Sleep loss causes social withdrawal and loneliness

Associations between adherence to 24-hour movement guidelines with depression, anxiety, and loneliness among Chinese adolescents

PURPOSE

While growing evidence suggests a link between meeting 24-hour movement guidelines and adolescent mental health, further investigation is needed to clarify this association. This cross-sectional study aimed to examine how adherence to single and combined 24-hour movement guidelines relates to depression, anxiety, and loneliness in adolescents, while exploring variations across sex and age.

METHODS

A total of 15,344 adolescents aged 10-18 years in Shanghai were selected using multi-stage stratified cluster random sampling in 2021. Data on movement behavior and mental health problems were collected through self-reported questionnaires. Logistic regression was used to assess the associations and stratified analyses were performed for sex and age groups. The STROBE checklist for observational research was adopted for reporting.

RESULTS

Only 2.7 % of our sample of Chinese adolescents met all three 24-hour movement behavior recommendations. Compared to not meeting any recommendations, meeting one or more recommendations was significantly associated with a lower risk of depression, anxiety, and loneliness (p < 0.001 for all), showing a dose-response gradient (p < 0.001 for all). Meeting both screen time and sleep recommendations showed near-equivalent protection against depression (OR = 0.47, 95%CI 0.37-0.61) to meeting all three recommendations (OR = 0.46, 95%CI 0.32-0.64). Meeting the guidelines appeared to have a stronger protective effect on the mental health of girls and younger adolescents than boys and older adolescents.

CONCLUSIONS

Meeting 24-hour movement guidelines, particularly screen time and sleep recommendations, was associated with a reduced risk of depression, anxiety, and loneliness in adolescents. These findings highlight the importance of integrating 24-hour movement guidelines into public health initiatives, such as school-based policies promoting balanced schedules and parental guidance on recreational screen use.

Mental health problems and influencing factors of parent-child separated children: An umbrella review of meta-analysis

BACKGROUND

An increasing number of parents are forced to part with their children due to the pressures of life or unpredictable circumstances. This forced separation often has a devastating effect on children's minds, leading to a range of mental health problems.

METHODS

We searched five databases (EBSCO, PubMed, Scopus, Web of Science, and China National Knowledge Infrastructure) from inception to November 17, 2023, and performed a systematic analysis using Comprehensive Meta-Analysis (CMA) 3.0.

RESULTS

We identified 28 eligible meta-analyses with 746,175 participants across 170 outcomes. Parent-child separated (PcS) children were at higher risk for emotional problems (d = 0.22 [95 % CI 0.17-0.28]), cognitive problems (d = 0.20 [95 % CI 0.10-0.29]), behavioral problems (d = 0.21 [95 % CI 0.15-0.27]) and psychosis (d = 0.22 [95 % CI 0.15-0.29]) than non-PcS children. Regarding influencing factors, both personal and social factors were moderately positively correlated with emotional and behavioral problems. Family factors had a moderate positive correlation between emotional problems (z = 0.20, [95CI% 0.12-0.28]), and a low positive correlation with behavioral problems (z = 0.13, [95CI% 0.04-0. 22]). After addressing the issue of overlapping data, there were no significant differences in emotional problems in children with PcS compared to non-PcS children.

LIMITATIONS

The majority of studies included in our umbrella review were from China, which may limit the generalizability of our findings.

CONCLUSION

PcS children suffer more mental health problems than non-PcS children. The community needs to act and intervene proactively to promote the improvement of the mental health of these children.

A bench-to-bedside narrative review of the sleep-social-oxytocin nexus

Although recognition of the significant reciprocal interplay between sleep and social processes has grown over the past two decades, theoretical frameworks conceptualising this interplay have predominantly focused on psychosocial factors. The current lack of attention to putative neurobiological substrates and physiological mechanisms that may facilitate the dynamics of sleep-social relationships limits interdisciplinary research into sleep and clinical treatment of sleep problems and disorders. Thus, this narrative review hypothesises that the neuropeptide oxytocin represents a promising candidate physiological substrate underpinning sleep-social interplay, and integrates the endogenous oxytocin system into a novel tripartite biopsychosocial framework-the sleep-social-oxytocin nexus. The current narrative review outlines the theoretical rationale for the existence of reciprocal sleep-social-oxytocin interactions, and examines the clinical and preclinical evidence for interactions between sleep processes, social processes, and the oxytocin system, highlighting the paucity of experimental research that addresses all three nexus factors. Subsequently, we explore important clinical implications of the sleep-social-oxytocin nexus: comorbidities between sleep, social, and oxytocinergic dysfunction in sleep and other psychiatric disorders, the emerging therapeutic potential of oxytocin-based therapeutics, and potential adjunctive interventions to achieve optimal treatment outcomes. We conclude by proposing future avenues for research and clinical implementation warranted within this space.

Cognitive behavioural therapy for sleep problems in psychosis: systematic review of effectiveness and acceptability

BACKGROUND

Sleep problems are common among people with psychosis. Research suggests poor sleep is causally related to psychosis, anxiety and depression.

AIMS

This review investigates the effectiveness and acceptability of cognitive-behavioural therapy (CBT) in targeting sleep problems in people with and at risk of psychosis.

METHOD

Four databases were searched in line with PRISMA guidelines. Eligible studies either evaluated (a) CBT targeting sleep problems in people with or at risk of psychosis, or (b) subjective experiences of this treatment. Articles not published in peer-review journals were excluded. Treatment effectiveness was investigated for sleep, psychosis and other clinical outcomes. Acceptability was evaluated using qualitative data, drop-out rates, adverse events and relevant questionnaires. Adaptations to standard treatment protocols were described. Research quality was appraised using Cochrane Risk of Bias tools for randomised and non-randomised trials, and a checklist was developed for qualitative papers.

RESULTS

Of the 975 records identified, 14 were eligible. The most common CBT target was insomnia. Treatment protocols were typically adapted by omitting sleep restriction. Large effect sizes were reported for sleep outcomes; however, effects for other clinical outcomes were less clear. Qualitative data and acceptability outcomes suggest that treatment was received positively by participants.

CONCLUSIONS

CBT is an effective and acceptable treatment for sleep problems in people with and at risk of psychosis. However, our conclusions are limited by few good-quality studies and small samples. Further gold-standard research is required to inform evidence-based guidelines.

Are sleep disturbances a risk factor for suicidal behavior in the first episode of psychosis? Evidence from a systematic review

Sleep disturbances are common in individuals with first-episode psychosis (FEP) and have been identified as potential contributors to an increased risk of suicidal behavior. This systematic review aims to synthesize the existing evidence on the association between sleep disturbances and suicidal behavior in individuals experiencing FEP, a critical period for early intervention. In accordance with the guidelines established by PRISMA, this systematic review was duly registered in PROSPERO (CRD42024598203) prior to its initiation. A comprehensive search was conducted across databases including PubMed, Web of Science, EMBASE, and PsycINFO, encompassing studies from their inception through February 2025. The review specifically included observational studies that investigated the association between sleep disturbances and suicidal behaviors, which include suicidal ideation, attempts, or completed suicides, among individuals with FEP. The inclusion criteria required that all studies featured adult participants aged 18 years and older, employed validated measures for both sleep disturbances and suicidality, and concentrated on populations with FEP. Reviews, case reports, and studies not published in English were systematically excluded. The selection of studies, extraction of data, and assessment of quality were conducted independently by two reviewers. Seven studies met the inclusion criteria, with sample sizes ranging from 118 to 688 participants. The findings indicate that sleep disturbances, especially insomnia, are significantly linked to an increased risk of suicidal ideation and behavior in individuals with FEP. The strength of these associations varied among the studies, with some reporting moderate to strong effect sizes. However, there was noted methodological heterogeneity, including variations in sleep assessment tools. This systematic review highlights sleep disturbances as a key modifiable risk factor for suicidal behavior in individuals with FEP. Future research should prioritize longitudinal designs and standardized sleep assessments to better characterize this relationship and guide targeted interventions.

Chain mediating role of hope and resilience in the relationship between perceived social support and loneliness among Chinese college students during COVID-19 pandemic: a cross-sectional questionnaire survey

BACKGROUND

The prevalence of loneliness among college students has elevated during the 2019 Coronavirus disease (COVID-19) pandemic. Thus, it is essential to clarify the factors that contribute to loneliness and seek out measures to reduce the influence of these factors on college students.

OBJECTIVE

To explore the mediating mechanisms underlying the association between perceived social support and loneliness among Chinese college students, and the multiple mediating roles of hope and resilience in this relationship.

METHOD

This online survey was conducted through the Wenjuanxing platform on March 3-15, 2020. A total of 1,627 effective questionnaires were received and the response rate was 94.3%. The UCLA loneliness scale, the Multi-Dimensional Scale of Perceived Social Support, the Herth Hope Index and Resilience Scale, and the scale of demographic variables were used for gathering data. Hierarchical multiple regression and the bootstrap method were used to explore and examine the chain mediation model.

