Comparative efficacy of psychological interventions on immune biomarkers: A systematic review and network meta-analysis (NMA).

Psychological interventions are viable, cost-effective strategies for improving clinical and psychological impact of inflammation-related conditions. However, their efficacy on immune system function remains controversial. We performed a systematic review and frequentist random-effects network meta-analysis of randomised controlled trials (RCTs) assessing the effects of psychological interventions, against a control condition, on biomarkers of innate and adaptive immunity in adults. PubMed, Scopus, PsycInfo, and Web of Science were searched from inception up to Oct 17, 2022. Cohen's d at 95% confidence interval (CI) was calculated to assess the effect sizes of each class of intervention against active control conditions at post-treatment. The study was registered in PROSPERO (CRD42022325508). Of the 5024 articles retrieved, we included 104 RCTs reporting on 7820 participants. Analyses were based on 13 types of clinical interventions. Compared with the control conditions, cognitive therapy (d =  - 0.95, 95% CI: -1.64 to - 0.27), lifestyle (d =  - 0.51, 95% CI: -0.99 to - 0.02), and mindfulness-based (d =  - 0.38, 95% CI: -0.66 to - 0.09) interventions were associated with post-treatment reduction of proinflammatory cytokines and markers. Mindfulness-based interventions were also significantly associated with post-treatment increase in anti-inflammatory cytokines (d = 0.69, 95% CI: 0.09 to 1.30), while cognitive therapy was associated also with post-treatment increase in white blood cell count (d = 1.89, 95% CI: 0.05 to 3.74). Results on natural killer cells activity were non-significant. Grade of evidence was moderate for mindfulness and low-to-moderate for cognitive therapy and lifestyle interventions; however, substantial overall heterogeneity was detected in most of the analyses.

Perseverative Cognition as a Mediator Between Perceived Stress and Sleep Disturbance: A Structural Equation Modeling Meta-analysis (meta-SEM).

BACKGROUND: According to the perseverative cognition (PC) hypothesis, the repetitive chronic activation of the cognitive representations of stressors are associated with a concomitant prolonged and sustained physiological stress response, including sleep disruption. PURPOSE: We conducted a systematic review and structural equation modeling meta-analysis (meta-SEM) on PC as mediator of the association between perceived stress and subjective sleep disturbance (i.e., difficulties falling asleep or maintaining sleep). METHODS: PubMed, Scopus, Medline, CINAHL, and PsycInfo were searched up to September 2021. To test mediation, only longitudinal studies assessing the predictor (perceived stress) at T0, the mediator (PC) at T1, and the outcome (sleep disturbance) at T2, were eligible. RESULTS: Findings on 3,733 individuals (k = 8) showed a significant component effect of perceived stress on PC (ß = 0.340, p < .001), which in turn was related to sleep disturbance (ß = 0.258, p < .001). The direct effect of stress on sleep disturbance was significant (ß = 0.133, p < .001). Lastly, the indirect effect between stress and sleep disturbance via PC supported the mediation hypothesis (ß = 0.09, 95% CI 0.078-0.100). The mediation path remained significant (ß = 0.03, 95% CI 0.020-0.036) after adjusting for baseline sleep disturbance. Further leave-one-out sensitivity and control analyses confirmed that all direct and indirect effects were not driven by any single study included in the meta-analysis, as well as their robustness when controlling for sex and age, respectively. CONCLUSIONS: Overall, results of this meta-analysis indicate that PC may be one of the mechanisms explaining how perceived stressful experiences lead to subjective sleep disturbance.

The repetitive chronic activation of the cognitive representations of stressors, known as perseverative cognition (PC), is associated with a concomitant prolonged and sustained physiological stress response, with may include sleep disturbance. This study investigates the mediating role of PC in the association between perceived stress and subjective indices of sleep disturbance using structural equation modeling meta-analysis (meta-SEM). PubMed, Scopus, Medline, CINAHL, and PsycInfo were searched up to September 2021. Findings on eight studies (n = 3,733 individuals) showed a significant component effect of perceived stress on PC, which in turn was related to sleep disturbance. The direct effect of stress on sleep disturbance was significant. Finally, the indirect effect between stress and sleep disturbance via PC supported the mediation hypothesis. Results of this meta-analysis suggest that PC may be one of the mechanisms explaining how perceived stressful experiences lead to subjective sleep disturbance.

Perseverative Cognition and Psychotic-Like Experiences in Young Adults: A Cross-Lagged Panel Model.

Psychotic-like experiences (PLEs), including persecutory ideation, bizarre experiences, and perceptual abnormalities, are considered risk factors for psychotic disorders and mental distress in the general population. The cognitive-affective mechanisms associated with PLEs remain under-investigated. We aimed to longitudinally assess the reciprocal associations between perseverative cognition (PC), an emerging transdiagnostic factor of psychopathology, and PLEs facets in young adults. Participants (n = 160) from the general population completed measures of PC and PLEs at baseline and at 2-month follow-up. A two-wave, three-variable, cross-lagged panel model was implemented controlling for well-established correlates of PC and PLEs such as depression, anxiety, and symptoms of sleep disturbance. Both PLEs and PC exhibited substantive rank-order stability (ß ranged from 0.359 to 0.657, ps < 0.001). Cross-lagged effects revealed that baseline PC was associated with bizarre experiences at 2-month follow-up (ß = 0.317; p < 0.01). This effect overcame the well-established cut-off for practical significance. In contrast, no baseline PLEs were associated with PC at follow-up. Findings suggest the presence of a monodirectional, rather than bidirectional, association between PC and bizarre experiences in young adulthood. Results should be interpreted in light of the relatively small, non-clinical, and convenient sample.

