Insomnia May Mediate the Relationship Between Stress and Anxiety: A Cross-Sectional Study in University Students

Assessment of an App-Based Sleep Program to Improve Sleep Outcomes in a Clinical Insomnia Population: Randomized Controlled Trial

BACKGROUND

Insomnia is the most commonly reported sleep disturbance and significantly impacts mental health and quality of life. Traditional treatments for insomnia include pharmacological interventions or cognitive behavioral therapy for insomnia (CBT-I), but these options may not be accessible to everyone who needs treatment.

OBJECTIVE

This study aims to assess the effectiveness of the app-based Headspace Sleep Program in adults with clinical insomnia on sleep disturbance and mental health outcomes, compared with a waitlist control group.

METHODS

This randomized controlled trial included 132 adults with clinical insomnia who were assigned to either the Headspace Sleep Program (an 18-session self-guided, in-app program utilizing CBT-I techniques augmented by mindfulness) or a waitlist control group. Sleep disturbance outcomes were assessed by changes in insomnia symptoms (measured using the Insomnia Severity Index) and sleep efficiency (measured via sleep diary and actigraphy). Mental health outcomes included perceived stress (measured by the 10-item Perceived Stress Scale), depressive symptoms (measured by the 8-item Patient Health Questionnaire), sleep quality (measured by the Pittsburgh Sleep Quality Index), anxiety symptoms (measured by the 7-item Generalized Anxiety Disorder Scale), and mindfulness (measured by the Mindful Attention Awareness Scale). Changes from baseline to postintervention and follow-up were assessed for each outcome.

RESULTS

Participants had a mean (SD) age of 37.2 (10.6) years, with 69 out of 132 (52.3%) identifying as female. Those randomized to the Headspace Sleep Program group experienced significantly greater improvements in insomnia symptoms from baseline to postintervention and follow-up compared with participants in the waitlist control group (P<.001, η²p=0.107). Improvements from baseline to postintervention and follow-up were also observed in the Headspace Sleep Program group for sleep efficiency, as measured by both sleep diary (P=.01, η²p=.03) and actigraphy outcomes (P=.01, η²p=.03). Participants in the Headspace Sleep Program group showed greater improvements in insomnia remission rates (8/66, 12%, at postintervention and 9/66, 14%, at follow-up) and treatment response (11/66, 17%, at postintervention and 15/66, 23%, at follow-up) compared with the control group (remission rate 2/66, 3%, at postintervention and 0/66, 0%, at follow-up; treatment response 3/66, 5%, at postintervention and 1/66, 2%, at follow-up). The results suggest significant improvements in depressive symptoms (P=.01, η²p=.04), anxiety symptoms (P=.02, η²p=.02), and mindfulness (P=.01, η²p=.03) in the Headspace Sleep Program group.

CONCLUSIONS

The Headspace Sleep Program is an effective intervention for improving sleep disturbances in adults with clinical insomnia.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05872672; https://clinicaltrials.gov/ct2/show/NCT05872672.

Wuling capsule combined with sertraline in the therapy of anxiety and depression with insomnia in adolescents

BACKGROUND

The treatment of adolescent patients with anxiety, depression and insomnia is challenging, and there is no ideal treatment method.

AIM

To evaluate the clinical efficacy of Wuling capsule combined with sertraline in the treatment of adolescent anxiety, depression and insomnia.

METHODS

Eighty adolescent patients with anxiety, depression with insomnia who were admitted to our hospital from April 1, 2022 to March 30, 2024. And the subjects were randomly classified into the control group (n = 40) and the observational group (n = 40). The control group was treated with a combination of sertraline and placebo. The observation group was treated with Wuling capsule in addition to sertraline. The two groups were cured continuously for 8 weeks. Insomnia severity index (ISI), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to evaluate the clinical symptoms before treatment and at 2, 4, 6 and 8 weeks after treatment. The Treatment Emergent Symptom Scale (TESS) was used to evaluate adverse reactions during treatment.

RESULTS

There was no obvious difference in HAMD, HAMA and ISI scores between the two groups before treatment (P > 0.05). After treatment, the HAMD, HAMA and ISI scores of patients in both groups decreased compared with before treatment, and HAMD, HAMA and ISI scores of patients in the observation group were remarkedly lower than those in the control group at each time point after treatment (P < 0.05). Compared with the control group, the TESS score of the study group were sharply lower (t = 18.239, P < 0.001).

