Mechanisms underlying the association between insomnia, anxiety, and depression in adolescence: Implications for behavioral sleep interventions

Prospective association between 24-hour movement behaviors and mental health among overweight/obese college students: a compositional data analysis approach

Background

24-h movement behaviors, including light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), screen-based sedentary behavior (SSB), non-screen-based sedentary behavior (NSB) and sleep are crucial components affecting mental health. This study aimed to examine the associations of movement behaviors with mental health outcomes among overweight/obese college students using a compositional data analysis approach.

Methods

Using a prospective design, 437 Chinese college students (20.1 ± 1.7 years, 51.7% female) completed a two-wave online data collection, where demographics and movement behaviors (LPA, MVPA, SSB, NSB, sleep) were collected at baseline, while depression, anxiety and stress were measured at the 2-month follow-up (Apr-Jul 2022). Compositional data analyses were implemented using R.

Results

Depression, anxiety, and stress were negatively associated with time spent in MVPA and sleep (p < 0.001) and positively associated with time spent in SSB and NSB (p < 0.001). Reallocating 15 min to MVPA from LPA, SSB and NSB predicted improvements in depression (LPA: -0.234 unit; SSB: -0.375 unit; NSB: -0.249 unit), anxiety (LPA: -0.092 unit; SSB: -0.284 unit; NSB: -0.165 unit), and stress (LPA: -0.083 unit; SSB: -0.312 unit; NSB: -0.191 unit). For dose-response relationships of 5-55 min isotemporal substitution, when time was reallocated to MVPA from LPA, NSB, and SSB, the estimated detriments to mental health were larger in magnitude than the estimated benefits of time reallocation from MVPA to LPA, NSB, and SSB.

Conclusion

The findings emphasize the importance of participating in MVPA to improve mental health in overweight/obese college students during the post-COVID-19 era. The compositional analysis produced clear targets for the time allocation of these behaviors for future interventions and policymaking.

Applicability of the cognitive model of generalized anxiety disorder to adolescents' sleep quality: A cross-sectional and longitudinal analysis

Background

Poor sleep quality is a prevalent health issue among adolescents, and few studies have examined the variables affecting adolescents' sleep quality from the perspective of the co-occurrence of sleep issues and anxiety disorders. Therefore, the current study investigated whether the cognitive model of generalized anxiety disorder applies to adolescents' sleep quality.

Method

In Study 1, a total of 2042 adolescents were recruited and they completed questionnaires relating to worry, intolerance of uncertainty (IU), negative problem orientation (NPO), cognitive avoidance (CA), and sleep quality. In Study 2, a total of 379 adolescents participated in a six-month longitudinal survey to verify the model that was obtained in Study 1.

Results

Study 1 showed the modified cognitive model of generalized anxiety disorder can be applied to adolescents' sleep quality. Specifically, IU was a higher-order vulnerability factor that directly affected worry, and indirectly fostered worry via NPO and CA, where worry only mediated the relationships between IU, NPO, and sleep quality. However, CA exerted no independent effect on worry or sleep quality beyond the influences of IU and NPO, therefore, it dropped out of the final model. Study 2 partially confirmed the above model again from the longitudinal perspective.

Conclusion

The present study constructs a new model to explain adolescents' sleep quality, providing a foundation for future interventions.

Network Analysis of Health-related Behaviors, Insomnia, and Depression Among Urban Left-behind Adolescents in China

Mental health of urban left-behind adolescents (LBA) is a public issue of growing concern. This study aims to examine the symptom level associations among multiple health-related behaviors, insomnia, and depression in urban LBA. Data on a sample of urban LBA aged 11-19 (N = 3,601) from the Adolescent Mental Health Survey in Shenzhen, China, were used. Health-related behaviors (i.e., Internet use, physical inactivity, social jetlag, smoking, and alcohol consumption), insomnia, and depressive symptoms were assessed using a self-administered questionnaire. Graphical Gaussian Model (GGM) was used to describe key bridging nodes in an undirected network. Directed Acyclic Graph (DAG) was used to construct a directed network and estimate the most likely causal associations among behaviors/symptoms. In the undirected network, Internet use was identified as the key bridging node most strongly associated with insomnia and depression. Two other key bridging nodes include difficulty initiating sleep and appetite change. In the directed network, anhedonia emerged as the most pivotal symptom, which could cause insomnia symptoms and behavioral changes, either directly, or through triggering other depressive symptoms, such as low energy and appetite change. These findings have implications for understanding the occurrence and maintenance process of health-related behaviors, insomnia, and depression in urban LBA. In practice, Internet use should be considered a priority in targeting multiple health behavior interventions. Meanwhile, early screening and treatment for anhedonia are of great significance as well.

Comparing Bayesian Variable Selection to Lasso Approaches for Applications in Psychology

In the current paper, we review existing tools for solving variable selection problems in psychology. Modern regularization methods such as lasso regression have recently been introduced in the field and are incorporated into popular methodologies, such as network analysis. However, several recognized limitations of lasso regularization may limit its suitability for psychological research. In this paper, we compare the properties of lasso approaches used for variable selection to Bayesian variable selection approaches. In particular we highlight advantages of stochastic search variable selection (SSVS), that make it well suited for variable selection applications in psychology. We demonstrate these advantages and contrast SSVS with lasso type penalization in an application to predict depression symptoms in a large sample and an accompanying simulation study. We investigate the effects of sample size, effect size, and patterns of correlation among predictors on rates of correct and false inclusion and bias in the estimates. SSVS as investigated here is reasonably computationally efficient and powerful to detect moderate effects in small sample sizes (or small effects in moderate sample sizes), while protecting against false inclusion and without over-penalizing true effects. We recommend SSVS as a flexible framework that is well-suited for the field, discuss limitations, and suggest directions for future development.

Aberrant single-subject morphological cerebellar connectome in chronic insomnia

BACKGROUND

To systematically investigate the topological organisation of morphological networks of the cerebellum using structural MRI and examine their clinical relevance in chronic insomnia (CI).

METHODS

One hundred and one patients with CI and 102 healthy controls (HCs) were recruited in this study. Individual morphological networks of the cerebellum were constructed based on regional grey matter volume, and topologically characterised using weighted graph theory-based network approaches. Between-group comparisons were performed using permutation tests, and Spearman's correlation was used to examine the relationships between topological alterations and clinical variables.

RESULTS

Compared with HCs, patients with CI exhibited a lower normalised clustering coefficient. Locally, CI patients exhibited lower nodal efficiency in the cerebellar lobule VIIb and vermis regions, but higher nodal efficiency in the right cerebellar lobule VIIIa regions. No correlations were observed between network alterations and clinical variables.

CONCLUSIONS

Individual morphological network analysis provides a new strategy for investigating cerebellar morphometric changes in CI, and our findings may have important implications in establishing diagnostic and categorical biomarkers.

Real-time monitoring of increases in restlessness to assess idiographic risk of recurrence of depressive symptoms

BACKGROUND

This confirmatory study aimed to examine whether we can foresee recurrence of depressive symptoms using personalized modeling of rises in restlessness.

METHODS

Participants were formerly depressed patients (N = 41) in remission who (gradually) discontinued antidepressants. Participants completed five smartphone-based Ecological Momentary Assessments (EMA) a day, for a period of 4 months, yielding a total of 21 180 observations. Statistical Process Control by means of Exponentially Weighted Moving Average (EWMA) control charts was used to detect rises in the EMA item 'I feel restless', for each individual separately.

RESULTS

An increase in restlessness was detected in 68.3% of the participants with recurring depressive symptoms, and in 26.3% of those who stayed in remission (Fisher's exact test p = 0.01, sensitivity was 68.3%, specificity was 73.7%). In the participants with a recurrence and an increase in restlessness, this increase could be detected in the prodromal phase of depression in 93.3% of the cases and at least a month before the onset of the core symptoms of depression in 66.7% of the cases.

CONCLUSIONS

Restlessness is a common prodromal symptom of depression. The sensitivity and specificity of the EWMA charts was at least as good as prognostic models based on cross-sectional patient characteristics. An advantage of the current idiographic method is that the EWMA charts provide real-time personalized insight in a within-person increase in early signs of depression, which is key to alert the right patient at the right time.

Abnormal functional connectivity in the habenula is associated with subjective hyperarousal state in chronic insomnia disorder

Background

The hyperarousal process model plays a central role in the physiology of chronic insomnia disorder (CID). Recent evidence has demonstrated that the habenula is involved in the arousal and sleep-wake cycle. However, whether the intrinsic habenular functional network contributes to the underlying mechanism of CID and its relationship to the arousal state in CID remains unclear.

Methods

This single-centered study included 34 patients with subjective CID and 22 matched good sleep control (GSC), and underwent a series of neuropsychological tests and resting-state functional magnetic resonance imaging scans. The habenular functional network was assessed using seed-based functional connectivity (FC) analysis. The subjective arousal state was evaluated with the hyperarousal scale (HAS). Alterations in the habenular FC network and their clinical significance in patients with CID were explored.

