Abstract
Up to 50% of children and adolescents in the United States (U.S.) experience sleep problems. While existing research suggests that perceived stress in caregivers is associated with poorer sleep outcomes in children, research on this relationship is often limited to infant and early childhood populations; therefore, we investigated this association in school-age children and adolescents. We used cross-sectional caregiver-reported surveys and applied item response theory (IRT) followed by meta-analysis to assess the relationship between caregiver perceived stress and child sleep disturbance, and moderation of this relationship by child age and the presence of a child mental or physical health condition. We analyzed data from the National Institutes of Health (NIH) Environmental influences on Child Health Outcomes (ECHO) Program, a collaboration of existing pediatric longitudinal cohort studies that collectively contribute a diverse and large sample size ideal for addressing questions related to children’s health and consolidating results across population studies. Participants included caregivers of children ages 8 to 16 years from four ECHO cohorts. Caregiver perceived stress was measured using the Perceived Stress Scale (PSS), and child sleep disturbance was assessed using five sleep-related items from the School-Age version of the Child Behavior Checklist (CBCL). Increases in caregiver perceived stress and child mental or physical health condition were independently associated with greater sleep disturbance among children. The findings reinforce the importance of accounting for, and potentially intervening on, the broader family context and children’s mental and physical health in the interest of improving sleep health.
Highlights
-
Existing research suggests caregiver perceived stress is associated with worse child sleep outcomes.
-
Data from eight cohorts in the National Institutes of Health (NIH) Environmental influences on Child Health Outcomes (ECHO) program were used.
-
We combined item-level analysis within each cohort with meta-analysis to aggregate results across cohorts.
-
Higher caregiver perceived stress and child health conditions were independently associated with poorer child sleep.
-
Study findings reinforce the importance of the broader family context in the interest of improving sleep health.
Similar content being viewed by others
Data availability
The datasets for this manuscript are not publicly available because, per the NIH-approved ECHO Data Sharing Policy, ECHO-wide data have not yet been made available to the public for review/analysis. Requests to access the datasets should be directed to the ECHO Data Analysis Center, ECHO-DAC@rti.org.
References
Achenbach, T. M., & Rescorla, L. A. (2000). Manual for the ASEBA preschool forms and profiles (Vol. 30). Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families.
Adam, E. K., Snell, E. K., & Pendry, P. (2007). Sleep timing and quantity in ecological and family context: a nationally representative time-diary study. Journal of Family Psychology, 21(1), 4.
Alley, D. E., Ashford, N. C., & Gavin, A. M. (2019). Payment innovations to drive improvements in pediatric care—the Integrated Care for Kids Model. JAMA pediatrics, 173(8), 717–718.
Astill, R. G., Van der Heijden, K. B., Van IJzendoorn, M. H., & Van Someren, E. J. (2012). Sleep, cognition, and behavioral problems in school-age children: a century of research meta-analyzed. Psychological Bulletin, 138(6), 1109.
Bacaro, V., Feige, B., Ballesio, A., De Bartolo, P., Johann, A. F., Buonanno, C., & Baglioni, C. (2019). Considering sleep, mood, and stress in a family context: a preliminary study. Clocks & Sleep, 1(2), 259272.
Balduzzi, S., Rücker, G., & Schwarzer, G. (2019). How to perform a meta-analysis with R: a practical tutorial. Evidence-Based Mental Health, 22(4), 153–160.
Bartel, K. A., Gradisar, M., & Williamson, P. (2015). Protective and risk factors for adolescent sleep: a meta analytic review. Sleep Medicine Reviews, 21, 72–85.
Beaton, A., & Gonzalez, E. (1995). NAEP primer. Chestnut Hill, MA: Center for the Study of Testing. Evaluation, and Educational Policy.
Becker, S. P., Ramsey, R. R., & Byars, K. C. (2015). Convergent validity of the Child Behavior Checklist sleep items with validated sleep measures and sleep disorder diagnoses in children and adolescents referred to a sleep disorders center. Sleep Medicine, 16(1), 79–86.
Beebe, D. W. (2011). Cognitive, behavioral, and functional consequences of inadequate sleep in children and adolescents. Pediatric Clinics, 58(3), 649–665.
Bélanger, M. È., Bernier, A., Simard, V., Bordeleau, S., & Carrier, J. (2015). Viii. Attachment and sleep among toddlers: disentangling attachment security and dependency. Monographs of the Society for Research in Child Development, 80(1), 125–140.
Bernier, A., Bélanger, M. È., Bordeleau, S., & Carrier, J. (2013). Mothers, fathers, and toddlers: parental psychosocial functioning as a context for young children’s sleep. Developmental Psychology, 49(7), 1375.
