Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Australia.
Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA Psychiatry. 2023 Jun 1;80(6):585-596. doi: 10.1001/jamapsychiatry.2023.0379.
Sleep problems and psychopathology symptoms are highly comorbid and bidirectionally correlated across childhood and adolescence. Whether these associations are specific to discrete profiles of sleep problems and specific internalizing and externalizing phenomena is currently unclear.
To characterize individual changes in profiles of sleep problems and their prospective associations with psychopathology symptoms across the transition from childhood to adolescence.
DESIGN, SETTING, AND PARTICIPANTS: This observational cohort study used baseline data (participant age of 9 to 11 years) and 2-year follow-up data (participant age of 11 to 13 years) from the community-setting, multicenter Adolescent Brain Cognitive Development (ABCD) study. Individuals were assessed for a range of sleep problems at both waves and categorized into profiles via latent profile analysis. The stability and change in these profiles over time was assessed via latent transition analysis. Logistic regression models examined whether psychopathology symptoms were cross-sectionally associated with profile membership and whether transitions between profiles were associated with changes psychopathology symptoms over time. Data were collected from September 2016 to January 2020, and data were analyzed from August 2021 to July 2022.
Sleep problems were assessed at both baseline and follow-up via the parent-reported Sleep Disturbance Scale for Children (SDSC).
Psychopathology symptoms at both baseline and follow-up were assessed using the internalizing and externalizing dimension scores derived from the parent-reported Child Behavior Checklist.
A total of 10 313 individuals (4913 [47.6%] were female) were categorized into 4 latent profiles of sleep problems at both baseline and follow-up: a low disturbance profile, a sleep onset/maintenance problems profile, a moderate and nonspecific disturbance profile (termed mixed disturbance), and a high disturbance profile. Individuals in the 3 more severe problem profiles displayed greater risk of concurrent internalizing symptoms (sleep onset/maintenance problems: odds ratio [OR], 1.30; 95% CI, 1.25-1.35; P < .001; mixed disturbance: OR, 1.29; 95% CI, 1.25-1.33; P < .001; high disturbance: OR, 1.44; 95% CI, 1.40-1.49; P < .001) and externalizing symptoms (sleep onset/maintenance problems: OR, 1.20; 95% CI, 1.16-1.23; P < .001; mixed disturbance: OR, 1.17; 95% CI, 1.14-1.20; P < .001; high disturbance: OR, 1.24; 95% CI, 1.21-1.28; P < .001). Transitions between sleep profiles over time were associated with prospective internalizing and externalizing symptoms, but not vice versa.
There are substantial changes in sleep problems across the transition to adolescence that are associated with later internalizing and externalizing symptoms. Sleep profiles could be targeted in future intervention and treatment programs to improve sleep-related and mental health-related outcomes across development.
睡眠问题和精神病理学症状在儿童和青少年时期高度共病且相互关联。这些关联是否特定于离散的睡眠问题特征和特定的内化和外化现象目前尚不清楚。
描述从儿童期到青春期过渡期间，睡眠问题特征的个体变化及其与精神病理学症状的前瞻性关联。
设计、地点和参与者：这项观察性队列研究使用了社区环境、多中心青少年大脑认知发展（ABCD）研究的基线数据（参与者年龄为 9 至 11 岁）和 2 年随访数据（参与者年龄为 11 至 13 岁）。在两个时间点都通过潜在剖面分析对一系列睡眠问题进行评估，并根据这些问题将个体分类为不同的特征。通过潜在转变分析评估这些特征随时间的稳定性和变化。逻辑回归模型检验了精神病理学症状是否与特征类别存在横断面关联，以及特征之间的转变是否与随时间变化的精神病理学症状有关。数据收集于 2016 年 9 月至 2020 年 1 月，数据分析于 2021 年 8 月至 2022 年 7 月进行。
在基线和随访时通过父母报告的儿童睡眠障碍量表（SDSC）评估睡眠问题。
在基线和随访时使用父母报告的儿童行为检查表得出的内化和外化维度得分评估精神病理学症状。
共有 10313 名个体（4913 [47.6%]为女性）在基线和随访时被分为 4 种睡眠问题的潜在特征类别：低干扰特征、睡眠起始/维持问题特征、中度和非特异性干扰特征（称为混合干扰）以及高干扰特征。在 3 种更严重的问题特征类别中，个体存在更高的同时发生内化症状（睡眠起始/维持问题：比值比[OR]，1.30；95%置信区间[CI]，1.25-1.35；P<0.001；混合干扰：OR，1.29；95%CI，1.25-1.33；P<0.001；高干扰：OR，1.44；95%CI，1.40-1.49；P<0.001）和外化症状（睡眠起始/维持问题：OR，1.20；95%CI，1.16-1.23；P<0.001；混合干扰：OR，1.17；95%CI，1.14-1.20；P<0.001；高干扰：OR，1.24；95%CI，1.21-1.28；P<0.001）的风险更高。随着时间的推移，睡眠特征的转变与随后的内化和外化症状相关，但反之则不然。
在向青春期过渡期间，睡眠问题发生了实质性变化，这些变化与后期的内化和外化症状相关。未来的干预和治疗计划可以针对睡眠特征进行，以改善整个发育过程中的睡眠相关和心理健康相关的结果。
