A systematic review and meta-analysis to assess the relationship between sleep duration/quality, mental toughness and resilience amongst healthy individuals

Impact of adverse childhood experiences and family resilience on sleep duration in autistic children

LAY ABSTRACT

Autistic children are more likely to have sleep difficulties and to experience adverse childhood experiences. Adverse childhood experiences can include parental divorce, bullying, or witnessing violence. We also know that children in families who are resilient (e.g. families who are connected, work together, and help each other) are less impacted by adverse childhood experiences. Our study examined whether there was a relationship between adverse childhood experiences and sleep duration in autistic children. We also wanted to find out whether family resilience protects from the negative impact of adverse childhood experiences on sleep duration. We used data from 3247 parent surveys about their children that we got from the National Survey of Children's Health. We found that children with adverse childhood experiences are more likely to get less sleep. We also found that children with resilient families were more likely to get more sleep. Our results show that family resilience helps weaken the relationship between adverse childhood experiences and sleep, so it is important to help families build resilience.

Role of social support in the relationship between resilience and sleep quality among cancer patients

Introduction

The present study aimed to investigate the effect of resilience on sleep quality and explore the role of social support between resilience and sleep quality in cancer patients.

Methods

A multicenter and cross-sectional study was conducted in China from May to November 2021. A total of 202 cancer patients were recruited to complete the questionnaires composed of demographic information, Pittsburg Sleep Quality Index (PSQI), Resilience Scale-14 (RS-14), and Multidimensions Scale of Perceived Social Support (MSPSS). The associations between resilience, social support, and sleep quality were explored through hierarchical regression analysis.

Results

The prevalence of poor sleep quality was 50% among cancer patients. Resilience, social support, and the interaction between resilience and social support were all found to be significantly associated with sleep quality. Results of simple slope analysis indicated that the association between resilience and sleep quality were gradually decreased with the increasing social support levels (1 SD below the mean, B=-0.225, β=-0.551, P<0.001), mean social support (B=-0.147, β=-0.353, P<0.001) and high social support (1 SD above the mean, B=-0.065, β=-0.156, P<0.001). Additionally, social support mediated the effect of resilience on sleep quality among cancer patients.

Discussion

Poor sleep quality has been common in cancer patients. Social support could mediate and alleviate the relationship between resilience and sleep quality among cancer patients. Besides providing sufficient social support, interventions based on resilience should be applied to address sleep problems in cancer patients.

Relationship between sleep quality and subjective well-being: resilience as a mediator and belief in a just world as a moderator

Background/Purpose

Sleep quality significantly impacts subjective well-being, yet its underlying mechanisms remain largely unknown from a scholarly perspective. Existing research has inadequately addressed the relationship between sleep quality and the subjective well-being of College students. This study primarily investigates the influence of sleep quality on the subjective well-being of College students and explores the mediating role of resilience and the moderating role of belief in a just world.

Methods

The study sample comprises 3349 enrolled College students. Measures include the Pittsburgh Sleep Quality Index, the Subjective Well-being Scale, resilience scale, and belief in a just world scale. A moderated mediation model is employed to verify the mediating role of resilience and the moderating role of belief in a just world.

Results

(1) Sleep quality among College students is significantly positively correlated with resilience, belief in a just world, and subjective well-being. (2) Sleep quality positively predicts subjective well-being among College students. Resilience among College students serves as a mediator between sleep quality and subjective well-being, while belief in a just world moderates the influence of resilience on subjective well-being.

Conclusion

The results suggest that sleep quality can directly enhance the subjective well-being of College students and can also indirectly affect it through resilience. Additionally, belief in a just world can enhance the promoting effect of resilience on the subjective well-being of College students. These findings may contribute to understanding the impact of sleep quality on the subjective well-being of College students and its pathways. These research findings can serve as a reference for improving the subjective well-being of College students.

Changes in sleep disturbance among Chinese adolescents: A population-based online survey

OBJECTIVE

Sleep disturbance is prevalent among adolescents but little is known about the short-term changes among Chinese adolescents. The study aimed to explore the prevalence and change patterns of sleep disturbance and identify its risk and protective factors.

METHODS

Data were collected online from April 21st to May 12th, 2021 (Time 1, T1) and December 17th to 26th, 2021 (Time 2, T2). The final sample comprised 34,260 adolescents. Self-administrated questionnaires were used to assess socio-demographic variables, sleep disturbance, depression, anxiety, life events, family function, and resilience.

