Interpersonal distress is associated with sleep and arousal in insomnia and good sleepers

Objective

The interpersonal environment is strongly linked to sleep. However, little is known about interpersonal distress and its association with sleep. We examined the associations among interpersonal distress, objective and subjective sleep in people with and without insomnia.

Methods

Participants in this cross-sectional observational study included men and women with insomnia (n = 28) and good sleeper controls (n = 38). Interpersonal distress was measured with the Inventory of Interpersonal Problems. Sleep parameters included insomnia severity, self-reported presleep arousal, and sleep quality; and polysomnographically-assessed sleep latency (SL), total sleep time (TST), wake after sleep onset (WASO), percent delta (stage 3 + 4 NREM), percent REM, and EEG beta power. Hierarchical linear regression was used to assess the relationship between distress from interpersonal problems and sleep and the extent to which relationships differed among insomnia patients and controls.

Results

More interpersonal distress was associated with more self-reported arousal and higher percentage of REM. More interpersonal distress was associated with greater insomnia severity and more cognitive presleep arousal for individuals with insomnia, but not for controls. Contrary to expectations, interpersonal distress was associated with shorter sleep latency in the insomnia group. Results were attenuated, but still significant, after adjusting for depression symptoms.

Conclusion

Distress from interpersonal problems is associated with greater self-reported arousal and higher percent REM. Individuals with insomnia who report more distress from interpersonal problems have greater insomnia severity and cognitive presleep arousal, perhaps due to rumination. These findings extend our knowledge of the association between interpersonal stressors and sleep. Assessment and consideration of interpersonal distress could provide a novel target for insomnia treatment.     

大学生家庭环境、社交回避及苦恼与睡眠质量的关系

目的 探讨家庭环境(亲密度、矛盾性、知识性、组织性)、社交回避及苦恼与大学生睡眠质量的关系,为学校心理健康教育及临床治疗提供依据.方法 采取整群随机抽样方法,抽取福建某师范院校大学生254名(均为住校生)为研究对象,采用《匹兹堡睡眠质量指数(PSQI)》、《家庭环境量表中文版(FES—CV)》及《社交回避及苦恼量表(SAD)》对大学生进行测量.结果 (1)睡眠问题检出率为18.9％.大学生在睡眠质量上存在显著的性别差异.(2)家庭环境、社交回避及苦恼和睡眠质量三者关系密切.家庭环境与睡眠质量呈显著正相关;社交回避及苦恼与睡眠质量呈显著负相关;家庭环境与社交回避及苦恼呈显著负相关.(3)家庭中的矛盾性和社交苦恼对睡眠质量有显著正向预测作用,家庭组织性对睡眠质量有显著负向预测作用.家庭环境和社交回避及苦恼共同影响睡眠质量,家庭环境除了对睡眠质量有直接影响外,还可以通过社交回避及苦恼对睡眠质量产生间接影响.结论 家庭环境和社交回避及苦恼共同影响睡眠质量,家庭环境除了对睡眠质量有直接影响外,还可以通过社交回避及苦恼对睡眠质量产生间接影响.     

Editorial: Child and Adolescent Mental Health: a global challenge

Welcome to the first issue of Child and Adolescent Mental Health of 2015. A pleasure of being an editor of this journal is the sheer breadth and diversity of papers that we receive. The best papers not only share the achievements and successes of new research and innovation but also shed light on the complex struggles and challenges involved in helping children and young people overcome the emotional, behavioural and other mental health difficulties they endure. Child and Adolescent Mental Health aims to publish high quality health services research that informs, influences and transforms the quality and effectiveness of the mental health care available to children, young people, their parents and families. When placed in the global context outlined by Patel and Rahman (2015) in this issue, the scale of this task is daunting. Nearly half of the world's population are under the age of 18 and only a small fraction of the global mental health resources currently available are invested in child and adolescent mental health care across low, medium and high income countries. Patel and Rahman (2015) argue that the step change needed to transform global child mental health requires a bold agenda that mobilises community assets, such as lay health workers, harnesses the use of mobile and electronic health technologies alongside more conventional improvement in access and effectiveness of both universal and specialist services from early life onwards. This agenda resonates for children and young people in high income countries as much as it does for those living in low and middle income countries. Child and Adolescent Mental Health needs to reflect the global challenge of children and young people's mental health. This issue contains papers from authors based in Australia, Brazil, India, Italy, Ireland, Turkey, the UK and the USA, each of which uses scientific methods to make an informed contribution to clinical practice.     

