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Saletin JM, Wolfson AR, Wahlstrom KL, Honaker SM, Owens JA, Seixas AA, Wong P, Carskadon MA, Meltzer LJ. Instructional approach, sleep, and perceived academic well-being in adolescents during COVID-19: Evidence from the NESTED study. Sleep Health 2024:S2352-7218(24)00089-5. [PMID: 38876932 DOI: 10.1016/j.sleh.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/11/2024] [Accepted: 04/21/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES At the peak of COVID-19, adolescent life was disrupted as schools adapted their instructional approaches such as online, in-person, or hybrid instruction. We and others have previously commented on how these shifts facilitated longer, later and (more developmentally appropriate) sleep. Here, we report how sleep contributed to associations between remote instruction and broader academic well-being (e.g., cognitive function, school connectedness, and stress). METHODS Adolescents from all 50 U.S. states (n = 4068) completed online self-report surveys in fall 2020. Instructional approach was operationalized from fully in-person instruction to fully asynchronous online education. Sleep parameters included sleep timing and duration, sleep disturbances, and sleep-related impairments. Perceived academic well-being was defined as cognitive function, school connectedness, and school-related stress. Sleep and perceived academic well-being are examined across instructional approaches, in their association, and in structural models. RESULTS Sleep and perceived academic well-being differed between hybrid and online instruction groups. Less variable or disturbed sleep was associated both with in-person instruction, and with positive outcomes in cognitive function, school connectedness, and stress domains. Sleep mediated a substantial portion of variance in perceived academic well-being attributable to instructional approach. CONCLUSION These data highlight the need to protect both healthy sleep and in-person instruction. Appropriate sleep timing and duration, fewer sleep disturbances and sleep-related impairments accounted for a substantial degree of variance in the association between remote instruction on academic outcomes. While many students experienced "lost learning" because of COVID-19, this study joins a broader discussion of ensuring developmentally appropriate school-start times to support both sleep and achievement.
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Affiliation(s)
- Jared M Saletin
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island, USA; E.P. Bradley Hospital, East Providence, Rhode Island, USA.
| | - Amy R Wolfson
- Department of Psychology, Loyola University Maryland, Baltimore, Maryland, USA
| | - Kyla L Wahlstrom
- Department of Organizational Leadership, Policy, and Development, University of Minnesota, St. Paul, Missouri, USA
| | - Sarah M Honaker
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Judith A Owens
- Department of Neurology, Boston Children's Hospital; Harvard Medical School, Boston, Massachusetts, USA
| | - Azizi A Seixas
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, Florida, USA
| | - Patricia Wong
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island, USA; E.P. Bradley Hospital, East Providence, Rhode Island, USA
| | - Mary A Carskadon
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, Rhode Island, USA; E.P. Bradley Hospital, East Providence, Rhode Island, USA
| | - Lisa J Meltzer
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
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Bauducco S, Gardner LA, Smout S, Champion KE, Chapman C, Gamble A, Teesson M, Gradisar M, Newton NC. Adolescents' trajectories of depression and anxiety symptoms prior to and during the COVID-19 pandemic and their association with healthy sleep patterns. Sci Rep 2024; 14:10764. [PMID: 38730014 PMCID: PMC11087504 DOI: 10.1038/s41598-024-60974-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
The COVID-19 pandemic has seen a rise in anxiety and depression among adolescents. This study aimed to investigate the longitudinal associations between sleep and mental health among a large sample of Australian adolescents and examine whether healthy sleep patterns were protective of mental health in the context of the COVID-19 pandemic. We used three waves of longitudinal control group data from the Health4Life cluster-randomized trial (N = 2781, baseline Mage = 12.6, SD = 0.51; 47% boys and 1.4% 'prefer not to say'). Latent class growth analyses across the 2 years period identified four trajectories of depressive symptoms: low-stable (64.3%), average-increasing (19.2%), high-decreasing (7.1%), moderate-increasing (9.4%), and three anxiety symptom trajectories: low-stable (74.8%), average-increasing (11.6%), high-decreasing (13.6%). We compared the trajectories on sociodemographic and sleep characteristics. Adolescents in low-risk trajectories were more likely to be boys and to report shorter sleep latency and wake after sleep onset, longer sleep duration, less sleepiness, and earlier chronotype. Where mental health improved or worsened, sleep patterns changed in the same direction. The subgroups analyses uncovered two important findings: (1) the majority of adolescents in the sample maintained good mental health and sleep habits (low-stable trajectories), (2) adolescents with worsening mental health also reported worsening sleep patterns and vice versa in the improving mental health trajectories. These distinct patterns of sleep and mental health would not be seen using mean-centred statistical approaches.
