Dysfunctional cognitions about sleep in psychiatric patients

Investigation on sleep-related cognition of Chinese health care workers during the first wave of COVID-19 pandemic

Background

The COVID pandemic has brought tremendous negative effects on the mental health of health care workers, such as anxiety, depression, and sleep disorders. We conducted this study to evaluate the sleep-related cognition of Chinese health care workers (HCWs) during the first wave of COVID-19 pandemic and analyze its association with sleep quality, so as to provide scientific reference for improving sleep of HCWs.

Patients and methods

A total of 404 HCWs from Yijishan Hospital of Wuhu City, China were enrolled in the study, selected by randomized cluster sampling in May 2020. We made a questionnaire to collect the general demographic information of the participants. The Pittsburgh Sleep Quality Index (PSQI) and a brief version of Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16) were used to measure sleep quality and sleep-related cognition, respectively.

Results

The results showed that 312 HCWs (77.2%) had false beliefs and attitudes about sleep, while only 92 HCWs (22.8%) had correct beliefs about sleep. In addition, we found that those HCWs who were older, married, with a bachelor’s degree or higher, nurses, more daily working hours (> 8 h) and monthly night shifts (≥ 5 times), had higher DBAS-16 scores (all p < 0.05). However, we did not find significant differences between men and women in DBAS-16 scores. According to the definition of PSQI, a total of 1/4 of the HCWs are poor sleepers and their DBAS-16 score was higher than good sleepers (t = 7.622, p < 0.001). In the end, we confirmed a positive correlation between sleep cognition and sleep quality (r = 0.392, p < 0.01).

Conclusion

Our study revealed false beliefs and attitudes about sleep were prevalent among HCWs during the first wave of COVID-19 pandemic, and these false beliefs about sleep were closely correlated to sleep quality. We recommend fighting against these false beliefs about sleep.

Psychosis and Hopelessness Mediate the Relationship Between Reduced Sleep and Suicidal Ideation in Schizophrenia Spectrum Disorders

OBJECTIVE

Suicide is a major cause of death amongst individuals with schizophrenia spectrum disorders (SSD). Despite numerous risk factors being identified, accurate prediction of suicidality and provision of tailored and effective treatment is difficult. One factor that may warrant particular attention as a contributor to increased psychopathology and suicidality in SSD is disturbed sleep. Sleep disturbances have been reliably linked to greater levels of suicidal ideation and are highly prevalent amongst individuals with SSD. This study aimed to examine if reduced sleep duration and psychopathology are associated with increased suicidal ideation.

METHOD

One-hundred and eighteen adults with chronic SSD living within the community participated in this cross-sectional study. Psychosis symptoms were assessed using the Positive and Negative Syndrome Scale. Items 4 and 10 from the Montgomery-Asperg Depression Rating Scale and Item 2 from the Calgary Depression Scale for Schizophrenia were used to assess reduced sleep duration, current suicidal ideation, and hopelessness, respectively. All measures were rated concurrently.

RESULTS

A hierarchical logistic regression revealed that greater acute sleep disturbances were associated with increased suicidal ideation and this relationship was found to be uniquely mediated by both positive symptom severity and hopelessness.

CONCLUSION

These results suggest that individuals with SSD who exhibited disrupted or disordered sleep, positive symptoms and/or hopelessness should be routinely screened for suicidal thinking. Furthermore, interventions that effectively target sleep disruptions may provide much-needed action against suicidal ideation.HIGHLIGHTSReduced sleep found to be associated with increased suicidal ideationThis was uniquely mediated by both hopelessness and positive symptomsMore regular screening of sleep problems in schizophrenia is needed.

Gender Differences in the Relationship Between Sleep Problems and Suicide Attempt in Adolescents

There are few studies examining which types of sleep problems are independently associated with suicide attempt (SA) and gender difference in adolescents. The aim of the present study was to examine whether specific sleep problems were uniquely associated with suicide attempt in adolescents and explore gender differences in the association. A school-based health survey was conducted in four provinces within China from November 2014 to January 2015. A total of 15,132 students aged 10-21 years completed standard questionnaires assessing past 12 month suicide attempt in addition to measures of sleep quality, quantity and sleep beliefs. 5.4% of participants reported a suicide attempt within the last 12 months. After adjustment for sociodemographic variables and psychological symptoms, almost all sleep problems remained significantly associated with a greater endorsement of suicide attempt. Further adjustment for co-occurring sleep problems revealed that weekday sleep duration (<6, 8-10, and ≥10 h), insomnia (often), and nightmares (sometimes and often) remained independently associated with suicide attempt in boys (p < 0.05). However in girls, weekday sleep duration (<6 and ≥10 h), weekend sleep duration (<6 h), midday nap (0 or 1-2 d/week), insomnia (sometimes and often), nightmare (often) and sleep beliefs (high) were independently associated with suicide attempt (p < 0.05). Multiple sleep problems are associated with suicide attempt in adolescents, however the relationship varies by gender.