RESULTS

The prevalence of loneliness among undergraduates was 55.2% (898/1627) during the COVID-19 pandemic, and there were significant differences in loneliness in gender (t = 4.131, p < 0.001) and sleeping duration (t = 3.971, p < 0.001). A significant chain mediation model was obtained in which college students' loneliness was affected by perceived social support through 3 different pathways: the mediating role of hope (42.28% of total effect), the mediating role of resilience (6.44% of total effect), and the chain mediating role of both hope, and resilience (4.91% of total effect). The total mediation effect was - 0.266, which accounted for 53.52% of the total effect.

CONCLUSION

Perceived social support, hope and resilience could relieve the feeling of loneliness effectively among Chinese college students. Hope and resilience play the chain mediation role in the association between perceived social support and loneliness. The psychological interventions about enhancing social support and improving hope and resilience may help to alleviate loneliness during the pandemic of COVID-19.

Subclinically Depressed Individuals Showed Less Trust after a Night of Sleep Deprivation

Insufficient sleep's impact on cognitive and emotional function is well-documented, but its effects on social functioning remain understudied. This research investigates the influence of depressive symptoms on the relationship between sleep deprivation (SD) and social decision-making. Forty-two young adults were randomly assigned to either the SD or sleep control (SC) group. The SD group stayed awake in the laboratory, while the SC group had a normal night's sleep at home. During the subsequent morning, participants completed a Trust Game (TG) in which a higher monetary offer distributed by them indicated more trust toward their partners. They also completed an Ultimatum Game (UG) in which a higher acceptance rate indicated more rational decision-making. The results revealed that depressive symptoms significantly moderated the effect of SD on trust in the TG. However, there was no interaction between group and depressive symptoms found in predicting acceptance rates in the UG. This study demonstrates that individuals with higher levels of depressive symptoms display less trust after SD, highlighting the role of depressive symptoms in modulating the impact of SD on social decision-making. Future research should explore sleep-related interventions targeting the psychosocial dysfunctions of individuals with depression.

Short-term prospective and reciprocal relations between social anxiety symptoms and sleep quality among community-recruited adolescents

OBJECTIVE

Research conducted with socially anxious youth suggests that there is an increased risk for poor sleep quality; however, this link is not consistent across the few studies and there is evidence to suggest that poor sleep quality may increase the risk for elevated social anxiety symptoms. The present study investigates both prospective and reciprocal associations between levels of self-reported social anxiety and global sleep quality while also distinguishing between within-person and between-person variations in these associations.

METHOD AND MEASURES

Community-recruited adolescents from the United States (N = 71; Mage=16.04, SD = 1.08; 64.8% girls; 80.3% White) completed a battery of questionnaires across three time-points within a six-month period; each wave occurred three months apart. A random-intercepts cross-lagged panel model was used for the analysis.

RESULTS

Findings indicated a positive relation between social anxiety and poor sleep quality at both within- and between-person levels. Higher levels of social anxiety were associated with poorer sleep quality three months later, but the reverse relation was not observed.

CONCLUSIONS

These findings provide evidence supporting the link between elevated social anxiety symptoms and future sleep problems among adolescents and lay groundwork for investigation of mechanisms driving this link. Findings suggests a need to screen for and treat sleep problems in socially anxious youth.

The associations between BMI, body appreciation, body image flexibility, sleep duration and loneliness in workers in southern China

BACKGROUND

Loneliness is a growing public health problem worldwide that can affect mental and emotional health and increase mortality. This study examined the relationship between body mass index (BMI), body image flexibility, body appreciation, and loneliness among Chinese workers, aiming to propose effective measures for reducing loneliness and promoting mental health.

METHODS

A total of 464 workers were recruited for this study. Participants completed the Chinese version of the Body Image Acceptance and Action Questionnaire, the BMI measure, a Standard Chinese translation of the Body Appreciation Scale, and the Chinese version of the short-form UCLA Loneliness Scale (ULS-8). Statistical analyses were performed using SPSS.

RESULTS

There were gender differences in body appreciation and body image flexibility scores were observed. Loneliness levels were higher among female workers than male workers. Male workers scored higher than female workers in body appreciation. Female workers scored significantly higher than male workers in body image flexibility and loneliness. Based on multiple regression analyses of the factors affecting loneliness scores, body image flexibility score (β = -0.19, p < 0.01) and body appreciation score (β = -0.25, p < 0.01) were significant predictors of loneliness.

CONCLUSION

As middle-aged individuals exhibit higher levels of loneliness. Policymakers should prioritize workplace mental health programs that combine body positivity workshops, sleep hygiene education, and peer support networks. For example, incorporating body image flexibility training into existing employee wellness programs to reduce isolation. In addition, public campaigns to combat weight stigma, such as media literacy programs, are urgently needed to address the social factors that contribute to loneliness.

Multidimensional frailty and sleep quality in late adulthood: A UK biobank examination

Frailty and sleep disturbances are two major concerns in late adulthood, that not only profoundly threaten health and wellbeing at the individual level but place enormous demands on our healthcare systems. Given that both constructs represent dynamic states that are preventable and reversible, understanding the potential pathways to and effects of these variables on one another is critical in providing effective and tailored support. However, despite growing interest in the relationship between sleep and frailty, only one study to date has directly explored their potential bidirectionality. Accordingly, this study was designed to extend the current understanding by investigating the reciprocal relationship of frailty and sleep quality at the multidimensional level. Specifically, the bidirectionality of these relationships was considered separately for physical, psychological, cognitive, and social frailty. Four random-intercept cross-lagged panel models with three time points were conducted, using 3192 older adults (Mage = 60.21; 46.37% female at baseline) from the UK Biobank. The results revealed that while physical, psychological, and cognitive frailty were neither predictive of, nor predicted by, sleep quality, social frailty and sleep share a reciprocal relationship. These data therefore offer important preliminary evidence for the efficacy of early intervention and prevention strategies aimed at enhancing sleep quality to reduce social frailty, and vice versa.

The impact of pharmacotherapy for premenstrual dysphoric disorder on sleep

Premenstrual dysphoric disorder (PMDD) affects a subset of women of reproductive age, characterized by severe mood disturbances and physical symptoms during the luteal phase of the menstrual cycle. Symptoms include mood swings, irritability, anxiety, fatigue, physical discomfort, and disruptions to sleep and circadian rhythms, such as altered melatonin secretion. Despite the prevalence of these symptoms, the impact of PMDD treatments on sleep and circadian markers, like melatonin, remains insufficiently understood. This review examines how dysregulated serotonin signaling, disrupted allopregnanolone activity (a neurosteroid derived from progesterone), and aberrant circadian rhythms contribute to PMDD. It also explores the effects of pharmacological treatments, including selective serotonin reuptake inhibitors, on sleep and melatonin regulation, and how these factors influence treatment outcomes. Additionally, the use of hypnotics and sedatives to manage sleep disturbances in PMDD is considered, weighing their potential benefits and risks. A deeper understanding of the interaction between PMDD symptoms, sleep, and circadian rhythms is crucial for developing more effective treatments. Further research is needed to explore the relationship between symptom management, sleep patterns, and circadian function in PMDD, and to determine how these factors can be optimized to improve clinical outcomes and quality of life for women affected by the disorder.

Sleep Deprivation Selectively Impairs Interpersonal Trust in Different Social Scenarios: Evidence from the Social Mindfulness Paradigm

Background

Sleep deprivation (SD) is widely recognized for its negative impact on both cognitive abilities and social interactions. Nonetheless, the effect of sleep deprivation on interpersonal trust in social scenarios is poorly understood.

Purpose

This study investigated the impact of total sleep deprivation on interpersonal trust under two different social scenarios: kindness and unkindness.

Patients and Methods

All participants (N = 49) completed the Social Mindfulness paradigm (SoMi) after both normal sleep (NS) and SD. Alertness changes were assessed using the Psychomotor Vigilance test (PVT) and the Karolinska Sleepiness Scale (KSS).

Results

Our results demonstrated that SD significantly impaired interpersonal trust when perceiving unkind intentions but did not affect trust in kind intentions (p < 0.05). Additionally, this detrimental effect was not related to changes in alertness (p > 0.05).

Conclusion

These findings suggest that SD selectively impacts interpersonal trust, and this effect is not influenced by simple cognitive functions such as alertness. Further research could incorporate brain imaging techniques to explore the association of other cognitive and affective factors with interpersonal trust after sleep loss.

Predictive effects of daily sleep on social motivation and social activity

This study examined the predictive effect of day-to-day variations in sleep on self-reported social motivation and social activity in 126 parents of young children with sleep problems. Controlling for other sleep factors, worse subjective sleep quality predicted less morning sociability and social motivation throughout the day. Unexpectedly, longer sleep duration predicted less social activity the following day. Sleepiness at wakeup predicted morning sociability, but not social motivation or activity throughout the day. This highlights the importance of good sleep quality for motivation to socialize, but also the complexity of investigating the relationship between sleep and social measures in daily life.

