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Caregiver Perceived Stress and Child Sleep Health: An Item-Level Individual Participant Data Meta-Analysis

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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.

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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.

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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.

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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.

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Correspondence to Maxwell Mansolf.

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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.

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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

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