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Bi K, Chen S. Sleep profiles as a longitudinal predictor for depression magnitude and variability following the onset of COVID-19. J Psychiatr Res 2022; 147:159-165. [PMID: 35038620 PMCID: PMC8748309 DOI: 10.1016/j.jpsychires.2022.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/02/2022] [Accepted: 01/09/2022] [Indexed: 11/29/2022]
Abstract
The coronavirus disease 2019 (COVID-19) has disrupted multiple domains of life including sleep. The present study used a longitudinal dataset (N = 671) and a person-centered analytic approach - latent profile analysis (LPA) - to elucidate the relationship between sleep and depression. We used LPA to identify profiles of sleep patterns assessed by Pittsburg Sleep Quality Index (PSQI) at the beginning of the study. The profiles were then used as a predictor of depression magnitude and variability over time. Three latent profiles were identified (medicated insomnia sleepers [MIS], inefficient sleepers [IS], and healthy sleepers [HS]). MIS exhibited the highest level of depression magnitude over time, followed by IS, followed by HS. A slightly different pattern emerged for the variability of depression: While MIS demonstrated significantly greater depression variability than both IS and HS, IS and HS did not differ in their variability of depression over time. Medicated insomnia sleepers exhibited both the greatest depression magnitude and variability than inefficient sleepers and healthy sleepers, while the latter two showed no difference in depression variability despite inefficient sleepers' greater depression magnitude than healthy sleepers. Clinical implications and limitations are discussed.
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Affiliation(s)
- Kaiwen Bi
- Tsinghua University, China; Columbia University, USA.
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152
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Blok E, Koopman-Verhoeff ME, Dickstein DP, Saletin J, Luik AI, Rijlaarsdam J, Hillegers M, Kocevska D, White T, Tiemeier H. Sleep and mental health in childhood: a multi-method study in the general pediatric population. Child Adolesc Psychiatry Ment Health 2022; 16:11. [PMID: 35177100 PMCID: PMC8851725 DOI: 10.1186/s13034-022-00447-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/31/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Sleep problems, altered sleep patterns and mental health difficulties often co-occur in the pediatric population. Different assessment methods for sleep exist, however, many studies only use one measure of sleep or focus on one specific mental health problem. In this population-based study, we assessed different aspects of sleep and mother-reported mental health to provide a broad overview of the associations between reported and actigraphic sleep characteristics and mental health. METHODS This cross-sectional study included 788 children 10-11-year-old children (52.5% girls) and 344 13-14-year-old children (55.2% girls). Mothers and children reported on the sleep of the child and wrist actigraphy was used to assess the child's sleep patterns and 24 h activity rhythm. Mental health was assessed via mother-report and covered internalizing, externalizing and a combined phenotype of internalizing and externalizing symptoms, the dysregulation profile. RESULTS Higher reported sleep problems were related to more symptoms of mental health problems in 10-11- and 13-14-year-old adolescents, with standardized ß-estimates ranging between 0.11 and 0.35. There was no association between actigraphy-estimated sleep and most mental health problems, but earlier sleep onset was associated with more internalizing problems (ß = - 0.09, SE = 0.03, p-value = 0.002), and higher intra-daily variability of the 24 h activity rhythm was associated with more dysregulation profile symptoms at age 10-11 (ß = 0.11, SE = 0.04, p-value = 0.002). DISCUSSION Reported sleep problems across informants were related to all domains of mental health problems, providing evidence that sleep can be an important topic to discuss for clinicians seeing children with mental health problems. Actigraphy-estimated sleep characteristics were not associated with most mental health problems. The discrepancy between reported and actigraphic sleep measures strengthens the idea that these two measures tap into distinct constructs of sleep.
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Affiliation(s)
- Elisabet Blok
- grid.416135.40000 0004 0649 0805Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children’s Hospital, University Medical Center, Rotterdam, The Netherlands ,grid.5645.2000000040459992XThe Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M. Elisabeth Koopman-Verhoeff
- grid.416135.40000 0004 0649 0805Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children’s Hospital, University Medical Center, Rotterdam, The Netherlands ,grid.5645.2000000040459992XThe Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands ,grid.5132.50000 0001 2312 1970Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands ,grid.281318.10000 0004 0443 4869Emma Pendleton Bradley Hospital, East Providence, RI USA
| | - Daniel P. Dickstein
- grid.38142.3c000000041936754XPediMIND Program, McLean Hospital, Harvard Medical School, Boston, MA USA ,grid.38142.3c000000041936754XSimches Center of Excellence in Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA USA
| | - Jared Saletin
- grid.281318.10000 0004 0443 4869Emma Pendleton Bradley Hospital, East Providence, RI USA ,grid.40263.330000 0004 1936 9094Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| | - Annemarie I. Luik
- grid.416135.40000 0004 0649 0805Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children’s Hospital, University Medical Center, Rotterdam, The Netherlands ,grid.5645.2000000040459992XDepartment of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jolien Rijlaarsdam
- grid.416135.40000 0004 0649 0805Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children’s Hospital, University Medical Center, Rotterdam, The Netherlands
| | - Manon Hillegers
- grid.416135.40000 0004 0649 0805Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children’s Hospital, University Medical Center, Rotterdam, The Netherlands
| | - Desana Kocevska
- grid.416135.40000 0004 0649 0805Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children’s Hospital, University Medical Center, Rotterdam, The Netherlands ,grid.5645.2000000040459992XThe Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, The Netherlands ,grid.5645.2000000040459992XDepartment of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands ,grid.419918.c0000 0001 2171 8263Department of Sleep and Cognition, Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Society for Arts and Sciences, Amsterdam, The Netherlands
| | - Tonya White
- grid.416135.40000 0004 0649 0805Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children’s Hospital, University Medical Center, Rotterdam, The Netherlands ,grid.5645.2000000040459992XDepartment of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Henning Tiemeier
- grid.416135.40000 0004 0649 0805Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children’s Hospital, University Medical Center, Rotterdam, The Netherlands ,grid.38142.3c000000041936754XDepartment of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Boston, MA USA
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153
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Rizzo RRN, Cashin AG, Bagg MK, Gustin SM, Lee H, McAuley JH. A Systematic Review of the Reporting Quality of Observational Studies That Use Mediation Analyses. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1041-1052. [PMID: 35167030 PMCID: PMC9343342 DOI: 10.1007/s11121-022-01349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/26/2022]
Abstract
Mediation analysis is a common statistical method used to investigate mechanisms of health exposure and interventions. The reporting quality of mediation studies used in randomised controlled trials has been considered heterogeneous and incomplete. The reporting quality of mediation analysis in observational studies is unknown. We conducted a systematic review to describe the reporting standards of recently published observational studies that used mediation analysis to understand the mechanism of health exposures. We searched for studies published between June 2017 and June 2019 indexed in EMBASE, MEDLINE and PsycINFO. Two reviewers screened articles and selected a random sample of 50 eligible studies for inclusion. We included studies across 13 healthcare fields and ten different health conditions. Most studies (74%) collected data on healthy individuals to assess their risk of developing a health disorder. Psychosocial and behavioural factors (self-control, self-esteem, alcohol consumption, pain) were the most prevalent exposures (n = 30, 60%), outcomes (n = 23, 46%) and mediators (n = 29, 58%). Most studies used a cross-sectional design (64%, n = 32), and a few studies reported sample size calculations (4%, n = 8). In 20% (n = 10) of the studies, adjustment for confounders was reported. Only 10% (n = 5) of studies reported the assumptions underlying the mediation analysis, and 14% (n = 7) of studies conducted some sensitivity analysis to assess the degree which unmeasured confounders would affect the estimate of the mediation effect. Mediation analysis is a common method used to investigate mechanisms in prevention research. The reporting of mediation analysis in observational studies is incomplete and may impact reproducibility, evidence synthesis and implementation.
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Affiliation(s)
- Rodrigo R N Rizzo
- School of Health Sciences, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
- New College Village, University of New South Wales, Sydney, Australia
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
| | - James H McAuley
- School of Health Sciences, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
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154
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Chan CS, Hazan H. The Health Hexagon Model: Postulating a holistic lifestyle approach to mental health for times and places of uncertainty. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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155
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Smejka T, Henry AL, Wheatley C, Espie CA, Johansen-Berg H, Fleming MK. A qualitative examination of the usability of a digital cognitive behavioral therapy for insomnia program after stroke. Brain Inj 2022; 36:271-278. [PMID: 35108134 PMCID: PMC9162493 DOI: 10.1080/02699052.2022.2034182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 09/20/2021] [Accepted: 01/22/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Sleep is commonly impaired after stroke. Cognitive Behavioral Therapy for Insomnia (CBT-I) is the first-line recommended treatment for sleep difficulty. "Sleepio" is a digital CBT-I program, allowing delivery of this treatment at scale. However, Sleepio has not yet been tested specifically in people with stroke. Before doing so, we wanted to explore the experience of people with stroke using the program, and potential barriers to completion. METHOD Community dwelling survivors of stroke (n = 11, 41-78 years of age, 6 male) were given access to Sleepio. Participants discussed their experiences with the program during a semi-structured interview, which was analyzed using thematic analysis. RESULTS We found four common themes: (1) positive and negative experiences impacted engagement with the program, (2) motivation to follow the program was proportional to perceived severity of sleep problem, (3) impractical advice for people with stroke, (4) difficulty operating the program. CONCLUSION Sleepio can be used by some people at the chronic stage of stroke. However, some barriers to completion were highlighted, and not all suggestions were deemed practical for everyone. We therefore suggest possible adaptations which may make the program more easily usable and engaging for survivors of stroke with varying impairments.
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Affiliation(s)
- Tom Smejka
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Alasdair L Henry
- Big Health Ltd, London, UK
- Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Catherine Wheatley
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Colin A Espie
- Big Health Ltd, London, UK
- Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Melanie K Fleming
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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156
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Illingworth G, Mansfield KL, Espie CA, Fazel M, Waite F. Sleep in the time of COVID-19: findings from 17000 school-aged children and adolescents in the UK during the first national lockdown. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2022; 3:zpab021. [PMID: 35128401 PMCID: PMC8807290 DOI: 10.1093/sleepadvances/zpab021] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVES Sleep is essential to young people's wellbeing, yet may be constricted by the adolescent delayed sleep phase coupled with school start times. COVID-19 restrictions caused major disruptions to everyday routines, including partial school closures. We set out to understand changes in students' self-reported sleep quality, and associations with mental wellbeing and interpersonal functioning, during these restrictions. METHODS The OxWell school survey-a cross-sectional online survey-collected data from 18 642 children and adolescents (aged 8-19 years, 60% female, school year 4-13) from 230 schools in southern England, in June-July 2020. Participants completed self-report measures of the impact of COVID-19 restrictions on sleep quality, happiness, and social relationships. Sleep timing was compared with data collected from 4222 young people in 2019. RESULTS Females and older adolescents were more likely to report deteriorations in sleep during the national lockdown. Regression analysis revealed that changes in happiness (β = .34) and how well students were getting on with others in their household (β = .07) predicted change in sleep quality. Students' bedtimes and wake times were later, and sleep duration was longer in 2020 compared to the 2019 survey. Secondary school students reported the greatest differences, especially later wake times. CONCLUSIONS During COVID-19 restrictions, sleep patterns consistent with adolescent delayed sleep phase were observed, with longer sleep times for secondary school students in particular. Perceived deteriorations in sleep quality were associated with reductions in happiness and interpersonal functioning, highlighting the importance of including sleep measures in adolescent wellbeing research.
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Affiliation(s)
- Gaby Illingworth
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Karen L Mansfield
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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157
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Nazari N, Sadeghi M, Samusenkov V, Aligholipour A. Factors associated with insomnia among frontline nurses during COVID-19: a cross-sectional survey study. BMC Psychiatry 2022; 22:40. [PMID: 35038999 PMCID: PMC8763304 DOI: 10.1186/s12888-022-03690-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/06/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Research predominantly suggests that nurses are at high risk of developing psychopathology. The empirical data show that the occurrence rate of problem-related sleep quality among clinical nurses is high. Therefore, this study was conducted to address the lack of information on the relationship between the coronavirus disease 2019 (COVID-19) pandemic and insomnia. METHODS A convenience sample of nurses (n = 680) completed an online survey that included the Insomnia severity index, the COVID-19-related psychological distress scale, the general health questionnaire, neuroticism, dysfunctional beliefs, attitudes about sleep scale, and difficulties in emotion regulation scale. RESULTS The results showed that 35.8% (n = 253) of nurses were classified as individuals with moderate to severe clinical insomnia. The results showed that the psychological distress generated by COVID-19 predicted insomnia (β = .47, SE = 0.02, P < .001, t = 13.27, 95% CI 0.31-0.46). Additionally, the association is mediated by psychopathology vulnerabilities, emotion dysregulation, dysfunctional beliefs about sleep, and neuroticism. Moreover, female nurses exhibited higher levels of insomnia (Cohen's d = .37), neuroticism (Cohen's d = 30), psychopathology vulnerability (Cohen's d = .26), and COVID-19-related psychological distress (Cohen's d = .23). CONCLUSION The present study's findings help to explain how pandemic consequences can be associated with insomnia. Additionally, the findings make a significant contribution to better understanding the role of neuroticism, emotion dysregulation, beliefs, and psychopathology vulnerability in the development of insomnia among nurses. The findings suggest the potential influence of cognitive behavioral therapy for insomnia (CBT-I) and transdiagnostic integrated therapies that could be incorporated into therapeutic programs designed to develop as a way of inhibiting or preventing insomnia among clinical nurses.