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Affiliation(s)
- Serena Bauducco
- Flinders University, Adelaide, Australia.
- Center for Health and Medical Psychology, Örebro University, Fakultetsgatan 1, 701 82, Örebro, Sweden.
| | - Lauren A Gardner
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Scarlett Smout
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Katrina E Champion
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Cath Chapman
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Amanda Gamble
- The Woolcock Institute, Macquarie University, Sydney, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Michael Gradisar
- WINK Sleep Pty Ltd, Adelaide, Australia
- Sleep Cycle AB, Gothenburg, Sweden
| | - Nicola C Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
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Nania C, Noyek SE, Soltani S, Katz J, Fales JL, Birnie KA, Orr SL, McMorris CA, Noel M. Peer Victimization, Posttraumatic Stress Symptoms, and Chronic Pain: A Longitudinal Examination. THE JOURNAL OF PAIN 2024:104534. [PMID: 38615800 DOI: 10.1016/j.jpain.2024.104534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
Chronic pain and posttraumatic stress disorder symptoms (PTSS) co-occur at high rates in youth and are linked to worse pain outcomes and quality of life. While peer victimization has been posited as a mechanism underlying the PTSS-pain relationship in youth, empirical evidence suggests that it may exacerbate both PTSS and pain. The present study aimed to longitudinally examine PTSS as a mediator in the relationship between peer victimization at baseline and pain-related outcomes at 3 months in youth with chronic pain. Participants included 182 youth aged 10 to 18 years recruited from a tertiary-level children's hospital in Western Canada. At baseline, participants completed measures to assess pain (intensity and interference), peer victimization (relational and overt), and PTSS. The pain was reassessed at a 3-month follow-up. Primary hypotheses were tested utilizing a series of mediation analyses with PTSS as a proposed mediator in the associations between peer victimization and pain outcomes. Youth PTSS mediated the relationship between higher baseline relational victimization and higher 3-month pain interference while controlling for baseline pain interference. Three-month pain intensity was not correlated with peer victimization; thus, pain intensity was not included in the analyses. These findings reveal that PTSS may be an underlying factor in the co-occurrence of peer victimization and chronic pain in youth. Further research is needed to better understand the role of peer victimization in the maintenance of chronic pain to ensure appropriate, effective, and timely interventions that address the social and mental health issues impacting the lives of these youth as well as their pain. PERSPECTIVE: PTSS may be an underlying factor in the co-occurrence between peer victimization and chronic pain in youth, highlighting the need to assess for both peer relationship problems and PTSS in youth with chronic pain.
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Affiliation(s)
- Cara Nania
- School and Applied Child Psychology, Werklund School of Education, University of Calgary, Calgary, Alberta, Canada
| | - Samantha E Noyek
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Sabine Soltani
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Jessica L Fales
- Department of Psychology, Washington State University, Vancouver, Washington
| | - Kathryn A Birnie
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Serena L Orr
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carly A McMorris
- School and Applied Child Psychology, Werklund School of Education, University of Calgary, Calgary, Alberta, Canada; Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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Wong P, Meltzer LJ, Barker D, Honaker SM, Owens JA, Saletin JM, Seixas A, Wahlstrom KL, Wolfson AR, Carskadon MA. The associations between instructional approach, sleep characteristics and adolescent mental health: Lessons from the COVID-19 pandemic. Sleep Health 2024:S2352-7218(23)00295-4. [PMID: 38262777 DOI: 10.1016/j.sleh.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVES To test whether adolescents' mental health during the COVID-19 pandemic is associated with the combination of their instructional approach(es) and their sleep patterns. DESIGN Cross-sectional. SETTING Adolescents were recruited through social media outlets in October and November 2020 to complete an online survey. PARTICIPANTS Participants were 4442 geographically and racially diverse, community-dwelling students (grades 6-12, 51% female, 36% non-White, 87% high schoolers). MEASUREMENTS Participants completed items from the PROMIS Pediatric Depressive Symptoms and Anxiety scales. Participants reported their instructional approach(es), bedtimes, and wake times for each day in the past week. Participants were categorized into five combined instructional approach groups. Average sleep opportunity was calculated as the average time between bedtime and waketime. Social jetlag was calculated as the difference between the average sleep midpoint preceding non-scheduled and scheduled days. RESULTS Emotional distress was elevated in this sample, with a large proportion of adolescents reporting moderate-severe (T-score ≥ 65) levels of depressive symptoms (49%) and anxiety (28%). There were significant differences between instructional approach groups, such that adolescents attending all schooldays in-person reported the lowest depressive symptom and anxiety T-scores (P < .001, ηp2 = .012), but also the shortest sleep opportunity (P < .001, ηp2 = .077) and greatest social jetlag (P < .001, ηp2 = .037) of all groups. Adolescents attending school in person, with sufficient sleep opportunity (≥8-9 hours/night) and limited social jetlag (<2 hours) had significantly lower depressive (ηp2 = .014) and anxiety (ηp2 = .008) T-scores than other adolescents. CONCLUSIONS Prioritizing in-person education and promoting healthy sleep patterns (more sleep opportunity, more consistent sleep schedules) may help bolster adolescent mental health.
