The Relationship Between Sleep Problems, Insufficient Sleep Duration, and Psychiatric Abnormalities in Children and Adolescents

Sleep problems and insufficient sleep duration can lead to long-term and sustained impairment of psychological health. Disturbed sleep is a frequent phenomenon in childhood and adolescence. It is associated with lower academic achievement, attention difficulties, increased aggressive behavior, and depressive symptoms. Most studies focus on poor sleep quality in terms of sleep problems or insufficient sleep duration, indicating low sleep quantity to be related to psychosocial health. However, there is a scarcity of studies that consider the effects both of sleep quality and of sleep quantity at the same time. Moreover, gender may influence the relationship between disturbed sleep and psychopathology, but gender-specific studies are rare. Therefore, the present paper investigates whether boys and girls who report sleep problems and insufficient sleep duration have a higher risk of internalizing and externalizing problems. The current data represent secondary analyses of a large German epidemiological study (German Health Survey of Children and Adolescents, KIGGS). The data of 3,414 boys and 3,256 girls were separated into two age groups (11-13 years and 14-17 years) in order to analyze sleep duration, sleep problems, and psychiatric abnormalities, the later determined using the Strengths and Difficulties Questionnaire (SDQ). Boys and girls with sleep problems showed a higher risk probability of internalizing and externalizing symptoms (OR = 1.52-3.38) in both age groups. While the presence of sleep problems increased the risk probability of internalizing and externalizing problems in both genders, insufficient sleep duration did so only in girls. Insufficient sleep duration increased the risk of abnormal scores on the emotional problems scale (OR11-13 = 1.70, OR14-17 = 1.56) and for the total score (OR11-13 = 1.48, OR14-17 = 1.66) only in girls of both age groups. Older girls who reported insufficient sleep duration had a higher risk of abnormal scores on the peer problems scale (OR = 1.36) while younger girls showed a higher risk of abnormal scores on the hyperactivity / inattentiveness scale (OR = 1.64) and on the conduct problems scale (OR = 1.78). It can be concluded that there is an association between sleep problems and psychiatric symptoms in different areas in boys and girls and across a wide age range. Insufficient sleep duration, by contrast, only appears to be a risk factor for psychological abnormalities in girls. These gender differences should be taken into account in future studies. A limitation of the presented study was that sleep duration and sleep problems were only assessed using one question each and no sleep-related questionnaire was employed. Nevertheless, the findings suggest that disturbed sleep may be a warning sign for worsened mental health states and should therefore be addressed in pediatric and psychiatric care.