Associations Between Patterns of Sleep Disturbances and Mental Health Among Child Welfare-Involved Adolescents

Background/Objectives: Sleep is an important biobehavioral process that supports child and adolescent health and development. However, many prior studies examining sleep and mental health have relied on total sleep scores, which may mask the heterogeneity of sleep disturbances. Youth exposed to childhood adversity are at increased risk for sleep disturbances and poor mental health, and thus it is important to examine the links between sleep and mental health within adversity-exposed samples, such as those involved with the child welfare system. Methods: This study used latent class analysis to identify underlying patterns of sleep disturbances and examine differences in mental health symptoms (assessed at baseline and at an 18-month follow-up) across the identified subgroups in a sample of child welfare-involved adolescents (N = 1041, Mage = 13.63 years, SD = 1.86). Our sample was derived from the second cohort of the National Survey on Child and Adolescent Well-Being (NSCAW) study. Results: We identified three subgroups of sleep disturbances: no sleep disturbances (38%), sleeping more than peers and overtired (16%), and trouble maintaining sleep (47%). We found significant mean differences in mental health symptoms across subgroups. Across internalizing, externalizing, and post-traumatic stress disorder (PTSD) symptoms at baseline and at an 18-month follow-up, those in the no sleep disturbances subgroup had overall lower levels of symptoms compared to those in the trouble maintaining sleep subgroup, which had higher levels of symptoms. Compared to those in the sleeping more than peers and overtired subgroup, the trouble maintaining sleep subgroup had higher levels of PTSD symptoms at baseline, and higher levels of externalizing and PTSD symptoms at the follow-up. Those in the sleeping more than peers and overtired subgroup had significantly higher levels of internalizing, externalizing, and PTSD symptoms at baseline compared to the no sleep disturbances subgroup, but there were no significant differences at the 18-month follow-up. Conclusions: The current study highlights the importance of considering the heterogeneity of sleep disturbances to identify child welfare-involved youth who may be more at risk for sleep disturbances and poor mental health and to inform more targeted sleep interventions for this population.