Sleep Problems Predict and Are Predicted by Generalized Anxiety/Depression and Oppositional Defiant Disorder

Abstract

Objective We tested whether sleep problems co-occur with, precede, and/or follow common psychiatric disorders during childhood and adolescence. We also clarified the role of comorbidity, and tested for specificity of associations among sleep problems and psychiatric disorders. Method Data came from the Great Smoky Mountains Study, a representative population sample of 1,420 children, assessed 4 to 7 times per person between ages 9 and 16 for major DSM-IV disorders and sleep problems. Sleep-related symptoms were removed from diagnostic criteria when applicable. Results Sleep problems during childhood and adolescence were common, with restless sleep and difficulty falling asleep being the most common symptoms. Cross-sectional analyses showed that sleep problems co-occurred with many psychiatric disorders. Longitudinal analyses revealed that sleep problems predicted increases in the prevalence of later generalized anxiety disorder and high generalized anxiety disorder/depression symptoms, and oppositional defiant disorder. In turn, generalized anxiety disorder and/or depression and oppositional defiant disorder predicted increases in sleep problems over time. Conclusions Sleep problems both predict and are predicted by a diagnostic cluster that includes oppositional defiant disorder, generalized anxiety disorder and depression. Screening children for sleep problems could offer promising opportunities for reducing the burden from mental illness during the early life course.

Advancing a Biopsychosocial and Contextual Model of Sleep in Adolescence: A Review and Introduction to the Special Issue

“…In a representative population sample of 1,420 youth (ages 8-14 years), Shanahan et al (2014) found that depression alone was neither predictive of nor predicted by sleep problems. In contrast, a reciprocal association was found between generalized anxiety and sleep problems: generalized anxiety predicted later sleep problems and sleep problems likewise predicted later generalized anxiety, leading the authors to conclude that ''generalized anxiety appeared to be the 'necessary ingredient' for longitudinal associations between internalizing distress disorders and sleep disturbance'' (Shanahan et al 2014, p. 555).…”

“…In considering externalizing problems more broadly, Armstrong et al (2014) found persistent parent-reported insomnia in childhood to significantly predict self-reported externalizing problems in adolescence. In the study by Shanahan et al (2014) described above, sleep problems both predicted and were predicted by oppositional defiant disorder (ODD), even after controlling for youth characteristics and comorbid psychiatric disorders. In addition, the bidirectional longitudinal associations with sleep problems were unique to oppositionality, as neither conduct disorder nor substance use disorders were longitudinally associated with sleep problems (Shanahan et al 2014).…”

“…In the study by Shanahan et al (2014) described above, sleep problems both predicted and were predicted by oppositional defiant disorder (ODD), even after controlling for youth characteristics and comorbid psychiatric disorders. In addition, the bidirectional longitudinal associations with sleep problems were unique to oppositionality, as neither conduct disorder nor substance use disorders were longitudinally associated with sleep problems (Shanahan et al 2014). Wong et al (2009) also found childhood sleep problems to longitudinally predict externalizing behaviors in adolescence.…”

“…Longitudinal research indicates that sleep functioning and substance use are reciprocally related (Pasch et al 2012), although exceptions have been reported (Shanahan et al 2014). In addition, it is unclear if the association between sleep problems and adolescent substance use is at least partly attributable to the presence of internalizing and externalizing mental health problems (Johnson and Breslau 2001) or if the link between sleep problems and teen substance use is independent of co-occurring psychopathology (Pieters et al 2010).…”

“…For instance, it appears that sleep problems do not confer risk for a specific mental health outcome (or select set of outcomes) but instead places youth at risk for a range of mental health difficulties (i.e., multifinality). That is, several of the studies summarized above show that sleep problems predict both externalizing and internalizing problems in adolescence (Gregory and O'Connor 2002;Gregory et al 2008;Shanahan et al 2014;Wong et al 2009). Recently, used crosslagged modeling to examine the reciprocal relations among sleep functioning (using both actigraphy and self-report ratings) and psychopathology symptoms over a 5-year period that included the transition into adolescence.…”