This study investigates the association between sleep duration and attentional and behavioral outcomes in preschool children of mothers with depression, a group at elevated developmental risk. Exploring data from the Future of Families and Child Wellbeing Study (N = 2945; female = 48%), we examine whether longer sleep durations are associated with reduced attentional and behavioral issues in these preschoolers from low-income, high-risk families. Specifically, we focus on attentional, externalizing, and internalizing problems. Our analysis employs both linear and non-linear models to parse the intricacies of sleep’s role on child behavior. Findings suggest that adequate sleep may play a key role in mitigating the negative developmental impacts of maternal depression. These insights pave the way for targeted interventions that could bolster child development through improved sleep practices.
The preschool years are crucial for attention and behavioral development, a time when the brain’s high receptivity to experiences heightens its vulnerability to both positive and negative influences (Belsky, 2013; Brown & Jernigan, 2012). Maternal depression has been identified as a significant risk factor associated with children’s development, particularly exacerbating internalizing and externalizing behaviors and general psychopathology, especially in low-income families (Baker et al., 2020; Goodman et al., 2011). Identifying protective factors to counteract these effects is essential. Sleep duration, known for its regulatory role on emotion and behavior (Mindell et al., 2017), can be a potential protective factor. This study explores how adequate sleep might mitigate the strains of maternal depression on preschoolers, emphasizing the need for targeted intervention programs for at-risk children.
Maternal Depression and Preschoolers’ Development
Depression is a common mental health disorder characterized by prolonged sadness and disinterest (Gelaye et al., 2016), particularly prevalent among women in their childbearing years (Kessler, 2003). It poses long-term developmental risks for children’s psychological development due to its recurrent nature (Ten Have et al., 2018) and can lead to cognitive and behavioral issues (Goodman et al., 2011; Bagner et al., 2010). Maternal depression can shape child development through two main pathways: it may impair parenting behaviors, resulting in less positive interactions (Lovejoy et al., 2000; Bernard et al., 2018), and disrupt household routines, contributing to chaotic environments that undermine children’s self-regulation and socio-emotional growth (Manczak et al., 2017; Hur et al., 2015). Chronic stressors can worsen maternal depression (Bartolomucci & Leopardi, 2009), but protective factors like structured daily routines (Nolen-Hoeksema & Watkins, 2011; Ivanova & Israel, 2006; Selman & Dilworth-Bart, 2024) and adequate sleep (Zajicek-Farber et al., 2012) may buffer its negativity on children.
Sleep Duration
Sleep is crucial for preschoolers, who typically need 10–13 h nightly to support their health and development (El-Sheikh et al., 2013, Hirshkowitz et al., 2015). Insufficient sleep can impair cognitive functions and contribute to social-emotional problems (Astill et al., 2012; Turnbull et al., 2013; Hysing et al., 2016). However, maintaining adequate sleep in early childhood can be challenging (Reynaud et al., 2018), particularly under the strain of maternal depression, which may disrupt consistent sleep schedules (Warren et al., 2006; Covington et al., 2019). This issue is often exacerbated by economic disadvantages, which are linked to shorter sleep durations (El-Sheikh et al., 2013). In low-income, high-risk settings, these challenges are magnified by factors like inconsistent bedtimes due to erratic parental work schedules and household disorganization (Marsh et al., 2020; Hoyniak et al., 2022). These socioeconomic and environmental factors critically alter sleep patterns and underscore the complex interplay of variables on child well-being (Boles et al., 2016; Grandner et al., 2016).
In addition, mothers with depression might also struggle with their own sleep issues, challenging their ability to manage their children’s sleep routines (Goyal et al., 2007). Their increased negativity and harshness can further prevent children from settling into a calm, secure state necessary for good sleep (Lovejoy et al., 2000). These factors are crucial as preschoolers rely heavily on their mothers for care, and insufficient sleep can significantly impair their cognitive and behavioral development (Reynaud et al., 2018).
