Welcome to the third article in a six-part series, covering “The Big 6:” the six key modifiable health behaviours that play a critical role in both the physical and mental health of youth, now and in the long-term [1,2]. These six behaviours are dietary intake, physical activity, sleep, sedentary recreational screen time, alcohol use and tobacco/e-cigarette use. Read about dietary intake here, and physical activity here.
In one of the largest school-based prevention clinical trials in Australia, the Health4Life program found significant associations between each of the Big 6 and depression, anxiety, and psychological distress symptoms in adolescents [1-3].
This blog post will cover the sleep component of the Big Six and how it impacts youth wellbeing.
Sleep and mental health in youth
Sleep deprivation impacts many facets of mental health, physical wellbeing, and behaviour, and the relationship between sleep and mental health is complex and bidirectional. With reports of sleep disturbances correlating with the rise in mental health concerns in adolescents, it is therefore crucial to understand the relationship between sleep and mental health, and the effects of poor sleep on the school experience [4].
Growing evidence suggests that lack of sleep during adolescence can disrupt the development of a brain pathway linking the prefrontal cortex and amygdala, making it harder for teens to regulate emotions and increasing their sensitivity to threats [1]. Sleep deprivation in teens is linked to increased anxiety, depression, unhappiness, and being more likely to be late or absent from school [5, 6]. The effects of sleep deprivation in teenagers may be written off as “normal” teenage moodiness and behavioural issues, but these symptoms, when due to lack of sleep, are not normal for teenagers and should be addressed.
The Australian Sleep Guidelines recommend that young people aged 14 to 17 years-old get 8 to 10 hours of uninterrupted sleep each night. However, a 2019 study of the sleep patterns of Australian youth found that a quarter of 12-15 year-olds and half of 16-17 year-olds are not meeting these guidelines.
Furthermore, teens often try to catch up on sleep by sleeping more on weekends, which can be detrimental as this “yoyo” pattern leads to disturbed sleep wake cycles, which goes against the sleep guidelines of keeping regular sleep and wake up times [5].
The Big 6: Sleep duration
The 2023 study conducted using the Health4Life data investigated associations between the Big 6 health behaviours and mental health among adolescents in Australia [1,3].
For sleep duration, the study found that:
- Young people who slept an average of 10–10.5 hours per night had the lowest anxiety scores – 30% lower than those who slept for less than five hours.
- Adolescents who slept 9.5–10 hours per night had the lowest depression and psychological distress scores – 64% and 48% lower respectively compared with those who slept for less than five hours.
How does the Health4Life program target sleep?
The Health4Life program utilises a strength-based and Multiple Health Behaviour Change (MHBC) approach, in which related health behaviours are addressed together to efficiently promote behaviour change among students. The six cartoon lessons impart knowledge about the ‘Big Six’ health behaviours (which includes healthy sleep patterns), and explain the associations and interrelations between multiple health behaviours, for example, how increasing physical activity can improve sleep.
Below are some examples from the cartoon storylines, where one character had stayed up late gaming the night before and was falling asleep in class. His classmate wakes him up and later in the story encourages him to join the basketball team to encourage being more physically active in his spare time and help his sleep.
Here is an example of a multiple-choice activity, which are embedded in each lesson along with ‘Stop & Think’ activities, to assess and consolidate learning:
The Health4Life program is the first online health education program teaching year 7-8 secondary school students about these Big 6 health behaviours. The program is aligned with the Australian Health and Physical Education curriculum and the NSW Personal Development, Health and Physical Education syllabus and requires no teacher training and minimal preparation for all class and homework activities. Read more about Health4Life here.
Click here for more information, including a factsheet about getting enough sleep for young people.
Author: Francesca Wallis
With expert review by researchers at the Matilda Centre for Research in Mental Health and Substance Use.
References:
[1] S. Smout, L. A. Gardner, N. Newton, and K. E. Champion, “Dose–response associations between modifiable lifestyle behaviours and anxiety, depression and psychological distress symptoms in early adolescence,” Australian and New Zealand Journal of Public Health, vol. 47, no. 1, p. 100010, Feb. 2023, doi: https://doi.org/10.1016/j.anzjph.2022.100010.[2] Teesson M, Champion KE, Newton NC, et al, “Study protocol of the Health4Life initiative: a cluster randomised controlled trial of an eHealth school-based program targeting multiple lifestyle risk behaviours among young Australians.” BMJ Open 2020;10:e035662. doi: 10.1136/bmjopen-2019-035662
[3] S. Smout and L. Gardner, “The big six modifiable factors for youth mental health,” InSight+, 2023. https://insightplus.mja.com.au/2023/17/the-big-six-modifiable-factors-for-youth-mental-health/
[4] M. Woodfield, N. G. Butler, and M. Tsappis, “Impact of sleep and mental health in adolescence: an overview,” Current Opinion in Pediatrics, vol. 36, no. 4, p. 10.1097/MOP.0000000000001358, Aug. 2024, doi: https://doi.org/10.1097/MOP.0000000000001358.
[5] T. Evans-Whipp and C. Gasser, “Are children and adolescents getting enough sleep?,” Australian Institute of Family Studies, Dec. 2019. Available: https://aifs.gov.au/media/australian-teens-not-getting-enough-sleep
[6] J. Garey, “Teens and Sleep: The Cost of Sleep Deprivation,” Child Mind Institute, Mar. 08, 2024. https://childmind.org/article/happens-teenagers-dont-get-enough-sleep/
