Psychometric assessment of the Chinese adolescent daytime sleepiness scale (CADSS)

Is it time to agree upon a standardised approach to the assessment of contributing factors and impacts of adolescent pelvic pain?

BACKGROUND

A biopsychosocial approach to the understanding of pelvic pain is increasingly acknowledged. However, there is a lack of standardised instruments - or their use - to assess risk factors and their impact on pelvic pain in both clinical and research settings. This review aims to identify validated tools used to assess known contributory factors to pelvic pain, as well as the validated tools to measure the impact of pelvic pain in adolescents and young adults, in order to provide a framework for future standardised, adolescent specific assessment and outcome tools.

METHODS

Literature searches were performed in MEDLINE, PsycInfo and PubMed. Search terms included pelvic pain, dysmenorrhoea, endometriosis, adolescent, pain measurement, quality of life, sleep, mental health, coping strategies and traumatic experience.

RESULTS

We found validated instruments to assess adverse childhood experiences and coping strategies, both known contributing factors to pelvic pain. The impact of pain was measured through validated tools for health-related quality of life, mental health and sleep.

CONCLUSIONS

Pelvic pain evaluation in adolescents should include a multi-factorial assessment of contributing factors, such as childhood adversity and coping strategies, and impacts of pelvic pain on quality of life, mental health and sleep, using validated instruments in this age group. Future research should focus on the development of consensus amongst researchers as well as input from young women to establish a standardised international approach to clinical trials involving the investigation and reporting of pelvic pain in adolescents. This would facilitate comparison between studies and contribute to improved quality of care delivered to patients.

Bidirectional associations between sleep problems and suicidal thought/attempt in adolescents: A 3-wave data path analysis

PURPOSE

This longitudinal data analysis examined the bidirectional relationships between sleep problems and suicidal thought (ST)/attempt (SA) in a large sample of Chinese adolescents.

METHODS

A total of 6995 adolescents (mean age = 14.86 years and 51.4% males) participated in a 3-wave longitudinal study of behavior and health in Shandong, China. A self-administered questionnaire and standardized scales were used to assess ST, SA, sleep duration, insomnia, daytime sleepiness, and behavioral/emotional problems in 2015 (T1), 1 year later (T2), and 2 years later (T3). Path analyses were performed without and with adjustment for covariates, including gender, grade level, chronic diseases, cigarette smoking, alcohol use, anxiety/depressive symptoms, paternal education, and family economic status.

RESULTS

The prevalence rates of short sleep (<7 h/night), insomnia symptoms, and daytime sleepiness were 46.9-58.8%, 16.0-19.4%, and 25.1-25.3% at T1, T2, and T3, respectively. The rates of past-year ST and SA were 9.1-12.4% and 1.6-2.4% at T1, T2, and T3, respectively. Path analyses showed that short sleep, insomnia, and daytime sleepiness predicted subsequent ST, and vice versa. Daytime sleepiness and SA predicted each other 1 year later. Sleep problems and ST/SA in the previous year significantly predicted themselves in the follow-up year.

STUDY LIMITATION

All data were based on self-report.

CONCLUSION

Short sleep, insomnia, and daytime sleepiness all had bidirectional relationships with ST. Daytime sleepiness and SA were bidirectionally linked. Our findings suggest that interventions should be taken for both night sleep disturbances and daytime sleepiness to prevent suicide. Adverse sleep outcomes in suicidal adolescents should be assessed, which can in turn increase suicide risk.

Psychometric properties of the Youth Self-rated Insomnia Scale (YSIS) in adolescent psychiatric patients

The 8-item Youth Self-rated Insomnia Scale (YSIS) was developed to assess insomnia severity in the past month among youths. The YSIS has satisfactory psychometric properties in the general adolescent population. This study examined psychometric properties of the YSIS in a large sample of adolescent psychiatric patients. A total of 536 patients aged 10-19 years were consecutively recruited from the outpatient department of Shandong Mental Health Center between December 2021 and March 2022. Patients completed a structured questionnaire consisting of the YSIS scale and questions about sleep duration, nightmares, psychiatric history, depression, psychiatric and sleep medications, and demographics. Patients were diagnosed following the ICD-10 criteria. Of the participants, the mean age was 15.30 years (SD = 1.95), 61.0% were female, 60.9% were diagnosed with mood disorders, 65.7% were on antidepressants, and 49.0% were on anxiolytics or hypnotics. The mean YSIS score was 22.6 (SD = 8.07). Coefficient omega was 0.84. Exploratory factor analysis revealed one factor and two correlated residuals. The YSIS scores were significantly correlated with depression scores (r = 0.68) and significantly increased with sleep onset latency, short sleep duration, nightmare frequency, and sleep medication use. The YSIS demonstrated satisfactory internal consistency reliability, construct validity, and criteria-related validity in adolescent psychiatric patients. The YSIS appears to be a reliable and valid scale for measuring insomnia severity in adolescent psychiatric patients.

