Sleep quality and psychological distress among undergraduate students of a Nigerian university

Psychological distress and trajectories of sleep duration among Australian adolescents: a prospective cohort study

OBJECTIVES

This study investigated the association between indicators of psychological distress and well-being and trajectories of sleep duration among a cohort of Australian adolescents.

DESIGN

A prospective cohort of adolescents was followed over 27 weeks (8 November 2019-14 May 2020). Data on sleep duration and psychological distress were collected via smartphones, based on ecological momentary assessments.

SETTING

Sydney population catchment, Australia.

PARTICIPANTS

Young people aged 13-19 years were recruited via social media (Instagram or Facebook).

PRIMARY OUTCOME MEASURE

Self-reported sleep duration in the past 24 hours. Sleep duration was dichotomised into 'less than 8 hours' and 'at least 8 hours', to represent those participants not meeting the recommended minimum amount of daily sleep.

RESULTS

Participants with high psychological distress had higher odds of sleeping less than 8 hours (OR 1.51 (95% CI 1.17 to 1.96)), compared with those with low psychological distress. Social media use (OR 1.34 (95% CI 1.01 to 1.79)) and longer periods spent on homework (OR 1.37, (95% CI 1.07 to 1.75)) were also associated with a sleep duration of less than 8 hours. Also, decreasing sleep trajectories were associated with increased psychological distress (β=0.069, (95% CI -0.010 to 0.149)) and increased homework hours (β=0.078 (95% CI 0.036 to 0.120)).

CONCLUSION

Findings highlight the adverse impact of psychological distress and high levels of social media use on sleep duration among adolescents. Longitudinal studies with longer follow-up periods are warranted to further explore the temporal associations between sleep duration and different health outcomes among varying populations.

Latent Profiles and Transitions of Bedtime Procrastination Among Chinese College Students: The Predictive Roles of Anxiety, Depression, Problematic Smartphone Use and Self-Control

Background

Bedtime procrastination (BP) has become an important factor affecting individual well-being. This study aimed to assess the stability and changes in BP and examine risk and protective factors.

Methods

The study recruited 1423 respondents. Latent profile analysis was used to identify subgroups of BP and latent transition analysis to determine transition probabilities for each subgroup. Logistic regression examined associations between identified classes and related factors.

Results

Three subgroups of BP were identified. In terms of stability and changes, the moderate bedtime procrastination group showed the highest stability (66%), followed by the severe bedtime procrastination group (62.4%), and the mild bedtime procrastination group had a 52% probability of switching to moderate bedtime procrastination. In terms of influencing factors, more problematic phone use (PSU) (OR: 1.08; 95% CI = 1.05-1.12), more depression (OR: 1.17; 95% CI = 1.06-1.29) and anxiety (OR: 1.16; 95% CI = 1.05-1.28) are all factors that aggravate the transition from mild to moderate sleep procrastination. Similarly, PSU (OR: 1.15; 95% CI = 1.12-1.19), anxiety (OR: 1.10; 95% CI = 1.06-1.14), and depression (OR: 1.10; 95% CI = 1.06-1.14) increased the risk of severe bedtime procrastination. Self-control emerged as a protective factor against BP.

Conclusion

This study identified three subgroups of BP at two time points and the rule of transition for each subgroup. Our findings indicate that BP were relatively stable, with some changes over time. The results also highlight the important function that PSU, depression, anxiety, and self-control can play in preventing and intervening in BP.

Sleep quality in relation to perceived psychological stress in patients with type 2 diabetes and in age- and sex-matched control individuals

AIM

To assess sleep quality in relation to perceived stress in patients with type 2 diabetes (T2DM) and age- and sex-matched controls.

METHODS

Perceived stress level and sleep quality assessed in 154 patients with T2DM (58 men, 96 women, age 58.3 ± 11.9 years), 154 matched controls (58 men, 96 women, age 56.8 ± 12.2 years) using Perceived Stress Scale and Pittsburgh Sleep Quality Index.

RESULTS

Patients with T2DM had worse subjective sleep quality (p < 0.001), sleep latency (p = 0.047) than controls. Patients with high stress level had worse subjective sleep quality (p = 0.027), higher use of sleeping medication (p = 0.023), daytime dysfunction (p < 0.001) than those with low stress level. No significant differences in sleep quality between controls with high and low perceived stress level. Perceived stress level in patients with T2DM correlated with subjective sleep quality (r = 0.260, p = 0.002), sleep duration (r = 0.228, p = 0.005), use of sleep medication (r = 0.245, p = 0.004), daytime dysfunction (r = 0.326, p < 0.001), in age- and sex-matched controls-to daytime dysfunction (r = 0.191, p = 0.037).

CONCLUSION

Sleep quality (subjective sleep quality, sleep latency) is worse in patients with type 2 diabetes than in age- and sex-matched controls. Patients with high perceived stress level have worse subjective sleep quality, higher use of sleeping medication, daytime dysfunction than patients with low perceived stress level; no significant differences in sleep quality between controls with high and low stress level. Perceived stress level in patients with type 2 diabetes is related to subjective sleep quality, sleep duration, use of sleep medication, daytime dysfunction, in age- and sex-matched controls-to daytime dysfunction.

The Prevalence of Depression and Anxiety and Its Association with Sleep Quality in the First-Year Medical Science Students

Methods

A total number of 471 freshmen students (NUMS) participated in the study, pinpointing that the data are collected in 2019 and 2020. In line with measuring depression, anxiety, and sleep quality, the Persian Beck Depression Inventory-II, Beck Anxiety Inventory, and Pittsburgh Sleep Quality Index were employed. The associations between depression and anxiety with sleep quality were assessed by using the multiple logistic regression model. All statistical analyses were conducted in STATA14, and the significant level was set at P < 0.05.

