The synergic relationship between social anxiety, depressive symptoms, poor sleep quality and body fatness in adolescents

Short-term prospective and reciprocal relations between social anxiety symptoms and sleep quality among community-recruited adolescents

OBJECTIVE

Research conducted with socially anxious youth suggests that there is an increased risk for poor sleep quality; however, this link is not consistent across the few studies and there is evidence to suggest that poor sleep quality may increase the risk for elevated social anxiety symptoms. The present study investigates both prospective and reciprocal associations between levels of self-reported social anxiety and global sleep quality while also distinguishing between within-person and between-person variations in these associations.

METHOD AND MEASURES

Community-recruited adolescents from the United States (N = 71; Mage=16.04, SD = 1.08; 64.8% girls; 80.3% White) completed a battery of questionnaires across three time-points within a six-month period; each wave occurred three months apart. A random-intercepts cross-lagged panel model was used for the analysis.

RESULTS

Findings indicated a positive relation between social anxiety and poor sleep quality at both within- and between-person levels. Higher levels of social anxiety were associated with poorer sleep quality three months later, but the reverse relation was not observed.

CONCLUSIONS

These findings provide evidence supporting the link between elevated social anxiety symptoms and future sleep problems among adolescents and lay groundwork for investigation of mechanisms driving this link. Findings suggests a need to screen for and treat sleep problems in socially anxious youth.

Examining the Latent Dimensions of Social Anxiety Disorder

While the body of literature has investigated the latent dimensions of Social Anxiety Disorder (SAD), only few have directly anchored in the DSM-5 SAD symptoms. Similarly, a continuing issue on measuring mental health disorders pertains to whether a symptom's frequency, intensity, or both, are appropriate and sufficient indicators of severity. To address this gap, the present study developed and validated a DSM-5-based measurement tool, the Social Anxiety Symptom Severity Inventory (SASSI), which assesses both the intensity (intensity of disturbance) and frequency (frequency of occurrence) of SAD symptoms. In study 1 (n = 6458, college students), the results revealed a two-factor structure using exploratory structural equation modeling. In study 2 (n = 425, left-behind emerging adults), confirmatory factor analysis, measurement invariance testing, and latent class analysis were used. Findings demonstrated the importance of using both frequency and intensity of symptoms in assessing SAD severity. Moreover, a five-class solution best fitted the sample. Studies 1 and 2 demonstrated the good psychometric properties of SASSI and filled an important gap among available measures in assessing SAD severity through symptom frequency and intensity.

The Relationship Between Social Anxiety and Depression Among Rural High School Adolescents: The Mediating Role of Social Comparison and Social Support

Objective: This study aimed to explore the impact of social anxiety on depression among high school students and examine the parallel mediating roles of social comparison and social support. Methods: A total of 806 rural high school students were surveyed using the Short Mood and Feelings Questionnaire, the Social Phobia Inventory, the Chinese version of the Social Comparison Orientation Scale, and the Multidimensional Scale of Perceived Social Support. Results: Social anxiety and social comparison were significantly and positively correlated with depression, while social support exhibited a significant negative correlation with depression. The direct effect of social anxiety on depression was also found to be significant. Moreover, social comparison and social support both played significant parallel mediating roles in the relationship between social anxiety and depression. Conclusions: Social anxiety has a direct positive predictive effect on depression, and this effect can be indirectly mediated through the parallel roles of social comparison and social support.

The moderating effects of physical activity on social anxiety and sleep disturbance: managing gaming disorder in young e-sports players

Background

Internet Gaming Disorder (IGD) has emerged as an increasing public health concern, particularly among adolescent and young e-sports players in recent years. The immersive and competitive nature of online gaming has been associated with an increase in mental health issues such as anxiety and insomnia among individuals with IGD. This study aims to examine the potential relationship between IGD, social anxiety, and insomnia, investigate the mediating role of social anxiety in this relationship, and explore the moderating role of physical activity in alleviating the negative effects of IGD.

Methods

The study involved 475 adolescent and young e-sports players aged 14-24, who typically engage in an average of 6 h of gaming per day. Participants completed the Internet Gaming Disorder Scale-Short Form, Social Anxiety Inventory, Insomnia Severity Index, and Physical Activity Frequency Question. Correlation and moderation analyses were used to examine the proposed relationships.

Results

The findings revealed significant positive associations between IGD, social anxiety, and insomnia. Moreover, physical activity demonstrated a negative correlation with both social anxiety and insomnia. Notably, physical activity served as a moderator in the relationship between IGD and both social anxiety and insomnia, with higher levels of physical activity attenuating the adverse effects of IGD.

Conclusion

This study illuminates the intricate relationship between IGD, social anxiety, and insomnia among adolescent and young e-sports players. The findings suggest that promoting physical activity may alleviate the negative psychological implications associated with IGD. These results provide important insights for the formulation of targeted intervention strategies aimed at this demographic.

The effect of depression status on osteoarthritis: A powerful two-step Mendelian randomization study

Osteoarthritis (OA) is a common degenerative disease that affects millions of individuals worldwide.

