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JRUMS 2026, 25(1): 77-90 |
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Ethics code: IR. USWR.REC.1402.063
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Rahimian S, Momeni F, Shakiba S, Hosseinzadeh S, Sahraian K. The Differential Role of Sleep Indices (Insomnia Severity, Sleep Quality, and Daytime Sleepiness) in Predicting Internalizing and Externalizing Problems among Adolescents in Mashhad in 2023: A Descriptive Study. JRUMS 2026; 25 (1) :77-90
URL: http://journal.rums.ac.ir/article-1-7896-en.html
URL: http://journal.rums.ac.ir/article-1-7896-en.html
University of Social Welfare and Rehabilitation Sciences
Abstract: (5 Views)
Background and Objectives: Sleep is a fundamental component of adolescent mental health; however, the differential associations between various sleep indices and internalizing versus externalizing dimensions of psychological problems remain underexplored. This study aimed to investigate the role of sleep patterns—including insomnia severity, sleep quality, and daytime sleepiness—in predicting internalizing and externalizing problems among adolescents.
Materials and Methods: This descriptive study was conducted on 381 adolescents aged 12 to 18 years who referred to education counseling centers in Mashhad, Iran, in 2023. Participants were selected using convenience sampling. Data were collected using the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), a daily sleep log, and the Youth Self-Report (YSR). Pearson’s correlation test and multiple linear regression analysis were employed for data analysis.
Results: Insomnia severity (r=0.573), poor sleep quality (r=-0.163), and daytime sleepiness (r=0.586) demonstrated significant correlations with internalizing problems (p<0.01). These indices also showed significant correlations with externalizing problems (p<0.01). Regression analysis revealed that insomnia severity (β=0.457) and daytime sleepiness (β=0.288) were significant positive predictors of internalizing problems (p<0.001). Similarly, insomnia severity (β=0.303) and daytime sleepiness (β=0.240) significantly predicted externalizing problems (p<0.001), whereas sleep quality did not contribute significantly to either model (p>0.05).
Conclusion: The current study indicated significant associations between sleep indices and psychological problems in adolescents. Insomnia severity showed the strongest correlation with internalizing problems, while daytime sleepiness was most strongly correlated with externalizing problems. These results underscore the importance of multidimensional sleep assessment in adolescent mental health screening and intervention programs.
Keywords: Sleep quality, Insomnia, Adolescent, Internalizing problems, Externalizing problems
Funding: This study did not have any funds.
Conflict of interest: None declared.
Ethical considerations: The Ethics Committee of the University of Social Welfare and Rehabilitation Sciences approved the study (IR.USWR.REC.1402.063).
Authors’ contributions:
- Conceptualization: Samira Rahimian, Fereshte Momeni, Shima Shakiba
-Methodology: Samira Rahimian, Fereshte Momeni, Shima Shakiba, Samaneh Hosseinzadeh
- Data collection: Samira Rahimian
- Formal analysis: Samira Rahimian, Samaneh Hosseinzadeh, Kimia Sahraian
- Supervision: Fereshte Momeni, Shima Shakiba
- Project administration: Fereshte Momeni
- Writing – original draft: Kimia Sahraian, Samira Rahimian
- Writing – review & editing: Kimia Sahraian, Samira Rahimian, Fereshte Momeni, Shima Shakiba, Samaneh Hosseinzadeh
Materials and Methods: This descriptive study was conducted on 381 adolescents aged 12 to 18 years who referred to education counseling centers in Mashhad, Iran, in 2023. Participants were selected using convenience sampling. Data were collected using the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), a daily sleep log, and the Youth Self-Report (YSR). Pearson’s correlation test and multiple linear regression analysis were employed for data analysis.
Results: Insomnia severity (r=0.573), poor sleep quality (r=-0.163), and daytime sleepiness (r=0.586) demonstrated significant correlations with internalizing problems (p<0.01). These indices also showed significant correlations with externalizing problems (p<0.01). Regression analysis revealed that insomnia severity (β=0.457) and daytime sleepiness (β=0.288) were significant positive predictors of internalizing problems (p<0.001). Similarly, insomnia severity (β=0.303) and daytime sleepiness (β=0.240) significantly predicted externalizing problems (p<0.001), whereas sleep quality did not contribute significantly to either model (p>0.05).
Conclusion: The current study indicated significant associations between sleep indices and psychological problems in adolescents. Insomnia severity showed the strongest correlation with internalizing problems, while daytime sleepiness was most strongly correlated with externalizing problems. These results underscore the importance of multidimensional sleep assessment in adolescent mental health screening and intervention programs.
Keywords: Sleep quality, Insomnia, Adolescent, Internalizing problems, Externalizing problems
Funding: This study did not have any funds.
Conflict of interest: None declared.
Ethical considerations: The Ethics Committee of the University of Social Welfare and Rehabilitation Sciences approved the study (IR.USWR.REC.1402.063).
