Abstract
Insomnia is prevalent in adolescents. Although several insomnia scales/questionnaires are available to assess insomnia symptoms and severity for adults, no insomnia scale has been specifically developed for adolescents. This study assessed the psychometric properties of the Youth Self-Rating Insomnia Scale (YSIS) in a large sample of Chinese adolescents. The YSIS consists of 8 items assessing insomnia symptoms, perceived sleep quality and insufficiency, and impaired daytime functioning. Each item is rated on a 5-point scale. A sample of 11,626 adolescents in China completed the YSIS and a structured questionnaire to assess sleep duration, sleep problems, hypnotic use, and behavioral/emotional problems. A subsample of 242 adolescents completed retest questionnaire 2 weeks later. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and a receiver operating characteristic (ROC) curve analysis were performed. The YSIS score ranged from 8 to 40 (M = 19.1, SD= 6.2). Internal consistency reliability coefficient was 0.80 and 2-week test–retest reliability coefficient was 0.82. Both EFA and CFA yielded 2 dominant factors defined as insomnia symptoms (3 items) and daytime distress or impairment (5 items). The YSIS score was significantly correlated with short nocturnal sleep duration, depression, hypnotic use, sleep disordered breathing problems, restless legs syndrome, and daytime sleepiness. Similar results were obtained between male and female adolescents. The YSIS appears to be a simple, reliable and valid scale for assessing insomnia severity in adolescents. Further research is warranted to assess its psychometric properties with clinical samples and non-Chinese adolescents.
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References
Carskadon MA. Sleep in adolescents: the perfect storm. Pediatr Clin North Am. 2011;58(3):637–47.
Carskadon MA, et al. Adolescent sleep patterns, circadian timing, and sleepiness at a transition to early school days. Sleep. 1998;21(8):871–81.
Owens J. Insufficient sleep in adolescents and young adults: an update on causes and consequences. Pediatrics. 2014;134(3):e921–32.
Keyes KM, et al. The great sleep recession: changes in sleep duration among US adolescents, 1991–2012. Pediatrics. 2015;135(3):460–8.
Liu X, Buysse DJ. Sleep and youth suicidal behavior: a neglected field. Curr Opin Psychiatry. 2006;19(3):288–93.
Dahl RE, Lewin DS. Pathways to adolescent health sleep regulation and behavior. J Adolesc Health. 2002;31(6 Suppl):175–84.
Gradisar M, Gardner G, Dohnt H. Recent worldwide sleep patterns and problems during adolescence: a review and meta-analysis of age, region, and sleep. Sleep Med. 2011;12(2):110–8.
Li SX, et al. Eveningness chronotype, insomnia symptoms, and emotional and behavioural problems in adolescents. Sleep Med. 2018;47:93–9.
Chung KF, Kan KK, Yeung WF. Assessing insomnia in adolescents: comparison of Insomnia Severity Index, Athens Insomnia Scale and Sleep Quality Index. Sleep Med. 2011;12(5):463–70.
Ji X, Liu J. Subjective sleep measures for adolescents: a systematic review. Child Care Health Dev. 2016;42(6):825–39.
Luginbuehl M, Kohler WC. Screening and evaluation of sleep disorders in children and adolescents. Child Adolesc Psychiatr Clin N Am. 2009;18(4):825–38.
Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146(5):1387–94.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.
Roth T. Insomnia: definition, prevalence, etiology, and consequences. J Clin Sleep Med. 2007;3(5 Suppl):S7–10.
Ohayon MM, Roberts RE. Comparability of sleep disorders diagnoses using DSM-IV and ICSD classifications with adolescents. Sleep. 2001;24(8):920–5.
Ohayon MM, et al. Prevalence and patterns of problematic sleep among older adolescents. J Am Acad Child Adolesc Psychiatry. 2000;39(12):1549–56.
Morin CM, et al. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011;34(5):601–8.
Liu X, Zhao Z, Jia C. Insomnia symptoms, behavioral/emotional problems, and suicidality among adolescents of insomniac and non-insomniac parents. Psychiatry Res. 2015;228(3):797–802.
Liu X, et al. Prevalence and correlates of self-reported sleep problems among Chinese adolescents. Sleep. 2000;23(1):27–34.