Results

The prevalence of depression, anxiety, and poor sleep quality in the study population was 21.4%, 31.9%, and 28%, respectively. Analytical analyses indicated that after adjusting for studied covariates, the odds of poor sleep quality in individuals with depression were 3.5 times higher compared to the counter group (P < 0.001). Moreover, the odds of poor sleep quality in individuals with anxiety were 2.1 times higher compared to the counter group (P < 0.001).

Conclusion

Noticeable proportion of freshmen students suffer from depression and anxiety; in line with such a critical issue, our study found that depression and anxiety had a statistical association with sleep quality in study population. From this respect, it seems that providing essential interventions and psychological counseling services could be constructive for the freshmen medical students.

Sleep quality and associated factors among university students in Africa: a systematic review and meta-analysis study

Background

Poor sleep quality significantly impacts academic performance in university students. However, inconsistent and inconclusive results were found in a study on sleep among university students in several African nations. Therefore, this study aimed to estimate the pooled prevalence and associated factors of poor sleep quality among university students in Africa.

Methods

The databases PubMed, Scopus, Cochrane Library, Science Direct, African Journal Online, and Google Scholar were searched to identify articles. A total of 35 primary articles from 11 African countries were assessed and included in this systematic review and meta-analysis. Data were extracted by using a Microsoft Excel spreadsheet and exported to STATA version 14 for analysis. The I2 test was used to assess the statistical heterogeneity. A random effect meta-analysis model was employed with 95% confidence intervals. Funnel plots analysis and Egger regression tests were used to check the presence of publication bias. A subgroup analysis and a sensitivity analysis were done.

Results

A total of 16,275 study participants from 35 studies were included in this meta-analysis and systematic review. The overall pooled prevalence of poor sleep quality among university students in Africa was 63.31% (95% CI: 56.91-65.71) I2 = 97.2. The subgroup analysis shows that the combined prevalence of poor sleep quality in East, North, West, and South Africa were 61.31 (95% CI: 56.91-65.71), 62.23 (95% CI: 54.07-70.39), 54.43 (95% CI: 47.39-61.48), and 69.59 (95% CI: 50.39-88.80) respectively. Being stressed (AOR= 2.39; 95% CI: 1.63 to 3.51), second academic year (AOR= 3.10; 95% CI: 2.30 to 4.19), use of the electronic device at bedtime (AOR= 3.97 95% CI: 2.38 to 6.61)) and having a comorbid chronic illness (AOR = 2.71; 95% CI: 1.08, 6.82) were factors significantly associated with poor sleep quality.

Conclusion

This study shows that there is a high prevalence of poor sleep quality among university students in Africa. Being stressed, in the second year, using electronic devices at bedtime, and having chronic illness were factors associated with poor sleep quality. Therefore, addressing contributing factors and implementing routine screenings are essential to reduce the burden of poor sleep quality.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42023493140.

Discovery of depression-associated factors among childhood trauma victims from a large sample size: Using machine learning and network analysis

BACKGROUND

Experiences of childhood trauma (CT) would lead to serious mental problems, especially depression. Therefore, it becomes crucial to identify influential factors related to depression and explore their associations. The objectives were to 1) identify critical depression-related factors using the extreme gradient boosting (XGBoost) method from a large-scale survey data; 2) explore associations between these factors for targeted interventions and treatments.

METHODS

A large-scale epidemiological study covering 63 universities was conducted in Jilin Province, China. The XGBoost model was trained and tested to classify young adults with CT experiences who had or did not have depression (N = 27,671). The essential factors were selected by SHapley Additive exPlanations (SHAP) value. Multiple logistic regression analyses were conducted for validation. The associations between these depression-related factors were further explored using network analysis.

RESULTS

The XGBoost model selected the top 10 features associated with depression with satisfactory performance (AUC = 0.91; sensitivity = 0.88 and specificity = 0.76). These factors significantly differed between depression and non-depression groups (p < 0.001). There are strong positive associations between anxiety and obsessive-compulsive disorder (OCD), anxiety and post-traumatic stress disorder (PTSD), social anxiety disorder (SAD) and appearance anxiety, and negative associations between sleep quality and anxiety, sleep quality and PTSD among CT participants with depression.

LIMITATIONS

The cross-sectional design cannot draw causality, and biases in self-report measurements cannot be ignored.

CONCLUSIONS

XGBoost model and network analysis were useful methods for discovering and understanding depression-related factors in this epidemiological study. Moreover, these essential factors could offer insights into future interventions and treatments for depressed young adults with CT experiences.

Insomnia Medication Use by University Students: A Systematic Review

Problematic sleep or insomnia has been a recognised issue for many individuals in society, and university students can be of particular concern due to unique academic pressures. A systematic review was designed to summarise the current evidence about the extent of insomnia medication used by university students and identify characteristics of those more willing to use medication to manage insomnia. Searches were undertaken using Psych INFO, PubMed, Embase, and Web of Science, resulting in 25 eligible studies across multiple countries between 1994 and 2020. The prevalence of sleep medication use by students varied widely, from 2% to 41.2%, with an average of 13.1%. Female gender, students experiencing poor sleep, smoking, drinking stimulant beverages, and undertaking fewer physical activities were associated with the use of insomnia medication. Insomnia medication use exists within university student populations but appears to vary considerably worldwide; identifying multiple population characteristics associated with such use would offer opportunities to identify and support those affected.

