Disengagement Coping and Sleep Problems Among Trauma-Exposed Adolescents

Abstract

Background:

The formation of healthy sleep patterns is a critical component of positive adolescent development. Dysregulated sleep habits can put youth at risk for the development of a multitude of inimical outcomes, particularly among those who are exposed to a traumatic event.

Design and methods:

The present study investigated the links between voluntary disengagement coping (e.g., avoidance, denial, wishful thinking) and sleep outcomes among 86 trauma-exposed and non-exposed adolescents between the ages of 12-17 (M_age = 15.44, SD = 1.51; 41.9% female).

Results:

The relationship between voluntary disengagement coping and sleep outcomes was significant only among trauma-exposed adolescents, such that greater use of voluntary disengagement strategies was associated with greater sleep disturbances and greater daytime dysfunction.

Conclusions:

Targeting disengagement coping may be an important strategy to improve sleep health among trauma-exposed adolescents. Continued efforts in improving the efficacy of trauma-exposed adolescent intervention strategies are needed.

Establishing healthy sleep patterns is a fundamental component of positive adolescent development (Brand & Kirov, 2011; Tarokh et al., 2016). However, the normative shift in sleep habits that occur during this developmental period mark it as one particularly vulnerable to significant sleep disruption and related risks (Owens, 2008). Disrupted sleep patterns are a key transdiagnostic risk factor implicated in difficulties with stress responsivity, mood disorders, and a general decrease in quality of life across periods of development, as well as obesity, decline in academic performance, and more frequent injuries among adolescents specifically (Medic et al., 2017). Poor sleep patterns during adolescence also are associated with mental health issues like anxiety, depression, conduct problems, and attention disruptions (Zhang et al., 2017). Research further indicates that adolescents who spend 6.5 or fewer hours sleeping have increased irritability and oppositionality (Baum et al., 2014), which may relate to increases in risky behavior and decision making, consequently impacting overall health later in life (Dahl, 2004). It is thus important to understand the correlates of sleep issues in adolescence given the central role sleep plays in regulating cognition, affect, and behavior (Fellman et al., 2021).

Adolescence is characterized by major physiological and psychosocial changes (Dahl et al., 2018) that can contribute to unique sleeping patterns. During this developmental period, normative shifts in the sleep-wake cycle occur as a result of several factors, including biological changes affecting the circadian rhythm (e.g., delayed melatonin release via onset of puberty, decline in homeostatic sleep drive), use of digital devices at night (e.g., phone, television), and increasing social activities (e.g., after school programs, sports, homework). Consequently, adolescents habitually stay up later, and sleep in more than most children and adults (Crowley & Carskadon, 2010; Jenni et al., 2005; Taylor et al., 2005). Mandated early school start times also perpetuate a buildup of “sleep-debt,” making students sleep for longer periods of time during the weekend to offset weekday sleep deprivation, thus disrupting the circadian rhythm of students (Crowley & Carskadon, 2010). Indeed, approximately 70% of adolescents obtain less than 8 hours of sleep per day (e.g., recommended sleep time 8-10 hours; Paruthi et al., 2016; Wheaton et al., 2018) and 25% of adolescents indicate the desire for more sleep (Sadeh & Gruber, 2002). Notably, the developmental period of adolescence itself cannot be a risk factor for developing sleep disorders (e.g., insomnia, sleep disturbances and daytime dysfunction; de Zambotti et al., 2018) given the normative changes in sleep patterns during this period; therefore, considering additional, malleable factors related to non-normative sleep difficulties is especially important.

