Longitudinal trajectories of insomnia symptoms among college students during the COVID-19 lockdown in China

Bedtime music therapy for college students with insomnia: A randomized assessor-blinded controlled trial

BACKGROUND

Insomnia, a prevalent sleep disorder in contemporary society, frequently coexists with other mental health conditions such as depression, schizophrenia, and obsessive-compulsive disorder. Sleep disorders can compromise daytime functioning and overall quality of life. While music has been explored as an adjunct therapy for insomnia, its efficacy in improving insomnia among students remains unclear.

METHODS

Seventy-five students, aged between 18 and 30 years with an average age of 20.97 years (SD: 1.92), presenting sleep issues were randomly allocated to one of three groups: the classical music group, the jazz music group, and the control group, each with 25 participants. Participants in the classical and jazz music group were instructed to listen to classical or jazz music for a minimum of 30 min preceding bedtime. This was paired with deep breathing and relaxation techniques, practiced two consecutive nights per week from 23:00 to 01:00 over a five-week intervention period. Conversely, participants in the control group were only directed to follow the deep breathing and relaxation techniques before sleep on two consecutive nights weekly. Insomnia severity with the Insomnia Severity Index (ISI), sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), depressive symptoms with the Beck Depression Inventory-II (BDI- II), and anxiety symptoms with the Self-rating Anxiety Scale (SAS). Measurements were taken at baseline, after the second week of intervention, at the intervention's conclusion (five weeks), and two months post-intervention (follow-up).

RESULTS

1. The music groups showed a significant difference in insomnia severity compared with the control group after five weeks of intervention(p < .05). 2. music groups exhibited significant enhancements in sleep quality relative to the control group after a five-week intervention (p < .05). 3. Regarding mood enhancement, music groups showed significant improvements in depression and anxiety symptoms compared to the baseline after the five-week intervention. Notably, the control group also displayed improvements in these symptoms post-intervention.

CONCLUSION

1. Integrating music into a consistent bedtime routine ameliorates sleep quality and insomnia severity. However, no specific genre of music emerged as the superior choice for pre-sleep listening. 2. While music can considerably enhance mood indicators like depression and anxiety, techniques such as deep breathing and mindfulness also contribute positively. 3. Incorporating music before sleep tangibly elevates overall quality of life and daytime functioning.

TRIAL REGISTRATION

ChiCTR2300073953.

Cross-Lagged Panel Networks of Sleep Inertia Across Its Distinct Change Patterns Among Intern Nurses with Shift Work in China

Purpose

Although experimental psychopathology using PET, EEG, and fMRI is at the forefront of understanding the underlying mechanisms of sleep inertia, many questions concerning causality remain unanswerable due to ethical constraints and the use of small and heterogeneous samples in experimental methods. There is a pressing need for a novel perspective in a large and relatively homogeneous population to fully capture and elucidate longitudinal processes and dynamic causality that culminate in episodes of sleep inertia over time. Therefore, this study aimed to reveal the causal relationships between symptoms of sleep inertia across its distinct patterns.

Patients and Methods

A total of 1636 intern nurses participated in the first survey (94.1% validity rate), then 1277 intern nurses were followed up (82.9% tracing rate). Symptoms of sleep inertia were self-reported using the Sleep Inertia Questionnaire. The cross-lagged panel network models were used to examine unique longitudinal relationships between symptoms of sleep inertia across distinct trajectories.

Results

Four distinct trajectories of sleep inertia were established. Additionally, we found differences in those symptoms with the highest influence on other symptoms at the subsequent point across the networks of four trajectories, particularly, "Difficulty in concentrating" in the persistent-high group and "Feeling tense" in the deteriorating groups.

Conclusion

The current study highlights changes in sleep inertia based on the long-term course over time. Notably, symptoms of "Difficulty in concentrating" and "Feeling tense" are imperative to address these specific symptoms within subpopulations.

Prevalence, correlates, and mental health outcomes of social jetlag in Chinese school-age adolescents: A large-scale population-based study

BACKGROUND

This cross-sectional study aimed to examine the prevalence and correlates of social jetlag (SJL) in Chinese adolescents, as well as to test the relationships between SJL and mental health problems.

METHODS

A total of 106979 students (Mage = 13.0 ± 1.8 years; Nmale = 58296 [54.5 %]) from Shenzhen, China completed an online survey from May 24th to June 5th, 2022. Information on sociodemographics, lifestyles, sleep characteristics, anxiety symptoms, and depressive symptoms was collected by a self-administered questionnaire. Multivariate and binary logistic regression were adopted for data analysis.