OBJECTIVE

There is no conclusive epidemiological evidence regarding the relationship between OA, depression, and whole-body fat mass. In this study, we conducted a two-step Mendelian randomization analysis to determine the causal relationships between them.

DESIGN

The published summary-level data are from genome-wide association studies (GWAS). Our study included 357,957 samples and 10,828,862 SNPs. Finally, the outcome GWAS data for OA came from a GWAS on the genetic architecture of OA using UK Biobank data. This study included 50,508 samples and 15,845,511 SNPs. We used five different modes of analysis, including inverse variance weighted meta-analysis (IVW), MR-Egger regression, weighted median, simple mode, and weighted mode, to explore causal relationships.

RESULTS

We found a positive correlation between depression and body fat mass, with depression leading to body fat mass an increase in (IVW result: p = 3.39E-07, OR (95 % CI) =2.16 (1.61, 2.90)). We also found a positive correlation between body fat mass and OA, with body fat mass increasing the risk of OA (IVW result: p = 1.65E-33, OR (95 % CI) = 1.98 (1.77, 2.21). Body fat mass played an important role as a mediator in the causal relationship between depression and OA, with approximately 14 % of the risk of OA caused by depression being mediated by body fat mass.

CONCLUSIONS

Our study offers reliable evidence that depression has a detrimental impact on the risk of OA. Future research can support these associations from improving depressed effect, including social, biological, and behavioral factors, to reduce the risk of chronic diseases such as osteoarthritis. And we identified high-risk variation of alleles which associated with OA and depression can be used to predict disease and provide a basis for clinical intervention and treatment of OA.

Associations of health literacy and sleep quality with depressive symptoms in Turkish adolescents: A descriptive cross-sectional study

PURPOSE

The purpose of this study was to determine the associations of health literacy and sleep quality with depressive symptoms in adolescents.

DESIGN AND METHODS

This descriptive cross-sectional study was conducted with 1081 high school students in Turkey. The data were collected online using the Health Literacy for School-Aged Children Scale, Pittsburg Sleep Quality Index, and the Center for Epidemiological Studies Depression Scale for Children. The chi-square test and binary logistic regression analysis were used to analyze the data obtained from the scales.

RESULTS

The prevalence of depressive symptoms, sleep problems, and low health literacy was 78.4%, 70.6%, and 11.3%, respectively. Sleep problems were significantly positively correlated with depressive symptoms (OR = 4.187, 95% CI: 2.998 -5.848). The students who were experiencing sleep problems and had low health literacy were at risk of the most severe depressive symptoms (OR = 12.696, 95% CI: 5.122-31.474).

CONCLUSIONS

Overall, depressive symptoms and sleep problems were common among the adolescents in the study sample. The students who had sleep problems and low health literacy were at an increased risk for depressive symptoms.

PRACTICAL IMPLICATIONS

To prevent mental health problems in adolescents, intervention programs focused on increasing the health literacy levels and improving sleep quality in this population are recommended.

Effects of Sleep Quality, Acute Sleep Deprivation, and Napping on Facial Emotion Recognition Accuracy and Speed

Objective

To investigate the effects of sleep quality, sleep deprivation, and napping on facial emotion recognition (FER) accuracy and speed.

Methods

This research included a cross-sectional study (102 qualified participants) and a randomized controlled study (26 in the napping group and 24 in the control group). The stimuli for the FER task were obtained from the Chinese Facial Affective Picture System (CFAPS). Four facial expressions (fearful, disgusted, sad, and angry) were used. The Pittsburgh Sleep Quality Index (PSQI), Self-Rating Anxiety Scale, and Self-Rating Depression Scale were used to measure participants' sleep quality and psychological conditions. In Study 1, FER ability was compared between good and poor sleepers. In Study 2, all participants were sleep-deprived for one night, and completed the FER task before and after sleep deprivation. After different interventions (ie, napping for one hour, or walking around for ten minutes), the participants completed the third FER task.

Results

Study 1: Poor sleepers were able to recognize sad expressions more accurately compared with good sleepers. Study 2: 30-h sleep deprivation had no significant effect on the accuracy (ACC). Napping after sleep deprivation improved the FER ACC of upper-face expressions and marginally significantly improved the FER ACC of disgusted expressions.

Conclusion

Better sleep quality was linked to lower FER accuracy, particularly in recognizing sad expressions, while no significant differences in recognition speed were observed. Additionally, 30 hours of sleep deprivation did not affect FER accuracy, but napping after sleep deprivation improved accuracy for upper-face and marginally for disgusted expressions.

Relationship between social anxiety and sleep quality in depressed adolescents: the mediating role of internet addiction

Objective

This study investigated the association between social anxiety and sleep quality and further explored the potential mediating role of internet addiction in depressed adolescents.

Methods

This study included 440 Chinese depressed adolescents (mean age = 15.0 years, SD = 2.0). Participants completed questionnaires, including Social Avoidance and Social Distress Scale, Internet Addiction Test, and Pittsburgh Sleep Quality Index. A structural equation model was used to analyze the association between social anxiety and sleep quality, with internet addiction as a mediator. Gender differences were examined by multi-group analysis.

