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Krokstad MA, Sund E, Rangul V, Bauman A, Olsson C, Bjerkeset O. Secular trends in risk factors for adolescent anxiety and depression symptoms: the Young-HUNT studies 1995-2019, Norway. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02373-2. [PMID: 38578474 DOI: 10.1007/s00787-024-02373-2] [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: 03/21/2023] [Accepted: 01/08/2024] [Indexed: 04/06/2024]
Abstract
In recent decades, increases in mental health problems in adolescents have been reported from several large population-based surveys. This raises questions about changes in underlying risk and protective factors that can inform future intervention strategies. Population data were collected from 1995 to 2019 in three waves of the Young-HUNT studies in Norway to map decennial trends in the prevalence of established risk factors for, and their associations with, adolescent mental health problems. All adolescents (aged 13-19 years) attending lower and upper secondary school in the county of Trøndelag were invited, representing three historical cohorts of 25,245 unique adolescents. Mental health problems (HSCL-5) and established mental health risk factors were self-reported. Using a generalized linear model and linear regression, we calculated changes in relative and absolute differences between risk factors and mental health problems. Overall, the prevalence of established risk factors for mental health problems in adolescence increased markedly between 1995 and 2019, especially in girls. Prominent increases were observed for fatigue, bullying, musculoskeletal pain and migraine, loneliness, and overweight. Furthermore, with the exception of excess alcohol use and family economy, associations between each risk factor and adolescent mental health problems strengthened over the same time span in girls, but less among boys. Our findings suggest that several modifiable risk factors for poor mental health in adolescence are increasing, especially among girls, and should be targeted in community, school, and in clinical settings.
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Affiliation(s)
- Morten Austheim Krokstad
- Faculty of Health Sciences and Nursing, Nord Universitet-Levanger Campus, Levanger, Norway.
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Erik Sund
- Faculty of Health Sciences and Nursing, Nord Universitet-Levanger Campus, Levanger, Norway
- Department of Public Health and Nursing, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Vegar Rangul
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Public Health and Nursing, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
| | - Adrian Bauman
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Craig Olsson
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Melbourne Victoria, Parkville, Australia
- School of Psychology, Faculty of Health, Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Ottar Bjerkeset
- Faculty of Health Sciences and Nursing, Nord Universitet-Levanger Campus, Levanger, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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Hua Y, Xue H, Zhang X, Fan L, Tian Y, Wang X, Ni X, Du W, Zhang F, Yang J. Joint Contributions of Depression and Insufficient Sleep to Self-Harm Behaviors in Chinese College Students: A Population-Based Study in Jiangsu, China. Brain Sci 2023; 13:brainsci13050769. [PMID: 37239241 DOI: 10.3390/brainsci13050769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Self-harm in young people is common, and previous studies have shown that insufficient sleep or depression was associated with self-harm. However, the joint association of insufficient sleep and depression with self-harm is unknown. We employed representative population-based data from the "Surveillance for Common Disease and Health Risk Factors Among Students in Jiangsu Province 2019" project. College students reported their self-harm behavior over the past year. Rate ratios (RRs) and corresponding 95% confidence intervals (CIs) for self-harm in relation to sleep and depression were modeled using negative binomial regression with a sample population as an offset, adjusting for age, gender, and region. The instrumental variable approach was used for the sensitivity analyses. Of the study population, approximately 3.8% reported self-harm behaviors. Students with sufficient sleep experienced a lower risk of self-harm than those with insufficient sleep. Compared with students with sufficient sleep and the absence of depression, the adjusted risk of self-harm was elevated 3-fold (1.46-4.51) in those reporting insufficient sleep in the absence of depression, 11-fold (6.26-17.77) in those with sufficient sleep and definite depression, and 15-fold (8.54-25.17) in those with both insufficient sleep and definite depression. The sensitivity analyses indicate that insufficient sleep remained a contributing risk factor for self-harm. Lack of sleep in young people is significantly associated with self-harm, particularly in the presence of depression. The provision of mental health care and attention to sleep deprivation are particularly important for college students.