CONCLUSION

Wuling capsule can further alleviate the insomnia symptoms of adolescents with anxiety and depression, and the efficacy and safety are high. It is recommended to promote the application.

Insomnia in teachers at the time of resumption of in-person instruction at schools amidst the COVID-19 pandemic: A cross-sectional study

BACKGROUND

The coronavirus (COVID-19) pandemic has affected people's economies, lifestyles, and physical, emotional, and sleep health. This research aimed to estimate the prevalence of insomnia and symptoms of stress, anxiety, and depression among teachers with the resumption of in-person instruction at schools following a hiatus after COVID-19 lockdowns in India. We also studied the association of teachers' insomnia with psychological symptoms and demographic variables.

METHODS

We conducted a cross-sectional survey between October -November 2021 after schools had reopened during the COVID-19 pandemic. Data was collected using standard questionnaires online among schoolteachers. We explored the association of insomnia with teachers' symptoms of stress, anxiety, depression, sex, school boards, and age groups.

RESULTS

Of 124 schoolteachers surveyed, the prevalence of insomnia was 37.9% (subthreshold in 25% and clinical in 12.9%). The prevalence of stress, depression, and anxiety was 20.2%, 30.6%, and 45.2%, respectively. There was a significant association (p<0.001) of insomnia with symptoms of anxiety, stress, and depression in univariate analysis. On multivariate analysis, we found that those feeling stressed had a 6.4 times higher risk of insomnia (95% CI: 1.5-28.3, p - 0.01). There was no association of insomnia with age, sex, school educational boards, and type of institution.

CONCLUSIONS

Over one-third (37.9%) of teachers reported having trouble sleeping when they returned to the school's typical face-to-face instruction modalities through COVID-19 times, and insomnia was more prevalent in those with stress.

Demographic Differences in Insomnia and Anxiety and the Association with Cardiovascular Risk Factors among Jordanian Healthy Adult

Background

Prior studies showed that anxiety and insomnia are both associated with Cardiovascular Disease (CVD). There is a lack of literature related to the prevalence of insomnia and anxiety among healthy adult populations in developing countries as in Jordan, Therefore, this study aimed to examine the association between the CVD risk factors and both insomnia and anxiety among healthy adults had one or more modifiable CVD risk factors.

Materials and Methods

A cross-sectional method was used to examine the prevalence of anxiety, insomnia, and demographical and clinical association with anxiety and insomnia among 1000 Jordanian adult participants using the Hamilton Anxiety Rating Scale and the insomnia severity index. Pearson's correlation was used to examine the correlation between anxiety and insomnia scores. Linear regression was used to examine predictors to anxiety and insomnia based on demographical and clinical details.

Results

The result of the current study showed that (30.20%) of participants had higher anxiety scores, (29.70%) had moderate to severe insomnia. Moreover, there was a significant positive correlation between anxiety and insomnia scores, p = 0.01. Based on the current study findings only marital status and anxiety were unique predictors of insomnia F(14,45) = 989, p = 0.001. Moreover, Predictors of anxiety were gender, hypertension, Diabetes mellitus, dyslipidemia, and insomnia F(19,89) = 989, p = 0.001.

Conclusions

Sleep and psychological well-being are important components of an adult's health and well-being. The study showed that marital status and anxiety are predictors of insomnia. Whereas, gender, hypertension, diabetes mellitus, dyslipidemia, and insomnia were predictors of anxiety. This study highlights the importance of the implementation of a primary prevention strategy for individuals with modifiable CVD risk factors to reduce anxiety and insomnia levels among adults.

Insomnia mediates the relation between empathy and anxiety among nursing students: a latent moderated mediation model of self-compassion

BACKGROUND

Nursing students are faced with multiple challenges and have a higher probability of suffering from anxiety. The current study aims to explore the relation between empathy and anxiety, examining the mediation and moderation effects of insomnia and self-compassion, respectively.