Results

Among participants, 61.8% reported poor sleep quality. The sleep quality was significantly different on the level of gender (p = 0.016), education level (p = 0.043), and family history (p = 0.002). Sleep quality was positively associated with social anxiety (p < 0.001) and internet addiction (p < 0.001). Furthermore, internet addiction partially mediated the relationship between social anxiety and sleep quality, and the mediation effect ratio was 16.1% (p < 0.001). Finally, no significant differences were found in this mechanism.

Conclusion

We concluded that both social anxiety and internet addiction were risk factors for depressed adolescents' poor sleep quality. Social anxiety further affected sleep quality through internet addiction.

Examining the influence of problematic internet use on sleep quality in Chinese adolescents: a study using the extended Stressor-Strain-Outcome (SSO) model

Objective

This study aims to explore how problematic internet use may affect the sleep quality of Chinese adolescents using the extended Stressor-Strain-Outcome (SSO) model. The model posits that stressors indirectly influence behavioral outcomes through the mediation of emotional and physiological strain responses.

Method

A sample of 4,365 adolescents in China participated in this study, which utilized questionnaires and other methods to develop a novel SSO model. In this model, problematic internet use was considered as the stressor, anxiety as an indicator of tension, and sleep quality as the ultimate outcome. Family health was introduced as a moderating variable.

Results

The study found that problematic internet use can significantly and positively predict adolescents' anxiety (β = 0.132, p < 0.001) and sleep quality (β = 0.362, p < 0.001). Furthermore, anxiety was identified as a significant mediating factor between problematic internet use and sleep quality [Effect = 0.066, p < 0.05, 95% CI (0.014, -0.0018)]. Family health was observed to have a moderating effect on the relationship between problematic internet use and anxiety (β = -0.075, p < 0.001).

Conclusion

The research indicates that problematic internet use not only directly increases individual anxiety as a stressor but also indirectly impacts sleep quality by exacerbating anxiety. However, a positive family health status can effectively moderate the adverse impact of problematic internet use on anxiety.

Social interaction anxiety and sleep quality in youth: Individual difference in childhood adversity and cardiac vagal control

BACKGROUND

Social interaction anxiety and sleep problems are prevalent during adolescence. Social interaction anxiety undermines sleep quality, however, little is known whether the association between social interaction anxiety and sleep quality is moderated by environmental factors such as childhood adversity and individual factors such as cardiac vagal control. This study sought to investigate the moderating effects of childhood adversity and cardiac vagal control on the link between social interaction anxiety and sleep quality.

METHOD

The Social Interaction Anxiety Scale, the Pittsburgh Sleep Quality Index and the Childhood Trauma Questionnaire were administered to 274 adolescents, who received 3-min resting ECG recording to assess respiratory sinus arrhythmia (RSA) as an index of cardiac vagal control.

RESULTS

Social interaction anxiety was negatively associated with sleep quality, and this association was moderated by childhood adversity and cardiac vagal control. In specific, social interaction anxiety was negatively associated with sleep quality among adolescents with low childhood adversity regardless of cardiac vagal control. Sleep quality was generally disrupted when adolescents exposed to high childhood adversity, but the negative association between social interaction anxiety and sleep quality among adolescents with high childhood adversity could be amortized by high cardiac vagal control.

LIMITATIONS

Cross-sectional design precluded establishing causality among variables.

CONCLUSION

These findings suggest that high cardiac vagal control reflecting better self-regulation might buffer the negative effect of social interaction anxiety on sleep quality particularly among adolescents exposed to early life stress.

Effects of stress on sleep quality: multiple mediating effects of rumination and social anxiety

BACKGROUND

In contemporary society, with the accelerated pace of work and life, more and more people feel different degrees of stress. Long-term stress may not only lead to insomnia, but also to mental health problems (e.g., anxiety and depression), which has a significant impact on people's quality of life and mental health.

OBJECTIVE

This study primarily investigates the mechanism through which stress affects sleep quality among college students.

METHODS

We conducted research on 1653 Chinese college students using four scales with high reliability and validity: stress, the Pittsburgh Sleep Quality Index, social anxiety, and rumination.

RESULTS

The study found: (1) Stress can significantly and positively predict sleep quality and rumination; (2) Rumination can positively predict social anxiety; (3) Social anxiety can positively predict sleep quality; (4) Stress can affect sleep quality through social anxiety and rumination separately, and stress can also affect sleep quality through the chained mediation of rumination and social anxiety.

CONCLUSION

This study reveals the relationship and mechanisms between stress and sleep quality. It not only deepens the research on the impact of stress on sleep quality but also provides theoretical support and new methods for mental health professionals to help clients improve their sleep quality. In practice, in addition to using some common psychological intervention methods to help individuals reduce stress, we should pay more attention to how to help clients reduce rumination and social anxiety, This is significant in improving the quality of an individual's sleep.

