Sleep disturbance and internalizing symptoms in adolescents: A moderated mediation model of self-control and mindfulness

doi:10.21203/rs.3.rs-3931584/v1

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Research Article

Sleep disturbance and internalizing symptoms in adolescents: A moderated mediation model of self-control and mindfulness

https://doi.org/10.21203/rs.3.rs-3931584/v1

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published 24 Apr, 2024

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Objectives

Despite accumulating evidence regarding the impact of sleep disturbance on internalizing symptoms among adolescents, the underlying psychological mechanisms remain inadequately explored. This study aimed to investigate a conceptual framework elucidating how sleep disturbance influences internalizing symptoms in adolescents through the mediating role of self-control, with mindfulness as a moderator.

Methods

A total of 1876 Chinese adolescents provided data on sleep-related variables, internalizing symptoms (anxiety and depression), mindfulness, and self-control. Utilizing the Process macro for SPSS, a moderated mediation model was analyzed, positing that sleep disturbance would positively relate to internalizing symptoms, with self-control acting as a mediator and mindfulness as a moderator.

Results

Sleep disturbance demonstrated a significant positive correlation with internalizing symptoms in adolescents, and self-control emerged as a mediating factor in this relationship. Furthermore, mindfulness moderated the pathways from self-control to internalizing symptoms, while the mediating relationships were weaker for adolescents exhibiting higher levels of mindfulness.

Conclusions

This study highlights the crucial role of self-control as a mediator in the relationship between sleep disturbance and internalizing symptoms in adolescents. Moreover, it underscores the moderating influence of mindfulness on the pathway from self-control to internalizing symptoms. These findings enhance our understanding of the impact, pathways, and influencing factors of sleep disturbance on internalizing symptoms in adolescents, which also suggest the importance of enhancing mindfulness levels in addressing self-control deficits and subsequently reducing internalizing symptoms among adolescents.

Sleep disturbance

internalizing symptoms

self-control

mindfulness

adolescents

Adolescence, recognized as a pivotal developmental stage for mental health [1], is characterized by a multitude of psychosocial and physiological changes, amplifying susceptibility to internalizing symptoms [2]. The most common kind of internalizing symptoms are depression and anxiety [3]. The prevalence of depression symptoms among adolescents is notably substantial, ranging from 20–50% [4]. Meanwhile, anxiety symptoms exhibit varying prevalence rates, ranging between 3.8% and 25%, as evidenced by a compilation of global studies [5]. Consequently, considering the consistent association of internalizing symptoms with compromised social and emotional functioning, diminished academic performance, substance use, and suicidal ideation [6, 7], it is imperative to identify their risk factors during adolescence.

Sleep disturbance emerges as a pivotal risk factor for internalizing symptoms [8], frequently antedating the onset of anxiety and depression symptoms [9]. With a growing body of evidence underscores the impact of sleep disturbance on internalizing symptoms [10, 11], researchers have proposed various biological mediators for this association, encompassing inflammatory markers [12], brain function [13], and grey matter structure [14]. However, despite the recognition that the interplay between sleep disturbance and internalizing symptoms in adolescents is shaped by both biological and psychological factors [15], there remains a paucity of research elucidating the potential psychological mechanisms mediating this effect.

Self-control, a fundamental cognitive ability, emerges as a plausible psychological mediator in this context. According to the strength model of self-control [16], this cognitive function relies on a finite reserve of energy, and depleted energy reserves can result in diminished self-control [17]. Specifically, this energy reserve is often equated with blood sugar in the brain [18]. Adequate sleep plays a crucial role in restoring optimal blood sugar levels and replenishing other essential nutrients, effectively renewing energy resources [19]. Consequently, when adolescents grapple with sleep disturbances, their blood sugar levels are likely to be substantially diminished, impairing self-control [20, 21]. Moreover, as energy depletion can trigger emotional exhaustion [22], the resulting low self-control may subsequently contribute to the emergence of internalizing symptoms [23]. Indeed, cross-sectional investigations have already established a close association between diminished self-control and heightened internalizing problems among adolescents [24, 25]. Meanwhile, longitudinal studies have corroborated the predictive role of low self-control in the development of internalizing problems [26]. Collectively, sleep disturbances may precipitate internalizing symptoms in adolescents by diminishing levels of self-control.