RESULTS

17.8 % of participants experienced SJL ≥ 2 h. To adjust the accumulated sleep debt, sleep-corrected SJL (SJLsc) was calculated and 8.3 % of individuals self-reported SJLsc ≥ 2 h. Both SJL and SJLsc show an increasing trend with age. Risk factors of SJL included females, poor parental marital status, being overweight, physically inactive, smoking, drinking, and having a late chronotype. Moreover, males, having siblings, boarding at school, short sleep duration, experiencing insomnia, and frequent nightmares were significantly associated with an increased risk of SJLsc. After adjusting for all covariates, adolescents with SJLsc ≥ 2 h were more likely to have anxiety symptoms (OR: 1.35, 95 % CI: 1.24-1.48) and depressive symptoms (OR: 1.35, 95 % CI: 1.25-1.46) than those with SJLsc < 1 h.

CONCLUSIONS

SJL is common among Chinese school-age adolescents. This study is valuable for the development of prevention and intervention strategies for SJL in adolescents at the population level. Additionally, the strong links between SJLsc and emotional problems underscore the critical significance of addressing SJL as a key aspect of adolescent well-being.

Bidirectional associations between short sleep duration, insomnia symptoms, and psychotic-like experiences in adolescents

This study investigates the prospective associations between short sleep duration, insomnia symptoms, and psychotic-like experiences (PLEs) in a large sample of Chinese adolescents. This study utilized a three-timepoint repeated cross-sectional survey with two nested longitudinal subsamples. A total of 17,722 adolescents were assessed at baseline (April 21 to May 12, 2021) and six months later (December 17 to 26, 2021). Out of these, 15,694 adolescents provided complete responses to the questions at baseline and one year later (May 17 - June 6, 2022). A self-administered questionnaire was used to measure sample characteristics (at baseline), sleep duration, insomnia symptoms, and PLEs (at each assessment), and negative life events (at two follow-ups). Baseline short sleep duration and insomnia symptoms predicted frequent PLEs at both follow-up assessments. Additionally, baseline frequent PLEs also predicted insomnia symptoms at six months and one year later. However, when controlling for confounders, PLEs at baseline only predicted short sleep duration at six months, and not at one year. This study reveals bidirectional prospective relationships between short sleep duration, insomnia symptoms, and PLEs, even after controlling for covariates. Therefore, it is crucial to assess both sleep patterns and PLEs in order to promote optimal sleep and mental health among adolescents.

Insomnia symptoms as a mediator between school connectedness and suicidal ideation in Chinese adolescents: A three-wave longitudinal model

AIM

School connectedness is related to suicidal ideation (SI) in adolescents. However, little is known about the mediating role of insomnia symptoms in the school connectedness-SI link. This study aimed to examine the longitudinal mediating effect of insomnia symptoms on the relationship between school connectedness and SI as well as the moderating effect of sex using a three-wave longitudinal design.

METHODS

A total of 3110 adolescents completed three online surveys. Data were collected over the course of 1 year, in three waves 6 months apart. Participants completed the School Connectedness Scale, Youth Self-Rating Insomnia Scale, Self-rating Idea of Suicide Scale, Beck Depression Inventory and a self-compiled demographic questionnaire. Linear regressions and mediation analyses were performed to examine the associations between school connectedness, insomnia symptoms and SI.

RESULTS

School connectedness had a significant mediating effect on SI through insomnia symptoms (βa×b = -.03, 95% confidence interval = -0.04, -0.02) after controlling for demographics and depressive symptoms. Mediation analyses showed that insomnia symptoms accounted for 23.1% of the total effects in the entire sample, with 13.3% in males and 27.3% in females. Sex had no significant moderating effect on the school connectedness-SI link association.

CONCLUSIONS

The association between school connectedness and SI appears to be mediated by insomnia symptoms. Assessing and promoting school connectedness, as well as intervening and treating distress associated with insomnia, may have important clinical implications for reducing the risk of SI in adolescents.

The development and evolution of the research topic on the mental health of college students: A bibliometric review based on CiteSpace and VOSviewer

Background

With the advances in society and in response to changing times, college students have had to face multiple challenges. These challenges frequently affect the mental health of college students, leading to significant consequences for their social lives, personal well-being, and academic achievements, thereby attracting extensive societal attention. Therefore, examining the current status of research topics related to the mental health of college students can assist academia in dissecting the influencing factors and seeking solutions at their source or through early intervention. This can contribute to a better understanding of and effectively address this challenge.