The developing proclivity toward certain stress response styles (i.e., coping) is one factor that may enhance vulnerability for significant sleep disruption among adolescents (El-Sheikh et al., 2014; Matthews et al., 2016; Sadeh et al., 2004). As volitional responses to stress become increasingly complex across development (Compas et al., 2001; Folkman & Lazarus, 1984), adolescents have greater capacity to explore and implement a multitude of engagement (e.g., problem-solving, emotional regulation) and disengagement (e.g., avoidance, denial) approaches to stress management, marking adolescence as a key sensitive period for both assessment and intervention (Compas et al., 2001; Connor-Smith et al., 2000). A tendency toward disengagement coping in particular is associated with a variety of negative health outcomes such as anxiety, depression, behavioral problems, and physical health issues (Connor-Smith et al., 2000; Littleton et al., 2007; Matthews et al., 2016; Roesch et al., 2005). For example, adolescents who use disengagement coping strategies in the face of stress are at heightened risk of also presenting with internalizing issues such as anxiety and depression (Connor-Smith et al., 2000). Importantly, such maladaptive coping behaviors have also been linked to poorer sleep quality among adolescents. For example, Palmer and colleagues (2018) found that the use of suppression and avoidance mechanisms specifically was positively correlated with overall sleep issues (e.g., difficulty initiating and maintaining sleep; early morning awakenings) in a large nationally-recruited sample of adolescents (age range = 13-18 years; 51% girls). Similarly, emotion-focused and avoidant coping were associated with sleep problems in a community sample of over 2,000 adolescents (Reigstad et al., 2010). Finally, Matthews et al. (2016) found that adolescents (N = 250; 53% girls) who generally used disengagement coping (e.g., denial, avoidance, venting) experienced more delayed sleep, daytime sleepiness, sleep fragmentation, and lower sleep duration. It is possible that disengagement mechanisms do not resolve the source of stress, but rather amplify arousal and anxiety that in turn disrupt sleep patterns (Matthews et al., 2016). Thus, it appears that adjustment difficulties such as emotion dysregulation and disengagement coping present compounding health problems, specifically in relation to poor sleep quality in adolescence. While a link between coping and sleep has been identified, more research is needed to understand the nature and bounds of this association (cf. Sadeh et al., 2004), including careful consideration of other factors that may influence or moderate this relationship, such as experiencing traumatic events.

Traumatic experiences are a widely accepted risk factor for developing problematic health conditions, and have the potential to disrupt emotion regulation processes, alter biological responses, and precipitate developmental delays (Gregorowski & Seedat, 2013; McLaughlin et al., 2013). Indeed, a number of studies highlight the association between traumatic event exposure and sleep problems among children and adolescents (e.g., Lind et al., 2017; Wamser-Nanney & Chesher, 2018). For example, Wamser-Nanney and Chesher (2018) found a greater occurrence of nightmares in children (M_age = 10.88; 63.4% girls) who were physically abused than children who had not experienced any abuse. In a community sample of adolescents (N = 737, M_age = 15.10), Park and colleagues (2021) found more sleepiness and insomnia among children and adolescents who had experienced life-threatening events than those who had not. Likewise, in a nationally-recruited sample of almost 10,000 adolescents (age range = 13-18 years, 48.7% girls), those who experienced interpersonal violence, and rape in particular, also reported experiencing greater symptoms of insomnia than adolescents who faced other types of adversities (Wang et al., 2016).

Notably, not all those who experience a trauma go on to develop significant problems (Yehuda et al., 1998), including sleep disturbances. Recently published data support the potential role of disengagement coping in elevating risk. Specifically, in a sample of over 3,000 7-9^th grade students in China (51.6% girls), Ren and colleagues (2021) not only identified positive correlations between adverse life events (e.g., physical abuse, financial strain, academic pressure), negative coping mechanisms (e.g., denial, wishful thinking, disengagement, substance use), and poor sleep quality, but also reported that adolescents with greater adverse life events and maladaptive coping behaviors had the highest likelihood of poor sleep quality. These data tentatively suggest that when adolescents are exposed to adverse life events, their use of maladaptive coping mechanisms may further interfere with sleep quality. However, further examination and replication of these results is needed.

The multifaceted nature of sleep requires a better understanding of the interrelatedness of voluntary disengagement with various sleep components, especially among adolescents who have been exposed to trauma, as they are more likely to experience sleep problems (Buysse, 2014). Therefore, the purpose of the present study was to explore the relations between voluntary disengagement and specific sleep indices (i.e., subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime functioning) among trauma exposed and non-exposed adolescents between the ages of 12-17 years old. It was hypothesized that greater voluntary disengagement coping would be associated with more sleep problems, and that this association would be stronger for trauma-exposed adolescents relative to non-trauma exposed adolescents. Further, given notable differences and changes in adolescent sleep patterns as a function of gender (e.g., Dewald et al., 2010; Johnson et al., 2006) and age (e.g., Crowley & Carskadon, 2010; Dewald et al., 2010) we included gender and age as covariates in the present study.

