Sour sleep, sweet revenge? Aggressive pleasure as a potential mechanism underlying poor sleep quality's link to aggression

Influence of sleep quality on aggressive behaviours: Predictive validity of the Brøset Violence Checklist-revised

INTRODUCTION

Violent behaviours in acute psychiatric settings represent a critical issue within health systems. Prompt identification of patients at risk is a priority for nurses. The Brøset Violence Checklist (BVC), created to support nursing assessment, showed good psychometric skills; a new version of the instrument (BVCrev), including sleep alterations, seems to improve the predictivity of sleep compared to the original scale but is not available in Italian.

AIMS

To evaluate the psychometric properties of the Italian version of the Brøset Violence Checklist revised (BVCita-rev).

MATERIALS AND METHODS

This was a prospective, observational study. After back-translation and content validity assessment, the BVCita and BVCita-rev were used simultaneously for risk assessment on a sample of patients admitted to the psychiatric inpatient wards of two Italian hospitals. Sensitivity, specificity, positive predictive value, negative predictive value, and ROC curve were calculated for both BVCita and BVCita-rev.

RESULTS

137 patients were enrolled, and 1117 evaluations were performed. Thirty-four subjects (24.82 %) engaged in aggressive actions during hospitalization, 24 of whom more than once. The predictivity of BVCita-rev was higher than that of BVCita (ROC = 0.9528 vs 0.8811). The S-CVI of the new version of the instrument was = 0.92.

CONCLUSIONS

Including an item addressing sleep disturbances enhances the predictive capabilities of the BVCita-rev. This modified version of the BVC proves to be an effective tool for supporting nurses in the short-term assessment of violence risk within acute psychiatric inpatient settings.

The Bidirectional Relationship Between Sleep Quality and Aggressive Behavior: Within-Person Mediated Effect of Self-Control

The correlation between sleep quality, self-control, and aggressive behavior has been assessed in previous empirical studies. However, the interrelationship and underlying mechanisms of sleep alterations and aggressive behavior among adolescents at the within-person level, particularly within the context of Chinese culture, have rarely been investigated. Using a random intercept cross-lagged panel model (RI-CLPM), this longitudinal study aims to (i) distinguish between-person and within-person effects when examining the interplay between sleep quality and aggressive behavior among adolescents and (ii) assess the potential mediating role of self-control in this relationship. The present sample consisted of 1240 Chinese adolescents, including 614 girls, with a mean age of 12.72 years (SD = 0.68) at baseline. Data were collected across four waves over 2 years, with an interval of 6 months between consecutive time points. The RI-CLPM results indicated that sleep quality directly predicted aggressive behavior at the within-person level and vice versa, demonstrating a bidirectional predictive relationship between the two constructs. Moreover, self-control mediated the prediction of aggressive behavior by sleep quality, but not the reverse. These findings underscore a reciprocal influence between sleep quality and aggressive behavior among Chinese youth, confirming that low levels of self-control significantly mediate the effect of sleep quality on aggression.

The effect of loneliness on interpersonal sensitivity among nursing undergraduates: a chain mediation role of problematic internet use and bedtime procrastination

BACKGROUND

Loneliness was associated with interpersonal sensitivity, but the factors contributing to this relationship in nursing students remain unclear. This study investigated the relationship between loneliness and interpersonal sensitivity among nursing undergraduates, with a specific focus on the mediating roles played by problematic internet use and bedtime procrastination.

METHOD

This study was conducted as a cross-sectional survey at a university in China between November and December 2022. Data were collected using a self-administered online questionnaire that included demographic characteristics, the Three-Item Loneliness Scale (T-ILS), the Chinese Version of Short Form of Interpersonal Sensitivity Measure (IPSM-CS), the 6-item short form of the Problematic Internet Use Questionnaire (PIUQ-SF-6), and the Bedtime Procrastination Scale (BPS). Pearson correlation analysis was employed to explore the relationships among loneliness, interpersonal sensitivity, problematic internet use, and bedtime procrastination. Structural equation modeling (SEM) was conducted using AMOS software to examine the mediating role of problematic internet use and bedtime procrastination between loneliness and interpersonal sensitivity.

RESULTS

Loneliness was positively related to interpersonal sensitivity among nursing undergraduates (β = 0.44, P < 0.001). There was a significant chain mediation role of problematic internet use and bedtime procrastination in the relationship between loneliness and interpersonal sensitivity.

CONCLUSIONS

The study contributed to deepening the understanding of the relationship between loneliness and interpersonal sensitivity and provided valuable insights into the improvement of interpersonal sensitivity in nursing undergraduates.

Is lifetime abuse forgivable in old age?

Old age is characterized by reflection and a retrospective examination of the multiple meanings of various life experiences, including lifelong abuse. Forgiveness is found to have a salutary effect, especially for older adults. To understand the place and role of forgiveness in the reflective process during aging, we performed a secondary analysis of in-depth, semi-structured interviews (N = 78) with older women survivors of abuse. Inductive thematic analysis was based on concepts developed deductively from the literature review. The findings include three main themes: (1) The dimensions of forgiving: The victim as subject; (2) Being forgiven: Between lost forgiveness and hope; and (3) Self-forgiveness and the aging self. Despite the known salutary effect of forgiveness, we must consider that this is not a universally desirable process. We included the dimension of forgiveness in the study of abuse throughout the older person's life course and identified further complexities in addition to the "forgiveness"/"unforgiveness."

