The association of insomnia with future mental illness: is it just residual symptoms?

Insomnia symptom severity and dynamics of arousal-related symptoms across the day

Arousal is a central component of many emotional symptoms and can contribute to insomnia. Here we assessed how the timing and fluctuating nature of arousal-related symptoms over the course of the day relate to insomnia symptom severity. In this study, 361 participants (M age = 31.9 years, 282 women, 77 men, 2 non-binary individuals) completed the Insomnia Severity Index to assess severity of insomnia symptoms, followed by repeated ratings of anxiety or nervousness, stress, sleepiness, and feeling down via their mobile phone between ~08:00 hours and 00:00 hours across 1 day. Measures of dynamics included: mean levels across the day; variation (standard deviation); instability (mean squared successive differences); and resistance to change/inertia (first-order autocorrelation). Time-of-day patterns were modelled using generalized additive mixed effects models. Insomnia symptom severity (mean Insomnia Severity Index = 9.1, SD = 5.2, range 0-25) was associated with higher mean levels of all arousal-related symptoms, and increased instability and variation throughout the day in anxiety or nervousness, stress, and feeling down. Resistance to change (inertia) was not associated with insomnia symptom severity. Generalized additive mixed effects analyses showed that while individuals with more severe insomnia symptoms had elevated symptoms across the entire day, they were especially more anxious or nervous and sleepy in the early morning (~08:00 hours), anxious or nervous, stressed and sleepy in the late afternoon/early evening (~16:00 hours-21:00 hours), and anxious or nervous and stressed in the late evening (~22:00 hours). Remarkably, higher arousal occurred in the presence of high subjective sleepiness. Together these results indicate that insomnia symptom severity is associated with problems with daytime and evening arousal regulation.

Relationships Between Childhood Bullying/Domestic Violence Experience and Insomnia among Employees in Japan

OBJECTIVE

Traumatic childhood experiences such as domestic violence and bullying have been reported to be associated with insomnia in adulthood. However, little evidence is available for the long-term effects of childhood adversity on workers' insomnia worldwide. Our objective was to examine whether childhood experiences of bullying and domestic violence are associated with insomnia in workers in adulthood.

METHODS

We used survey data from a cross-sectional study of the Tsukuba Science City Network in Tsukuba City, Japan. Workers aged 20 to 65 years (4509 men and 2666 women) were targeted. Binomial logistic regression analysis was performed with the Athens Insomnia Scale as the objective variable.

RESULTS

Binomial logistic regression analysis showed that childhood bullying and domestic violence experience of childhood bullying and domestic violence were associated with insomnia. As for the experience of domestic violence, the higher the time of experience, the higher the odds ratio of insomnia.

CONCLUSIONS

It may be useful to focus on childhood traumatic experiences regarding insomnia in workers. In the future, objective sleep time and sleep efficiency should be evaluated using an activity meter and other methods to verify the effects of bullying and domestic violence experiences.

Relationships Between Childhood Bullying/Domestic Violence Experience and Insomnia among Employees in Japan

OBJECTIVE

Traumatic childhood experiences such as domestic violence and bullying have been reported to be associated with insomnia in adulthood. However, little evidence is available for the long-term effects of childhood adversity on workers' insomnia worldwide. Our objective was to examine whether childhood experiences of bullying and domestic violence are associated with insomnia in workers in adulthood.

METHODS

We used survey data from a cross-sectional study of the Tsukuba Science City Network in Tsukuba City, Japan. Workers aged 20 to 65 years (4509 men and 2666 women) were targeted. Binomial logistic regression analysis was performed with the Athens Insomnia Scale as the objective variable.

RESULTS

Binomial logistic regression analysis showed that childhood bullying and domestic violence experience of childhood bullying and domestic violence were associated with insomnia. As for the experience of domestic violence, the higher the time of experience, the higher the odds ratio of insomnia.

CONCLUSIONS

It may be useful to focus on childhood traumatic experiences regarding insomnia in workers. In the future, objective sleep time and sleep efficiency should be evaluated using an activity meter and other methods to verify the effects of bullying and domestic violence experiences.

