Epidemiology of DSM-IV insomnia in adolescence: Lifetime prevalence, chronicity, and an emergent gender difference

Substance Abuse Epi, Prevention, and Risk Behavior, Research Triangle Institute International, Research Triangle Park, NC 27709-2194, USA.
PEDIATRICS (Impact Factor: 5.47). 03/2006; 117(2):e247-56. DOI: 10.1542/peds.2004-2629
Source: PubMed


The confluence of sleep/wake cycle and circadian rhythm changes that accompany pubertal development and the social and emotional developmental tasks of adolescence may create a period of substantial risk for development of insomnia. Although poor sleep affects cognitive performance and is associated with poor emotional and physical health, epidemiologic studies among adolescents have been limited. In this first epidemiologic study of insomnia defined by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria in a US sample of adolescents, we estimated lifetime prevalence of insomnia, examined chronicity and onset, and explored the role of pubertal development.
Data come from a random sample of 1014 adolescents who were 13 to 16 years of age, selected from households in a 400000-member health maintenance organization encompassing metropolitan Detroit. Response rate was 71.2%. The main outcome measured was DSM-IV-defined insomnia.
Lifetime prevalence of insomnia was 10.7%. A total of 88% of adolescents with a history of insomnia reported current insomnia. The median age of onset of insomnia was 11. Of those with insomnia, 52.8% had a comorbid psychiatric disorder. In exploratory analyses of insomnia and pubertal development, onset of menses was associated with a 2.75-fold increased risk for insomnia. There was no difference in risk for insomnia among girls before menses onset relative to boys, but a difference emerged after menses onset. In contrast, maturational development was not associated with insomnia in boys.
Insomnia seems to be common and chronic among adolescents. The often found gender difference in risk for insomnia seems to emerge in association with onset of menses.