Notably, adolescence, considered the second peak of physiological development, is marked by a substantial imbalance in both physical and mental growth. This developmental phase poses challenges to maintaining consistent levels of enduring self-control among adolescents, rendering them susceptible to fluctuations [27]. This inherent instability in self-control markedly heightens the risk that sleep disturbance may contribute to the emergence of internalizing symptoms through the avenue of compromised self-control. Consequently, there is a critical need to investigate protective factors that can attenuate the adverse impact of low self-control on internalizing symptoms. Mindfulness, defined as heightened awareness of present-moment experiences across physical, cognitive, and psychological domains, emerges as a promising psychological resource capable of buffering the risks associated with low self-control [28]. Empirical research consistently supports mindfulness as a counteractive force against the effects of self-control depletion [29]. Furthermore, the feasibility of enhancing mindfulness levels is notable due to the high efficiency and low time-cost associated with mindfulness-based training [30, 31]. For example, even brief mindfulness interventions, such as four 20-minute breathing meditation sessions, have demonstrated a rapid enhancement of present-moment awareness and overall mindfulness levels [32, 33]. Consequently, the cultivation of mindfulness presents an efficient strategy for adolescents to compensate for the inherent instability of self-control and alleviate the interplay between sleep disturbance, self-control, and internalizing symptoms.

Taken all together, for an enriched understanding of how sleep disturbance impacts internalizing symptoms among adolescents and to provide valuable insights for tailored interventions, this study aimed to examine: (1) the positive correlation between sleep disturbance and internalizing symptoms; (2) whether self-control acts as a mediator in the relationship between sleep disturbance and internalizing symptoms; and (3) the potential moderating role of mindfulness in both the association between self-control and internalizing symptoms and the mediating effect of self-control in the link between sleep disturbance and internalizing symptoms (see Fig. 1).

Participants

Convenience sampling was used to collect a large sample of students from 3 schools (1 primary school (grades 1–6), 1 junior high school (grades 7–9), and 1 secondary school (grades 7–12)) in one district of an eastern city in Guangdong, China. Because students in the 9th and 12th grades were preparing for the high school and college entrance exams, respectively, they were not recruited for this research. Specifically, the age ranges of primary school, junior high school, and secondary school are 9–14, 11–16, and 11–19, respectively. Finally, from April 7th to April 31st, 2023, a total of 2,229 students in grades 5–11 (except for the 9th and 12th grades) were invited to take part in the investigation.

As a means of controlling the quality of the survey responses, our exclusion standards were: (1) incorrect identity information; (2) short response time; and/or (3) inconsistent survey contents. These criteria were in line with the previous studies [34–36]. Therefore, a small number of participants met these exclusion criteria, leaving 1,876 valid responses.

Procedures

This study was carried out in accordance with the Helsinki Declaration as revised in 1989 and approved by the Ethics Committees of the University of the corresponding author (SCNU-PSY-2023-191). Before the survey, the local education bureau and the school jointly sent out invitation letters for the survey to all students and their guardians. Students and their guardians are required to scan the Quick Response (QR) code or click the link of the questionnaire through mobile phones or computers to complete the web-based survey and read the electronic informed consent at first. If both the students and their guardians agreed to participate in the study, they could continue to complete the survey. Responses to the survey were kept confidential, and all students and guardians provided electronic informed consent with the right to withdraw freely during the test period. As the online platform needed to finish all items before submission, there was no missing data for the variables studied in the current research.