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Affiliation(s)
- Patricia Wong
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/E. P. Bradley Hospital, Sleep for Science Research Lab, Providence, Rhode Island.
| | - Lisa J Meltzer
- Division of Pediatric Behavioral Health, Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - David Barker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Sarah M Honaker
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Judith A Owens
- Boston Children's Hospital, Harvard Medical School Division of Sleep Medicine, Boston, Massachusetts
| | - Jared M Saletin
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/E. P. Bradley Hospital, Sleep for Science Research Lab, Providence, Rhode Island
| | - Azizi Seixas
- Department of Informatics and Health Data Science, University of Miami Miller School of Medicine, Miami, Florida
| | - Kyla L Wahlstrom
- Department of Organizational Leadership, Policy and Development, College of Education and Human Development, University of Minnesota, Minneapolis, Minnesota
| | - Amy R Wolfson
- Department of Psychology, Loyola University Maryland, Baltimore, Maryland
| | - Mary A Carskadon
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/E. P. Bradley Hospital, Sleep for Science Research Lab, Providence, Rhode Island
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5
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Wesley KL, Cooper EH, Brinton JT, Meier M, Honaker S, Simon SL. A National Survey of U.S. Adolescent Sleep Duration, Timing, and Social Jetlag During the COVID-19 Pandemic. Behav Sleep Med 2023; 21:291-303. [PMID: 35699363 PMCID: PMC9747982 DOI: 10.1080/15402002.2022.2086871] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To assess changes in duration, timing, and social jetlag in adolescent sleep during the COVID-19 pandemic and evaluate the impact of mood, physical activity, and social interactions on sleep. STUDY DESIGN An online survey queried adolescents' sleep before (through retrospective report) and during the initial phase of COVID-19 in May 2020. Adolescents (N = 3,494), 13-19 years old, in the United States (U.S.) answered questions about their current and retrospective (prior to COVID-19) sleep, chronotype, mood, and physical and social activities. Linear regression models were fit for time in bed, reported bed and wake times, and social jetlag during COVID-19, accounting for pre-COVID-19 values. RESULTS Total reported time in bed (a proxy for sleep duration) increased on weekdays by an average of 1.3 ± 1.8 hours (p < .001) during COVID-19, compared to retrospective report of time in bed prior to COVID-19. During COVID-19, 81.3% of adolescents reported spending 8 hours or more in bed on weekdays compared to only 53.5% prior to COVID-19. On weekdays, bedtimes were delayed on average by 2.5 hours and wake times by 3.8 hours during COVID-19 compared to prior to COVID-19. On weekends, bedtimes were delayed on average by 1.6 hours and waketimes by 1.5 hours (all p's < 0.001). Social jetlag of >2 hours decreased to 6.3% during COVID-19 compared to 52.1% prior to COVID-19. Anxiety and depression symptoms and a decline in physical activity during COVID-19 were associated with delayed bed and wake times during COVID-19. CONCLUSIONS During COVID-19, adolescents reported spending more time in bed, with most adolescents reporting 8 hours of sleep opportunity and more consistent sleep schedules. As schools return to in-person learning, additional research should examine how sleep schedules may change due to school start times and what lessons can be learned from changes that occurred during COVID-19 that promote favorable adolescent sleep.
