Social Support as a Mediator Between Insomnia and Depression in Female Undergraduate Students

Post-Pandemic Insomnia in Healthcare Workers: A Prospective Study including Sociodemographic, Occupational and Psychosocial Variables

Background/Objectives: Previous research points to the prevalence of insomnia during the COVID-19 pandemic among healthcare workers (HCWs). However, longitudinal studies on its evolution, including the post-pandemic stage, are less abundant, with a special lack of research about possible psychosocial risk factors. The aim of the current study is to analyze the evolution of insomnia in Spanish HCWs from the beginning of the pandemic until two years later, examining the influence of sociodemographic, occupational and psychosocial variables. Methods: This was a prospective longitudinal design with three data collection periods in which insomnia was assessed using the Insomnia Severity Index (ISI), in addition to sociodemographic, occupational and psychosocial (i.e., social support, self-efficacy, resilience and cognitive fusion) variables in HCWs (n = 216) who were in direct contact with COVID-19 patients. Results: High scores were observed for insomnia, with a clear decrease throughout the periods studied (F = 30.198, p < 0.001). An association was observed between insomnia and certain sociodemographic and occupational variables (i.e., work category, p = 0.001; availability of Personal Protective Equipment (PPE), p < 0.001; workload, p < 0.001; worry about self or family contagion, p = 0.002, p = 0.003, respectively). Insomnia had negative relationships with social support (p = 0.014), self-efficacy (p < 0.001) and resilience (p < 0.001) and positive relationships with cognitive fusion (p < 0.001). Interaction effects between the evolution of insomnia and social support from friends (p = 0.024, ƞ2 = 0.34) and between the evolution of insomnia and cognitive fusion (p = 0.047; ƞ2 = 0.25) were found. Conclusions: Social support, self-efficacy and resilience act as buffers for insomnia. Cognitive fusion acts as a clear precipitator of insomnia as well as directly influencing its evolution. Social support from friends also affects the evolution of insomnia. Within the specific circumstances of the COVID-19 pandemic, a long-term effect of social support from friends and a short-term effect of cognitive fusion on the evolution of insomnia was observed. The findings emphasize the need to implement specific interventions to promote the mental well-being of HCWs, particularly in crisis contexts that involve an increase in occupational stress, emphasizing the role of certain psychosocial variables as protective factors.

The relationship between anxiety symptoms and disturbances in biological rhythms in patients with depression

BACKGROUND

Biological rhythms denote the cyclical patterns of life activities anchored to a 24-hour cycle. Research shows that depression exhibits disturbances in biological rhythms. Yet, the relationship between these biological rhythms and concomitant anxiety symptoms is insufficiently investigated in structured clinical assessments.

METHODS

This multicenter study, carried out in four Chinese hospitals, comprehensively examined the relationship between anxiety and disruptions in biological rhythms among patients with depression. The study encompassed 218 patients diagnosed with depression and 205 matched healthy controls. The Chinese version of the Biological Rhythms Interview of Assessment in Neuropsychiatry was utilized to evaluate the participants' biological rhythms, focusing on four dimensions: sleep, activity, social, and diet.

RESULTS

In patients with depression, there is a significant positive correlation between the severity of anxiety symptoms and the disturbances in biological rhythms. The severity of anxiety and depression, along with the quality of life, are independently associated with disruptions in biological rhythms. The mediation model reveals that anxiety symptoms mediate the relationship between depressive symptoms and biological rhythms.

CONCLUSION

This research highlights the role of anxiety within the spectrum of depressive disorders and the associated disturbances in biological rhythms. Our findings shed light on potential pathways towards more targeted preventive strategies and therapeutic interventions for individuals battling depression and anxiety.

Perceived stress, social support, and insomnia in hemodialysis patients and their family caregivers: an actor-partner interdependence mediation model analysis

Objectives

Patients' and caregivers' physical and mental health may interact. The theory of dyadic illness management holds that patients and caregivers should be regarded as a whole in health management. Previous studies have found that hemodialysis patients and their family caregivers experience poor sleep quality. Perceived stress and social support have effects on insomnia. However, the dyadic interaction between perceived stress, social support, and insomnia among hemodialysis patients and caregivers is unclear. This study aimed to explore the mediating role of social support in the association between perceived stress and insomnia in hemodialysis patient-caregiver dyads.

