in the non-NES group. Participants with evening hyperphagia and nocturnal ingestion had significantly higher anxiety scores (p < 0.05 and p < 0.001, respectively) and depression (p < 0.001 for both) than those without NES. Multiple logistic regression analysis revealed that evening hyperphagia was significantly and independently associated with higher body mass index, shorter sleep duration, later sleep-wake schedule, and higher insomnia score, while nocturnal ingestion was significantly and independently associated with younger age, smoking habit, living alone, earlier sleep-wake schedule, and higher insomnia score. Sleep duration and sleep-wake schedule characteristics in the two groups were opposite, suggesting differences in the sleep pathophysiology mechanisms.

Xiaoyao Pill improves the Affective Dysregulation of Sleep-deprived Female Mice by inhibiting Brain Injury and regulating the Content of Monoamine Neurotransmitter

BACKGROUND

Sleep curtailment is a serious problem in many societies. Clinical evidence has shown that sleep deprivation is associated with mood dysregulation, formation of false memory, cardio-metabolic risk factors and outcomes, inflammatory disease risk, and all-cause mortality. The affective disorder dysregulation caused by insufficient sleep has become an increasingly serious health problem. However, to date, not much attention has been paid to the mild affective dysregulation caused by insufficient sleep, and there is no clear and standard therapeutic method to treat it. The Xiaoyao Pill is a classic Chinese medicinal formula, with the effect of dispersing stagnated hepatoqi, invigorating the spleen, and nourishing the blood. Therefore, it is most commonly used to treat gynecological diseases in China. In the present study, the effects of the Xiaoyao Pill on affective dysregulation of sleep-deprived mice and its underlying molecular mechanisms were investigated.

METHODS

Forty adult female mice were used in the present study. The sleep deprivation model was established by improving the multi-platform water environment method. After 7 consecutive days of sleep deprivation, the mice were administrated low (LXYP, 0.32mg/kg) and high (HXYP, 0.64 mg/kg) doses of the Xiaoyao Pill for two weeks. Then, the body weight, behavioral deficits, and histopathology were evaluated. Meanwhile, the expression of c-fos protein and the concentrations of monoamine neurotransmitters in the hippocampus and prefrontal cortex were determined after two weeks of treatment.

RESULTS

Xiaoyao Pill treatment significantly increased body weight and sucrose consumption and decreased the irritability scores of the sleep-deprived mice. Meanwhile, Xiaoyao Pill treatment prevented brain injury and inhibited the expression of c-fos protein in the hippocampus and prefrontal cortex. In addition, HXYP treatment significantly upregulated the levels of NE in the hippocampus and prefrontal cortex (p < 0.01). LXYP treatment significantly up-regulated the levels of 5-HT in the prefrontal cortex. Meanwhile, both HXYP and LXYP treatment significantly up-regulated the levels of DA in the prefrontal cortex (p < 0.05 or p < 0.01) of sleep-deprived mice.

CONCLUSIONS

The present study demonstrates that Xiaoyao Pill treatment prevented the behavioral deficits of mice induced by sleep deprivation by promoting the recovery of brain tissue injury and up-regulating the levels of NE, 5-HT, and DA in the brain tissue.

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.

Association between Short Hours of Sleep and Overweight/Obesity in Mexican Adolescent Population: A School-Based Cross-Sectional Study

Background/Aim: Obesity in adolescents is increasing; as such, the aim of this study was to determine the prevalence of obesity in Mexican adolescents and examine its possible association with hours of sleep. Methods: A school-based cross-sectional study was carried out. This study included 863 adolescents aged between 11 and 16 years. The prevalence of obesity was estimated using the body mass index (BMI). The duration of sleep (and other information) was assessed by a self-reported questionnaire. The Cochran–Mantel–Hansel test for categorical variables and a general linear model for continuous variables were used to evaluate the interaction effect of BMI and sex with respect to sleeping and assessed activity conditions. Results: It was found that 47.6% of the adolescents were overweight/obese. Men were more frequently overweight/obese than women (52.6% vs. 41.8%, p = 0.002). Moreover, overweight/obese adolescents were younger and spent fewer daily hours watching television (p < 0.05). Men practiced sports more hours per week than women (p = 0.04). However, women spent more daily time on the internet (p = 0.05), and overweight/obese adolescent women slept fewer hours than overweight/obese men and adolescents with normal weight (p = 0.008). Conclusions: The development of strategies for the prevention of overweight/obesity and the improvement of sleep duration should include a gender perspective to improve health habits in Mexican adolescents.

Sex Differences in the Association between Internet Usage and Overweight/Obesity: Evidence from a Nationally Representative Survey in Nepal

Objective: To examine the associations between internet use and overweight/obesity in people aged 15–49 years in Nepal and the extent to which these associations differ by biological sex. Materials and methods: The study analyzed the nationally representative Nepal Demographic and Health Survey (NDHS) 2016 data. Multivariable ordinal logistic regression models were fitted to estimate the total effects of internet use (IU) in the last 12 months and frequency of internet use (FIU) in the last month on overweight/obesity adjusted for potential confounders. Results: Of the 10,380 participants, the prevalence of overweight/obesity by IU was 38% (95% confidence interval (CI): 35.9%, 40.1%) for males and 44.1% (95% CI: 41.6%, 46.6%) for female. The likelihood of overweight/obesity was significantly higher (adjusted odds ratio (aOR): 1.55; 95% CI: 1.40, 1.73; p < 0.001) among those participants who used the internet compared to the participants who did not use the internet in the last 12 months. Similar associations were observed when using the augmented measure of exposure-FIU in the last month. We observed the modification effect of sex in the associations of IU (p-difference < 0.001) and FIU (p-difference < 0.002) with overweight/obesity in Nepal. Conclusions: Our findings suggest that future overweight/obesity interventions in Nepal discourage unnecessary internet use, particularly among males.