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Affiliation(s)
- Nabi Nazari
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran.
| | - Masoud Sadeghi
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
| | - Vadim Samusenkov
- Department of Prosthetic Dentistry, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Akram Aligholipour
- Departments of Psychology, Faculty of Human Sciences, Allameh Tabatabai University, Tehran, Iran
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158
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Comsa M, Anderson KN, Sharma A, Yadav VC, Watson S. The relationship between sleep and depression and bipolar disorder in children and young people. BJPsych Open 2022; 8:e27. [PMID: 35027099 PMCID: PMC8811784 DOI: 10.1192/bjo.2021.1076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sleep difficulties are often reported in practice, and are part of the diagnostic criteria for depression and bipolar disorder. AIMS To inform the understanding of the relationship between sleep and both depression and bipolar disorder. METHOD We conducted a narrative literature review of affective disorders and sleep difficulties in children and young people. RESULTS Specific sleep disorders, such as parasomnias, narcolepsy and sleep-related movement disorders, are associated with depression, whereas insomnia, obstructive sleep apnoea and circadian rhythm disorders are associated with both depression and bipolar disorder in children and young people. Conversely, children and young people with depression can present with a number of sleep difficulties, and these are associated with higher depression severity and greater fatigue, suicidal ideation, physical complaints, pain and decreased concentration. Sleep disturbances among adolescents with bipolar disorder can affect the severity of depressive and manic symptoms, are a poor prognostic indicator and have been associated with social and academic impairment. Antidepressants and antipsychotics can directly affect sleep architecture, which clinicians need to be aware of. Non-pharmacological interventions for sleep problems could prevent and/or minimise the risk of relapse in affective disorders. CONCLUSIONS Sleep difficulties can occur before, during and after an episode of depression or bipolar disorder, and have a higher prevalence in affective disorders compared with the general population. A multi-modal approach would include the treatment of both the affective and specific sleep disorder. Further research is needed in this field to understand the impact of combined interventions on clinical outcomes.
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Affiliation(s)
- Monica Comsa
- Child and Adolescent Mental Health Service, Cumbria Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | | | - Aditya Sharma
- Translational and Clinical Research Institute, Newcastle University, UK; and Child and Adolescent Mental Health Service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Vanishri C Yadav
- Child and Adolescent Mental Health Service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Stuart Watson
- Translational and Clinical Research Institute, Newcastle University, UK; and Specialist Services, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
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159
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Cleper R, Hertz-Palmor N, Mosheva M, Hasson-Ohayon I, Kaplan R, Kreiss Y, Afek A, Pessach IM, Gothelf D, Gross R. Sleep Difficulties Among COVID-19 Frontline Healthcare Workers. Front Psychiatry 2022; 13:838825. [PMID: 35573372 PMCID: PMC9098971 DOI: 10.3389/fpsyt.2022.838825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/28/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To identify COVID-19 work-related stressors and experiences associated with sleep difficulties in HCW, and to assess the role of depression and traumatic stress in this association. METHODS A cross-sectional study of HCW using self-report questionnaires, during the first peak of the pandemic in Israel (April 2020), conducted in a large tertiary medical center in Israel. Study population included 189 physicians and nurses working in designated COVID-19 wards and a comparison group of 643 HCW. Mean age of the total sample was 41.7 ± 11.1, 67% were female, 42.1% physicians, with overall mean number of years of professional experience 14.2 ± 20. The exposure was working in COVID-19 wards and related specific stressors and negative experiences. Primary outcome measurement was the Insomnia Severity Index (ISI). Secondary outcomes included the Primary Care-Post Traumatic Stress Disorder Screen (PC-PTSD-5); the Patient Health Questionnaire-9 (PHQ-9) for depression; the anxiety module of the Patient-Reported Outcomes Measurement Information System (PROMIS); Pandemic-Related Stress Factors (PRSF) and witnessing patient suffering and death. RESULTS Compared with non-COVID-19 HCW, COVID-19 HCW were more likely to be male (41.3% vs. 30.7%) and younger (36.91 ± 8.81 vs. 43.14 ± 11.35 years). COVID-19 HCW reported higher prevalence of sleep difficulties: 63% vs. 50.7% in the non-COVID group (OR 1.62, 95% CI 1.15-2.29, p = 0.006), mostly difficulty maintaining sleep: 26.5% vs. 18.5% (OR 1.65, 95% CI 1.11-2.44, p = 0.012). Negative COVID-19 work-related experiences, specifically witnessing patient physical suffering and death, partially explained the association. Although past psychological problems and current depression and PTSD were associated with difficulty maintaining sleep, the main association remained robust also after controlling for those conditions in the full model. CONCLUSION AND RELEVANCE COVID-19 frontline HCW were more likely to report sleep difficulties, mainly difficulty maintaining sleep, as compared with non-COVID-19 HCW working at the same hospital. Negative patient-care related experiences likely mediated the increased probability for those difficulties. Future research is needed to elucidate the long-term trajectories of sleep difficulties among HCW during large scale outbreaks, and to identify risk factors for their persistence.
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Affiliation(s)
- Rony Cleper
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nimrod Hertz-Palmor
- The Chaim Sheba Medical Center, Ramat Gan, Israel.,School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Mariela Mosheva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
| | | | | | - Yitshak Kreiss
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Itai M Pessach
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Doron Gothelf
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Raz Gross
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Chaim Sheba Medical Center, Ramat Gan, Israel
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160
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Kodsi A, Bullock B, Kennedy GA, Tirlea L. Psychological Interventions to Improve Sleep in Young Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Behav Sleep Med 2022; 20:125-142. [PMID: 33554644 DOI: 10.1080/15402002.2021.1876062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The effects of impaired sleep on the wellbeing of young adults are profound, and the adverse outcomes for mental health are well documented in the research literature. OBJECTIVE This systematic review and meta-analysis aimed to identify, summarize, and synthesize the available evidence from randomized-controlled trials (RCTs) investigating psychological interventions aimed at improving sleep and related secondary outcomes such as anxiety and depression in healthy young adults. METHOD Nine electronic databases (Cochrane Central Registry of Controlled Trials [CENTRAL], PubMed, Scopus, PsycNET, CINHAL, INFORMIT, Web of Science [Science and Social Citation Index], OpenSigle and EMBASE) were searched, returning 54 full-text papers for assessment, with 13 studies meeting inclusion criteria for the meta-analysis. RESULTS A random effects meta-analysis showed that the combined effect of all interventions was moderate (ES = -0.53, 95% CIs [- 0.69, -0.36], p < .01), reflecting the efficacy of psychological interventions at improving sleep scores at post-intervention. Subgroup analyses of individual interventions showed that cognitive-behavioral interventions improved sleep (ES = -0.67, 95% CIs [-0.77, -0.57], p < .01) and secondary outcomes for anxiety (ES = -0.35, 95% CIs [-0.56, -0.15], p < .01) and depression (ES = -0.41, 95% CIs [-0.70, -0.13], p < .01) at post-intervention. CONCLUSION The results of the current review support the implementation of cognitive and behavioral interventions for sleep among young adults experiencing both sleep and comorbid mental health problems.
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Affiliation(s)
- Ali Kodsi
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Ben Bullock
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Gerard A Kennedy
- School of Health and Life Sciences, Federation University, Ballarat, Australia.,School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Loredana Tirlea
- Department of Health and Biomedical Sciences, Swinburne University of Technology, Melbourne, Australia
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161
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Zhou T, Yuan Y, Xue Q, Li X, Wang M, Ma H, Heianza Y, Qi L. Adherence to a healthy sleep pattern is associated with lower risks of all-cause, cardiovascular and cancer-specific mortality. J Intern Med 2022; 291:64-71. [PMID: 34237797 PMCID: PMC8688171 DOI: 10.1111/joim.13367] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Individual unhealthy sleep behaviours have been associated with increased risks of all-cause mortality and deaths due to cardiovascular disease (CVD) or cancer. The evidence regarding the association of sleep patterns with these risks is limited. OBJECTIVE To examine the associations of sleep patterns with all-cause, CVD and cancer mortality in a large prospective cohort. METHODS This prospective cohort study included 283,443 adults from UK Biobank without CVD and cancer at baseline. We created a healthy sleep score and sleep patterns combining five individual sleep behaviours. RESULTS During a mean (standard deviation) of 8.9 (1.1) years (2.5 million person-years) of follow up, a total of 7936 all-cause deaths, 762 CVD-caused deaths, and 4540 cancer-caused deaths occurred during follow up. One point increase of the healthy sleep score was associated with a 4-11% lower risk of all-cause mortality (Hazard Ratio [HR], 0.94; 95% CI, 0.92-0.96), CVD mortality (HR, 0.89; 95% CI, 0.83-0.95) and cancer mortality (HR, 0.96; 95% CI, 0.93-0.99), with adjustment for age, sex, assessment centres, smoking status, alcohol intake status, socioeconomic status and physical activity. Compared with participants with an unfavourable sleep pattern, those with a favourable sleep pattern had 24-42% lower risks of all-cause and CVD mortality. The association with all-cause mortality tended to be stronger among underweight participants and those with insufficient physical activity. CONCLUSIONS A healthy sleep pattern was associated with lower risks of all-cause mortality and mortality from CVD and cancer. Our findings highlight the importance of improving overall sleep behaviours in lowering mortality.
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Affiliation(s)
- Tao Zhou
- Department of Epidemiology and Biostatistics, School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou, China.,Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Yu Yuan
- Department of Occupational and Environmental Health, Key Laboratory of Environment and Health, Ministry of Education and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiaochu Xue
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Mengying Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA.,Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA.,Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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162
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Geographical variations in the association between bullying victimization and sleep loss among adolescents: a population-based study of 91 countries. Sleep Med 2021; 90:1-8. [PMID: 35051736 DOI: 10.1016/j.sleep.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 11/09/2021] [Accepted: 12/24/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine geographical variations in the association between bullying victimization and sleep loss over worry among adolescents. METHODS We used data from the Global School-based Student Health Survey conducted between 2003 and 2017 in 91 countries across the globe. Sleep loss was categorised as: none/minimum (reported never or rarely sleep loss), moderate (reported sometimes), and severe (reported most of the time or always). We obtained country-specific estimates from multiple multinomial logistic regression analyses and pooled estimates from meta-analyses. RESULTS Of 282,036 adolescents 13-17 years of age, 28.1% (male: 25.4%, female: 31.0%) and 8.4% (male: 7.3%, female: 9.5%) of adolescents reported moderate and severe sleep loss respectively. Adolescents who frequently experienced bullying (≥3 per 30 days) reported higher prevalence of severe sleep loss. Meta-analyses showed that increased frequency of bullying victimization is associated with increased odds of sleep loss, with adolescents who experienced bullying for ≥3 days in the past 30 days were 1.65 and 2.65 times more likely than adolescents without being bullied to experience respectively moderate (OR 1.65, 95% CI: 1.59-1.72) and severe (OR 2.65, 95% CI: 2.52-2.79) sleep loss. Irrespective of sex, the association between bullying victimization and sleep loss was significant in all regions, income groups, and in all but a few countries. CONCLUSIONS Increased frequency of bullying victimization is positively associated with increased sleep loss among adolescents. Appropriate policies and programmes to stop bullying at school could help downgrade the risk of sleep loss among adolescents.
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163
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Drew RJ, Morgan PJ, Collins CE, Callister R, Kay-Lambkin F, Kelly BJ, Young MD. Behavioral and Cognitive Outcomes of an Online Weight Loss Program for Men With Low Mood: A Randomized Controlled Trial. Ann Behav Med 2021; 56:1026-1041. [PMID: 34964449 DOI: 10.1093/abm/kaab109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression and obesity are major health concerns and commonly co-exist, but men rarely seek help for these conditions. SHED-IT: Recharge was a gender-tailored eHealth program for men that generated clinically meaningful improvements in weight and depressive symptoms. PURPOSE To evaluate behavioral and psychological outcomes from the SHED-IT: Recharge intervention designed for overweight/obese men with low mood. METHODS Overall, 125 men (18-70 years) with a BMI between 25 and 42 kg/m2 and depressive symptoms (PHQ-9 ≥ 5) were randomly allocated to SHED-IT: Recharge (n = 62) or wait-list control (n = 63) groups. The self-directed program targeted key health behaviors combined with online mental fitness modules based on cognitive behavioral therapy. Behavioral (e.g., physical activity) and psychological outcomes (e.g., cognitive flexibility) were assessed with validated measures at baseline, 3 months (post-test) and 6 months (follow-up). Intention-to-treat linear mixed models examined treatment effects, which were adjusted for covariates, and effect size estimated (Cohen's d). RESULTS At post-test, intervention men achieved small-to-medium improvements in several health behavior outcomes including moderate-to-vigorous physical activity, light physical activity, sedentary behavior, sleep, energy intake, portion size, and risky alcohol consumption (range, d = 0.3-0.5), when compared with the control group. Intervention effects were also observed for perceived physical self-worth, perceived physical strength, cognitive flexibility, and behavioral activation (range, d = 0.3-0.8). No effects were found for fruit and vegetable intake, or mindful attention. Most effects were maintained at follow-up. CONCLUSIONS This gender-tailored, eHealth program with integrated mental fitness support elicited meaningful improvements in health behaviors and psychological outcomes for men with low mood. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN12619001209189).
