Which should be targeted first? The comorbidity of sleep disturbances and anxiety symptoms among adolescents: Cross-sectional and longitudinal network analyses

Abstract

Background

The comorbidity of sleep disturbances and anxiety is well-established, but which symptoms to prioritize for intervention remains unclear. Academic stress, a key factor worsening both, is common among adolescents facing growing academic demands. Understanding how it affects both comorbidities from a symptomatology perspective is crucial for developing targeted interventions.

Methods

The longitudinal survey of 34,494 adolescents was conducted twice (M_age = 12.89 [1.76] years). Adolescents were categorized into three groups based on academic stress scores' mean ± 1 standard deviation. Then, we examined the moderating effect of academic stress on the relationship between sleep disturbances and anxiety symptoms longitudinally by comparing groups' network structures, where nodes represent symptoms, and edge thickness reflects the associations' strength.

Results

In the cross-sectional network, at both time points, the key bridge symptom is “sleep quality” (bridge Expected Influence (bEI) at T1 = 0.21; bEI at T2 = 0.20). In the longitudinal network, “irritability” (bEI = 0.21) and “sleep quality” (bEI = 0.21) are key bridge symptoms in the whole sample, with “sleep quality” (bEI = 0.36) most prominent in the high stress group. In the low stress group, it's “difficulty initiating sleep” (bEI = 0.14). Additionally, compared to the low group, adolescents with high academic stress possess more tightly connected relationships (edge weights ≥0.05) not only within single disorder symptom networks but also between two disorder symptom networks (number of edges: 2 vs 34).

Conclusion

These findings highlight the moderating role of academic stress, offering insights for targeted interventions to improve adolescent mental health.