Association between Asthma and Internet Addiction Status in Korean Adolescents

Background

Problematic Internet addiction (IA) has been shown to be associated with a variety of psychological comorbidities, but its relationship with adolescent asthma has not yet been investigated in detail.

Methods

We analyzed 18,473 adolescent patients with physician-diagnosed asthma and 205,069 non-asthmatic adolescent patients from the Korean Youth Risk Behavior Web-based Survey. Socioeconomic factors, health behavior factors, psychological factors, and IA status were assessed using the Korean Internet Addiction Proneness Scale. Multiple logistic regression analysis was performed, with adjustment for multiple cofounders, to explore the association between IA and adolescent asthma.

Results

Comparison between the adolescent asthma group and non-adolescent asthma group indicated higher rates of probable IA (13.7% vs. 12.1%, respectively, P<0.001), IA (4.8% vs. 3.1%, respectively, P<0.001), and problematic IA (18.5% vs. 15.2%, respectively, P<0.001) in the adolescent asthma group. After adjustment for multiple confounders, probable IA [odds ratio (OR): 1.16, 95% confidence interval (CI): 1.08–1.26] and IA (OR: 1.07, 95% CI: 1.02–1.12) were significantly associated with increased risk of adolescent asthma, compared to non-problematic Internet use.

Conclusions

IA is associated with an increased rate of asthma in Korean adolescents. So, IA has attracted minimal attention in relation to the treatment of asthma.

Neurobehavioural functions during variable and stable short sleep schedules

We investigated whether variable sleep schedules might mitigate the neurobehavioural deficits induced by multiple nights of sleep restriction. In this 4-night experiment, 78 young adults (age: 18-28 years) were randomly assigned to four groups: 8888, 8666, 8846 and 8486, where each digit corresponded to time-in-bed in hours for each study night. After one baseline night of 8-hr time-in-bed, time-in-bed remained unchanged for the 8888 group, while the other groups had short sleep schedules (total time-in-bed = 18 hr) that differed in the number of time-in-bed changes. Sleep was monitored using actigraphy at home. Daytime neurobehavioural functions were assessed in the laboratory at single time points, after the baseline night, and again after 3 nights of the sleep manipulation period. For sustained attention, the 8888 group responded faster in the Psychomotor Vigilance Task after the manipulation period (p = .01), while responses became slower for the less variable sleep schedules (8666 and 8846; p < .01), but not the most variable sleep schedule (8486; p = .14). Processing speed also improved in the 8888 group and the variable 8846 and 8486 groups (p < .01), but not in the stable 8666 group (p = .09). Furthermore, subjective sleepiness was preserved in the 8888 and, importantly, 8486 groups (p > .05), but was elevated in the 8666 and 8846 groups (p < .05). These findings suggest that when sleep opportunities are limited across multiple nights, a variable sleep schedule that allows for prophylactic and/or recovery sleep on some nights may mitigate some daytime neurobehavioural deficits as compared with a schedule with no opportunity for recovery.

Interplay between social media use, sleep quality, and mental health in youth: A systematic review

Social media applications are increasingly prominent among youth. This systematic review provides a comprehensive assessment of the literature on the relationship between active social media use, sleep quality, and common mental health outcomes (anxiety, depression, and psychological distress) among youth. MEDLINE, PsychINFO, EMBASE and Scopus were searched for observational studies investigating this relationship among youth (aged 16-25). Thirty-six cross-sectional studies and six prospective cohort studies met the inclusion criteria. Among cross-sectional studies, significant associations between excessive social media use with poor mental health outcomes (n = 33), poor sleep quality (n = 24), and significant associations between poor sleep quality and negative mental health (n = 16) were found. In longitudinal studies, frequent social media use was a risk factor for both poor mental health (n = 6) and poor sleep outcomes (n = 5). Some studies showed sleep quality mediating the relationship between social media use and negative mental health outcomes in youth. Overall, included evidence links excessive social media use to poor sleep quality and negative mental health in youth. Given the public health implications of sleep problems, excessive social media use warrants further investigation to clarify the directionality and strength of their associations with poor sleep quality and negative mental health outcomes.

