Starting School Before 8:30 AM Associated With More Anxiety and Depression in Adolescents Interview with:
Jack Peltz, Ph.D.

Clinical assistant professor in Psychiatry
Rochester Medical Center What is the background for this study? What are the main findings?

Response: Approximately 90% of high-school aged adolescents get either
insufficient sleep during school nights or barely meet the required
amount of sleep (ie, 8–10 hours) expected for healthy functioning.(1)

In fact, sleep problems and insufficient sleep are so pervasive for
adolescents that they could be considered an epidemic due to their
adverse impact on adolescent mental and physical health.(2–5)

As a result,addressing insufficient adolescent sleep represents a critical
point of study and intervention. The growing body of evidence suggests
that later school start times (SST), 8:30 AM or later as recommended
by the American Academy of Pediatricians,6 convey
multiple benefits on adolescents, including improved sleep, better
mental and physical health, and improved academic outcomes.(7–10)

This research, however, has focused on the direct effects of delaying
school start times, or specifically how moving SST back directly predicts changes
in an outcome (eg, mental health, academic achievement). This
type of analysis precludes examining the important role that SST
might play as a condition or context under which other sleeprelated
processes take place. For instance, earlier school start times might exacerbate
the impact of sleep-related processes on adolescent behavioral
health outcomes. Thus, incorporating school start times as a larger contextual variable
that might moderate models of sleep and adolescent functioning
represents a gap in the literature and a unique opportunity to advance
conceptual models. Accordingly, the current study examines
the moderating role of school start times on the associations between sleep hygiene,
sleep quality, and mental health.

The findings suggested that the association between adolescents’ baseline sleep hygiene and their daily psychological functioning was mediated by their daily
sleep quality only for students whose high schools started before
8:30 AM.

In contrast, the direct link between baseline sleep hygiene
and daily psychological functioning was marginally stronger for students
with later school start times. Our findings highlighted a new role for school start times
in understanding adolescent sleep processes and suggested a
potential mechanism for understanding how sleep hygiene could impact
psychological functioning. What should clinicians and patients take away from your report?

Response: Our findings suggest that sleep hygiene is directly associated with adolescent mental health (for both early and later starting schools), and that, for early starting schools (i.e., before 8:30am), students’ poor sleep hygiene was associated with worse sleep quality, which in turn, was associated with more depressive/anxiety symptoms. We believe that earlier starting schools put more pressure on students to obtain better quality sleep, and if they do not, they put themselves at greater risk for mental health issues. What recommendations do you have for future research as a result of this study?

Response: Although future replication of our findings is necessary, our results begin to suggest that a combined intervention that targeted both sleep hygiene and
later SSTs might yield better outcomes than interventions targeting
just one of those areas of intervention alone. Such an intervention
might involve a stepwise approach in which schools or school districts
(or even parents) begin with sleep hygiene interventions because
they require less comprehensive change to the overall system
of influences that are also related to adolescents’ sleep (ie, sports
schedules, after-school activities, parents’ work schedules). Thank you for your contribution to the community.

Jack S. Peltz, Ronald D. Rogge, Heidi Connolly, Thomas G. O’Connor. A process-oriented model linking adolescents’ sleep hygiene and psychological functioning: the moderating role of school start times. Sleep Health, 2017; DOI: 10.1016/j.sleh.2017.08.003

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on October 12, 2017 by Marie Benz MD FAAD