Measurements

Sociodemographic information

Self-reporting techniques were used to gather sociodemographic information, including age, gender, ethnicity, single child status, parental married status, family incomes, father’s educational level, mother’s educational level, father’s job stability, mother’s job stability, immigrants’ generation (immigrated to the current residential city from other places), left-behind status (parents migrated to another city or region for work over 6 months), local resident, degree of impact by COVID-19 on life, lifestyles (smoking, alcohol intake, and exercise), self history of psychiatric illness, family history of psychiatric illness, and chronic physical illness.

Sleep disturbance

Four items extracted from the Youth Self-Rating Insomnia Scale (YSIS) [37] were used to assess sleep disturbance in the past month. These items focused on various aspects of sleep, including three common insomnia symptoms (difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and early morning awakening (EMA)) and subjective sleep quality. The selection of these items aligned with the core features of sleep disturbance [38] and maintained consistency with prior research [35, 39, 40]. Responses to each item were recorded on a 5-point Likert scale. The items of DIS, DMS, and EMA ranged from 1- never, 2- <1 time/week, 3- 1-2 times/week, 4- 3-5 times/week, to 5- 6-7 times/week, while the item of subjective sleep quality ranged from 1- very good, 2- good, 3- fair, 4- poor, to 5- very poor [35, 41]. Scores from the four items were summed to generate a total score for the severity of sleep disturbance [35, 40]. In this study, the Cronbach’s alpha for these four items was 0.775.

Anxiety symptoms

The severity of anxiety symptoms experienced over the past two weeks was evaluated by the Chinese version of the GAD-7 [42], which exhibited strong psychometric properties in Chinese adolescents [43]. The ratings for each item range on a 4-point scale from 0 (not at all) to 3 (nearly every day). Item scores were added up to generate a total score, with a higher total score indicating a higher level of anxiety symptoms. In this study, its Cronbach’s alpha was 0.953.

Depression symptoms

The severity of depressive symptoms experienced over the past two weeks was assessed using the Chinese version of the 9-item Patient Health Questionnaire (PHQ-9) [44], which exhibited strong psychometric properties in Chinese adolescents [45]. The ratings for each item range on a 4-point scale from 0 (not at all) to 3 (nearly every day), and all the items were added together to get a total score. A higher total score denotes more severe depressive symptoms. In this study, its Cronbach’s alpha was 0.921.

Self-control

Self-control was evaluated by the Chinese version of the brief self-control scale (BSCS) [46], which had satisfactory-to-excellent psychometric properties among Chinese adolescents [47]. The BSCS included two domains: impulse control and self-discipline. Each item was rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). All items were added together to get a total score, with a higher score indicating a higher level of self-control. In this study, its Cronbach’s alpha was 0.791.

Mindfulness

Mindfulness was measured by the Chinese version of the Mindful Attention Awareness Scale-Children (MAAS-C) [48], which exhibits satisfactory psychometric properties among Chinese adolescents [49]. The MAAS-C is a 15-item scale developed to assess mindfulness in terms of trait, which is adapted from the Mindful Attention Awareness Scale (MAAS) [50]. Participants responded on a 6-point Likert scale ranging from 1 (always) to 6 (never), with higher scores indicating greater levels of mindfulness. In this study, its Cronbach’s α was 0.947.

Data analyses

First, descriptive statistics were calculated for sociodemographic information, while Pearson correlations were adopted to examine the relationships among sleep disturbance, anxiety symptoms, depression symptoms, self-control, and mindfulness. Second, the PROCESS macro in SPSS was used to test for the mediation and moderating effects, with bootstrapping for parameter estimation and a sample size of 5000. Significant parameters were identified as those with 95% confidence intervals that did not include 0. To be specific, we first utilized the model 4 in PROCESS to test the mediating model, with sleep disturbance as an independent variable, self-control as a mediating variable, and depression symptoms and anxiety symptoms as dependent variables, respectively. Then, we utilized the model 14 in PROCESS to test the moderated mediation model, with sleep disturbance as a predictor, self-control as a mediator, mindfulness as a moderator, and anxiety symptoms and depression symptoms as outcomes, respectively. Sociodemographic variables were included as covariates in the above analyses.

