Higher Rates of Sleep Disturbance Among Offspring of Parents With Recurrent Depression Compared to Offspring of Nondepressed Parents

Jessica L. Hamilton, PHD; Cecile D. Ladouceur, PHD; Jennifer S. Silk, PHD; Peter L. Franzen, PHD; Lauren M. Bylsma, PHD

Disclosures

J Pediatr Psychol. 2020;45(1):1-11. 

In This Article

Abstract and Introduction

Abstract

Objective: Youth who have a parent with recurrent depression are at high risk for mental health problems. There is a need to identify transdiagnostic and clinically actionable mechanisms that explain higher rates of psychopathology among high-risk youth. The present study sought to examine whether offspring of depressed parents exhibit greater parent- and self-reported sleep disturbance, shorter sleep duration, and later sleep midpoint compared to youth without any parental psychopathology.

Method: Participants included 82 youth, including 41 youth (ages 9–13; mean age = 11.07 years; 46% female) deemed to be at high-risk based on having a parent with a recurrent depression history, and 41 (mean age = 11.16 years; 49% female) at low-risk based on having parents without any history of psychopathology. Youth and their parents completed measures of youth sleep disturbance, and youth completed measures of sleep duration and midpoint using a daily sleep diary for 9 days.

Results: Offspring of parents with depression exhibited more sleep disturbance (e.g., problematic nighttime behaviors and daytime sleepiness) than low-risk youth as reported by both parents and youth. For parent-reported sleep disturbance, there were also sex differences. High-risk girls had more sleep disturbance than high-risk boys or low-risk girls. There were no group differences for daily sleep duration and midpoint.

Conclusion: Sleep disturbance may be an important area for assessment among offspring of parents with depression. Our findings highlight one potential transdiagnostic risk factor that may emerge among high-risk youth, and sex-specific differences in sleep disturbance, which have implications for prevention and intervention.

Introduction

Adolescence is a developmental period of heightened risk for first onset of psychopathology, including depression and suicidal thoughts and behaviors (Hankin et al., 1998). Parental depression is one of the most robust risk factors for developing depression in childhood and adolescence (Weissman et al., 2016), with a three- to fourfold increased risk for depression and suicidality in offspring of depressed parents than youth without depressed parents (Kovacs & Lopez-Duran, 2010; Weissman et al., 2016). Parental depression not only confers risk for offspring in developing depression, but also increases the likelihood of youth experiencing other disorders, such as anxiety, behavioral problems, and substance use (Lieb, Isensee, Hofler, Pfister, & Wittchen, 2002). Although a range of factors have been identified as potential mechanisms linking parental depression to offspring psychopathology (Goodman & Gotlib, 1999), including genetic heritability, impaired emotion regulation (Silk, Shaw, Skuban, Oland, & Kovacs, 2006), and family functioning (Daches, Vine, Layendecker, George, & Kovacs, 2018), there remains a need to identify risk factors that are developmentally informed, transdiagnostic, and modifiable to aid in early prevention and intervention efforts among high-risk offspring.

Sleep disturbances have received increasing attention as a promising target of prevention and intervention for psychiatric disorders (Harvey, 2009; Harvey et al., 2016). This is particularly relevant during adolescence when sleep undergoes significant developmental changes (Carskadon, 2011). Biological shifts in sleep, including changes in the circadian system that delay onset of melatonin, and slower build-up of the homeostatic "sleep" drive, contribute to an increased biological preference toward eveningness among adolescents (Hagenauer, Perryman, Lee, & Carskadon, 2009). Increased psychosocial demands, such as academic pressure, extracurricular activities, and late-night socializing, all combine to push sleep toward both biological and behaviorally induced later bedtimes and sleep midpoints (Carskadon, 2011; Hagenauer et al., 2009; Wong, Hasler, Kamarck, Muldoon, & Manuck, 2015). School start times remain early and typically shift even earlier as youth transition to middle school and again to high school. This combination of biological and environmental factors results in the majority of youth receiving less than 8 hrs of sleep per night and falling short of the recommended 9–11 hrs for youth ages 10–13 and 8–10 hrs of sleep for youth ages 14–17 (Hirshkowitz et al., 2015). Insomnia and sleep disturbance also increase across adolescence, with girls more likely to develop insomnia (Johnson, Roth, Schultz, & Breslau, 2006). Given developmental changes related to sleep duration (e.g., total time asleep), sleep midpoint (i.e., middle clock time of the sleep cycle), and sleep disturbance (e.g., difficulty falling and staying asleep, problematic nighttime behaviors, and daytime sleepiness), targeting these aspects of poor sleep may be critical for mental health prevention. Indeed, studies indicate that poor sleep precedes and predicts the onset of psychopathology (Hertenstein et al., 2019; Zhang et al., 2017). In particular, short sleep duration, later sleep midpoint, and sleep disturbance predict depression (Clarke & Harvey, 2012; Roberts & Duong, 2014), anxiety (McMakin & Alfano, 2015), and suicidality (Liu et al., 2019).

