Reciprocal Effects Between Loneliness and Sleep Disturbance in Older Americans

The relationship between social relationships and sleep quality in older adults: Loneliness as a mediator and cognitive status as a moderator

OBJECTIVES

This study investigates the complex relationships among social support, social strain, loneliness, cognitive status, and sleep quality in adults aged 51 and above. It aims to explore loneliness as a mediator between social support, social strain, and sleep quality and to examine if, and how, the mediating effect differs by cognitive status.

METHODS

Eight years of data from the University of Michigan Health and Retirement Study were analyzed using a cross-lagged panel model. Moderated mediation analyses examined loneliness's mediating effect and cognitive status's moderating influence on the associations among social support, social strain, and sleep quality.

RESULTS

Loneliness mediated the relationships between social support, social strain, and sleep quality. Individuals with better cognitive function experienced an increased influence of social support on sleep quality by mitigating loneliness.

CONCLUSION

Considering the moderating role of cognitive status, sleep interventions individualized and tailored to these differences become essential.

The effects of sleep quality on loneliness among older adults: cohort analysis from the life course perspective

BACKGROUND

Using cohort analysis to examine the effects of sleep quality on loneliness among older adults from the life course perspective.

METHODS

The hierarchical age-period-cohort growth curve model was used to analyze the data from the 2005-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS).

RESULTS

(1) Loneliness has a 'U' curve relationship with age, but with the rate of increase gradually slowing down. (2) There were significant differences in loneliness across birth cohorts, with younger cohorts having higher predicted loneliness than older cohorts at the same age. (3) The influence of different sleep quality on loneliness showed a trend of increasing with age. (4) There were no significant differences in the impact of sleep quality on loneliness in different cohorts.

CONCLUSIONS

This study has identified heterogeneity in loneliness, emphasising the need for a diversified intervention approach. Sleep quality has a protective effect on loneliness and is easy to assess, making it an important intervention tool. In addition, it is imperative to account for the influences of age and cohort effects when formulating intervention strategies.

Multidimensional frailty and sleep quality in late adulthood: A UK biobank examination

Frailty and sleep disturbances are two major concerns in late adulthood, that not only profoundly threaten health and wellbeing at the individual level but place enormous demands on our healthcare systems. Given that both constructs represent dynamic states that are preventable and reversible, understanding the potential pathways to and effects of these variables on one another is critical in providing effective and tailored support. However, despite growing interest in the relationship between sleep and frailty, only one study to date has directly explored their potential bidirectionality. Accordingly, this study was designed to extend the current understanding by investigating the reciprocal relationship of frailty and sleep quality at the multidimensional level. Specifically, the bidirectionality of these relationships was considered separately for physical, psychological, cognitive, and social frailty. Four random-intercept cross-lagged panel models with three time points were conducted, using 3192 older adults (Mage = 60.21; 46.37% female at baseline) from the UK Biobank. The results revealed that while physical, psychological, and cognitive frailty were neither predictive of, nor predicted by, sleep quality, social frailty and sleep share a reciprocal relationship. These data therefore offer important preliminary evidence for the efficacy of early intervention and prevention strategies aimed at enhancing sleep quality to reduce social frailty, and vice versa.

Understanding the Effect of Loneliness on Quality of Life in Older Adults from Longitudinal Approaches

Aim: To study the longitudinal relationship between loneliness and quality of life (QoL) in adults to identify key mechanisms to better design future psychosocial interventions. Method: 13,222 participants from three consecutive waves of the Survey of Health, Ageing, and Retirement in Europe (SHARE), aged 65 or older, 56.3% women. They were analyzed using cross-lagged panel model (CLPM), random intercept cross-lagged panel model (RI-CLPM), and multi-group models disaggregated by gender. Results: The RI-CLPM provided a better fit than the CLPM. Both models showed the stability of QoL and loneliness. All autoregressive paths were significant, and a negative association between concurrent QoL and loneliness was observed across all waves. The CLPM supported a reciprocal relationship, while the RI-CLPM only confirmed the effects of loneliness on QoL. Women reported higher levels of loneliness and poorer QoL, but no gender differences were identified in the longitudinal association. Conclusions: Addressing loneliness in early stages could be a better preventive measure to promote quality of life in both genders.

The association between loneliness, social isolation, and sleep disturbances in older adults: A follow-up study from the Swedish good aging in Skåne project

Objectives

The aim of this follow-up study was to investigate whether loneliness and social isolation in a sample of older adults, mean age of 67.4 years at baseline examination, were associated with sleep disturbances at re-examination at a mean age of 76.4 years.

Methods

The study sample consisted of 2897 participants. Data on loneliness, social isolation, and sleep disturbances were collected through questionnaires and medical examinations. Logistic regression models were constructed to identify associations between levels of loneliness and social isolation at baseline and sleep disturbances at follow-up. Sociodemographic and health-related confounding factors were controlled for in the models.

Results

Sleep disturbances were reported by 25.6% (95% CI: 24.0%-27.2%) at baseline and 23.7% (95% CI: 22.1%-25.3%) at re-examination. Odds ratios for sleep disturbances at re-examination in relation to not being lonely or socially isolated were as follows: single occasions of loneliness (OR: 1.37, 95% CI: 1.05-1.78), recurring periods/constant loneliness (OR: 1.92, 95% CI: 1.01-1.99), less severe social isolation (OR: 1.18, 95% CI: 0.78-1.79), and severe social isolation (OR: 1.88, 95% CI: 1.01-3.49).

Discussion

Sleep disturbances are common among older adults and are associated with loneliness and social isolation. Healthcare professionals should be aware of the potential effects of loneliness and social isolation when investigating sleep disturbances in older adults.

Sleep duration among adults exposed to family member incarceration during childhood

OBJECTIVES

The current study examines the association between family member incarceration during childhood and sleep duration among a national sample of adults (ages 18-80+).