Results

Compared with the GSC group, the CID group showed decreased habenular FC in the left caudate nucleus and right inferior parietal lobule and increased FC in the right habenula, bilateral calcarine cortex, and posterior cingulate cortex. The decreased FC between the left habenula and caudate nucleus was associated with an increased arousal state in the CID group.

Conclusion

The present results provide evidence for a dysfunctional habenular network in patients with CID. These findings extend our understanding of the neuropathological mechanisms underlying the hyperarousal model in chronic insomnia.

Marital status and living apart affect sleep quality in male military personnel: a study of the China's Navy during COVID-19

Background

Marital status is a robust sociodemographic predictor of sleep. Having to live apart from spouse may have different implications than those of cohabitants or singles, especially in military personnel. Further research on this group will help provide knowledge in advance and facilitate early targeted interventions.

Methods

An online questionnaire study was conducted from July to November 2021. A total of 1,832 male military personnel completed the questionnaire. The marital status was measured by a self-reported single choice question. Pittsburgh sleep quality index (PSQI), Epworth Sleepiness Scale (ESS) and The Dysfunctional Beliefs and Attitudes about sleep scale (DBAS-16) were used to measure sleep-related outcomes. Inverse probability weighting (IPW) was applied to reduce the effects of confounding. Logistic regression was used to analyze the relationship between marital status and sleep and explore the impact of living together or not.

Results

After inverse probability weighting, the prevalence of poor sleep quality, sleepiness and dysfunctional beliefs were 16.1, 20.1 and 7.1%, respectively. One-way ANOVA results for the means of both groups were statistically significantly different, except for the sleep latency and sleep disturbance dimensions of PSQI. Participants who were married were more likely to have poor sleep quality (OR: 1.408, 95% CI: [1.10, 1.80]), to have daytime sleepiness (OR: 1.560, 95% CI: [1.27, 1.92]) and to develop dysfunctional beliefs and attitudes (OR: 2.497, 95% CI: [1.65, 3.80]) than those who were unmarried. Further analysis showed that the odds of developing poor sleep quality and DBAS in participants who married but living apart were significantly bigger than those unmarried (OR: 1.548 and 3.991, respectively.), while there were no significant differences in the odds of daytime sleepiness (OR: 0.738, p = 0.050). Age was a protective factor for the development of bad sleep outcomes, while family economic was an independent risk factor.

Conclusion

Marital status appear important for sleep quality, daytime sleepiness and sleep beliefs. The effect of living apart or not should be considered separately as an important predictor of sleep.

Sleep and Sport Performance

SUMMARY

Elite athletes and coaches believe sleep is the most important recovery strategy and widely consider it critical to optimal performance. Despite this perceived importance, there are numerous circumstances that can reduce sleep quantity and quality in athletic populations. Because of the effects of sleep loss on various physical, neurophysiological, and cognitive parameters, such perturbations can have consequences for performance and recovery outcomes. Although peer-reviewed literature examining the interaction between sleep, performance, and recovery in athletes is increasing, understanding of these issues remains equivocal. Perhaps most pertinently, the effect of sleep on sport performance does not align with a one-size-fits-all approach and rather depends on numerous factors such as type of sport, scheduling, time of the season, and the intraindividual requirements for sleep. The relationship between brain plasticity and memory, which in turn can influence learning processes and long-term memory consolidation, suggests that sleep may play an important role in learning new skills and tactics for both elite and developing athletes. The aim of this special issue review was to analyze the evidence of sleep loss on sport performance and recovery, with a specific focus on elite athletes. An assessment of these sleep-compromising situations that elite athletes may face during a typical season and practical considerations for alleviating these issues is also provided to further the understanding for medical professionals, scientists, and applied sporting practitioners alike.

Establishment of insomnia model of chronic unpredictable stress in rats

It is well known that stressful situation is one of the important factors causing insomnia, however, the underlying mechanism is still elusive. Therefore, the establishment of a suitable animal model of stress insomnia will be of great help to solve this problem. In this study, by combining with chronic unpredictable stress (multitude of stressors) and sleep deprivation, we attempted to establish a rat model of stress insomnia. It was observed that rats with stress insomnia showed significant weight loss, and less sleep quality in pentobarbital sodium induced sleep test and electroencephalogram detection. Moreover, rats with stress insomnia showed greater depression and anxiety detected by forced swimming, sucrose preference test and open field. Since oxidative stress has been reported to be involved in insomnia, we further evaluated the production of oxidative stress and found that the levels of lipid peroxidation product malondialdehyde (MDA) in liver, serum total bilirubin and urine biopyrrin were all significantly increased in rats with stress insomnia. In addition, we also found that the memory of these rats with stress insomnia was also obviously reduced in water maze. Taken together, these results demonstrate that the emotional behaviors, memory, oxidative and metabolism of the rats were all significantly changed after modeling, indicating a rat model of stress insomnia was successful establishment, and this animal model will provide basis to further explore the underlying mechanism of chronic stress in insomnia.

Associations of Changes in Sleep and Emotional and Behavioral Problems From Late Childhood to Early Adolescence

Importance

Sleep problems and psychopathology symptoms are highly comorbid and bidirectionally correlated across childhood and adolescence. Whether these associations are specific to discrete profiles of sleep problems and specific internalizing and externalizing phenomena is currently unclear.

Objective

To characterize individual changes in profiles of sleep problems and their prospective associations with psychopathology symptoms across the transition from childhood to adolescence.

Design, Setting, and Participants

This observational cohort study used baseline data (participant age of 9 to 11 years) and 2-year follow-up data (participant age of 11 to 13 years) from the community-setting, multicenter Adolescent Brain Cognitive Development (ABCD) study. Individuals were assessed for a range of sleep problems at both waves and categorized into profiles via latent profile analysis. The stability and change in these profiles over time was assessed via latent transition analysis. Logistic regression models examined whether psychopathology symptoms were cross-sectionally associated with profile membership and whether transitions between profiles were associated with changes psychopathology symptoms over time. Data were collected from September 2016 to January 2020, and data were analyzed from August 2021 to July 2022.

Exposures

Sleep problems were assessed at both baseline and follow-up via the parent-reported Sleep Disturbance Scale for Children (SDSC).

Main Outcomes and Measures

Psychopathology symptoms at both baseline and follow-up were assessed using the internalizing and externalizing dimension scores derived from the parent-reported Child Behavior Checklist.

Results

A total of 10 313 individuals (4913 [47.6%] were female) were categorized into 4 latent profiles of sleep problems at both baseline and follow-up: a low disturbance profile, a sleep onset/maintenance problems profile, a moderate and nonspecific disturbance profile (termed mixed disturbance), and a high disturbance profile. Individuals in the 3 more severe problem profiles displayed greater risk of concurrent internalizing symptoms (sleep onset/maintenance problems: odds ratio [OR], 1.30; 95% CI, 1.25-1.35; P < .001; mixed disturbance: OR, 1.29; 95% CI, 1.25-1.33; P < .001; high disturbance: OR, 1.44; 95% CI, 1.40-1.49; P < .001) and externalizing symptoms (sleep onset/maintenance problems: OR, 1.20; 95% CI, 1.16-1.23; P < .001; mixed disturbance: OR, 1.17; 95% CI, 1.14-1.20; P < .001; high disturbance: OR, 1.24; 95% CI, 1.21-1.28; P < .001). Transitions between sleep profiles over time were associated with prospective internalizing and externalizing symptoms, but not vice versa.

Conclusions and Relevance

There are substantial changes in sleep problems across the transition to adolescence that are associated with later internalizing and externalizing symptoms. Sleep profiles could be targeted in future intervention and treatment programs to improve sleep-related and mental health-related outcomes across development.

The impact of insomnia on anxiety and depression: a longitudinal study of non-clinical young Chinese adult males

Insomnia, anxiety, and depression commonly co-occured and were closely related. Most of the prior studies were cross-sectional, with a poor ability to infer causality. Longitudinal study was needed to classify the relationships. The present study conducted a longitudinal study of non-clinical young Chinese males to investigate whether insomnia predicted the likelihood of future anxiety and depression, and vice versa. Convenient sampling method was applied, and 288 participants was recruited from Shanghai in October 2017 with Athens Insomnia Scale (AIS), Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). 120 of them were re-tested in June 2018. The drop-out rate was 58.33%. Correlation analyses and cross-lagged analysis showed that AIS global score was significantly positively related with scores of depression and anxiety at baseline and follow-up. Insomnia was a predictive factor of anxiety, but it can't predict depression. In sum, insomnia may be an important cause of anxiety, while no predictive relationship was found between insomnia and depression.

A cross-sectional study of non-suicidal self-injury in a Chinese adolescent inpatient cohort

Background

Non-suicidal self-injury (NSSI) is a significant predictor of completed suicide and is increasingly recognized as a serious public health concern. Multiple factors, including social, familial, mental, and genetic factors could influence the occurrence of this behavior. Identifying the early risk factors is important for screening and preventing this behavior.