Offspring of parents with depression have higher rates of psychiatric disorders. Poor sleep may be a candidate mechanism that explains the development of higher rates across psychiatric disorders among these vulnerable youth. Specifically, parents with depression may directly or indirectly contribute to poor sleep in their offspring through genetic risk, parenting practices (e.g., bedtime routine; modeling behavior), and/or associated environmental factors (e.g., stress, inadequate sleeping environment) that disrupt or impede healthy sleep (Goodman & Gotlib, 1999; Hall & Nethery, 2018). High-risk youth (i.e., offspring of depressed parents) may not only be more likely to develop sleep problems, but also more vulnerable to the cognitive and affective consequences of poor sleep (Palmer & Alfano, 2017). Indeed, several studies identify differences in sleep between offspring of parents with and without depression (Chen, Burley, & Gotlib, 2012) and risk for later disorder (Silk et al., 2007). Using actigraphy, questionnaires, and diary reports in 44 girls (10–16 years old) with and without maternal depression, high-risk girls reported poorer subjective sleep quality than low-risk girls, but there were no differences between actigraphy-derived or diary-reported sleep measures. This finding suggests that there only may be a subjective, but not objective, difference in sleep (Chen et al., 2012), reflecting a potential cognitive bias among high-risk offspring (Gobin, Banks, Fins, & Tartar, 2015). However, objective indices of sleep may differentiate risk for psychopathology over time among offspring of parents with mood disorders (Silk et al., 2007; Soehner et al., 2019). A longitudinal study of 14 high-risk girls found that those with longer sleep onset latency (derived from electroencephalography records) were more likely to have onset of major depression in young adulthood (Silk et al., 2007). A second longitudinal study of offspring of parents with bipolar disorders found that changes in sleep patterns (e.g., shorter sleep duration, later sleep timing, longer sleep latency, nighttime awakenings, and greater daytime sleepiness) also experienced increases in psychiatric symptoms over time (Soehner et al., 2019).

Together, these studies highlight the importance of examining sleep among offspring of parents with depression. Notably, however, research is needed to examine offspring prior to the onset of psychopathology to determine whether sleep problems are present prior to disorder rather than simply as a correlate. Given differences in development and psychiatric risk between adolescent girls and boys, with girls more at risk (Zahn-Waxler, Shirtcliff, & Marceau, 2008), it is also important to examine sex differences in sleep characteristics between high and low risk youth. Identifying potential sex differences between female and male high-risk youth may reveal unique or shared risk pathways and targets for prevention. Thus, the current study sought to test the hypothesis that high-risk youth (based on parents with recurrent depression) would exhibit impaired sleep patterns, including shorter duration, later midpoint, and more disturbance using questionnaires and sleep diaries, which may provide better estimates of sleep patterns than single items at one point in time. As an exploratory aim, we also explored potential sex differences in these processes. Building upon past research, the current study offers a unique contribution by examining both female and male offspring of parents with recurrent depression (including both biological mothers and fathers), younger offspring than prior studies, and assessment of multiple sleep characteristics by both sleep diary and parent- and youth-reported self-report measures.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....