Sleep disturbance and daytime functional impairment among adolescent outpatients with depression and non-suicidal self-injury.

OBJECTIVES

Sleep disturbance is common in depressed adolescents and may be linked to impaired daytime functioning, particularly among those with non-suicidal self-injury (NSSI). We examined associations between sleep characteristics and moderate/severe daytime functional impairment in depressed adolescent outpatients with NSSI.

METHODS

In this cross-sectional study, depressed adolescent outpatients with NSSI completed self-report measures of sleep over the past month. Daytime functional impairment was assessed using item 8 of the sleep questionnaire. For group comparisons, impairment was dichotomized as no/mild versus moderate/severe. For multivariable analyses, impairment was modeled as an ordinal outcome (none/mild, moderate, severe) using ordinal logistic regression, adjusting for age, sex, sleep duration, and depressive (BDI) and anxiety (BAI) symptom severity.

RESULTS

Among participants with available impairment data (n = 99), 74.7% reported moderate/severe daytime impairment. The moderate/severe group reported shorter sleep duration and greater insomnia symptom burden than the no/mild impairment group. In multivariable analyses including both insomnia symptom burden and sleep duration, greater insomnia symptom burden was independently associated with higher odds of being in a more severe category of daytime functional impairment (OR = 1.83, 95% CI 1.42–2.36; p<.001), whereas sleep duration was not independently associated. Other sleep metrics were not independently associated after adjustment.

CONCLUSIONS

Daytime functional impairment is highly prevalent in this high-risk adolescent population. The findings suggest that the subjective burden of insomnia symptoms—rather than sleep quantity alone—may be more strongly associated with functional impairment, independent of depressive and anxiety symptom severity. Targeted screening and intervention for insomnia symptoms may be important for improving daytime functioning and quality of life in adolescents with depression and NSSI. CLINICAL TRIAL NUMBER: Not applicable.