Berry, J. O., & Jones, W. H. (1995). The parental stress scale: initial psychometric evidence. Journal of Social and Personal Relationships, 12(3), 463–472.
Bethell, C. D., Garner, A. S., Gombojav, N., Blackwell, C., Heller, L., & Mendelson, T. (2022). Social and relational health risks and common mental health problems among US children: the mitigating role of family resilience and connection to promote positive socioemotional and school-related outcomes. Child and Adolescent Psychiatric Clinics, 31(1), 45–70.
Bevans, K. B., Meltzer, L. J., De La Motte, A., Kratchman, A., Viél, D., & Forrest, C. B. (2019). Qualitative development and content validation of the PROMIS Pediatric Sleep Health items. Behavioral Sleep Medicine, 17(5), 657–671. https://doi.org/10.1080/15402002.2018.1461102.
Bhargava, S. (2011). Diagnosis and management of common sleep problems in children. Pediatrics in Review, 32(3), 91–99.
Bronfenbrenner, U. (1979). The ecology of human development: experiments by nature and design. Harvard University Press.
Buxton, O. M., Chang, A. M., Spilsbury, J. C., Bos, T., Emsellem, H., & Knutson, K. L. (2015). Sleep in the modern family: Protective family routines for child and adolescent sleep. Sleep Health, 1(1), 15–27.
Buysse, D. J. (2014). Sleep health: can we define it? Does it matter? Sleep, 37(1), 9–17.
Byars, K. C., Yeomans-Maldonado, G., & Noll, J. G. (2011). Parental functioning and pediatric sleep disturbance: An examination of factors associated with parenting stress in children clinically referred for evaluation of insomnia. Sleep Medicine, 12(9), 898–905.
Chalmers, R. P. (2012). mirt: A multidimensional item response theory package for the R environment. Journal of Statistical Software, 48, 1–29.
Chang, L. Y., Wu, C. C., Yen, L. L., & Chang, H. Y. (2019). The effects of family dysfunction trajectories during childhood and early adolescence on sleep quality during late adolescence: resilience as a mediator. Social Science & Medicine, 222, 162–170.
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.
Cooper, H., & Patall, E. A. (2009). The relative benefits of meta-analysis conducted with individual participant data versus aggregated data. Psychological Methods, 14(2), 165.
Covington, L. B., Patterson, F., Hale, L. E., Teti, D. M., Cordova, A., Mayberry, S., & Hauenstein, E. J. (2021). The contributory role of the family context in early childhood sleep health: a systematic review. Sleep Health, 7(2), 254–265.
Deater-Deckard, K. (2008). Parenting stress. In Parenting stress. Yale University Press.
Dewald, J. F., Meijer, A. M., Oort, F. J., Kerkhof, G. A., & Bögels, S. M. (2010). The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: A meta-analytic review. Sleep Medicine Reviews, 14(3), 179–189.
Dubois-Comtois, K., Pennestri, M. H., Bernier, A., Cyr, C., & Godbout, R. (2019). Family environment and preschoolers’ sleep: the complementary role of both parents. Sleep Medicine, 58, 114–122.
El‐Sheikh, M., Buckhalt, J. A., Mark Cummings, E., & Keller, P. (2007). Sleep disruptions and emotional insecurity are pathways of risk for children. Journal of Child Psychology and Psychiatry, 48(1), 88–96.
El‐Sheikh, M., & Kelly, R. J. (2017). Family functioning and children’s sleep. Child development perspectives, 11(4), 264–269.
Embretson, S. E., & Reise, S. P. (2013). Item response theory. Psychology Press.
Enders, C. K. (2010). Applied missing data analysis. Guilford press.
Forrest, C. B., Meltzer, L. J., Marcus, C. L., de la Motte, A., Kratchman, A., Buysse, D. J., Pilkonis, P. A., Becker, B. D., & Bevans, K. B. (2018). Development and validation of the PROMIS pediatric sleep disturbance and sleep-related impairment item banks. Sleep, 41(6). https://doi.org/10.1093/sleep/zsy054.
Francazio, S. K., Fahrenkamp, A. J., D’Auria, A. L., Sato, A. F., & Flessner, C. A. (2015). Parent psychopathology as a mediator of the relationship between anxiety and sleep problems in children. Families, Systems, & Health, 33(2), 146.
Fuligni, A. J., Tsai, K. M., Krull, J. L., & Gonzales, N. A. (2015). Daily concordance between parent and adolescent. sleep habits. Journal of Adolescent Health, 56(2), 244–250.
