Prospective associations between sleep problems and subtypes of anxiety symptoms among disaster-exposed adolescents

Sleep Med. 2018 Oct;50:7-13. doi: 10.1016/j.sleep.2018.05.017. Epub 2018 Jun 1.


Objective: This study aimed to investigate longitudinal relationships between sleep problems and subtypes of anxiety symptoms among adolescent earthquake survivors.

Methods: Participants were 1573 adolescents (male, 45.8%; mean age at baseline 15.01 years, standard deviation (SD) = 1.26) in the Wenchuan Earthquake Adolescent Health Cohort. The Pittsburgh Sleep Quality Index and the Screen for Child Anxiety Related Emotional Disorders were used to assess participants' sleep problems and anxiety symptoms four times during 2.5 years after the earthquake. Anxiety symptoms included subtypes of panic disorder (PD), generalized anxiety disorder (GAD), separation anxiety disorder (SeAD), social phobia (SP), school phobia (ScP). Longitudinal lagged generalized estimating equations (GEE) models were used to determine the prospective associations.

Results: Overall, there was a bidirectional relationship between sleep problems and anxiety symptoms. For the specific sleep problems and anxiety subtypes, short sleep duration predicted symptoms of PD, GAD, and ScP, and was predicted by GAD; difficulty falling asleep predicted GAD symptoms, whereas PD symptoms increased difficulty falling asleep; poor sleep quality predicted ScP symptoms and was predicted by symptoms of GAD and ScP; difficulty maintaining sleep was not associated with any subtype of anxiety symptoms in any direction; SeAD and SP were not associated with any specific sleep problems in any direction.

Conclusion: While sleep problems and anxiety symptoms are bidirectional, the associations vary by subtypes of sleep problems and anxiety symptoms. The potential biological mechanisms for the specific associations between dimensional sleep and anxiety symptoms and their clinical implications should be further investigated.

Keywords: Adolescence; Anxiety subtypes; Longitudinal studies; Natural disasters; Sleep problems.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anxiety / diagnosis
  • Anxiety / epidemiology*
  • Anxiety / psychology
  • China / epidemiology
  • Earthquakes*
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Panic Disorder / diagnosis
  • Panic Disorder / epidemiology
  • Panic Disorder / psychology
  • Prospective Studies
  • Sleep Wake Disorders / diagnosis
  • Sleep Wake Disorders / epidemiology*
  • Sleep Wake Disorders / psychology*
  • Surveys and Questionnaires
  • Survivors / psychology*