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Associations Between Sleep Duration and Positive Mental Health Screens During Adolescent Preventive Visits in Primary Care
Abstract
Purpose:
The purpose of this paper was to understand associations between low sleep duration (<8 hours) and positive mental health screens among adolescents (ages 13-18) seen for preventive visits in primary care.
Methods:
Data were from two randomized controlled trials testing the efficacy of an electronic health risk behavior screening and feedback tool for adolescent preventive visits. Participants (n=601) completed screeners at baseline, 3-, and 6-months which included sleep duration in hours and the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 screeners for depression and anxiety, respectively. Main analyses included adjusted logistic regressions testing associations between low sleep duration and positive mental health screens.
Results:
Adjusted models showed that low sleep duration was associated with significantly greater odds of a positive depression screen (OR=1.58, 95% CI: 1.06-2.37) but not with a positive anxiety screen or co-occurring positive depression and anxiety screens. However, follow-up analyses indicated an interaction between sleep duration and anxiety in the association with a positive depression screen, such that the association between low sleep and a positive depression screen was driven by those who did not screen positive for anxiety.
Conclusions and implications:
As pediatric primary care guidelines for sleep continue to evolve further research, training, and support for sleep screening are warranted to ensure effective early intervention for sleep and mental health problems during adolescence.
... 11 Additionally, another study among Americans demonstrated that the rate of a positive depression screen was higher for those with insufficient sleep (OR =1.58). 39 Although the exact mechanism linking insufficient sleep and depressive symptoms remains unclear, several potential explanations exist, including altered neurodevelopment, 40,41 increased limbic system activity, endocrine and immune system disorders. 42,43 Among these mechanisms, neurocognitive factors and emotional memory need a special focus. ...
Purpose
There is a lack of national studies examining the relationship between insufficient sleep and depression among Chinese adolescents, and previous research has not comprehensively considered related factors. This study aimed to investigate the prevalence of depressive symptoms in adolescents with insufficient sleep and explore the role of associated factors using a nationally representative sample in China.
Patients and Methods
A pen-and-paper survey was conducted among 24147 Chinese adolescents from November 2019 to January 2020. Data on depressive symptoms, maltreatment experiences, psychological resilience, demographic information, parent–child relationships, parental marital status, and sleep duration were collected.
Results
A total of 22231 valid questionnaires were analyzed. Among the respondents, 67.7% reported insufficient sleep, while 32.3% had sufficient sleep. The prevalence of depressive symptoms was 25.3% in adolescents with insufficient sleep, compared to 8.2% in those with sufficient sleep. Insufficient sleep was identified as an independent risk factor for depressive symptoms (OR = 3.058, 95% CI: 2.753–3.396, P < 0.001). In adolescents with sufficient sleep, being female, emotional abuse, physical abuse, sexual abuse, and physical neglect were significant risk factors for depressive symptoms (P < 0.05), while higher resilience scores and a good parent–child relationship were protective factors (P < 0.05). Among adolescents with insufficient sleep, additional risk factors included higher body mass index (BMI), older age, parental divorce, and living with a single parent (P < 0.05).
Conclusion
Insufficient sleep is significantly associated with depressive symptoms in Chinese adolescents. The adolescents with insufficient sleep, particularly those who are older, have a higher BMI, or come from divorced or single-parent households, require increased attention.
... Mental health disorders are the result of the interaction of biological, psychological and social factors [5]. In terms of psychological and social factors, longer screen time [6], longer homework and reading duration [7], shorter sleep duration [8], and greater social jetlag [9] may have a significant impact on the mental health of children and adolescents. ...
Objectives
To examine the associations of screen time, homework and reading duration, sleep duration, social jetlag with mental health in children and adolescents, as well as its gender differences.
Methods
From December 2023 to April 2024, a total of 62 395 children and adolescents were selected from 51 schools in 17 cities of China by stratified cluster sampling. Screen time, homework and reading duration, sleep duration, and social jetlag were calculated by answering the questions about watching TV time, playing smartphones time, doing homework time, reading extracurricular books time, bedtime, wake-up time, and nap time during weekdays and weekends. Mental health was assessed by the Revised Mental Health Inventory-5 (MHI-5). The generalized linear model was used to determine the association between screen time, homework and reading duration, sleep duration, social jetlag, and mental health in children and adolescents.