METHODS

This study employed a convenient sampling method, recruiting 1,161 nursing students (female = 923, male = 238, Meanage = 18.37, SDage = 2.38) from three universities in China. These students completed the questionnaires online, including General Anxiety Disorder -7 (GAD-7), Jefferson Scale of Physician Empathy-Nursing student (JSPE-NS), Youth Self-rating Insomnia Scale -8 (YSIS-8), and Self-Compassion Scale (SCS). The study employed latent variable structural equation models to analyze the relation and mechanisms between empathy and anxiety. Then, the mediated role of insomnia and the moderated role of self-compassion were examined.

RESULTS

The prevalence rates of anxiety and insomnia in the current sample are 18.24% and 26.76%, respectively. The results showed that empathy could negatively predict anxiety, with a significant mediating effect of insomnia between them (B = -0.081, p < 0.05, 95% CI [-0.197, -0.063]). Additionally, it was proven that self-compassion moderated the positive relation between insomnia and anxiety. With a higher level of self-compassion, the indirect effect of empathy on anxiety through insomnia was weaker (B = -0.053, p < 0.01, 95% CI [-0.095, -0.019]). When individuals showed a lower level of self-compassion, the indirect effect of empathy on anxiety through insomnia was stronger (B = -0.144, p < 0.01, 95% CI [-0.255, -0.059]).

CONCLUSION

The analysis of this research proved that empathy was negatively related to anxiety, and insomnia served as a mediator between empathy and anxiety. Besides, the protective role of self-compassion on individuals' mental health was identified. The findings of the study suggest that the education of nursing students should highlight the significance of fostering empathy and self-compassion. The intervention on insomnia may be helpful in reducing the levels of anxiety since insomnia is a risky factor for anxiety.

Predictors of adherence to a brief sleep extension protocol in emerging adults

OBJECTIVES

This study examined how mental health symptoms (i.e., depression, anxiety, stress) and baseline sleep characteristics (i.e., sleep quality and levels of daytime sleepiness) predicted adherence to and initial success of a brief sleep extension research protocol in emerging adults.

METHODS

184 emerging adults (ages 18-25; M = 20.96, SD = 2.04) were asked to extend their nightly sleep opportunity to 8 hr for 1 week and to anchor bedtime and waketime. Sleep outcomes (adherence and initial protocol success) were tracked using actigraphy. Baseline sleep quality, daytime sleepiness, depression, anxiety, and stress were assessed using self-report questionnaires.

RESULTS

Poorer baseline sleep quality predicted better adherence to the protocol (p = .002). Other baseline sleep characteristics and mental health were not predictive of adherence (ps>.50). Lower levels of baseline daytime sleepiness approached significance in predicting greater initial protocol success following the protocol (p = .05). Baseline sleep quality and mental health did not predict initial protocol success (ps > 0.34).

CONCLUSIONS

Mental health symptoms did not significantly predict adherence to or the success of a sleep extension protocol. Surprisingly, individuals with poor baseline sleep quality were more likely to adhere to the extension protocol, perhaps suggesting heightened motivation for change or increased risk for sleep problems. This research provides valuable insight into factors that predict adherence to sleep extension protocols in emerging adults.

Prevalence and correlates of generalized anxiety disorder and perceived stress among Sudanese medical students

BACKGROUND

Generalized Anxiety Disorder (GAD) causes significant disturbance in an individual's well-being and activity. Whereby, interfering with the dynamic progress in life. Also, anxiety is a product of stress and a major predictor of academic performance. This study aimed to assess the prevalence of Generalized Anxiety Disorder (GAD), measure levels of anxiety and perceived stress, evaluate the academic profile, identify lifestyle characteristics, and explore the relationship between these factors.

METHODS

In this cross-sectional study, 340 Sudanese medical students filled out online questionnaires, composed of the sociodemographic and lifestyle characteristics, academic profile, Generalized Anxiety Disorder-2 scale (GAD-2), and Perceived Stress Scale-10 (PSS-10). Descriptive and inferential statistics were applied using Statistical Package for Social Science (SPSS) Version 20.0 for data analysis.

