Abstract
The current study examined prospective bidirectional links between dysregulated sleep, and anxiety and depression severity across 4 years, among youth with a history of anxiety disorder. Participants were 319 youth (age 11–26 years), who previously participated in a large multisite randomized controlled trial for the treatment of pediatric anxiety disorders, Child/Adolescent Anxiety Multimodal Study (CAMS), and subsequently enrolled in a naturalistic follow-up, Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), an average of 6.5 years later. They participated in four annual visits that included self-report items of dysregulated sleep and semi-structured multi-informant interviews of anxiety and depression. Dysregulated sleep was bidirectionally associated with clinician-rated anxiety and depression symptom severity across adolescence and young adulthood. However, these bidirectional relationships were attributable to youth mean levels of dysregulated sleep, and anxiety and depression severity over the 4 years. Elevations in dysregulated sleep at each visit, relative to mean levels, did not predict worse anxiety or depression severity 1 year later. Likewise visit-specific elevations in anxiety and depression severity, as opposed to average levels, did not predict higher levels of dysregulated sleep at the next visit. Having higher levels of dysregulated sleep or more severe internalizing problems across the four-year period, as opposed to reporting a relative increase in symptom severity at a particular visit, posed greater risk for poor mental health. Interventions should continue to assess and treat persistent sleep problems alongside anxiety and depression.
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Notes
Random slope effect of anxiety on sleep was excluded from the effect size calculations to improve convergence of comparable full, restricted and null models.
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This work was supported by the National Institute of Mental Health (R01MH064089, R01MH064003, R01MH64088, R01MH64092, R01MH64107, R01MH063747, T32MH073517).
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Dr. Bai has received support from NIMH and the American Psychological Foundation. Dr. Ricketts receives grant support from NIMH, the Tourette Association of America and the TLC Foundation for Body-Focused Repetitive Behaviors. Dr. Piacentini has received support from NIMH, the TLC Foundation for Body-Focused Repetitive Behaviors, the Tourette Association of America, the Pettit Family Foundation, and Pfizer Pharmaceuticals through the Duke University Clinical Research Institute Network. He has received royalties from Guilford Press and Oxford University Press. He has served on the speakers’ bureau of the Tourette Association of America, the International Obsessive-Compulsive Disorder Foundation, and the TLC Foundation for Body-Focused Repetitive Behaviors. Dr. Albano has received royalties from Oxford University Press for the Anxiety Disorders Interview Schedule, Child and Parent Versions. She has received an editor’s honorarium from the American Psychological Association. Dr. Compton has received support from NIMH, NC GlaxoSmithKline Foundation, Pfizer, Neurocrine Biosciences, and Mursion, Inc. He has served as a consultant for Shire and Mursion, Inc. He has received honoraria from the Nordic Long-Term OCD Treatment Study Research Group and the Centre for Child and Adolescent Mental Health, Eastern and Southern Norway. He has served on the scientific advisory board of Tourette Association of America, Anxiety and Depression Association of America, and Mursion, Inc. He has presented expert testimony for Duke University. Dr. Ginsburg has received support from NIMH and from the US Department of Education/Institute of Education Sciences and serves as a consultant for Syneos Health. Dr. Kendall has received support from NIMH and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). He has received royalties from the sales of materials related to the treatment of anxiety disorders in youth (eg, Guilford Press; Workbook Publishing; Gyldendal Norsk; Gyldendal Akademisk). Dr. Sakolsky has received support from NIMH and NARSAD. She has served as a consultant for LEK Consulting Inc. Dr. Keeton has received support from NIMH. Dr. Peris has received support from NIMH, the Society for Clinical Child and Adolescent Psychology, and the TLC Foundation for Repetitive Behavior Disorders. She has received royalties from Oxford University Press. No other disclosures were reported.
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Bai, S., Ricketts, E.J., Thamrin, H. et al. Longitudinal Study of Sleep and Internalizing Problems in Youth Treated for Pediatric Anxiety Disorders. Res Child Adolesc Psychopathol 48, 67–77 (2020). https://doi.org/10.1007/s10802-019-00582-x
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DOI: https://doi.org/10.1007/s10802-019-00582-x