The Bidirectional Associations Between Insomnia and Psychotic-Like Experiences Before and During the COVID-19 Pandemic

Longitudinal relationship between internet addiction and psychotic-like experiences among Chinese college students

BACKGROUND

While previous cross-sectional studies have suggested a link between psychotic-like experiences (PLEs) and internet addiction (IA), longitudinal evidence remains scarce. This study aimed to explore the prospective relationship between IA and PLEs among college students.

METHOD

A total of 636 college students (80 % female) were assessed in November 2022 and again one year later. IA was measured using the Internet Addiction Diagnosis Questionnaire (IADQ), and PLEs were assessed with the 16-item Prodromal Questionnaire (PQ-16). Demographic, psychological, and environmental factors were collected and controlled. Multiple logistic regression and cross-lagged panel analyses examined the longitudinal associations between IA and PLEs.

RESULTS

At baseline, the prevalence of IA and PLEs was 11.3 % and 16.8 %, respectively. Higher baseline IADQ scores (Adjusted odds ratio = 1.035; 95 % confidence interval = 1.002-1.069; p = 0.036) were independently associated with an increased risk of PLEs at follow-up, while baseline PQ-16 scores were not linked to later IA. Cross-lagged panel analysis revealed that IA at baseline predicted later PLEs (β = 0.082, p = 0.043), whereas baseline PLEs did not predict IA (β = 0.049, p = 0.255). Specifically, IA predicted unusual thoughts (β = 0.122, p = 0.003) and negative PLEs (β = 0.111, p = 0.008), but not perceptual abnormalities (β = 0.040, p = 0.301).

CONCLUSION

IA may be an independent risk factor for PLEs in college students, particularly for unusual thoughts and negative PLEs, but not for perceptual abnormalities. Targeted interventions addressing IA may help reduce PLEs.

Bidirectional associations between short sleep duration, insomnia symptoms, and psychotic-like experiences in adolescents

This study investigates the prospective associations between short sleep duration, insomnia symptoms, and psychotic-like experiences (PLEs) in a large sample of Chinese adolescents. This study utilized a three-timepoint repeated cross-sectional survey with two nested longitudinal subsamples. A total of 17,722 adolescents were assessed at baseline (April 21 to May 12, 2021) and six months later (December 17 to 26, 2021). Out of these, 15,694 adolescents provided complete responses to the questions at baseline and one year later (May 17 - June 6, 2022). A self-administered questionnaire was used to measure sample characteristics (at baseline), sleep duration, insomnia symptoms, and PLEs (at each assessment), and negative life events (at two follow-ups). Baseline short sleep duration and insomnia symptoms predicted frequent PLEs at both follow-up assessments. Additionally, baseline frequent PLEs also predicted insomnia symptoms at six months and one year later. However, when controlling for confounders, PLEs at baseline only predicted short sleep duration at six months, and not at one year. This study reveals bidirectional prospective relationships between short sleep duration, insomnia symptoms, and PLEs, even after controlling for covariates. Therefore, it is crucial to assess both sleep patterns and PLEs in order to promote optimal sleep and mental health among adolescents.

Association of Anxiety/Depressive Symptoms with Psychotic-like Experiences: The Moderation Effect of Sex and Resilience

BACKGROUND

Psychotic-like experiences (PLEs) are a part of the continuum of psychosis and are common in the general population. While most of these experiences are transient, they are strongly correlated with an increased risk of various adverse psychological outcomes. Anxiety and depressive symptoms also occur frequently in the adolescent population. Much research has previously demonstrated a correlation between these two symptoms and PLEs. However, few investigations have examined what influences this association, and sex and resilience may be important moderators.

METHODS

This study selected a sample of first-year students from a university in Shanghai. A total of 2970 adolescents completed questionnaires measuring sociodemographic characteristics, anxiety/depressive symptoms by SCL-90, resilience by CD-RISC, and self-reported PLEs by PQ-16.

RESULTS

The findings indicated that PLEs were prevalent in the sample, with at least one PQ-16 item present in 42.5% of individuals. Anxiety/depressive symptoms were significantly associated with PLEs, and there was a sex difference in this association (p < 0.001). What is more, this relationship was stronger in males than in females. Additionally, we found a significant interaction (p < 0.001) between resilience and anxiety/depressive symptoms when looking at the correlates of PLEs. Those with stronger resilience showed a considerably weaker connection between PLEs and symptoms of anxiety and depression.

CONCLUSIONS

These findings can potentially inform the development of targeted new clinical interventions.