Method

CiteSpace and VOSviewer were used to conduct a bibliometric analysis of 1609 journal articles indexed in the Web of Science (WoS) database over the past two decades (2000-2022), which helped identify the current state of research and hot topics in the field based on development trends. Furthermore, this study analyzes and discusses the core authors, high-productivity countries and organizations, key journals, and keyword clustering in this field. This study clarifies the current research landscape, analyzes evolving trends based on developmental trajectories, and identifies forefront research hotspots. This study provides scholars with reference research directions and ideas for conducting subsequent studies.

Results

Since the beginning of the 21st century, research on college students' mental health has increased, especially in the past three years, and due to the impact of the COVID-19 pandemic and online distance learning, the number of publications has increased rapidly. With the increase in attention and publication volume, the countries and organizations contributing papers as well as core journals have all started to take shape. Cluster and evolution analyses found that several stable research topics have been formed in this research field, and many new and diverse topics are continuously emerging with time.

Conclusion

and prospect: The findings prove that the field of college students' mental health has begun to take shape, gradually shifting from conceptual research to the implementation of specific interventions. However, whether specific interventions are effective and how effective they are require further investigation.

Insomnia is more likely to persist than remit after a time of stress and uncertainty: a longitudinal cohort study examining trajectories and predictors of insomnia symptoms

STUDY OBJECTIVES

The study aimed to characterize insomnia symptom trajectories over 12 months during a time of stress and uncertainty, the coronavirus disease 2019 (COVID-19) pandemic. It also aimed to investigate sleep and psychological predictors of persistent insomnia symptoms.

METHODS

This longitudinal cohort study comprised 2069 participants with and without insomnia symptoms during the first year of the pandemic. Participants completed online surveys investigating sleep, insomnia, and mental health at four timepoints over 12 months (April 2020-May 2021). Additional trait-level cognitive/psychological questionnaires were administered at 3 months only.

RESULTS

Six distinct classes of insomnia symptoms emerged: (1) severe persistent insomnia symptoms (21.65%), (2) moderate persistent insomnia symptoms (32.62%), (3) persistent good sleep (32.82%), (4) severe insomnia symptoms at baseline but remitting over time (2.27%), (5) moderate insomnia symptoms at baseline but remitting over time (7.78%), and (6) good sleep at baseline but deteriorating into insomnia symptoms over time (2.85%). Persistent insomnia trajectories were predicted by high levels of sleep reactivity, sleep effort, pre-sleep cognitive arousal, and depressive symptoms at baseline. A combination of high sleep reactivity and sleep effort reduced the odds of insomnia remitting. Higher sleep reactivity also predicted the deterioration of good sleep into insomnia symptoms over 12 months. Lastly, intolerance of uncertainty emerged as the only trait-level cognitive/psychological predictor of insomnia trajectory classes.

CONCLUSIONS

Insomnia was more likely to persist than remit over the first year of the COVID-19 pandemic. Addressing sleep reactivity and sleep effort appears critical for reducing insomnia persistence rates after times of stress and uncertainty.

Perceived Epidemic Impacts and Mental Symptom Trajectories in Adolescents Back to School After COVID-19 Restriction: A Longitudinal Latent Class Analysis

PURPOSE

This study aimed to assess the impacts of COVID-19 epidemic on various life aspects and identify the trajectories of common mental symptoms among adolescents back to school after COVID-19 restriction. Furthermore, potential predictors associated with those trajectories were investigated.

METHODS

This longitudinal study, with five data collection points and a total follow-up of 68.4 days, was conducted among 1,393 junior high school students (mean age: 13.8 years; male, 53.3%) shortly after school reopened during the first COVID-19 outbreak in China. Questions on sociodemographics and perceived COVID-19 epidemic impacts were completed at the baseline while the Patient Health Questionnaire, Generalized Anxiety Disorder Scale, and Insomnia Severity Index were measured throughout the study for depression, anxiety, and insomnia symptoms, respectively. Trajectories of mental symptoms were classified by longitudinal latent class analysis, and the associated predictive factors were identified with multinomial regression modelling.

RESULTS

Our study revealed high but steadily declining prevalence of depression, anxiety, and insomnia symptoms (p trend < .001). Five distinctive trajectories were identified for both depression and anxiety ("resistance," "low symptom," "recovery," "chronic dysfunction," and "delayed dysfunction") and three for insomnia ("resistance," "low symptom," and "chronic dysfunction"). Besides the significant association between the mental symptom trajectories and students' perceived COVID-19 impacts on study practice, family income, and family relationship, female gender, lower school grade, and higher body mass index were found to be predictive of high severity trajectories.

