Healthcare Workers and Patient Loss During the COVID-19 Pandemic: Interaction Between Grief, Viral Anxiety, and Depression.

OBJECTIVE: Coronavirus disease-2019 (COVID-19) had a significant impact on the mental health of healthcare workers. Related assessments should be included in plans for future pandemics. We investigated the connections between grief, viral anxiety, depression, and preoccupation in the context of COVID-19 in healthcare workers, to determine which factors will need to be incorporated. METHODS: A total of 267 healthcare workers who had experienced the death of at least one patient during the COVID-19 pandemic were asked to respond to questionnaires assessing grief, viral anxiety, depression, loneliness, and preoccupation with COVID-19, based on their emotional state during the 2 weeks immediately after the death. Multivariate linear regression, causal mediation analysis and structural equation modeling were used to examine the psychological processes underlying grief. RESULTS: Linear regression showed that viral anxiety (ß=0.287, 95% confidence interval [CI]: 0.235-0.338, p<0.001) and depression (ß= 0.157, 95% CI: 0.073-0.241, p<0.001) had independent associations with preoccupation with COVID-19. Causal mediation analysis revealed that both viral anxiety (proportion mediated: 0.51, 95% CI: 0.37-0.66, p<0.001) and depression (proportion mediated: 0.77, 95% CI: 0.50-1.08, p<0.001) were mediators between grief and preoccupation with COVID-19. In a structural equation model, viral anxiety and depression mediated most of the effects of grief on preoccupation with COVID-19, and loneliness was a mediator between grief and depression. CONCLUSION: Contingency plans for the next pandemic are being formulated. Effective measures to protect the mental health of healthcare workers should be included, and such measures should consist of assessments for grief, viral anxiety, depression, and loneliness.

Viral Anxiety, Reassurance-Seeking Behavior, and Depression Mediate the Influence of Dysfunctional Self-Focus on Preoccupation With COVID-19 Among Infected Cases.

OBJECTIVE: Amid the coronavirus disease 2019 (COVID-19) pandemic, the pervasive threat of infection has heightened public and individual health concerns. In the context of instability, although the dysfunctional aspect of self-focus was prominent, preoccupation with viral infection was greater. This study explored the applicability of a cognitive-behavioral model of hypochondriasis to individuals infected with COVID-19 and assessed whether dysfunctional self-focus were associated with the development of preoccupation. METHODS: An anonymous online survey was conducted via a professional survey platform in December 2022. Participants' clinical characteristics and responses to rating scales were collected, including Obsession with COVID-19 Scale (OCS), Coronavirus Reassurance-Seeking Behaviors Scale (CRBS), Stress and Anxiety to Viral Epidemic-6 items (SAVE-6), Patient Health Questionnaire-2 items (PHQ-2), and Dysfunctional Self-focus Attributes Scale (DSAS). RESULTS: Among the 265 participants, preoccupation with COVID-19 was predicted using CRBS (ß=0.60, p<0.001), SAVE-6 (ß=0.20, p=0.007), and PHQ-2 (ß=0.13, p<0.001) scores. Mediation analysis revealed that viral anxiety influenced this COVID-19 preoccupation, with the relationship mediated by coronavirus reassurance-seeking behavior. Another analysis indicated that dysfunctional self-focus had a significant total effect on preoccupation with COVID-19. However, its direct impact was statistically insignificant, with the association primarily influenced by three mediating factors: viral anxiety, depression, and reassurance-seeking behavior. CONCLUSION: Preoccupation with coronavirus is influenced by viral anxiety, depression, and reassurance-seeking behavior. Two mediation analyses showed that the application of the cognitive-behavioral model of hypochondriasis is feasible among COVID-19-infected cases and the association of dysfunctional self-focus with mediating factors. This finding highlights the need for personalized psychological support in managing COVID-19 cases.

Examining the Effect of Sleep Hygiene Education Given to Nursing Students on Sleep Quality.