METHODS

We employ data from the 2020 Behavioral Risk Factor Surveillance System (N = 116,631). We use stepwise, multinomial logistic regression to examine associations between exposure to family member incarceration during childhood and sleep duration during adulthood. We also utilize the Karlson-Holm-Breen method to investigate whether indicators of socioeconomic disadvantage, and poor mental and physical health attenuate this relationship. Finally, to examine the robustness of associations between family member incarceration and sleep duration, we used a strategic comparison approach in which participants experiencing family member incarceration were compared to participants experiencing alternative adverse childhood experiences in the absence of family member incarceration.

RESULTS

Findings demonstrate a significant association between family member incarceration and sleep duration, with particularly strong associations with short and long sleep durations (relative to optimum sleep duration). However, poor mental and physical health during adulthood and socioeconomic disadvantage significantly attenuated these associations. Strategic comparison models also revealed that the association between family member incarceration during childhood and sleep duration is robust to the accumulation of other childhood adversities.

CONCLUSIONS

Findings suggest that strategies are needed among public health practitioners, physicians, and sleep professionals to mitigate the potential adverse effects of family member incarceration during childhood on sleep duration among adults.

Generalized Anxiety Mediates the Relationship Between Loneliness and Sleep Quality Amongst Young Adults During the COVID-19 Pandemic

Since the outbreak of COVID-19, restrictions to minimize its spread have had a profound effect. Government instigated restrictions, such as social isolation, have affected millions worldwide, and the downstream consequences of perceived loneliness upon mental health and sleep are largely unknown. A total of 1662 individuals participated in an online survey. Loneliness, anxiety, and sleep quality were assessed using the UCLA Loneliness Scale, the Generalized Anxiety Disorders scale, and the Pittsburgh Sleep Quality Index, respectively. Higher levels of perceived loneliness, as well as each one-unit increase in anxiety, were independent predictors of poor sleep quality, where OR = 1.16 (95% CI: 1.03-1.31) and 1.16 (1.11-1.21), respectively, and after adjustment. In our path analysis, we revealed significant direct effects between loneliness and sleep quality (β = 0.25, p < .001), as well as generalized anxiety and sleep quality (β = 0.28, p < .001), and generalized anxiety mediated the relationship between loneliness and sleep quality (β = 0.33, p < .001). Heightened anxiety and perceived loneliness appear to be significant drivers of poor sleep quality during the COVID-19 pandemic. Digital media platforms that encourage support groups for those experiencing social isolation are encouraged, along with self-help and meditative practices, which may minimize an increase of mental health and sleep disorder diagnoses post COVID-19.

The Relationships between Various Factors and Sleep Status: A Cross-Sectional Study among Healthy Saudi Adults

Impaired sleep can adversely affect daily life. This study assesses the association between different factors and sleep status among apparently healthy Saudi adults. In total, 478 adults were included in this study. Data on anthropometrics, body composition, stress scales, physical activity, and dietary habits were collected. Fasting blood glucose and lipid profile were measured. Sleep quality and duration were assessed using the Pittsburgh Sleep Quality Index. Larger neck circumference (NC) was associated with short sleep duration (odds ratio (OR) 1.23; 95% confidence interval (CI) [1.08, 1.41]; p = 0.002). Higher triglyceride levels were associated with poor sleep quality (OR 1.01; 95% CI [1.002, 1.02]; p = 0.019) and short sleep duration (OR 1.01; 95% CI [1.004, 1.02]; p = 0.005). Stress was a risk factor for poor sleep quality (OR 1.15; 95% CI [1.09, 1.22]; p < 0.001). Being married was significantly associated with good sleep quality (OR 2.97; 95% CI [1.32, 6.71]; p = 0.009), while being single was correlated with longer sleep duration (OR 0.46; 95% CI [0.22, 0.96]; p = 0.039). Other factors such as having a larger waist circumference and more muscle mass were protective factors against poor sleep quality and/or short sleep duration. In conclusion, a larger NC is suggested as a risk factor for short sleep duration and a higher triglyceride level for both short and poor sleep among healthy Saudis. Investigating the factors associated with sleep status may help alleviate sleep disturbances and improve overall health. Further studies are needed to confirm causality using objective sleep measures.

[Loneliness and its association with sociodemographic and health indicators in Brazilian adults and older adults: ELSI-Brazil]

This study aimed to investigate the prevalence of loneliness and its associations with sociodemographic and health indicators in a nationally representative sample of Brazilian adults and older adults. Data from the baseline (2015-2016) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) were analyzed, and participants with complete information on the variables of interest (n = 7,957) were included. Loneliness was the outcome variable, which was based on the question "How often do you feel alone or lonely: always, sometimes, or never?" Independent variables included sociodemographic indicators and health behaviors and conditions. The analyses included the Pearson's chi-square test for calculating relative frequencies, and Poisson regression for estimating prevalence ratios (PR) and their respective 95% confidence intervals (95%CI). The prevalence of always feeling lonely was 16.8%; sometimes, 31.7%; and never, 51.5%. Significant associations were observed between always feeling lonely and depression (PR = 4.49; 95%CI: 3.93-5.11), living alone (PR = 2.44; 95%CI: 2.12-2.82), low education level (PR = 1.93; 95%CI: 1.61-2.32), being a woman (PR = 1.53; 95%CI: 1.36-1.72), self-rated poor/very poor health (PR = 1.48; 95%CI: 1.27-1.73), and poor/very poor sleep quality (PR = 1.21; 95%CI: 1.05-1.41). Given its potential to harm quality of life, it is necessary to longitudinally understand the trajectories of loneliness and associated variables, and to use this knowledge to design public policies and health interventions that could benefit the biopsychosocial well-being of Brazilian adults and older adults.