Prospective associations between joint categories of physical activity and insomnia symptoms with onset of poor mental health in a population-based cohort

BACKGROUND

Physical inactivity and insomnia symptoms are independently associated with increased risk of depression and anxiety; however, few studies jointly examine these risk factors. This study aimed to prospectively examine the joint association of physical activity (PA) and insomnia symptoms with onset of poor mental health in adults.

METHODS

Participants from the 2013 to 2018 annual waves of the Household Income and Labour Dynamics in Australia panel study who had good mental health (Mental Health Inventory-5 >54) in 2013, and who completed at least 1 follow-up survey (2014-2018), were included (n = 10,977). Poor mental health (Mental Health Inventory-5 ≤ 54) was assessed annually. Baseline (2013) PA was classified as high/moderate/low, and insomnia symptoms (i.e., trouble sleeping) were classified as no insomnia symptoms/insomnia symptoms, with 6 mutually exclusive PA-insomnia symptom groups derived. Associations of PA-insomnia symptom groups with onset of poor mental health were examined using discrete-time proportional-hazards logit-hazard models.

RESULTS

There were 2322 new cases of poor mental health (21.2%). Relative to the high PA/no insomnia symptoms group, there were higher odds (odds ratio and 95% confidence interval (95%CI)) of poor mental health among the high PA/insomnia symptoms (OR = 1.87, 95%CI: 1.57-2.23), moderate PA/insomnia symptoms (OR = 1.93, 95%CI: 1.61-2.31), low PA/insomnia symptoms (OR = 2.33, 95%CI: 1.96-2.78), and low PA/no insomnia symptoms (OR = 1.14, 95%CI: 1.01-1.29) groups. Any level of PA combined with insomnia symptoms was associated with increased odds of poor mental health, with the odds increasing as PA decreased.

CONCLUSION

These findings highlight the potential benefit of interventions targeting both PA and insomnia symptoms for promoting mental health.

Shift work, clinically significant sleep disorders and mental health in a representative, cross-sectional sample of young working adults

Mental health conditions confer considerable global disease burden in young adults, who are also the highest demographic to work shifts, and of whom 20% meet criteria for a sleep disorder. We aimed to establish the relationship between the combined effect of shift work and sleep disorders, and mental health. The Raine Study is the only longitudinal, population-based birth cohort in the world with gold-standard, Level 1 measurement of sleep (polysomnography, PSG) collected in early adulthood. Participants (aged 22y) underwent in-laboratory PSG and completed detailed sleep questionnaires. Multivariable adjusted robust linear regression models were conducted to explore associations with anxiety (GAD7) and depression (PHQ9), adjusted for sex, health comorbidities, and work hours/week. Data were from 660 employed young adults (27.3% shift workers). At least one clinically significant sleep disorder was present in 18% of shift workers (day, evening and night shifts) and 21% of non-shift workers (p = 0.51); 80% were undiagnosed. Scores for anxiety and depression were not different between shift and non-shift workers (p = 0.29 and p = 0.82); but were higher in those with a sleep disorder than those without (Md(IQR) anxiety: 7.0(4.0-10.0) vs 4.0(1.0-6.0)), and depression: (9.0(5.0-13.0) vs 4.0(2.0-6.0)). Considering evening and night shift workers only (i.e. excluding day shift workers) revealed an interaction between shift work and sleep disorder status for anxiety (p = 0.021), but not depression (p = 0.96), with anxiety scores being highest in those shift workers with a sleep disorder (Md(IQR) 8.5(4.0-12.2). We have shown that clinical sleep disorders are common in young workers and are largely undiagnosed. Measures of mental health do not appear be different between shift and non-shift workers. These findings indicate that the identification and treatment of clinical sleep disorders should be prioritised for young workers as these sleep disorders, rather than shift work per se, are associated with poorer mental health. These negative mental health effects appear to be greatest in those who work evening and/or night shift and have a sleep disorder.

