Trauma, Sleep, and Mental Health Problems in Low-Income Young Adults

Background: Insufficient sleep has been linked to greater risk for substance use, mental health problems, and even suicidality in youth transitioning to adulthood. Young adults from low-income backgrounds are more likely to experience traumatic events and other stressors that can have a deleterious effect on both their sleep and mental health. Seventy-five percent of those who develop mental health disorders do so in late adolescence or young adulthood, and nearly 20% of all 18 to 25-year olds reported depression or anxiety in the previous year.

While trauma is known to have a negative impact on sleep, the complex dynamic between sleep, trauma, and mental health is not clearly understood. Much of the research has focused on populations that experienced extreme violence such as terrorist attacks, military service, or natural disasters. The current study explores the mediating role of sleep in the relationship between trauma exposure and both depression and anxiety in a community sample of low-income youth. This study used actigraphy to capture sleep data instead of relying on self-report, as the literature shows that young adults with trauma histories may be unable to accurately recall sleep patterns.

Methods: Data were collected from a sample of 18 to 24-year olds (N=143) recruited from an agency that provides workforce development services to emerging adults at-risk for economic and social hardships. Study eligibility required participants to have a regular place to sleep and no diagnoses of sleep or psychotic disorders. They completed surveys on their life histories, trauma exposure, anxiety, depression, and substance use. Participants wore FitBit sleep monitors for four consecutive nights (Thursday-Sunday) to capture both weekday and weekend sleep patterns, and data on total sleep time were collected.

Descriptive statistics were used to provide information about the sample, and structural equation modeling (SEM) was used to explore the relationship between trauma, sleep problems, and depression and anxiety.

Results: The young adults in the sample had an average income of $175 per week. More than 70% of the sample reported trauma exposure, including child maltreatment, sexual assault, and life-threatening car crashes. Roughly 42% of young adults reported moderate to severe depression symptoms and 48% reported moderate to severe anxiety symptoms. FitBit data showed that the young adults sleep an average of 5.6 hours per night, significantly less than recommended by experts. SEM results showed direct relationships between trauma and both depression and anxiety. Mediation analyses showed that the relationship between both trauma and depression (Δb=.27, z=5.17, p<.001) and trauma and anxiety (Δb=.37, z=8.46, p<.001.) were partially mediated by fewer sleep hours.

Implications: Results indicate that sleep difficulties in low-income young adults may be a consequence of trauma, and in turn, may contribute to depression and anxiety. Addressing sleep problems can greatly and efficiently improve those mental health outcomes in emerging adulthood. More importantly, there is less stigma attached to insomnia compared to mental health issues, so young adults may be more likely to engage in sleep-focused treatment. Interventions that address both sleep and trauma, such as CBT-Insomnia, will be discussed.