Association Between Psychological Distress and Sleep Quality in Children and Adolescents: A Cross-Sectional Study in Zhejiang, China
Abstract
Background: Psychological distress has been increasingly recognized as an important determinant of sleep quality in children and adolescents. However, susceptible subgroups have not been clearly identified. This study aimed to examine the associations between psychological distress and sleep quality in children and adolescents. Methods: We conducted a cross-sectional study among 5771 school-aged children and adolescents (6–18 years) in Zhejiang Province. Psychological status was assessed using the Chinese version of the Depression Anxiety Stress Scale-21, and sleep quality was evaluated using the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). Thyroid-related biomarkers were measured via chemiluminescence immunoassay. Associations between psychological distress and sleep quality were analyzed using generalized linear models. In addition, stratified analyses were performed to identify potentially susceptible subgroups by age, sex, and BMI-for-age z score. Results: Each one-point increase in depression, anxiety, and stress scores was associated with an increase in PSQI scores of 0.18 (95% CI: 0.16, 0.19), 0.20 (95% CI: 0.18, 0.21), and 0.20 (95% CI: 0.19, 0.22), respectively. Subgroup analyses showed that the associations were more pronounced among older children (age > 12 years) and pediatric females. Exploratory mediation analyses suggested a possible but very limited indirect role of T3 in the associations of depression, anxiety, and stress with sleep quality,…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause.
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