Method

Participants

Eighty-six adolescents (41.9% girls) between the ages 12-17 years (M_age = 15.44, SD = 1.51) were recruited from the community and took part in a larger study examining substance use and emotional health between 2009-2011. The racial composition of the sample was primarily White (78.6%), followed by Biracial (7.1%), African American (4.8%), Other (4.8%), American Indian/Alaska Native (1.2%), Asian (2.4%), and Hawaiian/Pacific Islander (1.2%). The sample’s ethnic composition was primarily Non-Hispanic/Latino (87.1%). The majority of adolescents met DSM-IV criteria for trauma exposure (64%). The average total posttraumatic stress disorder (PTSD) symptoms among trauma-exposed adolescents, as indexed by the Child PTSD Symptom Scale interview (CPSS; Foa et al., 2001), was 4.50 (Range: 0-12; SD = 2.99). Given the goals and tasks involved in the larger study (e.g., early intervention mechanisms; potential for completion of a voluntary hyperventilation challenge), inclusionary/exclusionary criteria were: (1) oversampling of lifetime alcohol use (84.9%), (2) no history of potential alcohol use disorder, panic disorder, or posttraumatic stress disorder, (3) no history of relevant, chronic health conditions (e.g., respiratory or cardiovascular problems), (4) not currently pregnant, and (5) ability to come to the university research laboratory and provide written, informed parent/guardian consent and child assent for participation.

Measures

Traumatic Event Exposure.

As defined by the DSM-IV-TR (American Psychiatric Association, 2000), traumatic event exposure was determined using the Anxiety Disorders Interview Schedule for DSM-IV: Child Version (ADIS-C; Silverman, 1996). Participants were asked about eight specific events (e.g., “Has anyone ever robbed or attacked you?”) and about any other aversive events not listed. Trained research assistants examined affirming responses for the presence of an emotional response and significant threat (e.g., 4 or higher rating on 0-8 fear, helplessness, and/or horror feelings thermometer). Adolescents were classified as either trauma-exposed or non-trauma-exposed as a function of DSM-IV criterion A. The ADIS-C exhibits good psychometric properties (Lyneham et al., 2007; Wood et al., 2002).

Disengagement Coping.

The Responses to Stress Questionnaire - Social stress version, voluntary disengagement subscale (RSQ-VD), was used to assess volitional disengagement in response to social stressors (Connor-Smith et al., 2000). Participants were given a list and description of social stress scenarios (e.g., being excluded or rejected, being teased, feeling pressured) and were asked to respond to the questions regarding how they feel or react when experiencing these stressful experiences. The RSQ-VD comprises nine items including avoidance (e.g., “I try not to think about it, to forget all about it”), denial (e.g., “I try to believe it never happened”), and wishful thinking (e.g., “I wish that someone would just come and get me out of the mess”). Responses are reported on a four-point scale, 1 (Not at all) to 4 (A lot) in condition of social stress (e.g., feeling pressured). A total score ranging from 9 to 36 was obtained by summing the responses. Higher scores indicate greater usage of voluntary disengagement coping. The RSQ-VD demonstrates adequate reliability, validity, and internal consistency (Connor-Smith et al., 2000).

Sleep.

The 19-item Pittsburgh Sleep Quality Index (PSQI; Buysse et al., 1989) was used to assess self-reported sleep quality during the past month. The PSQI includes open-ended questions (e.g., “During the past month, when have you usually gone to bed at night?”) and 14 additional statements (e.g., “During the past month, how would you rate your sleep quality overall?”) rated on a 4-point Likert scale (0 = Not during the past month, 1 = Less than once a week, 2 = Once or twice a week, 3 = Three or more times a week). The PSQI consists of seven component scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. Each component score yields a score ranging from 0-3, with 3 indicating greater dysfunction. A global score is obtained by summing the seven component scores which range from 0-21. Higher scores are indicative of more severe sleep difficulties. A global score > 5 indicates poor sleep or significant disturbances in sleep (Buysse et al., 1989). The PSQI demonstrates satisfactory psychometric properties (Buysse et al., 1989).

