Disrupted sleep has small effect on youth depressive symptoms

Sleep disruption had a small but statistically significant impact on depressive symptoms among children and youths, according to results of a systematic review and meta-analysis published in JAMA Network Open.

“Whether treating sleep disturbances reduces depression in children and youths is still debated,” Cecilia Marino, MD, PhD, of the department of psychiatry at the University of Toronto in Canada, and colleagues wrote. “A recent meta-analysis reported a pooled effect size in the small range based on [four randomized clinical trials] of youths with subthreshold mental health problems. Similar RCTs of children and in clinical populations are lacking, to our knowledge.”

In the current study, Marino and colleagues aimed to assess the link between depression and disturbed sleep among children and adolescents. They searched six databases and included prospective cohort studies published between 1980 and August 2019 that reported estimates, adjusted for baseline depression, of the link between disturbed sleep and depression among participants aged 5 to 24 years from community and clinical-based samples with any comorbid diagnosis. Sleep disturbances or insomnia comprised disturbed sleep, which was the main measure. Age, sex and sociodemographic variables served as covariates. The researchers included 22 studies, with 28,895 patients, in the overall study, and 16 studies, with 27,073 patients, in the meta-analysis.

Results showed a pooled beta coefficient of 0.11 (95% CI, 0.06-0.15) for the association between disturbed sleep and depression. Those with disturbed sleep vs. those without had a pooled OR of depression of 1.5 (95% CI, 1.13-2). Pooled estimates did not appear to differ across any covariate, according to meta-regression and sensitivity analyses. The researchers reported substantial publication bias.

“Although the pooled effect sizes are small, the high prevalence of children and youths with disturbed sleep implies the existence of a large cohort of vulnerable individuals who could develop depression,” Marino and colleagues wrote. “Disturbed sleep could be one of the many risk factors to address in depression prevention programs. Randomized clinical trials targeting disturbed sleep as early as childhood are needed to inform the planning and evaluation of depression prevention programs. These findings must be considered in the context of the limitations and the overall very low quality of evidence of the included studies.”