Does disturbed sleeping precede symptoms of anxiety or depression in toddlers? The generation R study.
OBJECTIVE
To examine whether sleep problems in infancy and early toddlerhood precede symptoms of anxiety or depression at 3 years.


METHODS
Data on specific sleep problems at 2 months and 24 months were available for 4,782 children participating in a population-based cohort in The Netherlands. The Child Behavior Checklist for toddlers containing the Anxious/Depressed syndrome scale was assessed at 36 months. We adjusted the logistic regression analyses for several confounding factors; the analyses with sleep problems at 24 months were additionally adjusted for preexisting anxiety or depressive symptoms (at 18 months).


RESULTS
Dyssomnia and parental presence during sleep onset at 2 months and 24 months were associated with anxiety or depressive symptoms at 3 years (e.g., parental presence: odds ratio(2 months), 1.22; 95% confidence interval, 1.04-1.44; odds ratio(24 months), 1.58; 95% confidence interval, 1.30-1.92). Parasomnia, short sleep duration, and absence of set bedtime at 24 months, but not at 2 months, also preceded anxiety or depressive symptoms. These significant associations were not due to children's anxiety or depressive symptoms at 18 months. Rhythmicity and co-sleeping were not associated with later anxiety or depressive symptoms. Additional analyses provided little evidence for a bidirectional association with anxiety or depressive symptoms preceding later sleep problems.


CONCLUSIONS
Our findings highlight the importance of sleep problems early in life, because different sleep problems are associated with the frequency of anxiety or depressive symptoms. Therefore, healthcare practitioners must be particularly attentive to these problems in young children. Future research should address possible mechanisms underlying the association between disturbed sleeping and anxiety or depressive symptoms.
Erasmus Medical Center-University Medical Center Rotterdam, Department of Child and Adolescent Psychiatry, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.
Pauline W
PW
Jansen
Nathalie S
NS
Saridjan
Albert
A
Hofman
Vincent W V
VW
Jaddoe
Frank C
FC
Verhulst
Henning
H
Tiemeier
D000328:Adult; D000367:Age Factors; D001007:Anxiety / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D001008:Anxiety Disorders / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D057189:Checklist / Q000706:statistics & numerical data; D002675:Child, Preschool; D015897:Comorbidity; D003863:Depression / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D003866:Depressive Disorder / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D016487:Parenting / Q000523:psychology; D010290:Parents / Q000523:psychology; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*