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Affiliation(s)
- Yiwen Hua
- School of Public Health, Southeast University, Nanjing 210096, China
| | - Hui Xue
- School of Public Health, Southeast University, Nanjing 210096, China
| | - Xiyan Zhang
- Department of Child and Adolescent Health Promotion, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Lijun Fan
- School of Public Health, Southeast University, Nanjing 210096, China
| | - Yong Tian
- School of Public Health, Southeast University, Nanjing 210096, China
| | - Xin Wang
- Department of Child and Adolescent Health Promotion, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
| | - Xiaoyan Ni
- School of Public Health, Southeast University, Nanjing 210096, China
| | - Wei Du
- School of Public Health, Southeast University, Nanjing 210096, China
| | - Fengyun Zhang
- Department of Child and Adolescent Health Promotion, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
- Institute of Child and Adolescent Health, Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
| | - Jie Yang
- Department of Child and Adolescent Health Promotion, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China
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3
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Grove JL, Carlson SE, Parkhurst KA, O’Neill JC, Smith TW. Nonsuicidal self-injury, sleep quality, and shame response to a laboratory stress task. J Clin Psychol 2023; 79:871-885. [PMID: 36223526 PMCID: PMC9925399 DOI: 10.1002/jclp.23450] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/26/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Nonsuicidal self-injury (NSSI) frequently functions to regulate shame-based emotions and cognitions in the context of interpersonal stress. The present study sought to examine how sleep quality (SQ) may influence this process in a laboratory setting. METHODS Participants included 72 adults (Mage = 24.28; 36 with a lifetime history of NSSI) who completed a self-report measure of prior month SQ and engaged in a modified Trier social stress task (TSST). State shame ratings were collected immediately before and following the TSST, as well as 5 min post-TSST, to allow for the measurement of shame reactivity and recovery. RESULTS No significant results emerged for NSSI history and SQ as statistical predictors of shame reactivity. However, NSSI history was significantly associated with heightened shame intensity during the recovery period of the task, and this was moderated by SQ. Simple slopes analyses revealed a conditional effect whereby poorer SQ (1SD above the mean) was associated with greater intensity of shame during recovery, but only for those with a history of NSSI. CONCLUSION Poor SQ may contribute to worrisome emotional responses to daytime stressors in those at risk for NSSI.
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Sleep duration trajectory during the transition to adolescence and subsequent risk of non-suicidal self-harm. Eur Child Adolesc Psychiatry 2022; 31:1-9. [PMID: 33825948 DOI: 10.1007/s00787-021-01768-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 03/29/2021] [Indexed: 02/01/2023]
Abstract
Non-suicidal self-harm (NSSH) and chronic insufficient sleep are both major health problems during the transition from childhood to adolescence. We examined to identify sleep duration trajectories from childhood to adolescence and their associations with subsequent risk of NSSH. A cohort of children around the period of pubertal onset (7-9 years old) were followed from 2013 over 6 years. Group-based trajectory modeling was recruited to identify sleep duration trajectories derived from 5 repeated measures. Association between sleep duration trajectories with the risk of NSSH was examined using multivariate logistic regression model. Nonlinear dose-response associations between sleep duration and NSSH risk were also assessed using restricted cubic spline models. Of the 1973 participants included in the study (mean ± SD, 8.1 ± 0.9 years age at baseline, 41.1% female). Three sleep duration trajectories were identified: persistent sleeping ≥ 8 h/day (27.7%), moderately decreasing (60.8%) and rapidly decreasing (11.5%) sleep duration groups. After multivariable adjustment for covariates, compared with the persistent sleeping ≥ 8 h/day group, the odds ratio of NSSH was 2.58 (95% CI 1.92, 3.45) for the moderately decreasing group, and 4.16 (2.86, 6.04) for rapidly decreasing group. In dose-response analysis, sleep duration was associated with NSSH risk in a non-linear fashion (χ2 = 25.16, Pnonlinearity < 0.001). When compared with the reference (sleep duration = 8 h), the ORs (95% CI) for NSSH risks were 3.20 (1.93, 5.29), 2.37 (1.64, 3.41), 1.75 (1.39, 2.20) and 1.30 (1.18, 1.44) for sleep duration at 4 to 7 h, respectively. Also, we found sleep duration at 9 h [0.82 (0.75, 0.89)] and at 10 h [0.72 (0.57, 0.91)] significantly associated with decreased risk of NSSH. Longitudinal sleep duration patterns may assist in identification of adolescents at greatest risk of NSSH in the future, which could lead to improved targeting of prevention and intervention strategies. The findings also highlight a non-linear relationship between sleep duration and NSSH during the transition to adolescence.