RESULTS

The prevalence of sleep disturbance was 12.0% at T1 and 11.8% at T2, with higher rates in females than males. Four groups of sleep disturbance change patterns were identified: non-sleep disturbance group (80.4%), persistent group (4.2%), new-onset group (7.6%), and remission group (7.8%). Risk factors for new-onset sleep disturbance included being in junior high school (AOR = 1.26, 95%CI = 1.15-1.38), family history of mental disorders (AOR = 1.49, 95%CI = 1.03-2.15), and moderate (AOR = 1.24, 95%CI = 1.13-1.36) and severe (AOR = 1.48, 95%CI = 1.27-1.72) family dysfunction. Risk factors for persistent sleep disturbance included being in junior (AOR = 1.25, 95%CI = 1.08-1.45) and senior (AOR = 1.53, 95%CI = 1.15-2.03) high school, parental currently unmarried status (AOR = 1.34, 95%CI = 1.05-1.73), moderate (AOR = 1.19, 95%CI = 1.02-1.39) and severe (AOR = 1.28, 95%CI = 1.06-1.55) family dysfunction. Medium (AOR = 0.48, 95%CI = 0.43-0.53) and high (AOR = 0.34, 95%CI = 0.29-0.40) levels of resilience were protective factors against new-onset sleep disturbance, as well as against persistent sleep disturbance (medium level: AOR = 0.51, 95%CI = 0.43-0.60; high level: AOR = 0.32, 95%CI = 0.25-0.43).

CONCLUSIONS

Interventions aimed at promoting family functions and enhancing resilience may improve sleep disturbance among adolescents.

Association between stigma and sleep quality in patients with breast cancer: A latent profile and mediation analysis

PURPOSE

This study aims to identify the heterogeneity in the stigma experienced by patients with breast cancer and examine the mediation effect of resilience on the relation between stigma and sleep quality.

METHOD

A total of 396 patients with breast cancer were enrolled from Be Resilient to Breast Cancer (BRBC) program between January and April 2023. Participants completed the Social Impact Scale, the 10-item Connor-Davidson Resilience Scale, and the Pittsburgh Sleep Quality Index Scale. Latent profile analysis (LPA) and mediation analysis were conducted to analyze the data.

RESULTS

LPA categorized stigma into three subgroups, namely low-stigma (21.9%), moderate-stigma (64.9%), and high-stigma (13.2%). Mediation analysis revealed a fully mediated effect in the comparison between low-stigma and moderate-stigma groups (standard error [SE] = 0.13, 95%CI = 0.06,0.56), whereas a partially mediated effect was observed in the comparison between low-stigma and high-stigma groups (SE = 0.18, 95%CI = 0.39,1.10).

CONCLUSIONS

Stigma is a significant factor to sleep quality in breast cancer and resilience could act as a robust buffer against stigma resulting in improved sleep quality. Resilience-based interventions might be helpful in this population.

Sleep hygiene behaviours mediate the association between health/e-health literacy and mental wellbeing

BACKGROUND

Health literacy and e-health literacy are important factors helping people shape awareness of health behaviours in different aspects, including sleep hygiene behaviours. Good sleep hygiene behaviours promote sleep quality and are beneficial to overall mental wellbeing.

OBJECTIVE

We aimed to examine if sleep hygiene behaviours may mediate the association between health literacy/e-health literacy and mental wellbeing.

METHODS

Adult Iranian subjects (n = 9775; mean [SD] age = 36.44 [11.97] years; 67.3% females) completed the Health Literacy Instrument for Adults, eHealth Literacy Scale, three items on sleep hygiene behaviour that have been used in prior research and the Short Warwick Edinburgh Mental Wellbeing Scale. Data were then subjected to structural equation modelling (SEM) including 500 bootstrapping resampling to examine whether sleep hygiene is a mediator in the relationship between health literacy/e-health literacy and mental wellbeing.

FINDINGS

Both health literacy and e-health literacy were significantly associated with mental wellbeing (r = .63 for health literacy and .39 for e-health literacy; p < .001) and sleep hygiene behaviours (r = .58 for health literacy and .36 for e-health literacy; p < .001). Sleep hygiene behaviours were significantly associated with mental wellbeing (r = .42; p < .001). Moreover, SEM that incorporated bootstrapping approaches indicated that sleep hygiene behaviours were significant mediators in the association between health literacy/e-health literacy and mental wellbeing.

CONCLUSIONS

We conclude that health literacy and e-health literacy are associated with mental health wellbeing in the Iranian population. Additionally, the association could be mediated via sleep hygiene behaviours.

PATIENT OR PUBLIC CONTRIBUTION

The study was co-designed with healthcare providers from the vice-Chancellor's Office for Health Affairs of Qazvin University of Medical Sciences as equal partners. Moreover, the women's health volunteers were involved in the design of the study.

Family function and emotional behavior problems in Chinese children and adolescents: A moderated mediation model

BACKGROUND

Studies have shown that family function is associated with emotional behavior problems. However, the underlying relationship mechanisms between family function and emotional behavior problems in children and adolescents is not fully understood. Therefore, the purpose of this study is to explore the mediating effect of resilience and the moderating effect of sleep quality using a moderated mediation model.

METHODS

6363 children and adolescents in grades four to nine were surveyed in some areas of Anhui Province, China. Family function, resilience, sleep quality, and emotional behavior problems were measured through a self-administered questionnaire. All data analysis was by performed by SPSS 23.0.

RESULTS

The results showed that family function was negatively associated with emotional behavior problems (r = -0.307, p < 0.01). Resilience partially mediated the relationship between family function and emotional behavior problems (indirect effect = -0.108, accounted for 38.4 %). Sleep quality moderated the relationship between family function and resilience (β = -0.039, P < 0.001).

