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Associations Between Poor Sleep Quality, Anxiety Symptoms, and Depressive Symptoms Among Chinese Adolescents Before and During COVID-19: A Longitudinal Study.

ABSTRACT: Since the novel coronavirus disease 2019 (COVID-19) outbreak, adolescents' emerging mental health and behavior issues have been an international public health concern. This longitudinal study aimed to examine the situation of poor sleep quality, anxiety, and depressive symptoms among Chinese adolescents and to explore the associations between them before and during COVID-19. A total of 1,952 middle and high school students as eligible participants at baseline (pre-COVID-19, Wave 1; response rate: 98.79%), 1,831 eligible students were followed up at Wave 2 (October 2019 to December 2019, pre-COVID-19; retention rate: 93.80%), and 1,790 completed the follow-up at Wave 3 (during the COVID-19; retention rate: 97.80%). The mean age of the baseline students was 13.56 (SD: 1.46) years. The differences in anxiety and depressive symptoms between Wave 1, Wave 2, and Wave 3 were not statistically significant. The proportion of students with poor sleep quality increased over time, from Wave 1 (21.0%) to Wave 3 (26.0%, OR = 1.37, 95% CI = 1.17-1.60, P = 0.001) and from Wave 2 (21.9%) to Wave 3 (OR = 1.29, 95% CI = 1.11-1.51, P < 0.001). The cross-lagged generalized linear mixed models revealed that the concurrent and cross-lagged associations of poor sleep quality with anxiety symptoms across the three waves were significant (P < 0.05) and vice versa. Only a marginally significant positive cross-lagged association between poor sleep quality at Wave 2 and depressive symptoms at Wave 3 was found (standardized β estimate = 0.044, SE = 0.022, P = 0.045). Sleep quality was adversely affected during COVID-19, and the bidirectional associations of poor sleep quality with anxiety symptoms could not be neglected.

SUBMITTER: Wang W

PROVIDER: S-EPMC8795609 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ImportanceUnderstanding the longitudinal, bidirectional associations between disturbed sleep and depression in childhood and adolescence is crucial for the development of prevention and intervention programs.ObjectiveTo test for bidirectional associations and cascade processes between disturbed sleep and depressive symptoms covering both childhood and adolescence and to test for the moderating processes of sex and pubertal status in adolescence.Design, setting, and participantsA prospective cohort study using the Québec Longitudinal Study of Child Development (QLSCD; 1997-ongoing). QLSCD's objective is to identify early childhood factors associated with long-term psychosocial and academic adjustment. Data were collected across 8 waves between ages 5 years (2003) and 17 years (2015). Associations were tested through cross-lagged models in childhood (5, 7, and 8 years), and in adolescence (10, 12, 13, 15, and 17 years). Data were analyzed from February to October 2021.Main outcomes and measuresPrimary outcomes were disturbed sleep and depressive symptoms. Disturbed sleep was parent-reported and included sleep duration, time awake in bed, daytime sleepiness, sleep talking, sleepwalking, night terrors, and nightmares. Depressive symptoms were parent-reported in childhood (Child Behavior Checklist and Revised Ontario Child Health Study Scales), and self-reported in adolescence (Mental Health and Social Inadaptation Assessment for Adolescents).ResultsData on 1689 children (852 female [50.4%]) and 1113 adolescents (595 female [53.5%]) were included in the analyses. In childhood, significant bidirectional associations between depressive symptoms and disturbed sleep at all time points were found, indicating cascade processes (range β = 0.07; 95% CI, 0.02-012 to β = 0.15; 95% CI, 0.10-0.19). In adolescence, significant bidirectional associations from depressive symptoms to disturbed sleep (β = 0.09; 95% CI, 0.04-0.14) and vice versa (β = 0.10; 95% CI, 0.04-0.16) between 10 and 12 years were found. Between 12 and 13 years, depressive symptoms were modestly associated with disturbed sleep (β = 0.05; 95% CI, 0.001-0.10) but the reverse association was not significant. Cross-lagged estimates were nonsignificant after 13 years. The associations did not vary as a function of either sex or puberty-by-sex.Conclusions and relevanceThese findings suggest that disturbed sleep is associated with the consolidation of depressive symptoms starting in childhood, which, in turn, is associated with ongoing sleep problems. It is possible that timely and appropriate interventions for incipient disturbed sleep and depression prevent spiraling effects on both domains.

Project description:BackgroundParents have faced substantial social and economic challenges during the COVID-19 pandemic. Preliminary cross-sectional research has demonstrated increases in mental health problems in mothers during the COVID-19 pandemic compared with pre-pandemic estimates. We aimed to study an existing longitudinal cohort of mothers to assess changes in the prevalence of maternal depression and anxiety symptoms as a result of the COVID-19 pandemic over time and at the individual level.MethodsIn this longitudinal observational study, women who took part in the All Our Families pregnancy cohort in Canada were invited to complete a COVID-19 impact survey between May 20 and July 15, 2020. Women who had not agreed to additional research, had discontinued, were lost to follow-up, or who were not contactable via email were excluded. Maternal depression and anxiety symptoms during the COVID-19 pandemic were compared with three previous estimates collected at 3, 5, and 8-year timepoints (between April, 2012, and October, 2019). Depression symptoms were assessed using the 10-item Center for Epidemiological Studies Depression scale and anxiety symptoms were assessed using the short form of the Spielberger State-Trait Anxiety Inventory. Repeated cross-sectional analyses were done to assess temporal trends and fixed-effects regression models were fitted to assess within-person change over time.FindingsOf the 3387 women included in the All Our Families study, 2445 women were eligible and were invited to participate in the COVID-19 impact study, of whom 1333 consented to participate, and 1301 were included in the longitudinal analysis. At the COVID-19 impact survey timepoint, a higher proportion of mothers had clinically significant depression (35·21%, 95% CI 32·48-38·04) and anxiety symptoms (31·39%, 28·76-34·15) than at all previous data collection timepoints. The mean depression score (8·31, 95% CI 7·97-8·65) and anxiety score (11·90, 11·66-12·13) at the COVID-19 pandemic timepoint were higher than previous data collection waves at the 3-year timepoint (mean depression score 5·05, 4·85-5·25; mean anxiety score 9·51, 9·35-9·66), 5-year timepoint (mean depression score 5·43, 5·20-5·66; mean anxiety score 9·49, 9·33-9·65), and 8-year timepoint (mean depression score 5·79, 5·55-6·02; mean anxiety score 10·26, 10·10-10·42). For the within-person comparisons, depression scores were a mean of 2·30 points (95% CI 1·95-2·65) higher and anxiety scores were a mean of 1·04 points (0·65-1·43) higher at the COVID-19 pandemic timepoint, after controlling for time trends. Larger increases in depression and anxiety symptoms were observed for women who had income disruptions, difficulty balancing home schooling with work responsibilities, and those with difficulty obtaining childcare. White mothers had greater increases in anxiety scores than non-white mothers and health-care workers had smaller increases in depressive symptoms than non-health-care workers.InterpretationCompared with previous estimates, the prevalence of maternal depression and anxiety among mothers in a Canadian cohort increased during the COVID-19 pandemic. Financial support, childcare provision, and avoiding the closure of schools, might be key priorities for preventing future increases in maternal psychological distress.FundingAlberta Innovates Health Solutions Interdisciplinary Team, Canadian Institutes of Health Research, Alberta Innovates, and Alberta Children's Hospital Foundation.

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Associations Between Poor Sleep Quality, Anxiety Symptoms, and Depressive Symptoms Among Chinese Adolescents Before and During COVID-19: A Longitudinal Study.

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