RESULTS

Of 340 medical students, 3.8% of them were diagnosed with GAD, while 29.1% scored ≥ 3 in GAD-2, indicating a possible diagnosis. The study found that 9.7% of the participants used addictive substances, with 42% of them having high GAD-2 scores. Moreover, high anxiety levels were associated with high-stress scores (p-value = 0.000). Also, high GAD-2 scores were significantly associated with students who spent less than 10,000 SDG (18 USD) weekly, spent more time on entertainment using smart devices (p-value = 0.004), and had an unhealthy diet (p-value = 0.004). Low anxiety levels were associated with better sleep quality (p-value = 0.00), satisfaction with religious practices (p-value = 0.00), and increased leisure/hobby time (p-value = 0.018). High-stress levels were observed in females (p-value = 0.035), those with lower academic performance satisfaction levels, and increased hours of smart device usage for entertainment (p-value = 0.001). Reduced stress levels were associated with being ≥ 23 years old, increased leisure/hobby time (p-value = 0.002), satisfaction with religious practices [F(3, 166.6) = 10.8, p-value = 0.00)], and having a healthy diet (p-value = 0.006).

CONCLUSION

The low prevalence of GAD corresponded with previous literature, but 29.1% of medical students had a high probability of having GAD. The study emphasizes on providing accessible mental health services for medical students and interventions addressing modifiable risk factors.

Mediating Role of PERMA Wellbeing in the Relationship between Insomnia and Psychological Distress among Nursing College Students

BACKGROUND

Psychological distress is an important mental health problem in college students. Insomnia may be a major factor contributing to psychological distress. This study aimed to explore the indirect relationship between insomnia and psychological distress through the five PERMA wellbeing variables (i.e., positive emotions, engagement, relationships, meaning in life, and achievement) among nursing college students.

METHODS

A cross-sectional study was conducted in China using an online survey design. Mediation analyses were examined using the PROCESS macro version 4.1 for SPSS 27.0. A total of 1741 nursing college students completed the online survey.

RESULTS

Insomnia was positively associated with psychological distress (p < 0.01, r = 0.673), while negative associations were detected between PERMA wellbeing variables and insomnia (p < 0.01, r range = -0.176 and -0.272), as well as psychological distress (p < 0.01, r range = -0.196 and -0.386). The association between insomnia and psychological distress was partially mediated by the participants' positive emotions (indirect effect = 0.137, SE = 0.024, 95% CI boot = [0.094, 0.188]), engagement (indirect effect = -0.033, SE = 0.010, 95% CI boot = [-0.054, -0.017]), and meaning in life (indirect effect = 0.027, SE = 0.014, 95% CI boot = [0.001, 0.055]) but not their relationships or achievement of the PERMA wellbeing variables.

CONCLUSIONS

The findings of this study suggest that the PERMA wellbeing variables, especially positive emotions, engagement, and meaning in life, could be potential mechanisms by which insomnia is associated with psychological distress. The mediating roles of PERMA wellbeing variables between insomnia and psychological distress could be incorporated into the health management of university administrations to promote the health and wellbeing of nursing college students.

Stressors in university life and anxiety symptoms among international students: a sequential mediation model

BACKGROUND

Anxiety is a common mental health problem among university students, and identification of its risk or associated factors and revelation of the underlying mechanism will be useful for making proper intervention strategies. The aim of our study is to test the sequential mediation of self-efficacy and perceived stress in the association between stressors in university life and anxiety symptoms.

METHODS

A cross-sectional study design was adopted and a sample of 512 international students from a medical university of China completed the survey with measurements of stressors in university life, self-efficacy, perceived stress and anxiety symptoms.

RESULTS

We found that 28.71% of the international students had anxiety symptoms, and stressors in university life were positively associated with anxiety symptoms (β = 0.23, t = 5.83, p < 0.01). Moreover, sequential mediating role of self-efficacy and perceived stress in the association between the stressors and anxiety symptoms was revealed.

CONCLUSIONS

Our study provided a new perspective on how to maintain the mental health, which suggested that self-efficacy improvement and stress reduction strategies should be incorporated in the training programs to support students.

The mediating role of attention deficit in relationship between insomnia and social cognition tasks among nurses in Saudi Arabia: A cross-sectional study

Purpose

Insomnia-related affective functional disorder may negatively affect social cognition such as empathy, altruism, and attitude toward providing care. No previous studies have ever investigated the mediating role of attention deficit in the relationship between insomnia and social cognition.

