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Al-Khalil Z, Attarian H, Dunietz GL, Gavidia Romero R, Knutson K, Johnson DA. Sleep health inequities in vulnerable populations: Beyond sleep deserts. Sleep Med X 2024; 7:100110. [PMID: 38623559 PMCID: PMC11017343 DOI: 10.1016/j.sleepx.2024.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/17/2024] Open
Abstract
Despite the importance of sleep to overall health and well-being, there is a high prevalence of undiagnosed sleep disorders and adverse sleep health, particularly among vulnerable populations. Such vulnerable populations include people experiencing homelessness (PEH), refugees, and incarcerated individuals. In this narrative review, we provide an overview of the literature on sleep health and disorders among key and vulnerable populations (e.g., PEH, refugees, and incarcerated individuals). The limited research among these populations indicated a high prevalence of sleep disorders, mainly insomnia, short sleep duration, and fatigue. Substance abuse and PTSD were commonly found among PEH and refugee populations, respectively, which were was related to poor sleep. Similar across the included vulnerable populations, the individuals reside in environments/facilities with inopportune light exposure, noise disruption, inadequate bedding, and forced sleep schedules. Studies also found a high prevalence of psychosocial stress and reports of threats to safety, which were associated with poor sleep health outcomes. Additionally, several studies reported environmental barriers to adherence to sleep disorder treatment. This paper highlighted the conditions in which these vulnerable populations reside, which may inform interventions within these various facilities (homeless shelters, refugee camps, prisons/jails). The improvement of these facilities with a sleep equity focus may in turn improve quality of life and daily functioning.
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Affiliation(s)
| | - Hrayr Attarian
- Department of Neurology, Northwestern University Feinberg School of Medicine, USA
| | - Galit Levi Dunietz
- Department of Neurology, School of Medicine, University of Michigan, USA
| | | | - Kristen Knutson
- Department of Neurology, Northwestern University Feinberg School of Medicine, USA
| | - Dayna A. Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, USA
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Tussey EJ, Perez GR, Lynch SM. Sleepless behind bars: the connection between mental health, environment, and sleep among women in jail. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae012. [PMID: 38440256 PMCID: PMC10911691 DOI: 10.1093/sleepadvances/zpae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/26/2024] [Indexed: 03/06/2024]
Abstract
Study Objectives Given the barriers to good sleep in corrections facilities and the lack of research in this area, the current study aimed to characterize sleep quality and insomnia incidence in women in jail. Furthermore, we aimed to investigate the relation of sleep to depression, posttraumatic stress disorder (PTSD), and trauma exposure in incarcerated women. Lastly, we examined self-reports of environmental and individual factors that impaired sleeping in this population. Methods Participants included 176 women incarcerated in two jails in southeast Idaho. Participants were randomly selected to complete several self-report questionnaires, including the Pittsburgh Sleep Quality Index and the Insomnia Severity Index, verbally administered by interviewers. Results A majority of participants endorsed poor sleep quality (76%) and subthreshold or higher levels of insomnia (70%). Multiple regression analyses found that depressive symptoms and PTSD symptoms were both significantly related to insomnia and poor sleep quality. Excessive noise, poor bedding, and mental health were commonly cited factors that disrupted sleep. Conclusions These results are consistent with previous literature that has examined these outcomes in prison populations and incarcerated populations in other countries. Correctional facilities can consider altering environmental factors that impair sleep to not only promote better overall health but also as a way to address common manifestations of poor mental health in their inmate populations. Screening for and treating mental health problems, namely depression and PTSD, is another way these facilities can improve inmate health and promote better sleep.
