Prospective Longitudinal Associations Between Persistent Sleep Problems in Childhood and Anxiety and Depression Disorders in Adulthood

Article (PDF Available)inJournal of Abnormal Child Psychology 33(2):157-63 · May 2005with31 Reads
DOI: 10.1007/s10802-005-1824-0 · Source: PubMed
Abstract
The objective of this study was to examine the associations between persistent childhood sleep problems and adulthood anxiety and depression. Parents of 943 children (52% male) participating in the Dunedin Multidisciplinary Health and Development Study provided information on their children's sleep and internalizing problems at ages 5, 7, and 9 years. When the participants were 21 and 26 years, adult anxiety and depression were diagnosed using a standardized diagnostic interview. After controlling for childhood internalizing problems, sex, and socioeconomic status, persistent sleep problems in childhood predicted adulthood anxiety disorders (OR (95% CI) = 1.60 (1.05-2.45), p = .030) but not depressive disorders (OR (95% CI) = .99 (.63-1.56), p = .959). Persistent sleep problems in childhood may be an early risk indicator of anxiety in adulthood.

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GOLDSMITHS Research Online
Article (refereed)
Gregory, Alice M., Caspi, Avshalom, Eley, Thalia C., Moffitt, Terrie E.,
O'Connor, Thomas G. and Poulton, Richie
Prospective longitudinal associations between persistent
sleep problems in childhood and anxiety and depression
disorders in adulthood
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Prospective longitudinal associations between persistent sleep problems in
childhood and anxiety and depression disorders in adulthood. Journal of
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Originally published: Journal of Abnormal Child Psychology, Vol. 33, No. 2, April 2005, pp. 157–163 (
C_ 2005) Received March 21, 2004; revision received November 2, 2004; accepted November 18, 2004
DOI: 10.1007/s10802-005-1824-0
Prospective Longitudinal Associations Between
Persistent Sleep Problems in Childhood and Anxiety
and Depression Disorders in Adulthood
Alice M. Gregory,1,5 Avshalom Caspi,1,2 Thalia C. Eley,1 Terrie E.
Moffitt,
1,2 Thomas G. O’Connor,3 and Richie Poulton4
The objective of this study was to examine the associations between persistent childhood sleep
problems and adulthood anxiety and depression. Parents of 943 children (52% male)
participating in the Dunedin Multidisciplinary Health and Development Study provided
information on their children’s sleep and internalizing problems at ages 5, 7, and 9 years. When
the participants were 21 and 26 years, adult anxiety and depression were diagnosed using a
standardized diagnostic interview. After controlling for childhood internalizing problems, sex,
and socioeconomic status, persistent sleep problems in childhood predicted adulthood anxiety
disorders (OR (95% CI) = 1.60 (1.05– 2.45), p = .030) but not depressive disorders (OR (95% CI) =
.99 (.63–1.56), p = .959). Persistent sleep problems in childhood may be an early risk indicator of
anxiety in adulthood.
Keywords: sleep problems; anxiety; depression.
Introduction
Recent research suggests that childhood sleep problems may predict the development of
subsequent internalizing problems in adolescence (Gregory & O’Connor, 2002). Despite growing
support for this proposition, the longitudinal significance of childhood sleep problems for mental
health remains unclear because studies to date have used relatively short follow-up periods.
Furthermore, the possibility that sleep problems predict certain internalizing disorders and not
others has not been fully investigated as existing studies tend to examine variation in
general outcomes, rather than in specific psychiatric outcomes. This study seeks to clarify the
longitudinal significance and specificity of persistent sleep problems in childhood on anxiety and
depression diagnosed in adulthood.
1Institute of Psychiatry, King’s College London, London, United Kingdom. 2University of Wisconsin-
Madison, Madison, Wisconsin.
3University of Rochester, Rochester. 4University of Otago, Dunedin, New
Zealand.
