Sleep Problems From Childhood to Adolescence Tied to Worse Mental Health

Sleep problems throughout the transition from childhood to early adolescence were associated with psychopathology symptoms, highlighting the importance of good sleep for adolescents’ mental well-being, a large observational cohort study suggested.

Among over 10,000 kids, those with more severe sleep problem profiles had a higher risk of concurrent internalizing symptoms, reported Vanessa Cropley, PhD, of the University of Melbourne in Australia, and co-authors in JAMA Psychiatry:

• Sleep onset/maintenance problems profile: OR 1.30 (95% CI 1.25-1.35, P<0.001)
• Moderate and nonspecific (mixed) disturbance profile: OR 1.29 (95% CI 1.25-1.33, P<0.001)
• High disturbance profile: OR 1.44 (95% CI 1.40-1.49, P<0.001)

Similarly, these sleep profiles were also associated with an increased risk of concurrent externalizing symptoms:

• Sleep onset/maintenance problems: OR 1.20 (95% CI 1.16-1.23, P<0.001)
• Mixed disturbance: OR 1.17 (95% CI 1.14-1.20, P<0.001)
• High disturbance: OR 1.24 (95% CI 1.21-1.28, P<0.001)

Cropley and team noted that “developmental sleep problems are diverse, highly comorbid, and follow individualized trajectories across development,” adding that their results suggest that interventions should be focused on specific sleep patterns rather than generalized sleep interventions.

“Sleep is critically important in ensuring healthy mental and emotional development of children and young adolescents,” co-author Rebecca Cooper, MPO, also of the University of Melbourne, told MedPage Today. “Ensuring that sleep problems are adequately addressed and treated during this period is crucial to support a young person’s emotional and behavioral well-being at a vulnerable time during development.”

“We know that for mental health problems, early intervention is key,” Cooper said. “When looking at sleep problems, I think the almost ubiquitous nature of these symptoms indicates that the majority of children, and potentially parents, could benefit from early intervention programs into improving sleep habits.”

Karen Pierce, MD, of Northwestern University’s Feinberg School of Medicine in Chicago, told MedPage Today that these study results are a clear validation of the current literature.

“The difference is they’re using an amazing cohort. The ABCD [Adolescent Brain Cognitive Development] cohort is an incredible, diverse population that they’ve been following for years,” said Pierce, who was not involved in this study. “What this study shows is that you need good sleep to have good mental health, period.”

She noted that sleep hygiene should be discussed more for its importance to a child’s mental health and that physicians should work to educate parents about this need.

For this study, Cropley and colleagues used baseline and 2-year follow-up data on 10,313 participants starting at ages 9 to 11 years (mean age at baseline 9.9) from the ABCD cohort; 47.6% were girls, 13.6% were Black, 20% were Hispanic, and 54% were white.

The participants were assessed for sleep problems at both baseline and 2 years via the parent-reported Sleep Disturbance Scale for Children and categorized into four profile groups: a low disturbance profile, sleep onset/maintenance problems profile, a mixed disturbance profile, and a high disturbance profile.

Logistic regression models were used to examine whether psychopathology symptoms were associated with sleep profiles and whether transitions between profiles were associated with changes of psychopathology symptoms, which were assessed at both baseline and follow-up using the internalizing and externalizing dimension scores from the parent-reported Child Behavior Checklist. Data were collected from September 2016 to January 2020.

Cropley and team noted that sleep problems among racially and ethnically diverse populations are currently poorly understood and should be explored in further research.