Methods

A total of 259 hemodialysis patient-caregiver dyads completed the Chinese Perceived Stress Scales (CPSS), the Perceived Social Support Scale (PSSS), and the Athens Insomnia Scale (AIS) in Lanzhou, China, from May 2022 to July 2022. The actor-partner interdependence mediation model analysis was used for data analysis.

Results

In the actor effect, there was a significant positive correlation between perceived stress and insomnia in hemodialysis patients (β = 0.091, p = 0.001) and their family caregivers (β = 0.588, p < 0.001). Patient's and caregiver's social support played partial mediating roles in the relationship between caregiver's perceived stress and insomnia (β = 0.135, p < 0.001 and β = 0.111, p < 0.001). In the partner effect, caregiver's perceived stress was positively connected with patient's insomnia (β = 0.915, p < 0.001), and the mediating effect of patient's social support on the relationship between caregiver's perceived stress and patient's insomnia was statistically significant (β = -0.040, p = 0.046).

Conclusion

The perceived stress, social support and insomnia of hemodialysis patients and their family caregivers had interactive effects. Effective dyadic-based interventions should be developed to improve hemodialysis patients' and caregivers' sleep quality.

The Role of Sleep Effort as a Mediator Between Anxiety and Depression

Depression, anxiety, and insomnia are all conditions that share a complex bidirectional relationship. Sleep effort is a construct with cognitive and behavioral components that perpetuates insomnia. Although many studies have examined the associations between these three variables, no studies have yet examined sleep effort as a mediating variable between anxiety and depression and vice versa. Online versions of the Hospital Anxiety and Depression Scale and the Glasgow Sleep Effort Scale were administered to a sample of 1927 higher education students aged 18-40 years (75.9% women and 76% from 18 to 23 years old). As part of the survey, participants also completed a sociodemographic questionnaire. Mediation analysis indicated that sleep effort mediates the relationship between depression and anxiety, when the former was the predictor and the latter was the criterion. Moreover, sleep effort also mediated the relationship between anxiety and depression when the former was the predictor and the latter was the criterion, albeit in a lesser extent. Sleep effort appears to play a bidirectional mediational role between depression and anxiety, being a potential target for intervention.

COVID-19-related social isolation and symptoms of depression and anxiety in young men in Poland: Does insomnia mediate the relationship?

The need for physical distancing due to COVID-19 mitigation efforts forced prolonged social isolation, which may affect sleep and lead to mental health problems. Previous research has shown that young adults are particularly vulnerable to psychological stress caused by social isolation, the negative psychological impact of the pandemic, and greater frequency and severity of sleep problems. Therefore, the main goal of the present study was to examine whether insomnia could constitute a mediation mechanism that explains the relationship between social isolation experienced during the COVID-19 pandemic and mental health outcomes (depression and anxiety) reported up to 1.5 years later. The study was conducted among young (M±SD; 24.08±3.75) men (N = 1025) in Poland. Data were collected by means of self-report questionnaires, including The Social Isolation Index, The Athens Insomnia Scale, The State-Trait Anxiety Inventory (STAI-S) and Beck's Depression Inventory (BDI-II). The results show that insomnia mediates the relationships between social isolation and both anxiety and depression. The current findings emphasize the role of insomnia in the relationships between social isolation experienced during COVID-19 and negative emotional states. From a clinical perspective, the results suggest that implementing therapeutic components that address social isolation in insomnia treatment programs may prevent the development of depression and anxiety symptoms among young men.

Physical activity and social support mediate the relationship between chronic diseases and positive mental health in a national sample of community-dwelling Canadians 65+: A structural equation analysis

BACKGROUND

Mental health is a critical component of healthy aging. Aging increases the likelihood of developing chronic diseases. The negative effects of chronic diseases on mental health have been extensively documented. Physical activity and social support have been reported to influence mental health positively.