DISCUSSION

Our findings may help locate the most psychologically vulnerable adolescents during the epidemic and foster better implementation of targeted intervention.

Three measures of internet use, social media use and video game playing as predictors of insomnia during the pandemic among students

Existing research indicates that the relationship between digital technology use and insomnia can largely depend on which digital technology measure and which insomnia measure is considered. Data on 4261 Slovenian tertiary students was gathered through an online survey in February 2021, which included measures of depression and insomnia symptoms, as well as measures of internet, social media and video game use divided into three measurement levels (use, duration of use, addictive use). Regression analysis revealed an apparent effect of measurement level, where addictive use measures consistently outperformed other technology use measures in predicting insomnia. Regardless of measurement level, social media use seems to produce more risk for insomnia, compared to playing video games or general internet use for leisure purposes. Importantly, a single measure of depression symptoms explained more variance in insomnia than the nine measures of digital technology use combined, meaning that the effect of digital technology on sleep should not be overstated. Most of the effect of social media use on insomnia may in fact be explained by understanding users' depression symptoms. In case of gaming, a larger part of its effect on insomnia is independent of depression symptoms.

Prevalence of sleep disturbances in children and adolescents during COVID-19 pandemic: a meta-analysis and systematic review of epidemiological surveys

The COVID-19 pandemic and the ensuing widespread lockdown measures have had a negative impact on the mental health of children and adolescents. We thus conducted a meta-analysis of the worldwide prevalence of sleep disturbances in children and adolescents during the COVID-19 pandemic. We performed a systematic literature search of the major international (PubMed, PsycINFO, Web of Science) and Chinese (Chinese Nation Knowledge Infrastructure (CNKI) and WANFANG) databases from their commencement dates to 27 December 2022. Altogether, 57 articles covering 206,601 participants were included in the meta-analysis. The overall prevalence of sleep disturbances was 34.0% (95% confidence interval (CI): 28-41%). The prevalence of parent-reported sleep disturbances during the COVID-19 pandemic was significantly higher than that of self-reported (p = 0.005) sleep disturbances. Epidemiological studies jointly conducted across Asia and Europe had a higher prevalence of sleep disturbances compared to those conducted in Asia, Europe, America, Oceania, or South America alone (p < 0.001). Children had a significantly higher prevalence of sleep disturbances compared to adolescents alone or a mixed cohort of children and adolescents (p = 0.022). Meta-regression analyses revealed that mean age (p < 0.001), quality evaluation score (p < 0.001), and percentage of men (p < 0.001) showed negative associations, while time of survey (B = 1.82, z = 34.02, p < 0.001) showed a positive association with the prevalence of sleep disturbances. Sleep disturbances were common in children and adolescents during the COVID-19 pandemic.

A longitudinal study on the change in sleep across three waves of the COVID-19 outbreaks in Hong Kong

In the year 2020, Hong Kong experienced four COVID-19 epidemic waves. The present study aimed to examine the transition of sleep disturbances and explore its associated factors across the later three epidemic waves. Among the 1138 respondents who participated in an online survey at the second wave (T1, April 2020), 338 and 378 participants also completed a follow-up at the third (T2, August 2020) and fourth waves (T3, December 2020), respectively. Participants completed the Insomnia Severity Index and an investigator-designed questionnaire regarding potential factors associated with sleep change such as perceived risk of being infected, economic stress, and confidence in the government and health care professional. Sample of this study were mainly female (67.7%), married (50.3%), young adults (54.2%) with tertiary education (81.6%). Maintaining normal sleep was the most prevalent trajectory of sleep of all three waves (50.5%), followed by persistent insomnia (17.2%) and remitted insomnia (9.0%). Besides female, older-age and lower education level, the results showed that increment in worry about family being infected (adjusted risk ratio, RR = 1.28), perceived interference of daily lives (adjusted RR = 1.19), and economic distress (adjusted RR = 1.24) were significantly associated with the development of clinical insomnia during the three epidemic waves. These factors were also associated with worsening of other sleep parameters. Insomnia being persistent across the three waves of COVID-19 outbreaks was common. Increasing economic distress, daily interference, and worry about family members being infected were associated with an increasing risk of clinical insomnia across the three COVID-19 outbreaks.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41105-023-00486-w.