From sleeplessness to solitude: emotional repair as a buffer between insomnia and loneliness in university students

Loneliness and insomnia are endemic in college students, and emotion regulation is strongly related to both. Starting with a biopsychosocial framework, the present study tested a model in which emotional repair mediated the relationship between loneliness and insomnia, with the goal of using a potential mechanism of action to address loneliness. Participants were undergraduate students (N=1,513) in the United States who completed a survey including the Trait Meta-Mood Scale, Sleep Condition Indicator, and UCLA Loneliness Scale, amongst other measures. Insomnia had a significant total negative effect on loneliness, B = -0.46, 95% CI [-0.54, -0.39]. Emotional repair partially mediated this relationship, with an indirect effect of B = 0.015, 95% CI [-0.19, -0.12]. Participants with better sleep were more able to regulate their emotions, and thus tended to experience lower levels of loneliness. Treating insomnia (e.g., CBT-I) or skills associated with emotional repair and regulation (e.g., transdiagnostic approaches to emotion regulation) could reduce overall loneliness.

Exploring the association between sleep problems and loneliness in adolescents: Potential mediating effects of rumination and resilience

Sleep problems positively predict loneliness to a large extent, which would harm adolescent health. However, little is known about the underlying mechanism. This research investigates the potential mediating roles of rumination and resilience in the relation among adolescents and further examines the changing relationships. In Study 1, 1056 adolescents from two schools completed self-reported measures of sleep problems, loneliness, rumination, and resilience. We found that sleep problems were positively associated with loneliness, and that rumination and resilience mediated this relationship, both individually and sequentially. To examine the varying relationship between rumination, resilience, and loneliness, Study 2 adopted the cross-lagged design in a long-term longitudinal study of 131 students and found that rumination and resilience at T1 significantly predict loneliness at T2. To further directly explore the changing relationship between sleep problems and loneliness, we performed a short-term longitudinal study across 7 weeks of 242 adolescents in Study 3. The results replicated the findings of Study 2 and found sleep problems at T1 positively predicted loneliness at T2. These results underscore the significance of sleep problems in contributing to loneliness through mediating mechanisms and unveil the possible causal relationships, offering robust insights to alleviate adolescent loneliness.

Associations between Insomnia Severity, Perceived Stress, Mental Toughness, Dark Triad Traits, and Organizational Citizenship Behavior among Cadets of the Swiss Armed Forces

BACKGROUND

Compared to the general population, military personnel are at increased risk for insomnia and poor psychological well-being. The present study: (1) compared categories of insomnia severity between cadets of the Swiss Armed Forces (SAF) and previously published norms and (2) investigated the associations between insomnia and psychological well-being related to perceived stress, mental toughness, dark triad traits, and organizational citizenship behavior (OCB).

METHODS

A total of 216 cadets of the SAF (mean age: 20.80 years) completed self-rating questionnaires covering sociodemographic information, insomnia, perceived stress, mental toughness, dark triad, and organizational citizenship behavior. Data on insomnia sum scores and categories of historical samples (862 young adults and 533 police and emergency response service officers) were used for comparison.

RESULTS

Cadets of the SAF reported higher insomnia sum scores and insomnia severity categories, compared to young adults and police officers. Higher scores for insomnia were associated with higher scores for stress, dark triad traits, and with lower scores for mental toughness and OCB. Categories of low, medium, and high stress moderated the association between insomnia and dark triad traits.

CONCLUSIONS

Compared to norms of the general population, cadets of the SAF reported a higher insomnia severity. Given that standardized treatment programs for insomnia, mental toughness, and above all for coping with stress are available, such interventions might be promising avenues to improve a cadet's overall sleep, psychological well-being, and behavior.

Restless nights, cold hearts: Poor sleep causally blunts empathy

Poor sleep is pervasive in modern society. Poor sleep is associated with major physical and mental health consequences, as well as with impaired cognitive function. Less is known about the relationship between sleep and emotional and interpersonal behavior. In this work, we investigate whether poor sleep impairs empathy, an important building block of human interaction and prosocial behavior. We aimed to capture the effects of poor sleep on the various aspects of empathy: trait and state, affect and cognition. Study 1 (n = 155) assessed daily habitual sleep over several days, and global sleep quality in the past month. Participants who reported worse sleep quality exhibited lower empathic caring and perspective-taking traits. Study 2 (n = 347) induced a one-night disruption of sleep continuity to test a causal relationship between sleep and empathy. Participants in the sleep disrupted condition had to briefly wake up five times over the night, whereas the sleep-rested controls slept normally. In the next morning, participants' empathy and prosocial intentions were assessed. Participants in the sleep disruption condition exhibited lower empathic sensitivity and less prosocial decision-making than sleep-rested controls. The main contribution of this work is in providing a robust demonstration of the multi-faceted detrimental effects of poor sleep on trait and state empathy. Our findings demonstrate that poor sleep causally impairs empathic response to the suffering of others. These findings highlight the need for greater public attention to adequate sleep, which may impact empathy on a societal level.

Sleep-Related Disorders in Parkinson's Disease: Mechanisms, Diagnosis, and Therapeutic Approaches

BACKGROUND

Parkinson's Disease (PD) is frequently associated with a spectrum of sleep-related disorders, including insomnia, Excessive Daytime Sleepiness (EDS), REM sleep Behaviour Disorder (RBD), Restless Legs Syndrome (RLS), and Sleep-related Breathing Disorders (SBDs). These disorders significantly impact PD patients' Quality of Life (QoL) and present unique diagnostic and therapeutic challenges.

METHODS

This review has explored the intricate relationship between PD and sleep-related disorders, emphasizing their distinctive features and underlying neurobiological mechanisms. It aimed to consolidate current knowledge to optimize clinical management and improve patient care. The profound impact of these disorders on QoL has been evaluated, along with precise diagnostic methodologies. Additionally, various therapeutic strategies, including pharmacological treatments, nonpharmacological interventions, and device-aided therapies, have been examined.

RESULTS

Sleep-related disorders are prevalent among PD patients. Specifically, RBD exhibits a prevalence of 40-50%, often preceding the onset of motor symptoms, indicating its potential as an early marker of PD. Despite their significant impact on QoL, these non-motor symptoms are frequently under-recognized and inadequately managed in clinical practice. Pharmacological treatments, along with nonpharmacological interventions, like cognitive-behavioral therapy for insomnia and lifestyle modifications, have shown varied efficacy. Device-aided therapies have also demonstrated the potential to improve sleep-related disorders and overall non-motor symptom burden.

CONCLUSION

Effective management of sleep-related disorders in PD calls for personalized, comprehensive, and multimodal therapeutic approaches. This requires the collaborative efforts of neurologists, sleep specialists, psychiatrists, and other healthcare professionals. Future research should focus on the intricate relationship between PD and sleep disorders, aiming to develop innovative treatments and significantly improve patient outcomes.

The trajectories and associations of sleep disturbance symptoms with suicidal ideation in adolescents: A three-wave longitudinal study

BACKGROUND

This study aimed to investigate the developmental trajectories of sleep disturbance symptoms and examine whether specific trajectory memberships of sleep disturbance symptoms could prospectively predict suicidal ideation (SI) among a large sample of Chinese adolescents over one year.

METHODS

A three-wave longitudinal study was conducted from April 2021 to June 2022, with a sample of 19,095 adolescents from Shenzhen in Guangdong Province, China (51.2 % males; mean age = 12.4 ± 1.6 years at baseline). Socio-demographics (at baseline), SI, sleep disturbance symptoms (at each assessment), depressive symptoms (at the last follow-up), and negative life events (at two follow-ups) were assessed. Data were analyzed employing Growth Mixture Modeling and binary logistic regressions.

RESULTS

The Growth Mixture Modeling identified four trajectories of sleep disturbance symptoms over one year: resistant group (76.2 %), delayed-dysfunction group (8.8 %), recovery group (7.4 %), and chronic-dysfunction group (7.6 %). Binary logistic regression analysis revealed that adolescents in the group of delayed-dysfunction (OR = 2.86, 95 % CI = 2.51-3.27) and chronic-dysfunction (OR = 2.14, 95 % CI = 1.84-2.47) exhibited higher risks of developing SI compared to those in the resistant group, even after controlling for socio-demographics, negative life events, depressive symptoms, and baseline SI.

CONCLUSIONS

These findings underscore the importance of identifying individuals at higher risks of sleep disturbance and providing personalized and effective mental health services to reduce the incidence of SI.

