Associations between Child Maltreatment, Harsh Parenting, and Sleep with Early Adolescent Mental Health

Introduction: Mental and behavioral health (MBH) problems place a significant burden on society; youth who suffer from MBH disorders are at much greater risk for negative outcomes, including being arrested and substance abuse. Although many youth with MBH disorders have endured harsh parenting (corporal punishment and psychological aggression) and/or child maltreatment (CM), differential associations between these experiential factors have yet to be fully explored. Sleep problems have also been implicated in MBH problems and are consistently associated with CM. This longitudinal study examined differential associations between CM, harsh parenting and sleep problems with MBH symptoms.

Methods: Substance-naïve pre-adolescent youth (N = 529) were sampled from a working class, medium-sized city in northern Kentucky. An extensive battery of tests was administered to youth and a parent, including a sleep habits survey, assessments of parenting and CM, and diagnostic symptom counts of four MBH disorders: Conduct Disorder, Attention Deficit Hyperactivity Disorder, Anxiety and Depression. Negative binomial multiple regressions estimated symptom counts of each of the four MBH disorders at baseline and at follow-up 2-3 years later (controlling for baseline symptom counts) as a function of child age, CM or harsh parenting, sleep latency, and the interaction between sleep latency and either CM or harsh parenting.

Results: At baseline, CM and sleep problems were associated with symptoms of all four MBH disorders. CM was more strongly related to MBH symptoms than was harsh parenting, and indicators of harsh parenting exhibited stronger associations with externalizing symptoms than with internalizing symptoms. There were no interaction effects on MBH symptoms when CM and sleep problems co-occurred. Longitudinally, baseline MBH symptoms were the strongest predictor of symptoms 2-3 years later, and harsh parenting was most predictive of change in MBH symptoms.

Conclusions: This investigation addressed a gap pertaining to the development of early adolescent MBH problems by evaluating change in MBH symptoms in the context of two major putative risk factors (CM and harsh parenting), leading to a finding that these experiences were differentially predictive of MBH outcomes. Further, we found that sleep problems were associated with MBH symptoms in adolescence independent of associations with the two major putative risk factors. Identification of such experiential factors related to the emergence of MBH disorders informs the design of precision-based preventive and treatment interventions targeting conditions that are preventable or tractable. Our results also highlight the need for sleep problems to be assessed as part of standard child mental health evaluations.