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Affiliation(s)
- Ryan J Drew
- Priority Research Centre for Physical Activity and Nutrition, School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, New South Wales, Australia
| | - Philip J Morgan
- Priority Research Centre for Physical Activity and Nutrition, School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, New South Wales, Australia
| | - Clare E Collins
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Robin Callister
- Priority Research Centre for Physical Activity and Nutrition, School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Brian J Kelly
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Myles D Young
- Priority Research Centre for Physical Activity and Nutrition, School of Psychology, College of Engineering, Science and Environment, University of Newcastle, Callaghan, New South Wales, Australia
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164
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Miller BJ, McCall WV, Xia L, Zhang Y, Li W, Yao X, Liu H. Insomnia, suicidal ideation, and psychopathology in Chinese patients with chronic schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110202. [PMID: 33285266 DOI: 10.1016/j.pnpbp.2020.110202] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Insomnia occurs frequently in the clinical course of schizophrenia. A growing literature has found associations between insomnia, suicidal ideation, and psychopathology in patients with schizophrenia. We explored these associations in a cross-sectional study of a large sample of patients with chronic schizophrenia in China. We hypothesized that insomnia would be associated with an increased odds of current suicidal ideation and higher current psychopathology scores. METHODS We recruited 328 inpatients with chronic schizophrenia, all of whom were prescribed psychotropics. We investigated relationships between current insomnia, suicidal ideation over the past two weeks, and current psychopathology for subjects using regression models. RESULTS After controlling for multiple potential confounding factors, current insomnia was an indicator of a significant, 2.5-fold increased odds of suicidal ideation (OR = 2.56, 95% CI 1.10-5.95, p = 0.029). Insomnia was also a significant indicator of lifetime suicide attempt (OR = 1.07) as well as higher Positive and Negative Syndrome Scale total (β = 0.134, p = 0.017), positive (β = 0.154, p = 0.006) and general (β = 0.145, p = 0.010) subscale scores. CONCLUSION Insomnia is associated with suicidal ideation, lifetime suicide attempt, and higher psychopathology scores in inpatients with chronic schizophrenia. Formal assessment of insomnia appears relevant to the clinical care of patients with schizophrenia as an indicator of suicidal thinking and behavior, depression, and symptom severity.
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Affiliation(s)
- Brian J Miller
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia.
| | - William V McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Yulong Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Wenzheng Li
- Department of Psychiatry, Hefei Fourth People's Hospital, Hefei, Anhui Province, China
| | - Xianhu Yao
- Department of Psychiatry, Maanshan Fourth People's Hospital, Maanshan, Anhui Province, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, Anhui Province, China.
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165
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Bagrowska P, Pionke-Ubych R, Majchrowicz K, Gawęda Ł. The mediating effect of negative emotions on the relationship between subjective sleep quality and paranoia-like thoughts. J Psychiatr Res 2021; 145:132-136. [PMID: 34920163 DOI: 10.1016/j.jpsychires.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/25/2021] [Accepted: 12/10/2021] [Indexed: 11/23/2022]
Abstract
Sleep quality has been found to play an important role in paranoia-like thoughts both in clinical and non-clinical populations. Previous studies have shown that the presence of negative emotional states can mediate the link between sleep and paranoia, however, their role in the linkage is still not entirely clear. Hence, our study aimed to investigate further the mediating effect of negative emotions on the relationship between sleep quality and paranoia-like thoughts on a relatively large Polish sample drawn from the general population. We collected questionnaire data assessing paranoia-like thoughts, sleep quality and quantity, and negative affect from 604 Polish adults. We performed the correlation analysis and examined the mediating role of negative emotions in the relationship between sleep quality and paranoia. The results revealed significant moderate relationships between sleep quality and paranoia-like thoughts, negative emotions and paranoia-like thoughts, as well as between negative emotions and sleep quality. A mediation model for the relationship between sleep quality and paranoia-like thoughts revealed a complementary mediation by negative affect. The findings contribute to understanding the interrelatedness between sleep quality, negative emotions, and paranoia-like thoughts, as well as emphasize the importance of negative affect in the relationship between sleep and paranoia. Future research is needed to determine other factors that contribute to understanding the linkage as well as to determine the cause and effect.
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Affiliation(s)
- Paulina Bagrowska
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland.
| | - Renata Pionke-Ubych
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Kinga Majchrowicz
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
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166
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Chellappa SL, Aeschbach D. Sleep and anxiety: From mechanisms to interventions. Sleep Med Rev 2021; 61:101583. [PMID: 34979437 DOI: 10.1016/j.smrv.2021.101583] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/31/2022]
Abstract
Anxiety is the most common mental health problem worldwide. Epidemiological studies show that sleep disturbances, particularly insomnia, affect ∼50% of individuals with anxiety, and that insufficient sleep can instigate or further exacerbate it. This review outlines brain mechanisms underlying sleep and anxiety, by addressing recent human functional/structural imaging studies on brain networks underlying the anxiogenic impact of sleep loss, and the beneficial effect of sleep on these brain networks. We discuss recent developments from human molecular imaging studies that highlight the role of specific brain neurotransmitter mechanisms, such as the adenosinergic receptor system, on anxiety, arousal, and sleep. This review further discusses frontline sleep interventions aimed at enhancing sleep in individuals experiencing anxiety, such as nonbenzodiazepines/antidepressants, lifestyle and sleep interventions and cognitive behavioral therapy for insomnia. Notwithstanding therapeutic success, up to ∼30% of individuals with anxiety can be nonresponsive to frontline treatments. Thus, we address novel non-invasive brain stimulation techniques that can enhance electroencephalographic slow waves, and might help alleviate sleep and anxiety symptoms. Collectively, these findings contribute to an emerging biological framework that elucidates the interrelationship between sleep and anxiety, and highlight the prospect of slow wave sleep as a potential therapeutic target for reducing anxiety.
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Affiliation(s)
- Sarah L Chellappa
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.
| | - Daniel Aeschbach
- Department of Sleep and Human Factors Research, Institute of Aerospace Medicine, German Aerospace Center, Cologne, Germany; Institute of Experimental Epileptology and Cognition Research, University of Bonn Medical Center, Bonn, Germany; Division of Sleep Medicine, Harvard Medical School, Boston, United States
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167
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Drew RJ, Morgan PJ, Kay-Lambkin F, Collins CE, Callister R, Kelly BJ, Hansen V, Young MD. Men's Perceptions of a Gender-Tailored eHealth Program Targeting Physical and Mental Health: Qualitative Findings from the SHED-IT Recharge Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12878. [PMID: 34948488 PMCID: PMC8702011 DOI: 10.3390/ijerph182412878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
Despite increasing rates of co-morbid depression and obesity, few interventions target both conditions simultaneously, particularly in men. The SHED-IT: Recharge trial, conducted in 125 men with depressive symptoms and overweight or obesity, tested the efficacy of a gender-tailored eHealth program with integrated mental health support. The aims of this study were to examine the perceptions of men who received the SHED-IT: Recharge intervention in relation to recruitment, satisfaction with the program, and suggestions to improve the program. Individual semi-structured interviews were conducted in a random sub-sample, stratified by baseline depression and weight status (n = 19, mean (SD) age 49.6 years (11.6), PHQ-9 score 9.0 (3.7), BMI 32.5 kg/m2 (4.6)). Transcripts were analyzed using an inductive process by an independent qualitative researcher. Four themes emerged, namely, (i) specific circumstances determined men's motivation to enroll, (ii) unique opportunity to implement sustained physical and mental health changes compared to previous experiences, (iii) salience of the program elements, and (iv) further opportunities that build accountability could help maintain focus. Gender-tailored, self-directed lifestyle interventions incorporating mental health support are acceptable and satisfying for men experiencing depressive symptoms. These findings provide important insights for future self-guided lifestyle interventions for men with poor physical and mental health.
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Affiliation(s)
- Ryan J. Drew
- School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia; (R.J.D.); (P.J.M.)
| | - Philip J. Morgan
- School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia; (R.J.D.); (P.J.M.)
| | - Frances Kay-Lambkin
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (F.K.-L.); (B.J.K.)
| | - Clare E. Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Brian J. Kelly
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (F.K.-L.); (B.J.K.)
| | - Vibeke Hansen
- School of Health and Human Sciences, Southern Cross University, Coffs Harbour, NSW 2450, Australia;
| | - Myles D. Young
- School of Psychological Sciences, College of Engineering, Science and Environment, University of Newcastle, Callaghan, NSW 2308, Australia
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168
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Donohoe F, O'Meara Y, Roberts A, Comerford L, Kelly CM, Walshe JM, Peate M, Hickey M, Brennan DJ. The menopause after cancer study (MACS) - A multimodal technology assisted intervention for the management of menopausal symptoms after cancer - Trial protocol of a phase II study. Contemp Clin Trials Commun 2021; 24:100865. [PMID: 34869938 PMCID: PMC8626829 DOI: 10.1016/j.conctc.2021.100865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/06/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
Aims This study will aim to assess if a composite intervention which involves a specific evidence-based intervention for management of insomnia and non-hormonal pharmacotherapy to manage vasomotor symptoms (VMS) of menopause can improve quality of life for patients experiencing troublesome VMS after cancer who are not eligible for standard systemic menopausal hormone therapy (MHT). Participants will be asked to nominate a partner or companion to support them during this process as an additional form of support. Background The menopause transition and its symptoms represent a significant challenge for many patients after cancer treatment, particularly those for whom conventional MHT is contraindicated. These symptoms include hot flushes, night sweats, urogenital symptoms as well as mood and sleep disturbance. These symptoms can exacerbate the consequences of cancer and its treatment. Methods We will recruit 205 women who meet inclusion criteria and enrol them on a composite intervention which consists of four parts: (1) use of non-hormonal pharmacotherapy for the management of troublesome vasomotor symptoms of menopause tailored to the timing of predominant symptoms, (2) digital cognitive behavioural therapy for insomnia through the web based Sleepio service, (3) access to information regarding self-management strategies for the common symptoms of menopause and their consequences and (4) identification of a partner or other support person who commits to providing support during the study period. Outcomes The primary outcome will be cancer specific quality of life measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ C30). Secondary outcomes will include sleep quality, bother/interference of vasomotor symptoms and communication between couples about their cancer diagnosis and their menopause experience. Sleep will be measured using the Sleep Condition Indicator (SCI) tool, bother/interference of vasomotor symptoms will be measured by the Hot Flush Rating Scale (HFRS) and communication will be measured using the Couples’ Illness Communication Scale (CICS). These validated scales will be administered at baseline, four weeks, three months and six months. Registration This study is registered on ClinicalTrials.gov with number NCT 04766229.
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Affiliation(s)
- Fionán Donohoe
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Yvonne O'Meara
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Aidin Roberts
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Louise Comerford
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Catherine M Kelly
- Dept. of Medical Oncology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Janice M Walshe
- Dept. of Medical Oncology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Michelle Peate
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Victoria, Australia
| | - Martha Hickey
- Dept. of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Victoria, Australia
| | - Donal J Brennan
- UCD Gynaecological Oncology Group, UCD School of Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
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Digital cognitive behavioural therapy for insomnia and primary care costs in England: an interrupted time series analysis. BJGP Open 2021; 6:BJGPO.2021.0146. [PMID: 34862166 PMCID: PMC9447315 DOI: 10.3399/bjgpo.2021.0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/13/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Sleepio is an automated digital programme that delivers cognitive behavioural therapy for insomnia (dCBT-I). Sleepio has been proven effective in improving sleep difficulties. However, evidence for the possible impact of Sleepio use on health care costs in the United Kingdom has not previously been developed. AIM We sought to identify the effect of a population-wide rollout of Sleepio in terms of primary care costs in the National Health Service (NHS) in England. DESIGN & SETTING The study was conducted in the Thames Valley region of England, where access to Sleepio was made freely available to all residents between October 2018 and January 2020. The study relies on a quasi-experimental design, using an interrupted time series to compare the trend in primary care costs before and after the rollout of Sleepio. METHOD We use primary care data for people with relevant characteristics from nine general practices in Buckinghamshire. Primary care costs include general practice contacts and prescriptions. Segmented regression analysis was used to estimate primary and secondary outcomes. RESULTS For the 10,704 patients included in our sample, the total saving over the 65-week follow-up period was £71,027. This corresponds to £6.64 per person in our sample or around £70.44 per Sleepio user. Secondary analyses suggest that savings may be driven primarily by reductions in prescribing. CONCLUSION Sleepio rollout reduced primary care costs. National adoption of Sleepio may reduce primary care costs by £20 million in the first year. The expected impact on primary care costs in any particular setting will depend on the uptake of Sleepio.