5Address all correspondence to Alice Gregory, SGDPC, PO80, Institute of Psychiatry, De Crespigny
Park, London SE5 8AF, United Kingdom; e-mail: a.gregory@iop.kcl.ac.uk.
Predictive Associations Between Sleep Problems and Internalizing
Problems
Research examining predictive associations between sleep problems and internalizing problems
has focused on adults. Such work has typically examined the association between insomnia and
depression, and suggests that adults’ sleep problems forecast depression (e.g. Breslau,
Roth,Rosenthal,&Andreski, 1996; Chang, Ford, Mead, Cooper-Patrick, & Klag, 1997; Ford &
Kamerow, 1989; Livingston, Blizard, & Mann, 1993; Weissman, Greenwald, Nino-Murcia, &
Dement, 1997; for a review seeRiemann&Voderholzer, 2003). Longitudinal research linking sleep
problems and anxiety in adults also suggests a connection (e.g. Breslau et al., 1996; Ford &
Kamerow, 1989). The biological mechanisms underlying these associations have yet to be fully
elucidated.
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Childhood risk indicators, such as parental loss, family conflict, and physical and sexual abuse,
have been identified for the development of later internalizing problems (e.g. Birmaher et al.,
1996; Fergusson, Horwood, & Lynskey, 1996). Less attention, however, has been paid to assessing
the predictive associations between sleep problems and internalizing problems in children.
One prospective longitudinal study of 490 children found that a composite measure of commonly
reported sleep problems (e.g. nightmares, sleep-talking/walking, atypical sleep duration) at 4
years was associated with an increase in internalizing problems in mid-adolescence, after
controlling for early symptoms of internalizing problems (Gregory & O’Connor, 2002). Other
studies using different definitions of sleep problems and different age groups have found parallel
associations (Gregory, Eley, O’Connor, & Plomin, 2004; Wong, Brower, Fitzgerald, &
Zucker, 2004). Further studies examining clinically significant levels of internalizing problems
have not found a longitudinal link (Johnson, Chilcoat, & Breslau, 2000; Stoleru, Nottelmann,
Belmont, & Ronsaville, 1997). It is noteworthy that the prediction of later internalizing problems
from sleep problems is more robust in adults than in children, suggesting that sleep problems
may be a better predictor of internalizing problems in older than in younger participants. What no
research has yet investigated is whether sleep problems in childhood predict adult outcomes.
The hypothesis that sleep problems in childhood forecast internalizing psychopathology in
adulthood is suggested by research demonstrating persistence and co-occurrence of sleep and
internalizing problems over long time-frames (e.g. Gregory & O’Connor, 2002; Pine, Cohen,
Gurley, Brook, & Ma, 1998).
Predictive Associations Between Sleep Problems and Internalizing
Problems: Methodological and Conceptual Refinements
In contrast to the adult literature, which typically focuses on sleep problems predicting anxiety
and depression disorders (e.g. Ford & Kamerow, 1989), much of the child literature focuses
instead on individual differences incorporating both normal and pathological levels of
disturbance. In particular, some of the strongest evidence to date for a link between sleep and
later internalizing problems is based on nonclinical samples and variation within the normal
range rather than on outcomes with obvious clinical relevance. Accordingly, in the current study
we examine the extent to which early sleep problems in childhood predict clinically significant
levels of disturbance in adulthood, namely, disorder.
A further problem in much of the previous research on children is the reliance on parent reports
of both sleep problems and internalizing problems. This creates the possibility of rater bias
artificially inflating the association between sleep and internalizing problems. The current
study overcomes this limitation by directly assessing anxiety and depression according to
standard clinical interview techniques.
Adult studies examining different types of internalizing problems have found sleep problems to
forecast both anxiety and depression (e.g. Breslau et al., 1996; Ford & Kamerow, 1989). Child
research tends not to examine different types of internalizing problems, and often
examines combined anxiety-depression phenotypes, partly reflecting parents’ difficulty in
differentiating between symptoms of anxiety and of depression in their children (Achenbach,
1991). Hence, the possibility that childhood sleep problems predict certain internalizing problems
and not others needs to be further explored.
