Abstract
Sleep difficulties may be one explanatory factor in the association between depression and insulin resistance; yet, explicit tests of this hypothesis are lacking. We determined if there was an indirect effect of depression symptoms on insulin resistance through sleep duration in adolescents at risk for excess weight gain. We also investigated whether dispositional mindfulness moderated the interconnections among depression, sleep, and insulin resistance. Ninety adolescents (14.2 ± 1.6y; 50% female) at risk for excess weight gain (body mass index [BMI, kg/m2] z score 1.6 ± 0.6) participated in the cross-sectional, baseline phase of a health behaviors study. Depression was assessed with the Center for Epidemiologic Studies–Depression Scale, sleep duration with the Sleep Habits Survey, and mindfulness with the Mindful Attention and Awareness Scale. Homeostatic model assessment of insulin resistance was determined from fasting insulin and glucose. The product-of-coefficients method was used to test the indirect effect of depression on insulin resistance through sleep duration, accounting for age, sex, BMIz, puberty, and socioeconomic status (SES). Dispositional mindfulness was tested as a moderator of the associations among depression, sleep, and insulin resistance. There was a significant indirect effect of depression on insulin resistance through sleep duration, controlling for age, sex, BMIz, puberty, and SES, 95%CI [0.001, 0.05]. Dispositional mindfulness moderated the association between sleep duration and insulin resistance, such that lower sleep duration related to greater insulin resistance only among adolescents with lower mindfulness (p < .001). Short sleep may be one explanatory factor in the depression-insulin resistance connection in adolescents at risk for excess weight gain. Adolescents with poorer mindfulness and short sleep are at highest risk for insulin resistance, whereas higher mindfulness may be protective.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adam, T. C., Hasson, R. E., Ventura, E. E., et al. (2010). Cortisol is negatively associated with insulin sensitivity in overweight Latino youth. Journal of Clinical Endocrinology and Metabolism, 95(10), 4729–4735. https://doi.org/10.1210/jc.2010-0322
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/https://doi.org/10.1176/appi.books.9780890425596
Berkowitz, S. A., Traore, C. Y., Singer, D. E. et al. (2015). Evaluating area-based socioeconomic status indicators for monitoring disparities within health care systems: Results from a primary care network. Health Services Research, 50(2), 398–417. https://doi.org/10.1111/1475-6773.12229
Blake, M. J., Snoep, L., Raniti, M. et al. (2017). A cognitive-behavioral and mindfulness-based group sleep intervention improves behavior problems in at-risk adolescents by improving perceived sleep quality. Behavior Research and Therapy, 99, 147–156. https://doi.org/10.1016/j.brat.2017.10.006
Bogusch, L. M., Fekete, E. M., & Skinta, M. D. (2016). Anxiety and depressive symptoms as mediators of trait mindfulness and sleep quality in emerging adults. Mindfulness, 7(4), 962–970. https://doi.org/10.1007/s12671-016-0535-7
Braveman, P. A., Cubbin, C., Egerter, S. et al. (2005). Socioeconomic status in health research: One size does not fit all. JAMA, 294(22), 2879–2888. https://doi.org/10.1001/jama.294.22.2879
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848. https://doi.org/10.1037/0022-3514.84.4.822
Caldwell, K., Harrison, M., Adams, M. et al. (2010). Developing mindfulness in college students through movement-based courses: Effects on self-regulatory self-efficacy, mood, stress, and sleep quality. Journal of American College Health, 58(5), 433–442. https://doi.org/10.1080/07448480903540481
Creswell, J. D., & Lindsay, E. K. (2014). How does mindfulness training affect health? A mindfulness stress buffering account. Current Directions in Psychological Science, 23(6), 401–407. https://doi.org/10.1177/0963721414547415
Creswell, J. D., Lindsay, E. K., Villalba, D. K. et al. (2019). Mindfulness training and physical health: Mechanisms and outcomes. Psychosomatic Medicine, 81(3), 224–232. https://doi.org/10.1097/PSY.0000000000000675
Dunning, D. L., Griffiths, K., Kuyken, W. et al. (2019). Research review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents–a meta-analysis of randomized controlled trials. Journal of Child Psychology and Psychiatry and Allied Disciplines, 60(3), 244–258