Results
The generalized linear model results showed that longer watching TV time, longer playing smartphones time, longer homework time, and greater social jetlag were correlated with poorer mental health in children and adolescents, while longer nighttime sleep duration, and longer daytime nap duration were correlated with better mental health. Moreover, in primary school and junior high school, we found that this association was stronger during the weekdays. However, in senior high school, this association was stronger during the weekends. After according to gender stratified, we found that the strength of this association was different in boys and girls at different study phases. Furthermore, our findings also revealed a significant quadratic relationship, indicating the association of better mental health with an optimal amount of sleep duration.
Conclusions
There was a significant association between screen time, homework and reading duration, sleep duration, social jetlag, and mental health in children and adolescents. This study has the potential to offer useful insights for the prevention and control of mental health issues in children and adolescents.
... Pediatric primary care is ideal for preventing pediatric sleep disparities at the population level, yet providers in this setting typically lack the time and resources necessary to identify sleep problems (Honaker and Saunders, 2018;Mosher and Piccinini-Vallis, 2022;Williamson et al., 2022;Golden et al., 2023). Efficient machine learning and clinical decision support tools embedded in the pediatric primary care electronic health record (EHR) are needed to support universal screening of pediatric sleep problems at the population level (Anan et al., 2023). In addition, EHRembedded machine learning tools for data collection are essential to include patient-self report and aid providers with limited personnel and time constraints in pediatric primary care (Honaker et al., 2019;Huffstetler et al., 2022;Willis et al., 2022). ...
Introduction
Pediatric sleep problems can be detected across racial/ethnic subpopulations in primary care settings. However, the electronic health record (EHR) data documentation that describes patients' sleep problems may be inherently biased due to both historical biases and informed presence. This study assessed racial/ethnic differences in natural language processing (NLP) training data (e.g., pediatric sleep-related keywords in primary care clinical notes) prior to model training.
Methods
We used a predefined keyword features set containing 178 Peds B-SATED keywords. We then queried all the clinical notes from patients seen in pediatric primary care between the ages of 5 and 18 from January 2018 to December 2021. A least absolute shrinkage and selection operator (LASSO) regression model was used to investigate whether there were racial/ethnic differences in the documentation of Peds B-SATED keywords. Then, mixed-effects logistic regression was used to determine whether the odds of the presence of global Peds B-SATED dimensions also differed across racial/ethnic subpopulations.
Results
Using both LASSO and multilevel modeling approaches, the current study found that there were racial/ethnic differences in providers' documentation of Peds B-SATED keywords and global dimensions. In addition, the most frequently documented Peds B-SATED keyword rankings qualitatively differed across racial/ethnic subpopulations.
Conclusion
This study revealed providers' differential patterns of documenting Peds B-SATED keywords and global dimensions that may account for the under-detection of pediatric sleep problems among racial/ethnic subpopulations. In research, these findings have important implications for the equitable clinical documentation of sleep problems in pediatric primary care settings and extend prior retrospective work in pediatric sleep specialty settings.
Understanding the relationship between subjective and objective sleep measures is essential for evaluating their agreement and utility. This study compared Munich Chronotype Questionnaire (MCTQ) and Fitbit metrics for sleep duration, sleep midpoint and social jetlag in 5252 participants from the Adolescent Brain Cognitive Development (ABCD) study. Linear and nonlinear models assessed relationships between Fitbit‐derived and MCTQ‐reported metrics, whilst moderation analyses examined the influence of age, sex, household income and BMI. A sensitivity analysis compared results pre‐ and post‐COVID‐19 to assess pandemic‐related effects (pre‐COVID n = 4451). Correlations were weak to moderate: r = 0.15–0.21 for sleep duration, r = 0.37–0.42 for sleep midpoint, and r = 0.12–0.16 for social jetlag. Quadratic and LOESS models confirmed nonlinear trends for sleep midpoint, with greater Fitbit‐MCTQ divergence at extreme morningness or eveningness. Fitbit classified 63.2% of participants as having insufficient sleep, compared to 39.45% with MCTQ, suggesting Fitbit underestimates sleep duration. Bland–Altman plots confirmed MCTQ overestimation, especially for shorter sleepers. BMI was significantly associated with sleep duration and social jetlag, with higher BMI linked to shorter sleep and greater variability. Household income and BMI moderated specific sleep metrics, whilst age and sex did not significantly moderate any metric. Sensitivity analyses showed consistent results across pre‐ and post‐COVID periods. Findings highlight stronger agreement for sleep midpoint than for sleep duration or social jetlag, with methodological differences driving discrepancies. The consistency across demographics and time periods supports the complementary use of Fitbit and MCTQ for adolescent sleep assessment.
