Associations of sleep with psychological problems and well-being in adolescence: causality or common genetic predispositions?

The influence of after-school tutoring on the mental health of middle school students: A mediating effect test based on sleep deprivation and academic performance

Although Western studies have shown that adolescents' mental health is intimately linked to after-school tutoring, very few studies have addressed this issue among Chinese adolescents. Herein, this study investigated the effect of after-school tutoring on students' mental health using an empirical method and a mediation-effect test analysis. Based on 3581 China Education Panel Survey samples, results showed that sleep duration and academic performance act as mediators in the effect of after-school tutoring on students' mental health. After-school tutoring leads to depressive emotions in students through sleep deprivation, playing a partial mediating effect (Z = 2.785, p < 0.05). Academic performance is another factor leading to students' depressive emotions, similarly passing the mediation effect test (Z = 2.817, p < 0.05). Overall, after-school tutoring affects students' mental health by depriving them of sleep time, hence influencing their academic performance. We suggest the following. First, the regulation of off-campus tutoring should be strengthened. Second, efforts should be made to alleviate parents' educational anxiety. Lastly, students' sleep quality should be ensured, and attention should be paid to monitoring their mental health status.

Health enhancing behaviors in early adolescence: an investigation of nutrition, sleep, physical activity, mindfulness and social connectedness and their association with psychological distress and wellbeing

Introduction

Nutrition, sleep and physical activity are termed the "big three" health enhancing behaviors (HEB) associated with psychological distress and wellbeing. This study sought to understand differential associations between an expanded group of HEB (nutrition, sleep, physical activity, mindfulness, social connectedness) and psychological distress/wellbeing in early adolescents.

Methods

Correlational and regression analyses were conducted in N=103 (51% females) adolescents (12.6 ± 0.3 years of age) recruited from the Longitudinal Adolescent Brain Study.

Results

Higher scores on sleep, social connectedness and mindfulness scales were significantly associated with lower psychological distress scores. While higher scores on social connectedness and mindfulness scales were significantly associated with higher wellbeing scores. When adjusting for sex, nutrition, sleep, social connectedness and mindfulness accounted for a significant proportion of variance in the psychological distress model whereas physical activity and social connectedness accounted for a significant proportion of the variance in the wellbeing model.

Discussions

Overall findings make a strong case for expansion of the "big three" HEB to include mindfulness and social connectedness, especially given social connectedness emerged as the strongest predictor of both psychological distress and wellbeing. In addition, this research suggests that early adolescent nutrition, sleep quality, and mindfulness should be prioritized in efforts to reduce risk of difficulties, and physical activity prioritized as a protective factor for wellbeing in this population. Findings have implications for interventions, emphasizing the importance of addressing HEB factors comprehensively and tailoring strategies to the unique needs of early adolescents to foster positive mental health outcomes.

Exploring the relationship between sleep and aggression in adolescents: A cross sectional study using the UK Millennium cohort study

This study aimed to establish if a significant relationship exists between sleep and aggression in a large representative adolescent cohort and explores the impact of potential confounders. This cross-sectional secondary data analysis included 10,866 males and females aged 13-15 years, from the UK-based 2015 Millenium Cohort Study (sixth sweep). Independent variables included self-report measures of sleep duration and quality. The parent reported 'Strengths and Difficulties Questionnaire' conduct score measured aggression. Binary logistic regression examined independent associations between each sleep variable and aggression. Multiple regression models then adjusted for potential confounders: age, sex, socioeconomic status, arousal, and affect. Under 8 hours of sleep on average was significantly associated with aggression when age, sex and income were controlled (p = .008). This became insignificant following adjustment for both affect and arousal. Sleep quality remained significantly associated with aggression when all confounders were controlled: 'sleep onset latency >30 minutes' and 'wakening at least a good bit of the time' increased the odds of aggression by around 27.9% (p < .001) and 43.5% respectively (p < .001). A significant association exists between poor subjective sleep quality and heightened aggression in this cohort, when all our confounders are controlled, identifying sleep quality as a potential target in treating adolescent aggression.

Concordance in parent-child and sibling actigraphy-measured sleep: Evidence among early adolescent twins and primary caregivers

STUDY OBJECTIVES

Growing evidence suggests concordance between parent and youth sleep. However, no known study has simultaneously examined concordance among siblings' sleep patterns. This study investigated daily and average concordance in (1) parent-youth and (2) sibling actigraphy-measured sleep, as well as the degree to which sibling concordance varied by sleeping arrangements.

METHODS

516 twin siblings (Mage = 10.74, 51% female; 30% monozygotic (MZ) twin pairs, 37% same-sex dizygotic pairs (DZ-ss), 33% opposite-sex DZ pairs (DZ-os)) and their primary caregivers (Mage = 40.59, 95% female) wore wrist-based accelerometers for 7 consecutive nights to measure sleep duration, efficiency, midpoint time, and latency. Primary caregivers also reported on demographics, youth pubertal status, and room-sharing. Two-level multilevel models were estimated to examine daily and average concordance in parent-youth and sibling sleep.