Sleep-Related Problems and Pediatric Anxiety Disorders

Sleep-related problems are highly prevalent among childhood and adolescent anxiety disorders. The objective of this review was to summarize the relevant clinical research literature as it pertains to the nature of the association between sleep-related problems and youth anxiety, developmental factors relevant to this association, and intervention efforts to target comorbid sleep challenges and anxiety. Limitations of the literature and future directions are discussed.

The relationship between multiple sleep dimensions and obesity in adolescents: A systematic review

Sleep is an involuntary behaviour, biologically fundamental to survival and wellbeing. However, sleep is increasingly neglected, with significant health implications. Recent research has identified associations between sleep duration, quality, timing and risk of overweight/obesity in children and adults. The aim of this review was to systematically identify and examine research that investigates the relationships between multiple objective and subjective sleep outcomes and objective adiposity measures in adolescents. A systematic review of literature, published to December 2022, was conducted using ten bibliographic databases. Search terms included objective and subjective sleep/circadian rhythm outcomes, objective adiposity measurements, and adolescents aged 8-18 years. Eighty-nine studies were included in the final review. Sleep outcomes were synthesized into three sleep domains: pre-sleep, during sleep and post-sleep outcomes. In summary, pre-sleep outcomes (including poor sleep hygiene, later chronotype and increased variability and later sleep timings) and increased sleep disturbance are consistently significantly associated with increased obesity and adiposity in adolescents. The relationship between during-sleep outcomes (sleep quality and efficiency) with adiposity and obesity measures was mixed. These findings suggest that adapting an individual's schedule to best suit chronotype preference and improving sleep hygiene, including a consistent bedtime routine, could reduce adiposity and obesity in adolescents.

Multiclassification of the symptom severity of social anxiety disorder using digital phenotypes and feature representation learning

Objective

Social anxiety disorder (SAD) is characterized by heightened sensitivity to social interactions or settings, which disrupts daily activities and social relationships. This study aimed to explore the feasibility of utilizing digital phenotypes for predicting the severity of these symptoms and to elucidate how the main predictive digital phenotypes differed depending on the symptom severity.

Method

We collected 511 behavioral and physiological data over 7 to 13 weeks from 27 SAD and 31 healthy individuals using smartphones and smartbands, from which we extracted 76 digital phenotype features. To reduce data dimensionality, we employed an autoencoder, an unsupervised machine learning model that transformed these features into low-dimensional latent representations. Symptom severity was assessed with three social anxiety-specific and nine additional psychological scales. For each symptom, we developed individual classifiers to predict the severity and applied integrated gradients to identify critical predictive features.

Results

Classifiers targeting social anxiety symptoms outperformed baseline accuracy, achieving mean accuracy and F1 scores of 87% (with both metrics in the range 84-90%). For secondary psychological symptoms, classifiers demonstrated mean accuracy and F1 scores of 85%. Application of integrated gradients revealed key digital phenotypes with substantial influence on the predictive models, differentiated by symptom types and levels of severity.

Conclusions

Leveraging digital phenotypes through feature representation learning could effectively classify symptom severities in SAD. It identifies distinct digital phenotypes associated with the cognitive, emotional, and behavioral dimensions of SAD, thereby advancing the understanding of SAD. These findings underscore the potential utility of digital phenotypes in informing clinical management.

Relationship of sleep-quality and social-anxiety in patients with breast cancer: a network analysis

BACKGROUND

There is a complex relationship between social anxiety and sleep quality. However, network analysis studies of associations between social anxiety and sleep quality are lacking, particularly among patients with breast cancer. The current study aimed to extend this research to a sample of patients with breast cancer and to examine symptom-level associations between social anxiety and sleep quality using network analysis.

METHODS

Network analysis was conducted to explore their associations and identify bridge items of social anxiety and sleep quality.

RESULTS

The network structure revealed 9 important edges between social anxiety and sleep quality. "Subjective sleep quality" had the highest EI value in the network. "Working difficulty under watching" and "Sleep disorders" had the highest BEI values in their own communities.

CONCLUSION

There are complex pathological correlation pathways between social anxiety and sleep quality in breast cancer patients. "Subjective sleep quality", "Working difficulty under watching" and "Sleep disorders" have the potential to be intervention targets for sleep disorder-social anxiety comorbidity. Medical staff can take corresponding interventions according to the the centrality indices and bridge centrality indicators identified in this study, which is likely to effectively reduce the comorbidity of sleep disorders and social anxiety.

Effects of Social Anxiety and Subjective Well-Being on Problematic Mobile Social Media Use in First-Year University Students: The Mediating Role of Self-Esteem

Background: Problematic mobile social media use may impact college students' physical and mental health. This study aimed to elucidate the impact of social anxiety and subjective well-being on problematic mobile social media use and the mediating role of self-esteem in this relationship. Methods: A total of 387 first-year university students (39.8% females, 60.2% males; mean age = 18.74 years) were enrolled in this study and completed self-report measures of social anxiety, subjective well-being, self-esteem and problematic mobile social media use. A structural equation model was constructed and tested by AMOS 23.0 software. Results: (1) Social anxiety not only had a direct effect on problematic mobile social media use, but also had an indirect effect on problematic mobile social media use via self-esteem. (2) Subjective well-being was positively and significantly associated with self-esteem, as well as problematic mobile social media use. (3) Self-esteem played a suppressing role between subjective well-being and problematic mobile social media use. Conclusions: It is necessary to help college students reduce their social anxiety and increase their subjective happiness through appropriate ways, as this plays an important role in increasing self-esteem and reducing their problematic mobile social media use.