Item response theory analysis of the Dysfunctional Beliefs and Attitudes about Sleep-16 (DBAS-16) scale in a university student sample

Unhelpful beliefs about sleep have been shown to exacerbate distress associated with sleep-related difficulties. University students are particularly vulnerable to experiencing sleep-related problems. The Dysfunctional Beliefs and Attitudes about Sleep-16 (DBAS-16) scale is a widely used instrument that assesses for sleep-disruptive cognitions. Although psychometric support for the DBAS-16 is available, Item Response Theory (IRT) analysis is needed to examine its properties at the item level. Psychometric investigation in non-clinical samples can help identify people who may be at risk for developing sleep problems. We examined the DBAS-16 using IRT on a sample of 759 university students. Our results identified items and subscales that adequately/inadequately differentiated between students who held unhelpful beliefs about sleep and those who did not. The DBAS-16 is a valuable instrument to assess unhelpful beliefs about sleep. We outline recommendations to improve the discriminatory ability of the instrument. Future investigations should establish cross-validation with a clinical sample.

Examining bedtime procrastination, study engagement, and studyholism in undergraduate students, and their association with insomnia

Introduction

Compulsive overstudying, known as studyholism, is an emerging behavioral addiction. In this study, we examine the prevalence of, and the relationships between, insomnia, study engagement, studyholism, bedtime procrastination among undergraduate students.

Methods

The Studyholism (SI-10), Athens Insomnia (AIS), and bedtime procrastination scales were administered to a convenience sample of 495 university students.

Results

Our findings indicate that the prevalence of insomnia was 75.31%, high studyholism was found in 15.31% of the sample, and increased study engagement was detected in 16.94%. Gender differences analysis revealed that females reported higher studyholism and bedtime procrastination than males. Fifth-year students had higher levels of studyholism than internship (p < 0.001), first-year (p < 0.01), and sixth-year students (p < 0.05). Insomnia was positively related to studyholism and bedtime procrastination. Furthermore, insomnia can be positively predicted by studyholism and bedtime procrastination. Participants with a medium level of studyholism were twice as likely to experience insomnia as those with a low level. Studyholics were six times more susceptible to insomnia than students with low studyholism levels. Compared to individuals with low bedtime procrastination levels, those with medium and high bedtime procrastination were twice as likely to report insomnia.

Conclusion

Our study highlights the interplay between insomnia, studyholism, and bedtime procrastination. Further, the findings indicate the need to increase awareness of insomnia.

Association between visual impairment and sleep duration in college students: A study conducted in UAE and Lebanon

Objective: To examine whether self-reported sleep duration and visual impairment were associated among College students. Participants: Students (n = 1002, age 17-35 years) from Lebanon and the United Arab Emirates. Methods: Students were asked to complete a validated questionnaire between October 2018 and May 2019. The questions were related to sociodemographics, lifestyle characteristics, visual impairment status, sleeping pattern, mobile-phone use and chronic conditions. Results: 18.3% of the respondents reported to suffer from visual impairment. Among them, 72.7% were females (p < .001), 65% admitted to frequently use mobile phones before sleeping (p < .001), 54.6% reported to sleep less than 7 h (p = .008) and 71.6% reported to suffer from sleep disturbances (p = .05). Visual impairment was associated with poor sleep quality (p < .001), mobile phone use before sleeping (p < .01) and daily stress (p < .05). Conclusion: Visual impairment in college students is associated with short sleep duration, mobile phone use before sleeping and stress level.

"Leave your smartphone out of bed": quantitative analysis of smartphone use effect on sleep quality

Smartphones have become an integral part of people's everyday lives. Smartphones are used across all household locations, including in the bed at night. Smartphone screens and other displays emit blue light, and exposure to blue light can affect one's sleep quality. Thus, smartphone use prior to bedtime could disrupt the quality of one's sleep, but research lacks quantitative studies on how smartphone use can influence sleep. This study combines smartphone application use data from 75 participants with sleep data collected by a wearable ring. On average, the participants used their smartphones in bed for 322.8 s (5 min and 22.8 s), with an IQR of 43.7-456. Participants spent an average of 42% of their time in bed using their smartphones (IQR of 5.87-55.5%). Our findings indicate that smartphone use in bed has significant adverse effects on sleep latency, awake time, average heart rate, and HR variability. We also find that smartphone use does not decrease sleep quality when used outside of bed. Our results indicate that intense smartphone use alone does not negatively affect well-being. Since all smartphone users do not use their phones in the same way, extending the investigation to different smartphone use types might yield more information than general smartphone use. In conclusion, this paper presents the first investigation of the association between smartphone application use logs and detailed sleep metrics. Our work also validates previous research results and highlights emerging future work.

Self-reported sleep quality and mental health mediate the relationship between chronic diseases and suicidal ideation among Chinese medical students

High prevalence and strong associations of chronic disease, poor sleep quality, poor mental health, and suicidal ideation (SI) have been reported worldwide. However, the underlying mechanism remains unexamined. The participants were 2646 Chinese medical college students with an average age of 20.13 years. Pittsburgh Sleep Quality Index, the Kessler Psychological Distress Scale, and SI was evaluated. The lifetime SI, past 12-month SI, and chronic disease prevalence rates were 10.0%, 8.4%, and 4.6%, respectively. The results of logistic regression analysis in this study found that chronic disease, self-reported poor sleep quality, poor mental health, gender and scholarship were associated with lifetime SI. Similar results were also found for 12-month SI with an exception of region. This result indicated that the effects of chronic diseases on the SI were mediated by self-reported sleep quality and mental health. Physical diseases, sleep-related concerns, and mental health issues need to be addressed through a multidisciplinary team approach and various delivery systems to prevent SI among medical college students.