Dutil, C., & Chaput, J. P. (2017). Inadequate sleep as a contributor to type 2 diabetes in children and adolescents. Nutrition & Diabetes, 7(5), e266. https://doi.org/10.1038/nutd.2017.19
Epel, E., Daubenmier, J., Moskowitz, J. T. et al. (2009). Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres. Annals of the New York Academy of Sciences, 1172, 34–53. https://doi.org/10.1111/j.1749-6632.2009.04414.x
Field, A. E., Cook, N. R., & Gillman, M. W. (2005). Weight status in childhood as a predictor of becoming overweight or hypertensive in early adulthood. Obesity Research, 13(1), 163–169. https://doi.org/10.1038/oby.2005.21
Flint, J., Kothare, S. V., Zihlif, M. et al. (2007). Association between inadequate sleep and insulin resistance in obese children. Journal of Pediatrics, 150(4), 364–369. https://doi.org/10.1016/j.jpeds.2006.08.063
George, L., Bacha, F., Lee, S. et al. (2011). Surrogate estimates of insulin sensitivity in obese youth along the spectrum of glucose tolerance from normal to prediabetes to diabetes. Journal of Clinical Endocrinology and Metabolism, 96(7), 2136–2145. https://doi.org/10.1210/jc.2010-2813
Gungor, N., Saad, R., Janosky, J. et al. (2004). Validation of surrogate estimates of insulin sensitivity and insulin secretion in children and adolescents. Journal of Pediatrics, 144(1), 47–55. https://doi.org/10.1016/j.jpeds.2003.09.045
Hannon, T. S., Li, Z., Tu, W. et al. (2014). Depressive symptoms are associated with fasting insulin resistance in obese youth. Pediatric Obesity, 9(5), e103-107. https://doi.org/10.1111/ijpo.237
Hayes, A. F. (2009). Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76(4), 408–420. https://doi.org/10.1080/03637750903310360
Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (2nd ed.). (New York: Guilford Press).
Hirshkowitz, M., Whiton, K., Albert, S. M. et al. (2015). National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health, 1(1), 40–43. https://doi.org/10.1016/j.sleh.2014.12.010
Holt, R. I., de Groot, M., & Golden, S. H. (2014). Diabetes and depression. Current Diabetes Reports, 14(6), 491. https://doi.org/10.1007/s11892-014-0491-3
Howell, A. J., Digdon, N. L., & Buro, K. (2010). Mindfulness predicts sleep-related self-regulation and well-being. Personality and Individual Differences, 48(4), 419–424. https://doi.org/10.1016/j.paid.2009.11.009
Javaheri, S., Storfer-Isser, A., Rosen, C. L. et al. (2011). Association of short and long sleep durations with insulin sensitivity in adolescents. Journal of Pediatrics, 158(4), 617–623. https://doi.org/10.1016/j.jpeds.2010.09.080
Kabat-Zinn, J. (1991). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Dell Publishing.
Kan, C., Silva, N., Golden, S. H. et al. (2013). A systematic review and meta-analysis of the association between depression and insulin resistance. Diabetes Care, 36(2), 480–489. https://doi.org/10.2337/dc12-1442
Kuczmarski, R. J., Ogden, C. L., Guo, S. S. et al. (2002). 2000 CDC growth charts for the United States: methods and development. Vital Health Stat 11(246), 1–190. https://www.ncbi.nlm.nih.gov/pubmed/12043359
Lazarus, R. S., & Folkman, S. (1984). Coping and adaptations. In W. Gentry (Ed.), The handbook of behavioral medicine (pp. 282–325).
Leproult, R., Holmbäck, U., & Van Cauter, E. (2014). Circadian misalignment augments markers of insulin resistance and inflammation, independently of sleep loss. Diabetes, 63(6), 1860–1869. https://doi.org/10.2337/db13-1546
Loucks, E. B., Gilman, S. E., Britton, W. B. et al. (2016). Associations of mindfulness with glucose regulation and diabetes. American Journal of Health Behavior, 40(2), 258–267. https://doi.org/10.5993/AJHB.40.2.11
Lovato, N., & Gradisar, M. (2014). A meta-analysis and model of the relationship between sleep and depression in adolescents: Recommendations for future research and clinical practice. Sleep Medicine Reviews, 18(6), 521–529. https://doi.org/10.1016/j.smrv.2014.03.006
Lucas-Thompson, R. G., Miller, R. L., Seiter, N. S. et al. (2019). Dispositional mindfulness predicts cortisol, cardiovascular, and psychological stress responses in adolescence. Psychoneuroendocrinology, 110, 104405. https://doi.org/10.1016/j.psyneuen.2019.104405
Maslowsky, J., & Ozer, E. J. (2014). Developmental trends in sleep duration in adolescence and young adulthood: Evidence from a national United States sample. Journal of Adolescent Health, 54(6), 691–697. https://doi.org/10.1016/j.jadohealth.2013.10.201
