BACKGROUND: Studies in adults suggested that sleep could be a significant contributor to mental health. However, little is known about their relationship in adolescents. OBJECTIVE: The present study aimed to examine the overall associations of full-spectrum sleep behaviors, including sleep habits, sleep problems, and sleep hygiene, with mental health problems among adolescents in Shanghai, China. DESIGN: A stratified, cluster random sample of 4,823 adolescents aged 11 to 20 years participated in a cross-sectional survey. The Adolescent Sleep Disturbance Questionnaire and the modified Adolescent Sleep Hygiene Scale were used to examine sleep behaviors. The Strengths and Difficulties Questionnaire was used to evaluate mental health problems. RESULTS: Five sleep variables were found to be associated with adolescents’ mental health. The five factors covered three sleep domains: sleep habits (later bedtime during weekdays), sleep problems (maintaining sleep difficulties, disorders of arousal), and sleep hygiene (poor emotion at bedtime, unstable sleep schedule). CONCLUSIONS: The clinical significance of the findings lies in the emphasis of comprehensive screening of sleep in the predicting, diagnosis, nursing, and intervention of adolescents’ mental health problems.
AbbottS. M.ReidK. J.ZeeP. C. (2015). Circadian rhythm sleep-wake disorders. Psychiatric Clinics of North America, 38, 805-823.
2.
AlfanoC. A.GambleA. L. (2009). The role of sleep in childhood psychiatric disorders. Child & Youth Care Forum, 38, 327-340.
3.
American Sleep Disorders Association Atlas Task Force. (1993). Recording and scoring leg movements. Sleep, 16, 748-759.
4.
BruniO.OttavianoS.GuidettiV.RomoliM.InnocenziM.CortesiF.GiannottiF. (1996). The Sleep Disturbance Scale for Children (SDSC): Construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence. Journal of Sleep Research, 5, 251-261.
5.
CasementM. D.KeenanK. E.HipwellA. E.GuyerA. E.ForbesE. E. (2016). Neural reward processing mediates the relationship between insomnia symptoms and depression in adolescence. Sleep, 39, 439-447.
6.
CespedesE. M.HuF. B.RedlineS.RosnerB.AlcantaraC.CaiJ.. . . PatelS. R. (2016). Comparison of self-reported sleep duration with actigraphy: Results from the Hispanic community health study/Study of Latinos Sueño ancillary study. American Journal of Epidemiology, 183, 561-573.
7.
ChenT.WuZ.ShenZ.ZhangJ.ShenX.LiS. (2014). Sleep duration in Chinese adolescents: Biological, environmental, and behavioral predictors. Sleep Medicine, 15, 1345-1353.
8.
CheungL. M.WongW. S. (2011). The effects of insomnia and internet addiction on depression in Hong Kong Chinese adolescents: An exploratory cross-sectional analysis. Journal of Sleep Research, 20, 311-317.
9.
ChungK. F.CheungM. M. (2008). Sleep-wake patterns and sleep disturbance among Hong Kong Chinese adolescents. Sleep, 31, 185-194.
10.
ColeT. J.BellizziM. C.FlegalK. M.DietzW. H. (2000). Establishing a standard definition for child overweight and obesity worldwide: International survey. British Medical Journal, 320, 1240-1243.
11.
CostelloE. J.EggerH.AngoldA. (2005). 10-Year research update review: The epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 972-986.
12.
de BruinE. J.van KampenR. K.van KootenT.MeijerA. M. (2014). Psychometric properties and clinical relevance of the Adolescent Sleep Hygiene Scale in Dutch adolescents. Sleep Medicine, 15, 789-797.
13.
GehrmanP.SeeligA. D.JacobsonI. G.BoykoE. J.HooperT. I.GackstetterG. D. (2013). Predeployment sleep duration and insomnia symptoms as risk factors for new-onset mental health disorders following military deployment. Sleep, 36, 1009-1018.
