Insônia entre adolescentes: influência dos fatores socioeconômicos, comportamentais e de saúde mental

Abstract

INTRODUCTION: Insomnia, among sleep disorders, is increasingly frequent among adolescents and can bring negative repercussions for physical and mental health, compromising their development throughout the life cycle. Although evidence indicates an association between socioeconomic factors, risk behaviors, and psychological distress with changes in sleep patterns, such determinants have often been investigated in isolation, limiting the understanding of their interrelationships. OBJECTIVE: To analyze how socioeconomic, behavioral, and mental health factors are directly and indirectly related to the occurrence of insomnia in Brazilian adolescents. METHODOLOGY: This is a cross-sectional study with 2,515 adolescents, using data from the 1997/98 birth cohort of São Luís, Maranhão. The latent variable insomnia was assessed based on two components from the Pittsburgh Sleep Quality Index: sleep duration and efficiency. Latent constructs were also built for socioeconomic status, substance use-related behaviors, and internalizing disorders. Structural equation modeling was used to estimate direct and indirect effects among the investigated factors. RESULTS: It was observed that 3.98% of adolescents reported sleeping less than 5 hours per night, and 6.79% showed low sleep efficiency. Internalizing disorders showed a positive direct effect on insomnia, establishing themselves as the main proximal determinant of insomnia. Screen time and adolescent occupation also had positive direct effects on the outcome, while sex and socioeconomic status exerted indirect effects mediated by internalizing disorders. CONCLUSION: Insomnia in adolescents emerges as a result of the interaction between structural and behavioral determinants, centrally mediated by psychological distress, and understanding this dynamic enables the development of public policies aimed at the comprehensive health of this population.