Socioeconomic Deprivation, Sleep Duration, and Mental Health during the First Year of the COVID-19 Pandemic

Impact of environmental and lifestyle factors on adolescent sleep health in urban and semiurban areas

OBJECTIVES

This study examines the impact of lifestyle factors on adolescent sleep health across urban and semiurban settings.

METHODS

A cross-sectional survey was conducted among 1459 adolescents aged 14-19years from Tabriz (urban) and Hadishahr (semiurban), two cities with contrasting environmental conditions. Sleep duration and sleep deprivation were assessed using self-reported data, alongside key sociodemographic, behavioral, and health-related factors.

RESULTS

The results showed that adolescents in urban area were significantly more likely to experience shorter sleep durations (OR=0.63, 95% CI [0.48, 0.83]) and sleep deprivation (OR=0.66, 95% CI [0.51, 0.85]) compared to those in semiurban environments. Age was positively associated with short sleep (OR=1.21, 95% CI [1.07, 1.38]), while smoking (OR=1.46, 95% CI [1.02, 2.08]) and chronic cough (OR=1.35, 95% CI [1.01, 1.80]) were also linked to reduced sleep duration. In contrast, semiurban residents slept an average of 20minutes longer than urban residents (β=0.34, 95% CI [0.17, 0.51]). Sleep deprivation was strongly associated with lower Parent's income (OR=0.78, 95% CI [0.61, 0.98]) and daytime fatigue (OR=1.58, 95% CI [1.26, 2.00]).

CONCLUSIONS

The study highlights the need for public health interventions that address environmental barriers to healthy sleep, particularly in urban settings, to mitigate the long-term health risks associated with sleep deprivation.

Health Care Utilization in an Academic Integrative Medicine Center, 2011-2022

Objectives: As empirical evidence about the efficacy and therapeutic benefits of integrative medicine grows and insurance coverage of services increases, patient demand for integrative medicine is likely to increase. Relatively few studies have looked at electronic health records (EHRs) data to understand utilization of integrative medicine services within "real-world" practice settings. This study's objective is to describe sociodemographic data and health care utilization for adults (age 18 or older) within a large regional health system from 2011 to 2022. Methods: The study design was a longitudinal cohort analysis using EHRs data for patients seen at an integrative medicine center from 2011 to 2022. Setting/Location: UCHealth Integrative Medicine Center ("the Center") within UCHealth, a not-for-profit health care system with hospitals and clinical facilities throughout Colorado, southern Wyoming, and western Nebraska. Participants: Adults 18 years or older at the time of care delivery seen at the Center from April 1, 2011, through December 31, 2022. Results: The Center provided 95,754 visits to 15,157 unique individuals from April 1, 2011, through December 31, 2022. The average number of individuals seen was 1,833 per year (Range 1,405-2,347). The cohort's mean age was 43 years; the majority were female (75%) and white (77.2%) with commercial insurance (87.1%). Medicare (29.6%) and Medicaid (19.7%) insurance were also relatively common. The Social Deprivation Index scores were distributed broadly across the cohort. The top three reasons for visits were chronic pain, mental/behavioral health conditions, and obesity. The most frequent visits were for acupuncture, massage, and physician/physician assistant services. A total of 1,586 health care professionals from 52 different specialties, both within and outside UCHealth, referred to the Center. Conclusion: This study describes a large cohort of adults seen for integrative medicine services and referral sources within a large regional health care system. Study findings have the potential to shape future integrative health care provision, education, research, and policy.

Socio-demographic variation in diagnosis of and prescribing for common mental illnesses among children and young people during the COVID-19 pandemic: time series analysis of primary care electronic health records

BACKGROUND

The impact of the COVID-19 pandemic on the mental health of children and young people (CYP) has been widely reported. Primary care electronic health records were utilised to examine trends in the diagnosing, recording and treating of these common mental disorders by ethnicity and social deprivation in Greater Manchester, England.

METHODS

Time-series analyses conducted using Greater Manchester Care Record (GMCR) data examined all diagnosed episodes of anxiety disorders and depression and prescribing of anxiolytics and antidepressants among patients aged 6-24 years. The 41-month observation period was split into three epochs: Pre-pandemic (1/2019-2/2020); Pandemic Phase 1 (3/2020-6/2021); Pandemic Phase 2 (7/2021-5/2022). Rate ratios for all CYP specific to sex, age, ethnicity, and neighbourhood-level Indices of Multiple Deprivation (IMD) quintile were modelled using negative binomial regression.

