Associations between insomnia symptom trajectories with depression and self-harm behaviors in Chinese college students before and during the COVID-19 pandemic: A five-wave longitudinal investigation

Are trajectories of insomnia symptoms associated with clinically significant depressive symptoms or vice versa? Evidence from a 5-year longitudinal study

OBJECTIVES

To examine the association between different insomnia symptom trajectories and subsequent depressive symptoms, as well as the reverse.

METHODS

This was a secondary analysis of a population-based study on the natural course of insomnia in Canada, and 3030 participants (18-94 years) with valid data were included. Two separate analyses were conducted for the distinct objectives of the current study, which required different samples. Participants who exhibited the designated outcomes at baseline were excluded from each analysis. Growth mixture modeling was used to identify insomnia and depressive symptom trajectories over five years, measured by Insomnia Severity Index (ISI) and Beck Depression Inventory-II (BDI-II), respectively. Cases with clinically significant depressive symptoms at follow-ups were defined as reporting at least moderate depressive symptoms (BDI-II ≥ 20) and one core symptom of depression, while insomnia disorder at follow-ups was identified according to a validated algorithm using a combination of criteria from DSM-4 and ICSD-3 and self-reported use of sleep medication.

RESULTS

Five insomnia symptom trajectories were identified over five years: stable good sleepers (24 %), stable low insomnia severity (35 %), gradual improvements in symptoms (6 %), persistent insomnia symptoms (31 %), and progressive worsening of symptoms (5 %). Compared with good sleepers, the other insomnia trajectory groups all had higher risks of clinically significant depressive symptoms at follow-ups, especially those with progressive symptoms (harzad ratio [HR]: 19.77 [10.30 to 37.93]). In a parallel analysis, four depression trajectories emerged: noncases (49 %), stable low depressive severity (38 %), moderate symptoms improving over time (7 %), and progressive worsening of symptoms (6 %). Compared with noncases, the other depression trajectory groups all showed elevated risks of insomnia disorder, especially those with progressive worsening of symptoms (HR: 6.85 [5.26 to 8.93]).

CONCLUSIONS

Our findings support a close relationship between insomnia and depressive symptoms, especially when both symptoms become progressive or persistent.

Longitudinal Associations Between Sleep Disturbance Trajectories and Internet Gaming Disorder Mediated by Self-Control: A Six-Wave Longitudinal Investigation

Objective

The present study aims to analyze the heterogeneous trajectories of sleep disturbance (SD) among college students and to examine whether self-control mediates the association between sleep disturbance trajectories and Internet gaming disorder (IGD).

Methods

A total of 4352 students were initially invited to participate, and 4191 (M age = 19.12, SD = 0.98; 46.9% females) students were included as valid respondents at the first time-point. This study spanned six waves (from 2019 to 2022) with a six-month interval between each wave. Sleep disturbance was measured from Time 1 to Time 4, self-control was measured at Time 5, and Internet gaming disorder was measured at Time 6. Growth mixture modeling (GMM) was applied to identify latent classes of sleep disturbance over the four waves. Mediation analysis was conducted to examine the mediating role of self-control between sleep disturbance trajectories and IGD.

Results

The results of growth mixture modelling yielded a four-class solution for sleep disturbance: a stable-low group, an increasing group, a decreasing group, and a stable-high group. Additionally, the results of mediation models showed that increased sleep disturbance is associated with a higher likelihood of individuals becoming more addicted to Internet games due to decreased self-control. Conversely, improved sleep quality may decrease the likelihood of engaging in Internet games via by promoting higher levels of self-control.

Conclusion

Future prevention and intervention programs targeted at improving self-control may decrease the possibility of developing IGD.

Predisposing factors for symptoms of anxiety, depression, and insomnia in university students

OBJECTIVES

to characterize the sociodemographic and psychological aspects of university students who sought psychiatric care at a Student Support Center of a Federal University and to analyze associations between mental health issues and predisposing factors.

METHODS

a retrospective analysis of 103 medical records was conducted. The statistical analysis consisted of two steps: a descriptive analysis and a predictive analysis using the Logistic Regression Model.

RESULTS

the majority of the students were female. Symptoms of anxiety, depression, and insomnia were the main reasons for seeking care. Students who reported having emotional difficulties that negatively impacted their studies and those who had undergone some form of health treatment showed a higher probability of experiencing anxiety symptoms. Notable correlations were found between anxiety and emotional difficulties, depression and diarrhea, and insomnia and a sedentary lifestyle.

CONCLUSIONS

symptoms of anxiety, depression, and insomnia led students to seek psychiatric care at the university. Understanding the predisposing factors for mental health issues in university students can inform care strategies and promote academic success.

Prevalence and associated factors of depression, anxiety and stress among clinical therapists in China in the context of early COVID-19 pandemic

Objectives

To study the socio-demographic characteristics and the prevalence of depression, anxiety, and stress among clinical therapists in China during the early Coronavirus disease 2019 (COVID-19) pandemic and to identify associated factors.

Method

This cross-sectional study was part of a multicenter, nationally representative survey conducted through WeChat from January 2021 to March 2021. Data, including socio-demographics, health-related behaviors, and information on whether they participated in the frontline work of treating COVID-19, were collected anonymously. Respondents also completed the Depression Anxiety Stress Scales-21 (DASS-21).

Results

In total, 396 clinical therapists in the selected hospitals completed the questionnaires, with a response rate of 89.0%. Respondents were predominantly female (77.3%). About 6.6% of the participants were current tobacco users, and 20.7% had participated in the frontline work of treating COVID-19. Overall, 22.0%, 17.9%, and 8.8% of participants were classified as having clinically meaningful depression, anxiety, and stress, respectively, based on DASS-21 scores. Multiple logistic regression in Model 1 and Model 2 showed that depression, anxiety, and stress were associated with regular physical activity and frequent insomnia (all, p < 0.05). In anxiety model 2, the associated factors for anxiety during the pandemic were identified as education (master's degree or more, OR=0.520; 95% CI=0.283-0.955), marital status (single, OR=2.064; 95% CI=1.022-4.168), tobacco use (OR=4.265; 95% CI=1.352-13.454), regular physical activity (OR=0.357; 95% CI=0.192-0.663), frequent insomnia (OR=6.298; 95% CI =2.522-15.729), and participation in the frontline work of treating COVID-19 (OR=3.179; 95% CI=1.697-5.954). The COVID-19 epidemic did not significantly increase the depression and stress levels among clinical therapists, but it did significantly increase anxiety levels.

Conclusion

During the COVID-19 pandemic, depression, anxiety and stress were relatively common among clinical therapists in China. Regular physical activity and good sleep were important protective factors against emotional problems. Therefore, encouraging regular physical activity and actively addressing clinical therapists' sleep problems is beneficial to improving the ability to cope with negative emotions. The COVID-19 epidemic significantly increased anxiety, and awareness and interventions should be recommended to reduce anxiety among clinical therapists during the COVID-19 pandemic.