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Affiliation(s)
- Katherine L. Wesley
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado
| | - Emily H. Cooper
- Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado
| | - John T. Brinton
- Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado
| | - Maxene Meier
- Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado
| | - Sarah Honaker
- Department of Pediatrics, Indiana University School of Medicine
| | - Stacey L. Simon
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children’s Hospital Colorado
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6
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Hassinger AB, Monegro A, Perez G. Parental survey of the sleep patterns and screen time in US school children during the first 6 months of the COVID-19 pandemic. BMC Pediatr 2023; 23:65. [PMID: 36750939 PMCID: PMC9905756 DOI: 10.1186/s12887-023-03875-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 01/27/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND This study compared sleep duration, screen exposure and sleep quality in school-aged children before COVID-19 to that during school closures and again when schools re-opened in fall 2020. METHODS Cross-sectional anonymous, online survey of parents of children 5-13 years old. Questions elicited information about sleep timing and quality, screen time, and schooling at three distinct periods: before the pandemic, when schools first closed and then re-opened in the fall. RESULTS Respondents described 101 children who were an average of 8.5 years old and 51% male. In lockdown, children slept 25 min more (95%CI 00:13-00:38) due to later wake times (75 min, 95% CI 0:57-1:34) with later bedtimes (29 min, 95%CI 0:00-0:58). When schools re-opened, sleep duration returned to pre-pandemic levels, but sleep onset and offset times remained later. Despite more sleep, sleep quality and habits (e.g. bedtime refusal) worsened during lockdown and did not normalize in fall 2020. During lockdown, screen time increased in 65% of all children, and 96% of those in private schools. When schools reopened, 78% of children in hybrid/virtual learning had more than 4 h of screen exposure daily. Less screen time was associated with twofold higher odds of better sleep (OR 2.66, 95%CI 1.15-6.14). CONCLUSIONS Although school-aged children had more total sleep when schools were closed, sleep quality and habits worsened. Upon return to school, sleep times and quality did not normalize and were linked to screen time.
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Affiliation(s)
- Amanda B. Hassinger
- grid.273335.30000 0004 1936 9887Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 1001 Main Street, 5Th Floor, Buffalo, NY 14203 USA
| | - Alberto Monegro
- grid.273335.30000 0004 1936 9887Department of Internal Medicine and Pediatrics, Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY USA
| | - Geovanny Perez
- grid.273335.30000 0004 1936 9887Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 1001 Main Street, 5Th Floor, Buffalo, NY 14203 USA
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Crowley SJ, Velez SL, Killen LG, Cvengros JA, Fogg LF, Eastman CI. Extending weeknight sleep of delayed adolescents using weekend morning bright light and evening time management. Sleep 2023; 46:zsac202. [PMID: 36006948 PMCID: PMC9832518 DOI: 10.1093/sleep/zsac202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/13/2022] [Indexed: 01/14/2023] Open
Abstract
STUDY OBJECTIVES Shift sleep onset earlier and extend school-night sleep duration of adolescents. METHODS Forty-six adolescents (14.5-17.9 years; 24 females) with habitual short sleep (≤7 h) and late bedtimes (≥23:00) on school nights slept as usual for 2 weeks (baseline). Then, there were three weekends and two sets of five weekdays in between. Circadian phase (Dim Light Melatonin Onset, DLMO) was measured in the laboratory on the first and third weekend. On weekdays, the "Intervention" group gradually advanced school-night bedtime (1 h earlier than baseline during week 1; 2 h earlier than baseline during week 2). Individualized evening time management plans ("Sleep RouTeen") were developed to facilitate earlier bedtimes. On the second weekend, Intervention participants received bright light (~6000 lux; 2.5 h) on both mornings. A control group completed the first and third weekend but not the second. They slept as usual and had no evening time management plan. Weekday sleep onset time and duration were derived from actigraphy. RESULTS Dim light melatonin onset (DLMO) advanced more in the Intervention (0.6 ± 0.8 h) compared to the Control (-0.1 ± 0.8 h) group. By week 2, the Intervention group fell asleep 1.5 ± 0.7 h earlier and sleep duration increased by 1.2 ± 0.7 h; sleep did not systematically change in the Control group. CONCLUSIONS This multi-pronged circadian-based intervention effectively increased school-night sleep duration for adolescents reporting chronic sleep restriction. Adolescents with early circadian phases may only need a time management plan, whereas those with later phases probably need both time management and morning bright light. CLINICAL TRIALS Teen School-Night Sleep Extension: An Intervention Targeting the Circadian System (#NCT04087603): https://clinicaltrials.gov/ct2/show/NCT04087603.
