Eveningness chronotype, insomnia symptoms, and emotional and behavioural problems in adolescents

Shirley Xin Li; Ngan Yin Chan; Mandy Wai Man Yu; Siu Ping Lam; Jihui Zhang; Joey Wing Yan Chan; Albert Martin Li; Yun Kwok Wing

doi:10.1016/j.sleep.2018.03.025

Eveningness chronotype, insomnia symptoms, and emotional and behavioural problems in adolescents

Sleep Med. 2018 Jul:47:93-99. doi: 10.1016/j.sleep.2018.03.025. Epub 2018 Apr 17.

Authors

Shirley Xin Li¹, Ngan Yin Chan², Mandy Wai Man Yu³, Siu Ping Lam³, Jihui Zhang³, Joey Wing Yan Chan³, Albert Martin Li⁴, Yun Kwok Wing⁵

Affiliations

¹ Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region. Electronic address: shirley.li@hku.hk.
² Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region.
³ Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region.
⁴ Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region.
⁵ Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region. Electronic address: ykwing@cuhk.edu.hk.

PMID: 29778920
DOI: 10.1016/j.sleep.2018.03.025

Abstract

Objective: Eveningness tendency and insomnia are common in adolescents, but whether they have an independent or synergistic effect on the risk of psychopathology have remained undefined. The present study aimed to examine eveningness chronotype and insomnia symptoms in relation to mental health and emotional and behavioural problems in a community-based adolescent population.

Methods: A total of 4948 adolescents (weighted mean age: 14.5 ± 1.8 years, weighted percentage of females: 48.9%) completed the measures. Insomnia was assessed by the Insomnia Severity Index (ISI), and chronotype preference was measured by the reduced version of the Morningness-Eveningness Questionnaire (MEQ). Emotional and behavioural problems and mental health were assessed by the Strengths and Difficulties Questionnaire (SDQ) and the General Health Questionnaire (GHQ-12), respectively. Potential confounders including demographic factors, pubertal status, general health, and sleep duration were controlled for in the analyses.

Results: Insomnia symptoms were prevalent in evening-type adolescents (52% vs intermediate-type: 34.3%, morning-type: 18.0%, p < 0.001), especially two subtypes of insomnia symptoms, including difficulty initiating sleep and difficulty maintaining sleep. Eveningness and insomnia were independently associated with an increased risk of having emotional and behavioural problems (eveningness: adjusted odds ratio [AdjOR] = 1.88, 95% confidence interval [CI] = 1.61-2.19, p < 0.001; insomnia: AdjOR = 3.66, 95% CI = 2.73-4.91) as well as poor mental health in adolescents (eveningness: AdjOR = 1.25, 95% CI = 1.04-1.52, p < 0.001; insomnia: AdjOR = 3.63, 95% CI = 2.41-5.03).

Conclusions: Eveningness and insomnia symptoms are independently associated with the risk of psychopathology in adolescents. Our findings underscore the need to address both sleep and circadian factors in assessing and managing emotional and behavioural problems in the adolescent population.

Keywords: Adolescence; Chronotype; Eveningness; Insomnia; Psychopathology; Sleep.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Emotions
Female
Humans
Male
Prevalence
Problem Behavior / psychology*
Sleep Initiation and Maintenance Disorders / epidemiology*
Surveys and Questionnaires