Methods

A cross-sectional survey was carried out among 664 nurses (Mage = 33.03 years; SD ± 6.93 years) from December 2020 to September 2021. They completed the Scale of Attitude towards the Patient (SAtP), the Athens Insomnia Scale (AIS), a single-item numeric rating scale assessing the increasing severity of attention complaints, and questions relating to socio-demographic information. The analysis was carried out by examining the mediating role of attention deficit in the relationship between insomnia and social cognition.

Results

The prevalence of insomnia symptoms was high (52% insomnia using the AIS). Insomnia was significantly correlated with attention problems (b = 0.18, standard error (SE) = 0.02, p < 0.001). Attention problems were significantly negatively correlated with nurses' attitudes towards patients (b = -0.56, SE = 0.08, p < 0.001), respect for autonomy (b = -0.18, SE = 0.03, p < 0.001), holism (b = -0.14, SE = 0.03, p < 0.001), empathy (b = -0.15, SE = 0.03, p < 0.001), and altruism (b = -0.10, SE = 0.02, p < 0.001). Attention problems indirectly mediated the effect of insomnia on attitudes toward patients (99% CI = -0.10 [-0.16 to -0.05]), respect for autonomy (99% CI = -0.03 [-0.05 to -0.02]), holism (99% CI = -0.02 [-0.04 to -0.01]) empathy (99% CI = -0.03 [-0.04 to -0.01]), and altruism (99% CI = -0.02 [-0.03 to -0.01]).

Conclusion

Nurses with insomnia-related attention problems are likely to have poor explicit social cognition such as attitude toward patients, altruism, empathy, respect for autonomy, and holism.

Prevalence and factors associated with insomnia among medical students in China during the COVID-19 pandemic: characterization and associated factors

BACKGROUND

Insomnia has become an important issue in recent years. Insomnia is affected by many factors. Previous research has shown that during the COVID-19 pandemic, there would be a long-term negative effect on the mental health of medical college students. The state of medical college students' insomnia directly determines the results of medical education and the career development prospects of the medical students themselves. Therefore, it is very important to understand the insomnia situation of medical students in the post-epidemic era.

METHODS

This study was conducted 2 years after the global COVID-19 pandemic (April 1-April 23, 2022). The study used an online questionnaire, administered through a web-based survey platform. The Athens Insomnia Scale (AIS), Fear of COVID-19 Scale (FCV-19S), GAD-2, PHQ-2, and socio-demographic information were surveyed by the Questionnaire Star platform.

RESULTS

The prevalence of insomnia was 27.80% (636/2289). Grade(P < 0.05), age(P < 0.001), loneliness(P < 0.001), depression(P < 0.001), anxiety(P < 0.001), fear of COVID-19 was highly correlated with insomnia (P < 0.001). Adapting to online class(P < 0.001) was a protective factor of smartphone addiction.

CONCLUSIONS

This survey shows that Insomnia was highly prevalent among the Chinese medical college students during the COVID-19 pandemic. Governments and schools should through psychological interventions to address the current situation of insomnia among medical students, and formulate targeted programs and strategies to reduce their psychological problems.

Duration of Keeping an Exercise Habit and Mental Illness and Life Attitude among University Students

Physical exercise has beneficial effects on human health, and several studies have examined the association between exercise and mental health. However, most of these studies focused on exercise intensity, duration, or frequency. Evidence for the association between the duration of maintaining an exercise habit and mental illness is lacking, especially in young adulthood-a crucial period that bridges adolescence and adulthood. This study investigated the association between the duration of keeping an exercise habit and mental illness and life attitude among Chinese university students. A total of 11,392 university students participated in this study (6866 men and 4526 women). The duration of keeping an exercise habit was evaluated using a questionnaire with relevant questions. Exercise habit was defined as exercising for longer than 30 min per session and more than twice a week. Mental illness consisted of two elements: depressive symptoms-assessed using the Zung Self-rating Depression Scale, and anxiety symptoms-assessed using the seven-item Generalized Anxiety Disorder scale. Life attitude was assessed using a questionnaire with relevant questions. Multivariate logistic regression analysis examined the adjusted association between the duration of keeping an exercise habit and mental illness and life attitude. In the final adjusted model, compared to the no exercise category, the odds ratios and 95% confidence intervals (CIs) of depressive symptoms were 0.80 (0.70, 0.91) for those with an exercise habit of 1-4 months, and 0.72 (0.63, 0.83) for those with one of >4 months (p for trend <0.001). Additionally, when compared to participants with no exercise habit, the adjusted odds ratios (95% CIs) for anxiety symptoms were 1.01 (0.90, 1.14) for those with a habit of 1-4 months and 0.78 (0.69, 0.88) for those with one of >4 months (p for trend =0.001). A longer duration of keeping an exercise habit was also significantly associated with positive life attitudes. Our results showed that a long duration of keeping an exercise habit was significantly associated with a lower prevalence of mental illness among university students. Further, maintaining a more prolonged exercise habit may benefit individuals' mental health in young adulthood.

