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Du M, Liu M, Wang Y, Qin C, Liu J. Global burden of sleep disturbances among older adults and the disparities by geographical regions and pandemic periods. SSM Popul Health 2024; 25:101588. [PMID: 38225953 PMCID: PMC10788304 DOI: 10.1016/j.ssmph.2023.101588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/23/2023] [Accepted: 12/18/2023] [Indexed: 01/17/2024] Open
Abstract
Sleep disturbances are highly prevalent during the COVID-19 pandemic, especially among older adults. We aimed to evaluate sleep heath during COVID-19 pandemic and assess the differences among geographical regions and pandemic periods. We searched three databases (PubMed, Embase, Web of Science) to find articles up to March 12, 2023. We included observational studies that reported the prevalence of sleep disturbances among adults aged 60 years or older in any setting. Two researchers independently reviewed the literature and retrieved the data. We used Der Simonian-Laird random effects meta-analyses to pool the data, followed by subgroup analysis, sensitivity analysis, and meta-regression. A total of 64 studies with 181,224 older adults during the pandemic were included. The prevalence of poor sleep quality, short sleep duration, long sleep duration, and insomnia symptoms were 47.12% (95% CI: 25.97%, 68.27%), 40.81% (95% CI: 18.49%, 63.12%), 31.61% (95% CI: 24.83%, 38.38%), and 21.15% (95% CI: 15.30%, 27.00%), respectively. The prevalence of sleep problems reported by self-constructed items was 26.97% (95% CI: 20.73%, 33.22%). When compared to America (64.13%), Europe (20.23%) and the Western Pacific (21.31%) showed a lower prevalence of sleep problems (all P < 0.0001). The prevalence of worsened sleep problems was 27.88% (95% CI: 11.94%, 43.82%). Compared to 2020 (15.14%), it increased to 47.42% in 2021 (P < 0.05). Eight studies on sleep disturbances among 672 older COVID-19 patients were included. The prevalence of sleep problems and insomnia symptoms among older COVID-19 patients were 41.58% (95% CI: 21.97%, 61.20%) and 41.56% (95% CI: 28.11%, 58.02%), respectively. A significant burden related to poor sleep has been observed among older adults worldwide over the past three years, with variations across different regions and time periods. It is important to make more efforts in prevention and intervention to identify the risk factors, treatment, and rehabilitation of sleep disturbances for healthy aging.
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Affiliation(s)
- Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38, Xueyuan Road, Haidian District, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38, Xueyuan Road, Haidian District, Beijing, China
| | - Yaping Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38, Xueyuan Road, Haidian District, Beijing, China
| | - Chenyuan Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38, Xueyuan Road, Haidian District, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38, Xueyuan Road, Haidian District, Beijing, China
- Institute for Global Health and Development, Peking University, No.5, Yiheyuan Road, Haidian District, Beijing, 100871, China
- Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, No.38, Xueyuan Road, Haidian District, Beijing, 100191, China
- Key Laboratory of Reproductive Health, National Health and Family Planning Commission of the People's Republic of China, No.38, Xueyuan Road, Haidian District, Beijing, 100191, China
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, USA
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Liao DD, Hu JH, Ding KR, Hou CL, Tan WY, Ke YF, Jia FJ, Wang SB. Prevalence and Patterns of Insomnia Symptoms Among People Aged 65 and Above in Guangdong Province, China. ALPHA PSYCHIATRY 2024; 25:233-242. [PMID: 38798807 PMCID: PMC11117421 DOI: 10.5152/alphapsychiatry.2024.231458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/28/2024] [Indexed: 05/29/2024]
Abstract
Objective This survey investigated the prevalence, distribution, and correlative factors of insomnia symptoms among people aged 65 and above in Guangdong Province, China. Methods The Guangdong Mental Health Survey was conducted on the elderly in all 21 cities of Guangdong Province from September to December 2021. Multistage stratified cluster sampling was adopted, and 16 377 adult residents were interviewed face-to-face, from which 4001 elderly participants aged 65 and above were included for this study. Complex weighted adjustment methods were applied to weight the data. Multinomial logistic regression was applied to test the independent associations of clinical insomnia symptoms (CIS) and subthreshold insomnia symptoms (SIS) with the factors. Results The pooled estimate of insomnia symptoms was 13.44% [95% confidence interval (CI): 12.2 %-14.7%]. The 1-month weighted prevalence of SIS and CIS were 11.15% (95% CI: 10.05%-12.37%) and 2.28% (95%CI: 1.77%-2.94%), respectively. Multinomial logistic regression analysis revealed that urban residence, irregular diet, low body mass index, chronic disease, napping 3-4/week, early changes in dementia, symptoms of subthreshold depression, subthreshold generalized anxiety, and generalized anxiety disorder were positively associated with SIS. Additionally, living in urban areas, having chronic diseases, symptoms of subthreshold depression, major depressive disorder, subthreshold generalized anxiety, generalized anxiety disorder were positively associated with CIS. Conclusion Insomnia symptoms, including CIS and SIS, were prevalent among the elderly in Guangdong Province. Given the high burden of CIS and SIS, policymakers and healthcare professionals must explore and treat the related factors accordingly.
