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Blood C, Cacciatore J. "It Started After Trauma": The Effects of Traumatic Grief on Sleep Paralysis. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:1451-1472. [PMID: 35546322 DOI: 10.1177/00302228221093895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adverse life events are associated with the often-terrifying REM sleep parasomnia of sleep paralysis (SP), but the impact of bereavement on SP has not been specifically examined. This exploratory, mixed-methods study (N = 168) includes qualitative data from 55 participants who described factors they believed led to their SP. Of these, almost half with a traumatic loss listed death-related precipitants. In unadjusted (bivariate) negative binomial regression models, traumatic death, time since death, religiosity, and age estimated increased SP frequency in the prior month, prior year, or both. In multivariable models, traumatic death, time since death, and age estimated increased frequency in the prior month, prior year, or both. Unexpectedly, in all models, as compared to death ≥9 years earlier, prior month SP was greater with death 1-6 years earlier, but not <1 year earlier. Discussion includes the possible role of social constraints in traumatic grief trajectories and care provider recommendations.
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Affiliation(s)
- Cybele Blood
- Field Instructor, School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Joanne Cacciatore
- Professor, School of Social Work, Arizona State University, Phoenix, AZ, USA
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2
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Mak MSB, Gebara MA, Lenze EJ, Blumberger DM, Brown PJ, Cristancho P, Flint AJ, Karp JF, Lavretsky H, Miller JP, Reynolds CF, Roose SP, Mulsant BH, Stahl ST. Poor Sleep is Common in Treatment-Resistant Late-life Depression and Associated With Poorer Antidepressant Response: Findings From the OPTIMUM Clinical Trial. Am J Geriatr Psychiatry 2024:S1064-7481(24)00430-5. [PMID: 39209616 DOI: 10.1016/j.jagp.2024.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/23/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Adults with treatment-resistant late-life depression (TRLLD) have high rates of sleep problems; however, little is known about the occurrence and change in sleep during pharmacotherapy of TRLLD. This analysis examined: (1) the occurrence of insufficient sleep among adults with TRLLD; (2) how sleep changed during pharmacotherapy; and (3) whether treatment outcomes differed among participants with persistent insufficient sleep, worsened sleep, improved sleep, or persistent sufficient sleep. METHODS Secondary analysis of data from 634 participants age 60+ years in the OPTIMUM clinical trial for TRLLD. Sleep was assessed using the sleep item from the Montgomery-Asberg Depression Rating Scale at the beginning (week-0) and end (week-10) of treatment. The analyses examined whether treatment outcomes differed among participants with persistent insufficient sleep, worsened sleep, improved sleep, or persistent sufficient sleep during depression treatment. RESULTS About half (51%, n = 323) of participants reported insufficient sleep at baseline. Both persistent insufficient sleep (25%, n = 158) and worsened sleep (10%, n = 62) during treatment were associated with antidepressant nonresponse. Participants who maintained sufficient sleep (26%, n = 164) or who improved their sleep (n = 25%, n = 158) were three times more likely to experience a depression response than those with persistent insufficient sleep or worsened sleep. CONCLUSION Insufficient sleep is common in TRLLD and it is associated with poorer treatment response to antidepressants.
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Affiliation(s)
- Michael S B Mak
- Department of Psychiatry (MSBM, DMB, AJF, BHM), Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health (MSBM, DMB, BHM), Toronto, Canada
| | - Marie Anne Gebara
- Department of Psychiatry (MAG, CFR, STS), University of Pittsburgh School of Medicine, Toronto, Canada
| | - Eric J Lenze
- Department of Psychiatry (EJL, PC), Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Daniel M Blumberger
- Department of Psychiatry (MSBM, DMB, AJF, BHM), Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health (MSBM, DMB, BHM), Toronto, Canada
| | - Patrick J Brown
- Department of Psychiatry (PJB, SPR), Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY
| | - Pilar Cristancho
- Department of Psychiatry (EJL, PC), Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Alastair J Flint
- Department of Psychiatry (MSBM, DMB, AJF, BHM), Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Centre for Mental Health (AJF), University Health Network, Toronto, Canada
| | - Jordan F Karp
- Department of Psychiatry (JFK), College of Medicine, University of Arizona, Tucson, AZ
| | - Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences (HL), University of California, Los Angeles
| | - J Philip Miller
- Data Science and Biostatistics (JPM), Washington University School of Medicine in St. Louis, Institute for Informatics, St. Louis, MO
| | - Charles F Reynolds
- Department of Psychiatry (MAG, CFR, STS), University of Pittsburgh School of Medicine, Toronto, Canada
| | - Steven P Roose
- Department of Psychiatry (PJB, SPR), Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, NY
| | - Benoit H Mulsant
- Department of Psychiatry (MSBM, DMB, AJF, BHM), Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Centre for Addiction and Mental Health (MSBM, DMB, BHM), Toronto, Canada.
| | - Sarah T Stahl
- Department of Psychiatry (MAG, CFR, STS), University of Pittsburgh School of Medicine, Toronto, Canada
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3
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de Lang TA, Buyukcan-Tetik A, de Jong PJ, Lancel M, Eisma MC. Trajectories of insomnia following bereavement. Sleep Med 2024; 114:159-166. [PMID: 38194898 DOI: 10.1016/j.sleep.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/17/2023] [Accepted: 12/14/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Insomnia symptoms are common following bereavement and may exacerbate severe and protracted grief reactions, such as prolonged grief disorder (PGD). However, typical trajectories of insomnia symptoms and risk factors for having a more chronic insomnia trajectory following bereavement are yet unknown. METHOD In the current investigation, 220 recently bereaved (≤6 months post-loss) participants, completed questionnaires assessing sociodemographic and loss-related characteristics, rumination, experiential avoidance and symptoms of (prolonged) grief and depression, on three time-points (6 months apart). We applied growth mixture models to investigate the typical trajectories of insomnia symptoms following bereavement. RESULTS Three insomnia trajectory classes emerged, characterized by a resilient (47 %), recovering (43 %), and a chronic trajectory (10 %). Baseline depression symptoms best predicted the type of insomnia trajectory. At one-year follow-up, 9 %, 27 %, and 60 % of participants met the criteria for probable PGD within the resilient, recovering and chronic trajectory, respectively. A parallel process model showed that temporal changes in insomnia symptoms were strongly related to changes in prolonged grief symptoms. CONCLUSION The results suggest, that targeting insomnia symptoms in the treatment of PGD, particularly with comorbid depression, may be a viable option.
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Affiliation(s)
- Thomas A de Lang
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands.
| | - Asuman Buyukcan-Tetik
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands
| | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands
| | - Marike Lancel
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands; Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe Mental Health Institute, Dennenweg 9, 9404 LA, Assen, the Netherlands
| | - Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, the Netherlands
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4
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Nilaweera D, Gurvich C, Freak-Poli R, Woods R, Owen A, Murray A, Orchard SG, Britt C, Wu Z, McNeil J, Ryan J. Adverse events in older adults and the risk of dementia and cognitive decline. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2023; 13:100592. [PMID: 37475782 PMCID: PMC10357969 DOI: 10.1016/j.jadr.2023.100592] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Background Increasing evidence suggests that stress could be a risk factor for dementia but this might vary by gender. This study investigated whether adverse life events were associated with cognitive decline and dementia in later-life, separately in men and women. Methods Participants were 12,789 community-dwelling Australians aged ≥ 70 years. Ten common adverse events in later-life were self-reported. Cognitive decline was defined as a 1.5 SD decline from participants' baseline score in tests of global cognition, psychomotor speed, episodic memory, and executive functioning, which were assessed regularly over a maximum of 10.3 years. Dementia was diagnosed according to DSM-IV criteria. Results An increased risk of dementia was observed in participants who experienced the death of a spouse/partner (HR: 1.72, 95% CI: 1.17 - 2.52) and for individuals who experienced major financial problems (HR: 1.53, 95% CI: 1.05 - 2.23). The latter also increased the risk of cognitive decline in men specifically (HR: 1.43, 95% CI: 1.10 - 1.86). In contrast, some events for women were associated with a reduced risk of dementia (e.g. close family or friends lost their job/retired (HR: 0.62, 95% CI: 0.40-0.95)). Limitations Events including major money problems may result from prodromal dementia symptoms, thus reverse causation needs to be considered. Conclusions Adverse life events may influence dementia risk in older adults, but associations vary depending on the nature of the event, and across genders. These findings support the need for early interventions in older people who have experienced adversities, particularly for the death of a loved one.