BACKGROUND: The study aimed to ascertain the effect of sleep hygiene training on nursing students' sleep quality. METHODS: The research study group consisted of 80 nursing students studying in the nursing department. A quasi-experimental model with a pretest-posttest control group was used. Sleep hygiene training was given to nursing students in the experimental group. The sociodemographic data form for nurse students and the Pittsburg Sleep Quality Index (PSQI) were used to collect data. The t-test for independent groups was used to compare the PSQI pre-test and post-test scores of the experimental and control groups, and the dependent group t-test was used to compare the PSQI pre-test and post-test scores within groups. RESULTS: There was a difference in the sleep-related data of the nursing students in the experimental and control groups and between the PSQI pretest and posttest score averages according to the groups. No significant difference between the pre-test and post-test mean scores was observed in the control group for subjective sleep quality, sleep duration, sleep disturbance, and daytime dysfunction. CONCLUSIONS: Sleep hygiene education helps nursing students develop regular sleep behaviors.

Discrepancy Between Desired Time in Bed and Desired Total Sleep Time, Insomnia, Depression, and Dysfunctional Beliefs About Sleep Among a Clinical Sample of Patients With Insomnia.

OBJECTIVE: This study investigated whether the discrepancy between desired time in bed and desired total sleep time (DBST) index could be a meaningful indicator for assessing insomnia severity in a clinical sample of patients with insomnia. Furthermore, we sought to identify the mediators of the association between DBST and insomnia severity in individuals with insomnia. METHODS: We collected the medical records of 127 patients with insomnia. Each participant's DBST index was calculated using sleep indices, including time and duration variables. Psychological symptoms were investigated using the Insomnia Severity Index (ISI), Patients Health Questionnaire-9 items (PHQ-9), Generalized Anxiety Disorder-7, Dysfunctional Beliefs and Attitudes about Sleep-16 items (DBAS-16), and Epworth Sleepiness Scale. RESULTS: The DBST index was significantly correlated with the ISI (r=0.20, p<0.05), desired total sleep time (r=-0.52, p<0.001), and desired time in bed (r=0.32, p<0.01). Linear regression analysis revealed that insomnia severity was associated with age (ß=-0.18, p=0.018), DBST (ß=0.23, p=0.003), PHQ-9 (ß=0.23, p=0.031), and DBAS-16 (ß=0.42, p<0.001). The DBST directly influenced insomnia severity, although indirect effects of mediators were not significant. CONCLUSION: The DBST index directly influenced insomnia severity regardless of the mediating effects of psychological factors among a clinical sample of patients with insomnia. This finding implies that the DBST index can be a simple measure of insomnia severity, even among patients with insomnia.

Preoccupation with sleep and dysfunctional beliefs about sleep mediate the influence of psychological inflexibility on insomnia in the older adult population.

INTRODUCTION: This study aimed to explore whether the Discrepancy between the desired time in Bed and the desired total Sleep Time (DBST) index influences insomnia severity in the older adult population and examined the potential role of psychological inflexibility in this association. METHODS: An online survey study was conducted for older individuals aged ≥ 65 via a survey company between January and February 2023. A total of 300 responses and data without personally identifiable information were delivered to the researchers. The survey questionnaires include the DBST, Glasgow Sleep Effort Scale (GSES), Insomnia Severity Index (ISI), Dysfunctional Beliefs about Sleep-2 items (DBS-2), and Acceptance and Action Questionnaire-II (AAQ-II). RESULTS: The analysis included 295 older adult participants. The DBST index was significantly correlated with all questionnaires. Linear regression revealed the DBST index was predicted only by the ISI (ß = 0.26, p = 0.003). Mediation analysis showed that the GSES (Z = 2.92, p = 0.003) and DBS-2 (Z = 2.17, p = 0.030) mediated the effect of the DBST index on the ISI, while the AAQ-II did not. Path analysis showed that the DBST could be directly predicted by the ISI (Z = 2.94, p = 0.003), GSES (Z = 2.75, p = 0.006), and DBS2 (Z = 2.71, p = 0.007) but not by the AAQ-II itself. However, the AAQ-II exerted a significant indirect effect on the ISI through the DBS-2 (Z = 2.21, p = 0.027) and GSES (z = 2.24, p = 0.025). CONCLUSIONS: Our study showed that preoccupation and dysfunctional beliefs about sleep may mediate the relationship between the DBST index and insomnia severity in the older adult population. We opine that psychological inflexibility might play a significant role in insomnia severity via preoccupation with and dysfunctional beliefs about sleep.

