Adolescent Sleep as a Transdiagnostic Factor: Associations Between Actigraphy-Derived Night-to-Night Sleep Metrics and Adolescent Psychopathology

Abstract

Objective

This study examined associations between actigraphy-derived sleep metrics (ie, intraindividual sleep variability, average sleep duration, bedtime, and waketime) and psychopathology to discern their roles as potential transdiagnostic factors related to psychiatric problems during adolescence.

Method

In a sample of 238 adolescents (aged 14-18 years; 0.4% Asian American, 4.0% Black, 22.0% Multiracial, and 73.5% White; 53.4% female) oversampled for socioeconomic risk, we used a bifactor s-1 model of psychopathology, with emotion dysregulation as the reference indicator, to model the general factor of dysregulation and psychopathology (GF-DP) as well as specific internalizing and externalizing factors. We used multilevel structural equation modeling with the Markov chain Monte Carlo procedure to model latent means and intraindividual variability in nightly sleep duration, bedtime, and waketime over 14 nights, and to test whether they had general or specific associations with psychopathology. Furthermore, we examined whether sociodemographic variables moderated the associations between psychopathology and the various sleep metrics.

Results

Results indicated a significant positive association between the GF-DP and intraindividual variability in sleep duration (β = 0.18, 95% CI = 0.013, 0.335). This association was consistent across multiple demographic characteristics, highlighting its broad relevance. The study did not find significant associations with specific internalizing or externalizing problems or other sleep metrics.

Conclusion

Findings emphasize intraindividual variability in sleep duration as a key transdiagnostic factor in adolescent psychopathology. Targeting sleep variability could lead to more effective interventions, potentially reducing the prevalence of a broad spectrum of psychiatric disorders. Future research using diverse samples and longitudinal designs is warranted to build on these insights.

Plain language summary

In this study of 238 adolescents between the ages of 14 to 18, night-to-night sleep was measured using actigraphy watches and related to parent- and adolescent-rated mental health problems. Greater inconsistency in the amount of time an adolescent slept each night was related to greater emotion dysregulation and mental health problems, including internalizing (ie, depression, anxiety, somatic problems) and externalizing (ie, oppositionality, conduct problems, hyperactivity, and inattention) problems. The average amount of sleep time and bedtime and waketime were not significantly related to adolescents’ mental health problems.

Clinical guidance

• Clinicians should assess for consistency of adolescent sleep in addition to the amount of time an adolescent is sleeping. Sleep inconsistency may be more relevant to adolescents’ mental health problems than total sleep time.

• Interventions aimed at improving the consistency of young people’s sleep, such as the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C), may be beneficial in reducing diverse forms of mental health problems (eg, depression, anxiety, attention problems, oppositionality, and conduct problems).

• Improving consistency of sleep may be particularly beneficial for adolescents with comorbid mental health problems.