Associations of social isolation and loneliness with the onset of insomnia symptoms among middle-aged and older adults in the United States: A population-based cohort study

There is an inconsistent conclusion regarding the relationship of social isolation and loneliness with poor sleep. We investigated the associations of social isolation and loneliness with new-onset insomnia symptoms in a nationally-representative sample of 9,430 adults aged ≥50 who were free of any insomnia symptoms/sleep disorders at baseline (wave 12/13) and followed up to 4 years from the Health and Retirement Study. Social isolation was measured by Steptoe's Social Isolation Index. Loneliness was measured by the revised 3-item UCLA-Loneliness Scale. Insomnia symptoms were quantified using the modified Jenkins Sleep Questionnaire. During a mean follow-up of 3.52 years, 1,522 (16.1%) participants developed at least one insomnia symptom. Cox models showed that loneliness was associated with the onset of difficulties initiating or maintaining sleep, early-morning awakening, nonrestorative sleep, and at least one of these symptoms after adjusting for potential covariates; while social isolation was not associated with the onset of difficulties maintaining sleep, early-morning awakening, or at least one insomnia symptom after adjusting for health indicators. These results are consistent in sensitivity analyses and stratified analyses by age, sex, race/ethnicity, and obesity. Public health interventions aimed at fostering close emotional relationships may reduce the burden of poor sleep among middle-aged and older adults.

Reciprocal Effects between Sleep Quality and Life Satisfaction in Older Adults: The Mediating Role of Health Status

OBJECTIVES

to examine the causal relationship between sleep quality and life satisfaction and explore the mediating role of health status on the relationship between sleep quality and life satisfaction.

METHODS

A total of 1856 older Chinese people participating in 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. A cross-lagged panel analysis (CLPA) combined with mediator analysis was utilized.

RESULTS

The average sleep quality levels for the years 2011, 2014, and 2018 were 3.70, 3.63, and 3.47 out of 5, respectively. The corresponding average levels of health status were 3.47, 3.44, and 3.39 out of 5, and the average levels of life satisfaction were 3.75, 3.86, and 3.87 out of 5, respectively. In addition, sleep quality at prior assessment points was significantly associated with life quality at subsequent assessments, and vice versa. Also, health status partially mediated this prospective reciprocal relationship.

CONCLUSIONS

There is a nonlinear decreased trend in sleep quality and health status, while there exists a nonlinear increased trend in life satisfaction for older adults from 2011 to 2018. Reciprocal positive effects between sleep quality and life satisfaction in older adults exist and are mediated by health status.

Prevalence and factors associated with insomnia among medical students in China during the COVID-19 pandemic: characterization and associated factors

BACKGROUND

Insomnia has become an important issue in recent years. Insomnia is affected by many factors. Previous research has shown that during the COVID-19 pandemic, there would be a long-term negative effect on the mental health of medical college students. The state of medical college students' insomnia directly determines the results of medical education and the career development prospects of the medical students themselves. Therefore, it is very important to understand the insomnia situation of medical students in the post-epidemic era.

METHODS

This study was conducted 2 years after the global COVID-19 pandemic (April 1-April 23, 2022). The study used an online questionnaire, administered through a web-based survey platform. The Athens Insomnia Scale (AIS), Fear of COVID-19 Scale (FCV-19S), GAD-2, PHQ-2, and socio-demographic information were surveyed by the Questionnaire Star platform.

RESULTS

The prevalence of insomnia was 27.80% (636/2289). Grade(P < 0.05), age(P < 0.001), loneliness(P < 0.001), depression(P < 0.001), anxiety(P < 0.001), fear of COVID-19 was highly correlated with insomnia (P < 0.001). Adapting to online class(P < 0.001) was a protective factor of smartphone addiction.

CONCLUSIONS

This survey shows that Insomnia was highly prevalent among the Chinese medical college students during the COVID-19 pandemic. Governments and schools should through psychological interventions to address the current situation of insomnia among medical students, and formulate targeted programs and strategies to reduce their psychological problems.

Mobile Phone Addiction and Sleep Quality among Older People: The Mediating Roles of Depression and Loneliness

Rapid social development has made the elderly increasingly dependent on mobile phones, and mobile phone addiction has a negative effect on sleep quality. The underlying mechanism between the two is unclear. This study examined the mediating role of depression and loneliness in the relationship between phone addiction and sleep quality in older adults. Mobile Phone Addiction Scale Short Version, Pittsburgh Sleep Quality Index scale, UCLA (University of California, Los Angeles)-8 Loneliness Scale, and Short Geriatric Depression Scale (GDS-15) were used to investigate 459 older adults in China. The results showed that there was a positive correlation between mobile phone addiction and sleep quality in the elderly. In addition, depression and loneliness partially mediated the relationship between mobile phone addiction and sleep quality in older adults. The current study provides new insights into the impact of mobile phone addiction on sleep quality and the importance of depression and loneliness in older adults. The limitations and significance of this study are discussed.

The relationship between oral health status, loneliness, and sleep quality among the migrant elderly following children in Weifang, Shandong Province, China: A comparative analysis on different migration types

Background

The migrant elderly following children (MEFC) are a vulnerable group that emerged during fast urbanization in China. The MEFC faced physical and psychological discomfort upon their arrival in the inflow city, particularly those who came from rural areas.

Objective

This study aimed to explore the relationship between oral health status, loneliness, and sleep quality among the MEFC in China and to clarify the disparities in the above mentioned relationship by migration type.

Methods

In 2021, a cross-sectional survey was conducted in Weifang, Shandong Province, using multistage cluster random sampling to collect data from the MEFC aged 60 years and over. In total, 613 respondents [525 rural-to-urban (RTU) and 88 urban-to-urban (UTU)] were included in the final database. The chi-square test, t-test, and structural equation modeling (SEM) were used to investigate the relationship between oral health status, loneliness, and sleep quality among the RTU and UTU MEFC.