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Semenza DC, Meldrum RC, Testa A, Jackson DB. Sleep duration, depressive symptoms, and digital self-harm among adolescents. Child Adolesc Ment Health 2022; 27:103-110. [PMID: 33763977 DOI: 10.1111/camh.12457] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study examines the relationship between sleep duration, depression, and engagement in a novel cyber behavior, digital self-harm, among adolescents. METHOD Logistic regression analyses were conducted using cross-sectional data from the 2019 Florida Youth Substance Abuse Survey (N = 9,819; 48% male; avg. grade level = 9th grade [SD = 1.9]) to analyze the association between sleep duration and digital self-harm. A Karlson-Holm-Breen (KHB) analysis was used to assess whether depressive symptoms attenuate this association. RESULTS Bivariate results indicated that longer sleep duration was associated with lower incidence of digital self-harm. Multivariate results showed that sleep duration was inversely associated with engaging in digital self-harm, net of all covariates. Depressive symptoms attenuated the influence of sleep duration on digital self-harm by 50.72%. CONCLUSIONS Both insufficient sleep and depressive symptoms were associated with engagement in digital self-harm among adolescents. Prospective research is needed, however, to confirm this pathway. Practitioners and clinicians should consider discussing digital self-harm with adolescents and parents, especially if adolescents are experiencing poor sleep and depressive symptoms.
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Affiliation(s)
- Daniel C Semenza
- Department of Sociology, Anthropology, and Criminal Justice, Rutgers University, Camden, NJ, USA
| | - Ryan C Meldrum
- Department of Criminology and Criminal Justice, Florida International University, Miami, FL, USA
| | - Alexander Testa
- Department of Criminology and Criminal Justice, University of Texas at San Antonio, San Antonio, TX, USA
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Lazarević KK, Dolićanin ZĆ, Stojanović MM, Bogdanović DČ, Milićević SR. Violent deaths among adolescents in Serbia: past, present and future. Cent Eur J Public Health 2022; 29:279-283. [PMID: 35026066 DOI: 10.21101/cejph.a6502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/25/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of the study was to determine the trend and methods of violent deaths (suicide and homicide) in adolescents aged 15-19 years in Serbia. METHODS Mortality database was drawn from the Statistical Office of Serbia from the 1997-2019 period. To calculate the annual percentage change (APC) of mortality rate (MR) with corresponding 95% confidence interval we used join point regression analysis. Statistical analyses were also performed using the chi-square test and Spearman's rho correlation. RESULTS The average suicide rate was 3.65 per 100,000 and homicide rate was 1.36 per 100,000 adolescents. The boys to girls ratio was 4.2 for suicides and 2.7 for homicides. Among girls, suicide rate significantly decreased (APC -20.7%; 95% CI -32.5 to -6.8) and homicide rate insignificantly decreased (APC -19.3%; 95% CI -37.8 to 5.1). Among boys, suicide rate significantly decreased (APC -4.6%; 95% CI -7.0 to -2.0) as well as homicide rate (APC -7.7%; 95% CI -11.5 to -4.3). The most common method of suicide was hanging (195, 44.3%) and nearly one third (198, 32.6%) of violent deaths were caused by firearms. Significantly negative correlation was observed between the Human Development Index (HDI), gross domestic product (GDP) per capita and MR due to suicides and homicides among both genders (p < 0.05). CONCLUSIONS Increase of GDP and HDI, national preventive intervention and strict application of the provisions of the law regarding the possession and storage of weapons must be implemented in order to continue reducing violent deaths among adolescents.
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Affiliation(s)
- Konstansa K Lazarević
- Department for Biomedical Science, State University of Novi Pazar, Novi Pazar, Serbia
| | - Zana Ć Dolićanin
- Department for Biomedical Science, State University of Novi Pazar, Novi Pazar, Serbia
| | | | - Dragan Č Bogdanović
- Department for Biomedical Science, State University of Novi Pazar, Novi Pazar, Serbia
| | - Saša R Milićević
- Department for Biomedical Science, State University of Novi Pazar, Novi Pazar, Serbia
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Tang Y, Wan Y, Xu S, Zhang S, Hao J, Tao F. Nonlinear relationship between sleep duration and non-suicidal self-injurious behaviour among Chinese adolescents. BMC Psychiatry 2021; 21:521. [PMID: 34674680 PMCID: PMC8532314 DOI: 10.1186/s12888-021-03539-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/13/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Previous studies have shown a positive association between sleep deprivation and non-suicidal self-injury (NSSI) among adolescents, but few studies have described the effects of oversleeping and weekend catch-up sleep on NSSI. The present study aimed to explore the nonlinear relationship between sleep duration and NSSI among Chinese adolescents. METHODS Data from China's National Adolescent Health Surveillance for the years 2014 to 2015 were collected from 15,713 students located across four provinces in China. A self-report questionnaire was used to assess sleep duration and 12-month NSSI. Binomial logistic regression models were used to examine the association between NSSI and sleep duration. The locally estimated scatter plot smoothing (LOESS) method was used to explore the associations of total NSSI number with sleep duration, and binomial regression analysis was used to test this relationship. RESULTS About 68.5% of adolescents reported sleeping less than 8 h on weeknights, while 37.8% of adolescents slept more than 10 h per night during weekends. The 12-month prevalence rate of NSSI was 29.4%. Compared to adolescents who reported weekend catch-up sleep of 0-1 h, those who slept < 0 h (adjusted odds ratio [aOR] = 1.38, 95% Confidence Interval [95% CI]: 1.16-1.64) had a higher risk of NSSI. Males who reported ≥3 h of weekend catch-up sleep had significantly increased odds of NSSI (aOR = 1.20, 95%CI: 1.01-1.42). Notably, a positive U-shaped association was observed between the sleep duration and the total NSSI number. CONCLUSIONS The findings reveal a nonlinear relationship between sleep duration and NSSI among Chinese adolescents. Therefore, it is necessary to be vigilant and screen for sleep duration among adolescents in NSSI treatment or prevention.
