Loneliness and sleep in the American Indian Blackfeet community

Content analysis of factors related to sleep health among American Indian peoples

BACKGROUND

Chronic sleep problems are commonly reported in American Indian (AI) peoples, however there is a lack of qualitative research examining the behavioral, psychological, sociocultural, and economic factors surrounding sleep health among AI peoples. This study aims to remedy that oversight by providing qualitative data on AI peoples sleep health.

OBJECTIVES

To explore the perceived barriers to and facilitators of healthy sleep in AI peoples and identify protective cultural factors associated with sleep for AI peoples.

SETTING

Fifty-nine American Indians aged 30-79 located across 3 geographic sites: Arizona, South Dakota, and Oklahoma.

METHODS

Focus groups were collected in November 2019 and individual interviews were conducted between May and November 2020. Conventional content analysis was used to examine the recurring and overlapping themes related to perceptions of barriers to and facilitators of healthy sleep.

RESULTS

The results yielded 11 barriers to healthy sleep and 12 facilitators of healthy sleep. Facilitators included protective cultural factors such as good dreams, cultural bedtime routine, praying, traditional knowledge, ceremonies and practices, and traditional remedies.

CONCLUSIONS

The findings suggest future sleep health interventions among AI peoples should focus on promoting the cultural factors that were identified as protective factors and improving the sleep environment. Culturally tailoring sleep health interventions is an important step forward in decolonizing research methodologies.

Social connectedness and sleep in Blackfeet American Indian adults

OBJECTIVES

A growing body of work documents a link between indices of social connectedness and sleep health. Sleep is implicated in the chronic health conditions which disproportionately affect American Indian adults, however the relationship between social connectedness and sleep health is largely understudied in this population. The current project investigates relationships between multiple indices of social connectedness and sleep health in a sample of American Indian adults.

METHODS

In a sample of 275 American Indian adults residing in the Blackfeet Nation in Montana, we investigated links between social networks, loneliness, existential isolation (i.e., feeling alone in one's experiences) and sleep health. We used one linear regression model controlling for demographics and symptoms of anxiety and depression to investigate the relationship between measures of social connectedness and sleep health.

RESULTS

Existential isolation was the only statistically significant predictors of sleep health, with higher existential isolation relating to worse sleep health.

CONCLUSION

Existential isolation may be a particularly important measure of social connectedness in American Indian adults. More research is needed to understand precursors of existential isolation and the mechanisms contributing to the relationship between existential isolation and sleep health in Blackfeet American Indian adults.

Social Networks and Loneliness in the Blackfeet American Indian Community

BACKGROUND

While characteristics of an individual's social network and reported loneliness may be linked, they can be distinct. Prior work indicates that gender moderates the relationship between social networks and loneliness; however, these relationships have not been investigated in American Indian adults. The current work investigates whether the relationship between characteristics of one's social network (i.e., social network size and social integration) and loneliness is moderated by gender in a sample of Blackfeet American Indian adults.

METHOD

At Wave 1 of a longitudinal research project, we used linear regression to test whether gender moderates the relationship between social network characteristics and loneliness in a sample of 275 Blackfeet American Indian adults living in the Blackfeet nation in Montana. Our analyses controlled for age, education, and symptoms and depression and anxiety.

RESULTS

Gender moderated the relationship between social network size and loneliness (β = - 0.15, t(265) = - 2.71, p = 0.01, r2 change = .04), and the relationship between social integration and loneliness (β = - 0.14, t(265) = - 2.68, p = 0.01, r2 change = .03). Women with small social networks reported significantly greater loneliness compared to men with similarly small social networks, and for women higher social integration (i.e., more social roles) related to lower loneliness, but this was not the case for men.

CONCLUSION

Social network characteristics predict loneliness for Blackfeet women but not Blackfeet men in this sample. Future work should elucidate predictors of loneliness for Blackfeet men and consider whether daily changes in social connectedness predict changes in loneliness and whether changes in social networks predict changes in loneliness.

Loneliness and sleep in everyday life: Using ecological momentary assessment to characterize the shape of daily loneliness experience

BACKGROUND

Loneliness has been linked to an increased risk of sleep problems. Past research has largely relied on trait loneliness or daily recall loneliness when evaluating associations with sleep.

OBJECTIVE

The present study extended this work by evaluating the patterns of loneliness throughout the day, including a daily average of all reports, a maximum value, and daily variation. These loneliness patterns predicted daily subjective and objective sleep measures to evaluate whether they provide unique insight to this relationship.