Causal beliefs regarding schizophrenia and help-seeking behaviors among patients with schizophrenia and family caregivers attending psychiatric clinics in Cambodia

Schizophrenia often follows a chronic or recurrent course, placing an immense burden on patients and their families. Mental health services in Cambodia are still highly limited, thus there is a major treatment gap. It is common that people consult traditional healers (Kru Khmer) and monks. In this culture, people who receive psychiatric medical treatment are expected to exhibit higher mental health literacy, but little is known about this factor. In this study, we interviewed 59 patients with schizophrenia and 59 family caregivers attending psychiatric clinics in Cambodia. Through qualitative analysis using a thematic analysis approach, we extracted eight themes of causal beliefs regarding schizophrenia: (1) spiritual beliefs, (2) cultural symptoms, (3) physical problems, (4) heredity, (5) substance abuse, (6) traumatic events, (7) stress in human relationships or in one's social environment, and (8) socioeconomic position. We found that "thinking too much" (kit chroeun) and "worrying too much" (prouy / barom chroeun), cultural idioms of distress, were recognized as causal factors of schizophrenia by both parents and family caregivers. Some participants were aware of the possible causal factors in light of the latest psychiatry findings, such as genetic factors and childhood trauma. Our data show that causal beliefs are not a decisive factor in shortening the duration of untreated psychosis (DUP). In Cambodia, where the treatment for schizophrenia is pluralistic, we suggest that it is crucial to embed the meaning of psychiatric treatment into local meaning worlds for better help-seeking behaviors.

Anxiety, Insomnia, and Napping Predict Poorer Sleep Quality in an Autistic Adult Population

Autistic adults have a high prevalence of sleep problems and psychiatric conditions. In the general population sleep problems have been associated with a range of demographic and lifestyle factors. Whether the same factors contribute to different types of disturbed sleep experienced by autistic adults is unknown and served as the main aim of this study. An online survey was conducted with 493 autistic adults. Demographic information (e.g., age, gender), about lifestyle (e.g., napping), and information about comorbid conditions was collected. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality and the Epworth Sleepiness Scale (ESS) was used to assess daytime somnolence. Stepwise multiple regression analyses were used to examine predictors of each subscale score on the PSQI, as well as PSQI and ESS total scores. Results indicated that individuals who reported having a diagnosis of anxiety and insomnia were more likely to have poorer sleep quality outcomes overall. Furthermore, individuals who reported habitually napping had higher daytime dysfunction, increased sleep disturbances, and increased daytime sleepiness. These results provide novel insights into the demographic and lifestyle factors that influence sleep quality and daytime somnolence in autistic adults and can be used for targeted sleep interventions.

Genome-wide gene-environment interactions in neuroticism: an exploratory study across 25 environments

Gene-environment interactions (GxE) are often suggested to play an important role in the aetiology of psychiatric phenotypes, yet so far, only a handful of genome-wide environment interaction studies (GWEIS) of psychiatric phenotypes have been conducted. Representing the most comprehensive effort of its kind to date, we used data from the UK Biobank to perform a series of GWEIS for neuroticism across 25 broadly conceptualised environmental risk factors (trauma, social support, drug use, physical health). We investigated interactions on the level of SNPs, genes, and gene-sets, and computed interaction-based polygenic risk scores (PRS) to predict neuroticism in an independent sample subset (N = 10,000). We found that the predictive ability of the interaction-based PRSs did not significantly improve beyond that of a traditional PRS based on SNP main effects from GWAS, but detected one variant and two gene-sets showing significant interaction signal after correction for the number of analysed environments. This study illustrates the possibilities and limitations of a comprehensive GWEIS in currently available sample sizes.

Negative mood as a mediator of the association between insomnia severity and marijuana problems in college students

Insomnia symptoms have been linked to problematic marijuana use among young adults, but the mechanism underlying this association and whether sex differences exist, remains unclear. Using cross-sectional data, this study examined negative mood as a mediator of the association between insomnia and marijuana problems among male and female college students. Undergraduate students (n = 267; 61% female) reporting marijuana use in the past month completed an online survey assessing insomnia symptoms, negative mood and marijuana problems. Controlling for relevant covariates, negative mood was examined as a mediator of the association between insomnia and marijuana problems using bootstrapped significance tests for indirect effects (n-boot = 1,000). Results indicated that higher levels of insomnia were associated with greater levels of negative mood (regardless of sex), which in turn were associated with greater marijuana-related problems. In conclusion, insomnia symptoms are associated with more negative mood among college students who use marijuana, and this effect on negative mood accounts for a large part of the association of insomnia symptoms with marijuana-related problems. Research is needed to determine if these associations are maintained prospectively.