Menstrual pain mediated the association between daytime sleepiness and suicidal risk: A prospective study

BACKGROUND

Adolescents with daytime sleepiness have been demonstrated to have a higher level of suicidal risk than those without. Currently, few studies had examined the pathway from daytime sleepiness to suicidal risk among female adolescents. This study aimed to explore the association among menstrual pain, daytime sleepiness, and suicidal risk among female adolescents in China.

METHODS

Of 7072 adolescents who participated in the follow-up survey of Shandong Adolescents Behavior & Health Cohort (SABHC), 3001 were female adolescents who had begun to menstruate and included for the analysis. A structured self-administrated questionnaire was used to measure menstrual pain, daytime sleepiness, suicidal risk and demographic characteristics. Participants were first surveyed in November-December 2015 and resurveyed 1 year later.

RESULTS

Of 3001 participants, 11.43 % had suicidal risk, 79.8 % experienced menstrual pain. Cross-lagged analysis showed that there was cause-and-effect relationship between menstrual pain and daytime sleepiness. Moderate (OR = 1.79, 95%CI: 1.22-2.63) and severe (OR = 2.73, 95%CI: 1.80-4.12) menstrual pain (follow-up) were associated with suicidal risk (follow-up). Daytime sleepiness (baseline: OR = 1.04, 95%CI: 1.02-1.06, follow-up: OR = 1.07, 95%CI: 1.05-1.09) had effects on suicidal risk (follow-up). Mediation analysis showed that menstrual pain played a partially mediating role between daytime sleepiness and suicidal risk, with the indirect effect being 0.002 (95%CI: 0.001-0.004).

LIMITATIONS

All data were self-reported.

CONCLUSIONS

Menstrual pain and daytime sleepiness had effects on each other, and they both were the risk factors of suicidal risk. Among female adolescents, the association between daytime sleepiness and suicidal risk could be partially mediated by menstrual pain. Releasing the menstrual pain of female adolescents with daytime sleepiness could reduce their suicidal risk.

Associations between Insomnia, Daytime Sleepiness, and Depressive Symptoms in Adolescents: A Three-Wave Longitudinal Study

BACKGROUND

Insomnia, daytime sleepiness, and depressive symptoms are prevalent in adolescents. This three-wave prospective study examined the associations between the three symptoms in adolescents.

METHODS

A total of 6995 schoolchildren in 7th and 10th grades (Mean age = 14.86 years) participated in a longitudinal study of behavior and health in Shandong, China. Standardized rating scales were used to assess symptoms of insomnia, daytime sleepiness, and depression in November-December in 2015, 1 year later, and 2 years later.

RESULTS

Insomnia was cross-sectionally associated with 10-14-fold increased odds of daytime sleepiness and 5-9-fold increased odds of depression. Daytime sleepiness was associated with 4-5-fold increased odds of depression. Insomnia, daytime sleepiness, or depression at a later time point was significantly predicted by itself at earlier time points. Insomnia was a significant predictor of daytime sleepiness and depression and a mediator between depression and daytime sleepiness. Daytime sleepiness was a significant predictor of insomnia and a mediator between depression and insomnia. Depression was a significant predictor of insomnia and daytime sleepiness and a mediator between insomnia and daytime sleepiness.

CONCLUSIONS

Insomnia, daytime sleepiness, and depressive symptoms were highly comorbid in adolescents. The associations of insomnia with daytime sleepiness and depression were bidirectional. Depression predicted daytime sleepiness, but not vice versa. Further research is needed to understand the underlying neurobiological mechanisms between insomnia, daytime sleepiness, and depression during adolescence.

A Longitudinal Study of Insomnia, Daytime Sleepiness, and Academic Performance in Chinese Adolescents

BACKGROUND

Longitudinal data on the associations between sleep disturbances, daytime sleepiness, and daily functioning are limited in the general adolescent population. This study examined the cross-sectional and longitudinal associations between insomnia, excessive daytime sleepiness (EDS), and subject-specific academic performance in a large sample of Chinese adolescents.

METHOD

Data were derived from the Shandong Adolescent Behavior and Health Cohort (n = 7,072) study. A self-administered questionnaire was used to assess insomnia, EDS, academic performance (overall, Chinese, mathematics, and English), behavioral and emotional problems, and family demographics. The cross-sectional analysis was conducted with baseline data while the longitudinal analysis was conducted with both baseline and 1-year follow-up data. Logistic regression analyses and mediation models were performed to examine the associations between insomnia, EDS, and academic performance.

RESULTS

Logistic regression analyses revealed that insomnia and EDS had significant cross-sectional associations with overall performance and mathematics performance after controlling for age, gender, ever smoking, ever alcohol drinking, frequent snore, sleep duration, chronic disease, anxious/depressive symptoms, parents' education, parents' occupation, and family economic status. Both insomnia (OR = 1.20, 95% CI: 1.00-1.45) and EDS (OR = 1.22, 95% CI: 1.03-1.45) at baseline were significantly associated with poor mathematics performance 1 year later. The effect of insomnia at baseline on poor academic performance 1 year later was mediated by EDS except for the Chinese subject after controlling for the covariates.