Descriptive statistics of sample characteristics

The mean (SD) age of participants was 14.88 (1.47) years, ranging from 12 to 19. Boys made up 44.7% of this sample (n = 838), and the proportions for junior high school students and senior high school students were 60.3% (n = 1,131) and 39.7% (n = 727), respectively. Detailed sample characteristics are illustrated in Table 1.

Table 1

Descriptive statistics of the overall sample (n = 1876)
		n	%
Age ^a [year, mean(SD)]	14.88 (1.47)	-	-
Gender	Boys	838	44.7
Gender	Girls	1038	55.3
Grade [age]	7th [13.42 (0.72)]	569	30.3
	8th [14.35 (0.73)]	562	30.0
	10th [15.95 (0.59)]	387	20.6
	11th [16.86 (0.60)]	358	19.1
Ethnicity	Han ^b	1858	99.0
Ethnicity	Others	18	1.0
Parental martial status	Married	1754	93.5
Parental martial status	Not current married ^c	122	6.5
Immigrants’ second generation	Yes	155	8.3
Single child status	Yes	131	7.0
Left-behind status ^d	Yes	231	12.3
Father has a stable job	Yes	1593	84.9
Mother has a stable job	Yes	1382	73.7
Self history of psychiatric illness	Yes	9	0.5
Chronic physical illness ^e	Yes	106	5.7
Family history of psychiatric illness	Yes	11	0.6
Local resident	Yes	1520	81.0
Local resident	No	356	19.0
Family incomes	< 5000	446	23.8
	5000–10000	666	35.5
	10000–20000	174	9.3
	> 20000	43	2.3
	Unknown	547	29.2
Father’s educational level	Illiteracy	280	14.9
	Elementary school	986	52.6
	Junior high school	398	21.2
	Senior high school	136	7.2
	Junior college	73	3.9
	College	3	0.2
Mother’s educational level	Illiteracy	480	25.6
	Elementary school	908	48.4
	Junior high school	357	19.0
	Senior high school	88	4.7
	Junior college	40	2.1
	College	3	0.2
Degree of impact by COVID-19 on life	No impact	485	25.9
	Minimal impact	660	35.2
	Moderate impact	554	29.5
	Significant impact	149	7.9
	Very significant impact	28	1.5
Alcohol intake	Never	1718	91.6
	Sometime	154	8.2
	Often	4	0.2
	Everyday	0	0.0
Exercise	Never	96	5.1
	Sometime	1187	63.3
	Often	438	23.3
	Everyday	155	8.3
Smoking	Never	1844	98.3
	Sometime	19	1.0
	Often	1	0.1
	Everyday	5	0.3
	Quit smoking	7	0.4
Note:
^a The range of age in the current sample was 12–19.
^b Han is the major ethnic group in China.
^c Not current married included separated, divorced, and widowed.
^d Live separately from one or both parents for more than 6 months.
^e Chronic physical conditions referred to having at least one of arthritis angina, asthma, diabetes, visual impairment, or hearing problems.

Assessment of common method variance

As self-reporting was the only approach used to collect data in the present study, common method variance may exist. To examine it, we conducted Harman’s one-factor test [51]. The results indicated that the first principal factor explained 38.58% of the variance (< 40%), suggesting that common method variance is not a significant concern in this study.

Correlation analyses

Descriptive information and Pearson correlations for the studied variables are shown in Table 2. Sleep disturbance was significantly and positively associated with both anxiety symptoms and depression symptoms. Self-control was negatively correlated with sleep disturbance, anxiety symptoms, and depression symptoms. In addition, mindfulness were positively correlated with self-control and negatively correlated with sleep disturbance, anxiety symptoms, and depression symptoms.

