Mental health, family functioning, and sleep in cultural context among American Indian/Alaska Native urban youth: A mixed methods analysis

Content analysis of factors related to sleep health among American Indian peoples

BACKGROUND

Chronic sleep problems are commonly reported in American Indian (AI) peoples, however there is a lack of qualitative research examining the behavioral, psychological, sociocultural, and economic factors surrounding sleep health among AI peoples. This study aims to remedy that oversight by providing qualitative data on AI peoples sleep health.

OBJECTIVES

To explore the perceived barriers to and facilitators of healthy sleep in AI peoples and identify protective cultural factors associated with sleep for AI peoples.

SETTING

Fifty-nine American Indians aged 30-79 located across 3 geographic sites: Arizona, South Dakota, and Oklahoma.

METHODS

Focus groups were collected in November 2019 and individual interviews were conducted between May and November 2020. Conventional content analysis was used to examine the recurring and overlapping themes related to perceptions of barriers to and facilitators of healthy sleep.

RESULTS

The results yielded 11 barriers to healthy sleep and 12 facilitators of healthy sleep. Facilitators included protective cultural factors such as good dreams, cultural bedtime routine, praying, traditional knowledge, ceremonies and practices, and traditional remedies.

CONCLUSIONS

The findings suggest future sleep health interventions among AI peoples should focus on promoting the cultural factors that were identified as protective factors and improving the sleep environment. Culturally tailoring sleep health interventions is an important step forward in decolonizing research methodologies.

Change in Health Status Among American Indian/Alaska Native Adolescents Living Outside of Tribal Land in California Before and During the COVID-19 Pandemic

PURPOSE

This article describes change in health status by analyzing key health domains at two time points before and during the COVID-19 pandemic among a sample of American Indian/Alaska Native (AI/AN) adolescents living outside of tribal land (n = 114) throughout California.

METHODS

Data were analyzed from a longitudinal study, Native American Youth Sleep Health and Wellness (NAYSHAW). To test changes in health from baseline (March 2018-March 2020) to follow-up (December 2020-June 2022), we ran a series of linear regression models for continuous measures and repeated measures logistic regression models for dichotomous measures for physical health, behavioral health, and cultural contexts of health and well-being.

RESULTS

For physical health, body mass index percentile significantly decreased (p = 0.02), and both systolic and diastolic blood pressure significantly increased (p < 0.001 for both), although both measures remained within the normal range for adolescents. For behavioral health, depression and anxiety significantly increased (p = 0.005 and 0.008, respectively), although they remained within subclinical levels, and no significant changes were observed with alcohol and cannabis use. For cultural contexts of health and well-being, both cultural identity and sense of historical loss significantly increased (p < 0.001 and p = 0.03, respectively).

DISCUSSION

We observed a mix of positive and negative health changes among AI/AN adolescents living outside of tribal land before and during COVID-19. Findings highlight that enhanced cultural identity during adolescence may have helped foster resilience during this difficult period.

Addiction Memory, Family Functioning, and Depression in Illicit Drug Users: Self-Esteem as a Mediator

Depression is a common issue among illicit drug users. However, the interaction between addiction memory, family functioning, and depressive symptoms remains insufficiently examined. This study investigates the relationship between addiction memory, family functioning, and depressive symptoms, with self-esteem serving as a mediator. A random sample of 600 illicit drug users from Hubei, China, was evaluated using the Addiction Memory Intensity Scale (AMIS), Family APGAR Index, Patient Health Questionnaire (PHQ-9), and Rosenberg Self-Esteem Scale (RSES). A factorial algorithm was used to parcel the AMIS, PHQ-9, and RSES items, and structural equation modeling was applied to examine the mediation effect. The model fit the data well (χ2/df = 2.248, CFI = 0.956, NNFI = 0.966, RMSEA = 0.046, SRMR = 0.040), with significant path coefficients (p < 0.05). Addiction memory was positively correlated with depression (β = 0.195, p < 0.001), while family functioning negatively correlated with depression (β = -0.113, p = 0.008). Both addiction memory and family functioning indirectly influenced depression through self-esteem, with mediating effects equal to 1.154 (95% CI: 0.106 to 0.209) and -0.097 (95% CI: -0.154 to -0.047). These findings suggest that interventions targeting addiction memory and family functioning may alleviate depressive symptoms by improving self-esteem among illicit drug users.

