青少年失眠的临床特征——精神病理学的综合方法。
Clinical characterization of insomnia in adolescents - an integrated approach to psychopathology.
机构信息
Center for Health Sciences, SRI International, Menlo Park, CA, USA.
Center for Health Sciences, SRI International, Menlo Park, CA, USA; Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.
出版信息
Sleep Med. 2022 May;93:26-38. doi: 10.1016/j.sleep.2022.03.010. Epub 2022 Mar 24.
OBJECTIVES/BACKGROUND: Insomnia in adolescence is common and debilitating yet it remains poorly understood. Here, we examine the complexity of clinical, behavioral, and psychosocial factors characterizing insomnia in adolescents.
METHODS
Ninety-five adolescents (16-19 years) with (N = 47, 31 female) and without (N = 48, 28 female) insomnia symptoms participated. In the insomnia group, 26 (20 female) met full DSM-5 criteria for insomnia disorder, while 21 (11 female) met partial criteria. Participants completed a clinical interview and assessments of clinical, behavioral, and psychosocial dimensions associated with insomnia. GLMs and network analyses were used to evaluate group and sex differences in severity and inter-relationships between symptoms.
RESULTS
Adolescents with insomnia symptomatology had lower sleep hygiene and thought control, more depressive symptoms and dysfunctional sleep-related cognitions, and more substance use as a coping behavior than healthy controls. They also indicated higher neuroticism, stress levels, and sleep stress reactivity (p < 0.05), but no difference in adverse childhood experiences, than controls. Girls compared to boys with insomnia reported lower sleep quality, and more pre-sleep cognitive activity and sleep stress reactivity (p < 0.05). Compared to healthy girls, girls in the insomnia group reported lower sleep hygiene and higher agreeableness. Network analyses confirmed profound group differences in network topology, with the insomnia group having different levels of centrality and relationships between clinical characteristics compared with controls.
CONCLUSIONS
Findings highlight clinical and sex-specific characteristics of adolescent insomnia, with network analyses revealing a complex interplay between clinical, behavioral, and psychosocial domains. Adolescents with insomnia symptoms, particularly girls, may benefit from interventions to improve negative cognition, mood, and stress, and behavioral strategies to counteract sleep-related maladaptive behaviors.
目的/背景：青少年失眠是常见且令人衰弱的，但目前仍知之甚少。在这里，我们研究了青少年失眠的临床、行为和心理社会因素的复杂性。
方法
95 名青少年（16-19 岁）参加了研究，其中有（N=47，31 名女性）和没有（N=48，28 名女性）失眠症状。在失眠组中，26 名（20 名女性）符合 DSM-5 失眠障碍的全部标准，而 21 名（11 名女性）符合部分标准。参与者完成了临床访谈以及与失眠相关的临床、行为和心理社会维度的评估。GLM 和网络分析用于评估组间和性别间症状严重程度和症状间相互关系的差异。
结果
有失眠症状的青少年的睡眠卫生和思维控制较差，抑郁症状和睡眠相关认知障碍较多，应对行为中更多地使用物质，而健康对照组则较少。他们还表现出更高的神经质、压力水平和睡眠应激反应（p<0.05），但与对照组相比，不良童年经历没有差异。与失眠组的男孩相比，失眠组的女孩报告睡眠质量较低，入睡前认知活动和睡眠应激反应较多（p<0.05）。与健康女孩相比，失眠组的女孩睡眠卫生较差，而宜人性较高。网络分析证实了网络拓扑结构的显著组间差异，与对照组相比，失眠组的临床特征具有不同的中心度和关系。
结论
研究结果突出了青少年失眠的临床和性别特异性特征，网络分析揭示了临床、行为和心理社会领域之间的复杂相互作用。有失眠症状的青少年，尤其是女孩，可能受益于改善负面认知、情绪和压力的干预措施，以及对抗睡眠相关不良行为的行为策略。
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