Sleep Quality Worsens While Perceived Stress Improves in Healthcare Workers over Two Years during the COVID-19 Pandemic: Results of a Longitudinal Study

The purpose of the study was to measure changes in sleep quality and perceived stress and their interrelationships in a sample of healthcare workers two years post the COVID-19 pandemic. Using a cohort design, data were collected from frontline healthcare workers (FLHCW, n = 70) and non-frontline healthcare workers (NFLHCW, n = 74) in April 2020 (T1) and in February 2022 (T2). The Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS-10) were administered at both time points. There were no differences in sleep quality or perceived stress between FLHCW and NFLHCW at either timepoint. For the entire sample, the PSQI scores at T2 were significantly higher than at T1 (7.56 ± 3.26 and 7.25 ± 3.29, respectively) (p = 0.03, Cohen's d = 0.18). PSS-10 scores at T2 were significantly lower than at T1 (19.85 ± 7.73 and 21.13 ± 7.41, respectively) (p = 0.001, Cohen's d = 0.78). Baseline sleep quality PSQI (T1) was a significant predictor for changes in sleep quality. During the initial months of the outbreak of the COVID-19 pandemic, poor sleep quality and perceived stress were common for healthcare workers. Two years into the pandemic, the perceived stress was reduced, but sleep quality worsened.

Association between developmental dyslexia and anxiety/depressive symptoms among children in China: The chain mediating of time spent on homework and stress

BACKGROUND

The relationship between dyslexia and anxiety/depressive symptoms among children in China is unclear. Besides, the pathways to explain the risks are also undefined.

METHODS

3993 primary school students from grade 2 to 6 were recruited in this study. The Dyslexia Checklist for Chinese Children and the Pupil Rating Scale-Revised Screening for Learning Disabilities were used to filter the dyslexic children. The Chinese perceived stress scale, the Screen for Child Anxiety Related Emotional Disorders, and the Children's Depression Inventory-Short Form were used separately to assess stress, anxiety symptoms, and depressive symptoms of the children. Time spent on homework was obtained by asking their parents: "How long does it take the children to complete the homework every day?". The chain mediation models were examined using SPSS PROCESS macro 3.3 software.

RESULTS

Dyslexic children spend more time on homework (2.61±1.15), and have higher scores for depression (4.75±3.60) and stress (26.55±7.40) compared to normal children (1.87±0.77, 3.25±3.32, and 23.20±8.43, respectively). The differences are statistically significant (all P<0.01). There is no direct association between dyslexia and anxiety symptoms, while dyslexia has a direct link with depressive symptoms. Dyslexia could affect anxiety/depressive symptoms via the independent mediating effect of stress and the chain mediating effect of time spent on homework and stress. The total indirect effect is 0.21 and 0.25, respectively.

LIMITATIONS

The data used in our study is self-reported and this is a cross-sectional study.

CONCLUSIONS

Time spent on homework and stress could mediate the association between dyslexia and anxiety/depressive symptoms.

Insomnia Partially Mediates the Relationship of Occupational Stress with Mental Health Among Shift Working Nurses and Midwives in Polish Hospitals

PURPOSE

Insufficient sleep increases sensitivity to chronic stress and may be a precursor to the deterioration of mental health and the development of burnout. The aim of our study was to verify whether symptoms of insomnia mediate the relationship of occupational stress with mental health among nurses who work shifts.