An Interpersonal and Meta-analytic Approach to Parenting Behaviors and Adolescent Sleep

Two dimensions of parenting behaviors-affiliative/non-affiliative and autonomy/control- are each consistently linked to adolescent sleep health. Parenting behaviors that facilitate good sleep likely involve affiliation (i.e., warmth) and some degree of parental guidance and appropriate autonomy-granting to the adolescent; however, these domains are often confounded in parenting assessments, which limits understanding and specificity of recommendations for providers and families on how to optimize adolescents' sleep. Thus, we categorized existing literature according to an interpersonal developmental framework to identify parenting behaviors most strongly linked to adolescent sleep health. Studies (k = 42) included 43,293 participants (M age = 14.84, SD age = 2.04). Structural analysis of social behavior (SASB) interpersonal coding was applied to define and operationalize parenting behaviors (independent variables). Dependent variables included measures of sleep health (i.e., sleep regularity, duration, efficiency, latency, timing, quality, alertness/sleepiness) and sleep disturbance. The final effect size of interest for analysis was a correlation coefficient r. Optimal parenting behaviors (e.g., warm, autonomy-granting, moderately controlling) were associated with longer sleep duration, earlier bedtime, less daytime sleepiness, shorter sleep latency, and fewer sleep disturbances. Suboptimal parenting behaviors (e.g., hostile, controlling) were associated with more daytime sleepiness and more sleep disturbances. This is one of the first studies to specify that, when paired with affiliation, both moderate control and moderate autonomy-granting were associated with better adolescent sleep health. Findings indicate that the importance of parental interpersonal warmth extends into adolescence and further suggest that the interpersonal security necessary for good sleep includes appropriate use of control and autonomy-granting behaviors.

Association between cognitive insight and anxiety among community-dwelling schizophrenia patients: the chain mediating effects of family cohesion and chronotype

Objective

To investigate the effect of cognitive insight on anxiety in community-dwelling schizophrenia patients and to construct a chain mediating model to determine the underlying mechanisms of the relationship between cognitive insight and anxiety through family cohesion and chronotype.

Methods

The Beck Cognitive Insight Scale, the Chinese version of the Family Adaptability and Cohesion Scale, the Morningness-Eveningness Scale, and the Generalized Anxiety Disorder Scale were used to assess cognitive insight, family cohesion, chronotype, and anxiety in a sample of 785 individuals with schizophrenia living in the community. Spearman correlation analysis, multiple linear regression and Bootstrap methods were employed to analyze the four variables.

Results

Residential region, current employment status, and family economic status impacted anxiety among community-dwelling schizophrenia patients. All variables were associated with each other, but self-certainty was not significantly associated with anxiety. Cognitive insight and self-reflection had direct effects on anxiety, as well as indirect effects on anxiety through the partial mediating effect of chronotype, the suppressing effect of family cohesion, and the chain mediating effect of family cohesion and chronotype.

Conclusions

Family cohesion and chronotype can mediate the relationship between cognitive insight and anxiety. Improving family functioning, promoting emotional relationships within families, and correcting non-circadian sleep patterns can reduce anxiety in community-dwelling schizophrenia patients, with important implications for improving adverse mental health outcomes.

Enhancing sleep health in urban American Indian/Alaska Native adolescents: Implications for culturally tailored interventions

BACKGROUND

Urban American Indian/Alaska Native (AI/AN) adolescents are vulnerable to sleep and other health-related disparities due to numerous social drivers, including historical trauma and relocation to urban areas. This study aims to identify strategies to increase protective factors and culturally tailor sleep health interventions for this population.

METHODS

Using community-based participatory research, the NAYSHAW study conducted in-depth interviews with urban AI/AN adolescents aged 12-19 years to understand critical components needed for developing a culturally sensitive sleep health intervention. Data from two qualitative subsamples (N = 46) and parent surveys (N = 110) were analyzed, focusing on factors that affect sleep health behaviors, including parental involvement, technology, and traditional practices.

RESULTS

Key findings include the detrimental impact of electronics use at night and protective effects of traditional practices on sleep. Parental involvement in sleep routines varied by adolescent's age. Adolescents desired sleep health education in interactive formats, whereas parents preferred workshops and digital applications for sleep health strategies. Findings suggest that interventions need to address electronics use and should also be culturally tailored to address the unique experiences of urban AI/AN adolescents.

