Psychosocial Determinants of Insomnia in Adolescents: Roles of Mental Health, Behavioral Health, and Social Environment.

The theoretical explanation of human problems is derived from the complex interplay of psychological, social, economic, political, and physical factors.This study examined the roles of behavioral health (i.e., alcohol abuse and suicidality) and social environment (i.e., family support, school connectedness, and favorable neighborhood) and mental health [i.e., depression, anxiety, and attention deficit hyperactivity disorder (ADHD)] in predicting insomnia in adolescents in an ecological perspective.Approximately 6445 high school students in Taiwan were administered an anonymous self-report survey. Hierarchical multiple regression was performed to examine how multidimensional social environment, behavioral health, and mental health factors were associated with insomnia in adolescents.The prevalence rate of insomnia in the sample was 30%. The results indicated that alcohol abuse (β = 0.04), suicidality (β = 0.06), depression (β = 0.29), anxiety (β = 0.14), and ADHD (β = 0.11) were positively associated with insomnia ( < 0.001), whereas family support (β = -0.06), school connectedness (β = -0.05), and favorable neighborhood β = -0.10) were negatively associated with insomnia ( < 0.001). Sex did not predict insomnia, but age was positively associated with insomnia (β = 0.09, < 0.001). Among all predictors of insomnia in the study, mental health factors, especially depression, play a major role on insomnia among adolescents, and is as much important as social environment factors.This study demonstrated how both psychosocial variables (social environment and behavioral health) and psychological symptoms were associated with insomnia in adolescents when the demographic variables (sex and age) were controlled and provided valuable information and evidence for clinicians, social workers, and health professionals who provide support to adolescents with insomnia. Applying an ecological approach in practice can aid in understanding at individual, family, school, and community levels and in identifying the strengths and weaknesses of their interactions with each other.This perspective enables practitioners in effectively treating problems and addressing the needs of the various levels, including the individual, family, school, and the broader community. Thus, prevention and intervention of insomnia in adolescents should focus on multidimensional risk and protective factors, including mental health, behavioral health, and social environment, in the context of an ecological system.