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Pesquisa
Sleep health dimensions from wearables and transdiagnostic mental health in young adolescents
Cooper RE, Baker AE, Quick AD, Yu L, Gonzalez R, Clark DB, McMakin DL, Soehner AM, Jalbrzikowski M, Wallace ML. Sleep Health Dimensions From Wearables and Transdiagnostic Mental Health in Young Adolescents. JAMA Pediatr. 2026 May 1;180(5):535-545. doi: 10.1001/jamapediatrics.2026.0335. PMID: 41870441; PMCID: PMC13010210.
Abstract
Importance: Sleep behavior markedly shifts in adolescence, increasing vulnerability to mental health disorders. While sleep health is understood to be multidimensional, adolescent-specific sleep health dimensions have not been empirically validated, and their relevance to transdiagnostic mental health outcomes is unknown.
Objective: To identify sleep health dimensions using Fitbit devices in a large sample of young adolescents and assess concurrent and prospective associations between sleep health dimensions and transdiagnostic mental health outcomes.
Design: A longitudinal cohort study using data from the Adolescent Brain Cognitive Development Study (data release 5.1, collected 2018–2020) including early adolescents (age 11– 13 years) within the United States. We used exploratory factor analysis (EFA) to identify sleep health dimensions and confirmatory factor analysis (CFA) to confirm the factor structure in an independent subsample. We used linear mixed-effects models to test concurrent and prospective associations between sleep dimensions and mental health outcomes at 1-year follow-up.
Setting: Multicenter community setting.
Participants: 3,393 participants from the Adolescent Brain Cognitive Development Study.
Exposures: Objective sleep data collected for up to 21 days (range 7–21) using wearable Fitbit devices.
Main Outcomes and Measures: Transdiagnostic mental health outcomes assessed via the Child Behavior Checklist and Brief Problem Monitor (internalizing and externalizing symptoms), Prodromal Questionnaire-Brief Child Version (psychotic-like symptoms), and 10-Item Mania Scale (mania symptoms).
Results: 3,393 participants were split into EFA and CFA subsamples. We identified 6 factors using EFA: Irregularity, Timing, Social Jetlag, Duration, Weekend Oversleep, and Continuity. CFA confirmed this factor structure. Greater sleep Irregularity was associated with transdiagnostic mental health symptoms cross-sectionally, but not prospectively. Shorter Duration was associated with total, internalizing, externalizing and attention symptoms cross-sectionally, and total, attention and psychotic symptoms 1 year later.
Conclusions and Relevance: Wearable Fitbit data provide empirical support for multidimensional frameworks of sleep health in adolescence. Although effect sizes were small, sleep Irregularity and Duration emerged as key dimensions with relevance to mental health. These findings establish a foundation for myriad future investigations, including examining withinperson patterns of the 6 dimensions; extending to older adolescence; investigating associations with other health outcomes; replicating with research-grade actigraphy devices; and suggesting potential targets for pediatric sleep interventions.
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