Hypotheses
In summary, three hypotheses were tested. First, we tested the hypothesis that there is a
predictive association between sleep problems and internalizing problems from childhood to
adulthood. Second, we tested the hypothesis that childhood sleep problems predict adult
internalizing disorders. Third,we tested the exploratory hypothesis that sleep problems constitute
a nonspecific risk factor for internalizing disorders in adulthood. These hypotheses were
examined in an entire birth cohort of 1,037 children born in Dunedin, New Zealand in 1972–1973.
Sleep Problems, Anxiety and Depression Goldsmiths Research Online
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Method
Participants
Participants are members of the Dunedin Multidisciplinary Health and Development Study, a
longitudinal investigation of the health and behavior of a complete birth cohort. 1,037 children
born between April 1, 1972 and March 31, 1973 in Dunedin, New Zealand (91% of eligible births;
52% male) participated at age 3 years. Cohort families are primarily White and represent the
full range of socioeconomic status in the general population of New Zealand’s South Island.
Follow-ups have been carried out at ages 5, 7, 9, 11, 13, 15, 18, and 21, and most recently at 26
years (N = 980: 96% of the living cohort members). At each assessment, participants
(including overseas emigrants) are brought back to the research unit within 60 days of their
birthday for a full day of data collection. All examiners are unaware of responses given in previous
assessments. Participants are fully reimbursed for any costs (e.g., travel; lost wages; child care).
At each assessment, the study protocol is approved by the Otago Ethics Committee. Study
members give informed consent before participating. In this article we report data on
sleep problems and covarying anxiety/depression from the 5-, 7-, and 9-year-old assessments;
and on anxiety and depressive disorders at 21 and 26 years.
Measures
Socioeconomic status (SES) of the study members’ familieswas measured on a 6-point scale that
assessed parents’ self-reported occupational status. The scale allocates each occupation to one of
six categories (6 = unskilled laborer, 1 = professional) on the basis of the educational levels and
income associated with that occupation in data from the New Zealand census. The variable used
in our analyses, childhood SES, is the average of the highest SES level of either parent, assessed
repeatedly during the study member’s first 15 years. The variable of childhood SES thus reflects
the socioeconomic conditions experienced by the study members as they grew up.
Given that previous research has highlighted the importance of unresolved sleep problems in
predicting emotional problems (e.g., Ford&Kamerow, 1989), a measure of persistent sleep
problems was developed. Parents reported on their children’s sleep problems at the 5-, 7- , and 9-
year assessments. At both 5 and 7 years, three questions explored sleep problems (“Sleep
problems last night?”, “Typically has sleep problems?”, “Does child have sleep problems?”). At the
9-year-old assessment, six items addressed sleep problems (“Sleep problems last night?”,
“Sleeping difficulties?”, “Child has trouble falling asleep?”, “Child awakens at night and can’t
return to sleep?”, “Child slept much more recently?”, “Child wakens very early?”). Although these
items were originally coded on different scales, each item was recoded on a binary scale (0 = no
sign of a problem; 1 = sign of a problem). In order to focus on sleep problems that did not desist, a
binary “persistent sleep problem” variable was developed, with children scoring 1 if they showed
signs of a sleep problem at the latest (9-year-old) assessment (i.e., scored 1 point on at least 1
item) and at one or more other times, and 0 otherwise. Although the reliability of the persistent
sleep problem scale might have been improved by increasing the number of affirmative responses
necessary for group-membership, this would have reduced the number of participants in the
persistent sleep problem group (and hence power to detect effects). Juvenile internalizing
problems were assessed by parent report using the Rutter Child Behaviour Scales (Rutter, Tizard,
& Whitmore, 1970) at 5, 7, and 9 years. Items include: “Often worried, worries about many
things” and “often appears miserable, unhappy, tearful, or distressed.” Each item was scored on a
3-point scale (0 = does not apply; 1 = applies somewhat; 2 = certainly applies). Scores for these items
were summed separately at each age and then averaged across the three time-points. This
measure was used to control for childhood internalizing symptoms while testing for a connection
between childhood sleep and adult disorders. The reliability and validity of the Rutter Child
Behaviour Scale is demonstrated elsewhere (Sclare, 1997).
