The association between childhood maltreatment and multidimensional sleep health in adolescents at high risk of emotional and behavioral problems

Study Objectives: Impaired sleep following trauma such as childhood maltreatment is both a prognostic factor for future mental illness and a feasible intervention point. Yet, associations between childhood maltreatment and objectively measured sleep components are rarely found. New approaches advance the use of multidimensional sleep health scores instead of individual sleep components. However, no such methodology has been used to study the consequences of maltreatment on sleep health in adolescent cohorts so far. We hypothesized that childhood maltreatment will be associated with poorer sleep health in adolescence. Methods: A cross-sectional sample of 494 adolescents at high risk of emotional and behavioral problems (mean age 17.9) completed the Childhood Trauma Questionnaire-Short Form to assess five forms of maltreatment (emotional and physical abuse/neglect and sexual abuse) assessed as continuous sum scores. During nine nights of actigraphy and sleep diary measurements, data on sleep regularity, satisfaction, alertness, timing, efficiency, and duration were collected, which were combined into a sleep health composite score ranging from 0 to 6. Linear regression models were adjusted for age, sex, household income, ethnic origin, educational level, urbanization of living environment, and parental psychopathological problems. Results: Associations were found between all forms of maltreatment and poorer sleep health (p<.031), except for sexual abuse (p=.224). Partial r effect sizes ranged from-0.12 (95% CI=-0.22 to-0.01) for emotional neglect to-0.18 (-0.28 to-0.08) for total maltreatment. Conclusions: Maltreatment was associated with impairment in everyday sleep health, reflected in both subjective and objective measurements of sleep.