Methods

Here, we recruited a total of 742 adolescent inpatient participants from a mental health center and conducted a series of diagnostic interviews and questionnaires to assess NSSI behavior and other events. Bivariate analysis was used to detect differences between groups in NSSI and non-NSSI. Then, binary logistic regression was fitted to identify predictors of NSSI as a function of these questionnaire scores.

Results

Of the 742 adolescents examined, a total of 382 (51.5%) participants engaged in NSSI. Bivariate analysis showed that age, gender, depression, anxiety, insomnia, and childhood trauma was significantly associated with NSSI. Logistic regression results suggested that females had 2.43 higher odds of engaging in NSSI when compared to their male counterparts (OR = 3.43, 95%CI = 2.09-5.74, p = 1.70 × 10^-6). Depression was a primary risk predictor for NSSI with each additional increase in symptoms of depression increasing the odds of engaging in NSSI by 18% (OR = 1.18, 95%CI = 1.12-1.25, p = 2.25 × 10^-8).

Conclusion

More than half of the adolescent inpatients with psychiatric disorders have NSSI experience. Depression and gender were the risk factors for NSSI. Age at a specific range had a high prevalence of NSSI.

Persistent olfactory dysfunction associated with poor sleep quality and anxiety in patients with long COVID

Introduction

Poor sleep quality have been widely reported in patients with long COVID. Determining the characteristics, type, severity, and relationship of long COVID with other neurological symptoms is essential for the prognosis and management of poor sleep quality.

Methods

This cross-sectional study was conducted at a public university in the eastern Amazon region of Brazil between November 2020 and October 2022. The study involved 288 patients with long COVID with self-report neurological symptoms. One hundred thirty-one patients were evaluated by using standardised protocols: Pittsburgh sleep quality index (PSQI), Beck Anxiety Inventory, Chemosensory Clinical Research Center (CCRC), and Montreal Cognitive Assessment (MoCA). This study aimed to describe the sociodemographic and clinical characteristics of patients with long COVID with poor sleep quality and their relationship with other neurological symptoms (anxiety, cognitive impairment, and olfactory disorder).

Results

Patients with poor sleep quality were mainly women (76.3%), 44.04 ± 12.73 years old, with >12 years of education (93.1%), and had monthly incomes of up to US $240.00 (54.2%). Anxiety and olfactory disorder were more common in patients with poor sleep quality.

Discussion

Multivariate analysis shows that the prevalence of poor sleep quality was higher in patients with anxiety, and olfactory disorder is associated with poor sleep quality. In this cohort of patients with long COVID, the prevalence of poor sleep quality was highest in the group tested by PSQI and were associated with other neurological symptoms, such as anxiety and olfactory dysfunction. A previous study indicates a significant association between poor sleep quality and psychological disorders over time. Recent studies involving neuroimaging found functional and structural changes in Long COVID patients with persistent olfactory disfunction. Poor sleep quality are integral part of complex changes related to Long COVID and should be part of patient's clinical management.

Relationship between antenatal sleep quality and depression in perinatal women: A comprehensive meta-analysis of observational studies

BACKGROUND

Perinatal depression is a global mental health problem. Studies have suggested that perinatal depression is related to poor sleep quality during pregnancy. However, evidence on the influence and mechanism of sleep quality on the risk of developing perinatal depression remains limited and inconclusive.

METHODS

A systematic review was conducted in PubMed, Web of Science, Embase, CINAHI and Cochrane Library for relevant original quantitative studies published in English. A hand search of the reference list of relevant studies was also performed. Meta-analysis was performed using RevMan software and a random-effects model. Potential heterogeneity source was explored by subgroup and sensitivity analyses, and potential publication bias was tested using funnel plots and Begg's test.

RESULTS

A total of ten studies involving 39,574 participants were included in our meta-analysis. Overall, women who experienced poor sleep quality during pregnancy were at a significantly higher risk of developing depression, with antenatal depression 3.72 times higher, postpartum depression 2.71 times higher, and perinatal depression 3.46 times higher, compared to those did not experience poor sleep quality.

LIMITATIONS

Different measuring tools and unobserved confounding factors may make some bias in our result. What's more, not all included studies were initially designed to assess the association between antenatal sleep quality and the risk of developing perinatal depression.

CONCLUSION

Our meta-analysis found that antenatal sleep quality was negatively associated with the risk for perinatal depression. Our findings highlight the importance of improving sleep quality during pregnancy for mental health among perinatal women.

CaMKIIa Neurons of the Ventromedial Hypothalamus Mediate Wakefulness and Anxiety-like Behavior

Insomnia and anxiety are two common and closely related clinical problems that pose a threat to individuals' physical and mental well-being. There is a possibility that some nuclei and neural circuits in the brain are shared by both insomnia and anxiety. In the present study, using a combination of chemogenetics, optogenetics, polysomnographic recordings and the classic tests of anxiety-like behaviors, we verified that the calmodulin-dependent protein kinase II alpha (CaMKIIa) neurons of the ventromedial hypothalamus (VMH) are involved in the regulation of both wakefulness and anxiety. Chemogenetic manipulation of the VMH CaMKIIa neurons elicited an apparent increase in wakefulness during activation, whereas inhibition decreased wakefulness mildly. It substantiated that the VMH CaMKIIa neurons contribute to wakefulness. Then in millisecond-scale control of neuronal activity, short-term and long-term optogenetic activation induced the initiation and maintenance of wakefulness, respectively. We also observed that mice reduced exploratory behaviors in classic anxiety tests while activating the VMH CaMKIIa neurons and were anxiolytic while inhibiting. Additionally, photostimulation of the VMH CaMKIIa axons in the paraventricular hypothalamus (PVH) mediated wakefulness and triggered anxiety-like behaviors as well. In conclusion, our results demonstrate that the VMH participates in the control of wakefulness and anxiety, and offer a neurological explanation for insomnia and anxiety, which may be valuable for therapeutic interventions such as medication and transcranial magnetic stimulation.

Risk for depression tripled during the COVID-19 pandemic in emerging adults followed for the last 8 years

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has significantly increased depression rates, particularly in emerging adults. The aim of this study was to examine longitudinal changes in depression risk before and during COVID-19 in a cohort of emerging adults in the U.S. and to determine whether prior drinking or sleep habits could predict the severity of depressive symptoms during the pandemic.

METHODS

Participants were 525 emerging adults from the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA), a five-site community sample including moderate-to-heavy drinkers. Poisson mixed-effect models evaluated changes in the Center for Epidemiological Studies Depression Scale (CES-D-10) from before to during COVID-19, also testing for sex and age interactions. Additional analyses examined whether alcohol use frequency or sleep duration measured in the last pre-COVID assessment predicted pandemic-related increase in depressive symptoms.

RESULTS

The prevalence of risk for clinical depression tripled due to a substantial and sustained increase in depressive symptoms during COVID-19 relative to pre-COVID years. Effects were strongest for younger women. Frequent alcohol use and short sleep duration during the closest pre-COVID visit predicted a greater increase in COVID-19 depressive symptoms.

CONCLUSIONS

The sharp increase in depression risk among emerging adults heralds a public health crisis with alarming implications for their social and emotional functioning as this generation matures. In addition to the heightened risk for younger women, the role of alcohol use and sleep behavior should be tracked through preventive care aiming to mitigate this looming mental health crisis.

Sleep Deprivation and Insomnia in Adolescence: Implications for Mental Health

Sleep changes significantly throughout the human lifespan. Physiological modifications in sleep regulation, in common with many mammals (especially in the circadian rhythms), predispose adolescents to sleep loss until early adulthood. Adolescents are one-sixth of all human beings and are at high risk for mental diseases (particularly mood disorders) and self-injury. This has been attributed to the incredible number of changes occurring in a limited time window that encompasses rapid biological and psychosocial modifications, which predispose teens to at-risk behaviors. Adolescents’ sleep patterns have been investigated as a biunivocal cause for potential damaging conditions, in which insufficient sleep may be both a cause and a consequence of mental health problems. The recent COVID-19 pandemic in particular has made a detrimental contribution to many adolescents’ mental health and sleep quality. In this review, we aim to summarize the knowledge in the field and to explore implications for adolescents’ (and future adults’) mental and physical health, as well as to outline potential strategies of prevention.

Investigation of pain sensitivity following 3 nights of disrupted sleep in healthy individuals

BACKGROUND

Poor quality sleep is a common complaint among people with chronic pain. The co-occurrence of poor sleep quality and chronic pain often comes with increased pain intensity, more disability and a higher cost of healthcare. Poor sleep has been suggested to affect measures of peripheral and central pain mechanisms. To date, sleep provocations are the only models proven to affect measures of central pain mechanisms in healthy subjects. However, there are limited studies investigating the effect of several nights of sleep disruption on measures of central pain mechanisms.