RESULTS

Depression and anxiety disorder rates were highest in females, CYP aged 19-24, and White and 'Other' ethnic groups. During Pandemic Phase 1, rates for these diagnoses fell in all demographic subgroups and then rose to similar levels as those recorded pre-pandemic. In Pandemic Phase 2, rates in Black and Mixed-ethnicity females rose to a significantly greater degree (by 54% and 62%, respectively) than those in White females. Prescribing rates increased throughout the study period, with significantly greater rises observed in non-White females and males. The temporal trends were mostly homogeneous across deprivation quintiles.

CONCLUSION

The observed fluctuations in frequency of recorded common mental illness diagnoses likely reflect service accessibility and patients' differential propensities to consult as well as changing levels of distress and psychopathology in the population. However, psychotropic medication prescribing increased throughout the observation period, possibly indicating a sustained decline in mental health among CYP, and also clinicians' responses to problems presented. The comparatively greater increases in frequencies of diagnosis recording and medication prescribing among ethnic minority groups warrants further investigation.

Mental health, substance use, and a composite of sleep health in adults, 2018 Ohio behavioral risk factor surveillance system

OBJECTIVES

Various factors impact sleep health including mental health and substance use. Mental health issues and substance use continue to rise in the United States. Yet, the association between mental health, substance use and sleep health in adults remains unclear.

METHODS

We used multivariable linear regression models to examine the associations between mental health (poor mental health days in the past 30 days) and substance use (marijuana, tobacco, alcohol) with sleep health (individual dimensions of sleep: alertness, sleep efficiency, duration, and sleep health composite score) in 4333 participants from the 2018 Ohio Behavioral Risk Factor Surveillance System Survey.

RESULTS

Better mental health was associated with higher alertness, higher sleep efficiency, longer sleep duration and a higher sleep health composite score even after controlling for covariates (individual: sex at birth, age, body mass index, race, education, sleep disordered breathing, and area-level: socioeconomic deprivation) (all p < .001). Higher marijuana and tobacco use were associated with lower individual sleep health dimensions (marijuana with sleep efficiency and duration and tobacco use with lower efficiency) and a lower sleep health composite score even after controlling for covariates for tobacco use (p < .001). Contrary to the hypothesis, higher alcohol use was associated with higher alertness and a higher sleep health composite score (p < .001), however after adjusting for covariates these associations were no longer significant.

CONCLUSIONS

The implications of these trends on sleep health are important to address as mental health and substance use are modifiable targets to consider when addressing sleep health.

The effects of sleep on body image: examining the roles of depression, perceived stress, and anxiety

Objective: Although health and wellness behaviors are associated with positive body image, research is limited regarding the relationship between sleep and positive body image. We propose that negative affective states may link sleep and body image. Specifically, we examined whether better sleep may relate to positive body image through reductions in negative affective experiences. Participants: Participants were 269 undergraduate women. Methods: Cross-sectional surveys were administered. Results: We found correlations in the expected directions between sleep, positive body image variables (i.e., body appreciation, appearance evaluation, and appearance orientation), and negative affective states (i.e., depression, anxiety, and stress). There were group differences in negative affective states and body image based on adequate sleep. Data supported indirect effects of sleep through depression on appearance evaluation, and through depression and stress on body appreciation, respectively. Conclusions: Our findings indicate sleep warrants further research attention as a wellness behavior related to more positive body image.

Tele-Mental Health Service: Unveiling the Disparity and Impact on Healthcare Access and Expenditures during the COVID-19 Pandemic in Mississippi

During the COVID-19 pandemic, tele-mental health (TMH) was a viable approach for providing accessible mental and behavioral health (MBH) services. This study examines the sociodemographic disparities in TMH utilization and its effects on healthcare resource utilization (HCRU) and medical expenditures in Mississippi. Utilizing a cohort of 6787 insured adult patients at the University of Mississippi Medical Center and its affiliated sites between January 2020 and June 2023, including 3065 who accessed TMH services, we observed sociodemographic disparities between TMH and non-TMH cohorts. The TMH cohort was more likely to be younger, female, White/Caucasian, using payment methods other than Medicare, Medicaid, or commercial insurers, residing in rural areas, and with higher household income compared to the non-TMH cohort. Adjusting for sociodemographic factors, TMH utilization was associated with a 190% increase in MBH-related outpatient visits, a 17% increase in MBH-related medical expenditures, and a 12% decrease in all-cause medical expenditures (all p < 0.001). Among rural residents, TMH utilization was associated with a 205% increase in MBH-related outpatient visits and a 19% decrease in all-cause medical expenditures (both p < 0.001). This study underscores the importance of addressing sociodemographic disparities in TMH services to promote equitable healthcare access while reducing overall medical expenditures.