Relationships between Extra-School Tutoring Time, Somatic Symptoms, and Sleep Duration of Adolescent Students: A Panel Analysis Using Data from the Korean Children and Youth Panel Survey

As private tutoring has expanded worldwide, it has been noted that private tutoring and associated emotional distress can affect sleep duration and the health of adolescent students. However, the relationships between extra-school tutoring time, somatic symptoms, defined as physical symptoms of emotional distress, and sleep duration in adolescents has rarely been determined. The aim of this study was to identify these relationships in adolescent students. Data from the Korean Children and Youth Panel Survey were analyzed to address the research questions. Weekday sleep duration, extra-school tutoring time, and somatic symptoms were measured using adolescents’ self-report questionnaires. A multilevel, structural equation model was utilized to test the relationships between these variables and was deemed appropriate considering the repeated measure of the panel data. After controlling for respondent sex, parent working status and education level, and family structure, adolescents’ extra-school tutoring time and level of somatic symptoms were associated with sleep duration during weekdays. Furthermore, the association between extra-school tutoring time and sleep duration was partially mediated by somatic symptoms. Korean adolescent students slept less than the recommended duration. Intervention programs that increase parental interest and attention in adolescent students’ lives, not only focused on academic achievement but also emotional distress is needed. Researchers and policymakers should understand recommended age-appropriate sleep duration and the educational culture and provide balanced strategies between the consideration of the effect of private education on academic achievement and the need to guarantee physical and mental health in adolescent students.

The effect of short or long sleep duration on quality of life and depression: an internet-based survey in Japan

BACKGROUND

To date, no previous studies have evaluated the relationship between sleep duration and quality of life (QOL) or depression in the general population after controlling for daytime sleepiness and sleep disturbances.

METHODS

A web-based cross-sectional survey was conducted with 8698 subjects aged 20-69 years. We examined the relationships between weekday sleep duration and daytime sleepiness, sleep disturbance, QOL and depression, using the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (without the item for sleep duration), 8-item Short Form and Center for Epidemiological Studies Depression Scale (CES-D).

RESULTS

Daytime sleepiness tended to increase in proportion to shorter weekday sleep durations. Sleep disturbances, physical and mental QOL, and CES-D scores were worse in both the shorter and longer sleep groups compared with the group with 7-8 h of sleep. Hierarchical logistic regression analyses revealed that short sleep duration but not long sleep duration was significantly associated with reduction of both physical and mental QOL, even after controlling for the presence of daytime sleepiness and sleep disturbance. Both short and long sleep duration were independently and significantly correlated with depression after controlling for daytime sleepiness; however, there was no statistically significant association after adjusting for the effects of sleep disturbance.

CONCLUSIONS

The results suggested adverse effects of short sleep but not long sleep on both physical and mental QOL. In addition, the negative impact of specific types of sleep disturbance on depression may be greater than the impact of shortening of sleep duration.

The relationship between insomnia and trait anger and anger expression among adolescents

PROBLEM

Sleeplessness and inadequate sleep may cause an adolescent to experience reduced self-control and behavioral problems that include anger and an inclination toward crime. This study aimed to examine the relationship between insomnia and trait anger and anger expression among adolescents.

METHODS

The study was conducted with 749 students from 27 high schools who were selected by using the stratified cluster sampling method. The data were collected with an Individual Characteristics Form, the Trait Anger/Anger Expression Inventory, and the Insomnia Severity Index.

FINDINGS

The insomnia scores of 14.0% of the participants were over the clinical insomnia threshold of 15 points. A positive relationship was found between insomnia and trait anger, anger-in, anger-out scores but a negative relationship with anger control scores. It was observed that the determinants of the severity of insomnia were trait anger and anger-in, dozing off in class, feeling anger after a sleepless night, sleeping <6 h a night during the week and over the weekend.

CONCLUSION

It was found that 14.0% of the participants experienced insomnia and there was a two-way correlation between insomnia and anger among adolescents.

Associations between physical activity, sedentary behaviour and self-rated health among the general population of children and adolescents: a systematic review and meta-analysis

Background

Self-rated health (SRH) is an indicator that captures a person’s perception of their overall health status. The relationship between physical activity (PA), sedentary behaviour (SB) and SRH has been investigated in systematic reviews among adult and elderly populations. No systematic review to date has synthesized the relationship between PA, SB and SRH among children and adolescents. The purpose of this systematic review and meta-analysis was to synthesize the associations between PA, SB and SRH in the general population of children and adolescents and to investigate the dose-response relationship between PA, SB and SRH.

Methods

We conducted a computer search for English language studies in the databases of MEDLINE, EMBASE and PSYCINFO that were published between 1946 and 2019. We searched PubMed, Google Scholar, and the references of the identified publications for additional studies. A meta-analysis was employed to synthesize the associations between PA, SB respectively and SRH. The dose-response association was tested using a random effects meta-regression model. The review was reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.

Results

Sixty-eight published articles were included in the final review, including 59 cross-sectional and nine longitudinal studies. We found evidence that PA was associated with better SRH, and SB was associated with lower SRH among children and adolescents. A dose-response relationship between PA and SRH was observed, where a higher level of PA was associated with better SRH than a lower level of PA. The relationship between PA, SB and SRH was observed in both boys and girls, and did not show a significant gender difference.

Conclusions

The findings in the systematic review suggest that health intervention programmes targeting promoting PA and reducing SB among children and adolescents may enhance their overall health status. Future research is needed to expand prospective cohort and intervention studies to address directionality and causality in the relationships between PA, SB and SRH among children and youth.

Trial registration

PROSPERO - CRD42019142244. Registered on October 18, 2019.