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Affiliation(s)
- Emma J Tussey
- Department of Psychology, Idaho State University, Pocatello, ID, USA
| | - Gabriela R Perez
- Department of Psychology, Idaho State University, Pocatello, ID, USA
| | - Shannon M Lynch
- Department of Psychology, Idaho State University, Pocatello, ID, USA
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Elumn JE, Li P, Lytell MS, Garcia M, Wang EA, Klar Yaggi H. "What if that's your last sleep?" A qualitative exploration of the trauma of incarceration and sleep. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2023; 5:zpad055. [PMID: 38314119 PMCID: PMC10838125 DOI: 10.1093/sleepadvances/zpad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/06/2023] [Indexed: 02/06/2024]
Abstract
Study Background/Objectives Sleep is an underexplored factor in the health of people involved in the criminal legal system. This study addresses the paucity of research on how individual, social, and physical environmental factors impact sleep health during and after incarceration by highlighting the voices of people involved in the criminal legal system through a community-engaged qualitative research approach. Methods We conducted 20 semi-structured interviews with men recently released from prison for a study on trauma and healthcare during incarceration and after release. Interviews were coded and analyzed using reflexive thematic analysis and a critical realist framework. Our research team included people with a history of incarceration who performed central roles in the research process. Results Three themes emerged from participants' descriptions of sleep during and after incarceration: (1) concerns about health contributing to sleep problems, (2) lack of access to treatment for sleep disorders leading to ongoing sleep problems, and (3) issues of safety contributing to sleep problems during incarceration and after release. Conclusions This study identifies factors and domains influencing sleep during and after incarceration. By identifying which interpersonal, environmental, and structural factors impact sleep quality, medical and carceral staff are better equipped to ameliorate sleep health disparities within populations with a history of incarceration and those actively bound by the criminal legal system. Future research should examine other factors impacting sleep in incarcerated and recently released populations and develop multi-level interventions to improve sleep health. This paper is part of the Sleep and Circadian Health in the Justice System Collection.
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Affiliation(s)
- Johanna E Elumn
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA
- Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Patrick Li
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA
- Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Malcolm S Lytell
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA
- Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | | | - Emily A Wang
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA
- Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Henry Klar Yaggi
- Clinical Epidemiology Research Center, VA CT HCS, West Haven CT, USA
- Section Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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Geng F, Liang Y, Zhan N, Wang J. Prevalence, Clinical Features, and Psychological Characteristics of Dissociative Subtype of Posttraumatic Stress Disorder in Chinese Prisoners. J Trauma Dissociation 2023; 24:63-78. [PMID: 35611661 DOI: 10.1080/15299732.2022.2079797] [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] [Indexed: 12/27/2022]
Abstract
This study aimed to examine prevalence, clinical symptoms, and psychological characteristics of D-PTSD in a sample of Chinese prisoners with probable PTSD. A total of 1458 male prisoners were recruited from a large prison in Guangdong, China. Participants completed self-administrated questionnaires that assessed PTSD and dissociative symptoms, psychopathology, emotion regulation, emotional expressivity, social pleasure, traumatic events, and social support. According to DSM-5 criteria, participants were classified into four groups: D-PTSD, PTSD only, derealization/depersonalization (DD) only, and neither. The proportions of D-PTSD, PTSD only, DD only and neither were 2.5%, 4.7%, 2.4%, and 92.2%, respectively. PTSD symptoms and emotion regulation difficulties were distinguishing for the four groups: PTSD symptoms declined gradually in the order of D-PTSD, PTSD only, DD only, and neither, while emotion regulation difficulties declined in an order from D-PTSD, DD only, and PTSD only to neither, all ps < .001. D-PTSD and DD only had higher depressive and dissociative symptoms than PTSD only and the neither groups, all ps < .001. D-PTSD also had more borderline personality symptoms, emotion regulation difficulties, and more negative emotional expressivity than PTSD only and DD only, all ps < .05. Logistic regressions indicated that D-PTSD reported lower social support compared to PTSD only (OR = 0.95, p < .01), DD only (OR = 0.96, p < .05) and neither (OR = 0.93, p < .001). D-PTSD is common in probable PTSD in prisoners and is associated with complex clinical presentations as well as emotional processing. Social support is an important protective factor of D-PTSD.