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170
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Dhinagaran DA, Sathish T, Soong A, Theng YL, Best J, Tudor Car L. Conversational Agent for Healthy Lifestyle Behavior Change: Web-Based Feasibility Study. JMIR Form Res 2021; 5:e27956. [PMID: 34870611 PMCID: PMC8686401 DOI: 10.2196/27956] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The rising incidence of chronic diseases is a growing concern, especially in Singapore, which is one of the high-income countries with the highest prevalence of diabetes. Interventions that promote healthy lifestyle behavior changes have been proven to be effective in reducing the progression of prediabetes to diabetes, but their in-person delivery may not be feasible on a large scale. Novel technologies such as conversational agents are a potential alternative for delivering behavioral interventions that promote healthy lifestyle behavior changes to the public. OBJECTIVE The aim of this study is to assess the feasibility and acceptability of using a conversational agent promoting healthy lifestyle behavior changes in the general population in Singapore. METHODS We performed a web-based, single-arm feasibility study. The participants were recruited through Facebook over 4 weeks. The Facebook Messenger conversational agent was used to deliver the intervention. The conversations focused on diet, exercise, sleep, and stress and aimed to promote healthy lifestyle behavior changes and improve the participants' knowledge of diabetes. Messages were sent to the participants four times a week (once for each of the 4 topics of focus) for 4 weeks. We assessed the feasibility of recruitment, defined as at least 75% (150/200) of our target sample of 200 participants in 4 weeks, as well as retention, defined as 33% (66/200) of the recruited sample completing the study. We also assessed the participants' satisfaction with, and usability of, the conversational agent. In addition, we performed baseline and follow-up assessments of quality of life, diabetes knowledge and risk perception, diet, exercise, sleep, and stress. RESULTS We recruited 37.5% (75/200) of the target sample size in 1 month. Of the 75 eligible participants, 60 (80%) provided digital informed consent and completed baseline assessments. Of these 60 participants, 56 (93%) followed the study through till completion. Retention was high at 93% (56/60), along with engagement, denoted by 50% (30/60) of the participants communicating with the conversational agent at each interaction. Acceptability, usability, and satisfaction were generally high. Preliminary efficacy of the intervention showed no definitive improvements in health-related behavior. CONCLUSIONS The delivery of a conversational agent for healthy lifestyle behavior change through Facebook Messenger was feasible and acceptable. We were unable to recruit our planned sample solely using the free options in Facebook. However, participant retention and conversational agent engagement rates were high. Our findings provide important insights to inform the design of a future randomized controlled trial.
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Affiliation(s)
| | - Thirunavukkarasu Sathish
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - AiJia Soong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore, Singapore
| | - Yin-Leng Theng
- Centre for Healthy and Sustainable Cities, Nanyang Technological University, Singapore, Singapore, Singapore
| | - James Best
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore, Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Scott AJ, Webb TL, Martyn-St James M, Rowse G, Weich S. Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Med Rev 2021; 60:101556. [PMID: 34607184 PMCID: PMC8651630 DOI: 10.1016/j.smrv.2021.101556] [Citation(s) in RCA: 260] [Impact Index Per Article: 86.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 02/07/2023]
Abstract
The extent to which sleep is causally related to mental health is unclear. One way to test the causal link is to evaluate the extent to which interventions that improve sleep quality also improve mental health. We conducted a meta-analysis of randomised controlled trials that reported the effects of an intervention that improved sleep on composite mental health, as well as on seven specific mental health difficulties. 65 trials comprising 72 interventions and N = 8608 participants were included. Improving sleep led to a significant medium-sized effect on composite mental health (g+ = -0.53), depression (g+ = -0.63), anxiety (g+ = -0.51), and rumination (g+ = -0.49), as well as significant small-to-medium sized effects on stress (g+ = -0.42), and finally small significant effects on positive psychosis symptoms (g+ = -0.26). We also found a dose response relationship, in that greater improvements in sleep quality led to greater improvements in mental health. Our findings suggest that sleep is causally related to the experience of mental health difficulties. Future research might consider how interventions that improve sleep could be incorporated into mental health services, as well as the mechanisms of action that explain how sleep exerts an effect on mental health.
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Affiliation(s)
| | - Thomas L Webb
- Department of Psychology, The University of Sheffield, UK
| | | | - Georgina Rowse
- Clinical Psychology Unit, Department of Psychology, The University of Sheffield, UK
| | - Scott Weich
- School of Health and Related Research (ScHARR), The University of Sheffield, UK
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172
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Lüdtke T, Rüegg N, Moritz S, Berger T, Westermann S. Insight and the number of completed modules predict a reduction of positive symptoms in an Internet-based intervention for people with psychosis. Psychiatry Res 2021; 306:114223. [PMID: 34826711 DOI: 10.1016/j.psychres.2021.114223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022]
Abstract
Emerging evidence suggests that Internet-based interventions for people with psychosis (ICBTp) are feasible and efficacious. However, predictors of adherence and treatment outcomes are largely unknown. To narrow this research gap, we conducted secondary analyses on data from a randomized controlled trial, which evaluated an eight-week ICBTp intervention targeting topics, such as voice hearing, mindfulness, and others. In n = 100 participants with psychosis, we aimed at identifying sociodemographic, psychopathological, and treatment-related predictor variables of post-treatment symptoms and adherence (i.e., at least four completed modules). We followed a two-stage approach. First, we conducted regression analyses to examine the effect of single candidate predictors on post-treatment symptoms as well as adherence. Subsequently, we selected variables that met a significance threshold of p < .1 and entered them into linear and logistic multiple regression models. Whereas no variable was able to predict adherence, the number of completed modules was negatively associated with self-reported delusion severity at post-treatment. Additionally, higher pre-treatment insight predicted fewer hallucinations after treatment. Because this was one of the first studies to investigate predictors in ICBTp, more research is needed to customize future interventions to the needs of users.
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Affiliation(s)
- Thies Lüdtke
- Department of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany; Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway.
| | - Nina Rüegg
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Stefan Westermann
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany.
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173
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Lunsford-Avery JR, Damme KSF, Vargas T, Sweitzer MM, Mittal VA. Psychotic-Like Experiences Associated with Sleep Disturbance and Brain Volumes in Youth: Findings from the Adolescent Brain Cognitive Development Study. JCPP ADVANCES 2021; 1:e12055. [PMID: 36339462 PMCID: PMC9635573 DOI: 10.1002/jcv2.12055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Sleep disturbance is characteristic of schizophrenia and at-risk populations, suggesting a possible etiological role in psychosis. Biological mechanisms underlying associations between sleep and psychosis vulnerability are unclear, although reduced sleep-regulatory brain structure volumes are a proposed contributor. This study is the first to examine relationships between psychotic-like experiences (PLEs; subclinical symptoms reflecting psychosis vulnerability/risk), sleep, and brain volumes in youth. Methods Brain volumes of five sleep-related structures were examined in relation to PLEs and difficulties initiating and maintaining sleep (DIMS) in 9260 9-11 year-olds participating in the Adolescent Brain Cognitive Development (ABCD) study. Analytic models examined relationships between DIMS, PLEs, and brain volumes, as well as DIMS as a mediator of brain volume-PLEs relationships. Although sleep regulation structures (i.e., thalamus, basal forebrain, hypothalamus) were of primary interest, other potentially-relevant structures to sleep-related functioning and psychosis (i.e., hippocampus, amygdala) were also examined. Results PLEs were associated with increased DIMS as well as reduced volume in some, but not all, brain structures, including the thalamus and basal forebrain in children. DIMS was also associated with reduced left thalamus volume in youth. Increased DIMS partially, statistically mediated the relationship between left thalamic volume and PLEs, although the effect was relatively small. Conclusions Results highlight left thalamic volume as a potential neural mechanism underlying sleep disturbances and PLEs in childhood. Future studies should assess causal relationships between sleep, PLEs, and brain structure across adolescent development, interactions with other psychosis risk factors, and the role of sleep interventions in prevention of psychosis and a range of psychiatric conditions across the lifespan.
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Affiliation(s)
- Jessica R. Lunsford-Avery
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katherine S. F. Damme
- Department of Psychology, Northwestern University, Evanston, IL, USA,Institute for Innovations in Developmental Sciences, Northwestern University, Evanston and Chicago, IL, USA
| | - Teresa Vargas
- Department of Psychology, Northwestern University, Evanston, IL, USA,Institute for Innovations in Developmental Sciences, Northwestern University, Evanston and Chicago, IL, USA
| | - Maggie M. Sweitzer
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Vijay A. Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA,Institute for Innovations in Developmental Sciences, Northwestern University, Evanston and Chicago, IL, USA,Department of Psychiatry, Northwestern University, Chicago, IL USA,Medical Social Sciences, Northwestern University, Chicago, IL, USA,Institute for Policy Research (IPR), Northwestern University, Chicago, IL, USA
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174
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Wilson D, Driller M, Winwood P, Johnston B, Gill N. The Effects of a Brief Lifestyle Intervention on the Health of Overweight Airline Pilots during COVID-19: A 12-Month Follow-Up Study. Nutrients 2021; 13:4288. [PMID: 34959838 PMCID: PMC8707615 DOI: 10.3390/nu13124288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/26/2021] [Accepted: 11/26/2021] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to perform a 12-month follow-up of health parameters after a 17-week lifestyle intervention in overweight airline pilots. A parallel-group (intervention and control) study was conducted amongst 72 overweight airline pilots (body mass index > 25) over a 12-month period following the emergence of COVID-19. The intervention group (n = 35) received a personalized dietary, sleep, and physical activity program over a 17-week period. The control group (n = 37) received no intervention. Measurements for subjective health (physical activity, sleep quality and quantity, fruit and vegetable intake, and self-rated health) via an electronic survey, and objective measures of body mass and blood pressure were taken at baseline and at 12 months. Significant interactions for group × time from baseline to 12-months were found for all outcome measures (p < 0.001). Body mass and mean arterial pressure significantly decreased in the intervention group when compared to the control group (p < 0.001). Outcome measures for subjective health (physical activity, sleep quality and quantity, fruit and vegetable intake, and self-rated health) significantly increased in the intervention group when compared to the control group (p < 0.001). Results provide preliminary evidence that a brief three-component healthy sleep, diet and physical activity intervention can elicit and sustain long-term improvements in body mass and blood pressure management, health behaviors, and perceived subjective health in pilots and may support quality of life during an unprecedented global pandemic.
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Affiliation(s)
- Daniel Wilson
- Te Huataki Waiora School of Health, The University of Waikato, Hamilton 3216, New Zealand
- Faculty of Health, Education and Environment, Toi Ohomai Institute of Technology, Tauranga 3112, New Zealand; (P.W.); (N.G.)
| | - Matthew Driller
- Sport and Exercise Science, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne 3086, Australia;
| | - Paul Winwood
- Faculty of Health, Education and Environment, Toi Ohomai Institute of Technology, Tauranga 3112, New Zealand; (P.W.); (N.G.)
| | - Ben Johnston
- Aviation and Occupational Health Unit, Air New Zealand, Auckland 1142, New Zealand;
| | - Nicholas Gill
- Faculty of Health, Education and Environment, Toi Ohomai Institute of Technology, Tauranga 3112, New Zealand; (P.W.); (N.G.)
- New Zealand Rugby, Wellington 6011, New Zealand
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175
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Andreasson A, Axelsson J, Bosch JA, Balter LJ. Poor sleep quality is associated with worse self-rated health in long sleep duration but not short sleep duration. Sleep Med 2021; 88:262-266. [PMID: 34801824 DOI: 10.1016/j.sleep.2021.10.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/26/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
Unhealthy sleep duration, either short or long, is associated with worse health and central subjective dimensions of sleep and health such as fatigue. It has been argued that the link between sleep duration and health may depend on the quality of the slept hours, and on its functional impact (ie, fatigue). The present study therefore assessed whether the relationship between last night's sleep duration and general self-rated health (SRH) differs as a function of sleep quality, and secondly, whether current fatigue and sleep quality are factors linking sleep duration and SRH. The present cross-sectional dataset involved 1304 individuals (57% female, Mage = 28.8, range 18-79). Participants completed surveys for general SRH, previous night's sleep duration and sleep quality, and current fatigue. Results showed the expected inverted U-shaped (ie, quadratic) relation between last night's sleep duration and SRH and a linear relation between last night's sleep quality and SRH. However, long sleep duration was only associated with poorer SRH in individuals who also reported poor sleep quality. Further, the quadratic relationship between sleep duration and SRH was partially mediated by fatigue and sleep quality. The results of this multi-study analysis suggest that SRH is particularly poor in those who slept both long and with poor quality the night before, while good sleep quality may protect those with a long sleep duration from poor SRH. Thus, last night's long sleep does not seem to be associated with poor subjective health unless it is coupled with poor sleep quality. Furthermore, fatigue and sleep quality are potential pathways linking short and long sleep duration with SRH. Different dimensions of sleep interact in their association with health, and future research will benefit from an integrative approach.