Table 2

Descriptive statistics of the studied variables.
Variables	M	SD	1	2	3	4	5
1.Mindfulness	61.13	16.21	1
2.Self-control	23.39	4.99	0.44^***	1
3.Depression symptoms	5.57	5.33	−0.47^***	−0.53^***	1
4.Anxiety symptoms	3.98	4.91	−0.45^***	−0.49^***	0.87^***	1
5.Sleep disturbance	7.50	3.04	−0.39^***	−0.39^***	0.61^***	0.54^***	1
Note:
^p < 0.05, ^p < 0.01, ^**p < 0.001.

Mediation analyses

As shown in Table 3 and Table 4, the findings demonstrated that sleep disturbance had a significant total effect on anxiety symptoms (β = 0.481, p < 0.001) and depression symptoms (β = 0.543, p < 0.001), respectively. Sleep disturbance was negatively associated with self-control (β = -0.316, p < 0.001), and self-control negatively predicted anxiety symptoms (β = -0.288, p < 0.001) and depression symptoms (β = -0.306, p < 0.001), respectively. The bootstrap results with 5000 re-samples revealed a significant indirect effect. Specifically, self-control played a mediating role in anxiety symptoms (effect = 0.147, BootSE = 0.016) and depression symptoms (effect = 0.170, BootSE = 0.017). The mediating effect accounted for 18.9% and 17.9% of the total effect of sleep disturbance on anxiety symptoms and depression symptoms, respectively.

Table 3

Results of the mediation analysis (depression symptoms as dependent variable).
Variables	Model 1 (depression symptoms)		Model 2 (self-control)		Model 3 (depression symptoms)
Variables	β	t	β	t	β	t
Age	0.063^***	3.465	−0.103^***	-4.813	-0.032	1.849
Gender	0.129^***	7.041	−0.046^*	-2.143	0.115^***	6.710
Ethnicity	-0.027	-1.517	0.001	0.047	-0.027	-1.607
Single child status	-0.001	-0.023	−0.006	-0.257	-0.002	-0.123
Parental married status	0.012	0.646	0.012	0.518	0.016	0.891
Family incomes	0.017	0.936	−0.004	-0.209	0.015	0.992
Father’s educational level	-0.006	-0.300	0.007	0.294	-0.004	-0.208
Father’s job stability	0.004	0.233	−0.010	-0.449	0.001	0.076
Mother’s educational level	-0.019	-0.882	0.003	1.001	-0.011	-0.560
Mother’s job stability	0.002	0.099	0.001	0.012	0.002	0.111
Left-behind status	-0.040^*	-2.097	0.063^**	0.790	-0.021	-1.170
Immigrants’ second generation	0.021	1.147	−0.016	-0.734	0.016	0.946
Local resident	-0.000	-0.007	0.022	1.000	0.007	0.377
Degree of impact by COVID-19 on life	0.025	1.404	−0.023	-1.108	0.018	1.077
Family history of psychiatric illness	-0.029	-1.657	0.005	0.263	-0.028	-1.674
Self history of psychiatric illness	-0.047^**	-2.670	0.048^*	2.288	-0.033^*	-1.976
Chronic physical illness	-0.047^**	-2.654	0.031	1.521	-0.037^*	-2.256
Exercise	-0.032	-1.728	0.129^***	5.911	0.007	0.420
Smoking	0.031	1.665	−0.023	-1.082	0.023	1.367
Alcohol intake	0.146^***	7.874	−0.132^***	-6.072	0.106^***	6.039
Sleep disturbance	0.543^***	29.557	−0.316^***	-14.659	0.446^***	24.633
Self-control	-	-	-	-	-0.306^***	-16.568
R²	0.434		0.221		0.507
F	67.61		25.09		86.54
Note:
^p < 0.05, ^p < 0.01, ^**p < 0.001.

