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Aristodemou ME, Kievit RA, Murray AL, Eisner M, Ribeaud D, Fried EI. Common Cause Versus Dynamic Mutualism: An Empirical Comparison of Two Theories of Psychopathology in Two Large Longitudinal Cohorts. Clin Psychol Sci 2024; 12:380-402. [PMID: 38827924 PMCID: PMC11136614 DOI: 10.1177/21677026231162814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/31/2023] [Indexed: 06/05/2024]
Abstract
Mental disorders are among the leading causes of global disease burden. To respond effectively, a strong understanding of the structure of psychopathology is critical. We empirically compared two competing frameworks, dynamic-mutualism theory and common-cause theory, that vie to explain the development of psychopathology. We formalized these theories in statistical models and applied them to explain change in the general factor of psychopathology (p factor) from early to late adolescence (N = 1,482) and major depression in middle adulthood and old age (N = 6,443). Change in the p factor was better explained by mutualism according to model-fit indices. However, a core prediction of mutualism was not supported (i.e., predominantly positive causal interactions among distinct domains). The evidence for change in depression was more ambiguous. Our results support a multicausal approach to understanding psychopathology and showcase the value of translating theories into testable statistical models for understanding developmental processes in clinical sciences.
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Affiliation(s)
- Michael E. Aristodemou
- Department of Clinical Psychology, Leiden University
- Donders Center for Medical Neurosciences, Radboud University Medical Center
| | - Rogier A. Kievit
- Donders Center for Medical Neurosciences, Radboud University Medical Center
- MRC Cognition and Brain Sciences Unit, University of Cambridge
| | - Aja L. Murray
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh
| | - Manuel Eisner
- Institute of Criminology, University of Cambridge
- Jacobs Center for Productive Youth Development, University of Zurich
| | - Denis Ribeaud
- Jacobs Center for Productive Youth Development, University of Zurich
| | - Eiko I. Fried
- Department of Clinical Psychology, Leiden University
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Nam S, Jeon S, Lee SJ, Ash G, Nelson LE, Granger DA. Real-time racial discrimination, affective states, salivary cortisol and alpha-amylase in Black adults. PLoS One 2022; 17:e0273081. [PMID: 36103465 PMCID: PMC9473392 DOI: 10.1371/journal.pone.0273081] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 08/02/2022] [Indexed: 02/04/2023] Open
Abstract
Perceived racial discrimination has been associated with the autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis activities-two major stress response systems. To date, most studies have used cross-sectional data that captured retrospective measures of the racial discrimination associated with current physiological stress responses. The purpose of this study was to examine the relationship between racial discrimination measured in real-time and physiological stress responses. Twelve healthy Black adults completed baseline surveys and self-collected saliva samples 4x/day for 4 days to measure cortisol and alpha amylase (AA) as a proxy of HPA and ANS systems, respectively. Real-time racial discrimination was measured using ecological momentary assessments (EMA) sent to participants 5x/day for 7 days. Multilevel models were conducted to examine the relationship between racial discrimination and stress responses. In multilevel models, the previous day's racial discrimination was significantly associated with the next day's cortisol level at wakening (β = 0.81, partial r = 0.74, p<0.01) and diurnal slope (β = -0.85, partial r = -0.73, p<0.01). Also, microaggressions were significantly associated with the diurnal cortisol slope in the same day, indicating that on the day when people reported more microaggressions than usual, a flatter diurnal slope of cortisol was observed (β = -0.50, partial r = -0.64, p<0.01). The concurrent use of salivary biomarkers and EMA was feasible methods to examine the temporal relationship between racial discrimination and physiological stress responses. The within-person approach may help us understand the concurrent or lagged effects of racial discrimination on the stress responses. Further studies are needed to confirm the observed findings with a large sample size and to improve stress related health outcomes in racial/ethnic minorities.
