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Daily Associations Between Sleep and Affect in Youth at Risk for Psychopathology: The Moderating Role of Externalizing Symptoms

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Abstract

Problems with sleep, emotion regulation, and externalizing psychopathology are interrelated, but little is known about their day-to-day associations in youth. We examined self-reported daily sleep quality as a bidirectional predictor of next-day positive and negative affect (PA/NA), with externalizing symptoms as a moderator. Data were drawn from an ecological momentary assessment (EMA) study involving 82 youths (ages 9–13; 50% female; 44% White, 37% Black/African American) at high (n = 41) or low (n = 41) familial risk for psychopathology. Parents rated youths’ externalizing symptoms at baseline. Youths then completed a 9-day EMA protocol, reporting sleep quality 1x/day and affect 4-8x/day. Daily means, peaks, and variability in PA and NA were computed. Multilevel models examined bidirectional associations between sleep and affect (between- and within-person), testing externalizing symptoms as a moderator and controlling for age and sex. In models of sleep predicting affect: Within-person, poorer-than-usual sleep quality predicted greater variability and higher peaks in next-day NA, but only for youth with higher levels of externalizing symptoms. Between-person, poor sleep quality and higher levels of externalizing symptoms predicted lower mean and peak PA. In models of affect predicting sleep: Within-person, lower-than-usual mean PA predicted poorer subsequent sleep quality, but only for youth with higher levels of externalizing symptoms. Between-person, youths with higher mean and peak PA had better sleep quality. These findings suggest that affective functioning is bidirectionally linked to daily self-reported sleep quality among high- and low-risk youth. Specific disturbances in daily sleep-affect cycles may be distinctly associated with externalizing psychopathology.

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Notes

  1. The centering and coding of other variables in our models is as follows: SNAP externalizing symptoms were left such that 0 = no symptoms and higher scores reflecting higher externalizing symptoms. Age was centered such that 0 = 9 years, the youngest age in the sample. Sex is coded as 0 = male, 1 = female.

  2. SNAP Externalizing Symptom scores had a possible range from 0 to 78, with our sample’s M and SD both falling at 13 (rounded), making this a useful increment for probing different symptom levels from “none” to “high.” For reference, participants with any “elevated” ADHD or ODD scales (based on Swanson et al.’s, 2001 cutoffs) showed a total Externalizing Symptoms Score of M = 31.75 (SD = 15.43), as compared to those with all their SNAP scale scores below the cutoffs (M = 5.99, SD = 15.43).

  3. Time-varying variables (sleep quality and PA/NA variables) were grand- and person-mean-centered such that a value of 0 represents a “usual” day for the average participant in our sample. Relative to that mean/usual value, interactions were probed at within-person high and low values. Specifically, time-varying sleep-quality was probed at 0 ± 17, representing days on which each person’s sleep quality was better or worse than their usual by about 1 within-person SD. Similarly, person-mean PA variables were probed at 0 ± 11, representing days on which each person’s mean PA levels were higher or lower than their usual by about 1 within-person SD. These values for within-person SDs (17, 11) represent the mean of the within-person SDs, averaged across all participants.

  4. Specifically, when adding risk group as a covariate, the significance status (i.e., p < 0.05 vs. p ≥ 0.05) of the 84 fixed effects reported in Tables 2–4 and Tables S1–S3 remained the same. Risk emerged only as a significant covariate in two base models, predicting next-day PA mean (B = -7.837, SE = 3.825, p = 0.044) and the model predicting next-day PA peak (B = -8.528, SE = 3.610, p = 0.021); however, it was not associated with dependent variables in any of the Step 2 models (all risk coefficient ps > 0.152), suggesting that any effect of risk was overshadowed by externalizing symptoms. See also Table 1 for a breakdown of primary study variables by risk group: few group differences emerged, with risk being correlated as expected with externalizing symptoms (r = 0.37, p = 0.001), and with both variables being modestly associated with PA means and peaks (rs = -0.22 to -0.26, ps = 0.021 to 0.047).

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Acknowledgements

The authors thank the youth and parents who participated in this research. We are also grateful to all the research assistants who contributed to portions of this work, including Amanda Adams and Lorraine Scott for their assistance with study data collection, and Hilary Skov for helping prepare the data for the present analysis. Portions of these results were presented at the 2023 Meeting of the Anxiety and Depression Association of America (ADAA).

Funding

This study was funded by K01MH104325, awarded to LMB. Participant recruitment was also supported by a NIH grant to the University of Pittsburgh Clinical and Translational Science Institute (UL1TR001857). LMB was also supported by L30MH101750 during study data collection. SCE received support from L30MH120708 during the preparation of this manuscript. JLH received support from K01MH121584 and L30MH117642.

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Author notes

  1. Spencer C. Evans and Jessica L. Hamilton contributed equally to this work.

Authors and Affiliations

  1. Department of Psychology, University of Miami, Coral Gables, FL, USA

    Spencer C. Evans & Ashley R. Karlovich

  2. Department of Psychology, Rutgers University, Piscataway, NJ, USA

    Jessica L. Hamilton & Simone Imani Boyd

  3. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA

    Cecile D. Ladouceur & Lauren M. Bylsma

  4. Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA

    Cecile D. Ladouceur, Jennifer S. Silk & Lauren M. Bylsma

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  1. Spencer C. Evans
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Correspondence to Lauren M. Bylsma.

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Research Involving Human Participants and/or Animals

The study was approved by the appropriate institutional and/or national research ethics committee and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This study was approved by the institutional review board at the University of Pittsburgh.

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Informed consent was obtained from the legal guardians of all minors who participated in the study, and youth assent was obtained from all participating minors.

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Spencer C. Evans and Jessica L. Hamilton contributed equally in this work.

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Evans, S.C., Hamilton, J.L., Boyd, S.I. et al. Daily Associations Between Sleep and Affect in Youth at Risk for Psychopathology: The Moderating Role of Externalizing Symptoms. Res Child Adolesc Psychopathol 52, 35–50 (2024). https://doi.org/10.1007/s10802-023-01087-4

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