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Affiliation(s)
- Ying Tang
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032 Anhui China ,MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, 230032 Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University; No 81 Meishan Road, Hefei, 230032 Anhui China
| | - Yuhui Wan
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032 Anhui China ,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University; No 81 Meishan Road, Hefei, 230032 Anhui China
| | - Shaojun Xu
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University; No 81 Meishan Road, Hefei, 230032 Anhui China
| | - Shichen Zhang
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032 Anhui China ,MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, 230032 Anhui China
| | - Jiahu Hao
- grid.186775.a0000 0000 9490 772XDepartment of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032 Anhui China ,MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, 230032 Anhui China ,grid.186775.a0000 0000 9490 772XAnhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University; No 81 Meishan Road, Hefei, 230032 Anhui China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,MOE Key Laboratory of Population Health Across Life Cycle, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, No 81 Meishan Road, Hefei, 230032, Anhui, China. .,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University; No 81 Meishan Road, Hefei, 230032, Anhui, China.
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8
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Khazaie H, Zakiei A, McCall WV, Noori K, Rostampour M, Sadeghi Bahmani D, Brand S. Relationship between Sleep Problems and Self-Injury: A Systematic Review. Behav Sleep Med 2021; 19:689-704. [PMID: 32991212 DOI: 10.1080/15402002.2020.1822360] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective/Background: Previous studies suggested that sleep problems were related to non-suicidal self-injury. The current systematic review investigated more thoroughly this relationship.Methods: PubMED and Embase databases were searched. The keywords were "self-injury" OR "self-harm" OR "non-suicidal self-injury" OR "self-injurious behavior" OR "self-destructive behavior" OR "self-mutilation" AND "sleep problem" OR "sleep disturbance" OR insomnia OR nightmare OR "poor sleep quality" or "sleep disorders." A total of 16 studies were included in the present review.Results: The pattern of results indicated that sleep problems such as short sleep duration, sleep disturbances, and poor sleep quality were associated with non-suicidal self-injury. Additionally, emotional dysregulation, depression, and post-traumatic stress disorder appeared to mediate this relationship. Above all adolescents and young adults with sleep disruptions were at higher risk of non-suicidal self-injury.Conclusions:g Interventions to improve sleep quality and sleep duration might concomitantly decrease the risk of non-suicidal self-injury.