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Affiliation(s)
- Dan-Dan Liao
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong, China
- Southern Medical University, Second School of Clinical Medicine, Guangdong, China
| | - Jia-Hui Hu
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong, China
- Department of Psychology, Southern Medical University, School of Public Health, Guangdong, China
| | - Kai-Rong Ding
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong, China
- Department of Psychology, Southern Medical University, School of Public Health, Guangdong, China
| | - Cai-Lan Hou
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong, China
- Southern Medical University, Second School of Clinical Medicine, Guangdong, China
- Department of Psychology, Southern Medical University, School of Public Health, Guangdong, China
| | - Wen-Yan Tan
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong, China
| | - Yun-Fei Ke
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong, China
| | - Fu-Jun Jia
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong, China
- Southern Medical University, Second School of Clinical Medicine, Guangdong, China
- Department of Psychology, Southern Medical University, School of Public Health, Guangdong, China
| | - Shi-Bin Wang
- Guangdong Mental Health Center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangdong, China
- Zhuhai College of Science and Technology, School of Health, Guangdong, China
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Ruan J, Xu YM, Zhong BL. Loneliness in older Chinese adults amid the COVID-19 pandemic: Prevalence and associated factors. Asia Pac Psychiatry 2023; 15:e12543. [PMID: 37562972 DOI: 10.1111/appy.12543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/19/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Data on loneliness among older adults in China during the COVID-19 pandemic are still scarce. This study aimed to examine the prevalence of loneliness and identify its associated factors among older Chinese adults during the COVID-19 pandemic. METHODS During the COVID-19 pandemic, 1268 older Chinese adults (aged 50+ years) were recruited through snowball sampling. The Chinese version of the validated six-item De Jong Gierveld Loneliness Scale was used to assess participants' recent feelings of loneliness, and a cut-off score of two or more was used to indicate the presence of loneliness. RESULTS Loneliness was experienced by 37.9% of the participants in recent days. Factors significantly associated with loneliness included male sex (vs. female, OR: 1.62, p < .001), an education level of middle school and below (vs. college and above, OR: 1.50, p = .007), residing in the COVID-19 epicenter (vs. other provinces, OR: 1.48, p = .004), concern about contracting COVID-19 (OR: 1.68, p = .001), poor knowledge of COVID-19 (OR: 2.39, p = .012), and physical health problems (OR: 1.65, p < .001). DISCUSSION Loneliness is common among older Chinese adults amid the COVID-19 pandemic. Targeted intervention programs may be more effective in reducing loneliness among older adults who are worried about contracting COVID-19, have poor COVID-19 knowledge, and experience physical health problems.
