Limited sleep fuelling mental disorder in children – report

At least 17.6% of school-going children in Uganda are struggling with depressive mental disorder mainly due to limited sleep, a new study has revealed, raising a red flag on the mental well-being of learners in Uganda’s education system.

Conducted by Prof. Helen Weise from the London School of Hygiene and Tropical Medicine in the UK, in conjunction with the Medical Research Council (MRC), Uganda Virus Research Institute (UVRI) and Reach Out a Hand, a nongovernmental organisation, the study says there are also high cases of anxiety and insomnia among the learners.

Insomnia is a common disorder that makes it hard to fall asleep or stay asleep, while depression occurs when sufferers exhibit feelings of severe despondency and dejection. This problem is linked to many medical conditions, including increased suicidal thoughts among sufferers according to the World Health Organisation (WHO).

Titled Better Sleep Better Health, the study was carried out on a total of 358 secondary school students from two schools in Wakiso and Kalungu districts for a period of one year. According to the report, of those screened, 20% were found to be depressed while 10.1% were found to be struggling with insomnia.

High suicide cases

The development comes against a backdrop of rising cases of depression in schools. Some have culminated in some students taking their lives at a number of top schools.

The latest revelation also comes just months after a medical paper published in the National Library of Medicine last year put depression and anxiety among school children in Uganda at 26.6% and 8.6% respectively.

Denis Ndekezi, the co-ordinator of the study, said their findings follow an earlier study they conducted in 60 schools of 3,841 secondary students in Wakiso and Kalungu districts.

He said, although that study was about menstrual health, it was found that some of the students were facing challenges with sleep in schools.

“So, it is the reason we went ahead to conduct this study to understand the social and physical context of sleep in students,” he said.

According to him, of the 358 students that participated in the study, 36 reported having severe and moderate insomnia, and 63 for depression and 72 for anxiety.

Methodology

According to Ndekezi, the study involved implementing schoollevel interventions in two secondary schools, including education sessions for parents, staff and students. Others included five weekly sessions of group cognitive behaviour therapy for insomnia (CBT-I), delivered by trained psychologists to students with insomnia as well as collecting pre and post-intervention data on sleep health and mental health.

“The 36 (10.1%) that reported having sleep issues were given the cognitive behaviour therapy for insomnia (CBT-I),” he said, adding that those who were given CBTI therapy reported an improvement or reported reduced symptoms of insomnia. He said this therapy was also important to reducing some of the anxiety and depression issues they had.

“We found that insomnia or sleep issues were associated with anxiety and depression so the CBT-I sessions that were given to the students were very much helpful in addressing some of the mental health issues they had. This is because it has many components including relaxation,” the co-ordinator of the study said.

Why cases are high

David Mutebi, a member of the Uganda National Teachers Union and headteacher of Bright Future Secondary School (located where?), said some of the problems could be due to pressures on the students from school owners to excel. He said because they [school owners] want their schools to excel, some tend to draw tight and strict schedules so as to complete the syllabus beforehand.

“You find that where a subject is meant to be covered within one month, it is covered within two weeks. That pressure forces them to extend night prep hours till 10:00pm,” he said, explaining that this could exacerbate the problem.

According to Dr Catherine Abbo, an associate professor of psychiatry at Makerere University, too much work without rest exacerbates stress.

She said although stress is bad for people across all ages, it is especially dangerous for children because their brains are still developing.

She said the stress can derail the children’s mental development.

“If the stress is too much and they are not being helped to cope, there are parts of their brain that shrink because of excessive stress,” she said, adding that the hippocampus, the small part of the brain responsible for learning and storing memory, is very sensitive.

“In children, it [hippocampus] is still developing and you are diminishing that part of the brain when you subject them to excessive stress.”

She said by taking away opportunities for rest, schools will not be helping the children to reach their full potential. She said this can be the case even for adults.

According to the study report, incorporating sleep education into the curriculum in addition to training teachers on the importance of sleep for education and health could address the problem.

The authors of the study also recommend incorporating national modules on the importance of sleep into the national curriculum, implementing guidelines on school schedules like starting classes for all schools at 8:30am to 4:30pm and avoiding late-night study time in boarding schools, among others.

Psychologists weigh in

Ali Male, a counsellor and psychologist from A-Z Professional Counsellors and Support Centre, said deprivation of sleep and sleep interruptions can cause psychosocial issues such as depression and anxiety.