Gillman, M. W., & Blaisdell, C. J. (2018). Environmental Influences on Child Health Outcomes, a research program of the NIH. Current opinion in pediatrics, 30(2), 260.
Gregory, A. M., Cousins, J. C., Forbes, E. E., Trubnick, L., Ryan, N. D., Axelson, D. A., & Dahl, R. E. (2011). Sleep items in the child behavior checklist: a comparison with sleep diaries, actigraphy, and polysomnography. Journal of the American Academy of Child & Adolescent Psychiatry, 50(5), 499–507.
Gregory, A. M., & Sadeh, A. (2012). Sleep, emotional and behavioral difficulties in children and adolescents. Sleep. Medicine Reviews, 16(2), 129–136.
Hale, L., Emanuele, E., & James, S. (2015). Recent updates in the social and environmental determinants of sleephealth. Current Sleep Medicine Reports, 1(4), 212–217.
Hedges, L. V. (1992). Meta-analysis. Journal of Educational and Behavioral Statistics, 17(4), 279–296.
Hoyniak, C. P., Bates, J. E., McQuillan, M. E., Albert, L. E., Staples, A. D., Molfese, V. J., & Deater-Deckard, K. (2021). The family context of toddler sleep: routines, sleep environment, and emotional security induction in the hour before bedtime. Behavioral Sleep Medicine, 19(6), 795–813.
Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., & Wang, P. (2010). Research domain criteria (RDoC): Toward a new classification framework for research on mental disorders. American Journal of Psychiatry, 167(7), 748–751.
Keller, P., & El‐Sheikh, M. (2011). Children’s emotional security and sleep: longitudinal relations and directions of effects. Journal of Child Psychology and Psychiatry, 52(1), 64–71.
Kelly, R. J., & El-Sheikh, M. (2011). Marital conflict and children’s sleep: reciprocal relations and socioeconomic effects. Journal of Family Psychology, 25(3), 412.
Khor, S. P., McClure, A., Aldridge, G., Bei, B., & Yap, M. B. (2021). Modifiable parental factors in adolescent sleep: a systematic review and meta-analysis. Sleep Medicine Reviews, 56, 101408.
Lee, S., Ha, J. H., Moon, D. S., Youn, S., Kim, C., Park, B., & Chung, S. (2019). Effect of sleep environment of preschool children on children’s sleep problems and mothers’ mental health. Sleep and Biological Rhythms, 17(3), 277–285.
Lewandowski, A. S., Ward, T. M., & Palermo, T. M. (2011). Sleep problems in children and adolescents with common medical conditions. Pediatric Clinics, 58(3), 699–713.
Mannering, A. M., Harold, G. T., Leve, L. D., Shelton, K. H., Shaw, D. S., Conger, R. D., & Reiss, D. (2011). Longitudinal associations between marital instability and child sleep problems across infancy and toddlerhood in adoptive families. Child Development, 82(4), 1252–1266.
Mansolf, M. & Blackwell, C.K. (2023). Sleep-Related Items on the School-Age CBCL and the PROMIS Sleep Disturbance 4-Item Short-Form: A Psychometric Comparison from the Environmental Influences on Child Health Outcomes (ECHO) Program. Psychological Assessment. 35(5), 443–452.
Matricciani, L., Paquet, C., Galland, B., Short, M., & Olds, T. (2019). Children’s sleep and health: a meta-r review. Sleep Medicine Reviews, 46, 136–150.
McCabe, M. A., Leslie, L., Counts, N., & Tynan, W. D. (2020). Pediatric integrated primary care as the foundation for healthy development across the lifespan. Clinical Practice in Pediatric Psychology, 8(3), 278–287.
Meltzer, L. J., & Mindell, J. A. (2007). Relationship between child sleep disturbances and maternal sleep, mood, and parenting stress: a pilot study. Journal of Family Psychology, 21(1), 67.
Meltzer, L. J. & Mindell, J. A. (2011). Graduated extinction: Behavioral treatment for bedtime problems and night wakings in young children. In Behavioral Treatments for Sleep Disorders (pp. 265-273). Academic Press.
Meltzer, L. J., & Montgomery-Downs, H. E. (2011). Sleep in the family. Pediatric Clinics, 58(3), 765–774.
Meltzer, L. J., Williamson, A. A., & Mindell, J. A. (2021). Pediatric sleep health: it matters, and so does how we define it. Sleep Medicine Reviews, 57, 101425.
Milan, S., Snow, S., & Belay, S. (2007). The context of preschool children’s sleep: racial/ethnic differences in sleep locations, routines, and concerns. Journal of Family Psychology, 21(1), 20.