Authors’ contributions:
- Conceptualization: Samira Rahimian, Fereshte Momeni, Shima Shakiba
-Methodology: Samira Rahimian, Fereshte Momeni, Shima Shakiba, Samaneh Hosseinzadeh
- Data collection: Samira Rahimian
- Formal analysis: Samira Rahimian, Samaneh Hosseinzadeh, Kimia Sahraian
- Supervision: Fereshte Momeni, Shima Shakiba
- Project administration: Fereshte Momeni
- Writing – original draft: Kimia Sahraian, Samira Rahimian
- Writing – review & editing: Kimia Sahraian, Samira Rahimian, Fereshte Momeni, Shima Shakiba, Samaneh Hosseinzadeh
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Citation: Rahimian S, Momeni F, Shakiba Sh, Hosseinzadeh S, Sahraian K. The Differential Role of Sleep Indices (Insomnia Severity, Sleep Quality, and Daytime Sleepiness) in Predicting Internalizing and Externalizing Problems among Adolescents in Mashhad in 2023: A Descriptive Study. J Rafsanjan Univ Med Sci 2026 Apr; 25 (1): 77-90. doi: 1066224/jrums.25.1.77 [Farsi]
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Type of Study: Research |
Subject:
Psychiatry
Received: 2025/11/22 | Accepted: 2026/06/3 | Published: 2026/06/20
Received: 2025/11/22 | Accepted: 2026/06/3 | Published: 2026/06/20
References
1. Mashaikhi-Rad F, Sarkeshikiyan SM. Mediating Role of Sleep Quality and Perceived Stress in the Relationship Between Negative Emotional States and Health-related Quality of Life among Iranian Medical Students. Qom Univ Med Sci J 2025; 19(1): 3197. [Farsi]
2. Kansagra S. Sleep disorders in adolescents. Pediatrics 2020; 145(2): 204-9.
3. Morales-Muñoz I, Gregory AM. Sleep and mental health problems in children and adolescents. Sleep Med Clin 2023; 18(2): 245-54.
4. Al-Farsi HY, Al-Fahdi EY, Al-Balushi MA, Al-Jahwari AN, Al-Maskari AM, Das S. Sleep Disturbances Associated with Different Systems of the Body: Underlying Mechanisms Involved and Consequences. Curr Med Chem 2025; 32(34): 7624-50.
5. Li Y, Sahakian BJ, Kang J, Langley C, Zhang W, Xie C, et al. The brain structure and genetic mechanisms underlying the nonlinear association between sleep duration, cognition, and mental health. Nat Aging 2022; 2(5): 425-37.
6. Palagini L, Hertenstein E, Riemann D, Nissen C. Sleep, insomnia, and mental health. J Sleep Res 2022; 31(4): e13628.
7. Siavashi MS, Bagherzadeh R, Ravanipour M. Investigating sleep quality and related factors in adolescents in Bushehr in 2020. Iran J Pediatr Nurs 2023; 9(3): 11-24. [Farsi]
8. Ghadiri SAF, Abdolmohammadi K. Executive Functions in Adolescents with Sleep Disorder. Neurosci J Shefaye Khatam 2023; 11(2): 32-40. [Farsi]
9. Sarabadani E, Morovati Z. Comparison of Psychological Problems and Sleep Quality in Two Groups of Cyberbullying Victims and Normal People. Iran Evol Educ Psychol J 2022; 4(1): 103-14. [Farsi]
10. Khanshan M, Tamnaeifar MR. The relationship between parenting styles and attachment styles with adolescent sleep disorders: the mediating role of internet addiction. Rooyesh 2022; 11(1): 185-98. [Farsi]
11. Xue Y, Xue B, Zheng X, Shi L, Liang P, Xiao S, et al. Associations between internet addiction and psychological problems among adolescents: description and possible explanations. Front Psychol 2023; 14: 1097331.
12. Xiao H, Shen Y, Zhang W, Lin R. Applicability of the cognitive model of generalized anxiety disorder to adolescents’ sleep quality: A cross-sectional and longitudinal analysis. Int J Clin Health Psychol 2023; 23(4): 100406.
13. Zhou S-J, Zhang L-G, Wang L-L, Guo Z-C, Wang J-Q, Chen J-C, et al. Prevalence and socio-demographic correlates of psychological health problems in Chinese adolescents during the outbreak of COVID-19. Eur Child Adolesc Psychiatry 2020; 29(6): 749-58.
14. Yang Y, Liu X, Liu Z-Z, Tein J-Y, Jia C-X. Life stress, insomnia, and anxiety/depressive symptoms in adolescents: A three-wave longitudinal study. J Affect Disord 2023; 322: 91-8.
15. Castiglione-Fontanellaz CE, Schaufler S, Wild S, Hamann C, Kaess M, Tarokh L. Sleep regularity in healthy adolescents: Associations with sleep duration, sleep quality, and mental health. J Sleep Res 2023; 32(4): e13865.