Associations of Sleep Quality and Frailty among the Older Adults with Chronic Disease in China: The Mediation Effect of Psychological Distress

Frailty affects the elderly and leads to adverse health outcomes. Preliminary evaluations have suggested that sleep quality and psychological distress are predictors of frailty among older adults. However, the mechanisms by which sleep quality affect frailty had not been fully addressed in the previous research. This study aimed to explore the mediation effect of psychological distress on the association between sleep quality and frailty among the elderly with chronic diseases in rural China. A total of 2346 old adults were included in the analysis. Frailty status was measured by Fried Phenotype criteria. Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), and psychological distress was examined by Kessler Psychological Distress Scale (K10). Ordinal logistic regressions were performed to assess the relationships between sleep quality and frailty. Mediation test was also conducted by bootstrap method. The prevalence rate of frailty among the elderly with chronic diseases was 21% in rural China. Compared with the elder of robust status, respondents identified as having frailty have lower SES, less vigorous physical activity, and worse self-reported health status. Poor sleep quality was a significant predictor of frailty with mediators (OR = 1.44, 95% CI = 1.19-1.76). Mediation analysis suggested that psychological distress mediated 41.81% of total effect between sleep quality and frailty. This study indicated that poor sleep quality was significantly related to frailty, and psychological was a mediator of this association. However, we could not investigate causal relationships between variables since this was one cross-sectional study. These findings suggested that an early detection of sleep problems and also psychological disorders should be taken to prevent frailty among the rural older adults in China.

Sleep disturbances and disability following work-related injury and illness: Examining longitudinal relationships across three follow-up waves

Despite the high burden of sleep disturbances among the general population, there is limited information on prevalence and impact of poor sleep among injured workers. This study: (a) estimated the prevalence of sleep disturbance following work-related injury; and (b) examined the longitudinal association between sleep disturbances and disability/functioning, accounting for reciprocal relationships and mental illness. Longitudinal survey data were collected from workers' compensation claimants with a time-loss claim in Victoria, Australia (N = 700). Surveys were conducted at baseline, 6 months and 12 months. Sleep disturbance was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire. Disability/functioning was based on self-reported activity limitations, participation restrictions and emotional functioning. Path models examined the association between disability/functioning and sleep. Mean sleep disturbance T-scores were 55.2 (SD 11.4) at 6 months, with 36.4% of the sample having a T-score of 60+. Longitudinal relationships were observed between disability (specifically, emotional functioning) and sleep disturbances across successive follow-up waves. For example, each unit increase in T2 emotional functioning (five-point scale) was associated with a 1.1 unit increase in T3 sleep disturbance (approximately 29-76 scale). Cross-lagged path models found evidence of a reciprocal relationship between disability and sleep, although adjustment for mental illness attenuated the estimates to the null. In conclusion, sleep disturbances are common among workers' compensation claimants with work injuries/illnesses. Given the links between some dimensions of disability, mental health and sleep disturbances, the findings have implications for the development of interventions that target the high prevalence of sleep problems among working populations.

Sleep Quality in Autism from Adolescence to Old Age

Background

Sleep problems are common in autism from early childhood. Although research suggests that poor sleep continues at least into early middle age, the pattern of sleep problems has rarely been characterized beyond childhood. The aim of this study was to examine sleep quality from adolescence to old age in autistic individuals as compared with age-matched non-autistic comparison groups from the general population.

Methods

Participants ranged from 15 to 80 years; there were 297 participants in the autistic group (mean [M]_age = 34.36 years, standard deviation [SD] = 15.24), and the comparison group had 233 participants (M_age  = 33.01 years, SD = 15.53). Sleep quality, sleep onset latency (SoL), total night sleep, and sleep efficiency as measured by Pittsburgh Sleep Quality Index were compared between groups and across age groups (15-19, 20-39, 40-59, 60+ years). Five predictors of sleep quality (autistic traits, mental health condition, medication, employment, and sex) were also examined.