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Affiliation(s)
- Dinuli Nilaweera
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Caroline Gurvich
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Robyn Woods
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Anne Murray
- Berman Centre for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, USA
| | - Suzanne G. Orchard
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Carlene Britt
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Zimu Wu
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
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Kazan J, Lyew T, Croswell E, Buysse DJ, Gebara MA, Karp JF, Krafty RT, Rashied AA, Reynolds CF, Rollman BL, Smagula SF, Stahl ST. A digital health intervention to stabilize the 24-hour rhythm of sleep, meals, and physical activity for reducing depression among older bereaved spouses: Protocol for a randomized controlled trial. Contemp Clin Trials 2023; 124:107016. [PMID: 36414207 PMCID: PMC9839623 DOI: 10.1016/j.cct.2022.107016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite the high prevalence of depression and disruption to 24-h sleep-wake routines following the death of a spouse in late-life, no bereavement interventions have been developed to re-entrain a regular sleep-wake routine among older widow(er)s. We describe the rationale and methodology of the NIH-funded WELL Study (Widowed Elders' Lifestyle after Loss), a randomized controlled trial (RCT) comparing the efficacy of a digital health intervention (DHI) to enhanced usual care (EUC) arm for reducing depression symptoms in older spousally-bereaved adults. METHODS We will randomize approximately 200 recently bereaved (<12 months) adults aged 60+ years to one of two 12-week interventions: digital monitoring of the timing and regularity of sleep, meals, and physical activity plus weekly motivational health coaching; or enhanced usual care consisting of weekly telephone calls and similar assessment schedules. Participants will complete self-report and clinical assessments at baseline, post-intervention, and 3-, 6-, and 12-months post-intervention, and objective actigraphic assessments of their 24-h rest-activity rhythm (RAR) at baseline and 1-, 2-, and 3-months during the intervention. The primary outcome is change in depression symptoms burden (using the Hamilton Rating Scale for Depression) from pre- to post-intervention and over 12 months of follow-up. DISCUSSION WELL Study findings will inform the development of widely generalizable and scalable technology-based interventions to support bereaved spouses in community-based settings. Clinical http://Trials.gov Identifier: NCT04016896.
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Affiliation(s)
- Joseph Kazan
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thandi Lyew
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emilee Croswell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Marie Anne Gebara
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jordan F Karp
- Department of Psychiatry, University of Arizona, Tucson, AZ, USA
| | - Robert T Krafty
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | - Ammar A Rashied
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA
| | | | - Bruce L Rollman
- Center for Behavioral Health, Media, & Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen F Smagula
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah T Stahl
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
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6
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de Lang TA, Buyukcan-Tetik A, de Jong PJ, Lancel M, Eisma MC. Cross-Lagged Analyses of Prolonged Grief and Depression Symptoms with Insomnia Symptoms. Behav Ther 2022; 54:510-523. [PMID: 37088507 DOI: 10.1016/j.beth.2022.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
Prolonged grief disorder, characterized by severe, persistent and disabling grief, has recently been added to the DSM-5-TR and ICD-11. Treatment for prolonged grief symptoms shows limited effectiveness. It has been suggested that prolonged grief symptoms exacerbate insomnia symptoms, whereas insomnia symptoms, in turn, may fuel prolonged grief symptoms. To help clarify if treating sleep disturbances may be a viable treatment option for prolonged grief disorder, we examined the proposed reciprocal relationship between symptoms of prolonged grief and insomnia. On three time points across 6-month intervals, 343 bereaved adults (88% female) completed questionnaires to assess prolonged grief, depression, and insomnia symptoms. We applied random intercept cross-lagged panel models (RICLPMs) to assess reciprocal within-person effects between prolonged grief and insomnia symptoms and, as a secondary aim, between depression and insomnia symptoms. Changes in insomnia symptoms predicted changes in prolonged grief symptoms but not vice versa. Additionally, changes in depression and insomnia symptoms showed a reciprocal relationship. Our results suggest that targeting insomnia symptoms after bereavement is a viable option for improving current treatments for prolonged grief disorder.
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Affiliation(s)
| | | | | | - Marike Lancel
- University of Groningen; Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe Mental Health Institute
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7
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Chen MA, Fagundes CP. Childhood maltreatment, emotion regulation strategies and depressive symptoms during spousal bereavement. CHILD ABUSE & NEGLECT 2022; 128:105618. [PMID: 35344805 DOI: 10.1016/j.chiabu.2022.105618] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 02/18/2022] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Childhood maltreatment increases the risk of depression, especially after experiencing a stressful life event, such as bereavement. Employing emotion regulation strategies can mitigate the impact childhood maltreatment has on depression later in life following the loss of a spouse. OBJECTIVE We evaluated how cognitive reappraisal and expressive suppression moderated the impact of childhood maltreatment and depressive symptoms following spousal bereavement. PARTICIPANTS AND SETTING We examined 130 bereaved individuals 3 months after the death of a spouse, 4 months after the death of a spouse, and 6 months after the death of a spouse. METHODS We utilized a mixed model approach to test the interaction between childhood maltreatment and cognitive reappraisal and between childhood maltreatment and expressive suppression to predict depressive symptoms across 3 time points. RESULTS Cognitive reappraisal moderated the relationship between childhood maltreatment and depressive symptoms (b = - 0.17,p = .003); expressive suppression did not (b = 0.06,p = .452). Participants who used less cognitive reappraisal had a positive relationship between childhood maltreatment and depressive symptoms (b = 3.27,p < .001);participants who used more cognitive reappraisal did not (b = 1.09,p = .065). CONCLUSIONS Childhood maltreatment interacted with cognitive reappraisal, but not expressive suppression, to predict depressive symptoms following spousal bereavement. This study reveals how emotion regulation strategies can be utilized as a tool to buffer the impact of childhood maltreatment on mental health following a stressor later in life, which can serve as a target for future interventions for individuals experiencing a stressful life event.
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Affiliation(s)
- Michelle A Chen
- Department of Psychological Sciences, Rice University, Houston, TX, USA.
| | - Christopher P Fagundes
- Department of Psychological Sciences, Rice University, Houston, TX, USA; Department of Behavioral Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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8
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Al Karaki G, Hallit S, Malaeb D, Kheir N, Sacre H, Salameh P, Hallit R. Prevalence and Factors Associated with Insomnia Among a Representative Sample of the Lebanese Population: Results of a Cross-Sectional Study. J Epidemiol Glob Health 2021; 10:124-130. [PMID: 32538027 PMCID: PMC7310781 DOI: 10.2991/jegh.k.200117.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 01/06/2020] [Indexed: 12/18/2022] Open
Abstract
The objectives of the study were to identify the prevalence of insomnia among a representative sample of the Lebanese population and to assess potential factors associated with insomnia among this group. A cross-sectional study was done in the Lebanese population from August 2017 to April 2018 enrolling 789 participants using a proportionate random sample from all five Lebanese governorates. Participants filled a self-administered Arabic questionnaire. The Athens Insomnia Scale was used to diagnose insomnia. The Hamilton Depression Rating Scale and the Generalized Anxiety Disorder Scale were used to measure depression and anxiety, respectively. The prevalence of insomnia was 47.1% in the population sampled. The mean age of the participants was 37 years (64% females). Death in the family [adjusted odds ratio (aORa) = 1.59], drinking caffeine before sleep more than 2 days per week compared to none (aORa = 1.57), increased stress (aORa = 1.03), increased depression (aORa = 1.14), and anxiety scores (aORa = 1.07) were associated with higher odds of insomnia. The prevalence of insomnia was very high in the Lebanese population, and it was mainly associated with modifiable, treatable risk factors. Improved knowledge and adequate screening for insomnia are needed to promote better sleep quality.
