Mobile phone sleep self-management applications for early start shift workers: A scoping review of the literature.

Poor sleep has significant impacts on both mental and physical well-being. This is especially the case for shift workers who rely on good sleep practices to manage the disruption caused by their working conditions. In recent years there has been a proliferation of sleep-focused mobile phone applications, some of which may be suitable for use by shift workers. There is limited evidence however, on whether these applications are sufficient in managing the sleep needs of the early start shift working population (i.e., those whose work schedules begin pre-dawn). This scoping review aims to identify and discuss peer-reviewed literature on mobile sleep applications used by early start shift workers for sleep-self management. Four databases (Scopus, EBSCOhost, CINAHL and PsycInfo) were searched for relevant literature using a pre-determined search string. The initial search using the term early start shift work returned no papers, however a broadened search on shift work in general found 945 papers for title and abstract screening, of which 21 were deemed eligible for full text screening. Two of these papers met the inclusion criteria for this review. The results highlight, firstly, the paucity of research on the use of mobile phone applications for sleep self-management amongst early start shift workers, and secondly, the need for further research on the effectiveness of mobile applications for sleep self-management amongst shift workers in general. A working definition of early start shift work that can be used to stimulate research in this understudied population of shift workers is also proposed.

Social support mediates the effect of morningness on changes in subjective well-being over 6 months.

Studies show that morningness is positively associated with subjective well-being. Our previous research investigated factors that could underlie this relationship, finding that the association between morningness-eveningness and subjective well-being can be partially attributed to the higher levels of perceived social support received by morning-oriented individuals. In the present study, we examine the longitudinal effects of perceived social support in mediating the relationship between morningness-eveningness and subjective well-being. Our results show that this mediating effect remains significant with respect to changes in well-being over a 6-month period. It seems that the causal effect of morningness on well-being may be partially mediated by the causal effect of social support. The findings provide further support for the conclusion that perceived social support is an important contributing factor to the greater well-being reported by morning-oriented individuals. Additionally, our results provide seminal evidence for the causal effect of morningness on well-being.

Social Rhythm Disruption is Associated with Greater Depressive Symptoms in People with Mood Disorders: Findings from a Multinational Online Survey During COVID-19.

OBJECTIVES: Societal restrictions imposed to prevent transmission of COVID-19 may challenge circadian-driven lifestyle behaviours, particularly amongst those vulnerable to mood disorders. The overarching aim of the present study was to investigate the hypothesis that, in the routine-disrupted environment of the COVID-19, amongst a sample of people living with mood disorders, greater social rhythm disruption would be associated with more severe mood symptoms. METHODS: We conducted a two-wave, multinational survey of 997 participants (MAge=39.75±13.39,Female=81.6%) who self-reported a mood disorder diagnosis (i.e., major depressive disorder or bipolar disorder). Respondents completed questionnaires assessing demographics, social rhythmicity (The Brief Social Rhythm Scale), depression symptoms (Patient Health Questionnaire-9), sleep quality and diurnal preference (The Sleep, Circadian Rhythms and Mood questionnaire) and stressful life events during the COVID-19 pandemic (The Social Readjustment Rating Scale). RESULTS: The majority of participants indicated COVID-19-related social disruption had affected the regularity of their daily routines to at least some extent (n = 788, 79.1%). As hypothesised, lower social rhythmicity was associated with greater depressive symptoms when tested cross-sectionally (standardised ß = -.25, t = -7.94, P = 0.000) and when tested using a 2-level hierarchical linear model across two time points (b = -0.14, t = -3.46, df = 264, P ≤ 0.001). CONCLUSIONS: These results are consistent with the social zeitgeber hypothesis proposing that mood disorders are sensitive to life events that disrupt social rhythms.

Adrift in time: the subjective experience of circadian challenge during COVID-19 amongst people with mood disorders.