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Affiliation(s)
- Soohyun Nam
- Yale University, School of Nursing, Orange, CT, United States of America
| | - Sangchoon Jeon
- Yale University, School of Nursing, Orange, CT, United States of America
| | - Soo-Jeong Lee
- School of Nursing, University of California, San Francisco, San Francisco, CA, United States of America
| | - Garrett Ash
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States of America
- Center for Medical Informatics, Yale School of Medicine, New Haven, CT, United States of America
| | - LaRon E. Nelson
- Yale University, School of Nursing, Orange, CT, United States of America
| | - Douglas A. Granger
- School of Social Ecology, Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, United States of America
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Alaribe CU, Nwabara OU, Spruyt K. Daily concordance between ecological stressors and sleep in young minority children during the pre-COVID-19 outbreak period. SLEEP EPIDEMIOLOGY 2021; 1:100007. [PMID: 35673625 PMCID: PMC8442306 DOI: 10.1016/j.sleepe.2021.100007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/30/2021] [Accepted: 09/08/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE As the COVID-19 pandemic brings widespread changes in families, the sociology of sleep becomes noticeable. Yet, the socio-contextual determinants of a biopsychosocial phenomenon as sleep are poorly investigated. We examine changes concomitantly occurring in the child's sleep per familial and community stressors. METHODS During the pre-COVID-19 outbreak period, in 24 minority children (5.4 ± 1.7 years old, 54.2% girls), sleep was objectively measured 24 h for two consecutive weeks, and this was repeated three times over the study period of three months. The caregiver filled out questionnaires surveying sociodemographic, community and family aspects. RESULTS Children went to bed at 22:26 and woke up at 07:04, with each a variability of about 50 min. Money and time were revealed as related key stressors to sleep. Five dimensions best fitted their association. In general, concurrent changes within the individual child indicate that mean sleep variables seem to relate to predominantly features of the stressors (explained variance of 34.7 to 56.7%), while variability of sleep tends to associate to situational aspects of the stressors (explained variance of 30.4 to 61.8%). Associations were best explained in terms of the 24 h dimension, particularly exposing sleep variability. CONCLUSION Individual variabilities in a child's sleep are associated with familial resources, such as caregiver's time to self, money and basic needs. Time spent in bed, a modifiable factor by society and shaper of sleep quantity and quality, plays a key role in stressor-sleep associations. Insights from biopsychosocial perspectives may be valuable for understanding COVID-19 sleep studies, and the development of (post-) COVID-19 sleep recommendations.
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Key Words
- BN, basic needs
- BT, bedtime
- Child
- Family
- M, money
- Minority
- PEV, percentage explained variance
- RESTLESS, restlessness index
- RT, Risetime
- SES, socioeconomic status
- SOFL, sleep offset latency
- SONL, sleep onset latency
- Sleep duration
- Sleep variability
- Stress
- TF, time for family
- TIB, time in bed
- TS, time for self
- TST, total sleep time
- USS, urban stress score
- WASO, wake after sleep onset
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Affiliation(s)
- Calista U Alaribe
- College of Health Sciences, Department of Health Studies, Chicago State University, Chicago, IL, USA
| | - Odochi U Nwabara
- College of Health Sciences, Department of Health Studies, Chicago State University, Chicago, IL, USA
| | - Karen Spruyt
- NeuroDiderot -INSERM, Université de Paris, Paris F-75019, France
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Armstrong-Carter E, Nelson BW, Telzer EH. Prior night sleep moderates the daily spillover between conflict with peers and family and diurnal cortisol. Dev Psychobiol 2021; 63:e22209. [PMID: 34813096 PMCID: PMC9344783 DOI: 10.1002/dev.22209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 11/09/2022]
Abstract
We investigated whether daily experiences of conflict with family and peers were associated with fluctuations in diurnal cortisol, and whether sleep buffers the associations between conflict and diurnal cortisol. A racially diverse sample of 370 adolescents (ages 11-18; 57.3% female) provided daily diaries for 5 days and saliva samples for 4 days. Hierarchical linear models tested how peer and family conflict were associated with diurnal cortisol (i.e., total cortisol output, cortisol slope, and cortisol awakening response) the next day, and whether these associations were moderated by sleep duration the previous night. When adolescents experienced peer conflict, they showed higher area under the curve (AUC) the next day if they had slept less the night prior to conflict, but relatively lower cortisol awakening response (CAR) and flatter cortisol slope the next day if they had slept more the night prior to conflict. When adolescents experienced family conflict, they also showed higher AUC the next day if they had slept less the night prior to conflict, but higher CAR the next day if they had slept more the night prior to conflict. Family conflict and sleep were not directly or interactively related to cortisol slope.