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Affiliation(s)
- Juan Ruan
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Center for Psychological Consultation and Therapy, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Yan-Min Xu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Center for Psychological Consultation and Therapy, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Bao-Liang Zhong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
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Xu YM, Wang MF, Zhong BL. Both people living in the COVID-19 epicenter and those who have recently left are at a higher risk of loneliness. Sci Rep 2023; 13:21145. [PMID: 38036534 PMCID: PMC10689773 DOI: 10.1038/s41598-023-47140-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023] Open
Abstract
There is little empirical data on the heightened risk of loneliness among individuals residing in the COVID-19 epicenter or those who have recently left. This study compared the risk of loneliness in individuals residing in Wuhan, the COVID-19 epicenter in China, and those who had recently left during the initial outbreak period to those living in non-epicenter regions. During the COVID-19 outbreak in China in 2020, three samples were obtained using snowball sampling. The samples included 2882 epicenter residents, 1028 left residents, and 2963 non-epicenter residents. Loneliness was assessed using the six-item De Jong Gierveld Loneliness Scale, with a score of two or more indicating the presence of loneliness. 53.5% and 55.2% of epicenter and recently left residents, respectively, experienced loneliness, which was significantly higher than the 43.9% observed in non-epicenter residents. After adjusting for covariates, the risk of loneliness remained statistically significant for both epicenter and left residents (OR = 1.35, P < 0.001 and OR = 1.20, P = 0.017, respectively), when compared to non-epicenter residents. Individuals residing in the COVID-19 epicenter, as well as those who have recently left, are at a heightened risk of loneliness during the outbreak. These individuals need psychosocial support to mitigate their risk of loneliness and promote their psychological wellbeing.
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Affiliation(s)
- Yan-Min Xu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Center for Psychological Consultation and Therapy, Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Ming-Fang Wang
- Department of Clinical Nutrition, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Bao-Liang Zhong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei Province, China.
- Center for Psychological Consultation and Therapy, Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China.
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Zhong BL, Yuan MD, Li F, Sun P. The Psychological Network of Loneliness Symptoms Among Chinese Residents During the COVID-19 Outbreak. Psychol Res Behav Manag 2023; 16:3767-3776. [PMID: 37705850 PMCID: PMC10497046 DOI: 10.2147/prbm.s424565] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/23/2023] [Indexed: 09/15/2023] Open
Abstract
Purpose Social distancing measures implemented during the COVID-19 pandemic have contributed to increased levels of loneliness, but the specific interactions between loneliness symptoms in the context of the pandemic remain unknown. This study characterized the psychological network of loneliness symptoms in residents during the initial wave of COVID-19 outbreak in China. Patients and Methods The study recruited 8472 Chinese residents (61.5% women, aged 33.0±10.6 years) through online snowball sampling. The Six-item De Jong Gierveld Loneliness Scale (DJGLS) was used to measure loneliness symptoms. Central symptoms of and bridge symptoms between emotional and social loneliness subscales were identified based on centrality and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedures. Results The nodes in the loneliness network were separated into two groups, corresponding to the social and emotional loneliness domains of the DJGLS. The strongest direction association was between "no reliable people" and "no trustworthy people" (edge weight=0.546). "No trustworthy people" has the highest node strength (1.047) in the loneliness network, followed by "emptiness sense" (0.767) and "no reliable people" (0.749). "Feeling of rejection" (1.672) and "no close people" (0.403) showed the first and second highest bridge strengths, respectively. Both the stability and accuracy tests supported robustness of the whole network. Conclusion Interventions targeting central symptoms "no trustworthy people" and "emptiness sense" and central bridge symptom "feeling of rejection" may be effective for alleviating the overall level of loneliness in pandemic-affected Chinese residents.
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Affiliation(s)
- Bao-Liang Zhong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei Province, People’s Republic of China
- Research Center for Psychological and Health Sciences, China University of Geosciences (Wuhan), Wuhan, Hubei Province, People’s Republic of China
| | - Meng-Di Yuan
- Research Center for Psychological and Health Sciences, China University of Geosciences (Wuhan), Wuhan, Hubei Province, People’s Republic of China
| | - Fang Li