Intersections of Modifiable Risks: Loneliness is Associated with Poor Subjective Sleep Quality in Older Women at Risk for Alzheimer's Disease

We examined the relationship between subjective and objective sleep outcomes and loneliness in older women at risk for Alzheimer's disease (AD). Our sample consisted of 39 participants (aged 65+) with mild cognitive deficits who completed the UCLA Loneliness Scale, the Pittsburgh Sleep Quality Index (PSQI), and an at home sleep test, to determine presence of obstructive sleep apnea. Based on sleep quality scores, individuals categorized as "poor sleepers" had significantly higher loneliness scores than "good sleepers." However, total loneliness scores did not significantly differ between groups with or without sleep apnea. We found that higher loneliness was significantly associated to lower habitual sleep efficiency and sleep duration and was also influenced by use of sleep medication. Our findings suggest that increased loneliness relates to worse subjective sleep quality, but not to sleep apnea. These findings suggest that combined interventions targeting loneliness and sleep quality may be important for older women.

Appraising motivation as a predictor of independence in individual activities of daily living in patients with subacute stroke: a retrospective study

OBJECTIVES

This study aimed to evaluate the impact of motivation on independence in activities of daily living, such as eating, getting up, and rehabilitation, in subacute stroke patients.

MATERIALS AND METHODS

We retrospectively assessed the data of 191 first-stroke patients in a rehabilitation hospital ward. Motivation was examined using the following five elements of the Vitality Index: waking pattern, communication, feeding, on and off toilet, and rehabilitation and other activities. As an outcome measure, independence in activities of daily living, such as eating and dressing, was assessed using the Barthel Index. Logistic regression analysis was performed using the independence of each activities of daily living, as determined by the Barthel Index at discharge, as a dependent variable and each of the Vitality Index item scores as the independent variable.

RESULTS

Motivation to get up item of the Vitality Index was significantly associated with independence in grooming and dressing, whereas motivation to communicate item was significantly associated with independence in transferring (p < 0.05). Furthermore, motivation to eat item was significantly associated with independence in feeding, grooming, dressing, and transferring, whereas motivation to engage in rehabilitation and activities was significantly associated with independence in dressing, transferring, and toileting (p < 0.05).

CONCLUSIONS

Our results suggest that the motivation to eat, get up, communicate, and participate in rehabilitation and activities is associated with independence in different activities of daily living. The present study provides useful insights into the significance and interpretation of assessing motivation on independence in activities of daily living.

The effect of weighted blankets on sleep quality and mental health symptoms in people with psychiatric disorders in inpatient and outpatient settings: A systematic review and meta-analysis

There is limited synthesized evidence for weighted blankets usage in psychiatric patients. We performed a PRISMA compliant systematic review and meta-analysis of the effects of weighted blankets on sleep and mental health outcomes in psychiatric patients. MEDLINE, EMBASE, Cochrane Library, and PsycINFO were searched up to December 15th, 2023. Randomized controlled trials (RCT) or cohort studies reporting objective outcome scales of sleep and mental health were included. Standardized mean difference (SMD) measured effect size. Q and I2 tests measured heterogeneity. Cochrane Risk of Bias Tool 2 and NIH Quality Assessment Tool assessed risk of bias. Nine studies of 553 psychiatric inpatients and outpatients with diagnoses including depression, bipolar disorder, ADHD, and autism. 289 participants received weighted blankets and 264 were in control groups. Intervention length ranged from 5 min to one year. Four studies reported evidence for weighted blankets in improving insomnia, total sleep time, and sleep onset latency. Six studies reported evidence for reducing anxiety symptoms. When compared to placebo, those using weighted blankets had improvements to anxiety symptoms (SMD = -0.47, 95% CI: -0.68 to -0.25, p < 0.001). One RCT had low risk of bias, 3 had some concerns, 1 was high risk. Three cohort studies were "fair" and one was "poor" in quality. It was found that weighted blankets can be effective in reducing anxiety in psychiatric patients. However, the literature is limited by heterogeneity of outcome reporting, lack of well designed RCTs, and small sample sizes. Highlighting the need for higher quality studies.

Associations Between Delayed Sleep Phase Syndrome and Daytime Napping with the Metabolic Syndrome Among Adults: Results from the Ravansar Non-Communicable Disease (RaNCD) Cohort Study

Objective

Adverse sleep and wake patterns are associated with physical health complaints, including metabolic disorders. The aim of this study was to evaluate the relationship between delayed sleep phase syndrome (DSPS) and napping during the day with metabolic syndrome (MetS).

Methods

This study was conducted on 10 065 participants aged 35-65 years using baseline data from the Ravansar Non-Communicable Disease (RaNCD) cohort study. Delayed sleep phase syndrome was evaluated through a clinical interview to rule out the possibility that the sleep complaints were a result of psychiatric disorders. Logistic and linear regression models were used to determine associations.

Results

The severity of MetS was found to be higher in men, older age groups, married people, subjects with a lower education level, urban residents, smokers, people with low physical activity, and DSPS. In the fully adjusted model, the odds of having MetS were 26% (95% Confidence interval (CI): 1.08, 1.48) higher in those with DSPS compared to those without DSPS. Additionally, the odds of MetS were 18% higher in people who napped less than 1 hour per day, 26% higher in those who napped 1-2 hours per day, and 21% higher in those who napped over 2 hours per day, compared to non-nappers. All of these associations were statistically significant. The odds of having the severity of MetS were significantly 6% (95% CI: 0.01, 0.12) higher in those with DSPS compared to those without DSPS.

Conclusion

The findings of this study indicate that DSPS and daytime napping are associated with an increased risk of MetS. Interventions aimed at improving sleep quality are recommended as potential strategies to help reduce the risk of developing MetS.

Biopsychosocial Health Considerations for Astronauts in Long-Duration Spaceflight: A Narrative Review

Long-duration spaceflights beyond low-Earth orbit, including missions to the Moon and Mars, pose significant health risks. Although biomedical approaches commonly appear in the literature, considering psychological and social factors alongside physiologic health offers a more holistic approach to astronaut care. Integrating the biopsychosocial (BPS) framework into medical planning addresses complex spaceflight challenges and aids in developing mitigation strategies. This review examined health risks associated with long-duration spaceflight within a BPS framework. Sources included governmental space agencies, academic textbooks, and relevant publications from multiple databases. Considering the National Aeronautics and Space Administration's Human Research Program's 5 main hazards, a conceptual model was developed to highlight the multifactorial BPS effects of spaceflight. In space, astronauts face unique environments and biological adaptations, including fluid shift, plasma volume loss, bone density loss, and muscle atrophy. Noise and the absence of natural light disrupt circadian rhythms, causing sleep disturbances and fatigue, which affect physical and mental health. Studies on crews in isolated and confined extreme environments reveal psychosocial challenges, including impaired mood and cognition, interpersonal tension, and miscommunication. International collaboration in spaceflight introduces differences in communication, problem solving, and social customs due to diverse cultural backgrounds. Upcoming long-distance missions likely will amplify these challenges. This review emphasizes BPS health considerations in long-duration spaceflight. It highlights the interplay among psychological, social, and biological factors, advocating for multidisciplinary teams and a holistic approach to astronaut health and mission planning and the potential added value of BPS perspectives in considering countermeasures.

Feature Contributions and Predictive Accuracy in Modeling Adolescent Daytime Sleepiness Using Machine Learning: The MeLiSA Study

Background: Excessive daytime sleepiness (EDS) among adolescents poses significant risks to academic performance, mental health, and overall well-being. This study examines the prevalence and risk factors of EDS in adolescents in Bangladesh and utilizes machine learning approaches to predict the risk of EDS. Methods: A cross-sectional study was conducted among 1496 adolescents using a structured questionnaire. Data were collected through a two-stage stratified cluster sampling method. Chi-square tests and logistic regression analyses were performed using SPSS. Machine learning models, including Categorical Boosting (CatBoost), Extreme Gradient Boosting (XGBoost), Support Vector Machine (SVM), Random Forest (RF), K-Nearest Neighbors (KNN), and Gradient Boosting Machine (GBM), were employed to identify and predict EDS risk factors using Python and Google Colab. Results: The prevalence of EDS in the cohort was 11.6%. SHAP values from the CatBoost model identified self-rated health status, gender, and depression as the most significant predictors of EDS. Among the models, GBM achieved the highest accuracy (90.15%) and precision (88.81%), while CatBoost had comparable accuracy (89.48%) and the lowest log loss (0.25). ROC-AUC analysis showed that CatBoost and GBM performed robustly in distinguishing between EDS and non-EDS cases, with AUC scores of 0.86. Both models demonstrated the superior predictive performance for EDS compared to others. Conclusions: The study emphasizes the role of health and demographic factors in predicting EDS among adolescents in Bangladesh. Machine learning techniques offer valuable insights into the relative contribution of these factors, and can guide targeted interventions. Future research should include longitudinal and interventional studies in diverse settings to improve generalizability and develop effective strategies for managing EDS among adolescents.

