Sleep Disturbances Are Associated With Depressive Symptoms and Suicidality Among Adolescents in Pediatric Primary Care

Abstract

Objective

Sleep disturbances increase in adolescence and are associated with depression and suicide risk. However, research on enhancing depression and suicide risk assessment in clinical settings using behavioral markers, such as sleep, remains limited. Pediatric primary care (PPC) provides an opportunity for early risk identification, yet few studies examine how sleep disturbances, which are commonly reported, readily observable, and modifiable, are associated with concurrent depression and suicidality in PPC settings. This study examined the prevalence of adolescent sleep disturbances and concurrent associations with depression and suicidality in a large, sociodemographically diverse PPC sample.

Method

Between November 15, 2017, and February 1, 2020, 70,590 adolescents (ages 12-17) completed the Patient Health Questionnaire-9 modified for teens (PHQ-9-M) at PPC well visits. Logistic regressions examined associations between PHQ-9-M sleep item responses, sociodemographic variables, and depression and suicidality.

Results

Nearly 40% of youth endorsed sleep disturbances at their well visit via the PHQ-9-M sleep item. Youth who were older, female, racial or ethnic minoritized, and Medicaid insured were more likely to endorse sleep disturbances (odds ratios ≥1.03, ps < .001). Youth who endorsed sleep disturbances lasting several days or more were more than 20 times more likely to have a PHQ-9-M total score in the clinical range (odds ratio 23.31, 95% CI [21.64, 25.13]) and 4 times more likely to endorse any suicidality item (odds ratio 4.14, 95% CI [3.89, 4.41]).

Conclusion

Findings underscore the clinical utility of screening for sleep disturbances in PPC. Considering the significant associations between sleep disturbances and concurrent depression and suicidality, PPC providers may consider screening for and managing sleep disturbances.

Plain language summary

This study utilized retrospective data from pediatric primary care well visits occurring between November 2017 and February 2020 from a large healthcare network. The goal was to determine the rate and sociodemographic characteristics of youth reporting sleep disturbances in well visits, as well as how sleep disturbances were associated with concurrent depression and suicidality. Of 70,590 adolescents (12-17 years old) with well-visit data, 37% endorsed at least some difficulty falling or staying asleep or sleeping too much. Youth who endorsed sleep disturbances were more likely to be older, female, from a minoritized racial or ethnic group, and Medicaid insured, and were 23 times more likely to also have elevated depressive symptoms and 4 times more likely to endorse suicidality. Findings highlight the importance of screening for sleep disturbances in pediatric primary care clinics.

Clinical guidance

• Sleep disturbances among adolescents should be standardly screened in primary care.

• Risk for depression and suicide may be increased in adolescents endorsing sleep disturbances in primary care.

• Consider implementing and/or referring for evidence-based approaches to manage sleep disturbances.

Diversity & Inclusion Statement

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper received support from a program designed to increase minority representation in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.