Association between Poor Quality of Sleep and Metabolic Syndrome in Ghanaian University Students: A Cross-Sectional Study

Aim. This study aimed to determine the association between quality of sleep and metabolic syndrome (MetS) and physical activity level in young adults at the University of Ghana. Method. In a cross-sectional design, 340 university students, aged between 20-30 years were recruited. Quality of sleep was assessed using the Pittsburgh Sleep Quality index (PSQI) and physical activity with the short form of the International Physical Activity Questionnaire (IPAQ-SF). Poor quality of sleep was defined as a global PSQI score>5 and low physical activity level as those not meeting the criteria for vigorous-moderate physical activity. Anthropometric features and blood pressures were measured, and fasting blood samples were collected from the participants to measure plasma levels of glucose, lipid profile, urea, and creatinine. MetS was defined using the Joint Scientific Statement criteria. Results. In our study population of young adults from Ghana, the prevalence of poor quality of sleep as measured by PSQI was 54.1%, and MetS was 12.4%. MetS was associated with poor quality of sleep in females [ $\text{OR}\left(95\%\text{CI}\right)=2.11$ (1.04–4.25), $p=0.038$ ] and entire study participants [2.18 (1.09–4.37) $p=0.029$ ] in both crude and adjusted models; no association was found in male participants. Low physical activity status was not associated with poor sleep status. Obesity [1.32 (1.02–3.56), $p=0.043$ ], but not overweight [0.99 (0.58–2.34), $p=0.862$ ], was associated with poor quality of sleep. Conclusion. Young adults in a Ghanaian university have a high prevalence of poor quality of sleep and is associated with MetS and obesity. Physical activity status was not associated with poor quality of sleep.

Bedtime procrastination predicts the prevalence and severity of poor sleep quality of Chinese undergraduate students

ObjectiveBedtime procrastination is a type of unhealthy sleep behavior, but whether it affects sleep quality remains unknown. The current study aimed to examine the relationship between bedtime procrastination and poor sleep quality among Chinese college students. Participants: A total of 1550 Chinese undergraduates participated and effectively completed the study. Methods: This cross-sectional study collected information on bedtime procrastination and self-reported sleep quality via the Bedtime Procrastination Scale and the Pittsburgh Sleep Quality Index. Results: The prevalence of poor sleep quality was 39.42% among Chinese undergraduates. Age, education, and bedtime procrastination independently predicted the prevalence of poor sleep quality. Bedtime procrastination was a unique contributor to the severity of poor sleep quality. Conclusions: This study highlighted the independent associations between bedtime procrastination and the prevalence and severity of self-reported poor sleep quality. These findings may be helpful in designing effective measures to improve the sleep quality of college students.

Sleep quality and its correlates among undergraduate medical students in Nepal: A cross-sectional study

Poor sleep quality has been found to affect students' learning abilities, academic performance, and interpersonal relationships. However, little is known about this issue in Nepal. This study aimed to identify the factors associated with poor sleep quality among undergraduate medical students in Nepal. A web-based survey was conducted in March 2021 among 212 undergraduate medical students at the Institute of Medicine, Kathmandu, Nepal. Sleep quality was measured using a 19-item Pittsburgh Sleep Quality Index (PSQI). Multivariable logistic regression analysis was done to assess the factors associated with sleep quality. In the study participants, 38.2% of the students were identified as poor sleepers. Factors like being depressed (AOR = 4.5, 95% CI; 1.2-5.4), current alcohol use (AOR = 2.5, 95% CI; 1.8-10.8), poor academic achievement (AOR = 3.4, 95% CI; 1.1-10.9), and being a fourth-year student (AOR = 3.6, 95% CI; 1.1-11.8) were significantly associated with poor sleep quality. Poor sleep quality was common among undergraduate medical students. Routine screening of sleep quality and depressive symptoms is necessary to mitigate their impact among medical students. Medical students of the fourth year, current alcohol users, and those who did not have good academic achievement had poor sleep quality. Special attention on these population subgroups is thus needed to enhance sleep quality.

Poor sleep quality, excessive daytime sleepiness and association with mental health in college students

AIM

To estimate the prevalence of poor sleep quality and excessive daytime sleepiness (EDS) among college students and to analyse their association with aspects of mental health.

SUBJECTS AND METHODS

A cross-sectional study carried out with 1113 college students, enrolled in full-time courses at a public university in the Mid-West region of Brazil. Data were collected through a self-administered questionnaire with questions about demographics, socioeconomics, mental health, sleep quality, and EDS. Measurements of weight and height were taken to assess weight status using the body mass index. Multivariate logistic regression models were used to estimate the associations between perceived stress (classified as light, moderate, and high) and presence of depressive symptoms with poor sleep quality and presence of EDS.

RESULTS

High prevalence of poor sleep quality (65.5%) and EDS (55%) was observed. In the adjusted models, poor sleep quality was significantly associated with moderate and high perceived stress and presence of depressive symptoms. For EDS, there was also a significant association with moderate and high perceived stress and presence of depressive symptoms.

CONCLUSIONS

High prevalence of poor sleep quality and EDS was found among college students. Perceived stress and presence of depressive symptoms were significantly associated with both evaluated outcomes.

Psychological impacts of COVID-19 pandemic on the university students in Egypt

University students are at elevated risk for mental health problems. The COVID-19 pandemic and subsequent public health measures taken to combat it burdened the students' life with additional dramatic psychological impacts. The aim of this study was to investigate the psychological impacts that affected the university students in Egypt during the COVID-19 pandemic. An online survey was sent to the Egyptian university students via all means of online communication during the first week of May 2020 by using a non-probability snowball sampling. A survey included a short version Depression Anxiety Stress Scale-21 (DASS-21) and socio-demographic data. Overall, 70.5, 53.6 and 47.8% of Egyptian students had depression, anxiety and stress, respectively. Being a female, having a relative or acquaintance infected with COVID-19, having a preexisting chronic disease and lacking of psychological support from families, community and universities increase the risk of depression, anxiety and stress among Egyptian students. Being a medical student is associated with depression while, spending more time to follow news of COVID-19 pandemic is associated with increased anxiety. Egyptian students experience varying levels of psychological disturbance during COVID-19 pandemic. This study suggests that mental health of the university students should be carefully, monitored during the crisis and the universities should provide psychological-oriented services, adapted to these circumstances to mitigate its emotional impact on the students.