Changes in sleep disturbance among Chinese adolescents: A population-based online survey

OBJECTIVE

Sleep disturbance is prevalent among adolescents but little is known about the short-term changes among Chinese adolescents. The study aimed to explore the prevalence and change patterns of sleep disturbance and identify its risk and protective factors.

METHODS

Data were collected online from April 21st to May 12th, 2021 (Time 1, T1) and December 17th to 26th, 2021 (Time 2, T2). The final sample comprised 34,260 adolescents. Self-administrated questionnaires were used to assess socio-demographic variables, sleep disturbance, depression, anxiety, life events, family function, and resilience.

RESULTS

The prevalence of sleep disturbance was 12.0% at T1 and 11.8% at T2, with higher rates in females than males. Four groups of sleep disturbance change patterns were identified: non-sleep disturbance group (80.4%), persistent group (4.2%), new-onset group (7.6%), and remission group (7.8%). Risk factors for new-onset sleep disturbance included being in junior high school (AOR = 1.26, 95%CI = 1.15-1.38), family history of mental disorders (AOR = 1.49, 95%CI = 1.03-2.15), and moderate (AOR = 1.24, 95%CI = 1.13-1.36) and severe (AOR = 1.48, 95%CI = 1.27-1.72) family dysfunction. Risk factors for persistent sleep disturbance included being in junior (AOR = 1.25, 95%CI = 1.08-1.45) and senior (AOR = 1.53, 95%CI = 1.15-2.03) high school, parental currently unmarried status (AOR = 1.34, 95%CI = 1.05-1.73), moderate (AOR = 1.19, 95%CI = 1.02-1.39) and severe (AOR = 1.28, 95%CI = 1.06-1.55) family dysfunction. Medium (AOR = 0.48, 95%CI = 0.43-0.53) and high (AOR = 0.34, 95%CI = 0.29-0.40) levels of resilience were protective factors against new-onset sleep disturbance, as well as against persistent sleep disturbance (medium level: AOR = 0.51, 95%CI = 0.43-0.60; high level: AOR = 0.32, 95%CI = 0.25-0.43).

CONCLUSIONS

Interventions aimed at promoting family functions and enhancing resilience may improve sleep disturbance among adolescents.

COVID-19 lockdown stress and problematic social networking sites use among quarantined college students in China: A chain mediation model based on the stressor-strain-outcome framework

The COVID-19 pandemic has coincided with a global increase in problematic social networking sites use (PSNSU). By drawing on transactional stress theory and applying the stressor-strain-outcome (SSO) framework, we proposed and verified a chain mediation model to explore the mediating roles of fear of missing out (FoMO) and future anxiety (FA) in the relationship between COVID-19 lockdown stress (CL stress) and PSNSU. Our sample of 670 quarantined college students in China responded to a COVID-19 student stress questionnaire, a social network addiction scale, a fear of missing out scale, and a dark future scale. The results revealed that (1) CL stress significantly positively predicted PSNSU, (2) both FoMO and FA mediated the relationship between CL stress and PSNSU, (3) FoMO significantly positively predicted FA, and (4) a full chain mediation was observed between CL stress and PSNSU.

Associations between insomnia symptom trajectories with depression and self-harm behaviors in Chinese college students before and during the COVID-19 pandemic: A five-wave longitudinal investigation

BACKGROUND

Sleep problems are highly prevalent during COVID-19 pandemic. However, only very limited studies have examined the changing patterns of insomnia symptom before and during the COVID-19 pandemic, and most of these studies were limited to two-wave designs and the variable-centered approach.

METHODS

The data was taken from a large-scale health-related cohort among Chinese college students. This cohort was a five-wave design and 3834 participants who completed at least two waves were included in the present study. Growth mixture modeling (GMM) was used to estimate trajectory classes for insomnia symptoms, followed by binary logistic regression to explore the association between trajectory classes and subsequent mental health problems.

RESULTS

GMM analyses extracted four distinct trajectories of insomnia symptoms: stable-low pattern (n = 2897, 75.6 %), increasing pattern (n = 405, 10.6 %), decreasing pattern (n = 182, 4.7 %), and stable-high pattern (n = 350, 9.1 %). Additionally, we found that individuals in stable-high and increasing patterns were more likely to experience mental health problems after the COVID-19 pandemic even after adjusting significant covariates and outcomes at baseline.

CONCLUSIONS

Appreciable heterogeneity in insomnia symptoms among college students was revealed before and during the COVID-19 pandemic. About 20 % of college students were classified as high-risk patterns of insomnia symptoms. Psychological interventions should target such vulnerable groups to reduce the rates of mental health problems.