Matthews, K. A., Dahl, R. E., Owens, J. F. et al. (2012). Sleep duration and insulin resistance in healthy black and white adolescents. Sleep, 35(10), 1353–1358. https://doi.org/10.5665/sleep.2112
Matthews, K. A., Hall, M. H., Cousins, J. et al. (2016). Getting a good night’s sleep in adolescence: Do strategies for coping with stress matter? Behavior Sleep Medicine, 14(4), 367–377. https://doi.org/10.1080/15402002.2015.1007994
Metz, S. M., Frank, J. L., Reibel, D. et al. (2013). The effectiveness of the Learning to BREATHE program on adolescent emotion regulation. Research in Human Development, 10(3), 252–272. https://doi.org/10.1080/15427609.2013.818488
Mi, S. J., Kelly, N. R., Brychta, R. J. et al. (2019). Associations of sleep patterns with metabolic syndrome indices, body composition, and energy intake in children and adolescents. Pediatric Obesity, 14(6), e12507. https://doi.org/10.1111/ijpo.12507
Misra, M., Bredella, M. A., Tsai, P. et al. (2008). Lower growth hormone and higher cortisol are associated with greater visceral adiposity, intramyocellular lipids, and insulin resistance in overweight girls. American Journal of Physiology: Endocrinology and Metabolism, 295(2), E385-392. https://doi.org/10.1152/ajpendo.00052.2008
Morris, N. M., & Udry, J. R. (1980). Validation of a self-administered instrument to assess stage of adolescent development. Journal of Youth and Adolescence, 9(3), 271–280. https://doi.org/10.1007/BF02088471
Nagel, K. E., Dearth-Wesley, T., Herman, A. N. et al. (2020). The association between dispositional mindfulness and glycemic control in type 1 diabetes during early adulthood: Differences by age and adverse childhood experiences. Pediatric Diabetes, 21(4), 681–691. https://doi.org/10.1111/pedi.13000
Pallozzi, R., Wertheim, E., Paxton, S. et al. (2017). Trait mindfulness measures for use with adolescents: A systematic review. Mindfulness, 8(1), 110–125. https://doi.org/10.1007/s12671-016-0567-z
Phillips, G. A., Shadish, W. R., Murray, D. M. et al. (2006). The Center for Epidemiologic Studies Depression Scale with a young adolescent population: A confirmatory factor analysis. Multivariate Behavior Research, 41(2), 147–163. https://doi.org/10.1207/s15327906mbr4102_3
Pivarunas, B., Kelly, N. R., Pickworth, C. K., Cassidy, O., Radin, R. M., Shank, L. M., Vannucci, A., Courville, A. B., Chen, K. Y., Tanofsky-Kraff, M., Yanovski, J. A., & Shomaker, L. B. (2015). Mindfulness and eating behavior in adolescent girls at risk for type 2 diabetes. International Journal of Eating Disorders, 48(6), 563–569. https://doi.org/10.1002/eat.22435
Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods Instruments and Computers, 36(4), 717–731. https://doi.org/10.3758/BF03206553
Preacher, K. J., Rucker, D. D., & Hayes, A. F. (2007). Addressing moderated mediation hypotheses: Theory, methods, and prescriptions. Multivariate Behavior Research, 42(1), 185–227. https://doi.org/10.1080/00273170701341316
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306
Rawat, A., Gangwar, A. K., Tiwari, S., Kant, S., Garg, R. K., & Singh, P. K. (2019). Sleep quality and insulin resistance in adolescent subjects with different circadian preference: A cross-sectional study. Journal of Family Medicine in Primary Care, 8(7), 2502–2505. https://doi.org/10.4103/jfmpc.jfmpc_400_19
Reutrakul, S., & Van Cauter, E. (2018). Sleep influences on obesity, insulin resistance, and risk of type 2 diabetes. Metabolism, 84, 56–66. https://doi.org/10.1016/j.metabol.2018.02.010
Shomaker, L. B., Bruggink, S., Pivarunas, B., Skoranski, A., Foss, J., Chaffin, E., Dalager, S., Annameier, S., Quaglia, J., Brown, K. W., Broderick, P., & Bell, C. (2017). Pilot randomized controlled trial of a mindfulness-based group intervention in adolescent girls at risk for type 2 diabetes with depressive symptoms. Complementary Therapies in Medicine, 32, 66–74. https://doi.org/10.1016/j.ctim.2017.04.003
Shomaker, L. B., Berman, Z., Burke, M., Annameier, S. K., Pivarunas, B., Sanchez, N., Smith, A. D., Hendrich, S., Riggs, N. R., Legget, K. T., Cornier, M., Melby, C., Johnson, S. A., & Lucas-Thompson, R. G. (2019). Mindfulness-based group intervention in adolescents at-risk for excess weight gain: A randomized controlled pilot study. Appetite 140, 213-222. https://doi.org/10.1016/j.appet.2019.05.022