This study examined the relationships between caffeine intake, screen time, and chronotype/sleep outcomes in adolescents, with a focus on differences between Hispanic and non-Hispanic groups and the influence of peer network health, school environment, and psychological factors, including perceived stress, depression, and anxiety. Data from the Adolescent Brain Cognitive Development (ABCD) study were analyzed using t-tests and structural equation modeling (SEM) to assess behavioral, social, and psychological predictors of chronotype, social jetlag, and weekday sleep duration, incorporating demographic covariates. Hispanic adolescents exhibited a later chronotype (Cohen’s d = 0.42), greater social jetlag (Cohen’s d = 0.38), and shorter weekday sleep duration (Cohen’s d = -0.12) compared to non-Hispanic peers. They also reported higher caffeine intake (Cohen’s d = 0.22), though caffeine was not significantly associated with sleep outcomes. Screen time was more prevalent among Hispanic adolescents, particularly on weekday evenings (Cohen’s d = 0.27) and weekend evenings (Cohen’s d = 0.35), and was strongly associated with later chronotype and greater social jetlag. Higher perceived stress was linked to later chronotype and greater social jetlag, while depressive symptoms were associated with earlier chronotype and lower social jetlag. The SEM model explained 12.9% of variance in chronotype, 10.5% in social jetlag, and 6.2% in weekday sleep duration. These findings highlight disparities in adolescent sleep health but should be interpreted cautiously due to methodological limitations, including low caffeine use and assessment timing variability. Targeted interventions addressing screen time, peer relationships, and stress may improve sleep, while longitudinal research is needed to clarify causality.
Background
Health risk behaviors are the most common sources of morbidity among adolescents. Adolescent health guidelines (Guidelines for Preventive Services by the AMA and Bright Futures by the Maternal Child Health Bureau) recommend screening and counseling, but the implementation is inconsistent.
Objective
This study aims to test the efficacy of electronic risk behavior screening with integrated patient-facing feedback on the delivery of adolescent-reported clinician counseling and risk behaviors over time.
Methods
This was a randomized controlled trial comparing an electronic tool to usual care in five pediatric clinics in the Pacific Northwest. A total of 300 participants aged 13-18 years who attended a well-care visit between September 30, 2016, and January 12, 2018, were included. Adolescents were randomized after consent by employing a 1:1 balanced age, sex, and clinic stratified schema with 150 adolescents in the intervention group and 150 in the control group. Intervention adolescents received electronic screening with integrated feedback, and the clinicians received a summary report of the results. Control adolescents received usual care. Outcomes, assessed via online survey methods, included adolescent-reported receipt of counseling during the visit (measured a day after the visit) and health risk behavior change (measured at 3 and 6 months after the visit).
ResultsOf the original 300 participants, 94% (n=282), 94.3% (n=283), and 94.6% (n=284) completed follow-up surveys at 1 day, 3 months, and 6 months, respectively, with similar levels of attrition across study arms. The mean risk behavior score at baseline was 2.86 (SD 2.33) for intervention adolescents and 3.10 (SD 2.52) for control adolescents (score potential range 0-21). After adjusting for age, gender, and random effect of the clinic, intervention adolescents were 36% more likely to report having received counseling for endorsed risk behaviors than control adolescents (adjusted rate ratio 1.36, 95% CI 1.04 to 1.78) 1 day after the well-care visit. Both the intervention and control groups reported decreased risk behaviors at the 3- and 6-month follow-up assessments, with no significant group differences in risk behavior scores at either time point (3-month group difference: β=−.15, 95% CI −0.57 to −0.01, P=.05; 6-month group difference: β=−.12, 95% CI −0.29 to 0.52, P=.57).
Conclusions
Although electronic health screening with integrated feedback improves the delivery of counseling by clinicians, the impact on risk behaviors is modest and, in this study, not significantly different from usual care. More research is needed to identify effective strategies to reduce risk in the context of well-care.