Social distancing/lockdown policies during the coronavirus (COVID-19) pandemic may alter social rhythms of people through imposition of restrictions on normal daily activities. This may in turn challenge circadian function, particularly in people with mood disorders. Although objective data describing the relationship between circadian disturbances and mood disorders exist, data regarding the subjective experience of circadian challenge is sparse, and its association with mood symptoms is unclear. The present qualitative study was one component of a mixed-methods multi-national project, which took advantage of widespread disruption to daily routines due to Government COVID-related lockdowns during 2020. The Behavior Emotion and Timing during COVID-19 (BEATCOVID) survey study included three open questions generating qualitative data on participants' subjective experience of social disruption due to social distancing/lockdown policies, two of which asked about the barriers and opportunities for stabilizing routines. Responses were coded and analyzed using Thematic Analysis. A total of N = 997 participants responded to at least one of the free-text questions. Four themes were identified: 1) loss of daily timed activities, 2) role of social interaction, 3) altered time perception and 4) disruption to motivation and associated psychological effects. Themes were organized into a provisional heuristic map, generating hypotheses for future research centered on the new concept of 'psychological drift.'

The mediating role of perceived social support in the relationship between morningness-eveningness and subjective well-being.

Studies show that morningness preference and subjective well-being are positively related. However, little is known about potential factors that may underpin this association. In the present study, we explored the mediational role of general social support and its facets (family, friends, and significant other) in the relationship between morningness-eveningness and subjective well-being. The present study was conducted with a sample of 1,067 adults (51% women), with a mean (SD, range) age of 36.41 (9.95, 18-55) years. Our results corroborated earlier findings that morningness was positively associated with both subjective well-being and social support. Controlling for age and gender, we obtained significant mediation effects, showing that the association between morningness-eveningness and subjective well-being might stem, at least in part, from the higher levels of social support received by morning-oriented individuals. This may lead to the conclusion that social support is an important antecedent of the greater well-being reported by morning-oriented individuals.

Psychological Interventions to Improve Sleep in Young Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

INTRODUCTION: The effects of impaired sleep on the wellbeing of young adults are profound, and the adverse outcomes for mental health are well documented in the research literature. OBJECTIVE: This systematic review and meta-analysis aimed to identify, summarize, and synthesize the available evidence from randomized-controlled trials (RCTs) investigating psychological interventions aimed at improving sleep and related secondary outcomes such as anxiety and depression in healthy young adults. METHOD: Nine electronic databases (Cochrane Central Registry of Controlled Trials [CENTRAL], PubMed, Scopus, PsycNET, CINHAL, INFORMIT, Web of Science [Science and Social Citation Index], OpenSigle and EMBASE) were searched, returning 54 full-text papers for assessment, with 13 studies meeting inclusion criteria for the meta-analysis. RESULTS: A random effects meta-analysis showed that the combined effect of all interventions was moderate (ES = -0.53, 95% CIs [- 0.69, -0.36], p < .01), reflecting the efficacy of psychological interventions at improving sleep scores at post-intervention. Subgroup analyses of individual interventions showed that cognitive-behavioral interventions improved sleep (ES = -0.67, 95% CIs [-0.77, -0.57], p < .01) and secondary outcomes for anxiety (ES = -0.35, 95% CIs [-0.56, -0.15], p < .01) and depression (ES = -0.41, 95% CIs [-0.70, -0.13], p < .01) at post-intervention. CONCLUSION: The results of the current review support the implementation of cognitive and behavioral interventions for sleep among young adults experiencing both sleep and comorbid mental health problems.

Sleep Problems in School Aged Children: A Common Process across Internalising and Externalising Behaviours?

Sleep problems are common in childhood and impact cognitive, psychological and physical wellbeing. The current study investigated the association between sleep problems and internalising and externalising behaviour in 114 school-aged children (5-12 years) from four primary schools in Melbourne, Australia. Data were collected using the Sleep Disorder Inventory for Students to measure sleep and the Conners Behavior Rating Scale to assess behaviour, both by parent report. Hierarchical regression analysis, controlling for socioeconomic status and age, identified moderate associations between sleep problems and emotional distress, aggressive behaviour and hyperactivity/impulsivity. Findings suggest screening for sleep problems in children presenting clinically with behavioural issues is a potentially important clinical practice. Additionally, results support the elaboration of transdiagnostic theory, whereby sleep problems are a common process in both internalising and externalising behaviour in children.

Measuring circadian function in bipolar disorders: Empirical and conceptual review of physiological, actigraphic, and self-report approaches.

