Research shows a consistent association of behavioural problems during childhood with insomnia symptoms in adulthood


Parents should help their children with better sleep patterns, along with any problem behavioural issues, because this can lead to severe insomnia in middle age, a groundbreaking new study shows.

Published in JAMA Network Open journal today, Australian researchers have used data from a long-running UK population study to find links between moderate to severe childhood behavioural problems and insomnia in adults by the age of 42 years old.

Insomnia is the most common sleep disorder in adults, estimated to affect almost one in three people. Chronic insomnia is associated with an increased risk of mental health and other health, wellbeing and economic consequences including working capacity.

“This study shows a consistent association of behavioural problems during childhood, particularly at ages 5 and 10 years, with insomnia symptoms in adulthood,” says senior author Flinders University’s Robert Adams, Professor of Respiratory and Sleep Medicine at the Adelaide Institute for Sleep Health (AISH) – a leading Australian research centre.

“The findings suggest that early intervention to manage children’s externalised behaviours, such as bullying, irritability or constant restlessness, may reduce the risk of adult insomnia.

“As well as identifying sleep problems early in life, we should also identify children with moderate to severe behavioural problems that persist through childhood as potential beneficiaries of early intervention with a sleep health focus,” Professor Adams says.

“This study is the first to our knowledge to suggest an unfavourable association between early-life behavioural problems in children and addressing insomnia, from a life-long perspective,” says Flinders University lead author, Dr. Yohannes Adama Melaku.

“Given the cost of sleep disorders, including insomnia, to every economy and society in the world, it’s another important step towards managing this endemic problem in the community,” he says.

“This first study is important because we don’t know exactly the childhood or early-life factors that potentially influence this outcome of insomnia and finding these connections could reduce sleep disorders in the future.”

The United Kingdom 1970 Birth Cohort Study is a large-scale study of more than 16,000 babies born in a single week.

The current study includes people from the cohort aged 5 (8550 participants), 10 (9090 people) and 16 years (7653) followed up to age 42 years (2012). Statistical analysis was performed from February 1 to July 15, 2019.

The Flinders University study focused on externalised behavioural problems reported by parents, including cases of restlessness, disobedience, fighting, bullying, property damage and theft and irritability.

The research team’s next paper will focus on the effect of maternal smoking during pregnancy and childhood and any impact on insomnia and related sleep issues in adults.

Childhood trauma is highly prevalent in depression, with over half of individuals with depression endorsing childhood abuse and neglect (1).

Meta-analyses indicate that individuals exposed to childhood maltreatment are not only more likely to develop depression, but also experience depression that has a more severe, chronic, and treatment-resistant course [e.g., (13)].

Although all types of childhood maltreatment can have lasting consequences, research highlights a distinct relationship between emotional maltreatment and depression, such that emotional abuse and neglect more strongly predict depression course and severity than physical or sexual abuse (13).

Given the increased risk of chronic, recurrent depression among those exposed to childhood maltreatment, it is critical to identify potential mechanisms through which childhood maltreatment, particularly emotional abuse and neglect, may confer risk for future depression.

Importantly, sleep disturbance may be one critical mechanism through which individuals exposed to maltreatment are vulnerable for recurrent depressive episodes.

Indeed, sleep complaints are among the most common residual symptoms of depression (45). In particular, shorter sleep duration and difficulty initiating and maintaining sleep (i.e., insomnia symptoms) robustly predict depression recurrence (68), and are associated with increased risk of suicide (9).

Although research has only recently explored the long-term effects of childhood adversity on sleep in adulthood [for a review see (10)], studies indicate that childhood maltreatment and trauma contributes to poor sleep among adults decades later, even after taking into account intermediate life stress and depression [e.g., (1112)].

Further, a recent study of young adults undergoing the college transition prospectively evaluated the impact of specific subtypes of childhood trauma, including emotional, physical, and sexual abuse and neglect, on changes in sleep across the transition (13).

This study found that only childhood emotional neglect predicted current psychological distress and subsequent decreases in sleep quality over 6 months later among young adults (13), thereby highlighting a unique relationship between childhood emotional neglect and poor sleep in the context of transitional life stress.

Although childhood maltreatment, and specifically emotional neglect, is associated with both sleep and depression, it remains unclear to what extent childhood trauma contributes to current sleep (duration and insomnia) among clinical populations (e.g., among young adults with a depression history), which may provide valuable information for intervention.

Examining the effects of maltreatment and sleep within a group of individuals with former depression may yield critical information regarding individual differences in risk, and identify a potential mechanism through which individuals with childhood maltreatment are at heightened risk of recurrent depressive episodes.

Given that sleep is a modifiable risk factor, it may represent a potential treatment target for prevention of recurrence among those exposed to child maltreatment and trauma.

To date, however, most research has generally relied on retrospective recall of sleep quality over a significant stretch of time (e.g., 6 months), which, in addition to inherent limitations in temporal resolution, could potentially be confounded by current psychological distress.

Thus, as an initial step along this line of empirical inquiry, the present study evaluated the effects of childhood maltreatment on current sleep among young adults with a history of depression.

Specifically, we evaluated both childhood maltreatment (emotional abuse, emotional neglect, physical abuse, sexual abuse) and general childhood trauma as predictors of sleep duration and insomnia symptoms reported over 2-week daily assessments. Although we hypothesized all forms of childhood maltreatment to be positively associated with insomnia symptoms and shorter sleep duration, we expected a more robust prospective relationship for emotional maltreatment with sleep given prior research indicating a unique role for emotional maltreatment (13).

Thus, we expected that emotional abuse and neglect would be the most robust prospective predictors of sleep disturbance (duration, insomnia symptoms), after controlling for current depressive and anxiety symptoms.

More information:JAMA Network Open (2019). DOI: 10.1001/jamanetworkopen.2019.10861

Journal information: JAMA Network Open
Provided by Flinders University


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