What's keeping kids up at night? How psychosocial stressors exacerbate the relationship between sleep and mental health

Abstract

Background: Although it is well established that healthy sleep promotes positive mental health, little is known about how sleep operates in children and adolescents who experience a range of psychosocial stressors. This study examined the association between sleep duration and serious mental illness (SMI) and how this pathway is moderated by psychosocial stressors (discrimination, bullying, and perceived school and neighborhood safety). Methods: A cross-sectional study was conducted among students in a California school district serving a low-income community in 2019–2020. A non-probability convenience sampling method was used, and surveys were administered in English, in a single class period. Basic descriptive statistics and a hierarchical linear regression analysis were used. Results: Students (n = 24,439) in grades 5–12 were surveyed. An average of 18.7% of the students reported having SMI; however, distribution increased by grade from 13.6% in 5th grade to 24.5% in 11th grade. Sleep duration was inversely associated with SMI, as the hours of sleep decreased, the risk of SMI increased. The negative effect of poor sleep on SMI was further exacerbated by perceived discrimination at school (β = 0.13, p < 0.001), feeling unsafe in one's neighborhood (β = 0.32, p < 0.001), feeling unsafe at school (β = 0.23, p < 0.001), and being bullied at school (β = 0.54, p < 0.001). Conclusion: This study was demonstrated that increased sleep among children and adolescents was associated with reduced SMI. However, in the presence of psychosocial stressors (discrimination, bullying, and perceived school and neighborhood safety), the effect of sleep on SMI was moderated and despite increased sleep.