Poor sleep quality in infants increases the risk of depression in adulthood


Researchers at the Institute for Mental Health, at the University of Birmingham in collaboration with the Finnish Institute for Health and Welfare, in Helsinki, found a clear relationship between sleep problems in infancy such as frequent night wakings, short sleep duration or difficulty in falling asleep and particular emotional and behavioural problems at 24 months of age.

Although childhood sleep problems are extremely common and their association with daytime behavioural difficulties is well recognised, this study shows for the first time how sleep problems in infancy and very early childhood are associated with emotional and behavioural problems later in childhood.

The team believes these findings, published in BMJ Paediatrics Open, highlight the need to address infant sleep problems at an early stage, to prevent the development or worsening of future emotional and behavioural problems in later stages of childhood.

The team studied the results of two sleep questionnaires completed by parents within the CHILD-SLEEP birth-cohort, a large study cohort based in southern Finland.

For this specific study, the researchers obtained information from nearly 1700 parents who completed a baseline questionnaire, and reported on sleep habits of their children at 3,8, 18 and 24 months.

These results were compared with a separate questionnaire on emotional and behavioural symptoms, which was completed by 950 parents at the child´s age of 24 months..

The researchers found that high frequency of night wakings at 3 months was strongly linked to emotional, behavioural and self-regulation (the ability to control emotions and behaviours) problems in toddlers.

Further, infants who experienced shorter sleep duration, who took longer to fall asleep and who experienced frequent night wakings at different stages of early childhood were likely to find problems in regulating their behaviour and emotions at the age of 24 months, leading to disrupting emotions and behaviours, such as temper tantrums.

The study contributes to recent research on the role of early sleep problems in socio-emotional development.

The team believes these findings, published in BMJ Paediatrics Open, highlight the need to address infant sleep problems at an early stage, to prevent the development or worsening of future emotional and behavioural problems in later stages of childhood.

Lead researcher Dr Isabel Morales-Muñoz explained: “Our results show that infants who sleep for shorter periods of time, take longer to fall asleep and wake up more frequently during the night are more likely to show emotional and behavioural problems in later stages of childhood.

It’s likely that sleep quality in these early months and the development of self-regulation – the ability to control our behaviour – are closely intertwined.”

The study suggests that infant sleep problems may be due to a variety of mechanisms, including genetic and environmental factors.

“Scientists think there are links in the central nervous system between sleep-wake behaviour and our emotions, and so it’s possible these links have a biological basis,” says Dr Morales-Muñoz.

“Environmental factors, such as sleeping practices in the family, parental reactions to crying and parental stress also play an important part in a child’s sleep and socioemotional development.”

Dr Morales-Muñoz added: “Although more research needs to be done in this area, we think early interventions in infants experiencing these sleep problems could be really beneficial and help very young children develop their behavioural and emotional self-control.”

From a social-emotional developmental perspective, adolescence is a period of life that maybe specially vulnerable to physiological and psychological impact factors, for instance confusion and greater psychological pressure.

It could even be the peak period for the onset of mental health problems [12]. Because emotion regulation mechanisms have not yet fully developed in adolescence, such as the ability to cope with negative emotions, adolescents are prone to many mental and behavioural problems [3].

Worldwide 10% to 20% of children and adolescents experience mental health problems, such as schizophrenia, depression, anxiety and intellectual disabilities, accounting for a large portion of the global burden of disease [4].

Anxiety and depression are the two most common psychological problems that can threaten adolescents’ mental health and academic performance [5]. Anxiety refers to the brain response to dangerous stimuli that an organism will actively attempt to avoid, which is not typically pathological as it is adaptive in many scenarios when it facilitates avoidance of danger [6].

Depression refers to the occasional sadness and gloom which accompanies the ups and downs of everyday life [7]. Childhood and adolescence are the core risk phase for the development of mental symptoms and syndromes, ranging from transient mild symptoms to full-blown mental disorders [6].

For example, depressive symptoms are known to escalate during adolescence, and adolescents who experience depressive disorder have an increased risk of mental illness in adulthood [8].

Thus, these conditions severely influence adolescents’ development, their educational achievement and their quality of life. However, these conditions could be contained efficiently or even reversed by improving level of mental health literacy (MHL) [910].

Sleep problems are related to a variety of mental health problems in both children and adolescents, impacting the ability to regulate emotions [1112]. There is extensive evidence suggesting that adolescents having sleep problems report increased negative emotions [13].

Part of the relationship may be accounted for the effects of stress and emotional arousal interfering with sleep, although other evidence showing that sleep disruption can cause irritability and negative mood to adolescents [1415].

Clinical epidemiological studies have also suggested that sleep disturbance is concomitant with mental disturbance [1617]. Adolescents with disturbed sleep exhibit more signs of depression, anxiety, conduct problems, substance abuse, and suicidal behaviors [1819].

Laboratory studies in particular have documented that impaired cognitive function, daytime sleepiness, and fatigue are consequences of sleep disturbance [2021]. A longitudinal study revealed that sleep disturbance predicted increases in the prevalence of subsequent anxiety and depression [22].

In addition, the relationship between sleep and mental health problems in adolescents must be considered in both directions, which anxiety symptoms and depressed mood may be the most prevalent causes of sleep disturbance [23].

Mental health literacy is defined which “knowledge and beliefs about mental disorders, which aid their recognition, management or prevention” [24], it includes being knowledgeable about the preventive measures, clinical symptoms, treatment of mental disorders, self-support strategies and others experiencing from mental health status [10].

Growing evidences have shown that mental disorders can be halted and even reversed by elevating MHL level, particularly for those adolescents who exhibit depression and anxiety [2526].

In addition, general health literacy (HL) which includes the domains of spiritual growth and stress management are closely related to MHL, which is also an important determinant of promoting mental health [2728], and we thus used HL in the present study. Numerous studies observed that bad sleep quality (e.g. insufficient sleep, low night sleep duration, sleep delay) of children is associated with parental HL [2931].

However, the health outcomes of adolescents are related to their own HL [32]. In addition, people with sleep disorders often exhibit lower HL, for instance limited HL was associated with obstructive sleep apnea [3334].

Nevertheless, previous studies regarding the mental health problems focused on the effect of either HL or sleep quality independently, and the sizes of samples used in those studies were relatively small. Namely, no or very few studies described the interactive effect of HL and sleep disturbance on mental health problems. In this study, we aimed to examin the association between HL and sleep problems with mental health in Chinese students in combined junior and senior high school. In this regard, we hypothesized that low HL and sleep problems would be associated with the prevalence of mental health problems of students.

University of Birmingham


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