Maternal depression can complicate children’s sleeping patterns and developmental trajectories, but adequate sleep could mitigate these adverse outcomes. Establishing consistent sleep practices, such as setting early bedtimes (Mindell et al., 2009) by involving support from secondary caregivers (Martin et al., 2022), may help ensure sufficient sleep and alleviate the strain of maternal depression. Given the critical role of sleep in emotional and behavioral regulation (Mindell et al., 2017), it has the potential to lessen the strains of maternal depression on preschooler behavior. Therefore, sufficient sleep may offer children of mothers with depression benefits beyond buffering maternal stress.
Research demonstrates that the association between sleep duration and well-being may follow a U-shaped curve in both adults (Cappuccio et al., 2010) and children, as highlighted by James and Hale (2017), indicating that both insufficient and excessive sleep can detrimentally alter well-being. Nevertheless, contrasting findings, such as those from Price et al. (2016), indicate a linear association, leaving the determination of optimal sleep durations for child development unresolved. Given that sleep patterns can be particularly disrupted in children of mothers with depression (Covington et al., 2019), understanding the nature of this association, whether linear or nonlinear, becomes critical. This study aims to elucidate the role of sleep duration on children’s well-being in the context of maternal depression, thereby addressing a gap in the current understanding and potentially guiding future intervention strategies.
The Current Study
The primary objective of this study was to examine how sleep duration and maternal depression interact in influencing attentional, externalizing, and internalizing problems in preschoolers from low-income, high-risk families. We hypothesize that longer sleep duration will mitigate the association between maternal depression and attentional, externalizing, and internalizing problems. We are modeling this as an interaction due to the structure of our data, and maternal depression as the moderator in the association between sleep duration and child behaviors (James & Hale, 2017). The secondary objective was to extend the work of James and Hale (2017) by examining the possibility of curvilinear associations between sleep duration and child behavior in the context of maternal depression. Based on this, we expect to observe a U-shaped association between sleep duration and child behavior problems, indicating that moderate sleep duration will be associated with the lowest levels of attentional, externalizing, and internalizing problems in preschoolers from low-income, high-risk families with children of mothers with depression.
Method
We report how we determined all data exclusions, sample size, manipulations, and measures in the study, consistent with reporting standards for quantitative research (Appelbaum et al., 2018; Simmons et al., 2012). This study analyzed de-identified, publicly available data from the Future of Families and Child Wellbeing Study (FFCWS). Under U.S. federal regulations (45 CFR 46.102(e)(1)), these secondary analyses did not constitute human subjects research; therefore, IRB review and informed consent for the present analyses were not required. Original FFCWS data collection procedures received IRB oversight and participant consent from the host institutions. All data, analysis code, and research materials are available by emailing the corresponding author. Data and research materials are also accessible through the Future of Families and Child Wellbeing Study (FFCWS) at https://doi.org/10.3886/ICPSR31622.v3.
Participants
Data for this research was obtained from the Future of Families and Child Wellbeing Study (FFCWS; detailed study design can be found in Reichman et al., 2001). FFCWS, a longitudinal survey, followed over 4800 children born in 20 major U.S. cities during 1998–2000. The study’s sample was stratified and randomly selected from U.S. cities with a population over 200,000. The cities were categorized based on three criteria: the strength of the labor market, the effectiveness of child support enforcement, and the level of welfare grants (McLanahan & Garfinkel, 2000). The FFCWS particularly emphasized the diversity of family structures and child development by oversampling children born to unmarried mothers, with around half of these parents living together and the other half not. This approach guaranteed a sample that was diverse in terms of race and socioeconomic status, accurately reflecting the population of children born in large cities (with populations over 200,000) during the 1998–1999 period (James et al., 2021).
