title: Trends in self-reported sleep problems, tiredness and related school performance among Finnish adolescents from 1984 to 2011.
abstract: The aim of this study was to investigate long-term trends in insomnia symptoms, tiredness and school performance among Finnish adolescents. A time-series from 1984 to 2011 was analysed from two large-scale survey studies, the Finnish School Health Promotion Study and the Health Behavior in School-Aged Children study. A total of 1,136,583 adolescents aged 11-18 years answered a standardized questionnaire assessing frequency of insomnia symptoms, tiredness and school performance. A clear approximately twofold increasing trend in insomnia symptoms and tiredness was found from the mid-1990s to the end of the 2000s. The increase was evident in all participating age groups and in both genders. After 2008, the increase seems to have stopped. Insomnia symptoms and tiredness were associated with lower school performance and they were more prevalent among girls (11.9 and 18.4%) compared to boys (6.9 and 9.0%, respectively). Unexpectedly, we also observed an increasingly widening gap in school performance between normally vigilant and chronically tired pupils. The underlying causes of these phenomena are unknown, but may concern changes in the broader society. The observed recent increasing trend in adolescents' sleep problems is worrisome: poor sleep quality has also been suggested to associate with clinical or subclinical mood or anxiety disorders and behavioural problems and predispose to sleep and psychiatric disorders later in life. Our results justify further studies and call for serious attention to be paid to adolescent's sleep in the Finnish educational system and society at large.
authors.affiliation: National Institute for Health and Welfare, Turku, Finland.
authors.forename: Erkki
authors.initials: E
authors.lastname: Kronholm
authors.forename: Riikka
authors.initials: R
authors.lastname: Puusniekka
authors.forename: Jukka
authors.initials: J
authors.lastname: Jokela
authors.forename: Jari
authors.initials: J
authors.lastname: Villberg
authors.forename: Anna Sofia
authors.initials: AS
authors.lastname: Urrila
authors.forename: Tiina
authors.initials: T
authors.lastname: Paunio
authors.forename: Raili
authors.initials: R
authors.lastname: Välimaa
authors.forename: Jorma
authors.initials: J
authors.lastname: Tynjälä
mesh_terms: D000293:Adolescent; D000339:Affect; D001008:Anxiety Disorders / Q000150:complications; D004521:Educational Measurement / Q000706:statistics & numerical data*; D005221:Fatigue / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007858:Learning; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology; D015995:Prevalence; D012574:Schools; D057566:Self Report; D012890:Sleep / Q000502:physiology; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014851:Wakefulness / Q000502:physiology
keywords: adolescent; school performance; secular trends; sleep; tiredness