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Abstract Introduction Poor sleep and mental health problems commonly emerge in adolescence, with a higher prevalence in females and those who suffer from obesity. Here, we evaluated the complex associations between poor sleep, obesity, and biological sex and how they interact to influence wellbeing in a large, diverse cohort of adolescents in the US. Methods Data were analyzed from 7,261 adolescents (Year 2: Mean age=11.94 years, range: 10-14 years, 47.3% female), collected as part of the ongoing ABCD Study®. Sleep duration was assessed with the Munich Chronotype questionnaire (youth-report), and sleep quality was assessed with a question about having trouble falling or staying asleep in the past two weeks from the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5) (youth-report). Internalizing and externalizing problems were assessed using the Child Behavior Checklist (caregiver-report). Positive affect was assessed with the NIH-toolbox measures. Regression models examined associations between obesity (95 body mass index percentile), sleep behavior and mental health, considering sex differences, age, and socio-demographic characteristics. Results Short sleep duration and poorer sleep quality, as well as obesity were associated with higher internalizing (p.01) and externalizing (p.01) problems. Adolescents with obesity and prolonged sleep duration had higher internalizing (p=.01) and externalizing problems (p.01). Shorter sleep duration (p.01) and poorer sleep quality (p=.01) were associated with lower positive affect, with stronger effects in female adolescents. Obesity partially mediated the association between sleep problems and positive affect (p.01). Conclusion This study demonstrates a strong link between sleep, obesity, and mental health outcomes in adolescents, highlighting significant sex differences. Poor sleep quality and obesity is related to more internalizing and externalizing problems and lower positive affect, with notable with notable impacts on female adolescents. These findings highlight the importance of addressing sleep and obesity in adolescent mental health interventions, recognizing the unique vulnerabilities and needs of male and female adolescents and those with obesity. Support (if any) National Institutes of Health: U01DA041022
Harkness et al. (Sat,) studied this question.