METHODS

The current study implemented three nights of sleep disruption with three planned awakenings per night in 30 healthy subjects sleeping at home. Pain testing was conducted at the same time of day at baseline and follow-up for each subject. Pressure pain thresholds were assessed bilaterally on the infraspinatus and gastrocnemius muscles. Using handheld pressure algometry, suprathreshold pressure pain sensitivity and area were also investigated on the dominant infraspinatus muscle. Cuff-pressure pain detection and tolerance thresholds, temporal summation of pain and conditioned pain modulation were investigated using cuff-pressure algometry.

RESULTS

Temporal summation of pain was significantly facilitated (p = 0.022), suprathreshold pain areas (p = 0.005) and intensities (p < 0.05) were significantly increased, and all pressure pain thresholds were decreased (p < 0.005) after sleep disruption compared to baseline.

CONCLUSIONS

The current study found that three consecutive nights of sleep disruption at home induced pressure hyperalgesia and increased measures of pain facilitation in healthy subjects, which is consistent with previous findings.

SIGNIFICANCE

Poor quality of sleep is often experienced by patients with chronic pain, with the most common complaint being nightly awakenings. This exploratory study is the first to investigate changes in measures of central and peripheral pain sensitivity in healthy subjects after sleep disruptions for three consecutive nights without any restrictions on total sleep time. The findings suggest that disruptions to sleep continuity in healthy individuals can induce increased sensitivity to measures of central and peripheral pain sensitization.

Associations of social jetlag and insomnia symptoms with depressive symptoms among Chinese adolescents: A large population-based study

OBJECTIVE

This study aimed to evaluate the associations of social jetlag and insomnia symptoms with depressive symptoms among adolescents.

METHODS

A total of 37,871 junior high students completed an online survey between May 24th and Jun 5th, 2022. Insomnia symptoms were assessed by three items based on the Diagnostic and Statistical Manual of Mental Disorders criteria. Social jetlag and depressive symptoms were evaluated by the Munich Chronotype Questionnaire and the Patient Health Questionnaire, respectively. Restricted cubic splines were used to explore the relationship between social jetlag and depressive symptoms. Joint effects of social jetlag and insomnia symptoms on depressive symptoms were estimated using additive interaction models.

RESULTS

The prevalence of depressive symptoms was 13.1%. Depressive symptoms were more common in adolescents with social jetlag ≥2 h (OR: 1.51, 95% CI: 1.39-1.65) and insomnia symptoms (OR: 6.91, 95% CI: 6.41-7.44). There was a J-shaped relationship between social jetlag and depressive symptoms when we took social jetlag as a continuous variable. Moreover, a positive additive interaction of social jetlag ≥2 h and insomnia symptoms on depressive symptoms was found in female adolescents (RERI: 2.30, 95% CI: 0.11-4.49).

CONCLUSIONS

Our findings suggested that social jetlag ≥2 h and insomnia are related to the occurrence of depressive symptoms in adolescents. Their coexistence additively enhances the strength of the association with depressive symptoms. Early screening and intervention for insomnia, as well as methods to reduce social jetlag, should be comprised as part of preventive strategies for depression in adolescents.

Efficacy of Cognitive Behavioral Therapy for Insomnia for the Treatment of Child and Adolescent Anxiety and Depression: A Systematic Review From Randomized Controlled Trials

ABSTRACT

Cognitive behavioral therapy for insomnia (CBT-I) has shown promising results in the adult population. However, there is not enough evidence for children and adolescents. Hence, we evaluated the current evidence of CBT-I in the treatment of anxiety and depression in children and adolescents. Published randomized clinical trials published before June 2020 were searched from PubMed, Cochrane Library of database, clinicaltrials.gov, and Google Scholar. Out of seven included studies, six studies assessed the effect of CBT-I on depression, and five assessed the effect on anxiety. In this review, most studies in this review showed a strong effect of CBT-I on symptoms of depression. Although a positive effect of CBT-I on anxiety was noted, only a small number of studies have considered this management. These findings should be considered preliminary, and further large-scale studies are warranted to further explore this finding further.

A case-control study of sexualised behaviour in sleep: A strong association with psychiatric comorbidity and relationship difficulties

Sexualised behaviour in sleep (SBS) is a relatively rare parasomnia consisting of instinctive behaviours of a sexual nature occurring during non-rapid-eye movement (NREM) sleep. Little information exists at present regarding the clinical features and onset of this condition as well as its link to psychiatric comorbidity, other sleep disorders and history of adverse early life experience. Aims were to typify the condition further and compare features of SBS patients to those with other NREM parasomnias.

METHODS

Details of 335 consecutive patients presenting to a single tertiary sleep centre with non-rapid eye movement (NREM)-parasomnias over a 15-year period (2005-2020) were examined. Data were collated by reviewing case-notes for anthropometric data, past medical history, clinical findings, and video polysomnography. SBS patients were compared to a cohort of 270 non-SBS, NREM-sleep disorder patients (case-control) to ascertain whether they had any distinguishing features from other parasomnias classified in this group.

RESULTS

Sixty-five patients with SBS were identified: 58 males, 7 females (comprising 19.4% of the cohort overall). Mean age at presentation was 33(±9.5) years. Onset of behaviours was commoner in adulthood in the SBS cohort, whereas non-SBS, NREM-parasomnia onset (n = 270) was commoner in childhood: 61.1% and 52.9% respectively (p = 0.007). An association was identified between the presence of psychiatric diagnoses and onset of SBS (p = 0.028). Significant triggers for SBS behaviours included alcohol consumption (p < 0.001), intimate relationship difficulties (p = 0.009) and sleep deprivation (p = 0.028). Patients with SBS were significantly more likely to report sleepwalking as an additional NREM behaviour (p < 0.001). Males were more likely to present at clinic together with their bedpartner and females presented alone. A history of SBS appeared to be more common in those working in the armed forces or the police compared to those presenting with non-SBS, NREM-parasomnias (p = 0.004).

CONCLUSIONS

SBS is more common in clinical practice than previously described and presents with some distinguishing features within the NREM disorder category. This study is the first to identify that onset in childhood or lack of amnesia does not preclude the condition and that patterns of presentation differ between men and women. Sleepwalkers particularly should be asked about SBS. Comorbid psychiatric conditions, profession and intimate partner difficulties are strong determinants of the presentation.

Insomnia and multiple health outcomes: umbrella review of meta-analyses of prospective cohort studies

OBJECTIVES

To evaluate existing evidence of prospective cohort studies on associations between insomnia and multiple health outcomes.

STUDY DESIGN

An umbrella review of meta-analyses of prospective cohort studies.

METHODS

A systematic search was undertaken in Pubmed, Embase, Cochrane, and Web of Science from inception to October 2021 to find meta-analyses of prospective cohort studies investigating the association of insomnia with any health outcome. The summary relative risk (SRR) for each meta-analysis was recalculated with random-effects model. The methodological quality and the quality of evidence were assessed by the A Measurement Tool to Assess Systematic Reviews and Grading of Recommendations, Assessment, Development and Evaluation, respectively.

RESULTS

A total of 25 published meta-analyses of prospective cohort studies, reporting 63 SRRs for 29 unique outcomes were included. Insomnia was mainly related to cardiovascular outcomes and mental disorders. The former comprised atrial fibrillation (SRR: 1.30, 95% confidence interval: 1.26 to 1.35), cardiovascular diseases (1.45, 1.29 to 1.64), coronary heart disease (1.28, 1.10 to 1.50), myocardial infarction (1.42, 1.17 to 1.72), and stroke (1.55, 1.39 to 1.72). The latter involved alcohol abuse (1.35, 1.08 to 1.67), all mental disorders (2.16, 1.70 to 3.97), anxiety (3.23, 1.52 to 6.85), depression (2.31, 1.90 to 2.81), suicidal ideation (2.26, 1.79 to 2.86), suicidal attempt (1.99, 1.31 to 3.02), and suicidal death (1.72, 1.42 to 2.08). Besides, insomnia enhanced the risk of Alzheimer's disease (1.51, 1.06 to 2.14) and hyperlipidemia (1.64, 1.53 to 1.76).

CONCLUSION

Insomnia exhibits considerable adverse outcomes, primarily comprises cardiovascular outcomes and mental disorders, but further studies with robustly designed trials are needed to draw firmer conclusions.

Insomnia in Infancy, Childhood, and Adolescence

Insomnia is the most prevalent sleep disorder in youth, tends to persist over time, and is associated with a myriad of adverse outcomes. This paper synthesizes the current evidence regarding the phenomenology, prevalence, assessment, consequences, cause, and treatment of pediatric insomnia, highlighting areas that warrant further research and addressing the unique characteristics of this disorder in infants, children, and adolescents.

Sleep and Mental Health Problems in Children and Adolescents

Previous reviews have described the links between sleep and mental health extensively. In this narrative review, we focus on literature published during the last decade investigating the links between sleep and mental health difficulties in childhood and adolescence. More specifically, we focus on the mental health disorders listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders. We also discuss possible mechanisms underlying these associations. The review ends with a discussion of possible future lines of enquiry.