Table 4

Results of the mediation analysis (anxiety symptoms as dependent variable).
Variables	Model 1 (anxiety symptoms)		Model 2 (self-control)		Model 3 (anxiety symptoms)
Variables	β	t	β	t	β	t
Age	0.064^**	3.298	−0.103^***	−4.813	0.035	1.861
Gender	0.128^***	6.527	−0.046^*	−2.143	0.115^***	6.157
Ethnicity	−0.037	−1.953	0.001	0.047	−0.037^*	−2.042
Single child status	−0.007	−0.346	−0.006	−0.257	−0.008	−0.450
Parental married status	0.003	0.160	0.012	0.518	0.007	0.341
Family incomes	0.002	0.114	−0.004	−0.209	0.001	0.051
Father’s educational level	0.011	0.511	0.007	0.294	0.014	0.636
Father’s job stability	−0.015	−0.773	−0.010	−0.449	−0.018	−0.964
Mother’s educational level	−0.031	−1.385	0.003	1.001	−0.024	−1.126
Mother’s job stability	0.003	0.181	0.001	0.012	0.004	0.195
Left-behind status	−0.045^*	−2.216	0.063^**	2.790	−0.027	−1.404
Immigrants’ second generation	0.024	1.234	−0.016	−0.734	0.019	1.056
Local resident	0.007	0.343	0.022	1.000	0.013	0.694
Degree of impact by COVID-19 on life	0.026	1.373	−0.023	−1.108	0.019	1.077
Family history of psychiatric illness	−0.040^*	−2.092	0.005	0.263	−0.038^*	−2.117
Self history of psychiatric illness	−0.041^*	−2.144	0.048^*	2.288	−0.027	−1.495
Chronic physical illness	−0.064^***	−3.393	0.031	1.521	−0.055^**	−3.068
Exercise	−0.009	−0.445	0.129^***	5.911	0.028	1.485
Smoking	0.036	1.833	−0.023	−1.082	0.029	1.570
Alcohol intake	0.124^***	6.264	−0.132^***	−6.072	0.086^***	4.534
Sleep disturbance	0.481^***	24.515	−0.316^***	−14.659	0.390^***	19.833
Self-control	-	-	-	-	−0.288^***	−14.333
R²	0.353		0.221		0.417
F	48.07		25.09		60.28
Note:
^p < 0.05, ^p < 0.01, ^**p < 0.001.

Moderated mediation analyses

After controlling the influence of sociodemographic information, the interaction between mindfulness and self-control had a significant predictive effect on anxiety symptoms (β = 0.007, p < 0.001) and depression symptoms (β = 0.006, p < 0 .001), respectively (see Table 5 and Table 6). Based on the plots depicting that the relation between self-control and anxiety symptoms/depression symptoms separately for low and high levels of mindfulness (i.e., 1 SD below the mean and 1 SD above the mean, respectively) (see Fig. 2 and Fig. 3), our simple slope test showed, for adolescents with low levels of mindfulness, self-control have a significant negative predictive effect on anxiety symptoms (β_simple = -0.334, p < 0.001) and depression symptoms (β_simple = -0.366, p < 0.001); Yet, for those with high levels of mindfulness, self-control have a significant negative but weaker predictive effect on anxiety symptoms (β_simple = -0.105, p < 0.001) and depression symptoms (β_simple = -0.168, p < 0.001). In addition, as illustrated in Table 5 and Table 6, the conditional indirect effect analysis showed that under high levels of mindfulness, the mediating effect of self-control in the relationship between sleep disturbance and anxiety symptoms/depression symptoms was much weaker than under low levels of mindfulness.

