Hao T. Duong

Chronic Insomnia and Its Negative Consequences for Health and Functioning of Adolescents : A 12-Month Prospective Study

PURPOSE To estimate prevalence and chronicity of insomnia and the impact of chronic insomnia on health and functioning of adolescents. METHODS Data were collected from 4175 youths 11-17 at baseline and 3134 a year later sampled from managed care groups in a large metropolitan area. Insomnia was assessed by youth-reported DSM-IV symptom criteria. Outcomes are three measures of somatic health, three measures of mental health, two measures of substance use, three measures of interpersonal problems, and three of daily activities. RESULTS Over one-fourth reported one or more symptoms of insomnia at baseline and about 5% met diagnostic criteria for insomnia. Almost 46% of those who reported one or more symptoms of insomnia in Wave 1 continued to be cases at Wave 2 and 24% met DSM-IV symptom criteria for chronic insomnia (cases in Wave 1 were also cases in Wave 2). Multivariate analyses found chronic insomnia increased subsequent risk for somatic health problems, interpersonal problems, psychological problems, and daily activities. Significant odds (p < .05) ranged from 1.6 to 5.6 for poor outcomes. These results are the first reported on chronic insomnia among youths, and corroborate, using prospective data, previous findings on correlates of disturbed sleep based on cross-sectional studies. CONCLUSIONS Insomnia is both common and chronic among adolescents. The data indicate that the burden of insomnia is comparable to that of other psychiatric disorders such as mood, anxiety, disruptive, and substance use disorders. Chronic insomnia severely impacts future health and functioning of youths. Those with chronic insomnia are more likely to seek medical care. These data suggest primary care settings might provide a venue for screening and early intervention for adolescent insomnia.

SLEEPLESS IN ADOLESCENCE: PROSPECTIVE DATA ON SLEEP DEPRIVATION, HEALTH AND FUNCTIONING

We estimate prevalence, incidence and persistence of short sleep or sleep deprivation in a two wave cohort study of 4175 youths 11-17 years old at baseline and 3134 of these a year later. Data were collected using computer interviews and questionnaires. Sleep deprivation was defined as 6h or less per night during the past 4 weeks. Weighted logistic regression procedures were employed to calculate prevalence, incidence, persistence/chronicity, and odds ratios. Prevalence rates and rates of persistence suggest sleep deprivation is highly prevalent and chronic. Multivariate analyses indicate that short sleep increases risk across multiple domains of dysfunction, suggesting pervasive deleterious effects. The broad impact of sleep deprivation and its pervasiveness suggests interventions will need to focus on multilevel changes to increase sleep time and reduce the negative impact of sleep deprivation among adolescents.

The prospective association between sleep deprivation and depression among adolescents.

STUDY OBJECTIVES To examine the prospective, reciprocal association between sleep deprivation and depression among adolescents. DESIGN A community-based two-wave cohort study. SETTING A metropolitan area with a population of over 4 million. PARTICIPANTS 4,175 youths 11-17 at baseline, and 3,134 of these followed up a year later. MEASUREMENTS Depression is measured using both symptoms of depression and DSM-IV major depression. Sleep deprivation is defined as ≤ 6 h of sleep per night. RESULTS Sleep deprivation at baseline predicted both measures of depression at follow-up, controlling for depression at baseline. Examining the reciprocal association, major depression at baseline, but not symptoms predicted sleep deprivation at follow-up. CONCLUSION These results are the first to document reciprocal effects for major depression and sleep deprivation among adolescents using prospective data. The data suggest reduced quantity of sleep increases risk for major depression, which in turn increases risk for decreased sleep.

Depression and Insomnia Among Adolescents: A Prospective Perspective

BACKGROUND No studies of adolescents have examined the prospective, reciprocal association between insomnia and major depression. METHODS A two-wave, community-based cohort of 3134 youths aged 11-17 at baseline. Major depression was assessed using DSM-IV criteria. Three measures of insomnia were used also following DSM-IV: P1, any symptom of insomnia; P2, any symptom plus impairment; P3, P2 with no comorbid mood, anxiety or substance use disorders. RESULTS In general, the association between insomnia and depression was stronger and more consistent for major depression than for symptoms of depression. Baseline insomnia (P1 and P2) increased subsequent risk of major depression 2-3-fold and P1 2-fold in multivariate analyses. Major depression increased risk for subsequent insomnia 2-3-fold for P1 and P2 2-fold for P2 in multivariate analyses. Results varied by measure of insomnia used. LIMITATIONS Only symptoms of insomnia were assessed, so we could not examine the effects of comorbid sleep disorders nor did we have objective or biological measures of disturbed sleep. We also did not collect data on parental reports of youth depression nor insomnia or sleep problems. CONCLUSION Our results provide the first prospective data on insomnia and major depression among adolescents indicating the two are reciprocally related. More studies are needed examining trajectories of insomnia and major depression in childhood and adolescence.

Obese youths are not more likely to become depressed, but depressed youths are more likely to become obese

BACKGROUND Overweight/obesity and depression are both major public health problems among adolescents. However, the question of a link between overweight/obesity and depression remains unresolved in this age group. We examined whether obesity increases risk of depression, or depression increases risk of obesity, or whether there is a reciprocal effect. METHOD A two-wave prospective cohort study of adolescents aged 11–17 years at baseline (n=4175) followed up a year later (n=3134) sampled from the Houston metropolitan area. Overweight was defined as 95th percentile >body mass index (BMI) < or = 85th percentile and obese as BMI >95th percentile. Three indicators of depression were examined: any DSM-IV mood disorder, major depression, and symptoms of depression. RESULTS Data for the two-wave cohort indicated no evidence of reciprocal effects between weight and depression. Weight status predicted neither major depression nor depressive symptoms. However, mood disorders generally and major depression in particular increased risk of future obesity more than twofold. Depressed males had a sixfold increased risk of obesity. Females with depressive symptoms had a marginally increased risk of being overweight but not obese. CONCLUSIONS Our findings, combined with those of recent meta-analyses, suggest that obese youths are not more likely to become depressed but that depressed youths are more likely to become obese.