Results

Total scores [mean ± standard deviation (SD)] for oral health status, loneliness, and sleep quality were 54.95 ± 6.47, 8.58 ± 3.03, and 4.47 ± 3.60, respectively. SEM revealed that, among the RTU and UTU MEFC, oral health status was positively and significantly related to sleep quality; however, the correlation was slightly stronger in the UTU MEFC. In both groups, there was a significant negative correlation between oral health status and loneliness, which was stronger in the UTU MEFC. In the RTU MEFC, a significant negative correlation between loneliness and sleep quality was observed, and in the UTU MEFC, no significant association between loneliness and sleep quality was observed.

Conclusion

The sleep quality among the MEFC in this study was higher compared to previous studies. Oral health status was negatively correlated with loneliness and positively associated with sleep quality, whereas loneliness was negatively correlated with sleep quality. These three associations differed significantly between the UTU and RTU MEFC. The government, society, and families should take measures to improve oral health and reduce loneliness among the MEFC to improve their sleep quality.

The association between loneliness and sleep quality among older adults: A systematic review and meta-analysis

OBJECTIVE

To systematically review studies and explore the association between loneliness and sleep quality among older adults.

METHODS

A comprehensive literature search was conducted in 8 databases from their inception to February 28, 2022. Studies that investigated the association between loneliness and sleep quality among older people were obtained. Comprehensive Meta-analysis was used to meta-analyze data in the included studies.

RESULTS

In total, 16 studies with 23,485 participants were included in this review, and 6 of these studies were included in the meta-analysis. The meta-analysis showed that older adults who were lonely were significantly more likely to suffer from low sleep quality than their counterparts without loneliness (pooled OR = 1.750, 95% CI: 1.511-2.026, p < 0.01).

CONCLUSIONS

Loneliness is associated with poor sleep quality among older adults. Loneliness reduction measures should be considered as one of the essential elements in sleep management programs for older people with low sleep quality.

Validation of the De Jong Gierveld Loneliness Scale in Peruvian old adults: a study based on SEM and IRT multidimensional models

Loneliness is a public health problem. Its assessment is important to identify older adults who experience greater loneliness and appropriate interventions can be carried out. The De Jong Gierveld Solitude Scale (DJGLS) is one of the most widely used, at least in the European context, to measure loneliness. Although the Spanish version of the DJGLS has shown reliability and validity in Spanish samples of older adults, there is no evidence of adequacy in the Latin American context. Therefore, this study aims to evaluate the psychometric properties of the DJGLS in Peruvian older adults. Specifically, factorial validity, internal consistency and criterion-related validity were studied, based on a double analytical perspective: Classical Test Theory (SEM models) and Item Response Theory. The participants were 235 Peruvian older adults with ages ranging from 61 to 91 years old (Mean = 72.69, SD = 6.68) that assisted to Centers for the Elderly in the city of Trujillo, Peru. Together with the DJGLS, information from the three-item UCLA loneliness scale, Satisfaction with Life Scale, Brief Resilient Coping Scale and the Patient Health Questionnarie-2 was also gathered. The results support a one-dimensional structure of the DJGLS but with the presence of method effects associated to the negatively worded items. Additionally, the IRT multidimensional model applied also indicated the presence of a second dimension related to these negative items. Finally, other evidences of reliability and validity were adequate. In summary, the DJGLS may be considered a reliable and valid instrument to be used in the Peruvian (older adults) context.

Assessing the Effectiveness of Intergenerational Virtual Service-Learning Intervention on Loneliness and Ageism: A Pre-Post Study

BACKGROUND

Service-learning is an effective intervention to solve social issues. The purpose of this study is to assess the effectiveness of intergenerational virtual service-learning on loneliness and ageism.

METHOD

This study used a pre-post design. A group of undergraduate students were randomly assigned to a "service-learning" project (n = 18). They were paired with seniors (n = 22) to have at least a 30-min weekly virtual interaction for six weeks. The following scales were used: the Aging Semantic Differential (ASD) Scale, the UCLA Loneliness Scale, a one-item researcher generated Likert-rating of loneliness, and two-item researcher generated Likert-rating of student competence.

RESULTS

Among college students, the service-learning group showed lower ASD and ageism scores at the post-test compared to the non-service-learning group, t (1, 40) = -2.027, p = 0.049; t (1, 40) = -2.102, p = 0.042, respectively. Among seniors, loneliness scores on the UCLA Scale and the one-item scale of loneliness dropped significantly from pre- to post-interactions with students, t (1, 19) = 2.301, p = 0.033, and t (1, 22) = 2.412, p = 0.009, respectively.

CONCLUSION

Virtual service-learning is an effective way to solve social issues such as loneliness and ageism.

The contribution of social isolation and loneliness to sleep disturbances among older adults: a systematic review

A large number of older people encounter both objective and subjective types of social isolation and sleep disorders. Social isolation increases a person's risk of a wide range of adverse health outcomes and premature death. Social isolation can cause poor sleep quality that has been proposed as one of the possible mechanisms by which social isolation affects people's health and quality of life. The present study was conducted to determine the relationship between objective and subjective social isolation with sleep difficulties among older adults. All articles in PubMed, Web of Science, Scopus, Embase, PsycInfo, and Social care online databases published by December 2020 were systematically searched for relevant published articles. Two authors separately checked the acceptability and quality of the studies using the Newcastle Ottawa checklist. Any disagreement was resolved by consulting the third author. According to the inclusion criteria, 11 studies were systematically reviewed, of which five were cross-sectional, and six were longitudinal studies. No meta-analysis was performed due to the high heterogeneity of the studies. Based on the present study results, both objective and subjective social isolation are related to sleep disturbance in older people. This systematic review showed that objective and subjective social isolation are associated with low sleep quality. It is recommended to investigate the causal relationships and possible pathways that affect the studied variables in future studies.