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    • "Similar to another study conducted with a sample of diverse adolescents (Roberts et al., 2009), we found that a quarter of adolescents slept 7 hours or fewer per night. The high rates of perceived sleep dysfunction in our study could be related to the general low socioeconomic status of the families, which might expose adolescents to stressors that interfere with sleep functioning (Johnson et al., 2004). "
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    ABSTRACT: Despite the importance of parenting practices for adolescent adjustment, parenting correlates of adolescent sleep functioning remain understudied. This study delineated patterns of sleep functioning in a sample of ethnically diverse, low-income, adolescents and examined associations among three types of parenting practices (parental involvement, parent-child conflict, and parental control) and adolescent sleep functioning (difficulties initiating sleep and maintaining sleep, and sleep duration). Adolescents (N = 91, 11-19 years old) self-reported on sleep functioning and parenting practices. Results showed that in the preceding month, 60.5% of adolescents had difficulties initiating sleep and 73.6% had difficulties maintaining sleep. Most adolescents slept 8 or more hours per night, but 30.7% slept less than 8 hours. Latino adolescents slept longer and had fewer difficulties maintaining sleep than non-Latino. High school students had fewer difficulties maintaining sleep than their middle school counterparts; conversely, older adolescents experienced shorter sleep duration than younger ones. Adolescents whose parents had post-secondary education had shorter sleep duration than those whose parents had not graduated from high school. Parental control was correlated with fewer difficulties initiating sleep, whereas parent-child conflict was correlated with more difficulties maintaining sleep. There were no parenting correlates of sleep duration. Latino adolescents had better sleep profiles than non-Latino ones. Regression analyses showed that parental control and parent-child conflict were associated with adolescent sleep functioning across ethnicities. Results suggest that parenting practices, as well as demographic characteristics, are associated with adolescent sleep functioning and should be taken into account in interventions aimed at improving sleep functioning among adolescents.
    Journal of Child and Family Studies 11/2015; 24(11):3331-3340. DOI:10.1007/s10826-015-0135-5 · 1.42 Impact Factor
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    • "No information regarding the time-frame of these symptom was available. To establish a proxy for assessing DSP (as closely as possible, given the available sleep items) in line with the International Classification of Sleep Disorders–2 (American Academy of Sleep Medicine, 2005), we employed the following criteria, as specified in Johnson et al. and published in Pediatrics (Johnson et al., 2006): (1) minimum 1-h shift in sleep-onset and wake times from the weekdays to the weekend, (2) complaint of frequent (≥3 days per week) difficulty falling asleep, (3) report of little or no (≤1 day per week) difficulty maintaining sleep and (4) frequent difficulty awakening (oversleep 'sometimes' or more often). This operationalization has been applied previously in a recent publication from the youth@hordaland-survey (Sivertsen et al., 2013). "
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    ABSTRACT: The aim of the current study was to compare mental health problems, resilience and family characteristics in adolescents with and without delayed sleep phase (DSP) in a population-based sample. Data were taken from the youth@hordaland-survey, a large population-based study in Hordaland County in Norway conducted in 2012. In all, 9338 adolescents aged 16–19 years (53.5% girls) provided self-reported data on a wide range of instruments assessing mental health symptoms, including depression, anxiety, obsessive–compulsive behaviours, attention deficit hyperactive disorder (ADHD) symptoms, perfectionism, resilience and sleep. Measures of socioeconomic status were also included. Three hundred and six adolescents (prevalence 3.3%) were classified as having DSP [according to the International Classification of Sleep Disorders-2 (ICSD-2)] criteria. Adolescents with DSP reported higher levels of depression, anxiety and ADHD symptoms. Adolescents with DSP also exhibited significantly lower levels of resilience. The Cohen's d effect sizes ranged from small [obsessive–compulsive disorder (OCD): d = 0.15] to moderate (inattention: d = 0.71). In the fully adjusted model, the significant predictors of DSP included inattention [odds ratio (OR): 2.11], lack of personal structure (OR: 2.07), low (OR: 1.85) and high (OR: 1.91) paternal education, parents not living together (OR: 1.81), hyperactivity/inattention (OR: 1.71) and poorer family economy (OR: 1.59). In conclusion, the high symptom load across a range of mental health measures suggests that a broad and thorough clinical approach is warranted when adolescents present with DSP.
    Journal of Sleep Research 10/2014; 24(1). DOI:10.1111/jsr.12254 · 3.35 Impact Factor
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    • "For adolescent DSPD, Moore and Meltzer (2008) report a prevalence of 5–10 %, and Gradisar et al. (2011) report a prevalence of 7–16 %. For insomnia a distinction in reported prevalences can be made between insomnia diagnosis [4–5 % (Ohayon et al. 2000; Roberts et al. 2008)] and current insomnia symptoms (9.4 % (Johnson et al. 2006); 25–27 % (Ohayon et al. 2000; Roberts et al. 2008)). From these varying prevalences, we chose 15 % as a conservative estimate of general prevalence of sleep reduction symptoms. "
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    ABSTRACT: Sleep reduction, resulting from insufficient or poor sleep, is a common phenomenon in adolescents. Due to its severe negative psychological and behavioral daytime consequences, it is important to have a reliable and valid measure to assess symptoms of sleep reduction. This study aims to validate the Sleep Reduction Screening Questionnaire (SRSQ) that can be used to screen for symptoms of sleep reduction in adolescents. Various samples from the general population and clinical cases were included in the study. The SRSQ is a nine-item questionnaire that is based on the longer, four dimensional Chronic Sleep Reduction Questionnaire (Meijer 2008). Items were selected on the basis of principal components analysis, item-total correlations, and substantive consideration. The SRSQ was validated by calculating correlations with self-reported and objective sleep and self-reported daytime functioning. Cut-off scores were determined so that the SRSQ can be used as a screening instrument. Internal consistencies of the SRSQ were good (Cronbach’s alpha = .79 in the general population). Correlations with self-reported sleep, daytime functioning and objective sleep variables were satisfactory and in the expected directions. The SRSQ discriminates well between clinical and non-clinical cases. When accounting for prevalence of sleep reduction symptoms in the general population, the Area Under the Curve (AUC) was .91, sensitivity was .80 and specificity was .87. The SRSQ appears to be a reliable and valid questionnaire. Due to the limited number of items and the availability of cut-off scores, it is a practical tool for clinical and research purposes.
    Child and Youth Care Forum 04/2014; in press, accepted(5). DOI:10.1007/s10566-014-9256-z · 1.25 Impact Factor
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