Shomaker, L. B., Pivarunas, B., Annameier, S. K., Gulley, L., Quaglia, J., Brown, K. W., Broderick, P., & Bell, C. (2019). One-year follow-up of a randomized controlled trial piloting a mindfulness-based group intervention for adolescent insulin resistance. Frontiers in Psychology, 10, 1040. https://doi.org/10.3389/fpsyg.2019.01040
Shomaker, L. B., Tanofsky-Kraff, M., Stern, E. A., Miller, R., Zocca, J. M., Field, S. E., Yanovski, S. Z., Hubbard, V. S., & Yanovski, J. A. (2011). Longitudinal study of depressive symptoms and progression of insulin resistance in youth at risk for adult obesity. Diabetes Care, 34(11), 2458–2463. https://doi.org/10.2337/dc11-1131
Simon, S. L., Behn, C. D., Cree-Green, M., Kaar, J. L., Pyle, L., Hawkins, S. M. M., Rahat, H., Garcia-Reyes, Y., Wright, K. P., Jr., & Nadeau, K. J. (2019). Too late and not enough: School year sleep duration, timing, and circadian misalignment are associated with reduced insulin sensitivity in adolescents with overweight/obesity. Journal of Pediatrics, 205(257–264), e251. https://doi.org/10.1016/j.jpeds.2018.10.027
Stockings, E., Degenhardt, L., Lee, Y. Y., Mihalopoulos, C., Liu, A., Hobbs, M., & Patton, G. (2015). Symptom screening scales for detecting major depressive disorder in children and adolescents: A systematic review and meta-analysis of reliability, validity and diagnostic utility. Journal of Affective Disorders, 174, 447–463. https://doi.org/10.1016/j.jad.2014.11.061
Suglia, S. F., Koenen, K. C., Boynton-Jarrett, R., Chan, P. S., Clark, C. J., Danese, A., Faith, M. S., Goldstein, B. I., Hayman, L. L., Isasi, C. R., Pratt, C. A., Slopen, N., Sumner, J. A., Turer, A., Turer, C. B., & Zachariah, J. P. (2018). Childhood and adolescent adversity and cardiometabolic outcomes: A scientific statement from the American Heart Association. Circulation, 137(5), e15–e28. https://doi.org/10.1161/CIR.0000000000000536
Turner, T., & Hingle, M. (2017). Evaluation of a mindfulness-based mobile app aimed at promoting awareness of weight-related behaviors in adolescents: A pilot study. JMIR Research Protocols, 6(4), e67. https://doi.org/10.2196/resprot.6695
Wolfson, A. R., & Carskadon, M. A. (1998). Sleep schedules and daytime functioning in adolescents. Child Development, 69(4), 875–887. https://doi.org/10.2307/1132351
Wolfson, A. R., Carskadon, M. A., Acebo, C., Seifer, R., Fallone, G., Labyak, S. E., & Martin, J. L. (2003). Evidence for the validity of a sleep habits survey for adolescents. Sleep, 26(2), 213–216. https://doi.org/10.1093/sleep/26.2.213
Funding
This work was supported by the Colorado Clinical and Translational Sciences Institute [NIH/NCATS Colorado CTSA Grant Number UL1 TR002535] and the Colorado Agricultural Experiment Station [NIFA/USDA Grant Number COLO0724]; efforts of MC and NS on this project were supported by graduate research assistantships from the Colorado School of Public Health.
Author information
Authors and Affiliations
Contributions
E.L.C. created the first draft of the manuscript and conducted the analyses; L.D.G. and M.P. provided statistical guidance on the analyses, helped interpret the results, and edited the manuscript. M.C., N.S., and S.A.J. collected the data, managed and prepared the data, assisted in interpretation of the results, and edited the manuscript. V.J., R.M., I.C., J.L.K., and S.L.S. assisted in interpretation of the results and edited the manuscript. C.M., R.G.L., and L.B.S. designed the study, obtained funding to support the study, assisted in interpretation of the results, and edited the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
No author has a conflict of interest to disclose.
Ethical approval
This study was approved by the Institutional Review Board (IRB) of Colorado State University. All study procedures were followed in accordance with the ethical standards of the Colorado State University IRB, and all parents/guardians and participants in the study provided written consent and assent, respectively.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Clark, E.L., Gulley, L.D., Prince, M.A. et al. The role of mindfulness in associations among depression symptoms, sleep duration, and insulin resistance in adolescents. J Behav Med 44, 694–703 (2021). https://doi.org/10.1007/s10865-021-00225-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10865-021-00225-x