The initial interviews for the study were conducted shortly after the birth of the children, followed by subsequent interviews at ages 1, 3, 5, 9, and 15. For the current study, we specifically utilized data from Year 5, focusing on the preschool years. By the Year 5, 4139 of these mothers had provided further data. To account for potential confounders, baseline measures were incorporated as covariates. Data from Year 5 was used for quantifying the duration of children’s sleep and measuring their behavioral and attentional problems. We exclusively used reports from biological mothers for all children to maintain consistency in the primary respondent’s relationship with the child, following methodologies typical in similar research (as shown in studies by Muñiz et al., 2014; Lee et al., 2019). The analysis in this paper was confined to those families for which we had complete data on sleep duration for the 5-year-olds and where the mothers had completed an in-home assessment at the time their children were 5, aligning with the standard practices of previous research utilizing FFCWS data (e.g., Lee et al., 2019).
Our sample included 2974 mothers and their young children (Mage = 61 months; 51% male); these are the focal children of this study. The average age of these mothers when the child was 5 years old was 30.2 years (range age 21 to age 49), and 70% of these women were unmarried. Half of the sample identified as Black, Non-Hispanic (51%), and the other half was mostly White, Non-Hispanic (21%), or Hispanic (25%). Further, about 25% of these women reported having not completed high school, 25% reported having a high school degree or equivalent, and another 35% stated they had some college or technical school. Additional demographic characteristics of the sample are shown in Table 1.
Table 1
a. Demographic Characteristics of the Study Sample (N = 2974). b. Percentage of children’s sleep duration and mothers’ depression
Variable
N (%)
a
Gender (n, %)
Male
1539 (51.7%)
Female
1435 (48.3%)
Age (M, SD)
Child (month)
61.3 (2.49)
Mother
30.2 (5.97)
Father
32.9 (7.06)
Race (Mother)
Black, non-hispanic
1513 (50.9%)
Hispanic
738 (24.8%)
White, non-hispanic
632 (21.3%)
Other
85 (2.9%)
Missing
6 (0.2%)
Race (Father)
Black, non-hispanic
1566 (52.7%)
Hispanic
738 (24.8%)
White, non-hispanic
556 (18.7%)
Other
98 (3.3%)
Missing
16 (0.5%)
Level of education (Mother)
College
374 (12.6%)
Some college
1065 (35.8%)
High school
767 (25.8%)
Less than high school
766 (25.8%)
Missing
2 (0.1%)
Level of education (Father)
College
280 (9.4%)
Some college
649 (21.8%)
High school
609 (20.5%)
Less than high school
601 (20.2%)
Missing
835 (28.1%)
Poverty Ratio (M, SD)
1.85 (2.28)
Relationship status
Not married
2079 (69.9%)
Married
892 (30.0%)
Missing
3 (0.1%)
N (%)
b
Sleep Duration (Hours)
0–5
8 (0.3%)
6
26 (0.9%)
7
84 (3%)
8
648 (22%)
9
719 (24%)
10
972 (33%)
11
385 (13%)
12
116 (4%)
13
11 (0.4%)
14–17
5 (0.2%)
Maternal Depression
No clinical depression
2622 (88%)
Clinical depression
349 (12%)
As shown in Supplemental Table 1, there were some minor differences between those who completed in-home assessments at age 5 (61%) and those who did not (39%). The data revealed no significant differences in several demographic aspects, including the child’s sex, maternal education levels, and the number of children residing in the home. However, differences emerged in other areas such as maternal age, racial/ethnic background, relationship status, household poverty ratio, and the number of adults in the household. Specifically, the sample included a higher proportion of Black mothers. Additionally, participants who were dropped from the study tended to have a higher household poverty ratio and were more likely to be married. Households of participants who were dropped out from the study typically had a greater number of adults present, compared to those who remained in the sample. These findings inform the composition of the study sample and its potential impact on data analysis and interpretation.
Measures
Maternal Depression
In the study, depression was measured using the Composite International Diagnostic Interview - Short Form (CIDI-SF; Kessler et al., 1998), designed to assess depressive symptoms and commonly used for diagnosing major depressive disorders (APA, 1994). The questionnaire format includes structured questions that delve into various aspects of depression. As part of the Year 5 wave of the FFCWS, participants were interviewed about their mental health. Specifically, they were asked if they had experienced dysphoria, a persistent feeling of sadness, or anhedonia, which is the inability to feel pleasure, for a period of at least 2 weeks in the past year. Those who responded affirmatively were then asked additional questions concerning symptoms such as loss of interest, fatigue, weight changes, sleep disturbances, concentration difficulties, feelings of worthlessness, and thoughts of death. A dichotomous scoring system was employed to classify individuals as probable cases or non-cases of major depression, with scores of three or more indicating probable cases (no clinical symptoms = 0, clinical symptoms = 1) (Kessler et al., 1998).