Demographic and Socioeconomic Influences on Sleep Patterns among Adolescent Students

Although proper sleep is an important topic in adolescent health, little is known about the sleep patterns of adolescents from a longitudinal and non-Western perspective. To fill this gap, the present research conducted a longitudinal study of the impact of demographic and socioeconomic factors on sleep patterns among Korean adolescent students. The relationship could positively or negatively affect sleep. Therefore, it is important to understand which demographic and socioeconomic factors are related to sleep patterns. This study used nationally representative panel data from the Korean Children and Youth Panel Survey. A series of descriptive analyses were conducted to provide overall characteristics of the sample. Furthermore, mixed effect regression analysis techniques were employed to test the relationship between demographic and socioeconomic factors and sleep patterns. Paternal employment status was associated with adolescent sleep patterns, while maternal employment status was not. Adolescents with both parents working compared to adolescents with one parent or none working showed different sleep patterns on weekdays but not on weekends. Both parents possessing college degrees, household income, living in an urban area, and family type were associated with adolescent sleep pattern indicators to varying degrees. Some of these associations varied according to adolescent sex. This study provides insight into the impact of demographic and socioeconomic factors on weekend and weekday sleep patterns among adolescent students by sex. These findings provide information for the promotion of healthy sleep in adolescents by addressing demographic and socioeconomic factors.

Low physical activity and high sedentary behaviour are associated with adolescents' suicidal vulnerability: Evidence from 52 low- and middle-income countries

AIM

To examine the relationships of physical activity (PA) and sedentary behaviour (SB) with suicidal thoughts and behaviour among adolescents in low- and middle-income countries (LMICs).

METHODS

Global School-based Student Health Survey data from 206 357 students (14.6 ± 1.18 years; 51% female) in 52 LMICs were used. Students reported on suicidal ideation, suicide planning, suicide attempts, PA, leisure-time SB and socio-demographic characteristics. Multilevel mixed-effects generalised linear modelling was used to examine the associations.

RESULTS

High leisure-time SB (≥3 hours/day) was independently associated with higher odds of suicidal ideation, suicide planning and suicide attempts for both male and female adolescents. Insufficient PA (<60 mins/day) was not associated with higher odds of ideation for either sex; however, it was associated with planning and attempts for male adolescents. The combination of insufficient PA and high SB, compared with sufficient PA and low SB, was associated with higher odds of suicidal ideation and suicide planning for both male and female adolescents, and suicide attempts for male adolescents.

CONCLUSION

High SB may be an indicator of suicidal vulnerability among adolescents in LMICs. Low PA may be a more important risk for suicidal thoughts and behaviours among male, than female, adolescents. Promoting active lifestyle should be integrated into suicide prevention programmes in resource-poor settings.

Sleep and suicidality in school-aged adolescents: A prospective study with 2-year follow-up

Current evidence about the association between sleep and suicide are conflicting. This study aimed to investigate the association between sleep duration and quality with suicidal behaviors in a group of school-aged adolescents in China. The baseline survey was conducted among Chinese adolescents aged 12-13 years in October 2016. All participants were asked to complete a self-administered questionnaire. After 2 years follow-up, a total of 1513 adolescents completed the follow-up. The multivariable logistic regression analysis showed that shorter sleep duration (<8 h per night) in baseline was associated with an increased likelihood of suicidality in boys [suicidal ideation, adjusted odds ratio (OR)=2.18, 95% confidence interval (CI)=1.97 to 3.98; suicide planning, OR=2.47, 95% CI=1.22 to 5.01; suicide attempt, OR=2.97, 95% CI=1.39 to 6.38]. Similarly, poor sleep quality [Pittsburgh Sleep Quality Index (PSQI) ≧ 5] was associated with an increased likelihood of suicidal ideation and suicide planning in boys (OR=2.14, 95% CI=1.15 to 3.99 and OR=2.47, 95% CI=1.16 to 5.25, respectively). This study indicates that school-aged boys are more likely to experience suicidality in exposure to short sleep or poor sleep quality.

Association between insufficient sleep and suicidal ideation among adolescents

The objective of this study was to examine the association between insufficient sleep and suicidal ideation among adolescents. Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 13,659 adolescents aged 14-18 years (51.8% female) were analyzed using logistic regression with suicidal ideation as the outcome variable and insufficient sleep as the main explanatory variable. Of the 13,659 adolescents, 2,409 representing 17.6% experienced suicidal ideation during the past 12 months and three out of four adolescents (75.2%) had insufficient sleep on an average school night. Controlling for all other predictors, the odds of experiencing suicidal ideation were 1.35 times higher for adolescents who had insufficient sleep relative to those who had sufficient sleep on an average school night (AOR = 1.35, 95% CI = 1.16-1.58). Other factors associated with suicidal ideation include female gender, sexual minority, history of traditional bullying and cyberbullying victimization, feeling sad or hopeless, being slightly or very overweight, and substance use. Physical activity was inversely associated with suicidal ideation. School counselors, clinicians, and practitioners should consider adequate sleep as an important intervention in suicide prevention.