RESULTS

Daily concordance was observed between parent and youth sleep duration and midpoint; average concordance was found for sleep duration, midpoint, and latency. Within sibling dyads, daily and average concordance was evident across all sleep parameters (duration, efficiency, midpoint, latency), with generally stronger concordance patterns for MZ than DZ twin pairs, and for twins who shared a room with their co-twin.

CONCLUSIONS

This is the first known study to document concordance among parent-youth and siblings' actigraphy-measured sleep within the same study (i.e., triad). Our findings can help inform the development of family-level interventions targeting daily and overall sleep hygiene.

Polygenic predisposition, sleep duration, and depression: evidence from a prospective population-based cohort

Suboptimal sleep durations and depression frequently cooccur. Short-sleep and long-sleep are commonly thought of as symptoms of depression, but a growing literature suggests that they may be prodromal. While each represents a process of mutual influence, the directionality between them remains unclear. Using polygenic scores (PGS), we investigate the prospective direction involved in suboptimal sleep durations and depression. Male and female participants, aged ≥50, were recruited from the English Longitudinal Study of Ageing (ELSA). PGS for sleep duration, short-sleep, and long-sleep were calculated using summary statistics data from the UK Biobank cohort. Sleep duration, categorised into short-sleep ("≤5 h"), optimal-sleep (">5 to <9 h"), and long-sleep ("≥9 h"), was measured at baseline and across an average 8-year follow-up. Subclinical depression (Centre for Epidemiological Studies Depression Scale [≥4 of 7]) was also ascertained at baseline and across an average 8-year follow-up. One standard deviation increase in PGS for short-sleep was associated with 14% higher odds of depression onset (95% CI = 1.03-1.25, p = 0.008). However, PGS for sleep duration (OR = 0.92, 95% CI = 0.84-1.00, p = 0.053) and long-sleep (OR = 0.97, 95% CI = 0.89-1.06, p = 0.544) were not associated with depression onset during follow-up. During the same period, PGS for depression was not associated with overall sleep duration, short-sleep, or long-sleep. Polygenic predisposition to short-sleep was associated with depression onset over an average 8-year period. However, polygenic predisposition to depression was not associated with overall sleep duration, short-sleep or long-sleep, suggesting different mechanisms underlie the relationship between depression and the subsequent onset of suboptimal sleep durations in older adults.

Sleep Well, Study Well: A Systematic Review of Longitudinal Studies on the Interplay between Sleep and School Experience in Adolescence

Adolescents spend most of their daily time in school and performing school-related activities. Different aspects of their school experiences, such as school performance, psychological factors related to school, and structural factors, consistently impact adolescents' health and are likely to be intertwined with their sleep (i.e., quantity and quality, sleep disturbances). This systematic review aimed to comprehensively summarize the reciprocal and longitudinal associations between adolescents' sleep and multiple aspects of their school experience. Using multiple search strategies and applying a two-step selection process, 25 journal articles matched the eligibility criteria and were thus included in the review. The results highlighted the contribution of poor sleep quality and sleep disturbances in predicting longitudinal school experiences-related outcomes (i.e., decreasing school engagement and performance, and increasing school-related burnout, absenteeism, and bullying). At the same time, the results showed how experiences related to the school's psychological factors (e.g., high levels of school burnout and stressful environment) and structural characteristics (e.g., early school entrance time) affect youth sleep over time (i.e., decreasing sleep quality and quantity). These main findings provided novel insights into the bidirectional relationship between school experience and sleep health, highlighting the importance of more longitudinal research investigating all aspects of healthy sleep, including the size and direction of the association.

Trajectories of Perceived Technological Impairment and Psychological Distress in Adolescents

Fears that digital technologies harm adolescents' mental health abound; however, existing research is mixed. This study examined how perceived technological impairment (i.e., perceptions of digital technology interfering with daily life) related to psychological distress across five years in adolescence. A latent curve model with structured residuals was applied to disentangle between-from within-person associations, in which it was tested whether (a) adolescents who increased in their perceptions of technological impairment over time also increased in psychological distress (between-person) and (b) if an adolescent who reported greater perceptions of technological impairment relative to their underlying trajectory at one wave consequently reported greater distress at the subsequent wave (within-person). These associations were tested in a sample of 2104 adolescents (Mage = 12.36; 52% girls; 48% Non-White). Perceived technological impairment and psychological distress increased together over time. Girls and older adolescents (13-15 at baseline) reported greater initial levels of perceived impairment. Younger adolescents (9-12 at baseline) increased more steeply in perceived impairment over time. There was no evidence of longitudinal within-person associations. The findings suggest that although there is evidence of between-person associations in which increases in perceived technological impairment coincide with increases in psychological distress, the absence of within-person associations cautions against a cause-and-effect narrative between digital technology use and mental health.