METHODS

Undergraduate students (n = 71; 77% female; age 18-28) completed 2weeks of electronic surveys 4 times a day to assess loneliness. Each morning participants completed a diary of their prior night's sleep quality, as well as wore actigraphy devices to objectively assess sleep parameters. A total of 778 momentary surveys and 565days of actigraphy-assessed sleep data were collected. Multilevel models tested whether within-person daily aggregates of loneliness were associated with within-person daily sleep outcome variables.

RESULTS

Subjective sleep duration, quality, and fatigue were significantly predicted by daily average loneliness. Subjective sleep latency, quality, and fatigue were significantly predicted by daily max loneliness. Only fatigue was significantly predicted by daily loneliness variability. No objective sleep measures were significantly predicted by daily loneliness measures.

CONCLUSIONS

Patterns of daily loneliness focusing on central tendency (average) or intensity (max) were more consistently associated with subjective (but not objective) assessments of sleep than variability.

Loneliness dynamics and physical health symptomology among midlife adults in daily life

OBJECTIVE

The current study examined how average daily loneliness (between-persons [BPs]), intraindividual variability in loneliness across days (within-persons [WPs]), and loneliness stability informed physical health symptomatology.

METHOD

We utilized daily diary data from a national sample of 1,538 middle-aged adults (Mage = 51.02; 57.61% women) who completed eight end-of-day telephone interviews about daily experiences, including loneliness and physical health symptoms (e.g., headaches, nausea). Via multilevel modeling, we examined average daily loneliness (BPs), intraindividual variability in loneliness (WPs), stability in loneliness (individual mean-squared successive difference) in association with the number and average severity of daily physical health symptoms.

RESULTS

When participants were less lonely on average, and on days when loneliness was lower than a person's average, they had fewer and less severe physical health symptoms. Additionally, participants who were more stable in loneliness across 8 days had less severe physical health symptoms. Further, there was a stronger association between instability in loneliness and more physical health symptoms for people who were lonelier on average. Finally, the increase in physical health symptom severity associated with WP loneliness was strongest for participants with low variability in loneliness.

CONCLUSION

Loneliness is associated with physical health symptoms on a day-to-day basis, especially for people who are highly variable in loneliness. Considerations of multiple sources of variation in daily loneliness may be necessary to adequately address loneliness and promote health. Public health interventions addressing loneliness may be most effective if they support social connectedness in people's everyday lives in ways that promote stable, low levels of loneliness. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Bidirectional Associations Between Loneliness, Emotional Support, and Sleep in Daily Life

OBJECTIVE

Evidence suggests a link between positive social relationship perceptions and improved sleep (e.g., quality, efficiency) across the life span. Less work has probed the directionality of these relationships. Here, we report findings from the first study to examine bidirectional between- and within-person associations between loneliness and emotional support with daily life measures of sleep.

METHODS

Participants were 389 healthy adults aged 40 to 64 years (61% female) who completed hourly surveys assessing loneliness and perceptions of emotional support over the course of 4 days. Measures of actigraphy-assessed sleep and nightly sleep quality were also assessed for 7 to 10 days.

RESULTS

Individuals with lower average daily loneliness showed higher sleep quality and efficiency than individuals with higher loneliness (r = -0.19, p < .001; r = -0.14, p = .008, respectively), and greater average emotional support was likewise linked with better sleep quality (r = 0.18, p < .001). Controlling for neuroticism attenuated the effects of average loneliness on sleep. Within-person analyses showed unexpected bidirectional effects. Specifically, days in which people felt relatively lonelier were followed by nights with greater sleep efficiency (γ = 1.08, p = .015), and nights when people reported relatively poorer sleep quality were followed by days with greater emotional support (γ = -0.04, p = .013). These unexpected findings are probed in exploratory analyses.

CONCLUSIONS

Individuals with higher loneliness and lower emotional support report poorer sleep quality and efficiency, on average. Day-to-day fluctuations in perceptions of social relationships may affect the following night's sleep, and vice versa.

Community-Based Interventions to Address Disparities in Cardiometabolic Diseases Among Minoritized Racial and Ethnic Groups

PURPOSE OF REVIEW

Cardiometabolic diseases (CMDs) are leading causes of death and disproportionally impact historically marginalized racial/ethnic groups in the United States. The American Heart Association developed the Life's Essential 8 (LE8) to promote optimal cardiovascular health (CVH) through eight health behaviors and health factors. The purpose of this review is to summarize contemporary community-engaged research (CER) studies incorporating the LE8 framework among racial/ethnic groups.