Sleepless nights and social plights: medial septum GABAergic hyperactivity in a neuroligin 3-deficient autism model

Social deficits represent a core symptom domain of autism spectrum disorder (ASD), which is often comorbid with sleep disturbances. In this issue of the JCI, Sun et al. explored a medial septum (MS) circuit linking these behaviors in a neuroligin 3 conditional knockout model of autism. They identified GABAergic neuron hyperactivity following neuroligin 3 deletion in the MS. This hyperactivity resulted in the inhibition of the downstream preoptic area (POA) and hippocampal CA2 region, resulting in sleep loss and social memory deficits, respectively. Inactivating the hyperactive MS GABA neurons or activating the POA or CA2 rescued the behavioral deficits. Together, these findings deepen our understanding of neural circuits underlying social and sleep deficits in ASD.

Longitudinal association of social isolation and loneliness with physical function among in-patients living with schizophrenia

WHAT IS KNOWN ON THE SUBJECT?: People living with schizophrenia have reduced physical function and are more likely to experience loneliness than those without condition. Low physical function is associated with greater loneliness in people with psychosis. However, it is unclear whether social isolation and loneliness contribute to impaired physical function in this population. Loneliness is linked to an increased risk of physical function impairment among older individuals, but research on patients living with schizophrenia is limited. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study is the first to evaluate the longitudinal association of social isolation and loneliness with physical function among inpatients living with schizophrenia. It showed that more than one third of the participants experienced a decline in physical function over a 2-year period. Loneliness, rather than social isolation, was associated with an increase in physical function impairment over 2 years among inpatients living with schizophrenia. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Healthcare professionals should recognize loneliness as a potential risk factor for impaired physical function among inpatients diagnosed with schizophrenia. It is recommended that people living with schizophrenia are assessed for loneliness and that interventions are offered to alleviate their feelings of loneliness. Implementing interventions to reduce loneliness may help improve physical function and overall quality of life for individuals living with schizophrenia.

ABSTRACT

INTRODUCTION: Patients living with schizophrenia often experience low physical function, which is associated with negative health outcomes. Therefore, investigating the risk factors for physical function is crucial in this population.

AIM

This study examined the longitudinal association of social isolation and loneliness with physical function among inpatients living with schizophrenia.

METHODS

Physical function was assessed using measures of activities daily living (ADL), instrumental activities daily living (IADL) and the combination scores of ADL/IADL. Social isolation was indexed with five types of social connection and loneliness was measured using UCLA Loneliness Scale.

RESULTS

Social isolation was not associated with the measures of physical function over 2 years. Loneliness exhibited an association with IADL and ADL/IADL at follow-up, after adjustment for baseline levels of the outcomes. These associations remained when both social isolation and loneliness were simultaneously entered into the model.

DISCUSSION

Loneliness, rather than social isolation, was associated with increased physical function impairment over 2 years among inpatients living with schizophrenia.

IMPLICATIONS FOR PRACTICE

Healthcare professionals should consider loneliness as a potential risk factor for impaired physical function. It would be beneficial to assess patients for loneliness and implement interventions to reduce feelings of loneliness.

A Bio-Psycho-Social Approach to Understanding Optimism and Pessimism in Response to Stress

Stress is widely known to have debilitating effects on physical health and mental wellbeing, particularly on one's coping styles, personality traits, and outlook on life. Cumulative and chronic stress, which can serve as a triggering or aggravating factor for many pathological disorders if left unaddressed, has been linked to many life-threatening diseases. While many studies have looked at how optimism and pessimism are used as a form of coping mechanism, few have examined how different bio-psycho-social reactions to stress shape the level of optimism and pessimism. Using a sample of adult individuals aged 18 and older in the United States (n = 3361), this study addressed the following research questions: (1) What types of stress are predictive of optimism and pessimism? (2) Which responses to stress and coping mechanisms are most predictive of optimism and pessimism? (3) Do optimism and pessimism share the same stress-related risk and protective factors? Overall, this study found that while optimism and pessimism share conceptual similarities, they are not necessarily influenced by the same stress mechanisms. Stress, whether personal or financial, was associated with a negative outlook on life. This study showed that having good sleep quality and a lower number of psychological stress symptoms was linked to increasing optimism and reducing pessimism, while overeating or eating unhealthily was connected to both optimism and pessimism. Additionally, this study found that exercise/walking and emotional support mediated the effects of the responses to stress on the respondents' level of optimism and pessimism.

Sleep and socio-occupational functioning in adults with serious mental illness: A systematic review

Sleep is a crucial factor influencing mental health and quality of life. Individuals with serious mental illness (SMI) often experience significant sleep problems. This can further exacerbate their symptoms and impact their socio-occupational functioning (SOF) (the extent to which a person is able to engage in 'self-care and activities of daily living, communication, interpersonal relations, instrumental living skills, and work'). Despite the well-established bidirectional relationship between sleep and mental health, the specific association between sleep and SOF in the context of SMI remains underexplored. A systematic review was conducted. Comprehensive searches in PubMed and PsycNet yielded 832 results. After applying inclusion criteria, 24 studies were included in the narrative synthesis. Study characteristics and key findings were extracted for analysis. Collectively, studies investigated sleep quality, satisfaction, duration, disturbance, specific disorders, and objectively-recorded sleep parameters across various study designs. Studies included a total population of 10,938, utilising a range of sleep and SOF outcome measures. Nearly all studies indicated that worsened sleep was associated with reduced SOF in SMI populations. The review supports the potential role of improved sleep as a route to improved SOF in SMI populations. This has clear implications for research and clinical care for patients with SMI.

Interpersonal consequences of paranoid ideation, negative symptoms and sleep problems in a transdiagnostic sample of individuals with psychosis

Paranoid ideation is a transdiagnostic construct that is associated with social impairment and often occurs in psychotic spectrum disorders. Little research has examined how paranoid ideation is related to social behaviors that underlie social impairment and may ultimately lead to social rejection. It is important to consider that negative symptoms and sleep problems also contribute to social impairment. No research has assessed the unique and combined influence of paranoid ideation, negative symptoms, and sleep problems on social impairment. Therefore, the current study examined how paranoid ideation, negative symptoms, and sleep problems contribute to poorer social skills and social rejection in a transdiagnostic sample of persons with psychosis and community members (N = 112). Assessments included diagnostic and symptom interviews, questionnaires, behavioral ratings of social skill and facial displays of affect, and naive observer reactions utilizing thin-slice methodology. Greater paranoid ideation, negative symptoms, and sleep problems were each related to poorer social skill and more negative reactions from observers. When considered in path analyses, negative symptoms were associated with observer reports of less willingness to interact with participants through poorer social skill. These findings demonstrate the symptom correlates of social rejection and how interpersonal behavior may contribute to social exclusion.

Efficacy of eHealth Versus In-Person Cognitive Behavioral Therapy for Insomnia: Systematic Review and Meta-Analysis of Equivalence

BACKGROUND

Insomnia is a prevalent condition with significant health, societal, and economic impacts. Cognitive behavioral therapy for insomnia (CBTI) is recommended as the first-line treatment. With limited accessibility to in-person-delivered CBTI (ipCBTI), electronically delivered eHealth CBTI (eCBTI), ranging from telephone- and videoconference-delivered interventions to fully automated web-based programs and mobile apps, has emerged as an alternative. However, the relative efficacy of eCBTI compared to ipCBTI has not been conclusively determined.

OBJECTIVE

This study aims to test the comparability of eCBTI and ipCBTI through a systematic review and meta-analysis of equivalence based on randomized controlled trials directly comparing the 2 delivery formats.

METHODS

A comprehensive search across multiple databases was conducted, leading to the identification and analysis of 15 unique randomized head-to-head comparisons of ipCBTI and eCBTI. Data on sleep and nonsleep outcomes were extracted and subjected to both conventional meta-analytical methods and equivalence testing based on predetermined equivalence margins derived from previously suggested minimal important differences. Supplementary Bayesian analyses were conducted to determine the strength of the available evidence.

RESULTS

The meta-analysis included 15 studies with a total of 1083 participants. Conventional comparisons generally favored ipCBTI. However, the effect sizes were small, and the 2 delivery formats were statistically significantly equivalent (P<.05) for most sleep and nonsleep outcomes. Additional within-group analyses showed that both formats led to statistically significant improvements (P<.05) in insomnia severity; sleep quality; and secondary outcomes such as fatigue, anxiety, and depression. Heterogeneity analyses highlighted the role of treatment duration and dropout rates as potential moderators of the differences in treatment efficacy.

CONCLUSIONS

eCBTI and ipCBTI were found to be statistically significantly equivalent for treating insomnia for most examined outcomes, indicating eCBTI as a clinically relevant alternative to ipCBTI. This supports the expansion of eCBTI as a viable option to increase accessibility to effective insomnia treatment. Nonetheless, further research is needed to address the limitations noted, including the high risk of bias in some studies and the potential impact of treatment duration and dropout rates on efficacy.

TRIAL REGISTRATION

PROSPERO CRD42023390811; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=390811.