One can tell whether a student is depressed if they lack interest in what interests them most including books and class, appearing withdrawn from the rest, thinking and writing about things that could harm themselves among others, Male added in a telephone interview with New Vision.

To help a depressed child, Male called for adequate sleep which he said is the first therapeutic treatment for depression before other assessments can be conducted on such a child.

He added that the ideal hours for sleeping that schools and even homes should enforce is sleeping for eight hours. For schools that are surrounded by a noisy environment such as busy streets, roads, industrial areas, nightclubs, should find ways of sound-proofing their dormitories where students go to sleep.

“The advantage of ideal sleep which is between seven to eight hours is that it rejuvenates the brain, hence awakens the mental abilities and energy that enables a student or any other human being to focus the following day,” Male added.

Anne Tweheyo, a counselling psychologist, attributes mental health issues among students to school programmes and schedules. For example, she said children in the nursery and primary sections find it hard to cope with the new schedule.

“The brain is still growing, that transition from a home setting becomes hard. Although they may not get depressed as such, the whole-body system gets disorganised leading to challenges such as sickness and lack of concentration,” she said.

“For upper classes, including those in secondary school, the situation gets worse because as they get to new school programmes, there is also bullying and poor feeding. So, orientation should be key for all children to understand the school, teachers to understand the children and the parent to understand school programmes in order to help the child fit in,” Tweheyo said

Impact on children’s future?

In terms of the future of the wellbeing of a depressed child, Tweheyo said that school-driven depression may affect the child’s future prospects since such a child will find it hard as an adult to interact with society or people around them.

Ministry guidelines

When contacted, the director of education standards in the education ministry, Frances Atim, declined to comment, and requested for more time to study the report before she can make her submission. But circular number 20 from the ministry that was released on September 29, 2022, calls on stakeholders to prioritise mental health education and care in education institutions.

This followed the COVID-19 outbreak that led to the closure of schools hence affecting the growth and development of children, including the teaching learning process.

In the circular, the ministry advised schools to designate two senior women teachers and two senior men teachers to co-ordinate guidance and counselling activities of staff and learners in schools.

They also called for the orientation of teachers on their roles using the education ministry guidelines for senior women/male teachers in addition to setting aside a guidance and counselling commission headed by senior woman/man.

The ministry also wants schools to accommodate peer-to-peer or group intervention for counselling sessions to help in the recovery process and that every school should implement at least one hour of every week dedicated to counselling sessions while working with external professional psychologists among others.

What could be the remedies?

Mubiru adds that to help the children at school, school owners should have staggered prep times, such that some days have no preps, other days short preps while weekends should be spared of early morning preps to allow students to have enough rest.

The sleeping arrangement should also be factored in such a way that lights are switched off in time for all students to take a break, but he adds that this should be enforced with enough wardens as opposed to schools with over 1,000 boys, being supervised by one warden.

For future management, schools should include a mental health check-up for students when reporting to school for proper management.

About depression

Depressive disorder (also known as depression) is a common mental disorder, according to the World Health Organisation (WHO). During a depressive episode, a person experiences a depressed mood (feeling sad, irritable, empty). They may feel a loss of pleasure or interest in activities.

A depressive episode may last most of the day, nearly every day, for at least two weeks. The WHO lists other symptoms including poor concentration, feelings of excessive guilt or low self-worth, hopelessness about the future, thoughts about dying or suicide, disrupted sleep, changes in appetite or weight, and feeling very tired or low in energy.

Sleep: Benefits, side effects

According to the American Academy of Sleep Medicine, sleeping the number of recommended hours on a regular basis is associated with better health outcomes including: improved attention, behaviour, learning, memory, emotional regulation, quality of life, and mental and physical health.

Regularly sleeping fewer than the number of recommended hours is associated with attention, behaviour, learning, memory, emotional regulation, quality of life, and mental and physical health

Insufficient sleep also increases the risk of accidents, injuries, hypertension, obesity, diabetes, and depression.

“Insufficient sleep in teenagers is also associated with increased risk of self-harm, suicidal thoughts, and suicide attempts. Regularly sleeping more than the recommended hours may be associated with adverse health outcomes such as hypertension, diabetes, obesity, and mental health problems,” the Academy stated in a research report published in the Journal of Clinical Medicine in 2016.

The academy advises parents who are concerned that their child is sleeping too little or too much to consult their healthcare provider for evaluation of a possible sleep disorder.