CONCLUSIONS

Results underscore the importance of utilizing community-based strategies to develop culturally tailored sleep interventions for underserved populations, specifically urban AI/AN adolescents. Integrating traditional practices with evidence-based sleep health strategies can provide a holistic approach to improving sleep and overall well-being. Parental education and involvement will be critical to the success of such interventions.

Trying to Do What's Best: Maternal Perspectives About Toddler Sleep Health Among an Underresourced Sample of Mothers With Diverse Racial and Ethnic Identities

INTRODUCTION

This study describes mothers' knowledge, attitudes, beliefs, and practices about their toddler's sleep health among an underresourced sample of mothers with diverse racial and ethnic identities.

METHOD

This was a descriptive qualitative study with 16 mothers and their 12- to 36-month-old child. Mothers completed a semistructured, audio-recorded interview about their toddler's sleep health. Data were analyzed using inductive content analysis on the basis of established methods.

RESULTS

Mothers self-identified as 18.8% Black, 43.8% White, 12.5% multiracial, 25.0% other race, and 37.5% Hispanic. Of the mothers, 80.0% reported a past year household income of ≤ $40,000. A core construct, "Trying to do What's Best," emerged from the interview data, and this construct included three domains: Getting Good Sleep, Getting Thrown Off, and Rolling With It.

DISCUSSION

Findings support future strengths-based and multilevel sleep health-promoting interventions.

Microaggressions, perceptions of campus climate, mental health, and alcohol use among first-year college students of color

Depressive and anxiety symptoms are increasingly common, and problematic alcohol use remains prevalent in college. To expand on prior research on mostly white samples, we surveyed first-year students of color from our predominately white university (Southeastern US) to identify risk factors for mental health symptoms and potentially co-occurring problematic alcohol use. Results showed significant associations between microaggressions and poor campus climate (hypothetical predictors) with depressive, anxiety, somatic symptoms (hypothetical outcomes) that were indirectly linked through perceived stress, poor sleep, and academic burnout (hypothetical mediators). Poor campus climate, academic burnout, and using alcohol to cope were the most relevant to alcohol use disorder symptoms. Results support efforts to address and reduce racial microaggressions and promote a positive campus climate for all.

Resilience and health in American Indians and Alaska Natives: A scoping review of the literature

American Indians and Alaska Natives suffer from disproportionately high rates of chronic mental and physical health conditions. These health inequities are linked to colonization and its downstream consequences. Most of the American Indian and Alaska Native health inequities research uses a deficit framework, failing to acknowledge the resilience of American Indian and Alaska Native people despite challenging historical and current contexts. This scoping review is based on a conceptual model which acknowledges the context of colonization and its consequences (psychological and health risk factors). However, rather than focusing on health risk, we focus on protective factors across three identified domains (social, psychological, and cultural/spiritual), and summarize documented relationships between these resilience factors and health outcomes. Based on the scoping review of the literature, we note gaps in extant knowledge and recommend future directions. The findings summarized here can be used to inform and shape future interventions which aim to optimize health and well-being in American Indian and Alaska Native peoples.

Health Disparities in Pediatric Sleep

This article reviews disparities in pediatric sleep health and sleep disorders from early childhood through adolescence (birth to age 18 years). Sleep health is a multidimensional construct including sleep duration, consolidation, and other domains, whereas sleep disorders reflect both behaviorally (eg, insomnia) and medically based (eg, sleep disordered breathing) sleep diagnoses. Using a socioecological framework, we review multilevel (ie, child, family, school, health-care system, neighborhood, and sociocultural) factors linked to sleep health disparities. Mechanistic research and studies using an intersectional lens to understand overlapping marginalized identities are needed to inform multilevel interventions to promote sleep health equity in pediatrics.

Poor self-reported sleep quality associated with suicide risk in a community sample of American Indian adults

Study Objectives

Although American Indian/Alaska Native (AI/AN) have high suicide rates few studies have systematically investigated sleep quality and its association with suicidal behaviors in AI/AN. This study is a cross-sectional investigation of self-reported sleep quality and suicidal behaviors in an adult AI population.

Methods

A semi-structured interview was used to collect data on suicidal ideation, suicidal plans, and suicidal attempts and the Pittsburgh Sleep Quality Index (PSQI) was collected to assess sleep quality in American Indian adults.