16. Hamzehpour Matoughy F, Tavoli A, Salmanian M. Comparison of sleep problems and self-efficacy in individuals with symptoms of major depressive and social anxiety and normal individuals in 2022: A descriptive study. J Rafsanjan Univ Med Sci 2023; 22(7): 691-706. [Farsi]
17. Mehrabian T, Rahmani F. Prediction of insomnia severity based on cognitive and emotional variables and personality traits presented by DSM-5 in students of Kurdistan University in 2016. J Rafsanjan Univ Med Sci 2018; 16(11): 1025-40. [Farsi]
18. Karami J, Momeni K, Alimoradi F. The relationship between sleep quality with cognitive emotion regulation strategies and brain-behavioral systems in pregnant women. Avicenna J Nurs Midwifery Care 2018; 26(4): 219-26. [Farsi]
19. Farahani H, RoshanChesli R. Calculation and justification of sample size in researches of psychological sciences: Application of G*Power software. Clin Psychol Pers 2023; 20(2): 221-34. [Farsi]
20. Achenbach TM, Ruffle TM. The Child Behavior Checklist and related forms for assessing behavioral/emotional problems and competencies. Pediatr Rev 2000; 21(8): 265-71.
21. Kakaberaie K, Habibi AAM, Fedaei Z. Validation of Achenbach’s behavioral problems: performing the Youth Self-Report scale (YSR) for 11-18-year-old adolescents in high school students. Res Psychol Health 2008; 1(4): 50-66. [Farsi]
22. Achenbach TM, Rescorla LA. Manual for the ASEBA adult forms & profiles. 1st ed. Burlington, VT: University of Vermont, Research Center for Children, Youth & Families; 2003. p 432.
23. Habibi Asgarabad M, Besharat MA, Fadaei Z, Najafi M. Confirmatory factorial structure, reliability and validity of the Achenbach Youth Self-Report (YSR): Monozygotic and dizygotic twins. J Clin Psychol 2009; 1(1): 1-18. [Farsi]
24. Achenbach TM, Edelbrock CS. Manual for the youth self-report and profile. 1st ed. University of Vermont. Department of Psychiatry; 1987. p 280.
25. Morin CM. Insomnia: Psychological assessment and management. 1st ed. New York: Guilford Press; 1993. p 290.
26. 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.
27. Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2001; 2(4): 297-307.
28. Chahoud M, Chahine R, Salameh P, Sauleau E-A. Reliability, factor analysis and internal consistency calculation of the Insomnia Severity Index (ISI) in French and in English among Lebanese adolescents. eNeurologicalSci 2017; 7: 9-14.
29. Chehri A, Goldasteh N, Ahmadi S. Psychometric properties of the Epworth Sleepiness Scale in adolescents. Ravansanji 2019; 31(8): 91-108. [Farsi]
30. Buysse DJ, Reynolds III CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989; 28(2): 193-213.
31. Raniti MB, Waloszek JM, Schwartz O, Allen NB, Trinder J. Factor structure and psychometric properties of the Pittsburgh Sleep Quality Index in community-based adolescents. Sleep 2018; 41(6).
32. Chehri A, Brand S, Goldaste N, Eskandari S, Brühl A, Sadeghi Bahmani D, et al. Psychometric properties of the Persian Pittsburgh sleep quality index for adolescents. Int J Environ Res Public Health 2020; 17(19): 7095.
33. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991; 14(6): 540-5.
34. Johns MW. Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep 1992; 15(4): 376-81.
35. O’Callaghan VS, Couvy-Duchesne B, Strike LT, McMahon KL, Byrne EM, Wright MJ. A meta-analysis of the relationship between subjective sleep and depressive symptoms in adolescence. Sleep Med 2021; 79: 134-44.
36. Reynolds AC, Lechat B, Melaku YA, Sansom K, Brown BW, Crowther ME, et al. Shift work, clinically significant sleep disorders, and mental health in a representative, cross-sectional sample of young working adults. Sci Rep 2022; 12(1): 16255.
37. Cooper R, Di Biase MA, Bei B, Quach J, Cropley V. Associations of changes in sleep and emotional and behavioral problems from late childhood to early adolescence. JAMA Psychiatry 2023; 80(6): 585-96.
38. Bacaro V, Miletic K, Crocetti E. A meta-analysis of longitudinal studies on the interplay between sleep, mental health, and positive well-being in adolescents. Int J Clin Health Psychol 2024; 24(1): 100424.
39. Liu X. Trajectories of sleep problems and the longitudinal associations with mental health difficulties among Chinese adolescents. Soc Sci Med 2024; 358: 117203.
40. Sanabria AS, Fogel A, Natarajan P, Rodriguez A, Gunnar EJ. Active Components in Digital Health Interventions for Sleep among Adolescents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. NPJ Digital Medicine 2025; 8(1): 743.
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