14.
GoodmanR. (1997). The Strengths and Difficulties Questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38, 581-586.
15.
GoodmanR.MeltzerH.BaileyV. (2003). The Strengths and Difficulties Questionnaire: A pilot study on the validity of the self-report version. International Review of Psychiatry, 15, 173-177.
16.
HashizumeY. (2014). The importance of sleep in the mental health. Japanese Journal of Clinical Medicine, 72, 341-346.
17.
Ka-FaiC.Miao-MiaoC. (2008). Sleep-wake patterns and sleep disturbance among Hong Kong Chinese adolescents. Sleep, 31, 185-194.
18.
KielingC.Baker-HenninghamH.BelferM.ContiG.ErtemI.OmigbodunO.. . . RahmanA. (2011). Child and adolescent mental health worldwide: Evidence for action. Lancet, 378, 1515-1525.
19.
KouJ. H.DuY. S.XiaL. M. (2007). Formulation of Children Strengths and Difficulties Questionnaire (the edition for students) for Shanghai norm. China Journal of Health Psychology, 15, 3-5. (In Chinese)
20.
LeBourgeoisM. K.GiannottiF.CortesiF.WolfsonA. R.HarshJ. (2005). The relationship between reported sleep quality and sleep hygiene in Italian and American adolescents. Pediatrics, 115, 257-265.
21.
LegerD.BeckF.RichardJ. B.GodeauE. (2012). Total sleep time severely drops during adolescence. PLoS One, 7, e45204.
22.
LiuX.HubbardJ. A.FabesR. A.AdamJ. B. (2006). Sleep disturbances and correlates of children with autism spectrum disorders. Child Psychiatry & Human Development, 37, 179-191.
23.
LiuX.LiuL.OwensJ. A.KaplanD. L. (2005). Sleep patterns and sleep problems among schoolchildren in the United States and China. Pediatrics, 115, 241-249.
24.
LiuX.ZhaoZ.JiaC.BuysseD. J. (2008). Sleep patterns and problems among Chinese adolescents. Pediatrics, 121, 1165-1173.
25.
LuoC. L.ZhangJ.PanJ. (2013). One-year course and effects of insomnia in rural Chinese adolescents. Sleep, 36, 377-384.
26.
MatamuraM.TochigiM.UsamiS.YoneharaH.FukushimaM.NishidaA.. . . SasakiT. (2014). Associations between sleep habits and mental health status and suicidality in a longitudinal survey of monozygotic twin adolescents. Journal of Sleep Research, 23, 290-294.
27.
MeijerA. M.ReitzE.DekovićM.van den WittenboerG. L.StoelR. D. (2010). Longitudinal relations between sleep quality, time in bed and adolescent problem behaviour. Journal of Child Psychology and Psychiatry, 51, 1278-1286.
MooreM.KirchnerH. L.DrotarD.JohnsonN.RosenC.Ancoli-IsraelS.RedlineS. (2009). Relationships among sleepiness, sleep time, and psychological functioning in adolescents. Journal of Pediatric Psychology, 34, 1175-1183.
30.
MorinC. M.WareJ. C. (1996). Sleep and psychopathology. Applied & Preventive Psychology, 5, 211-224.
31.
MunezawaT.KaneitaY.OsakiY.KandaH.OhtsuT.SuzukiH.. . . OhidaT. (2011). Nightmare and sleep paralysis among Japanese adolescents: A nationwide representative survey. Sleep Medicine, 12, 56-64.
32.
PatelV.FlisherA. J.HetrickS.McGorryP. (2007). Mental health of young people: A global public-health challenge. Lancet, 369, 1302-1313.
33.
PilcherJ. J.GinterD. R.SadowskyB. (1997). Sleep quality versus sleep quantity: Relationships between sleep and measures of health, well-being and sleepiness in college students. Journal of Psychosomatic Research, 42, 583-596.
34.