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Affiliation(s)
| | - Benjamin W Nelson
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill
| | - Eva H Telzer
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill
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Rowe H, Jarrin DC, Noel NAO, Ramil J, McGrath JJ. The curious incident of the dog in the nighttime: The effects of pet-human co-sleeping and bedsharing on sleep dimensions of children and adolescents. Sleep Health 2021; 7:324-331. [PMID: 33935015 DOI: 10.1016/j.sleh.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/29/2021] [Accepted: 02/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pets are often thought to be detrimental to sleep. Up to 75% of households with children have a pet, and 30-50% of adults and children regularly share their bed with their pets. Despite these high rates, few studies have examined the effect of pet-human co-sleeping on pediatric sleep. This study compared subjective and objective sleep in youth who never, sometimes, or frequently co-slept with pets. METHODS Children (N = 188; aged 11-17 years; M = 13.25 years) and their parents answered standardized sleep questionnaires assessing timing, duration, onset latency, awakenings, and sleep quality. Children completed a home polysomnography (PSG) sleep study for one night and wore an actigraph for two weeks accompanied with daily sleep diary. Based on reported frequency of bedsharing with pets, children were stratified into three co-sleeping groups: never (65.4%), sometimes (16.5%), frequently (18.1%). RESULTS Overall, 34.6% of children reported co-sleeping with their pet sometimes or frequently. Results revealed largely identical sleep profiles across co-sleeping groups; findings were congruent across sleep measurement (subjective: child, parent report; objective: PSG, actigraphy). Effect sizes indicated that frequent co-sleepers had the highest overall subjective sleep quality, but longest PSG onset-latency compared to the sometimes group. CONCLUSIONS Co-sleeping with pets was prevalent in one third of children. Sleep dimensions were similar regardless of how frequently children reported sharing their bed with their pet. Future research should examine dyadic measurement of co-sleepers to derive causal evidence to better inform sleep recommendations.
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Affiliation(s)
- Hillary Rowe
- Pediatric Public Health Psychology Laboratory, Concordia University, Montréal, Québec, Canada
| | - Denise C Jarrin
- Pediatric Public Health Psychology Laboratory, Concordia University, Montréal, Québec, Canada
| | - Neressa A O Noel
- Pediatric Public Health Psychology Laboratory, Concordia University, Montréal, Québec, Canada
| | - Joanne Ramil
- Pediatric Public Health Psychology Laboratory, Concordia University, Montréal, Québec, Canada
| | - Jennifer J McGrath
- Pediatric Public Health Psychology Laboratory, Concordia University, Montréal, Québec, Canada.
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Wang C, Dai J, Li J. Mediating effects of hair cortisol on the mutual association of job burnout and insomnia: A retrospective exploratory study. J Psychiatr Res 2019; 117:62-67. [PMID: 31302350 DOI: 10.1016/j.jpsychires.2019.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUNDS The present study was designed to clarify the mutual association of job burnout and insomnia and to detect the mediating effects of hair cortisol on that association. METHODS In all, 68 female employees were recruited for the study from one secondary and one tertiary hospital between October 2018 and November 2018 in Beijing. Participants completed a questionnaire for the collection of demographic data and standardized measures for burnout and insomnia. Hair sample collection and anthropometric measurements were performed at the same time. RESULTS Median hair cortisol concentration (HCC) was 5.89 ng/g hair (interquartile range = 2.20-10.74). And ages are between 22 and 51 years old (32.50 ± 6.13), among which 22 were below 30 years, 20 were between 30 and 35 years, and 26 were over 35 years. A majority of Pearson's coefficients were significant, with the exception of that for the correlation between personal accomplishment and HCC or depersonalization. Significant mutual correlations were shown between burnout dimensions and insomnia directly. HCC acted as a mediator in the pathway from emotional exhaustion, depersonalization to insomnia; and no significant mediating effect of HCC in the pathway from insomnia to burnout was found. CONCLUSIONS Job burnout may directly or indirectly (through chronically elevated cortisol) increase insomnia risk, whereas insomnia probably promotes burnout. Prospective studies involving different body systems and a larger sample size should be performed to further identify the mechanisms underlying the associations between burnout and insomnia among the working population.
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Affiliation(s)
- Chao Wang
- Department of Disease Surveillance, Beijing Prevention and Treatment Hospital of Occupational Disease for Chemical Industry, Beijing, 100093, China; School of Public Health, Fudan University, Shanghai, 200032, China.
| | - Junming Dai
- School of Public Health, Fudan University, Shanghai, 200032, China.
| | - Jue Li
- Department of Disease Surveillance, Beijing Prevention and Treatment Hospital of Occupational Disease for Chemical Industry, Beijing, 100093, China.
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Dockray S, O'Neill S, Jump O. Measuring the Psychobiological Correlates of Daily Experience in Adolescents. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2019; 29:595-612. [PMID: 31573767 DOI: 10.1111/jora.12473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Mapping the psychobiological correlates of social contexts, experiences, and emotional responses of adolescents in their daily lives provides insight into how adolescent well-being shapes, and is shaped by, experience. Measures of these psychobiological correlates are enabled by devices and technologies that must be precise and suitable for adolescent participants. The present report reviews the most often used research measures, and suggests strategies for best practice, drawn from practical experience. The rapid advances in technological methods to collect attuned measures of psychological processes, social context, and biological function indicate the promise for multimodal measures in ecological settings. Attaining these methodological goals will support research to secure comprehensive, quality data, and advance the understanding of psychobiological function in ambulatory settings.