- Department of Psychiatry, Huangpu District Mental Health Center, Shanghai, People’s Republic of China
| | - Peng Sun
- Department of Psychiatry, Huangpu District Mental Health Center, Shanghai, People’s Republic of China
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Zhang HG, Fan F, Zhong BL, Chiu HFK. Relationship between left-behind status and cognitive function in older Chinese adults: a prospective 3-year cohort study. Gen Psychiatr 2023; 36:e101054. [PMID: 37337546 PMCID: PMC10277132 DOI: 10.1136/gpsych-2023-101054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/11/2023] [Indexed: 06/21/2023] Open
Abstract
Background Due to the inaccuracy of the traditional geographical distance-based definition of left-behind status, data on the negative effect of left-behind status on cognitive function among older adults are controversial. Aims This study examined the cross-sectional and longitudinal associations of left-behind status with cognitive function in older Chinese adults. The left-behind status definition was based on the frequency of face-to-face parent-child meetings. Methods Data from a nationally representative sample of 8 682 older adults (60+ years) in 2015 (5 658 left behind and 3 024 non-left behind), of which 6 933 completed the follow-up in 2018, were obtained from the China Health and Retirement Longitudinal Study. Left-behind older adults were broadly defined as those aged 60+ years who had living adult children and saw their children less than once per month. The cognitive function was assessed with a composite cognitive test with higher total scores indicating better cognitive function. Results Left-behind older adults had significantly lower cognitive test scores than non-left-behind older adults in both 2015 (11.1 (6.0) vs 13.2 (5.9), t=15.863, p<0.001) and 2018 (10.0 (6.6) vs 12.4 (6.7), t=14.177, p<0.001). After adjusting for demographic factors, lifestyle factors, chronic medical conditions and the baseline cognitive test score (in the longitudinal analysis only), on average, the cognitive test score of left-behind older adults was 0.628 lower than their non-left-behind counterparts in 2015 (t=5.689, p<0.001). This difference in cognitive test scores attenuated to 0.322 but remained significant in 2018 (t=2.733, p=0.006). Conclusions Left-behind older Chinese adults have a higher risk of poor cognitive function and cognitive decline than their non-left-behind counterparts. Specific efforts targeting left-behind older adults, such as encouraging adult children to visit their parents more regularly, are warranted to maintain or delay the progression of cognitive decline.
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Affiliation(s)
- Hong-Guang Zhang
- Department of Psychiatry, Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, Hubei, China
| | - Fang Fan
- Department of Psychiatry, Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, Hubei, China
| | - Bao-Liang Zhong
- Department of Psychiatry, Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, Hubei, China
| | - Helen Fung-Kum Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
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Zhang C, Zeng S, Xu Y, Liu S, Du S, Fang L, Lv Z, Zhang L, Zhang B. Baseline symptoms of depression and anxiety negatively impact the effectiveness of CBTi in treating acute insomnia among young adults. Gen Psychiatr 2023; 36:e101013. [PMID: 37265474 PMCID: PMC10230965 DOI: 10.1136/gpsych-2023-101013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/17/2023] [Indexed: 06/03/2023] Open
Abstract
Background Cognitive-behavioural therapy for insomnia (CBTi) is the first-line treatment for those with this sleep disorder. However, depressive and anxiety symptoms often co-occur with acute insomnia, which may affect the effectiveness of CBTi treatment. Aims This study aimed to determine the impact of depressive and anxiety symptoms on the efficacy of CBTi in treating acute insomnia. Methods A single-arm clinical trial was conducted among individuals who have acute insomnia. Participants underwent self-guided CBTi for 1-week. Their insomnia, depressive symptoms and anxiety symptoms were evaluated using the Insomnia Severity Index and the Hospital Anxiety and Depression Scale at baseline, post-treatment and 3-month follow-up. Repeated measures analysis of variance was used to assess the effectiveness of CBTi in treating insomnia, depressive symptoms and anxiety symptoms. A multivariate Cox regression model was used to determine the impact of depressive and anxiety symptoms on insomnia. Results The study found significant reductions in insomnia, depressive symptoms and anxiety symptoms at both post-treatment and 3-month follow-up (F=17.45, p<0.001; F=36.37, p=0.001; and F=81.51, p<0.001, respectively). The duration of CBTi treatment had a positive impact on insomnia recovery (hazard ratio (HR)=0.94, p=0.018). However, baseline depressive symptoms (HR=1.83, p=0.004) and baseline anxiety symptoms (HR=1.99, p=0.001) had significant negative effects on insomnia recovery. Conclusions The study showed that a 1-week self-guided CBTi treatment is effective in treating acute insomnia and comorbid depressive and anxiety symptoms. However, baseline depressive and anxiety symptoms negatively impact treatment effectiveness. Therefore, clinicians should assess for depressive and anxiety symptoms before treating acute insomnia with monotherapy CBTi.