Anxiety and depression were examined in private standardized interviews at 21 and 26 years by
means of the Diagnostic Interview Schedule (Robins, Cottler, Bucholz, & Compton, 1995; Robins,
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Helzer, Croughan, & Ratcliff, 1981), administered by interviewers unaware of cohort members’
previous data, including their mental health status. Modifications, procedures, reliability,
validity, prevalence, and evidence of impairment have been described in detail at 21 years of age
(Newman, Moffitt, Silva, & Stanton, 1996). At age 26, diagnoses were made following the
Diagnostic and Statistical Manual of Mental Disorders, Version 4 (DSM-IV: American
Psychiatric Association, 1994) criteria, and at 21 years disorders were diagnosed according to the
then-current DSM-IIIR (American Psychiatric Association, 1987) criteria. The reporting periodwas
12 months before interview. Dunedin cohort prevalence rates in young adulthood match
closely those from the U.S. National Comorbidity Survey (Kessler et al., 1994; Newman et al.,
1996). Here we focus on study members who met criteria for any anxiety disorder or any
depressive disorder at either time-point. The seven anxiety disorders examined were Generalized
Anxiety Disorder, Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder (data only
available at 26 years), Panic Disorder, Agoraphobia, Simple Phobia, and Social Phobia. The
depressive disorders examined were Major Depressive Episode (MDE) and Dysthymia.
Statistical Analyses
Differences between children with and without persistent sleep problems were examined using
two-tailed tests. The associations between childhood sleep problems and adulthood anxiety and
depression were examined using chi-squared tests. The prediction of anxiety in adulthood from
persistent sleep problems up to age 9 years was established by means of two-tailed logistic
regression. Two different models examined the prediction of each phenotype. Model 1 examines
the unadjusted odds ratio for persistent sleep problems predicting the outcome variable (anxiety
or depression). Model 2 examines the odds ratio for sleep problems predicting the outcome
variable, after controlling for the effects of sex, SES, and childhood internalizing problems.
Childhood internalizing problems were controlled to demonstrate whether childhood
sleep problems, apart from those secondary to childhood anxiety and depression, predicted adult
disorder, over and above the known continuity from childhood internalizing symptoms to adult
disorders. Incidentally, controlling for childhood anxiety and depression also accounted for
the contemporary effects of risk factors associated with these problems.
Results
Data on sleep problems were available for 943 children (52% male); 12.4% (n = 117) of the
children had a persistent sleep problem. Children with and those without persistent sleep
problems did not differ significantly on SES or sex. Children with persistent sleep problems,
however, had more internalizing childhood problems (mean= 2.76, SD = 1.55) than those without
persistent sleep problems (mean=2.09, SD=1.44; t (940)=4.66,p < .001). Of those children
providing data on sleep problems at 9 years old, 912 (97%) also provided data on anxiety and
depression in adulthood (at 21 and/or 26 years old). Of these adults, 34% and 28% were
considered to have any anxiety and depression disorders, respectively. Figure 1 shows the
proportion of children with and those without persistent sleep problems who have anxiety
and depression disorders in adulthood. Forty-six per cent of children with persistent sleep
problems had anxiety in adulthood, compared to 33% of children without persistent sleep
problems at 9 (÷
2 = 6.74, df = 1, p = .014). In contrast, there were no differences in the proportion
of participants with and those without persistent sleep problems who manifested depression in
adulthood (both = 28%; ÷
2 = 0, df = 1, p = 1.000). The results of the logistic regression analyses
are presented in Table I. Even after controlling for child sex, SES, and childhood internalizing
problems, persistent sleep problems predicted adulthood anxiety (OR (95% CI) = 1.60 (1.05–
2.45), p = .030), but not depression (OR(95% CI) = 1.04 (.63–1.56), p = .959).