Procedure

All procedures were approved by the university Institutional Review Board prior to participant contact. Adolescents and parents/guardians responding to fliers contacted the laboratory for more information, study-specific screening, and scheduling. Following written informed assent and consent (for child participation), parents/guardians reported their child’s medical history, and adolescents completed their own medical history and a series of screening questions to confirm eligibility. Adolescents then completed a randomly ordered battery of questionnaires including those described above, a set of semi-structured interviews (e.g., ADIS, CPSS), and laboratory tasks unrelated to the current project (e.g., voluntary hyperventilation). Participants were fully debriefed (i.e., purpose of the study and any specific questions) and compensated $40 for their time.

Analytic Plan

All analyses were performed with IBM Statistical Package for the Social Sciences (SPSS) version 27. Descriptive statistics including means, standard deviations, and correlations were computed for the full sample (see Table 1) and by trauma exposure status (see Table 2). Trauma type frequencies and traumatic event counts were calculated for adolescents exposed to trauma (see Tables 3 and 4). Sleep variables evidencing a significant relation with voluntary disengagement at the zero-order level were then subjected to further testing to examine the potential moderating role of trauma exposure. Moderation analyses were tested using PROCESS macro model 1 with bias-corrected 95% confidence intervals and 5,000 bootstrap iterations (Hayes, 2013). Variables with continuous data were mean-centered and a heteroskedasticity-consistent (HC4) robust standard error was used to mitigate against heteroskedasticity (Hayes & Cai, 2007). Age and gender were included as covariates in the final moderation analyses as both variables have been found to be associated with sleep (Dewald et al., 2010). Tests of simple slopes were used to examine the relative strength of the moderator (i.e., trauma exposure), and the squared semi-partial correlation coefficient (sr²) was used as a measure of effect size.

Table 1.

Means, Standard Deviations, and Spearman’s Rho Correlation Matrix Full Sample

Variable	M	SD	1	2	3	4	5	6	7	8	9	10	11
1. DSM-IV Trauma Exposure Criteria (trauma)	64.0%	-
2. Voluntary Disengagement Coping	17.83	4.10	.04
3. Subjective Sleep Quality	0.98	0.72	.22*	.18
4. Sleep Latency	1.22	0.92	.08	.15	.33**
5. Sleep Duration	0.86	1.02	.12	.10	.35**	−.02
6. Habitual Sleep Efficiency	0.39	0.80	.09	−.07	.48**	.20	.43**
7. Sleep Disturbances	1.20	0.56	.19*	.26**	.40**	.28**	.18	.26**
8. Sleep Medications	0.39	0.87	.23*	−.04	.21*	.05	0.10	.05	.09
9. Daytime Dysfunction	0.84	0.76	.24*	.38**	.43**	.37**	.05	.22*	.43**	.20*
10. Global sleep quality	5.88	3.21	.27**	.16	.71**	.60**	.50**	.55**	.52**	.47**	.61**
11. Age	15.44	1.51	.02	.01	.02	−.06	.18	−.00	−.13	.02	.03	.01
12. Gender (female)	41.90%	-	.08	.20*	−.06	−.05	−.09	.06	0.10	−.11	.10	−.05	0.8

Note. N =86; Measures used include DSM-IV-TR (trauma exposure status), RSQ-Social Stress Version (voluntary disengagement coping), PSQI (sleep indices), age, and gender. Due to missing data, the number of participants for each PSQI component score ranges from 72 to 86. Trauma Exposure was coded 0 = no trauma, 1 = trauma; Gender was coded 0 = male, 1 = female

^*p < .05,

^**p < .01

Table 2.

