Do Sleep Problems Exacerbate the Mental Health Consequences of Discrimination Among Adults?

OBJECTIVE: An emerging literature suggests that sleep may play an important role in moderating the association between discrimination and mental health problems among adolescents. However, few if any studies have considered this topic among adults. Addressing this knowledge gap, the current study examined multiple sleep parameters as moderating variables in the association between discrimination and mental health problems among adults. METHODS: Participants were 874 adults residing in small towns and semirural contexts within the Southeastern region of the United States ( Mage = 41 years, SD = 7; 57% female; 31% Black, 69% White; 52% income-to-needs < 2). Sleep duration and night-to-night variability in duration were assessed using wrist actigraphy. Established self-report measures were used to assess global sleep problems, experiences of discrimination, and mental health problems (anxiety, depression, and externalizing symptoms). RESULTS: Experiences of discrimination were associated with more depression, anxiety, and externalizing problems. Two out of three sleep parameters were found to moderate the effects of discrimination on mental health. The association between discrimination and externalizing problems (but not anxiety or depression) was attenuated among those with less night-to-night variability in sleep duration. The associations between discrimination and anxiety and externalizing problems (but not depression) were attenuated among those with fewer global sleep problems. Less variability in sleep duration and fewer global sleep problems were also directly associated with lower levels of depression, anxiety, and externalizing problems. CONCLUSIONS: Greater consistency in sleep duration from night-to-night, and fewer overall sleep problems appear to mitigate risk of mental health problems among adults, particularly in contexts where discrimination is prevalent.

Trauma exposure and associated sleep problems in Black adolescent and young adult students attending an alternative high school.

OBJECTIVE: Given the dearth of literature examining the link between trauma exposure and sleep among youth and young adults of color, the current study examined the association between individual types of trauma exposure, accumulation within subtypes of trauma exposure, and overall cumulative trauma exposure with sleep problems in a sample of Black students attending an alternative high school. METHOD: Participants were recruited from an alternative high school in a large, southeastern city in the United States, of which all students qualify for free/reduced lunch. The sample included 101 students (53% female) ages 16-24 (M = 17.86 years, SD = 1.36) who identified as Black. RESULTS: Participants reported a high rate of trauma exposure (M = 6.03 unique traumatic experiences, SD = 2.63). Linear regression models showed that exposure to more overall cumulative trauma and to interpersonal loss was significantly associated with higher levels of insomnia symptoms. Threats to health were significantly related to daytime sleepiness. Other threats to safety were associated with restless legs syndrome symptoms. CONCLUSIONS: Adolescence and young adulthood are a time of complex sleep-related issues. Black youth and young adults have elevated risk of trauma exposure and sleep problems; therefore, targeted assessment and intervention are warranted. Clinicians and researchers addressing sleep in youth and young adults, and those working within alternative school settings, should also consider a trauma-informed lens to optimize outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Neighborhood environment and adolescent sleep: The role of family socioeconomic status.

OBJECTIVES: Socioeconomic status (SES) and neighborhood context are influential predictors of adolescent sleep, yet little is known about how they may interact to influence sleep. We examined multiple dimensions of family SES as moderators of associations between neighborhood risk and multiple sleep parameters. METHODS: Participants were 323 adolescents (Mage = 17.4 years, SD = 0.86; 48% male; 60% White/European American, 40% Black/African American). Sleep was assessed using 7 nights of actigraphy from which sleep duration (minutes from onset to wake time), efficiency, long wake episodes, and variability in minutes over the week were derived. Youth reported on their sleep/wake problems and sleepiness, as well as their perceptions of safety and violence in their neighborhoods. Parents reported on SES indices, including income-to-needs ratio and perceived financial stability. RESULTS: Lower SES (income-to-needs, perceived financial stability) was associated with lower sleep efficiency and more frequent long wake episodes. Lower neighborhood safety and greater community violence concerns were related to greater subjective sleep problems. Moderation effects illustrated two general patterns. For actigraphy-derived sleep variables, lower neighborhood safety was associated with poor sleep only among youth from lower-income families. For subjective sleep/wake problems and daytime sleepiness, associations between neighborhood risk and sleep difficulties were pronounced for higher SES youth, while lower SES youth had greater sleep problems regardless of neighborhood factors. CONCLUSIONS: Findings suggest that several dimensions of SES and neighborhood risk may be consequential for adolescents' sleep. Moderation effects highlight the significance of considering multiple contextual influences towards a better understanding of adolescents' sleep.