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Affiliation(s)
- Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Zakiei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - William Vaughn McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Khadijeh Noori
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoumeh Rostampour
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Dena Sadeghi Bahmani
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Psychiatric Hospital, Center of Affective, Stress and Sleep Disorders, University of Basel, Basel, Switzerland.,Departments of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama.,School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Serge Brand
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Psychiatric Hospital, Center of Affective, Stress and Sleep Disorders, University of Basel, Basel, Switzerland.,School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Department of Sport, Exercise and Health, Division of Sport Science and Psychosocial Health, University of Basel, Basel, Switzerland
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9
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Lei B, Zhang J, Chen S, Chen J, Yang L, Ai S, Chan NY, Wang J, Dai XJ, Feng H, Liu Y, Li SX, Jia F, Wing YK. Associations of sleep phenotypes with severe intentional self-harm: a prospective analysis of the UK Biobank cohort. Sleep 2021; 44:6153445. [PMID: 33640972 DOI: 10.1093/sleep/zsab053] [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: 10/06/2020] [Revised: 01/06/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY OBJECTIVES We aimed to investigate the prospective associations of sleep phenotypes with severe intentional self-harm (ISH) in middle-aged and older adults. METHODS A total of 499,159 participants (mean age: 56.55 ± 8.09 years; female: 54.4%) were recruited from the UK Biobank between 2006 and 2010 with follow-up until February 2016 in this population-based prospective study. Severe ISH was based on hospital inpatient records or a death cause of ICD-10 codes X60-X84. Patients with hospitalized diagnosis of severe ISH before the initial assessment were excluded. Sleep phenotypes, including sleep duration, chronotype, insomnia, sleepiness, and napping, were assessed at the initial assessments. Cox regression analysis was used to estimate temporal associations between sleep phenotypes and future risk of severe ISH. RESULTS During a follow-up period of 7.04 years (SD: 0.88), 1,219 participants experienced the first hospitalization or death related to severe ISH. After adjusting for demographics, substance use, medical diseases, mental disorders, and other sleep phenotypes, short sleep duration (HR: 1.50, 95% CI: 1.23-1.83, P < .001), long sleep duration (HR: 1.56, 95% CI: 1.15-2.12, P = .004), and insomnia (usually: HR: 1.57, 95% CI: 1.31-1.89, P < .001) were significantly associated with severe ISH. Sensitivity analyses excluding participants with mental disorders preceding severe ISH yielded similar results. CONCLUSION The current study provides the empirical evidence of the independent prediction of sleep phenotypes, mainly insomnia, short and long sleep duration, for the future risk of severe ISH among middle-aged and older adults.
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Affiliation(s)
- Binbin Lei
- Li Chiu Kong Family Sleep assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jihui Zhang
- Li Chiu Kong Family Sleep assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Sijing Chen
- Li Chiu Kong Family Sleep assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jie Chen
- Li Chiu Kong Family Sleep assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Lulu Yang
- Li Chiu Kong Family Sleep assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.,Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Sizhi Ai
- Li Chiu Kong Family Sleep assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jing Wang
- Li Chiu Kong Family Sleep assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xi-Jian Dai
- Li Chiu Kong Family Sleep assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Hongliang Feng
- Li Chiu Kong Family Sleep assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Yaping Liu
- Li Chiu Kong Family Sleep assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Fujun Jia
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yun-Kwok Wing
- Li Chiu Kong Family Sleep assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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10
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Latina D, Bauducco S, Tilton‐Weaver L. Insomnia symptoms and non-suicidal self-injury in adolescence: understanding temporal relations and mechanisms. J Sleep Res 2021; 30:e13190. [PMID: 32893426 PMCID: PMC7900995 DOI: 10.1111/jsr.13190] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/09/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022]
Abstract
We propose a theoretical model of insomnia symptoms and non-suicidal self-injury (NSSI) that posits bidirectional linkages. We hypothesised that heightened depressive symptoms and impulsivity that result from insomnia increase NSSI. We also posit that the shame associated with NSSI triggers repetitive negative thinking, in turn increasing insomnia. Using three longitudinal waves of questionnaire data collected annually from a sample of Swedish adolescents (n = 1,457; Mage = 13.2, SD = 0.43; 52.7% boys), we assessed the mediating role of depressive symptoms, impulsivity, rumination, and worry on the link between insomnia and NSSI. After controlling for depressive symptoms, we found that insomnia was related to increases in NSSI from the second to the third time point (ß23 = 0.09, p = .01). NSSI was consistently related to increased insomnia (ß12 = 0.09, p = .01; ß23 = 0.11, p < .001). In addition, depressive symptoms (ßind = 0.01, p = .02), but not impulsivity (ßind = 0.01, p = .09), mediated the path from insomnia to increased NSSI. Neither worry (ßind = 0.00, p = .59) nor rumination (ßind = 0.00, p = .96) mediated the link between NSSI and increased insomnia. We conclude that NSSI and insomnia maintain each other over time. Thus, screening adolescents for insomnia symptoms may help identify those at risk of NSSI. Although depression seems to explain why insomnia is a risk factor for NSSI, further studies should investigate why NSSI plays a role in the maintenance of insomnia. This understanding will lay the foundation for intervention.