Trial RegistrationClinicalTrials.gov NCT02882919; https://clinicaltrials.gov/ct2/show/NCT02882919
Background
Sleep problems are common in adolescence, and frequently comorbid with both anxiety and depression. Research studies have suggested a bidirectional relationship between sleep and psychopathology, which includes evidence that sleep interventions can alleviate symptoms of anxiety and depression. However, little is known about the nature of sleep problems amongst adolescents with anxiety and depression, and whether specific sleeping difficulties are involved in the longitudinal relationship between sleep, anxiety and depression.
Method
The sample was derived from the Avon Longitudinal Study of Parents and Children (ALSPAC), a population‐based, prospective, birth cohort study of children born in 1991–1992. Data were explored from a subset of participants who took part in a clinical assessment at age 15, on self‐report sleep patterns and quality, and diagnostic outcomes of anxiety and depression (N = 5,033). Subsequent diagnostic and symptom severity data on anxiety and depression at ages 17, 21 and 24 were also examined.
Results
Cross‐sectional and longitudinal analyses were conducted to explore the relationship between sleep problems, anxiety and depression. Results revealed that adolescents aged 15 with depression experience difficulties with both sleep patterns and sleep quality, whereas adolescents with anxiety only reported problems with sleep quality. A range of sleep variables at age 15 predicted the severity of anxiety and depression symptoms and the diagnoses of anxiety and depressive disorders at age 17, 21 and 24 years.
Conclusions
The results provide further insight into the nature of sleep problems amongst adolescents with anxiety and depression, and the prospective relationship between sleep disturbance and future psychopathology. These data suggest that targeting sleep difficulties during adolescence may have long‐term mental health benefits.
Importance
Health risk behaviors are a leading cause of morbidity during adolescence. Screening and counseling for health risk behaviors are recommended but infrequently performed.
Objective
To test the effect of an electronic screening and feedback tool on clinician counseling and adolescent-reported health risk behaviors.
Design, Setting, and Participants
A randomized clinical trial compared electronic screening and feedback on an intention-to-treat basis with usual care among 300 youths 13 to 18 years of age at 5 pediatric clinics in the Pacific Northwest. Outcomes were assessed via electronic survey at 1 day and 3 months after the initial visit. Study data collection occurred from March 13, 2015, to November 29, 2016, and statistical analysis was conducted between February 6, 2017, and June 20, 2018.
Interventions
Youths in the intervention group (n = 147) received electronic screening and personalized feedback with clinician clinical decision support. Youths in the control group (n = 153) received standard screening and counseling as provided by their clinic.
Main Outcomes and Measures
Youths’ report of receipt of counseling during the visit and risk behaviors at 3 months.
Results
In the final study sample of 300 youths (intervention group, 75 girls and 72 boys; mean [SD] age, 14.5 [1.4 years]; and control group, 80 girls and 73 boys; mean [SD] age, 14.5 [1.4] years), 234 (78.0%) were aged 13 to 15 years. After adjusting for age, sex, and random effect of clinic, youths in the intervention group were more likely to receive counseling for each of their reported risk behaviors than were youths in the control group (adjusted rate ratio, 1.32; 95% CI, 1.07-1.63). Youths in the intervention group had a significantly greater reduction (β = –0.48; 95% CI, –0.89 to –0.02; P = .02) in their risk behavior scores at 3 months when compared with youths in the control group.
Conclusions and Relevance
Electronic screening of health risk behavior with clinical decision support and motivational feedback to teens can improve care delivery and outcomes.
Trial Registration
ClinicalTrials.gov identifier: NCT02360410
Not only do anxiety and depression diagnoses tend to co-occur, but their symptoms are highly correlated. Although a plethora of research has examined longitudinal associations between anxiety and depression, this data has not yet been effectively synthesized. To address this need, the current study undertook a systematic review and meta-analysis of 66 studies involving 88,336 persons examining the prospective relationship between anxiety and depression at both symptom and disorder levels. Using mixed-effect models, results suggested that all types of anxiety symptoms predicted later depressive symptoms (r = 0.34), and all types of depressive symptoms predicted later anxiety symptoms (r = 0.31). Although anxiety symptoms more strongly predicted depressive symptoms than vice-versa, the difference in effect size for this analysis was very small and likely not clinically meaningful. Additionally, all types of diagnosed anxiety disorders predicted all types of later depressive disorders (OR = 2.77), and all depressive disorders predicted later anxiety disorders (OR = 2.73). Most anxiety and depressive disorders predicted each other with similar degrees of strength, but depressive disorders more strongly predicted social anxiety disorder (OR = 6.05) and specific phobia (OR = 2.93) than vice-versa. Contrary to conclusions of prior reviews, our findings suggest that depressive disorders may be prodromes for social and specific phobia, whereas other anxiety and depressive disorders are bidirectional risk factors for one another.