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Affiliation(s)
- Anna Andreasson
- Stress Research Institute, Psychology Department, Stockholm University, Stockholm, Sweden; Department of Medicine Solna, Division of Clinical Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Macquarie University, NSW, Australia
| | - John Axelsson
- Stress Research Institute, Psychology Department, Stockholm University, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Stockholm, Karolinska Institutet, Stockholm, Sweden
| | - Jos A Bosch
- Clinical Psychology, Psychology Department, University of Amsterdam, Amsterdam, the Netherlands
| | - Leonie Jt Balter
- Stress Research Institute, Psychology Department, Stockholm University, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Stockholm, Karolinska Institutet, Stockholm, Sweden.
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176
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Comparative efficacy of digital cognitive behavioral therapy for insomnia: A systematic review and network meta-analysis. Sleep Med Rev 2021; 61:101567. [PMID: 34902820 DOI: 10.1016/j.smrv.2021.101567] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 12/19/2022]
Abstract
The comparative efficacy of various approaches of digital cognitive behavioral therapy for insomnia (CBTi) is still unclear. This network meta-analysis explored the comparative efficacy of digital CBTi approaches in adults with insomnia. Four electronic databases were searched from inception to June 27, 2020. Primary outcomes were self-reported total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency (SE), and insomnia symptoms; these were measured using sleep diaries or valid questionnaires. A random-effects network meta-analysis in a frequentist framework was used. Fifty-four randomized controlled trials comprising 11,815 participants were included. Compared with usual care, web-based CBTi with a therapist demonstrated significantly longer TST (mean difference [MD]: 23.19 min, 95% confidence interval [CI]: 18.98-27.39 min), shorter SOL (MD: -18.76 min, 95% CI -24.20 to -13.31 min), lower WASO (MD: -31.40 min, 95% CI: -36.26 to -26.55 min), and greater SE (MD: 10.37%, 95% CI: 8.08%-12.65%). The surface under the cumulative ranking curve indicates that web-based CBTi with therapists is most likely to be ranked the highest among all treatments, and thus, this network meta-analysis suggests that such a treatment is the optimal intervention for improving sleep duration and SE as well as the reductions in SOL and WASO. PROSPERO REGISTRATION NUMBER: CRD42020171134.
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177
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Facer-Childs ER, Mascaro L, Hoffman D, Mansfield D, Drummond SPA, Rajarathnam SW. Sleep as a Major Determinant for Mental Health Outcomes in Elite Australian Football League (AFL) Athletes. Med Sci Sports Exerc 2021; 54:665-672. [PMID: 34772903 DOI: 10.1249/mss.0000000000002825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The link between mental health and sleep is well documented in the general population, with the majority of mental health disorders involving some type of sleep disturbance. There is, however, limited research investigating this relationship in elite athlete populations. The aim of this study was to identify whether sleep and mental health outcomes are associated in elite athletes, and if so, what measures of sleep were the most predictive of mental health outcomes. METHODS A comprehensive assessment of sleep was conducted using both objective and subjective methods in 68 Australian Football League athletes (male, mean age = 23.3 ± 3.4 years, median = 23 range 18 - 32 years). Rest-activity patterns were recorded using wrist actigraphy for an average of 13.8 ± 3.6 days (total 884 days data). Subjective sleep data were collected using daily sleep diaries and validated questionnaires. Validated mental health questionnaires were used to assess depression, anxiety and stress symptoms. Multiple linear regression modelling was used to investigate the relationship between sleep and mental health. RESULTS Using a combination of sleep variables, poor sleep predicted 51% of the variation in clinical depression, 42% of the variation in stress, and 31% in clinical anxiety. Self-reported insomnia symptoms (using the Insomnia Severity Index), were the strongest predictors of poor mental health outcomes, followed by objective sleep monitoring via actigraphy. Sleep diary measures were the weakest predictors of mental health. CONCLUSION Our results present poor sleep as a major determinant of impaired mental health outcomes in a population that is constantly under pressure to perform at the highest level and may underreport mental health symptoms. These findings support the inclusion of sleep assessments as an initial screening tool as well as a core component of all routine health and rehabilitation programs.
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Affiliation(s)
- Elise R Facer-Childs
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia Monash Respiratory and Sleep Medicine, Monash Health, Clayton, Victoria, Australia
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178
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Guo R, Shi AM, Deng L, Li L, Wang LC, Oteng AB, Wei MP, Zhao ZH, Hooiveld G, Zhang C, Wang Q. Flavonoid-Like Components of Peanut Stem and Leaf Extract Promote Sleep by Decreasing Neuronal Excitability. Mol Nutr Food Res 2021; 66:e2100210. [PMID: 34747100 DOI: 10.1002/mnfr.202100210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 10/10/2021] [Indexed: 12/16/2022]
Abstract
SCOPE Peanut stem and leaf (PSL), a traditional Chinese medicine, is widely used as a dietary supplement to improve sleep quality; however, the underlying mechanism is unclear. Here, the study aims to determine whether active compounds in PSL extract exert their effects by mediating neuronal excitability. METHODS AND RESULTS Aqueous PSL extract (500 mg kg-1 BW) increases the duration of total sleep (TS), slow wave sleep (SWS) and rapid eye movement sleep (REMS) in BALB/c mice after 7 and 14 continuous days of intragastric administration. Two PSL extract components with flavonoid-like structures: 4',7-di-O-methylnaringenin (DMN, 61 µg kg-1 BW) and 2'-O-methylisoliquiritigenin (MIL, 12 µg kg-1 BW), show similar effects on sleep in BALB/c mice. Moreover, incubation with DMN (50 µM) and MIL (50 µM) acutely reduces voltage-gated sodium and potassium currents and suppresses the firing of evoked action potential in mouse cortical neurons, indicating the inhibition on neuronal excitability. Meanwhile, RNA-seq analysis predicts the potential regulation of voltage-gated channels, which is according with the molecular docking simulation that both MIL and DMN can bind to voltage gated sodium channels 1.2 (Nav 1.2). CONCLUSIONS DMN and MIL are the active ingredients of PSL that improve sleep quality, suggesting that PSL promotes sleep by regulating the excitability of neurons.
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Affiliation(s)
- Rui Guo
- Institute of Food Science and Technology, Chinese Academy of Agricultural Sciences/Key Laboratory of Agro-Products Processing, Ministry of Agriculture and Rural Affairs, Beijing, 100193, China
| | - Ai-Min Shi
- Institute of Food Science and Technology, Chinese Academy of Agricultural Sciences/Key Laboratory of Agro-Products Processing, Ministry of Agriculture and Rural Affairs, Beijing, 100193, China
| | - Lei Deng
- Nutrition, Metabolism and Genomics Group, Human Nutrition and Health Division, Wageningen University and Research, Wageningen, WE 6708, The Netherlands
| | - Lei Li
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Anhui, 230031, China
| | - Lie-Chen Wang
- Department of Physiology, School of Basic Medical Sciences, Anhui Medical University, Anhui, 230031, China
| | | | - Meng-Ping Wei
- School of Basic Medical Sciences, Beijing Key Laboratory of Neural Regeneration and Repair, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China
| | - Zhi-Hao Zhao
- Institute of Food Science and Technology, Chinese Academy of Agricultural Sciences/Key Laboratory of Agro-Products Processing, Ministry of Agriculture and Rural Affairs, Beijing, 100193, China
| | - Guido Hooiveld
- Nutrition, Metabolism and Genomics Group, Human Nutrition and Health Division, Wageningen University and Research, Wageningen, WE 6708, The Netherlands
| | - Chen Zhang
- School of Basic Medical Sciences, Beijing Key Laboratory of Neural Regeneration and Repair, Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, 100069, China
| | - Qiang Wang
- Institute of Food Science and Technology, Chinese Academy of Agricultural Sciences/Key Laboratory of Agro-Products Processing, Ministry of Agriculture and Rural Affairs, Beijing, 100193, China
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179
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Neary M, Bunyi J, Palomares K, Mohr DC, Powell A, Ruzek J, Williams LM, Wykes T, Schueller SM. A process for reviewing mental health apps: Using the One Mind PsyberGuide Credibility Rating System. Digit Health 2021; 7:20552076211053690. [PMID: 34733541 PMCID: PMC8558599 DOI: 10.1177/20552076211053690] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/29/2021] [Indexed: 12/14/2022] Open
Abstract
Objective Given the increasing number of publicly available mental health apps, we need independent advice to guide adoption. This paper discusses the challenges and opportunities of current mental health app rating systems and describes the refinement process of one prominent system, the One Mind PsyberGuide Credibility Rating Scale (PGCRS). Methods PGCRS Version 1 was developed in 2013 and deployed for 7 years, during which time a number of limitations were identified. Version 2 was created through multiple stages, including a review of evaluation guidelines and consumer research, input from scientific experts, testing, and evaluation of face validity. We then re-reviewed 161 mental health apps using the updated rating scale, investigated the reliability and discrepancy of initial scores, and updated ratings on the One Mind PsyberGuide public app guide. Results Reliabilities across the scale's 9 items ranged from -0.10 to 1.00, demonstrating that some characteristics of apps are more difficult to rate consistently. The average overall score of the 161 reviewed mental health apps was 2.51/5.00 (range 0.33-5.00). Ratings were not strongly correlated with app store star ratings, suggesting that credibility scores provide different information to what is contained in star ratings. Conclusion PGCRS summarizes and weights available information in 4 domains: intervention specificity, consumer ratings, research, and development. Final scores are created through an iterative process of initial rating and consensus review. The process of updating this rating scale and integrating it into a procedure for evaluating apps demonstrates one method for determining app quality.
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Affiliation(s)
- Martha Neary
- Department of Psychological Science, University of California, University of California, Irvine, CA, USA
| | - John Bunyi
- Department of Psychological Science, University of California, University of California, Irvine, CA, USA
| | - Kristina Palomares
- Department of Psychological Science, University of California, University of California, Irvine, CA, USA
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | | | - Josef Ruzek
- Palo Alto University, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust London, UK
| | - Stephen M Schueller
- Department of Psychological Science, University of California, University of California, Irvine, CA, USA
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180
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Brewer R, Murphy J, Bird G. Atypical interoception as a common risk factor for psychopathology: A review. Neurosci Biobehav Rev 2021; 130:470-508. [PMID: 34358578 PMCID: PMC8522807 DOI: 10.1016/j.neubiorev.2021.07.036] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/09/2021] [Accepted: 07/31/2021] [Indexed: 02/06/2023]
Abstract
The inadequacy of a categorial approach to mental health diagnosis is now well-recognised, with many authors, diagnostic manuals and funding bodies advocating a dimensional, trans-diagnostic approach to mental health research. Variance in interoception, the ability to perceive one's internal bodily state, is reported across diagnostic boundaries, and is associated with atypical functioning across symptom categories. Drawing on behavioural and neuroscientific evidence, we outline current research on the contribution of interoception to numerous cognitive and affective abilities (in both typical and clinical populations), and describe the interoceptive atypicalities seen in a range of psychiatric conditions. We discuss the role that interoception may play in the development and maintenance of psychopathology, as well as the ways in which interoception may differ across clinical presentations. A number of important areas for further research on the role of interoception in psychopathology are highlighted.
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Affiliation(s)
- Rebecca Brewer
- Department of Psychology, Royal Holloway, University of London, United Kingdom
| | - Jennifer Murphy
- Department of Psychology, Royal Holloway, University of London, United Kingdom.
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, United Kingdom; Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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181
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Dhungel B, Tsuguhiko K, Kachi Y, Ochi M, Gilmour S, Takehara K. Prevalence of and associated factors for psychological distress among single fathers in Japan. J Epidemiol 2021. [PMID: 34690244 PMCID: PMC10165216 DOI: 10.2188/jea.je20210273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In Japan, ten percent of single-parent households are led by fathers. Taking care of children as a single father is very stressful and could put a strain on their health. It is very important to prevent and identify psychological distress among fathers for both their own health and to avoid negative impacts on children. This study aims to determine the prevalence of, and factors associated with psychological distress among single fathers and understand how it is different from partnered fathers. METHODS We used data from the Comprehensive Survey of Living Conditions 2016. Psychological distress, assessed using the K6 scale, was analysed among 868 single and 43,880 partnered fathers. Logistic regression analysis was performed to assess the risk factors for psychological distress such as employment type, sleep hours, smoking and drinking habits. RESULTS Single fathers had a higher proportion (8.5%) of psychological distress compared to partnered fathers (5.0%). A large percentage of single fathers had a lower educational level and were non-regular workers, self-employed or unemployed, compared to partnered fathers. Among single fathers, the crude and adjusted odds ratio for employment type and sleep hours were significantly associated with psychological distress. CONCLUSION As single parents who are self-employed or directors are likely to have significantly reduced psychological distress than those with regular jobs, measures are needed to improve the work-family balance for non-self-employed fathers. There is a need to provide assistance to improve the quality and amount of sleep of single fathers to ensure their and their children's good health.