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Affiliation(s)
- Stephanie J Crowley
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Sabrina L Velez
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Logan G Killen
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Jamie A Cvengros
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Louis F Fogg
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Charmane I Eastman
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
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8
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Kater MJ, Werner A, Schlarb AA, Lohaus A. Sleep Reactivity and Related Factors in Adolescence: An Increased Risk for Insomnia? A Longitudinal Assessment. Nat Sci Sleep 2023; 15:207-216. [PMID: 37069845 PMCID: PMC10105585 DOI: 10.2147/nss.s401452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/25/2023] [Indexed: 04/19/2023] Open
Abstract
Purpose The individual vulnerability for stress-related sleep difficulties (eg, sleep reactivity) is known as a predisposing factor of insomnia in adults, yet relatively little is known about sleep reactivity in adolescence. The study goal is to determine factors related to sleep reactivity and to investigate whether sleep reactivity and related factors predict current and new incidents of insomnia in adolescents. Patients and Methods At baseline, 11-to-17-year-olds (N = 185, Mage = 14.3 years, SD = 1.8, 54% female) answered an age-appropriate version of the Ford Insomnia Response to Stress Test, questionnaires about sleep, stress, psychological symptoms, and resources, filled out a sleep diary and used actigraphy. Insomnia diagnoses according to ISCD-3 criteria were assessed at baseline, after 9 months and after one and a half years. Results Adolescents with high compared to low sleep reactivity had increased pre-sleep arousal, negative sleep-related cognitions, pre-sleep mobile phone use, stress experience, stress vulnerability, internalizing and externalizing symptoms, less social resources, and a later midpoint of bedtime. High sleep reactivity increased the likelihood for currently having insomnia, but not for the development of insomnia at subsequent assessments. Conclusion The findings suggest that high sleep reactivity is related to poor sleep health and mental health but cast doubt on sleep reactivity as a pivotal predisposing factor for the development of insomnia in adolescence.
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Affiliation(s)
- Maren-Jo Kater
- Faculty of Psychology and Sports Science, Department of Developmental Psychology and Developmental Psychopathology, Bielefeld University, Bielefeld, North Rhine Westphalia, Germany
- Correspondence: Maren-Jo Kater, Bielefeld University, Faculty of Psychology and Sports Science, Developmental Psychology and Developmental Psychopathology, P.O. Box 10 01 31, Bielefeld, 33501, Germany, Tel +49 0521 - 106 4461, Email
| | - Anika Werner
- Faculty of Psychology and Sports Science, Department of Developmental Psychology and Developmental Psychopathology, Bielefeld University, Bielefeld, North Rhine Westphalia, Germany
| | - Angelika Anita Schlarb
- Faculty of Psychology and Sports Science Clinical, Department of Psychology and Psychotherapy of Children and Adolescents, Bielefeld University, Bielefeld, North Rhine Westphalia, Germany
| | - Arnold Lohaus
- Faculty of Psychology and Sports Science, Department of Developmental Psychology and Developmental Psychopathology, Bielefeld University, Bielefeld, North Rhine Westphalia, Germany
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9
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Rynders CA, Bowen AE, Cooper E, Brinton JT, Higgins J, Nadeau KJ, Wright KP, Simon SL. A Naturalistic Actigraphic Assessment of Changes in Adolescent Sleep, Light Exposure, and Activity Before and During COVID-19. J Biol Rhythms 2022; 37:690-699. [PMID: 36124632 PMCID: PMC9726638 DOI: 10.1177/07487304221123455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The majority of high school-aged adolescents obtain less than the recommended amount of sleep per night, in part because of imposed early school start times. Utilizing a naturalistic design, the present study evaluated changes in objective measurements of sleep, light, and physical activity before (baseline) and during the first wave of the COVID-19 pandemic (during COVID-19) in a group of US adolescents. Sixteen adolescents (aged 15.9 ± 1.2 years, 68.8% female) wore an actigraphy monitor for 7 consecutive days during an in-person week of school before the pandemic (October 2018-February 2020) and again during the pandemic when instruction was performed virtually (May 2020). Delayed weekday sleep onset times of 1.66 ± 1.33 h (p < 0.001) and increased sleep duration of 1 ± 0.87 h (p < 0.001) were observed during COVID-19 compared with baseline. Average lux was significantly higher during COVID-19 compared with baseline (p < 0.001). Weekday physical activity parameters were not altered during COVID-19 compared with baseline, except for a delay in the midpoint of the least active 5 h (p value = 0.044). This analysis provides insight into how introducing flexibility into the traditional school schedule might influence sleep in adolescents.