Prevalence and Associated Factors of Nocturnal Eating Behavior and Sleep-Related Eating Disorder-Like Behavior in Japanese Young Adults: Results of an Internet Survey Using Munich Parasomnia Screening

Nocturnal (night) eating syndrome and sleep-related eating disorder have common characteristics, but are considered to differ in their level of consciousness during eating behavior and recallability. To date, there have been no large population-based studies determining their similarities and differences. We conducted a cross-sectional web-based survey for Japanese young adults aged 19-25 years to identify factors associated with nocturnal eating behavior and sleep-related eating disorder-like behavior using Munich Parasomnia Screening and logistic regression. Of the 3347 participants, 160 (4.8%) reported experiencing nocturnal eating behavior and 73 (2.2%) reported experiencing sleep-related eating disorder-like behavior. Smoking (p < 0.05), use of hypnotic medications (p < 0.01), and previous and/or current sleepwalking (p < 0.001) were associated with both nocturnal eating behavior and sleep-related eating disorder-like behavior. A delayed sleep-wake schedule (p < 0.05) and sleep disturbance (p < 0.01) were associated with nocturnal eating behavior but not with sleep-related eating disorder-like behavior. Both nocturnal eating behavior and sleep-related eating disorder-like behavior had features consistent with eating disorders or parasomnias. Nocturnal eating behavior but not sleep-related eating disorder-like behavior was characterized by a sleep-awake phase delay, perhaps representing an underlying pathophysiology of nocturnal eating syndrome.

The relationship between screen-based sedentary behaviors and symptoms of depression and anxiety in youth: a systematic review of moderating variables

Background

To elucidate the populations and conditions where screen-based sedentary behaviors (SB) and internalizing symptoms are coupled, this review synthesized the evidence for factors that may moderate the associations between screen-based SB, depressive symptoms, and anxiety symptoms among youth.

Methods

Two independent researchers conducted a systematic literature search of the Medline, psycINFO, and Scopus electronic databases in late 2018 for observational studies assessing moderators of the association between screen-based SB and depressive and anxiety symptoms. Studies among children and adolescents were eligible if moderation was assessed by statistical test (interaction) or stratification; and a narrative synthesis of eligible studies was conducted in accordance with PRISMA guidelines.

Results

Seventy empirical studies (46 cross-sectional, 19 longitudinal, and 5 both) of 13 different moderating variables of screen-based SB-internalizing symptom associations met the eligibility criteria. Of these, 40 studies were of depressive symptoms, 2 were of anxiety symptoms, and 28 studies assessed symptoms of both. The most consistent evidence of moderation was for screen-type, such that TV viewing was not as strongly associated with internalizing symptoms compared to other forms of screen-based SB. There was also inconsistent evidence for physical activity buffering screen-based SB-internalizing symptom associations and for female sex amplifying screen-based SB-internalizing symptom associations. In general, the body of evidence for anxiety symptoms was more limited than that for depressive symptoms, and were therefore more inconsistent.

Conclusions

Screen-type, physical activity, and sex may influence the magnitude of screen-based SB-internalizing symptom coupling; highlighting potential sources of heterogeneity of screen-based SB-internalizing symptom associations. Additional studies aimed at understanding potential mechanistic explanations for the above moderators are needed prior to the development of tailored intervention strategies designed to decouple screen-based SB and internalizing symptoms among youth.

The Moderating Role of Sleep in the Relationship Between Social Isolation and Internalising Problems in Early Adolescence

Social isolation may be a unique risk factor for depression and anxiety in early adolescence. However, optimal sleep may protect adolescents from the emotional sequela of social isolation. The present study aimed to investigate whether sleep moderates the relationship between social isolation and symptoms of anxiety and depression in early adolescence. Five hundred and twenty eight early adolescents (M = 11.18 years, SD = 0.56, range 10-12 years, 51% male) completed online questionnaires assessing social isolation, sleep duration, daytime sleepiness and symptoms of generalised anxiety, social anxiety, separation anxiety and depression. Sleep duration moderated the effect of social isolation on symptoms of generalised anxiety, social anxiety and depression, but not separation anxiety. Daytime sleepiness emerged as an additional sleep-related risk factor in the relationship between social isolation and depressive symptoms. Therefore, sleep may be an important modifiable risk or protective factor to target, in the prevention of depression and anxiety in adolescence.

Type of screen time moderates effects on outcomes in 4013 children: evidence from the Longitudinal Study of Australian Children

Background

Excessive engagement with digital screens is harmful to children’s health. However, new evidence suggests that exposure at moderate levels may not be harmful and may even provide benefit. Therefore, our objective was to determine if there are curvilinear relationships between different types of screen time and a diverse set of outcomes, including health and education.

Methods

We address our objective using a repeated measures design. Children (N = 4013), initially aged 10–11 were assessed every 2 years between 2010 and 2014. Children’s screen time behavior was measured using time-use diaries, and categorized into five types: social, passive, interactive, educational, or other. We used measures of children’s physical health, health-related quality of life, socio-emotional outcomes, and school achievement. The analysis plan was pre-registered. Models were adjusted for gender, socio-economic status, ethnicity, number of siblings, and housing factors.

Results

There were linear associations between total screen time and all outcomes, such that more screen time was associated with worse outcomes. However, there was variability when examined by screen time type. Passive screen time (e.g., TV) was associated with worse outcomes, educational screen time (e.g., computer for homework) was associated with positive educational outcomes and had no negative relations with other outcomes. Interactive screen time (e.g., video games) had positive associations with educational outcomes but negative associations with other outcomes. In all instances, these significant associations were small or very small, with standardised effects < 0.07. We found little evidence of curvilinear relationships.

