Sleep disturbance as transdiagnostic mediator between adverse childhood experiences and psychopathology in children and adolescents: A structural equation modeling meta‐analysis

Abstract

BackgroundIncreasing research efforts have focused on understanding why some individuals develop severe psychopathology after exposure to adverse childhood experiences (ACEs). Sleep disturbances (insomnia, nightmares, and sleep disorders) are prevalent sequelae of ACEs and associated with psychopathology; however, there is no meta‐analytic evidence on whether sleep disturbance functions as a transdiagnostic mediator in the relationship between ACEs and psychopathology (internalizing/externalizing disorders and psychosis) in children and adolescents.MethodsSystematic searches in three databases (PubMed; PsycINFO; Web of Science) identified 98 articles (N = 402,718; age range 1–17 years) and the present study used a novel two‐stage meta‐analytic structural equation model to investigate whether ACEs predict psychopathology through sleep disturbance. Subgroup analyses determined potential biases due to study design (cross‐sectional vs. longitudinal) and geographical differences (Western vs. non‐Western countries). Sensitivity analyses evaluated the influence of early childhood (<5 years old) and overlapping symptoms (i.e., nightmares and trauma symptoms) on model stability.ResultsThe pooled correlations among ACEs, sleep disturbance, and psychopathology were significant; the effect sizes ranged from moderate to high (r = 0.21 to r = 0.29). The indirect effect from ACEs via sleep disturbance to psychopathology was significant (β = 0.05, 95% CI [0.04, 0.06]). The direct effect of ACEs on psychopathology was significant (β = 0.18, 95% CI 0.13–0.24). Subgroup analyses revealed larger effects for cross‐sectional studies than longitudinal studies (Δ χ2 (3) = 9.71, p = 0.021). Sensitivity analyses revealed stable and consistent results.ConclusionsThe present meta‐analytic results indicate that sleep disturbance is a transdiagnostic mediator in the relationship between ACEs and psychopathology among children and adolescents. Further research is required to determine the synergistic effects between sleep disturbance and other risk mechanisms, and elucidate the complex pathways that lead to disorder in the aftermath of childhood adversities.

Evidence‐based child and adolescent mental health care: The role of high‐quality and transparently reported evidence synthesis studies

“…These papers not only focused on important research questions but also showcased recent developments in methodology for evidence synthesis and good practices for reporting findings of systematic reviews and meta-analyses. In particular, Liu et al (2023) used meta-analytic structural equation modelling as their primary analytic method. This novel methodology for evidence synthesis allows to combine the strengths of meta-analysis and structural equation modelling for investigating complex relationships between different outcome measures (in this case, adverse childhood experiences, sleep problems, and psychopathology).…”

“…Another key focus was on early predictors, including one study reporting an association between markers of autonomic functioning and self‐injurious thoughts and behaviours in children and young people (Bellato et al., 2023 ), and another showing that sleep disturbances are transdiagnostic mediating factors of the relationship between adverse childhood experiences and psychopathology in children and adolescents (Liu et al., 2023 ).…”

“…In particular, Liu et al. ( 2023 ) used meta‐analytic structural equation modelling as their primary analytic method. This novel methodology for evidence synthesis allows to combine the strengths of meta‐analysis and structural equation modelling for investigating complex relationships between different outcome measures (in this case, adverse childhood experiences, sleep problems, and psychopathology).…”

Evidence-based child and adolescent mental health care: The role of high-quality and transparently reported evidence synthesis studies

“…Another key focus was on early predictors, including one study reporting an association between markers of autonomic functioning and self-injurious thoughts and behaviours in children and young people (Bellato et al, 2023), and another showing that sleep disturbances are transdiagnostic mediating factors of the relationship between adverse childhood experiences and psychopathology in children and adolescents (Liu et al, 2023).…”