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Koss KJ, Gunnar MR. Annual Research Review: Early adversity, the hypothalamic-pituitary-adrenocortical axis, and child psychopathology. J Child Psychol Psychiatry 2018; 59:327-346. [PMID: 28714126 PMCID: PMC5771995 DOI: 10.1111/jcpp.12784] [Citation(s) in RCA: 261] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Research on early adversity, stress biology, and child development has grown exponentially in recent years. FINDINGS We review the current evidence for the hypothalamic-pituitary-adrenocortical (HPA) axis as a stress-mediating mechanism between various forms of childhood adversity and psychopathology. We begin with a review of the neurobiology of the axis and evidence for relations between early adversity-HPA axis activity and HPA axis activity-psychopathology, as well as discuss the role of regulatory mechanisms and sensitive periods in development. CONCLUSIONS We call attention to critical gaps in the literature to highlight next steps in this research including focus on developmental timing, sex differences, stress buffering, and epigenetic regulation. A better understanding of individual differences in the adversity-HPA axis-psychopathology associations will require continued work addressing how multiple biological and behavioral systems work in concert to shape development.
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Affiliation(s)
- Kalsea J. Koss
- Center for Research on Child Wellbeing, Office of Population Research, Department of Molecular Biology, Princeton, Princeton University, NJ, USA
| | - Megan R. Gunnar
- Center for Research on Child Wellbeing, Office of Population Research, Department of Molecular Biology, Princeton, Princeton University, NJ, USA
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Chang LY, Chang HY, Wu WC, Lin LN, Wu CC, Yen LL. Dual Trajectories of Sleep Duration and Cigarette Smoking during Adolescence: Relation to Subsequent Internalizing Problems. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2018. [DOI: 10.1007/s10802-018-0414-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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10
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Bublitz MH, Bourjeily G, D’Angelo C, Stroud LR. Maternal Sleep Quality and Diurnal Cortisol Regulation Over Pregnancy. Behav Sleep Med 2018; 16:282-293. [PMID: 27485239 PMCID: PMC6126356 DOI: 10.1080/15402002.2016.1210147] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Poor sleep in pregnancy is related to adverse neonatal health. Elevated maternal cortisol has been proposed as a pathway, yet the association in pregnancy is not well understood. The goals of the current study were to examine associations between (a) sleep and cortisol, (b) sleep, cortisol, and neonatal outcomes, and (c) variables that could explain these associations. Two hundred pregnant women completed the Pittsburgh Sleep Quality Index (PSQI; Buysse, Reynolds, Monk, Berman, & Kupfer, 1989) and provided diurnal salivary cortisol samples at two times over pregnancy. Poor sleep quality was associated with greater evening cortisol concentrations at 36 weeks' gestation. This association was mediated by anxiety symptoms. Higher evening cortisol at 36 weeks' gestation was associated with shorter gestation.
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Affiliation(s)
- Margaret H. Bublitz
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI USA,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University Providence, RI USA
| | - Ghada Bourjeily
- Department of Medicine, The Miriam Hospital, Alpert Medical School of Brown University Providence, RI USA
| | - Christina D’Angelo
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI USA
| | - Laura R. Stroud
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI USA,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University Providence, RI USA
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Meyer C, Barbosa DG, Junior GJF, Andrade RD, Silva DAS, Pelegrini A, Gomes Felden ÉP. Proposal of cutoff points for pediatric daytime sleepiness scale to identify excessive daytime sleepiness. Chronobiol Int 2017; 35:303-311. [PMID: 29144155 DOI: 10.1080/07420528.2017.1400980] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective of the present study was to propose cutoff points for the Pediatric Daytime Sleepiness Scale (PDSS) through sensitivity and specificity analyses in order to identify excessive daytime sleepiness, considering parameters such as duration and quality of sleep, health perception, stress control and depressive moods (feelings of sadness) in adolescents. A total of 1,132 adolescents, aged 14-19 years old, of both sexes, from the public high school of São José - SC, answered the questionnaire with information on age, daytime sleepiness, sleep duration, health perception, stress management, depressive moods (feelings of sadness) and quality of sleep. The Receiver Operating Characteristic (ROC) curve was used to estimate cutoff points considering the sensitivity and specificity values that best identify adolescents with excessive daytime sleepiness, using independent variables as a reference. The majority of the sample was female (54.2%), aged 14-16 years. The girls presented worse quality of sleep (66.4%), and the boys had a more positive perception of health (74.8%), better stress control (64.8%) and lower depressive moods (feelings of sadness) (63.3%). The largest area in the ROC curve was the one that considered sleep quality as a parameter in both sexes (area of the curve = 0.709 and 0.659, respectively, for boys and girls, p < 0.001). Considering sleep quality as a reference, the cutoff point for excessive daytime sleepiness was 15 points. The other parameters used were also significant (p < 0.005). Poor sleep quality was the parameter most strongly related to daytime sleepiness, and a cutoff of 15 points for the PDSS for both sexes should be used in the definition of excessive daytime sleepiness. For the other parameters, stress management, depressive mood (feelings of sadness) and health perception, different cutoff points are suggested for boys and girls.