Conclusions

The small effects of screen time on children’s outcomes appear to be moderated by the type of screen time. Policy makers, educators, and parents should consider the type of screen time when considering the benefits and harms of use.

Sleep characteristics and health-related quality of life in 9- to 11-year-old children from 12 countries

INTRODUCTION

Previous studies have linked short sleep duration, poor sleep quality, and late sleep timing with lower health-related quality of life (HRQoL) in children. However, almost all studies relied solely on self-reported sleep information, and most studies were conducted in high-income countries. To address these gaps, we studied both device-measured and self-reported sleep characteristics in relation to HRQoL in a sample of children from 12 countries that vary widely in terms of economic and human development.

METHODS

The study sample included 6,626 children aged 9-11 years from Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom, and the United States. Waist-worn actigraphy was used to measure total sleep time, bedtime, wake-up time, and sleep efficiency on both weekdays and weekends. Children also reported ratings of sleep quantity and quality. HRQoL was measured by the KIDSCREEN-10 survey. Multilevel regression models were used to determine the relationships between sleep characteristics and HRQoL.

RESULTS

Results showed considerable variation in sleep characteristics, particularly duration and timing, across study sites. Overall, we found no association between device-measured total sleep time, sleep timing or sleep efficiency, and HRQoL. In contrast, self-reported ratings of poor sleep quantity and quality were associated with HRQoL.

CONCLUSIONS

Self-reported, rather than device-based, measures of sleep are related to HRQoL in children. The discrepancy related to sleep assessment methods highlights the importance of considering both device-measured and self-reported measures of sleep in understanding its health effects.

The Predictive Relationship of Health Related Quality of Life on Objectively-Measured Sleep in Children: A Comparison Across BMI Ranges

Sleep is considered a major factor related to children's general quality of life with regards to their health outcomes, general well-being, and daily life functions. Kid-KINDL, a health-related quality of life (HRQOL) measure, was used in a consecutive 12-week longitudinal study to compare the association between children's quality of life (QoL) and sleep duration across different BMI ranges. To reduce recall bias, each child wore an electronic pedometer on their wrist to record their sleep duration. The Pearson χ2 test, one-way analysis of variance (ANOVA), and mixed effect repeated measures analysis was used to investigate the association between children's QoL and their sleep duration. The original QoL scores showed that underweight children had lower emotional, family relationship, friendship, and school-related scores, and that overweight children had lower physical satisfaction and self-esteem scores. Emotional (beta = -0.3, p < 0.01) and family relationships (beta = 0.20, p = 0.01) significantly influenced the sleep duration of underweight children. The score of emotional well-being decreased by 0.3, while sleep duration increased by an hour. The poorer the emotional well-being of children, the longer they slept. The score of family well-being increased by 0.2, while sleep duration increased by an hour. The better family quality children had, the longer they slept; For overweight children, the score of family well-being increased by 0.08, while sleep duration increased by an hour (beta = 0.08, p = 0.04). Their sleep got longer when they had better family quality. Physical and school satisfaction scores also significantly affected the sleep duration of obese children. When the score of physical and school increased by 0.09, the sleep duration increases by an hour (beta = 0.09, p = 0.01; beta = 0.09, p < 0.01, respectively). The better the quality of physical condition and school life was, the longer sleep they would get. This study might be the first longitudinal study to evaluate the relationship between QoL and sleep duration, using an objective device but subjective questionnaires, across BMI ranges in a pediatric population.

Der Zusammenhang zwischen Schlafproblemen, unzureichender Schlafdauer und psychischen Auffälligkeiten bei Kindern und Jugendlichen

Zusammenfassung. Schlafprobleme und eine unzureichende Schlafdauer können die psychische Gesundheit im Kindes- und Jugendalter nachhaltig beeinträchtigen. Daten von 6.670 Jungen und Mädchen im Alter von 11 – 13 und 14 – 17 Jahren, aus dem Kinder- und Jugendgesundheitssurvey (KIGGS), wurden getrennt nach Geschlechtern analysiert, um zu untersuchen, ob Schlafprobleme und eine unzureichende Schlafdauer mit einer höheren Risikowahrscheinlichkeit für psychische Auffälligkeiten einhergehen. Während Schlafprobleme unabhängig von Geschlecht und Alter mit einem höheren Risiko für alle Symptombereiche (OR = 1.52 – 3.49) verbunden sind, findet sich hinsichtlich einer geringen Schlafdauer nur bei Mädchen eine höheres Risikowahrscheinlichkeit für Auffälligkeiten im externalisierenden und internalisierenden Bereich. Damit scheint sich der Zusammenhang zwischen unzureichender Schlafdauer und psychischen Auffälligkeiten bei Jungen und Mädchen zu unterscheiden. Mögliche Ursachen und Implikationen für die pädiatrische und psychiatrische Praxis werden diskutiert.

Levels and correlates of 24-hour movement behaviors among South Koreans: Results from the Korea National Health and Nutrition Examination Surveys, 2014 and 2015

PURPOSE

This study aimed to examine the levels and correlates of 24-h movement behaviors (i.e., physical activity, sedentary time, and sleep), and different patterns of these behaviors in a nationally representative sample of South Koreans aged 12 years and older. This study also aimed to examine the sociodemographic correlates of 24-h movement behaviors stratified by age groups.

