Childhood adversity and insomnia in adolescence

Abstract

Objective: The study aims to evaluate the association between exposure to childhood adversity and insomnia, with an emphasis on the role of adversity type, timing, and accumulation (i.e., the number of specific types of adversities the child reported being exposed to).

Methods: Our analytic sample comprised 9582 adolescents from the National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a nationally representative population-based sample. We examined the association between 18 different types of retrospectively reported adversities (capturing interpersonal violence, accidents and injuries, social network or witnessing events, and other adverse events) and risk of self-reported past-year insomnia. We also examined whether the age at first exposure to adversity was associated with the risk of insomnia, and whether exposure to a greater number of different types of adversities (ie, accumulation) conferred an elevated risk of insomnia. In addition, we performed a sensitivity analysis excluding adolescents with a past-year diagnosis of major depression, dysthymia, post-traumatic stress disorder (PTSD), or generalized anxiety disorder.

Results: Almost one-third of adolescents reported insomnia, with a higher prevalence among girls and those from racial/ethnic minority groups. Adolescents exposed to at least one childhood adversity of any type (59.41%) were more likely than their nonexposed peers to experience insomnia (across adversities, prevalence ratios (PRs) ranged from 1.31 to 1.89). Risk of insomnia differed based on the age at first exposure to adversity as well as the type of adversity. Adolescents exposed to a greater number of different types of adversities had a higher risk of insomnia compared to those experiencing fewer adversities. These results were similar, by and large, to those obtained after excluding adolescents with at least one of the four past-year psychiatric disorders.

Conclusions: Exposure to adversity confers an elevated risk of insomnia. This association varied by type, timing, and accumulation of exposure and did not appear to be driven by psychiatric disorders. Given the well-documented physical and mental health consequences of insomnia, such findings further support the need for practitioners to screen children for exposure to childhood adversity and insomnia symptoms.

Keywords: Adolescence; Childhood adversity; Epidemiology; Insomnia; Sensitive periods.

Figure 1. Risk of insomnia by count of the number of exposures to childhood adversity

This figure presents the results of the generalized estimating equation (GEE) model examining the risk of insomnia based on the count of the number of total adversities experienced as well as count of each subtype, after adjusting for covariates. The reference group refers to adolescents who experienced zero adversities. A false discovery rate (FDR) correction was applied to adjust our alpha level for the multiple testing of 19 different exposures (including exposure to any adversity). Statistical significance after imposing the FDR correction is denoted with an asterisk. Specific p-values for these associations are denoted in Supplemental Table 6.