Socioemotional health, trauma exposure, and internalizing symptoms in students attending an alternative high school.

Students attending alternative schools often present with internalizing symptoms, likely related to high rates of trauma. Little is known about factors that buffer the relationship between trauma exposure and internalizing symptoms in this population. The present study examined the role of internal (i.e., self-efficacy, self-awareness, persistence) and external resources (i.e., peer support, family coherence, school support) as buffers in the association between trauma exposure and symptoms of depression and anxiety in 113 students (55% female, 91% Black, 8% Hispanic or Latinx, Mage = 18.0, SD = 1.5) attending an alternative school in a large, southeastern city. Results showed that trauma exposure was positively associated with depression and anxiety symptoms, while self-awareness and family coherence were negatively associated with depression and anxiety symptoms. Additionally, significant interactions revealed that trauma exposure was associated with depression symptoms at low but not high levels of self-awareness, and at low but not high levels of family coherence. Understanding strengths to support alternative high school students exposed to trauma is a valuable component of mental health intervention. Future research should investigate ways to cultivate self-awareness and enhance family coherence to address the complex needs of alternative school students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Discrimination and adjustment in adolescence: the moderating role of sleep.

STUDY OBJECTIVES: We examined multiple actigraphy-based sleep parameters as moderators of associations between experiences of general and racial discrimination and adolescent internalizing symptoms (anxiety, depression) and externalizing behavior (rule-breaking). Adolescent sex and race were examined as additional moderators. METHODS: Participants were 272 adolescents (Mage = 17.3 years, SD = 0.76; 51% male; 59% White/European American, 41% Black/African American). Sleep was assessed using actigraphs for 7 consecutive nights from which sleep duration (minutes), efficiency, and variability in minutes over the week were derived. Youth reported on their experiences of general discrimination, racial discrimination, anxiety, depressive symptoms, and rule-breaking behavior. RESULTS: Both types of discrimination were associated with poorer adjustment outcomes. Longer sleep duration, greater sleep efficiency, and less variability in sleep duration were protective in associations between race-specific and general discrimination and internalizing symptoms. Findings for duration and efficiency were more pronounced for females such that the adverse effects of discrimination were minimized among females with longer and more efficient sleep. Greater variability in sleep exacerbated rule-breaking behavior among adolescents experiencing general or racial discrimination. Associations did not differ by adolescent race. CONCLUSIONS: Short and poor-quality sleep may exacerbate internalizing symptoms for adolescents experiencing discrimination, particularly females. Variability in sleep duration was a key moderator of associations between discrimination and internalizing symptoms as well as rule-breaking behavior. Findings illustrate that actigraphy-assessed sleep parameters play a key role in ameliorating or exacerbating adjustment problems associated with discrimination.

Adolescents' sleep and adjustment: Reciprocal effects.

Reciprocal relations between sleep and adjustment were investigated. Participants included 246 adolescents (M = 15.80 years; 67.5% White, 32.5% Black/African American; 53% female, 47% male) at Time 1 (data collected 2012-2013), 227 at Time 2 (M = 16.78 years) and 215 at Time 3 (M = 17.70 years). Sleep-wake variables were measured with self-reports (sleepiness) and actigraphy (average sleep minutes and efficiency, variability in sleep minutes and efficiency). Adolescents reported on depression and anxiety symptoms, and parents reported on externalizing problems. Greater variability in sleep duration and efficiency as well as sleepiness predicted adjustment problems (range of R2 : 36%-60%). Reciprocal relations were supported mostly for sleepiness (range of R2 : 16%-32%). Results help understand bidirectional relations between sleep and adjustment.

Linear and nonlinear associations between the sleep environment, presleep conditions, and sleep in adolescence: moderation by race and socioeconomic status.

