Sleep’s role in the development and resolution of adolescent depression

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Abstract

Two adolescent mental health fields — sleep and depression — have advanced largely in parallel until about four years ago. Although sleep problems have been thought to be a symptom of adolescent depression, emerging evidence suggests that sleep difficulties arise before depression does. In this Review, we describe how the combination of adolescent sleep biology and psychology uniquely predispose adolescents to develop depression. We describe multiple pathways and contributors, including a delayed circadian rhythm, restricted sleep duration and greater opportunity for repetitive negative thinking while waiting for sleep. We match each contributor with evidence-based sleep interventions, including bright light therapy, exogenous melatonin and cognitive-behaviour therapy techniques. Such treatments improve sleep and alleviate depression symptoms, highlighting the utility of sleep treatment for comorbid disorders experienced by adolescents.

Abstract

Sleep problems are both a symptom and precursor of adolescent depression. In this Review, Gradisar et al. describe how the combination of adolescent sleep biology and psychology predisposes adolescents to develop depression, and describe interventions that improve sleep and depression symptoms in this population.

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Insomnia is one of the most prevalent psychological disorders, causing sufferers severe distress as well as social, interpersonal, and occupational impairment. Drawing on well-validated cognitive models of the anxiety disorders as well as on theoretical and empirical work highlighting the contribution of cognitive processes to insomnia, this paper presents a new cognitive model of the maintenance of insomnia. It is suggested that individuals who suffer from insomnia tend to be overly worried about their sleep and about the daytime consequences of not getting enough sleep. This excessive negatively toned cognitive activity triggers both autonomic arousal and emotional distress. It is proposed that this anxious state triggers selective attention towards and monitoring of internal and external sleep-related threat cues. Together, the anxious state and the attentional processes triggered by it tricks the individual into overestimating the extent of the perceived deficit in sleep and daytime performance. It is suggested that the excessive negatively toned cognitive activity will be fuelled if a sleep-related threat is detected or a deficit perceived. Counterproductive safety behaviours (including thought control, imagery control, emotional inhibition, and difficulty problem solving) and erroneous beliefs about sleep and the benefits of worry are highlighted as exacerbating factors. The unfortunate consequence of this sequence of events is that the excessive and escalating anxiety may culminate in a real deficit in sleep and daytime functioning. The literature providing preliminary support for the model is reviewed and the clinical implications and limitations discussed.

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Author and article information

Contributors

Michael Gradisar:

ORCID: http://orcid.org/0000-0002-5146-2657

grad0011.mg@gmail.com

Journal

Journal ID (nlm-ta): Nat Rev Psychol

Journal ID (iso-abbrev): Nat Rev Psychol

Title: Nature Reviews Psychology

Publisher: Nature Publishing Group US (New York )

ISSN (Electronic): 2731-0574

Publication date (Electronic): 20 June 2022

Pages: 1-12

Affiliations

[1 ]WINK Sleep Pty Ltd, Adelaide, Australia

[2 ]Sleep Cycle AB, Gothenburg, Sweden

[3 ]GRID grid.1014.4, ISNI 0000 0004 0367 2697, School of Psychology, , Flinders University, ; Adelaide, Australia

[4 ]GRID grid.12136.37, ISNI 0000 0004 1937 0546, School of Psychological Sciences, , Tel Aviv University, ; Tel Aviv, Israel

[5 ]School of Psychology, University of East Sussex, Brighton, United Kingdom

[6 ]GRID grid.15895.30, ISNI 0000 0001 0738 8966, School of Law, Psychology and Social Work, , Örebro University, ; Örebro, Sweden

[7 ]GRID grid.1012.2, ISNI 0000 0004 1936 7910, School of Psychological Science, , University of Western Australia, ; Perth, Australia

Author information

Michael Gradisar http://orcid.org/0000-0002-5146-2657

Chelsea Reynolds http://orcid.org/0000-0002-5604-6388

Faith Orchard http://orcid.org/0000-0002-5324-5007

Serena Bauducco http://orcid.org/0000-0002-1485-8564

Kate Bartel http://orcid.org/0000-0002-3438-3105

Cele Richardson http://orcid.org/0000-0001-9425-2337

Article

Publisher ID: 74

DOI: 10.1038/s44159-022-00074-8

PMC ID: 9208261

PubMed ID: 35754789

SO-VID: 4cf4c80b-6908-4566-8b54-734ccf58a174

License:

This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

History

Date accepted : 23 May 2022

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