Abstract
There is limited knowledge about sleep in adolescents with elevated levels of anxiety treated within primary health care settings, potentially resulting in sleep problems not being sufficiently addressed by primary health care workers. In the current study self-reported anxiety, insomnia, sleep onset latency, sleep duration, and depressive symptoms were assessed in 313 adolescents (12–16 years; mean age 14.0, SD = 0.84, 84.0% girls) referred to treatment for anxiety within primary health care. Results showed that 38.1% of the adolescents met criteria for insomnia, 34.8% reported short sleep duration (<7 h), and 83.1% reported long sleep onset latency (≥30 min). Total anxiety symptoms were related to all sleep variables after controlling for age and sex. Furthermore, all anxiety symptom sub-types were associated with insomnia and sleep onset latency, whereas most anxiety subtypes were associated with sleep duration. Adolescents’ depressive symptoms accounted for most of the anxiety-sleep associations, emphasizing the importance of depressive symptoms for sleep. However, anxiety was associated with insomnia and sleep onset latency also among youth with low levels of depressive symptoms. The findings suggests that primary health care workers should assess sleep duration, sleep onset latency, and insomnia in help-seeking adolescents with anxiety.
Highlights
Sleep undergoes major changes during adolescence, and is generally characterized by short sleep duration, long sleep onset latency (SOL), and high rates of insomnia (Gradisar et al, 2011; Hysing et al, 2013)
Norwegian (92.0%), with the majority living in two-parent families (78.8%), and the social class of most families (62.9%) categorized as medium
The high rate of insomnia and the long SOL found among adolescents with different subtypes of anxiety, suggest a need to assess sleep among all adolescents who seek help for anxiety within primary health care services, regardless of subtype of anxiety they present with
Summary
Sleep undergoes major changes during adolescence, and is generally characterized by short sleep duration, long sleep onset latency (SOL), and high rates of insomnia (Gradisar et al, 2011; Hysing et al, 2013). Clinical research on the association between anxiety and sleep problems has primarily focused on adolescents with anxiety disorders, often in specialized treatment settings (Brown et al, 2018). We know much less about sleep in adolescents with anxiety receiving treatment within primary health care services. Such information is important because a large proportion of adolescents with symptoms of internalizing disorders (i.e., anxiety disorders and/or depression) seek help within primary health settings (Zachrisson et al, 2006). By reaching adolescents early and within their everyday contexts (e.g., school), primary health services may overcome some of the barriers against seeking help for mental health problems in youth (Salloum et al, 2016; Reardon et al, 2017)
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