OBJECTIVE/BACKGROUND: The role of the sleep environment and presleep conditions that may influence adolescents' sleep are understudied. The aims of the current study were to examine linear and nonlinear associations between the sleep environment and presleep conditions and adolescents' daytime sleepiness and sleep/wake problems. METHOD: Participants included 313 adolescents (Mage = 17.39 years, SD = 10.38 months; 51.4% girls, 48.6% boys; 59.1% White/European American, 40.3% Black/African American) from a wide range of socioeconomic backgrounds living in the southeastern United States. Adolescents completed surveys assessing the sleep environment (eg, light, bedding), four presleep conditions (ie, general worries, family concerns, arousal, somatic complaints), and sleep (daytime sleepiness, sleep/wake problems). RESULTS: Sleep environment disruptions and worse presleep conditions were positively associated with sleepiness and sleep/wake problems in a linear fashion. Nonlinear associations emerged such that levels of sleepiness increased rapidly between low and average levels of the sleep environment and two presleep conditions (worries, arousal); the slope leveled off between average and high levels. Moreover, linear effects of environmental disruptions, family concerns, somatic complaints, and presleep arousal on sleep/wake problems were moderated by race and/or SES, indicating that positive associations between some presleep conditions and sleep/wake problems were more pronounced for Black and lower SES youth. CONCLUSIONS: Results support the importance of the sleep environment and multiple presleep conditions and assessments of both linear and nonlinear effects for a better understanding of factors that may contribute to sleep. Additionally, results indicate the sleep environment and some presleep conditions may be more consequential for disadvantaged youth.

Exposure to peer aggression and adolescent sleep problems: Moderation by parental acceptance.

Many adolescents experience or witness aggression by peers at school. The purpose of the current study was to examine associations between exposure to peer aggression (i.e., peer victimization and witnessing school violence) and sleep problems and whether these associations are moderated by parental acceptance. Participants included 272 adolescents attending high school (M age = 17.27 years; 49% female; 59% White/European American, 41% Black/African American). Adolescents reported on exposure to peer aggression, parental acceptance, and two key sleep domains: sleep quality problems and daytime sleepiness. Results indicated that exposure to peer aggression was directly associated with poor sleep quality and sleepiness. Furthermore, peer victimization and witnessing school violence interacted with parental acceptance to predict sleep quality. Specifically, exposure to peer aggression was associated with sleep quality problems at higher (but not lower) levels of parental acceptance. The lowest levels of sleep quality problems were apparent at low levels of peer aggression and high levels of parental acceptance, but parental acceptance did not protect adolescents with high exposure to peer aggression against sleep problems. Findings illustrate the importance of considering moderators of effects and the conjoint roles of family and peer processes when considering individual differences in adolescents' sleep. Future research should examine whether parental strategies targeted to address peer victimization are protective against the detrimental effects of exposure to peer aggression. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Trajectories of sleep problems in childhood: associations with mental health in adolescence.

STUDY OBJECTIVES: We examined initial levels (intercepts) of sleep-wake problems in childhood and changes in sleep-wake problems across late childhood (slopes) as predictors of externalizing behavior problems, depressive symptoms, and anxiety in adolescence. To ascertain the unique effects of childhood sleep problems on adolescent mental health, we controlled for both childhood mental health and adolescent sleep problems. METHODS: Participants were 199 youth (52% boys; 65% White/European American, 35% Black/African American). Sleep-wake problems (e.g. difficulty sleeping and waking up in the morning) were assessed during three time points in late childhood (ages 9, 10, and 11) with self-reports on the well-established School Sleep Habits Survey. At age 18, multiple domains of mental health (externalizing behavior problems, depressive symptoms, and anxiety) and sleep-wake problems were assessed. RESULTS: Latent growth curve modeling revealed that children with higher levels of sleep-wake problems at age 9 had consistently higher levels of such problems between ages 9 and 11. The initial level of sleep-wake problems at age 9 predicted externalizing behaviors, depressive symptoms, and anxiety at age 18, controlling for mental health in childhood and concurrent sleep-wake problems in adolescence. The slope of sleep-wake problems from ages 9 to 11 did not predict age 18 mental health. CONCLUSIONS: Youth who had higher sleep-wake problems during late childhood had higher levels of mental health problems in adolescence even after controlling for childhood mental health and concurrent sleep-wake problems. Findings illustrate that childhood sleep problems may persist and predict adolescent mental health even when potentially confounding variables are rigorously controlled.