Neighborhood-level social determinants of health measures independently predict receipt of living donor liver transplantation in the United States

Disparities exist in the access to living donor liver transplantation (LDLT) in the United States. However, the association of neighborhood-level social determinants of health (SDoH) on the receipt of LDLT is not well-established. This was a retrospective cohort study of adult liver transplant recipients between January 1, 2005 and December 31, 2021 at centers performing LDLT using the United Network for Organ Sharing database, which was linked through patients' ZIP code to a set of 24 neighborhood-level SDoH measures from different data sources. Temporal trends and center differences in neighborhood Social Deprivation Index (SDI), a validated scale of socioeconomic deprivation ranging from 0 to 100 (0=least disadvantaged), were assessed by transplant type. Multivariable logistic regression evaluated the association of increasing SDI on receipt of LDLT [vs. deceased donor liver transplantation (DDLT)]. There were 51,721 DDLT and 4026 LDLT recipients at 59 LDLT-performing centers during the study period. Of the 24 neighborhood-level SDoH measures studied, the SDI was most different between the 2 transplant types, with LDLT recipients having lower SDI (ie, less socioeconomic disadvantage) than DDLT recipients (median SDI 37 vs. 47; p < 0.001). The median difference in SDI between the LDLT and DDLT groups significantly decreased from 13 in 2005 to 3 in 2021 ( p = 0.003). In the final model, the SDI quintile was independently associated with transplant type ( p < 0.001) with a threshold SDI of ~40, above which increasing SDI was significantly associated with reduced odds of LDLT (vs. reference SDI 1-20). As a neighborhood-level SDoH measure, SDI is useful for evaluating disparities in the context of LDLT. Center outreach efforts that aim to reduce disparities in LDLT could preferentially target US ZIP codes with SDI > 40.

The Intersection of Health Literacy and Public Health: A Machine Learning-Enhanced Bibliometric Investigation

In recent decades, health literacy has garnered increasing attention alongside a variety of public health topics. This study aims to explore trends in this area through a bibliometric analysis. A Random Forest Model was utilized to identify keywords and other metadata that predict average citations in the field. To supplement this machine learning analysis, we have also implemented a bibliometric review of the corpus. Our findings reveal significant positive coefficients for the keywords "COVID-19" and "Male", underscoring the influence of the pandemic and potential gender-related factors in the literature. On the other hand, the keyword "Female" showed a negative coefficient, hinting at possible disparities that warrant further investigation. Additionally, evolving themes such as COVID-19, mental health, and social media were discovered. A significant change was observed in the main publishing journals, while the major contributing authors remained the same. The results hint at the influence of the COVID-19 pandemic and a significant association between gender-related keywords on citation likelihood, as well as changing publication strategies, despite the fact that the main researchers remain those who have been studying health literacy since its creation.

Aptitude measurement: is measurement validity compromised in the morning

The purpose of the present study was to evaluate the reliability and validity of the General Aptitude Test (GAT), a national instrument for the measurement of aptitude/achievement in the Kingdom of Saudi Arabia as a function of daytime testing. Participants were 722 students who took on the GAT across morning and evening administrations in a within-person pre-post design. Participants were matched for gender, parental education, and test center characteristics (i.e., size). The GAT was tested for its psychometric properties and its measurement invariance across time of day. Results pointed to a significant misfit using an exact invariance protocol. Specifically, there was a large number of non-invariant items pointing to Differential Item Functioning (DIF). Second, internal consistency reliabilities were consistently lower during morning testing compared to evening testing as evidenced using both statistical and visual means. Concerns about dimensionality were also raised for the morning compared to the evening administration. Last, comparison of performance levels indicated that morning testing was associated with significant decrements in performance across all domains compared to performance levels during evening testing. The results have implications for the validity of measurement and public testing policy if test validity during morning administration is compromised.