CONCLUSION

Resilience and sleep quality respectively played a mediating and moderating effect in the relationship between family function and emotional behavior problems. These findings suggest that we should pay attention to the family function of children and adolescents in time, improve their resilience and sleep quality, so as to effectively reduce the occurrence of emotional behavior problems.

From childhood adversity to latent stress vulnerability in adulthood: the mediating roles of sleep disturbances and HPA axis dysfunction

Childhood adversity is a prominent predisposing risk factor for latent stress vulnerability, expressed as an elevated likelihood of developing stress-related psychopathology upon subsequent exposure to trauma in adulthood. Sleep disturbances have emerged as one of the most pronounced maladaptive behavioral outcomes of childhood adversity and are also a highly prevalent core feature of stress-related psychopathology, including post-traumatic stress disorder (PTSD). After reviewing the extensive literature supporting these claims, the current review addresses the notion that childhood adversity-induced sleep disturbances may play a causal role in elevating individuals' stress vulnerability in adulthood. Corroborating this, sleep disturbances that predate adult trauma exposure have been associated with an increased likelihood of developing stress-related psychopathology post-exposure. Furthermore, novel empirical evidence suggests that sleep disturbances, including irregularity of the sleep-wake cycle, mediate the link between childhood adversity and stress vulnerability in adulthood. We also discuss cognitive and behavioral mechanisms through which such a cascade may evolve, highlighting the putative role of impaired memory consolidation and fear extinction. Next, we present evidence to support the contribution of the hypothalamic-pituitary-adrenal (HPA) axis to these associations, stemming from its critical role in stress and sleep regulatory pathways. Childhood adversity may yield bi-directional effects within the HPA stress and sleep axes in which sleep disturbances and HPA axis dysfunction reinforce each other, leading to elevated stress vulnerability. To conclude, we postulate a conceptual path model from childhood adversity to latent stress vulnerability in adulthood and discuss the potential clinical implications of these notions, while highlighting directions for future research.

The impact of sleep quality on mental health in working Australians: A quasi-experimental approach

Work conditions such as job demand can impact individual sleep quality, and subsequently impact mental health. This study aims to investigate pathway effects of exogenous factors on mental health via sleep, and the direct effect of sleep quality on mental health in working Australians. We employ a novel method in public health studies, a quasi-experimental (instrumental variable) approach, which can address reciprocal relationships between sleep and mental health in order to estimate causal effect of sleep quality on mental health in a sample of 19,789 working Australians aged 25-64 from waves 2013, 2017, and 2021 of the Household, Income and Labour Dynamics in Australia (HILDA) survey data. We find that high job demand, as a valid instrument, adversely affects sleep quality, and the changes in sleep quality ultimately affect mental health of working Australians. These findings highlight the need for policies that address employment conditions by reducing high work demand or work pressure to mitigate poor sleep quality in the Australian workforce, ultimately improving workers' sleep quality and promoting better mental health, overall health outcomes and productivity.

Mental Health Issues as a Consequence of the Pandemic: Group Psycho-Educational Intervention to Support Patients Recovered from COVID-19 Infection

Common psycho-physical symptoms have emerged in patients who were previously recovered for COVID-19 infection, including traumatic experience and enduring emotional disturbances. A group psycho-educational intervention of seven weekly sessions and a follow-up after three months was proposed to all Italian-speaking patients formally discharged from a public hospital in northern Italy and physically recovered from infection. Eighteen patients were recruited and divided into four age-homogenous groups, each led by two facilitators (psychologists and psychotherapists). The group sessions followed a structured format with thematic modules, including main topics, tasks, and homework assignments. Data were collected through recordings and verbatim transcripts. The objectives of the study were twofold: (1) to analyze the emerging themes and gain insight into the significant aspects of the participants' lived experience of COVID-19, and (2) to examine changes in how participants approached these themes throughout the intervention process. Semantic-pragmatic text analyses, specifically thematic analysis of elementary context and correspondence analysis, were conducted using T-LAB software. Linguistic analysis revealed a congruence between the intervention's objectives and the participants' experiences. The study highlighted an evolution in the narratives, as participants transitioned from a passive and concrete perspective on the disease to a more comprehensive cognitive and emotional elaboration of their personal illness stories. These findings hold potential relevance for healthcare services and professionals working in this field.

Correlates of resilience among university students in Oman: a cross-sectional study

BACKGROUND

Resilience has a paramount role in dealing with different life stressors and has a great impact on mental health.

AIM

To assess the level of resilience among university students and explore the relation between resilience and a number of variables including psychological well-being, self-esteem and physical health.

METHODS

A cross-sectional design was utilized. Data was collected from 676 university students. Students were required to complete a demographic sheet, Brief Resilience Scale, World Health Organization Well-Being Index, Rosenberg Self-Esteem Scale and a physical health survey.

RESULTS

Overall, less than half of the participants have reported low levels of resilience (45.3%; n = 306). Regular sleep, perceived stress, WHO well-being index, self-esteem, and having a cumulative GPA of more than two, were factors that significantly predicted positive resilience in multivariate analysis.

CONCLUSION

Resilience is a necessary skill among university students that requires more academic attention. Factors predicting positive resilience should be considered when implementing mental health promotion programs.