Bipolar disorder increases the risk of poor sleep quality among senior high school students

Main Article Content

Surilena Hasan
Christopher Yovan Junardi


Patients with bipolar disorder commonly experience sleeping problems. On the other hand, sleep disturbances have been suggested as one of the symptoms that indicate the development of bipolar disorder. Considering the detrimental effect of bipolar disorder, especially in young people, this study aimed to determine the relationship between sleep quality and risk of bipolar disorder in senior high school students.

A cross-sectional study was conducted involving 725 senior high school students. The instruments used were a demographic questionnaire, Young Mania Rating Scale (YMRS), MINI International Neuropsychiatric Interview (MINI ICD-10), Hypomania/Mania Symptom Checklist (HCL-32), and Pittsburgh Sleep Quality Index (PSQI). Univariate and bivariate (simple logistic regression) analyses were performed to evaluate the relation between sleep quality and the risk of bipolar disorder.

Around 28% of subjects were at risk of bipolar disorder, of which 96.6% were prone to type I, and the rest were type II. Most of the participants with bipolar disorder (64%) had poor sleep quality. The percentage of participants with type I bipolar disorder that had poor sleep quality was higher than that of type II (65.3% and 28.6%, respectively). There was a significant relationship between bipolar disorder and sleep quality (OR = 2.2; 95% CI=1.581-3.087; p=0.000).

Our study demonstrated that in senior high school students, bipolar disorder increased the risk of poor sleep quality. Assessment of sleep disturbances routinely in psychiatric interviews may improve sleep quality.

Keywords: Bipolar disorder, sleep quality, senior high school student

Article Details

How to Cite
Hasan, S., & Junardi, C. Y. (2020). Bipolar disorder increases the risk of poor sleep quality among senior high school students. Universa Medicina, 39(2), 128–134.
Original Articles


Carlson GA, Dubicka B. Very early onset bipolar disorder - international differences in prevalence, practice or language? Child Adolesc Ment Health 2019;24:86-7.

Melo MCA, Garcia RF, Neto VBL, et al. Sleep and circadian alterations in people at risk for bipolar disorder: a systematic review. J Psychiatr Res 2016;83:211–9.

van Meter A, Moreira ALR, Youngstrom E. Updated meta-analysis of epidemiologic studies of pediatric bipolar disorder. J Clin Psychiatry 2019;80:18r12180. doi: 10.4088/JCP.18r12180.

World Health Organization. International Statistical Classification of Diseases and Related Health Problems 10th Revision. Geneva :World Health Organization; 2016.

Bobo WV. The diagnosis and management of bipolar I and II disorders: clinical practice update. Mayo Clinic Proceedings 2017;92:1532-51.

Melo MCA, Abreu RLC, Neto VBL, de Bruin PFC, de Bruin VMS. Chronotype and circadian rhythm in bipolar disorder: a systematic review. Sleep Medicine Rev 2017;34:46-58. doi: 10.1016/j.smrv.2016.06.007.

Skjelstad DV, Malt UF, Holte A. Symptoms and signs of the initial prodrome of bipolar disorder: a systematic review. J Affect Disord 2010;126:1. DOI: 10.1016/j.jad.2009.10.003

Ritter PS, Höfler M, Wittchen HU, et al. Disturbed sleep as risk factor for the subsequent onset of bipolar disorder – data from a 10-year prospective-longitudinal study among adolescents and young adults. J Psychiatr Res 2015;68:76-82. doi: 10.1016/j.jpsychires.2015.06.005.

Levenson JC, Soehner A, Rooks B, et al. Longitudinal sleep phenotypes among offspring of bipolar parents and community controls. J Affect Disord 2017;215:30-6.

Baglionia C, Battaglieseb G, Feigea B, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord 2011;135:10-9.

Findling RL, Stepanova E, Youngstrom EA, Young AS. Progress in diagnosis and treatment of bipolar disorder among children and adolescents: an international perspective. Evidence Based Mental Health 2018;21:177.

Maramis MM, Karimah A, Yulianti E, Bessing YF. Screening of bipolar disorders and characteristics of symptoms in various populations in Surabaya, Indonesia. Anima Indonesian Psychol J 2017;32:90-8.

Cazorla P, Zhao J, Mackle M, Szegedi A. Asenapine effects on individual Young Mania Rating Scale items in bipolar disorder patients with acute manic or mixed episodes: a pooled analysis. Neuropsychiatr Dis Treat 2013;9:409–13. doi: 10.2147/NDT.S38390.

Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structural diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59(Suppl 20):22–33.

Soares OT, Moreno DH, de Moura EC, Angst J, Moreno RA. Reliability and validity of a Brazilian version of the Hypomania Checklist (HCL-32) compared to the Mood Disorder Questionnaire (MDQ). Rev Bras Psiquiatr 2010;32:416–23. doi: 10.1590/s1516-44462010000400015.

Buysse DJ, Reynolds III CF , Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213. doi: 10.1016/0165-1781(89)90047-4.

Hernandez M, Marangoni C, Grant MC, Estrada J, Faedda GL. Parental reports of prodromal psychopathology in pediatric bipolar disorder. Curr Neuropharmacol 2017;15:380-5. doi: 10.2174/1570159X14666160801162046.

Sebela A, Novak T, Kemlink D, Goetz M. Sleep characteristics in child and adolescent offspring of parents with bipolar disorder: a case control study. BMC Psychiatr 2017;17:199.

Baroni A, Hernandez M, Grant M, Faedda G. Sleep disturbances in pediatric bipolar disorder: a comparison between bipolar I and bipolar NOS. Front Psychiatry 2012;3. DOI: 10.3389/fpsyt.2012.00022.

Steinan MK, Scott J, Lagerberg TV, et al. Sleep problems in bipolar disorders: more than just insomnia. Acta Psychiatr Scand 2016: 133: 368–77. doi: 10.1111/acps.12523.

Roybal DJ, Chang KD, Chen MC, Howe ME, Gotlib IH, Singh MK. Characterization and factors associated with sleep quality in adolescents with bipolar I disorder. Child Psychiatry Hum Dev 2011;42:724-40. doi: 10.1007/s10578-011-0239-0.

Gershon A, Johnson SL, Thomas L, Singh MK. Double trouble: weekend sleep changes are associated with increased impulsivity among adolescents with bipolar I disorder. Bipolar Disord 2019;21:132-41. doi: 10.1111/bdi.12658.