Internal consistency and temporal stability of the Community Assessment of Psychic Experiences (CAPE): A reliability generalization meta-analysis

Psychotic experiences (PE) are prevalent in general and clinical populations and can increase the risk for mental disorders in young people. The Community Assessment of Psychic Experiences (CAPE) is a widely used measure to assess PE in different populations and settings. However, the current knowledge on their overall reliability is limited. We examined the reliability of the CAPE-42 and later versions, testing the role of age, sex, test scores, and clinical status as moderators. A systematic search was conducted on the Scopus, Web of Science, PubMed, EBSCOhost, ProQuest, and GoogleScholar databases. Internal consistency and temporal stability indices were examined through reliability generalization meta-analysis (RGMA). Moderators were tested through meta-regression analysis. From a pool of 1,015 records, 90 independent samples were extracted from 71 studies. Four versions showed quantitative evidence for inclusion: CAPE-42, CAPE-20, CAPE-P15, and CAPE-P8. Internal consistency indices were good (α/ω≈.725-0.917). Temporal stability was only analyzed for the CAPE-P15, yielding a moderate but not-significant effect (r=0.672). The evidence for temporal stability is scant due to the limited literature, and definitive conclusions cannot be drawn. Further evidence on other potential moderators such as adverse experiences or psychosocial functioning is required.

Psychotic-Like Experiences and Suicidal Ideation Among Adolescents: The Chain Mediating Role of Insomnia Symptoms and Resilience

Background

Individuals who experience psychotic-like experiences (PLEs) are at significant risk of suicide-related behaviors. This two-wave longitudinal study aimed to investigate the relationships among PLEs, insomnia symptoms, resilience, and suicidal ideation (SI) among adolescents.

Methods

A total of 2231 college students [mean age (standard deviation) = 20.02 (1.39) years] completed two web-based surveys. Participants completed self-report measures of sample characteristics, PLEs, insomnia symptoms, resilience, and SI.

Results

The findings indicated a significantly positive correlation between PLEs and SI that was sequentially mediated by insomnia symptoms and resilience. Furthermore, insomnia symptoms and resilience played a chain-mediating role between PLEs and adolescent SI.

Conclusion

These findings suggest potential mechanism for the PLEs-SI link, which helps us better understand how PLEs can influence individual SI and provides important information for early prevention.

The predictive role of psychotic-like experiences in suicidal ideation among technical secondary school and college students during the COVID-19 pandemic

BACKGROUND

Previous research has shown the strong association between psychotic-like experiences (PLEs) and suicide. However, the predictive role of PLEs in suicidal ideation (SI) during the COVID-19 pandemic remains unclear.

AIMS

This study aimed to explore the association between PLEs before the pandemic and SI during the pandemic among late adolescents.

METHODS

A total of 938 technical secondary school and college students completed both waves of the online survey before and during the pandemic. PLEs were assessed through the 15-item Positive Subscale of the Community Assessment of Psychic Experiences. SI was evaluated by the frequency of SI during the pandemic.

RESULTS

In early stage of the pandemic, most students had low frequent SI, and only 3.3% students showed high frequent SI. Compared to the low frequent group, the high frequent group exhibited significantly higher levels of PLEs (p < 0.001) and scored lower in resilience (p = .001) and perceived social support (p = .008) across the two timepoints. PLEs were significantly associated with higher risk of high frequent SI (OR = 2.56, 95%: 1.07-6.13), while better resilience (OR: 0.93, 95% CI: 0.88-0.99) and stronger perceived social support (OR: 0.96, 95% CI: 0.93-0.99) appeared to be protective factors. No interactions were found among PLEs and other psychosocial and psychological factors.

CONCLUSIONS

PLEs may increase the risk of SI in early stage of the pandemic, while good resilience and adequate social support can help weaken the risk.

Incidence and Persistence of Psychotic Experiences in the General Population: Systematic Review and Meta-Analysis

BACKGROUND AND HYPOTHESIS

Psychotic experiences (PEs) are associated with increased risk for mental disorders, in particular persistent PEs. PEs therefore might be useful within intervention research. We sought to systematically determine the incidence and persistence of PEs in the general population.

STUDY DESIGN

A double-blind search of databases (Embase, Pubmed PMC, Psychinfo, Medline, and Web of Science) from inception to January 2023 and data extraction, were conducted. Study quality was assessed using the NIH assessment tool. Random effects models were conducted to calculate pooled incidence rate per person-year and proportion of persistent PEs per year. Age and study design were all examined using subgroup analyses. Demographic, risk factors, and outcomes for incidence and persistence of PEs were reported in a narrative synthesis.

STUDY RESULTS

Using a double-blind screening method for abstract (k = 5763) and full text (k = 250) were screened. In total 91 samples from 71 studies were included, of which 39 were included in a meta-analysis (incidence: k = 17, n = 56 089; persistence: k = 22, n = 81 847). Incidence rate was 0.023 per person-year (95% CI [0.0129;0.0322]). That is, for every 100 people, 2 reported first onset PEs in a year. This was highest in adolescence at 5 per 100(13-17 years). The pooled persistence rate for PEs was 31.0% (95% CI [26.65,35.35]) This was highest in adolescence at 35.8%. Cannabis was particularly associated with incidence of PEs, and persistence of PEs were associated with multiple mental disorders.