METHODS

Self-reported, repeated cross-sectional data from 10,708 participants in the 2014 and 2015 Korea National Health and Nutrition Examination surveys were used. Key variables included moderate-to-vigorous intensity physical activity, muscular strengthening exercises, walking, active transportation, sedentary time, and sleep. Sociodemographic variables included age, sex, household income, area of residence, and education level. Descriptive statistics by sex and age as well as general linear models by age group were performed.

RESULTS

The proportions of individuals meeting the moderate-to-vigorous intensity physical activity, muscular strengthening exercises, and sleep guidelines were, respectively, 21.6%, 22.1%, and 32.5% in male youth; 6.9%, 4.5%, and 22.8% in female youth; 55.5%, 30.8%, and 54.0% in male adults; 48.8%, 14.4%, and 57.6% in female adults; 44.0%, 30.6%, and 45.5% in male older adults; and 29.5%, 8.9%, and 37.3% in female older adults. The proportions of individuals showing the most ideal combinations of 24-h movement behaviors were only 3.2% in youth, 0.4% in adults, and 0 in older adults. Universally, older age, female sex, or living in metro Seoul were associated with unfavorable patterns of 24-h movement behaviors across different age groups. However, the associations of income and education with movement behaviors were mixed across age groups.

CONCLUSION

Overall, the proportion of South Koreans with a healthy 24-h movement behavior pattern is low. The sociodemographic correlates of different types of 24-h movement behaviors should be considered when designing targeted interventions for the promotion of healthy active living for South Koreans.

Chronic sleep disturbance, not chronic sleep deprivation, is associated with self-rated health in adolescents

Improving our understanding of the cumulative effects of persistent sleep problems on adolescent health has been identified as an important area of research. This prospective study aimed to ascertain prospectively gender-specific associations between quantity and quality of sleep and self-reported health. Data from a cohort of 3104 adolescents (13-18 y) with repeated measures of sleep deprivation and sleep disturbance (2011 fall, 2012 spring, 2012 fall), and self-reported health (SRH) (2011 fall, 2012 fall) were analysed with multivariable logistic regression models adjusted for confounders. The results of the regression models indicated that cumulative exposure to sleep disturbance was monotonically associated with SRH in both genders, however cumulative sleep deprivation was not associated with self-reported health among young people. Young women reporting chronic exposure to sleep disturbance had over twice the odds of reporting sub-optimal health at follow-up (OR 2.18 [CI95: 1.13, 4.22]), compared to those with no history. Similar results were found in chronically sleep disturbed young men (OR 2.41 [1.05, 5.51]). These findings suggest that chronic exposure to impaired quality of sleep, such as difficulty falling or staying asleep, is related to adolescent self-reported health and thus may be an important determinant of young people's wellbeing.

Relationships between Sleep Patterns, Health Risk Behaviors, and Health Outcomes among School-Based Population of Adolescents: A Panel Analysis of the Korean Children and Youth Panel Survey

Sleep patterns among adolescents are related to health outcomes and health risk behaviors. This study aimed to describe sleep patterns of Korean adolescents and to find the association between sleep patterns and health risk behaviors and health outcomes. Using the junior high school students’ panel data (n = 2351, 12–15 years old) from the Korean Children and Youth Panel Survey, this study described the sleep patterns operationalized as rising time, bedtime, and sleep duration both on weekdays and weekends. The relationships of sleep patterns with health outcomes and/or health risk behaviors were tested using mixed effect linear regression for continuous health variables and using mixed effect logit regression for binary health variables. Obesity status, the number of chronic symptoms, self-rated health status, smoking, and alcohol consumption were associated with rising time on weekdays after controlling for gender, living area, and housing type. The same set of variables except for the number of chronic symptoms were associated with bedtime during the weekdays. Sleep duration during the weekdays was associated with obesity status, smoking, and alcohol consumption. Similar patterns of association between sleep pattern variables during the weekends and health-related outcome variables were found, but were less obvious than those for weekdays. Significant relationships between sleep patterns and various health-related variables were found among adolescents in Korea. The results from this study indicate that helping adolescents change their sleeping times as necessary to ensure adequate sleep should be considered important in diminishing health risk behaviors and promoting positive health outcomes.

The Relationship Between Sleep Quality and Internet Addiction Among Female College Students

BACKGROUND

Over 40% of Taiwanese College students experience sleep problems that not only impair their quality of life but also contribute to psychosomatic disorders. Of all the factors affecting the sleep quality, internet surfing is among one of the most prevalent. Female college students are more vulnerable to internet-associated sleep disorders than their male counterparts. Therefore, this study aims to investigate (1) the relationship between internet addiction and sleep quality, and (2) whether significant variations in sleep quality exist among students with different degrees of internet use.

METHODS

This structured questionnaire-based cross-sectional study enrolled students from a technical institute in southern Taiwan. The questionnaire collected information on the following three aspects: (1) demography, (2) sleep quality with Pittsburgh Sleep Quality Index (PSQI), and (3) severity of internet addiction using a 20-item Internet Addiction Test (IAT). Multiple regression analysis was performed to examine the correlation between PSQI and IAT scores among the participants. Logistic analysis was used to determine the significance of association between PSQI and IAT scores.

