Relationship between subjective and objective fatigue and sleep characteristics in individuals with anxiety and mood disorders: An exploratory study

OBJECTIVE

Fatigue and sleep disturbances are important symptoms of anxiety and mood disorders (AMD). Studies about the relationship between these variables usually rely on self-report assessments. Therefore, the aim of our exploratory study was to investigate the independent correlations between subjective and objective fatigue and sleep characteristics in individuals with AMD.

METHODS

In sum, 233 individuals with AMD attending a stress-related disorders day care unit (78.5 % females, mean age 39.0 years old) participated in a cross-sectional study. Participants completed the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Multidimensional Fatigue Inventory-20, and Pittsburgh Sleep Quality Index self-report questionnaires, as well as an exercise capacity workload test for assessing objective fatigue and polysomnography monitoring for evaluation of sleep structure.

RESULTS

In individuals with AMD, exercise capacity workload was associated with lower percent of stage 1 sleep (β = - 0.17, p = 0.006), REM latency (β = -0.13, p = 0.042), and wake after sleep onset (β = -0.12, p = 0.039). General fatigue was associated with a higher percent of body movements (β = 0.12, p = 0.047), as well as mental fatigue was associated with a higher percent of body movements (β = 0.13, p = 0.029), and a higher score on the PSQI (β = 0.21, p = 0.002).

CONCLUSIONS

Objective sleep characteristics were associated with objective assessment of fatigue, while subjective sleep quality was associated with subjectively assessed mental fatigue.

Validation of the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 in Lithuanian individuals with anxiety and mood disorders

The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) are short self-report questionnaires used to screen and assess depression and anxiety severity in medical and community samples. However, little is known about their psychometric properties in individuals with anxiety and mood disorders (AMD) This study evaluated the psychometric properties of the PHQ-9 and GAD-7 in individuals with AMD. Individuals (n = 244, mean age 39.9 ± 12.3 years) with AMD completed the PHQ-9, GAD-7, as well as other measures of depression, anxiety, and a structured diagnostic interview. The PHQ-9 and GAD-7 demonstrated good internal consistency (Cronbach's alpha 0.87 and 0.84, respectively). The PHQ-9 and GAD-7 showed a weak correlation with clinician-rated scales HAM-D and HAM-A (r = 0.316, p < 0.01, r = 0.307, p < 0.01, respectively). For the PHQ-9, a cut score of ≥11 resulted in 72% sensitivity and 72% specificity at recognizing depression symptoms. For the GAD-7, a cut score ≥7 resulted in 73% sensitivity and 54% specificity at recognizing any anxiety disorders. The confirmatory factor analysis suggested a two-factor structure ("cognitive/affectional", "somatic") for both the PHQ-9 and GAD-7. In conclusion, the PHQ-9 and GAD-7 have adequate formal psychometric properties as severity measures for symptoms of anxiety and depression in individuals with AMD. The PHQ-9 performs well as a screener using a cut score of ≥11. However, the clinical utility of the GAD-7 as a diagnostic tool for recognition of anxiety disorders is limited.

Mental fatigue in individuals with psychiatric disorders: a scoping review

Objective: The aim of this study was to complete a scoping review of the published literature describing the relationship between mental fatigue and various psychiatric disorders, to better understand its frequency and clinical impact, and to provide recommendations for future clinical research.Methods: A scoping review using PubMed/MEDLINE, Cochrane and PsychArticles databases was conducted using the keywords 'mental fatigue', 'mental tiredness' or 'mental exhaustion', and completed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols Extension for Scoping Reviews 2018 checklist.Results: We extracted 10 studies fulfilling our inclusion criteria from a total of 2937 publications. Mental fatigue was studied within mood disorders, anxiety disorders, obsessive compulsive disorder and obsessive-compulsive personality disorder. A commonly used tool to measure mental fatigue in these samples was the Multidimensional Fatigue Inventory-20. Specific cognitive factors (unhelpful beliefs about sleep, symptom-focussed rumination) and personality risk factors (harm avoidance, self-directedness, cooperativeness, persistence) were relevant to predicting mental fatigue symptoms and rates of mental fatigue may vary with gender and diagnosis.Conclusion: Research into mental fatigue in adult psychiatric sample was limited to a few psychiatric disorders and requires further investigation.Key pointsA commonly used tool to measure mental fatigue was the Multidimensional Fatigue Inventory-20. However, more research into the validity and reliability for illness specific instruments to measure mental fatigue in psychiatric population is required.Reduction of mental fatigue was associated with improvement on quality of life.Specific cognitive factors (unhelpful beliefs about sleep, symptom-focussed rumination) and personality risk factors (harm avoidance, self-directedness, cooperativeness, persistence) were relevant to predicting mental fatigue symptoms and rates of mental fatigue may vary with gender.Reviewed articles indicated that mental fatigue presence was associated with lower odds of OCD. In addition, the results suggested that mental fatigue symptoms were more common in individuals with OCPD rather than OCD.Research into mental fatigue in adult psychiatric sample was limited to a few psychiatric disorders and requires further investigation to prevent potential misattribution as mental fatigue symptoms overlap between different psychiatric disorders.

Mental Health and Wellbeing in Lithuanian Medical Students and Resident Doctors During COVID-19 Pandemic

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has had a negative effect on mental health and subjective psychological wellbeing. One of the most affected population is medical students, reporting higher levels of depression, anxiety, sleep difficulties, and overall poorer wellbeing. However, the relationship between depression, anxiety, and sleep difficulties, and subjective psychological wellbeing has not been extensively researched in medical students in the context of COVID-19 pandemic. The aim of this study was to investigate the associations between depression, anxiety, and sleep quality, and subjective psychological wellbeing.

METHODS

In total, 524 medical students and resident doctors (78.6% female, mean age 24 ± 3 years old) participated in an online survey between December 2020 and February 2021. Participants completed the WHO-Five Wellbeing Index Questionnaire, the Pittsburgh Sleep Quality Index questionnaire, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder Assessment-7.

RESULTS

Multivariable logistic regression analysis showed that female participants' worse subjective psychological wellbeing was associated with sleep difficulties [odds ratio (OR) = 2.39, 95% CI = 1.37-4.18, p = 0.002], higher depression (OR = 6.13, 95% CI = 3.46-10.88, p < 0.001), and anxiety symptoms (OR = 2.95, 95% CI = 1.66-5.22, p < 0.001). In male participants, analysis revealed an association between worse subjective psychological wellbeing and higher depression scores (OR = 9.94, 95% CI = 3.29-30.03, p < 0.001).

CONCLUSION

Sex differences are an important factor to consider when evaluating subjective psychological wellbeing. Clinicians should be aware of significant contributors, such as sleep patterns anxiety, and depression, to subjective psychological wellbeing.