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Affiliation(s)
- Corey A. Rynders
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Department of Kinesiology, School of Education and Human Development, University of Virginia, Charlottesville, Virginia
| | | | - Emily Cooper
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - John T. Brinton
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Janine Higgins
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kristen J. Nadeau
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kenneth P. Wright
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado,University of Colorado Boulder, Boulder, Colorado
| | - Stacey L. Simon
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Stacey L. Simon, Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13123 E 16th Avenue, Box B395, Aurora, CO 80045, USA; e-mail:
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10
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Bothe K, Schabus M, Eigl ES, Kerbl R, Hoedlmoser K. Self-reported changes in sleep patterns and behavior in children and adolescents during COVID-19. Sci Rep 2022; 12:20412. [PMID: 36437313 PMCID: PMC9701691 DOI: 10.1038/s41598-022-24509-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022] Open
Abstract
The COVID-19 pandemic and lockdowns worldwide forced children and adolescents to change and adapt their lives to an unprecedented situation. Using an online survey, we investigated whether they showed changes in sleep quality and other related factors due to this event. Between February 21st, 2021 and April 19th, 2021, a total of 2,290 Austrian children and adolescents (6-18 years) reported their sleep habits and quality of sleep as well as physical activity, daylight exposure and usage of media devices during and, retrospectively, before the pandemic. Results showed an overall delay of sleep and wake times. Almost twice as many respondents reported having sleeping problems during the pandemic as compared to before, with insomnia, nightmares and daytime sleepiness being the most prevalent problems. Furthermore, sleeping problems and poor quality of sleep correlated positively with COVID-19 related anxiety. Lastly, results showed a change from regular to irregular bedtimes during COVID-19, higher napping rates, a strong to very strong decrease in physical activity and daylight exposure, as well as a high to very high increase in media consumption. We conclude that the increase in sleeping problems in children and adolescent during COVID-19 is concerning. Thus, health promoting measures and programs should be implemented and enforced.
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Affiliation(s)
- Kathrin Bothe
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Salzburg, Austria.
| | - Manuel Schabus
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Salzburg, Austria
| | - Esther-Sevil Eigl
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Salzburg, Austria
| | - Reinhold Kerbl
- Department of Pediatrics and Adolescent Medicine, Leoben Regional Hospital, Leoben, Styria, Austria
| | - Kerstin Hoedlmoser
- Laboratory for Sleep, Cognition and Consciousness Research, Department of Psychology, Centre for Cognitive Neuroscience, University of Salzburg, Salzburg, Salzburg, Austria.
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11
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Goetting MG. Role of Psychologists in Pediatric Sleep Medicine. Pediatr Clin North Am 2022; 69:989-1002. [PMID: 36207108 DOI: 10.1016/j.pcl.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sleep disorders commonly afflict infants, children, and adolescents and have a significant adverse impact on them and their families, sometimes to a severe degree. They can cause immediate stress and suffering and long-term loss of opportunities and potential. Many of these disorders can be well managed by the psychologist and often one is required, either as the sole provider or as an integral part of a team. Sleep disorders have a bidirectional interplay with mental health disorders. The patient may therefore present initially to the psychologist, primary care provider, or the sleep medicine specialist.
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Affiliation(s)
- Mark G Goetting
- Department of Pediatric and Adolescent Medicine; Department of Medicine, Center for Clinical Research, Western Michigan University Homer Stryker M.D. School of Medicine, Office 2627, 1000 Oakland Drive, Kalamazoo, MI 49008-8010, USA.