Moore, K. M., Gordon, J. E., & McLean, L. A. (2012). Child sleep problems and parental depression: testing a risk and resistance model. Journal of Child and Family Studies, 21(6), 982–991.
O’Connor, T. G., Caprariello, P., Blackmore, E. R., Gregory, A. M., Glover, V., & Fleming, P., ALSPAC Study Team. (2007). Prenatal mood disturbance predicts sleep problems in infancy and toddlerhood. Early Human Development, 83(7), 451–458.
Paule, R. C., & Mandel, J. (1982). Consensus values and weighting factors. Journal of Research of the National Bureau of Standards, 87(5), 377.
Peltz, J., & Rogge, R. (2022). Adolescent and parent sleep quality mediates the impact of family processes on family members’ psychological distress. Sleep Health, 8(1), 73–81.
Philbrook, L. E., & Teti, D. M. (2016). Bidirectional associations between bedtime parenting and infant sleep: Parenting quality, parenting practices, and their interaction. Journal of Family Psychology, 30(4), 431.
R Core Team. (2019). R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing. http://www.R-project.org..
Reeve, B. B., & Payers, P. (2005). Applying item response theory modelling for evaluating questionnaire item and scale properties. Assessing quality of life in clinical trials: Methods and practice, 55. Oxford University Press.
Rojo-Wissar, D. M., Owusu, J. T., Nyhuis, C., Jackson, C. L., Urbanek, J. K., & Spira, A. P. (2020). Parent–child relationship quality and sleep among adolescents: modification by race/ethnicity. Sleep Health, 6(2), 145–152.
Rudd, B. N., Reilly, M. E., Holtzworth-Munroe, A., D’Onofrio, B. M., & Waldron, M. (2021). Interactive effects of parental separation and socioeconomic status on child sleep quality and child development. Journal of Child and Family Studies, 30(9), 2180–2190.
Sadeh, A., Tikotzky, L., & Scher, A. (2010). Parenting and infant sleep. Sleep Medicine Reviews, 14(2), 89–96.
Samejima, F. (1968). Estimation of latent ability using a response pattern of graded scores 1. ETS Research Bulletin Series, 1968(1), i–169.
Schmeer, K. K., Tarrence, J., Browning, C. R., Calder, C. A., Ford, J. L., & Boettner, B. (2019). Family contexts and sleep during adolescence. SSM-Population Health, 7, 100320.
Shochat, T., Cohen-Zion, M., & Tzischinsky, O. (2014). Functional consequences of inadequate sleep in adolescents: a systematic review. Sleep Medicine Reviews, 18(1), 75–87.
Sinai, D., & Tikotzky, L. (2012). Infant sleep, parental sleep and parenting stress in families of mothers on maternity leave and in families of working mothers. Infant Behavior and Development, 35(2), 179–186.
Smaldone, A., Honig, J. C., & Byrne, M. W. (2007). Sleepless in America: inadequate sleep and relationships to health and well-being of our nation’s children. Pediatrics, 119(Supplement_1), S29–S37.
Spilsbury, J. C., Patel, S. R., Morris, N., Ehayaei, A., & Intille, S. S. (2017). Household chaos and sleep-disturbing behavior of family members: Results of a pilot study of African American early adolescents. Sleep Health, 3(2), 84–89.
Stewart, L. A., & Tierney, J. F. (2002). To IPD or not to IPD? Advantages and disadvantages of systematic reviews using individual patient data. Evaluation & the Health Professions, 25(1), 76–97.
Stoléru, S., Nottelmann, E. D., Belmont, B., & Ronsaville, D. (1997). Sleep problems in children of affectively ill mothers. Journal of Child Psychology and Psychiatry, 38(7), 831–841.
Strine, T. W., & Chapman, D. P. (2005). Associations of frequent sleep insufficiency with health-related quality of life and health behaviors. Sleep Medicine, 6(1), 23–27.
Tinker, E. C., Garrison, M. M., & Ward, T. M. (2020). Development of the Sleep Health in Preschoolers (SHIP) Intervention: integrating a theoretical framework for a family-centered intervention to promote healthy sleep. Families, Systems, & Health, 38(4), 406.
Tsai, K. M., Dahl, R. E., Irwin, M. R., Bower, J. E., McCreath, H., Seeman, T. E., & Fuligni, A. J. (2018). The roles of parental support and family stress in adolescent sleep. Child Development, 89(5), 1577–1588.
Tyler, D., Donovan, C. L., Scupham, S., Shiels, A. L., & Weaver, S. A. (2019). Young children’s sleep problems: the impact of parental distress and parenting style. Journal of Child and Family Studies, 28(8), 2098–2106.
