Reciprocal relations between sleep and internalizing and externalizing problems: A cohort study of Chinese adolescents

Sleep problems and mental health problems are of great concern after the disasters. Although some studies have established that sleep problems and internalizing and externalizing problems are associated in children and adolescents who have not experienced trauma, the directionality of this association and whether sleep problems are differentially associated with different types of internalizing and externalizing problems after disasters are largely unknow. Data came from a cohort study of Chinese adolescents after earthquake. A total of 1275 adolescents (Mage = 15.96, SD = 1.30; 56.2% female) were surveyed at 18 months (T18m) and 30 months (T30m) post-earthquake. Self-administered structured questionnaires were used to assess sleep problems, and internalizing and externalizing problems. Cross-lagged models were used to investigate reciprocal relations between two variables over time after adjusting for some confounders. Significant bidirectional associations were detected between sleep problems and emotional symptoms (sleep to emotion: β = 0.15; emotion to sleep: β = 0.17), peer problems (sleep to peer: β = 0.07; peer to sleep: β = 0.06), and ADHD symptoms (sleep to ADHD: β = 0.14; ADHD to sleep: β = 0.13). Although sleep was a significant driver of later conduct problems (β = 0.14), the reverse association was not significant. Given that sleep problems may precipitate internalizing and externalizing problems in disaster-exposed adolescents, early intervention programs aimed at improving sleep quality may be helpful in promoting and preventing mental health after disasters.