CONCLUSIONS

Insomnia and daytime sleepiness are significantly associated with poor academic performance, particularly in mathematics. EDS mediates the association between insomnia and poor academic performance. Further research is warranted to investigate the effects of sleep disturbance and daytime sleepiness on the learning process and performance across academic subjects.

Longitudinal associations of the duration of mobile phone use with suicidal behavior in adolescents: The mediating role of depressive symptoms

BACKGROUND

Prolonged mobile phone use has been demonstrated to be associated with mental health problems and suicidal behavior in adolescents. This study examined the mediating role of depressive symptoms in the association between duration of mobile phone use (DMPU) and suicidal behavior in adolescents.

METHODS

A total of 6,923 participants from the Shandong Adolescent Behavior & Health Cohort (SABHC) were included in the analysis. Participants completed a self-administered questionnaire to assess DMPU on weekdays and weekends, mental disorders, insomnia symptoms, depressive symptoms, suicidal behavior (thought, plan, or attempt), and family demographics in November-December 2015. One year later, a follow-up survey was conducted to ask participants to report their depressive symptoms and suicidal behavior. Path analyses with logistic regressions were performed to examine the mediating role of depressive symptoms in the DMPU-suicidal behavior link.

RESULTS

Of the sample, mean age was 14.58 (SD = 1.45) and 3,455 (49.9 %) were female at baseline. 12.12 % of participants reported having ever suicidal behavior during the past 12 months at baseline, and 10.63 % reported having ever suicidal behavior during 1-year follow-up. Path analyses showed that the depressive symptoms played a partial mediating role in the association of DMPU on weekdays and weekends with subsequent suicidal behavior. After controlling for covariates, depressive symptoms accounted for 33.6 % and 58.6 % of the total effect of DMPU on weekdays and weekends on suicidal behavior, respectively.

LIMITATION

All variables were measured based on self-report.

CONCLUSIONS

The link between DMPU and suicidal behavior was partially mediated by depressive symptoms. Prolonged mobile phone use and depressive symptoms should be assessed and intervened to prevent suicidal behavior in adolescents.

Adolescent mobile phone addiction during the COVID-19 pandemic predicts subsequent suicide risk: a two-wave longitudinal study

Both the rate of mobile phone addiction and suicidality among adolescents have increased during the pandemic lockdown. However, the relationship between mobile phone addiction and suicide risk and the underlying psychological mechanisms remains unknown. This study examined the associations between mobile phone addiction in adolescents during the first month of lockdown and the suicide risk in the subsequent five months. A two-wave short-term longitudinal web-based survey was conducted on 1609 senior high school students (mean age = 16.53 years, SD = 0.97 years; 63.5% female). At Time 1 (T1), the severity of mobile phone addiction and basic demographic information was collected from Feb 24 to 28, 2020 in Sichuan Province, China (at the pandemic’s peak). Five months later, between July 11 and July 23 (Time 2, T2), mobile phone addiction, daytime sleepiness, depression, and suicidality were measured within the past five months. The regression analysis revealed that mobile phone addiction during quarantine directly predicted suicidality within the next five months, even after controlling for the effect of depression and daytime sleepiness. Meanwhile, mobile phone addiction at T1 also indirectly predicted suicidality at T2, with depression and daytime sleepiness mediating this association. Programs targeting improvement of daytime sleepiness and depressive symptoms may be particularly effective in reducing suicide risk among adolescents with mobile phone addiction.

Associations between experienced aggression, poor sleep, and suicide risk among Chinese adolescents

STUDY OBJECTIVES

The physical and mental health of adolescents is an important study area. This study aims to examine the occurrence of aggression, sleep disturbances, and suicide risk among Chinese adolescents, along with the relationships between these factors.

METHODS

This is a cross-sectional study conducted through an online survey. Of the original 7011 Chinese adolescent respondents, the analysis included data from 6122 adolescents, aged between 12 and 18 years, from 23 regions, whose average age was 16.12 (±1.44) years, with 48.8% being male. While the chi-square test and t-test were used for analyzing demographic data and continuous variables, respectively, mediation analysis was used to explore the mechanism of experiencing aggression on suicide risk. The respondents' sleep quality, nightmare distress, daytime sleepiness, fatigue, and suicide risk were assessed using the Pittsburgh Sleep Quality Index (PSQI), Nightmare Distress Questionnaire-Chinese version (NDQ-CV), Chinese Adolescent Daytime Sleepiness Scale (CADSS), Multidimensional Fatigue Inventory (MFI-20), and the suicide risk module of the Mini-International Neuropsychiatric Interview (MINI), respectively. Four items were used to assess adolescents' experiences with aggression.

