Evaluation and treatment of sleep disorders in adolescents with depression; a scoping review

BACKGROUND: Adolescent depression is a common and disabling disorder that is frequently associated with large-scale sleep disturbances. Adolescents with depression frequently experience poor sleep quality, insomnia, and delayed sleep phase syndrome, which intensify and prolong depressive symptoms. Since mood disorder and sleep disorder are bidirectional, early diagnosis and treatment of sleep disorders in adolescent with depression are clinically critical. OBJECTIVE: This scoping review aimed to synthesize existing evidence on the evaluation and intervention of sleep disorders among adolescents with depression. The objective was to describe assessment methods, synthesize evidence on both non-pharmacological (e.g., CBT-I, mindfulness) and pharmacological (e.g., melatonin) interventions, and identify key research gaps for clinical practice and future trials. METHODS: The review followed Arksey and O’Malley’s framework and PRISMA-ScR guidelines. Searches of PubMed, Web of Science, CINAHL, PsycINFO, and Scopus were conducted for studies published between January 2000 and January 2024. Twenty-six peer-reviewed studies meeting the inclusion criteria were analyzed. RESULTS: From the study, 26 papers met the inclusion criteria. 17 of these were considered CBT-I or CBT-I-based interventions, 3 examined mindfulness-based interventions, 3 evaluated the use of melatonin, 2 considered psychoeducation or sleep hygiene, and 1 focused on group treatment. CBT-I was able to produce consistent results regarding sleep behavior, and many research studies have reported improvements in depressive symptoms that accompany sleep behavior change. Mindfulness-based therapies proved potentially valuable, but the results were more diverse in their inter-population and intervention format. Online CBT-I tools like Sleep Ninja + were found to be feasible and accessible. Melatonin was commonly used as a complementary treatment and generated short-term effects on getting sleep; however, the evidence of long-term safety and sustained effectiveness was limited. Most studies depended on subjective sleep assessment (e.g., PSQI, ISI), while only a small fraction of studies used objective indicators of sleep such as actigraphy and polysomnography. Divergent comparability and different participant characteristics were the limitations of the methodological heterogeneity that hampered the comparability and prevented sound conclusions of any generalization. CONCLUSION: Addressing sleep disturbances is essential for the effective treatment of adolescent depression. Studies indicates that combining CBT-I with other therapies can enhance treatment outcomes, but further studies are necessary to confirm long-term results, assess potential medication risks, and ensure the treatments are suitable for all individuals. RELEVANCE: This review provides a foundational synthesis for clinicians and researchers aiming to improve diagnostic precision and treatment outcomes in adolescents experiencing both sleep disorders and depression. CLINICAL TRIAL NUMBER: Not applicable.