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Affiliation(s)
- Delia Latina
- Center for Lifespan Developmental ResearchÖrebro UniversityÖrebroSweden
- Department of Child and Adolescents Psychiatry and PsychotherapyUniversity of UlmUlmGermany
| | - Serena Bauducco
- Center for Health and Medical PsychologyÖrebro UniversityÖrebroSweden
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Liu ZZ, Tein JY, Jia CX, Liu X. Depression as a mediator between frequent nightmares and non-suicidal self-injury among adolescents: a 3-wave longitudinal model. Sleep Med 2020; 77:29-34. [PMID: 33307303 DOI: 10.1016/j.sleep.2020.11.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/12/2020] [Accepted: 11/18/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Frequent nightmares and depression are associated with non-suicidal self-injury (NSSI) in adolescents. Little is known about the mediating role of depression in the nightmare-NSSI link. This study explores the longitudinal mediating effect of depression on the relationship between frequent nightmares and NSSI as well as the moderating effect of gender using a three-wave longitudinal design. METHODS Participants were adolescents from the Shandong Adolescent Behavior and Health Cohort who were surveyed at baseline, 1 year later, and 2 years later. A self-administered questionnaire was used to measure nightmare frequency, depression, and NSSI. Structural equation modeling and multiple-group analysis were used to test the mediating effect of depression and the moderating effect of gender. Covariates included demographics and earlier measures of depression and NSSI. RESULTS Among 6995 participants, 3399 (48.6%) were females, mean age was 14.86 (SD = 1.50) years at baseline. Frequent nightmares had a significant mediation effect on NSSI through depression (Bab = 0.06, 95% CI = 0.02-0.10) after controlling for demographics and earlier measures of depression and NSSI. Gender had no significant moderating effect on the nightmare-NSSI association. LIMITATIONS All data were collected by self-report. CONCLUSIONS The association between frequent nightmares and NSSI in adolescents was partially mediated by depression. Frequent nightmares and depression should be assessed and treated to prevent self-harm in adolescents.
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Affiliation(s)
- Zhen-Zhen Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University and Shandong University Center for Suicide Prevention Research, Jinan, PR China; REACH Institute, Psychology Department, Arizona State University, Tempe, AZ, USA
| | - Jenn-Yun Tein
- REACH Institute, Psychology Department, Arizona State University, Tempe, AZ, USA
| | - Cun-Xian Jia
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University and Shandong University Center for Suicide Prevention Research, Jinan, PR China.
| | - Xianchen Liu
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, USA.
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Characteristics associated with later self-harm hospitalization and/or suicide: A follow-up study of the HUNT-2 cohort, Norway. J Affect Disord 2020; 276:369-379. [PMID: 32871667 DOI: 10.1016/j.jad.2020.03.163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 02/20/2020] [Accepted: 03/29/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND To improve suicide and self-harm prevention in adults, better knowledge on preexisting characteristics and risk factors is of great importance. METHODS This is a population-based case-control study; baseline measures were collected in the second wave of the North-Trøndelag Health Study (HUNT-2, 1995-1997) in Norway, and outcomes were observed for up to 19 years. Average follow up time was 4.9 years for self-harm and 6.8 years for suicides. Out of 93,898 eligible adult inhabitants aged 20 and above, a total of 65,229 (70%) participated in the study. The data were linked to the National Mortality Registry and hospital patient records in the three hospitals covering the HUNT-2 catchment area. RESULTS Among the participants, 332 patients (68% women) were hospitalized because of self-harm (HSH), and 91 patients (32% women) were died by suicide (SU). A total of 10% of those who died by SU had previously been HSH. People in the HSH and SU groups were younger, reported more depression and anxiety symptoms, sleeping problems, higher use of alcohol and tobacco, poorer social network and more economic problems, compared to the rest of the HUNT-2 population. In addition, the HSH group reported more somatic health problems, higher use of health services, higher sick leave, and lower work participation than the SU group. LIMITATIONS Younger adults (20-40 years) were under-represented in HUNT-2. Younger adults (20-40 years) were constituted 31.7% in HUNT-2, 50% in HSH and 33% in SU. Further, we did not identify less severe self-harm, not requiring hospitalization. Life changes, adverse events, and other possible triggers to self-harming behavior were not recorded. CONCLUSION Psychological problems were long-term predictors of both HSH and SU. Somatic health problems and lower functional performance were more present in HSH-group compared to the SU-group.
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Sleep loss among Thai high school students smartphone users affected by smartphone electromagnetic pollution. JOURNAL OF HEALTH RESEARCH 2020. [DOI: 10.1108/jhr-05-2019-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
Adolescents being in a stage of growth need good sleep, but, today, they suffer from sleep deprivation due to such extrinsic factor as a smartphone which they enjoy spending time using the device. However, the effects of smartphone output power (SOP) on the duration of good sleep remains unclear. The purpose of this paper is to investigate the correlation of the SOP and sleep loss in high school students.