Buysse DJ, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213.
Soldatos CR, Dikeos DG, Paparrigopoulos TJ. Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria. J Psychosom Res. 2000;48(6):555–60.
Roberts RE, Roberts CR, Chan W. Persistence and change in symptoms of insomnia among adolescents. Sleep. 2008;31(2):177–84.
Johnson EO, et al. Epidemiology of DSM-IV insomnia in adolescence: lifetime prevalence, chronicity, and an emergent gender difference. Pediatrics. 2006;117(2):e247–56.
Buysse DJ, et al. Recommendations for a standard research assessment of insomnia. Sleep. 2006;29(9):1155–73.
Moul DE, et al. Self-report measures of insomnia in adults: rationales, choices, and needs. Sleep Med Rev. 2004;8(3):177–98.
Chervin RD, et al. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Med. 2000;1(1):21–32.
Wolfson AR, et al. Evidence for the validity of a sleep habits survey for adolescents. Sleep. 2003;26(2):213–6.
Luginbuehl M, et al. Pediatric sleep disorders: validation of the sleep disorders inventory for students. School Psychol Rev. 2008;37(3):409–31.
Liu XC et al. Prevalence of suicidal behaviour and associated factors in a large sample of Chinese adolescents. Epidemiol Psychiatr Sci. 2019;28:280–89.
Liu X et al. Insomnia and psychopathological features associated with restless legs syndrome in Chinese adolescents. J Clin Psychiatry. 2018. https://doi.org/10.4088/JCP.16m11358.
Liu X et al. Early menarche and menstrual problems are associated with sleep disturbance in a large sample of Chinese adolescent girls. Sleep. 2017. https://doi.org/10.1093/sleep/zsx107.
Liu ZZ, et al. Psychological and behavioral characteristics of suicide attempts and non-suicidal self-injury in Chinese adolescents. J Affect Disord. 2018;226:287–93.
Owens JA, Spirito A, McGuinn M. The Children’s Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep. 2000;23(8):1043–51.
Liu X, et al. Sleep patterns and problems among Chinese adolescents. Pediatrics. 2008;121(6):1165–73.
Liu X, et al. Poor sleep quality and nightmares are associated with non-suicidal self-injury in adolescents. Eur Child Adolesc Psychiatry. 2017;26(3):271–9.
Liu XC, et al. Psychometric assessment of the Chinese adolescent daytime sleepiness scale (CADSS). Sleep Biol Rhythms. 2017;15:207–16.
Allen RP, et al. Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med. 2003;4(2):101–19.
Radloff LS. The CES-D scale: A self report depression scale for research in the general population. 1, 385–401. Appl Psychol Measure. 1977;1:385–401.
Liu X, et al. Reliability and validity of the Youth Self-Report (YSR) of Achenbach’s Child Behavior Checklist (CBCL)[in Chinese]. Chin Mental Health J. 1997;11(4):200–3.
Green SB, Yang Y. Reliability of summed item scores using structural equation modeling: an alternative to coefficient alpha. Psychometrika. 2009;74(1):155–67.
Acknowledgements
The authors would like to thank staffs at Yanggu County Center for Disease Control and Prevention, Li** County Center for Disease Control and Prevention, and Zoucheng City Center for Disease Control and Prevention, Shandong Province, China and all participating school teachers for their help with data collection and all students for their voluntarily participating in the study. The authors would also like to thank Colin Liu for assistance with literature search.
Funding
This research was funded in part for data collection by National Natural Science Foundation of China (Grant Number 81573233).
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This study was approved by the research ethics committee of Shandong University and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
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Appendix
Appendix
Youth Self-Rating Insomnia Scale (YSIS)
During the past month, how often would you rate your sleep? Please circle your answer to the following questions.
过去一个月,你的睡眠情况如何?请对每个问题选择适合你的答案。.
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Liu, X., Yang, Y., Liu, ZZ. et al. Psychometric properties of Youth Self-Rating Insomnia Scale (YSIS) in Chinese adolescents. Sleep Biol. Rhythms 17, 339–348 (2019). https://doi.org/10.1007/s41105-019-00222-3
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DOI: https://doi.org/10.1007/s41105-019-00222-3