Emotional Profiles of Anxiety, Depression, and Stress: Differences in School Anxiety

INTRODUCTION

This study aims to confirm the existence of profiles according to the combinations of anxiety, depression, and stress, and looks to examine the differences between profiles according to the mean scores obtained in school anxiety.

METHODS

A total of 1,234 Spanish students at the secondary education level with an age range of 13-16 years old (M = 14.52; SD = 1.24) participated in the study by completing the abbreviated version of the Depression, Anxiety, and Stress Scale (DASS-21) and the School Anxiety Inventory.

RESULTS

The results showed positive, statistically significant, and moderate-sized correlations between all the variables analyzed. The Latent Profile Analysis identified four distinct profiles of depression, anxiety, and stress: Low DAS, Moderate DAS, High DAS, and Very High DAS. The results of the MANOVA showed statistically significant differences between these profiles regarding the school anxiety dimensions, with the profiles Very High DAS and Low DAS being the ones that reported, respectively, the highest and lowest levels in all the school anxiety components. Post hoc analyses revealed significant differences for the large part of profile comparisons, with there being large and moderate differences observed in the majority of cases (d = .30 and 1.66).

CONCLUSIONS

The results show the importance of considering social anxiety as a construct that is strongly associated with emotional problems such as depression, anxiety, and stress when developing effective actions to detect them and intervene with adolescents.

How relative deprivation affects the sleep quality of Chinese college students: testing an integrated model of social anxiety and trait mindfulness

Although previous studies have confirmed the association between relative deprivation and individual health, the relationship between and underlying mechanisms of relative deprivation and sleep quality have rarely been explored. Therefore, the present study investigated how relative deprivation affected sleep quality by testing an integrated model and examining the roles of social anxiety and trait mindfulness. We surveyed 568 college students using the Relative Deprivation Scale, Interaction Anxiousness Scale, Mindful Attention Awareness Scale, and Pittsburg Sleep Quality Index. Data were analyzed using SPSS 24.0 and PROCESS macro for SPSS. We found that a high relative deprivation score predicted poor sleep quality, and social anxiety partially mediated this relationship. Our model also indicated that the relationship between relative deprivation and sleep quality via social anxiety was moderated by mindfulness. Specifically, increasing trait mindfulness may decrease the indirect effect of relative deprivation on sleep quality through social anxiety. The current study expands our understanding of the underlying mechanisms, paths, and conditions of the effects of relative deprivation on sleep quality. Furthermore, we provide additional evidence that trait mindfulness can mitigate the adverse effects of negative events. College students should consciously use trait mindfulness techniques to consider problems, reduce anxiety, and improve their sleep quality.

The relationship between emotional neglect and non-suicidal self-injury among middle school students in China: the mediating role of social anxiety symptoms and insomnia

 BACKGROUND: Non-suicidal self-injury (NSSI) is a vital public concern around the world, and it often starts in adolescence. Emotional neglect (EN) has been considered a distal risk factor for NSSI, but the effects of social anxiety symptoms (SA) and insomnia on this relationship have remained unclear. This study aimed to investigate the potential pathways from EN to NSSI, examining the role of SA and insomnia in this association.

METHODS

One thousand three hundred thirty seven Chinese middle school students (M_age = 13.040, SD = 0.981, 50.2% males) in China were enrolled in this cross-sectional study. Participants completed the Emotional Neglect sub-scale of Childhood Trauma Questionnaire (CTQ-SF), the Social Anxiety Scale for Adolescent (SAS-A), Athens Insomnia Scale (AIS) and non-suicidal self-injury assessment. Structural equation modelling (SEM) was used to test the possible mediation model among these variables.

RESULTS

231(17.3%) students reported NSSI history during last year and 322 (24.1%) participants reported experiences of EN. Students who experienced EN have higher rates of NSSI compared to students without EN history (29.2% vs 13.5%). EN, SA, insomnia and NSSI were positively related to each other. Furthermore, both SA and insomnia played a mediating role in the relationship between EN and NSSI, the series mediating effect of SA and insomnia on this association was also significant after controlling for demographics. Indirect effects accounted for 58.26% of the total effects (EN → NSSI).

CONCLUSIONS

Our study revealed that EN was associated with NSSI, SA and insomnia play indirect roles in the association between EN and NSSI. The findings of our research may have implications for clinicians, families, and schools in their efforts to lower the risk of NSSI in adolescents.

The relationship between social anxiety and academic engagement among Chinese college students: A serial mediation model

BACKGROUND

Few studies have elucidated the mechanisms linking social anxiety and academic engagement. This study aimed to explore the link between social anxiety and academic engagement through a series of mediating effects of social media addiction and sleep quality among college students.