Physical activity and social anxiety symptoms among Chinese college students: a serial mediation model of psychological resilience and sleep problems

BACKGROUND

Social anxiety symptoms are common and harmful psychological illness in college students. Although some studies have illustrated that physical activity could reduce social anxiety symptoms, the specific mechanism is still unclear. Based on theoretical studies on resilience and sleep, this study constructed a serial mediation model to explore whether they mediate between physical activity and social anxiety symptoms among college students.

METHODS

This study surveyed 9,530 college students from three colleges in China to explore the mediating effect of physical activity and sleep problems between physical activity and social anxiety symptoms. Participants were investigated with the International Physical Activity Questionnaire, Connor-Davidson Resilience Scale, Sleep-related problems, and the Social Interaction Anxiety Scale and the Social Phobia Scale. Correlations between variables were analysed using Pearson correlation analysis and mediation analyses were performed using SPSS PROCESS macro 3.3 software.

RESULT

The study found that physical activity was negatively associated with social anxiety symptoms and sleep problems, but positively with psychological resilience. After controlling for sociodemographic variables, physical activity can not only indirectly alleviate social anxiety symptoms through the separate mediation of psychological resilience and sleep problems, but also through the serial mediation of psychological resilience and sleep problems.

CONCLUSION

These results suggest that improving physical activity levels could reduce social anxiety scores by increasing psychological resilience and sleep quality. This is of great reference significance for the prevention and intervention of college students' mental health.

Sleep disturbances and psychological well-being among military medical doctors of the Swiss Armed Forces: study protocol, rationale and development of a cross-sectional and longitudinal interventional study

Background

Compared to civilians and non-medical personnel, military medical doctors are at increased risk for sleep disturbances and impaired psychological well-being. Despite their responsibility and workload, no research has examined sleep disturbances and psychological well-being among the medical doctors (MDs) of the Swiss Armed Forces (SAF). Thus, the aims of the proposed study are (1) to conduct a cross-sectional study (labeled 'Survey-Study 1') of sleep disturbances and psychological well-being among MDs of the SAF; (2) to identify MDs who report sleep disturbances (insomnia severity index >8), along with low psychological well-being such as symptoms of depression, anxiety and stress, but also emotion regulation, concentration, social life, strengths and difficulties, and mental toughness both in the private/professional and military context and (3) to offer those MDs with sleep disturbances an evidence-based and standardized online interventional group program of cognitive behavioral therapy for insomnia (eCBTi) over a time lapse of 6 weeks (labeled 'Intervention-Study 2').

Method

All MDs serving in the SAF (N = 480) will be contacted via the SAF-secured communication system to participate in a cross-sectional survey of sleep disturbances and psychological well-being ('Survey-Study 1'). Those who consent will be provided a link to a secure online survey that assesses sleep disturbances and psychological well-being (depression, anxiety, stress, coping), including current working conditions, job-related quality of life, mental toughness, social context, family/couple functioning, substance use, and physical activity patterns. Baseline data will be screened to identify those MDs who report sleep disturbances (insomnia severity index >8); they will be re-contacted, consented, and randomly assigned either to the eCBTi or the active control condition (ACC) ('Intervention-Study 2'). Individuals in the intervention condition will participate in an online standardized and evidence-based group intervention program of cognitive behavioral therapy for insomnia (eCBTi; once the week for six consecutive weeks; 60-70 min duration/session). Participants in the ACC will participate in an online group counseling (once the week for six consecutive weeks; 60-70 min duration/session), though, the ACC is not intended as a bona fide psychotherapeutic intervention. At the beginning of the intervention (baseline), at week 3, and at week 6 (post-intervention) participants complete a series of self-rating questionnaires as for the Survey-Study 1, though with additional questionnaires covering sleep-related cognitions, experiential avoidance, and dimensions of self-awareness.

Expected outcomes

Survey-Study 1: We expect to describe the prevalence rates of, and the associations between sleep disturbances (insomnia (sleep quality); sleep onset latency (SOL); awakenings after sleep onset (WASO)) and psychological well-being among MDs of the SAF; we further expect to identify specific dimensions of psychological well-being, which might be rather associated or non-associated with sleep disturbances.Intervention-Study 2: We expect several significant condition-by-time-interactions. Such that participants in the eCBTi will report significantly greater improvement in sleep disturbances, symptoms of depression, anxiety, stress reduction both at work and at home (family related stress), and an improvement in the overall quality of life as compared to the ACC over the period of the study.

Conclusion

The study offers the opportunity to understand the prevalence of sleep disturbances, including factors of psychological well-being among MDs of the SAF. Further, based on the results of the Intervention-Study 2, and if supported, eCBTi may be a promising method to address sleep disturbances and psychological well-being among the specific context of MDs in the SAF.

Temperature exposure and sleep duration: Evidence from time use surveys

The Earth's climate is projected to warm significantly in the 21st century, and this will affect human societies in many ways. Since sleep is a basic human need and part of everyone's life, the question of how temperature affects human sleep naturally arises. This paper examines the effect of daily mean temperature on sleep duration using nationally representative Hungarian time use surveys between 1976 and 2010. Compared to a day with an average temperature of 5-10 °C, colder temperatures do not influence sleep duration. However, as daily mean temperatures rise, sleep duration starts to strongly decline. The effect of a hot (>25 °C) day is -13.3 minutes, but if preceded by a few other hot days, the effect is even stronger, -24.7 minutes. The estimated sleep loss is especially large on weekends and public holidays, for older individuals, and men. Combining the estimated effects with temperature projections of twenty-four climate models shows that the warming climate will substantially decrease sleep duration. The projected impacts are especially large when taking into account the effects of heatwave days. This study also shows that different groups in society are likely to be affected in significantly different ways by a warming climate.

Examining bi-directional links between loneliness, social connectedness and sleep from a trait and state perspective

Greater loneliness as well as a lack of social connectedness have often been associated with poorer sleep. However, the temporal dynamics and direction of these associations remain unclear. Aim of the current study was to examine bi-directional associations between loneliness/social connectedness and sleep in 48 stress-exposed medical students during their first medical internship, considered a period of heightened stress. We obtained trait-level questionnaire data on loneliness and global sleep completed before and during the internship as well as state-level diary- and wearable-based data on daily changes in social connectedness and sleep collected twice over the period of seven consecutive days, once before and once during the internship. Bi-directional associations among greater loneliness and higher daytime dysfunction on trait-level were identified. In addition, several uni-directional associations between loneliness/social connectedness and sleep were found on trait- and state-level. In sum, findings of this study point at a bi-directional relation among loneliness/social connectedness and sleep, in which variables seem to reciprocally influence each other across longer-term periods as well as on a day-to-day basis.

Autism-associated neuroligin 3 deficiency in medial septum causes social deficits and sleep loss in mice

Patients with autism spectrum disorder (ASD) frequently experience sleep disturbance. Genetic mutations in the neuroligin 3 (NLG3) gene are highly correlative with ASD and sleep disturbance. However, the cellular and neural circuit bases of this correlation remain elusive. Here, we found that the conditional knockout of Nlg3 (Nlg3-CKO) in the medial septum (MS) impairs social memory and reduces sleep. Nlg3 CKO in the MS caused hyperactivity of MSGABA neurons during social avoidance and wakefulness. Activation of MSGABA neurons induced social memory deficits and sleep loss in C57BL/6J mice. In contrast, inactivation of these neurons ameliorated social memory deficits and sleep loss in Nlg3-CKO mice. Sleep deprivation led to social memory deficits, while social isolation caused sleep loss, both resulting in a reduction in NLG3 expression and an increase in activity of GABAergic neurons in the MS from C57BL/6J mice. Furthermore, MSGABA-innervated CA2 neurons specifically regulated social memory without impacting sleep, whereas MSGABA-innervating neurons in the preoptic area selectively controlled sleep without affecting social behavior. Together, these findings demonstrate that the hyperactive MSGABA neurons impair social memory and disrupt sleep resulting from Nlg3 CKO in the MS, and achieve the modality specificity through their divergent downstream targets.

The role of objective sleep in implicit and explicit affect regulation: A comprehensive review

Impairments in sleep and affect regulation are evident across a wide range of mental disorders. Understanding the sleep factors that relate to affect regulatory difficulties will inform mechanistic understanding and aid in treatment. Despite rising interest, some research challenges in this area include integrating across different clinical and non-clinical literatures investigating the role of sleep architecture (measured with polysomnography) and experimentally manipulated sleep, as well as integrating more explicit versus implicit affect regulation processes. In this comprehensive review, we use a unifying framework to examine sleep's relationship with implicit-automatic regulation and explicit-controlled regulation, both of which are relevant to mental health (e.g., PTSD and depression). Many studies of implicit-automatic regulation (e.g., fear extinction and safety learning) demonstrate the importance of sleep, and REM sleep specifically. Studies of explicit-controlled regulation (e.g., cognitive reappraisal and expressive suppression) are less consistent in their findings, with results differing depending on the type of affect regulation and/or way that sleep was measured or manipulated. There is a clear relationship between objective sleep and affect regulation processes. However, there is a need for 1) more studies focusing on sleep and explicit-controlled affect regulation; 2) replication with the same types of regulation strategies; 3) more studies experimentally manipulating sleep to examine its impact on affect regulation and vice versa in order to infer cause and effect; and 4) more studies looking at sleep's impact on next-day affect regulation (not just overnight change in affect reactivity).

