Impact of parental absence on insomnia and nightmares in Chinese left-behind adolescents: A structural equation modeling analysis
Introduction
Sleeping problems have become a challenge for adolescents worldwide. Previous studies have found that many adolescents suffer from frequent nightmares or chronic insomnia (10–35%) (Liu et al., 2000, Munezawa et al., 2011). Liu found that 16.9% of Chinese adolescents between 12 and 18 had experienced insomnia or sleeping difficulties in the previous month (N = 1365), such as difficulty falling sleep (10.8%), difficulty maintaining sleep (6.3%), waking up early (2.1%), and nightmares (6.8%) (Liu, Uchiyama et al., 2000). An American sample found that insomnia symptoms peaked at 19.3% in a study of 700 children aged 5–12 (Calhoun, Fernandez-Mendoza, Vgontzas, Liao, & Bixler, 2014) and 27.88% of 5 081 Australian adolescents reported having had occasional nightmares in the previous 6 months (Fatima, Cairns, Skinner, Doi, & Al Mamun, 2018). Sleeping problems such as these can have a serious impact on adolescent health, with sleep disturbances having been associated with significant functional impairments, emotional difficulties (e.g. anxiety and depression) and behavioral difficulties (e.g. attention, conduct and self-harm) (Liu et al., 2019, Zhang et al., 2018), and nightmares that have lengthy, elaborate dream sequences being found to provoke anxiety or terror. Because of the many negative short-and long-term side effects of poor sleep quality, identifying the specific predictors of adolescent disturbed sleep is important.
Adolescent sleep quality can be disturbed for several reasons, an important but easily neglected one of which is the family environment (Billows et al., 2009, Dahl and El-Sheikh, 2007, Gregory et al., 2006). The emotional climate in a family can significantly affect adolescent sleep behaviors (El-Sheikh, Buckhalt, Keller, Cummings, & Acebo, 2007) as humans have evolved to only sleep well in environments in which they feel safe, which is generally associated with the social belonging and social connectedness provided by the family. Parental behavior significantly contributes to adolescent family environment experiences (Morris, Silk, Steinberg, Myers, & Robinson, 2007), which in turn affects their sleep behavior. Therefore, sleep researchers have often suggested that the quality of parent–child relations can have a significant regulating function on child and adolescent sleep (Erath & Tu, 2011). Although previous studies have demonstrated how parental absence can increase the risk of or exacerbate mental health problems, few studies have addressed the role of long-term parental absence on child and adolescent sleep quality (Allen et al., 2015, Shen et al., 2015).
China has around 61 million “left-behind children” (LBC) (Federation, 2013), who are children whose parent(s) have been absent for at least one year because they sought work in larger cities (Fan, Su, Gill, & Birmaher, 2010). Parental absence has already been found to negatively impact parent–child relationships (Schroeder & Kelley, 2010), family structures (Song, Ma, Gu, & Zuo, 2018), social abilities (Ding, Chen, Fu, Li, & Liu, 2019) and mental health (Fan and Lu, 2020, Lu et al., 2016, Zhao and Fu, 2020). Although labor-related migration tends to improve a family’s socioeconomic situation, prolonged separation from migrant parents can impair the children's normal development and put them at an increased risk of psychosomatic and psychiatric symptoms. While the relationships between LBC and other mental health variables, such as depressive symptoms (Fellmeth et al., 2018, Wang et al., 2019, Zhen et al., 2020), anxiety symptoms (Tang et al., 2018), psychiatric symptoms (Sun et al., 2017), and suicide ideation (Chang et al., 2017) have been established, little is known about the relationships between LBC and adolescent sleep.
An association between a child’s socioeconomic status such as poverty (Blank and Diderichsen, 1997, Friberg et al., 2015) and sleep has been established in previous research, with children from lower socioeconomic backgrounds in the United States being found to have shorter sleep durations and more sleep difficulties than those from higher socioeconomic families (El-Sheikh, Kelly, Buckhalt, & Benjamin Hinnant, 2010). Coming from a lower socioeconomic background was also found to be robust determinant for Norwegian adolescent sleep problems (Hysing, Petrie, Bøe, Lallukka, & Sivertsen, 2017). However, there have been few studies on the effects of family poverty on adolescent sleep in the Chinese context. In a Chinese study of 997 adolescents, it was found that family economic hardship was significantly associated with adolescent sleep quality, which was mediated through the adolescents’ perceived economic discrimination (Bao et al., 2016). Therefore, as there have been few definitive studies, more research is needed to examine the effect of economic gradients on adolescent sleep parameters.