Discussion
Findings from this prospective longitudinal cohort study of nearly 1,000 individuals support a
link between persistent sleep problems in childhood and diagnosed anxiety in adulthood, after
controlling for sex, SES, and childhood internalizing symptoms. Although childhood internalizing
problems were controlled in the analyses, these results do not necessarily imply that early
Sleep Problems, Anxiety and Depression Goldsmiths Research Online
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sleep problems predict an increase in later anxiety, as different measures were used to examine
anxiety at the different ages. Furthermore, it is possible that anxiety in adulthood is qualitatively
different from that experienced in childhood. Nevertheless, these data provide the strongest
evidence to date of the association between sleep problems in childhood and psychiatric
disorders in adulthood. The association between childhood sleep problems with diagnosed
depression in adulthood was nonsignificant.
Childhood Sleep Problems Predict Anxiety in Adulthood
One possible mechanism underlying the association of sleep problems with anxiety is that both
have similar underlying risk factors. Certain environmental risk factors, such as difficult peer
relations and stressful life events, may influence both sleep problems and anxiety (Eley
& Stevenson, 2000; Kumpulainen et al., 1998; Sadeh, 1996;
Fig. 1. Percentage of study members with and without persistent childhood sleep problems who develop anxiety
and depressive disorders in adulthood (with standard error bar).
Table I. Predicting Anxiety and Depressive Disorders in Adulthood From Persistent Sleep Problems in Childhood
Model number Variable
B SE
p
OR
95% CI for
OR
Predicting anxiety disorders at
21/26
Model 1 Sleep problems .53 .21 .010 1.70 1.14–2.54
Model 2 Anxiety/depression at 5, 7, and 9 .16 .05 .001 1.17 1.07–1.29
Sex -.80 .15 .000 .45a .34–.60
SES -.21 .07 .002 .81 .71–.93
Sleep problems .47 .22 .030 1.60 1.05–2.45
Predicting depression
disorders at 21/26
Model 1 Sleep problems .00 .23 1.000 1.00 .64–1.56
Model 2 Anxiety/depression at 5, 7, and 9 .07 .05 .175 1.07 .97–1.19
Sex -.81 .15 .000 .45 .33–.60
SES .02 .07 .781 1.02 .89–1.16
Sleep problems -.01 .23 .959 .988 .63–1.56
Note. Models 1 provide the unadjusted odds ratio for sleep problems predicting later anxiety and depressive disorders.
Models 2 provide the odds ratios after controlling for covarying factors. B = coefficient; SE = Standard Error of B; p =
significance level; OR = odds ratio; CI = confidence intervals.
aCoded as: 1 = female; 2 = male.
Williams, Chambers, Logan, & Robinson, 1996). Recent research also suggests that genetic
influences may play a part in the association between anxiety and sleep problems (Gregory et al.,
2004). Candidate genes playing a role in the association between sleep problems and
anxiety include those involved in the serotonin system, which contributes to variation in many
physiological functions, including sleep and anxiety (Adrien, 2002; Eley, Collier, & McGuffin,
2002). Additionally, cognitive biases such as anxiety sensitivity and depressogenic attributional
style are associated with both sleep problems and anxiety, and may act as risk factors for both (see
Gregory & Eley, in press).
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A second possible mechanism for the association between persistent sleep problems and anxiety
is causal. Longitudinal research comparing the psychiatric status of adults successfully treated for
childhood sleep problems with that of those untreated for childhood sleep problems could provide
a means of testing this hypothesis.
