Repetitive Negative Thinking Mediates the Relationship Between Sleep Disturbance and Symptoms of Generalized Anxiety, Social Anxiety, Depression, and Eating Disorders in Adolescence: Findings From a 5-Year Longitudinal Study

Sleep problems commonly co-occur alongside generalized and social anxiety, depression, and eating disorders in young people. Yet it is unclear if sleep disturbance conveys risk for these social-emotional disorders across early to middle adolescence and whether repetitive negative thinking (RNT) mediates this association. In this study, we examined longitudinal relationships between sleep (morning/eveningness, school-night sleep duration, and sleepiness), general and presleep RNT, and symptoms of generalized and social anxiety, depression, and eating disorders across 5 years. As part of the wider Risks to Adolescent Wellbeing Project, these constructs were assessed in a cohort of 528 youths over six annual waves of data collection, spanning ages 11 to 16. Cross-lagged panel models that examined direct, indirect, and bidirectional associations showed that worse adolescent sleep predicted increases in symptoms of generalized anxiety, social anxiety, depression, and eating disorders across each wave directly and indirectly through general and presleep RNT. Symptoms of social-emotional disorders did not predict worsening in sleep. Results suggest that sleep disturbance and RNT should be targeted simultaneously in the prevention and treatment of social-emotional disorders in adolescence, although limitations around the use of self-report and nondiagnostic symptom measures are noted.