The Social Side of Sleep: A Systematic Review of the Longitudinal Associations between Peer Relationships and Sleep Quality

In adolescence, peer relationships become crucial since youths start to rely on their peers for support. Thus, multiple facets of adolescents' well-being are affected by their peer relationships. In this vein, one of the central well-being aspects that could be affected by the peer relationships of adolescents is sleep quality. Nevertheless, it is still unclear how multiple peer relationship factors (i.e., positive, negative, emotional, and behavioral issues related to peer relationships) are intertwined with adolescents' sleep quality. For this reason, this systematic review with meta-analysis aims to summarize longitudinal studies to uncover how the interplay between peer relationship factors and adolescents' sleep quality unfolds over time. Nineteen longitudinal studies involving a total of 21,232 adolescents were included. Overall, findings from this review showed that (a) positive peer relationships and sleep quality were not associated over time; (b) negative peer relationships and sleep quality were bidirectionally associated over time; (c) few studies evaluated the bidirectional relations between emotional and behavioral issues and sleep quality, showing links with sleep schedule and duration, but not with sleep quality. Meta-analytic results were discussed, considering their implications.

The bidirectional relationship between sleep and externalizing behavior: A systematic review

It is well-established that sleep and behavior are interrelated. Although studies have investigated this association, not many have evaluated the bidirectional relationship between the two. To our knowledge this is the first systematic review providing a comprehensive analysis of a reciprocal relationship between sleep and externalizing behavior. Five databases (PsycINFO, PubMed, Web of Science, Scopus, and Google Scholar) were utilized to yield a total of 3,762 studies of which 20 eligible studies, empirical articles examining bidirectionality of sleep and externalizing behavior, were selected for analysis. According to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis, the varying methodological approaches used in these studies were analyzed and synthesized, including examining differences and similarities in outcomes between distinct study designs (longitudinal vs cross-sectional), sleep measures (objective vs subjective vs a combination of both), informants (parents, self-report, teachers), and recruited participants (clinical, subclinical and typical populations). The assessment of risk of bias and quality of studies was guided by the instruments employed in research on sleep and behavior in the past. This review establishes that a bidirectional relationship between sleep problems and externalizing behavior clearly exists, and identifies limitations in the existing literature. Furthermore, the importance of early interventions that target both externalizing behaviors and sleep problems is highlighted as a potentially effective way of breaking the sleep-externalizing behavior relationship. Nonetheless, causality cannot be claimed until more trials that manipulate sleep and evaluate changes in externalizing behavior are conducted.

Insomnia disorder: State of the science and challenges for the future

Insomnia disorder comprises symptoms during night and day that strongly affect quality of life and wellbeing. Prolonged sleep latency, difficulties to maintain sleep and early morning wakening characterize sleep complaints, whereas fatigue, reduced attention, impaired cognitive functioning, irritability, anxiety and low mood are key daytime impairments. Insomnia disorder is well acknowledged in all relevant diagnostic systems: Diagnostic and Statistical Manual of the American Psychiatric Association, 5th revision, International Classification of Sleep Disorders, 3rd version, and International Classification of Diseases, 11th revision. Insomnia disorder as a chronic condition is frequent (up to 10% of the adult population, with a preponderance of females), and signifies an important and independent risk factor for physical and, especially, mental health. Insomnia disorder diagnosis primarily rests on self-report. Objective measures like actigraphy or polysomnography are not (yet) part of the routine diagnostic canon, but play an important role in research. Disease concepts of insomnia range from cognitive-behavioural models to (epi-) genetics and psychoneurobiological approaches. The latter is derived from knowledge about basic sleep-wake regulation and encompass theories like rapid eye movement sleep instability/restless rapid eye movement sleep. Cognitive-behavioural models of insomnia led to the conceptualization of cognitive-behavioural therapy for insomnia, which is now considered as first-line treatment for insomnia worldwide. Future research strategies will include the combination of experimental paradigms with neuroimaging and may benefit from more attention to dysfunctional overnight alleviation of distress in insomnia. With respect to therapy, cognitive-behavioural therapy for insomnia merits widespread implementation, and digital cognitive-behavioural therapy may assist delivery along treatment guidelines. However, given the still considerable proportion of patients responding insufficiently to cognitive-behavioural therapy for insomnia, fundamental studies are highly necessary to better understand the brain and behavioural mechanisms underlying insomnia. Mediators and moderators of treatment response/non-response and the associated development of tailored and novel interventions also require investigation. Recent studies suggest that treatment of insomnia may prove to add significantly as a preventive strategy to combat the global burden of mental disorders.

"School of hard knocks" - what can mental health researchers learn from the COVID-19 crisis?

Since the COVID-19 pandemic took hold in the first quarter of 2020, children and their families across the world have experienced extraordinary changes to the way they live their lives - creating enormous practical and psychological challenges for them at many levels. While some of these effects are directly linked to COVID-related morbidity and mortality, many are indirect - due rather to governmental public health responses designed to slow the spread of infection and minimise the numbers of deaths. These have often involved aggressive programmes of social distancing and quarantine, including extended periods of national social and economic lockdown, unprecedented in the modern age. Debates about the appropriateness of these measures have often referenced their potentially negative impact on people's mental health and well-being - impacts which both opponents and advocates appear to accept as being inevitable.