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Affiliation(s)
- Bibha Dhungel
- Department of Health Policy, National Centre for Child Health and Development.,Graduate School of Public Health, St. Luke's International University
| | - Kato Tsuguhiko
- Graduate School of Public Health, St. Luke's International University.,Department of Social Medicine, National Centre for Child Health and Development
| | - Yuko Kachi
- Department of Public Health, Kitasato University School of Medicine.,School of Humanities and Social Sciences, Tokyo Metropolitan University
| | - Manami Ochi
- Department of Social Medicine, National Centre for Child Health and Development.,Department of Health and Welfare Services, National Institute of Public Health
| | - Stuart Gilmour
- Graduate School of Public Health, St. Luke's International University
| | - Kenji Takehara
- Department of Health Policy, National Centre for Child Health and Development
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182
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Collard VEJ, Moore C, Nichols V, Ellard DR, Patel S, Sandhu H, Parsons H, Sharma U, Underwood M, Madan J, Tang NKY. Challenges and visions for managing pain-related insomnia in primary care using the hybrid CBT approach: a small-scale qualitative interview study with GPs, nurses, and practice managers. BMC FAMILY PRACTICE 2021; 22:210. [PMID: 34666682 PMCID: PMC8527665 DOI: 10.1186/s12875-021-01552-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/01/2021] [Indexed: 08/30/2023]
Abstract
Background Chronic pain and insomnia have a complex, bidirectional relationship – addressing sleep complaints alongside pain may be key to alleviating patient-reported distress and disability. Healthcare professionals have consistently reported wanting to offer psychologically informed chronic pain management at the primary care level. Research in secondary care has demonstrated good treatment efficacy of hybrid CBT for chronic pain and insomnia. However, primary care is typically the main point of treatment entry, hence may be better situated to offer treatments using a multidisciplinary approach. In this study, primary care service providers’ perception of feasibility for tackling pain-related insomnia in primary care was explored. Methods The data corpus originates from a feasibility trial exploring hybrid CBT for chronic pain and insomnia delivered in primary care. This formed three in-depth group interviews with primary care staff (n = 9) from different primary care centres from the same NHS locale. All interviews were conducted on-site using a semi-structured approach. Verbal data was recorded, transcribed verbatim and analysed using the thematic analysis process. Results Eight themes were identified – 1) Discrepant conceptualisations of the chronic pain-insomnia relationship and clinical application, 2) Mismatch between patients’ needs and available treatment offerings, 3) Awareness of psychological complexities, 4) Identified treatment gap for pain-related insomnia, 5) Lack of funding and existing infrastructure for new service development, 6) General shortage of psychological services for complex health conditions, 7) Multidisciplinary team provision with pain specialist input, and 8) Accessibility through primary care. These mapped onto four domains - Current understanding and practice, Perceived facilitators, Perceived barriers, Ideal scenarios for a new treatment service – which reflected the focus of our investigation. Taken together these provide key context for understanding challenges faced by health care professionals in considering and developing a new clinical service. Conclusions Primary care service providers from one locale advocate better, multidisciplinary treatment provision for chronic pain and insomnia. Findings suggest that situating this in primary care could be a feasible option, but this requires systemic support and specialist input as well as definitive trials for success. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01552-3.
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Affiliation(s)
- V E J Collard
- Department of Psychology, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
| | - C Moore
- Department of Psychology, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| | - V Nichols
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - D R Ellard
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - S Patel
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - H Sandhu
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - H Parsons
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - U Sharma
- University/User Teaching and Research Action Partnership, University of Warwick, Coventry, CV4 7AL, UK
| | - M Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - J Madan
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - N K Y Tang
- Department of Psychology, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
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183
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Amicucci G, Salfi F, D’Atri A, Viselli L, Ferrara M. The Differential Impact of COVID-19 Lockdown on Sleep Quality, Insomnia, Depression, Stress, and Anxiety among Late Adolescents and Elderly in Italy. Brain Sci 2021; 11:1336. [PMID: 34679402 PMCID: PMC8533758 DOI: 10.3390/brainsci11101336] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 12/17/2022] Open
Abstract
The restraining measures due to the COVID-19 outbreak deeply affected the general population's sleep health and psychological status. The current literature proposes young and older people as two particularly at-risk groups. However, the differential impact of the lockdown period in these specific age categories needs to be disentangled. Through a web-based survey adopting validated questionnaires, we evaluated and compared sleep quality/habits, insomnia, perceived stress, depression, and anxiety symptoms of Italian late adolescents (n = 670; mean age ± SD, 19.38 ± 0.74, 18-20 years) and elderly (n = 253; 68.18 ± 2.79, 65-75 years). Young respondents reported more severe insomnia symptoms, worse subjective sleep quality, longer sleep latency, higher daytime dysfunction, and a more prevalent disruption of sleep habits (bedtime, get-up time, nap) than the elderly. On the other hand, older participants showed shorter sleep duration, lower habitual sleep efficiency, and greater use of sleep medications. Finally, the younger population displayed higher levels of depression and perceived stress. Our findings indicate that the lockdown period had more pervasive repercussions on sleep and the mental health of late adolescents. The implementation of supportive strategies is encouraged for this vulnerable population group.
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Affiliation(s)
- Giulia Amicucci
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (G.A.); (F.S.); (A.D.); (L.V.)
- Department of Psychology, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Federico Salfi
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (G.A.); (F.S.); (A.D.); (L.V.)
| | - Aurora D’Atri
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (G.A.); (F.S.); (A.D.); (L.V.)
| | - Lorenzo Viselli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (G.A.); (F.S.); (A.D.); (L.V.)
| | - Michele Ferrara
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (G.A.); (F.S.); (A.D.); (L.V.)
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184
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Ling J, Lin X, Li X, Chan NY, Zhang J, Wing YK, Hu X, Li SX. Neural Response to Rewards in Youths with Insomnia. Sleep 2021; 45:6380671. [PMID: 34604904 DOI: 10.1093/sleep/zsab238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 08/03/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES Insomnia and depression are common comorbid conditions in youths. Emerging evidence suggests that disrupted reward processing may be implicated in the association between insomnia and the increased risk for depression. Reduced reward positivity (RewP) as measured by event-related potential (ERP) has been linked to depression, but has not been tested in youths with insomnia. METHODS Twenty-eight participants with insomnia disorder and without any comorbid psychiatric disorders and 29 healthy sleepers aged between 15-24 completed a monetary reward task, the Cued Door task, whilst electroencephalographic activity was recorded. RewP (reward minus non-reward difference waves) was calculated as the mean amplitudes within 200ms to 300ms time window at FCz. Two analyses of covariance (ANCOVAs) were conducted with age as a covariate on RewP amplitude and latency, respectively. RESULTS Participants with insomnia had a significantly lower RewP amplitude regardless of cue types (Gain, Control, and Loss) than healthy sleepers, F (1, 51) = 4.95, p = .031, indicating blunted reward processing. On the behavioural level, healthy sleepers were more prudential (slower reaction time) in decision making towards Loss/Gain cues than their insomnia counterparts. Trial-by-trial behavioural adjustment analyses showed that, compared with healthy sleepers, participants with insomnia were less likely to dynamically change their choices in response to Loss cues. CONCLUSIONS Dysfunctional reward processing, coupled with inflexibility of behavioural adjustment in decision-making, is associated with insomnia disorder among youth, independent of mood disorders. Future studies with long-term follow-up are needed to further delineate the developmental trajectory of insomnia-related reward dysfunctions in youth.
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Affiliation(s)
- Jiefan Ling
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong
| | - Xuanyi Lin
- The Social and Cognitive Neuroscience Lab, Department of Psychology, The University of Hong Kong
| | - Xiao Li
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong
| | - Ngan Yin Chan
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong
| | - Jihui Zhang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong.,Guang Dong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences
| | - Yun Kwok Wing
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong
| | - Xiaoqing Hu
- The Social and Cognitive Neuroscience Lab, Department of Psychology, The University of Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
| | - Shirley Xin Li
- Sleep Research Clinic and Laboratory, Department of Psychology, The University of Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
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185
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Abstract
Sleep disturbances and depression are closely linked and share a bidirectional relationship. These interconnections can inform the pathophysiology underlying each condition. Insomnia is an established and modifiable risk factor for depression, the treatment of which offers the critical opportunity to prevent major depressive episodes, a paradigm-shifting model for psychiatry. Identification of occult sleep disorders may also improve outcomes in treatment-resistant depression. Sleep alterations and manipulations may additionally clarify the mechanisms that underlie rapid-acting antidepressant therapies. Both sleep disturbance and depression are heterogeneous processes, and evolving standards in psychiatric research that consider the transdiagnostic components of each are more likely to lead to translational progress at their nexus. Emerging tools to objectively quantify sleep and its disturbances in the home environment offer great potential to advance clinical care and research, but nascent technologies require further advances and validation prior to widespread application at the interface of sleep and depression.
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Affiliation(s)
- David T Plante
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison
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186
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Fekih-Romdhane F, Nefzi H, Sassi H, Cherif W, Cheour M. Sleep in first-episode schizophrenia patients, their unaffected siblings and healthy controls: A comparison. Early Interv Psychiatry 2021; 15:1167-1178. [PMID: 33037776 DOI: 10.1111/eip.13058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 08/04/2020] [Accepted: 09/26/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sleep disturbances in schizophrenia are common throughout its course including in the prodrome, and have been mainly attributed to severity of symptoms and antipsychotic use. We aimed to investigate whether early course patients with schizophrenia and young non-psychotic siblings of patients with schizophrenia also show sleep disturbances and whether sleep correlates with symptoms and functioning. METHODS Three study groups, that is, adults newly diagnosed with schizophrenia (n = 54), young non-psychotic siblings of schizophrenia patients (n = 56) and a sample of healthy controls matched to the patients and siblings (n = 61) were evaluated on Horne and Ostberg Morningness-Eveningness Questionnaire, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index. Severity of symptoms and functioning are assessed using the Positive and Negative Syndrome Scale and the Global Assessment of Functioning Scale, respectively. Age, gender, occupation and marital status were regarded as covariates, and differences between the three groups were evaluated using analysis of covariance. RESULTS Early course schizophrenia patients and non-psychotic siblings of schizophrenia patients showed significantly reduced sleep quality relative to healthy controls (P < .001). Schizophrenia patients had significantly higher daytime sleepiness compared to controls (P < .001). Chronotypes in schizophrenia patients and unaffected siblings did not significantly differ from those of the healthy controls. CONCLUSIONS Like chronic medicated schizophrenia patients, early course schizophrenia patients and young non-psychotic siblings of individuals with schizophrenia have sleep disturbances. These findings indicate that sleep markers can distinguish unaffected siblings of schizophrenia from healthy controls and serve as an endophenotype for schizophrenia.
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Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Department of psychiatry "Ibn Omrane", Razi Hospital, Mannouba, Tunisia
| | - Houssem Nefzi
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Department of psychiatry "Ibn Omrane", Razi Hospital, Mannouba, Tunisia
| | - Hadhami Sassi
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Department of psychiatry "Ibn Omrane", Razi Hospital, Mannouba, Tunisia
| | - Wissal Cherif
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Department of psychiatry "Ibn Omrane", Razi Hospital, Mannouba, Tunisia
| | - Majda Cheour
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.,Department of psychiatry "Ibn Omrane", Razi Hospital, Mannouba, Tunisia
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187
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Wainberg M, Jones SE, Beaupre LM, Hill SL, Felsky D, Rivas MA, Lim ASP, Ollila HM, Tripathy SJ. Association of accelerometer-derived sleep measures with lifetime psychiatric diagnoses: A cross-sectional study of 89,205 participants from the UK Biobank. PLoS Med 2021; 18:e1003782. [PMID: 34637446 PMCID: PMC8509859 DOI: 10.1371/journal.pmed.1003782] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Sleep problems are both symptoms of and modifiable risk factors for many psychiatric disorders. Wrist-worn accelerometers enable objective measurement of sleep at scale. Here, we aimed to examine the association of accelerometer-derived sleep measures with psychiatric diagnoses and polygenic risk scores in a large community-based cohort. METHODS AND FINDINGS In this post hoc cross-sectional analysis of the UK Biobank cohort, 10 interpretable sleep measures-bedtime, wake-up time, sleep duration, wake after sleep onset, sleep efficiency, number of awakenings, duration of longest sleep bout, number of naps, and variability in bedtime and sleep duration-were derived from 7-day accelerometry recordings across 89,205 participants (aged 43 to 79, 56% female, 97% self-reported white) taken between 2013 and 2015. These measures were examined for association with lifetime inpatient diagnoses of major depressive disorder, anxiety disorders, bipolar disorder/mania, and schizophrenia spectrum disorders from any time before the date of accelerometry, as well as polygenic risk scores for major depression, bipolar disorder, and schizophrenia. Covariates consisted of age and season at the time of the accelerometry recording, sex, Townsend deprivation index (an indicator of socioeconomic status), and the top 10 genotype principal components. We found that sleep pattern differences were ubiquitous across diagnoses: each diagnosis was associated with a median of 8.5 of the 10 accelerometer-derived sleep measures, with measures of sleep quality (for instance, sleep efficiency) generally more affected than mere sleep duration. Effect sizes were generally small: for instance, the largest magnitude effect size across the 4 diagnoses was β = -0.11 (95% confidence interval -0.13 to -0.10, p = 3 × 10-56, FDR = 6 × 10-55) for the association between lifetime inpatient major depressive disorder diagnosis and sleep efficiency. Associations largely replicated across ancestries and sexes, and accelerometry-derived measures were concordant with self-reported sleep properties. Limitations include the use of accelerometer-based sleep measurement and the time lag between psychiatric diagnoses and accelerometry. CONCLUSIONS In this study, we observed that sleep pattern differences are a transdiagnostic feature of individuals with lifetime mental illness, suggesting that they should be considered regardless of diagnosis. Accelerometry provides a scalable way to objectively measure sleep properties in psychiatric clinical research and practice, even across tens of thousands of individuals.