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Affiliation(s)
- Gloria Al Karaki
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Diana Malaeb
- School of Pharmacy, Lebanese International University, Beirut, Lebanon.,Life Sciences and Health Department, Paris-Est University, Paris, France
| | - Nelly Kheir
- Faculty of Pedagogy, Holy Family University, Batroun 5534, Lebanon
| | - Hala Sacre
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Drug Information Center, Lebanese Order of Pharmacists, Beirut, Lebanon
| | - Pascale Salameh
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Pharmacy, Lebanese University, Beirut, Lebanon.,Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Rabih Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
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9
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Sveen J, Jernelöv S, Pohlkamp L, Kreicbergs U, Kaldo V. Feasibility and preliminary efficacy of guided internet-delivered cognitive behavioral therapy for insomnia after the loss of a child to cancer: Randomized controlled trial. Internet Interv 2021; 25:100409. [PMID: 34401368 PMCID: PMC8350585 DOI: 10.1016/j.invent.2021.100409] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/25/2021] [Accepted: 06/02/2021] [Indexed: 11/03/2022] Open
Abstract
Bereaved individuals often experience sleep problems. The aim of this study was to evaluate feasibility and preliminary effects of internet-delivered cognitive behavioral therapy for insomnia (iCBT-i) in bereaved parents. Parents were randomized to iCBT-i (n = 10) or an active control group (n = 11). Primary outcome (insomnia) and secondary outcomes (prolonged grief, depression, posttraumatic stress, and grief rumination) were assessed pre- and post-treatment, with 9- and 18-month follow-ups. Feasibility was assessed post-treatment and one month later. Most parents reported positive effects of the treatment. The intervention group improved significantly from pre- to post-treatment and had a significantly larger reduction of insomnia when analyzed over all four time-points (Wald χ2 = 30.0, p < 0.001), although the effect at post-treatment was very small (d = 0.1) for insomnia. Thus, iCBT-i was feasible and was related to reduced insomnia and psychological distress in bereaved parents, both short- and long-term, but the results regarding the treatment effect are preliminary due to the small sample size.
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Affiliation(s)
- Josefin Sveen
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden,National Center for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden,Corresponding author at: National Center for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala University Hospital entrance 10, 751 85 Uppsala, Sweden.
| | - Susanna Jernelöv
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Sweden
| | - Lilian Pohlkamp
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden,Department of Women's and Children's Health, Paediatric Oncology and Haematology, Karolinska Institutet, Stockholm, Sweden
| | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Sweden,Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
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10
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Sleep and social relationships in healthy populations: A systematic review. Sleep Med Rev 2021; 57:101428. [PMID: 33596514 DOI: 10.1016/j.smrv.2021.101428] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022]
Abstract
Over the past decade, research linking sleep and social relationships has burgeoned. Researchers across the globe are trying to understand whether the quality and quantity of our social relationships matter for sleep, and vice versa. We conducted a systematic review of the literature, identifying over 200 relevant articles examining sleep and social relationships in healthy populations. Here, we summarize our findings by reviewing 1) links between sleep and broad social ties across the lifespan, and 2) links between sleep and specific social relationships identified in the literature search, including romantic relationships, family relationships, and work relationships. Taken together, the literature provides evidence that the quality and presence of social relationships, especially our closest relationships, play a role in how we sleep. Likewise, sleep appears to influence our social bonds. However, the majority of work is correlational, limiting conclusions about the directionality of these effects. We conclude by synthesizing the findings, considering the limitations of the present literature, and identifying key future directions for this emerging area of research.
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11
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Franceschini C, Musetti A, Zenesini C, Palagini L, Scarpelli S, Quattropani MC, Lenzo V, Freda MF, Lemmo D, Vegni E, Borghi L, Saita E, Cattivelli R, De Gennaro L, Plazzi G, Riemann D, Castelnuovo G. Poor Sleep Quality and Its Consequences on Mental Health During the COVID-19 Lockdown in Italy. Front Psychol 2020; 11:574475. [PMID: 33304294 PMCID: PMC7693628 DOI: 10.3389/fpsyg.2020.574475] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/15/2020] [Indexed: 02/05/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) seriously affected the whole of Italy. The extreme virulence and the speed of propagation resulted in restrictions and home confinement. This change was immediately perceived by people who found themselves exposed to feelings of uncertainty, fear, anger, stress, and a drastic change in the diurnal but above all nocturnal lifestyle. For these reasons, we aimed to study the quality of sleep and its connection to distress levels and to evaluate how lifestyle changed in the Italian population during the lockdown. Methods By means of an Internet survey we recruited 6,519 adults during the whole of the COVID-19 lockdown (from March 10–1st phase to May 4–2nd phase). We investigated the sociodemographic and COVID-19-related information and assessed sleep quality using the Medical Outcomes Study–sleep scale (MOS-SS) and mental health with the short form of Depression, Anxiety, and Stress Scales–21 Items (DASS-21). Multiple logistic regression model was used to evaluate the multivariate association between the dependent variable (good sleeper vs. poor sleeper) and all the variables that were significant in the univariate analysis. Results A total of 3,562 (55.32%) participants reported poor sleep quality according to the MOS-Sleep Index II score. The multiple binary logistic regression results of poor sleepers revealed several risk factors during the outbreak restrictions: female gender, living in Central Italy, having someone close who died because of COVID-19, markedly changed sleep–wake rhythms characterized by earlier or postponed habitual bedtime, earlier habitual awakening time and reduced number of afternoon naps, and extremely severe levels of stress, anxiety, and depression. Conclusion This is the first study designed to understand sleep quality and sleep habits during the whole of the lockdown period in the Italian population that provides more than 6,000 participants in a survey developed specifically for the health emergency related to COVID-19. Our study found that more than half of the Italian population had impaired sleep quality and sleep habits due to elevated psychological distress during the COVID-19 lockdown containment measures. A multidisciplinary action should be undertaken in order to plan appropriate responses to the current crisis caused by the lockdown for the COVID-19 outbreak.
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Affiliation(s)
| | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, Parma, Italy
| | - Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Laura Palagini
- Department of Clinical and Experimental Medicine, Psychiatric Section, University of Pisa, Azienda Ospedaliera Universitaria Pisana (AOUP), Pisa, Italy
| | | | | | - Vittorio Lenzo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Daniela Lemmo
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
| | - Elena Vegni
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Lidia Borghi
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Emanuela Saita
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Roberto Cattivelli
- Department of Psychology, Catholic University of Milan, Milan, Italy.,Psychology Research Laboratory, Ospedale San Giuseppe, Istituto Auxologico Italiano IRCCS, Verbania, Italy
| | | | - Giuseppe Plazzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Dieter Riemann
- Medical Center, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, Milan, Italy.,Psychology Research Laboratory, Ospedale San Giuseppe, Istituto Auxologico Italiano IRCCS, Verbania, Italy
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12
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Digital Monitoring of Sleep, Meals, and Physical Activity for Reducing Depression in Older Spousally-Bereaved Adults: A Pilot Randomized Controlled Trial. Am J Geriatr Psychiatry 2020; 28:1102-1106. [PMID: 32265094 PMCID: PMC7483357 DOI: 10.1016/j.jagp.2020.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate the feasibility and acceptability of a behavioral intervention and explore its impact on depression symptom burden among older spousally-bereaved adults. METHODS Participants were age ≥60 years, bereaved ≤8 months, and at high risk for depression. Participants were randomized to 12 weeks of digital monitoring of sleep, meals, and physical activity; digital monitoring plus health coaching; or enhanced usual care and followed for 9 months for new-episode depression. RESULTS We enrolled 57 participants, 85% of eligible adults and 38% of all adults screened. We observed high levels of adherence in both digital monitoring (90%) and health coaching (92%); 88% of participants were retained. In linear mixed-effects models, depression symptoms significantly decreased, but the interaction between time and intervention was not significant. CONCLUSION A behavioral intervention that uses both digital monitoring and motivational health coaching is feasible and acceptable to older bereaved adults.