A third explanation for the association between sleep problems and anxiety is that the former are
a subclinical prodrome of the latter. Sleep problems may represent subclinical anxiety symptoms
that parents did not pick up or report. These anxiety symptoms may develop to become clinically
significant, as the result of a more stressful developmental era (i.e., adolescence), or may be
identified in adulthood by the employment of more sensitive measurement made directly of the
affected individual. Explanations for the longitudinal association between sleep problems and
anxiety need to be further developed in order to account for the nonassociation between sleep
and depression.
Childhood Sleep Problems Do Not Predict Depression in Adulthood
The finding that childhood sleep problems predict anxiety but not depression was unexpected.
Although fewer adults were considered depressed than anxious, differences in power to detect
associations cannot explain the specificity reported in this study, as there was no sign of a trend
for persistent childhood sleep problems predicting adulthood depression. Furthermore, the
possibility that the association between early sleep problems and later depression was not found
because confounding variables were overcontrolled cannot explain the results reported here; for
removing childhood internalizing problems, sex, and SES from the analyses (models 1) resulted in
substantially identical results. Instead, the findings reported here suggest that there may be
etiological differences between anxiety and depression. However, it is somewhat puzzling that
sleep problems predict anxiety and not depression, given high levels of comorbidity between
anxiety and depression (Kovacs & Devlin, 1998). Hence, a replication of this finding would be
valuable.
Limitations
Despite the many strengths of this study—including the use of an entire birth cohort, the
longitudinal nature of the study, low attrition rates and diagnostic data—its limitations must be
acknowledged. One limitation concerns the measure used to examine sleep problems. As is
common in epidemiological samples, this study did not include a detailed assessment of sleep
problems. Instead, a measure was developed from available items for the purposes of this report.
Themeasure used provides subjective information about the persistence of commonly-reported
childhood sleep problems, in contrast to polysomnographic data on sleep disorders. The general
nature of the questions used to examine sleep problems (e.g. “Does child have sleep problems?”)
means that parents may have reported upon a wide range of sleep problems, such as insomnia,
nightmares, and sleepwalking, and may have included problems of varying severity. Hence, these
findings should not be extrapolated to clinically significant specific sleep disorders such as
insomnia, which may have different associations with anxiety and depression. A further
consideration with regard to the interpretations of the results concerns the method used to
categorize sleep problems. For a priori reasons specified above, the focus of this report was sleep
problems that did not desist by the age of 9 years. However, when other sleep problem scales were
examined, significant results were not always obtained. For example, when persistence was
defined as a sleep problem at any two or more time points, there was a nonsignificant trend for
sleep problems to predict anxiety (OR (95% CI) = 1.35 (.92–2.00), p = .13) but not depression (OR
(95% CI) = .89 (.58–1.35), p = .57). However, by taking the mean of all 12 dichotomous
sleep problem items and standardizing the scale, sleep problems predicted anxiety (OR (95% CI) =
1.15 (1.00–1.32), p = .05) but not depression (OR (95% CI) = 1.02 (.89– 1.18), p = .75). These
results need to be considered when interpreting the results of this study.
A further limitation is that the sleep measure used in this study relied on parent-reports.
Although parentreports are useful in the assessment of child sleep problems, additional self-
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reports would have been informative (especially in later childhood assessments). Despite
the shortcomings of our sleep-measure we found a specific association with adulthood anxiety
disorders. It is therefore possible that using an improved sleep-measure we would have found an
even stronger effect.
An additional limitation concerns the absence of sleep data from the adulthood assessment. This
means that alternative hypotheses concerning the direction of effects between sleep and co-
occurring problems could not be examined. Finally, associations between persistent sleep
problems and different types of anxiety disorders are not presented here. Unreported analyses
indicated trends for children with persistent sleep problems to be more likely to have each type of
anxiety disorder (with the exception of agoraphobia). Only the associations between persistent
sleep problems and social phobia and generalized anxiety disorder reached significance. For
clarity of presentation, and because groups having specific anxiety disorders tended to be small,
co-morbid with other anxiety disorders, or both, these analyses are not reported. Although MDE
and dysthymia were also grouped, analyses (unreported) showed that MDE examined
separately showed similar null associations with sleep problems.
