The Longitudinal Effects of Maltreatment on Sleep and Mental Health Symptoms

Background and Purpose: A history of childhood maltreatment has been linked to sleep problems, depressive symptoms, and posttraumatic stress disorder (PTSD) symptoms. Additionally, sleep problems are correlated with depressive symptoms and PTSD. Sleep problems are also associated with the neighborhood environment. However, no studies have examined the pathways from maltreatment to sleep problems and mental health symptoms across adolescence, comparing maltreated youth to comparison youth living in the same neighborhoods. Data from an ongoing longitudinal study were used to examine the reciprocal relationships between sleep and mental health symptoms over time, and how these variables are affected by experiences of child-welfare documented maltreatment. We hypothesized that childhood maltreatment would predict sleep disturbances and that mental health symptoms would mediate this relationship.

Methods: The design and sample for this study was from assessments at Time 3 (average age 14 years; N= 191 maltreated and N= 128 comparison) and at Time 4 (average age 18 years; N= 222 maltreated; N= 128 comparison).  Seventy-seven percent of the participants were Black or Latino. Participants completed a modified Pittsburg Sleep Inventory questionnaire, which included items regarding sleep disturbances and sleep duration, Children’s Depression Inventory, and the Youth Symptom Survey Checklist (PTSD). Items regarding sleep were excluded when calculating the depression and PTSD sum scores. Path models were tested using Mplus with the MLR estimator. Four separate models tested cross-lagged effects between sleep and mental health symptoms and included main effects of maltreatment on all four variables. The first model included sleep disturbances and depressive symptoms at T3 and T4, the second included sleep disturbances and PTSD symptoms, the third included sleep duration and depressive symptoms, and the fourth sleep duration and PTSD.  Age at Time 1 and sex were included as covariates.

Results: Model 1 showed reciprocal effects between sleep disturbances and depressive symptoms. Depressive symptoms at T3 predicted sleep disturbances at T4 (β=.25, p<.01). In addition, sleep disturbances at T3 predicted depressive symptoms at T4 (β=.11, p<.05). However, there was no main effect or indirect effect of maltreatment on either depressive symptoms or sleep disturbances. For model 2 (PTSD), there were also reciprocal effects between sleep and PTSD, T3 sleep disturbances predicted T4 PTSD (β=.13, p<.01) and T3 PTSD predicted T4 sleep disturbances (β=.17, p<.05).  Again in Model 2, there were no main or indirect effects of maltreatment on either PTSD or sleep disturbances. There were no significant findings for models 3 and 4 with sleep duration.

Conclusions: Child-welfare documented maltreatment had no direct or indirect effect on sleep disturbances. Thus, it could be that neighborhood environment may have mitigated some of the effect of maltreatment on the relationship of mental health symptoms to sleep problems. All youth were exposed to a high stress, low-income, dense urban environment. The reciprocal relationships between sleep disturbances and mental health symptoms longitudinally illustrate the need to identify and treat both psychological and physical sleep symptoms to improve outcomes for youth living in neighborhoods similar to the youth in this study.