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13
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Lancel M, Stroebe M, Eisma MC. Sleep disturbances in bereavement: A systematic review. Sleep Med Rev 2020; 53:101331. [PMID: 32505968 DOI: 10.1016/j.smrv.2020.101331] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022]
Abstract
Severe, persistent and disabling grief occurs among a sizable minority experiencing bereavement, with diagnostic manuals newly including complicated grief (CG) disorders. Sleep disturbances/disorders have been established as worsening affective and stress-related conditions. However, the role of sleep difficulties in bereavement and CG has not received similar scientific attention. We therefore conducted a systematic review with narrative syntheses on this topic to clarify the role of sleep in bereavement (PROSPERO: CRD42018093145). We searched PubMed, Web of Science and PsychInfo for peer-reviewed English-language articles including (at least one) bereaved sample and sleep disturbance measure. We identified 85 articles on 12.294 participants. We answered seven pre-defined research questions demonstrating: high prevalence of sleep disturbances in bereavement; positive associations of grief intensity with sleep difficulties; preliminary indications of risk factors of post-loss sleep disturbance; higher prevalence of sleep disturbances in CG, enhanced by psychiatric comorbidity (i.e., depression); and initial evidence of causal relationships between (complicated) grief and sleep. Grief therapy partly improves sleep difficulties, yet no intervention studies have specifically targeted sleep problems in bereaved persons. Causal relationships between sleep and grief require further examination in intensive longitudinal investigations, including randomized trials, thereby clarifying whether treating sleep problems enhances CG treatment effects.
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Affiliation(s)
- Marike Lancel
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands; Psychiatric Sleep Center Assen, Mental Health Services Drenthe, the Netherlands.
| | - Margaret Stroebe
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Maarten C Eisma
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
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14
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Costa AR, Alves L, Lunet N. Healthcare services and medication use among widowed partners of patients deceased due to cancer - results from the Survey of Health, Ageing and Retirement in Europe (SHARE). Psychooncology 2020; 29:1255-1262. [PMID: 32364627 DOI: 10.1002/pon.5400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/30/2020] [Accepted: 04/21/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aimed to quantify the effect of a cancer death on healthcare and medication use among widowed individuals (Widowed-Cancer), by comparing this population with partnered individuals and with widowed individuals whose partners were deceased due to cardiovascular diseases (Widowed-CVD). METHODS Data were retrieved from the Sixth Wave of the Survey of Health, Ageing and Retirement in Europe - SHARE, conducted in 2015, in 18 countries. Widowed-Cancer were matched by country, sex, age and educational level with currently partnered individuals (1:2; n = 901 and n = 1802, respectively) and with Widowed-CVD (1:1; n = 606 and n = 606, respectively). Adjusted odds ratios (OR) and 95% confidence intervals (95%CI) were computed using logistic regression. RESULTS The use of drugs for sleep problems (OR = 1.42, 95%CI:1.12-1.80) and anxiety or depression (OR = 1.56, 95%CI:1.20-2.03) was more common among Widowed-Cancer than in partnered individuals; a tendency towards higher odds of being hospitalised in the previous year was also observed in Widowed-Cancer (OR = 1.20, 95%CI:0.98-1.47). Among participants whose partners were deceased in 2015, Widowed-Cancer were more likely than Widowed-CVD to report ≥10 contacts with medical doctors or nurses in the previous year (OR = 3.32, 95%CI:1.20-9.24; P for interaction = .042) and a higher use of drugs for sleep problems (OR = 14.43, 95%CI:1.74-119.84; P for interaction = .027). CONCLUSION Widowed individuals whose partners were deceased due to cancer had a higher use of healthcare, which highlights the importance of improving the quality of end-of-life care, even during widowhood.
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Affiliation(s)
- Ana Rute Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Luís Alves
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.,USF St. André de Canidelo, ACES Grande Porto Gaia VII, Vila Nova de Gaia, Portugal
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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15
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Vala CH, Lorentzon M, Sundh V, Johansson H, Lewerin C, Sten S, Karlsson M, Ohlsson C, Johansson B, Kanis JA, Mellström D. Increased risk for hip fracture after death of a spouse-further support for bereavement frailty? Osteoporos Int 2020; 31:485-492. [PMID: 31832693 PMCID: PMC7075824 DOI: 10.1007/s00198-019-05242-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/19/2019] [Indexed: 12/16/2022]
Abstract
UNLABELLED Death of a spouse is associated with poorer physical and mental health. We followed all married individuals, born from 1902 to 1942, during the period from 1987 to 2002, and found that widows and widowers had higher risk for hip fracture, compared with still married women and men. INTRODUCTION Spousal bereavement can lead to poorer physical and mental health. We aimed to determine whether married women and men had an elevated risk of hip fracture after death of a spouse. METHODS In a retrospective cohort study, we followed all Swedish married individuals aged 60 to 100 years (n = 1,783,035), from 1987 to 2002. Data are presented as mean with 95% confidence interval (CI). RESULTS During the follow-up period, 21,305 hip fractures among widows and 6538 hip fractures among widowers were noted. The hazard ratio (HR) for hip fracture in widows compared with married women was 1.34 (95% CI 1.31 to 1.37) and for widowers compared with married men 1.32 (95% CI 1.29 to 1.35). The HR for hip fracture in the first 6 months after death of a spouse was in widows compared with married women 1.62 (95% CI 1.53 to 1.71) and in widowers compared with married men 1.84 (95% CI 1.68 to 2.03). The elevated risk was especially prominent in young widowers in the age range 60-69 years. During the first 6 months they showed a HR of 2.76 (95% CI 1.66 to 4.58) for a hip fractvure compared with age matched married men. Widows aged 60-69 years showed a HR of 1.59 (95% CI 1.26 to 1.99) compared with age matched married women. CONCLUSION Our observation of a higher hip fracture risk in both genders in connection with the death of a spouse indicates a possible effect of bereavement on frailty.
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Affiliation(s)
- C H Vala
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 413 45, Göteborg, Sweden.
- Region Västra Götaland, Geriatric Medicine Clinic, Sahlgrenska University Hospital, 431 80, Mölndal, Sweden.
| | - M Lorentzon
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 413 45, Göteborg, Sweden
- Region Västra Götaland, Geriatric Medicine Clinic, Sahlgrenska University Hospital, 431 80, Mölndal, Sweden
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
| | - V Sundh
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 413 45, Göteborg, Sweden
| | - H Johansson
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 413 45, Göteborg, Sweden
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
| | - C Lewerin
- Section of Haematology and Coagulation, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - S Sten
- Department of Archaeology and Ancient History, Uppsala University-Campus Gotland, 621 57, Visby, Sweden
| | - M Karlsson
- Department of Orthopedics and Clinical Sciences, Skåne University Hospital, Lund University, 205 02, Malmö, Sweden
| | - C Ohlsson
- Center for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - B Johansson
- Department of Psychology, University of Gothenburg, 405 30, Gothenburg, Sweden
| | - J A Kanis
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Disease, Medical School, University of Sheffield, Sheffield, S10 2RX, UK
| | - D Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 413 45, Göteborg, Sweden
- Region Västra Götaland, Geriatric Medicine Clinic, Sahlgrenska University Hospital, 431 80, Mölndal, Sweden
- Center for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
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Pohlkamp L, Kreicbergs U, Sveen J. Bereaved mothers' and fathers' prolonged grief and psychological health 1 to 5 years after loss—A nationwide study. Psychooncology 2019; 28:1530-1536. [DOI: 10.1002/pon.5112] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/06/2019] [Accepted: 05/13/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Lilian Pohlkamp
- Department of Health Care Sciences, Palliative Research CentreErsta Sköndal Bräcke University College Stockholm Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research CentreErsta Sköndal Bräcke University College Stockholm Sweden
- Department of Women's and Children's HealthKarolinska Institutet Stockholm Sweden
| | - Josefin Sveen
- Department of Health Care Sciences, Palliative Research CentreErsta Sköndal Bräcke University College Stockholm Sweden
- Department of Neuroscience, PsychiatryUppsala University Uppsala Sweden
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17
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Chen MA, Lewis MR, Chirinos DA, Murdock KW, Fagundes C. Differential psychological reactions to grief: The role of childhood adversity for depression symptoms among bereaved and non-bereaved adults. DEATH STUDIES 2019; 44:778-786. [PMID: 31094661 PMCID: PMC6858533 DOI: 10.1080/07481187.2019.1614107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Childhood maltreatment dysregulates an individual's physiological response to stress, increasing reactivity to stressors across the lifespan. Given the prevalence and impact of bereavement, we examined whether the association between childhood maltreatment and depression was exacerbated by spousal bereavement. We identified an interaction between childhood maltreatment and bereavement using linear regression analysis (B = 0.79, p < .001). A simple slopes test indicated a positive association between childhood maltreatment and depressive symptoms among those who were bereaved (B = 0.86, p < .001), but such association did not emerge among those who were not bereaved (B = 0.06, p = .60).