Sleep Duration
When the children reached the age of 5, mothers provided a report regarding the total number of hours that their child slept on a weeknight basis. The range of sleep duration, as reported by the mothers, varied from a minimum of 0 h to a maximum of 17 h. The mean sleep duration was 9.4 h (SD = 1.3), and the median sleep duration was 10 h. Most children in the sample sleep for 8–10 h at night (see Table 1b).
Child Measures
The Child Behavior Checklist (CBCL/4-18) was used to assess the externalizing, internalizing, and attentional problems of the children (Achenbach, 1992) in the primary caregiver interview. Attentional problems were evaluated using 7 relevant items. Externalizing behavior was evaluated using the Aggressive and Delinquent subscales, and their scores were combined to create the total externalizing behavior score, which consisted of 24 items. Internalizing behaviors were measured using the Anxious/Depressed and Withdrawn subscales, and their scores were combined to create the total internalizing behavior score, which consisted of 15 items. All items were rated on a three-point scale (not true = 0, somewhat or sometimes true = 1, very true or always true = 2). Internal consistency for the scales assessing attention, externalizing, and internalizing problems was evaluated using Cronbach’s α, with results of 0.60, 0.84, and 0.70 respectively. These values suggest varying levels of reliability across the scales: a value of 0.84 for externalizing problems indicates good reliability; 0.70 for internalizing problems denotes acceptable reliability; and 0.60 for attention problems, which is relatively lower, suggests marginal reliability. This lower reliability for the attention problems scale may be attributed to its fewer number of items, totaling only seven.
Covariates
To control for the high proportion of families with low income levels and single parents in the sample, income level and relationship status (0 = Not married, 1 = Married) were included as control variables based on prior research (James & Hale, 2017), as they are linked to various health, cognitive, and socioemotional outcomes in children (Bradley & Corwyn, 2002; Conway & Li, 2012). Mother age was also controlled since it correlates with numerous child developmental outcomes (Duncan et al., 2018). This approach enhances the validity of the findings by minimizing potential bias from these demographic variables.
Analysis Plan
All analyses were performed in R (version 4.1.3) (R Core Team, 2022). For each of the three dependent variables (attentional problems, externalizing behavior, and internalizing behavior), we tested two regression models. In the ‘linear regression model,’ we simultaneously included (a) control variables such as income level, mother relationship status and mother age; (b) main effects of maternal depression and sleep duration; and (c) the interaction term between sleep duration and maternal depression. The ‘nonlinear regression model’ consisted of all the variables from ‘linear regression model’, and we included the squared term of sleep duration, and the interaction between this squared term and maternal depression. We compared the fit of the linear to nonlinear regression models using F-statistics to see if the addition of the nonlinear terms in nonlinear regression models provided a better fit to the data. Subgroup analyses were conducted to further investigate the interaction effect of sleep duration with the dependent variables. All independent variables were centered for ease of interpretation.
Results
The present study’s statistical analysis results are presented in the following subsections. Bivariate correlations are reported in Table 2. The results of regression analyses examining the interaction effects of sleep duration and maternal depression on each dependent variable separately are presented in Table 3, linear and nonlinear association results are illustrated in Fig. 1.