In addition to family adversity, school adversity can also be an important factor affecting sleep. As sleep plays a major role in student emotional well-being and behavior, determining the possible relationships between sleep parameters and school bullying is important. For example, peer bullying within the school environment has been linked to sleep difficulties in teenage victims (Hunter et al., 2014, Zhou et al., 2015), and it has also been found that frequently bullied children were more likely to have difficulty sleeping (Williams, Chambers, Logan, & Robinson, 1996). Studies have also shown that being involved in school bullying was a risk factor for poor sleep quality in Chinese adolescents (Zhou et al., 2015). Adolescent students living in remote rural areas in China often face intertwined adversities, such as being left behind, being poor and being bullied. Therefore, when examining the negative sleep effects of LBC, such as nightmares and insomnia, it is also necessary to consider the potentially combined effects of poverty and school bullying.
Psychological distress has been found to have a negative impact on quality adolescent sleep (Roberts & Duong, 2013), and sleep problems in children have been seen as possible indicators for the onset of internal problems such as depression and anxiety (Alvaro, Roberts, & Harris, 2013), with anxiety and/or depressive symptoms having been found to be possible predictors for adolescent sleep problems over time (Shanahan, Copeland, Angold, Bondy, & Costello, 2014). As a direct link has been proven between LBC, poverty, being bullied and psychological distress (Lereya et al., 2015, Wang et al., 2019), psychological distress could be a mediator between adolescent adversities and sleep difficulties. However, little information is currently available to assist psychologists, social workers or policy makers understand the effects that parental migration may have on the sleep in left behind adolescents or whether psychological distress is a mediator.
To address this gap, the influences of parental migration, type of primary caregiver, separation length, socio-economic factors (poverty and bullying), and psychological distress on insomnia and nightmares in LBC children were examined by comparing LBC and non-LBC samples. Structural equation models were used to explore the potential relationships between these variables.
From previous research, therefore, it was hypothesized that:
Hypothesis 1. The LBC have a greater incidence of insomnia and nightmares than their non-LBC peers.
Hypothesis 2. Poverty and bullying have a negative effect on insomnia and nightmares.
Hypothesis 3. Separation length and type of caregiver are risk factors for poor sleep quality in LBC.
Hypothesis 4. Psychological distress is a mediator between these adversities and adolescent insomnia and nightmares.
Section snippets
Participants
This cross-sectional survey was conducted from 13 March to 9 June 2017 in Sichuan Province, which has the second largest trans-provincial migrant population and the largest number of LBC in China at 11.34% of the national total (Federation, 2013). Two counties from each of the four regions (northwest, east, south and central) as divided by the Sichuan government were selected based on economic development and geographical location (Yang, Han, & Song, 2014) after which two junior high schools
Sample characteristics
A total of 3346 participants were included in this study (Table 1), of which 1 663 were LBC (865 (52.0%) females; mean age of 13.9 years; SD, 1.18; range, 12–16 years), and 1 683 were controls (849 (50.2%) females; mean age of 13.8 years; SD, 1.17; range, 12–16 years). There were significant differences found between the LBC and controls for ‘moderately often’ and ‘very often’ peer bullying (18.5% vs. 11.3%), but no differences were found for age, gender, only child status or family income.
Insomnia and nightmares stratified by left-behind status
The
Discussion
Evidence suggests that unstable family contexts have adverse effects on sleep; however, the link between parental absence and sleep in adolescents is less clear. To the best of our knowledge, this is the first comprehensive study of the effects of parental absence and other adversity correlates on adolescent sleep in a large sample of Chinese LBC. The findings suggest that as a group, LBC have worse sleep outcomes than the adolescents of non-migrant parents. First, the presence of insomnia
Declaration of Competing Interest
The authors declared that there is no conflict of interest.
Acknowledgements
The authors would like to thank all the participants in this study. This research was supported by grants to Dr. Wanjie Tang from the Program of the National Social Science Foundation of China (18BSH121).
References (77)
- et al.
Interpreting scores on the Kessler psychological distress scale (K10)
Australian and New Zealand Journal of Public Health
(2001) - et al.
Test–retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia
Journal of Psychosomatic Research
(2002) - et al.
Family economic hardship and Chinese adolescents' sleep quality: A moderated mediation model involving perceived economic discrimination and coping strategy
Journal of Adolescence
(2016) - et al.
Perceived parenting styles, personality traits and sleep patterns in adolescents
Journal of Adolescence
(2009) - et al.
Prevalence of insomnia symptoms in a general population sample of young children and preadolescents: Gender effects
Sleep Medicine
(2014) - et al.
Psychometric evaluation of the Pittsburgh sleep quality index
Journal of Psychosomatic Research
(1998) - et al.
Anxiety, happiness and self-esteem of western Chinese left-behind children
Child Abuse & Neglect
(2018) - et al.
Testing the effect of perceived social support on left-behind children’s mental well-being in mainland China: The mediation role of resilience
Children and Youth Services Review
(2020) - et al.
Health impacts of parental migration on left-behind children and adolescents: A systematic review and meta-analysis
The Lancet
(2018) - et al.
Parental poverty and occupation as risk factors for pediatric sleep-disordered breathing
Sleep Medicine
(2015)