To Örebro University

Introduction

Sleep problems are increasingly recognized as a significant health concern among youth, with insufficient sleep affecting the majority of adolescents worldwide. Emerging research challenges the traditional view that sleep disturbances are merely symptoms of underlying mental disorders, suggesting instead a bidirectional relationship where sleep issues may also contribute to the development of psychopathology. Despite this growing evidence in adults, the role of sleep disturbances as predictors of mental illness in children and adolescents remains inconclusive. 

Aim

This study aims to systematically review and synthesize existing research to better understand how sleep problems in children and adolescents may predict future mental health issues.

Methods

* Conducted per PRISMA and SYMBALS guidelines, combining active learning machine learning and backwards snowballing.

* Titles and abstracts were screened by multiple authors using ASReview software.

* The databases Embase, MEDLINE, Web of Science and PsychINFO were searched. * Inclusion criteria: Primary studies in English language, Participants 0-18 years at baseline, Sleep disturbance as exposure, Mental illness (diagnosis or symptoms) as outcome, Longitudinal studies with at least 1 month between timepoints.

Results

A total of 136* studies were eligible for inclusion in the systematic review, published between 2000 and 2024.

Of these, 63 concerned adolescents at baseline, 45 school-aged children, and 28 concerned infants, toddlers and pre-school children. 

Some 46 of the studies concerned the broader construct Internalising symptoms, encompassing both depression and anxiety. A total of 59 studies concerned depression as outcome, 26 studies anxiety, 18 studies ADHD, 5 studies GAD, 5 studies social anxiety, 5 studies separation anxiety, and 4 studies psychosis. Rarer outcomes included panic disorder, PTSD, borderline personality disorder, oppositional defiant disorder, mania, OCD, and bipolar disorder. 

A significant association was found in 153 of the analyses (81.8 %), while 34 (18.2 %) did not. The most studied outcome was depression, where 50 studies found an association and 9 did not, followed by internalising symptoms (45 yes, 1 no) and anxiety (24 yes, 2 no). Several additional outcomes were studied, demonstrating more ambiguous results. The information is depicted in Figure 1. 

Conclusions

The preliminary results of this study provide convincing evidence that sleep problems predict later mental illness in children and adolescents: primarily regarding internalising symptoms, anxiety and depression, with more equivocal evidence regarding ADHD, psychosis, GAD, social anxiety and separation anxiety. The majority of studies concern adolescents. More studies on specific mental disorders beyond depression and anxiety are needed.