RESULTS

Of the respondents, 42% reported experiencing aggression by others, especially parental physical maltreatment. Furthermore, 26.9% of adolescents in school, and in particular, 31.8% in senior high school experienced insomnia symptoms. Adolescents who reported experiences of aggression had more severe insomnia symptoms, nightmare distress, fatigue, and a higher risk of suicide when compared with those who did not (all ps < 0.001). Insomnia symptoms, nightmare distress, and fatigue all mediated the relationship between aggression and suicide risk, and there was a chain of mediating effects between these factors [for total indirect effect β = 1.1512, 95% CI (0.9671 to 1.3426), direct effect β = 0.4934, 95% CI (0.1978 to 0.7891), and total effect β = 1.6446, 95% CI (1.3479 to 1.9414)].

CONCLUSIONS

Our findings indicate that among adolescents, experiencing aggression is associated with an increased suicide risk. In addition to the direct effect of aggression on suicide risk, insomnia, nightmare distress, and fatigue mediate the relationship between aggression and suicide risk. More attention should be paid to adolescents experiencing aggression, and interventions should be implemented and strengthened.

Nightmare Distress as a Risk Factor for Suicide Among Adolescents with Major Depressive Disorder

PURPOSE

Nightmare is common and is also independently implicated in suicide risk among the adolescent population. Adolescents with major depressive disorder (MDD) are at an increased risk of suicide. Therefore, comorbid nightmares may amplify suicide risk among this clinical population. This study aimed to explore the effects of nightmares on suicide risk among adolescents with MDD.

PATIENTS AND METHODS

Subjects were 499 outpatients aged 12-18 in four large psychiatric hospitals clinic of China, from January 1 to October 31, 2021. Simultaneously, we matched 499 healthy controls according to gender and age. All participants underwent affective state (depressive and anxiety symptoms) and sleep variable (nightmare frequency/distress, insomnia symptoms, and daytime sleepiness) evaluation as well as MDD diagnoses and determination of suicide risk by a fully structured diagnostic clinical interview.

RESULTS

Adolescents with MDD reported a higher incidence of frequent nightmares (at least one night per week) and level of nightmare distress than healthy controls (22.0% vs 6.1%; 28.85 ± 11.92 vs 17.30 ± 5.61). Over half of the patients with suicide risk (51.6%) experienced frequent nightmares compared with approximately one-third of those at a risk for suicide (30.7%). Patients with suicide risk scored scientifically higher on sleep variables, depressive and anxiety symptoms than those without the risk. Further logistic regression analysis indicated that female gender, junior grade, recurrent depressive episode, severe nightmare distress and severe depressive symptoms were independently and significantly associated with suicide risk.

CONCLUSION

Our study provided evidence that adolescents with MDD experienced a higher prevalence of frequent nightmares and suffered more nightmare distress. Nightmare distress is an independent risk factor for suicide risk.

Repeat self-harm among Chinese adolescents: 1-year incidence and psychosocial predictors

PURPOSE

Self-harm in adolescents is prevalent and is the most significant predictor of future self-harm and suicide. Longitudinal data on the incidence and predictors of repeat self-harm in the general population of adolescents are limited. This study investigated 1-year incidence and psychosocial predictors of repeat self-harm in Chinese adolescents.

METHODS

Shandong Adolescent Behavior and Health Cohort is a longitudinal study of behavior and health in adolescents in Shandong Province, China. Of 7072 participants who were assessed in 2015 and again 1 year later in 2016, 1879 reported a history of self-harm at the baseline survey and were included for this analysis. A self-administered structured questionnaire was used to assess behavioral and emotional problems, sleep, life stress, previous history of self-harm and suicidal thought, and family factors at baseline and self-harm at 1-year follow-up.

RESULTS

Mean age of the sample was 14.86 (SD 1.36) years and 54.6% were female. At 1-year follow-up, 22.1% participants engaged in repeat self-harm. Multiple logistic regression analyses showed that female gender (OR 1.45, 95% CI 1.11-1.89), alcohol use (OR 1.95, 95% CI 1.48-2.57), frequent nightmares (OR 1.61, 95% CI 1.14-2.28), elevated depression score (OR 1.59, 95% CI 1.05-2.42), and prior suicidal thought (OR 1.79, 95% CI 1.37-2.34) were independently and significantly associated with an increased risk of repeat self-harm.

CONCLUSION

More than one in five Chinese adolescents who had a history of self-harm engaged in self-harm at 1-year follow-up. Multiple psychosocial factors including female gender, alcohol use, frequent nightmares, depression, and prior suicidal thought appeared to be significant predictors of repeat self-harm. Our findings highlight the importance of comprehensive psychosocial assessment and intervention of repeat self-harm in adolescents.

Prospective Associations of Frequent Pain Symptoms With Suicidal Behavior in Adolescents

Chronic pain and suicidal behavior are prevalent in adolescents. This longitudinal study examined the associations between pain symptoms and suicidal behavior in adolescents. A total of 7,072 adolescents participated in a follow-up study of behavior and health in Shandong, China. A self-administered structured questionnaire was used to assess pain symptoms (headache, stomachache, and other nonspecific pain), insomnia, anxiety/depression, substance use, stressful life events, prior suicidal behavior, and family environment in November-December in 2015. One year later, a follow-up survey was conducted. Mean age of the sample was 14.6 years, and half were female. Of the sample, 44.8% and 8.4% reported having one or more pain symptoms "sometimes" and "often", respectively. A total of 22.4% and 10.6% reported having lifetime suicidal behavior at baseline and subsequent suicidal behavior over the 1-year follow-up, respectively. Frequent pain was significantly associated with increased risk of suicidal behavior at baseline (OR=1.64, 95%CI=1.32-2.03) and during the subsequent year (OR=1.50, 95%CI=1.17-1.93) while adjusting for adolescent individual and family covariates. Among adolescents without a history of prior suicidal behavior, frequent pain was significantly associated with an approximately 70% increased risk of incident suicidal behavior (OR= 1.69, 95%CI=1.14-2.51). In conclusion, frequent pain appears to be predictive of adolescent suicidal behavior one year later. PERSPECTIVE: This article presents the prospective associations of frequent pain symptoms with suicidal behavior in adolescents. Frequent pain was associated with a 50-70% increased risk of suicidal behavior 1 year later. The finding underscores the importance of pain assessment and treatment in comprehensive suicide prevention efforts in adolescents.

Associations of frequent pain symptoms with excessive daytime sleepiness in adolescents: a longitudinal study

STUDY OBJECTIVES

Pain symptoms, sleep disturbance, and daytime sleepiness are common in adolescents. This study examined the cross-sectional and prospective associations between pain symptoms and excessive daytime sleepiness (EDS) in a large sample of adolescents.

METHODS

Participants were 7,072 adolescents (mean age = 14.6 years) in a follow-up study of behavior and health in Shandong, China. A self-administered structured questionnaire was used to assess pain symptoms (headache, stomachache, and other general pain), body weight and height, sleep, anxiety/depression, substance use, and family environment in November-December in 2015 and one year later. The Chinese adolescent daytime sleepiness scale (CADSS) was used to measure daytime sleepiness.

RESULTS

Of the sample, 19.8% and 23.2% had moderate or severe EDS at baseline and at 1-year follow-up, respectively. The prevalence and 1-year incidence rates of EDS significantly increased with the frequencies of pain symptoms. Frequent pain was significantly associated with increased risk of EDS at baseline (OR=2.01, 95% CI=1.56-2.59), incident EDS (OR=1.41, 95% CI=1.03-1.93), and persistent EDS (OR=2.17, 95% CI=1.52-3.09) while adjusting for adolescent and family covariates, including anxiety/depression, nocturnal sleep duration, insomnia symptoms, frequent snoring, body mass index, and hypnotic use. Similar associations were observed across headache, stomachache, and other pain.

CONCLUSIONS

Frequent pain is significantly and independently associated with increased risk of EDS. Our findings suggest that assessing and treating pain symptoms is important to improve healthy sleep and reduce risk of EDS in adolescents. Further research is needed to understand the underlying psychological and neurobiological mechanisms between pain and daytime sleepiness in adolescents.

Longitudinal associations of nightmare frequency and nightmare distress with suicidal behavior in adolescents: mediating role of depressive symptoms

STUDY OBJECTIVES

Nightmares are a significant risk factor of suicidal behavior. This study examined the longitudinal associations of nightmare frequency and distress with suicidal thought (ST), suicide plan (SP), and suicide attempt (SA) and mediating role of depressive symptoms in adolescents.

METHODS

A total of 6,923 adolescents who participated in the 1-year follow-up of Shandong Adolescent Behavior & Health Cohort were included for the analysis. Participants completed a self-administered questionnaire to assess nightmares, sleep duration, insomnia, depressive symptoms, substance use, prior suicidal behavior, and family demographics in November-December in 2015. One year later, a follow-up survey was conducted to ask participants to report their depressive symptoms and suicidal behaviors.

RESULTS

Of the sample, 26.2% reported having frequent nightmares (at least twice/month) at baseline, and 10.0%, 3.6%, and 2.7% reported having ST, SP, and SA over 1-year follow-up. The rates of subsequent ST, SP, and SA all significantly increased with baseline nightmare frequency and distress. Path analyses showed that depressive symptoms played a significant mediating role in the associations of frequent nightmares and elevated nightmare distress with ST, SP, and SA before and after adjusting for adolescent and family covariates and prior suicidal behavior.

CONCLUSIONS

Suicidal risk increased with nightmare frequency and distress among adolescents. The association between nightmares and suicidal behavior was at least partially mediated by depressive symptoms. Assessing and intervening nightmares and depressive symptoms associated with nightmares may have important implications for preventing adolescent suicidal behavior.

The mediating role of daytime sleepiness between problematic smartphone use and post-traumatic symptoms in COVID-19 home-refined adolescents

Background

COVID-19 was first recognized in late 2019 in China, at which time school closures forced most students to isolate at home or maintain social distance, both of which increased smartphone use, daytime sleepiness and post traumatic disorder (PTSD) risks. However, to date, no research has fully explored these behavioral risks or the consequences.

Methods

Two thousand and ninety home-confined students from two Chinese high schools participated in an online-based questionnaire battery that assessed their sociodemographic characteristics, COVID-19 related exposures, daytime sleepiness, problematic smartphone use, and PTSD. The subsequent data were subjected to mediation analysis, and structural equation models (SEM) were employed to explore the variable relationships.

Results

The problematic smartphone use, daytime sleepiness and PTSD prevalence were respectively 16.4%, 20.2% and 6.9%. The number of COVID-19 related exposure was directly associated with problematic smartphone use and PTSD symptoms. Problematic smartphone use was found to be a mediator between COVID-19 related exposure and PTSD symptoms, and daytime sleepiness was found to partially mediate the associations between problematic smartphone use and PTSD.

Conclusions

The more exposure associated with the pandemic, the more psychological and behavioral problems the adolescents had. The relatively high rate of problematic smartphone use in home isolated adolescents possibly increased the risk of daytime sleepiness and psychological problems. Therefore, targeted improvements are needed to reduce the risk of psychological problems and daytime sleepiness in adolescents.

Shift work disorder and related influential factors among shift workers in China

BACKGROUND

Shift work may cause insomnia and sleepiness in individuals. The present study aimed to exam shift work disorder (SWD), and to investigate their associations with individual characteristics.

METHODS

A total of 1833 shift workers were assessed using the Pittsburg Sleep Quality Index, Epworth Sleepiness Scale (ESS), Composite Scale of Morningness (CSM), Circadian Type Inventory (CTI), Center for Epidemiologic Studies-Depression Scale (CES-D), Beck Anxiety Inventory (BAI) and other self-compiled socio-demographic questionnaires.

RESULTS

In the current sample, 17.1% shift workers have experienced insomnia symptoms, 20.9% were tested for daytime sleepiness, and 19.9% were categorized as having SWD. Logistics regressions revealed that history of mental disorders (OR = 2.04, 95% CI = 1.30-3.21), chronic physical illness (OR = 1.53, 95% CI = 1.17-1.99), CES-D scores (OR = 1.03, 95% CI = 1.02-1.05), BAI scores (OR = 1.04, 95% CI = 1.03-1.06), languid/vigorous tendencies (OR = 1.06, 95% CI = 1.03-1.10) were positively associated with the onset of SWD, while morningness (OR = 0.97, 95% CI = 0.94-0.99) decreased the odds of SWD onset.

CONCLUSIONS

These findings suggested that attention should be drawn to individuals with mental and chronic diseases in when scheduling work shifts. While SWD and its associates should be considered when providing psychological services to shift workers.

Psychometric properties of the Chinese version of nightmare distress questionnaire (NDQ-CV) in adolescents

BACKGROUND

The Nightmare Distress Questionnaire (NDQ) is the most common scale used to measure nightmare distress for its satisfactory psychometric properties. This study assessed the psychometric properties of the Chinese version of NDQ (NDQ-CV) in a large sample of adolescents.

METHODS

The NDQ-CV consists of 14 items (12 original NDQ items, 1 modified NDQ item and 1 new item) to assess waking distress associated with nightmares. Each item is rated on a 5-point scale from 1 = Never to 5 = Always. Subjects used for psychometric assessment of the NDQ-CV were 11,831 participants of the Shandong Adolescent Behavior and Health Cohort in China. Participants completed the NDQ-CV and a structured questionnaire to assess nightmare frequency, sleep, anxiety/depression, and academic performance.

RESULTS

The NDQ-CV score ranged from 14 to 70 (M = 22.5, SD = 8.7). Internal consistency reliability coefficient was 0.90. Both exploratory and confirmatory factor analyses yielded 2 dominant factors defined as nightmare general distress (10 items) and daytime reality perception (4 items). The NDQ-CV score was significantly correlated with short nocturnal sleep duration, anxiety/depression, insomnia, daytime sleepiness, and poor academic performance. Furthermore, NDQ-CV significantly predicted depressive symptoms 1 year later.

STUDY LIMITATIONS

All data were self-reported.

CONCLUSIONS

The NDQ-CV appears to be a simple, reliable, and valid scale for assessing nightmare distresses in Chinese adolescents. Further studies are warranted to test the reliability and validity of the NDQ-CV with adult samples.

Digital media use and subsequent self-harm during a 1-year follow-up of Chinese adolescents

BACKGROUND

Excessive digital media use is prevalent and has a negative impact on sleep, daytime functioning, and mental health in adolescents. We examined the prospective associations between digital media use and subsequent suicidal and non-suicidal self-harm.

METHODS

Shandong Adolescent Behavior & Health Cohort (SABHC) is a longitudinal study of adolescent behavior and health in Shandong, China. Participants included for the analysis were 7,072 SABHC adolescents who were initially assessed in 2015 and were reassessed in 2016. A self-administered structured questionnaire was used to measure digital media use (i.e., television watching, internet use, and mobile phone use) on weekdays and at the weekend, mental health, and self-harm.

RESULTS

Multivariable logistic regression analyses showed that daily internet use ≥2 h on weekdays (odd ratio (OR) = 1.86, 95% confidence interval(CI) = 1.25-2.76) and ≥3 h at the weekend (OR = 1.46, 95%CI = 1.06-2.00) and daily mobile phone use 2-3 h (OR = 1.46, 95%CI = 1.02-2.10) and ≥4 h (OR = 1.74, 95%CI = 1.20-2.51) at the weekend were significantly associated with increased risk of recurrent self-harm. Daily internet use ≥ 2 h on weekdays (OR = 1.81, 95%CI = 1.20-2.74) and ≥3 h at the weekend (OR = 1.55, 95%CI = 1.12-2.15), daily mobile phone use 1-2 h on weekdays (OR = 1.47, 95%CI = 1.02-2.12) and 2-3 h (OR = 1.49, 95%CI = 1.01-2.19) and ≥4 h (OR = 1.93, 95%CI = 1.31-2.85) at the weekend were significantly associated with increased risk of recurrent non-suicidal self-injury. Daily internet use 1-2 h on weekdays and 2-3 h at the weekend were significantly associated with increased risk of new suicide attempt (OR =  1.80, 95%CI =  1.07- 3.03) and recurrent suicide attempt (OR =  6.26, 95%CI = 1.31-29.88), respectively.

LIMITATIONS

All data were self-reported.

CONCLUSIONS

Excessive use of internet or mobile phone appears to be a significant risk factor of self-harm, suggesting that limiting adolescent use of internet and mobile phone may be beneficial to reduce risk of self-harm.

Depressive symptoms are associated with short and long sleep duration: A longitudinal study of Chinese adolescents

AIMS

Sleep loss and irregular sleep patterns in adolescents are major public health concerns in the modern society. This study aimed to explore the associations between short and long sleep duration and depressive symptoms among Chinese adolescents.

METHODS

A total of 7311 adolescents who participated in the baseline survey and were followed up 1 year or 2 years later were included in the analyses. Participants completed a self-administered questionnaire at baseline and follow-up surveys. The Center for Epidemiologic Studies Depression (CES-D) scale was used to assess depressive symptoms. Generalized estimating equation (GEE) and restrictive cubic spline models were used to estimate the association between sleep duration and depressive symptoms.

RESULTS

After adjusting for adolescent and family covariates, sleep duration <8 h and >=9 h on weekdays and sleep duration <8 h and >=12 h on weekends were significantly associated with depressive symptoms compared with sleep 8 h. Weekend-weekday sleep difference >=3 h or <-1 h (ie. sleeping >1 h on weekdays than weekends) was also associated with depressive symptoms. There were U-shaped relationships between sleep duration on weekdays, weekends, or weekday-weekend sleep difference and depressive symptoms.

LIMITATIONS

Sleep duration and depression were measured by self-report.

CONCLUSIONS

Our findings highlight the risk of short and long sleep duration, and weekday-weekend sleep imbalance for depression in adolescents.

Measuring patient activation in Chinese patients with hypertension and/or diabetes: reliability and validity of the PAM13

Objective

Patient activation is important in the management of chronic diseases (CDs), especially hypertension and diabetes. The 13-item short form Patient Activation Measure (PAM13) is widely used, but data are lacking for China. The study aim was to assess the reliability and validity of the PAM13 in Chinese patients with hypertension and/or diabetes in a community management setting.

Methods

A cross-sectional survey was conducted at four community health centres in Kunming (Yunnan province, China) Participants were patients (n = 519) with hypertension and/or type 2 diabetes mellitus being managed at the community health centres. Patient activation was measured using the Chinese version of the PAM13. Reliability and validity were tested using Cronbach’s α and confirmatory factor analysis.

Results

The male to female ratio was 1:1.65. In total, 307 (60.3%) patients had ≤9 years of education and 213 (41.8%) had a low household income (≤5000 RMB/month). Cronbach’s α was 0.920 and item–total correlations ranged from 0.535 to 0.714. Confirmatory factor analysis showed a good fit to the data.

Conclusions

The PAM13 shows good reliability and validity for measuring patient activation in Chinese patients with CDs (hypertension and/or diabetes).