Effect of Long-Term Diving Exposure on Sleep of Male Occupational Divers in Southern Taiwan: A Cross-Sectional Study

OBJECTIVE

Divers with a history of decompression sickness may be at high risk for sleep problems. However, limited studies have investigated the relationship between diving exposure and sleep problems of occupational divers. This study investigated the association between diving exposure and sleep quality and quantity among male occupational divers in southern Taiwan.

METHODS

This descriptive, cross-sectional study included 52 occupational divers and 121 non-divers recruited from southern Taiwan in 2018. Survey data were collected using the Taiwanese version of the Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and a self-report questionnaire that included demographic variables, diving exposure/protocols, and factors associated with sleep quality.

RESULTS

Among all participants examined, occupational divers were significantly more likely to have both poor sleep quality (adjusted odds ratio [OR] = 3.00; 95% confidence interval [CI] = 1.48-6.06; P = 0.002) and excessive daytime sleepiness (adjusted OR = 4.49; 95% CI = 2.12-9.52; P < 0.001). The diving exposure time, depth, ascent rate, and decompression table use showed no significant associations between poor and good sleepers in the divers group. However, a history of decompression sickness was associated with poor sleep quality among divers (adjusted OR = 2.20; 95% CI = 1.07-4.54; P = 0.032).

CONCLUSIONS

Our results showed that occupational divers had poor sleep quality and more excessive sleepiness than non-divers. Decompression sickness likely contributes to poor sleep quality. Prevention and early detection of decompression sickness-related sleep problems should be an occupational health priority.

WITHDRAWN: Primary school math anxiety and physical and mental health using mental health risk assessment

Ahead of Print article withdrawn by publisher.

The Role of Plant-Based Protein Functional Food in Preventing Acute Respiratory Disease: A Case Study

The Kaliningrad region is known for its specific climate, which can negatively affect the adaptive potential of the body. This manifests in an increased incidence of respiratory diseases and skin conditions. To prevent high morbidity, a plant protein product was included in the diet of first-year university students. This study aimed to assess the effectiveness of this food intervention in preventing the most common diseases among Kaliningrad students. Two groups of university students took part in the food trial. In the control group, catabolic processes prevailed in nutrient metabolism. Disadaptation manifested itself in the metabolism of proteins, vitamins, minerals, hematopoiesis and humoral immunity. Inflammation was indicated by α1- and α2-globulins, a weak immune response, and IgM and IgG. High oxidative stress and low antioxidative ability of blood serum were observed. The plant-based protein product (FP) helped preserve testosterone level and prevent an increase in catabolic reactions. Moreover, it had a positive effect on both red blood cell hematopoiesis (a smaller increase in the average volume of erythrocytes, the same average concentration and content of hemoglobin, an increased relative red cell distribution width (RDW) and white blood cell hematopoiesis (a beneficial effect for the immune system: lymphocytes, the relative content of neutrophils, monocytes, basophils and eosinophils). The stimulation of humoral immunity was evidenced by beta- and gamma-globulins, an active immune response, the level of IgM and IgG, antioxidant protection, reduction of peroxides and an increase in antioxidant activity of blood serum. The 34-week observation showed a 1.7-fold decrease in the incidence of respiratory illnesses and a 5.7-fold decrease in skin and subcutaneous tissue diseases. Acute respiratory infections were reduced 1.8-fold. There were no cases of community-acquired pneumonia in the treatment group, compared with 55.1‰ in the control group. The incidence of respiratory diseases was 3.3-10.6 times lower in the treatment group than in the control group in weeks 6-19. The findings testify to the prophylactic effect of functional food during social adaptation and acclimatization of students.

Should I study or should I go (to sleep)? The influence of test schedule on the sleep behavior of undergraduates and its association with performance

Sleep is crucial for college students' well-being. Although recommended sleep duration is between 7-9 hours per day, many students do not sleep that much. Scholar demands are among the causes of observed sleep deprivation in youth. We explored the influence of having a school test on previous night sleep in first-year students and the association of sleep duration and test performance. We ran two surveys in freshman students of the Universidad de la República, Montevideo, Uruguay: 1) 97 students of the School of Sciences who took the test at the same time; and 2) 252 School of Psychology students who took the test in four successive shifts. More than 1/2 of the participants (survey #1) and almost 1/3 (survey #2) reported short regular sleep duration (< 7h). In both samples, the sleep duration of the night before the test was reduced with respect to regular nights (survey #1: 2.1 ± 0.2 h, p < 0.001; survey #2: between 1.7 ± 0.4 h and 3.6 ± 0.3 h, all p < 0.001), with more than 10% of the students who did not sleep at all. In survey 2, sleep duration increased in later shifts (F (3,248) = 4.6, p = 0.004). Using logit regressions, we confirmed that sleep duration was positively related to test scores in both samples (survey #1: exp B = 1.15, p < 0.001; pseudo-R2 = 0.38; survey #2: exp B = 1.03, p < 0.001; pseudo-R2 = 0.25). Delaying test start time may prevent the reduction in sleep duration, which may also improve school performance. In addition, educational policies should include information for students about the impact of sleep on learning and of the consequences of reduced sleep duration.

