青少年之社交孤寂發展軌跡與睡眠時型之關係

Abstract

背景：睡眠在人類生長發育的過程中扮演十分重要的角色，而睡眠「時型 (chronotype)」的延後為青少年族群常見的睡眠問題。根據研究，越晚的睡眠時型對於健康會造成嚴重的危害，包括增加肥胖風險、憂鬱，以及菸、酒等物質使用等不健康的生活習慣。另外，社交孤寂為兒童中期至青少年時期間常見的情緒，亦被視為影響青少年睡眠健康的重要因子。然而，過去針對社交孤寂與睡眠之研究多聚焦於老年族群且多以橫斷性的研究設計為主，鮮少研究探討社交孤寂的發展軌跡對於青少年睡眠時型之影響。 目的：本研究欲以長期追蹤的二手資料庫中的青少年樣本，探討研究樣本於兒童中期至青少年晚期之社交孤寂發展軌跡樣貌，並進一步檢視不同社交孤寂發展軌跡與青少年睡眠時型之關係及其關聯是否存在性別差異。 方法：本研究以「兒童與青少年行為之長期發展研究計畫」(Child and Adolescent Behaviors in Long-term Evolution，簡稱 CABLE) 中，擷取其2001年至2012年間共2398位青少年在於6歲至18歲期間所提供的資料進行分析。以群組化軌跡模式 (group-based trajectory modeling) 和多元線性迴歸(multiple linear regression) 作為主要分析方法。 研究結果：本研究發現男孩有五組社交孤寂發展軌跡，分別為低下降組 (19%)、低穩定組 (27%)、中度上升組 (35%)、高度下升組 (27%)，及高穩定組(27%)；女生則有四組社交孤寂發展軌跡，分別是低穩定組 (45%)、中穩定組 (35%)、低至中度上升組 (13%)、中至高度上升組 (7%)。進一步探討社交孤寂發展軌跡與睡眠時型的關係發現，從男生的結果發現，身為「高度下降組」者會比身為「低下降組」者在青少年晚期經歷更早的睡眠時型 (B= – 0.07; p<0.05)；而女生方面則發現，身為「低至中度上升組」者會比為「低穩定組」者在青少年晚期經歷更延後的睡眠時型 (B= – 0.07; p<0.05)。 結論：本研究發現兒童中期至青少年時期的社交孤寂發展軌跡，尤其是發展軌跡有明顯的波動者，對於青少年晚期的睡眠時型有顯著影響，並具有性別差異。另外，研究結果強調了早期關注青少年發展心理相關問題之重要性，特別是社交孤寂的發展，並建議應早期執行相關介入措施以促進青少年的睡眠健康。最後，未來研究或相關介入政策應納入性別差異作為考量。

Background: The significantly delaying sleep chronotype during adolescence is a critical risk factor for poor health outcomes among adolescents, including elevating cardiometabolic risk, decreasing emotional well‐being, and unhealthy lifestyles. Social loneliness is an emotion that people commonly develop when entering childhood and is proven to influence sleep behaviors negatively. While relationships between loneliness and sleep behaviors had been frequently discussed, most had targeted the older population and applied cross-sectional approaches, and no study has explored the influence of loneliness trajectories on sleep chronotype among adolescents. Aims: This study aims to identify the developmental trajectories of social loneliness from middle childhood to adolescence, compare the potential effects of diverse loneliness trajectories on sleep chronotype in late adolescence, and evaluate their sex differences. Method: Data was obtained from a total of 2398 adolescents participating in the Child and Adolescent Behaviors in Long-term Evolution project across age 6 to age 18 in northern Taiwan. Group-based trajectory modeling and multiple linear regression were applied to depict social loneliness trajectories and examine their association with sleep chronotype, respectively. Results: Boys displayed five social loneliness trajectory groups, including “low decreasing” (19%), “low stable” (27%), “moderate increasing” (35%), “high decreasing” (22%), and “high stable” (9%) groups; girls demonstrated four groups, including the “low stable” (45%), “moderate stable” (35%), “low to moderate increasing” (13%), and “moderate to high increasing” (7%) groups. Results showed that boys in the 'high decreasing' group experienced an earlier sleep chronotype during late adolescence than those in the “low decreasing” group (B= – 0.07; p<0.05), whereas girls in the “low to moderate increasing” group exhibited a more delayed sleep chronotype than those in the “low stable” group (B= 0.06; p<0.05). Conclusion: Trajectories of social loneliness, especially those displaying significant fluctuation, are critical indicators that influence sleep chronotype among adolescents, urging the need for early interventions to restrain its long-term development. Findings also shed light on the future directions to promote adolescents’ sleep health by highlighting the importance of addressing psychological factors such as social loneliness. Lastly, taking sex differences into account may be essential for future studies to expand existing knowledge.