Abstract
Sleep problems are a risk factor for the development of depressive disorders and influence the severity and treatment of depressive symptoms negatively. To enhance treatment for depression in young people, it is important to advance the understanding of the relationship between sleep problems and depressive symptoms. Since deficits in emotion regulation are discussed as possible underlying mechanisms, the present study investigated the mediating effect of maladaptive and adaptive strategies for emotion regulation on the association between sleep problems and depressive symptoms. Emotion regulation strategies, depression and sleep quality were assessed via self-report in a large clinical sample of 602 adolescents (age 13–18 years) who reported clinically relevant symptoms of depression. The questionnaires were assessed at admission for inpatient psychiatric treatment. Correlation and mediation analyses were performed. There was a significant partial mediation effect (β = 0.554, p < 0.001, R2 = 0.527), indicating that sleep problems influenced depressive symptoms via the decreased use of adaptive strategies and the increased use of maladaptive strategies. Additionally, a direct effect of sleep problems on depressive symptoms emerged (β = 0.251, p < 0.001, R2 = 0.364). This cross-sectional study provides first indications that additional treatment modules focusing on sleep and ER skills in prevention and treatment programs for adolescents would be important steps. Longitudinal studies are needed to substantiate these results.
Highlights
Depression in youth is a prevalent disease associated with a high risk of chronicity and functional impairment [1]
Correlation analyses were conducted between the three variables emotion regulation (ER) and sleep problems as well as depressive symptoms
Independent t-tests revealed significant differences between girls and boys, with girls showing more sleep problems and depressive symptoms as well as a greater use of maladaptive strategies and a reduced use of adaptive strategies compared to boys
Summary
Depression in youth is a prevalent disease associated with a high risk of chronicity and functional impairment [1]. Sleep problems are common and may aggravate the course of the disease [2, 3]. Recent evidence outlines the importance of emotion regulation (ER) as a possible underlying mechanism of the association between sleep problems and depression [4, 5]. In adolescents with clinically relevant levels of depression empirical evidence is missing. The described studies miss to include adaptive strategies in contrast to maladaptive strategies when looking at the indirect association of depression with sleep problems through dysfunctional ER [6]. It seems to be relevant to examine the associations between sleep problems, dysfunctions in ER and depressive symptoms in clinical adolescents with depression to strengthen prior findings. The results may help to provide insights to inform treatment and prevention efforts in adolescent depression
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