Perceived weight in youths and risk of overweight or obesity six years later

OBJECTIVE To examine the association between perceived overweight in adolescents and the development of overweight or obesity later in life. METHODS This paper uses data from a prospective, two-wave cohort study. Participants are 2445 adolescents 11-17years of age who reported perceived weight at baseline and also had height and weight measured at baseline and at follow-up six years later sampled from managed care groups in a large metropolitan area. RESULTS Youths who perceived themselves as overweight at baseline were approximately 2.5 times as likely to be overweight or obese six years later compared to youths who perceived themselves as average weight (OR=2.45, 95% CI=1.77-3.39), after adjusting for weight status at baseline, demographic characteristics, major depression, physical activity and dieting behaviors. Those who perceived themselves as skinny were less likely to be overweight or obese later (OR=0.36, 95% CI=0.27-0.49). CONCLUSIONS Perceived overweight was associated with overweight or obesity later in life. This relationship was not fully explained by extreme weight control behaviors or major depression. Further research is needed to explore the mechanism involved.

Do Anxiety Disorders Play a Role in Adolescent Obesity

BackgroundThere have been few prospective studies on the association between anxiety disorders and adolescent obesity; none examine potential reciprocal effects.PurposeThe purpose of this paper is to examine the prospective association between anxiety disorders and obesity among adolescents.MethodsUsing data from a two-wave, prospective study of 3134 adolescents, we examined reciprocal effects between body weight and DSM-IV anxiety disorders.ResultsWeight status did not increase future risk of anxiety disorders nor did anxiety disorders at baseline increase risk of future obesity in the overall sample. Stratifying by gender revealed an increased risk of overweight and obesity in males with anxiety disorders, but not for females. Major depression did not mediate these associations.ConclusionSimilar to prospective studies of depression, it appears anxiety disorders may increase risk of obesity. However, more research is needed on the role of psychopathology in adolescent obesity, in particular anxiety disorders and possible moderators (such as gender) and mediators.

Is there an association between adolescent sleep restriction and obesity.

OBJECTIVE This is the first prospective study of the reciprocal association between sleep restriction and weight among adolescents. Evidence on sleep duration and obesity in youth is sparse and the results have been equivocal. METHODS Data are from a community-based, two-wave cohort study. The setting was a metropolitan area with a population of over 4 million. The cohort consisted of 4175 youths 11-17 at baseline and 3134 of these followed up a year later. Obesity was defined as body mass index >95th percentile for children of the same age and sex. Sleep restriction was defined as 6 or fewer hours of sleep per night on weeknights or on both weekends and weeknights. Covariates examined were age, gender, family income and depression. RESULTS Results clearly demonstrated that there was no association between sleep restriction and obesity at baseline. In prospective analyses, sleep restriction did not increase future risk of obesity, nor did obesity increase risk of future sleep restriction. CONCLUSIONS These findings call into question previous research based primarily on cross-sectional data suggesting a positive correlation between sleep restriction and obesity. However, the results for adolescents in this study are supported by one study of adolescents and by studies of adults using prospective designs. At this point, there appears to be little evidence for a temporal relation between sleep duration and obesity among adults or adolescents.

Does major depression affect risk for adolescent obesity

OBJECTIVE The purpose of this paper is to reexamine the association between major depression and obesity in adolescents, testing the hypothesis that body image mediates this association. This is the first paper to examine this question using DSM-IV diagnosis of depression and data from a two-wave cohort of adolescents. METHODS Participants were 4175 youths 11-17 years of age sampled from the community who were followed up a year later (n=3134). Major depression was assessed using DSM-IV diagnostic criteria. Body image was measured with perceived weight. Obesity was defined as BMI ≥95th percentile using measured height and weight. RESULTS When we examined a model which included obesity, perceived weight, major depression and covariates, there was no association between major depression at baseline and obesity at follow-up. We found no independent association between major depression and body weight. LIMITATIONS The study was limited in that it is not a national sample, BMI was the only measure of adiposity, perceived weight was the only measure of body image, and there were no data on lifetime trajectories of depression, obesity, or body image. CONCLUSIONS If there is an etiologic link between major depression and body weight among adolescents, it most likely operates through processes involving components of body image, since controlling for body image eliminated the association between depression and obesity. Clinically, addressing body image in depressed patients who are obese may improve outcomes.

Is there an association between short sleep duration and adolescent anxiety disorders

OBJECTIVE The purpose of this study is to provide the first data on the prospective, reciprocal association between short sleep duration and DSM-IV anxiety disorders among adolescents. METHODS A community-based two-wave cohort study included 4175 youths aged 11-17 years at baseline, with 3134 of these followed up a year later, drawn from a metropolitan area with a population of over 4 million. Anxiety is defined as any DSM-IV anxiety disorder in the past year generalized anxiety: panic disorder, agoraphobia without panic, social phobia, and post-traumatic stress disorder. Short sleep duration is defined as ≤6 h of sleep per night. RESULTS/CONCLUSIONS In multivariate analyses, short sleep duration every night at baseline predicted anxiety disorders at follow-up, controlling for anxiety at baseline. Examining the reciprocal association, anxiety disorders at baseline did not predict short sleep duration at follow-up. We are the first to examine the reciprocal effects for anxiety disorders and sleep duration among adolescents using prospective data. The data suggest that reduced quantity of sleep may increase risk for anxiety, but anxiety does not increase risk for decreased sleep duration.