大学新生网络成瘾、睡眠质量及日周期类型的现况调查

目的:调查大学新生中网络成瘾、睡眠质量及日周期类型的检出情况,并进行相关因素分析。方法:通过网络调查于2019年9—12月对四川大学2019年9 157名新入学本科生进行心身健康问卷调查,采用杨氏网络成瘾问卷、匹兹堡睡眠质量指数、清晨型-夜晚型问卷,分别调查网络成瘾、睡眠质量以及日周期类型的检出情况。采用Logisti...     

Patterns of Child and Adolescent Mental Health Care in Greece

During the last 20 years the mental health care system in Greece underwent a dramatic change; the implementation of the EEC Reg. 815/84 programme contributed to a significant shift towards the extramural care and rehabilitation of patients with long-term mental health problems. The child and adolescent mental health (CAMH) care system was transformed by this change to a lesser degree. Despite bureaucratic obstacles and other difficulties, a substantial number of CAMH outpatient services have been developed in Greece. They are concentrated mainly in the larger cities and they focus on providing assessment and to some extent therapy and counselling; prevention and promotion of CAMH are not yet perceived as priority areas. In addition, there is a lack of specialised day care services for specific populations such as young people with disorders of the autistic spectrum and intellectual disabilities. There have been some recent improvements in education and research in the field of CAMH but these sectors are in need of further investment and development. Unfortunately, the current economic crisis has affected both the development of new services and the optimal functioning of those already in operation. Nevertheless, Greece must invest in CAMH and the rights of the children and young people should be protected.     

Routine Outcome Measurement: A Survey of UK Child and Adolescent Mental Health Services

Background:  Research suggests that the routine measurement of treatment outcomes is a neglected area of clinical practice within mental health care settings. Still it is not clear to what extent such findings apply to child and adolescent mental health services (CAMHS). A cross-sectional survey of UK CAMHS revealed that although quantitative clinical measures are commonly used within these services, there is little uniformity in the instruments utilised, and they rarely inform a system of routine outcome measurement. However, in general, respondents did not have a philosophical or scientific objection to the practice of routinely measuring outcomes, but rather felt that they lacked the necessary resources to facilitate such initiatives.     

The impact of disaster work on community volunteers: The role of peri-traumatic distress,level of personal affectedness,sleep quality and resource loss,on post-traumatic stress disorder symptoms and subjective health

Disaster work has shown to cause PTSD symptoms and subjective health complaints in professional emergency personnel. However, very little is known about how disaster work affects community volunteers.This first time longitudinal study examined factors contributing to post-traumatic stress disorder symptoms (PTSD) and subjective health complaints in volunteers working in an earthquake setting. At six and eighteen months post disaster, a sample of 506 Indonesian Red Cross volunteers were assessed using the Impact of Event Scale-Revised and the Subjective Health Complaints Inventory. Factors analyzed in relation to the outcomes included: peri-traumatic distress, level of personal affectedness by the disaster, sleep quality and loss of resources as a consequence of the disaster.At 18 months post-disaster the findings showed high levels of PTSD symptoms and subjective health complaints. Quality of sleep was related to both outcomes but resource loss only to PTSD symptoms. Neither peri-traumatic distress nor level of affectedness by the disaster (external versus directly affected volunteers), were predictive of symptoms. This study indicates that characteristics of disaster work e.g. low quality of sleep, may be an important contributor to PTSD symptoms and subjective health complaints in volunteers.     

