Associations of Pre-Sleep Arousal and Dysfunctional Sleep Belief with Depression in Youths with Eveningness

Dandan Liao, J. A. H. Man, Fiona Yujing Jin, Forrest Tin Wai Cheung, Yue Pan, Hao Fong Sit, Joey Wing Yan Chan, Ngan Yin Chan, Yuen Kwok Wing, Shirley Xin Li

Abstract

Introduction: Youths with eveningness are vulnerable to developing sleep disturbances and mood related psychopathology. Psychological and arousal related factors may contribute to both insomnia and depression. Although previous research has investigated the association between insomnia, chronotype and depression, there has been limited research to explore insomnia-related cognitive and physiological factors specifically in youths with eveningness, especially in the context of depression.

Materials and methods: A total of 112 youths with eveningness (mean age = 18.3±1.7; 69.6% female), as defined by a Morningness-Eveningness Questionnaire (MEQ) score of ≤ 41, were recruited. Participants were classified into depressed (DA group: n = 59, mean age =18.2±1.8, 76.3% female) and non-depressed groups (Control group: n= 53, mean age =18.5±1.7, 62.3% female), based on the presence of depressive disorders by DSM-IV criteria as confirmed by the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) psychiatric interview. Insomnia severity (Insomnia Severity Index, ISI), dysfunctional sleep beliefs (Dysfunctional Beliefs and Attitudes about Sleep Scale, DBAS-16), and pre-sleep arousal (Pre-Sleep Arousal Scale, PSAS) were assessed.

Results: Depressed participants, as compared to non-depressed participants reported significantly higher levels of insomnia severity (ISI: DA:15.0 vs. Control:1.76, t = 22.90, p < .001), more dysfunctional sleep beliefs (DBAS: DA 97.2 vs. Control 71.5, t = 4.36, p < .001), and heightened pre-sleep arousal (PSAS: DA 40.0 vs. Control 30.2, t = -4.14, p < .001). Linear regression analysis demonstrated that depression was significantly associated with more severe insomnia (ISI: β = 0.77, p < .001), and elevated pre-sleep arousal (PSAS-C: β = 0.24, p =0.02), after controlling for education level.

Conclusions: These findings highlight a significant association between depression and insomnia among youths with eveningness. In addition, pre-sleep cognitive arousal was elevated in depressed adolescents with eveningness. The findings underscore the importance in attending to insomnia-related factors in assessing depression in adolescents with eveningness. Interventions that address cognitive hyperarousal, alongside mood symptoms may be needed for this vulnerable group.

Acknowledgments: This work was supported by the General Research Fund from the Hong Kong Research Grants Council awarded to SXL (Ref. 17615722) and the Seed Fund for Basic Research (University Research Committee, The University of Hong Kong) awarded to SXL.

Recommended citation: Liao, D. D., Man, J. A. H., Jin, F. Y., Cheung, F. T. W., Pan, Y., Sit, H. F., Chan, J. W.-Y., Chan, N. Y., Wing, Y.-K., & Li, S. X. (2026). Associations of Pre-Sleep Arousal and Dysfunctional Sleep Belief with Depression in Youths with Eveningness. Sleep Medicine, 138, 108298. https://doi.org/10.1016/j.sleep.2025.108298