Validation of Shortened Forms of Metacognition Questionnaire-Insomnia and Its Feasibility in the Discrepancy-Cognitive Arousal Model of Insomnia Among Patients With Cancer.

OBJECTIVE: We aimed to explore the reliability and validity of the two shortened versions of the Metacognition Questionnaire-Insomnia (Metacognition Questionnaire-Insomnia-6 items [MCQI-6], Metacognition Questionnaire-Insomnia-14 items [MCQI-14]) among patients with cancer and examine the feasibility of the Discrepancy-Cognitive Arousal (DCA) model of insomnia among the cancer patients. METHODS: A total of 154 patients with cancer were enrolled in this survey, which included rating scales such as the discrepancy between desired time in bed and desired total sleep time (DBST) index, Insomnia Severity Index (ISI), Cancer-related Dysfunctional Beliefs and Attitude about Sleep-14 items (C-DBAS-14), MCQI-6, and MCQI-14. RESULTS: Both the MCQI-6 and MCQI-14 showed a good reliability of internal consistency. Confirmatory factor analysis showed a good model fit for two single-factor shortened versions. The total score of the MCQI-6 was significantly correlated with the MCQI-14 (r=0.97, p<0.01), ISI (r=0.68, p<0.01), C-DBAS-14 (r=0.78, p<0.01), and DBST index (r=0.21, p<0.05). Mediation analysis showed that the DBST index did not directly influence insomnia severity; however, the relationship was mediated by cancer-related dysfunctional beliefs about sleep and sleep-related metacognitive process among patients with cancer. CONCLUSION: The Korean versions of MCQI-6 and MCQI-14 are useful, reliable, and valid tools to evaluate sleep-related metacognitive processes among patients with cancer. The DCA model of insomnia was feasible even among cancer patients.

Dysfunctional Beliefs and Attitudes about Sleep-6 (DBAS-6): Data-driven shortened version from a machine learning approach.

BACKGROUND: The Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16) is a widely used self-report instrument for identifying sleep-related cognition. However, its length can be cumbersome in clinical practice. This study aims to develop a data-driven shortened version of the DBAS-16 that efficiently predicts the DBAS-16 total score among the general population. METHODS: We collected 1000 responses to the DBAS-16 from the general population through three separate surveys, each focusing on different aspects of insomnia severity and related factors. Using Exploratory Factor Analysis (EFA) on the survey responses, we grouped DBAS-16 items based on response pattern similarities. The most representative item from each group, showing the highest regression performance with eXtreme Gradient Boosting (XGBoost) in predicting the DBAS-16 total score, was selected to create a shortened version of the DBAS-16. RESULTS: Through EFA and XGBoost, we categorized the DBAS-16 items into six distinct groups. Selecting one item from each group, based on the highest coefficient of determination R2 values in predicting the DBAS-16 total score. After measuring the R2 values for all possible combinations of six items, items 4, 5, 7, 11, 13, and 15 were chosen, exhibiting the highest R2 value. Based on these six items, we developed the DBAS-6, a data-driven shortened version of the DBAS-16. The DBAS-6 exhibited outstanding predictive ability, achieving the highest R2 value of 0.90 for predicting the DBAS-16 total score, surpassing that of a previously developed shortened version. Notably, the DBAS-6 efficiently encapsulates the core aspects of the DBAS-16 and demonstrates robust predictive power over heterogeneous test data samples with distinct statistical characteristics from the training data. CONCLUSION: With its concise format and high predictive accuracy, the DBAS-6 offers a practical tool for assessing dysfunctional beliefs about sleep in clinical settings.

Comparison of the Stress and Anxiety to Viral Epidemic-9 and SAVE-6 scales among healthcare workers in Peru.