CONCLUSIONS

Each year incidence of PEs is 2 of every 100 people, and persists each year in 31% of cases, this risk is highest in adolescents.

A latent profile analysis of sleep disturbance in relation to mental health among college students in China

Aims

This study aimed to examine the subtype classification characteristics of sleep disturbance (SD) in college students and their associations with sample characteristic factors and mental health outcomes.

Methods

The sample comprised 4,302 college students (Mean age = 19.92 ± 1.42 years, 58.6% females). The Youth Self-Rating Insomnia Scale, Beck Depression Inventory, 8-item Positive Subscale of the Community Assessment of Psychic Experiences, and 10-item Connor-Davidson Resilience Scale were used to assess adolescents' sleep disturbance, depressive symptoms, psychotic-like experiences (PLEs), and resilience. Latent profile analysis, logistic regression, and liner regression analysis were used to analyze the data.

Results

Three subtypes of SD in college students were identified: the high SD profile (10.6%), the mild SD profile (37.5%), and the no SD profile (51.9%). Compared with college students in the "no SD" profile, risk factors for "high SD" include being male and poor parental marital status. Sophomores were found to predict the "high SD" profile or "mild SD" profile relative to the "no SD" profile. College students in the "mild SD" profile or "high SD" profile were more likely to have a higher level of depressive symptoms and PLEs, while a lower level of resilience.

Conclusion

The findings highlighted that target intervention is urgently needed for male college students, sophomores, and those with poor parental marital status in the "mild SD" profile or "high SD" profile.

Mediation effect of insomnia symptoms between positive psychotic like experiences and suicidal ideation among Lebanese young adults

BACKGROUND

Psychotic symptoms reported by healthy individuals in the general population are referred to as psychotic-like experiences (PLEs) and have been proven to increase the risk of suicidal ideation (SI) in these individuals. As it is well established that PLEs and insomnia share a bidirectional association and also that insomnia is linked to SI, we hypothesized that insomnia may represent a mediator underlying the relationship between PLEs and SI. Our aim was to validate this hypothesis among Lebanese young adults.

METHODS

A total of 3103 young adults (mean age 21.73 ± 3.80 years; 63.6% females) recruited from all Lebanese governorates completed a self-administered online questionnaire. PLEs were assessed using the CAPE-42 scale, SI using the Columbia Suicide Rating Scale, and insomnia using the Insomnia Severity Index). We conducted a mediation analysis using SPSS PROCESS v3.4 model 4 with three pathways. Variables that showed a p < 0.25 in the bivariate analysis were entered in the path analysis.

RESULTS

A total of 1378 participants (44.4%) had insomnia; 18.8% had SI; 42.5% reported at least one positive PE 'nearly always', and 30.5% reported at least one negative PE with this frequency. The results of the mediation analysis showed that insomnia severity partially mediated the association between positive dimension and SI; higher positive dimension was significantly associated with more insomnia severity, which was, in turn, significantly associated with more SI. Finally, more positive dimension was significantly and directly associated with more SI.

CONCLUSION

These preliminary findings might encourage the implementation of new preventive measures to reduce SI among PLEs patients. Treating symptoms of insomnia might help reduce the risk of suicide.

Potential mechanisms between psychotic-like experiences and suicidal ideation in the context of COVID-19: A longitudinal study

OBJECTIVE

Although many studies have found an association between psychotic-like experiences (PLEs) and suicidal ideation (SI), the underlying psychological mechanisms have not been well established. Therefore, we conducted a longitudinal study in technical secondary school and college students to explore the role of fear-response to the COVID-19 and depression in the association between PLEs and SI in the context of the COVID-19 pandemic.

METHODS

PLEs were assessed using the 15-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-P15). Depression, fear, and SI were assessed using the Psychological Questionnaire for Public Health Emergency (PQPHE). PLEs were evaluated before the pandemic (T1), and fear, depression, and SI were measured during the pandemic (T2).

RESULT

A total of 938 students completed both waves of the survey through electronic questionnaires. PLEs, fear, depression, and SI were all correlated with each other (all p < 0.01). T2 depression partly (58.2 %) mediated the relationship between T1 PLEs and T2 SI (b = 0.15, 95%CI = 0.10, 0.22). T2 Fear moderated the relationship between T1 PLEs and T2 depression (b = 0.05, 95%CI = 0.01, 0.09) and the relationship between T1 PLEs and T2 SI (b = 0.11, 95%CI = 0.06, 0.16).

