Sleep in a large, multi-university sample of college students: sleep problem prevalence, sex differences, and mental health correlates

OBJECTIVES

To (1) describe sleep problems in a large, multi-university sample of college students; (2) evaluate sex differences; and (3) examine the unique associations of mental health symptoms (i.e., anxiety, depression, attention-deficit/hyperactivity disorder inattention [ADHD-IN], ADHD hyperactivity-impulsivity [ADHD-HI]) in relation to sleep problems.

METHODS

7,626 students (70% female; 81% White) ages 18-29 years (M=19.14, SD=1.42) from six universities completed measures assessing mental health symptoms and the Pittsburgh Sleep Quality Index (PSQI).

RESULTS

A substantial minority of students endorsed sleep problems across specific sleep components. Specifically, 27% described their sleep quality as poor, 36% reported obtaining less than 7 hours of sleep per night, and 43% reported that it takes >30 minutes to fall asleep at least once per week. 62% of participants met cut-off criteria for poor sleep, though rates differed between females (64%) and males (57%). In structural regression models, both anxiety and depression symptoms were uniquely associated with disruptions in most PSQI sleep component domains. However, anxiety (but not depression) symptoms were uniquely associated with more sleep disturbances and sleep medication use, whereas depression (but not anxiety) symptoms were uniquely associated with increased daytime dysfunction. ADHD-IN symptoms were uniquely associated with poorer sleep quality and increased daytime dysfunction, whereas ADHD-HI symptoms were uniquely associated with more sleep disturbances and less daytime dysfunction. Lastly, ADHD-IN, anxiety, and depression symptoms were each independently associated with poor sleep status.

CONCLUSIONS

This study documents a high prevalence of poor sleep among college students, some sex differences, and distinct patterns of mental health symptoms in relation to sleep problems.

Sluggish cognitive tempo is associated with academic functioning and internalizing symptoms in college students with and without attention-deficit/hyperactivity disorder

OBJECTIVES

The purposes of the present studies were to (a) examine the factor structure of sluggish cognitive tempo (SCT) and attention-deficit/hyperactivity disorder (ADHD) in college students and (b) examine the associations between SCT and academic functioning and internalizing symptoms in college students with and without ADHD.

METHOD

In Study 1, a confirmatory factor analysis of the Barkley Adult ADHD Rating Scale-IV (BAARS-IV) was conducted in a sample of 768 college students (aged 17-34 years, 68% female). In Study 2, we examined the relation of SCT to academic functioning and internalizing symptoms in a sample of 72 college students rigorously diagnosed with ADHD (aged 17-35 years, 44% female).

RESULTS

Study 1 results supported the factor structure of the BAARS-IV, with the optimal model comprising 4 correlated but distinct factors: SCT, Inattention, Hyperactivity, and Impulsivity. After controlling for correlated demographic variables and ADHD symptoms, SCT was significantly related to academic impairment (including grade point average), anxiety, and depression. In Study 2, SCT again contributed unique variance to internalizing symptoms and academic impairment after controlling for correlated participant characteristics (i.e., sex, age, race, parent education level, family income, ADHD medication use, and mental health service utilization) and ADHD symptom severity.

CONCLUSIONS

These results fill an important gap in the literature by (a) confirming SCT to be distinct from ADHD in emerging adulthood, (b) demonstrating SCT to be strongly linked to college student adjustment, and (c) providing support for the hypothesis that SCT is associated with psychosocial functioning in both individuals with and without ADHD.

Sleep problems and suicidal behaviors in college students

Using a large sample of college students, objectives were to examine (1) the overlap between poor sleep and suicide risk status, (2) whether poor sleep was associated with suicide behaviors above and beyond depression, (3) whether sleep problems and depression interacted to predict increased suicidal behaviors or risk, and (4) which specific components of sleep were uniquely associated with suicidal behaviors. Participants were 1700 college students (ages 18-29 years; 65% female) from two universities who completed measures assessing sleep, depressive symptoms, and suicidal behaviors (Suicidal Behaviors Questionnaire-Revised [SBQ-R], a composite measure including ideation, past attempt, disclosure to others, and future likelihood of suicide that includes a cutoff for determining participants with suicide risk). Approximately one-quarter (24%) of participants were classified with suicide risk. Four-fifths (82.7%) of participants classified with suicide risk also met cutoff criteria for sleep problems; conversely, almost one-third (31.3%) of the participants classified with sleep problems were also classified with suicide risk. Total sleep problems remained significantly associated with suicidal behaviors above and beyond depressive symptoms, though sleep and depression did not interact to predict suicidal behaviors or risk. When considered together and controlling for sex, the odds of being classified with suicide risk were 6.54 times greater for participants with elevated depressive symptoms and 2.70 times greater for participants with sleep problems. Analyses examining specific sleep domains found shorter sleep duration, having bad dreams, feeling too cold while sleeping, and sleep medication use to each be independently associated with suicidal behaviors. Findings add to a growing body of literature linking sleep and suicide in college students.