The new science of sleep: From cells to large-scale societies

In the past 20 years, more remarkable revelations about sleep and its varied functions have arguably been made than in the previous 200. Building on this swell of recent findings, this essay provides a broad sampling of selected research highlights across genetic, molecular, cellular, and physiological systems within the body, networks within the brain, and large-scale social dynamics. Based on this raft of exciting new discoveries, we have come to realize that sleep, in this moment of its evolution, is very much polyfunctional (rather than monofunctional), yet polyfunctional for reasons we had never previously considered. Moreover, these new polyfunctional insights powerfully reaffirm sleep as a critical biological, and thus health-sustaining, requisite. Indeed, perhaps the only thing more impressive than the unanticipated nature of these newly emerging sleep functions is their striking divergence, from operations of molecular mechanisms inside cells to entire group societal dynamics.

Objective monitoring of loneliness levels using smart devices: A multi-device approach for mental health applications

Loneliness is linked to wide ranging physical and mental health problems, including increased rates of mortality. Understanding how loneliness manifests is important for targeted public health treatment and intervention. With advances in mobile sending and wearable technologies, it is possible to collect data on human phenomena in a continuous and uninterrupted way. In doing so, such approaches can be used to monitor physiological and behavioral aspects relevant to an individual's loneliness. In this study, we proposed a method for continuous detection of loneliness using fully objective data from smart devices and passive mobile sensing. We also investigated whether physiological and behavioral features differed in their importance in predicting loneliness across individuals. Finally, we examined how informative data from each device is for loneliness detection tasks. We assessed subjective feelings of loneliness while monitoring behavioral and physiological patterns in 30 college students over a 2-month period. We used smartphones to monitor behavioral patterns (e.g., location changes, type of notifications, in-coming and out-going calls/text messages) and smart watches and rings to monitor physiology and sleep patterns (e.g., heart-rate, heart-rate variability, sleep duration). Participants reported their loneliness feeling multiple times a day through a questionnaire app on their phone. Using the data collected from their devices, we trained a random forest machine learning based model to detect loneliness levels. We found support for loneliness prediction using a multi-device and fully-objective approach. Furthermore, behavioral data collected by smartphones generally were the most important features across all participants. The study provides promising results for using objective data to monitor mental health indicators, which could provide a continuous and uninterrupted source of information in mental healthcare applications.

Postpartum loneliness predicts future depressive symptoms: a nationwide Japanese longitudinal study

PURPOSE

The COVID-19 pandemic has intensified feelings of loneliness, especially among postpartum women. This nationwide Japanese longitudinal study assessed the impact of such feelings on depressive symptoms and mother-to-infant bonding difficulties (MIBD), two pivotal determinants of maternal and infant well-being.

METHODS

Starting with a baseline survey conducted between July and August 2021, we tracked 1254 postpartum Japanese women who initially reported minimal depressive symptoms (i.e., Edinburgh Postnatal Depression Scale < 9) and MIBD (i.e., Mother-to-Infant Bonding Scale < 5), over a follow-up period of approximately 6 months. Baseline loneliness was evaluated with the UCLA Loneliness Scale Short-Form (UCLA-LS3-SF3).

RESULTS

Forty-nine percent of the sample reported the presence of baseline feelings of loneliness. After propensity score matching on sociodemographics and various pregnancy, childbirth, and COVID-19-related aspects, baseline loneliness was associated with increased risks of later depressive symptoms but not MIBD. Using restricted cubic spline logistic regression and considering loneliness as a continuous variable, we found a positive increasing quadratic relationship with depressive symptoms. As loneliness increased, so did the risk of later depressive symptoms. However, there was no significant association between loneliness and MIBD. These results were confirmed through a sensitivity analysis using inverse probability weighting to address attrition bias.

CONCLUSION

Feelings of postpartum loneliness are associated with future risks of depressive symptoms. The data suggests that addressing loneliness in postpartum women early is crucial to safeguarding their well-being and that of their infants.

ChatGPT-generated help produces learning gains equivalent to human tutor-authored help on mathematics skills

Authoring of help content within educational technologies is labor intensive, requiring many iterations of content creation, refining, and proofreading. In this paper, we conduct an efficacy evaluation of ChatGPT-generated help using a 3 x 4 study design (N = 274) to compare the learning gains of ChatGPT to human tutor-authored help across four mathematics problem subject areas. Participants are randomly assigned to one of three hint conditions (control, human tutor, or ChatGPT) paired with one of four randomly assigned subject areas (Elementary Algebra, Intermediate Algebra, College Algebra, or Statistics). We find that only the ChatGPT condition produces statistically significant learning gains compared to a no-help control, with no statistically significant differences in gains or time-on-task observed between learners receiving ChatGPT vs human tutor help. Notably, ChatGPT-generated help failed quality checks on 32% of problems. This was, however, reducible to nearly 0% for algebra problems and 13% for statistics problems after applying self-consistency, a "hallucination" mitigation technique for Large Language Models.

Insight into sleep quality and its relationship with emotional intelligence: results of a cross-sectional study among Italian university students

Background

This study aimed to investigate sleep habits and examine the relationship between sleep quality and its potential predictors, namely Emotional Intelligence (EI) and perceived health status.

Methods

The present cross-sectional study was conducted between February 13 and February 28, 2023, at the "Magna Græcia" University of Catanzaro, in the Southern part of Italy. The study involved undergraduate students who were 18 years or older, proficient in the Italian language, and with no restrictions on the major attended. They completed a self-administered survey on socio-demographic information, health status, sleep quality (Pittsburgh Sleep Quality Index-PSQI), EI, and perceived health status.

Results

The majority of the sample (59.6%) was enrolled in medical or life science majors. The results showed a high prevalence of poor sleep quality and sleep latency was identified as the most affected aspect of it. The female gender and the self-perceived health status were the strongest predictors of poor sleep quality. Poor sleepers showed lower emotional clarity, emotional repair, and total EI scores. Moreover, as age increased, the odds of being classified as a poor sleeper increased by 7%.

Conclusion

The survey highlights that poor sleep health is still a significant issue and empowering individuals to make proactive decisions to adopt healthy lifestyles in the early phase of life is of paramount importance. The study exhibited the interesting role of EI in influencing sleep quality, highlighting that when emotional events are insufficiently regulated, it may result in sleep disturbances. Therefore, the promotion of sleep quality requires an integrated yet innovative approach including emotion regulation.

Human Prosocial Preferences Are Related to Slow-Wave Activity in Sleep

Prosocial behavior is crucial for the smooth functioning of the society. Yet, individuals differ vastly in the propensity to behave prosocially. Here, we try to explain these individual differences under normal sleep conditions without any experimental modulation of sleep. Using a portable high-density EEG, we measured the sleep data in 54 healthy adults (28 females) during a normal night's sleep at the participants' homes. To capture prosocial preferences, participants played an incentivized public goods game in which they faced real monetary consequences. The whole-brain analyses showed that a higher relative slow-wave activity (SWA, an indicator of sleep depth) in a cluster of electrodes over the right temporoparietal junction (TPJ) was associated with increased prosocial preferences. Source localization and current source density analyses further support these findings. Recent sleep deprivation studies imply that sleeping enough makes us more prosocial; the present findings suggest that it is not only sleep duration, but particularly sufficient sleep depth in the TPJ that is positively related to prosociality. Because the TPJ plays a central role in social cognitive functions, we speculate that sleep depth in the TPJ, as reflected by relative SWA, might serve as a dispositional indicator of social cognition ability, which is reflected in prosocial preferences. These findings contribute to the emerging framework explaining the link between sleep and prosocial behavior by shedding light on the underlying mechanisms.

Resilience Building Practices for Women Physicians

Women now make up more than half of the physician workforce, but they are disproportionately plagued by burnout. Medicine is a fast-paced stressful field, the practice of which is associated with significant chronic stress due to systems issues, crowding, electronic medical records, and patient case mix. Hospitals and health care systems are responsible for mitigating system-based burnout-prone conditions, but often their best efforts fail. Physicians, particularly women, must confront their stressors and the daily burden of significant system strain when this occurs. Those who routinely exceed their cumulative stress threshold may experience burnout, career dissatisfaction, and second victim syndrome and, ultimately, may prematurely leave medicine. These conditions affect women in medicine more often than men and may also produce a higher incidence of health issues, including depression, substance use disorder, and suicide. The individual self-care required to maintain health and raise stress thresholds is not widely ingrained in provider practice patterns or behavior. However, the successful long-term practice of high-stress occupations, such as medicine, requires that physicians, especially women physicians, attend to their wellness. In this article, we address one aspect of health, resilience, and review six practices that can create additional stores of personal resilience when proactively integrated into a daily routine.