METHODS

Data analyzed are drawn from the national Canadian Community Health Survey - Mental Health in 2012. Structural equation modeling (SEM) techniques were used to estimate and test the mediating role of physical activities and social support in the relationship between chronic disease, positive mental health, and psychological distress in a national adult population sample aged 65+.

RESULTS

Approximately 83% of the older adults sample reported having at least one chronic disease, and the mean score of psychological distress and positive mental health was 14.15 ± 4.73 and 55.28 ± 10.67, respectively. Initial analysis found that chronic illness was negatively related to positive mental health (β= -0.72, P < 0.001) and positively related to psychological distress (β=0.98, P < 0.001). The final structural model found that physical activity and social support partially mediated the negative consequences of chronic disease on psychological distress and strengthened seniors' positive mental health.

LIMITATIONS

Limiting causal attribution, potential reporting bias and limited in recognizing negative and positive social support are the major limitations.

CONCLUSIONS

Older adults with chronic diseases should be encouraged to increase physical activity and social support levels. The study outcomes have clinical implications for the delivery of mental health services to improve mental health and resilience to coping with stress among older adults.

Psychometric Properties of the Multidimensional Scale of Perceived Social Support (MSPSS) Among Family Caregivers of People with Schizophrenia in China

INTRODUCTION

The Multidimensional Scale of Perceived Social Support (MSPSS) is one of the most widely used scales for social support. Although previous studies have shown good reliability and concurrent validity, conflicting evidence exists on its factor structures.

AIM

To validate the MSPSS among caregivers of people with schizophrenia in China and assess its factor structure.

METHODS

A cross-sectional study was conducted of 449 family caregivers in 12 communities for psychometric testing, eg, internal consistency reliability, test-retest reliability, construct validity, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

RESULTS

The MSPSS showed good internal consistency with a Cronbach's alpha of 0.95, good test-retest reliability with intraclass correlation coefficient (ICC) of 0.91, and kappa ranging from 0.62 to 0.71. Concurrent validity was supported by its negative correlations with perceived stress, and significant positive correlations with caregiving rewarding feelings, family functioning, and coping. EFA yielded a two-factor structure (family vs non-family), while CFA generally supported a three-factor structure (family, friends, and significant others).

CONCLUSION

Our findings show good psychometric properties of the MSPSS among caregivers of people with schizophrenia in China. EFA yields two-factor structure and CFA yields three factors consistent with the theory underlying the measure's development.

Examining the Moderator Role of Sleep Quality in the Relationship Among Test Anxiety, Academic Success and Mood

This study explored associations among test anxiety, GPA, sleep quality, and mood in college students. Data were collected from undergraduate students (N = 316). Results revealed that higher levels of test anxiety and sleep impairment predicted negative mood in undergraduates. Findings suggest that prioritizing sleep could help improve overall mood among students with test anxiety. Future studies should work toward clarifying the complex and reciprocal relationship between sleep and test anxiety.

Factors Associated With Healthcare Workers' Insomnia Symptoms and Fatigue in the Fight Against COVID-19, and the Role of Organizational Support

Background: Healthcare workers (HCWs) have been exposed to increased risks of insomnia and fatigue during the COVID-19 pandemic. In this study, we identify important risk factors associated with insomnia symptoms and fatigue among HCWs, and evaluate the effect of organizational support on insomnia and fatigue symptoms. Methods: This is an online cross-sectional survey of HCWs in China administered during the COVID-19 epidemic (from February 27, 2020 to March 12, 2020). We employed the AIS-8 scale for insomnia screening, and a self-reported ten-point scale to evaluate subjects' degrees of fatigue. We also designed a four-point scale to assess the degree of social support provided on an organizational level. Additionally, we conducted logistic regression analysis to identify risk factors. Results: This study included a total of 3,557 participants, 41% of which consisted of non-frontline HCWs and 59% of which was frontline HCWs. Of the non-frontline HCWs, 49% reported insomnia symptoms, and 53.8% reported a moderate to high degree of fatigue. Meanwhile, among the frontline HCWs, the percentages for insomnia and moderate to high fatigue were 63.4% and 72.2%, respectively. Additionally, frontline HCWs and HCWs employed at Centers for Disease Control and Prevention (CDCs) had elevated risks of insomnia and fatigue. However, with increased organizational support, insomnia symptoms decreased among frontline HCWs. Also, organizational support mitigated the positive correlation between daily working hours and degree of fatigue among HCWs. Conclusion: Frontline HCWs and staff in Chinese CDCs have been at a high risk of insomnia symptoms and fatigue during the fight against COVID-19. This study provides evidence for the positive effects of organizational support in relation to insomnia and fatigue among HCWs. This sheds light on government responses to the COVID-19 epidemic for other countries.

