Abstract
Insufficient sleep is a risk factor for depression, suicidality, and substance use, yet little is known about gender, ethnic, and community-level differences in sleep and its associated outcomes, especially during adolescence. Further, much of the prior work has compared groups of teens getting plenty as opposed to insufficient amounts of sleep rather than examine sleep hours continuously. The present study examined adolescent weekday self-reported sleep duration and its links with hopelessness, suicidality, and substance use in a suburban community with very early high school start times. We utilized a large (N = 27,939, 51.2 % female) and ethnically diverse sample of adolescents from the 2009 Fairfax County (Virginia) Youth Survey, an anonymous, self-report, population-level survey administered to all 8th, 10th and 12th grade students in public schools in the county. High-school students reported an average 6.5 h of sleep per school night, with 20 % obtaining ≤5 h, and only 3 % reporting the recommended 9 h/night. Females and minority youth obtained even less sleep on average, and the reduction in sleep in the transition from middle school to high school was more pronounced for females and for Asian students. Hierarchical, multivariate, logistic regression analyses, controlling for background variables, indicated that just 1 h less of weekday sleep was associated with significantly greater odds of feeling hopeless, seriously considering suicide, suicide attempts, and substance use. Relationships between sleep duration and suicidality were stronger for male teens, and sleep duration was more associated with hopelessness for white students compared to most ethnic minority groups. Implications for intervention at multiple levels are discussed.
Similar content being viewed by others
Notes
We also ran regression models with the substance use composites treated continuously and found the same pattern of results as reported here, with no particular type of substance showing a noticeably different pattern.
It is worth noting, however, that whereas we used hours of sleep reported, Maslowsky and Ozer (2014) calculated youth sleep hours on the basis of reported bedtime and waketime. It is not known whether this methodological difference also contributes to the difference observed.
Supplemental and parallel logistic regression analyses to those reported here were also done to see if the difference in receiving 9 vs. 10+ hours of sleep mattered for the outcomes. In all cases, the demographic predictors behaved the same as what is reported below. Moving from 9 to 10+ hours of sleep night was not significantly associated with increased hopelessness, but was significantly associated with increased odds of the other four negative health outcomes.
References
Andrade, M. M. M., Benedito-Silva, A. A., Domenice, S., Arnhold, I. J. P., & Menna-Barreto, L. (1993). Sleep characteristics of adolescents: A longitudinal study. Journal of Adolescent Health, 14(5), 401–406. doi:10.1016/S1054-139X(08)80016-X.
Buckhalt, J. A., El-Sheikh, M., & Keller, P. (2007). Children’s sleep and cognitive functioning: Race and socioeconomic status as moderators of effects. Child Development, 78, 213–231.
Byrnes, J. P., Miller, D. C., & Schafer, W. D. (1999). Gender differences in risk taking: A meta-analysis. Psychological Bulletin, 125, 367–383.
Calamaro, C. J., Mason, T. B., & Ratcliffe, S. J. (2009). Adolescents living the 24/7 lifestyle: Effects of caffeine and technology on sleep duration and daytime functioning. Pediatrics, 123, 1005–1010.
Carskadon, M. A., & Acebo, C. (2002). Regulation of sleepiness in adolescence: Update, insights, and speculation. Sleep, 25, 606–616.
Carskadon, M. A., Wolfson, A. R., Acebo, C., Tzischinsky, O., & Seifer, R. (1998). Adolescent sleep patterns, circadian timing, and sleepiness at a transition to early school days. Sleep, 21, 871–881.
Cash, S. J., & Bridge, J. A. (2009). Epidemiology of youth suicide and suicidal behavior. Current Opinion in Pediatrics, 21, 613–619.
Centers for Disease Control and Prevention. (n.d.). Youth risk survellance system. Author. http://www.cdc.gov/HealthyYouth/yrbs/index.htm?s_cid=tw_cdc16.
Chahal, H., Fung, C., Kuhle, S., & Veugelers, P. J. (2013). Availability and night-time use of electronic entertainment and communication devices are associated with short sleep duration and obesity among Canadian children. Pediatric Obesity, 8, 42–51.
Colrain, I. M., & Baker, F. (2011). Changes in sleep as a function of adolescent development. Neuropsychology Review, 21, 5–21.
Crowley, S. J., Acebo, C., & Carskadon, M. A. (2007). Sleep, circadian rhythms, and delayed phase in adolescence. Sleep Medicine, 8(6), 602–612.