Sleep beliefs and attitudes and the association with insomnia among psychiatric outpatients

Background: While it has been demonstrated that dysfunctional sleep beliefs can contribute to sleep disturbances, less is known about it in psychiatric patients and the role these beliefs play in influencing sleep.Aims: To examine maladaptive sleep cognition among psychiatric patients and to assess its association with insomnia.Method: Participants were outpatients (n = 400) recruited from a tertiary psychiatric hospital. The Dysfunctional Beliefs and Attitudes about Sleep (DBAS-16) scale was administered to examine sleep-related cognitions in different domains. Clinical insomnia was assessed using the Insomnia Severity Index. Factors associated with DBAS were explored using linear regression and the association between DBAS scores and insomnia was tested using logistic regression.Results: Among psychiatric patients, factors associated with the DBAS domains were ethnicity, educational attainment, psychiatric comorbidity, and consumption of sleep medication. Higher dysfunctional sleep beliefs were associated with insomnia. The association was particularly prominent in the mood disorder diagnostic group.Conclusions: Dysfunctional sleep beliefs were associated with insomnia among psychiatric patients. Addressing these maladaptive cognitions is critical in alleviating sleep problems in psychiatric patients.

Targets for the Treatment of Insomnia in Veterans With Serious Mental Illness

STUDY OBJECTIVES

Insomnia is pervasive among people with serious mental illnesses (SMI) and has a profound negative impact on their psychiatric symptom management and recovery. However, little is known about the factors that affect severity of insomnia in those with SMI. In addition, very few studies have explored whether evidence-based interventions developed for those without SMI are appropriate for or applicable to individuals with SMI. The purpose of this study was to test the role of arousal, dysfunctional cognitions about sleep, and sleep-related behaviors in predicting severity of insomnia in a sample of 60 Veterans who were receiving care in Veterans Health Administration mental health and psychosocial rehabilitation programs and who reported subjective insomnia. In addition, information was collected regarding the types of insomnia treatments provided to these Veterans.

METHODS

Participants completed assessments of insomnia severity and sleep-related arousal, behaviors, and cognitions. Medical records were reviewed to determine whether participants had been screened/assessed for insomnia and whether treatments for insomnia were provided before the date of referral to the study. Multiple regression was used to predict insomnia severity on the basis of these factors.

RESULTS

Most participants (81.7%) reported moderate to severe insomnia, although only 3.3% had a diagnosis of insomnia in their medical records. Worry and helplessness about sleep were predictive of insomnia severity; better self-reported sleep hygiene and higher levels of arousal were also associated with greater severity of insomnia. Education about sleep hygiene and medication were the only types of insomnia treatment received.

CONCLUSIONS

Similar to insomnia among individuals without SMI, insomnia in Veterans with SMI is associated with dysfunctional sleep-related behaviors and cognitions. Many of the Veterans also lacked access to settings and resources conducive to healthy sleep. Veterans with SMI should be regularly assessed for insomnia. Research is needed concerning optimal evidence-based insomnia interventions for addressing behaviors and cognitions in this population in the context of these challenges.

Sensory Hypersensitivity Predicts Reduced Sleeping Quality in Patients With Major Affective Disorders

The goal of this study was to examine the sensory profile (expressed as hypersensitivity or hyposensitivity) of patients with major affective disorders and its relative contribution to the prediction of sleep quality while considering affective temperaments and depression, which may impact sleep quality. We recruited 176 participants (mean age, 47.3 y), of whom 56.8% had a diagnosis of unipolar major depressive disorder and 43.2% a diagnosis of bipolar disorder. Reduced sleep quality was evaluated using the Pittsburgh Sleep Quality Index. Affective temperaments were assessed using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego. Sensory hypersensitivity, assessed using the Adolescent/Adult Sensory Profile, significantly distinguished between poor and good sleepers. Sleep quality was mainly predicted by the Beck Depression Inventory-II total score and anxious temperament. Sensory hypersensitivity contributed to this prediction mainly with regard to sleep efficiency and related daytime dysfunction.