Psychotic-Like Experiences and Suicidal Ideation Among Adolescents: The Chain Mediating Role of Insomnia Symptoms and Resilience

Background

Individuals who experience psychotic-like experiences (PLEs) are at significant risk of suicide-related behaviors. This two-wave longitudinal study aimed to investigate the relationships among PLEs, insomnia symptoms, resilience, and suicidal ideation (SI) among adolescents.

Methods

A total of 2231 college students [mean age (standard deviation) = 20.02 (1.39) years] completed two web-based surveys. Participants completed self-report measures of sample characteristics, PLEs, insomnia symptoms, resilience, and SI.

Results

The findings indicated a significantly positive correlation between PLEs and SI that was sequentially mediated by insomnia symptoms and resilience. Furthermore, insomnia symptoms and resilience played a chain-mediating role between PLEs and adolescent SI.

Conclusion

These findings suggest potential mechanism for the PLEs-SI link, which helps us better understand how PLEs can influence individual SI and provides important information for early prevention.

A randomized controlled trial examining a Tranquil sitting intervention compatible with Confucian values

Introduction

During the COVID-19 pandemic in China, the silent management (Lockdown) policy has caused severe sleep problems for university students. Long-term isolation may further deteriorate sleep quality, and it requires practical interventions. Today in mental and sleep health, interventions based on Buddhist, Taoist and Confucian ethics have been proven effective in reducing cognition and sleep disorders. However, such interventions also have limitations. They tend to focus on peace of mind or some technical means with the main direction of symptom improvement but neglect the mundane activities of daily life.

Methods

We conducted an innovative tranquil sitting intervention program based on the Chinese Confucian value of the "tranquility and reverence" method, integrating various intervention techniques traditionally recognized as effective for achieving more lasting mental health and sleep quality. This study aims to assess the effectiveness and feasibility of a tranquil sitting intervention in improving sleep problems in isolated university students. Using a randomized control trial (RCT), the participants in the intervention program (n = 35) practiced the tranquil sitting intervention program for ten weeks. They had their PSQI scores measured at the pre-experimental, post-test, and 1-month follow-up time points and compared to the control group (n = 35).

Results

The participants who received the tranquil sitting intervention had significantly better sleep quality than the control group, with moderate to large effect sizes in the middle and late stages. The instructor may challenge the intervention group at the beginning of the tranquil sitting technique. However, the improvement in sleep quality was significant after fully mastering the method.

Discussion

The intervention program in this study emphasized the importance of "tranquility" and showed the same sleep improvement as in other traditional interventions. In conclusion, this intervention is a feasible and promising new approach to improving sleep quality among youths.

Sleep disturbance is predictive of psychotic-like experiences among adolescents: A two-wave longitudinal survey

PURPOSE

Psychotic-like experiences (PLEs) are prevalent among adolescents and are the most significant predictor of future mental disorders. This study aims to examine the cross-sectional and longitudinal associations between sleep disturbance and PLEs in a large cohort of adolescents.

METHODS

The 17,722 adolescents in our study were assessed from April 21 to May 12, 2021 (Time 1, T1) and again 6 months later from December 17 to 26, 2021 (Time 2, T2). The Youth Self Rating Insomnia Scale and 8-item Positive Subscale of the Community Assessment of Psychic Experiences were used to assess sleep and PLEs, respectively. Sample characteristics and depression were also evaluated at T1, and negative life events were measured at T2. Sleep duration ≤6 h per night was considered as sleep deprivation, and sleep disturbance was defined as having insomnia or poor sleep quality.

RESULTS

The prevalence of sleep disturbance and frequent PLEs at T1 were 14.1% and 14.5%, respectively. Sleep disturbance and sleep deprivation at T1 were significantly associated with increased risk for PLEs at T2 after adjusting for sample characteristics, depression, and negative life events. Furthermore, sleep disturbance and sleep deprivation also predicted the new onset and persistence of PLEs.

CONCLUSION

Sleep disturbance predicts the development and persistence of PLEs. Early assessment and treatment of sleep disturbance may therefore contribute to a comprehensive strategy for the successful prevention and treatment of PLEs in adolescents.