Introduction: Peru is a country that has a high incidence of viral outbreaks and epidemics, which is why it is necessary to validate a scale that measures anxiety and stress in professionals who are on the front lines of these events. Therefore, our objective was to validate the Peruvian-Spanish version of the Stress and Anxiety to Viral Epidemics-9 items (SAVE-9) scale and to concurrently compare its validity and internal consistency with the SAVE-6 scale among healthcare workers (HCWs). Materials and methods: We conducted a cross-sectional study based on data collected from a self-reported survey in paper-and-pencil format between April and July 2023. A total of 203 HCWs participated in the research. We developed a confirmatory factor analysis (CFA) and item response theory (IRT). We calculated Cronbach's α coefficient and McDonald's ω to assess the internal consistency of the scales. Results: The results show that SAVE-9 (a two-factor model) and SAVE-6 (a one-factor model) provided an excellent fit in the confirmatory factor analysis. Both scales demonstrated strong internal consistency (Cronbach's α 0.85 and 0.86, respectively). Significant correlations were found between the SAVE-9 and SAVE-6 scales and Generalized Anxiety Disorder-7 items scale (r = 0.44 and r = 0.38, respectively, p < 0.001) as well as the Patient Health Questionnaire-9 items (r = 0.39 and r = 0.35, respectively, p < 0.001). The optimal cutoff points for SAVE-9 and SAVE-6 were identified for assessing anxiety, aligned with a GAD-7 score ≥5 points. Conclusion: The Peruvian-Spanish SAVE-9 and SAVE-6 scales are reliable and valid rating scales to assess the anxiety response of HCWs in response to viral epidemics. Though COVID-19 is diminished, these scales will be useful for other viral epidemics in the future.

Dysfunctional Self-Focus and Fear of Progression in Cancer Patients Mediated by Depression, Anxiety, and Dysfunctional Sleep Beliefs.

OBJECTIVE: This study explores whether cancer patients' dysfunctional self-focus is a significant contributor to their fear of progression. In addition, we investigated whether their psychiatric symptoms such as depression, anxiety, and dysfunctional beliefs about sleep may mediate the relationship between these factors. METHODS: We conducted a retrospective medical records review of 196 cancer patients who visited the Stress Management Clinic for the first time from March to September 2022. Their demographic information and responses to rating scales such as the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), Dysfunctional Self-focus Attribution Scale (DSAS), Patient Health Questionnaire-9 Items (PHQ-9), State subcategory of the State and Trait of Anxiety Inventory (STAI-S), Insomnia Severity Index (ISI), Cancer-related Dysfunctional Beliefs about Sleep scale (C-DBS), and numeric rating scales of pain and fatigue were collected. RESULTS: A high FoP-Q-SF score was significantly correlated with high PHQ-9 (r=0.60), STAI-S (r=0.38), ISI (r=0.34), C-DBS (r=0.47), pain (r=0.24), fatigue (r=0.37), and DSAS (r=0.58, all p<0.001). A linear regression analysis showed that the FoP-Q-SF score was significantly predicted by younger age (ß=-0.13, p=0.011), PHQ-9 (ß=0.36, p<0.001), STAI-S (ß=0.18, p=0.001), C-DBS (ß=0.22, p<0.001), and DSAS (ß=0.25, p<0.001). A mediation analysis showed that dysfunctional self-focus directly influenced patients' fear of progression. In addition, cancer patients' depression, anxiety, and cancer-related dysfunctional beliefs about sleep mediated this relationship. CONCLUSION: We observed that dysfunctional self-focus may influence cancer patients' fear of progression, mediated by depression, anxiety, and cancer-related dysfunctional beliefs about sleep.

Stress, Mental Health, Sleep, and Healthy Habits in Spanish Healthcare Professionals Along the Pandemic: A Case-Control, and Follow-Up Study.