Fear of COVID-19 and quality of life: the mediating role of loneliness among older Turkish adults

The novel coronavirus (COVID-19) outbreak has affected living standards around the world, and pandemic anxiety has changed social habits. In this context, this paper investigates the relationship between fear of COVID-19 and quality of life, and assesses the mediating effect of loneliness on this relationship among a sample of older adults in Turkey. The study considers data from approximately 400 people, all of whom completed the CASP-19 Quality of Life Scale in Older People, the Loneliness Scale for the Elderly and the Fear of COVID-19 Scale. Confirmatory factor analyses were performed to confirm a one-factor structure for each instrument. Subsequently, mediation analysis, correcting for age as a continuous covariate, was performed to assess the nature of the relationship between fear and quality of life, and the extent to which that relationship is mediated by loneliness. Our study showed that there is a negative and direct relationship between loneliness and quality of life. Another important finding of our research is that fear of COVID-19 has a significant effect on loneliness. Finally, loneliness mediates the relation between fear of COVID-19 and quality of life. This finding strongly suggests that fear of COVID-19 influences quality of life via loneliness. This result is noteworthy, as we could not find any similar finding in the literature.

Sleep Disturbances and Their Association With Quality of Life in Older Psychiatric Patients During the COVID-19 Pandemic

AIMS

The negative effect of the COVID-19 pandemic on sleep quality of clinically stable psychiatric patients is unknown. This study examined the prevalence of sleep disturbances and their association with quality of life (QOL) in clinically stable older psychiatric patients during the COVID-19 pandemic.

METHODS

This multicenter, cross-sectional study involved older patients attending maintenance treatment at outpatient departments of four major psychiatric hospitals in China. Patients' socio-demographic and clinical characteristics were collected. Sleep disturbances, depressive symptoms, and QOL were assessed with the Insomnia Severity Index, the 9-item Patient Health Questionnaire, and 2 items of the World Health Organization Quality of Life-Brief version, respectively. Binary logistic regression analysis was conducted to examine the independent associations of socio-demographic and clinical variables with sleep disturbances, while the association between sleep disturbances and QOL was explored with analysis of covariance.

RESULTS

A total of 941 patients were recruited. The prevalence of sleep disturbances was 57.1% (95% CI: 53.9-60.2%). Analysis of covariance revealed that QOL was significantly lower in patients with sleep disturbances compared to those without. Multivariate logistic regression analysis showed that sleep disturbances were positively and independently associated with more severe depressive symptoms (OR = 1.32, 95% CI: 1.26-1.37). Compared to patients with major depressive disorder, those with other psychiatric diagnoses had a significantly higher prevalence of sleep disturbances (OR = 1.44, 95% CI: 1.00-2.08).

CONCLUSION

Sleep disturbances were common among clinically stable older psychiatric patients during the COVID-19 pandemic. Considering the negative association with QOL, this subpopulation needs regular assessment and timely treatment to reduce their sleep disturbances and improve their QOL.

Sleepless in Solitude-Insomnia Symptoms Severity and Psychopathological Symptoms among University Students during the COVID-19 Pandemic in Poland

Since 25 March 2020, all schools, colleges, and universities in Poland have indefinitely closed and, where possible, have activated distance learning because of the COVID-19 pandemic. Considering that the undergraduate years are usually characterized by a high prevalence of emotional disorders and sleep problems, it can be expected that the current situation may have a remarkable impact on the student population. This study aimed to investigate the occurrence of sleep problems among Polish university students as well as the relationship of insomnia symptoms severity with psychopathological symptoms, posttraumatic stress disorder (PTSD) symptoms, and behavioral factors, such as substance use, changes in the amount of sleep, and the level of physical activity during the COVID-19 pandemic. Data were collected from 1111 Polish university students via an online survey conducted between IV and VI 2020. The survey included demographic variables, the level of psychopathological symptoms (General Health Questionnaire, GHQ-28), insomnia (Insomnia Severity Index, ISI), and symptoms of posttraumatic stress (Impact of Events Scale-Revised, IES-R). The results showed that over half of the studied group of students had some form of sleep disturbances during the period of data collection, with moderate-to-severe insomnia symptoms noted in 21.6%. At the same time, the majority of the sample declared they slept more during the pandemic. A significant positive correlation was observed between the severity of insomnia symptoms and PTSD symptoms, as well as GHQ scores, increased substance use, and decreased physical activity. An additional association between the presence of dreams related to the event and insomnia symptoms as well as GHQ scores has been found. The results suggest that sleep problems may be prevalent among university students during the pandemic. Moreover, although the symptoms of insomnia, as well as the severity of sleep disturbance, significantly correlated with all the investigated variables, the direction of those associations remains to be established.

The Impact of COVID-19 on Sleep Quality in People Living With Disabilities

Background: Research exploring the impact of the COVID-19 pandemic on sleep in people with disabilities has been scarce. This study provides a preliminary assessment of sleep in people with disabilities, across two timepoints during the pandemic, with a focus on those with visual impairment (VI).

Methods: Two online surveys were conducted between April 2020 and March 2021 to explore sleep quality using the Pittsburgh Sleep Quality Index (PSQI). A convenience sample of 602 participants completed the first survey and 160 completed the follow-up survey.

Results: Across both timepoints, participants with disabilities reported significantly poorer global sleep quality and higher levels of sleep disturbance, use of sleep medication and daytime dysfunction than those with no disabilities. Participants with VI reported significantly higher levels of sleep disturbance and use of sleep medication at both timepoints, poorer global sleep quality, sleep duration and latency at time 1, and daytime dysfunction at time 2, than those with no disabilities. Global sleep quality, sleep duration, sleep efficiency, and self-rated sleep quality deteriorated significantly in participants with no disabilities, but daytime dysfunction increased in all three groups. Disability and state anxiety were significant predictors of sleep quality across both surveys.

Conclusion: While sleep was consistently poorer in people with disabilities such as VI, it appears that the COVID-19 pandemic has had a greater impact on sleep in people with no disabilities. State anxiety and, to a lesser extent, disability, were significant predictors of sleep across both surveys, suggesting the need to address anxiety in interventions targeted toward improving sleep.