Fig. 1
Interaction model of linear effect sleep duration on the association between the maternal depression and preschoolers’ attentional, externalizing and internalizing problems
Summary of regression analysis for linear regression models
Attentional Problems
Externalizing Problems
Internalizing Problems
Income
−0.04*
−0.04
−0.07***
Relationship Status
−0.11*
−0.12**
−0.06
Mother Age
−0.01***
−0.02***
−0.01***
Maternal Depression
0.36***
0.43***
0.34***
Sleep Duration
0.02
−0.06**
−0.01
Maternal Depression*Sleep Duration
−0.19***
−0.13*
−0.12*
*: p < 0.05. **:p < 0.01. ***: p < 0.001
Preliminary Analysis
Most children in the sample slept for 8–10 h at night, with the highest percentage of children (33%) sleeping for 10 h. A significant number of children (24%) slept for 9 h, and 22% slept for 8 h (see Table 1b). Additionally, around 88% of the participating mothers reported no clinical depression, while 12% reported clinical depression. No significant difference was found in mean child sleep duration between mothers with and without depression, t(425.75) = 1.26, p = 0.21. Bivariate correlation analyses indicated that there was a significant positive correlation between maternal depression and attentional problems (r = 0.12, p < 0.001), externalizing problems (r = 0.15, p < 0.001), and internalizing problems (r = 0.12, p < 0.001). These findings suggested that as maternal depression levels increased, so did attentional, externalizing, and internalizing problems in preschool-aged children. Child sleep duration was not significantly correlated with child attentional problems, but it was negatively correlated with child externalizing problems (r = −0.10, p < 0.001) and internalizing problems (r = −0.04, p < 0.001). These results suggested that as sleep duration levels increased, preschool-aged children experienced fewer externalizing and internalizing problems.
Primary Analysis
In our moderated regression analyses, we specifically investigated the interaction between sleep duration and maternal depression on various child behavior problems (attentional, externalizing, and internalizing), while controlling for household income, maternal relationship status, and maternal age.
For attentional problems, we observed a significant interaction effect between sleep duration and maternal depression (β = −0.19, p < 0.001), suggesting that sleep duration indeed interacted with maternal depression on these problems. Specifically, in preschoolers of mothers with depression, a notable negative association was found between sleep duration and attentional problems (β = −0.15, p < 0.001), while this association was not significant in preschoolers of mothers with depression (β = 0.02, p = 0.31) (Fig. 1a). The quadratic term of sleep duration also interacted significantly with maternal depression (β = 0.05, p = 0.02), indicating a more complex, curvilinear pattern in terms of the role of sleep duration on attentional problems. This indicates that both very short and very long sleep durations could be linked to greater attentional problems in preschoolers of mothers with depression, compared to moderate sleep durations which might be more protective against these problems. Model comparisons highlighted an improved fit when including the interaction and squared terms (F(2, 2890) = 8.80, p < 0.001). Subgroup analysis showed the quadratic sleep duration term was significant for attentional problems in preschoolers of mothers with depression (β = 0.07 p < 0.001) but not without (β = 0.02, p = 0.06).
Regarding externalizing problems, a similar pattern emerged. The interaction between sleep duration and maternal depression was significant (β = −0.13 p = 0.01). In preschoolers of mothers with and without depression, sleep duration was significantly associated with fewer externalizing problems (β = −0.18 p < 0.001 vs. β = −0.06, p = 0.002) (Fig. 1b). However, the quadratic term of sleep duration on these problems did not show a significant interaction with maternal depression (β = 0.02, p = 0.40). The quadratic term results from the subgroup analysis show that the squared term of sleep duration did not show a significant association with externalizing problems in either subgroup.
For internalizing problems, the interaction between sleep duration and maternal depression was significant (β = −0.12, p = 0.02). Subgroup analysis indicated sleep duration was significantly associated with fewer internalizing problems in preschoolers of mothers with depression (B = −0.12, p = 0.009) but not in those without (β = −0.01, p = 0.51) (Fig. 1c). In addition, the quadratic sleep duration term showed no significant interaction with maternal depression (β = 0.01, p = 0.48).
The robustness analysis showed that including various covariates did not change the significance of the results. Analyses with no covariates, three covariates (income, relationship status, mother age), and five covariates (income, relationship status, mother age, child gender, mother education) all yield consistent results. This stability across models confirms that our findings are reliable despite variations in demographic and socioeconomic factors. Overall, these findings suggest that sleep duration significantly interacts with maternal depression, influencing various child behavioral problems, particularly attentional, externalizing, and internalizing issues in preschoolers of mothers with depression. The results particularly highlight the complex, nonlinear nature of this association, as seen in the quadratic sleep duration interaction in relation to attentional problems.
