Trajectories of Sleep Problems in Childhood: Associations with Mental Health in Adolescence

• In Event: Sleep across the lifecourse

Abstract

Sleep problems in childhood and adolescence are prevalent. Cross-sectional and short-term longitudinal studies suggest that disturbed sleep may compromise youth’s mental health, including externalizing behavior problems, depressive symptoms, and anxiety (e.g., Tomasiello et al., 2019). However, less is known about long-term associations between sleep problems and mental health. Several studies suggest that sleep problems predict later emotional and behavioral problems in childhood (e.g., Gregory et al., 2005), yet few studies have examined this relation over longer developmental periods across childhood and adolescence. Further, few studies have examined trajectories of sleep problems as predictors of later mental health difficulties. Children may experience stable good sleep, stable sleep problems, or increases or decreases in sleep problems over time. Such variability in initial levels and change over time in sleep problems may predict later mental health outcomes. We thus examined initial levels (age 9) and changes in sleep-wake problems across childhood (ages 9, 10, 11) as predictors of externalizing behavior problems, depressive symptoms, and anxiety in adolescence (age 18).

Data were analyzed for 199 youth (52% boys; 65% White/European American, 35% Black/African American). Measures included youth reports on sleep-wake problems, depression, anxiety, and externalizing behaviors. To ascertain the unique effects of childhood sleep problems on adolescent mental health, we controlled for both childhood mental health and adolescent sleep problems, along with other covariates (SES, race, sex, age, and BMI).

An unconditional growth model was fit to examine the trajectory of sleep-wake problems across ages 9 to 11. A significant negative fixed effect of the linear slope emerged, as did the fixed effect of the intercept and variance of the intercept (ps<.001), while the slope variance was not significant. This indicated that, on average, sleep-wake problems declined over childhood, yet there were no inter-individual differences in the trajectory of change, suggesting rank-order stability in childhood sleep-wake problems across ages 9 to 11 (Figure 1A). Next, we utilized the intercept and slope of childhood sleep-wake problems to predict mental health at age 18. Because a non-significant slope variance was detected in the unconditional growth model, we specified the model so that neither the covariates nor the outcome was linked to the slope of sleep-wake problems (Figure 1B). The intercept of childhood sleep-wake problems was significantly and positively associated with externalizing behaviors, depressive symptoms, and anxiety in adolescence (ps<.001; Table 1) with individuals maintaining their rank order in sleep-wake problems across ages 9 to 11.

Results indicate that sleep-wake problems were stable throughout childhood, and youth who persistently had higher sleep-wake problems across ages 9 to 11 had greater levels of externalizing behavior problems, depressive symptoms, and anxiety at age 18. These findings contribute to the literature by demonstrating that childhood sleep problems are associated with increased risk for multiple domains of mental health difficulties in adolescence, beyond the effects of concurrent sleep problems in adolescence and mental health in childhood. Our study highlights the potential long-term implications of persistent sleep problems in childhood and the importance of early screening and treatment of sleep difficulties.

Authors

• Mina Shimizu, Auburn University
  Presenting Author

• Megan Zeringue, Middle Tennessee State University
  Non-Presenting Author

• Stephen Erath, Auburn University
  Non-Presenting Author

• Ben Hinnant, Auburn University
  Non-Presenting Author

• Mona M El-Sheikh, Auburn University
  Non-Presenting Author