METHODS

2661 college students completed the Liebowitz Social Anxiety Scale, the Bergen Social Media Addiction Scale, the Pittsburgh Sleep Quality Index, and the Utrecht Work Engagement Scale for Student. The serial mediation analysis was conducted using Hayes' PROCESS macro (Model 6).

RESULTS

Social anxiety had a significantly direct effect on academic engagement (c = -0.162, p < 0.001) and through three significantly indirect pathways: (1) through social media addiction (B = -0.019, 95% CI: -0.027 to -0.011), accounting for 11.7% of the total effect; (2) through poor sleep quality (B = -0.043, 95% CI: -0.052 to-0.034), accounting for 26.5% of the total effect; and (3) through the serial mediators involving in social media addiction and poor sleep quality (B = -0.007, 95% CI: -0.009 to -0.005), accounting for 4.3% of the total effect. The total mediating effect was 42.6%.

LIMITATIONS

This cross-sectional study prevented us from establishing causality.

CONCLUSIONS

This study highlights the serial mediating role of social media addiction and sleep quality, the behavior and lifestyle factors, in the relationship between social anxiety and academic engagement. Therefore, social media addiction and sleep quality interventions for college students with social anxiety have the potential to improve their academic engagement.

Exposure to domestic violence and depressive symptoms in Chinese adolescents: Sleep problems as a mediator

INTRODUCTION

Exposure to domestic violence has been shown to be an important risk factor of depression in western studies, but has received less attention in Chinese context. Additionally, the underlying mechanism of its link with depression has not been fully studied. With a longitudinal design, we examined the mediating role of sleep problems between exposure to domestic violence and depressive symptoms in Chinese adolescents, and further considered potential age and gender differences in the direct and indirect pathways.

METHODS

Participants were recruited from primary and junior high schools in China and were surveyed across two waves with a 6-month interval. There were 1949 participants at Wave 1 and 1283 at Wave 2. Structural equation model was conducted to examine the mediating role of sleep problems in the association between exposure to domestic violence and depressive symptoms. Multigroup analyses were applied to test potential age and gender differences in the process.

RESULTS

Participants' exposure to domestic violence predicted increasing sleep problems, which further predicted more depressive symptoms. Age and gender moderated the indirect pathway from exposure to domestic violence to depressive symptoms through sleep problems, such that the mediating effects of sleep problems were significantly stronger in early-age adolescents and girls than middle-age ones and boys.

IMPLICATION

Parents should avoid the use of corporal punishment and protect their children from domestic violence. For adolescents who have underwent domestic violence, parents and clinicians might consider to decrease their depressive symptoms by ameliorating sleep problems, especially for the early-age adolescents and girls.

Potential Applications of Social Robots in Robot-Assisted Interventions for Social Anxiety

Social anxiety disorder or social phobia is a condition characterized by debilitating fear and avoidance of different social situations. We provide an overview of social anxiety and evidence-based behavioural and cognitive treatment approaches for this condition. However, treatment avoidance and attrition are high in this clinical population, which calls for innovative approaches, including computer-based interventions, that could minimize barriers to treatment and enhance treatment effectiveness. After reviewing existing assistive technologies for mental health interventions, we provide an overview of how social robots have been used in many clinical interventions. We then propose to integrate social robots in conventional behavioural and cognitive therapies for both children and adults who struggle with social anxiety. We categorize the different therapeutic roles that social robots can potentially play in activities rooted in conventional therapies for social anxiety and oriented towards symptom reduction, social skills development, and improvement in overall quality of life. We discuss possible applications of robots in this context through four scenarios. These scenarios are meant as ‘food for thought’ for the research community which we hope will inspire future research. We discuss risks and concerns for using social robots in clinical practice. This article concludes by highlighting the potential advantages as well as limitations of integrating social robots in conventional interventions to improve accessibility and standard of care as well as outlining future steps in relation to this research direction. Clearly recognizing the need for future empirical work in this area, we propose that social robots may be an effective component in robot-assisted interventions for social anxiety, not replacing, but complementing the work of clinicians. We hope that this article will spark new research, and research collaborations in the highly interdisciplinary field of robot-assisted interventions for social anxiety.

Prevalence of overweight and obesity among Brazilian adolescents over time: a systematic review and meta-analysis

OBJECTIVE

To estimate the burden of excess weight in Brazilian adolescents.

DESIGN

Systematic review with meta-analysis.

SETTING

We searched the literature in four databases (MEDLINE/PubMed, EMBASE, SciELO and LILACS). Studies were included if they had cross-sectional or cohort design and enrolled Brazilian adolescents. Studies based on self-reported measures were excluded. Random effect models were used to calculate prevalence estimates and their 95 % CI.

PARTICIPANTS

Brazilian adolescents (10 to 19 years old).