Quality of Life, Insomnia and Coping Strategies during COVID-19 Pandemic in Hospital Workers. A Cross-Sectional Study

COVID-19 became a pandemic in a few months, leading to adverse health outcomes, reducing the quality of life, affecting the sleep/wake cycle, and altering coping strategies, especially among hospital personnel. Life quality, insomnia, and coping strategies were thus assessed among hospital personnel during the first wave of the COVID-19 pandemic in Italy. This cross-sectional study was conducted from May to November 2020 through an online survey. There were 558 participants (28.5% males and 71.5% females) enrolled in two different metropolitan areas (in North and South of Italy, respectively). Three standardized questionnaires were administered: European Quality of life-5 Dimensions (EQ-5D), Athens Insomnia Scale (AIS), and Brief COPE. Differences in sociodemographic characteristics and work-related factors were also investigated in order to identify possible predictors through a generalized linear model and logistic regression analysis. Results showed good perceived life quality and high insomnia prevalence. After sample stratification, the statistical analysis highlighted that personal (gender, age, educational level) and work-related factors (employment in COVID wards, remote working) played different roles in predicting quality of life, insomnia, and coping attitude. Active, Planning, and Acceptance were the most frequently adopted coping strategies. Despite women confirming their attitude in reacting to the difficulties, adopting emotion-focused coping strategies, they showed a higher probability to develop insomnia, so a gender perspective should be considered in the health protection of this working category. An integrated approach should be implemented at individual, interpersonal and organizational levels aiming to monitor psychological distress, favor regular sharing and communication between peers, and also allow conciliation of work with family life. At the organizational level, preventive and protective measures adequate to work-related risk to COVID-19 should be adopted.

Healthcare Professionals' Perceptions of Loneliness amongst Older Adults: A Qualitative Study

BACKGROUND

Loneliness amongst older adults is linked to poor health outcomes and constitutes a public health issue worldwide. Healthcare professionals' perceptions could influence the strategies they implement in order to prevent, detect and manage loneliness amongst older adults. The aim of this study was to describe and understand healthcare professionals' perceptions of loneliness amongst older adults.

METHODS

A descriptive qualitative study. Twenty-six Spanish healthcare professionals with experience caring for older adults participated in the study. Data were collected between November 2019 and September 2020 using focus groups and in-depth interviews. Data were analysed following a content analysis method using ATLAS.ti software.

RESULTS

Healthcare professionals' perceptions of loneliness amongst older adults is represented by three themes: (1) "when one's personal life and social context lead to loneliness"; (2) "from abandonment to personal growth: the two faces of loneliness"; and (3) "loneliness as a health issue that needs to be addressed".

CONCLUSIONS

Healthcare professionals perceive loneliness as a multifactorial, subjective experience that can trigger different coping mechanisms and negatively affect older people's health. Healthcare professionals consider that a greater involvement of the whole society is needed in order to fight loneliness amongst older adults as a public health issue.

SmartCards as Analogous Tools to Operate Tablet Computers for Elderly-A Feasibility Study

BACKGROUND

Older adults sometimes shy away from using modern digital communication devices due to lacking experience and fear of failure. Within the present project, SmartCards were developed as analogous means to operate tablet computers for older adults with little previous computer experience. We investigated whether the SmartCards-Tablet-System would (a) increase use of digital communication and (b) affect loneliness, autonomy, cognitive ability and wellbeing of the users.

METHODS

The suitability and acceptance of the system was evaluated during a three month trial period with seniors in retirement homes, seniors with home assistance care and a waiting control group.

RESULTS

Acceptance, duration of use and frequency of use were high in both experimental groups. Cognitive ability significantly improved after three months' use in both experimental groups. Effects on loneliness, autonomy and wellbeing could not be observed.

DISCUSSION

Our results indicate that seniors are very much able and curious to use modern digital devices if the interface and hardware are adjusted to their needs and capabilities without being stigmatizing. The use of modern communication services and the World Wide Web can promote contact of seniors with their (younger) relatives.

The Long-Term Impact of the COVID-19 Pandemic on Loneliness in People Living With Disability and Visual Impairment

Background: There has been growing concern about the impact of restrictions put in place to contain the coronavirus pandemic on loneliness, particularly in individuals with disabilities. This study explored the longitudinal impact of the pandemic on loneliness in these individuals, with a focus on those living with visual impairment (VI). Methods: An online survey was conducted in April-2020 and repeated in March 2021 to explore current life circumstances, health-related behaviours, sleep (Pittsburgh Sleep Quality Index) and social well-being, including state anxiety (State-Trait Anxiety Index) and loneliness (UCLA Loneliness scale). A convenience sample of 602 participants completed the first survey. Participants who agreed to be re-contacted were invited to take part in the follow-up survey. Results: Data is presented for the 160 participants who completed both timepoints. At both timepoints, median loneliness was significantly higher in participants with disabilities and those with VI than in participants with no disabilities. While there was no significant change in loneliness in any of the three subgroups, participants with VI experienced the largest increase in median loneliness. Loneliness was associated with having a mental health condition and higher levels of state anxiety at both timepoints. Conclusions: Individuals with disabilities such as VI experienced consistently higher levels of loneliness than those with no disabilities throughout the pandemic. While loneliness remained relatively stable in individuals with no disabilities, it increased, albeit to a non-significant level, in those with disabilities and particularly those with VI. Interventions designed to alleviate loneliness may benefit from addressing state anxiety.