Associations of bullying, victimization, and daytime sleepiness with academic problems in adolescents attending an alternative high school.

Adolescents attending alternative high schools often present with high rates of academic and behavior problems. They are also at increased risk of poor health behaviors and engaging in physical violence compared with students in traditional high school settings. To address the needs of students in these educational settings, examining factors that influence academic problems in this population is essential. Research has established that both bullying/victimization and sleep problems increase adolescents' risk for academic problems. Little is known about how these 2 factors together may exacerbate risk for academic problems among students attending an alternative high school. The current study investigated the interaction between teacher-reported bullying, victimization and daytime sleepiness on academic concerns (attention and learning problems) among a sample of 172 students (56% female; age M = 18.07 years, SD = 1.42) attending an alternative high school in a large, Southeastern U.S. city. Findings from path models indicated that daytime sleepiness, bullying, and victimization were uniquely associated with attention and learning problems. Further, significant interactions indicated that the association between victimization/bullying and attention/learning problems weakened as levels of daytime sleepiness increased. Results suggest the importance of assessing and addressing multiple contextual risk factors in adolescents attending alternative high schools to provide comprehensive intervention for students in these settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The sleep environment and its association with externalizing behaviors in a sample of low-income adolescents.

This study examined the sleep environment and its association with externalizing problems in adolescents attending an alternative high school. Participants included 114 students (56% female, 91% Black, mean age = 18.03, standard deviation [SD] = 1.49) from an alternative high school in a southeastern city. Most participants reported sleeping in a bed (83%) and at their house (72%) for 7 nights in the past week. Participants reported an average of 2.34 (SD = 1.86) past-week ambient sleep disruptions. Sleeping fewer nights in their own home and experiencing higher levels of ambient sleep disruptions were associated with delinquency engagement. Fewer nights sleeping in a bed and higher levels of ambient sleep disruptions were associated with a significant arrest history. The sleep environment is important to consider when assessing sleep problems, particularly among low-income adolescents living in urban environments. This information may inform comprehensive interventions to address behavioral health concerns.

Negative reactions to monitoring: Do they undermine the ability of monitoring to protect adolescents?

This study focused on adolescents' negative reactions to parental monitoring to determine whether parents should avoid excessive monitoring because adolescents find monitoring behaviors to be over-controlling and privacy invasive. Adolescents (n = 242, M age = 15.4 years; 51% female) reported monitoring, negative reactions, warmth, antisocial behavior, depressive symptoms, and disclosure. Adolescents additionally reported antisocial behavior, depressive symptoms, and disclosure one to two years later. In cross-sectional analyses, less monitoring but more negative reactions were linked with less disclosure, suggesting that negative reactions can undermine parents' ability to obtain information. Although monitoring behaviors were not related to depressive symptoms, more negative reactions were linked with more depressive symptoms, suggesting that negative reactions also may increase depressive symptoms as a side effect of monitoring behavior. Negative reactions were not linked to antisocial behavior. There were no longitudinal links between negative reactions and changes in disclosure, antisocial behavior, or depressive symptoms.

Warmth and legitimacy beliefs contextualize adolescents' negative reactions to parental monitoring.

This study sought to identify conditions under which parents' monitoring behaviors are most strongly linked to adolescents' negative reactions (i.e., feelings of being controlled and invaded). 242 adolescents (49.2% male; M age = 15.4 years) residing in the United States of America reported parental monitoring and warmth, and their own feelings of being controlled and invaded and beliefs in the legitimacy of parental authority. Analyses tested whether warmth and legitimacy beliefs moderate and/or suppress the link between parents' monitoring behaviors and adolescents' negative reactions. Monitoring was associated with more negative reactions, controlling for legitimacy beliefs and warmth. More monitoring was associated with more negative reactions only at weaker levels of legitimacy beliefs, and at lower levels of warmth. The link between monitoring and negative reactions is sensitive to the context within which monitoring occurs with the strongest negative reactions found in contexts characterized by low warmth and weak legitimacy beliefs.