CONCLUSION

PLEs are both directly and indirectly related to SI. Depression can result from PLEs and lead to the subsequent SI. Additionally, high levels of fear during the COVID-19 pandemic can aggravate the adverse impact of PLEs on mental health problems. These findings provide potential targets for future suicide prevention.

Sleep disturbance is predictive of psychotic-like experiences among adolescents: A two-wave longitudinal survey

PURPOSE

Psychotic-like experiences (PLEs) are prevalent among adolescents and are the most significant predictor of future mental disorders. This study aims to examine the cross-sectional and longitudinal associations between sleep disturbance and PLEs in a large cohort of adolescents.

METHODS

The 17,722 adolescents in our study were assessed from April 21 to May 12, 2021 (Time 1, T1) and again 6 months later from December 17 to 26, 2021 (Time 2, T2). The Youth Self Rating Insomnia Scale and 8-item Positive Subscale of the Community Assessment of Psychic Experiences were used to assess sleep and PLEs, respectively. Sample characteristics and depression were also evaluated at T1, and negative life events were measured at T2. Sleep duration ≤6 h per night was considered as sleep deprivation, and sleep disturbance was defined as having insomnia or poor sleep quality.

RESULTS

The prevalence of sleep disturbance and frequent PLEs at T1 were 14.1% and 14.5%, respectively. Sleep disturbance and sleep deprivation at T1 were significantly associated with increased risk for PLEs at T2 after adjusting for sample characteristics, depression, and negative life events. Furthermore, sleep disturbance and sleep deprivation also predicted the new onset and persistence of PLEs.

CONCLUSION

Sleep disturbance predicts the development and persistence of PLEs. Early assessment and treatment of sleep disturbance may therefore contribute to a comprehensive strategy for the successful prevention and treatment of PLEs in adolescents.

Prevalence and risk factors of self-reported psychotic experiences among high school and college students: A systematic review, meta-analysis, and meta-regression

BACKGROUND

Adolescents are at high risk of incident psychopathology. Fleeting psychotic experiences (PEs) that emerge in young people in response to stress may be warning signs that are missed by research that fails to study stressed populations, such as late high school and college/university students. Our aim in this systematic review was to conduct a meta-analysis that estimates prevalence rates of PEs in students, and to assess whether these rates differ by gender, age, culture, and COVID-19 exposure.

METHOD

We searched nine electronic databases, from their inception until January 31, 2022 for relevant studies. We pooled the estimates using the DerSimonian-Laird technique and random-effects meta-analysis. Our main outcome was the prevalence of self-reported PEs in high school and college/university students. We subsequently analyzed our data by age, gender, population, country, culture, evaluation tool, and COVID-19 exposure.

RESULTS

Out of 486 studies retrieved, a total of 59 independent studies met inclusion criteria reporting 210' 024 students from 21 different countries. Nearly one in four students (23.31%; 95% CI 18.41%-29.05%), reported having experienced PEs (heterogeneity [Q = 22,698.23 (62), p = 0.001] τ2  = 1.4418 [1.0415-2.1391], τ = 1.2007 [1.0205-1.4626], I2  = 99.7%, H = 19.13 [18.59-19.69]). The 95% prediction intervals were 04.01%-68.85%. Subgroup analyses showed that the pooled prevalence differed significantly by population, culture, and COVID-19 exposure.

CONCLUSION

This meta-analysis revealed high prevalence rates of self-reported PEs among teen and young adult students, which may have significance for mental health screening in school settings. An important realization is that PEs may have very different mental health meaning in different cultures.

Has the "Double Reduction" policy relieved stress? A follow-up study on Chinese adolescents

PURPOSE

"Double Reduction" Policy requires schools to reduce the burden of excessive homework and off-campus training for Chinese students to reduce their academic stress and promote mental health. We conducted a study in compulsory education students before and after the "Double Reduction" Policy to explore changes in mental health problems and relevant influential factors.

METHODS

A total of 28,398 elementary and junior high school students completed both waves of the survey through electronic questionnaires. Depressive symptoms were assessed using the Patient Heath Questionnaire (PHQ-9), and anxiety symptoms were assessed using the Generalized Anxiety Disorder Scale (GDA-7). Demographic information was evaluated at baseline, and "Double Reduction" related factors and negative life events were measured at follow up.

RESULTS

The overall depression and anxiety levels significantly decreased after the "Double Reduction" Policy. Girls, poor parental marital quality, chronic physical illness, and psychiatric family history were related to increased occurrence of mental health. Sleep duration > 8 h/night, reduced homework, more extracurricular activities more time with parents, and reduced academic stress were protective factors against mental health problems.

CONCLUSIONS

The "Double Reduction" Policy has improved the mental health symptoms of students to a certain extent. Appropriately increasing sleep time, participating in more extracurricular activities and parental involvement, and reducing the burden of homework are effective ways to promote the development of students' mental health.