Social Disconnection in Late Life Suicide: An NIMH Workshop on State of the Research in Identifying Mechanisms, Treatment Targets, and Interventions

Both social disconnection and suicide are significant public health concerns among older adults, and social disconnection is associated with greater risk for suicide-related thoughts and behaviors in late life. We present a synthesis of research discussed during a workshop hosted by the National Institute of Mental Health on social disconnection and late-life suicide. Social disconnection is related to suicide risk in late life via a variety of mechanisms, including biological, behavioral, and psychological correlates. Researchers in several scientific fields have begun to establish these connections and identify targets for interventions to reduce risk in late life. While research has demonstrated that social connection is amenable to change, there is little research to date on the most evidence-based interventions to mitigate social disconnection or the related risks. However, there are several promising biological, behavioral, and psychological interventions that may target various mechanisms, as well as social disconnection itself. With a relative paucity of research in this area, these lines of study are ripe for innovative investigation. In order to most effectively advance the field, we must establish more consistent definitions of social connection and disconnection; more accurately measure and assess older adults' social needs; examine the most effective approaches and modalities for assessment and intervention; take into account important contextual factors; and apply a translational, convergent scientific approach.

Loneliness and sleep in the American Indian Blackfeet community

BACKGROUND

Sleep is largely understudied in American Indians (AIs), even though sleep is implicated in the chronic diseases which disproportionately affect AI communities.

OBJECTIVE

To investigate relationships between daily self-reported loneliness and sleep as measured with actigraphy.

METHODS

In a sample of 98 Blackfeet adults living on the Blackfeet reservation in Montana, we used Ecological Momentary Assessment and actigraphy over a week-long period to investigate relationships between loneliness and sleep. Loneliness was measured daily using the Short Loneliness Scale and actigraphy was used to measure total sleep time, sleep onset latency (SOL), wake after sleep onset (WASO), and sleep efficiency (SE).

RESULTS

Using a series of generalized linear mixed-effects models controlling for demographic characteristics, anxiety and depressive symptoms, and adverse childhood experiences, we found that those who were lonelier had higher WASO and SOL, and lower SE relative to those who were less lonely. Within-subject effects indicate that participants who were lonelier for a given day relative to their own weekly average had higher WASO that night relative to their own weekly average.

CONCLUSIONS

Our findings provide initial preliminary evidence suggesting that loneliness may be a psychosocial factor which contributes to poor sleep in AI communities.

People with dyssomnia showed increased vulnerability to CoVID-19 pandemic: a questionnaire-based study exploring the patterns and predictors of sleep quality using the latent class analysis technique in Indian population

INTRODUCTION

CoVID-19 pandemic and the subsequent lockdown have impacted the sleep quality and the overall wellbeing of mankind. The present epidemiological study measured various aspects of sleep disturbance such as sleep quality, daytime impairments, negative emotionality, sleep hygiene, and well-being associated with CoVID-19 pandemic among the Indian population.

METHODS

This cross-sectional voluntary online survey (using Google form) was communicated across the country from 4th June to 3rd July 2020 through mail and social media applications. The responses received (N = 450) were categorized and validated using the latent class analysis and logistic regression tests respectively, and the classes and subclasses derived were profiled. These techniques are used for the first time in a CoVID-19 sleep study.

RESULTS

Out of the three classes derived from the LCA, people with severe dyssomnia belonging to class 1 (33.3%) showed high daytime impairments, negative emotionality and high vulnerability towards CoVID-19 pandemic measures. In addition, the two subclasses derived from the severe dyssomnia group; one with negative emotionality predominance and the other with excessive daytime sleepiness, were similarly affected by CoVID-19 measures. People with moderate dyssomnia (class 2, 28.5%) showed frequent arousals with daytime impairments and the majority (38.2%) which fell in to class 3, the 'no dyssomnia' category, were not impacted by CoVID-19 pandemic.

CONCLUSION

People with existing sleep problems or those who were vulnerable to the same were the ones affected by CoVID-19 pandemic. Those with inadequate emotional coping styles have showed heightened vulnerability. Proper medical and cognitive interventions are highly recommended for this population. No or moderate dyssomnia categories (class 3 and 2 respectively) were less impacted by CoVID-19.

Impact of COVID-19 lockdown on sleep quality in university students and administration staff

INTRODUCTION

In Italy, lockdown due to COVID-19 health emergency started on March 10 and partially ended on May 3rd, 2020. There was a significant increase of psychological distress and symptoms of mental illness, and worsening of quality of sleep in the general population.

METHODS

Participants completed an anonymous web-based survey that include questionnaires about sleep and anxiety and depression symptoms. Our sample included 400 subjects: 307 students (mean age 22.84 ± 2.68) and 93 university administration staff workers (mean age 37.02 ± 12.46).

RESULTS

we found an increase in Bed Time hour, Sleep Latency, and Wake-Up time between before and during COVID-19 emergency and a worsening of sleep quality and of insomnia symptoms. In particular, during the lockdown, the impact of the delay in Bed Time and in Wake-Up was more pronounced in students. In workers, we observed a prevalence of maintenance insomnia before COVID-19 of 24% that significantly increase during COVID-19 reaching 40%, while workers with difficulties in sleep initiation were only 15% that increased to 42%. In our sample, 27.8% showed depressive symptoms, while 34.3% showed anxious symptoms, in particular in students.

CONCLUSION

The impact of lockdown was greater in students than in workers, and in females than in males. Concerning the psycho-emotional aspects, about one-third of our sample showed depressive or anxious symptoms. The results of our study may provide support for the implementation of some interventions for well-being in pandemic condition.

Assessment of the frequency of sleep complaints and menopausal symptoms in climacteric women using the Jenkins Sleep Scale

OBJECTIVE

To identify the frequency of sleep complaints (SC) and associated menopausal symptoms in climacteric women, apparently healthy, residing in three different capital cities of the Colombian Caribbean.

MATERIAL AND METHODS

Cross-sectional study which is part of the investigation project CAVIMEC [Calidad de Vida en la Menopausia y Etnias Colombianas]. Data were collected by interviewers, on a door-to-door visit. Healthy women residing in the Colombian Caribbean, 40-59 years old, were studied. Sociodemographic characteristics form and scales were applied: Menopause Rating Scale, Jenkins Sleep Scale, Perceived Psychological Stress (perceived stress), Goldberg Anxiety and Depression Scale, SCOFF scale (eating disorders), and Loneliness Scale by Hughes. The women were divided into two groups: with SC and without SC, according to the Jenkins scale result. Crude and adjusted logistic regressions were performed: SC (dependent variable) with sociodemographic characteristics and the results of the scales used (independent variables).

