PracticeUpdate Conference Series European Congress of Psychiatry 2019

Adolescent Sleep Problems Typically Precede Anxiety Symptoms The findings suggest that addressing sleep problems early onmay help prevent the development of anxiety.

B oth sleep problems and anxiety are common complaints among adolescents and new research suggests that the sleep problems might actually come first, suggesting they may even play a causative role in the development of anxiety. Altanzul Narmandakh, a PhD student at the University of Groningen in The Netherlands, joined with three colleagues to investigate the association between anxiety and sleep issues among Dutch adolescents. They operated from the premise that sleep problems and anxiety symptoms increase considerably during adolescence. The bidirec- tional association between sleep problems and anxiety symptoms has been explored in other studies, but those studies have not distinguished differences occurring between persons from dif- ferences occurring within individuals over time. Narmandakh et al believe that this could have led to erroneous conclusions regarding underlying causal mechanisms. They therefore undertook to investigate the bidi- rectional association between sleep problems and anxiety symptoms during adolescence and young adulthood, with a particular focus on distinguish- ing between within-person and between-person effects. Their data came from the Tracking Adolescents’ Individual Lives Survey (TRAILS), a prospective cohort study of Dutch adolescents that includes six waves of data spanning 15 years. Sleep prob- lems and anxiety symptoms were measured by self-report questionnaires. The investigators looked at data from 2230 ado- lescents with a mean age at baseline of 11.1 years. These subjects were assessed every 2 to 3 years up until young adulthood (mean age 25.6 years).

Among the study participants, those who reported sleep problems were significantly more likely to report elevated anxiety than those who did not report sleep problems (beta coefficient = 0.58, P < .001). Over the 15 years of an individual sub- ject’s participation, that individual’s sleep problems and anxiety were cross-sectionally associated at all waves (beta coefficient = 0.014–0.018, P < .001). The study also showed that an individual’s experience of poor sleep predicted greater anxiety symptoms after 2 years at some assessment waves, but the reverse association was not statistically significant. Narmandakh and colleagues concluded in their abstract that their findings “tentatively suggest that adolescent sleep problems may precede anxiety symptoms, and … that anxiety might be prevented by alleviating sleep problems. “Anxiety symptoms and sleep problems become more prevalent among adolescents, and the authors of this study advance a hypothesis that sleep problems can precede and may cause anxiety problems,” Dennis Butler, PhD, Professor Emeritus of Family Medicine at the Medical College of Wisconsin in Milwaukee, told Elsevier’s PracticeUpdate in a comment on the study.

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PRACTICEUPDATE CONFERENCE SERIES • EPA 2019