The Child Concentration Inventory (CCI): Initial validation of a child self-report measure of sluggish cognitive tempo

Sluggish cognitive tempo (SCT) is characterized by excessive daydreaming, mental confusion, slowness, and low motivation. Several teacher- and parent-report measures of SCT have recently been developed but a child self-report measure of SCT does not yet exist despite clear links between SCT and internalizing psychopathology (for which self-report is often desired). This study examined the initial reliability and validity of the Child Concentration Inventory (CCI), a child self-report measure of SCT symptoms, in a school-based sample of 124 children (ages 8-13; 55% female). Children completed the CCI and measures of academic/social functioning, emotion regulation, and self-esteem. Teachers completed measures of psychopathology symptoms (including SCT) and academic/social functioning. Although exploratory structural equation modeling (ESEM) supported a 3-factor model of the CCI (consisting of slow, sleepy, and daydreamer scales closely resembling the factor structure of the parent-report version of this measure), bifactor modeling and omega reliability indices indicated that the CCI is best conceptualized as unidimensional. CCI scores were significantly correlated with teacher-rated SCT and were statistically distinct from teacher-rated ADHD and child-rated anxiety/depression. After controlling for sex, grade, and other psychopathology symptoms, the CCI total score was significantly associated with poorer child-reported academic/social functioning and self-worth in addition to increased loneliness and emotion dysregulation. Child ratings on the CCI were moderately to strongly correlated with poorer teacher-rated academic/social functioning but these associations were reduced to nonsignificance after controlling for demographics and other psychopathology symptoms. Findings provide preliminary support for the CCI, and future directions include replication with adolescents and clinical samples in order to further examine the CCI's factor structure, reliability, validity, and clinical utility.

Does Emotion Dysregulation Mediate the Association Between Sluggish Cognitive Tempo and College Students' Social Impairment?

OBJECTIVE

Studies demonstrate an association between sluggish cognitive tempo (SCT) and social impairment, although no studies have tested possible mechanisms of this association. This study aimed to (a) examine SCT in relation to college students' social functioning; (b) test if SCT is significantly associated with emotion dysregulation beyond depressive, anxious, and ADHD symptoms; and (c) test if emotion dysregulation mediates the association between SCT symptoms and social impairment.

METHOD

College students (N = 158) completed measures of psychopathology symptoms, emotion dysregulation, and social functioning.

RESULTS

Participants with elevated SCT (12%) had higher ADHD, depressive, and anxious symptoms in addition to poorer emotion regulation and social adjustment than participants without elevated SCT. Above and beyond other psychopathologies, SCT was significantly associated with social impairment but not general interpersonal functioning. SCT was also associated with emotion dysregulation, even after accounting for the expectedly strong association between depression and emotion dysregulation. Further analyses supported emotion dysregulation as a mediator of the association between SCT and social impairment.

CONCLUSION

These findings are important for theoretical models of SCT and underscore the need for additional, longitudinal research.

Sluggish cognitive tempo in adults: Psychometric validation of the Adult Concentration Inventory