Despite the recognition that behavioral and medical health conditions are frequently intertwined, the existing health care system divides management for these issues into separate settings. This separation results in increased barriers to receipt of care and contributes to problems of underdetection, inappropriate diagnosis, and lack of treatment engagement. Adolescents and young adults with mental health conditions have some of the lowest rates of treatment for their conditions of all age groups. Integration of behavioral health into primary care settings has the potential to address these barriers and improve outcomes for adolescents and young adults. In this paper, we review the current research literature for behavioral health integration in the adolescent and young adult population and make recommendations for needed research to move the field forward.
Adolescence is marked by dramatic changes in sleep. Older adolescents go to bed later, have an increased preference for evening activities, and sleep less than younger adolescents. This behavior change is driven by external factors, notably increased pressures from academic, social, and extracurricular activities and by biological circadian factors. There are also substantial changes in sleep architecture across adolescence, with dramatic declines in slow wave sleep, and slow wave activity (delta, ~ 0.5-4.5 Hz). These changes are associated with underlying changes in brain structure and organization, with a decrease in synaptic density likely underlying the reduction in high amplitude slow waveforms. While changes in sleep across adolescence are a normal part of development, many adolescents are getting insufficient sleep and are consequently, less likely to perform well at school, more likely to develop mood-related disturbances, be obese, and are at greater risk for traffic accidents, alcohol and drug abuse.
Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity.
A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use.
A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale.
The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
Objective
To examine associations between adverse childhood experiences (ACEs) and age specific insufficient sleep duration (ISD) in American youth.
Methods
Data from the 2016-2017 National Survey of Children's Health, a sample of 46,209 youth ages 6-17 were analyzed. The main outcome was sleep duration that did not meet the recent recommendations of the American Academy of Sleep Medicine. Nine types of ACEs, as well as a cumulative count of ACEs, were examined as independent variables in unadjusted and adjusted logistic regression models.
Results
Approximately half of U.S. children and adolescents (ages 6-17) experienced at least one ACE and a third did not get sufficient sleep. Among those exposed to any ACE, 40.3% had insufficient sleep duration. Seven of the nine ACEs examined were significantly associated with a 20-60% increase in odds of not getting sufficient sleep (adjusted ORs between 1.2 and 1.6). Children exposed to two or more ACEs were nearly twice as likely as those exposed to no ACE to have insufficient sleep duration (adjusted OR=1.7, 95% CI: 1.5-1.9). Moreover, each individual ACE, except parental death was significantly associated with more than one hour less sleep than recommended.
Conclusions
This study reports the association of specific and cumulative ACEs with insufficient sleep duration in a nationally representative sample of American youth. The study findings underscore the importance of screening for both ACEs and insufficient sleep during primary care encounters and addressing potential sleep problems in those exposed to ACEs.
Importance
Emerging research suggests that the global prevalence of child and adolescent mental illness has increased considerably during COVID-19. However, substantial variability in prevalence rates have been reported across the literature.
Objective
To ascertain more precise estimates of the global prevalence of child and adolescent clinically elevated depression and anxiety symptoms during COVID-19; to compare these rates with prepandemic estimates; and to examine whether demographic (eg, age, sex), geographical (ie, global region), or methodological (eg, pandemic data collection time point, informant of mental illness, study quality) factors explained variation in prevalence rates across studies.
Data Sources
Four databases were searched (PsycInfo, Embase, MEDLINE, and Cochrane Central Register of Controlled Trials) from January 1, 2020, to February 16, 2021, and unpublished studies were searched in PsycArXiv on March 8, 2021, for studies reporting on child/adolescent depression and anxiety symptoms. The search strategy combined search terms from 3 themes: (1) mental illness (including depression and anxiety), (2) COVID-19, and (3) children and adolescents (age ≤18 years). For PsycArXiv, the key terms COVID-19, mental health, and child/adolescent were used.
Study Selection
Studies were included if they were published in English, had quantitative data, and reported prevalence of clinically elevated depression or anxiety in youth (age ≤18 years).
