Fourteen-year-old James had experienced more than his share of troubles. In the previous year he was in a major car accident where his father, the driver, was killed and his mother spent months in hospital. James was not physically injured but spent hours trapped in the wreckage awaiting help. He is reluctant to attend school and spends hours in his room alone, sleeping until midday and becoming increasingly isolated from family and friends. His GP has diagnosed ‘anxiety and depression’ . As a practitioner, where to begin?
Adolescents and Trauma
Experiencing trauma in childhood and adolescence has been shown to result in social, academic, and emotional consequences. Increased threat detection and hypervigilance, which are adaptive in the immediate aftermath, become maladaptive when they occur beyond the context of the trauma and increase the risk of anxiety and depression.
Another risk factor following trauma is sleep disturbance. An explanation for this is that ‘exposure to traumatic events induce and maintain states of physiological hyperarousal, which may interfere directly with sleep while increasing susceptibility to other mental health conditions, such as anxiety and depression.’ Disturbance of the sleep-wake cycle further exacerbate physiological sensitivity to stress and may be a key component in the development of trauma related disorders and predictive of the development of depression and anxiety. However, it is unclear whether sleep provides a buffer against the development of mental health symptoms in adolescents exposed to trauma and this is an area of study authors Coote et al (2025) chose to address.
Exploring the Relationship Between Sleep, Mental Health, and Trauma in Adolescence
The study first aimed to identify whether any exposure to trauma was independently associated with mental health outcomes, secondly if trauma was associated with sleep and lastly whether sleep moderates the impact of trauma on mental health. 752 Australian year 8 and 9 students completed a baseline survey of trauma, sleep and measures of depression, anxiety, and mental wellbeing.
The results showed that trauma was independently associated with higher levels of depressive and anxiety symptoms and lower mental wellbeing and that those who had experienced one or more events were significantly more likely to have difficulty falling asleep and reported sub-optimal amounts of sleep. Failing to meet sleep duration guidelines was found to moderate the relationship between trauma and symptoms of anxiety and depression.
However, the results did not demonstrate a significant moderating effect between trauma and sleep duration on mental wellbeing. This suggests that difficulty falling asleep may be associated with mental health of adolescents irrespective of trauma.
In Conclusion
While the study leaves questions unanswered about the directionality of the relationship between adolescent trauma, sleep, and mental health it confirms the centrality of sleep in supporting mental health. The clinician confronted with the complexity of a young person who has experienced distressing events knows the inside neurobiology and outside socio- relational matters must all be addressed. However, finding an effective starting point is not always obvious. Establishing good sleep can be an effective and intuitively sensible place to begin and one that is supported by evidence.
Coote, T.,Barrett,E. and Grummitt, L. Sleep duration in adolescence buffers the impact of childhood trauma on anxiety and depressive symptoms BMC Public Health (2025) 25:437https://doi.org/10.1186/s12889-025-21621-x
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