[Correction Notice: An Erratum for this article was reported in Vol 30(3) of Psychological Assessment (see record 2017-30273-001). In the article, the Table 1 item content was incorrectly ordered. The table, as well as text referencing Table 1 in the Results and Discussion, have been corrected in all versions of this article.] As interest in sluggish cognitive tempo (SCT) increases, a primary limitation for the field is the lack of a unified set of symptoms for assessing SCT. No existing SCT measure includes all items identified in a recent meta-analysis as optimal for distinguishing between SCT and attention-deficit/hyperactivity disorder (ADHD) inattention. This study evaluates a new self-report measure for assessing SCT in adulthood, the Adult Concentration Inventory (ACI), which was developed in response to the meta-analytic findings for assessing SCT. Using a large, multiuniversity sample (N = 3,172), we evaluated the convergent and discriminant validity and reliability of the ACI. We also evaluated the ACI measure of SCT in relation to self-reported demographic characteristics, daily life executive functioning, socioemotional adjustment (i.e., anxiety/depression, loneliness, emotion dysregulation, self-esteem), and functional impairment. Exploratory confirmatory factor analyses resulted in 10 ACI items demonstrating strong convergent and discriminant validity from both anxiety/depressive and ADHD inattentive symptom dimensions. SCT was moderately to-strongly correlated with daily life EF deficits, poorer socioemotional adjustment, and greater global functional impairment. Moreover, SCT remained uniquely associated in structural regression analyses with most of these external criterion domains above and beyond ADHD. Finally, when internalizing symptoms were also covaried, SCT, but not ADHD inattention, remained significantly associated with poorer socioemotional adjustment. These findings support the use of the ACI in future studies examining SCT in adulthood and make a major contribution in moving the field toward a unified set of SCT items that can be used across studies. (PsycINFO Database Record

Suicidal Behaviors in College Students: Frequency, Sex Differences, and Mental Health Correlates Including Sluggish Cognitive Tempo

PURPOSE

To (1) describe rates of suicidal behaviors in a sample of college students, (2) evaluate sex differences, and (3) provide a preliminary examination of the unique association of sluggish cognitive tempo (SCT) symptoms and other mental health dimensions in relation to suicidal behaviors in college students.

METHODS

Participants were 1,704 college students from two universities who completed measures assessing mental health symptoms and suicidal behaviors (i.e., past ideation/attempts, past-year ideation, disclosure of intent to commit suicide to another person, and likelihood of a future suicide attempt).

RESULTS

Four percent of participants reported a previous suicide attempt and 2.2% indicated that it was likely they would attempt suicide someday. 7.5% reported thinking about killing themselves often in the past year; 41.4% of these participants reported they had never told someone they might attempt suicide. Approximately one quarter (24%) of participants were classified with suicide risk based on an empirically established cutoff score, though rates differed between women (26.1%) and men (20.4%). Women were also more likely than men to report a previous suicide attempt and to tell someone else about their suicidal ideation. In regression models, depression was the strongest correlate of suicidal behaviors. Attention-deficit/hyperactivity disorder symptoms were unassociated with suicidal behaviors when accounting for internalizing symptoms. SCT remained significantly associated with increased suicidal behaviors beyond other mental health dimensions including depression.

CONCLUSIONS

A substantial minority of college students report suicidal behaviors, with sex differences dependent on the specific behavior examined. This study provides the first evidence linking SCT to suicidal behaviors in young adults.

Positive and negative family emotional climate differentially predict youth anxiety and depression via distinct affective pathways

A socioaffective specificity model was tested in which positive and negative affect differentially mediated relations of family emotional climate to youth internalizing symptoms. Participants were 134 7(th)-9(th) grade adolescents (65 girls; 86 % Caucasian) and mothers who completed measures of emotion-related family processes, experienced affect, anxiety, and depression. Results suggested that a family environment characterized by maternal psychological control and family negative emotion expressiveness predicted greater anxiety and depression, and was mediated by experienced negative affect. Conversely, a family emotional environment characterized by low maternal warmth and low positive emotion expressiveness predicted only depression, and was mediated through lowered experienced positive affect. This study synthesizes a theoretical model of typical family emotion socialization with an extant affect-based model of shared and unique aspects of anxiety and depression symptom expression.

Attention-deficit/hyperactivity disorder dimensions and sluggish cognitive tempo symptoms in relation to college students' sleep functioning

