Cited by 594Sleep and related disordersChild and Adolescent Psychosocial and Emotional DevelopmentSleep and Wakefulness Research

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A meta-analysis and model of the relationship between sleep and depression in adolescents: Recommendations for future research and clinical practice

Lovato, Nicole, Gradisar, Michael·2014·Sleep Medicine Reviews

DOI 10.1016/j.smrv.2014.03.006

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Abstract

The purpose of this review was to quantify the strength of evidence for a directional relationship between sleep disturbance and depression in adolescents. A literature search was conducted to identify research investigating the relationship between sleep disturbance and depression in adolescent samples (12-20 y). Twenty-three studies were identified; 13 explored associations between depression and sleep disturbance; seven examined the prospective role of sleep disturbance in the development of depression; and three investigated the role of adolescent depression in the development of subsequent sleep disturbance. Average weighted mean differences in sleep/depression-related outcome variables were calculated between adolescents with depression, and non-clinical adolescents, or those in remission. Adolescents with depression experienced significantly more wakefulness in bed (sleep onset latency, wake after sleep onset, number of awakenings and sleep efficiency), lighter sleep (more stage 1), and reported more subjective sleep disturbance. Overall effect sizes from longitudinal and treatment studies suggest sleep disturbance acts as a precursor to the development of depression. At follow-up, depressed adolescents had significantly longer sleep onset, more wake after sleep onset, and lower sleep efficiency compared to adolescents who were non-clinical, or had undergone remission. Little support was found for a predictive role of depressive symptoms in the development of sleep disturbance. Based on these findings we propose a model to understand the development of depression from initial sleep disturbance, provide recommendations for clinicians and recommendations for future research.

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“3 In addition, sleep disturbance and short total sleep duration are independently associated with suicidal thoughts and plan, even after controlling for the presence of depression.”
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“In their model, Lovato and Gradisar (2014) stipulate that more time spent awake in bed, in an environment free of visual and auditory distraction, the greater the opportunity for rumination.”
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“, 2019) and reviewed findings (Lovato and Gradisar, 2014) but appears to contrast with prior Bangladeshi reports (Anjum et al.”
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“This ﬁ nding is in line with the conclusion obtained by Orzech et al. (2011) through an interview survey and con ﬁ rms the hypothesis in the prior literature that sleep and depression in adolescents may have a bidirectional relationship (Illingworth, 2020; Lovato & Gradisar, 2014).”
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“A meta-analysis of 23 studies examining the prospective role of sleep and depression predicting each other found stronger evidence for sleep disturbance predicting later depression than the opposite trajectory in young people (Lovato & Gradisar, 2014).”
Background
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“A growing number of studies have further indicated the relation between sleep disorder and depressive symptoms (14, 18).”
Background
Effect of adjuvant sleep hygiene psychoeducation and lorazepam on depression and sleep quality in patients with major depressive disorders: results from a randomized three-arm intervention
Brand, S., Rahimi, A., Ahmadpanah, M., Shamsaei, F., Cheraghi, F., Bahmani, D. S., & Holsboer‐Trachsler, E. (2016) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s110978 · Cited by 26
“Strikingly, Lovato and Gradisar 14 showed in their meta-analysis that, among adolescents, sleep disturbances preceded symptoms of depression and not vice versa.”
Repetitive Negative Thinking Mediates the Relationship Between Sleep Disturbance and Symptoms of Generalized Anxiety, Social Anxiety, Depression, and Eating Disorders in Adolescence: Findings From a 5-Year Longitudinal Study
Richardson, C. E., Magson, N. R., Oar, E. L., Fardouly, J., Johnco, C. J., Freeman, J. Y. A., & Rapee, R. M. (2024) · Clinical Psychological Science · doi:10.1177/21677026241230458 · Cited by 23
“Current evidence more strongly suggests that sleep disturbance predicts subsequent increases in anxiety (Willis & Gregory, 2015) and depression (Lovato & Gradisar, 2014) than the inverse (i.e., that anxiety and/or depression predict worsening of sleep), although there is a lack of research…”
Influential
Social jetlag and depressive symptoms among young people: a systematic review and meta-analysis
Sun, S., Yang, Y., Yu, F., He, Y., Luo, C., Zhang, M., Chen, H., & Tung, T. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07066-x · Cited by 27
“Although recent meta-analytic evidence suggests that sleep disturbance in adolescents typically precedes the onset of depression [48], this study should still be cautiously interpreted.”
Risk for Sleep Disorder Measured During Students’ First College Semester May Predict Institutional Retention and Grade Point Average Over a 3-Year Period, With Indirect Effects Through Self-Efficacy
Gaultney, J. F. (2015) · Journal of College Student Retention Research Theory & Practice · doi:10.1177/1521025115622784 · Cited by 23
“A link between insomnia and depression has been widely reported (Lovato & Gradisar, 2014).”
Background
Review: Schlafprobleme und psychische Störungen im Kindes- und Jugendalter
Schnatschmidt, M., & Schlarb, A. A. (2018) · Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie · doi:10.1024/1422-4917/a000605 · Cited by 23

Authors: Lovato, N., & Gradisar, M.
Affiliations: Flinders University (AU)
Corresponding author: Lovato, Nicole
ORCID: Lovato, Nicole
Gradisar, Michael
Venue: Sleep Medicine Reviews
Publisher: Elsevier BV
Published: 2014-12
Volume: 18
Issue: 6
Pages: 521-529
ISSN: 1087-0792 (ISSN-L)
DOI: 10.1016/j.smrv.2014.03.006
OpenAlex: W2064090130
Cited by: 594
References: 98
Citations by year: 2026: 59 · 2025: 65 · 2024: 61 · 2023: 59 · 2022: 64 · 2021: 58 · 2020: 42 · 2019: 62 · 2018: 43 · 2017: 33 · 2016: 27 · 2015: 15 · 2014: 4
FWCI: 3.50
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Sleep Medicine Reviews (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
Keywords: sleep disorders, adolescent depression, sleep latency, wake after sleep onset, sleep efficiency, depression onset, remission, clinical guidelines
MeSH terms: Adolescent, Child, Depression, Major Depressive Disorder, Humans, Models, Theoretical, Sleep Wake Disorders, Young Adult

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A meta-analysis and model of the relationship between sleep and depression in adolescents: Recommendations for future research and clinical practice

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