Patterns of unhealthy behaviours during adolescence and subsequent anxiety and depression in adulthood: a prospective register linkage study of the HUNT survey and health registries

BACKGROUND

There is increasing need for prospective investigations in the preventing role of health-related behaviours on mental health problems. The aim of this study is to identify patterns of health-related behaviours in adolescence, and the association between the behavioural patterns and the subsequent diagnoses and/or drug treatment for anxiety and/or depression in adulthood.

METHODS

This prospective study consisted of 13-19-year-old participants in the Trøndelag Health Study (Young-HUNT3) in 2006-2008 (n = 2061, 1205 females and 856 males) in Norway, who also participated in HUNT4 (2017-2019). Survey data on health-related behaviours in adolescence, including low level of physical activity, low consumption of wholegrain bread, fish, fruit, vegetables and high consumption of sugar-sweetened beverages and insomnia were linked on an individual level to prospective information on drug use and diagnosis in national health registries. The different patterns of health-related behaviours were identified through latent class analysis. Subsequent anxiety or depression was defined as at least one recording in either of three registries covering recorded diagnosis in primary and specialist healthcare, or dispensed prescription drugs during 2008-2019. Additionally, self-reported psychological distress measured in young adulthood was applied as a supplemental outcome measure.

RESULTS

Four patterns of health-related behaviours were identified: high risk behaviours (class 1), moderate to high risk behaviours (class 2), low to moderate risk behaviours (class 3) and low risk behaviours (class 4). Adolescents in class 3 showed higher odds of subsequent diagnoses for anxiety and/or depression in primary and specialist healthcare compared to class 4 participants. In addition, both class 1 and class 4 participants had higher odds for self-reported psychological distress than those class 4 (OR = 1.56 and OR = 1.86, respectively).

CONCLUSIONS

Our findings suggest that health-related behaviours are clustered among Norwegian adolescents. The patterns of unhealthy behaviours during adolescence only partly increased the risk of anxiety and depression in adulthood. Promoting healthy behaviours during adolescence may potentially reduce the burden of mental illness in adulthood, but further research is needed to clarify the nature of the relationships.

Internet addiction and suicidal behavior among vocational high school students in Hunan Province, China: A moderated mediation model

Background

Vocational education is an important part of high school education in China. However, there is little research on high school students' mental health. This study aimed to investigate the prevalence of suicidal behavior (SB) among this population and the mediating role of insomnia, depression, anxiety, and stress in the relationship between Internet addiction (IA) and SB using a structural equation model.

Methods

A cross-sectional questionnaire survey was conducted among several vocational high school students in Hunan Province, and 7,968 valid questionnaires were obtained. General demographic data and data from the Dual-Mode Self-Control Scale, Athens Insomnia Scale, Depression Anxiety Stress scale-21, and Revised Chen Internet Addiction Scale were collected. A structural equation model was used to explore the different pathways from IA to SB.

Results

Among the participants, 37.7, 15.7, and 21.8% reported suicidal ideation, plans, and attempts, respectively. The structural equation model confirmed that IA was indirectly related to SB and was mediated by insomnia and/or depression, anxiety, and stress.

Limitations

First, we only recruited students from vocational schools in Hunan Province, therefore, the sample may not represent the entire population of vocational students in China. Second, self-report scales were used in this study, and clinical diagnosis required professional interviews. Third, since this study had a cross-sectional design, the causal relationship between the variables could not be determined.

Conclusions

The prevalence of SB among vocational high school students in China was significantly high. The prevention of SB related to IA can be attributed to the improvement of insomnia and emotional problems.

Differential Associations Between Meeting 24-Hour Movement Guidelines With Mental Wellbeing and Mental Illness Among Chinese Adolescents

PURPOSE

Contemporary mental health models simultaneously consider psychological distress and wellness. Researchers have proposed that adhering to the 24-hour movement guidelines (24-HMG) contributes to mental health. 24-HMG integrates recommendations of time distribution among sleep, screen use, and moderate to vigorous physical activity (MVPA). Yet, there are few studies on the relationship between meeting 24-HMG and mental health, especially mental wellbeing. This study aimed to examine the associations between adherence to 24-HMG with mental wellbeing and mental illness among Chinese adolescents.

METHODS

Cross-sectional data of 67,281 Chinese adolescents aged 10-17 years (mean age = 13.0 years, 51.9% males) were collected by sending online questionnaires to local primary and middle schools in Shenzhen in 2021. We used multilevel generalized linear models to analyze associations between meeting 24-HMG with mental wellbeing (subjective wellbeing, resilience, and positive youth development) and mental illness (depression and anxiety).

RESULTS

Only 1.7% of participants met recommendations for all three behaviors (sleep, screen use, and MVPA). Compared with meeting none of the recommendations, participants who met one or more recommendations reported significantly better performance in mental wellbeing (all p < .001); on the contrary, meeting one or more recommendations (except for only meeting the MVPA recommendation) were significantly related to lower severity of mental illness (all p < .001). The relationship between the number of recommendations met with mental well-being and mental illness indicators presented a dose-response pattern (all p < .001).

DISCUSSION

Meeting 24-HMG was associated with superior mental health, including a higher propensity for mental wellbeing and a lower risk of mental illness. The importance of limiting screen time and getting enough sleep should be highlighted in promoting mental health in adolescents.

[Insomnia in the context of affective disorders]

The article analyzes the current literature on the relationship of insomnia with affective disorders, in particular with depression and anxiety. Research shows that there is a strong multi-channel relationship between insomnia, depression, and anxiety, with insomnia being considered a risk factor for mood disorders more often than vice versa. The so-called insomnia paradox of bipolar disorder is described, the essence of which is that in manic episodes the frequency of insomnia is higher than in depressive episodes. The data of a network meta-analysis, which found an evidence base for the use of a variety of drugs used for the pharmacological treatment of insomnia in adults, are presented. Efficiency and convenience in taking the drug Valocordin-Doxylamine are noted.

Restraint stress induced anxiety and sleep in mice

In humans and animals, exposure to changes in internal or external environments causes acute stress, which changes sleep and enhances neurochemical, neuroendocrine, and sympathetic activities. Repeated stress responses play an essential role in the pathogenesis of psychiatric diseases and sleep disorders. However, the underlying mechanism of sleep changes and anxiety disorders in response to acute stress is not well established. In the current study, the effects of restraint stress (RS) on anxiety and sleep-wake cycles in mice were investigated. We found that after RS, the mice showed anxiety-like behavior after RS manipulation and increased the amounts of both non-rapid eye movement (NREM) and rapid eye movement (REM) sleep in the dark period. The increase in sleep time was mainly due to the increased number of episodes of NREM and REM sleep during the dark period. In addition, the mice showed an elevation of the EEG power spectrum of both NREM and REM sleep 2 h after RS manipulation. There was a significant reduction in the EEG power spectrum of both NREM and REM sleep during the darkperiod in the RS condition. The expression of the c-Fos protein was significantly increased in the parabrachial nucleus, bed nucleus of the stria terminalis, central amygdala, and paraventricular hypothalamus by RS manipulation. Altogether, the findings from the present study indicated that neural circuits from the parabrachial nucleus might regulate anxiety and sleep responses to acute stress, and suggest a potential therapeutic target for RS induced anxiety and sleep alterations.

COVID-19-related social isolation and symptoms of depression and anxiety in young men in Poland: Does insomnia mediate the relationship?

The need for physical distancing due to COVID-19 mitigation efforts forced prolonged social isolation, which may affect sleep and lead to mental health problems. Previous research has shown that young adults are particularly vulnerable to psychological stress caused by social isolation, the negative psychological impact of the pandemic, and greater frequency and severity of sleep problems. Therefore, the main goal of the present study was to examine whether insomnia could constitute a mediation mechanism that explains the relationship between social isolation experienced during the COVID-19 pandemic and mental health outcomes (depression and anxiety) reported up to 1.5 years later. The study was conducted among young (M±SD; 24.08±3.75) men (N = 1025) in Poland. Data were collected by means of self-report questionnaires, including The Social Isolation Index, The Athens Insomnia Scale, The State-Trait Anxiety Inventory (STAI-S) and Beck's Depression Inventory (BDI-II). The results show that insomnia mediates the relationships between social isolation and both anxiety and depression. The current findings emphasize the role of insomnia in the relationships between social isolation experienced during COVID-19 and negative emotional states. From a clinical perspective, the results suggest that implementing therapeutic components that address social isolation in insomnia treatment programs may prevent the development of depression and anxiety symptoms among young men.

Effects of dysfunctional beliefs about sleep on sleep quality and mental health among patients with COVID-19 treated in Fangcang shelter hospitals

Introduction

With the COVID-19 pandemic in China, a large number of mild or ordinary confirmed cases have been sent to Fangcang shelter hospitals for treatment. We aimed to investigate the mental health condition of Fangcang patients 2 years after the pandemic when patients knew more about COVID-19 and the virus was less virulent. We focused on the effect of dysfunctional beliefs and attitudes about sleep on depression, anxiety, and insomnia.

