The Relationship of School Start Times, Sleep Duration and Mental Health among a Representative Sample of High School Students in Colorado, 2019

Abstract

This cross-sectional study utilized responses from 46,537 students enrolled in grades 9 through 12 in 166 high schools across the state of Colorado via the 2019 Healthy Kids Colorado Survey to: (1) quantify the association between high school start times and student sleep duration and (2) investigate the associations between school start times and student mental health. Descriptive and bivariate analyses were used to investigate associations between school start times and self-reported demographic, sleep, and mental health factors. Survey-weighted multivariate regression modeling was used to investigate associations between school start times, sleep duration, and mental health. Schools with late start times (≥8:30 a.m.) saw 32.2% (95% Confidence Interval: 29.5–35.0) of students sleeping 8 h or more relative to 23.2% (22.0–24.4) in schools with very early start times (<8:00 a.m.). For every 15 min later school start time, students’ sleep duration was 4.6 (3.4–5.9) min longer. Students attending schools with very early start times had 1.10 (0.95–1.27) times the odds of attempting suicide compared to those attending schools with later start times, while students at schools with early starts (8:00–8:29 a.m.) were associated with 1.11 (0.98–1.27) times the odds. Schools with later school start times had a statistically significantly higher proportion of students sleeping 8+ hours. Schools with start times before 8:30 a.m. had 10–11% higher odds of students attempting suicide compared to schools with late start times, though these differences were not statistically significant. Student mental health should continue to be investigated when assessing the potential impacts of delayed school start times.

Association Between Insufficient Sleep, Depressive Symptoms, and Suicidality Among Florida High School Students

“…Yet, unlike that study, insufficient sleep was not significantly associated with seriously considering suicide in our sample after adjusting for risk and protective factors. This finding aligns with past studies demonstrating that depressive symptoms explained the relationship between insufficient sleep and suicidal ideation ( 4 , 23 ). Given these inconsistent findings, additional research capturing a broader range of outcomes, including anxiety and resilience, is needed to fully investigate the implications of insufficient sleep on mental health.…”

Associations between sleep habits, quality, chronotype and depression in a large cross-sectional sample of Swedish adolescents

“…In fact, delaying school start times has been shown to increase adolescents’ sleep duration and improve academic performance [ 85 , 86 ]. Studies found that a 15-minute delay in school start times was associated with a 5-minute increase in sleep duration [ 87 ] and a 50-minute delay was associated with a 43-minute increase [ 88 ].…”

Building Bridges With School Boards—An Understudied Seat of Health Equity

“…2,3 In an effort to improve mental health outcomes, boards may guide school day start times to accommodate students' natural sleep patterns. 4 In addition, boards shape the built environment through investments in air filters, air conditioning systems, and protection from excessive sun exposure. Significantly, their influence extends to health care: from hiring schoolbased health professionals and fostering partnerships with county health offices to supporting comprehensive school-based health services that span preventative, acute, and emergency care.…”

“…For example, boards interpret and implement federal guidelines for cafeteria nutrition, a lever for addressing rates of obesity . In an effort to improve mental health outcomes, boards may guide school day start times to accommodate students’ natural sleep patterns . In addition, boards shape the built environment through investments in air filters, air conditioning systems, and protection from excessive sun exposure.…”