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12
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Chai W, Li X, Shek DTL. The Effectiveness of a Leadership Subject Using a Hybrid Teaching Mode during the Pandemic: Objective Outcome and Subjective Outcome Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9809. [PMID: 36011436 PMCID: PMC9408400 DOI: 10.3390/ijerph19169809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
Positive youth development (PYD) is an innovative approach to protect students from mental health problems and promote their positive and holistic development. Although there are many studies on the beneficial effects of PYD programs on youth in high school and community contexts, it is not clear whether subjects adopting PYD principles can promote positive development for university students. Moreover, it is unclear whether such subjects are effective under COVID-19, where subjects are commonly taught via the "hybrid" mode (i.e., face-to-face plus online teaching). The present study examined students' changes in the PYD, wellbeing, and desired graduate attributes after they had taken a leadership subject utilizing PYD principles taught by the "hybrid" mode (N = 630). Adopting the one-group pre-test and post-test design (i.e., objective outcome evaluation), we found that students showed significant positive improvement in PYD indicators, wellbeing, as well as desired graduate attributes. Additionally, students had high satisfaction with the course design and teaching staff, and perceived many benefits from this subject based on the subjective outcome evaluation conducted at the end of the subject. Results also showed that students' satisfaction with the curriculum significantly and positively predicted their positive change in PYD indicators, indicating the convergence of subjective outcome evaluation and objective outcome evaluation. The results highlight the positive impacts of the hybrid mode leadership subject with PYD principles in higher education.
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13
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Gradisar M, Kahn M, Micic G, Short M, Reynolds C, Orchard F, Bauducco S, Bartel K, Richardson C. Sleep’s role in the development and resolution of adolescent depression. NATURE REVIEWS PSYCHOLOGY 2022; 1:512-523. [PMID: 35754789 PMCID: PMC9208261 DOI: 10.1038/s44159-022-00074-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 12/03/2022]
Abstract
Two adolescent mental health fields — sleep and depression — have advanced largely in parallel until about four years ago. Although sleep problems have been thought to be a symptom of adolescent depression, emerging evidence suggests that sleep difficulties arise before depression does. In this Review, we describe how the combination of adolescent sleep biology and psychology uniquely predispose adolescents to develop depression. We describe multiple pathways and contributors, including a delayed circadian rhythm, restricted sleep duration and greater opportunity for repetitive negative thinking while waiting for sleep. We match each contributor with evidence-based sleep interventions, including bright light therapy, exogenous melatonin and cognitive-behaviour therapy techniques. Such treatments improve sleep and alleviate depression symptoms, highlighting the utility of sleep treatment for comorbid disorders experienced by adolescents. Sleep problems are both a symptom and precursor of adolescent depression. In this Review, Gradisar et al. describe how the combination of adolescent sleep biology and psychology predisposes adolescents to develop depression, and describe interventions that improve sleep and depression symptoms in this population.
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14
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Owens J. The complex impact of the COVID-19 pandemic on sleep. J Pediatr (Rio J) 2022; 98:221-222. [PMID: 34942155 PMCID: PMC8664709 DOI: 10.1016/j.jped.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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15
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Estevan I, Tassino B, Vetter C, Silva A. Challenged by extremely irregular school schedules, Uruguayan adolescents only set their waking time. J Adolesc 2022; 94:488-492. [DOI: 10.1002/jad.12036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/18/2022] [Accepted: 02/17/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Ignacio Estevan
- Programa de Neuropsicología y Neurobiología, Facultad de Psicología Universidad de la República Montevideo Uruguay
| | - Bettina Tassino
- Sección Etología; Facultad de Ciencias Universidad de la República Montevideo Uruguay
| | - Céline Vetter
- Department of Integrative Physiology University of Colorado Boulder Boulder Colorado USA
| | - Ana Silva
- Laboratorio de Neurociencias, Facultad de Ciencias Universidad de la República Montevideo Uruguay
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16
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Sleep Quality, Mental Health and Learning among High School Students after Reopening Schools during the COVID-19 Pandemic: Results of a Cross-Sectional Online Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052553. [PMID: 35270245 PMCID: PMC8909739 DOI: 10.3390/ijerph19052553] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 12/20/2022]
Abstract
We aimed to assess whether high school students’ sleep quality, mental health and learning changed during the COVID-19 pandemic as adolescents transitioned from learning online back to studying in person. We conducted an anonymous online cross-sectional survey study at three competitive high schools in Vilnius, Lithuania, after they were reopened. Students provided subjective views on their study quality, their health as well as daily life while studying either virtually or in person and completed the Beck depression inventory (BDI), the Generalized anxiety scale-7 (GAD-7) and the Pittsburgh sleep quality index (PSQI). Among 628 (70.4% female) respondents, 268 (42.7%), 342 (54.5%) and 398 (63.4%) are suspected to have depression, an anxiety disorder or poor sleep, respectively. Students reported better study quality (Z = −12.435, p < 0.001) and physical health (Z = −9.176, p < 0.001), but worse sleep quality (Z = −19.489, p < 0.001), shorter sleep duration (Z = −19.509, p < 0.001) and worse self-reported mental health (Z = −2.220, p < 0.05) while learning in person. However, higher scores of in-person study quality and physical health were associated with lower depression and anxiety levels as well as better sleep. Our study suggests that the reopening of schools may exacerbate sleep and mental health-related issues among high school students but also be beneficial for their academic development and levels of physical activity.