Dahl, R. E., & Lewin, D. S. (2002). Pathways to adolescent sleep and behaviour. Journal of Adolescent Health, 31, 175–184.
Dewald-Kaufmann, J. F., Oort, F. J., & Meijer, A. M. (2014). The effects of sleep extension and sleep hygiene advice on sleep and depressive symptoms in adolescents: A randomized controlled trial. Journal of Child Psychology and Psychiatry, 55, 273–283.
Dexter, D., Bijwadia, J., Schilling, D., & Applebaugh, G. (2003). Sleep, sleepiness and school start times: A preliminary study. Wisconsin Medical Journal, 102(1), 44–46.
Eaton, D. K., McKnight-Eily, L. R., Lowry, R., Perry, G. S., Presley-Cantrell, L., & Croft, J. B. (2010). Prevalence of insufficient, borderline, and optimal hours of sleep among high school students—United States. Journal of Adolescent Health, 46(4), 399–401.
Else-Quest, N. M., Hyde, J. S., Goldsmith, H. H., & Van Hulle, C. A. (2006). Gender differences in temperament: A meta-analysis. Psychological Bulletin, 132, 33–72. doi:10.1037/0033-2909.132.1.33.
Fairfax County. (2009). The 2009 Fairfax County youth survey. Fairfax County, VA. http://www.fairfaxcounty.gov/youthsurvey.
Fairfax County, Virginia. (n.d.). http://en.wikipedia.org/wiki/Fairfax_County,_Virginia.
Fairfax County Public Schools. (2014). School profiles. http://commweb.fcps.edu/schoolprofile.
Fitzgerald, C. T., Messias, E., & Buysse, D. J. (2011). Teen sleep and suicidality: Results from the youth risk behavior surveys of 2007 and 2009. Journal of Clinical Sleep Medicine, 7(4), 351–356.
Fredriksen, K., Rhodes, J., Reddy, R., & Way, N. (2004). Sleepless in Chicago: Tracking the effects of adolescent sleep loss during the middle school years. Child Development, 75, 84–95.
Gangwisch, J. E., Babiss, L. A., Malaspina, D., Turner, J. B., Zammit, G. K., & Posner, K. (2010). Earlier parental set bedtimes as a protective factor against depression and suicidal ideation. Sleep, 33(1), 97–106.
Giannotti, F., Cortesi, F., Sebastiani, T., & Ottaviano, S. (2002). Circadian preference, sleep and daytime behaviour in adolescence. Journal of Sleep Research, 11, 191–199.
Gregory, A. M., Rijsdijk, F. V., Lau, J. Y. F., Dahl, R. E., & Eley, T. C. (2009). The direction of longitudinal associations between sleep problems and depression symptoms: A study of twins aged 8 and 10 years. Sleep, 32, 189–199.
Gregory, A. M., & Sadeh, A. (2012). Sleep, emotional and behavioral difficulties in children and adolescents. Sleep Medicine Reviews, 16, 129–136.
Johnson, E. O., & Breslau, N. (2001). Sleep problems and substance use in adolescence. Drug and Alcohol Dependence, 64(1), 1–7.
Judd, L. L., Akiskal, H. S., & Paulus, M. P. (1997). The role and clinical significance of subsyndromal depressive symptoms (SSD) in unipolar major depressive disorder. Journal of Affective Disorders, 45(1–2), 5–17.
Kelly, R. J., & El-Sheikh, M. (2014). Reciprocal relations between children’s sleep and their adjustment over time. Developmental Psychology, 50, 1137–1147.
Kenney, S. R., Lac, A., Labrie, J. W., Hummer, J. F., & Pham, A. (2013). Mental health, sleep quality, drinking motives, and alcohol-related consequences: A path-analytic model. Journal of Studies on Alcohol and Drugs, 74(6), 841–851.
Kirby, M., Maggi, S., & D’Angiulli, A. (2011). School start times and the sleep–wake cycle of adolescents: A review and critical evaluation of available evidence. Educational Researcher, 40(2), 56–61.
Knutson, K. L., & Lauderdale, D. S. (2009). Sociodemographic and behavioral predictors of bed time and wake time among US adolescents aged 15 to 17 years. Journal of Pediatrics, 154(3), 426–430. doi:10.1016/jpeds.2008.08.035.
