title: Sleep problems as a mediator of the association between parental education levels, perceived family economy and poor mental health in children.
abstract: OBJECTIVE
  The aim of this study was to investigate the association between familial socioeconomic status (SES) and children's sleep problems, and the role of sleep problems as a mediator between familial SES and childhood mental health problems.
  
  
  METHODS
  Participants were 5781 11-13 year old children from the Bergen Child Study. Data were collected on family economy, parental education, and children's difficulties initiating and/or maintaining sleep (DIMS), time in bed (TIB) and self-reported mental health problems using the Strengths and Difficulties Questionnaire (SDQ).
  
  
  RESULTS
  Sleep problems were significantly more common in children from lower SES families. Children from families with poor and average perceived family economy had significantly higher odds of reporting DIMS compared to children from families with very good economy (ORs=3.5 and 1.7, respectively). The odds were reduced by 12-36% adjusting for poor parental health and single parenting, but remained significant. Children from families with a poor economy had increased odds of a short TIB, both in the crude model (OR=1.9) and adjusted for parental characteristics (OR=2.2). Maternal education level was significantly associated with short TIB. Path analysis was conducted to investigate the potential mediating role of DIMS in the relationship between SES and mental health. The significant direct association between perceived family economy and SDQ total problems score was partially mediated by a significant indirect effect of sleep problems.
  
  
  CONCLUSIONS
  Sleep problems are common among children from families with a lower SES and may be a potential mechanism through which low SES is translated into mental health problems.
authors.affiliation: Centre for Child and Adolescent Mental Health and Welfare, West, Uni health, Uni research, Bergen, Norway. Tormod.Boe@uni.no
authors.forename: Tormod
authors.initials: T
authors.lastname: Bøe
authors.forename: Mari
authors.initials: M
authors.lastname: Hysing
authors.forename: Kjell Morten
authors.initials: KM
authors.lastname: Stormark
authors.forename: Astri J
authors.initials: AJ
authors.lastname: Lundervold
authors.forename: Børge
authors.initials: B
authors.lastname: Sivertsen
mesh_terms: D000293:Adolescent; D002648:Child; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000209:etiology; D010290:Parents / Q000193:education / Q000523:psychology; D012893:Sleep Wake Disorders / Q000453:epidemiology / Q000209:etiology*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires