The impact of sleep and psychiatric symptoms on alcohol consequences among young adults

Psychometric analysis of the Psychiatric Diagnostic Screening Questionnaire (PDSQ) and determinants of psychopathology in two outpatient clinics in Navarre (Spain)

BACKGROUND

The self-report Psychiatric Diagnostic Screening Questionnaire PDSQ is designed to screen Axis I psychiatric disorders. We aim to determine its psychometric properties in Spanish outpatients and assess its relationship with two interviews (for psychopathology and for personality disorders) and clinical/demographic variables.

METHODOLOGY

We administered the study questionnaire, the Mini International Neuropsychiatric Interview Plus (MINI-Plus), the Standardised Assessment of Personality Abbreviated Scale (SAPAS), and the List of Threatening Experiences Questionnaire (LTE-Q) to 375 patients at two public outpatient centres. Reliability of the study questionnaire was evaluated (Cronbach's alpha, ?) and known-group validity measured by comparing groups based on demographic and clinical variables (binary logistic regression analysis) and MINI-Plus diagnoses (Mann-Whitney U). The diagnostic accuracy of the study questionnaire score was analysed taking the MINI-Plus diagnoses as the gold standard (ROC analysis).

RESULTS

Internal consistency was adequate across all PDSQ scales (? >0.7; mean ?=0.85). Known-group comparisons were satisfactory. Female and male patients showed higher prevalence of internalizing and externalizing diagnoses, respectively. Younger age, more life events and limitations, higher SAPAS scores, and lower economic levels were linked to a greater number of PDSQ diagnoses. Inter-group differences were found for all PDSQ scales based on the corresponding MINI-Plus diagnoses. Mean values of sensitivity, AUC, and negative predictive value were 88.7, 0.82, and 96.7, respectively.

CONCLUSIONS

When applied to a sample of Spanish outpatients, the PDSQ exhibits satisfactory psychometric properties and adequate relationships with the psychopathology and personality interviews, and clinical and demographic variables. The study questionnaire is suitable for assessing comorbidity and psychopathology dimensions.

A systematic review and meta-analysis of the association between young adults' sleep habits and substance use, with a focus on self-medication behaviours

Young adults (18-30 years) are vulnerable to sleep-wake disturbances and substance use, which are bi-directionally associated. The present work aims to organise the literature that deals with the association between sleep and substance use in young adults, also considering self-medication behaviours. We adopted a framework that accounts for the multidimensionality of sleep and the effect of different substances. We considered sleep disturbances (insomnia symptoms, sleep quality), sleep health dimensions (duration, satisfaction, efficiency, timing, daytime alertness), circadian characteristics (chronotype). Substances were alcohol, caffeine, nicotine, cannabis, others. We included 46 studies. The use of caffeine and nicotine was associated with higher odds of sleep disturbances. No significant effect was detected for sleep duration. In narrative findings, daytime dysfunction was associated with alcohol and caffeine use, and poor sleep satisfaction with nicotine use. Few evidence were available for the other sleep health dimensions. Evening chronotype was associated with alcohol, caffeine, and nicotine use. Few studies focused on cannabis or self-medication. Longitudinal results were inconclusive. We found a distinct pattern of associations between different substances and different sleep outcomes. Further investigation considering the multidimensionality of sleep would create a better understanding of the complex relationship between substance use and sleep health in young adults.

Insomnia as a moderator of alcohol use and blackout: Potential role in acute physiological consequences

BACKGROUND

Alcohol-induced blackout is associated concurrently and prospectively with alcohol-related harm, including emergency room visits and sexual coercion. Although sleep has not been linked empirically to blackout, symptoms of insomnia have also been linked to memory impairment, in which case insomnia symptoms may compound alcohol's negative effects on memory. This study tested insomnia symptoms as a moderator of the association between heavy drinking and alcohol-induced blackout.

METHODS

Heavy-drinking young adults in college (N = 461, 69% female) completed assessments online from remote locations. Hierarchical linear regression was used to test a moderation model predicting blackout frequency. Logistic regression was used to test post hoc hypotheses.

RESULTS

In contrast to our main hypothesis, heavy drinking was more weakly (not more strongly) associated with blackout in the context of more severe insomnia. Post hoc analyses tested insomnia symptoms as a unique moderator of the association between heavy drinking and likelihood of acute physiological consequences of alcohol use (blackout, passing out, nausea/throwing up, and hangover). Insomnia severity at least marginally moderated the association between heavy drinking and 4 out of 5 physiological consequences of alcohol use, and only moderated the association between drinking and 1 of 19 remaining consequences.

CONCLUSIONS

Symptoms of insomnia are associated with alcohol-related harm, but may buffer associations between drinking and acute physiological consequences of alcohol. Additional research is needed to determine if alcohol heightens sensitivity to the acute physiological effects of alcohol, in which case less alcohol may be required for young adults with insomnia to experience these effects.

Poor subjective sleep predicts compromised quality of life but not cognitive impairment in abstinent individuals with Alcohol Use Disorder

How disrupted sleep contributes to cognitive dysfunction over the dynamic course of Alcohol Use Disorder (AUD) is an emerging topic of investigation. Here, the Pittsburgh Sleep Quality Index (PSQI) was used to evaluate subjective sleep in 90 individuals with AUD sober for an average of 3 months and in 50 healthy controls. Relative to controls, AUD individuals had higher global PSQI scores (worse sleep), higher scores on the Beck Depression Inventory (BDI), worse Quality of Life (QoL) indicators, and poorer performance on cognitive composite tests (executive functioning, attention and working memory, visual and verbal learning or memory). Among AUD individuals, a higher PSQI score correlated with a higher BDI scores and worse QoL, but not with cognitive scales. Also noted in the AUD group were higher global PSQI scores in individuals also diagnosed with major depressive (MDD) or generalized anxiety (GAD) disorders. Together, the 4 variables explained 29.8% of the variance in AUD PSQI scores. In women with AUD, the 4 factors explained 39.3% of the variance in PSQI scores; in AUD men, the 4 measures explained 19.9% of the variance: MDD was salient in women, QoL in men with AUD suggesting differential factors associate with poor sleep in men and women with AUD even with sustained alcohol abstinence. Here, global PSQI scores were related to clinical diagnoses and life functioning but failed to predict cognitive performance in abstinent AUD individuals.

Know Your Safe Drinking Skills: Adaptation Strategies for the College Effect

Objective: The current study investigates the effects of an alcohol-prevention program delivered to college students in a formal classroom setting. Participants: The sample comprised 231 first-year college students who enrolled in a multisection “First Year Experience” course at a large northeastern university in the United States. Method: A naturalistic experiment was conducted, with a baseline evaluation at the beginning of the semester and a post-experiment evaluation near the end of the semester. Results: Social drinking attitudes, proximal drinking norm and the college effect are significant predictors of pre- and post-intervention episodic drinking frequency. The intervention reduced episodic drinking frequency as well as perceived distal and proximal drinking norms. It also increased drinking attitudes and did not change perceived efficacy or drinking-outcome expectancies. Conclusions: Practitioners could consider implementing a similar intervention to allow students to learn and practice safe drinking skills in the first year of their college life.

Determinants of sleep quality in college students: A literature review

PURPOSE

To review the various determinants of sleep quality among college students.

METHODS

The PubMed, Web of Science and Cochrane Library databases were searched with the search string "sleep quality" AND "college students" for articles published between January 2007 and October 2017. Articles were excluded if they (1) examined sleep quality as a risk factor for other outcomes or (2) involved inpatients or participants under medical care.

RESULTS

The 112 identified studies were classified into categories according to the investigated determinants and their effect on sleep quality. Physical activity and healthy social relations improved sleep quality, while caffeine intake, stress and irregular sleep-wake patterns decreased sleep quality. Less consistent results were reported regarding eating habits and sleep knowledge, while proper napping during the day might improve overall sleep quality.

CONCLUSIONS

College students are vulnerable to different risk factors for sleep quality. When designing interventions to improve sleep quality among college students, the main determinants need to be taken into consideration.

The role of alcohol-induced blackouts in symptoms of depression among young adults

OBJECTIVE

Blackouts are associated with other alcohol-related consequences and depression among young adults, but the mechanisms underlying these associations are unclear. Using two separate samples, we tested the hypothesis that blackouts would be linked to symptoms of depression due in part to their association with other alcohol-related consequences.

METHOD

Young adults who use alcohol completed assessments at baseline in Sample 1 (N₁ = 381, 58% female) and baseline, 3 months, and 6 months in Sample 2 (N₂ = 603, 53 % female). Bootstrapped confidence intervals were used to examine the direct and indirect effects of blackouts on depressive symptoms, using cross-sectional mediation analysis in Sample 1 and a counterfactual approach with longitudinal data in Sample 2.

RESULTS

In both samples, alcohol-induced blackouts were associated with alcohol-related consequences, which in turn were associated with symptoms of depression. In Sample 1, blackouts had both direct and indirect (mediated) effects on depressive symptoms. In Sample 2, blackouts measured at baseline only had an indirect effect on depressive symptoms six months later through other alcohol-related consequences at three months.

CONCLUSIONS

Among heavy-drinking college students, the majority of whom reported minimal symptoms of depression, blackouts were associated with increases in other alcohol-related consequences, which in turn were associated with increases in symptoms of depression. These findings suggest that prevention and intervention efforts targeting blackouts may help reduce other alcohol-related consequences among young adults.

