Insomnia, Sleep Disturbance Associated With Depression in Children and Adolescents

Insomnia and sleep disturbance among children and adolescents may increase risk of depressive symptoms, according to study findings published in JAMA Network Open.

As researchers note, depression can begin in childhood, with onset typically peaking at 20 years of age. Although treatment for depression in adolescence has shown limited effectiveness, they say that early identification and prevention may be a critical complementary tool to reduce risk of depression.

“Factors associated with first-onset depression in young adulthood include female sex, familial history of mood disorders, childhood sexual abuse, anxiety disorder, poor physical health, and sub-threshold depressive symptoms, including disturbed sleep,” the authors wrote.

The impact of impaired sleep has been highlighted in prior research as a factor in irritability and potential behavioral changes, attention difficulties, and memory problems in children and teenagers.

Seeking to further evaluate how disturbed sleep may influence development of later depression in these populations, researchers conducted a systematic review and meta-analysis of prospective cohort studies on the association among 5- to 24-year-old participants from community and clinical-based samples with any comorbid diagnosis.

Defining disturbed sleep as sleep disturbances or insomnia, the study included a total of 22 studies (n = 28,895), with 16 of those included in the meta-analysis (n = 27,073).

Researchers used the I² statistic to assess heterogeneity, with a fixed-effect model used to pool effect estimates if I² was less than 50% and a random-effects model if otherwise.

“Meta-regression analyses were used to explore the heterogeneity associated with type of ascertainment, type of and assessment tool for disturbed sleep and depression, follow-up duration, disturbed sleep at follow-up, and age at baseline,” said researchers.

In the analysis, complete data on beta (β) coefficients were available from 1 study on insomnia and depression and from 8 studies on sleep disturbances and depression. Complete data on odds ratios (ORs) were available from 3 studies on insomnia and depression and from 5 studies on sleep disturbances and depression.

Findings indicated that the pooled β coefficient of the association between disturbed sleep and depression was 0.11 (95% CI, 0.06-0.15; P < .001; n = 14 067; I² = 50.8%), which remained of comparable magnitude (0.08; 95% CI, 0.05-0.11; P < .001; I² = 34.9%; P = .16) and heterogeneity (0.10; 95% CI, 0.06-0.14; P < .001; I² = 51.3%; P = .045) after accounting for bias in the sensitivity analysis.

In examining risk of depression, participants with disturbed sleep were 1.5 times more likely to have depression than those without disturbed sleep (OR, 1.50; 95% CI, 1.13-2.00; P = .005; n = 13,006; I² = 87.7%). No sensitivity analysis was performed for these studies as they were cited to have low risk-of-bias scores.

Meta-regression and sensitivity analyses showed no evidence that pooled estimates differed across any covariate, noted researchers, with a substantial publication bias found in the analysis.

“This meta-analysis found a small but statistically significant effect size indicating an association between sleep disruption and depressive symptoms in children and youths,” concluded the study authors. “Disrupted sleep should be included in multifaceted prevention programs starting in childhood.”

Reference

Marino C, Andrade B, Campisi SC, et al. Association between disturbed sleep and depression in children and youths. JAMA Netw Open. Published online March 22, 2021. doi:10.1001/jamanetworkopen.2021.2373