Prevalence of suicidal behaviour and associated factors in a large sample of Chinese adolescents

AIMS

Suicidal behaviour is prevalent among adolescents and is a significant predictor of future suicide attempts (SAs) and suicide death. Data on the prevalence and epidemiological characteristics of suicidal behaviour in Chinese adolescents are limited. This study was aimed to examine the prevalence, characteristics and risk factors of suicidal behaviour, including suicidal thought (ST), suicide plan (SP) and SA, in a large sample of Chinese adolescents.

METHOD

This report represents the first wave data of an ongoing longitudinal study, Shandong Adolescent Behavior and Health Cohort. Participants included 11 831 adolescent students from three counties of Shandong, China. The mean age of participants was 15.0 (s.d. = 1.5) and 51% were boys. In November-December 2015, participants completed a structured adolescent health questionnaire, including ST, SP and SA, characteristics of most recent SA, demographics, substance use, hopelessness, impulsivity and internalising and externalising behavioural problems.

RESULTS

The lifetime and last-year prevalence rates were 17.6 and 10.7% for ST in males, 23.5 and 14.7% for ST in females, 8.9 and 2.9% for SP in males, 10.7 and 3.8% for SP in females, 3.4 and 1.3% for SA in males, and 4.6 and 1.8% for SA in females, respectively. The mean age of first SA was 12-13 years. Stabbing/cutting was the most common method to attempt suicide. Approximately 24% of male attempters and 16% of female attempters were medically treated. More than 70% of attempters had no preparatory action. Female gender, smoking, drinking, internalising and externalising problems, hopelessness, suicidal history of friends and acquaintances, poor family economic status and poor parental relationship were all significantly associated with increased risk of suicidal behaviour.

CONCLUSIONS

Suicidal behaviour in Chinese adolescents is prevalent but less than that previously reported in Western peers. While females are more likely to attempt suicide, males are more likely to use lethal methods. Multiple child and family factors are associated with suicidal behaviour. These findings highlight the importance of early screening and intervention of suicidal behaviour in Chinese adolescents.

Agreement between parent-reports and child self-reports of sleep problems in Chinese children

Sleep problems are major concerns for parents, health professionals, and children and youths themselves. For assessing sleep problems, both parent and child reports are important, with each having its unique features. However, little is known about the correlates of the agreement between parent and child self-reports. This study evaluated the agreement between the youth self-report sleep questionnaire (YSRSQ) and the parent-reported children's sleep habits questionnaire (CSHQ) and assessed the associated sociodemographic factors, as well as the underlying discrepancies. The participants included 3143 pairs of Chinese preadolescents (mean age = 11.03, SD = 0.98) and parents. Sleep-disordered breathing (SDB), daytime sleepiness, and parasomnia were assessed by both the YSRSQ and CSHQ. Significant but low correlations were present between parent report and preadolescent self-report items on SDB problems, daytime sleepiness, and parasomnias. Although the agreement between SDB symptoms and parasomnias was stronger for girls than for boys, the degree of concordance between SDB symptoms and parasomnia increased with preadolescent age, with the highest agreement achieved among preadolescents aged 12 years or older for SDB problems and 11 years or older for parasomnias. Findings underscore the importance of utilizing both parental and preadolescent self-reports in accurately assessing and diagnosing sleep impairment in pediatric samples.

Course, risk factors, and mental health outcomes of excessive daytime sleepiness in rural Chinese adolescents: A one-year prospective study

BACKGROUND

This study aimed to examine the one-year incidence and persistence of excessive daytime sleepiness (EDS) in rural Chinese adolescents and their risk factors. In addition, we also aimed to explore the potential bidirectional associations of EDS with anxiety symptoms and depressive symptoms.

METHODS

A total of 3736 adolescents from 5 high schools from rural area in the south China were eligible for follow-up. Among them, 2787 responded to follow-up after one year. EDS was defined as having a total score of the Epworth Sleepiness Scale over 10.

RESULTS

The one-year persistence rate and incidence rate of EDS were 27.6% and 9.3%, respectively. After controlling for age and sex, new incident EDS was significantly associated with perceived high study stress, depressive symptoms, insomnia symptoms, and high life events at baseline. Baseline EDS predicted new onsets of depression and anxiety at follow-up. Cross-lagged analyses further revealed that there were bidirectional associations between EDS and anxiety symptom and between EDS and depressive symptoms. Persistent EDS was only associated with eveningness chronotype. In particular, short sleep duration and obesity were associated with neither new incidence nor persistence of EDS in this population.

LIMITATIONS

All measures relied on self-reported questionnaires rather than objective assessments, which might have led to report bias.

CONCLUSIONS

We have identified a number of risk factors of the one-year incidence of EDS (such as perceived high study stress, depressive symptoms, insomnia symptoms, and high life events) and persistence of EDS (eveningness chronotype) in rural adolescents. There is a reciprocal relationship of EDS with anxiety and depression. In this population, sleep loss and obesity seem not related to the course of EDS.