RESULTS

Five hundred eighty-five women were studied. 16.5% with SC. No differences were observed in age, BMI, and high blood pressure. Proportionally more women with SC had depression, anxiety, perception of loneliness, severe menopausal symptoms, somatic, psychological, urogenital, and quality of life severe impairment (p<0.05). There were no differences in eating disorders and perceived stress. In the adjusted model, only depression was associated with SC, OR: 9.81 [95% CI: 1.29-74.3], p<0.05.

CONCLUSION

SC were identified in 16.5% of the climacteric women of the Colombian Caribbean. In an adjusted model, probable depression was the only factor associated with SC.

Prevalence and correlates of fatigue and its association with quality of life among clinically stable older psychiatric patients during the COVID-19 outbreak: a cross-sectional study

Background

The pattern of fatigue in older psychiatric patients during the COVID-19 outbreak was unknown. This study examined the prevalence of fatigue and its association with overall quality of life (overall QOL) in clinically stable older patients with psychiatric disorders during the COVID-19 outbreak.

Methods

This was a multicenter, cross-sectional study. Fatigue, depressive symptoms, pain, insomnia symptoms, and overall QOL were assessed with standardized instruments.

Results

A total of 1063 patients were recruited. The prevalence of fatigue was 47.1% (95%CI: 44.1–50.1%). An analysis of covariance revealed that overall QOL was significantly lower in patients with fatigue compared to those without (P = 0.011). A multiple logistic regression analysis revealed that more severe depressive symptoms (OR = 1.15, P < 0.001), insomnia symptoms (OR = 1.08, P < 0.001) and pain (OR = 1.43, P < 0.001) were significantly associated with fatigue.

Conclusions

Fatigue is common among clinically stable older patients with psychiatric disorders during the COVID-19 outbreak. Considering its negative impact on overall QOL, regular assessment of fatigue and appropriate treatment warrant attention in this subpopulation.

Associations of Social Isolation with Anxiety and Depression During the Early COVID-19 Pandemic: A Survey of Older Adults in London, UK

The COVID-19 pandemic is imposing a profound negative impact on the health and wellbeing of societies and individuals, worldwide. One concern is the effect of social isolation as a result of social distancing on the mental health of vulnerable populations, including older people. Within six weeks of lockdown, we initiated the CHARIOT COVID-19 Rapid Response Study, a bespoke survey of cognitively healthy older people living in London, to investigate the impact of COVID-19 and associated social isolation on mental and physical wellbeing. The sample was drawn from CHARIOT, a register of people over 50 who have consented to be contacted for aging related research. A total of 7,127 men and women (mean age=70.7 [SD=7.4]) participated in the baseline survey, May-July 2020. Participants were asked about changes to the 14 components of the Hospital Anxiety Depression scale (HADS) after lockdown was introduced in the UK, on 23rd March. A total of 12.8% of participants reported feeling worse on the depression components of HADS (7.8% men and 17.3% women) and 12.3% reported feeling worse on the anxiety components (7.8% men and 16.5% women). Fewer participants reported feeling improved (1.5% for depression and 4.9% for anxiety). Women, younger participants, those single/widowed/divorced, reporting poor sleep, feelings of loneliness and who reported living alone were more likely to indicate feeling worse on both the depression and/or anxiety components of the HADS. There was a significant negative association between subjective loneliness and worsened components of both depression (OR 17.24, 95% CI 13.20, 22.50) and anxiety (OR 10.85, 95% CI 8.39, 14.03). Results may inform targeted interventions and help guide policy recommendations in reducing the effects of social isolation related to the pandemic, and beyond, on the mental health of older people.

Insomnia during COVID-19 pandemic and lockdown: Prevalence, severity, and associated risk factors in French population

In response to Voitsidis et al. (2020) published in Psychiatry Research addressing the paucity of research on insomnia during a pandemic, we obtained data from an online cross-sectional survey by documenting the prevalence of clinical insomnia and its contributing factors in a French general public sample. Participants (N = 556) completed the Insomnia Severity Index, UCLA Loneliness scale, and provided information on sociodemographics, antecedents of mental and physical health conditions, and COVID-19-related stressful life events. In our sample, 19.1% met the diagnostic criteria of clinical insomnia, which was twice lower than that reported in the study by Voitsidis et al., but close to those found among Chinese and Italian populations. We confirmed COVID-19-related worries and loneliness to be the major contributing factors to clinical insomnia, in addition to education status, being infected by the virus and pre-existing mental health illness. These findings underscore that sleep-related problems should be an important component of mental health interventions during pandemics.

Insomnia during the COVID-19 pandemic in a Greek population

Insomnia is a major health issue associated with great psychological burden. Research of insomnia during a pandemic crisis is limited. The aim of the present study was to explore sleep difficulties during the COVID-19 pandemic in a Greek population. The three-day online survey included questions about sociodemographic characteristics, contact with COVID-19 and COVID-19-related negative attitudes, as well as the Athens Insomnia Scale (AIS), the Intolerance to Uncertainty scale (IUS), the De Jong Gierveld Loneliness scale (JGLS) and the Patient Health Questionnaire-2 (PHQ-2) Depression Scale. Altogether, 2,427 individuals participated in the study (with 2,363 of them providing all basic demographic data). Sleep problems were detected in 37.6% of the participants. Women and people in urban areas were more vulnerable to sleep problems, while younger age showed a non-significant trend. Those uncertain about having themselves, or someone close to them contracted the virus, also demonstrated elevated insomnia scores. Lastly, according to the regression analysis, higher levels of intolerance to uncertainty, COVID-19-related worry, loneliness, as well as more severe depressive symptoms, were all predictive of insomnia. Results may be used for the development of therapeutic strategies and implementation of social policies to support people with sleep difficulties.