Methods

A total of 1,014 patients from two large Fangcang shelter hospitals in Shanghai between 22 April and 8 May 2022 completed a set of questionnaires comprising: the Dysfunctional Beliefs and Attitudes about Sleep scale, the Generalized Anxiety Disorder scale, the Patient Health Questionnaire, and the Insomnia Severity Index scale.

Results

Results show that the positive screening rates for anxiety, depression, and insomnia among tested patients were 55.3, 27.0, and 47.8%, respectively. Patients were more likely to report higher anxiety, depression, and insomnia, and to endorse affective and sleep disorders if they were: female, aged 18-40 years, with undergraduate course or above, white-collar employees, or those who thought the pandemic would have severe economic effects. About 51.4% of the participants had dysfunctional beliefs about sleep to varying degrees. Compared with patients who had accurate beliefs about sleep, the ratios of insomnia, anxiety, and depression were significantly higher among patients with dysfunctional beliefs about sleep.

Discussion

Attention should be paid to the mental health problems of patients in Fangcang shelter hospitals. The results indicate that dysfunctional beliefs about sleep significantly increased anxiety, depression, and insomnia of Fangcang patients.

The contribution of transdiagnostic vulnerability factors in patients with chronic insomnia

Introduction

Various transdiagnostic factors have been associated with insomnia severity. The current study aimed to predict insomnia severity based on a group of transdiagnostic factors including neuroticism, emotion regulation, perfectionism, psychological inflexibility, anxiety sensitivity, and repetitive negative thinking after controlling for depression/anxiety symptoms and demographic characteristics.

Methods

Two hundred patients with chronic insomnia disorder were recruited from a sleep disorder clinic. Participants completed the Insomnia Severity Index (ISI), Clinical Perfectionism Questionnaire (CPQ), Acceptance and Action Questionnaire-II (AAQ-II), Anxiety Sensitivity Index-3 (ASI-3), Repetitive Thinking Questionnaire (RTQ-10), Big Five Inventory (BFI-10), Emotion Regulation Questionnaire (ERQ), and Depression Anxiety Stress Scale (DASS-21).

Results

After controlling for the confounding variables (depression/anxiety symptoms and demographic characteristics), hierarchical multiple linear regression suggested the significant association of neuroticism (BFI), cognitive reappraisal (ERQ), personal standards (CPQ), evaluative concerns (CPQ), physical concerns (ASI), cognitive concerns (ASI), and repetitive negative thinking (RTQ) with insomnia severity.

Discussion

The findings support the role of transdiagnostic factors, especially physical concerns, repetitive negative thinking, and neuroticism in chronic insomnia. Future research using longitudinal designs is required to verify the causal status of transdiagnostic variables.

Mobile phone use addiction, insomnia, and depressive symptoms in adolescents from ethnic minority areas in China: A latent variable mediation model

BACKGROUND AND AIMS

Although previous studies have discussed the association between mobile phone use addiction (MPUA) and depressive symptoms in adolescents, studies on Chinese adolescents are limited, with no studies being reported on adolescents from ethnic minority areas within Yunnan. This study aimed to explore the mediating mechanism of insomnia in the association between MPUA and depressive symptoms among Yunnan college students.

METHODS

A sample survey was conducted among 10,121 college students from four colleges in Yunnan province, China, from November to December 2021 via cluster sampling. Insomnia was assessed using the Insomnia Severity Index Scale, MPUA was assessed using the Self-Rating Questionnaire for Adolescent Problematic Mobile Phone Use, and depressive symptoms were assessed using the Patient Health Questionnaire-9 items. A generalized linear model was used to analyze the association between MPUA, insomnia, and depressive symptoms. The structural equation model was used to analyze the mediating effect of insomnia.

RESULTS

The positive rates of depressive symptoms, MPUA, and insomnia were 39.2 %, 30.8 %, and 22.3 %, respectively. After adjusting for the demographic and confounding variables, MPUA (β = 0.14, 95 % CI: 0.13-0.15, P < 0.01) and insomnia (β = 0.44, 95 % CI: 0.43-0.46, P < 0.01) were associated with depressive symptoms (P < 0.05). The mediating effect of insomnia accounted for 34.7 % of the total effect in the mediating model of MPUA associated with depressive symptoms.

CONCLUSION

Our findings suggest that insomnia partially mediates the association between MPUA and depressive symptoms among Yunnan college students.

Worsened Anxiety and Loneliness Influenced Gaming and Gambling during the COVID-19 Pandemic

Aim: To study the prevalence and patterns of problematic gaming and gambling during the COVID-19 pandemic and the association with psychiatric traits and major types of anxiety categories. Method: 1067 young adults participated in both wave 3 (2018) and wave 4 (2021) of the SALVe Cohort. Associations with psychiatric symptoms and anxiety were examined using logistic regression and Chi-square tests. Results: Problematic gaming decreased by 1.3 percentage points to 23.2% since the start of the pandemic, while problematic gambling increased by 0.9 percentage points to 6.5% in w4. Average time spent playing video games/day decreased from 2.2 h (w3) to 1.7 h (w4), while increases in gaming activity were associated with worsened feelings of loneliness (p = 0.002), depression (p < 0.001), and anxiety (p < 0.01) during the pandemic. Predictors for problematic gaming at w4 were previous problematic gaming and social anxiety (p = < 0.001 and 0.01, respectively). Moreover, previous problem gambling also predicted problem gambling at w4 p < 0.001. All anxiety categories were associated with both problematic gaming and gambling when adjusted for age and sex. However, after adjusting for depression and insomnia, social anxiety was associated with problematic gaming (p < 0.001), while panic was associated with problem gambling (p < 0.001). Conclusion: Overall, problematic gaming has decreased since the start of the pandemic, while problem gambling has increased. Worsened feelings of loneliness, depression, and anxiety during the pandemic are associated with increased gaming. Moreover, the association between problematic gaming and gambling and anxiety is independent of depression and sleep problems.

Association between sleep and problematic behaviours in gifted children: a polysomnographic study

Neurological uniqueness, maladaptive behaviours, as well as atypical sleep patterns are reported to be defining characteristics of giftedness, but this has received little empirical support. We studied the polysomnography recorded sleep of gifted and typically-developing children together with features of maladaptive behaviours. The association of sleep macrostructure and sleep instability with maladaptive behaviours was also investigated in gifted children. In all, 19 gifted children (74% boys) and 17 typically-developing children (76% boys) aged 6-12 years were studied. Giftedness was identified using Renzulli's three-factor definition. The microarousal index, number of awakenings, and number of Stage shifts between sleep stages throughout the night were computed as sleep instability parameters. Maladaptive behaviours were assessed using the Child Behaviour Checklist. We found significantly more Stage N1 and less Stage N3 in gifted children compared to typically-developing children. More Stage N1 sleep was correlated with more externalising problems and less Stage N3 sleep was correlated with more internalising problems. Gifted children also displayed more rapid eye movement (REM) sleep, but this was not significantly correlated with behavioural scales. Gifted children displayed two opposing trends of sleep instability: more instability involving N1 sleep and less instability involving N2, N3 and REM sleep. More total Stage shifts were correlated with more internalising and externalising problems. The results of this study provide initial evidence of polysomnography-based characteristics of giftedness. Further studies are needed to explore common pathways linking sleep alterations and maladaptive behaviours in children with giftedness.

Association of circadian rhythms with brain disorder incidents: a prospective cohort study of 72242 participants

Circadian rhythm disruption (CRD) is a shared characteristic of various brain disorders, such as Alzheimer's disease (AD), Parkinson's disease (PD), and major depression disorder (MDD). Disruption of circadian rhythm might be a risk factor for brain disorder incidents. From 7-day accelerometry data of 72,242 participants in UK Biobank, we derived a circadian relative amplitude variable, which to some extent reflected the degree of circadian rhythm disruption. Records of brain disorder incidents were obtained from a wide range of health outcomes across self-report, primary care, hospital inpatient data, and death data. Using multivariate Cox proportional hazard ratio regression, we created two models adjusting for different covariates. Then, linear correlations between relative amplitude and several brain morphometric measures were examined in participants with brain MRI data. After a median follow-up of around 6.1 years, 72,242 participants were included in the current study (female 54.9%; mean age 62.1 years). Individuals with reduced relative amplitude had increasing risk of all-cause dementia (Hazard ratio 1.23 [95% CI 1.15 to 1.31]), PD (1.33 [1.25 to 1.41]), stroke (1.13 [1.06 to 1.22]), MDD (1.18 [1.13 to 1.23]), and anxiety disorder (1.14 [1.09 to 1.20]) in fully adjusted models. Additionally, significant correlations were found between several cortical regions and white matter tracts and relative amplitude that have been linked to dementia and psychiatric disorders. We confirm CRD to be a risk factor for various brain disorders. Interventions for regulating circadian rhythm may have clinical relevance to reducing the risk of various brain disorders.

