Eleanor L. McGlinchey

Sleep deprivation in adolescents and adults: changes in affect.

The present study investigated the impact of sleep deprivation on several aspects of affective functioning in healthy participants selected from three different developmental periods: early adolescence (ages 10-13), midadolescence (ages 13-16), and adulthood (ages 30-60). Participants completed an affective functioning battery under conditions of sleep deprivation (a maximum of 6.5 hours total sleep time on the first night followed by a maximum of 2 hours total sleep time on the second night) and rest (approximately 7-8 hours total sleep time each night for two consecutive nights). Less positive affect was observed in the sleep-deprived, compared to rested, condition. This effect held for 9 of the 12 positive affect items on the PANAS-C. Participants also reported a greater increase in anxiety during a catastrophizing task and rated the likelihood of potential catastrophes as higher when sleep deprived, relative to when rested. Early adolescents appraised their main worry as more threatening when sleep deprived, relative to when rested. These results support and extend previous research underscoring the adverse affective consequences of sleep deprivation.

Double Trouble? The Effects of Sleep Deprivation and Chronotype on Adolescent Affect.

BACKGROUND   Two understudied risk factors that have been linked to emotional difficulties in adolescence are chronotype and sleep deprivation. This study extended past research by using an experimental design to investigate the role of sleep deprivation and chronotype on emotion in adolescents. It was hypothesized that sleep deprivation and an evening chronotype would be associated with decreased positive affect (PA), increased negative affect (NA), and lower positivity ratios. METHODS   Forty-seven healthy adolescents (aged 10-15 for girls, 11-16 for boys) participated in a sleep deprivation and a rested condition. A subsample of 24 adolescents was selected on the basis of extreme morningness or eveningness scores (based on outer quartiles of scores on the Childrens Morningness-Eveningness Preferences Scale). PA and NA were measured using the Positive and Negative Affect Schedule for Children, and positivity ratios were calculated by dividing PA by NA. RESULTS   Participants reported less positive affect and lower positivity ratios when sleep deprived, relative to when rested. Evening chronotypes reported less positive affect and lower positivity ratios than morning chronotypes in both rested and sleep deprivation conditions. CONCLUSIONS   These findings extend previous research by suggesting that adolescents are adversely impacted by sleep deprivation, and that an evening chronotype might serve as a useful marker of emotional vulnerability. Early intervention and prevention strategies can focus on improving sleep and on using chronotherapy principles to reduce eveningness.

The effect of sleep deprivation on vocal expression of emotion in adolescents and adults.

STUDY OBJECTIVE Investigate the impact of sleep deprivation on vocal expression of emotion. DESIGN Within-group repeated measures analysis involving sleep deprivation and rested conditions. SETTING Experimental laboratory setting. PATIENTS OR PARTICIPANTS Fifty-five healthy participants (24 females), including 38 adolescents aged 11-15 y and 17 adults aged 30-60 y. INTERVENTIONS A multimethod approach was used to examine vocal expression of emotion in interviews conducted at 22:30 and 06:30. On that night, participants slept a maximum of 2 h. MEASUREMENTS AND RESULTS Interviews were analyzed for vocal expression of emotion via computerized text analysis, human rater judgments, and computerized acoustic properties. Computerized text analysis and human rater judgments indicated decreases in positive emotion in all participants at 06:30 relative to 22:30, and adolescents displayed a significantly greater decrease in positive emotion via computerized text analysis relative to adults. Increases in negative emotion were observed among all participants using human rater judgments. Results for the computerized acoustic properties indicated decreases in pitch, bark energy (intensity) in certain high frequency bands, and vocal sharpness (reduction in high frequency bands > 1000 Hz). CONCLUSIONS These findings support the importance of sleep for healthy emotional functioning in adults, and further suggest that adolescents are differentially vulnerable to the emotional consequences of sleep deprivation.

The Effects of Bedtime and Sleep Duration on Academic and Emotional Outcomes in a Nationally Representative Sample of Adolescents

PURPOSE The overall aim of this study was to clarify and better characterize the sleep/circadian patterns of adolescents in a nationally representative sample. METHODS We used three waves of data from the National Longitudinal Study of Adolescent Health to assess sleep/circadian patterns of 2,700 adolescents in grades seven through 12. RESULTS Late school year bedtime was associated with shorter total sleep time cross-sectionally, whereas late summertime bedtime was not. Moreover, late school year bedtime was not associated with late summertime bedtime cross-sectionally. Late school year bedtime in Wave I (1994-1995) was associated with worse educational outcomes and emotional distress 6-8 years later. In addition, late summertime bedtime in Wave II (1996) was associated with more emotional distress at Wave III (2001-2002). Short total sleep time was not associated longitudinally with changes in emotional and academic functioning. Across Waves I and II, more than three quarters of adolescents who went to sleep at 11:15 a.m. or later during the school year or 1:30 a.m. or later during the summer reported sleeping fewer than the recommended 9 hours. CONCLUSIONS These findings underscore the significance of evaluating and monitoring bedtime in adolescents and the importance of intervention strategies that target bedtimes in an effort to reduce associated functional impairments, and improve academic and emotional outcomes.