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Affiliation(s)
- Carolina Meyer
- Center of Physical Activity and Health Research, Santa Catarina State University (UDESC), Florianópolis, SC, Brazil
| | - Diego Grasel Barbosa
- Center of Physical Activity and Health Research, Santa Catarina State University (UDESC), Florianópolis, SC, Brazil
| | - Geraldo Jose Ferrari Junior
- Center of Physical Activity and Health Research, Santa Catarina State University (UDESC), Florianópolis, SC, Brazil
| | - Rubian Diego Andrade
- Center of Physical Activity and Health Research, Santa Catarina State University (UDESC), Florianópolis, SC, Brazil
| | | | - Andreia Pelegrini
- Center of Physical Activity and Health Research, Santa Catarina State University (UDESC), Florianópolis, SC, Brazil
| | - Érico Pereira Gomes Felden
- Center of Physical Activity and Health Research, Santa Catarina State University (UDESC), Florianópolis, SC, Brazil
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Bai S, Robles TF, Reynolds BM, Repetti RL. Children's diurnal cortisol responses to negative events at school and home. Psychoneuroendocrinology 2017. [PMID: 28623764 DOI: 10.1016/j.psyneuen.2017.05.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This study examined the within-and between-person associations between daily negative events - peer problems, academic problems and interparental conflict - and diurnal cortisol in school-age children. Salivary cortisol levels were assessed four times per day (at wakeup, 30min later, just before dinner and at bedtime) on eight days in 47 youths ages 8-13 years old (60% female; M age=11.28, SD=1.50). The relative contributions of within- and between-person variances in each stressor were estimated in models predicting same-day diurnal cortisol slope, same-day bedtime cortisol, and next morning wakeup cortisol. Children who reported more peer problems on average showed flatter slopes of cortisol decline from wakeup to bedtime. However, children secreted more cortisol at wakeup following days when they had reported more peer or academic problems than usual. Interparental conflict was not significantly associated with diurnal cortisol. Findings from this study extend our understanding of short-term cortisol responses to naturally occurring problems in daily life, and help to differentiate these daily processes from the cumulative effects of chronic stress.
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Affiliation(s)
- Sunhye Bai
- University of California, Los Angeles, United States.
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13
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Baranger DAA, Margolis S, Hariri AR, Bogdan R. An earlier time of scan is associated with greater threat-related amygdala reactivity. Soc Cogn Affect Neurosci 2017; 12:1272-1283. [PMID: 28379578 PMCID: PMC5597858 DOI: 10.1093/scan/nsx057] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/25/2017] [Accepted: 04/02/2017] [Indexed: 12/13/2022] Open
Abstract
Time-dependent variability in mood and anxiety suggest that related neural phenotypes, such as threat-related amygdala reactivity, may also follow a diurnal pattern. Here, using data from 1,043 young adult volunteers, we found that threat-related amygdala reactivity was negatively coupled with time of day, an effect which was stronger in the left hemisphere (β = -0.1083, p-fdr = 0.0012). This effect was moderated by subjective sleep quality (β = -0.0715, p-fdr = 0.0387); participants who reported average and poor sleep quality had relatively increased left amygdala reactivity in the morning. Bootstrapped simulations suggest that similar cross-sectional samples with at least 300 participants would be able to detect associations between amygdala reactivity and time of scan. In control analyses, we found no associations between time and V1 activation. Our results provide initial evidence that threat-related amygdala reactivity may vary diurnally, and that this effect is potentiated among individuals with average to low sleep quality. More broadly, our results suggest that considering time of scan in study design or modeling time of scan in analyses, as well as collecting additional measures of circadian variation, may be useful for understanding threat-related neural phenotypes and their associations with behavior, such as fear conditioning, mood and anxiety symptoms, and related phenotypes.