Efficacy and Effectiveness of Child and Adolescent Psychotherapy and Pharmacotherapy

Decades of intervention research have produced a rich body of evidence on the effects of psychotherapies and pharmacotherapies with children and adolescents. Here we summarize and critique that evidence. We review findings bearing on the efficacy of psychosocial treatments and medications under controlled experimental conditions. We also report evidence, where available, on the effectiveness of both classes of treatment with clinically referred youth treated in real-world clinical contexts. In general, the large body of evidence on efficacy contrasts sharply with the small base of evidence on effectiveness. Addressing this gap through an enriched research agenda could contribute importantly to linking scientific inquiry and clinical practice—to the benefit of both ventures. This is one element of a multifaceted agenda for future research and for synthesis of research, which will require the interplay of multiple disciplines related to child and adolescent mental health.     

Self-reported symptoms of sleep disturbance and inflammation, coagulation, insulin resistance and psychosocial distress: evidence for gender disparity

Self-reported ratings of sleep quality and symptoms of poor sleep have been linked to increased risk of coronary heart disease (CHD), Type 2 diabetes and hypertension with recent evidence suggesting stronger associations in women. At this time, the mechanisms of action that underlie these gender-specific associations are incompletely defined. The current study examined whether gender moderates the relation of subjective sleep and sleep-related symptoms to indices of inflammation, coagulation, insulin resistance (IR) and psychosocial distress, factors associated with increased risk of cardiovascular and metabolic disorders. Subjects were 210 healthy men and women without a history of sleep disorders. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality and frequency of sleep symptoms. In multivariate-adjusted models, overall poor sleep quality, more frequent problems falling asleep (>2 night/week) and longer periods to fall asleep (>30 min) were associated with greater psychosocial distress, higher fasting insulin, fibrinogen and inflammatory biomarkers, but only for women. The data suggest that subjective ratings of poor sleep, greater frequency of sleep-related symptoms, and longer period of time to fall asleep are associated with a mosaic of biobehavioral mechanisms in women and that these gender-specific associations have direct implications to recent observations suggesting gender differences in the association between symptoms of poor sleep and cardiovascular disease.     

Child and Adolescent Mental Health within Primary Care: A Study of General Practitioners' Perceptions

Background:  Primary Care teams play an important role in the provision of mental health care to children and young people.
Methods:  We developed and distributed a questionnaire to all General Practitioners within one Health Authority area.
Results:  Many of the respondents rated as less than satisfactory their competence and their knowledge and skills in important areas of child and adolescent mental health practice. A significant minority expressed a high level of interest in child and adolescent mental health and most respondents reported that they would value further training.
Conclusions:  General Practitioners should be provided with more training and support in their role as providers of child and adolescent mental health care.     

Effects of sleep duration and weekend catch-up sleep on falling injury in adolescents: a population-based study

ObjectiveThis population-based study aimed to determine the effects of sleep deprivation and compensatory weekend catch-up sleep on the risk of falls in adolescents.MethodsData from the 2013 Korean Youth Risk Behavior Web-based Survey on 57,225 adolescents were investigated. Demographic, socioeconomic, sleep-related, health-related behavioral, and psychological variables were compared between fallers (n = 7346) and non-fallers (n = 49,879). Multivariate logistic regression analysis using a hierarchical model was carried out to identify sleep-related factors (eg, sleep duration, longer weekend catch-up sleep) independently contributing to the risk of falls.ResultsCompared to non-fallers, fallers were associated with a shorter sleep duration (p = 0.001) and later bedtimes on weekdays and weekends (p < 0.001). An average sleep duration of ≤ 5 h (odds ratio [OR] 1.23, 95% confidence interval [CI] 1.12–1.34) and of 6 h (OR 1.12, CI 1.03–1.21) were associated with an increased risk of falls. By contrast, an average sleep duration of ≥ 9 h (OR 0.90, CI: 0.82–0.99) and longer weekend catch-up sleep (OR 0.94, CI: 0.89–0.99) were associated with a decreased risk of falls.ConclusionOur results corroborate previous suggestions that short sleep duration is a major risk factor for falls among adolescents. Moreover, our study provided a novel finding that longer sleep duration and longer weekend catch-up sleep may have a protective effect against falls. Our findings have important public health implications that modifying school schedules to increase sleep duration could reduce unintentional falls and injuries in school-aged adolescents.     

