The wake-up call we keep ‘snoozing’: the role of sleep and circadian factors in adolescent anxiety

Abstract

Adolescent mental health is a rising concern, with anxiety presenting as the most prevalent need. As onset during adolescence can present long-term challenges, early identification and intervention is key. Concurrently, sleep problems alongside biological changes in sleep, such as a shift towards ‘eveningness’ (i.e., becoming more of a ‘night owl’) is prevalent. This shift creates tensions with societal demands like early school start times, leading to weekday sleep deprivation and compensatory weekend lie-ins – a pattern known as ‘social jetlag’.
Given the bidirectional relationship between sleep and anxiety, this thesis explores their association in greater depth. A systematic literature review and meta-analysis explores the magnitude of the relationship between social jetlag and anxiety in adolescence. A multi-level random-effect meta-analysis found a small, positive, significant association, suggesting that adolescents experiencing greater social jetlag are likely to report higher anxiety.
An empirical study explores the extent to which sleep and circadian factors influence anxiety and emotional processing – an underlying mechanism of anxiety. Participants aged 16-18 completed an online survey consisting of self-report measures of sleep (quality, latency, duration, efficiency, disturbance, daytime dysfunction, circadian regularity, sleep continuity, chronotype, sleep inertia, insomnia) and mental health (generalised anxiety, state anxiety, depression, quality of life), alongside two emotional processing tasks (emotional classification task, emotional flanker task). Correlational analyses showed that insomnia, daytime dysfunction, sleep quality, sleep disturbance, sleep latency, circadian regularity, sleep continuity, and sleep inertia significantly correlated with anxiety. Hierarchical regressions identified sleep disturbance, sleep inertia, and insomnia as significant contributors of anxiety. Whilst sleep/circadian factors did not explain additional variance in anxiety beyond depression, many mediated the relationship between depression and anxiety. In the tasks, sleep/circadian factors influenced sensitivity to fear and correct-response reaction times to happy and sad emotional expressions. Circadian regularity arose as the most consistently associated variable across mental health and task outcomes, highlighting its importance in promoting adolescent wellbeing.

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Identifiers

ORCID for Hannah Louise Ravenhall: orcid.org/0009-0009-6111-0071

ORCID for Matthew Garner: orcid.org/0000-0001-9481-2226

ORCID for Sarah Chellappa: orcid.org/0000-0002-6190-464X

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