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Affiliation(s)
- David A. A. Baranger
- BRAIN Laboratory, Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
- Division of Biology and Biomedical Sciences, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Seth Margolis
- BRAIN Laboratory, Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Ahmad R. Hariri
- Laboratory of NeuroGenetics, Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA
| | - Ryan Bogdan
- BRAIN Laboratory, Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
- Division of Biology and Biomedical Sciences, Washington University in St. Louis, St. Louis, MO 63110, USA
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Bernard K, Frost A, Bennett CB, Lindhiem O. Maltreatment and diurnal cortisol regulation: A meta-analysis. Psychoneuroendocrinology 2017; 78:57-67. [PMID: 28167370 DOI: 10.1016/j.psyneuen.2017.01.005] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 01/03/2017] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
Childhood maltreatment leads to a host of negative physical and mental health outcomes, with cortisol dysregulation implicated as a possible mechanism. Given inconsistencies across in the literature regarding the direction and magnitude of the association between maltreatment and diurnal cortisol regulation, the current meta-analysis of 27 studies aimed to examine the association between maltreatment and at least one of 3 indicators of diurnal cortisol regulation: wake-up cortisol levels, the cortisol awakening response (CAR), and/or the diurnal cortisol slope. Effect sizes were calculated using Hedges' g formula and were pooled using a random effects model. For the association between maltreatment and wake-up cortisol level, the aggregate effect size was g=0.08, p=0.26. Notably, effect sizes between maltreatment and wake-up cortisol were significantly larger (Qbetween=5.18, p=0.02) for studies of agency-referred samples, g=0.24, p=0.006, than studies for which maltreatment status was based on self-report, g=0.00, p=0.97, with maltreatment associated with reduced wake-up cortisol levels. For the association between maltreatment and the CAR and diurnal cortisol slope, the aggregate effect sizes were non-significant and none of the moderator variables were significant. Although results did not indicate a large and robust association between maltreatment and various indicators of diurnal cortisol, studies with more rigorous designs (i.e., agency-referred samples) showed a small, significant association between maltreatment and blunted wake-up cortisol levels, suggesting a pattern of hypocortisolism.
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Affiliation(s)
- Kristin Bernard
- Department of Psychology, Stony Brook University, United States.
| | - Allison Frost
- Department of Psychology, Stony Brook University, United States
| | | | - Oliver Lindhiem
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States
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Fernandez-Mendoza J, Baker JH, Vgontzas AN, Gaines J, Liao D, Bixler EO. Insomnia symptoms with objective short sleep duration are associated with systemic inflammation in adolescents. Brain Behav Immun 2017; 61:110-116. [PMID: 28041986 PMCID: PMC5316336 DOI: 10.1016/j.bbi.2016.12.026] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/28/2016] [Accepted: 12/28/2016] [Indexed: 01/14/2023] Open
Abstract
Inflammation has been suggested as a potential pathway by which insomnia and short sleep can affect risk of morbidity in adults. However, few studies have examined the association of insomnia with inflammation in adolescents, despite accumulating evidence that pathophysiologic changes may already occur during this critical developmental period. The present study sought to examine the association of insomnia symptoms with systemic inflammation and the role of objective sleep duration in this association. Participants were 378 adolescents (16.9±2.3y, 45.8% female) from the Penn State Child Cohort, a population-based sample who underwent 9-h polysomnography (PSG) followed by a single fasting blood draw to assess plasma levels of C-reactive protein (CRP) and other inflammatory markers. Insomnia symptoms were defined by a self-report of difficulties falling and/or staying asleep, while objective sleep duration groups were defined as a PSG total sleep time ⩾8, 8-7, and ⩽7h. We assessed the association of insomnia symptoms, objective sleep duration, and their interaction with inflammatory markers, while adjusting for multiple potential confounders. Adolescents reporting insomnia symptoms had significantly higher levels of CRP compared to controls and a significant interaction (p<0.01) showed that objective sleep duration modified this association. Elevated CRP was present in adolescents with insomnia symptoms and ⩽7h of sleep (1.79mg/L) as compared to controls or adolescents with insomnia symptoms and ⩾8h of sleep (0.90mg/L and 0.98mg/L, respectively) or controls with ⩽7h of sleep (0.74mg/L; all p-values <0.01). In sum, insomnia symptoms with objective short sleep duration are associated with systemic inflammation as early as adolescence. This study suggests that chronic low-grade inflammation may be a common final pathway towards morbidity in adulthood in this insomnia phenotype.