Results

In this sample (n = 477), 91 (19%) of the participants endorsed suicidal ideation (thoughts and plans), and 66 (14%) reported suicidal attempts, including four who subsequently died by suicide. More women reported suicidal thoughts or acts than men. Those endorsing suicidal thoughts slept fewer hours during the night, reported more nocturnal awakenings, and showed poorer subjective sleep quality according to PSQI total scores compared to those with no suicidal thoughts or acts. Participants with suicidal acts (n = 66) reported more bad dreams and higher PSQI total scores compared to those with no suicidal thoughts or acts. When those with any suicidal thoughts or acts (n = 157, 33%) were compared to those without, they were more likely to endorse nocturnal awakenings and bad dreams and demonstrated significantly higher PSQI total scores.

Conclusions

Although additional research is needed to evaluate sleep disturbances as a proximal, causal risk factor for suicidal behaviors in AI, findings highlight need for further study of sleep as a warning sign and intervention tool for suicide prevention among American Indian adults.

Nighttime sleep duration and variability in children with obstructive sleep apnea syndrome: Sociodemographic disparities and neurobehavioral outcomes

OBJECTIVES

This study examined differences in sleep patterns by race, ethnicity, and socioeconomic status (SES) among children with Obstructive Sleep Apnea Syndrome (OSAS), and linkages between sleep patterns and neurobehavioral functioning.

METHOD

We used baseline data from the Childhood Adenotonsillectomy Study (CHAT), a multicenter, single-blind, randomized controlled trial designed to evaluate the efficacy of early adenotonsillectomy versus watchful waiting with supportive care for children with OSAS. Participants included children with OSAS (ages 5.0-9.9 years). SES indicators were obtained via questionnaire and geocoding (ArcGIS version 10.1). Caregivers and teachers reported on child inattention/impulsivity and executive functioning. Nighttime sleep duration and variability were measured using five-night sleep diaries.

RESULTS

Black children experienced shorter nighttime sleep duration than White children, by about 25 min, as well as greater sleep duration variability, while sleep duration was more variable in children of "other" racial and ethnic backgrounds versus White children. Of the socioeconomic correlates, only lower family income was associated with sleep duration variability. A short and more variable nighttime sleep duration were each associated with caregiver-rated child inattention and impulsivity. Greater sleep duration variability was linked to greater teacher-rated, but not caregiver-rated, executive functioning impairments.

CONCLUSIONS

Compared to White children with OSAS, Black children with OSAS experience a shorter and more variable nighttime sleep duration. Having a short and/or variable sleep duration may increase risk for neurobehavioral impairments in youth with OSAS, underscoring the potential benefits of sleep health promotion in the context of OSAS care.

Sleep Deprivation and Central Appetite Regulation

Research shows that reduced sleep duration is related to an increased risk of obesity. The relationship between sleep deprivation and obesity, type 2 diabetes, and other chronic diseases may be related to the imbalance of appetite regulation. To comprehensively illustrate the specific relationship between sleep deprivation and appetite regulation, this review introduces the pathophysiology of sleep deprivation, the research cutting edge of animal models, and the central regulatory mechanism of appetite under sleep deprivation. This paper summarizes the changes in appetite-related hormones orexin, ghrelin, leptin, and insulin secretion caused by long-term sleep deprivation based on the epidemiology data and animal studies that have established sleep deprivation models. Moreover, this review analyzes the potential mechanism of associations between appetite regulation and sleep deprivation, providing more clues on further studies and new strategies to access obesity and metabolic disease.

Leisure-Time Activities in Different Contexts and Depressive Symptoms in Norwegian Adolescents: A Cross-Sectional Study

The purpose of this study was to examine the association between physical activity organised in sports clubs, non-organised physical activity, other organised leisure-time activities, and depressive symptoms among adolescents. This study was based on cross-sectional data from the Ungdata survey conducted between 2017 and 2019. The sample comprised 7656 adolescents (aged 13-16 years). Binominal logistic regression was used to analyse the association between the three different leisure-time activities and depressive symptoms. All models were adjusted for gender, family economy, parents' higher education, having friends, alcohol intoxication, and smoking. The odds for symptoms of depression were higher for those who were less physically active in a sports club (OR: 1.34, 95% CI: 1.15-1.57) and in non-organised physical activities (OR: 1.50, 95% CI: 1.29-1.74) and lower for those who participated less in other organised leisure-time activities (OR: 0.79, 95% CI: 0.68-0.92) compared with those who were physically active (sports club and non-organised) and those who participated in other organised leisure-time activities. Our findings suggested that being physically active, both in a sports club and in non-organised activities, was associated with lower odds of depressive symptoms among adolescents. Additional research is needed to confirm a possible causal relationship.