Associations between dietary intake, diet quality and depressive symptoms in youth: A systematic review of observational studies

Background: Depression is the third leading cause of worldwide disease burden among youth, and nutrition- and diet-related behaviors have been considered as an effective strategy for reducing the risk of depressive symptoms. This systematic review aims to examine associations between dietary intake and diet quality with depressive symptoms among youth. Methods: In this systematic review, a search of scientific articles published between 2000 and 2021 was performed in four databases (CINAHL, Embase, PsycInfo, and PubMed) according to the PRISMA checklist. After applying inclusion and exclusion criteria, observational studies that focused on associations between micronutrient, macronutrient, food group intake, and diet quality and depressive symptoms among youth, ages 3 to 18, were selected for review. Results: Thirty-two articles met the review criteria. Dietary intake of magnesium, vitamin B12, fiber, fruits, vegetables, and fish were consistently inversely related to depressive symptoms. However, the evidence of associations between intake of vitamins B6, C, D, and E, iron, copper, zinc, omega-3 fatty acids, carbohydrate, and dietary fat and depressive symptoms was mixed. Dietary effects on decreased depressive symptoms were more pronounced in children than adolescents. Additionally, most studies failed to adjust for potential confounding variables. Conclusion: This review provides preliminary and comprehensive evidence for a relationship between dietary intake, diet quality, and depressive symptoms in youth. Although the results are heterogeneous and more research is needed, our findings indicate the importance of nutrition interventions for youth for decreasing depressive symptoms or for preventing further symptom exacerbation.

Do both timing and duration of screen use affect sleep patterns in adolescents?

BACKGROUND

Sleep duration has declined in adolescents over the last 30 years and screen use has been identified as a risk factor. Studies have examined the duration of screen use and screen-based activities but have not differentiated between evening and night-time use.

METHODS

Cross sectional questionnaire survey of adolescents recruited in schools. Sleep habits on school nights and weekends, symptoms of insomnia and daytime repercussions were recorded using an online questionnaire administered in the classroom setting. Sleep deprivation (<7 hours in bed /night), school night sleep restriction (≥2 hours difference in sleep duration on school nights vs weekends), excessive sleepiness (score >6 on a visual analogue scale), duration of screen use and timing of screen use (evening vs after bedtime) were determined.

RESULTS

2513 students (53.4% female, median age 15 years) were included. 20% were sleep deprived and 41% sleep restricted. A clear dose effect relationship in a model controlling for age, sex, school level and sociodemographic class was seen with all levels of night-time screen use on sleep deprivation and sleep restriction (>2 hours use sleep deprivation OR 5.23[3.03-9.00]. sleep restriction OR 2.05[1.23-3.42]) and > 2 hours evening use (>2 hours use sleep deprivation OR 2.72[2.15-3.44] sleep restriction OR 1.69[1.36-2.11]) but not moderate evening use. All night-time use and > 2 hours evening use increased the risk of insomnia, non refreshing sleep, and affected daytime function (daytime sleepiness, lack of energy and irritability).

CONCLUSIONS

Both duration of screen use and timing are associated with adverse effects on sleep and daytime functioning in adolescents. More than 2 hours evening use and all night-time use should be avoided.

Energy Drinks and Sleep among Adolescents

Many adolescents worldwide have the problem of meeting recommended nightly sleep hours. The causes of sleep disturbance are multifactorial, but interest in food’s effect on sleep has dramatically increased lately. In this study, we investigated the association between regular energy drink (ED) intake (weekly or more frequent) and sufficient sleep (SS) (≥8 h) in adolescents. Additional objectives were to examine the relationship between health-related behaviors and SS, stratified by gender. A population-based cross-sectional study was conducted during the 2019/2020 school year from 12 schools in Belgrade. There were 1287 students aged 15 to 19 who participated (37.4% male). We used a modified version of the food frequency questionnaire adapted for Serbian adolescents. Logistic regression revealed that regular ED consumption was an independent risk factor negatively related to SS in both sexes. Additionally, daily vegetable and water intake (≥2 L) showed a positive correlation with SS in boys, while in girls, the odds of realizing SS decreased with statements of sedative use. In conclusion, we show that ED intake is negatively associated with SS in both sexes; daily vegetable and water intake (≥2 L) may raise the odds of SS in boys, while sedative use may decrease the chances of SS in girls.

Sleep to Internalizing Pathway in Young Adolescents (SIPYA): A proposed neurodevelopmental model

The prevalence of internalizing disorders, i.e., anxiety and depressive disorders, spikes in adolescence and has been increasing amongst adolescents despite the existence of evidence-based treatments, highlighting the need for advancing theories on how internalizing disorders emerge. The current review presents a theoretical model, called the Sleep to Internalizing Pathway in Young Adolescents (SIPYA) Model, to explain how risk factors, namely sleep-related problems (SRPs), are prospectively associated with internalizing disorders in adolescence. Specifically, SRPs during late childhood and early adolescence, around the initiation of pubertal development, contribute to the interruption of intrinsic brain networks dynamics, both within the default mode network and between the default mode network and other networks in the brain. This interruption leaves adolescents vulnerable to repetitive negative thought, such as worry or rumination, which then increases vulnerability to internalizing symptoms and disorders later in adolescence. Sleep-related behaviors are observable, modifiable, low-stigma, and beneficial beyond treating internalizing psychopathology, highlighting the intervention potential associated with understanding the neurodevelopmental impact of SRPs around the transition to adolescence. This review details support for the SIPYA Model, as well as gaps in the literature and future directions.

Detecting negative valence symptoms in adolescents based on longitudinal self-reports and behavioral assessments

BACKGROUND

Given the high prevalence of depressive symptoms reported by adolescents and associated risk of experiencing psychiatric disorders as adults, differentiating the trajectories of the symptoms related to negative valence at an individual level could be crucial in gaining a better understanding of their effects later in life.

METHODS

A longitudinal deep learning framework is presented, identifying self-reported and behavioral measurements that detect the depressive symptoms associated with the Negative Valence System domain of the NIMH Research Domain Criteria (RDoC).

RESULTS

Applied to the annual records of 621 participants (age range: 12 to 17 years) of the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA), the deep learning framework identifies predictors of negative valence symptoms, which include lower extraversion, poorer sleep quality, impaired executive control function and factors related to substance use.

LIMITATIONS

The results rely mainly on self-reported measures and do not provide information about the underlying neural correlates. Also, a larger sample is required to understand the role of sex and other demographics related to the risk of experiencing symptoms of negative valence.

CONCLUSIONS

These results provide new information about predictors of negative valence symptoms in individuals during adolescence that could be critical in understanding the development of depression and identifying targets for intervention. Importantly, findings can inform preventive and treatment approaches for depression in adolescents, focusing on a unique predictor set of modifiable modulators to include factors such as sleep hygiene training, cognitive-emotional therapy enhancing coping and controllability experience and/or substance use interventions.

Effects of Automated Diurnal Variation in Electronic Screen Temperature on Sleep Quality in Young Adults: A Randomized Controlled Trial

OBJECTIVE

Determine whether automated changes in electronic screen color temperature of personal electronic devices is associated with changes in objective and self-reported indices of sleep and mental health in young adults, as well as determine feasibility and acceptability of the experimental manipulation.

PARTICIPANTS

A single-blind randomized controlled trial was conducted at a large public university in the Pacific Northwest region of the United States. Fifty-five participants (female=78%, mean age=19.45 years) who reported using a smartphone and/or laptop computer two hours before bedtime were randomized into either an experimental group (EG; n=29) or active control group (ACG; n=26).

METHODS

Both the EG and ACG had installed on their devices a piece of software that automatically lowers the color temperature of these devices' screens as the day progresses ("f.lux"). However, only the EG had the blue-light-reducing features activated, and participants were blind to condition. Before and after the one-week long experimental manipulation period, participants completed the Pittsburgh Sleep Quality Index (PSQI), Pediatric Daytime Sleepiness Scale (PDSS), Pre-Sleep Arousal Scale (PSAS), and Patient Health Questionnaire (PHQ) and wore an actiwatch for seven consecutive nights.

RESULTS

Participants in the EG did not show greater improvement in objective sleep, self-reported sleep, or mental health compared to participants in the ACG. Participants in the EG rated the software as more distracting and purposely disabled the software more often compared to participants in the ACG.

CONCLUSIONS

Automated diurnal variation in electronic screen temperature in personal devices did not improve sleep or mental health in young adults.

Internet addiction among teenagers in a Chinese population: Prevalence, risk factors, and its relationship with obsessive-compulsive symptoms

BACKGROUND AND AIMS

Internet addiction (IA) among teenagers has been reported frequently in China, although research has seldom focused on vocational high school students. This study investigated the prevalence and risk factors among this special adolescent population. Moreover, we illustrate the complex relationship between obsessive-compulsive (OC) symptoms, insomnia, psychological states, and IA.

METHODS

A cross-sectional design was applied to collect information from three different vocational high schools in Hunan Province, China. Socio-demographic characteristics, OC symptoms, insomnia, depression, anxiety, and stress symptoms were compared between the IA and non-IA groups. Then, a structural equation model (SEM) was established to test our hypothesis regarding different paths from OC symptoms to IA.

