Research report
Prior sleep problems predict internalising problems later in life

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Abstract

Background

One possible risk marker of later internalising symptoms is poor sleep, which is a problem for up to 40% of children. The present study investigated whether prior sleep problems could predict internalising symptoms over a period of 18 years of follow-up.

Methods

The study sample included 1503 French young adults from the TEMPO cohort (mean age=28.8±3.6 years) whose parents participate in the GAZEL cohort study. All TEMPO participants previously took part in a study of children’s mental health and behaviour in 1991 (mean age=10.3±3.6 years) and 1999 (mean age=18.8±3.6 years). Sleep problems and internalising symptoms (depression, anxiety, somatic complaints) were assessed three times (1991, 1999, 2009) using the Achenbach System of Empirically Based Assessment (ASEBA) questionnaire. The association between sleep problems in 1991 and trajectories of internalising problems from 1991 to 2009 was tested in a multinomial logistic regression framework, controlling for sex, age, baseline temperament, behavioural problems and stressful life events, as well as family income, and parental history of depression.

Results

We identified four trajectories of internalising symptoms: high-persistent (2.5%), high-decreasing (11.4%), low-increasing (11.6%), and low-persistent (74.5%). After controlling for covariates, compared to participants who did not have sleep problems in 1991, those who did were 4.51 times (95% CI=1.54–13.19, P=.006) more likely to have high-persistent internalising symptoms and 3.69 times (95% CI=2.00–6.82, P<.001) more likely to have high-decreasing internalising symptoms over the 18-year follow-up.

Limitations

Sleep problems and internalising symptoms were based on self-report questions, results should be interpreted with due caution.

Conclusions

Sleep problems early in life are associated with an increased likelihood of internalising symptoms that persist from childhood to adulthood.

Introduction

Internalising problems, defined as a spectrum of symptoms of depression, anxiety, withdrawal, and somatic complaints (Achenbach et al., 1989), affect up to 40% of youth (Crawford et al., 2001). In up to 50% of cases, these symptoms persist over time, affecting quality of life, interpersonal relationships, as well as academic and occupational attainment (Bongers et al., 2003). It is therefore important to identify youth at risk of persistent internalising symptoms in order to address their mental health needs early on and potentially prevent a long-term cycle of poor outcomes.

One possible risk marker of later internalising symptoms is poor sleep, which is a problem for up to 40% of children (Mindell et al., 1999). Although sleep problems are sometimes considered a sign of anxiety and depression (Ostberg and Hagelin, 2011), research shows that they often precede the occurrence of other manifestations of psychological difficulties (such as excessive worry, unexplained somatic symptoms, sadness or social withdrawal). Sleep problems are associated with increased risk of internalising symptoms (particularly anxiety) in toddlers (Jansen et al., 2011), children (Pesonen et al., 2010), adolescents (Gregory and O'Connor, 2002), and adults (Gregory et al., 2005). For instance, a longitudinal study which followed 4–19 year olds over a period of 14 years, found that various types of sleep problems, as reported by the parents using the Child Behavioural Checklist (CBCL) (e.g., “decreased sleep”, “overtiredness”, and “trouble sleeping”) predicted later depression and anxiety (Gregory et al., 2008). However, to our knowledge, the relationship between sleep problems early on and trajectories of psychological difficulties has not been studied. In the present study, we examined the relationship between sleep problems measured between 4 and 16 years of age, and internalising symptoms over an 18 year follow-up period, accounting for factors which could explain this association (sex (Hankin et al., 2007), temperament (Touchette et al., 2005), behavioural difficulties (Silk et al., 2003), stressful life events (Eley and Stevenson, 2000), family socioeconomic position (Arber et al., 2009, Lorant et al., 2003, Melchior et al., 2011), and parental depression (Swanson et al., 2010)).

Section snippets

Study population

The TEMPO (Trajectoires Epidémiologiques en Population) cohort study, based in France, was set up in 2009 to follow-up young adults (22–35 years) who had taken part in a study of children’s psychological problems and access to mental health care in 1991. The original sample of children surveyed in 1991 (GAZEL Youth study, n=2498) was selected among 4–16 year olds whose parents participate in the GAZEL cohort study which follows 20,624 employees of a large French public-sector utility company by

Transversal analyses between sleep and internalising problems

In the present study, 17.4% (n=260) of children had sleep problems in 1991, 29.9% (n=330) in 1999 and 34.3% (n=364) in 2009. Restricting the definition to frequent sleep problems, prevalences were as follows: 3.7% (n=56) in 1991, 7.1% (n=78) in 1999 and 7.5% (n=80) in 2009. Table 1 shows moderate age and sex-adjusted correlations between sleep problems in 1991 and internalising problems in 1991 (r=.18), 1999 (r=.17), and no association with internalising symptoms in 2009 (r=.03). As shown in

Discussion

Studying a sample of young adults drawn from the community, we found that participants who had prior sleep problems had an elevated likelihood of experiencing long-term internalising problems. After accounting for important covariates, children who had sleep problems were 4.5 times more likely to have persistently high levels of internalising symptoms into young adulthood but, 3.7 times more likely to have high levels of internalising symptoms that later decreased. This association did not

Conclusion

Sleep problems early in life may contribute to the development of internalising problems which persist for a significant period of life. Specifically, children with sleep problems appear vulnerable to internalising symptoms in adolescence, which sometimes persist into young adulthood. These results highlight the importance of investigating the presence of sleep problems in children, as these may be indicative of risk of long-term psychological difficulties. Future studies should explore the

Role of funding source

Maria Melchior is the recipient of a Young Researcher Award from the French National Research Agency (ANR).

Conflict of interest

The authors declare that they have no competing interests. These funding organizations had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Acknowledgements

The authors wish to thank the GAZEL study team for help in implementing the TEMPO cohort.

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