Design/methodology/approach
The time-series study was conducted among 145 high school students in Chiang Mai Province who completed a sleep diary which applied by the Pittsburg Sleep Quality Index. The SOP was corrected by a smartphone application and transmitted by e-mail to a researcher every day. The completed data set contains 12,969 entries. Headache, anxiety and depression were also assessed. Data were analyzed using the generalized estimating equation adjusted for demographic data, smartphone use and other factors.
Findings
Most of the study subjects are female, 17.4 years old on average. The prevalence of sleep loss (<8 h) was 52.9 percent with averagely 7.4 ±1.7 h of sleep duration and poor sleep at 32.1 percent. Anxiety, depression, headache had relationships with sleep loss. The daily dose, evening and nocturnal SOP in the range of ≥ 2.00 × 10‒5 mW had stronger relationships with sleep loss than their effects in the range of ≤ 1.79 × 10‒5 mW (ORadj1.32; 95% CI: 1.26–1.76, ORadj1.34; 95% CI: 1.07–1.17 and ORadj1.41; 95% CI: 1.07–1.17, respectively). Meanwhile, morning Lag_2 and daytime Lag_1 in the range of ≥ 2.00 × 10‒5 mW appeared to have a strong relationship with sleep loss (ORadj1.60; 95% CI: 1.26–1.76, ORadj1.36; 95% CI: 1.07–1.17). The relationship between Lag_4 daily dose and sleep loss took the form of a reverse dose-response.
Originality/value
Sleep loss in adolescents has an increasing trend of prevalence and has been found to be correlated with the highest SOP group (≥ 2.00 × 10‒5 mW range). These results confirmed that increased and longer smartphone use result in reduced sleep time. This causes them to be exposed to smartphone electromagnetic radiation and smartphone screen lighting. This disturbs brain waves and nervous system controlling sleep balance mechanisms. The findings recommended parents setting time and boundaries around technology use at home to reduce contact with electromagnetic radiation and smartphone screen lighting, thereby increasing sleeping time in order to create good sleep quality.
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Adolescent personality traits, low self-esteem and self-harm hospitalisation: a 15-year follow-up of the Norwegian Young-HUNT1 cohort. Eur Child Adolesc Psychiatry 2019; 28:329-339. [PMID: 30027416 DOI: 10.1007/s00787-018-1197-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/05/2018] [Indexed: 12/20/2022]
Abstract
Affective disorders are closely related to self-harm and suicidal behaviours. Less is known about how adolescent personality traits and self-esteem influence the development of later self-harm. We examined associations between personality traits such as neuroticism, psychoticism and extroversion, and self-esteem, in adolescence, and the risk of future self-harm hospitalisation. Baseline information from 13 to 19-year-old participants in the Norwegian Young-HUNT1 study in 1995-97 (n = 8965) was linked to endpoint data recorded from participants' hospital records, describing self-harm hospitalisation episodes within the catchment area. Crude and adjusted hazard ratios (HR) were estimated by Cox regression analyses. A one-unit increase on the 0-6 scale for neuroticism was associated with a HR of 1.29, 95% confidence interval (CI) 1.14-1.47. Corresponding HR for psychoticism was 1.30, 95% CI 1.03-1.63 per unit increase, and for extroversion risk was reduced (HR 0.89, 95% CI 0.77-1.04). Positive perception of self-esteem was more strongly associated with reduced risk of self-harm hospitalisation (HR per unit increase on the 0-12 scale was 0.74, 95% CI 0.68-0.82). Additional adjustment for alcohol use and symptoms of combined anxiety and depression symptoms attenuated effect estimates, in particular for neuroticism (HR 1.13, 95% CI 0.96-1.32) and psychoticism (HR 1.07, 95% CI 0.82-1.40). In contrast, self-esteem associations remained largely the same after adjustment. Our results indicate that brief assessments of personality and self-esteem might add additional relevant information, and could be included as a supplement to standard suicidal risk assessment in adolescents.
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Abstract
Hospitalized patients frequently have disordered and poor-quality sleep due to a variety of both intrinsic and extrinsic factors. These include frequent nighttime intrusions, insomnia related to pain and unfamiliar environments, dark conditions during the day with loss of natural light, and disruption of the natural sleep cycle due to illness. Sleep wake disturbances can result in a deleterious consequence on physical, emotional, and cognitive status, which may impact patient satisfaction, clinical recovery, and hospital length of stay. Despite this, clinicians frequently fail to document sleep disturbances and are generally unaware of the best practices to improve sleep quality in the hospital. A PubMed search was conducted using the terms: ("sleep and hospitalized patients") and ("sleep and hospitalization") to review the published data on the topic of sleep in hospitalized medical patients. The search was limited to English-language articles published between 2000 and 2018. Subsequent PubMed searches were performed to clarify the data described in the initial search, including the terms "hospital sleep protocols," "hospitalized patients sleep documentation," and "hospitalized patients sleep quality". The purpose of this review is to discuss sleep disturbances in hospitalized patients with a focus on causes of sleep disturbance, the effect of poor-quality sleep, high risk populations, considerations for surveillance and prevention, and pharmacologic and non-pharmacologic options for treatment.