Families, Schools, and the Longitudinal Changes in Psychological Distress among College Students during the First Year of the COVID-19 Pandemic: Evidence from a National Panel Survey in China

BACKGROUND

The psychological well-being of students in higher education has become an increasingly important concern in the context of the COVID-19 pandemic. The majority of prior studies were cross-sectional and thereby failed to capture the individual changes in mental health over time. Moreover, few studies have explored whether and how socioeconomic and education backgrounds could be related to college students' mental health changes. This study aimed to fill these gaps.

METHODS

Data were from a nationwide, two-wave panel survey of college students in China. Baseline information was collected in November 2019, i.e., before the outbreak of the COVID-19 epidemic in China. A follow-up survey was conducted in November and December 2020, when the epidemic was effectively contained in mainland China. In both waves, mental health was assessed with the 10-item Kessler Psychological Distress Scale (K10). The between-wave changes in psychological distress were measured and categorized.

RESULTS

Overall, 13.5% of students experienced at least a one-standard-deviation increase in psychological distress over the one-year follow-up. Results from both bivariate and multivariable analysis showed that this marked distress increase was more pronounced among vocational college students (vs. academic undergraduate and postgraduate students) and those with lower levels of academic performance. In contrast, family socioeconomic status (as measured by parental education, family economic condition, and current residence) was not associated with distress changes over time.

CONCLUSIONS

These findings highlight the importance of the educational disparities within the higher education system in understanding the mental health dynamics of college students in the context of the COVID-19 pandemic.

Centrality and bridge symptoms of anxiety, depression, and sleep disturbance among college students during the COVID-19 pandemic-a network analysis

Symptoms of depression and anxiety usually co-occur and are inextricably linked to sleep disturbance. However, little is known about the symptom-to-symptom relationships among these three mental disorders. Hence, to improve our understanding of concurrent depression, anxiety, and sleep disturbance, we used the network analysis approach to construct an interplay relationship among the above three mental disorders and identify which specific symptoms bridge these aggregations. We collected data from a large sample (N = 6710, male = 3074, female = 3636; mean age = 19.28) at a university. We estimated the symptom network structure of depression, anxiety, and sleep disturbance as assessed by the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Youth Self-Rating Insomnia Scale during the COVID-19 lockdown. We further investigated four goals: first, identifying the individual core symptoms in the network by the index of "expected influence"; second, determining the bridge symptoms that play roles in linking different mental disorders by the index of bridge expected influence (1-step); third, examining the robustness of all results; and fourth, providing an overall structure that may or may not differ by sex. The network structure was stable, accurate, and predictable. Items referring to sleep dissatisfaction, poor sleep quality, and uncontrollable worry were potentially core symptoms in the interplay among depression, anxiety, and sleep disturbance. Sleep, guilt, restlessness, irritability, and feeling afraid can function as bridges among depression, anxiety, and sleep disturbance, which is clinically relevant and theoretically important. The results suggested that the network structures significantly differed between the female and male networks. Robustness tests also revealed that the results were reliable.

Changes in suicidal ideation and related influential factors in college students during the COVID-19 lockdown in China

This study aims to investigate the patterns and predictors of suicidal ideation (SI) trajectories among college students during extended lockdowns in China. A three-wave survey was conducted during the outbreak period, remission period, and prevention period of COVID-19. Distinct patterns of SI trajectories were established by grouping respondents based on temporal changes in SI. Multivariate logistic regressions were performed to examine predictors for delay-occurrence and persistent SI. From a total of 35,516 college students included in the study, rates of SI increased significantly from T1 to T2 (7.3% v. 9.4%) and from T2 to T3 (9.4% v. 12.6%). Five SI trajectories were observed: resilient (80.5% of the sample), recovery (3.6%), relapsing/remitting (4.8%), persistent dysfunction (2.3%) and delayed dysfunction (8.7%). Further, junior-year undergraduates, postgraduates, only-child families, mental health history, confirmed cases in the community of residence, depressive symptoms, and negative coping strategies were significant predictors of distinct SI trajectories, whereas greater social support, more positive coping strategies, and better family functioning were associated with a lower probability of developing delayed or persistent dysfunction during the lockdown period. These findings suggest that continuous preventive and intervening measures for college students during COVID-19 lockdowns are of global importance, particularly among vulnerable groups who experience the most distress.