RESULTS

In total, 503 female students were recruited (mean age 17.05 ± 1.34). After controlling for age, body mass index, smoking and drinking habits, religion, and habitual use of smartphone before sleep, internet addiction was found to be significantly associated with subjective sleep quality, sleep latency, sleep duration, sleep disturbance, use of sleep medication, and daytime dysfunction. Worse quality of sleep as reflected by PSQI was noted in students with moderate and severe degrees of internet addiction compared to those with mild or no internet addiction. Logistic regression analysis of the association between scores on IAT and sleep quality, demonstrated significant correlations between quality of sleep and total IAT scores (odds ratio = 1.05:1.03 ∼ 1.06, p < 0.01).

CONCLUSION

The results of this study demonstrated significant negative association between the degree of internet addiction and sleep quality, providing reference for educational institutes to minimize adverse effects associated with internet use and improve students' sleep quality.

Leisure-time sedentary behavior and suicide attempt among 126,392 adolescents in 43 countries

BACKGROUND

Adolescent suicide is a major global mental health problem. Exploring variables associated with suicide attempts is important for the development of targeted interventions. The aim of the current study was to explore associations between leisure-time sedentary behavior and suicide attempts.

METHODS

Data from the Global School-based Student Health Survey were analyzed. Data on past 12-month suicide attempts and self-reported leisure-time sedentary time were collected. Multivariable logistic regression and meta-analysis were conducted to assess the associations.

RESULTS

Among 126,392 students from 43 countries (mean age 13.8 ± 0.96 years; 48.9% female), 10.6% had attempted suicide. The prevalence of suicide attempts increased with increasing sedentary leisure-time per day (from 9% at <1 h/day to 16.8% at >8 h/day). Compared to those engaging in <1 h/day sedentary during leisure-time, there was a dose-dependent increase in odds ratios (ORs) for suicide attempts, with the OR for >8 h/day being 1.45 (95% confidence interval=1.19-1.77).

LIMITATIONS

The study is cross-sectional, therefore the directionality of the relationships cannot be deduced.

CONCLUSIONS

Our data suggest that leisure-time sedentary behavior is associated with increased odds for suicide attempt in adolescence. Future longitudinal data are required to confirm/refute the findings to inform public prevention campaigns.

Stressful life events, insomnia and suicidality in a large sample of Chinese adolescents

AIMS

This study aimed to examine the associations between stressful life events, insomnia, and suicidality including suicidal ideation (SI), suicide plan (SP) and suicide attempt (SA) in a large sample of Chinese adolescents.

METHODS

A total of 11,831 adolescents who participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort were included for the analysis. Participants were sampled from 8 middle/high schools in 3 counties of Shandong, China. Participants completed a structured behavior and health questionnaire, including suicidality, demographics, depression/anxiety, stressful life events (SLEs), and insomnia in November-December 2015. A series of logistic regression models and mediation analyses were performed to examine the associations between SLEs, insomnia and suicidality.

RESULTS

The prevalence rates of overall suicidality, SI, SP and SA in the last year were 13.1%, 12.5%, 3.3%, and 1.5%, respectively. SLEs were significantly associated with overall suicidality, SI, and SP. Insomnia was an independent risk factor of suicidality and a mediator of the association between SLEs and suicidality. The total effect of SLEs on overall suicidality was 0.597 (95%CI: 0.534-0.661), including 0.457 (95%CI: 0.391-0.523) for direct effect and 0.158 (95%CI: 0.138-0.178) for indirect effect. Insomnia also mediated the associations of SLEs with SI, SP and SA, respectively.

LIMITATIONS

Causal relationship could not be concluded because this study is cross-sectional.

CONCLUSIONS

Stressful life events and insomnia are directly associated with suicidality in adolescents. The association between SLEs and suicidality is partially mediated by insomnia.

A longitudinal view of rumination, poor sleep and psychological distress in adolescents

BACKGROUND

Given the high prevalence and negative impact of psychological problems during adolescence, examining transdiagnostic factors that may have scope to positively influence a variety of psychological problems is imperative. The main purpose of this study was to investigate the longitudinal relationship between rumination and psychological distress and whether sleep mediated this relationship over a 2 year period.

METHODS

Participants were 1620 high school students in the 7th and 8th grade at baseline from 17 public schools in three middle Sweden communities. Students completed questionnaires at school during the spring of 2014, 2015 and 2016. Rumination and psychological distress were self-reported, and sleep duration was calculated from reported bed-times, wake-times and sleep onset latencies.

RESULTS

Sleep duration declined with age, whereas rumination and psychological distress increased. Rumination was predictive of future psychological distress and distress at a given time was predictive of concurrent rumination. Sleep duration did not consistently mediate the reciprocal relationships between rumination and psychological distress over time.

LIMITATIONS

Stronger longitudinal associations may have been obtained by using smaller measurement intervals or further delineation of outcome constructs.

CONCLUSIONS

Reducing rumination, rather than targeting sleep patterns, may work towards preventing the development of a number of psychological problems and is a strategy anticipated to function across disorders to improve young people's mental wellbeing.