OBJECTIVE: The aim of this study was to assess short and medium-term impact of the coronavirus disease-2019 (COVID-19) pandemic on stress, mental health, and sleep in Spanish healthcare professionals (HCP), and analyze the association between healthy habits, anxiety, and depression during the same period. METHODS: An online survey including five validated scales (the Perceived Stress Scale, the Goldberg Anxiety and Depression Scales, the Pre-Sleep Arousal Scale, and the Pittsburgh Sleep Quality Index), and some questions about healthy habits were completed by HCP in charge of patients without and with coronavirus. Once for the control group (baseline), and twice for the case group (baseline and follow-up). RESULTS: Overall 563 questionnaires were included. Moderate-severe stress was reported by 98.1% of subjects, anxiety and depression by 55.1% and 78.7% respectively, and poor sleep quality by 96.6%. Anxiety was reported more frequently by females and singles. HCP in charge of COVID-19 patients showed, in the baseline, a higher frequency of anxiety compared to controls (58.9% vs. 42.8%, p=0.002), and of depression (82.1% vs. 67.6%, p=0.001), that persisted in the follow-up assessment. Furthermore, HCP in charge of COVID-19 patients also exhibited more elevated mean scores for stress (p=0.005) and poor sleep (p=0.019). A decrease of sunlight exposure was associated with an increase of anxiety and depression symptoms, and less physical activity with depression. CONCLUSION: Stress, sleep, and mental problems were common in Spanish HCP, especially in those in charge of COVID patients. These findings persisted throughout the pandemic, and may impact in the post-pandemic mental health of HCP.

Data-driven shortened Insomnia Severity Index (ISI): a machine learning approach.

BACKGROUND: The Insomnia Severity Index (ISI) is a widely used questionnaire with seven items for identifying the risk of insomnia disorder. Although the ISI is still short, more shortened versions are emerging for repeated monitoring in routine clinical settings. In this study, we aimed to develop a data-driven shortened version of the ISI that accurately predicts the severity level of insomnia disorder. METHODS: We collected a sample of 800 responses from the EMBRAIN survey system. Based on the responses, seven items were grouped based on the similarity of their response using exploratory factor analysis (EFA). The most representative item within each group was selected by using eXtreme Gradient Boosting (XGBoost). RESULTS: Based on the selected three key items, maintenance of sleep, interference with daily function, and concerns about sleep problems, we developed a data-driven shortened questionnaire of ISI, ISI-3 m (machine learning). ISI-3 m achieved the highest coefficient of determination ( R 2 = 0.910 ) for the ISI score prediction task and the accuracy of 0.965, precision of 0.841, and recall of 0.838 for the multiclass-classification task, outperforming four previous versions of the shortened ISI. CONCLUSION: As ISI-3 m is a highly accurate shortened version of the ISI, it allows clinicians to efficiently screen for insomnia and observe variations in the condition throughout the treatment process. Furthermore, the framework based on the combination of EFA and XGBoost developed in this study can be utilized to develop data-driven shortened versions of the other questionnaires.

Loneliness, Social Isolation, and Obsession with COVID-19 among Older Adults.

During the COVID-19 pandemic, older people were socially isolated for their protection against the virus impacting their mental health. Aiming to explore the role of loneliness and social isolation in the obsession with COVID-19 among older adults, we conducted an anonymous online survey with 300 older adults aged 65-80 years in South Korea between January and February 2023. The survey collected demographic information, past psychiatric history, medical disease, current psychological distress, and experiences related to COVID-19. Rating scales were the Obsession with COVID-19 Scale (OCS), Coronavirus Reassurance-seeking Behaviors Scale (CRBS), Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), and Loneliness and Social Isolation Scale (LSIS). The regression analysis revealed that CRBS (ß = 0.55, p < 0.001) and SAVE-6 (ß = 0.34, p < 0.001) were significant predictors of obsession with COVID-19 (adjusted R2 = 0.63, F = 126.9, p < 0.001). Mediation analysis showed that loneliness and social isolation had a positive total effect on obsession with COVID-19, mediated by reassurance-seeking behavior and viral anxiety (Standardized Estimator = 0.21, standard error = 0.05, p < 0.001, 95% confidence interval 0.20-0.41). Loneliness and social isolation were found to be indirectly linked to obsession with COVID-19 through reassurance-seeking behavior and viral anxiety. The findings highlight the importance of addressing loneliness and social isolation among older adults during the COVID-19 pandemic to prevent obsession with COVID-19.

