The relation between sleep and affect in youth during remission from anxiety and depression

Objective In youth remitted from anxiety and depressive disorders, lower daytime positive (PA) or higher negative affect (NA) and suboptimal sleep could reinforce one another in bidirectional vicious feedback loops. The strength of these loops may contribute to increase of anxiety or depressive symptoms four months later. Method Remitted 13-to-21-year-olds engaged in a two-week app-based daily diary with affect items, wearing a wrist-worn accelerometer assessing sleep, and completed anxiety (RCADS), depression (BDI) and sleep (SRSQ) questionnaires at baseline and four-month follow-up. Autoregressive models using lagged correlation estimated PA and NA from daily means and fluctuations, sleep from total sleep time and sleep efficiency, and assessed overall and individual bidirectional associations. Regression analyses examined bidirectional and exploratively unidirectional associations as predictors of the four-month anxiety and depression symptom course. Subgroups with and without clinically relevant sleep problems were exploratively compared. Results In 118 youth (89.8% female; M _age = 19.37; SD _age = 1.70), daytime PA was negatively associated to subsequent nighttime sleep (β = −0.07, p = .03), especially in the no self-reported clinical sleep problems group (β = −0.14, p < .01). No other associations were significant, and no associations were robust significant symptom course predictors. Conclusion Instead of a feedback loop, found patterns only suggest that youth who feel higher daytime PA subsequently sleep shorter and less efficiently. The interplay of objective sleep and affect may not be caught in a day-to-day pattern in youth, and may require studying longer cumulative or delayed effects of low sleep quality.