Understanding the cognitive and neuroimaging bases underlying the detrimental impact of sleep deprivation on reciprocity

Although the impact of sleep loss on social behaviors has been widely observed in recent years, the mechanisms underpinning these impacts remain unclear. In this study, we explored the detrimental effects of sleep deprivation on reciprocity behavior as well as its underlying psychological and neuroimaging mechanisms by combining sleep manipulation, an interpersonal interactive game, computational modeling and neuroimaging. Our results suggested that after sleep deprivation, individuals showed reduced reciprocity behavior, mainly due to their reduced weights on communal concern when making social decisions. At neural level, we demonstrated that sleep deprivation's effects were observed in the precuneus (hyperactivity) and temporoparietal junction, dorsal lateral prefrontal cortex (DLPFC) (both hypoactivity), and reduced reciprocity was also accounted for by increased precuneus-thalamus connectivity and DLPFC-thalamus connectivity. Our findings contributed to the understanding of the psychological and neuroimaging bases underlying the deleterious impact of sleep deprivation on social behaviors.

Postweaning intermittent sleep deprivation enhances defensive attack in adult female mice via the microbiota-gut-brain axis

Sleep is one of the most important physiological activities in life and promotes the growth and development of an individual. In modern society, sleep deprivation (SD), especially among adolescents, has become a common phenomenon. However, long-term SD severely affected adolescents' neurodevelopment leading to abnormal behavioral phenotypes. Clinical studies indicated that sleep problems caused increased aggressive behavior in adolescents. Aggressive behavior was subordinate to social behaviors, in which defensive attack was often the last line for survival. Meanwhile, increasing studies shown that gut microbiota regulated social behaviors by affecting specific brain regions via the gut-brain axis. However, whether postweaning intermittent SD is related to defensive attack in adulthood, and if so, whether it is mediated by the microbiota-gut-brain axis are still elusive. Combined with microbial sequencing and hippocampal metabolomics, the present study mainly investigated the long-term effects of postweaning intermittent SD on defensive attack in adult mice. Our study demonstrated that postweaning intermittent SD enhanced defensive attack and impaired long-term memory formation in adult female mice. Moreover, microbial sequencing and LC-MS analysis showed that postweaning intermittent SD altered the gut microbial composition and the hippocampal metabolic profile in female mice, respectively. Our attention has been drawn to the neuroactive ligand-receptor interaction pathway and related metabolites. In conclusion, our findings provide a new perspective on the relationship of early-life SD and defensive attack in adulthood, and also highlight the importance of sleep in early-life, especially in females.

Associations of perceived stress with loneliness and depressive symptoms: the mediating role of sleep quality

BACKGROUND

Whether perceived stress is associated with loneliness and depressive symptoms in general adults, and to what extent sleep quality mediates the associations, remains unknown. The aim of this study was to estimate the associations of perceived stress with loneliness and depressive symptoms, and the mediating role of sleep quality in these associations.

METHODS

Cross-sectional data on 734 participants (aged 18-87 years) were analyzed. Perceived stress was assessed using the 10-item Perceived Stress Scale (PSS-10; range 0-40). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI; range 0-21). Loneliness was assessed using the three-item short form of the Revised University of California, Los Angeles (UCLA) loneliness scale (range 3-9). Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression (CESD-10) Scale (range 0-30). General linear regression models, multivariable logistic regression models, and formal mediation analysis were performed.

RESULTS

After adjustment for age and sex, we found that with each 1-point increment in the perceived stress score, both the loneliness score (β = 0.07; 95% confidence interval [CI]: 0.06, 0.08) and depression score (β = 0.45; 95% CI: 0.40, 0.49) increased significantly. Robust results were observed when adjusting for more confounders. Furthermore, sleep quality mediated 5.3% (95% CI: 1.3%, 10.0%; P = 0.014) and 9.7% (95% CI: 6.2%, 14.0%; P < 0.001) of the associations of perceived stress score with loneliness score and depression score, respectively.

CONCLUSIONS

In general Chinese adults, perceived stress was positively associated with loneliness and depressive symptoms, and sleep quality partially mediated these associations. The findings reveal a potential pathway from perceived stress to mental health through sleep behaviors, and highlight the importance of implementing sleep intervention programs for promoting mental health among those who feel highly stressed.

Association between social withdrawal and suicidal ideation in patients with major depressive disorder: The mediational role of emotional symptoms

BACKGROUND

The study was designed to investigate the associations between social withdrawal, emotional symptoms, and suicide ideation in patients with major depressive disorder (MDD).

METHODS

This cross-sectional study included 2678 MDD patients from the National Survey on Symptomatology of Depression (NSSD). Differences in the sociodemographic factors, clinical characteristics, suicide ideation, and emotional symptoms were compared in patients with different frequencies of social withdrawal. Pearson correlation, multiple linear regression analysis, and mediation analysis were employed to assess the contribution of social withdrawal to suicide ideation.

RESULTS

MDD patients with a higher frequency of social withdrawal were prone to have a higher frequency of suicide ideation (p for trend <0.001) and history of suicide behavior (p for trend <0.001). Multiple linear regression analysis showed that there was a dose-response relationship between social withdrawal and suicide ideation in MDD patients, but this association became insignificant after adjusting for emotional symptoms. Mediation analysis suggested that all of the emotional symptoms had significant mediating effects on the association between social withdrawal and suicide ideation in MDD patients (p < 0.05). The magnitude of mediation varied between 4.3 % and 64.3 %, with the largest mediating effect in the feeling of despair (64.3 %), helplessness (41.2 %), and loneliness (40.0 %).

CONCLUSION

Our study provides evidence that social withdrawal was a common clinical presentation and it may increase the risk for suicide through emotional symptoms in MDD patients.

LIMITATIONS

Causal conclusions could not be drawn between social withdrawal, emotional symptoms, and suicide ideation because of the cross-sectional design of the study.

The Negative Effects of Travel on Student Athletes Through Sleep and Circadian Disruption

Collegiate athletes must satisfy the academic obligations common to all undergraduates, but they have the additional structural and social stressors of extensive practice time, competition schedules, and frequent travel away from their home campus. Clearly such stressors can have negative impacts on both their academic and athletic performances as well as on their health. These concerns are made more acute by recent proposals and decisions to reorganize major collegiate athletic conferences. These rearrangements will require more multi-day travel that interferes with the academic work and personal schedules of athletes. Of particular concern is additional east-west travel that results in circadian rhythm disruptions commonly called jet lag that contribute to the loss of amount as well as quality of sleep. Circadian misalignment and sleep deprivation and/or sleep disturbances have profound effects on physical and mental health and performance. We, as concerned scientists and physicians with relevant expertise, developed this white paper to raise awareness of these challenges to the wellbeing of our student-athletes and their co-travelers. We also offer practical steps to mitigate the negative consequences of collegiate travel schedules. We discuss the importance of bedtime protocols, the availability of early afternoon naps, and adherence to scheduled lighting exposure protocols before, during, and after travel, with support from wearables and apps. We call upon departments of athletics to engage with sleep and circadian experts to advise and help design tailored implementation of these mitigating practices that could contribute to the current and long-term health and wellbeing of their students and their staff members.

Sleep and Socioemotional Outcomes Among Sexual and Gender Minority Adolescents: A Longitudinal Study

Sexual and gender minority adolescents face specific stressors associated with their minority status, leading to compromised socioemotional outcomes and sleep. Sleep patterns have, in turn, been found to predict socioemotional outcomes. As such, we aimed to investigate whether healthy sleep patterns prospectively predicted socioemotional outcomes, and whether associations varied as a function of sexual and gender minority status. We conducted a secondary data analysis among adolescents at age 14 to 17, from a nationally representative prospective cohort in the United Kingdom (N = 8923, mean age = 13.8), with 7021 cisgender heterosexual, 1801 sexual minority, and 101 gender minority adolescents. Indicators of socioemotional outcomes included self-esteem, emotional well-being, peer relationships, and relationship with parents. The results showed that gender minority adolescents reported the worst sleep patterns and socioemotional outcomes, followed by sexual minority and cisgender heterosexual adolescents. Results from multi-group path analyses showed that emotional well-being, self-esteem, and peer relationships at age 17 were prospectively predicted by sleep patterns and the associations were moderated by sexual and gender minority status. Influence of sleep patterns, particularly sleep initiation problems and frequent awakening, on socioemotional outcomes was greater among gender minority adolescents, when compared to cisgender heterosexual adolescents. In conclusion, positive socioemotional outcomes were predicted by healthy sleep patterns. The potential role of sleep health in optimizing socioemotional outcomes among sexual and gender minority adolescents might warrant further investigation in prevention or intervention studies.