Sleep and Women's Health: Sex- and Age-Specific Contributors to Alcohol Use Disorders

Prior research on alcohol use disorder (AUD) has focused primarily on men, but psycho-social-cultural changes have led to more women drinking or binge drinking, thus highlighting sex differences observed in alcohol use. In parallel, recent evidence indicates bidirectional links between alcohol use and sleep disruption, offering a burgeoning field of research for the study of sex differences in sleep-alcohol interactions. As part of the 2018 Research Conference on Sleep and the Health of Women at the National Institutes of Health, three presentations focused on the intersection between alcohol and sleep in women, including links between disrupted sleep and the risk of AUD. The literature to date hints at sex differences in the relationships between sleep and alcohol use that may be relevant to prevention and/or intervention. For example, insomnia is more prevalent among women, yet men may be more likely to self-medicate insomnia with alcohol and may benefit more from alcohol's sedating effects. Sex differences in sleep timing and duration that begin during adolescence may also be relevant, as later and/or shorter sleep appear to be risk factors for binge drinking. Preliminary data also implicate circadian timing as a sex difference potentially relevant to alcohol use. Limited extant data suggest complex relationships between sex, sleep, and alcohol problems, but defy easy summary. Relevant studies sufficiently powered to test sex differences are needed.

Alcohol Consumption as a Moderator of Anxiety and Sleep Quality

BACKGROUND

Although people who sleep poorly may attempt to relieve anxiety for better sleep quality, whether daily alcohol consumption is a factor that moderates anxiety and sleep disturbance is not known.

PURPOSE

The aim of the study was to explore (a) the association between anxiety and sleep quality and (b) whether daily alcohol consumption acted as a moderator between anxiety and sleep quality in those who reported sleeping poorly.

METHODS

Eighty-four participants aged 20-80 years who reported poor sleep (Pittsburgh Sleep Quality Index > 5) in northern Taiwan were enrolled in this cross-sectional study. A structured questionnaire covering demographics (including daily alcohol consumption), level of anxiety, level of depression, and perceived sleep quality was used to collect data.

RESULTS

The participants were mostly women (72.6%). The mean age was 41.81 (SD = 12.62) years; 51.2%, 19.0%, 13.1%, and 14.3%, respectively, had minimal, mild, moderate, and severe anxiety. After adjusting for factors related to sleep quality using multiple regression analysis, receiving sleep therapy, consuming alcohol on a daily basis, and having anxiety were found to be predictors of poor sleep quality. Moreover, daily alcohol consumption was found to moderate the relationship between anxiety and sleep quality.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

People who sleep poorly should avoid misusing alcohol to self-treat poor sleep quality or anxiety and should instead utilize sleep hygiene education and mental healthcare. Daily alcohol consumption may be a moderator between anxiety status and sleep quality.

Relationships between Sleep Patterns, Health Risk Behaviors, and Health Outcomes among School-Based Population of Adolescents: A Panel Analysis of the Korean Children and Youth Panel Survey

Sleep patterns among adolescents are related to health outcomes and health risk behaviors. This study aimed to describe sleep patterns of Korean adolescents and to find the association between sleep patterns and health risk behaviors and health outcomes. Using the junior high school students’ panel data (n = 2351, 12–15 years old) from the Korean Children and Youth Panel Survey, this study described the sleep patterns operationalized as rising time, bedtime, and sleep duration both on weekdays and weekends. The relationships of sleep patterns with health outcomes and/or health risk behaviors were tested using mixed effect linear regression for continuous health variables and using mixed effect logit regression for binary health variables. Obesity status, the number of chronic symptoms, self-rated health status, smoking, and alcohol consumption were associated with rising time on weekdays after controlling for gender, living area, and housing type. The same set of variables except for the number of chronic symptoms were associated with bedtime during the weekdays. Sleep duration during the weekdays was associated with obesity status, smoking, and alcohol consumption. Similar patterns of association between sleep pattern variables during the weekends and health-related outcome variables were found, but were less obvious than those for weekdays. Significant relationships between sleep patterns and various health-related variables were found among adolescents in Korea. The results from this study indicate that helping adolescents change their sleeping times as necessary to ensure adequate sleep should be considered important in diminishing health risk behaviors and promoting positive health outcomes.