Resilience as a Buffering Variable Between the Big Five Components and Factors and Symptoms of Academic Stress at University

The aim of this cross-sectional study was to establish predictive relationships of the Big Five personality factors (according to their self-regulatory level), together with resilience (proactive and reactive factors), for factors and symptoms of academic stress related to teaching and learning in the University context. A total of 405 female undergraduate students were selected, and completed questionnaires that had been previously validated in Spanish University students (Big Five personality factors, resilience, and academic stress symptoms and factors). A linear, ex-post facto design was used, including linear regression, Structural Equation Modeling (SEM), and mediational analyses. Specific linear regression showed the expected gradation: that self-regulatory personality factors (conscientiousness, extraversion) were positive linear predictors of proactive resilience, as well as significant negative predictors of stress factors and symptoms of academic stress; while the non-regulatory personality factors (openness to experience, agreeableness) showed little relationship. By contrast, the dysregulatory personality factor (neuroticism) was a negative predictor of proactive resilience, a positive predictor of reactive resilience, and positively predicted academic stress factors in the teaching and learning process, as well as stress symptoms. SEM general analysis showed that personality factors positively predicted resilience, and resilience negatively predicted factors and symptoms of academic stress. Specific mediational model analysis, with each personality factor, confirmed the different mediating relationships that appeared in the linear regression analyses. These results are discussed from the perspective of promoting resilience and healthy personalities in the University context. Implications for addressing academic stress at University are discussed.

Poor sleep health is associated with increased mental health problems, substance use, and HIV sexual risk behavior in a large, multistate sample of gay, bisexual and other men who have sex with men (GBMSM) in Nigeria, Africa

BACKGROUND

Poor sleep health has been linked to mental health problems, substance use, and sexual risk-taking among gay, bisexual, and other men who have sex with men (GBMSM). No known published study has examined these relationships among African GBMSM. Consequently, we investigated poor sleep health and associated health-related factors among a large multistate sample of Nigerian GBMSM.

METHODS

Between March and June 2019, 406 GBMSM were recruited from Abuja, Delta, Lagos, and Plateau and asked to complete an interviewer-administered survey. Bivariate and multivariable logistic regression models were constructed to examine the relationship between poor sleep health and other health-related factors.

RESULTS

In the past month, 45.5% of participants reported sleeping an average of 6 hours or less every night, and 30.7% reported experiencing a sleep problem. Factors associated with increased odds of reporting short sleep included: residing in Delta [adjusted odds ratio (aOR) 2.16; 95% confidence interval (CI): 1.15 to 4.04] and Lagos (aOR 2.40; 95% CI: 1.29 to 4.45), depressive symptoms (aOR 1.94; 95% CI: 1.13 to 3.32), and reporting lifetime history of using four or more drugs (aOR 2.52; 95% CI: 1.06 to 6.01). Reporting condom use at last anal sex was associated with decreased odds of reporting short sleep in the last month (aOR 0.54; 95% CI: 0.31 to 0.92). Factors associated with increased odds of reporting sleep problems included: reporting an STI diagnosis in the last year (aOR 1.79; 95% CI: 1.05 to 3.05) and reporting monthly or higher polydrug use in the last 3 months (aOR 2.19; 95% CI: 1.14 to 4.24).

DISCUSSION

Sleep health interventions should be developed for Nigerian GBMSM, which may improve mental health and reduce substance use and sexual risk-taking.

Psychological Distress, Drug Use, and Internet Use: The Association with Poor Sleep Quality in a Sample of Secondary School Students

Sleep problems are common among children and adolescents. Sleep quality plays a significant role in their mental health. We aimed to determine the prevalence of poor sleep quality (PSQ) among secondary school students, identify sociodemographic factors associated with PSQ in this group, and examine the independent associations of psychological distress, stimulant use, and internet use with PSQ. Data were collected from 420 secondary school students from four different schools who were selected using a mixture of convenience and random sampling. A set of questionnaires was administered to collect data, and it consisted of 5 sections measuring: the sociodemographic, drug use, psychological distress, internet use, and sleep quality. A total of 378 questionnaires were analyzed. The participants comprised 174 (46.2%) males and 203 (53.8%) females who were between 10 and 21 years. The mean age was 14.78 years. The prevalence of those who had PSQ was 12.2%. A logistic regression model showed that anxiety (AOR = 1.20, 95% CI: 1.10-1.32), depression (AOR = 1.12, 95% CI: 1.00-1.25), and internet use (AOR = 1.02, 95% CI: 1.00-1.03) were significantly associated with PSQ. PSQ commonly exists among students and has a relationship with their psychological state and potentially addictive behavior, such as internet use. We prescribed the optimal treatment of psychological disorders and addictive behavior, of which sleep problems are a typical fallout.

Poorer sleep quality correlated with mental health problems in college students: A longitudinal observational study among 686 males

OBJECTIVE

Poor sleep quality and mental health problems are common in college students. The objective of this study is to examine whether sleep quality predicts the risk of future mental health problems, and vice versa.

METHODS

The sleep quality and mental health status of 686 male college students were estimated, and 582 of them were followed up a year later. Subjective sleep quality and mental health problems were measured with the Pittsburgh Sleep Quality Index (PSQI) and the Depression Anxiety Stress Scale-21 (DASS-21), respectively.

RESULTS

Either at baseline or during follow-up, the PSQI global score was positively associated with scores for depression, anxiety, and stress on the DASS-21 (p's < 0.001). Longitudinal analyses revealed that DASS-21 total score increased in line with increased of PSQI global score during the year (p < .001). More importantly, the cross-lagged analysis showed that (i) PSQI global score at baseline was positively related to depression (β = 0.261), anxiety (β = 0.321), and stress (β = 0.311) scores a year later (p's < 0.001) and (ii) depression (β = 0.259), stress (β = 0.245) and anxiety (β = 0.292) scores at baseline were related to PSQI global score a year later (p's < 0.001). Finally, we further found that among those without mental health problems at baseline, poorer baseline sleep quality predicted a higher risk of anxiety symptoms a year later (RR 3.07, 95% CI 1.36-6.97, p = .007).

CONCLUSIONS

These data may suggest a bidirectionally relationship between sleep quality and mental health problems.

