title: Youth internalizing symptoms, sleep-related problems, and disordered eating attitudes and behaviors: A moderated mediation analysis.
abstract: OBJECTIVE
  Internalizing symptoms increase the risk for disordered eating; however, the mechanism through which this relationship occurs remains unclear. Sleep-related problems may be a potential link as they are associated with both emotional functioning and disordered eating. The present study aims to evaluate the mediating roles of two sleep-related problems (sleep disturbance and daytime sleepiness) in the relationship between youth internalizing symptoms and disordered eating, and to explore if age moderates these relations.
  
  
  METHODS
  Participants were 225 youth (8-17years) attending a primary care appointment. Youth and legal guardians completed questionnaires about youth disordered eating attitudes and behaviors, internalizing symptoms, sleep disturbance, and daytime sleepiness. Mediation and moderated mediation analyses were utilized.
  
  
  RESULTS
  The mediation model revealed both youth sleep disturbance and daytime sleepiness independently mediated the association between internalizing symptoms and disordered eating attitudes and behaviors, and explained 18% of the variance in disordered eating. The moderated mediation model including youth age accounted for 21% of the variance in disordered eating; youth age significantly interacted with sleep disturbance, but not with daytime sleepiness, to predict disordered eating. Sleep disturbance only mediated the relationship between internalizing symptoms and disordered eating in youth 12years old and younger, while daytime sleepiness was a significant mediator regardless of age.
  
  
  CONCLUSIONS
  As sleep-related problems are frequently improved with the adoption of health behaviors conducive to good sleep, these results may suggest a relatively modifiable and cost-effective target to reduce youth risk for disordered eating.
authors.affiliation: Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL 32610, USA. Electronic address: mchardon@phhp.ufl.edu.
authors.forename: Marie L
authors.initials: ML
authors.lastname: Chardon
authors.affiliation: Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL 32610, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Janicke
authors.affiliation: Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, FL 32610, USA.
authors.forename: Julia K
authors.initials: JK
authors.lastname: Carmody
authors.affiliation: Department of Pediatrics, University of Florida College of Medicine, P.O. Box 100296, Gainesville, FL 32610, USA.
authors.forename: Marilyn C
authors.initials: MC
authors.lastname: Dumont-Driscoll
mesh_terms: D000293:Adolescent; D001290:Attitude; D002648:Child; D004644:Emotions; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008960:Models, Psychological; D017008:Negotiating / Q000379:methods / Q000523:psychology*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D011795:Surveys and Questionnaires
keywords: Daytime sleepiness; Disordered eating; Internalizing; Sleep disturbance