Data Extraction and Synthesis
A total of 3094 nonduplicate titles/abstracts were retrieved, and 136 full-text articles were reviewed. Data were analyzed from March 8 to 22, 2021.
Main Outcomes and Measures
Prevalence rates of clinically elevated depression and anxiety symptoms in youth.
Results
Random-effect meta-analyses were conducted. Twenty-nine studies including 80 879 participants met full inclusion criteria. Pooled prevalence estimates of clinically elevated depression and anxiety symptoms were 25.2% (95% CI, 21.2%-29.7%) and 20.5% (95% CI, 17.2%-24.4%), respectively. Moderator analyses revealed that the prevalence of clinically elevated depression and anxiety symptoms were higher in studies collected later in the pandemic and in girls. Depression symptoms were higher in older children.
Conclusions and Relevance
Pooled estimates obtained in the first year of the COVID-19 pandemic suggest that 1 in 4 youth globally are experiencing clinically elevated depression symptoms, while 1 in 5 youth are experiencing clinically elevated anxiety symptoms. These pooled estimates, which increased over time, are double of prepandemic estimates. An influx of mental health care utilization is expected, and allocation of resources to address child and adolescent mental health concerns are essential.
Background:
Increasingly, youth with mental health disorders and suicidality are presenting to emergency departments (EDs) and requiring hospitalization. For youth with suicidality, studies reveal seasonal variations in frequency of presentations but do not identify associated diagnoses or whether other primary mental health complaints also reveal seasonal variations.
Methods:
Data were collected between January 2015 and December 2019 by a child and adolescent psychiatry consultation-liaison service in a pediatric ED and hospital. Descriptive analysis and multiple linear regression were performed to assess volume over time, seasonal trends, and associated diagnoses.
Results:
A total of 2367 patients were included, with an average age of 13.9 years and female predominance (62.3%). During the study period, annual ED consultations increased 87.5% and hospital consultations increased 27.5%. Consultations revealed seasonal trends, with highest volumes during January, April, May, October, and November (P < .001; adjusted R2 = 0.59). The most frequent diagnostic categories were depressive disorders and trauma- or stressor-related disorders. Thirty-six percent of patients presented after a suicide attempt, with the highest rates in spring (P = .03; adjusted R2 = 0.19). Boarding rates revealed significant seasonality, with higher instances in February, March, April, May, and October (P = .009; adjusted R2 = 0.32).
Conclusions:
Mental health presentations to a pediatric ED and hospital reveal seasonal trends, with the highest volumes in fall and spring and the most common diagnoses being depressive and trauma-related disorders. Suicide attempts are highest in late spring. Knowledge of these trends should inform hospitals, mental health services, and school systems regarding staffing, safety, surveillance, and prevention.
Objectives
This study provides the first investigation into the correspondence between self-reported and actigraph-measured nighttime sleep duration in adolescents that disambiguates between- vs. within-person associations. Moderators were evaluated to determine if between- and within-person correspondence vary by participant characteristics.
Methods
One hundred fifty adolescents (14–21 years) reported sleep time for 1 week, while wearing an actigraph, and reported on moderators, including demographics (i.e., sex, age, ethnicity, and socioeconomic status), depressive symptoms, and perceived stress. Mixed effects models evaluated within- and between-person associations between self-reported and actigraph-measured sleep, and examined whether these associations differed by possible moderators.
Results
Results indicated significant between- (b = 0.77, SE = 0.08, P < .001) and within-person (b = 0.51, SE = 0.04, P < .001) associations between self-reported and actigraph-measured sleep duration, with no significant moderation effects.
Conclusions
Our results support the use of either self-reports or actigraphs to examine within-person nighttime sleep duration in adolescent community samples.
It has been established that 4.4 to 20% of the general population suffers from a major depressive disorder (MDD), which is frequently associated with a dysregulation of normal sleep-wake mechanisms. Disturbances of circadian rhythms are a cardinal feature of psychiatric dysfunctions, including MDD, which tends to indicate that biological clocks may play a role in their pathophysiology. Thus, episodes of depression and mania or hypomania can arise as a consequence of the disruption of zeitgebers (time cues). In addition, the habit of sleeping at a time that is out of phase with the body's other biological rhythms is a common finding in depressed patients. In this review, we have covered a vast area, emerging from human and animal studies, which supports the link between sleep and depression. In doing so, this paper covers a broad range of distinct mechanisms that may underlie the link between sleep and depression. This review further highlights the mechanisms that may underlie such link (e.g. circadian rhythm alterations, melatonin, and neuroinflammatory dysregulation), as well as evidence for a link between sleep and depression (e.g. objective findings of sleep during depressive episodes, effects of pharmacotherapy, chronotherapy, comorbidity of obstructive sleep apnea and depression), are presented.
