Psychosocial Determinants of Insomnia in Adolescents: Roles of Mental Health, Behavioral Health, and Social Environment.

Yi-Ping Hsieh,Wei-Hsin Lu,Cheng-Fang Yen

doi:10.3389/fnins.2019.00848

Abstract

The theoretical explanation of human problems is derived from the complex interplay of psychological, social, economic, political, and physical factors.AimsThis study examined the roles of behavioral health (i.e., alcohol abuse and suicidality) and social environment (i.e., family support, school connectedness, and favorable neighborhood) and mental health [i.e., depression, anxiety, and attention deficit hyperactivity disorder (ADHD)] in predicting insomnia in adolescents in an ecological perspective.MethodsApproximately 6445 high school students in Taiwan were administered an anonymous self-report survey. Hierarchical multiple regression was performed to examine how multidimensional social environment, behavioral health, and mental health factors were associated with insomnia in adolescents.ResultsThe prevalence rate of insomnia in the sample was 30%. The results indicated that alcohol abuse (β = 0.04), suicidality (β = 0.06), depression (β = 0.29), anxiety (β = 0.14), and ADHD (β = 0.11) were positively associated with insomnia (p < 0.001), whereas family support (β = −0.06), school connectedness (β = −0.05), and favorable neighborhood (β = −0.10) were negatively associated with insomnia (p < 0.001). Sex did not predict insomnia, but age was positively associated with insomnia (β = 0.09, p < 0.001). Among all predictors of insomnia in the study, mental health factors, especially depression, play a major role on insomnia among adolescents, and is as much important as social environment factors.ConclusionThis study demonstrated how both psychosocial variables (social environment and behavioral health) and psychological symptoms were associated with insomnia in adolescents when the demographic variables (sex and age) were controlled and provided valuable information and evidence for clinicians, social workers, and health professionals who provide support to adolescents with insomnia. Applying an ecological approach in practice can aid in understanding at individual, family, school, and community levels and in identifying the strengths and weaknesses of their interactions with each other.ImplicationsThis perspective enables practitioners in effectively treating problems and addressing the needs of the various levels, including the individual, family, school, and the broader community. Thus, prevention and intervention of insomnia in adolescents should focus on multidimensional risk and protective factors, including mental health, behavioral health, and social environment, in the context of an ecological system.

Highlights

Insomnia is a subjective complaint, defined as difficulty in falling asleep, trouble in staying asleep, or having poor sleep quality (Ohayon, 2002)
In addition to mental health [i.e., depression, anxiety, and attention deficit hyperactivity disorder (ADHD)], the current study examined the roles of behavioral health and social environment simultaneously in predicting insomnia in adolescents
The participants in this study were enrolled from the 2009 Project for the Health of Children and Adolescents in Southern Taiwan, a research program studying the mental health status of children and adolescents living in four counties and three metropolitan areas in southern Taiwan (Yen et al, 2010a)

Summary

Introduction

Insomnia is a subjective complaint, defined as difficulty in falling asleep, trouble in staying asleep, or having poor sleep quality (Ohayon, 2002). In Taiwan, >25% (n = 36,743) of adults and 18.7% adolescents (aged 12–18 years) experienced insomnia (Kao et al, 2008; Huang et al, 2010). Insufficient and unsatisfactory sleep in adolescents is associated with adverse outcomes across various areas of youth development, including physical health (e.g., inflammation), cognitive and behavioral function, school performance, delinquency, substance use, depression, diminished quality of life, and even suicide ideation and self-harm behavior (Roberts et al, 2001; Sadeh et al, 2003; Curcio et al, 2006; Clinkinbeard et al, 2011; Mueller et al, 2011; Wong et al, 2011; Pasch et al, 2012; Park et al, 2016; Wang et al, 2017). In addition to previous studies focusing on physical conditions such as chronic painful physical condition as a major contributive factor for insomnia (Ohayon, 2005), it is important for the present study to identify psychological, social, behavioral, and contextual barriers and aids to induce good sleep

Methods

Results

Discussion

Conclusion