Association Between Psychological Distress and Sleep Quality in Children and Adolescents: A Cross-Sectional Study in...

Background: Psychological distress has been increasingly recognized as an important determinant of sleep quality in children and adolescents. However, susceptible subgroups have not been clearly identified. This study aimed to examine the associations between psychological distress and sleep quality in children and adolescents. Methods: We conducted a cross-sectional study among 5771 school-aged children and adolescents (6-18 years) in Zhejiang Province. Psychological status was assessed using the Chinese version of the Depression Anxiety Stress Scale-21, and sleep quality was evaluated using the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). Thyroid-related biomarkers were measured via chemiluminescence immunoassay. Associations between psychological distress and sleep quality were analyzed using generalized linear models. In addition, stratified analyses were performed to identify potentially susceptible subgroups by age, sex, and BMI-for-age z score. Results: Each one-point increase in depression, anxiety, and stress scores was associated with an increase in PSQI scores of 0.18 (95% CI: 0.16, 0.19), 0.20 (95% CI: 0.18, 0.21), and 0.20 (95% CI: 0.19, 0.22), respectively. Subgroup analyses showed that the associations were more pronounced among older children (age > 12 years) and pediatric females. Exploratory mediation analyses suggested a possible but very limited indirect role of T3 in the associations of depression, anxiety, and stress with sleep quality, with all estimated proportions mediated below 1%. Conclusions: Psychological distress was significantly associated with poorer sleep quality in children and adolescents, particularly among older individuals and pediatric females. These findings highlight the importance of early identification and intervention for psychological distress to improve sleep health in younger populations. Further longitudinal studies are needed to clarify underlying mechanisms.