Background:
Previous studies have suggested a bidirectional association between sleep problems and anxiety symptoms in adolescents. These studies used methods that do not separate between-person effects from within-person effects, and therefore their conclusions may not pertain to within-person mutual influences of sleep and anxiety. We examined bidirectional associations between sleep problems and anxiety during adolescence and young adulthood while differentiating between person effects from within-person effects.
Methods:
Data came from the Dutch TRacking Adolescents' Individual Lives Survey (TRAILS), a prospective cohort study including six waves of data spanning 15 years. Young adolescents (N = 2230, mean age at baseline 11.1 years) were followed every 2-3 years until young adulthood (mean age 25.6 years). Sleep problems and anxiety symptoms were measured by the Youth Self-Report, Adult Self-Report and Nottingham Health Profile. Temporal associations between sleep and anxiety were investigated using the random intercept cross-lagged panel model.
Results:
Across individuals, sleep problems were significantly associated with (β = 0.60, p < 0.001). At the within-person level, there were significant cross-sectional associations between sleep problems and anxiety symptoms at all waves (β = 0.12-0.34, p < 0.001). In addition, poor sleep predicted greater anxiety symptoms between the first and second, and between the third and fourth assessment wave. The reverse association was not statistically significant.
Conclusions:
Within-person associations between sleep problems and anxiety are considerably weaker than between-person associations. Yet, our findings tentatively suggest that poor sleep, especially during early and mid-adolescence, may precede anxiety symptoms, and that anxiety might be prevented by alleviating sleep problems in young adolescents.
Objectives:
To update clinical practice guidelines to assist primary care (PC) clinicians in the management of adolescent depression. This part of the updated guidelines is used to address practice preparation, identification, assessment, and initial management of adolescent depression in PC settings.
Methods:
By using a combination of evidence- and consensus-based methodologies, guidelines were developed by an expert steering committee in 2 phases as informed by (1) current scientific evidence (published and unpublished) and (2) draft revision and iteration among the steering committee, which included experts, clinicians, and youth and families with lived experience.
Results:
Guidelines were updated for youth aged 10 to 21 years and correspond to initial phases of adolescent depression management in PC, including the identification of at-risk youth, assessment and diagnosis, and initial management. The strength of each recommendation and its evidence base are summarized. The practice preparation, identification, assessment, and initial management section of the guidelines include recommendations for (1) the preparation of the PC practice for improved care of adolescents with depression; (2) annual universal screening of youth 12 and over at health maintenance visits; (3) the identification of depression in youth who are at high risk; (4) systematic assessment procedures by using reliable depression scales, patient and caregiver interviews, andDiagnostic and Statistical Manual of Mental Disorders, Fifth Editioncriteria; (5) patient and family psychoeducation; (6) the establishment of relevant links in the community, and (7) the establishment of a safety plan.
Conclusions:
This part of the guidelines is intended to assist PC clinicians in the identification and initial management of adolescents with depression in an era of great clinical need and shortage of mental health specialists, but they cannot replace clinical judgment; these guidelines are not meant to be the sole source of guidance for depression management in adolescents. Additional research that addresses the identification and initial management of youth with depression in PC is needed, including empirical testing of these guidelines.
Background
Mounting evidence indicates that early recognition and treatment of behavioral health disorders can prevent complications, improve quality of life, and help reduce health care costs. The aim of this systematic literature review was to identify and evaluate publicly available, psychometrically tested tools that primary care physicians (PCPs) can use to screen adult patients for common mental and substance use disorders such as depression, anxiety, and alcohol use disorders.
Methods
We followed the Institute of Medicine (IOM) systematic review guidelines and searched PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health Literature, and Health and Psychosocial Instruments databases to identify literature addressing tools for screening of behavioral health conditions. We gathered information on each tool’s psychometrics, applicability in primary care, and characteristics such as number of items and mode of administration. We included tools focused on adults and the most common behavioral health conditions; we excluded tools designed for children, youth, or older adults; holistic health scales; and tools screening for serious but less frequently encountered disorders, such as bipolar disorder.