Impact of sleep problems on daytime function in school life: a cross-sectional study involving Japanese university students

BACKGROUND

The aims of this study were 1) to clarify the prevalence of sleep problems (insomnia, insufficient sleep, and delayed sleep-wake phase) among Japanese university students; 2) to examine sociodemographic characteristics, lifestyle, and sleep-related symptoms in each sleep problem; and 3) to evaluate the association between the above-mentioned sleep problems and daytime dysfunction in school life.

METHODS

Self-report questionnaire surveys were conducted at eight universities in Japan, and we received 1034 valid answers (78% female). The questionnaire consisted of socio-demographic characteristics, information on lifestyle, sleep pattern, sleep-related symptoms, and daytime dysfunction in school life. Groups with insomnia, behaviorally induced insufficient sleep syndrome (BIISS), delayed sleep-wake phase (DSWP), and BIISS + DSWP were defined. To identify the association between sleep problems and daytime dysfunction in school life, the generalized linear mixed effect model was conducted.

RESULTS

Sleep duration on weekdays was 5.9 ± 1.2 h, and 38.2% of the students had a sleep duration < 6.0 h. About 16% of the students were categorized as evening-type individuals. More than half of the students (56.1%) had excessive daytime sleepiness. Insomnia was associated with tardiness (aOR: 0.8, 95%CI: 0.7-0.9) and falling asleep during class (aOR: 1.6: 95%CI: 1.4-2.0). BIISS was associated with tardiness (aOR: 1.5, 95%CI: 1.1-2.2) and interference with academic achievement (aOR: 1.9, 95%CI: 1.3-2.6). DSWP and BIISS + DSWP were associated with absence (aOR: 3.4, 95%CI: 2.2-5.1 / aOR: 4.2, 95%CI: 3.2-5.6), tardiness (aOR: 2.7, 95%CI: 1.8-4.1 / aOR: 2.2, 95%CI: 1.6-2.8), falling asleep during class (aOR: 2.6, 95%CI: 1.4-4.8 / aOR: 7.6, 95%CI: 3.3-17.2), and interference with academic achievement (aOR: 2.6, 95%CI: 1.7-3.9 / aOR: 2.1, 95%CI: 1.6-2.8).

CONCLUSIONS

Students with DSWP and BIISS + DSWP were significantly associated with daytime dysfunction in school life, i.e. absence, tardiness, falling asleep during class and interference with academic achievement. Students displaying BIISS + DSWP were considered to have a relatively more serious condition compared with those with only insomnia, DSWP, or BIISS. It is therefore of utmost importance that university students aim to prevent DSWP and BIISS which were associated with daytime function in school life.

Sleep Health and Serious Psychological Distress: A Nationally Representative Study of the United States among White, Black, and Hispanic/Latinx Adults

PURPOSE

Prior studies investigating the relationship between sleep and serious psychological distress (SPD) have lacked racial/ethnic diversity and generalizability. We investigated associations between sleep and SPD among a large, nationally representative, and racially/ethnically diverse sample of US adults.

METHODS

We pooled cross-sectional data from the 2004 to 2017 National Health Interview Survey. Participants self-reported sleep duration and sleep disturbances (eg, trouble falling and staying asleep). SPD was defined as a Kessler Psychological Distress Scale (K6) score ≥13. Adjusting for sociodemographic, health behavior, and clinical characteristics, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) of SPD for each sleep characteristic, overall and by race/ethnicity.

RESULTS

Among 316,840 participants, the mean age ± standard error was 46.9 ± 0.1 years, 52% were women, 75% were non-Hispanic (NH)-White, 16% NH-Black, and 9% Hispanic/Latinx. The prevalence of SPD was 3.4% for NH-Whites, 4.1% for NH-Blacks, and 4.5% for Hispanics/Latinxs. Participants with <7 hours versus 7-9 hours of sleep duration were more likely to have SPD, and the magnitude of the association was strongest among NH-Black participants (PR_NH-Blacks=3.50 [95% CI: 2.97-4.13], PR _{Hispanics/Latinx}=2.95 [2.42-3.61], and PR_NH-Whites=2.66 [2.44-2.89]). Positive associations between sleep disturbances and SPD were generally stronger among NH-Black and Hispanic/Latinx compared to NH-White adults.

CONCLUSION

Poor sleep health was positively associated with SPD, and the magnitude of the association was generally stronger among racial/ethnic minorities. Future investigations should prospectively focus on the determinants and health consequences of SPD attributable to objectively measured sleep across racial/ethnic groups.

A Correlational Analysis of the Relationships among Intolerance of Uncertainty, Anxiety Sensitivity, Subjective Sleep Quality, and Insomnia Symptoms

In this study, we used structural equation modeling to investigate the interplay among Intolerance of Uncertainty (IU), Anxiety Sensitivity (AS), and sleep problems. Three hundred undergraduate students completed the Intolerance of Uncertainty Scale, the Intolerance of Uncertainty Inventory, the Anxiety Sensitivity Index, the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Pittsburgh Sleep Quality Index and the Insomnia Severity Index. 68% and 40% of the students reported poor sleep quality or sub-threshold insomnia problems, respectively. Depression and anxiety levels were above the cut-off for about one-fourth of the participants. Structural equation modeling revealed that IU was strongly associated with AS, in turn influencing both insomnia severity and sleep quality via depression and anxiety. Significant indirect effects revealed that an anxious pathway was more strongly associated with insomnia severity, while a depression pathway was more relevant for worsening the quality of sleep. We discussed the results in the frameworks of cognitive models of insomnia. Viewing AS and IU as antecedents of sleep problems and assigning to AS a pivotal role, our study suggested indications for clinical interventions on a population at risk for sleep disorders.

