Article

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

ABSTRACT

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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    • "In line with the results of previous studies (Leger et al., 2012; Meijer, 2008; Roberts et al., 2008), adolescent girls reported symptoms of insomnia as well as tiredness and fatigue much more often than did boys. It has been suggested previously that the gender difference in symptoms of insomnia emerges only after puberty, before which there is either no gender difference, or boys may report insomnia-related symptoms more often do than girls (Johnson et al., 2006; Luntamo et al., 2012). We found the maximum overall prevalence of sleep-related symptoms among the 15-year-olds, possibly because of the puberty-related circadian shift towards eveningness, which may cause a delay in sleep timing, difficulty falling asleep, a shortening of sleep duration, a growing discrepancy between weekday and weekend sleep patterns and daytime tiredness (Carskadon et al., 1993; Crowley et al., 2007). "
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