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Affiliation(s)
- Fulei Geng
- School of Psychology, Jiangxi Normal University, Nanchang, Jiangxi, China
| | - Yingxin Liang
- School of Biological Sciences, Faculty of Science, The University of Hong Kong, Hong Kong
| | - Nalan Zhan
- School of Psychology, Jiangxi Normal University, Nanchang, Jiangxi, China
| | - Jian Wang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China
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Yang C, Wang J, Shao Y, Liu M, Geng F. Antisocial and borderline personality traits and childhood trauma in male prisoners: Mediating effects of difficulties in emotional regulation. CHILD ABUSE & NEGLECT 2022; 132:105822. [PMID: 35944450 DOI: 10.1016/j.chiabu.2022.105822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/10/2021] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the prevalence of probable antisocial personality disorder (ASPD) and borderline personality disorder (BPD) among prisoners, and further examine the mediating effect of difficulties in emotional regulation (ER) between childhood trauma and symptoms of ASPD and BPD. METHODS A total of 1491 male participants (35.4 ± 9.69 years) were recruited from a prison in Guangdong, China. The symptoms of ASPD and BPD, childhood trauma, difficulties in ER, and suicidal behaviors were measured by self-administered structured questionnaires. Logistic regressions were performed to investigate the associations of ASPD and BPD with suicidal behaviors. Path analysis was used to examine the mediating effects of difficulties in ER between childhood trauma and symptoms of ASPD and BPD. RESULT Approximately, 21.2 % and 11.2 % of the participants were screened as ASPD and BPD, respectively. Probable ASPD and BPD were associated with higher risk of suicidal behaviors. Childhood trauma and difficulties in ER were significantly associated with suicidal behaviors in prisoners with probable ASPD and BPD. Path analyses showed that partial mediating effects of difficulties in ER were significant in the dimensions of clarity and strategies on ASPD, and in the dimensions of clarity, impulse, and strategies on BPD. CONCLUSION ASPD and BPD are two of the common personality disorders in prisoners. Difficulties in ER are key to understanding the relationships between childhood trauma and personality disorders.
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Affiliation(s)
- Chenxiao Yang
- School of Psychology, Jiangxi Normal University, Nanchang, China
| | - Jian Wang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Yuan Shao
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Mingfan Liu
- School of Psychology, Jiangxi Normal University, Nanchang, China
| | - Fulei Geng
- School of Psychology, Jiangxi Normal University, Nanchang, China.
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Insomnia and Post-traumatic Stress Disorder: A Meta-analysis on Interrelated Association (n=57,618) and Prevalence (n=573,665). Neurosci Biobehav Rev 2022; 141:104850. [DOI: 10.1016/j.neubiorev.2022.104850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/27/2022] [Accepted: 08/27/2022] [Indexed: 12/14/2022]
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Geng F, Lu H, Zhang Y, Zhan N, Zhang L, Liu M. Dissociative depression and its related clinical and psychological characteristics among Chinese prisoners: A latent class analysis. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02751-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Geng F, Li S, Yang Y, Zou J, Tu L, Wang J. Trauma exposure and posttraumatic stress disorder in a large community sample of Chinese adults. J Affect Disord 2021; 291:368-374. [PMID: 34089929 DOI: 10.1016/j.jad.2021.05.050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 05/10/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study investigated the prevalence and related factors of trauma exposure and probable posttraumatic stress disorder (PTSD) in adults from a Chinese community sample. METHODS Participants were 7218 adults recruited from Jiangxi and Hunan provinces in China. Life Events Checklist and Posttraumatic Stress Disorder Checklist for DSM-5 were used to screen lifetime trauma exposure and PTSD symptoms, respectively. Participants' adverse and positive childhood experiences, behavioral inhibition, depression, insomnia, psychotic-like experiences (PLEs) and ADHD symptoms were also measured. Multiple regressions were performed to examine the correlates of PTSD. RESULTS Approximately 67.1% of participants reported one traumatic event; 27.1% experienced four or more. Participants recruited from private school, male, young age, low socioeconomic status, and poor physical health were associated with more trauma-exposure. The prevalence of PTSD was 2.1% in the total sample and 3.1% among the trauma-exposed. Among participants with PTSD, 53.6% were screened as depression, 54.3% had insomnia, 65.6% had one to three PLEs, 12.6% had four to seven PLEs, and 26.5% were screened as likely ADHD, and 5.3% highly likely ADHD. Younger age, being less educated, poor marriage quality and physical health, more adverse childhood experiences, behavioral inhibition and less positive childhood experiences were associated with increased risk of PTSD among the trauma exposed. After adjustment of these related factors, depression, insomnia, PLEs and ADHD were related to PTSD. CONCLUSIONS PTSD is relatively prevalent among Chinese community population. Childhood experiences, behavioral inhibition, and concurrent mental health account for individual differences in vulnerability to PTSD.