Means, Standard Deviations, and Spearman’s Rho Correlation Matrix by Trauma Exposure Status

Variable	M (NT)	SD (NT)	1	2	3	4	5	6	7	8	9	10	11	M (T)	SD (T)
1. Voluntary Disengagement Coping	17.45	4.18	-	.26	.00	.15	−.04	.31*	−.21	.55**	.12	.15	.20	18.03	4.07
2. Subjective Sleep Quality	0.77	0.72	−.18	-	.27	.47**	.42**	.46**	.19	.34*	.59**	.01	−.06	1.09	0.71
3. Sleep Latency	1.25	0.97	−.04	.49**	-	.14	.39**	.22	.10	.26	.63**	.09	−.09	1.20	0.90
4. Sleep Duration	0.63	0.85	.03	.07	−.24	-	.51**	.41**	.15	.13	.69**	−.03	−.04	1.00	1.10
5. Habitual Sleep Efficiency	0.41	0.91	−.20	.65**	.09	.39*	-	.38**	−.01	.01	.58**	−.26	.02	0.36	0.73
6. Sleep Disturbances	1.07	0.37	−.06	.33	.23	−.37*	.13	-	.11	.49**	.62**	−.04	.03	1.28	0.63
7. Sleep Medications	0.16	0.64	.14	.07	−.04	.30	.25	−.05	-	.14	.44**	−.09	−.29*	0.52	0.97
8. Daytime Dysfunction	0.68	0.76	−.19	.43*	.29	−.00	.55**	.28	.17	-	.49**	.06	.14	0.94	0.83
9. Global sleep quality	4.93	2.99	−.10	.81**	.60**	.34	.73**	.32	.34	.66**	-	−.10	−.09	6.31	3.26
10. Age	15.26	1.71	−.09	−.09	−.13	.38*	.19	−.26	.33	.04	.14	-	−.13	15.55	1.39
11. Gender (female)	38.70%	-	.03	−.21	−.01	.03	−.08	.05	−.21	−.15	−.09	.00	-	43.60%	-

Notes. Means, standard deviations, and Spearman’s Rho correlations for non-trauma (NT) exposed adolescents (n = 31) are to the left of and below the diagonal. Means, standard deviations, and Spearman’s Rho correlations for trauma-exposed (T) adolescents (n = 55) are to the right of and above the diagonal. Measures used include DSM-IV-TR (trauma exposure status), The RSQ-Social Stress Version (voluntary disengagement coping), PSQI (sleep indices), age, and gender. Due to missing data, the number of participants for each PSQI component score ranges from 72 to 86.

^*p < .05,

^**p < .01

Table 3.

Trauma type frequencies

Trauma Type	% (n)
General Illness	20.9% (18)
Witness Harm	20.9% (18)
Accident/Fire	14.0% (12)
Natural Disaster	18.6% (16)
Rob/Attack	9.3% (8)
Touched	11.6% (10)
Touched Other	1.2% (1)
Hit/Hurt by Other	5.8% (5)
Other	5.8% (5)

Notes. n = 55

Table 4.

Total number of traumatic events endorsed

Total Traumatic Events Endorsed	% (n)
1	39.5% (34)
2	14.0% (12)
3	4.7% (4)
4	3.5% (3)
5	1.2% (1)
6	1.2% (1)

Notes. n = 55

Results

As shown in Table 1, adolescents reported an average voluntary disengagement score of 17.83 (SD = 4.10), and a global sleeping quality score of 5.88 (SD = 1.51). On average, adolescents exposed to trauma had higher scores on the global sleep quality scale (M = 6.31) than adolescents not exposed to trauma (M = 4.93). Adolescents who had been exposed to trauma had a mean score of 18.03 (SD = 4.07) on the voluntary disengagement scale, while those who had not been exposed to trauma had a mean score of 17.45 (SD = 4.18). Voluntary disengagement coping was significantly correlated with sleep disturbances (r = .26, p = .009) and daytime dysfunction (r = .38, p < .001) in the full sample. The use of voluntary disengagement coping also correlated with sleep disturbances (r = .31, p = .023) and daytime dysfunction (r = .55, p < .001) among trauma-exposed adolescents, but not among non-trauma exposed adolescents (see Table 2). In the first moderation model (i.e., Model 1.1), trauma exposure, voluntary disengagement, and their interaction accounted for approximately 15% of the variance in sleep disturbances while controlling for age and gender (see Table 5). There was a significant association between trauma exposure and sleep disturbances (b = −0.91, p = .030, sr² = .04); however, neither voluntary disengagement, age, nor gender had a direct association with sleep disturbances. Trauma exposure significantly moderated the initial relationship between voluntary disengagement and sleep disturbances (b = 0.06, p = .005). For adolescents exposed to trauma, use of more voluntary disengagement strategies was associated with more sleep disturbances (b =0.06, p = .005). For adolescents not exposed to trauma, voluntary disengagement strategies were not significantly associated with sleep disturbances (b = −0.008, p = .495; see Figure 1).