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17
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Ziporyn TD, Owens JA, Wahlstrom KL, Wolfson AR, Troxel WM, Saletin JM, Rubens SL, Pelayo R, Payne PA, Hale L, Keller I, Carskadon MA. Adolescent sleep health and school start times: Setting the research agenda for California and beyond: A research summit summary: A research summit summary. Sleep Health 2021; 8:11-22. [PMID: 34991996 DOI: 10.1016/j.sleh.2021.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/18/2021] [Accepted: 10/14/2021] [Indexed: 12/26/2022]
Abstract
In fall 2019, California passed and signed into law SB328, the first US statewide legislation explicitly designed to protect adolescent sleep health by requiring most California public school districts to start no earlier than 8:00 AM for middle schools and 8:30 AM for high schools. Recognizing the unique opportunity presented by the bill's 3-year implementation period, a group of experts in adolescent sleep and school start times held a virtual summit on January 22-23, 2021 to (1) summarize the research on adolescent sleep and school start time change; (2) develop recommendations for relevant, refined, and innovative research areas and research questions; (3) provide input regarding research design, methodology, and implementation; and (4) offer a forum for networking, exchanging ideas, and establishing interdisciplinary research collaborations. Participants represented a multidisciplinary range of academic backgrounds including sleep and circadian biology, neuroscience, education, medicine, public health, mental health, safety, public policy, economics, implementation science, criminology, diversity studies, and science communication. This paper summarizes summit presentations regarding current knowledge on adolescent sleep health and school start times and key research recommendations from small group workshops on topics including research design and tools, methodological issues, sleep health disparities, logistical challenges in conducting school-based research, public-health impact, and novel and expanded approaches to research.
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Affiliation(s)
| | | | - Kyla L Wahlstrom
- Department of Organizational Leadership, Policy and Development, College of Education and Human Development, University of Minnesota, Minneapolis, Minnesota, USA
| | - Amy R Wolfson
- Department of Psychology, Loyola University Maryland, Baltimore, Maryland, USA
| | - Wendy M Troxel
- Behavior and Policy Sciences, RAND Corporation, Pittsburgh, Pennsylvania, USA
| | - Jared M Saletin
- EP Bradley Hospital Sleep Research Laboratory, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sonia L Rubens
- Department of Counseling Psychology, Santa Clara University, Santa Clara, California, USA
| | - Rafael Pelayo
- Stanford University School of Medicine, Department of Psychiatry & Behavioral Sciences, Stanford, California, USA
| | | | - Lauren Hale
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Irena Keller
- Department of Psychology, Las Positas College, Livermore, California, USA
| | - Mary A Carskadon
- EP Bradley Hospital Sleep Research Laboratory, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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18
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Gruber R. Challenges And Opportunities Related To Pediatric Sleep Research During The Covid-19 Pandemic. Sleep 2021; 44:6401865. [PMID: 34664674 PMCID: PMC8574531 DOI: 10.1093/sleep/zsab255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Reut Gruber
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada.,Attention, Behaviour and Sleep Lab, Douglas Mental Health University, Institute, Montréal, QC H4H 1R3, Canada
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