Results

Overall, problematic sleep was more common for the autistic participants (63.7%) than the comparison group (46.4%), and autistic participants had poorer sleep quality and longer SoL (all p < 0.001). In early adulthood and middle age, autistic adults had significantly poorer sleep quality and longer SoL than similar age comparison group adults; autistic and comparison group adolescents and the elderly did not differ. In the autistic group, predictors accounted for 21% of sleep quality variance. Sex (p < 0.001) was the strongest predictor, with all predictors except employment contributing unique variance. In the comparison group, predictors accounted for 25% of the variance in sleep quality. The strongest predictor was mental health condition (p < 0.001), with all predictors except sex contributing unique variance.

Conclusions

Autistic adolescents and adults, particularly females, remain vulnerable to sleep problems, with early and middle adulthood being at times of particular risk. Targeted sleep interventions are required.

Lay summary

Why was this study done?: Difficulty sleeping is a common occurrence among autistic individuals, but we know very little about sleep in autistic adults.What was the purpose of the study?: To compare self-reported sleep quality in autistic and non-autistic people aged 15 to 80 years.What did the researchers do?: Online surveys were completed by 297 autistic individuals (average age 34.36 years) and 233 non-autistic individuals (average age 33.01 years). Participants were asked questions about their sleep quality, the time it takes them to fall asleep (sleep latency), and the number of hours of sleep they usually get each night (total sleep). Using information about how long they slept and their responses to questions about their bedtime and wake time we calculated the percentage of time they spent in bed asleep (sleep efficiency [SE]). We compared these sleep measures between the autistic and non-autistic participants. We also split the participants into four age groups (15-19, 20-39, 40-59, and 60+ years) to look at any differences at specific age points. Finally, we looked to see whether autistic symptoms, having a mental health problem, being on medication, being unemployed, and/or sex (male/female) predicted sleep quality.What were the results of the study?: Poor sleep quality was more common for the autistic participants (63.7%) than non-autistic participants (46.4%). On average, autistic participants also had poorer sleep quality scores and it took them longer to fall asleep than non-autistic participants. Autistic participants in early adulthood (20-39) and middle age (40-59) had poorer sleep quality and took longer to fall asleep than non-autistic adults of the same age. There were no differences between autistic and non-autistic adolescents (15-19) or older adults (60+). For autistic participants, the best predictor of poor sleep quality was being female; other predictors of poor sleep quality were having a mental health problem, more autistic symptoms, and being on medication. Among non-autistic participants, the best predictor of poor sleep quality was having a mental health problem; other predictors were more autistic symptoms, being on medication, and being unemployed.What do these findings add to what is already known?: Similar to the findings in autistic children, autistic adults are more likely to have poor sleep quality compared with non-autistic adults. Autistic females are particularly at risk for poor sleep, and autistic adults aged 20 to 59 years are more at risk for poor sleep quality.What are potential weaknesses in the study?: Sleep was measured by using a self-report questionnaire, which is not as reliable as using a sleep diary or other objective measures of sleep (e.g., actigraphy). In addition, this study only looked at data collected at one point in time, and as such it is not possible to examine changes over time in sleep quality among autistic adults.How will these findings help autistic adults now or in the future?: The findings in this study identified that sleep difficulties persist across the lifespan for autistic adults. Therefore, there is a critical need for future research to focus on understanding the cause of poor sleep quality in autism and develop sleep interventions for autistic adults.

The Impact of Ghana's National Health Insurance on Psychological Distress

BACKGROUND

Poor mental health is among the growing number of noncommunicable diseases in low- and middle-income countries. Despite poor mental health accounting for an already considerable and growing burden of disease in many low- and middle-income countries, policy action to confront the challenge has been limited, at both international and national levels. Recently, several low- and middle-income countries have embarked on the journey toward universal health coverage by expanding their public health insurance provision, with the ultimate objective of improving population health, in addition to other health system objectives. Mental health interventions typically may not have been specifically covered in the publicly funded benefit package, and this raises the question of whether, and if so, by how much, the expansion of public health insurance may have directly or indirectly contributed to improved mental health.

OBJECTIVE

We assessed the impact of Ghana's implementation of national health insurance on psychological distress.

METHODS

Our study used the first wave of the 2009-2010 Ghana Social Economic Panel survey, including 10,007 respondents. We employed instrumental variable and propensity score matching methods to estimate the causal impact of health insurance on psychological distress, measured by the Kessler Psychological Distress Scale (K10). Higher K10 values indicate greater psychological distress.