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Affiliation(s)
- Chenxi Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shufei Zeng
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Xu
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shuai Liu
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shixu Du
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Leqin Fang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhihong Lv
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Lili Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Center of Sleep Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Brown LA, Zhu Y, Hamlett GE, Moore TM, DiDomenico GE, Visoki E, Greenberg DM, Gur RC, Gur RE, Barzilay R. COVID-19 Worries and Insomnia: A Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4568. [PMID: 36901578 PMCID: PMC10001605 DOI: 10.3390/ijerph20054568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic was associated with significant increases in sleep disorder symptoms and chronic worry. We previously demonstrated that worry about the pandemic was more strongly associated with subsequent insomnia than the converse during the acute (first 6 months) phase of the pandemic. In this report, we evaluated whether that association held over one year of the pandemic. Participants (n = 3560) completed self-reported surveys of worries about the pandemic, exposure to virus risk factors, and the Insomnia Severity Index on five occasions throughout the course of one year. In cross-sectional analyses, insomnia was more consistently associated with worries about the pandemic than exposure to COVID-19 risk factors. In mixed-effects models, changes in worries predicted changes in insomnia and vice versa. This bidirectional relationship was further confirmed in cross-lagged panel models. Clinically, these findings suggest that during a global disaster, patients who report elevations in either worry or insomnia should be considered for evidence-based treatments for these symptoms to prevent secondary symptoms in the future. Future research should evaluate the extent to which dissemination of evidence-based practices for chronic worry (a core feature of generalized anxiety disorder or illness anxiety disorder) or insomnia reduces the development of co-occurring symptoms during a global disaster.
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Affiliation(s)
- Lily A. Brown
- Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA
| | - Yiqin Zhu
- Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA
| | - Gabriella E. Hamlett
- Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA
| | - Tyler M. Moore
- Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA
- Lifespan Brain Institute of the Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Grace E. DiDomenico
- Lifespan Brain Institute of the Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Elina Visoki
- Lifespan Brain Institute of the Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - David M. Greenberg
- Department of Music, Bar Ilan University, Ramat Gan 5290002, Israel
- Interdisciplinary Department of Social Sciences, Bar-Ilan University, Ramat Gan 5290002, Israel
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK
| | - Ruben C. Gur
- Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA
- Lifespan Brain Institute of the Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Raquel E. Gur
- Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA
- Lifespan Brain Institute of the Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
| | - Ran Barzilay
- Department of Psychiatry, School of Medicine, University of Pennsylvania Perelman, 3535 Market Street Suite 600N, Philadelphia, PA 19104, USA
- Lifespan Brain Institute of the Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA 19104, USA
- Department of Child Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
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Zhong BL, Li HJ, Xu YM, Jiang XF. Clinical insomnia among elderly primary care attenders in Wuhan, China: A multicenter cross-sectional epidemiological study. Front Public Health 2022; 10:1026034. [PMID: 36339226 PMCID: PMC9634545 DOI: 10.3389/fpubh.2022.1026034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/10/2022] [Indexed: 01/28/2023] Open
Abstract
Background and objectives Integrating sleep health into primary care is a promising approach to narrow the treatment gap for insomnia in older adults but data regarding the epidemiological characteristics of insomnia among elderly primary care attenders (EPCAs) are very limited. This study examined the prevalence and correlates of clinical insomnia among Chinese EPCAs. Methods By using two-stage consecutive sampling method, a total of 757 EPCAs were recruited from seven urban and six rural primary care centers in Wuhan, China. The Insomnia Severity Index (ISI) and the Geriatric Depression Scale (15 item version) were administered to assess insomnia severity and depressive symptoms, respectively. Results The two-week prevalence of clinical insomnia (ISI score ≥ 15) was 28.9%. Significant correlates of clinical insomnia were: female sex (vs. male, OR = 2.13, P < 0.001), fair and poor family relationship (vs. good, OR = 1.59, P = 0.028), hypertension (OR = 1.67, P = 0.004), heart disease (OR = 1.73, P = 0.048), arthritis (OR = 2.72, P = 0.001), and depressive symptoms (OR = 4.53, P < 0.001). Conclusion The high prevalence of clinical insomnia among Chinese EPCAs suggests a high level of sleep health need in older patients in China's primary care settings. Considering the many negative outcomes associated with insomnia, it is necessary to integrate sleep health into primary care in China.