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Affiliation(s)
- Julio Fernandez-Mendoza
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA, USA.
| | - Joshua H. Baker
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA
| | - Alexandros N. Vgontzas
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA
| | - Jordan Gaines
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA
| | - Duanping Liao
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA
| | - Edward O. Bixler
- Sleep Research and Treatment Center, Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA
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Radin RM, Shomaker LB, Kelly NR, Pickworth CK, Thompson KA, Brady SM, Demidowich A, Galescu O, Altschul AM, Shank LM, Yanovski SZ, Tanofsky-Kraff M, Yanovski JA. Cortisol response to an induction of negative affect among adolescents with and without loss of control eating. Pediatr Obes 2016; 11:513-520. [PMID: 26667312 PMCID: PMC4909600 DOI: 10.1111/ijpo.12095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 11/11/2015] [Accepted: 11/12/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Adults with binge eating disorder may have an exaggerated or blunted cortisol response to stress. Yet, limited data exist among youth who report loss of control (LOC) eating, a developmental precursor to binge eating disorder. METHODS We studied cortisol reactivity among 178 healthy adolescents with and without LOC eating. Following a buffet lunch meal adolescents were randomly assigned to watch a neutral or sad film clip. After, they were offered snacks from a multi-item array to assess eating in the absence of hunger. Salivary cortisol was collected at -80, 0, 30 and 50 min relative to film administration, and state mood ratings were reported before and after the film. RESULTS Adolescents with LOC had greater increases in negative affect during the experimental paradigm in both conditions (ps > 0.05). Depressive symptoms, but not LOC, related to a greater cortisol response in the sad film condition (ps > 0.05). Depressive symptoms and state LOC were related to different aspects of eating behaviour, independent of film condition or cortisol response (ps > 0.05). CONCLUSIONS A film clip that induced depressed state affect increased salivary cortisol only in adolescents with more elevated depressive symptoms. Adolescents with and without LOC were differentiated by greater increases in state depressed affect during laboratory test meals but had no difference in cortisol reactivity. Future studies are required to determine if adolescents with LOC manifest alterations in stress reactivity to alternative stress-inducing situations.
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Affiliation(s)
- Rachel M. Radin
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Lauren B. Shomaker
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, 80523, USA
| | - Nichole R. Kelly
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA,Department of Human Development and Family Studies, Colorado State University, Fort Collins, Colorado, 80523, USA
| | - Courtney K. Pickworth
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Katherine A. Thompson
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Sheila M. Brady
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Andrew Demidowich
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Ovidiu Galescu
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Anne M. Altschul
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
| | - Lisa M. Shank
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Susan Z. Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Office of Obesity Research, Division of Digestive Diseases and Nutrition, National Institute of Diabetes, Digestive, and Kidney Disorders, NIH, DHHS, Bethesda, Maryland, 20892, USA
| | - Marian Tanofsky-Kraff
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA,Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Jack A. Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892, USA
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Reichl C, Heyer A, Brunner R, Parzer P, Völker JM, Resch F, Kaess M. Hypothalamic-pituitary-adrenal axis, childhood adversity and adolescent nonsuicidal self-injury. Psychoneuroendocrinology 2016; 74:203-211. [PMID: 27665080 DOI: 10.1016/j.psyneuen.2016.09.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Whereas childhood adversity (CA) and the hypothalamus-pituitary-adrenal (HPA) axis have been suggested to play a major role in the etiology of non-suicidal self-injury (NSSI), no study has thus far investigated both its associations and interactions with adolescent NSSI. METHOD We investigated CA (antipathy, neglect, physical, psychological, and sexual abuse) and indices of HPA axis activity (salivary and hair cortisol) in a clinical sample of 26 adolescents engaging in NSSI and 26 age- and gender-matched healthy controls (HC). We used standardized interviews for the assessment of CA (CECA), NSSI (SITBI-G), and axis I diagnoses (MINI-KID). Salivary cortisol sampling was surveyed using a monitoring system and instructed via telephone calls. RESULTS Adolescents engaging in NSSI exhibited significantly higher cortisol awakening responses compared to HC. No differences were found with respect to the diurnal slope or hair cortisol. In the presence of CA, healthy adolescents showed flatted diurnal cortisol slopes while those engaging in NSSI exhibited significantly steeper ones. CONCLUSIONS Our findings indicate that adolescents engaging in NSSI may exhibit a stronger cortisol awakening response, potentially in expectation of strain. However, elevated cortisol levels may not be maintained throughout the day, especially among adolescents with a history of CA.