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Affiliation(s)
- Michelle. A. Chen
- Department of Psychological Sciences, Rice University, 6500 Main Street, Houston, TX 77030
| | - Megan R. Lewis
- Department of Psychological Sciences, Rice University, 6500 Main Street, Houston, TX 77030
- Department of Medicine, Dell Medical School, 1501 Red River Street, Austin, TX 78712
| | - Diana A. Chirinos
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario, Suite 7-200, Chicago, IL 60611
| | - Kyle W. Murdock
- Department of Biobehavioral Health, Pennsylvania State University, 219 Biobehavioral Health Building, University Park, PA 16802
| | - Christopher Fagundes
- Department of Psychological Sciences, Rice University, 6500 Main Street, Houston, TX 77030
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, TX 77030
- Department of Psychiatry, Baylor College of Medicine, 1977 Butler Boulevard, Houston, TX 77030
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18
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Sveen J, Pohlkamp L, Kreicbergs U, Eisma MC. Rumination in bereaved parents: Psychometric evaluation of the Swedish version of the Utrecht Grief Rumination Scale (UGRS). PLoS One 2019; 14:e0213152. [PMID: 30889209 PMCID: PMC6424480 DOI: 10.1371/journal.pone.0213152] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/17/2019] [Indexed: 12/14/2022] Open
Abstract
Background Bereaved parents may be at higher risk to develop persistent, severe and disabling grief, termed prolonged grief. Grief rumination, repetitive thinking about the causes and consequences of the loss, is a malleable cognitive process that maintains prolonged grief. Grief rumination can be measured with the Utrecht Grief Rumination Scale (UGRS). The present study aimed to examine the psychometric properties of the new Swedish version of the UGRS in a sample of bereaved parents. Methods A Swedish nationwide postal survey including measures of demographic and loss-related variables, grief rumination (UGRS), and symptoms of prolonged grief, posttraumatic stress, anxiety, depression, and insomnia, was completed by 226 parents (133 mothers and 93 fathers) who lost a child to cancer in the past five years. Psychometric properties of the UGRS were examined through confirmatory factor analyses (CFA), reliability analyses, and assessment of UGRS score associations with symptoms of prolonged grief, posttraumatic stress, depression, anxiety, and insomnia. Results The internal consistency of the Swedish UGRS was good. The CFA yielded an acceptable fit for a two-factor hierarchical model with five sub-factors. Grief rumination was positively associated with all psychopathology symptom measures. Higher scores on UGRS were found in parents with possible prolonged grief disorder compared to those without (d = 1.47). Moreover, the Swedish UGRS was associated with prolonged grief symptoms over and above loss-related and demographic variables and other psychopathology symptoms. Conclusions The Swedish UGRS demonstrated good psychometric properties, which supports its use as a measure to assess grief rumination in Swedish bereaved parents in research and practice.
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Affiliation(s)
- Josefin Sveen
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- National Center for Disaster Psychiatry, Department of Neuroscience, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Lilian Pohlkamp
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Health Care Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women’s and Child’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Maarten C. Eisma
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
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19
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Milic J, Saavedra Perez H, Zuurbier LA, Boelen PA, Rietjens JA, Hofman A, Tiemeier H. The Longitudinal and Cross-Sectional Associations of Grief and Complicated Grief With Sleep Quality in Older Adults. Behav Sleep Med 2019; 17:31-40. [PMID: 28107032 DOI: 10.1080/15402002.2016.1276016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE/BACKGROUND About 15% of grievers experience complicated grief. We determined cross-sectional and longitudinal relations of grief and complicated grief with sleep duration and quality in the general population of elderly adults. PARTICIPANTS We included 5,421 men and women from the prospective population-based Rotterdam Study. METHODS The Inventory of Complicated Grief was used to define grief and complicated grief. We assessed sleep with the Pittsburgh Sleep Quality Index. RESULTS After 6 years, 3,511 (80% of survivors) underwent the follow-up interview. Complicated grief was cross-sectionally associated with shorter sleep duration and lower sleep quality. These associations were explained by the presence of depressive symptoms. The prospective analyses showed that sleep duration and sleep quality did not decline further during follow-up of persons who experienced grief or complicated grief. CONCLUSION In community-dwelling, middle-aged and older adults, persons with normal and complicated grief had both a shorter sleep duration and a lower sleep quality, mainly explained by depressive symptoms. However, prospective analyses showed that sleep quality and sleep duration do not decline further in persons with normal grief and complicated grief.
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Affiliation(s)
- Jelena Milic
- a Department of Epidemiology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Heidi Saavedra Perez
- a Department of Epidemiology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Lisette A Zuurbier
- a Department of Epidemiology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Paul A Boelen
- b Department of Clinical and Health Psychology , Utrecht University , Utrecht , The Netherlands
| | - Judith A Rietjens
- c Department of Public Health , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Albert Hofman
- a Department of Epidemiology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Henning Tiemeier
- a Department of Epidemiology , Erasmus Medical Center , Rotterdam , The Netherlands.,d Department of Psychiatry , Erasmus Medical Center , Rotterdam , The Netherlands.,e Department of Child and Adolescent Psychiatry , Erasmus Medical Center , Rotterdam , The Netherlands
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20
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Zhuravlyova EV, Dubinina EA, Korostovtseva LS, Filchenko IA, Bochkarev MV, Stankova EP, Sviryaev YV, Alekhin AN, Konradi AO. [Stress levels and coping behavior in patients with chronic insomnia]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:35-42. [PMID: 30059050 DOI: 10.17116/jnevro20181184235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To assess stress level and coping strategies in chronic insomnia as its potential psychological factors. MATERIAL AND METHODS The study group included 29 patients (19 women), aged 18-55 years old (mean age 33.1±2.1 years), with chronic insomnia diagnosed in accordance with the International Classification of Sleep Disorders III. The control group was formed by 32 subjects (11 men), aged 18-55 years old (mean age 31.5±2.0 years), without sleep disorders. Insomnia Severity Index and polysomnography were used to evaluate sleep quality. Stress level and coping strategies were assessed via an interview (stressfull life events during last year, their duration, their controllability, unexpectedness, and outcome), and by 'Level of subjective control' and 'Ways of coping questionnaires'. RESULTS Both groups were comparable by the mean number of significant events during last year (4.97±0.34 vs 4.72±0.23, p=0.54). Patients with insomnia more often reported the loss of a relative (p=0.04), while controls more frequently reported positive events, such as pregnancy (p=0.007) or wedding (p=0.02) among close ones. Insomniacs more often described the stressful events as uncontrolled (p<0.001) and prolonged (p<0.001). They demonstrated lower indices of all the scales of the 'Level of subjective control', questionnaire except the scale of interpersonal attitudes. They rarely implemented confrontive coping (p=0.001), seeking social support (p<0.001), accepting responsibility (p<0.001) and positive reappraisal (p<0.001). CONCLUSIONS The interpretation of stressful events and personal response in insomnia patients might be considered as psychological risk factors for insomnia development.