Evidence for a Possible Link between Bedtime and Change in Body Mass Index

OBJECTIVES The aim of the current study was to examine the longitudinal relationship between bedtimes and body mass index (BMI) from adolescence to adulthood in a nationally representative sample. DESIGN Three waves of data from the National Longitudinal Study of Adolescent Health were used to assess the bedtimes and BMI of 3,342 adolescents between 1994 and 2009. Hypotheses were tested with hierarchical linear models using a two-level, random intercept and slopes model. RESULTS Later average bedtime during the workweek, in hours, from adolescence to adulthood was associated with an increase in BMI over time (b = 0.035 kg/m(2) per min later bedtime per 6 years; standard error = 0.016; t = 2.12, degrees of freedom = 3,238, P < 0.05). These results remained significant after controlling for demographic characteristics and baseline BMI. Although sleep duration, screen time, and exercise frequency did not attenuate the relationship between workday bedtime and BMI over time, fast-food consumption was recognized as a significant partial mediator of the relationship between bedtimes and BMI longitudinally. CONCLUSIONS The results highlight bedtimes as a potential target for weight management during adolescence and during the transition to adulthood.

Social support and social strain in inter-episode bipolar disorder.

Eidelman P, Gershon A, Kaplan K, McGlinchey E, Harvey AG. Social support and social strain in inter‐episode bipolar disorder. 
Bipolar Disord 2012: 14: 628–640.

The role of sleep disturbance in suicidal and nonsuicidal self-injurious behavior among adolescents

The relationship between different sleep disturbances and self-harm thoughts and behaviors was examined among 223 adolescents presenting to a community clinic for mood disorders and suicidal and nonsuicidal self-injurious behaviors. Two-thirds of the adolescents reported nightly, severe sleep complaints. Relative to adolescents without significant sleep complaints, patients with severe sleep complaints at the time of clinic entry endorsed significantly more engagement in nonsuicidal self-injury. Middle insomnia and circadian reversal were both significant predictors of suicide attempts. Terminal insomnia was significantly associated with suicidal ideation. Results support the importance of assessing sleep difficulties among adolescents at risk for suicide.

Sleep and Adolescents

Abstract Adolescents experience dramatic maturational sleep changes along with changes in all of the related neurobiological, hormonal, psychosocial, and physical processes. Thus, the role of sleep in the mental and physical health of adolescents is complex. Sleep is fundamental for multiple domains of health and functioning across development. Robust evidence shows that sleep deprivation undermines emotion regulation among youth ( McGlinchey et al., 2011 , Talbot et al., 2010 ), and inadequate sleep compromises learning ( Dewald et al., 2010 , Sadeh et al., 2003 ). Clearly, inadequate or disturbed sleep in childhood and adolescence may have immediate adverse effects in domains important for optimal development, with potential long-term consequences of great concern. This chapter presents contemporary views about the complex neurobiology of sleep and its functions with important implications for adolescence. Timely diagnosis and management of sleep problems appear critical for growth and development in adolescents.

Innovations in Practice: The relationship between sleep disturbances, depression, and interpersonal functioning in treatment for adolescent depression

BACKGROUND Sleep disturbance is frequently comorbid with depression and sleep complaints are the most common residual symptoms after treatment among adolescents with depression. The present analyses investigated the effect of sleep disturbance in depressed adolescents treated with Interpersonal Psychotherapy for Adolescents (IPT-A) versus Treatment as Usual (TAU) in school-based mental health clinics. METHOD 63 adolescents participated in a randomized clinical trial of IPT-A versus TAU for adolescent depression. Participants were diagnosed with a DSM-IV depressive disorder and assessed for symptoms of depression, interpersonal functioning and sleep disturbance. Measures were assessed at baseline, session 4 and 8 of treatment, and session 12 for post-acute treatment follow-up. Hierarchical linear modeling (HLM) was used to model change in depression, interpersonal functioning and sleep disturbance. RESULTS Ongoing sleep disturbance was significantly associated with worse depression scores as rated by clinician (γ = 1.04, SE = 0.22, p < .001) and self-report (γ = 1.63, SE = 0.29, p < .001), as well as worse interpersonal functioning across the course of treatment (γ = 0.09, SE = 0.02, p < .001). Treatment condition did not predict change in sleep disturbance (γ = -0.13, SE = 0.14, p = ns). CONCLUSIONS For all patients in the study, sleep disturbance was a predictor of depression and interpersonal functioning for depressed adolescents. Sleep disturbance predicted more depression and interpersonal stress across treatments and led to a slower improvement in depression and interpersonal functioning. This data suggests that sleep disturbance should be a target for future treatment development research among depressed adolescents.

Assessing sexual symptoms and side effects in adolescents

In a recent clinical research meeting, an incident was discussed involving an adolescent boy who was part of a trial investigating pediatric anxiety and taking a selective serotonin reuptake inhibitor (SSRI) for the first time. His therapist noticed he was shutting her out in therapy and did not want to take his medication any longer. The therapist was confused, because the boy’s anxiety appeared to be lessening. During his next meeting with the study psychiatrist (a man), the patient confessed that he was worrying whether he would ever have sex, given that his previous frequent sexual thoughts and feelings had disappeared since he began taking the medication. After the patient’s self-prompted report, the psychiatrist and therapist were able to work together to address the patient’s loss of libido. The fact that the patient had to offer this information on his own accord makes it likely that others, who might be less comfortable discussing sexual issues, might discontinue the medication without addressing this issue with their practitioners. As researchers embarking on new translational research in the area of mood and anxiety disorders and SSRI treatment in children and adolescents, we found ourselves examining the side effect profiles of children and adolescents treated with SSRIs. Through our review of the literature we discovered that a profound piece of information was missing: the assessment or screening of sexual behavior and dysfunction, resulting in missing evidence-based knowledge about these issues in the adolescent population. This was concerning given the high prevalence of sexual side effects … Address correspondence to Amir Levine, MD, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University, and New York State Psychiatry Institute, 1051 Riverside Dr, Kolb Annex Unit 78, New York, NY 10032 E-mail: ama146{at}columbia.edu