Workplace violence and risk for psychiatric morbidity among health workers in a tertiary health care setting in Nigeria: Prevalence and correlates

The objectives were to evaluate the workplace violence and risk for psychiatric morbidity, as well as their correlates, among health workers in a tertiary healthcare setting in Nigeria. A stratified random sampling technique was used to recruit the health workers. Each participant was administered a socio-demographic questionnaire, the ILO/ICN/WHO/PSI Workplace Violence Questionnaire and the 12- item General Health Questionnaire. A total of 380 health workers were recruited, with a mean age of 36.4 (±7.64) years. The prevalence rates of workplace violence and risk of psychiatric morbidity were 39.9% and 38.5%. Factors with independent associations with workplace violence included young age, female sex and worry about workplace violence while a widowed, separated or divorced marital status and being victim of workplace violence independently increased risk for developing psychiatric morbidity. This study therefore showed that workplace violence is common in the health care setting, and significant proportion of workers are at risk for developing psychiatric morbidity. These observations suggest need for the regular mental health screening of health workers, as well as the need for programmes aimed at preventing workplace violence in this setting.

Sleep Hygiene Index: Psychometric Characteristics and Usefulness as a Screening Tool in a Sample of Nigerian Undergraduate Students

STUDY OBJECTIVES

The objectives of this study were to investigate the psychometric properties of the Sleep Hygiene Index (SHI) and determine its capacity to screen for poor sleep quality in a nonclinical sample of Nigerian university students.

METHODS

A total of 348 students appropriately completed the SHI, the Morningness-Eveningness Questionnaire (MEQ), the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS).

RESULTS

The internal consistency (Cronbach alpha) of the SHI was .64 and its construct validity was modestly satisfactory. It had a significant negative correlation with the MEQ (r = -.170, P < .001) and positive correlations with global PSQI (r = .289, P < .001) and ESS (r = .219, P < .001) scores. Prior to the factor analysis, our sample was randomly divided into two. In one half of the sample (sample 1), exploratory factor analysis of the SHI items yielded a three-factor model. Confirmatory factor analysis on the other half (sample 2) corroborated this model with satisfactory indices of fitness (c² = 67.805; df = 55; c²/df = 1.233; P = .115; goodness of fit index = .943; Tucker-Lewis index = .958; incremental fit index = .972; comparative fit index = .970; root mean square error of approximation = .037). A cutoff total score of 16 on the SHI had the best sensitivity (77.0%) and specificity (47.5%) to identify students who were categorized as experiencing poor sleep quality, according to the PSQI (area under the curve = 0.65, 95% confidence interval = 0.59-0.71).

CONCLUSIONS

The SHI exhibited satisfactory psychometric properties as a self-rated assessment instrument in the evaluation of sleep hygiene and as a screening instrument for poor sleep quality among Nigerian undergraduate students.

Sleep in a large, multi-university sample of college students: sleep problem prevalence, sex differences, and mental health correlates

OBJECTIVES

To (1) describe sleep problems in a large, multi-university sample of college students; (2) evaluate sex differences; and (3) examine the unique associations of mental health symptoms (i.e., anxiety, depression, attention-deficit/hyperactivity disorder inattention [ADHD-IN], ADHD hyperactivity-impulsivity [ADHD-HI]) in relation to sleep problems.

METHODS

7,626 students (70% female; 81% White) ages 18-29 years (M=19.14, SD=1.42) from six universities completed measures assessing mental health symptoms and the Pittsburgh Sleep Quality Index (PSQI).

RESULTS

A substantial minority of students endorsed sleep problems across specific sleep components. Specifically, 27% described their sleep quality as poor, 36% reported obtaining less than 7 hours of sleep per night, and 43% reported that it takes >30 minutes to fall asleep at least once per week. 62% of participants met cut-off criteria for poor sleep, though rates differed between females (64%) and males (57%). In structural regression models, both anxiety and depression symptoms were uniquely associated with disruptions in most PSQI sleep component domains. However, anxiety (but not depression) symptoms were uniquely associated with more sleep disturbances and sleep medication use, whereas depression (but not anxiety) symptoms were uniquely associated with increased daytime dysfunction. ADHD-IN symptoms were uniquely associated with poorer sleep quality and increased daytime dysfunction, whereas ADHD-HI symptoms were uniquely associated with more sleep disturbances and less daytime dysfunction. Lastly, ADHD-IN, anxiety, and depression symptoms were each independently associated with poor sleep status.

CONCLUSIONS

This study documents a high prevalence of poor sleep among college students, some sex differences, and distinct patterns of mental health symptoms in relation to sleep problems.

Quality of Sleep and Depression in College Students: A Systematic Review

Background

Nowadays, sleep-related problems are a prevalent occurrence among university students. Poor sleep quality is one of the most studied aspects of sleep complaints, affecting from 10% to 50% of this population. Poor sleep quality consequences are many and have a profound impact in the student's psychobiological health. University students live through a period of psychological challenge and adaptation, since the transition from high school to professional life. Abrupt autonomy challenges students to deal with many choices, from their academic and social life to their intimate habits. Frequently, sleep hygiene is neglected, or they are unable to use proper coping mechanisms, resulting in disturbing consequences that could impact their lives as adults. Research has found a significant association between sleep quality and depression or depressive symptoms, but this relationship is still somewhat difficult to interpret.

Objective

The objective of this review is to appraise the current knowledge around the relationship of sleep with depression in this group of young adults. Data Source: Articles included in Medline database.

Methods

After a careful search, the articles selected aimed mainly college students. The studies had sleep quality and depression objectively assessed, focused in the relationship between both, and addressed possible influencing factors.

Results

The current literature still supports a bidirectional relationship between sleep and depression, however, the importance of sleep quality is becoming a very relevant variable.

Conclusion

Education and the application of policies regarding sleep hygiene may prevent, in some cases, the development of depression and improve the quality of sleep in other cases. Future research should clarify the relationship between sleep problems and depression in a way they could be prevented or, at least, minimalized with effective and achievable interventions.