The experience of sleep problems for adolescents with depression in short-term psychological therapy

Abstract

A growing body of literature demonstrates a strong relationship between sleep disturbances and depression in adolescence. In spite of this, few studies have explored how adolescents with depression experience sleep problems. The present study aimed to qualitatively explore the experience of sleep problems in adolescents with depression, including their understanding of how a psychological therapy impacted on these sleep difficulties. The sample included 12 adolescents with sleep disturbances who had been offered treatment for depression through a large, multi-centre, randomised controlled trial. Semi-structured interviews conducted after treatment and 1-year post treatment were analysed using thematic analysis. Two main themes were identified. Both themes demonstrated how an overarching desire to escape impacted the adolescents’ sleep in distinct ways; ‘thinking about the ‘bad stuff’’ was characterised by ruminative thinking, which prevented sleep, whereas ‘sleep as an escape’ indicated a desire to sleep excessively due to feelings of helplessness. Overall, the findings demonstrate a nuanced relationship between sleep and depression in adolescence, and imply that the underlying meaning of the sleep difficulties for each young person should be considered in the delivery of therapy for adolescent depression.

The lived experience of adolescent depression: A systematic review and meta‐aggregation

“…Immense and relentless suffering was evident when depression was likened to “a heart ripping apart” (Ofonedu et al, 2013, p. 100), a “black hole” (Weitkamp et al, 2016, p. 4) and “a pit where you just can't get out anymore” (McCann et al, 2012a, p. 337). Facing symptoms could be “a disorienting battle” (Oliver et al, 2015, p. 5) leading to feelings of helplessness and hopelessness (Jernslett et al, 2021; McCann et al, 2012a).…”

“…Concerns about stigma, judgement and bullying led to some adolescents being aggressive (Ofonedu et al, 2013) or hiding their depression (de Mol et al, 2018; McCann et al, 2012b): “I have programmed myself not to show any sadness at that school because they will take it and eat it up” (Ofonedu et al, 2013, p. 100). Furthermore, oversleeping could be a way to escape from the painful reality of depression (Jernslett et al, 2021). Adolescent's also described ways that “harm to self” could occur in response to depression.…”

“…Even for the 53% of studies that did provide theoretical or cultural attributes of the researcher, the information tended to be brief, such as stating their job role. Furthermore, only 33% of studies addressed the influence of the researcher, such as using a bracketing interview or reflexive log (de Mol et al, 2018; Farmer, 2002; Hannor‐Walker et al, 2020; Jernslett et al, 2021; Midgley et al, 2017).…”

“…Is there anything good to look forward to?” (Oliver et al, 2015, p. 5). This could interfere with sleep (Jernslett et al, 2021). Indeed, “fatigue” was another symptom described by adolescents.…”

“…All studies explored the lived experience of adolescents with depression. Seven studies had narrowed aims, such as exploring perspectives on social support (McCann et al, 2012b), interpersonal relationships (Elsina & Martinsone, 2020), beliefs about causes of depression (Midgley et al, 2017), the role of social media (Radovic et al, 2017), the role of social representations (de Mol et al, 2018) and specific experiences of rumination (Oliver et al, 2015) and sleep problems (Jernslett et al, 2021). Some studies had a particular cultural stance, including understanding the experience of Black adolescents in rural areas (Hannor-Walker et al, 2020) and African American adolescents in an inner city (Ofonedu et al, 2013).…”