Discussion
We examined how sleep duration interacts with maternal depression and relates to preschoolers’ attentional, externalizing, and internalizing problems. For attentional problems, the interaction between sleep duration and maternal depression significantly influences outcomes. Specifically, longer sleep was significantly linked to fewer attentional problems in preschoolers of mothers with depression, but this link was not evident in preschoolers of mothers without depression. In the case of externalizing problems, a similar significant interaction was observed, where longer sleep durations were associated with fewer externalizing behaviors, especially in preschoolers of mothers with depression compared to those without. For internalizing problems, the interaction was also significant. Here, longer sleep was associated with fewer internalizing behaviors in preschoolers of mothers with depression, with no notable association in preschoolers of mothers without depression. These findings underscore the protective role of adequate sleep in managing behavioral issues in preschoolers, particularly in the context of maternal depression, suggesting that tailored sleep interventions may be beneficial.
Adequate sleep is crucial for the optimal functioning of the prefrontal cortex, which plays a key role in regulating attention, emotions (Breitenstein et al., 2021), and impulsive behaviors (Bebee, 2011). It reinforces the protective buffer theory, suggesting that sufficient sleep can bolster emotional regulation, particularly in children exposed to the emotional strain of maternal depression (Vandekerckhove & Wang, 2017). In preschoolers of mothers with depression, disrupted sleep may impair prefrontal cortex function, compounding the role of maternal depression (Goodman et al., 2011; Breitenstein et al., 2021). This impairment can exacerbate externalizing problems, potentially further aggravated by increased stress hormone levels due to sleep disturbances, which elevate cortisol levels, disrupting emotional regulation and amplifying susceptibility to conditions like anxiety and depression (Beebe, 2011; Gregory & Sadeh, 2012). Given the combined impact of maternal depression and inadequate sleep, these children are at heightened vulnerability (Gissandaner et al., 2023; Covington et al., 2021). Therefore, interventions focused on improving sleep could be vital, aiding attentional development and mitigating externalizing behaviors while also facilitating improved socio-emotional growth (Short et al., 2018).
Considering our findings, it is crucial to explore additional factors that may interact with sleep to influence preschooler behavior, especially since we observed no significant differences in sleep duration between preschoolers of mothers with and without depression. This outcome, which diverges from previous research suggesting that maternal depression disrupts children’s sleep (Ystrøm et al., 2017; Meltzer & Mindell, 2007), highlights the potential role of compensatory mechanisms within the family environment. The presence of other supportive adults in the household, such as secondary caregivers, may act as a crucial buffer (Pyper et al., 2017). These adults can provide emotional support and stability, potentially alleviating some of the strains of maternal depression. Moreover, engagement in structured settings such as daycare, preschool, or kindergarten may represent another significant factor (Ward et al., 2007; Moon et al., 2016). These settings not only support regular sleep patterns and social development but also aid in the early detection and management of behavioral issues (Hoyniak et al., 2020). Thus, while sleep duration is a critical factor, other variables also contribute to protective or risk-reducing role on preschooler behavior, underscoring the importance of further research into these protective factors and their impact on child well-being.
It’s also important to highlight the quadratic sleep effect, which reveals a curvilinear association between sleep duration and attentional problems. The anticipated quadratic sleep duration term was not statistically significant for externalizing or internalizing problems our large sample. Specifically, in preschoolers of mothers with depression, there exists a U-shaped association: attentional problems decline with increased sleep, but after a threshold, they rise again. This association is less pronounced for preschoolers of mothers without depression, suggesting that these children may have specific sleep needs or vulnerabilities compared to their peers. Echoing James and Hale’s (2017) findings, we observed similar U-shaped associations in the FFCWS dataset, particularly for preschool children. Yet, our research extends this by emphasizing the profound role of maternal depression on these associations. While fatigue and irritability resulting from sleep deprivation can explain some of the association, oversleeping (less than 5% of high-risk preschoolers in our sample slept for more than 12 h), albeit less common, might be linked to other unidentified risk factors or medical conditions like sleep disorders (Belmon et al., 2019).