RESULTS

The median K10 score in Ghana was 16 (P < 0.001), with a minimum of 10 (P < 0.001) and a maximum of 45 (P < 0.001). The results from the instrumental variable estimations, without matching, indicated that the K10 score for the insured was 11.8% lower (P < 0.001) than that of the uninsured. After running the instrumental variable regression on the matched sample, the K10 score for the insured was 10.6% (P < 0.001) lower than that of the uninsured. Similarly, the estimates based on propensity score matching indicated that the insured had a lower K10 score (- 0.023; P < 0.05). Furthermore, the beneficial impact of health insurance on psychological distress is larger for wealthier than poorer insurance members and varies across regions in Ghana. The findings were robust to the various estimation methods.

CONCLUSION

This study suggests that having health insurance is associated with reduced psychological distress and hence improved mental health, even though mental illness treatment or prevention were at best only partially covered by the National Health Insurance Scheme in Ghana.

A Narrative Review of the Literature on Insufficient Sleep, Insomnia, and Health Correlates in American Indian/Alaska Native Populations

Insufficient sleep and insomnia promote chronic disease in the general population and may combine with social and economic factors to increase rates of chronic health conditions among AI/AN people. Given that insufficient sleep and insomnia can be addressed via behavioral interventions, it is critical to understand the prevalence and correlates of these disorders among AI/AN individuals in order to elucidate the mechanisms associated with health disparities and provide guidance for subsequent treatment research and practice. We reviewed the available literature on insufficient sleep and insomnia in the AI/AN population. PubMed, PsycINFO, Google Scholar, and ProQuest were searched between June 12th and October 28th of 2018. Prevalence of insufficient sleep ranged from 15% to 40%; insomnia prevalence ranged from 25% to 33%. Insufficient sleep was associated with unhealthy diet, low physical activity levels, higher BMI, worse self-reported health, increased risk for diabetes mellitus, cardiovascular disease, frequent mental distress, smoking, binge drinking, depression, and chronic pain. Insomnia was associated with depression, childhood abuse, PTSD, anxiety, alcohol use, low social support, and low trait-resilience levels. Research on evidence-based treatment and implementation practices targeting insufficient sleep and insomnia was lacking, and only one study described the development/validation of a measure of insufficient sleep among AI/AN people. There is a need for rigorous sleep research including testing and implementation of evidence-based treatment for insufficient sleep and insomnia in this population in an effort to help eliminate health disparities. We present recommendations for research and clinical practice based on the current review.

Sleep disturbance at pre-deployment is a significant predictor of post-deployment re-experiencing symptoms

Background: Insomnia is common in service members and associated with many mental and physical health problems. Recently, longitudinal data have been used to assess the impact of disturbed sleep on mental health outcomes. These studies have consistently shown relationships between sleep disturbance and development of mental illness. Objective: The present study examined the longitudinal relationship between sleep disturbance and PTSD symptomatology in a cohort of Marines and Navy Corpsmen deployed to Iraq and Afghanistan (n = 2,404) assessed prior to deployment, as well as at -3 and 6 months post-deployment. Additionally, we aimed to investigate the extent to which these relationships are moderated by combat-stress severity, and to what extent these findings are replicated in a second, separate cohort of Marines and Navy corpsmen (n = 938) assessed with identical measures prior to deployment and within 3 months of return. Method: The present study employed latent variable path models to examine the relationships between pre-deployment sleep disturbance and post-deployment re-experiencing symptoms. Initial cross-lagged path models were conducted on discovery and replication samples to validate the hypothesized predictive relationships. Follow up moderation path models were then conducted to include the effect of combat-stress severity on these relationships. Results: Initial cross-lagged models supported a significant relationship between pre-deployment sleep disturbance and future re-experiencing PTSD symptoms at all time points. Initial moderation models showed a small moderator effect of combat-stress severity, though the main predictive relationship between pre-deployment sleep disturbance and PTSD symptoms remained significant. The moderator effect was not significant in the replication sample. Conclusions: The results of this study support pre-deployment sleep disturbance as a risk factor for development of post-deployment PTSD symptoms. Interventions aimed at normalizing sleep may be important in preventive measures for PTSD.