Presleep thoughts and dysfunctional beliefs in subjects of insomnia with or without depression: Implications for cognitive behavior therapy for insomnia in Indian context

BACKGROUND

Presleep thoughts may vary between patients of insomnia with or without depression. They are important for cognitive behavior therapy for insomnia (CBT-I), but they have never been systemically examined in Indian population.

MATERIALS AND METHODS

Patients with insomnia (>1 month) who were willing to undergo CBT-I were included in this study after obtaining informed consent. They were requested to fill a sleep diary and return after 15 days. At the time of intake, diagnosis of depression and anxiety disorders was made according to Diagnostic and Statistical Manual - IV-Text Revision. They were encouraged to provide information regarding presleep thoughts through open-ended and then, close-ended questions. Dysfunctional attitudes and beliefs about sleep were assessed with Hindi version of "dysfunctional beliefs and attitudes scale-brief version". Hindi version of "insomnia severity index" was used to assess the severity of insomnia. Subjects were divided into two-groups - insomnia without depression (I) and insomnia with major depressive disorder (I-MDD+).

STATISTICAL ANALYSIS

It was done with the help of SPSS v 21.0. Descriptive statistics was calculated. Proportions between groups were tested with Chi-square analysis and categorical variables were compared using independent sample t-test.

RESULTS

This study included a total of 63 subjects, out of which 60% were women. Mean age of the whole group was 41.7 ± 11.8 years. About 40% of all the subjects were diagnosed as having I-MDD+. Forty-one percent of the subjects had clinically significant anxiety. Both groups - I and I-MDD+ had comparable proportion of female subjects (χ(2) = 0.002; P = 0.96) and there was no difference regarding precipitating factors for insomnia (χ(2) = 0.97; P = 0.61). They were also comparable with regards to sleep-related measures, themes of presleep thoughts, and dysfunctional beliefs and attitudes about sleep and insomnia severity. Major themes of presleep thoughts included family issues and health issues. Only a small proportion had recurrent thoughts related to insomnia and its consequences.

CONCLUSION

Insomnia is a co-morbid illness with depression and it needs to be separately addressed during therapy. CBT-I should include the element of problem-solving technique, especially when we are dealing with the Indian population.

Sleep Disorders Among People With Schizophrenia: Emerging Research

Up to 80 % of individuals with schizophrenia spectrum disorders experience sleep disturbances, which impact physical and mental health, as well as quality of life. In this paper, we review and integrate emerging literature, published between 2012 and 2014, regarding approaches to diagnosis and treatment of major sleep disorders for people with schizophrenia spectrum disorders, including insomnia, obstructive sleep apnea (OSA), circadian rhythm dysfunction, and restless legs syndrome (RLS). We advocate for (1) the need to evaluate the utility of nonpharmacological approaches in people with schizophrenia spectrum disorders; (2) documentation of guidelines to assist providers in clinically tailoring such interventions when their clients experience positive, negative, and/or cognitive symptoms; (3) research on the best ways providers can capitalize on clients' self-identified needs and motivation to engage in sleep treatments through shared decision making; and (4) the importance of investigating whether and how mental health and sleep treatment services should be better connected to facilitate access for people with schizophrenia spectrum disorders. Assessment and tailored treatment of sleep disorders within mental health treatment settings has the potential to reduce sleep problems and improve functioning, quality of life, and recovery of this population.

Sleep cognitions associated with anxiety and depression in the elderly

PURPOSE

The objective of this study was to identify the maladaptive sleep-related cognitions most often maintained by the elderly, according to the presence or absence of anxiety and mood disorders. The presence of dysfunctional sleep-related beliefs and attitudes at bedtime in asymptomatic, depressive, and anxious seniors was thus compared. The second objective was to verify the relationships between various dysfunctional cognitions and mental disorders.

METHOD

The sample in this study consisted of 2,759 participants aged 65 years and over, with a mean age of 73.8 years. They were recruited through a method of random generation of telephone numbers according to a sampling strategy based on geographic location. After the goal of the study was explained to them, the participants agreed to have health professionals visit their home and to answer questions in a 1.5-hour-long structured interview (after signing a consent form).

RESULTS

Depressive and anxious seniors adopt dysfunctional sleep-related cognitions in higher proportions than asymptomatic older persons. Once we had controlled for the other factors, we were able to specifically link two sleep-related beliefs and all the sleep-related attitudes studied to the probability of being anxious or depressive.

CONCLUSION

The clarifications obtained will make it possible to improve detection, assessment, and intervention processes regarding anxiety or mood disorders, by pinpointing the most direct link between each of the dysfunctional cognitions and the two types of mental disorders, and not just the link to sleep problems.