Validation of the Pandemic Grief Risk Factors and Its Relationship With Work-Related Stress and Grief Reaction Among Healthcare Workers Who Witnessed Patient Deaths.

BACKGROUND: The Pandemic Grief Risk Factors (PGRFs) was developed as a self-report tool to compile a comprehensive list of unique risk factors related to grief when experiencing a coronavirus disease 2019 (COVID-19) loss. We explored the reliability and validity of the PGRF among healthcare workers who witnessed their patients' deaths during the COVID-19 pandemic. Further, we examined whether the general severity of PGRF may have been associated with work-related stress and pandemic grief reactions. METHODS: An online survey was conducted among tertiary hospital healthcare workers (doctors and nursing professionals) who had witnessed the deaths of patients they cared for. Pandemic Grief Scale for healthcare workers, the Stress and Anxiety to Viral Epidemics-3 items, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7 responses were collected. RESULTS: In total, 267 responses were analyzed. The single-factor structure of the Korean version of the PGRF showed a good fit for the model. The scale demonstrated good internal consistency and convergent validity with other depression and anxiety rating scales. The mediation analysis revealed that work-related stress directly influenced pandemic grief reactions positively, and depression, anxiety, and general severity of grief risk factors partially mediated the association positively. CONCLUSION: Among healthcare workers who witnessed the deaths of their patients due to COVID-19, the Korean version of the PGRF was valid and reliable for measuring the overall severity of PGRF. The PGRF can be used to identify individuals at risk for dysfunctional grief.

Social Stigma Toward Individuals with Schizophrenia in a Lebanese Population.

Background: Schizophrenia has been recognized as the most stigmatized mental disorder, imposing a substantial burden on affected individuals. However, no prior studies have investigated social stigma toward individuals with schizophrenia in Lebanon. Purpose: We aimed to examine three components of social stigma including knowledge, attitude, and behavior toward individuals with schizophrenia in a Lebanese population and to explore associated factors with the level of social stigma. Patients and Methods: A cross-sectional online survey was administered, and data from 469 participants were gathered from January 31, 2023, to February 18, 2023. We used previously validated questionnaires to assess the knowledge, attitude (Social Distance Scale), and behavior (Reported and Intended Behavior Scale) of participants toward individuals with schizophrenia. The score for each section was calculated and used to explore the associations between sociodemographic factors and the levels of stigma in each domain. Results: The study participants had a moderate understanding of schizophrenia. However, a substantial proportion showed negative attitudes and unfavorable behaviors toward individuals with schizophrenia. We identified several sociodemographic factors associated with the knowledge, attitude, and behavior scores. Notably, a higher knowledge score and more positive attitudes were positively correlated with improved intended behaviors. Conclusion: This study highlights the pervasive stigma encompassing issues in knowledge, attitudes, and behavior surrounding schizophrenia in a Lebanese population. Our study suggests a pressing need for targeted interventions to increase public awareness and decrease the social stigma of schizophrenia in Lebanon.

The Effect of Psychological Inflexibility on Social-Distancing Phobia Mediated by Preoccupation With Sleep and Intolerance of Uncertainty in the Elderly Population During the COVID-19 Pandemic.

OBJECTIVE: The aim of this study was to explore whether psychological inflexibility in the elderly population is related to social-distancing phobia, and examine whether their viral anxiety, preoccupation with sleep, or intolerance of uncertainty may mediate the relationship. METHODS: Among the elderly population aged ≥65 in Korea, we conducted an anonymous online survey during January and February 2023. We collected the responses of 300 participants, collected demographic information, and symptoms using rating scales such as the Social-Distancing Phobia scale, Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), Intolerance of Uncertainty Scale-12 (IUS-12), Acceptance and Action Questionnaire-II (AAQ-II), and Glasgow Sleep Effort Scale (GSES). RESULTS: Social-distancing phobia was expected by the SAVE-6 (ß=0.34, p<0.001), IUS-12 (ß=0.18, p=0.003), and GSES (ß=0.18, p= 0.001) in the linear regression analysis. In the mediation analysis, psychological inflexibility did not directly influence social-distancing phobia. However, viral anxiety, intolerance of uncertainty, or preoccupation with sleep completely mediated the influence of psychological inflexibility on social-distancing phobia among elderly population. CONCLUSION: The management of psychological inflexibility, intolerance of uncertainty, or preoccupation with sleep needs to be considered when designing interventions to address social-distancing phobia in elderly populations in future pandemics.