Results
We identified 24 screening tools that met the inclusion criteria. Fifteen tools were subscales stemming from multiple-disorder assessments or tools that assessed more than one mental disorder or more than one substance use disorder in a single instrument. Nine were ultra-short, single-disorder tools. The tools varied in psychometrics and the extent to which they had been administered and studied in primary care settings.
Discussion
Tools stemming from the Patient Health Questionnaire had the most testing and application in primary care settings. However, numerous other tools could meet the needs of primary care practices. This review provides information that PCPs can use to select appropriate tools to incorporate into a screening protocol.
Sleep is essential for optimal health in children and adolescents. Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health in children and adolescents using a modified RAND Appropriateness Method. The recommendations are summarized here. A manuscript detailing the conference proceedings and the evidence supporting these recommendations will be published in the Journal of Clinical Sleep Medicine.
Objective:
The objective was to conduct a scientifically rigorous update to the National Sleep Foundation's sleep duration recommendations.
Methods:
The National Sleep Foundation convened an 18-member multidisciplinary expert panel, representing 12 stakeholder organizations, to evaluate scientific literature concerning sleep duration recommendations. We determined expert recommendations for sufficient sleep durations across the lifespan using the RAND/UCLA Appropriateness Method.
Results:
The panel agreed that, for healthy individuals with normal sleep, the appropriate sleep duration for newborns is between 14 and 17 hours, infants between 12 and 15 hours, toddlers between 11 and 14 hours, preschoolers between 10 and 13 hours, and school-aged children between 9 and 11 hours. For teenagers, 8 to 10 hours was considered appropriate, 7 to 9 hours for young adults and adults, and 7 to 8 hours of sleep for older adults.
Conclusions:
Sufficient sleep duration requirements vary across the lifespan and from person to person. The recommendations reported here represent guidelines for healthy individuals and those not suffering from a sleep disorder. Sleep durations outside the recommended range may be appropriate, but deviating far from the normal range is rare. Individuals who habitually sleep outside the normal range may be exhibiting signs or symptoms of serious health problems or, if done volitionally, may be compromising their health and well-being.
This study examined associations between the extent of anxiety disorder in adolescence (14-16 years) and young people's later risks of a range of mental health, educational, and social role outcomes (16-21 years).
Data were gathered over the course of a 21-year longitudinal study of a birth cohort of 1,265 New Zealand children. Measures collected included (1) an assessment of DSM-III-R anxiety disorders between the ages of 14 and 16 years; (2) assessments of mental health, educational achievement, and social functioning between the ages of 16 and 21 years; and (3) measures of potentially confounding social, family, and individual factors.
Significant linear associations were found between the number of anxiety disorders reported in adolescence and later risks of anxiety disorder; major depression; nicotine, alcohol, and illicit drug dependence; suicidal behavior; educational underachievement; and early parenthood. Associations between the extent of adolescent anxiety disorder and later risks of anxiety disorder, depression, illicit drug dependence, and failure to attend university were shown to persist after statistical control for the confounding effects of sociofamilial and individual factors.
Findings suggest that adolescents with anxiety disorders are at an increased risk of subsequent anxiety, depression, illicit drug dependence, and educational underachievement as young adults. Clinical and research implications are considered.
To examine the correlates and consequences of high levels of depressive symptoms among adolescents.
Secondary analysis of the 1997 Commonwealth Fund Survey of the Health of Adolescent Girls, a survey of a nationally representative sample of 4648 adolescent boys and girls between the ages of 10 and 18 years, inclusive, conducted in school settings. The self-administered questionnaire contains a screening instrument for depression based on the Children's Depression Inventory.
Days of school missed, performance at grade level, alcohol use, drug use, smoking, and bingeing.
After controlling for sociodemographics, life events, sexual abuse, physical abuse, and exposure to violence, relative to other children, children and adolescents with high degrees of depressive symptoms missed about 1 day more of school in the month preceding the survey (P<.05) and had higher odds of smoking (odds ratio, 1.84; P<.001), bingeing (odds ratio, 2.02; P<.001), and suicidal ideation (odds ratio, 16.59; P<.001).
High levels of depressive symptoms are correlated with serious and significant consequences, even after controlling for life circumstances.
The PHQ-9: validity of a brief depression severity measure
- Kroenke