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Sleep Problems Predict and Are Predicted by Generalized Anxiety/Depression and Oppositional Defiant Disorder

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Objective

We tested whether sleep problems co-occur with, precede, and/or follow common psychiatric disorders during childhood and adolescence. We also clarified the role of comorbidity and tested for specificity of associations among sleep problems and psychiatric disorders.

Method

Data came from the Great Smoky Mountains Study, a representative population sample of 1,420 children, assessed 4 to 7 times per person between ages 9 and 16 years for major Diagnostic and Statistical Manual-Fourth Edition (DSM-IV) disorders and sleep problems. Sleep-related symptoms were removed from diagnostic criteria when applicable.

Results

Sleep problems during childhood and adolescence were common, with restless sleep and difficulty falling asleep being the most common symptoms. Cross-sectional analyses showed that sleep problems co-occurred with many psychiatric disorders. Longitudinal analyses revealed that sleep problems predicted increases in the prevalence of later generalized anxiety disorder (GAD) and high GAD/depression symptoms, and oppositional defiant disorder (ODD). In turn, GAD and/or depression and ODD predicted increases in sleep problems over time.

Conclusions

Sleep problems both predict and are predicted by a diagnostic cluster that includes ODD, GAD, and depression. Screening children for sleep problems could offer promising opportunities for reducing the burden of mental illness during the early life course.

Section snippets

Participants

The Great Smoky Mountains Study is a longitudinal study of the development of psychiatric disorders in rural and urban youth.18, 19 A representative sample of 3 cohorts of children, aged 9, 11, and 13 at intake, was recruited from 11 counties in western North Carolina. Potential participants were selected from the population of some 12,000 children using a household equal probability, accelerated cohort design. All children scoring above a predetermined cutoff point (the top 25% of the total

Prevalence of Sleep Problems

Sleep problems were fairly common (Table 1). In all, 26.1% of observations had 1 or more sleep problems in the past 3 months, 12.4% had 2 or more sleep problems. The most common problems were restless sleep and difficulty falling asleep. There was only 1 individual symptom for which there was a sex difference: girls were more than 3 times more likely than boys to report feeling “tired or weary at least half the time” (girls, 4.1%; 95% CI = 2.7%, 5.5%; boys, 1.2%; 95% CI = 0.4%, 2.0%; p <

Discussion

Sleep problems have been identified as correlates of common psychiatric disorders of childhood and adolescence.4 DSM-IV criteria specify that sleep disturbance can be the result of a mental disorder, but longitudinal research during the early life course currently provides more evidence for predictions from sleep problems to psychiatric disorders.4 The current study tested predictions from sleep problems to psychiatric disorder and vice versa during adolescence while addressing several

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    The work presented here was supported by the National Institute on Drug Abuse (NIDA) and the National Institute of Mental Health (NIMH) (DA/MH011301, MH63970, MH48085, MH080230, MH094605, DA023026), National Alliance for Research on Schizophrenia and Depression (NARSAD), and the William T. Grant Foundation.

    Alaattin Erkanli, PhD, of Duke University Medical School, serves as the statistical advisor for the Great Smoky Mountains Study.

    Disclosure: Dr. Shanahan has received research support from NIMH and NIDA. Dr. Copeland has received research support from NIMH, NIDA, the National Institute on Alcohol and Alcohol Abuse, and NARSAD. Dr. Angold has received research support from NIMH and NIDA. Dr. Angold co-authored the following assessment tool: Preschool Age Psychiatric Assessment (PAPA). No personal income is derived from this measure. Dr. Costello has received research support from NIMH and NIDA. Drs. Costello and Angold are co-recipients of the 2009 NARSAD Ruane Prize for Outstanding Child and Adolescent Psychiatric Research. Drs. Angold and Costello co-authored the following assessment tools: Child and Adolescent Psychiatric Assessment (CAPA), Young Adult Psychiatric Assessment (YAPA), Child and Adolescent Impact Assessment (CAIA), Child and Adolescent Services Assessment (CASA), and Mood and Feelings Questionnaire (MFQ). No personal income is derived from any of these measures. Ms. Bondy reports no biomedical financial interests or potential conflicts of interest.

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