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Self-Reported Time in Bed and Sleep Quality in Association with Internalizing and Externalizing Symptoms in School-Age Youth

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Abstract

This study investigated the relationship between self-reported time in bed and sleep quality in association with self-reported internalizing and externalizing symptoms in a sample of 285 elementary school students (52 % female) recruited from a rural Midwestern elementary school. Path models were used to estimate proposed associations, controlling for grade level and gender. Curvilinear associations were found between time in bed and anxiety, depressive symptoms, and irritability. Marginal curvilinear trends were found between time in bed and emotion dysregulation, reactive aggression, and proactive aggression. Sleep quality was negatively associated with anxiety, depressive symptoms, irritability, reactive aggression, and delinquency engagement. Gender and grade differences were found across models. Findings suggest that examining self-reported time in bed (both linear and quadratic) and sleep quality is important for understanding internalizing and externalizing symptoms associated with sleep in school-age youth. Incorporating self-reported sleep assessments into clinical practice and school-based evaluations may have implications for a child’s adjustment.

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Notes

  1. We considered whether the extreme observations for time in bed might exert a disproportionate effect on the model compared to other participants (i.e., possible outlier effects). To assess this, we re-estimated all models after dropping the cases with the maximum (14.5 h) and minimum (5 h) values. Results showed that nearly all parameter estimates that were previously significant or marginally significant (p < .1) remained within this range (ps = < .001–.082). The only exception was that the previously marginally significant associations between time in bed and proactive aggression and delinquency became nonsignificant, both with and without the quadratic terms included in the model (all ps > .2). Thus, overall, the results appear to be largely unaffected by extreme values. Accordingly, all model results reported in this paper are based on analyses using all data from the entire sample.

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Acknowledgments

Portions of this research were completed with support from the American Psychological Foundation (Elizabeth Munsterberg Koppitz Child Psychology Graduate Student Fellowship, SCE) and the National Institute of Mental Health (K23MH108603, SPB). The content is solely the responsibility of the authors and does not necessarily represent the official views of any funding agency.

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Authors and Affiliations

  1. Department of Psychology, University of New Orleans, Geology and Psychology Building, Room 2001, 2000 Lakeshore Drive, New Orleans, LA, 70148, USA

    Sonia L. Rubens & Andrea M. Tountas

  2. Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA

    Spencer C. Evans & Paula J. Fite

  3. Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Stephen P. Becker

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  1. Sonia L. Rubens
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  2. Spencer C. Evans
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Correspondence to Sonia L. Rubens.

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Rubens, S.L., Evans, S.C., Becker, S.P. et al. Self-Reported Time in Bed and Sleep Quality in Association with Internalizing and Externalizing Symptoms in School-Age Youth. Child Psychiatry Hum Dev 48, 455–467 (2017). https://doi.org/10.1007/s10578-016-0672-1

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