This study examined separate inattentive, hyperactive, and impulsive dimensions of attention-deficit/hyperactivity disorder (ADHD), as well as sluggish cognitive tempo (SCT) symptoms, in relation to college students' sleep functioning. Participants were 288 college students (ages 17-24; 65 % female; 90 % non-Hispanic White; 12 % self-reported having an ADHD diagnoses) who completed measures of ADHD/SCT symptoms and sleep functioning. Participants reported obtaining an average of 6.8 h of sleep per night (only 26 % reported obtaining ≥8 h of sleep) and having a sleep onset latency of 25 min. 63 % were classified as "poor sleepers," and poor sleepers had higher rates of ADHD and SCT symptoms than "good sleepers". Path analysis controlling for ADHD status and psychiatric medication use was used to determine associations between psychopathology and sleep functioning domains. Above and beyond covariates and other psychopathologies, hyperactivity (but not impulsivity) was significantly associated with poorer sleep quality, longer sleep latency, shorter sleep duration, and more use of sleep medications. SCT symptoms (but not inattention) were significantly associated with poorer sleep quality and increased nighttime sleep disturbance (e.g., having bad dreams, waking up in the middle of the night, feeling too cold or too hot). Both inattention and SCT were associated with greater daytime dysfunction. Regression analyses demonstrated that hyperactivity predicted sleep quality above and beyond the influence of daytime dysfunction, and inattention and SCT predicted daytime dysfunction above and beyond sleep quality. Further studies are needed to examine the interrelations of nighttime sleep functioning, ADHD/SCT, and daytime dysfunction, as well to elucidate mechanisms contributing to related functional impairments.

Sluggish Cognitive Tempo is Associated With Poorer Study Skills, More Executive Functioning Deficits, and Greater Impairment in College Students

OBJECTIVES

Few studies have examined sluggish cognitive tempo (SCT) in college students even though extant research suggests a higher prevalence rate of SCT symptoms in this population compared to general adult or youth samples. The current study examined SCT symptoms in relation to two domains related to college student's academic success, study skills and daily life executive functioning (EF), as well as specific domains of functional impairment.

METHOD

158 undergraduate students (M_age = 19.05 years; 64% female) completed measures of psychopathology symptoms, study skills, daily life EF, and functional impairment.

RESULTS

After controlling for demographics and symptoms of attention-deficit/hyperactivity disorder (ADHD), anxiety, and depression, SCT remained significantly associated with poorer study skills, greater daily life EF deficits, and global impairment and with greater functional impairment in the specific domains of educational activities, work, money/finances, managing chores and household tasks, community activities, and social situations with strangers and friends. In many instances, ADHD inattentive symptoms were no longer significantly associated with study skills or impairment after SCT symptoms were added to the model.

CONCLUSION

SCT is associated with poorer college student functioning. Findings highlight the need for increased specificity in studies examining the relation between SCT and adjustment.

Rumination in relation to suicide risk, ideation, and attempts: Exacerbation by poor sleep quality?

BACKGROUND

Rumination, particularly brooding rumination, is associated with suicide risk, ideation and attempts; however, findings are inconsistent with respect to reflective rumination. Recent research suggests reflective rumination might be associated with increased suicide risk specifically among vulnerable individuals. Poor sleep quality is related to both suicide risk and rumination, yet no research has examined whether reflective rumination and sleep quality interact in relation to suicidal risk. This study, therefore, examined whether sleep quality moderates the link between ruminative subtypes and (a) suicide risk overall, and (b) suicidal ideation and (c) history of suicide attempts, specifically.

METHODS

Participants were 1696 college students (ages 18-29 years; 65% female) who completed measures assessing rumination, sleep, and suicidal ideation and behavior. Hierarchical linear and logistic regressions were performed regressing overall suicide risk (linear), suicidal ideation (linear) and history of attempts (logistic) on ruminative subtypes controlling for demographics. Sleep quality was examined as a moderator of the rumination-suicide risk/ideation/attempts link.

RESULTS

Brooding rumination was significantly associated with increased suicide risk, ideation, and attempts but these associations were not moderated by sleep quality. Sleep quality exacerbated the association of reflective rumination with overall suicide risk and suicidal ideation specifically. Reflective rumination was not itself, or in interaction with sleep quality, significantly associated with a history of suicide attempts.

LIMITATIONS

The study is cross-sectional and utilizes a college student sample.

CONCLUSIONS

This study adds to the literature that suggests reflective rumination is associated with suicide risk and ideation in certain cases, such as in individuals with lower sleep quality. In addition, the study adds continued support for an association between brooding rumination and suicidal behaviors. More studies that examine the relations between ruminative subtypes and attempts are needed. Interventions that target sleep problems and rumination may be beneficial for suicide prevention and intervention.

