Impact of social support on PTSD : Chain mediating effects of insomnia and anxiety

Objective

To reveal the chain mediating roles of insomnia and anxiety between social support and PTSD in nursing staff under the stage of COVID-19 regular pandemic prevention and control in China.

Methods

A total of 784 nurses were recruited using the convenience sampling method in Jiangsu Province, China. Demographic questionnaire, Perceived Social Support Scale, Impact of Event Scale-Revised, Generalized Anxiety Disorder-7 and Insomnia Severity Index were applied to collect data.

Results

Social support, PTSD, insomnia and anxiety were significantly correlated with each other. Insomnia and anxiety acted as chain mediators between social support and PTSD.

Conclusion

Insufficient social support may trigger PTSD through the chain mediating effects of insomnia and anxiety in nursing staff under the stage of COVID-19 regular pandemic prevention and control. Measures focusing on social support, insomnia and anxiety should be taken to reduce or even prevent PTSD in nursing staff in Chinese hospitals in similar crises in the future.

The psychological impact of the COVID-19 pandemic on physicians in Puerto Rico: a cross-sectional study after the second wave in 2021

Introduction

Health care providers faced a challenge with the emergence of COVID-19 and its rapid spread. Early studies measuring the psychological impact of COVID-19 on the general population found high levels of anxiety and sleep disorders. The primary goal of this project was to assess the psychological impact of COVID-19 on physicians in Puerto Rico.

Materials and methods

A cross-sectional study of physicians in Puerto Rico was conducted anonymously and electronically from February 2021 through April 2021. The electronic survey included socio-demographic data and 4 self-administered assessment tools (Generalized Anxiety Disorder-7, Perceived Stress Scale-10, Pittsburgh Sleep Quality Index and COVID-19 Organizational Support) for anxiety, perceived stress, sleep disturbances, and organizational support during the COVID-19 pandemic.

Results

A total of 145 physicians completed the survey, with a female predominance of 53.5% and a majority practicing in the San Juan metropolitan area (50.3%). Mild anxiety symptoms were reported in 26.9% of physicians, and 33.8% had moderate to severe anxiety symptoms. Moderate to high perceived stress was found in 69.9% of participants, and women reported statistically significantly higher levels of anxiety symptoms (8.84 ± 5.99; p = 0.037) and stress (19.0 ± 6.94, p = 0.001). The Pittsburgh Sleep Quality Index reported 67.9% of physicians with global scores associated with poor sleep quality. Assessment of perceived organizational support found a high perception of work support (65.7%) but low perception of personal support (43.4%) and risk support (30.3%). A correlation analysis found a negative correlation for work and personal support, but a positive correlation for risk support, all statistically significant.

Conclusion

COVID-19 had a lasting psychological impact in health care providers in Puerto Rico a year after the beginning of the pandemic. Our data supports the importance of organizational support and its correlation with the development of anxiety. It is thus essential to develop strategies to identify individuals at risk of experiencing psychological disturbances and to provide effective support for medical professionals during medical emergencies for their well-being and optimal delivery of patient care.

The impact of insomnia on anxiety and depression: a longitudinal study of non-clinical young Chinese adult males

Insomnia, anxiety, and depression commonly co-occured and were closely related. Most of the prior studies were cross-sectional, with a poor ability to infer causality. Longitudinal study was needed to classify the relationships. The present study conducted a longitudinal study of non-clinical young Chinese males to investigate whether insomnia predicted the likelihood of future anxiety and depression, and vice versa. Convenient sampling method was applied, and 288 participants was recruited from Shanghai in October 2017 with Athens Insomnia Scale (AIS), Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). 120 of them were re-tested in June 2018. The drop-out rate was 58.33%. Correlation analyses and cross-lagged analysis showed that AIS global score was significantly positively related with scores of depression and anxiety at baseline and follow-up. Insomnia was a predictive factor of anxiety, but it can't predict depression. In sum, insomnia may be an important cause of anxiety, while no predictive relationship was found between insomnia and depression.

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

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

Prevalence of Insomnia and Associated Factors in Outpatients With Generalized Anxiety Disorder Treated in Psychiatric Clinics

Sleep disturbance is one of the key diagnostic criteria for generalized anxiety disorder (GAD). In this cross-sectional, prospective, observational, and multicenter study, factors associated with the prevalence of insomnia and the impact of insomnia-associated factors on quality of life were evaluated. Using multivariate analyses, the factor most strongly associated with the presence of insomnia (ISI ≥ 8) was the severity of the disorder (Odds Ratio [OR]: 9.253 for severe GAD; 95% Confidence Interval [CI]: 1.914-44.730; p = 0.006), pain interference and symptoms of depression (OR: 1.018; 95% CI 1.003-1.033; p = 0.016 and OR: 1.059; 95% CI 1.019-1.101; p = 0.004, respectively). Insomnia was not related to quality of life. Our results show insomnia to be a common health condition among patients with GAD, associated with the severity of anxiety and depressive symptoms and pain interference.

