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Poor sleep is prevalent in adolescents with bipolar disorder, precedes illness onset, and is associated with worse mood symptoms. Furthermore, adolescents with bipolar disorder are at a heightened risk for suicidal behavior. 

Because many risk factors for suicidal behavior (e.g., prior history of trauma, family history of bipolar disorder) are not modifiable, it is critical to identify novel risk factors for bipolar disorder symptoms in youths that can help improve quality of life. Poor sleep quality, which is modifiable, may be an important risk factor for mood symptoms in bipolar disorder, particularly during the vulnerable period of adolescence.

Scientists from Pitt Psychiatry including Michelle Stepan, PhD (Assistant Professor of Psychiatry); Peter Franzen, PhD (Associate Professor of Psychiatry, Psychology, and Clinical and Translational Science); and Tina Goldstein, PhD (Pittsburgh Foundation Endowed Professor in Psychiatry Research and Professor of Psychiatry and Associate Professor of Psychology), conducted a study to improve our understanding of the association between poor sleep and mood symptoms in adolescents with bipolar disorder.

“In adolescents, examining relationships between sleep and mood is especially important since both tend to undergo substantial changes—often for the worse—during this developmental period, particularly for adolescents with bipolar disorder,” said Dr. Stepan, first and corresponding author of the study, which was published in the Journal of Affective Disorders. 

Adolescents with bipolar disorder participated in a two-year longitudinal treatment study, which included repeated self-report assessments of sleep quality, using the Pittsburgh Sleep Quality Index (PSQI), and weekly clinician-rated mood symptoms. Lag models tested whether sleep quality predicted future mood symptoms over the next month. Inverse models, whether mood symptoms predicted future sleep quality, were also tested.

The investigators found that poor sleep quality was, at a minimum, common among adolescents with bipolar disorder, with over 75% of participants meeting the criteria for poor sleep quality at baseline. Furthermore, poor sleep quality largely persisted across treatment for bipolar disorder, despite an initial improvement. Poor sleep quality predicted worse future mood symptoms in the middle of treatment and was also related to more suicide attempts during the study. On the other hand, worse mood symptoms tended to predict worse future sleep quality either very early in treatment or later at the end of treatment/during the post-treatment follow-up. “Fortunately, there are effective interventions to improve sleep health,” said Dr. Franzen, co-author. 

“Our findings suggest that using evidence-based approaches to treat sleep difficulties among youth with bipolar disorder, adjunct to other indicated treatments, may represent a promising approach to improve mood symptoms and decrease suicide risk in this high-risk population,” said Dr. Goldstein, the study’s senior author.

Sleep quality predicts future mood symptoms in adolescents with bipolar disorder
Stepan ME, Franzen PL, Teresi GI, Rode N, Goldstein TR.
Journal of Affective Disorders vol. 361, 15 September 2024, pages 664-673.