Psychosocial Determinants of Insomnia in Adolescents: Roles of Mental Health, Behavioral Health, and Social Environment

Abstract

The theoretical explanation of human problems is derived from the complex interplay of psychological, social, economic, political, and physical factors. Aims This study examined the roles of behavioral health (i.e., alcohol abuse and suicidality) and social environment (i.e., family support, school connectedness, and favorable neighborhood) and mental health [i.e., depression, anxiety, and attention deficit hyperactivity disorder (ADHD)] in predicting insomnia in adolescents in an ecological perspective. Methods Approximately 6445 high school students in Taiwan were administered an anonymous self-report survey. Hierarchical multiple regression was performed to examine how multidimensional social environment, behavioral health, and mental health factors were associated with insomnia in adolescents. Results The prevalence rate of insomnia in the sample was 30%. The results indicated that alcohol abuse (β = 0.04), suicidality (β = 0.06), depression (β = 0.29), anxiety (β = 0.14), and ADHD (β = 0.11) were positively associated with insomnia ( p < 0.001), whereas family support (β = −0.06), school connectedness (β = −0.05), and favorable neighborhood ( β = −0.10) were negatively associated with insomnia ( p < 0.001). Sex did not predict insomnia, but age was positively associated with insomnia (β = 0.09, p < 0.001). Among all predictors of insomnia in the study, mental health factors, especially depression, play a major role on insomnia among adolescents, and is as much important as social environment factors. Conclusion This study demonstrated how both psychosocial variables (social environment and behavioral health) and psychological symptoms were associated with insomnia in adolescents when the demographic variables (sex and age) were controlled and provided valuable information and evidence for clinicians, social workers, and health professionals who provide support to adolescents with insomnia. Applying an ecological approach in practice can aid in understanding at individual, family, school, and community levels and in identifying the strengths and weaknesses of their interactions with each other. Implications This perspective enables practitioners in effectively treating problems and addressing the needs of the various levels, including the individual, family, school, and the broader community. Thus, prevention and intervention of insomnia in adolescents should focus on multidimensional risk and protective factors, including mental health, behavioral health, and social environment, in the context of an ecological system.

Family and School Context: Effects on the Mental Health of Brazilian Students

“…Furthermore, changes in sleep quality and behavioral problems are related to mental health, as explained by Short et al [18] and Xiao et al [34]. Poor sleep quality can cause psychosomatic problems and can indicate mental suffering [35].…”

“…Additionally, adolescents who experience unstructured families, disagreements, breakups and marital violence between parents, and familial violence are at a greater risk of mental disorders [10,36]. Stressful relationships with family and limited emotional support [35] are related to poor sleep quality and difficulty in falling asleep due to worry.…”

“…The support of parents, guardians, teachers, and friends alleviates the effects of exposure to both familial and school violence, playing a protective role for mental health [4,8,10,13,41]. Loneliness [33] and poor sleep quality [35] can cause serious physical and psychological problems, worsening mental health in the long term.…”

Psychosocial factors affecting sleep misperception in middle-aged community-dwelling adults

“…Most are internal factors (e.g., psychiatric/medical comorbidities or subclinical psychological problems) that can cause mismatches between perceived and measured sleep times [ 15 , 16 ]. Insomnia is also affected by social factors, such as marital status, social support, and social connectedness [ 17 – 19 ]. Unfavorable social factors can act as psychological stressors and cause insomnia, regardless of whether an individual has depression or anxiety [ 20 ].…”

Social Media Big Data-Based Research on the Influencing Factors of Insomnia and Spatiotemporal Evolution

“…Bao et al [15] found through a questionnaire survey of 1,053 volunteers that family income is a risk factor for sleep quality; when the household income is higher, the probability of insomnia is lower. Hsieh et al [16] surveyed 6,445 college students and found that social factors play an important role in adolescents' sleeping problems. However, as mentioned above, most of the existing studies conduct questionnaire surveys among a limited population, and the sample size and questionnaire recovery rate are generally low.…”