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Affiliation(s)
- E V Zhuravlyova
- Herzen State Pedagogical University of Russia, St. Petersburg, Russia
| | - E A Dubinina
- Herzen State Pedagogical University of Russia, St. Petersburg, Russia; Bekhterev National Research Medical Center of Psychiatry and Neurology, St. Petersburg, Russia
| | | | - I A Filchenko
- Almazov National Medical Research Centre, St. Petersburg, Russia; First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia; Sechenov Institute of Evolutionary Physiology and Biochemistry of RAS, St. Petersburg, Russia
| | - M V Bochkarev
- Almazov National Medical Research Centre, St. Petersburg, Russia
| | - E P Stankova
- Sechenov Institute of Evolutionary Physiology and Biochemistry of RAS, St. Petersburg, Russia
| | - Yu V Sviryaev
- Almazov National Medical Research Centre, St. Petersburg, Russia; Sechenov Institute of Evolutionary Physiology and Biochemistry of RAS, St. Petersburg, Russia
| | - A N Alekhin
- Herzen State Pedagogical University of Russia, St. Petersburg, Russia
| | - A O Konradi
- Almazov National Medical Research Centre, St. Petersburg, Russia; ITMO University, St. Petersburg, Russia
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Shahane AD, Fagundes CP, Denny BT. Mending the heart and mind during times of loss: A review of interventions to improve emotional well-being during spousal bereavement. BEREAVEMENT CARE : FOR ALL THOSE WHO HELP THE BEREAVED 2018; 37:44-54. [PMID: 31548757 PMCID: PMC6756769 DOI: 10.1080/02682621.2018.1493640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Spousal loss is one of life's greatest stressors. Bereaved spouses are at risk for aberrant cognitive and affective processing. Recent work in psychoneuroimmunology and cognitive neuroscience reveals physiological biomarkers and neural mechanisms underlying acute distress and grief during bereavement that may represent targets for future interventions. We review evidence from existing pharmacological and psychotherapeutic treatment approaches for normal bereavement, complicated grief, and bereavement-related depression. We propose promising future directions, namely the development and empirical validation of novel, personalised cognitive and neurostimulatory interventions to promote adaptive emotion regulation and reduce depressive symptoms following spousal loss. Future work may substantiate which interventions to improve emotional and physical health will be best matched to the needs of a particular surviving spouse.
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Affiliation(s)
| | - Christopher P. Fagundes
- Rice University, Houston, TX
- The University of Texas MD Anderson Cancer Center, Houston, TX
- Baylor College of Medicine, Houston, TX
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Smith G, Farrimond H. Active ageing, emotional care and the threat of stigma: Identity management in older adults using sleeping medication long-term. Health (London) 2018. [PMID: 29517399 DOI: 10.1177/1363459318762034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Amid fears about the medicalisation of old age, the high prevalence of sleeping medication use in older cohorts is a significant public health concern. Long-term use is associated with a plethora of negative effects, such as cognitive impairment and risk of addiction. However, little is known about the lived experience of older adults using sleeping medication longer term. Episodic interviews lasting approximately 90 minutes were conducted with 15 independently living adults, aged 65-88 years, who were using sedative-hypnotic or tricyclic sleeping medication for more than 11 years on average. Thematic analysis shows that participants divided their rationale for use into two temporal periods: (1) to ensure physical ability in the daytime and (2) to ensure emotional stability at night. Long-term sleeping medication was thus characterised as a form of 'emotional self-management' of the negative emotions associated with later life, blotting out feelings of loss and loneliness by inducing sleep. Participants feared loss of access to their medication 'supply', employing strategies to ensure its continuity, while expressing shame about their dependence. However, identity management, in the form of explanations, minimisations and social comparisons, functioned to downplay their addiction. Through this, long-term sleeping medication users were able to elude the spoiled identities and multiple stigmas of both the 'out of control' addict and the unsuccessful older adult by asserting a positive identity; that of the 'new' older adult, actively medicating for success both day and night.
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Melton L. Cognitive Behavioral Therapy for Sleep in Cancer Patients: Research, Techniques, and Individual Considerations. J Adv Pract Oncol 2018; 9:732-740. [PMID: 31249720 PMCID: PMC6570518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This article reviews cognitive behavioral therapy techniques for sleep in the cancer realm. There are unique factors associated with cancer that can exacerbate sleep issues. Stimulus control, sleep restriction, relaxation, paradoxical intention, and cognitive therapy are discussed as specific components of cognitive behavioral therapy for sleep, and practical techniques for implementation are provided. Individual considerations in implementing these techniques are also discussed, including factors such as age, ethnicity, gender, relationship status, educational level, work status, cancer history, pharmacologic treatments, and health beliefs.
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Stahl ST, Emanuel J, Albert SM, Dew MA, Schulz R, Robbins-Welty G, Reynolds CF. Design and Rationale for a Technology-based Healthy Lifestyle Intervention in Older Adults Grieving the Loss of a Spouse. Contemp Clin Trials Commun 2017; 8:99-105. [PMID: 29170758 PMCID: PMC5695565 DOI: 10.1016/j.conctc.2017.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Experiencing the death of a spouse during late life is associated with an increased risk of developing debilitating mental health problems. Healthy lifestyle practices, such as regular exercise, healthy eating, and good sleep hygiene are promising strategies to influence the mental health and associated physical symptoms of late-life spousal bereavement. Objective This paper describes the design and rationale of an intervention development study addressing selective and indicated prevention of depression, anxiety, and/or complicated grief disorder(s) among adults 60 years and older who are grieving the recent loss (within 8 months) of a spouse or partner. Methods In Phase I, now complete, we developed and standardized behavioral self-monitoring of daily lifestyle choices via an electronic diary (BSM) and the combined BSM + motivational interviewing-based lifestyle coaching (BSM+MI) to be administered to participants grieving the loss of loved one. In Phase II, we have been implementing the interventions in a randomized controlled trial and addressing challenges related to recruitment. Randomization is to one of three cells: BSM, BSM+MI, or an enhanced usual care condition. Discussion Several challenges in implementing our lifestyle interventions to older widow(er)s who are at risk for common mental disorders have been identified. Direct outreach to hospice organizations is an effective way to identify older adults in the early months following spousal death. Results from study may advance the field of grief support and promote a healthy adaptation to widowhood.
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Affiliation(s)
- Sarah T. Stahl
- Department of Psychiatry, University of Pittsburgh, USA
- Corresponding author. Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
| | - James Emanuel
- Department of Psychiatry, University of Pittsburgh, USA
| | - Steven M. Albert
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, USA
| | | | - Richard Schulz
- Department of Psychiatry, University of Pittsburgh, USA
- University Center for Social and Urban Research, University of Pittsburgh, USA
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Badcock JC, Dehon H, Larøi F. Hallucinations in Healthy Older Adults: An Overview of the Literature and Perspectives for Future Research. Front Psychol 2017; 8:1134. [PMID: 28736541 PMCID: PMC5500657 DOI: 10.3389/fpsyg.2017.01134] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/21/2017] [Indexed: 12/22/2022] Open
Abstract
KEY POINTS➢ Studies suggest a substantial minority of healthy older adults have hallucinatory experiences, in line with existing evidence on hallucinations in other age groups, though it is still unclear if hallucination prevalence increases or declines with age in older cohorts. ➢ Stigma attached to both hallucinations and ageing leads to considerable under-reporting of these experiences in healthy older adults and may negatively bias how professionals, family members, and the public respond. ➢ Why and when hallucinations in healthy older adults remit, persist, or progress to other clinical disorders remains poorly understood. ➢ Current evidence points to a range of factors associated with hallucinations in older adults including decline in sensory or cognitive functioning, poor sleep, and psychosocial stressors (e.g., social isolation, loneliness, and bereavement), highlighting the need for accurate assessment and tailored interventions.
Hallucinations, though common in youth and younger adults, are not the preserve of these age groups. Accumulating evidence shows that hallucinatory experiences are also present at surprisingly high rates in healthy older adults in the general community. Furthermore, stigma and misunderstanding of hallucinations, together with ageism, may lead to under-reporting of these experiences by older adults, and misdiagnosis or mismanagement by health and mental health practitioners. Consequently, improved public and professional knowledge is needed about the nature and significance of hallucinations with advancing age. The purpose of this review is to provide a comprehensive overview, and critical analysis, of research on the prevalence, psychosocial, and neurobiological factors associated with hallucinations in people aged 60 years and over. To the best of our knowledge, this is the first review of its kind in the literature. The evidence supports a dynamic conceptualization of hallucinations, in which the emergence of hallucinations is viewed as a balance between the sensory, cognitive, or social impairments accompanying advancing age and the degree to which compensatory processes elicited by these impairments are successful. We briefly summarize the implications of the literature for aged care services and interventions, and stress that far more studies are needed in this important field of research.