Contribution of dysfunctional sleep-related cognitions on insomnia severity: a network perspective.

STUDY OBJECTIVES: Various models of insomnia stress the role of cognitive components, such as dysfunctional sleep-related beliefs, in maintenance and exacerbation of insomnia. This study aimed to use network analysis to identify the particular beliefs that are central and have strong associations with insomnia severity. In addition, we aimed to use a relative importance network to map out predictive pathways between types of dysfunctional beliefs and insomnia severity. METHODS: This study was a retrospective study, with data collected from 219 patients with insomnia. Patients' responses to the Dysfunctional Beliefs about Sleep Scale-16 (DBAS-16) and Insomnia Severity Index (ISI) were collected. All network analyses were performed using R Studio to produce 3 networks: (1) DBAS-16 network, (2) DBAS-16 and ISI network, and (3) relative importance network containing DBAS-16 subscales and ISI. RESULTS: Beliefs reflecting overestimation of negative consequences of sleep (eg, "insomnia is ruining life"), loss of ability (eg, "worry about losing abilities to sleep"), and unpredictability (eg, "can't predict sleep quality") were identified as most central and strongly associated with insomnia severity. Worry/helplessness about insomnia had the largest predictive value on insomnia severity, and also acted as a mediator between other subscales and insomnia severity. CONCLUSIONS: The results of our study suggest that overestimation of negative consequences, loss of ability, and unpredictability are key beliefs that exacerbate and maintain insomnia, thus supporting existing cognitive models of insomnia. CITATION: Cha EJ, Hong S, Kim S, Chung S, Jeon HJ. Contribution of dysfunctional sleep-related cognitions on insomnia severity: a network perspective. J Clin Sleep Med. 2024;20(5):743-751.

Psychometric Properties of the Insomnia Severity Index and Its Comparison With the Shortened Versions Among the General Population.

OBJECTIVE: The aim of this study was to explore the psychometric properties of the Insomnia Severity Index (ISI) based on modern test theory, such as item response theory (IRT) and Rasch analysis, with shortened versions of the ISI among the general population. METHODS: We conducted two studies to evaluate the reliability and validity of the shortened versions of the ISI in a Korean population. In Study I, conducted via online survey, we performed an exploratory factor analysis (n=400). In Study II, confirmatory factor analysis (CFA) was conducted (n=400). IRT and Rasch analysis were performed on all samples. Participants symptoms were rated using the ISI, Dysfunctional Beliefs and Attitudes about Sleep-16 items, Dysfunctional Beliefs about Sleep-2 items, Patient Health Questionnaire-9 items, and discrepancy between desired time in bed and desired total sleep time. RESULTS: CFA showed a good fit for the 2-factor model of the ISI (comparative fit index=0.994, Tucker-Lewis index=0.990, root-meansquare-error of approximation=0.039, and standardized root-mean-square residual=0.046). The 3-item versions also showed a good fit for the model. All scales showed good internal consistency reliability. The scale information curve of the 2-item scale was similar to that of the full-scale ISI. The Rasch analysis outputs suggested a good model fit. CONCLUSION: The shortened 2-factor ISI is a reliable and valid model for assessing the severity of insomnia in the Korean population. The results are needed to be explored further among the clinical sample of insomnia.

Efficacy and safety of digital therapeutic application of Sleep Index-Based Treatment for Insomnia (dSIBT-I): a pilot study.