Cognitive behavioural therapy for anxiety disorders and insomnia: a commentary on future directions

Anxiety disorders and insomnia significantly impair daily functioning. Similar underlying mechanisms may account for the high comorbidity of both disorders, and respective treatments share pharmacological and behavioural features. This review suggests the utility of an integrated CBT approach in the treatment of generalized anxiety, post-traumatic stress, and panic disorders, and comorbid insomnia. Other anxiety disorders were not explored because current data are limited or inconsistent. A comprehensive, non-systematic review of the literature was conducted to evaluate the treatment of comorbid anxiety and insomnia disorders, and data reveal shared pharmacological and behavioural features of insomnia and anxiety disorders treatment. However, research demonstrates that CBT maintains successful treatment results longer than drug therapies. Despite similar treatment approaches, there is a paucity of research that explores integrated CBT approaches for comorbid anxiety and insomnia disorders. This review suggests that future research should assess the impact of combined therapeutic approaches on the simultaneous reduction of anxiety disorders, insomnia, and relapse rates.

The gendered construction and experience of difficulties and rewards in cancer care

Women cancer carers have consistently been found to report higher levels of distress than men carers. However, there is little understanding of the mechanisms underlying these gender differences in distress, and a neglect of rewarding aspects of care. We conducted in-depth semistructured interviews with 53 informal cancer carers, 34 women and 19 men, to examine difficult and rewarding aspects of cancer care. Thematic analysis was used to analyze the transcripts. Women were more likely to report negative changes in the relationship with the person with cancer; neglect of self, social isolation, and physical health consequences; anxiety; personal strength and growth; and to position caring as a privilege. Men were more likely to report increased relational closeness with the person with cancer, and the burden of additional responsibilities within the home as a difficult aspect of caring. We interpret these findings in relation to a social constructionist analysis of gender roles.

Sleep America: managing the crisis of adult chronic insomnia and associated conditions

INTRODUCTION

Chronic insomnia, a public health crisis affecting 10-15% of the U.S. population and costing billions of dollars annually, typically presents with one or more comorbid psychiatric or organic conditions. Historical classification of chronic insomnia as "secondary" to a presenting comorbid condition has resulted in under-recognition and under-treatment of both the insomnia and comorbid condition(s). Though critical in any model of comorbid disease management, chronic insomnia receives little, if any, public policy attention.

METHOD

We conducted a systematic review of recent empirical studies, review papers, books, government documents, press releases, advertisements, and articles pertaining to the classification, epidemiology, treatment, and physiology of sleep, insomnia, and comorbid conditions. Data were located primarily through MEDLINE, PsycINFO, SCOPUS, and PUBMED databases.

OBJECTIVE AND RESULTS

Our goal was to provide an overview of the systems for classifying insomnia and available epidemiological data, and to review theoretical models regarding the etiology and maintaining factors of chronic insomnia along with research on the complex, bidirectional associations between chronic insomnia and various affective (and other) conditions.

CONCLUSIONS

After thorough review of the literature, we propose several public policy measures as an initial step in managing chronic insomnia in the United States. These include introducing a nation-wide multi-modal educational and awareness campaign titled "Sleep America;" increasing the availability and demand for behavioral sleep medicine - the initially preferred treatment approach; and increasing the use of monitoring and enforcement activities by regulatory authorities to curtail false and misleading claims by sponsors of supplements or treatments for insomnia. Through the adoption of such measures, we hope to galvanize a national interest in healthy sleep and the evidence-based treatment of chronic insomnia.

Two sessions of sleep-focused mind-body bridging improve self-reported symptoms of sleep and PTSD in veterans: A pilot randomized controlled trial

OBJECTIVE

Sleep disturbance is highly prevalent among veterans. As an alternative to sleep medications with their undesirable side effects, nonpharmacological mind-body interventions may be beneficial for sleep management in primary care. The aim of this pilot study was to investigate whether a novel mind-body intervention, mind-body bridging (MBB), focusing on sleep, could improve self-reported sleep disturbance and comorbid symptoms in veterans.

METHODS

This pilot study was a randomized controlled trial at the Veterans Affairs Salt Lake City Health Care System in which 63 veterans with self-reported sleep disturbance received MBB or an active sleep education control. Both interventions were conducted in two sessions, once per week. Patient-reported outcomes included the following: primary-Medical Outcomes Study (MOS) Sleep Survey, MOS Short Form-36V; secondary-Center for Epidemiological Studies-Depression, PTSD Check List-Military, Five-Factor Mindfulness Questionnaire.

RESULTS

At both Week 1 (1 week after the first session) and post-intervention assessments, while sleep disturbance decreased in both groups, MBB performed significantly better than did the control group. Furthermore, self-reported PTSD symptoms improved in MBB, while they remained unchanged in the control. Overall mindfulness increased in MBB, while it remained unchanged in the control.

CONCLUSIONS

This study provides preliminary evidence that a brief sleep-focused MBB could be a promising intervention for sleep and potentially other comorbid symptoms (e.g., PTSD). MBB could help patients develop awareness skills to deal with sleep-related symptoms. Integration of MBB into primary care settings may enhance care of patients with sleep disturbance and co-morbid symptoms.