Sleep CHAMPzzz: Sleep and Circadian Health in Adolescents - a Mental-health Participation Study (protocol)

Background Adolescence is characterised by changes in brain development, sleep and circadian biology. Sleep and circadian processes are important modulators of depression and anxiety, which can increase mental health difficulties, and often progress to chronic disorders in adulthood. This study aims to identify sleep and circadian-related mechanisms through which adolescents may either develop or demonstrate resilience to depression and anxiety. Methods SleepCHAMPzzz (Sleep and Circadian Health in Adolescents - a Mental-health Participation Study) is a longitudinal, multi-site study using complementary techniques to examine the pathway from sleep- and circadian-related changes to depression and anxiety during adolescence. To ensure the research findings are applicable across geographical, societal and cultural contexts, we will compare adolescent sleep and mental health trajectories in those living in lower, medium and higher income communities in the Global North (United Kingdom) and Global South (South Africa). We will work with lived-experience experts in the design, implementation, and dissemination phases to ensure relevant and context-sensitive research. Expected outcomes We hypothesise that circadian misalignment will drive poor sleep and night-time hyperarousal, which in turn will contribute to emotional dysregulation (characterised by over-active limbic circuits and under-active frontal circuits), a primary mechanism leading to depression and anxiety. Adolescents who experience less circadian misalignment and better sleep health will experience fewer symptoms or show recovery from symptoms of depression and anxiety. The strength and timing of specific biopsychosocial factors may moderate sleep/circadian and mental health associations. Conclusions By identifying how (mechanisms) and when (timing) sleep and mental health difficulties emerge, and what context-relevant factors influence the associations, data from this study may identify specific patterns of vulnerability. Such nuanced information can guide future interventions that both prevent and provide for early treatment of adolescent depression and anxiety, to reduce the future burden of care associated with chronic adult depression and anxiety.