title: Hours of sleep in adolescents and its association with anxiety, emotional concerns, and suicidal ideation.
abstract: OBJECTIVE
  Anxiety and concerns in daily life may result in sleep problems and consistent evidence suggests that inadequate sleep has several negative consequences on cognitive performance, physical activity, and health. The aim of our study was to evaluate the association between mean hours of sleep per night, psychologic distress, and behavioral concerns.
  
  
  METHODS
  A cross-sectional analysis of the correlation between the number of hours of sleep per night and the Zung Self-rating Anxiety Scale (Z-SAS), the Paykel Suicidal Scale (PSS), and the Strengths and Difficulties Questionnaire (SDQ), was performed on 11,788 pupils (mean age±standard deviation [SD], 14.9±0.9; 55.8% girls) from 11 different European countries enrolled in the SEYLE (Saving and Empowering Young Lives in Europe) project.
  
  
  RESULTS
  The mean number of reported hours of sleep per night during school days was 7.7 (SD, ±1.3), with moderate differences across countries (r=0.06; P<.001). A reduced number of sleeping hours (less than the average) was more common in girls (β=0.10 controlling for age) and older pupils (β=0.10 controlling for sex). Reduced sleep was found to be associated with increased scores on SDQ subscales of emotional (β=-0.13) and peer-related problems (β=-0.06), conduct (β=-0.07), total SDQ score (β=-0.07), anxiety (Z-SAS scores, β=-10), and suicidal ideation (PSS, β=-0.16). In a multivariate model including all significant variables, older age, emotional and peer-related problems, and suicidal ideation were the variables most strongly associated with reduced sleep hours, though female gender, conduct problems measured by the SDQ, and anxiety only showed modest effects (β=0.03-0.04).
  
  
  CONCLUSIONS
  Our study supports evidence that reduced hours of sleep are associated with potentially severe mental health problems in adolescents. Because sleep problems are common among adolescents partly due to maturational processes and changes in sleep patterns, parents, other adults, and adolescents should pay more attention to their sleep patterns and implement interventions, if needed.
authors.affiliation: Department of Heath Sciences, University of Molise, Campobasso, Italy. Electronic address: marco.sarchiapone@me.com.
authors.forename: Marco
authors.initials: M
authors.lastname: Sarchiapone
authors.affiliation: Department of Heath Sciences, University of Molise, Campobasso, Italy; Department of Biomedical and Neuromotor Sciences, Psychiatric Section, University of Bologna, Italy; National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute (KI), Stockholm, Sweden.
authors.forename: Laura
authors.initials: L
authors.lastname: Mandelli
authors.affiliation: National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute (KI), Stockholm, Sweden; WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention, Stockholm, Sweden.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Carli
authors.affiliation: Department of Heath Sciences, University of Molise, Campobasso, Italy.
authors.forename: Miriam
authors.initials: M
authors.lastname: Iosue
authors.affiliation: Department of Heath Sciences, University of Molise, Campobasso, Italy; Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA.
authors.forename: Camilla
authors.initials: C
authors.lastname: Wasserman
authors.affiliation: National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute (KI), Stockholm, Sweden.
authors.forename: Gergö
authors.initials: G
authors.lastname: Hadlaczky
authors.affiliation: Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.
authors.forename: Christina W
authors.initials: CW
authors.lastname: Hoven
authors.affiliation: Feinberg Child Study Centre, Schneider Children's Medical Centre, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Alan
authors.initials: A
authors.lastname: Apter
authors.affiliation: Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary; Semmelweis University, School of Ph.D. Studies, Budapest, Hungary.
authors.forename: Judit
authors.initials: J
authors.lastname: Balazs
authors.affiliation: Department of Psychiatry, School of Medicine, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Oviedo, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Bobes
authors.affiliation: Section for Disorders of Personality Development, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
authors.forename: Romuald
authors.initials: R
authors.lastname: Brunner
authors.affiliation: National Suicide Research Foundation, Cork, Ireland.
authors.forename: Paul
authors.initials: P
authors.lastname: Corcoran
authors.affiliation: Clinical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
authors.forename: Doina
authors.initials: D
authors.lastname: Cosman
authors.affiliation: Research Division for Mental Health, University for Medical Information Technology (UMIT), Innsbruck, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Haring
authors.affiliation: Section for Disorders of Personality Development, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; Orygen Youth Health, Melbourne, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Kaess
authors.affiliation: National Suicide Research Foundation, Cork, Ireland.
authors.forename: Helen
authors.initials: H
authors.lastname: Keeley
authors.affiliation: Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary; Semmelweis University, School of Ph.D. Studies, Budapest, Hungary.
authors.forename: Agnes
authors.initials: A
authors.lastname: Keresztény
authors.affiliation: Department of Psychiatry, Centre Hospitalo-Universitaire CHU de NANCY, Université H. Poincaré, Nancy, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Kahn
authors.affiliation: Slovene Centre for Suicide Research, Andrej Marušič Institute, University of Primorska Muzejski trg 2, 6000 Koper, Slovenia.
authors.forename: Vita
authors.initials: V
authors.lastname: Postuvan
authors.affiliation: Slovene Centre for Suicide Research, Andrej Marušič Institute, University of Primorska Muzejski trg 2, 6000 Koper, Slovenia.
authors.forename: Urša
authors.initials: U
authors.lastname: Mars
authors.affiliation: Department of Psychiatry, School of Medicine, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Oviedo, Spain.
authors.forename: Pilar A
authors.initials: PA
authors.lastname: Saiz
authors.affiliation: Estonian-Swedish Mental Health & Suicidology Institute, Center for Behavioral and Health Sciences, Tallinn, Estonia; Tallinn University, Tallinn, Estonia.
authors.forename: Peter
authors.initials: P
authors.lastname: Varnik
authors.affiliation: Estonian-Swedish Mental Health & Suicidology Institute, Center for Behavioral and Health Sciences, Tallinn, Estonia; Tallinn University, Tallinn, Estonia.
authors.forename: Merike
authors.initials: M
authors.lastname: Sisask
authors.affiliation: National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institute (KI), Stockholm, Sweden; WHO Collaborating Centre for Research, Methods Development and Training in Suicide Prevention, Stockholm, Sweden.
authors.forename: Danuta
authors.initials: D
authors.lastname: Wasserman
mesh_terms: D000293:Adolescent; D000342:Affective Symptoms / Q000209:etiology; D001007:Anxiety / Q000209:etiology*; D003430:Cross-Sectional Studies; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D011581:Psychological Tests; D012890:Sleep; D012893:Sleep Wake Disorders / Q000150:complications*; D013315:Stress, Psychological / Q000209:etiology*; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Adolescents; Anxiety; Psychosocial difficulties; SEYLE study; Sleep; Suicidal ideation