Interestingly, the non-significant curvilinear association observed in preschoolers of mothers without depression may hint at possible age-specific differences in sleep needs. While both short and long sleep durations have been associated with behavioral problems in 9-year-olds (James & Hale, 2017), younger children might have distinct sleep needs (Hirskowitz et al., 2015). Hence, the repercussions of longer sleep at age 9 could be different from those at age 5 due to developmental variations. Further investigations are imperative to fully understand these age and development-related factors on sleep and behavioral development.
Overall, our findings underscore the significant associations between sleep duration, maternal depression, and their relations with preschoolers’ attentional, externalizing, and internalizing behavior problems. While the linear associations provide clear evidence that longer sleep generally corresponds with fewer behavioral problems, the quadratic associations suggest a more complex association, indicating that optimal sleep durations may vary, particularly among those affected by maternal depression. Specifically, for attentional problems, we observed a curvilinear association, which was present regardless of maternal depression status, although less pronounced in preschoolers of mothers without depression. This suggests that both insufficient and excessive sleep could be linked to increased attentional issues, particularly in preschoolers of mothers with depression. In contrast, no nonlinear associations were observed for externalizing or internalizing behaviors, potentially due to distinct underlying mechanisms governing these types of behavior. It is plausible that attentional problems, which are closely linked to cognitive processes directly influenced by prefrontal cortex activity, might be more sensitive to variations in sleep duration. The prefrontal cortex, crucial for attention regulation, may exhibit a more pronounced response to both inadequate and excessive sleep, hence the observed curvilinear pattern (Maski & Kothare, 2013; McQuillan et al., 2021). On the other hand, externalizing and internalizing behaviors could be influenced by a broader range of biological, psychological, and environmental factors, which may dilute or overshadow the impact of sleep duration alone (Hatoum et al., 2018). Future research should explore how specific sleep durations interact with maternal mental health to affect various developmental outcomes.
Strengths and Limitations
Our study significantly advances existing research by using both linear and nonlinear models to examine the association between sleep duration and behavioral problems in preschoolers of mothers with depression, focusing on a large sample of preschoolers from high-risk families. This methodological approach uncovers potential complexities that linear analyses might overlook, highlighting the critical role of adequate sleep in mitigating the adverse outcomes of maternal depression on child development. These findings are crucial for high-risk families facing economic and social constraints. Our study provides actionable insights for healthcare providers and policymakers, highlighting the need for tailored interventions to improve developmental outcomes by addressing mental health and daily routines in vulnerable populations.
The study’s reliance on cross-sectional data limits the ability to establish causality or directionality of associations among constructs, highlighting the need for future longitudinal or experimental research. Nonetheless, cross-sectional data provide a crucial foundation for forming hypotheses to be explored in more complex studies. Additionally, the study’s strength lies in its consistent results across multiple developmental domains and its exploration of both linear and quadratic associations between sleep duration and preschoolers’ behavioral issues. Furthermore, including covariates in this analysis enhances the robustness of the findings by accounting for critical demographic and socioeconomic factors that significantly influence child developmental outcomes. By controlling for variables such as income, relationship status, mother age, child gender, and mother education, the study ensures that the observed effects are more accurately attributed to the variables of interest, thereby increasing the validity and reliability of the results. On the other hand, the attentional measure showed low reliability, suggesting caution in interpreting its significant curvilinear association with sleep duration. Since the other two outcomes showed no curvilinear association, this unique finding may warrant further exploration with more reliable measures to confirm its validity.