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Affiliation(s)
- Michael Wainberg
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Canada
| | - Samuel E. Jones
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- University of Exeter Medical School, Exeter, United Kingdom
| | - Lindsay Melhuish Beaupre
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Sean L. Hill
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Physiology, University of Toronto, Toronto, Canada
| | - Daniel Felsky
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Manuel A. Rivas
- Department of Genetics, Stanford University, Stanford, California, United States of America
| | - Andrew S. P. Lim
- Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Hanna M. Ollila
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, United States of America
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Shreejoy J. Tripathy
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Physiology, University of Toronto, Toronto, Canada
- * E-mail:
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188
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Eveningness chronotype preference among individuals at clinical high risk for psychosis. Schizophr Res 2021; 236:3-8. [PMID: 34358763 PMCID: PMC8464500 DOI: 10.1016/j.schres.2021.07.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/19/2021] [Accepted: 07/25/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Circadian rhythm disturbances are frequently implicated in psychosis. Indeed, research has suggested several avenues by which circadian rhythms may play a mechanistic role as well as contribute to clinical outcomes. Despite its potential role as a risk factor, little is known about circadian rhythm disruption among individuals at clinical high risk (CHR) for psychosis, clinical correlates, or specificity to the psychosis risk syndrome. METHODS Eighty-four CHR, 74 individuals with depressive disorders (DD), and 101 non-psychiatric controls (NPC) participated in structured clinical interviews and provided self-reports of chronotype preference. Clinical (positive, negative, anxious, and depressive symptoms) and social functioning outcomes were self-reported and/or clinician-rated. Analyses of covariance controlling for demographics examined group differences in chronotype preference, and partial Pearson correlations evaluated associations with clinical/functional outcomes. RESULTS Group differences were observed (F(11, 246) = 8.05, p < .001) with CHR and DD individuals indicating greater eveningness preference compared to NPC. A follow-up sensitivity analysis examining CHR participants with (n = 25) and without (n = 59) depressive disorders indicated no difference in chronotype preference (F(10,72) = 0.00, p = .99). Greater eveningness preference was related to greater negative symptoms (i.e., avolition; r = -0.25) and anxiety (r = -0.34) among CHR individuals. CONCLUSIONS CHR and DD display greater preference for eveningness chronotype compared to NPC indicating the disruption is associated with a range of mental health concerns, and not specific to the psychosis-risk syndrome. However, comorbidity with DD did not appear to be driving the finding in the CHR group. Further research may examine shared versus non-shared underlying mechanisms contributing to chronotype preference across psychiatric presentations.
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189
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Abstract
Sleep disturbances are commonly observed in schizophrenia, including in chronic, early-course, and first-episode patients. This has generated considerable interest, both in clinical and research endeavors, in characterizing the relationship between disturbed sleep and schizophrenia. Sleep features can be objectively assessed with EEG recordings. Traditionally, EEG studies have focused on sleep architecture, which includes non-REM and REM sleep stages. More recently, numerous studies have investigated alterations in sleep-specific rhythms, including EEG oscillations, such as sleep spindles and slow waves, in individuals with schizophrenia compared with control subjects. In this article, the author reviews state-of-the-art evidence of disturbed sleep in schizophrenia, starting from the relationship between sleep disturbances and clinical symptoms. First, the author presents studies demonstrating abnormalities in sleep architecture and sleep-oscillatory rhythms in schizophrenia and related psychotic disorders, with an emphasis on recent work demonstrating sleep spindles and slow-wave deficits in early-course and first-episode schizophrenia. Next, the author shows how these sleep abnormalities relate to the cognitive impairments in patients diagnosed with schizophrenia and point to dysfunctions in underlying thalamocortical circuits, Ca+ channel activity, and GABA-glutamate neurotransmission. Finally, the author discusses some of the next steps needed to further establish the role of altered sleep in schizophrenia, including the need to investigate sleep abnormalities across the psychotic spectrum and to establish their relationship with circadian disturbances, which in turn will contribute to the development of novel sleep-informed treatment interventions.
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Affiliation(s)
- Fabio Ferrarelli
- Department of Psychiatry, University of Pittsburgh School of Medicine Pittsburgh, PA, 15213
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190
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Meaklim H, Junge MF, Varma P, Finck WA, Jackson ML. Pre-existing and post-pandemic insomnia symptoms are associated with high levels of stress, anxiety, and depression globally during the COVID-19 pandemic. J Clin Sleep Med 2021; 17:2085-2097. [PMID: 33985647 PMCID: PMC8494096 DOI: 10.5664/jcsm.9354] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/15/2021] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has led to an increased prevalence of insomnia and mental health symptoms globally. However, most studies to date have not examined mental health symptoms between individuals with insomnia, either pre-existing or developing post-pandemic compared with good sleepers. This study examined differences in stress, anxiety, and depression between individuals with pre-existing insomnia symptoms, post-pandemic insomnia symptoms, and no insomnia symptoms in response to the COVID-19 pandemic. METHODS A cross-sectional survey was completed by 2724 participants from 67 countries during the COVID-19 pandemic. Perceived stress, anxiety, and depressive symptoms were compared between individuals with post-pandemic insomnia symptoms (n = 1007), pre-existing insomnia symptoms (n = 804), and no insomnia symptoms (n = 913). RESULTS Post-pandemic insomnia symptoms were associated with higher levels of stress, anxiety, and depression than pre-existing or no insomnia symptoms (P < .001). Pre-existing insomnia symptoms were also associated with higher levels of stress, anxiety, and depression than no insomnia symptoms (P < .001). Individuals who met likely criteria for acute insomnia also reported higher stress, anxiety, and depression than those with insomnia disorder (P < .001). Across all groups, individuals reporting a previous mental health diagnosis had worse stress, anxiety, and depression than those without a previous mental health diagnosis (P < .001). Last, individuals from South Africa reported higher levels of stress, anxiety, and depression than other countries (P < .01). CONCLUSIONS Internationally, individuals with pre-existing and post-pandemic insomnia symptoms may be more susceptible to stress, anxiety, and depression during the COVID-19 pandemic. Public health initiatives should include insomnia management to improve mental health during the pandemic. CITATION Meaklim H, Junge MF, Varma P, Finck WA, Jackson ML. Pre-existing and post-pandemic insomnia symptoms are associated with high levels of stress, anxiety, and depression globally during the COVID-19 pandemic. J Clin Sleep Med. 2021;17(10):2085-2097.
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Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Moira F. Junge
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- The Sleep Health Foundation, Blacktown, New South Wales, Australia
| | - Prerna Varma
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Wendy A. Finck
- Faculty of Education, Monash University, Melbourne, Victoria, Australia
| | - Melinda L. Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
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191
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Laskemoen JF, Aas M, Vaskinn A, Berg AO, Lunding SH, Barrett EA, Melle I, Simonsen C. Sleep disturbance mediates the link between childhood trauma and clinical outcome in severe mental disorders. Psychol Med 2021; 51:2337-2346. [PMID: 32321600 PMCID: PMC8506345 DOI: 10.1017/s0033291720000914] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/10/2020] [Accepted: 03/20/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND The experience of childhood trauma is linked to more severe symptoms and poorer functioning in severe mental disorders; however, the mechanisms behind this are poorly understood. We investigate the relationship between childhood trauma and sleep disturbances in severe mental disorders including the role of sleep disturbances in mediating the relationship between childhood trauma and the severity of clinical symptoms and poorer functioning. METHODS In total, 766 participants with schizophrenia-spectrum (n = 418) or bipolar disorders (n = 348) were assessed with the Childhood Trauma Questionnaire. Sleep disturbances were assessed through the sleep items in the self-reported Inventory of Depressive Symptoms. Clinical symptoms and functioning were assessed with The Positive and Negative Syndrome Scale and the Global Assessment of Functioning Scale. Mediation analyses using ordinary least squares regression were conducted to test if sleep disturbances mediated the relationship between childhood trauma and the severity of clinical symptoms and poorer functioning. RESULTS Symptoms of insomnia, but not hypersomnia or delayed sleep phase, were significantly more frequent in participants with childhood trauma experiences compared to those without. Physical abuse, emotional abuse, and emotional neglect were significantly associated with insomnia symptoms. Insomnia symptoms partly mediate the relationship between childhood trauma and the severity of positive and depressive/anxiety symptoms, in addition to poorer functioning. CONCLUSION We found frequent co-occurrence of childhood trauma history and current insomnia in severe mental disorders. Insomnia partly mediated the relationship between childhood trauma and the severity of clinical symptoms and functional impairment.
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Affiliation(s)
- Jannicke Fjæra Laskemoen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Monica Aas
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anja Vaskinn
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Akiah Ottesen Berg
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Synve Hoffart Lunding
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elizabeth Ann Barrett
- Division of Mental Health and Addiction, Early Intervention in Psychosis Advisory Unit for South East Norway, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Carmen Simonsen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Early Intervention in Psychosis Advisory Unit for South East Norway, Oslo University Hospital, Oslo, Norway
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192
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Egbegi DR, Bella-Awusah T, Omigbodun O, Ani C. A controlled trial of Cognitive Behavioural Therapy-based strategies for insomnia among in-school adolescents in southern Nigeria. Child Adolesc Psychiatry Ment Health 2021; 15:52. [PMID: 34563220 PMCID: PMC8465787 DOI: 10.1186/s13034-021-00406-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sleep difficulties are highly prevalent among adolescents, and are associated with significant impairments. The effectiveness and acceptability of Cognitive Behavioural Therapy-based (CBT-based) treatment for insomnia in adolescents is established for High Income Countries, but unknown for African settings. Thus, the aim of this study was to assess the effect of CBT-based intervention among in-school adolescents with sleep difficulties in Southern Nigeria. METHODS This was a pilot controlled trial involving 50 adolescents with highest ranked scores on the Insomnia Severity Index (ISI) recruited from four schools (two government and two privately owned). Balloting was used to assign two schools (public and private) with 25 participants to the intervention group, and the other two schools (public and private) with 25 participants as waiting-list controls. The two groups were dyad-matched for baseline ISI scores, gender, and type of school to reduce baseline differences. The treatment group received weekly group-based manualised CBT-based intervention over 5 weeks. Primary outcome was ISI score at 6th week. Secondary outcomes were sleep onset latency (SOL), Total sleep duration (TSD), depressive symptoms, sleep hygiene, and knowledge about sleep. RESULTS Participants were aged 13-17 years (M = 14.9, SD = 1.16) and consisted of 18 males and 32 females. Controlling for baseline scores, the intervention group showed significantly lower post-intervention insomnia scores compared with the control group {F (1, 34) = 1.10, p = 0.0001, (ηp2 = 0.59}, shorter SOL {F (1, 33) = 1.41, p = 0.0001, ηp2 = 0.39}, longer TSD {F (1, 33) = 1.03, p = 0.0001, ηp2 = 0.47}, lower depressive symptoms {F (1, 31) = 1.32, p = 0.002 (ηp2 = 0.34}, higher knowledge of sleep {F (1, 34) = 1.02, p = 0.001, ηp2 = 0.36}, but no significant change in sleep hygiene {F (1, 32) = 1.08, p = 0.08, ηp2 = 0.15}. All participants in the intervention group rated the programme as good or excellent. CONCLUSION This pilot CBT-based intervention for adolescents with insomnia was feasible, well received and showed promising efficacy in this setting. Larger controlled trials are recommended to establish the generalisability of these findings in this region. Trial registration Pan African Clinical Trial Registry (Registration Number PACTR202001710494962).
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Affiliation(s)
- Diseyei R. Egbegi
- grid.9582.60000 0004 1794 5983Centre for Child and Adolescent Mental Health, University of Ibadan, Ibadan, Nigeria
| | - Tolulope Bella-Awusah
- grid.9582.60000 0004 1794 5983Centre for Child and Adolescent Mental Health, University of Ibadan, Ibadan, Nigeria ,grid.9582.60000 0004 1794 5983Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olayinka Omigbodun
- grid.9582.60000 0004 1794 5983Centre for Child and Adolescent Mental Health, University of Ibadan, Ibadan, Nigeria ,grid.9582.60000 0004 1794 5983Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Cornelius Ani
- Division of Psychiatry, Imperial College London, Hammersmith Hospital Campus, 2nd Floor Commonwealth Building, Du Cane Road, London, W12 0NN, UK. .,Surrey and Borders Partnership, NHS Foundation Trust, Leatherhead, Surrey, UK.