Adolescent substance use, sleep, and academic achievement: evidence of harm due to caffeine

Using academic achievement as the key outcome variable, 7377 Icelandic adolescents were surveyed for cigarette smoking, alcohol use, daytime sleepiness, caffeine use, and potential confounders. Structural equation modeling (SEM) was used to examine direct and indirect effects of measured and latent variables in two models: the first with caffeine excluded and the second with caffeine included. A substantial proportion of variance in academic achievement, which might otherwise have been attributed to the harmful effects of cigarette smoking and alcohol use, was found to be attributable to caffeine. Evidence was obtained that daytime sleepiness, which was found to be independently associated with usage of licit substances (nicotine and alcohol) and caffeine, may be an important mediator of the negative impact of those substances on academic achievement. Findings suggest the importance of including measurements of caffeine consumption in future studies of adolescent substance use.     

Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization

The widely-used Kessler K6 non-specific distress scale screens for severe mental illness defined as a K6 score ≥ 13, estimated to afflict about 6% of US adults. The K6, as currently used, fails to capture individuals struggling with more moderate mental distress that nonetheless warrants mental health intervention. The current study determined a cutoff criterion on the K6 scale indicative of moderate mental distress based on mental health treatment need and assessed the validity of this criterion by comparing participants with identified moderate and severe mental distress on relevant clinical, impairment, and risk behavior measures. Data were analyzed from 50,880 adult participants in the 2007 California Health Interview Survey. Receiver operating characteristic curve analysis identified K6 ≥ 5 as the optimal lower threshold cut-point indicative of moderate mental distress. Based on the K6, 8.6% of California adults had serious mental distress and another 27.9% had moderate mental distress. Correlates of moderate and serious mental distress were similar. Respondents with moderate mental distress had rates of mental health care utilization, impairment, substance use and other risks lower than respondents with serious mental distress and greater than respondents with none/low mental distress. The findings support expanded use and analysis of the K6 scale in quantifying and examining correlates of mental distress at a moderate, yet still clinically relevant, level.     

A Triage Clinic in a Child and Adolescent Mental Health Service

Aims: To determine whether non-urgent referrals can be adequately assessed in a triage clinic, to determine the service outcome of these referrals, and whether triage was acceptable to families, referrers and CAMHS clinicians.
Method: Families, CAMHS clinicians and GPs were surveyed to ascertain the acceptability of triage. Non-attendance and outcome of triage were recorded.
Results: Ninety-two cases were included and the DNA rate fell by one-third.
Conclusions: Overall, clinicians and families reported high rates of satisfaction with triage (93.7% and 95.2%) and multidisciplinary working improved.     

Association of psychological distress late in life and dementia-related mortality

Objective: It is not fully understood how subjective feelings of psychological distress prognosticate dementia. Our aim was to investigate the association between self-reported psychological distress and risk of dementia-related mortality.

Method: We included 31,043 eligible individuals between the ages of 60 and 80 years, at time of examination, from the CONOR (Cohort of Norway) database. They were followed for a period of 17.4 years (mean 11.5 years). The CONOR Mental Health Index, a seven-item self-report scale was used. A cut-off score equal to or above 2.15 on the scale denoted psychological distress. Cox regression was used to assess the association between psychological distress and risk of dementia-related mortality.