REVIEW OF FINDINGS

Limited studies focused on the interface of CER and LE8. Based on synthesis of articles in this review, the application of CER to individual/collective LE8 metrics may improve CVH and reduce CMDs at the population level. Effective strategies include integration of technology, group activities, cultural/faith-based practices, social support, and structural/environmental changes. CER studies addressing LE8 factors in racial/ethnic groups play an essential role in improving CVH. Future studies should focus on broader scalability and health policy interventions to advance health equity.

Poor self-reported sleep quality associated with suicide risk in a community sample of American Indian adults

Study Objectives

Although American Indian/Alaska Native (AI/AN) have high suicide rates few studies have systematically investigated sleep quality and its association with suicidal behaviors in AI/AN. This study is a cross-sectional investigation of self-reported sleep quality and suicidal behaviors in an adult AI population.

Methods

A semi-structured interview was used to collect data on suicidal ideation, suicidal plans, and suicidal attempts and the Pittsburgh Sleep Quality Index (PSQI) was collected to assess sleep quality in American Indian adults.

Results

In this sample (n = 477), 91 (19%) of the participants endorsed suicidal ideation (thoughts and plans), and 66 (14%) reported suicidal attempts, including four who subsequently died by suicide. More women reported suicidal thoughts or acts than men. Those endorsing suicidal thoughts slept fewer hours during the night, reported more nocturnal awakenings, and showed poorer subjective sleep quality according to PSQI total scores compared to those with no suicidal thoughts or acts. Participants with suicidal acts (n = 66) reported more bad dreams and higher PSQI total scores compared to those with no suicidal thoughts or acts. When those with any suicidal thoughts or acts (n = 157, 33%) were compared to those without, they were more likely to endorse nocturnal awakenings and bad dreams and demonstrated significantly higher PSQI total scores.

Conclusions

Although additional research is needed to evaluate sleep disturbances as a proximal, causal risk factor for suicidal behaviors in AI, findings highlight need for further study of sleep as a warning sign and intervention tool for suicide prevention among American Indian adults.

A two-mediator serial mediation chain of the association between social isolation and impaired sleep in old age

Poor sleep is a long-term public health issue that has become increasingly prevalent among socially isolated older adults. However, research on the mechanisms explaining the link between social isolation and impaired sleep (IS) remains limited, particularly in low- and middle-income countries. This study explored the serial mediating effects of loneliness and mental distress on the association of social isolation with IS among Ghanaian older adults. We analyzed data from 1201 adults aged ≥ 50 from Ghana's AgeHeaPsyWel-HeaSeeB study (mean age = 66.14, SD = 11.85, age range = 50-111; women = 63.28%). Measures included the UCLA 3-item Loneliness Scale, modified Berkman-Syme Social Network Index, Sleep Quality Scale, and Mental Distress Questionnaire. We used bootstrapping techniques from Hayes' PROCESS macro program to estimate the hypothesized serial mediation. Social isolation was significantly associated with IS (β = 0.242, p < 0.001). Crucially, social isolation indirectly predicted IS via three significant mediating pathways. Loneliness accounted for 17.6% (β = 0.054, CI = 0.096, 0.016), mental distress accounted for 6.5% (β = 0.020, 95% CI = 0.004, 0.040), and loneliness and mental distress accounted for 32.2% (β = 0.099, 95% CI = 0.065, 0.138) of the overall effect. The total mediating effect was 56.4%. These findings suggest that the social isolation-sleep link is respectively and serially explained by loneliness and mental distress. Social integrative interventions for sleep quality in old age should target mental and emotional well-being.

Covid-19 and changes in sleep health in the Blackfeet Community

We examined changes in psychological outcomes related to the COVID-19 pandemic (ie psychological stress, perceived control, and perceived ability to cope) and changes in sleep health in the American Indian Blackfeet community over 4 months (August 24, 2020-November 30, 2020). American Indian adults residing on the Blackfeet reservation (n = 167) completed measures of perceived control over contracting COVID-19, perceived ability to cope with pandemic stressors, psychological stress linked to the pandemic, and a measure of sleep health each month. Linear-effects mixed models were used to examine changes in our outcomes. Community members who reported more control over contracting the virus had better sleep health relative to those who reported less control (B = 0.72, SE = 0.29, p = 0.015). Further, during months when individuals felt they had more control over contracting the virus compared to their average perceived control levels, they had better sleep health relative to their own average (B = 1.06, SE = 0.13, p < 0.001). Average sleep health was the lowest in October, 2020, the month during which COVID-19 incidence was at its highest on the reservation. Declines in sleep health linked to low levels of control over contracting COVID-19 may exacerbate high incidence of chronic mental and physical health conditions in tribal communities. Interventions which highlight strategies known to reduce risk of contracting the virus, may increase perceived control and sleep health, and thus may improve downstream health outcomes for this at-risk population.