Table 5

Result of the moderated mediation analysis (depression symptoms as dependent variable).
Outcome variable: Self-control	β	t	SE	p
Constant	-0.064	-0.014	4.511	0.989
Sleep disturbance	-0.518	-14.659	0.035	< 0.001
R²	0.221
F	25.09
Outcome variable: Depression symptoms	β	t	SE	p
Constant	2.395	0.642	3.731	0.521
Sleep disturbance	0.649	21.796	0.032	< 0.001
Self-control	-0.267	-13.236	0.020	< 0.001
Mindfulness	-0.061	-10.116	0.006	< 0.001
Self-control × Mindfulness	0.006	6.482	0.001	< 0.001
R²	0.539
F	90.25
Conditional indirect effect analysis at different values of mindfulness (M ± SD)	β	BootSE	BootLLCI	BootULCI
M−1SD	0.190	0.024	0.144	0.236
M	0.138	0.016	0.107	0.172
M + 1SD	0.087	0.014	0.060	0.116

Table 6

Result of the moderated mediation analysis (anxiety symptoms as dependent variable).
Outcome variable: Self-control	β	t	SE	p
Constant	-0.064	-0.014	4.511	0.990
Sleep Disturbance	-0.518	-14.659	0.035	< 0.001
R²	0.221
F	25.09
Outcome variable: Anxiety symptoms	β	t	SE	p
Constant	3.221	0.866	3.720	0.387
Sleep Disturbance	0.541	17.050	0.032	< 0.001
Self-control	-0.224	-11.161	0.020	< 0.001
Mindfulness	-0.061	-10.122	0.006	< 0.001
Self-control × Mindfulness	0.007	7.880	0.001	< 0.001
R²	0.460
F	65.73
Conditional indirect effect analysis at different values of mindfulness (M ± SD)	β	BootSE	BootLLCI	BootULCI
M−1SD	0.178	0.023	0.134	0.224
M	0.116	0.015	0.088	0.147
M + 1SD	0.054	0.013	0.031	0.080

In scrutinizing the moderated mediation model, this study elucidates the pathway through which sleep disturbance impacts internalizing symptoms by influencing self-control and identifies the conditions under which the interplay among sleep disturbance, self-control, and internalizing symptoms is most pronounced in adolescents. The principal findings are as follows: (1) a positive correlation between sleep disturbance and internalizing symptoms was discerned; (2) self-control served as a mediator in the relationship between sleep disturbance and internalizing symptoms; and (3) mindfulness played a moderating role in the connection between self-control and internalizing symptoms, indicating that adolescents with high mindfulness exhibited diminished susceptibility to internalizing symptoms resulting from self-control. These findings advance our comprehension of the nexus between sleep disturbance and internalizing symptoms in adolescents, offering valuable insights for prospective intervention strategies.

Consistent with prior investigations [52–54], our study establishes a positive association between sleep disturbance and internalizing symptoms, supporting again the notion that sleep disturbance as a precursor to internalizing symptoms [55]. In fact, over the past decades, sleep disturbance has emerged as an early and dependable indicator of vulnerability to anxiety and depression in adolescents [10, 56]. Hence, implementing interventions targeting sleep, including the modification of adverse sleep habits and addressing symptoms of insomnia, proves crucial in alleviating internalizing symptoms among adolescents.

Complementing current research on biological mediators [12–14], our study unveils a novel psychological mediator, elucidating how sleep disturbance might compromise self-control, consequently leading to internalizing symptoms. Drawing insights from established literature [57, 58] and the strength model of self-control [19, 59], self-control hinges on a finite energy reserve, and its exertion depletes this reserve. Effective sleep, a primary avenue for energy restoration, plays a pivotal role in sustaining self-control. Therefore, pronounced sleep disturbance in adolescents may impede the replenishment of resources from the preceding day [60], resulting in attenuated self-control [17]. Furthermore, in addition to the documented positive correlations between self-control and internalizing symptoms [61, 62], researchers have also revealed the impact of specific self-control components on internalizing symptoms [63]. For instance, deficits in impulse control often manifest as difficulties in regulating emotions and behaviors, heightening the challenge of disengaging from anxious emotions [64]. Simultaneously, individuals with low self-discipline may be more prone to succumb to temptations, leading to a higher likelihood of developing addictions [65, 66] and, consequently, an increased risk of depressive symptoms [67]. Taken together, our findings underscore the potential of sleep disturbance to diminish self-control, thereby contributing to the severity of internalizing symptoms.

