Grade-specific associations between insomnia and depressive symptoms in adolescents: a cross-lagged panel network analysis.

Abstract

Background: Insomnia and depression frequently co-occur during adolescence, posing significant challenges to adolescent mental health. However, the direction of their association remains inconsistent in the literature and may show grade-specific patterns. Grounded in psychopathology network theory and informed by the developmental psychopathology perspective, this study examined symptom-level associations between insomnia and depression to better characterize these association patterns.

Methods: This study employed cross-lagged panel network analysis to explore symptom-level interactions between insomnia and depression from Grades 5 to 12, capturing both contemporaneous (within-timepoint) associations and temporal (cross-timepoint) predictive associations. A large cohort of 175,950 adolescents (M_Age = 14.35, SD = 2.14; 52.72% female) completed the Insomnia Severity Index (ISI) and Patient Health Questionnaire-9 (PHQ-9) at two time points.

Results: The findings showed both relatively stable and grade-specific patterns of association between insomnia and depression. In the contemporaneous networks, Motor descriptively showed the highest strength centrality in most grades, although the symptom with the highest centrality differed in some grades. In the temporal networks, descriptive centrality results indicated that Sad Mood had the highest out-expected influence in most grades, except for Anhedonia in Grade 6 and 8 and Suicide in Grade 12; Daily Function descriptively had the highest in-expected influence in most grades, except for Fatigue in Grade 10 and 11.

Conclusion: These findings highlight several symptoms in the insomnia-depression network, with some variation across grades. By moving beyond total-score approaches, this symptom-level perspective provides exploratory insights that may shed light on inconsistencies in prior findings regarding the directionality of the insomnia-depression association and offer a more nuanced understanding of insomnia-depression relationships during adolescence.