Aggression and the risk for suicidal behaviors among children

Two subtypes of aggression--reactive and proactive--were examined to see how they relate to suicidal behaviors among young children admitted for acute psychiatric inpatient care. The children and their parents completed self-report questionnaires/interviews. Regression analyses revealed that depressed girls who scored higher on reactive aggression reported more suicidal behaviors; whereas proactive aggression did not relate to suicidal behaviors for either boys or girls.

Acute Stress Attenuates Cognitive Flexibility in Males Only: An fNIRS Examination

Cognitive processes that afford us the ability to control thoughts and achieve goal-directed behavior are known as executive functions. Empirical evidence in the past few years has demonstrated that executive functions can be influenced by acute stress. The impact of acute stress on cognitive flexibility, a key aspect of executive functions, has received little attention in the literature. We present the results of two experiments conducted to examine the effect of acute stress on cognitive flexibility. Acute stress was induced using the cold pressor task. Cognitive flexibility was assessed using the Wisconsin Card Sorting Test (WCST). Across both experiments acute stress had an attenuating effect on task switching on the WCST. Our findings also indicate that this effect was moderated by the participant’s gender. In Study 1, we observed that following stress exposure male participants in the stress condition made more perseverative errors than participants in the control group. In Study 2, we examined the bilateral hemodynamics in the prefrontal cortex (PFC) during acute stress induction using functional near infrared spectroscopy (fNIRS). Our analysis indicated that functional oxyHb signals fluctuated with greater amplitude than systemic components for participants in the stress group relative to those in the control group. In addition, oxyHb levels post stress induction were correlated with performance on the WCST for the male participants in the stress group only. Concordant with previous reports, our findings indicate that acute stress impacts cognitive flexibility in males and females differentially. Our work also demonstrates the feasibility of using fNIRS as a practical and objective technique for the examination of hemodynamics in the PFC during acute stress.

Social information processing in children: specific relations to anxiety, depression, and affect

Two studies examined shared and unique relations of social information processing (SIP) to youth's anxious and depressive symptoms. Whether SIP added unique variance over and above trait affect in predicting internalizing symptoms was also examined. In Study 1, 215 youth (ages 8-13) completed symptom measures of anxiety and depression and a vignette-based interview measure of SIP. Anxiety and depression were each related to a more negative information-processing style. Only depression was uniquely related to a less positive information processing style. In Study 2, 127 youth (ages 10-13) completed measures of anxiety, depression, SIP, and trait affect. SIP's relations to internalizing symptoms were replicated. Over and above negative affect, negative SIP predicted both anxiety and depression. Low positive SIP added variance over and above positive affect in predicting only depression. Finally, SIP functioning partially mediated the relations of affect to internalizing symptoms.

Evidence-based practice in psychology: Perceptions of graduate students in scientist–practitioner programs

The evidence-based practice movement in psychology (EBPP) is a relatively recent initiative to improve client care by integrating the best available research evidence with clinicians' expertise in the context of patient values and preferences. As this movement gains momentum in the field of psychology, training programs will likely need to modify their curricula to include training in the process of EBPP. An online survey was conducted of clinical psychology graduate students in programs that identified themselves as having a scientist-practitioner or clinical science model (N = 1,195). Understanding of, experiences with, attitudes towards, and training in EBPP was assessed. Students had a generally favorable view of psychology's move toward EBPP. Although students reported a moderate amount of exposure to and experiences with EBPP, misunderstandings about the principles of EBPP were prevalent. Compared to students planning primarily clinical practice careers, students planning primarily clinical research careers were more favorable towards EBPP, expected EBPP to be more influential in their future careers, and were more likely to use research, but less likely to use client preferences to guide treatment planning. Recommendations for modifying training programs to promote EBPP are discussed.

The moderating effects of parenting styles on African-American and Caucasian children's suicidal behaviors