RESULTS

One hundred and fifty-one studies were included. Trend analyses showed a significant increase in the prevalence of excess weight in the last decades: 8·2 % (95 % CI 7·7, 8·7) until year 2000, 18·9 (95 % CI 14·7, 23·2) from 2000 to 2009, and 25·1 % (95 % CI 23·4, 26·8) in 2010 and after. A similar temporal pattern was observed in the prevalence of overweight and obesity separately. In sensitivity analyses, lower prevalence of excess weight was found in older adolescents and those defined using International Obesity Task Force cut-off points. The Southeast and South regions had the highest prevalence of excess weight, overweight and obesity. No significant difference in prevalence by sex was found, except for studies before the year 2000.

CONCLUSIONS

The prevalence of overweight and obesity in Brazilian adolescents is high and continues to rise. Public policies on an individual level and targeting modifications in the obesogenic environment are necessary.

Constructs of poor sleep quality in adolescents: associated factors

This study aims to evaluate factors associated with sleep quality (overall and by domains) in adolescents. A cross-sectional study. This study was conducted with 1,296 first-year high school students from public schools in the Northern Region of the State of Pernambuco, Brazil. Demographic, socioeconomic, and behavioral data were obtained with a questionnaire. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI) Body mass index (BMI) was calculated based on the ratio of weight and height squared. Multilevel linear and logistic regressions evaluated factors associated with sleep quality. We observed 53% of adolescents reported poor sleep quality. Adolescents at higher risk of clinical depression were 3.45 times more likely to have poor sleep quality (95%CI: 2.04; 5.81), and each additional unit in the social anxiety score presented 1.03 (95%CI: 1.01; 1.05) higher odds of adolescents having poor sleep quality. Adolescents with depressive symptoms had higher sleep latency, greater sleep disturbance, and greater daytime sleep dysfunction. Social anxiety was associated with sleep latency, sleep disturbance, and daytime sleep dysfunction. Higher risk of clinical depression was associated with all domains related to sleep quality. Negative health perception was associated with sleep disturbance, and physical inactivity was associated with daytime sleep dysfunction. Social anxiety and especially higher risk of clinical depression were determinants of poor sleep quality. Changes in sleep latency, sleep disturbance and daytime sleep dysfunction seems to be relevant to poor sleep quality.

Social Anxiety in 15-19 Year Adolescents in Association with Their Subjective Evaluation of Mental and Physical Health

BACKGROUND

Studies show that social anxiety in adolescence have negative impact on quality of life. The study evaluates social anxiety links with mental and physical health factors in adolescents aged 15-19 years.

METHODS

The research was performed in 2018 in secondary schools in Lithuania and included 1722 participants (46.1% males and 53.9% females). The social anxiety was assessed using Social Anxiety and Avoidance Scale for Adolescents. The main results were obtained using univariate and multivariate logistic regression analysis.

RESULTS

Total of 58.5% of adolescents were characterized by high social anxiety and 14.7% by high avoidance. Females more often were characterized by high anxiety compared to males. Multivariate logistic regression revealed that good mental health was a significant protective factor against high SA in adolescents. For females, high anxiety and avoidance were associated with living with both parents, for males, high anxiety was linked with mother's university education. Very common stomach and abdominal pain in females as well as severe and very common stomach or abdominal pain in males, increase the risk of major social anxiety.

CONCLUSIONS

High social anxiety were more prevalent between females than males and was linked with various well-being and health aspects in adolescents.

Sleep Quality in Medical Staffs During the Outbreak of Coronavirus Disease 2019 in China: A Web-Based Cross-Sectional Study

Background: The aim of this study was to describe the sleep quality and its influencing factors among medical workers of different working statuses and staff types during the coronavirus disease 2019 (COVID-19) epidemic. Methods: Through an online questionnaire survey, all medical staffs in Xiangya Hospital were invited to complete sections on general information, the Self-Rating Scale of Sleep (SRSS), the Depression, Anxiety and Stress Scale (DASS-21), the Social Support Rating Scale (SSRS), and the Simplified Coping Style Questionnaire (CSQ). Results: A total of 4,245 respondents completed the survey. Among them, 38.7% had sleep disturbance. After matching, the SRSS scores in the staffs who were assigned to the intensive care unit (ICU) of Union Hospital in Wuhan and working in the epidemic area of Xiangya Hospital were not significantly different (P > 0.05); the SRSS scores in the battlefront staffs were significantly higher than (P < 0.05) those who were not treating patients infected with COVID-19. The SRSS scores of nurses were significantly higher than those of doctors and hospital administrators (P < 0.01). Anxiety, depression, and coping style were associated with sleep disturbance. Conclusion: The sleep quality of the medical staffs has been impaired during the epidemic period, especially among nurses, doctors, and administrators who are working on the front line. Medical institutions should strengthen psychological services and coping strategies for medical staffs.

Sleep-Related Problems and Pediatric Anxiety Disorders

Sleep-related problems are highly prevalent among childhood and adolescent anxiety disorders. The objective of this review was to summarize the relevant clinical research literature as it pertains to the nature of the association between sleep-related problems and youth anxiety, developmental factors relevant to this association, and intervention efforts to target comorbid sleep challenges and anxiety. Limitations of the literature and future directions are discussed.