The aim of this study was to evaluate the safety and efficacy of digital therapeutic application of Sleep Index-Based Treatment for Insomnia (dSIBT-I) and compare them with those of digital application of Cognitive Behavioural Therapy for Insomnia (dCBT-I). This randomised prospective pilot study was conducted at the Asan Medical Center. A total of 50 patients with insomnia were recruited between December 2022 and January 2023 and randomly allocated to the dSIBT-I or dCBT-I group. The study was carried out for one month. The primary outcome was the significant reduction in Insomnia Severity Index score at Week 4 compared to baseline, while the secondary outcome was proportion of participants whose Insomnia Severity Index scores were reduced to <15 at Week 4. We performed linear mixed model and generalised estimating equation analyses. Both dSIBT-I and dCBT-I groups showed significant improvements in Insomnia Severity Index scores at Week 4. There was no significant difference between two groups in terms of Insomnia Severity Index scores at Week 4 (group × time effect, F = 1.07, p = 0.382) and proportion of participants whose Insomnia Severity Index scores were reduced to <15 at Week 4 (group × time effects, F = 1.80, p = 0.615). However, at Week 2, the dSIBT-I group showed better results than the dCBT-I group in terms of both Insomnia Severity Index scores (p = 0.044) and proportion of participants whose Insomnia Severity Index scores were reduced to <15 (82.6% vs. 48.0%, p = 0.017). No treatment-emergent adverse events were reported in either group. The dSIBT-I is a safe and effective therapy for insomnia, with rapid treatment effects.

Assessing Stress and Anxiety in Firefighters During the Coronavirus Disease-2019 Pandemic: A Comparative Adaptation of the Stress and Anxiety in the Viral Epidemic-9 Items and Stress and Anxiety in the Viral Epidemics-6 Items Scales.

OBJECTIVE: This study assessed the reliability and validity of the Stress and Anxiety to Viral Epidemics-9 items (SAVE-9) and Stress and Anxiety to Viral Epidemics-6 items (SAVE-6) scales for measuring viral anxiety among firefighters during the coronavirus disease-2019 pandemic. METHODS: An online survey was conducted among 304 firefighters assigned in Gyeonggi-do. The SAVE-9 scale, initially developed for healthcare workers, was adapted for firefighters. We compared it with the SAVE-6 scale designed for the general population among the firefighters sample. The confirmatory factor analysis (CFA) was conducted to explore the factor structure of both scales. Internal consistency reliability was checked using Cronbach's alpha and McDonald's omega. Convergent validity was assessed in accordance with the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scales. RESULTS: The SAVE-9 scale demonstrated a Cronbach alpha of 0.880, while the SAVE-6 scale yielded an alpha of 0.874. CFA indicated good model fits for both SAVE-9 and SAVE-6 scales among firefighters sample. The SAVE-9 and SAVE-6 comparably measures viral anxiety of firefighters. CONCLUSION: Both of the SAVE-9 and SAVE-6 scales are reliable and valid instruments for assessing viral anxiety among firefighters during the pandemic.

Catastrophizing Maladaptive Coping Affects the Association Between Viral Anxiety and Fear of Progression in Cancer Patients During COVID-19 Pandemic.

OBJECTIVE: The aim of the present study was to explore whether or not cancer patients' viral anxiety and depression during the coronavirus-2019 (COVID-19) pandemic were associated with a fear of cancer progression. We also assessed whether coping strategies affected the relationship. METHODS: The present cross-sectional survey included cancer patients who visited Ulsan University Hospital in Ulsan, Korea. The participants' demographic information and responses to the following symptoms rating scales were collected: Stress and Anxiety to Viral Epidemic-6; Patient Health Questionnaire-9; Cognitive Emotion Regulation Questionnaire-short version; or Fear of Progression Questionnaire-short version. RESULTS: Of the 558 cancer patients surveyed, 25 (4.5%) reported that their treatment schedule was delayed during the COVID-19 pandemic. The patients' fear of progression was found to be related to age (ß=-0.08; p=0.011), viral anxiety (ß=0.40; p<0.001), depression (ß=0.26; p<0.001), and catastrophizing coping strategies (ß=0.15; p=0.004), for an overall adjusted R2 of 0.46 (F=66.8; p<0.001). Mediation analysis showed that viral anxiety and depression were directly associated with fear of progression, while catastrophizing mediated this relationship. CONCLUSION: Fear of progression in cancer patients was associated with viral anxiety, depression, and maladaptive coping techniques, such as catastrophizing, during the COVID-19 pandemic.