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Affiliation(s)
- Johanna C Badcock
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Faculty of Health and Medical Sciences, The University of Western AustraliaPerth, WA, Australia.,Australia and Perth Voices Clinic, Murdoch University Child and Adult Psychology Service, Murdoch UniversityMurdoch, WA, Australia
| | - Hedwige Dehon
- Psychology and Neuroscience of Cognition Research Unit, University of LiegeLiege, Belgium
| | - Frank Larøi
- Psychology and Neuroscience of Cognition Research Unit, University of LiegeLiege, Belgium.,Department of Biological and Medical Psychology, University of BergenBergen, Norway.,NORMENT - Norwegian Centre of Excellence for Mental Disorders Research, University of OsloOslo, Norway
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26
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Affiliation(s)
- M Katherine Shear
- Center for Complicated Grief, Columbia University School of Social Work, New York, USA
| | | | - Vyjeyanthi Periyakoil
- Palliative Care Education and Training, Stanford Hospice and Palliative Medicine Fellowship Program, Stanford Ethnogeriatrics and Successful Aging Portal, Stanford University, Stanford, California, USA; and Palliative Care Services, Veterans Affairs Palo Alto Health Care System
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Sleep disturbances in caregivers of patients with advanced cancer: A systematic review. Palliat Support Care 2017; 15:125-140. [PMID: 28095943 DOI: 10.1017/s1478951516001024] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Sleep disturbances are a common issue for those who provide informal care to someone with a life-limiting condition. The negative consequences of poor sleep are well documented. The purpose of the present study was to determine the sleep patterns of caregivers of patients with advanced cancer. METHOD An extensive systematic review of studies reporting empirical sleep data was undertaken in 2015 in accordance with the PRISMA Statement. A total of eight electronic databases were searched, with no date restrictions imposed. Additionally, a search of the bibliographies of the studies identified during the electronic search was conducted. Search terms included: "sleep," "insomnia," "sleep disturbance," "circadian rhythm," "caregiver," "carer," "advanced cancer," "palliative cancer," and MESH suggestions. The inclusion criteria required studies to be in English and to report primary qualitative and/or quantitative research that examined sleep in caregivers of patients with advanced cancer. Unpublished studies, conference papers, and dissertations were excluded. RESULTS Overall, 10 studies met the inclusion criteria and were included in the review. Two major findings emerged from the data synthesis. First, at least 72% of caregivers reported moderate to severe sleep disturbance as measured by the Pittsburgh Sleep Quality Index. Second, objective measurement of caregivers' sleep identified that some caregivers experienced up to a 44% reduction in their total sleep time compared to the recommended eight hours. SIGNIFICANCE OF RESULTS Reduction in total sleep time appears to be the biggest issue facing caregivers' sleep. Future studies need to explore the specific factors that cause these sleep disturbances and thus help to identify interventions to optimize sleep.
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Abstract
OBJECTIVES To examine how social contact during daily activities differs by age and relates to sleep outcomes. METHODS Fifty younger (M = 19.9 years, SD = 2.76) and 48 older (M = 67.6 years, SD = 6.63), community-dwelling adults completed the Social Rhythm Metric-17 and daily sleep diary online for 14 days. RESULTS Younger adults completed a greater proportion of activities with active others than older adults. Age significantly interacted with the proportion of activities completed alone, β = -.77, p = .04. Alone activities negatively predicted total sleep time in older, not younger adults. DISCUSSION Social contact, or lack thereof, is important for sleep, particularly for older adults who may be more prone to aloneness due to life course events.
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Affiliation(s)
| | | | - Christina S McCrae
- b Department of Clinical and Health Psychology University of Florida , USA
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Branger P, Arenaza-Urquijo EM, Tomadesso C, Mézenge F, André C, de Flores R, Mutlu J, de La Sayette V, Eustache F, Chételat G, Rauchs G. Relationships between sleep quality and brain volume, metabolism, and amyloid deposition in late adulthood. Neurobiol Aging 2016; 41:107-114. [PMID: 27103523 DOI: 10.1016/j.neurobiolaging.2016.02.009] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 02/04/2016] [Accepted: 02/08/2016] [Indexed: 11/18/2022]
Abstract
Recent studies in mouse models of Alzheimer's disease (AD) and in humans suggest that sleep disruption and amyloid-beta (Aβ) accumulation are interrelated, and may, thus, exacerbate each other. We investigated the association between self-reported sleep variables and neuroimaging data in 51 healthy older adults. Participants completed a questionnaire assessing sleep quality and quantity and underwent positron emission tomography scans using [18F]florbetapir and [18F]fluorodeoxyglucose and an magnetic resonance imaging scan to measure Aβ burden, hypometabolism, and atrophy, respectively. Longer sleep latency was associated with greater Aβ burden in prefrontal areas. Moreover, the number of nocturnal awakenings was negatively correlated with gray matter volume in the insular region. In asymptomatic middle-aged and older adults, lower self-reported sleep quality was associated with greater Aβ burden and lower volume in brain areas relevant in aging and AD, but not with glucose metabolism. These results highlight the potential relevance of preserving sleep quality in older adults and suggest that sleep may be a factor to screen for in individuals at risk for AD.
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Affiliation(s)
- Pierre Branger
- U1077, INSERM, GIP Cyceron, Caen, 14000, France; UMR-S1077, Ecole Pratique des Hautes Etudes, Caen, 14000, France; UMR-S1077, University of Caen Normandy, Caen, 14000, France; Neurology Department, Caen University Hospital, Caen, 14000, France
| | - Eider M Arenaza-Urquijo
- U1077, INSERM, GIP Cyceron, Caen, 14000, France; UMR-S1077, Ecole Pratique des Hautes Etudes, Caen, 14000, France; UMR-S1077, University of Caen Normandy, Caen, 14000, France; U1077, Caen University Hospital, Caen, 14000, France
| | - Clémence Tomadesso
- U1077, INSERM, GIP Cyceron, Caen, 14000, France; UMR-S1077, Ecole Pratique des Hautes Etudes, Caen, 14000, France; UMR-S1077, University of Caen Normandy, Caen, 14000, France; U1077, Caen University Hospital, Caen, 14000, France
| | - Florence Mézenge
- U1077, INSERM, GIP Cyceron, Caen, 14000, France; UMR-S1077, Ecole Pratique des Hautes Etudes, Caen, 14000, France; UMR-S1077, University of Caen Normandy, Caen, 14000, France; U1077, Caen University Hospital, Caen, 14000, France
| | - Claire André
- U1077, INSERM, GIP Cyceron, Caen, 14000, France; UMR-S1077, Ecole Pratique des Hautes Etudes, Caen, 14000, France; UMR-S1077, University of Caen Normandy, Caen, 14000, France; U1077, Caen University Hospital, Caen, 14000, France
| | - Robin de Flores
- U1077, INSERM, GIP Cyceron, Caen, 14000, France; UMR-S1077, Ecole Pratique des Hautes Etudes, Caen, 14000, France; UMR-S1077, University of Caen Normandy, Caen, 14000, France; U1077, Caen University Hospital, Caen, 14000, France
| | - Justine Mutlu
- U1077, INSERM, GIP Cyceron, Caen, 14000, France; UMR-S1077, Ecole Pratique des Hautes Etudes, Caen, 14000, France; UMR-S1077, University of Caen Normandy, Caen, 14000, France; U1077, Caen University Hospital, Caen, 14000, France
| | - Vincent de La Sayette
- U1077, INSERM, GIP Cyceron, Caen, 14000, France; UMR-S1077, Ecole Pratique des Hautes Etudes, Caen, 14000, France; UMR-S1077, University of Caen Normandy, Caen, 14000, France; Neurology Department, Caen University Hospital, Caen, 14000, France
| | - Francis Eustache
- U1077, INSERM, GIP Cyceron, Caen, 14000, France; UMR-S1077, Ecole Pratique des Hautes Etudes, Caen, 14000, France; UMR-S1077, University of Caen Normandy, Caen, 14000, France; U1077, Caen University Hospital, Caen, 14000, France
| | - Gaël Chételat
- U1077, INSERM, GIP Cyceron, Caen, 14000, France; UMR-S1077, Ecole Pratique des Hautes Etudes, Caen, 14000, France; UMR-S1077, University of Caen Normandy, Caen, 14000, France; U1077, Caen University Hospital, Caen, 14000, France
| | - Géraldine Rauchs
- U1077, INSERM, GIP Cyceron, Caen, 14000, France; UMR-S1077, Ecole Pratique des Hautes Etudes, Caen, 14000, France; UMR-S1077, University of Caen Normandy, Caen, 14000, France; U1077, Caen University Hospital, Caen, 14000, France.