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Affiliation(s)
- Fulei Geng
- School of Psychology, Jiangxi Normal University, Nanchang, China.
| | - Shuhan Li
- School of Psychology, Jiangxi Normal University, Nanchang, China
| | - Yanling Yang
- School of Psychology, Jiangxi Normal University, Nanchang, China
| | - Jiaqi Zou
- School of Psychology, Jiangxi Normal University, Nanchang, China
| | - Liangqi Tu
- School of Psychology, Jiangxi Normal University, Nanchang, China
| | - Jian Wang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
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Geng F, Tu L, Zhan N, Zhang Y, Wang J. Associations of substance abuse histories and gambling addiction history with post-traumatic stress symptoms and depressive symptoms among Chinese prisoners. Eur J Psychotraumatol 2021; 12:1906022. [PMID: 33968330 PMCID: PMC8075087 DOI: 10.1080/20008198.2021.1906022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Although there are over two million prisoners in China, few studies have reported the prevalence and correlates of mental health problems in this population. Objective: This study investigated the prevalence rates of trauma exposure, post-traumatic stress disorder (PTSD) and depression among Chinese male prisoners and further examined the associations of substance abuse histories and gambling addiction history with PTSD and depressive symptoms. Method: Participants were 1,484 male prisoners (mean age 35.44 years, sd = 9.66) recruited from a large prison in Guangdong, China. Self-administered standardized questionnaires were used to assess trauma exposure, histories of substance abuse and perceived gambling addiction, social supports, childhood trauma, PTSD and depression. Criminal background information was extracted from jail record. Linear regressions were performed to examine the correlates of PTSD and depressive symptoms. Results: Of these participants, 78.8% had experienced at least one trauma exposure, 26.7% had drug addiction, 85.5% had smoked cigarettes, 70.8% had used alcohol and 21.4% had gambling addiction before incarceration. The prevalence rates of PTSD and depression were 7.1% and 28.8%, respectively. Trauma exposure was significantly associated with PTSD and depressive symptoms, but not substance abuse histories and gambling history except for drinking. Histories of drinking and perceived gambling addiction were significantly related to PTSD and depressive symptoms after adjustment of demographics, criminal background, health status, social supports, childhood trauma and lifetime traumatic exposure. Conclusions: Trauma exposure, PTSD and depression are common among prisoners. Furthermore, this study for the first time demonstrates a significant relationship between gambling addiction history and PTSD.
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Affiliation(s)
- Fulei Geng
- School of Psychology, Jiangxi Normal University, Nanchang, P.R. China
| | - Liangqi Tu
- School of Psychology, Jiangxi Normal University, Nanchang, P.R. China
| | - Nalan Zhan
- School of Psychology, Jiangxi Normal University, Nanchang, P.R. China
| | - Yeqing Zhang
- School of Psychology, Jiangxi Normal University, Nanchang, P.R. China
| | - Jian Wang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, P.R. China
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