Sleep, stress and aggression: Meta-analyses investigating associations and causality

Prior research suggests that sleep is associated with increased subjective stress and aggression, but important questions remain about the typical magnitude of these relationships, as well as their potential moderators. We therefore conducted the first meta-analysis of this literature. Across 340 associational and experimental studies, significant associations were identified between sleep with both subjective stress (r = 0.307, p < .001) and aggression (r = 0.258, p < .001) in individuals from the general population, as well as between sleep with subjective stress (r = 0.425, p < .001) in individuals with sleep disorders. Experimental sleep restriction also led to increased subjective stress (g = 0.403, p = .017) and aggression (g = 0.330, p = .042). These findings suggest that poorer sleep is associated with - and leads to - heightened levels of subjective stress and aggression. These findings, and their implications, are discussed in relation to neurobiological literature, which highlights the complex interplay between metabolic activity in the brain, hormonal changes, and behavior.

Psychological distress mediates the connection between sleep deprivation and physical fighting in adolescents

Lack of sleep is common in adolescence, and represents an important threat to adolescents' well-being, academic commitment, and general health. It also has significant behavioral consequences through an increased likelihood of interpersonal violence. Previous studies have demonstrated an association between aggressive behavior and lack of sleep, but the psychological mediators remain completely unexplored. Grounded in the General Aggression Model, we investigated the affective pathway as one of the potential mechanisms linking lack of sleep and aggression. We hypothesized and showed that psychological distress is an intermediary phenomenon linking lack of sleep and physical aggression. Based on a school sample of 11,912 participants (median age: 14.5), we observed that 23.7% of the young people admitted having been involved in physical fighting on one or more occasions, and that 25.81% were in sleep debt when referred for medical assessment. We analyzed the relationship between sleep duration and physical fighting and the mediating link of psychological distress by performing multiple regressions in the components' paths. The results showed that the adolescents' amount of sleep appeared to be a significant predictor of physical fighting, and that this relationship was partially mediated by psychological distress. These results are consistent with the General Aggression Model, and represent the first empirical confirmation that psychological distress symptoms partially mediate the connection between lack of sleep and physical aggression.

The association of sleep quality and aggression: A systematic review and meta-analysis of observational studies

Poor sleep quality is closely related to aggression, but despite the promise of new therapeutic possibilities, a systematic synthesis of observational research on the association between sleep quality and aggression is lacking. This systematic review and meta-analysis examined the association between sleep quality and aggression, using the academic databases PubMed and PsycINFO. Subjective and objective measures of sleep quality were included, as well as multiple measures of aggression, assessing aggressive and externalizing behavior, anger, hostility and irritability. Ninety-two observational articles, containing 96 studies, encompassing a total of 58.154 children, adolescents and adults were sourced out of 7161 references identified. Methodological quality was moderate or strong in 76% of studies. Data for meta-analysis was available from 74 studies. Poorer sleep quality was associated with higher aggression in 80.8% of studies. Pooled results showed a correlation of 0.28 (95%CI 0.25-0.31; I² = 90.1%) and odds ratio of 3.61 (95%CI 1.13-11.51; I² = 88.3%). Effect estimates and heterogeneity varied according to population type and measurement instruments, but not according to article quality or age group. Our findings confirm that poor sleep quality is consistently associated with higher aggression. As most evidence is cross-sectional, more prospective and high-quality experimental evidence is required to elucidate cause-effect and optimize prevention and treatment of aggression.

The flux, pulse, and spin of aggression-related affect

Aggression is an affect-laden behavior. The within-person variability of affective states that immediately precede, accompany, and follow aggression-and their links to between-person variability in aggressive behavior and traits-remain incompletely understood. To address this gap in our understanding, we examined 8 studies in which 2,173 participants reported the negative and positive affect they experienced before, during, and after a laboratory or online aggression task. We quantified the within-person variability within (flux) and across (pulse) negative and positive affect intensity, as well as the variability in oscillations between negative and positive affect (spin). Internal meta-analyses revealed an association between aggressive behavior and traits and flux in positive affect (against our preregistered predictions). Probing this effect with piecewise growth models showed that less aggressive individuals exhibited a pronounced decrease in positive affect during aggression, as compared to before and after the act. This downward fluctuation in positive affect was attenuated among aggressive individuals, who exhibited relatively stable levels of positive aggression-related affect. Thus, stable positive affect surrounding an aggressive act and higher positive affect during the act may buttress and promote aggressive tendencies. These findings support a reinforcement model of aggressive behavior, contrast with the aggression literature's conventional focus on negative affect and the instability thereof, and point to the utility of dynamic measures of moment-to-moment affect in understanding human social behavior. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Predictive Properties of Violence Risk Instruments May Increase by Adding Items Assessing Sleep

Background: The psychometric instruments developed for short-term prediction of violence in psychiatric inpatients do not include variables assessing sleep. Disturbances in sleep may precede aggression in this setting. We investigated whether adding information on sleep improved the predictive properties of the Brøset Violence Checklist (BVC). Methods: The study population consists of all patients admitted to a psychiatric intensive care unit (PICU) over a 6-month period who were hospitalized for at least one night (n = 50). Sleep observed by staff (521 nights), behavior assessed with the BVC (433 days), and aggressive incidents recorded by the Staff Observation Scale-Revised (n = 14) were included in the analysis. Results: The ability of the BVC to predict aggressive incidents improved from AUC_ROC 0.757 to AUC_ROC 0.873 when a combined sleep variable including both sleep duration and night-to-night variations of sleep duration was added to the BVC recordings. The combined sleep variable did not significantly predict aggressive incidents (AUC_ROC 0.653, p = 0.051). Conclusions: A sleep disturbance variable improves the predictive properties of the BVC in PICUs. Further studies of sleep duration, night-to-night variations in duration of sleep, and aggression are needed.