RobertsR. E.DuongH. T. (2013). Depression and insomnia among adolescents: A prospective perspective. Journal of Affective Disorders, 148, 66-71.
35.
RobertsR. E.RobertsC. R.DuongH. T. (2008). Chronic insomnia and its negative consequences for health and functioning of adolescents: A 12-month prospective study. Journal of Adolescent Health, 42, 294-302.
36.
RussoP. M.BruniO.LucidiF.FerriR.ViolaniC. (2007). Sleep habits and circadian preference in Italian children and adolescents. Journal of Sleep Research, 16, 163-169.
37.
SarchiaponeM.MandelliL.CarliV.IosueM.WassermanC.HadlaczkyG.. . . WassermanD. (2014). Hours of sleep in adolescents and its association with anxiety, emotional concerns, and suicidal ideation. Sleep Medicine, 15, 248-254.
38.
SeibC.AndersonD.LeeK.HumphreysJ. (2013). Predictors of mental health in post-menopausal women: Results from the Australian healthy aging of women study. Maturitas, 76, 377-383.
39.
SheavesB.PorcheretK.TsanasA.EspieC. A.FosterR. G.FreemanD.. . . GoodwinG. M. (2015). Insomnia, nightmares, and chronotype as markers of risk for severe mental illness: Results from a student population. Sleep, 39, 173-181.
40.
SingareddyR.KrishnamurthyV. B.VgontzasA. N.Fernandez-MendozaJ.CalhounS. L.ShafferM. L.BixlerE. O. (2013). Subjective and objective sleep and self-harm behaviors in young children: A general population study. Psychiatry Research, 209, 549-553.
41.
SpruytK.O’BrienL. M.CluydtsR.VerleyeG. B.FerriR. (2005). Odds, prevalence and predictors of sleep problems in school-age normal children. Journal of Sleep Research, 14, 163-176.
42.
Storfer-IsserA.LeBourgeoisM. K.HarshJ.TompsettC. J.RedlineS. (2013). Psychometric properties of the Adolescent Sleep Hygiene Scale. Journal of Sleep Research, 22, 707-716.
43.
SunW. Q.SpruytK.ChenW. J.JiangY. R.SchonfeldD.AdamsR.. . . JiangF. (2014). The relation among sleep duration, homework burden, and sleep hygiene in Chinese school-aged children. Behavioral Sleep Medicine, 12, 398-411.
44.
TsunoN.BessetA.RitchieK. (2005). Sleep and depression. Journal of Clinical Psychiatry, 66, 1254-1269.
45.
VostanisP. (2006). Strengths and Difficulties Questionnaire: Research and clinical applications. Current Opinion in Psychiatry, 19, 367-372.
46.
WadaK.NakamuraK.TamaiY.TsujiM.WatanabeK.AndoK.NagataC. (2013). Associations of endogenous melatonin and sleep-related factors with behavioral problems in preschool Japanese children. Annals of Epidemiology, 23, 469-474.
47.
WinokurA. (2015). The relationship between sleep disturbances and psychiatric disorders: Introduction and overview. Psychiatric Clinics of North America, 38, 603-614.
48.
WitcherL. A.GozalD.MolfeseD. M.SalatheS. M.SpruytK.CrabtreeV. M. (2012). Sleep hygiene and problem behaviors in snoring and non-snoring school-age children. Sleep Medicine, 13, 802-809.
49.
YangY. F. (2016a). Rating scales for children’s developmental behavior and mental health. People’s Medical Publishing House, 1, 189-191. (In Chinese)
50.
YangY. F. (2016b). Rating scales for children’s developmental behavior and mental health. People’s Medical Publishing House, 1, 191-193. (In Chinese)
51.
YokomakuA.MisaoK.OmotoF.YamagishiR.TanakaK.TakadaK.KohyamaJ. (2008). A study of the association between sleep habits and problematic behaviors in preschool children. Chronobiology International, 25, 549-564.
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