Lee, Y. J., Cho, S. J., Cho, I. H., & Kim, S. J. (2012). Insufficient sleep and suicidality in adolescents. Sleep, 35(4), 455–460.
Lee, S., Juon, H.-S., Martinez, G., Hsu, C. E., Robinson, E. S., Bawa, J., et al. (2009). Model minority ar risk: Expressed needs of mental health by Asian American young adults. Journal of Community Health, 34, 144–152.
Lee, K. A., McEnany, G., & Weekes, D. (1999). Gender differences in sleep patterns for early adolescents. Journal of Adolescent Health, 24, 16–20.
Liu, X. (2004). Sleep and adolescent suicidal behavior. Sleep, 27(7), 1351–1358.
Lufi, D., Tzischinsky, O., & Hadar, S. (2011). Delaying school starting time by one hour: Some effects on attention levels in adolescents. Journal of Clinical Sleep Medicine, 7(2), 137–143.
Manber, R., Edinger, J. D., Gress, J. L., San Pedro-Salcedo, M. G., Kuo, T. F., & Kalista, T. (2008). Cognitive behavioral therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep, 31(4), 489–495.
Maslowsky, J., & Ozer, E. J. (2014). Developmental trends in sleep duration in adolescence and young adulthood: Evidence from a national United States sample. Journal of Adolescent Health, 54, 691–697.
McKnight-Eily, L. R., Eaton, D., Lowry, R., Croft, J., Presley-Cantrell, L., & Perry, G. (2011). Relationships between hours of sleep and health-risk behaviors in US adolescent students. Preventative Medicine, 53(4–5), 271–273.
Mednick, S. C., Christakis, N. A., & Fowler, J. H. (2010). The spread of sleep loss influences drug use in adolescent social networks. PLoS One, 5(3), e9775.
Meijer, A. M. (2008). Chronic sleep reduction, functioning at school and school achievement in preadolescents. Journal of Sleep Research, 17(4), 395–405. doi:10.1111/j.1365-2869.2008.00677.x.
Meijer, A. M., Reitz, E., Dekovic, M., Van den Wittenboer, G. L. H., & Stoel, R. D. (2010). Longitudinal relations between sleep quality, time in bed and adolescent problem behavior. Journal of Child Psychology and Psychiatry, 51, 1278–1286.
Ming, X., Koransky, R., Kang, V., Buchman, S., Sarris, C. E., & Wagner, G. C. (2011). Sleep insufficiency, sleep health problems and performance in high school students. Clinical Medicine Insights. Circulatory, Respiratory and Pulmonary Medicine, 5, 71–79.
Moseley, L., & Gradisar, M. (2009). Evaluation of a school-based intervention for adolescent sleep problems. Sleep, 32(3), 334–341.
National Center for Education Statistics. (n.d.). Schools and staffing survey. http://nces.ed.gov/surveys/sass/tables/sass1112_201381_s1n.asp.
National Sleep Foundation. (2006). Sleep in America poll. Washington, DC: National Sleep Foundation.
Nrugham, L., Larsson, B., & Sund, A. M. (2008). Specific depressive symptoms and disorders as associates and predictors of suicidal acts across adolescence. Journal of Affective Disorders, 111, 83–93.
Nunes, J., Giradin, J. L., Zizi, F., Casimir, G. J., von Gizycki, H., Brown, C. D., et al. (2008). Sleep duration among black and white Americans: Results of the National Health Interview Survey. Journal of the National Medical Association, 100(3), 317–322.
O’Brien, E. M., & Mindell, J. A. (2005). Sleep and risk-taking behavior in adolescents. Behavioral Sleep Medicine, 3(3), 113–133.
Owens, J. A., Belon, K., & Moss, P. (2010). Impact of delaying school start time on adolescent sleep, mood, and behavior. Archives of Pediatrics and Adolescent Medicine, 164(7), 608–614.
Pasch, K. E., Laska, M. N., Lytle, L. A., & Moe, S. G. (2010). Adolescent sleep, risk behaviors, and depressive symptoms: Are they linked? American Journal of Health Behavior, 34(2), 237–248.
Pena, J. B., Matthieu, M. M., Zayas, L. H., Masyn, K. E., & Caine, E. D. (2012). Co-occurring risk behaviors among White, Black, and Hispanic US high school adolescents with suicide attempts requiring medical attention 1999–2007: Implications for future prevention initiatives. Social Psychiatry and Psychiatric Epidemiology, 47, 29–42.
