Clinical characterization of insomnia in adolescents - an integrated approach to psychopathology.

Objectives/background: Insomnia in adolescence is common and debilitating yet it remains poorly understood. Here, we examine the complexity of clinical, behavioral, and psychosocial factors characterizing insomnia in adolescents.

Methods: Ninety-five adolescents (16-19 years) with (N = 47, 31 female) and without (N = 48, 28 female) insomnia symptoms participated. In the insomnia group, 26 (20 female) met full DSM-5 criteria for insomnia disorder, while 21 (11 female) met partial criteria. Participants completed a clinical interview and assessments of clinical, behavioral, and psychosocial dimensions associated with insomnia. GLMs and network analyses were used to evaluate group and sex differences in severity and inter-relationships between symptoms.

Results: Adolescents with insomnia symptomatology had lower sleep hygiene and thought control, more depressive symptoms and dysfunctional sleep-related cognitions, and more substance use as a coping behavior than healthy controls. They also indicated higher neuroticism, stress levels, and sleep stress reactivity (p < 0.05), but no difference in adverse childhood experiences, than controls. Girls compared to boys with insomnia reported lower sleep quality, and more pre-sleep cognitive activity and sleep stress reactivity (p < 0.05). Compared to healthy girls, girls in the insomnia group reported lower sleep hygiene and higher agreeableness. Network analyses confirmed profound group differences in network topology, with the insomnia group having different levels of centrality and relationships between clinical characteristics compared with controls.

Conclusions: Findings highlight clinical and sex-specific characteristics of adolescent insomnia, with network analyses revealing a complex interplay between clinical, behavioral, and psychosocial domains. Adolescents with insomnia symptoms, particularly girls, may benefit from interventions to improve negative cognition, mood, and stress, and behavioral strategies to counteract sleep-related maladaptive behaviors.