Trajectories of mental health status during the early phase pandemic in China: A longitudinal study on adolescents living in the community with confirmed cases

Sufficient research reports that individuals living in the community with confirmed COVID-19 cases are more likely to exhibit poor mental health condition. However, little is known about the longitudinal trajectories of mental health status among these people who are exposed to increased risk of contracting COVID-19. Using a 3-wave longitudinal survey between February and June 2020, data has been collected from 2,352 adolescents living in the community with confirmed cases. Depressive/anxiety symptoms, soc-demographic, and other psychological factors of interest (e.g., social support) were measured. Using latent growth mixture modeling, we identified two subgroups (Resistance vs. Dysfunction) of adolescents based on their depressive and anxiety symptoms. More social support and positive coping are identified as protective factors for mental health, whereas higher level of negative coping predicts unfavorable outcomes. These findings suggested that adolescents living in the community with confirmed cases of COVID-19 are a group to which researchers should pay more attention when studying the impacts of quarantine on mental health. It is also crucial to emphasize the role of social support and positive coping in planning psychological interventions for adolescents.

Alcohol Use and Misuse Among Chinese Psychiatrists During the Early COVID-19 Pandemic

AIM

Survey alcohol use and misuse among Chinese psychiatrists during the Coronavirus diseases 2019 (COVID-19) pandemic.

METHODS

We conducted a large-scale, nationwide online survey of psychiatrists regarding their alcohol use during the pandemic. The Alcohol Use Disorder Identification Test-Concise (AUDIT-C) was used to assess alcohol use and misuse.

RESULTS

Of 3,815 psychiatrists who completed the survey, alcohol use and misus were 47.5% and 8.2%, respectively, and both were significantly higher in males. The majority (59%) reported no change in alcohol use during the pandemic, one-third (34.5%) reported a decrease, and 6.5% reported an increase. Alcohol misuse was associated with middle-age (OR = 1.418), male sex (OR = 5.089), Northeast China (OR = 1.507), cigarette-smoking (OR = 2.335), insomnia (OR = 1.660), and regular exercise (OR = 1.488). A master's degree (OR = 0.714) and confidence in clinical work (OR = 0.610) were associated with less alcohol misuse. Those who reported a decrease in alcohol use during the pandemic were more likely to be male (OR = 2.011), located in Northeast China (OR = 1.994), and feel confident in their clinical work (OR = 1.624). Increased alcohol use was significantly associated with insomnia (OR = 3.139).

CONCLUSIONS

During the COVID-19 pandemic, alcohol use and misuse among Chinese psychiatrists declined. While males were more likely to misuse alcohol, they were also more likely to have reduced their intake. Age, location, and lifestyle factors also predicted alcohol use and misuse. Further examination of specific factors that reduced alcohol use and misuse may help guide public health efforts to sustain the lower rates beyond the pandemic.

Mental burden among Chinese undergraduate medical students: A prospective longitudinal study before, during, and after the COVID-19 outbreak

BACKGROUND

Increasing evidence indicated a clear association between COVID-19 pandemic and mental health. This study aimed to assess the dynamic change of mental burden during and after the COVID-19 outbreak and related predictive factors among Chinese undergraduate medical students.

METHODS

This longitudinal survey was conducted among Chinese undergraduate medical students before, during, and after the COVID-19 outbreak. We focused on COVID-19 related mental burdens including psychological distress, stress reaction, and insomnia symptoms, and defined the sum score of the three specific mental burden indexes as the overall mental burden index. The prevalence of specific and overall mental burdens and their changing patterns at two phases of the pandemic (during vs. after the COVID-19 outbreak) were measured. In addition, multinomial logistic regressions were used to assess the associations between the psychosocial status before the pandemic and specific and overall mental burden changing patterns.

RESULTS

Our findings showed that the prevalence of overall mental burden increased (from 27.46 to 37.28%) after the COVID-19 outbreak among the 863 Chinese undergraduate medical students who participated in the surveys at baseline, during, and after the COVID-19 outbreak. Specifically, the prevalence of stress reaction symptoms decreased (from 10.90 to 3.60%), while the rates of psychological distress (from 28.06 to 37.95%) and insomnia symptoms (from 12.54 to 20.71%) increased. Participants, with obsessive-compulsive symptoms, somatic symptoms, internet addiction, childhood adversity, stressful life events, and being neurotic were found to have a higher risk of developing mental burden in at least one survey (during or after the COVID-19 outbreak). Healthy family function and being extravert were found to positively impact mental burden.

CONCLUSION

Psychological distress, stress reaction and insomnia symptoms have been prevalent among Chinese undergraduate medical students during the COVID-19 outbreak, and the prevalence of overall mental burden increased after the COVID-19 outbreak. Some students, especially those with the risk factors noted above, exhibited persistent or progression symptoms. Continued mental health care was in demand for them even after the COVID-19 outbreak.