Clinical Implications
The possibility that sleep problems are a sign of concurrent anxiety tendencies that parent reports
do not identify, suggests that it may be beneficial to obtain detailed examinations of anxiety
symptoms in children presenting with sleep problems. Furthermore, the finding that persistent
sleep problems in childhood predict adulthood anxiety disorders suggests that persistent
childhood sleep problems should not be ignored as some cases may represent an early indicator
that subsequent anxiety may develop. Once individuals at risk of later anxiety disorders are
identified, the likelihood of an anxiety disorder developing may be reduced by employing
preventive programs (Rapee, 2002). As there was also a high rate of anxiety disorders in adults
who did not have persistent sleep problems as children, other risk factors for the development
of adulthood anxiety need to be considered. Finally, if it were found that sleep problems were
themselves a risk factor for the development of anxiety, then the early identification and treatment
of sleep problems in children might prevent the development of later anxiety disorders.
Acknowledgements
We thank the Dunedin Study members, Unit research staff, Air NewZealand, Alan Taylor,
HonaLee Harrington, and Phil Silva. The Dunedin Multidisciplinary Health and Development
Research Unit is supported by the New Zealand Health Research Council. This research is
supported by grants from the National Institute of Mental Health (MHY9414, MH5070) and the
UK MRC. Terrie Moffitt is a Royal SocietyWolfson Research Merit Award holder. Alice Gregory
was supported by a UK MRC studentship whilst involved in much of this research. She
is currently funded by an ESRC Postdoctoral Fellowship.
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Sleep Problems, Anxiety and Depression Goldsmiths Research Online
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    • "Future studies are needed to clarify the independence of the nightmares-BPD link, and may incorporate qualitative assessments to identify themes pertinent to BPD symptoms specifically. Third, as with other epidemiological studies conducted over long time-spans (Gregory et al. 2005 ), we had to rely on fairly crude caregiverreported measures of sleep problems and other risk factors, some of which were assessed with just one item. For example , mothers were asked whether their child had Bregular^ sleep problems, precluding ascertainment of the precise frequency of sleep problems at each time-point. "
    [Show abstract] [Hide abstract] ABSTRACT: Sleep disorders, such as insomnia and nightmares, are commonly associated with Borderline Personality Disorder (BPD) in adulthood. Whether nightmares and sleep-onset and maintenance problems predate BPD symptoms earlier in development is unknown. We addressed this gap in the literature using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants included 6050 adolescents (51.4 % female) who completed the UK Childhood Interview for DSM-IV BPD at 11 to 12 years of age. Nightmares and sleep onset and maintenance problems were prospectively assessed via mother report when children were 2.5, 3.5, 4.8 and 6.8 years of age. Psychopathological (i.e., emotional temperament; psychiatric diagnoses; and emotional and behavioural problems) and psychosocial (i.e., abuse, maladaptive parenting, and family adversity) confounders were assessed via mother report. In logistic regressions, persistent nightmares (i.e., regular nightmares at 3 or more time-points) were significantly associated with BPD symptoms following adjustment for sleep onset and maintenance problems and all confounders (Adjusted Odds Ratio = 1.62; 95 % Confidence Interval = 1.12 to 2.32). Persistent sleep onset and maintenance problems were not significantly associated with BPD symptoms. In path analysis controlling for all associations between confounders, persistent nightmares independently predicted BPD symptoms (Probit co-efficient [β] = 0.08, p = 0.013). Emotional and behavioural problems significantly mediated the association between nightmares and BPD (β =0.016, p < 0.001), while nightmares significantly mediated associations between emotional temperament (β = 0.001, p = 0.018), abuse (β = 0.015, p = 0.018), maladaptive parenting (β = 0.002, p = 0.021) and subsequent BPD. These findings tentatively support that childhood nightmares may potentially increase the risk of BPD symptoms in early adolescence via a number of aetiological pathways. If replicated, the current findings could have important implications for early intervention, and assist clinicians in the identification of children at risk of developing BPD.
