Kumar Manasi, Mwavua Shillah Mwaniga, Cheng Sabrina, Chung Alicia, Njiru Leonard Njeru, Obonyo Georgina, Dayow Mohammad, Huang Keng-Yen
Institute for Excellence in Health Equity, New York University School of Medicine, 180 Madison Avenue, 7th Floor, New York, NY, 10016, USA.
Nairobi City County Health Wellness and Nutrition department, Nairobi, Kenya.
Ann Glob Health. 2025 Aug 14;91(1):46. doi: 10.5334/aogh.4810. eCollection 2025.
Loneliness is emerging as a key risk factor for child and adolescent mental health. Exacerbated by lack of support, busy routines, continuous adversities, and poor social networks, it is a public health concern. Sleep is essential for healthy development and emotional regulation, critical for modulating risk‑taking, and determines optimal learning and mental health. However, the connection between loneliness and sleep and their impact on mental health and educational outcomes is not well known in low‑ and middle‑income countries (LMICs) like Kenya, where a large portion of the population is young. (1) Examine the bidirectional relationship between loneliness and impaired sleep in a Kenyan adolescent cohort. (2) assess the individual and joint contribution of loneliness and sleep impairment relationship in common mental health problems such as anxiety, depression, and anger, while controlling for adverse childhood experiences (ACEs). A cross‑sectional study with 70 adolescents (ages 11-15) from Nairobi schools. Measures used: Loneliness (NIH Toolbox), Sleep Impairment (PROMIS), Mental Health (PROMIS‑Anger, Anxiety, Depression), ACEs (WHO ACEs‑IQ). We found a strong association between loneliness and sleep impairment, even after controlling for ACEs (associated with 32.0%-33.9% of variance). Higher ACEs were also associated with increased loneliness and sleep impairment. Notably, after adjusting for the ACE confounder, both sleep impairment and loneliness were significantly associated with adolescent mental disturbances (anxiety, depression, and anger), with sleep impairment explaining greater variance (27.2%-30.4%) than loneliness (11.8%-27.4%) for the anxiety, anger, depression outcomes. Jointly, loneliness and sleep impairment were associated with 28.8%-30.4% of the variance in adolescents' mental health problems. Our article contributes new evidence that sleep health is critical to mental well‑being for adolescents living in high ACEs and LMIC contexts. Providing intervention strategies to reduce loneliness and promote sleep health should be considered to improve adolescent mental health.
孤独正成为儿童和青少年心理健康的一个关键风险因素。由于缺乏支持、日常事务繁忙、持续的逆境以及不良的社交网络，孤独感愈发严重，这已成为一个公共卫生问题。睡眠对于健康发育和情绪调节至关重要，对调节冒险行为起着关键作用，并决定着最佳学习状态和心理健康。然而，在肯尼亚这样大部分人口为年轻人的低收入和中等收入国家（LMICs），孤独与睡眠之间的联系及其对心理健康和教育成果的影响尚不为人所知。（1）在肯尼亚青少年队列中研究孤独与睡眠障碍之间的双向关系。（2）在控制童年不良经历（ACEs）的同时，评估孤独与睡眠障碍关系对焦虑、抑郁和愤怒等常见心理健康问题的个体和共同影响。对来自内罗毕学校的70名青少年（11 - 15岁）进行了一项横断面研究。使用的测量方法：孤独感（美国国立卫生研究院工具箱）、睡眠障碍（患者报告结果测量信息系统）、心理健康（患者报告结果测量信息系统 - 愤怒、焦虑、抑郁）、童年不良经历（世界卫生组织童年不良经历问卷）。我们发现，即使在控制了童年不良经历之后，孤独与睡眠障碍之间仍存在很强的关联（与32.0% - 33.9%的方差相关）。较高的童年不良经历也与孤独感增加和睡眠障碍有关。值得注意的是，在调整了童年不良经历这一混杂因素后，睡眠障碍和孤独感均与青少年心理障碍（焦虑、抑郁和愤怒）显著相关，对于焦虑、愤怒、抑郁结果，睡眠障碍解释的方差（27.2% - 30.4%）比孤独感（11.8% - 27.4%）更大。孤独感和睡眠障碍共同与青少年心理健康问题中28.8% - 30.4%的方差相关。我们的文章提供了新的证据，表明睡眠健康对于生活在高童年不良经历和低收入及中等收入国家环境中的青少年的心理健康至关重要。应考虑提供干预策略以减少孤独感并促进睡眠健康，从而改善青少年心理健康。