Table 5.

Direct and interactive effects of trauma exposure and voluntary disengagement coping (VD) on sleep variables

Moderation Model	Model Summary	Outcome Variable	Predictor Variables Entered	Coeff	t-value	SE (HC4)	p-value	LLCI	ULCI
1.1	F [5, 77], = 4.05, p = .002 R2 = .15, F2 =.17	Sleep Disturbances	Trauma Exposure (trauma)	−0.91	−2.21	0.41	.030*	−1.72	−0.09
			VD	0.01	−0.69	0.01	.495	−0.03	0.01
			Age	0.05	−1.34	0.03	.183	−0.12	0.02
			Gender (female)	−0.03	−0.24	0.13	.810	−0.28	0.22
			Trauma X VD	0.06	2.89	0.03	.005*	0.02	0.11
1.2	F [5, 77], = 5.07, p < .001 R2 = .30, F2 = .44	Daytime Dysfunction	Trauma Exposure (trauma)	−2.26	−2.90	0.78	.005*	−3.81	−0.71
			VD	−0.02	−0.46	0.04	.650	−0.10	0.06
			Age	0.01	0.24	0.04	.813	−0.08	0.10
			Gender (female)	0.10	−0.62	0.15	.534	−0.40	0.21
			Trauma X VD	0.14	3.04	0.05	.003*	0.05	0.23

Notes. N = 83 (missing data on PSQI); VD: voluntary disengagement coping, Trauma X VD: interaction, Coefficients (Coeff) are unstandardized, SE (HC4): heteroskedasticity-consistent robust standard error, LLCI: lower limit confidence interval, ULCI: upper limit confidence interval. Covariates included are age and gender. Measures used include DSM-IV-TR (trauma exposure status), The RSQ-Social Stress Version (voluntary disengagement coping), PSQI (sleep disturbances and daytime dysfunction), age, and gender. Trauma Exposure was coded 0 = no trauma, 1 = trauma; Gender was coded 0 = male, 1 = female

^*p < .05,

^**p < .001

Figure 1.

Moderating effect of trauma exposure on the relationship between voluntary disengagement and sleep disturbances

Approximately 30% of the variance in daytime dysfunction was accounted for by trauma exposure, voluntary disengagement coping, and their interaction while controlling for age and gender (see Table 3). Trauma exposure had a direct association with daytime dysfunction (b = −2.26, p = .005, sr² = .02); however, neither voluntary disengagement, age, nor gender were significantly associated with daytime functioning. Trauma exposure was also a significant moderator of the initial relationship between voluntary disengagement coping and daytime dysfunction (b = .14 p =.003). For adolescents exposed to trauma, use of more voluntary disengagement strategies was associated with more daytime dysfunction (b = 0.12, p < .001). For adolescents not exposed to trauma, there was no significant association between voluntary disengagement strategies and daytime dysfunction (b = −0.02, p = .650; see Figure 2).

Figure 2.

Moderating effect of trauma exposure on the relationship between voluntary disengagement and daytime dysfunction

Discussion

An integral part of healthy adolescent development is promoting productive sleep and adaptive coping mechanisms. Coping strategies can dramatically affect adolescents’ ability to fall asleep, stay asleep, and obtain restorative sleep. The present study is the first to examine whether trauma exposure moderates the relation between voluntary disengagement coping and specific sleep outcomes among adolescents. The current findings present support for positive associations between voluntary disengagement coping and sleep disturbances/daytime impairment. More specifically, for trauma-exposed adolescents, greater use of voluntary disengagement strategies was associated with greater sleep disturbances and more daytime dysfunction. However, there were no statistically significant relations among these variables for non-trauma-exposed adolescents. Notably, these findings were robust to covarying for both age and gender in final models.