    Full-text · Article · Apr 2016
    • "As expected, children from the high-risk families rated their homes as having more conflict, although groups did not differ in perceived cohesion. Conflict correlated with TST, in line with reports that the nature of the home environment during childhood is linked with selfreported sleep difficulties in children (e.g., Gregory et al., 2005). However, contrary to other studies that used parental reports on conflict, here we used children's reports. "
    [Show abstract] [Hide abstract] ABSTRACT: Children of alcoholic parents are at greater risk for developing substance use problems. Having a parent with any mental illness increases the risk for sleep disorders in children. Using actigraphy, this study characterized sleep in children of alcoholics and community controls over a period of 1 week. This study further examined whether sleep characteristics of the children mediated the relationship between self-regulation indices (i.e. undercontrol and resiliency) and outcome measures of function (e.g. problem behaviours and perceived conflict at home). Eighty-two children (53 boys, 29 girls, 7.2–13.0 years old) were recruited from the ongoing Michigan Longitudinal Study. Seventeen participants had no parental history of alcohol abuse or dependence (FH−), 43 had at least one parent who was a recovered alcoholic, and 22 had at least one parent who met diagnostic criteria within the past 3 years. Sleep was assessed with actigraphy and sleep diaries for 1 week, and combined with secondary analysis of data collected for the longitudinal study. FH− children had more objectively measured total sleep time. More total sleep time was associated with greater resiliency and behavioural control, fewer teacher-reported behavioural problems, and less child-reported conflict at home. Further, total sleep time partially mediated the relationship between resiliency and perceived conflict, and between resiliency and externalizing problems. These findings suggest that in high-risk homes, the opportunity to obtain sufficient sleep is reduced, and that insufficient sleep further exacerbates the effects of impaired dispositional self-regulatory capacity on behavioural and emotional regulation.
    Full-text · Article · Feb 2016
    • "It can be argued that fetal exposure to signals of adversity results in neurodevelopmental adjustments to prepare for a postnatal environment predicted to be hostile or threatening (Gluckman and Hanson, 2004 ). Internalizing symptoms could then reflect a survival strategy of increased vigilance in the face of threat or withdrawal from threat in an effort to conserve resources (Copeland et al., 2013; Gregory et al., 2005; Ialongo et al., 2001; Roza et al., 2003). Follow-up of the current study's cohort into adolescence will allow for continued examination of the potentially long-term effects of pCRH exposures. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: Fetal exposure to maternal prenatal stress hormones such as cortisol exerts influences on the developing nervous system that persist and include risk for internalizing symptoms later in life. Placental corticotropin-releasing hormone (pCRH) is a feto-placental stress signal that also shapes fetal neurodevelopment and may be a more direct indicator of the fetal experience than maternal stress hormones. The programming effects of pCRH on child development are unknown. The current investigation examined associations between prenatal maternal and placental stress hormone exposures (maternal cortisol and pCRH) and child self-reported internalizing symptoms at age 5. Method: Maternal plasma cortisol and pCRH levels were measured at 15, 19, 25, 31, and 36 weeks' gestation in a sample of 83 women and their 91 children (8 sibling pairs from separate pregnancies), who were born full-term. Child self-reported internalizing symptoms at age 5 were obtained using scales of the Berkeley Puppet Interview. Results: Placental CRH profiles (including elevations in mid-gestation) were associated with higher levels of internalizing symptoms at age 5. This effect was not explained by critical prenatal or postnatal influences, including obstetric risk, concurrent maternal psychological state, and family socio-economic status. Prenatal maternal cortisol was not significantly associated with child self-reported internalizing symptoms. Conclusions: Findings suggest that elevated exposures to the feto-placental stress signal pCRH exert programming effects on the developing fetal central nervous system, with lasting consequences for child mental health.
    Full-text · Article · Feb 2016
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