[Insomnia and Hypersomnia among Children and Adolescents with Psychiatric Disorders]

Insomnia and Hypersomnia among Children and Adolescents with Psychiatric Disorders The common symptom of sleep disorders is non-restorative sleep, which results in daytime sleepiness. Therefore in clinical practice simultaneous complaints of "not enough" and "too much" sleep are very frequent. For the investigation and treatment of organic sleep disorders, available instruments, guidelines and specialised institutions (sleep centres or sleep laboratories) are more advanced than for non-organic sleep disorders. Especially in the child and adolescent psychiatric and psychotherapeutic field this complicates an appropriate treatment. In addition multiple psychiatric, neurological and other somatic diseases can disrupt nighttime sleep and cause impairments during the day too. There are various instruments and methods to cover disturbed nocturnal sleep, some of which have already found widespread use in clinical practice (e. g. sleep diaries or specific questionnaires and interviews). For the examination of daytime sleepiness instruments and methods are available too, which by now seem to be less widely used. Against this background an overview of definitions, distinctive features and clinical instruments as well as guidelines for dealing with "too much and too little sleep" during the day or at night shall be presented.

Insomnia and Regulation of Sleep-Wake Cycle With Drugs Among Adolescent Risky Drinkers

STUDY OBJECTIVES

We aimed to explore symptoms of insomnia in a group of youths characterized as engaging in risky drinking, their use of drugs as sleep/ wake aids, and the relationships between alcohol and other drug use and insomnia.

METHODS

Face-to-face interviews were conducted with 596 Australian 14 to 19-year-olds identified as engaging in regular risky drinking. They completed the Insomnia Severity Index and were assessed for recent alcohol and other drug use, including drugs used specifically as sleep aids or to stay awake. Alcohol-related problems, emotional distress, self-control, and working outside of traditional hours were also assessed using validated scales.

RESULTS

More than one-third of the study participants (36%) reported moderate to very severe sleep-onset insomnia, and 39% screened positive for clinical insomnia using adolescent criteria. Three-fourths used drugs in the past 2 weeks to regulate their sleep cycle (65% used stimulants to stay awake, mainly caffeine, and 32% used a depressant to get to sleep, mainly cannabis). Regression analyses showed that after controlling for variables such as sex, emotional distress, self-control, alcohol use problems, and past 6-month illicit or non-prescribed drug use, those who used drugs specifically to get to sleep or to stay awake were 2.0 (P < .001) and 1.7 (P = .02) times more likely to report clinical insomnia, respectively.

CONCLUSIONS

Insomnia was commonly reported in this community sample of adolescents characterized as engaging in risky drinking. Those with symptoms of insomnia appeared to be managing their sleep-related symptoms through alcohol and other drug use, which may have further exacerbated their sleep issues.

The effects of acute alcohol withdrawal on sleep

OBJECTIVES

Although sleep disturbances are prominent during alcohol withdrawal, less is known about the specific components of sleep that are disturbed prior to and during acute detoxification. This study aimed to determine whether specific sleep components are affected prior to and during acute detoxification and their relationship to psychological distress.

METHODS

Twenty-nine participants were recruited from a residential detoxification service in Melbourne, Australia, and completed both subjective methods of sleep and distress, in addition to wearing an actigraphy device.

RESULTS

Daytime dysfunction, sleep quality, and sleep disturbances were the components that were most disturbed in the month prior to admission, and poor sleep efficiency was detected during acute withdrawal using actigraphy. A significant association was found between sleep and psychological distress in this group.

CONCLUSIONS

Specific disturbances in sleep are experienced prior to and during acute alcohol withdrawal, suggesting that tailored interventions may be effective in the treatment of sleep deficits during these periods.

Reciprocal variations in sleep and drinking over time among heavy-drinking young adults

Prior studies have established an association between sleep problems during early adolescence and heavy alcohol use/alcohol use disorder (AUD) risk in late adolescence. Less research has explored the association between sleep problems and heavy alcohol use during young adulthood, the period when AUD onset peaks. Moreover, research to date has primarily utilized cross-sectional, between-subjects' methods to examine this relationship, with limited focus on the potential intraindividual variation in these behaviors. Multilevel modeling techniques are well-suited to examine the variability in sleep problems and risky alcohol use over time and the dynamic bidirectional relations among these behaviors. This article reports on 42 heavy-drinking college students at-risk for an AUD based on their responses to a validated alcohol screener who completed daily diaries of sleep and alcohol use and wore a sleep-wake activity monitor (i.e., Philips Respironics Actiwatch 2™) daily for 7 days yielding a total of 294 reports. Hierarchical linear models demonstrated that days of heavy drinking predicted delayed bed and wake times within individuals and those individuals who tended to drink more heavily on average had shorter sleep durations. Conversely, days of shorter sleep duration, earlier wake times, and greater perceived sleep quality upon waking predicted greater alcohol use within individuals, and those who tended to feel more alert upon waking drank more on average. These results highlight important within- and between-person variability in the associations among objective and subjective sleep-related problems and at-risk drinking among young adults. Further, the results have implications for alcohol prevention/intervention strategies for young adults at risk for AUDs. (PsycINFO Database Record