Examination of our descriptive data indicated consistency with other, larger studies examining sleep quality (e.g., Raniti et al., 2018) and disengagement coping (Arsenio & Loria, 2014) among adolescents in the general community. The current findings at the zero-order level are also consistent with prior work identifying a relation between disengagement coping and sleep problems among adolescents (Matthews et al., 2016; Ren et al., 2021). Reliance upon avoidance strategies may buffer a person’s initial reaction to stress, but may increase later arousal and anxiety, thereby reinforcing the tendency to avoid stressful situations (Chaffin et al., 1997) as well as having a negative impact on mental and physical health (Herman-Stabl et al., 1995). For example, Maskevich et al. (2020) reported that adolescents who utilized more avoidant coping strategies had higher levels of pre-sleep arousal (i.e., rapid heartbeat and inability to stop thoughts). Furthermore, pre-sleep arousal has been linked to sleep disturbances among children and early adolescents (Gregory et al., 2008), suggesting that when stressors remain unresolved, arousal increases, and sleep and daytime functioning are likely to be affected (Fuligni & Hardway, 2006). More detailed assessments of coping styles (e.g., evaluating the context of the stressor) as well as looking at sleep dimensions (e.g., sleep quantity, timing, and continuity) in greater detail (Buysse, 2014; Luecken & Gallo, 2008; Steptoe et al., 2010) are crucial to unraveling the dynamic interplay between stress and sleep.

Although global sleep quality depicts a broader picture of sleep health, investigating distinct characteristics of sleep may shed light on the specific types of impairment most strongly associated with development and functioning. Our results indicated no significant correlations among voluntary disengagement and most of the sleep indices outlined by the PSQI. One possible explanation is that sleep disturbances and daytime dysfunction are characteristics most indicative of insomnia (Karna & Tatikonda, 2020; Walker et al., 1990), which is strongly linked to avoidant behaviors (Palagini et al., 2016). The empirical understanding of these relationships among adolescents remains limited, however; future research could combine perceived sleep indices with more behavioral or physiological measures (e.g., actigraphy or polysomnography), as this may provide a more comprehensive representation of sleep quality. Studies may also benefit from using ecological momentary assessment or daily diary designs to better represent the complex within-person relations among disengagement coping and the different facets of sleep. Indeed, the limited work directly examining facets of sleep disruption also highlights links between trauma exposure, sleep disturbances, and worse daytime functioning specifically (Noll et al., 2006; Osorio et al., 2013; Tang et al., 2018; Wamser-Nanney & Chesher, 2018). Contemporary theoretical models suggest that the arousal mechanisms of the central nervous system may become hyperactive as a result of trauma exposure, thereby disrupting the sleep-wake cycle (Sinha, 2016). The need for prospective examination, including psychophysiological assessments, type of trauma, and clinical samples, is essential to further understand the dynamic of trauma and sleep in adolescents.

The present findings did not indicate a direct relationship between disengagement coping and sleep problems among non-trauma exposed youth, suggesting trauma exposure may be a key factor in strengthening the association between disengagement coping and sleep issues. Adolescents are more susceptible to heightened stress reactivity (Walker et al., 2004), and those who have experienced trauma may find it even more difficult to implement adaptive coping strategies, since trauma has been linked to dysregulation of stress response (Bremner, 2022). More specifically, trauma may impact the hypothalamic pituitary adrenal axis and the prefrontal cortex, which are responsible for regulating stress responses and decision making (Cicchetti & Rogosch, 2009). Consequently, trauma exposure may entail increased stress reactivity and difficulty in implementing effective coping strategies (Danese & Baldwin, 2017). It is also possible that as a result of trauma exposure, adolescents may display abnormal cortisol levels, resulting in a state of heightened alertness or avoidance of threats and stressful situations (Fellman et al., 2021). Likewise, experiencing traumatic events may interfere with cognition (i.e., working memory; Dunn et al., 2016). Dysfunctional cognitions (e.g., disruption in executive functioning or self-regulation) resulting from traumatic events require consideration, since they are associated with a reduced use of problem-focused and proactive strategies (Evans et al., 2016). Subsequently, youth who frequently engage in avoidant coping may be less able to process trauma and/or stress (Kliewer et al., 1998), and such behaviors may prolong or trigger intrusive thoughts and impair sleep (Lepore, 1997).