Given that parenting practices have been linked to suicidal behavior in adolescence, examining the moderating effect of parenting styles on suicidal behavior early in development could offer potential insight into possible buffers as well as directions for suicide prevention and intervention later in adolescence. Hence, the moderating effects of parenting styles, including authoritarian, permissive, and features of authoritative parenting, on depressed and aggressive children's suicidal behavior, including ideation and attempts, were evaluated with young children (N = 172; 72% male, 28% female) ranging from 6 to 12 years of age. African American (69%) and Caucasian (31%) children admitted for acute psychiatric inpatient care completed standardized measures of suicidal behavior, depressive symptoms, and proactive and reaction aggression. Their parents also completed standardized measures of parental distress and parenting style. Hierarchical regression analyses revealed that, while statistically controlling for age and gender, children who endorsed more depressive symptoms or reactive aggression reported more current and past suicidal behavior than children who endorsed fewer depressive or aggressive symptoms. The significant positive relationship observed between depressive symptoms and childhood suicidal behavior, however, was attenuated by parental use of authoritarian parenting practices for African-American and older children but not for younger and Caucasian children. The ethnic/racial difference observed for the buffering effect of authoritarian parenting practices offers potential theoretical and clinical implications for conceptualizing the moderating effects of parenting styles on African-American and Caucasian children's suicidal behavior.

Fear of positive evaluation and social anxiety: A systematic review of trait-based findings

BACKGROUND

Although fear of negative evaluation (FNE) has long been recognized as a core cognitive bias in social anxiety, fear of positive evaluation (FPE) has received considerable attention over the past several years. The literature would benefit from a synthesis of the current state of the research in order to contribute to our understanding of FPE.

METHODS

A systematic review of the literature was conducted in order to address several questions: (a) Is self-reported FPE distinct from self-reported FNE? (b) Is self-reported FPE related to social anxiety symptomatology? and (c) Is self-reported FPE uniquely related to social anxiety symptomatology when accounting for self-reported FNE? Inclusion criteria included studies published in English, testing FPE and FNE with trait-based measures, and testing social anxiety with either self-report or diagnostic interviews.

RESULTS

There were 33 studies identified in this review that provided convincing empirical support for each of these questions across community and clinical samples of adolescents, undergraduates, and adults.

LIMITATIONS

The systematic review did not have access to null results, present meta-analytic results, or include studies that evaluated FPE or social anxiety with experimental designs.

CONCLUSIONS

The findings from the systematic review support updated theoritical models of social anxiety and highlight the importance of assessing and treating FPE in clinical interventions.

Perceived maternal and paternal psychological control: relations to adolescent anxiety through deficits in emotion regulation

The current study compared the differential effects of early adolescents' perceived maternal and paternal psychological control (as well as their discrepancy) on adolescent anxiety. It also tested whether psychological control leads to deficits in youths' ability to regulate their negative emotions, and if, in turn, such deficits lead to anxiety. Sixth- and seventh-grade students (n = 214; 59% girls; 60% Caucasian) completed measures of perceived psychological control, regulation of negative emotions, and anxiety symptoms. The discrepancy between perceived mothers' and fathers' control was also calculated. Although perceptions of mothers' control, fathers' control, and their discrepancy were each bivariately related to adolescent anxiety, when considered together, only a larger discrepancy in parents' psychological control was uniquely associated with higher self-reported anxiety. Further, adolescents' dysregulation of negative emotions partially explained the relation of both maternal psychological control and the discrepancy in parental control to anxiety. Implications for understanding family-based etiological correlates of anxiety are discussed.

Mountain Dew or mountain don't?: a pilot investigation of caffeine use parameters and relations to depression and anxiety symptoms in 5th- and 10th-grade students

BACKGROUND

Caffeine, the only licit psychoactive drug available to minors, may have a harmful impact on students' health and adjustment, yet little is known about its use or effects on students, especially from a developmental perspective. Caffeine use in 5th- and 10th-grade students was examined in a cross-sectional design, and relations and potential mediators of caffeine use to depression and anxiety symptoms were investigated.

METHODS

Children (n = 135) and adolescents (n = 79) completed a measure of naturalistic use of caffeinated and noncaffeinated beverages. Furthermore, daily availability, perceived benefits, and stimulating, psychological, and withdrawal effects of caffeinated and noncaffeinated beverages were assessed. Measures of depression and anxiety were also administered.

RESULTS

Fifth and 10th graders used caffeine frequently. Depression was positively related to caffeine use for both cohorts, though mediated by caffeine withdrawal effects. Surprisingly, anxiety was unrelated to use. Fifth graders reported less daily access to caffeine, but more psychological and stimulating effects of caffeine than 10th graders.

CONCLUSIONS

Although both children and adolescents experience negative caffeine-related outcomes, intake is seemingly not greatly limited in either cohort. In particular, youth appear vulnerable to increased depressive symptoms with increasing caffeine consumption. Implications for school policy regarding students' caffeine use are discussed.