New research provides evidence that sleep problems in early childhood are associated with psychosis and borderline personality disorder in adolescence. The findings, published in JAMA Psychiatry, indicate that different sleep problems are associated with different psychopathological symptoms.
“Until recently, sleep had not been considered an important factor in the development of mental health problems, but as an isolated factor. However, there is currently growing evidence suggesting the important role of sleep in the development of some specific mental disorders,” said lead researcher Isabel Morales-Muñoz, a postdoctoral research fellow at National Institute for Health and Welfare in Helsinki and the Institute for Mental Health at the University of Birmingham.
“Interestingly, there is recent evidence suggesting that sleep problems in childhood may even precede the development of mental disorders in adolescence, such as psychosis and borderline personality disorder (BPD). However, this scarce research has only focused in one specific aspect of sleep (nightmares), while the impact of other more common sleep problems in childhood, such as behavioral sleep problems (short sleep, sleep fragmentation or irregular sleep routines) on the development of these specific mental disorders had not been investigated.”
“Also, although there is some evidence about these potential associations between early sleep and psychosis and BPD in adolescence, it was still unknown whether similar associations appeared; furthermore, it was unclear which were the potential mechanisms underlying these associations,” Morales-Muñoz explained.
For their study, the researchers examined data from the Avon Longitudinal Study of Parents and Children birth cohort, a longitudinal study that recruited pregnant mothers of 13,488 babies when it was set up almost three decades ago. As part of the study, parents reported the sleep behavior of their children when the children were 6, 18 and 30 months old, and again at 3.5, 4.8 and 5.8 years old.
Morales-Muñoz and her colleagues were particularly interested in about 7,000 children with psychotic symptoms in early adolescence, and more than 6,000 children with BPD symptoms in early adolescence.
They found that children with frequent night awakenings at 18 months of age and irregular sleep routines at 6 and 30 months and 5.8 years of age were more likely to report psychotic experiences at 12 to 13 years of age. In addition, children who had less sleep during the night and went to bed later at the age of three-and-a-half years were more likely to report BPD symptoms in early adolescence.
The results show that healthy sleep and regular sleep routines are important during early stages of childhood and “that they have a specific impact in the development of specific mental health problems in later stages of life, such as adolescence. For instance, frequent night awakenings and irregular sleep routines are more relevant in psychosis; while the target in BPD should be sleep duration,” Morales-Muñoz told PsyPost.
“Also, depression at the age of 10 months plays a very important role, as it partially explains the associations between these specific sleep problems and psychotic symptoms, while it seems that there could be a direct association between sleep problems and BPD, as depression at 10 years did not mediate the associations between sleep and BPD symptoms.”
“These findings highlight the relevance of assessing and/or considering the important role of sleep problems already in early childhood as a potential risk factor for the development of prospective psychopathology in adolescence. Furthermore, different behavioral sleep problems should be addressed, depending on the psychopathology (i.e. frequent night awakenings and irregular sleep routines are more relevant in psychosis; while the target in BPD should be sleep duration),” Morales-Muñoz added.
“The results of this study could have important implications for helping practitioners identify children who might be at higher risk for psychotic experiences or BPD symptoms in adolescence, and potentially lead to the design of more effectively targeted sleep or psychological interventions to prevent the onset or attenuate these mental disorders.”
The researchers controlled for a number of factors, including but not limited to socioeconomic status, physical and sexual abuse, and emotional temperament. But like all research, the study includes some limitations.
“The sleep measures used here were parent-reported measures, and thus they were subjective measures. Therefore, future studies should include more objective sleep measures, such as actigraphy methods, to control for the potential bias of subjective reports. Further, there are other potential factors that might affect these results, such as parental mental health or other environmental and socio-economic factors. However, in this study we tried to address the most relevant confounding factors,” Morales-Muñoz explained.
“At this point, there are still at least two important questions that need to be addressed: 1) whether other potential relevant factors, in addition to depression at 10 years, might underlie the associations between behavioral sleep problems in childhood and psychotic and BPD symptoms in adolescence. Some of these potential factors could be cognitive factors, such as executive functioning; 2) whether sleep interventions would indeed prevent and/or ameliorate the development of future psychotic and/or BPD symptoms, which would provide evidence for the potential causal role of sleep.”