Longitudinal Association Between Depressive Symptoms and Sleep Problems in Adolescents Following a Natural Disaster: Understanding the Role of Psychological Inflexibility.

Previous studies have investigated the temporal associations between depressive symptoms and sleep problems in traumatized adolescents. However, controversy remains regarding the directionality and underlying mechanisms of these associations, because within- and between-individual effects have not been differentiated. To examine this issue, the current study used the random-intercept cross lagged panel model (RI-CLPM) to assess the temporal associations between depressive symptoms, sleep problems and psychological inflexibility in adolescents following Typhoon Lekima. A sample of 1,341 adolescents completed self-report questionnaires at three time points (November 2019, November 2020, and November 2021). RI-CLPM analysis was used to examine the autoregressive and cross-lagged effects among variables. The results indicated stable and direct predictive within-individual effects from depressive symptoms to psychological inflexibility, and from psychological inflexibility to sleep problems, as well as potential mediation effects from depressive symptoms to sleep problems via psychological inflexibility. Meanwhile, between-individual effect analyses revealed positive relationships among depressive symptoms, sleep problems and psychological inflexibility. These findings indicate that higher levels of depressive symptoms predict subsequent worse sleep problems via possible moderation effects of psychological inflexibility, suggesting that prior intervention should focus more on alleviating symptoms of depressive symptoms and improving psychological flexibility after natural disasters.