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Published on: October 2, 2019
Sleep and mental health in childhood: a multi-method study in the general pediatric population
Elisabet Blok1,2, M Elisabeth Koopman-Verhoeff3,4,5,6, Daniel P Dickstein7,8
1Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, University Medical Center, Rotterdam, The Netherlands.
Insights
Reported sleep problems in children are linked to mental health issues. Objective sleep measures, however, showed fewer associations, suggesting reported and measured sleep capture different aspects of child well-being.
Area of Science:
- Pediatric Sleep Medicine
- Child and Adolescent Mental Health
- Behavioral Sleep Medicine
Background:
- Sleep problems and mental health challenges frequently co-occur in children.
- Existing research often uses single sleep measures or focuses on specific mental health conditions.
- A comprehensive understanding of the relationship between sleep and mental health in youth requires diverse assessment methods.
Purpose of the Study:
- To investigate the associations between various sleep characteristics (reported and actigraphy-measured) and mental health in children.
- To explore the relationship between sleep patterns, 24-hour activity rhythms, and internalizing, externalizing, and dysregulation profiles in pediatric populations.
- To compare findings from subjective sleep reports with objective actigraphy data.
Main Methods:
- Cross-sectional study of 788 children aged 10-11 and 344 aged 13-14.
- Sleep assessed via maternal report and wrist actigraphy for sleep patterns and 24-hour activity rhythm.
- Mental health evaluated through mother-reported internalizing, externalizing symptoms, and a dysregulation profile.
Main Results:
- Higher reported sleep problems correlated with increased mental health symptoms in both age groups (ß estimates 0.11-0.35).
- Actigraphy-measured sleep showed limited associations; earlier sleep onset linked to more internalizing problems (ß=-0.09, p=0.002).
- Higher intra-daily activity rhythm variability associated with more dysregulation symptoms in 10-11 year olds (ß=0.11, p=0.002).
Conclusions:
- Subjective reports of sleep problems are broadly associated with mental health issues in children, highlighting sleep as a clinical consideration.
- Objective actigraphy-derived sleep measures showed weaker associations with most mental health outcomes.
- The divergence between reported and actigraphy sleep data suggests they represent distinct constructs relevant to child mental health.
Background:
Sleep problems, altered sleep patterns and mental health difficulties often co-occur in the pediatric population. Different assessment methods for sleep exist, however, many studies only use one measure of sleep or focus on one specific mental health problem. In this population-based study, we assessed different aspects of sleep and mother-reported mental health to provide a broad overview of the associations between reported and actigraphic sleep characteristics and mental health.
Methods:
This cross-sectional study included 788 children 10-11-year-old children (52.5% girls) and 344 13-14-year-old children (55.2% girls). Mothers and children reported on the sleep of the child and wrist actigraphy was used to assess the child's sleep patterns and 24 h activity rhythm. Mental health was assessed via mother-report and covered internalizing, externalizing and a combined phenotype of internalizing and externalizing symptoms, the dysregulation profile.
Results:
Higher reported sleep problems were related to more symptoms of mental health problems in 10-11- and 13-14-year-old adolescents, with standardized ß-estimates ranging between 0.11 and 0.35. There was no association between actigraphy-estimated sleep and most mental health problems, but earlier sleep onset was associated with more internalizing problems (ß = - 0.09, SE = 0.03, p-value = 0.002), and higher intra-daily variability of the 24 h activity rhythm was associated with more dysregulation profile symptoms at age 10-11 (ß = 0.11, SE = 0.04, p-value = 0.002).
Discussion:
Reported sleep problems across informants were related to all domains of mental health problems, providing evidence that sleep can be an important topic to discuss for clinicians seeing children with mental health problems. Actigraphy-estimated sleep characteristics were not associated with most mental health problems. The discrepancy between reported and actigraphic sleep measures strengthens the idea that these two measures tap into distinct constructs of sleep.
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