Although relying solely on data from biological mothers might introduce biases, such as a heightened focus on negative events, especially if the caregiver experiences depression (Goodman et al., 2011), this approach also offers unique insights. Maternal caregivers are often the primary observers of their child’s daily routines, including sleep schedules and behavioral patterns. Additionally, no significant difference was found in mean child sleep duration between mothers with and without depression, reinforces the reliability of maternal observations in assessing child sleep patterns, even in the context of maternal depression. Moreover, parental report of children’s sleep is an established indicator of sleep health (Chaput et al., 2017). A meta-analysis reported that sleep duration significantly correlates with children’s cognitive performance, unlike sleep efficiency (Astill et al., 2012). Hirshkowitz et al. (2015) highlight its value as a practical, validated measurement for practitioners. Studies, reveal strong correlations between parental reports and objective measures like actigraphy and sleep diaries (Touchette et al., 2007). However, complementing maternal reports with data from objective measurements like actigraphy, could offer a more robust perspective on the child’s sleep in future research.
Furthermore, we acknowledge the temporal and contextual limitations of our dataset from the economic and social contexts of 1998–2000. However, these limitations are inevitable in large-scale longitudinal studies, which span decades and capture demographic shifts, still underscoring the need to interpret findings within this context. Key constructs such as sleep duration, maternal depression, and child behavioral problems, measured by well-validated scales, remain relevant today and exhibit stability across time, reinforcing the significance of our findings despite the temporal gap. For example, the consistency of using sleep duration as a variable over time further supports the validity of our results (Tsai et al., 2023). The use of the CIDI-SF, based on DSM-IV criteria, ensures comparability across studies, as the core criteria for diagnosing major depressive episodes have remained consistent despite the advent of DSM-5. Additionally, the Child Behavior Checklist (CBCL) scales are reliable for assessing child behaviors, ensuring the robustness of our findings. Thus, despite the temporal distance, our results are important for demonstrating the association between sleep duration, maternal depression, and child development.
The demographic differences between children assessed in-home at age 5 and those not assessed suggest potential biases in the study’s findings. Differences in mother race/ethnicity and education levels exist, with more Hispanic mothers and mothers with less than high school education dropped. However, child sex, mother’s age, relationship status, poverty ratio, and number of kids in the home showed no significant differences, mitigating some concerns. This may indicate that the current sample has fewer Hispanic mothers and fewer mothers with less than high school education than the baseline assessments, but still includes 25% Hispanic mothers and 32% of mothers with less than high school education.
The weak associations observed between sleep duration and externalizing and internalizing problems in children, with correlation coefficients around 0.13 and 0.12, offer a nuanced perspective on the matter. While such modest correlations might initially seem to limit the practicality of the findings, they serve as a compelling counterargument against method variance, suggesting that these associations are not mere artifacts of measurement but potentially genuine reflections of the complex interplay between child sleep and behavior. Importantly, in psychological research, particularly in areas as intricate as child behavior and sleep, even small effect sizes can be meaningful. These subtle correlations highlight the intricate and multifaceted nature of child development, emphasizing the need to consider a broad array of variables and interactions. Therefore, rather than seeing the limited magnitude of these associations as a disadvantage, it should be recognized as an important insight into the subtle yet significant ways sleep duration may intersect with various aspects of a child’s well-being.
Future Directions
Further research should delve deeper into the underlying mechanisms between sleep duration, maternal depression, and preschooler behavior problems. It may be informative to examine associations between the sleep of mothers who experience depression and their children’s sleep, as disruptions could indirectly play a role in child’s well-being. Alongside duration, factors such as sleep onset, disorders, and napping habits might alter child behavior. Additionally, the role of family dynamics, environment, and parenting should be investigated. Enhancing parental awareness of sleep’s role, especially in the context of maternal depression, can benefit child development. Prioritizing early interventions for maternal sleep and depression is essential for supporting children and families.
Conclusion
In conclusion, our study reveals that longer sleep duration mitigates the impact of maternal depression on attentional, externalizing, and internalizing problems in preschoolers. These findings highlight the importance of adequate sleep in early childhood, especially for children at risk due to maternal mental health issues.
Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health under award numbers R01HD036916, R01HD039135, and R01HD040421, as well as a consortium of private foundations. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Compliance with ethical standards
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The authors declare no competing interest.
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