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Abstract
Sleep disturbances are a common presenting symptom of older-age adults to their physicians. This article explores normal changes in sleep pattern with aging and primary sleep disorders in the elderly. Behavioral factors and primary psychiatric disorders affecting sleep in this population are reviewed. Further discussion examines sleep changes associated with 2 common forms of neurocognitive disorder: Alzheimer disease and Lewy Body Dementia. Common medical illnesses in the elderly are discussed in relation to sleep symptoms. Nonpharmacological and pharmacologic treatment strategies are summarized, with emphasis placed on risk of side effects in older adults. Future targets are considered.
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Affiliation(s)
- Kristina F Zdanys
- Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA.
| | - David C Steffens
- Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA
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Association between depressive symptoms and changes in sleep condition in the grieving process. Support Care Cancer 2014; 23:1925-31. [PMID: 25487842 DOI: 10.1007/s00520-014-2548-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/30/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Bereaved families often suffer from insomnia and depression. However, the associations between depressive state and changes in sleep condition during the grieving process have not been investigated. This study aimed to clarify the prevalence of insomnia symptoms and to explore associations between present depressive state and changes in sleep condition in the grieving process in bereaved families of Japanese patients with cancer. METHODS A cross-sectional, multicenter survey was conducted in 103 certified palliative care units. A questionnaire asking insomnia symptoms and depressive symptoms by the Center for Epidemiological Studies Depression Scale (CES-D) was mailed to bereaved families (N = 987). The association between present depressive state (CES-D ≥7) and sleep conditions in the grieving process were analyzed. RESULTS A total of 561 families were enrolled for analysis. Fifty-three percent of family members were considered to be in a depressive state at the time of the investigation. Prevalence of past insomnia was 86.5% at "within a few weeks before the patient's death" (T1) and 84.5% at "within 6 months after the patient's death" (T2) in all bereaved family members. However, in contrast to decreased severity of insomnia between T1 and T2 in the non-depressive group (p < 0.05), severity of insomnia was unchanged in the depressive group during this period (p = 0.139). CONCLUSIONS Insomnia symptoms are highly prevalent and may be associated with posthumous depressive state in bereaved Japanese families. These results suggest the need for careful observation of changes in sleep condition during the grieving process.
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Simpson C, Allegra JC, Ezeamama AE, Elkins J, Miles T. The impact of mid- and late-life loss on insomnia: findings from the health and retirement study, 2010 cohort. FAMILY & COMMUNITY HEALTH 2014; 37:317-326. [PMID: 25167072 DOI: 10.1097/fch.0000000000000039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Bereavement and insomnia are both well-documented risk factors for illness. We use cohort data to estimate risk of insomnia after death of a family member among adults aged 50 to 70 years. Each day, 6700 persons die in the United States. During the next 20 years, this number will increase. In this cohort, any loss increases the likelihood of insomnia. The highest rates of insomnia occur among women aged 50 to 59 years; men aged 65 to 70 years, and persons reporting death of a spouse/partner or child. Physical activity reduces this risk by one-third. Bereavement is a public health issue requiring a targeted response.
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Affiliation(s)
- Cherie Simpson
- School of Nursing, The University of Texas at Austin, Austin (Dr Simpson); and Department of Epidemiology and Biostatistics (Mr Allegra and Drs Ezeamama and Miles) and School of Social Work (Dr Elkins), University of Georgia, Athens
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Stahl ST, Schulz R. The effect of widowhood on husbands' and wives' physical activity: the Cardiovascular Health Study. J Behav Med 2014; 37:806-17. [PMID: 23975417 PMCID: PMC3932151 DOI: 10.1007/s10865-013-9532-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022]
Abstract
This prospective study examined the effect of widowhood on physical activity by comparing widowed elders to health status-, age-, and sex-matched married controls. Participants included 396 married controls and 396 widows/widowers age 64-91 (M age = 72.7 years) who experienced the death of their spouse while participating in the Cardiovascular Health Study. Compared to married controls, widowed men, but not women, were more likely to increase their physical activity following the death of their spouse. However, this increased level of activity was not sustained and declines as time since spousal death passes. Moreover, during the year before spousal death, soon-to-be widowed men, but not women, increase their physical activity. Our results suggest that widowed men experience significant changes in physical activity and that the transition to widowhood contribute to these changes.
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Affiliation(s)
- Sarah T Stahl
- Department of Psychiatry, University Center for Social and Urban Research, University of Pittsburgh, 3343 Forbes Ave., Pittsburgh, PA, 15260, USA,
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Hadi Khafaji HAR, Al Habib K, Asaad N, Singh R, Hersi A, Al Falaeh H, Al Saif S, Al-Motarreb A, Almahmeed W, Sulaiman K, Amin H, Al-Lawati J, Al-Sagheer NQ, Alsheikh-Ali AA, Al Suwaidi J. Marital status and outcome of patients presenting with acute coronary syndrome: an observational report. Clin Cardiol 2012; 35:741-8. [PMID: 22740441 DOI: 10.1002/clc.22034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/17/2012] [Indexed: 12/18/2022] Open
Abstract
UNLABELLED BACKGROUND & HYPOTHESIS: Data on the clinical characteristics and outcome of patients presenting with acute coronary syndrome (ACS) according to their marital status is not clear. METHODS A total of 5334 patients presenting with ACS in 65 hospitals in 6 Middle East countries in the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2) were studied according to their marital status (5024 married, 100 single, and 210 widowed patients). RESULT When compared to married patients, widowed patients were older and more likely to be female. Widowed patients were more likely to have diabetes mellitus, hypertension, history of heart failure, and peripheral vascular disease and were less likely to be tobacco users when compared to the other groups. Widowed patients were also more likely to present with atypical symptoms and have advanced Killip class. Widowed patients were more likely to present with non-ST-elevation myocardial infarction (NSTEMI) when compared to the other 2 groups. Widowed patients were more likely to have heart failure (P = 0.001), cardiogenic shock (P = 0.001), and major bleeding (P = 0.002) when compared to the other groups. No statistically significant difference was observed in regard to duration of hospital stay, door to needle time in STEMI patients, or cardiac arrhythmias between the various groups. Widowed patients had higher in-hospital, 30-day, and 1-year mortality rates (P = 0.001). Marital status was an independent predictor for in-hospital mortality. CONCLUSION Widowed marital status was associated with worse cardiovascular risk profile, and worse in-hospital and 1-year outcome. Future work should be focused on whether the provision of psychosocial support will result in improved outcomes among this high-risk group.
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Affiliation(s)
- Hadi A R Hadi Khafaji
- Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Buckley T, Sunari D, Marshall A, Bartrop R, McKinley S, Tofler G. Physiological correlates of bereavement and the impact of bereavement interventions. DIALOGUES IN CLINICAL NEUROSCIENCE 2012; 14:129-39. [PMID: 22754285 PMCID: PMC3384441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
The death of a loved one is recognized as one of life's greatest stresses, with reports of increased mortality and morbidity for the surviving spouse or parent, especially in the early months of bereavement. The aim of this paper is to review the evidence to date to identify physiological changes in the early bereaved period, and evaluate the impact of bereavement interventions on such physiological responses, where they exist. Research to date suggests that bereavement is associated with neuroendocrine activation (cortisol response), altered sleep (electroencephalography changes), immune imbalance (reduced T-lymphocyte proliferation), inflammatory cell mobilization (neutrophils), and prothrombotic response (platelet activation and increased vWF-ag) as well as hemodynamic changes (heart rate and blood pressure), especially in the early months following loss. Additional evidence suggests that bereavement interventions have the potential to be of value in instances where sleep disturbance becomes a prolonged feature of complicated grief, but have limited efficacy in maintaining immune function in the normal course of bereavement.
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