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      Prevalence and correlates of sleep disturbance and depressive symptoms among Chinese adolescents: a cross-sectional survey study

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          Abstract

          Study objective

          To investigate the prevalence and the correlates of sleep disturbance and depressive symptoms among Chinese adolescents and to examine the association between the two problems.

          Design

          Cross-sectional survey.

          Participants

          A total of 3186 school students in grades 7–12 were sampled from the schools in Guangdong. A stratified-cluster random-sampling strategy was used to select the schools.

          Main outcome measures

          A self-administered questionnaire was used. The Pittsburgh Sleep Quality index (PSQI) was used to assess the occurrence of sleep disturbance, and the Center for Epidemiology Scale for Depression (CES-D) was used to identify whether individuals had depressive symptoms.

          Results

          The mean PSQI global score was 8.7 (±2.4) points, and 39.6% of the total sample had sleep disturbance. The mean CES-D score of students was 15.2 (±9.4) points, and 6.4% of the students had depressive symptoms. Additionally, girls and older adolescents were more likely to suffer from sleep disturbance, and the students who had depressive symptoms were 2.47 (95% CI 1.61 to 3.79) times more likely to suffer from sleep disturbance. Factors that were correlated with sleep disturbance and depressive symptoms were having a poor relationship with teachers, feeling lonely, suicide ideation and having run away from home.

          Conclusions

          Sleep disturbance was determined to be more prevalent among Chinese adolescents with depressive symptoms. Sleep disturbance and depressive symptoms were associated with each other, while school factors, family factors and psychosocial adjustment were comprehensively correlated with both.

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          Most cited references32

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          Sleep and emotions: bidirectional links and underlying mechanisms.

          A growing body of literature suggests that sleep and emotions are closely linked, and that the relationship between these two domains is complex and bidirectional. This review synthesizes some of the most current empirical findings with regard to the effects of sleep (with an emphasis on sleep deprivation) on subsequent emotional state, and the effects of emotions on subsequent sleep. Furthermore, we review a selection of possible mechanisms underlying some of these associations. Finally, suggestions are made for future research as part of the effort to develop a more comprehensive theory for this emerging field.
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            Use of a self-report symptom scale to detect depression in a community sample.

            The authors gave the CES-D, a self-report depression symptom scale, to 515 people drawn from a longitudinal community survey. The subjects were also interviewed using the Schedule for Affective Disorders and Schizophrenia (SADS). From the information collected on the SADS, the subjects were given diagnoses based on Research Diagnostic Criteria. The results indicate a modest relationship between self-reported symptoms of depression and the diagnosis of a major or minor depression. However, the groups defined as "cases" by such reports also include many people with other diagnoses or with no diagnoses at all. Thus, symptom scales are useful for the screening of depressed persons in research studies but are only rough indicators of clinical depression in the community.
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              Adolescent insomnia as a risk factor for early adult depression and substance abuse.

              To evaluate the association between adolescent insomnia and mental health during adolescence and young adulthood. Cross-sectional and prospective study. School and in home. Nationally based population sample of 4494 adolescents, 12 to 18 years old at baseline (mean = 15.83 years), with 3582 young adults, 18 to 25 years old (mean = 21.25 years) at 6- to 7-year follow-up. Self-report measures of mental health. Insomnia symptoms were reported by 9.4% of the adolescents. Cross-sectionally, adolescent insomnia symptoms were associated with use of alcohol, cannabis, and drugs other than cannabis; depression; suicide ideation; and suicide attempts (all P values < 0.01) after controlling for sex. Prospectively, insomnia symptoms during adolescence were a significant risk factor for depression diagnosis (odds ratio = 2.3) in young adulthood after controlling for sex and baseline depression. This study is the first to longitudinally evaluate insomnia symptoms during adolescence as a risk factor for mental health problems in young adulthood. The findings indicate that insomnia is a prevalent problem for adolescents and argue for future treatment-outcome studies to evaluate the efficacy and effectiveness of various insomnia interventions in this age group.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2014
                29 July 2014
                : 4
                : 7
                : e005517
                Affiliations
                [1 ]Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University , Guangzhou, People's Republic of China
                [2 ]Center for ADR monitoring of Guangdong , Guangzhou, People's Republic of China
                Author notes
                [Correspondence to ] Dr Ciyong Lu; luciyong@ 123456mail.sysu.edu.cn

                LG, JXD and YH contributed equally.

                Article
                bmjopen-2014-005517
                10.1136/bmjopen-2014-005517
                4120320
                25079937
                0b04b298-d8a4-4cbf-a5bb-1db78764d290
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 21 April 2014
                : 1 July 2014
                : 8 July 2014
                Categories
                Epidemiology
                Research
                1506
                1692
                1692
                1712
                1724

                Medicine
                epidemiology,mental health,paediatrics
                Medicine
                epidemiology, mental health, paediatrics

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