Perkinson-Gloor, N., Lemola, S., & Grob, A. (2013). Sleep duration, positive attitude toward life, and academic achievement: The role of daytime tiredness, behavioral persistence, and school start times. Journal of Adolescence, 36(2), 311–318.
Sarchiapone, M., Mandelli, L., Carli, V., Iosue, M., Wasserman, C., Hadlaczky, G., et al. (2014). Hours of sleep in adolescents and its association with anxiety, emotional concerns, and suicidal ideation. Sleep Medicine, 15, 248–254.
Short, M. A., Gradisar, M., Lack, L. C., & Wright, H. R. (2013). The impact of sleep on adolescent depressed mood, alertness, and academic performance. Journal of Adolescense, 36(6), 1025–1033.
Silva, G. E., Goodwin, J. L., Parthasarathy, S., Sherrill, D. L., Vana, K. D., Drescher, A. A., et al. (2011). Longitudinal association between short sleep, body weight, and emotional and learning problems in Hispanic and Caucasian children. Sleep, 34(9), 1197–1205.
Substance Abuse and Mental Health Services Administration. (2004). Communities that care survey. http://store.samhsa.gov/product/Communities-That-Care-Youth-Survey/CTC020.
Tonetti, L., Fabbri, M., & Natale, V. (2008). Sex difference in sleep-time preference and sleep need: A cross-sectional survey among Italian pre-adolescents, adolescents, and adults. Chronobiology International, 25, 745–759.
Tremaine, R. B., Dorrian, J., & Blunden, S. (2010). Subjective and objective sleep in children and adolescents: Measurement, age, and gender differences. Sleep and Biological Rhythms, 8, 22938.
Vedaa, Ø., Saxvig, I. W., Wilhelmsen-Langeland, A., Bjorvatn, B., & Pallesen, S. (2012). School start time, sleepiness and functioning in Norwegian adolescents. Scandinavian Journal of Educational Research, 56(1), 55–67.
Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32, 20–47.
Winters, K. C., Stinchfield, R. D., Henly, G. A., & Schwartz, R. H. (1990). Validity of adolescent self-report of alcohol and other drug involvement. International Journal of Addiction, 25, 1379–1395.
Wolfson, A. R., & Carskadon, M. A. (1998). Sleep schedules and daytime functioning in adolescents. Child Development, 69(4), 875–887.
Wong, M. W., & Brower, K. J. (2012). The prospective relationship between sleep problems and suicidal behavior in the National Longitudinal Study of Adoescent Health. Journal of Psychiatric Research, 46, 953–959.
Wong, M. M., Brower, K. J., Fitzgerald, H. E., & Zucker, R. A. (2004). Sleep problems in early childhood and early onset of alcohol and other drug use in adolescence. Alcoholism, Clinical and Experimental Research, 28, 578–587.
Wong, M. M., Brower, K. J., & Zucker, R. A. (2011). Sleep problems, suicidal ideation, and self-harm behaviors in adolescence. Journal of Psychiatric Research, 45(4), 505–511.
Fairfax County Public Schools. (n.d.). http://en.wikipedia.org/wiki/Fairfax_County_Public_Schools.
Yang, C. K., Kim, J. K., Patel, S. R., & Lee, J. H. (2005). Age-related changes in sleep/wake patterns among Korean teenagers. Pediatrics, 115, 250–256.
Author contributions
A.W. conceived of the study, coordinated the project, conducted the final data analyses, reviewed the literature, and drafted most of the manuscript and revisions. R.V. contributed to the conceptualization of the project and writing of the manuscript. P.P. helped conceive of the study and acquire the data, gathered collaborators, and provided input on the writing. A.D. conducted most of the original data analyses, prepared earlier conference presentation versions of the work, and provided input on the writing. M.S.C. contributed to the conceptualization of the project and interpretation of results, reviewed the literature, wrote the first partial draft of the manuscript, and contributed substantially to the writing of subsequent drafts. M.S.C. and R.V. provided critical revisions of the manuscript for important intellectual content. All authors read and approved the final manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Winsler, A., Deutsch, A., Vorona, R.D. et al. Sleepless in Fairfax: The Difference One More Hour of Sleep Can Make for Teen Hopelessness, Suicidal Ideation, and Substance Use. J Youth Adolescence 44, 362–378 (2015). https://doi.org/10.1007/s10964-014-0170-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10964-014-0170-3