How Mental and Behavioral Health and Social Environment Contribute to Sleep Problems Among Youth in an Ecological Perspective

Background: The primary premise explaining human problems is derived from the complex interplay of psychological, social, economic, political and physical forces. In addition to mental health (depression, anxiety, ADHD), this study aims to examine the roles of multidimensional psychosocial determinants such as behavioral health (alcohol abuse and suicidality) and social environment (family support, school connectedness, favorable neighborhood) in predicting adolescents’ insomnia in an ecological perspective.

Methods: About 6,445 high school students in Taiwan participated in the study using an anonymous self-report survey. Measures included the Athens Insomnia Scale, the Center for Epidemiological Studies-Depression Scale, the Multidimensional Anxiety Scale for Children, the Vanderbilt ADHD Diagnostic Parent Rating Scale, the CRAFFT substance abuse screening test, the Kiddie Schedule for Affective Disorders and Schizophrenia, the Family APGAR Index, the Taiwanese Quality of Life Questionnaire for Adolescents, and five school connectedness questions. Hierarchical multiple regression was performed to examine how multidimensional factors of social environment, behavioral health, and mental health were associated with adolescents’ insomnia.

Results: The results showed that demographic factors such as sex and age explained 2% of the variance. Adding social environment and behavioral health factors significantly increased 23% of variance explained. Furthermore, adding mental health factors significantly increased 13% of variance explained. In total, these sociodemographic, psychosocial variables and psychological symptoms explained 37% of the variance, and the model was significant. The regression coefficients indicated that alcohol use, suicide ideation, depression, anxiety, and ADHD were positively associated with insomnia, whereas family support, school connectedness, and favorable neighborhood were negatively associated with insomnia. In conclusion, this study demonstrates how both psychosocial variables (social environment and behavioral health) and psychological symptoms were associated with adolescent insomnia, while controlling for the demographic variables (sex and age).

Implications: The study provides valuable information and evidence for social workers, clinicians and health professionals working to support adolescents with insomnia. In social work practice, applying an ecological approach can be best understood as we look at persons, families, schools, and communities to identify strengths and weaknesses in the transactional processes between these systems. This perspective allows the practitioner to effectively treat problems and needs in multiple systemic levels including the individual, family, school, and the larger community. In sum, prevention and intervention of adolescent insomnia should focus on multidimensional risk and protective factors including mental health, behavioral health, and social environment in the ecological system contexts.