Results: Total number of registered deaths was 11,762 and 1118 (9.5%) were classified as cases of dementia-related mortality. We found that 2501 individuals (8.1%) had psychological distress, of these, 119 (10.6%) had concomitant dementia-related mortality. Individuals with psychological distress had an increased risk of dementia-related mortality HR = 1.52 (95% confidence interval (CI) 1.25–1.85) after adjusting for age, gender and education. The association remained significant although attenuated when implemented in a full adjusted model, including general health status, smoking, obesity, hypertension, diabetes and history of cardiovascular disease; hazard ratio, HR = 1.30 (95% CI 1.06–1.59).

Conclusion: Our results indicate that psychological distress in elderly individuals is associated with increased risk of dementia-related mortality. Individuals at increased risk of dementia may benefit from treatments or interventions that lessen psychological distress, but this needs to be confirmed in future clinical studies.     

Clinical use of the Kessler psychological distress scales with culturally diverse groups

The Kessler 10 (K10) and embedded Kessler 6 (K6) was developed to screen for non‐specific psychological distress and serious mental illness in mental health surveys of English‐speaking populations, but has been adopted in Western and non‐Western countries as a screening and outcome measure in primary care and mental health settings. This review examines whether the original K6/K10's validity for culturally diverse populations was established, and whether the cultural equivalence, and sensitivity to change of translated or culturally adapted K6/K10s, has been demonstrated with culturally diverse client groups. Evidence for the original K6/K10's validity for culturally diverse populations is limited. Questions about the conceptual and linguistic equivalence of translated/adapted K6/K10s arise from reports of changes in item connotation and differential item functioning. Evidence for structural equivalence is inconsistent, as is support for criterion equivalence, with the majority of studies compromising on accuracy in case prediction. Research demonstrating sensitivity to change with culturally diverse groups is lacking. Inconsistent evidence for the K6/K10's cultural appropriateness in clinical settings, and a lack of clinical norms for either majority or culturally diverse groups, indicate the importance of further research into the psychological distress construct with culturally diverse clients, and the need for caution in interpreting K6/K10 scores. Copyright © 2014 John Wiley & Sons, Ltd.     

Facing the future: a call for higher education in sleep technology

The American Association of Sleep Technologists (AAST) is the national membership organization representing sleep technologists. The Board of Directors of the AAST recognizes that changes in the workforce will result in an increased need for technologists with a higher level of education. In order to meet the needs of members, the AAST has: (1) convened a summit of stakeholders to discuss the changing landscape for sleep technologists; (2) hosted an educational task force to provide ongoing communication and support; and (3) commissioned a survey of members, educators and employers to better define educational gaps and opportunities for sleep technologists. This report summarizes the results of the survey and provides a roadmap for future educational development. Demographic information highlights the diversity of those in the field of sleep technology. The majority of respondents agree that new technical skills will be needed to achieve competence in sleep technology in the near future, but also that clinical and communication skills will be critical in expanding the role of the sleep technologist in the sleep center. These findings led the AAST leadership to propose new directions for the AAST in serving the needs of its members and the field of sleep technology. This will include a continued focus on education, both basic and advanced, and development of diverse pathways for senior sleep technologists as well as those just entering the field.     

Psychological wellbeing,distress and coping in Australian Indigenous and multicultural prisoners: a mixed methods analysis

The Australian prison population is growing and becoming increasingly diverse. Yet very little research has investigated mental health concerns for multi-cultural prisoners. This mixed methods study aimed to identify the prevalence of mental health factors (wellbeing, distress and coping) in a cohort of 530 prisoners from Indigenous, culturally and linguistically diverse (CALD) and English-speaking backgrounds (ESB) at a maximum-security prison in Victoria, Australia. Focus group interviews were also conducted with an additional 40 prisoners. It was found that Indigenous prisoners had significantly higher levels of distress and more symptoms of anxiety and depression than CALD and ESB prisoners. CALD prisoners had a greater sense of ‘feeling in control’ in prison than ESB prisoners. The focus group interviews also identified several factors that contributed to mental health differences between the groups. Findings reinforce the need for a more individualised approach in addressing mental health issues for prisoners cross-culturally.