RESULTS

IA prevalence was 13.4% among 7990 vocational high school students. Individuals with IA were more likely to be male and students with more severe depression, stress, anxiety, and insomnia symptoms (all p < 0.001). SEM verified that OC symptoms were related to IA both directly and indirectly, where the latter relationship was mediated through insomnia or mental disorders.

LIMITATIONS

This study cannot confirm the causal relationships among the variables and should be generalized cautiously to other groups.

CONCLUSIONS

More attention should be paid to Chinese vocational high school students, especially those with more severe OC symptoms, poor mental health, and insomnia. We should consider OC symptoms, insomnia, psychological suffering, and IA together when addressing related problems.

Exploring potential mechanism of ciwujia tablets for insomnia by UPLC-Q-TOF-MS/MS, network pharmacology, and experimental validation

Insomnia, whether chronic or intermittent, is a common central nervous system disease. Ciwujia Tablet (CWT) is a well-known traditional Chinese medicine (TCM) made from the extract of Eleutherococcus senticosus (Rupr. & Maxim.) Maxim. This medication is commonly used for treating insomnia in China, but the lack of in-depth research focused on the chemical ingredients of CWT creates a gap in knowledge regarding its effective constituents against insomnia. Considering that the therapeutic material basis, targets, and pathways related to this drug have not been fully investigated by scholars in the field, the focus of this study is on identifying the chemical ingredients or structural characteristics of CWT by the UPLC-Q-TOF-MS/MS technique. Besides, concepts of network pharmacology were also used to investigate the targets and pathways of CWT. An insomnia rat model was established by intraperitoneal injection of p-chlorophenylalanine, and the results were verified through various experiments. A total of 46 ingredients were identified in CWT, such as eleutheroside B, eleutheroside E, isofraxidin, and chlorogenic acid. Among them, 17 ingredients with good solubility, favorable gastrointestinal absorption, and high bioavailability were selected for network pharmacological analysis. It was concluded that CWT participated in the regulation of neurotransmitter levels, modulation of ion transport, neurotransmitter receptor activity, synaptic transmission, dopaminergic transmission and other essential processes. Results from the animal experiments showed that CWT can increase the content of inhibitory neurotransmitters 5-HT and GABA in the brain, reduce the synthesis of excitatory escalating transmitters DA and NE, shorten the sleep latency and prolong the sleep duration of insomnia rats. Furthermore, CWT could significantly alleviate the symptoms of insomnia in model rats. Identifying the chemical ingredients of CWT in this experiment is of great significance for exploring its potential curative effects, which provides a solid basis for further understanding the therapeutic value of this medication.

Why Sleep is Key: Poor Sleep Quality is a Mechanism for the Bidirectional Relationship between Major Depressive Disorder and Generalized Anxiety Disorder Across 18 Years

BACKGROUND

Generalized anxiety disorder (GAD) and major depressive disorder (MDD) reliably precede and predict one another. However, there is insufficient data on mediators through which the longitudinal GAD-MDD association unfold. Based on insomnia theories, such as the hyperarousal model of sleep, we tested the degree to which poor global sleep quality functioned as a mediator of the prospective bidirectional anxiety-depression relationship.

METHOD

Participants were 3,294 community-dwelling adults who partook in three measurement waves nine years apart. The Composite International Diagnostic Interview-Short Form assessed GAD and MDD in-person at baseline (Time 1 [T1]), Time 2 (T2; nine years after T1), and 18 years later (T3). T2 global sleep quality was measured using the multiple-domain Pittsburgh Sleep Quality Index self-report at T2. We used longitudinal structural equation modeling mediation analyses.

RESULTS

Analyses showed that higher T1 MDD and GAD severity individually predicted lower T2 global sleep quality (Cohen's d = -0.561 to -0.480) and less T2 global sleep quality, thereby forecasted both higher T3 MDD and GAD (d = -0.275 to -0.190). Poorer T2 global sleep quality significantly mediated the T1 GAD-T3 MDD relation, explaining 41% of the association. Worse global sleep quality at T2 also significantly mediated the T1 MDD-T3 GAD association, mediating 11% of the T1 MDD-T3 GAD pathway. The results remained similar after controlling for multiple sociodemographic and clinical variables.

CONCLUSIONS

Findings offer evidence for transdiagnostic theories of sleep and insomnia. Theoretical and clinical implications, such as prioritizing sleep improvement in cognitive-behavioral therapies, are also discussed.

Persistence of Anxiety/Depression Symptoms in Early Adolescence: A Prospective Study of Daily Life Stress, Rumination, and Daytime Sleepiness in a Genetically Informative Cohort

In this prospective study of mental health, we examine the influence of three interrelated traits - perceived stress, rumination, and daytime sleepiness - and their association with symptoms of anxiety and depression in early adolescence. Given the known associations between these traits, an important objective is to determine the extent to which they may independently predict anxiety/depression symptoms. Twin pairs from the Queensland Twin Adolescent Brain (QTAB) project were assessed on two occasions (N = 211 pairs aged 9-14 years at baseline and 152 pairs aged 10-16 years at follow-up). Linear regression models and quantitative genetic modeling were used to analyze the data. Prospectively, perceived stress, rumination, and daytime sleepiness accounted for 8-11% of the variation in later anxiety/depression; familial influences contributed strongly to these associations. However, only perceived stress significantly predicted change in anxiety/depression, accounting for 3% of variance at follow-up after adjusting for anxiety/depression at baseline, although it did not do so independently of rumination and daytime sleepiness. Bidirectional effects were found between all traits over time. These findings suggest an underlying architecture that is shared, to some degree, by all traits, while the literature points to hypothalamic-pituitary-adrenal (HPA) axis and/or circadian systems as potential sources of overlapping influence and possible avenues for intervention.

Depression and sleep disorders among AIDS orphans in an HIV/AIDS high-epidemic area in China

BACKGROUND

The Liangshan Yi Autonomous Prefecture is home to the largest population of Yi ethnic minority within mainland China. Due to the high HIV/AIDS epidemic, many Yi children become AIDS orphans who lost one or both parents to AIDS-related causes. This study explored the prevalence and correlates of AIDS orphans' depressive symptom, sleep disorders and their comorbidity.

METHODS

A cross-sectional survey was conducted to collect pertinent information from 467 AIDS orphans and 856 non-orphans of Yi ethnic minority. Depressive symptoms were screened by a two-item Patient Health Questionnaire (PHQ-2). The symptoms of insomnia were assessed by the Insomnia Severity Index (ISI), which was complemented by one item from the Pittsburgh Quality Sleep Index (PSQI) to measure the frequency of nightmare.

RESULTS

The prevalence of depression (26.8% vs. 20.4%, P = 0.009) and comorbidity of depression, insomnia and nightmare (7.5% vs. 4.3%, P = 0.046) was significantly higher for AIDS orphans than for non-orphans. Risk factors such as ostracization and self-reported poor physical health had stronger effects on depressive symptoms and sleep disorders for AIDS orphans than for non-orphans. On the other hand, peer support, as an important protective factor, was significantly and negatively associated with depressive symptoms and sleep disorders for AIDS orphans.

CONCLUSIONS

AIDS orphans of Yi ethnic minority reported higher levels of depressive symptoms and comorbidity of depression and sleep disorders than their non-orphan counterparts. These symptoms were exacerbated by ostracization and self-rated poor physical health but lowered by peer support.

A greater modified Mediterranean diet score is associated with lower insomnia score among adolescent girls: a cross-sectional study

Background

Previous studies has shown that a low quality diet is related to sleep disorders. A Mediterranean diet is considered to be a high quality diet and has been shown to have beneficial effects on overall health. Thus, the aim of our study was to investigate the association between adherence to Mediterranean dietary pattern and insomnia score among adolescent girls.

Methods

The data for 733 adolescent girls between 12–18 years old was assessed in this cross-sectional study. A 147 item-food frequency questionnaire was used to assess dietary intake. A modified model of Mediterranean diet score was calculated that ranged from 0–9 points. A validated version of Insomnia Severity Index questionnaire was used to assess insomnia. To explore the association between modified Mediterranean (mMED) diet score and insomnia, linear regression was conducted in crude and adjusted models (energy intake adjustmet in Model I, further adjustments were performed for physical activity, father’s and mother’s education in Model II and full adjusted model adjusted for age, body mass index percentiles, and abdominal obesity).

Results

A significant inverse association between mMED diet score and insomnia score was observed using a crude model (β = -0.091, 95% confidence interval (CI): -0.392 to -0.046); P-value = 0.013) and also after adjustment for confounding factors in Model I (β = -0.098, CI: -0.423 to -0.045; P = 0.015), Model II (β = -0.092, CI: -0.410 to -0.029; P-value = 0.024), Model III (β = -0.082, CI: -0.385 to -0.006); P = 0.044).

Conclusion

There was an inverse relationship between adherence to the mMED diet score and insomnia level among Iranian adolescent girls. Prospective studies are needed to confirm these results and clarify whether a causal relationship exists.