Building upon this mediating pathway, our study unveils the moderating influence of mindfulness in the connection between self-control and internalizing symptoms. Among adolescents exhibiting high levels of mindfulness, the impact of self-control on internalizing symptoms diminishes. This buffering effect indicates that enhanced mindfulness might furnish adolescents with supplementary resources, such as emotional intelligence and psychological capital, fortifying their mental well-being [68]. Consequently, it mitigates the detrimental repercussions of low self-control [69]. Hence, our findings underscore the potential of mindfulness as a compensatory strategy amid the inherent instability of self-control during adolescence. The implementation of mindfulness-based training for adolescents may be a beneficial approach to attenuate the mediating effect of self-control in the relationship between sleep disturbance and internalizing symptoms.

Several limitations of this study should be acknowledged. Firstly, the cross-sectional nature of the research design underscores the need for caution in establishing causal relationships. Future investigations would benefit from employing longitudinal or experimental designs to more effectively elucidate the direction of causality. Secondly, reliance on self-reported measurement may introduce potential response bias and inaccuracies in recall. Subsequent research should bolster the robustness of findings by integrating data from diverse sources, including peers, parents, and teachers, to validate the reported outcomes. Lastly, the current sample of adolescents was drawn from a singular district, necessitating circumspection when extrapolating the findings more broadly. Future research should consider applying the proposed model to diverse adolescent samples to assess the generalizability of results and explore potential influences of cultural contexts on the outcomes.

Despite these limitations, the present study advances our understanding of the psychological mechanisms linking sleep disturbance with internalizing symptoms. We identified self-control as a mediating factor and mindfulness as a moderating influence, delineating how and under what conditions sleep disturbance relates to internalizing symptoms. Notably, our findings underscore the beneficial role of mindfulness in mitigating the impact of low self-control on internalizing symptoms. Thus, implementing mindfulness-based training emerges as a particularly effective strategy to compensate the inherent instability of self-control in adolescents. In brief, our study underscores the pivotal role of enhancing mindfulness levels in addressing self-control deficits and subsequently reducing internalizing symptoms among adolescents.

Acknowledgments

The authors want to express their sincere gratitude to all participants for participating in the study.

Declaration of Competing Interest

The authors declare no conflicts of interest regarding data and materials presented in this paper.

Authors’ contribution

All authors participated in the data collection and provided advice on the interpretation of the data. Authors Haoxian Ye and Nan Jiang wrote the first draft of the manuscript and modified the manuscript. Authors Sisi He, Haoxian Ye, and Nan Jiang undertook the statistical analysis. Author Sisi He finished the tables and figures. Author Fang Fan designed the study and wrote the protocol. All authors contributed to and have approved the final manuscript.

Funding

The present study was funded by National Natural Science Foundation of China (Grant No. 32271135), and Graduate Research and Innovation Project of School of Psychology, South China Normal University (PSY-SCNU202237).

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Ethics approval and consent to participate

This study was approved by the Human Research Ethics Committee of South China Normal University (SCNU-PSY-2023-191). The survey was conducted under the principle of voluntary participation. The participants and their guardians carefully read, signed, and returned the informed consent form to the researcher.

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Sleep disturbance and internalizing symptoms in adolescents: A moderated mediation model of self-control and mindfulness

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Introduction

Methods

Participants

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Sleep disturbance

Anxiety symptoms

Depression symptoms

Self-control

Mindfulness

Data analyses

Results

Descriptive statistics of sample characteristics

Assessment of common method variance

Correlation analyses

Mediation analyses

Moderated mediation analyses

Discussion

Conclusions

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