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Affiliation(s)
- Corinna Reichl
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Anne Heyer
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Romuald Brunner
- Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Peter Parzer
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Julia Madeleine Völker
- Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Franz Resch
- Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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Zhang HS, Mai YB, Li WD, Xi WT, Wang JM, Lei YX, Wang PX. Sleep quality and health service utilization in Chinese general population: a cross-sectional study in Dongguan, China. Sleep Med 2016; 27-28:9-14. [PMID: 27938926 DOI: 10.1016/j.sleep.2016.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 10/07/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The aims of this study were to explore the Pittsburgh Sleep Quality Index (PSQI) and health service utilization in Chinese general population, to investigate the association between PSQI and health service utilization and to identify the independent contributions of social demographic variables, health related factors and PSQI to health service utilization. METHODS In a cross-sectional community-based health survey using a multi-instrument questionnaire, 4067 subjects (≥15 years old) were studied. The Chinese version of the PSQI was used to assess sleep quality. Health service utilization was measured by recent two-week physician visit and annual hospitalization rates. RESULTS Higher PSQI scores were associated with more frequent health service utilization. Higher scores in subjective sleep quality were associated with higher rate of recent two-week physician visit (adjusted OR = 1.24 per SD increase, P = 0.015). Higher scores in habitual sleep efficiency (adjusted OR = 1.24 per SD increase, P = 0.038) and sleep disturbances (adjusted OR = 2.09 per SD increase, P < 0.001) were associated with more frequent annual hospitalization. The independent influence of PSQI on the risk of recent two-week physician visit was 0.7%, and that of annual hospitalization 31.4%. CONCLUSIONS Poorer sleep quality predicted more frequent health service utilization. The independent contribution of PSQI on health service utilization was smaller than social demographic variables.
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Affiliation(s)
- Hui-Shan Zhang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China.
| | - Yan-Bing Mai
- Shenzhen Guangming New District People's Hospital, China.
| | - Wei-Da Li
- Guangdong Pharmaceutical University, China.
| | - Wen-Tao Xi
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China.
| | - Jin-Ming Wang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China.
| | - Yi-Xiong Lei
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China.
| | - Pei-Xi Wang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China.
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Oh WO, Im Y, Suk MH. The mediating effect of sleep satisfaction on the relationship between stress and perceived health of adolescents suffering atopic disease: Secondary analysis of data from the 2013 9th Korea Youth Risk Behavior Web-based Survey. Int J Nurs Stud 2016; 63:132-138. [PMID: 27615414 DOI: 10.1016/j.ijnurstu.2016.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 08/09/2016] [Accepted: 08/17/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Difficulty in sleep is one disturbing symptom in adolescents with atopic diseases including asthma, allergic rhinitis, and atopic dermatitis. Assuming psychological stress can affect adolescents' health status, impaired sleep quality can be one mediator that negatively impacts the health status of adolescents with atopic disease. OBJECTIVES This study aimed to identify the mediating effect of sleep satisfaction on the relationship between stress and perceived health status in Korean adolescents with atopic disease and to examine the differences among three types of atopic disease. DESIGN A cross-sectional descriptive study was completed based on secondary analysis of raw data from the 2013 9th Korea Youth Risk Behavior Web-based Survey. SETTINGS AND PARTICIPANTS The 21,154 adolescents (29.2%) ever diagnosed and treated for at least one atopic disease regardless of the symptom presence in a recent year were extracted out of 72,435 survey participants. Then, the 13,216 individuals with exclusively single atopic diseases were included in analyzing the mediation model. METHODS Variables including demographics, stress, perceived health status, and sleep satisfaction were included. Pearson correlation, one-way ANOVA, path analysis to define direct/indirect effects with bootstrapping analysis, and multi-group variance analysis were conducted. RESULTS High levels of stress in adolescents with atopic diseases had a significant and direct effect on their negative health status perception for all atopic disease groups. A significant negative mediating effect of sleep satisfaction was identified on the relationship between stress and perceived health status, irrespective of the type of atopic disease. Total effect and remaining direct effect on the path from stress and perceived health status via sleep satisfaction was high in adolescents with atopic dermatitis and allergic rhinitis compared to those with asthma. CONCLUSIONS To improve sleep satisfaction for adolescents with atopic diseases, interventions are needed to enhance the adolescents' perceived health status through stress reduction and sleep quality improvement.
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Affiliation(s)
- Won Oak Oh
- College of Nursing, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, South Korea.
| | - YeoJin Im
- College of Nursing Science, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
| | - Min Hyun Suk
- College of Nursing, CHA University, 120, Haeryong-ro, Pocheon-si, Gyuonggi-do, 11160, South Korea.
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20
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Sleep problems predict cortisol reactivity to stress in urban adolescents. Physiol Behav 2016; 155:95-101. [DOI: 10.1016/j.physbeh.2015.12.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/19/2015] [Accepted: 12/06/2015] [Indexed: 11/21/2022]
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