Limitations and Future Research Directions

The present study has important limitations that need to be considered. This was a cross-sectional design and used a subjective sleep questionnaire which may be susceptible to self-report bias. However, self-reported symptoms are the gold standard for diagnosing insomnia, and such measures still contribute valuable information that may be obscured by more “objective” measures. It will be important for future research to consider likely bi-directional effects, for example through daily diary or longitudinal approaches, given research implicating poor sleep in difficulty employing adaptive coping mechanisms (Kahn & Sadeh, 2013); a finding which may be particularly strong among trauma-exposed adolescents. Notably, the current study also examines coping in relation to social stress specifically, and while this is a broad and developmentally-relevant context, future research should consider examining voluntary disengagement coping in relation to other non-social stressors (e.g., family conflict, academic stress). Additionally, while gender did not predict statistically significant variance in the current study’s final models, given a well-established literature indicating gender and/or sex-related differences in adolescent traumatic event exposure (Tolin & Foa, 2008; Wamser-Nanney & Cherry, 2018), stress responding (Stroud et al., 2002; 2004), and sleep (Lee et al., 1999; Tremaine et al., 2016), future work designed and powered to examine these relations between differing gender classifications may further refine developmental models.

The current study is a secondary analysis of data collected within a larger project with related but distinct study aims (e.g., alcohol consumption behaviors), and both the larger and current projects target subclinical processes to lay the groundwork for the development of early prevention/intervention strategies. Therefore, more targeted efforts are needed to include clinical populations, as well as stronger, more comprehensive assessment tools (e.g., Trauma Symptom Checklist for Children; Briere, 1996) in understanding trauma and stress responses as they relate to sleep health in adolescence. Indeed, it may be necessary to investigate whether specific PTSD symptoms are particularly associated with voluntary disengagement coping and sleep in adolescence as symptomatology has been linked to the maintenance of stress responding and sleep issues (Charuvastra & Cloitre, 2009; Stratta et al., 2015). Further, future research should include assessment of sleep medications, as well as participants with potentially relevant sleep health conditions (e.g., sleep apnea, asthma) as such factors may also interfere with overall sleep and emotional functioning (Felt & Chervin, 2014; Lewandowski et al., 2011). Finally, the majority of the sample identified as Non-Hispanic White and within the 15-16 age range. Thus, more intentional recruitment efforts are needed in obtaining diverse samples in order to represent the general population.

Conclusion

The present study suggests that associations between voluntary disengagement coping and sleep problems (i.e., sleep disturbances and daytime dysfunction) may be patterned by trauma exposure. Indeed, the final models reported here indicate that the combination of traumatic event exposure and a proclivity towards voluntary disengagement coping accounted for moderate-large amounts of variance in both sleep disturbances and daytime dysfunction. Since adolescence is a sensitive developmental period, it is a key window in which to examine non-normative factors like trauma in order to better understand problematic coping behaviors and sleep patterns. While the effectiveness of coping strategies may differ based on context, resource availability, type of stressor, or appraisal (Austenfeld & Stanton, 2004), the present study emphasizes the potential of targeting voluntary disengagement behaviors in efforts aimed at reducing sleep problems among trauma-exposed youth. Additionally, researchers and clinicians can further identify the specific coping behaviors and sleep problems most commonly presenting among trauma-exposed adolescents to better inform such programming. Given support from replication and extension efforts, the current data also indicate value in direct assessment of coping and sleep behaviors among trauma-exposed youth, and conversely, coping strategies and traumatic event exposure among adolescents presenting with significant sleep problems. Such efforts may aid in furthering existing psychoeducation (e.g., Blunden et al., 2012) and selective/indicated intervention programming (e.g., Blake et al., 2017) in efforts to support healthy sleep among trauma-exposed adolescents. The current study provides a springboard for the development of such models and interventions.

Data Availability Statement

Materials and data for this study are available by emailing the corresponding authors.