US Department of Health and Human Services. (2019). Report #7: assessment and recommendations for proposed objectives for healthy people 2030. Washington, DC: US Department of Health and Human Services Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030. https://health.gov/sites/default/files/2021-09/Report%207_Reviewing%20Assessing%20Set%20of%20HP2030%20Objectives_Formatted%20EO_508_05.21.pdf.
Varma, P., Conduit, R., Junge, M., Lee, V. V., & Jackson, M. L. (2021). A systematic review of sleep associations in parents and children. Journal of Child and Family Studies, 30(9), 2276–2288.
Veroniki, A. A., Jackson, D., Viechtbauer, W., Bender, R., Bowden, J., Knapp, G., & Salanti, G. (2016). Methods to estimate the between‐study variance and its uncertainty in meta‐analysis. Research Synthesis Methods, 7(1), 55–79.
Williamson, A. A., & Mindell, J. A. (2020). Cumulative socio-demographic risk factors and sleep outcomes in early childhood. Sleep, 43(3), zsz233.
Williamson, A. A., Mindell, J. A., Hiscock, H., & Quach, J. (2019). Sleep problem trajectories and cumulative socio-ecological risks: Birth to school-age. The Journal of Pediatrics, 215, 229–237.
Zapata Roblyer, M. I., & Grzywacz, J. G. (2015). Demographic and parenting correlates of adolescent sleep functioning. Journal of Child and Family Studies, 24(11), 3331–3340.
Acknowledgements
The authors wish to thank our ECHO colleagues, the medical, nursing and program staff, as well as the children and families participating in the ECHO cohorts. We also acknowledge the contribution of the following ECHO program collaborators: ECHO Components – Coordinating Center: Duke Clinical Research Institute, Durham, North Carolina: Smith PB, Newby KL, Benjamin DK; Data Analysis Center: Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD: Jacobson LP; Research Triangle Institute, Durham, NC: Parker CB; Person-Reported Outcomes Core: Northwestern University, Chicago, IL: Gershon R, Cella D. ECHO Awardees and Cohorts – Icahn School of Medicine at Mount Sinai, New York, NY: Wright RJ; New York University, New York City, NY: Blair CB; University of Colorado Denver, Denver, CO: Dabelea D; University of Washington, Seattle, WA: Karr CJ. University of Oregon, Eugene, OR: Leve L; Penn State University, State College, PA: Neiderhiser J; George Washington University, Washington, DC: Ganiban J.
Environmental influences on Child Health Outcomes
ECHO Components – Coordinating Center P. B. Smith9, K. L. Newby9, D. K. Benjamin9, L. P. Jacobson2, C. B. Parker10, R. Gershon1, D. Cella1 ECHO Awardees and Cohorts R. J. Wright3, C. B. Blair11, D. Dabelea12, C. J. Karr13, L. Leve14, J. Neiderhiser15, J. Ganiban16
Funding
Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), U24OD023319 with co-funding from the Office of Behavioral and Social Sciences Research (OBSSR; Person Reported Outcomes Core, Gershon, Cella), UH3OD023272 (Schantz), UH3OD023288 (McEvoy), UH3OD023337 (Wright), UH3OD023389 (Leve), UH3OD023271 (Karr) and by the Economic and Social Research Council, UK, ES/S004467/1 (Harold). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Author information
Authors and Affiliations
Consortia
Contributions
M.M. conceptualized the study, created the datasets, carried out the analysis, drafted the Method and Results sections, and contributed to the Introduction and Discussion sections. C.K.B. drafted the Introduction and Discussion sections and reviewed and revised the manuscript. A.C., E.C., S.G., G.H., C.M., H.P.S., and P.R.S. contributed to the conceptualization of the manuscript and to drafting of the initial Introduction and Discussion sections, as well as reviewing and revising the manuscript. S.B. and R.J.W. were responsible for acquisition of the data and critically reviewed the manuscript including approval of the final draft. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare no competing interests.
Ethics Approval
Research involved analysis of existing data from human subjects on the ECHO de-identified database. Local Institutional Review Boards (IRBs) and/or the central ECHO IRB (Western IRB) reviewed all research methods and procedures.
Consent to Participate
All participants provided informed consent to include their data in this database and for those data to be used in secondary analyses.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Members of the Environmental influences on Child Health Outcomes are listed below Acknowledgements.
Supplementary information
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Mansolf, M., Blackwell, C.K., Chandran, A. et al. Caregiver Perceived Stress and Child Sleep Health: An Item-Level Individual Participant Data Meta-Analysis. J Child Fam Stud 32, 2558–2572 (2023). https://doi.org/10.1007/s10826-023-02624-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10826-023-02624-x