| Objective Mental health problems in preschool children are susceptible to a variety of external factors,and sleep disturbances has been recognized as an important influential factor on mental health problems in preschool children.Early identification of sleep disturbances and mental health problems in preschool children and early intervention can contribute to the healthy development of preschool children.In this study,we investigated the association between sleep change patterns and emotional behavioral problems and anxiety in preschool children based on data from a longitudinal follow-up study of preschool children in Anhui Province,and the mediating mechanism of resilience,and further explored the mediating role of resilience in the different sleep subscale change patterns and emotional behavioral problems and anxiety,as well as the gender differences between the mediating roles.Methods A longitudinal follow-up study design was adopted in this study.The children in junior and middle classes of 26 kindergartens in rural areas in southern,northern and central Anhui Province were selected as research subjects.Based on baseline investigation,follow-up survey was conducted one year apart.A structured questionnaire was completed by children’s parents or caregivers in the form of filling by themselves or face-to-face interview.The questionnaires included basic information about the children and family,sleep habits,emotional behavioral problems,anxiety and resilience.Statistical analysis was performed by SPSS 23.0 and Mplus 8.3 software.Nonparametric tests were used to compare group differences between children’s baseline and follow-up sleep disturbances,emotional behavioral problems,anxiety,and resilience.Generalized estimation equation(GEE)was used to analyze the effect of the presence or absence of sleep disturbances on emotional behavior problems,anxiety,and resilience scores.Spearman correlations were used to analyze the relationship between children’s sleep disturbances at baseline and follow-up and the relationship between emotional behavioral problems,anxiety,and resilience at follow-up.Generalized linear regression was used to analyze the association between sleep change patterns and emotional behavioral problems,anxiety,and resilience.Mediation analyses were implemented by Structural Equation Modeling(SEM).Results The results of the longitudinal follow-up study of 1595 preschool children showed that children’s sleep disturbances displayed a downward trend during the follow-up period,but the overall detection rate of sleep disturbances was still high(baseline: 91%;follow-up: 88.5%),difference for comparison of baseline and follow-up results was statistically significant(P<0.001).The detection rates of bedtime resistance,sleep onset delay,sleep anxiety,night waking,parasomnias and sleep disorders breathing reduced to different degrees during the follow-up period(P<0.05),the detection rates of sleep duration and daytime sleepiness were relatively stable(P>0.05).The total scores of emotional behavioral problems and anxiety in preschool children also both showed a decreasing trend at follow-up(P<0.001),while the total scores of resilience in children showed an increasing trend at follow-up(P<0.001).The results of the analysis of the association between sleep disturbances and emotional behavioral problems,anxiety and resilience in preschool children based on GEE showed that sleep disturbances in preschool children positively predicted the level of children’s emotional behavioral problems(β=2.62,95% CI=1.80-3.44)and anxiety(β=9.87,95%CI=7.33-12.41)scores,and negatively predicted the score level of children’s resilience(β=-10.44,95% CI=-14.16 to-6.72).Sleep disturbances in preschool children were classified into four different patterns of change: persistent-high pattern(81.3%),persistent-low pattern(1.7%),decreasing pattern(9.8%)and increasing pattern(7.3%).Statistically significant differences(P<0.05)were found in the comparison between groups of emotional behavioral problems,anxiety and resilience of children in different sleep change patterns.The results of the analysis of the associations between sleep change patterns and emotional behavioral problems,anxiety and resilience in preschool children using generalized linear regression showed that compared with persistent-low pattern,increasing pattern and persistent-high pattern were significantly positively correlated emotional behavioral problems(β=1.788,P=0.045;β=2.028,P=0.013,respectively),and anxiety(β=9.287,P=0.003;β=9.240,P=0.001,respectively);whereas increasing pattern and persistent-high pattern were significantly negatively correlated with resilience(β=-15.828,P<0.001;β=-12.182,P=0.003,respectively).After adjusting for resilience as a mediator,the association between increasing pattern and persistent-high pattern and emotional behavioral problems was no longer statistically significant(P>0.05),while the positive association with anxiety remained statistically significant(β=8.231,P=0.007;β=8.427,P=0.003).The results of the mediation analysis using SEM found that resilience played a fully mediating role in the relationship between increasing pattern and persistent-high pattern and emotional behavioral problems in preschool children,resilience partially mediated the relationship between increasing pattern and persistent-high pattern and anxiety in preschoolers.Resilience in the male group fully mediated the association between increasing pattern and persistent-high pattern of the total sleep scale and emotional behavioral problems,as well as between increasing pattern and anxiety.However,no significant mediating effect was found in the female group.Conclusion Resilience fully mediated the association between increasing pattern and persistent-high pattern and emotional behavioral problems in preschool children.Resilience partially mediated the association between increasing pattern and persistent-high pattern and anxiety in preschool children.This suggests that resilience is important for understanding the mechanisms underlying the association between sleep change patterns and emotional behavioral problems and anxiety in preschool children,and that early prevention or development of appropriate intervention strategies for resilience may be considered for emotional behavioral problems and anxiety in preschool children. |
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