The Association Between Depressive Symptoms and Insomnia in College Students in Qinghai Province: The Mediating Effect of Rumination

Background: This study investigates the mediating effect of rumination on the associations between depressive symptoms and insomnia. Methods: This is a cross-sectional study. Insomnia Severity Index (ISI), Ruminant Response Scale (RRS) and Beck Depression Inventory (BDI) were determined in 12,178 college students in Qinghai province by a questionnaire network platform. Results: The prevalence of insomnia was 38.6% in the participants. Insomnia symptoms [interquartile range: 6 (3, 9)], depressive symptoms [interquartile range: 5 (1, 9)], and rumination [interquartile range: 22 (20, 26)] were positively correlated (r = 0.25-0.46, p < 0.01). Mediation effect analysis showed that the depressive symptoms affected insomnia directly and indirectly. The direct effect and the indirect effect through rumination account for 92.4 and 7.6% of the total effect, respectively. Conclusion: The study shows that insomnia, depressive symptoms, and rumination are related constructs in college students in Qinghai province. It demonstrates the direct effects and the rumination-mediated indirect effects between depressive symptoms and insomnia; the direct effects seem to be dominant.

Mediating effect of social support on the association between life events and depression: A cross-sectional study of adolescents in Chongqing China

Depression is one of the most common mental health problems in adolescents. The link between negative life events and depression has been well established. However, our understanding about the role of social support in the link, which is likely culture-dependent, is quite limited. This study aimed to determine the mediating effect of social support on the association between life events and depression in adolescents in Chongqing China.A total of 1512 adolescents aged 12 to 17 years old in Chongqing of China were selected using a stratified cluster sampling strategy. Depression symptoms, negative life events, and perceived social support of the participants were measured using the Children's Depression Inventory, Adolescent Life Event Scale, and Child and Adolescent Social Support Scale, respectively. Pearson correlation analyses were performed to detect their associations. A multivariate linear regression model was established to determine the association between life events and depression after adjustment for variations in socio-demographic variables. The mediating effect of social support on the association between negative life events and depression was tested using the structural equation model.About 16.8% of the participants were detected with depression. Depression was associated with negative life events and low levels of social support (P < .05). Both frequency and perceived importance of social support showed a mediating effect on the association between life events and depression.Social support has a mediating effect on the association between life events and depression. Strengthening social support may be considered as an effective interventional strategy on depression in adolescents.

Stressors of COVID-19 and stress consequences: The mediating role of rumination and the moderating role of psychological support

BACKGROUNDS AND AIMS

As COVID-19 spreads rapidly, this global pandemic has not only brought the risk of death but also spread unbearable psychological pressure to people around the world. The aim of this study was to explore (a) the mediating role of rumination in the association between stressors of COVID-19 and stress consequences of college students, and (b) the moderating role of psychological support in the indirect relationship between stressors of COVID-19 and stress consequences of college students.

METHODS

Eight hundred and forty-one Chinese college students (Mage = 19.50 years, SD = 1.580) completed the measures of stressors of COVID-19, stress consequences, rumination, and psychological support.

RESULTS

Stressors of COVID-19 were significantly positively associated with stress consequences, and mediation analyses indicated that rumination partially mediated this association. Moderated mediation analysis further revealed that psychological support buffered the relation between stressors of COVID-19 and rumination, as well as the relation between rumination and stress consequences.

DISCUSSION AND CONCLUSION

Findings of this study demonstrated that stressors associated with COVID-19 is positively related to rumination, which in turn, is related to stress consequences in college students. However, psychological support buffered this effect at both indirect mediation paths, suggesting that college students with greater psychological support may be better equipped to prevent negative stress consequences.