BACKGROUND: Interest in biological clock pathways in bipolar disorders (BD) continues to grow, but there has yet to be an audit of circadian measurement tools for use in BD research and practice. PROCEDURE: The International Society for Bipolar Disorders Chronobiology Task Force conducted a critical integrative review of circadian methods that have real-world applicability. Consensus discussion led to the selection of three domains to review-melatonin assessment, actigraphy, and self-report. RESULTS: Measurement approaches used to quantify circadian function in BD are described in sufficient detail for researchers and clinicians to make pragmatic decisions about their use. A novel integration of the measurement literature is offered in the form of a provisional taxonomy distinguishing between circadian measures (the instruments and methods used to quantify circadian function, such as dim light melatonin onset) and circadian constructs (the biobehavioral processes to be measured, such as circadian phase). CONCLUSIONS: Circadian variables are an important target of measurement in clinical practice and biomarker research. To improve reproducibility and clinical application of circadian constructs, an informed systematic approach to measurement is required. We trust that this review will decrease ambiguity in the literature and support theory-based consideration of measurement options.

An Interdisciplinary Perspective on the Association Between Chronotype and Well-being.

Individuals with a circadian preference for mental and physical activity later in the day ("Evening types") are consistently found to fare worse on most facets of well-being than individuals with a circadian preference for mental and physical activity earlier in the day ("Morning types"). Several explanatory hypotheses of this association between chronotype and well-being have been proposed, including shared genetic, biological, developmental, and psychosocial mechanisms. This paper presents a critical summary of these explanatory mechanisms and offers suggestions for their integration in an interdisciplinary biopsychosocial framework.

Traits related to bipolar disorder are associated with an increased post-illumination pupil response.

Mood states in bipolar disorder appear to be closely linked to changes in sleep and circadian function. It has been suggested that hypersensitivity of the circadian system to light may be a trait vulnerability for bipolar disorder. Healthy persons with emotional-behavioural traits associated with bipolar disorder also appear to exhibit problems with circadian rhythms, which may be associated with individual differences in light sensitivity. This study investigated the melanopsin-driven post-illumination pupil response (PIPR) in relation to emotional-behavioural traits associated with bipolar disorder (measured with the General Behavior Inventory) in a non-clinical group (n = 61). An increased PIPR was associated with increased bipolar disorder-related traits. Specifically, the hypomania scale of the General Behavior Inventory was associated with an increased post-blue PIPR. Further, both the full hypomania and shortened '7 Up' scales were significantly predicted by PIPR, after age, sex and depressive traits were controlled. These findings suggest that increased sensitivity to light may be a risk factor for mood problems in the general population, and support the idea that hypersensitivity to light is a trait vulnerability for, rather than symptom of, bipolar disorder.

A psychometric investigation of the sleep, circadian rhythms, and mood (SCRAM) questionnaire.

The sleep, circadian rhythms, and mood (SCRAM) questionnaire (Byrne, Bullock et al., 2017) was designed to concurrently measure individual differences in three clinically important functions: diurnal preference, sleep quality, and mood. The 15-item questionnaire consists of three 5-item scales named Morningness, Good Sleep, and Depressed Mood. The overarching aim of the current project was to investigate the validity and reliability of the questionnaire. Here, we report on associations investigated in three data sets. Study 1 (N = 70, 80% females) was used to examine the test-retest reliability of the questionnaire, finding strong test-retest reliability of the three scales over a 2-week period (r's ranging from 0.73 to 0.86). Study 2 (N = 183, 80% females) enabled us to examine the construct validity of the SCRAM scales against well-validated self-report measures of diurnal preference, sleep quality, and depression. Strong correlations were found between each SCRAM scale and their respective measure in bivariate analyses, and associations were robust after the inclusion of the remaining two SCRAM scales as predictors in regression analyses. Data from Study 3 (N = 42, 100% males) were used to measure the extent to which SCRAM scores correlated with objective measures of sleep-wake behavior using actigraphy. Morningness was found to be related to earlier sleep onset and offset times, and Good Sleep was related to higher sleep efficiency but to no other measures of sleep quality; Depressed Mood was not related to actigraphy measures. The findings provide provisional support for construct validity and reliability of the SCRAM questionnaire as a measure of diurnal preference, sleep quality, and depressed mood. Future research into the psychometrics of SCRAM should test the questionnaire's discriminant and predictive validity in clinical samples.