Association between leg motor restlessness and depression among Chinese males living at high-altitude: the mediating role of insomnia

OBJECTIVE

Previous research has documented an association between insomnia and depression among patients with restless legs syndrome (RLS)/Willis-Ekbom disease. Given that leg motor restlessness (LMR) is closely related to RLS, the purpose of this study was to investigate the prevalence of insomnia and depression among individuals with LMR. In addition, we examined the associations among LMR, insomnia, and depression in a sample of young Chinese men living in high-altitude areas.

METHODS

Chinese military personnel working on the Qinghai Tibet Plateau (Lhasa, an altitude of 3600 m) were recruited in 2019 to complete a series of questionnaires. Participants having the urge to move their legs but not meeting the diagnostic criteria for RLS were classified as having LMR. Hierarchical linear regressions and mediational analyses using the SPSS PROCESS macro in SPSS were conducted to examine the associations among LMR, insomnia, and depression.

RESULTS

Of 196 participants, 36 (18%) had LMR. Only 1 participant was diagnosed with RLS. The proportions of participants suffering from insomnia who had LMR and did not have LMR were 44% and 22%, respectively. For depression, the proportions were 47% and 28%, respectively. Results of the hierarchical linear regressions showed that both LMR and depression were associated with increased insomnia symptoms. In addition, results from the mediational analyses indicated that the indirect effect of LMR on depression was significant and accounted for 52% of the total effect.

CONCLUSIONS

Participants with LMR had a higher prevalence of insomnia and depression compared with those without LMR. In addition, LMR was correlated with depression, and insomnia played a significant role in this co-occurrence.

Effects of Strength Training on Sleep Parameters of Adolescents: A Randomized Controlled Trial

Santiago, LCS, Lyra, MJ, Germano-Soares, AH, Lins-Filho, OL, Queiroz, DR, Prazeres, TMP, Mello, MT, Pedrosa, RP, Falcão, APST, and Santos, MAM. Effects of strength training on sleep parameters of adolescents: a randomized controlled trial. J Strength Cond Res XX(X): 000-000, 2020-This study aimed to examine the effects of 12-weeks of strength training (ST) on sleep quality and daytime sleepiness in adolescents with sleep complaints. Thirty adolescents were randomly assigned to 2 groups: ST group (ST, n = 18) and control group (CG, n = 12). Anthropometric, body composition, one-repetition maximum test, and sleep parameters (Pittsburgh Sleep Quality Index [PSQI] and Epworth Sleepiness Scale [ESS]) were evaluated. Training consisted of 55 min·d (3 times a week, for 12-weeks), 3 sets of 10-12 repetitions with a 1-minute rest interval between sets and exercises. Baseline and postintervention differences were analyzed using Generalized Estimating Equations and the effect size (ES) with Cohen's d coefficient. Significance was set at (p < 0.05). After 12-weeks of ST, a significant decrease in the PSQI score (7.3 ± 0.7 vs. 5.1 ± 0.6; ES = 4.10) was observed in the ST group, but not in the CG (6.3 ± 0.8 vs. 7.4 ± 0.7; ES = 1.53). A significant decrease in ESS score was found in the ST group (10.1 ± 0.7 vs. 8.2 ± 0.7; ES = 3.08), without differences in the CG (10.7 ± 0.8 vs. 11.0 ± 0.7; ES = 0.56). The ST group presented increased total sleep duration (h·min) (6.2 ± 0.2 vs. 6.9 ± 0.2; ES = 3.60), but not the CG (7.0 ± 0.2 vs. 6.8 ± 0.1; ES = 1.32). Individual analyses showed ≈67% of adolescents experienced a reduction in PSQI (8.3; confidence interval [CI] 95% 6.8-10.1) and ESS (8.3; CI 95% 6.7-9.9) scores after ST, whereas only ≈17% of control participants presented reduced scores (PSQI [11.1; CI 95% 9.5-12.9] and ESS [11.0; CI 95% 9.4-12.6]). Strength training improved sleep quality and increased total sleep duration.

Structural Alterations in Large-scale Brain Networks and Their Relationship with Sleep Disturbances in the Adolescent Population

Although sleep disturbances are highly prevalent in adolescents, neuroimaging evidence on the effects of sleep disturbances on their developing brains remains limited. Therefore, we explored gray matter volumes (GMVs) at the whole-brain level and investigated their relationship to sleep disturbances in a sample of Korean adolescents in the general population. We recruited participants from one middle school and high school. All participants and their legal guardians gave informed consent before participating in our study. We used component 5 of the Pittsburgh Sleep Quality Index to measure sleep disturbances and conducted a voxel-based morphometry-DARTEL procedure to measure GMVs. We performed partial correlation analyses to examine whether the GMVs were associated with sleep disturbances. A total of 56 adolescents participated in this study. Our results revealed that GMVs in multiple global regions were negatively correlated with sleep disturbances. Moreover, most of these identified regions belong to large-scale brain networks categorized by functional neuroimaging studies. We found an association between regional GMVs in multiple global regions involved in large-scale networks and the severity of sleep disturbances in the adolescent population. Based on this evidence and previous neuroimaging evidence, we suggest that structural alterations in the networks may be linked to sleep disturbances.