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193
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Spanhel K, Burdach D, Pfeiffer T, Lehr D, Spiegelhalder K, Ebert DD, Baumeister H, Bengel J, Sander LB. Effectiveness of an internet-based intervention to improve sleep difficulties in a culturally diverse sample of international students: A randomised controlled pilot study. J Sleep Res 2021; 31:e13493. [PMID: 34549852 DOI: 10.1111/jsr.13493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Abstract
Sleep difficulties are widespread among international students. Internet-based interventions are suggested as a low-threshold treatment option but may require cultural adaptation among culturally diverse populations. The present pilot study investigated the effectiveness and acceptance of an internet-based intervention to improve sleep difficulties in international students. A total of 81 international students of 36 nationalities were randomly assigned to the intervention (n = 41) or waitlist control group (n = 40). The intervention group received immediate access to a culturally non-adapted unguided internet-based sleep intervention consisting of three modules based on sleep hygiene and cognitive techniques to reduce rumination. At baseline, 4 and 12 weeks after randomisation, insomnia severity, measured by the Insomnia Severity Index, and secondary outcomes (sleep quality, depression, anxiety, perceived stress, well-being, presenteeism, mental health literacy) were assessed. Data were analysed using linear multi-level analyses. Additionally, satisfaction and perceived cultural appropriateness of the intervention were evaluated by international students after 4 weeks, and compared with ratings of German students, who represent the original target group. Insomnia severity improved over time in the intervention group compared to the control group, revealing a significant estimated mean difference of -5.60 (Hedges' g = 0.84, p < 0.001) after 12 weeks. Satisfaction and perceived cultural appropriateness was high and comparable to that of German students. The present study shows that a culturally non-adapted internet-based sleep intervention can be a low-threshold treatment option to help meet the high demand for mental healthcare among international students. It thus indicates that cultural adaptation might not represent a precondition for providing effective internet-based sleep interventions to this target group.
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Affiliation(s)
- Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Daniela Burdach
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Teresa Pfeiffer
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Dirk Lehr
- Department of Health Psychology, Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David D Ebert
- Psychology und Digital Mental Health Care, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Juergen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
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194
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Zaks N, Velikonja T, Parvaz MA, Zinberg J, Done M, Mathalon DH, Addington J, Cadenhead K, Cannon T, Cornblatt B, McGlashan T, Perkins D, Stone WS, Tsuang M, Walker E, Woods SW, Keshavan MS, Buysse DJ, Velthorst E, Bearden CE. Sleep Disturbance in Individuals at Clinical High Risk for Psychosis. Schizophr Bull 2021; 48:111-121. [PMID: 34536012 PMCID: PMC8781348 DOI: 10.1093/schbul/sbab104] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Disturbed sleep is a common feature of psychotic disorders that is also present in the clinical high risk (CHR) state. Evidence suggests a potential role of sleep disturbance in symptom progression, yet the interrelationship between sleep and CHR symptoms remains to be determined. To address this knowledge gap, we examined the association between disturbed sleep and CHR symptoms over time. METHODS Data were obtained from the North American Prodrome Longitudinal Study (NAPLS)-3 consortium, including 688 CHR individuals and 94 controls (mean age 18.25, 46% female) for whom sleep was tracked prospectively for 8 months. We used Cox regression analyses to investigate whether sleep disturbances predicted conversion to psychosis up to >2 years later. With regressions and cross-lagged panel models, we analyzed longitudinal and bidirectional associations between sleep (the Pittsburgh Sleep Quality Index in conjunction with additional sleep items) and CHR symptoms. We also investigated the independent contribution of individual sleep characteristics on CHR symptom domains separately and explored whether cognitive impairments, stress, depression, and psychotropic medication affected the associations. RESULTS Disturbed sleep at baseline did not predict conversion to psychosis. However, sleep disturbance was strongly correlated with heightened CHR symptoms over time. Depression accounted for half of the association between sleep and symptoms. Importantly, sleep was a significant predictor of CHR symptoms but not vice versa, although bidirectional effect sizes were similar. DISCUSSION The critical role of sleep disturbance in CHR symptom changes suggests that sleep may be a promising intervention target to moderate outcome in the CHR state.
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Affiliation(s)
- Nina Zaks
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, NY, USA
| | - Tjasa Velikonja
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, NY, USA,Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, London, UK
| | - Muhammad A Parvaz
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, NY, USA,Department of Neuroscience, Icahn School of Medicine, Mount Sinai, NY, USA
| | - Jamie Zinberg
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Monica Done
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Daniel H Mathalon
- San Francisco VA Health Care System,University of California, San Francisco, CA, USA
| | - Jean Addington
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Kristin Cadenhead
- Department of Psychiatry, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Tyrone Cannon
- Departments of Psychiatry and Psychology, Yale University, New Haven, CT, USA
| | - Barbara Cornblatt
- Department of Psychology, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, and Feinstein Institute for Medical Research, Garden City, NY, USA
| | - Thomas McGlashan
- Departments of Psychiatry and Psychology, Yale University, New Haven, CT, USA
| | - Diana Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - William S Stone
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ming Tsuang
- Department of Psychiatry, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Elaine Walker
- Department of Psychology, Emory University, Atlanta, Georgia, USA
| | - Scott W Woods
- Departments of Psychiatry and Psychology, Yale University, New Haven, CT, USA
| | - Matcheri S Keshavan
- Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel J Buysse
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Eva Velthorst
- Department of Psychiatry, Icahn School of Medicine, Mount Sinai, NY, USA,Seaver Center of Research and Treatment, Icahn School of Medicine, Mount Sinai, NY, USA
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA,Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA,To whom correspondence should be addressed; A7-460 Semel Institute, Los Angeles, CA 90095, USA; tel: 310-206-2983, fax: 310-794-9517, e-mail:
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195
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Caffeine exposure from beverages and its association with self-reported sleep duration and quality in a large sample of Icelandic adolescents. Food Chem Toxicol 2021; 157:112549. [PMID: 34509583 DOI: 10.1016/j.fct.2021.112549] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/16/2021] [Accepted: 09/07/2021] [Indexed: 11/23/2022]
Abstract
Previous risk assessments have concluded that adolescent's caffeine exposure from energy drinks (ED) are of limited concern. Recent surveys have, however, shown substantial increase in consumption. This cross-sectional survey conducted in 2020 estimated caffeine exposure from beverages among ∼80% of all 13-15-year-old adolescents (n = 10358) relative to the European Food Safety Authority's level of no safety concern of (3.0 mg/kg bw) and level for effects on sleep (1.4 mg/kg bw). Associations with self-reported sleep duration and quality were also explored. ED consumers were more likely to exceed the limit of no safety concern (prevelance: 12-14%) compared to non-ED-consumers (1-2%). Exceeding the limit for effects on sleep was also higher among ED consumers (31-38%) than non-ED-consumers (5-8%). Across categories of low (<0.5 mg/kg bw) to high (>3.0 mg/kg bw) caffeine intake, the prevalence of participants sleeping <6 h increased from 3% to 24%, respectively. The corresponding adjusted Prevalence Ratio was 4.5 (95% CI: 3.6, 5.7) and mean decrease in duration of sleep was 0.74 h (95% CI: 0.65, 0.84). In conclusion, caffeine intake from beverages above the limit of no safety concern was largely confined to ED consumers. Consistent with effects from intervention studies in adults, caffeine intake was strongly associated with self-reported sleep duration in this representative population.
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196
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Hong JS, Wasden C, Han DH. Introduction of digital therapeutics. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 209:106319. [PMID: 34364181 DOI: 10.1016/j.cmpb.2021.106319] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 07/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Digital therapeutics are an emerging type of medical therapy and are defined as evidence-based therapeutic interventions for patients by means of qualified software programs to prevent, manage, or treat medical conditions. Today, digital therapeutics products are on the market or under development for a wide range of medical conditions such as diabetes, oncology treatment management, and neuropsychiatric disorders including anxiety disorder, depression, and substance use disorder. Digital therapeutics can be more flexible than other treatment methods to address patients' individual needs. METHODS AND RESULTS The advantages of digital therapeutics fall in line with market demand; thus, the digital therapeutics market is expanding globally, focusing on advanced medical markets. There are many digital therapeutics products such as Sleepio for insomnia, Daylight for anxiety, Livongo and Omada products for diabetes, pre-diabetes, hypertension, etc. None of these are cleared by the Food and Drug Administration (FDA), but all are commercially available through health insurance or employers. The EU, including Germany, and a number of Asian countries, including Korea, Japan, and China, are also introducing policies for the regulation of new fields and digital therapeutics. CONCLUSIONS The adoption of digital therapeutics is intricate and often involves various interests in numerous fields, decision-making processes, and individual or organizational value judgments. For digital therapeutics to be thoroughly introduced into real life, technical aspects must be supported, and an approach that considers users must be further investigated.
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Affiliation(s)
- Ji Sun Hong
- Department of Psychiatry, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Republic of Korea.
| | | | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University Hospital, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Republic of Korea.
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197
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Shanahan PJ, Isaac M, Blackwell JE. Sleep disorders in attention-deficit hyperactivity disorder and autism spectrum disorder: a pragmatic approach to assessment and management. BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2020.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYSleep is essential for survival and humans spend approximately one-third of their life asleep. Adequate sleep is needed to maintain both physical and psychological health. Routinely getting less than the recommended amount of sleep for your age can have profound negative effects on health, such as increasing the likeliness of psychiatric illness, diabetes, cardiovascular disease and stroke. In children and adults with neurodevelopmental disorders, the prevalence of sleep disorders is significantly higher than in the general population. Given the relationship between sleep and psychiatric disorders, it is essential that psychiatrists have knowledge of the principles of sleep medicine. In this article, we focus on the common sleep disorders found in those with attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) and give an overview of screening, diagnosis and management.
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198
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Sleep Habits during COVID-19 Confinement: An Exploratory Analysis from Portugal. INFORMATICS 2021. [DOI: 10.3390/informatics8030051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
COVID-19 pandemic consequences are tragic, and many problems will persist after the health problem ends. Some studies have focused on mental health issues, reporting worrying percentages. It is known that there is a bidirectional relationship between mental health and sleep quality, and it would be expected that sleep would be affected by the pandemic. In order to know the Portuguese people’s habits before and during the confinement, we carried out a survey of 188 people aged 13 to 84 (38 ± 15) to find out the most frequent sleep patterns, habits and disorders before and during confinement. With this survey it was also intended to measure the most frequent changes in sleep patterns, habits, and disturbances on the general population and according to demographic data (gender, age group and professional status), sleep disorders arise, perceptions about sleep during confinement and if Portuguese think that in the future the sleep patterns will be the pre or during outbreak. Results indicate that, comparing before and during confinement, there is a slight correlation between gender and sleep disorders (before vs. during), a correlation between age group and professional status time to wake up, and between professional status and sleep disorders, and a strong correlation between the professional situation and changes in the invigorated feeling level (p < 0.001). Support for mental health and interventions to improve sleep quality should be offered to the population in general, and, according to our study, the Portuguese population.
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199
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Meaklim H, Rehm IC, Monfries M, Junge M, Meltzer LJ, Jackson ML. Wake up psychology! Postgraduate psychology students need more sleep and insomnia education. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1955614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Hailey Meaklim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Imogen C. Rehm
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
- College of Health and Biomedicine, Victoria University, Melbourne, Australia
| | - Melissa Monfries
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Moira Junge
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
- The Sleep Health Foundation, Blacktown, Australia
| | - Lisa J. Meltzer
- Department of Pediatrics, National Jewish Health, Denver, USA
| | - Melinda L. Jackson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia
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200
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Clarke S, Hanna D, Davidson S, Shannon C, Mulholland C. The association between sleep quality and attenuated psychotic symptoms. Early Interv Psychiatry 2021; 15:837-848. [PMID: 32672874 DOI: 10.1111/eip.13020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 12/16/2022]
Abstract
AIM To determine if poor sleep makes a unique contribution in predicting the likelihood of experiencing six or more attenuated psychotic symptoms and associated distress, after examining and controlling for sociodemographic factors, depression and drug/alcohol use. METHOD An online survey was conducted using Amazon's online crowdsourcing service Mechanical Turk (MTurk). The sample was 1013 adults (18 to 36 years) from the general population in the United States. The survey consisted of the Prodromal Questionnaire 16 (PQ-16), the Pittsburgh Sleep Quality Index, the Patient Health Questionnaire 9, the Drug Abuse Screening Test 10 and the Alcohol Use Disorders Identification Test. Regression analyses were performed with the PQ-16 as the dependent variable, and sleep quality as the predictor variable, holding constant sociodemographic variables, depression, and alcohol/drug abuse. RESULTS 37% of the sample endorsed six or more PQ-16 items, which may be suggestive of an at-risk mental state, with sleep disturbance significantly increasing the likelihood (Odds ratio 2.09 < .001) of endorsing six or more PQ-16 items. After controlling for sociodemographic variables, depression and drug/alcohol abuse, poor sleep quality made a unique contribution of 5.8% of the variance accounted for in level of distress experienced by attenuated psychotic symptoms. CONCLUSION Effective treatment of sleep disturbance may reduce the likelihood ofexperiencing attenuated psychotic symptoms and associated distress.
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Affiliation(s)
- Stephen Clarke
- School of Psychology, Queen's University Belfast, Belfast, UK
| | - Donncha Hanna
- School of Psychology, Queen's University Belfast, Belfast, UK.,Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
| | | | - Ciarán Shannon
- Holywell Hospital, Northern Health & Social Care Trust, Antrim, UK
| | - Ciaran Mulholland
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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