Development of a Measure of Sleep, Circadian Rhythms, and Mood: The SCRAM Questionnaire.

Sleep quality, circadian phase, and mood are highly interdependent processes. Remarkably, there is currently no self-report questionnaire that measures all three of these clinically significant functions: The aim of this project was to address this deficit. In Study 1, 720 participants completed a set of potential items was generated from existing questionnaires in each of the three domains and refined to follow a single presentation format. Study 2 used an independent sample (N = 498) to interrogate the latent structure. Exploratory factor analysis was used to identify a parsimonious, three-factor latent structure. Following item reduction, the optimal representation of sleep quality, circadian phase, and mood was captured by a questionnaire with three 5-item scales: Depressed Mood, Morningness, and Good Sleep. Confirmatory factor analysis found the three-scale structure provided adequate fit. In both samples, Morningness and Good Sleep were positively associated, and each was negatively associated with the Depressed Mood scale. Further research is now required to quantify the convergent and discriminant validity of its three face-valid and structurally replicated scales. The new sleep, circadian rhythms, and mood (SCRAM) questionnaire is the first instrument to conjointly measure sleep quality, circadian phase, and mood processes, and has significant potential as a clinical tool.

Highs and lows, ups and downs: Meteorology and mood in bipolar disorder.

Seasonal variation of manic and depressive symptoms is a controversial topic in bipolar disorder research. Several studies report seasonal patterns of hospital admissions for depression and mania and variation in symptoms that appear to follow a seasonal pattern, whereas others fail to report such patterns. Differences in research methodologies, data analysis strategies, and temporal resolution of data may partly explain the variation in findings between studies. The current study adds a novel perspective to the literature by investigating specific meteorological factors such as atmospheric pressure, hours of sunshine, relative humidity, and daily maximum and minimum temperatures as more proximal predictors of self-reported daily mood change in people diagnosed with bipolar disorder. The results showed that daily maximum temperature was the only meteorological variable to predict clinically-relevant mood change, with increases in temperature associated with greater odds of a transition into manic mood states. The mediating effects of sleep and activity were also investigated and suggest at least partial influence on the prospective relationship between maximum temperature and mood. Limitations include the small sample size and the fact that the number and valence of social interactions and exposure to natural light were not investigated as potentially important mediators of relationships between meteorological factors and mood. The current data make an important contribution to the literature, serving to clarify the specific meteorological factors that influence mood change in bipolar disorder. From a clinical perspective, greater understanding of seasonal patterns of symptoms in bipolar disorder will help mood episode prophylaxis in vulnerable individuals.

Social rhythms and vulnerability to bipolar disorder.

BACKGROUND: Reduced social rhythmicity is a commonly reported feature of bipolar disorder which may extend to non-clinical populations at risk of bipolar disorder. The aim of the current study was to investigate social rhythms across three groups of participants; a clinical group of bipolar disorder outpatients, and two non-clinical groups with high- and low-vulnerability to bipolar disorder, respectively. It was expected that reduced social rhythmicity would differentiate the clinical group from the low-vulnerability group, but not the high vulnerability group. METHODS: Non-clinical participants were selected on the basis of scores derived from the General Behaviour Inventory and allocated to groups of high (n=36) and low (n=36) trait vulnerability to bipolar disorder. The clinical group (n=15) were volunteers recruited from an outpatient clinic. Participants completed a self-report social rhythmicity measure daily for seven consecutive days. RESULTS: One-way analysis of covariance (age) showed a significant overall effect for group, F (2,83)=4.67, p<.05. Post hoc comparisons revealed significant differences in social rhythms between the two nonclinical groups only. LIMITATIONS: The cross-sectional design of the study limits the strength of conclusions that can be drawn. CONCLUSIONS: The hypothesis was only partially supported. Consistent with expectations, the non-clinical group with higher vulnerability to bipolar disorder recorded lower social rhythmicity than the non-clinical group with lower vulnerability to bipolar disorder. The clinical group however, did not differ in social rhythmicity from the lower vulnerability group. The findings may have consequences for the way in which vulnerability to bipolar disorder is managed.