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Affiliation(s)
- Anne Marie Morse
- Geisinger Commonwealth School of Medicine, Department of Child Neurology and Sleep Medicine Geisinger Medical Center, Janet Weis Children’s Hospital, 100 N. Academy Ave, Danville, PA 17820, USA
| | - Evin Bender
- Department of Neurology, Geisinger Medical Center, 100 N. Academy Ave, Danville, PA 17820, USA
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Junker A, Bjørngaard JH, Bjerkeset O. Adolescent health and subsequent risk of self-harm hospitalisation: a 15-year follow-up of the Young-HUNT cohort. Child Adolesc Psychiatry Ment Health 2017; 11:25. [PMID: 28469702 PMCID: PMC5410696 DOI: 10.1186/s13034-017-0161-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 04/13/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Self-harm is associated with increased suicide risk, and constitutes a major challenge in adolescent mental healthcare. In the current study, we examined the association between different aspects of adolescent health and risk of later self-harm requiring hospital admission. METHODS We linked baseline information from 13 to 19 year old participants (n = 8965) in the Norwegian Young-HUNT 1 study to patient records of self-harm hospitalisation during 15 years of follow-up. We used Cox regression to estimate risk factor hazard ratios (HR). RESULTS Eighty-nine persons (71% female) were admitted to hospital because of self-harm. Intoxication/self-poisoning was the most frequent method (81%). Both mental (anxiety/depression, loneliness, being bullied) and somatic (epilepsy, migraine) health issues were associated with up to fourfold increased risk of self-harm-related hospital admission. CONCLUSIONS Several health issues during adolescence markedly increased the risk of later self-harm hospitalisation. Current findings should be incorporated in the strive to reduce self-harming and attempted suicides among young people.
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Affiliation(s)
- Asbjørn Junker
- 0000 0001 1516 2393grid.5947.fDepartment of Neuroscience, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Johan Håkon Bjørngaard
- 0000 0001 1516 2393grid.5947.fDepartment of Public Health and General Practice, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway ,0000 0004 0627 3560grid.52522.32Forensic Department and Research Centre Brøset, St. Olavs University Hospital, Trondheim, Norway
| | - Ottar Bjerkeset
- 0000 0001 1516 2393grid.5947.fDepartment of Neuroscience, Faculty of Medicine, NTNU-Norwegian University of Science and Technology, Trondheim, Norway ,grid.465487.cFaculty of Health Sciences, Nord University, Levanger, Norway
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Kitagawa Y, Ando S, Yamasaki S, Foo JC, Okazaki Y, Shimodera S, Nishida A, Togo F, Sasaki T. Appetite loss as a potential predictor of suicidal ideation and self-harm in adolescents: A school-based study. Appetite 2017; 111:7-11. [DOI: 10.1016/j.appet.2016.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 12/11/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
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Sleep in infancy and childhood: implications for emotional and behavioral difficulties in adolescence and beyond. Curr Opin Psychiatry 2014; 27:453-9. [PMID: 25247458 DOI: 10.1097/yco.0000000000000109] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Extensive scientific efforts have been made in an attempt to identify early markers of behavioral and emotional problems. In this context, sleep has received considerable research attention, as it appears to be closely linked to developmental psychopathology. The present review synthesizes some of the most recent findings regarding the concurrent and longitudinal associations between psychopathology and behavioral manifestations of sleep in childhood and adolescence. RECENT FINDINGS Recent evidence suggests that compromised sleep is associated with both internalizing and externalizing problems in childhood and adolescence. Moreover, sleep problems have been shown to predict the development of various emotional and behavioral problems, including depression, anxiety, attention-deficit hyperactivity disorder, risk-taking and aggression. Yet, inconsistencies are apparent, particularly among findings that are based on objective sleep measurement. SUMMARY Taken together, most recent findings suggest that poor sleep in childhood and adolescence constitutes a risk factor for psychopathological symptoms. Accordingly, the importance of early detection and intervention should be a primary goal in clinical settings. In the research domain, the underlying mechanism of these associations should receive future research attention, in an attempt to broaden the understanding of the relationship between sleep and psychopathology.
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