MATERIALS AND METHODS

The analyses included 117 female nurses and midwives who work shifts. They filled in the 16-item Effort-Reward Imbalance Questionnaire (ERIQ) assessing occupational stress, the Insomnia Severity Index (ISI), the Patient Health Questionnaire (PHQ-9, the question about sleep was excluded from the analyses), the Generalized Anxiety Disorder Assessment (GAD-7), and the 16-item Oldenburg Burnout Inventory (OLBI) consisting of two scales - Disengagement and Exhaustion (OLBI-D and OLBI-E).

RESULTS

Insomnia partially mediated the association of the effort-reward imbalance ratio with depression, anxiety and the exhaustion dimension of burnout. We found no association of insomnia symptoms with the depersonalization dimension of burnout, but the effort-reward imbalance ratio was associated with the depersonalization scale.

CONCLUSION

The results showed that occupational stress has varying degrees of influence on mental health, partly depending on the severity of insomnia symptoms among nurses and midwives who work shifts.

The Effects of Research Activities on Biomedical Students' Mental Health: A National Cross-Sectional Study

Mental health disorders are prevalent among biomedical students, and scientific research is one of their main activities, yet less is known about the relationship between research activities and mental health among these students. The aim of this cross-sectional study was to assess the associations between research activities and mental health and to identify the potential risk factors for anxiety and depression among biomedical students in China. This study enrolled 1,079 participants between November 2020 and December 2020 from 29 Chinese provinces and collected participants' basic characteristics, work situations, scientific achievements, and potential stress sources via an online questionnaire. Anxiety and depression were evaluated by two widely used scales, the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), respectively. The study also assessed the associations between scientific research duration and mental health. Univariate and multivariate analyses were performed to identify the predictors of anxiety and depression. Among the participants, 39.02% scored as having moderate to severe anxiety, and 37.54% scored as having moderate to severe depression. When the Youden index reached its maximum, the optimal cutoff was 7.17 h for the GAD-7 and 6.83 h for the PHQ-9. After adjustment for confounders, a longer research work duration was significantly associated with a higher anxiety [odds ratio (OR) = 1.32, 95% confidence interval (CI): 1.21-1.44, p < 0.01] and depression (OR = 1.27, 95% CI: 1.17-1.39, p < 0.01). Of all the participants working for 7 h a day, 37.04% had already published at least one paper and 25.93% had at least one Science Citation Index paper. Anxiety and depression are common among biomedical students. The research work duration of 7 h a day is the best cutoff for mental health, and it is associated with acceptable scientific research achievements. Not more than 7 h a day on research is recommended for biomedical students to maintain a balance between mental health and scientific research achievements.

Psychometric Properties of the General Anxiety Disorders-7 Scale Using Categorical Data Methods: A Study in a Sample of University Attending Ethiopian Young Adults

BACKGROUND

Few studies have investigated the psychometric validation of the General Anxiety Disorders-7 Scale (GAD-7) using appropriate data assumptions. This study examined the reliability, factorial validity, divergent validity, and item analysis of the GAD-7 using categorical data methods in a sample of Ethiopian young adults.

METHODS

A sample of 270 students in the age group (18-20 years) was recruited during February-May of 2017 in this cross-sectional study using simple random sampling. The participants completed a tool for socio-demographic details, the GAD-7, and the Perceived Stress Scale-10 (PSS-10).

RESULTS

The cumulative variance rule (> 40%), the scree test, Kaiser's criteria (Eigenvalues > 1), and the parallel analysis found a 1-factor model for the GAD-7 (factor loadings, 0.38 to 0.63). Fit indices suggested a 1-factor model: the tests applied included the weighted root mean square residual (0.030), comparative fit index (1.000), the goodness of fit index (1.00), root mean square error of approximation (0.037) and the non-normed fit index (1.00). McDonald's Omega (0.772) implied that the scores had adequate internal consistency. Divergent validity was supported by significant but weak correlations that were found between the GAD-7 and PSS-10 scores (r = 0.11 to 0.25, p<0.05).

CONCLUSION

The psychometric validity of the GAD-7 in Ethiopian university attending young adults was supported by the categorical data method.