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Affiliation(s)
- Bao-Liang Zhong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China,Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Hong-Jie Li
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China,Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Yan-Min Xu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China,Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Xue-Feng Jiang
- Department of Outpatient and Emergency, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China,*Correspondence: Xue-Feng Jiang
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Ruan J, Xu YM, Zhong BL. Depressive disorders in older Chinese adults with essential hypertension: A classification tree analysis. Front Cardiovasc Med 2022; 9:1035203. [PMID: 36277764 PMCID: PMC9579371 DOI: 10.3389/fcvm.2022.1035203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although there has been accumulating evidence on the elevated risk of depression in hypertensive patients, data regarding depressive disorders in older adults with hypertension and the interplay between factors associated with depression in this population are very limited. Disentangling the mutual influences between factors may help illuminate the pathways involved in the pathogenesis of the comorbidity of depression in hypertension. This study investigated the prevalence of depressive disorders in older Chinese adults with hypertension and examined major correlates of depressive disorders and the interactions between correlates by using classification tree analysis (CTA). Methods In total, 374 older adults with essential hypertension were enrolled from seven urban and six rural primary care centers in Wuhan, China, and interviewed with the Chinese Mini-international Neuropsychiatric Interview 5.0. Family relationship and feelings of loneliness were assessed with standardized questions. A checklist was used to assess the presence of six major medical conditions: diabetes mellitus, heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, chronic gastric ulcer, and arthritis. Results The 1-month prevalence rate of depressive disorders was 25.7%. The CTA model identified four major correlates of depressive disorders: loneliness was the most salient, followed by arthritis, family relationship, and heart disease. There were statistically significant interactions between loneliness and arthritis, loneliness and family relationship, and arthritis and heart disease. Conclusion Over one out of every four older Chinese adults with hypertension suffer from depressive disorders. Collaborative multidisciplinary management services are needed to reduce the burden of depression in hypertensive older adults, which may include social work outreach services to promote family relationship, mental health services to relive loneliness, and primary care services to manage arthritis and heart disease.
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Affiliation(s)
- Juan Ruan
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Center for Psychological Consultation and Therapy, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Yan-Min Xu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Center for Psychological Consultation and Therapy, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Bao-Liang Zhong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
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Yuan MD, Wang ZQ, Fei L, Zhong BL. Prevalence of prolonged grief disorder and its symptoms in Chinese parents who lost their only child: A systematic review and meta-analysis. Front Public Health 2022; 10:1016160. [PMID: 36238241 PMCID: PMC9550932 DOI: 10.3389/fpubh.2022.1016160] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/12/2022] [Indexed: 01/28/2023] Open
Abstract
Background Parents who lost their only child and cannot have a second child ("Shidu") have been a large population in China. Prolonged grief disorder (PGD) in Shidu parents is of clinical and public health concern but the reported PGD prevalence varies widely. To facilitate the planning of grief counseling services, this meta-analysis estimated prevalence of PGD and its symptoms and identified subgroups at elevated risk for PGD. Methods We searched English and Chinese literature databases to identify cross-sectional surveys reporting prevalence of PGD or PGD symptoms in Chinese Shidu parents. The Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data ("JBI") was used to assess risk of bias of included studies. Results Seven studies with a total of 2,794 Shidu parents were included and their JBI scores ranged from five to eight. The pooled prevalence of PGD and PGD symptoms was 20.9% and 75.0%, respectively. Greater risk of PGD was observed in mothers [vs. fathers, OR (odds ratio) = 1.89, P = 0.001] and in parents with religious beliefs (vs. without religious beliefs, OR = 1.65, P = 0.040). More severe PGD symptoms were presented in parents whose only child died from accidents [vs. illness, MD (mean difference) = 3.99, P < 0.001]. Deceased children of PGD parents were older than those of non-PGD parents (MD = 1.64, P = 0.035) and PGD parents had a shorter duration since the loss than non-PGD parents (MD = -3.26, P = 0.013). Conclusions PGD is prevalent among Shidu parents. Grief counseling services for Shidu parents would be more effective if they target those who are mothers and have religious beliefs and those whose children died from accidents, lost children are older, and loss occurs more recently.
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Affiliation(s)
- Meng-Di Yuan
- Research Center for Psychological and Health Sciences, China University of Geosciences (Wuhan), Wuhan, China
| | - Zong-Qin Wang
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Lei Fei
- Department of Ultrasound, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Bao-Liang Zhong
- Research Center for Psychological and Health Sciences, China University of Geosciences (Wuhan), Wuhan, China
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Department of Clinical Psychology, Wuhan Hospital for Psychotherapy, Wuhan, China
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