Longitudinal association between sleep disturbance and inflammation, and the role of positive affect.

Previous longitudinal evidence suggested that sleep disturbance (i.e., difficulties in sleep onset and sleep maintenance) may be longitudinally associated with systemic inflammation, which is involved in the pathophysiology of mental and somatic illness. The mechanisms underlying this association, however, remain largely unexplored. In the context of health psychology, a substantial body of literature showed that positive affect may have a favourable impact on immune and inflammatory response and buffer the proinflammatory effects of stress. Therefore, the aim of this study was to assess whether subjective sleep disturbance is longitudinally associated with serum high sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation, and whether this association is mediated by a decrease in positive affect. The data of 1894 participants aged 64.11 ± 8.02 years from the English Longitudinal Study of Ageing (ELSA) across three waves of data collection were analysed. Self-reported sleep disturbance was assessed in 2008-2009, (wave 4), positive affect was assessed in 2010-2011 (wave 5), and hs-CRP was assessed in 2012-2013 (wave 6). Path analysis adjusted for health-related variables including depressive symptoms, cardiovascular disease, BMI, smoking, alcohol consume, and drug intake showed a significant direct effect of sleep disturbance to positive affect; positive affect directly predicted hs-CRP. Lastly, an indirect effect between sleep disturbance to hs-CRP through the mediating role of positive affect emerged. The findings suggest that sleep onset and sleep maintenance difficulties may be associated with inflammation through the mediation of low positive affect. The clinical significance of the findings should be further explored.

Associations between orthorexia, disordered eating, and obsessive-compulsive symptoms: A systematic review and meta-analysis.

OBJECTIVE: Orthorexia nervosa (ON) is defined as an unhealthy obsession with healthy eating, focusing on concerns regarding food quality and composition. Currently, there is still a lack of consensus about a clear definition of the construct. Specifically, it has yet to be clarified whether ON pertains to eating disorders (EDs) or obsessive-compulsive disorder (OCD) spectrum. Hence, we conducted a systematic review and meta-analysis addressing the magnitude of the association between these groups of symptoms. METHOD: PubMed, Medline, SCOPUS, PsychINFO, CINAHL, and Web of Science were searched from inception up to February 2021. Data from individual studies were pooled using a random-effects model. Pearson's r was used as the effect size metric. Subgroup analyses were conducted exploring the role of ON-related instruments, body mass index, study quality, and cultural context. RESULTS: Thirty-six studies met the eligibility criteria and were included in the meta-analysis. Random-effects model yielded a moderate association between ON and EDs symptoms with an overall effect size of r = .36 (p < .001; 95% confidence interval [CI] = 0.30-0.43). On the other hand, the results showed a small association between ON and OCD symptoms with a mean effect size of r = .21 (p < .001; 95% CI = 0.15-0.27). DISCUSSION: Meta-analytic findings showed that ON symptoms are more associated to EDs compared to OCD. Despite the similarities, the nonhigh magnitude of the pooled correlations suggests that ON might be different from pre-existing EDs and OCD. Hence, ON might be treated as a stand-alone ED and included as an emerging syndrome in the DSM classification.

OBJETIVO: La ortorexia nerviosa (ON) se define como una obsesión poco saludable con la alimentación saludable, centrándose en las preocupaciones con respecto a la calidad y composición de los alimentos. Actualmente, todavía hay una falta de consenso sobre una definición clara del constructo. Específicamente, aún no se ha aclarado si la ON se refiere al espectro de los trastornos de la conducta alimentaria (TCAs) o al trastorno obsesivo-compulsivo (TOC). Por lo tanto, se realizó una revisión sistemática y un metanálisis que abordaron la magnitud de la asociación entre estos grupos de síntomas. MÉTODO: Se realizaron búsquedas en PubMed, Medline, SCOPUS, PsychINFO, CINAHL y Web of Science desde su inicio hasta febrero de 2021. Los datos de los estudios individuales se agruparon mediante un modelo de efectos aleatorios. Se utilizó la r de Pearson como métrica del tamaño del efecto. Se realizaron análisis de subgrupos que exploraron el papel de los instrumentos relacionados con ON, el índice de masa corporal, la calidad del estudio y el contexto cultural. RESULTADOS: Treinta y seis estudios cumplieron los criterios de elegibilidad y se incluyeron en el metanálisis. El modelo de efectos aleatorios produjo una asociación moderada entre los síntomas de ON y EDs con un tamaño del efecto general de r = 0,36 (p<0,001; IC del 95% = 0,30 a 0,43). Por otro lado, los resultados mostraron una pequeña asociación entre los síntomas de ON y TOC con un tamaño medio del efecto de r = 0,21 (p<0,001; IC del 95% = 0,15 a 0,27). DISCUSIÓN: Los hallazgos metaanalíticos mostraron que los síntomas de ON están más asociados a los TCAs en comparación con el TOC. A pesar de las similitudes, la magnitud no alta de las correlaciones agrupadas sugiere que la ON podría ser diferente de los TCA y el TOC preexistentes. Por lo tanto, la ON podría tratarse como un trastorno de la conducta alimentaria independiente e incluirse como un síndrome emergente en la clasificación del DSM.

Caring for the carers: Advice for dealing with sleep problems of hospital staff during the COVID-19 outbreak.

Hospital staff are at the frontline in the COVID-19 outbreak. The stressors they experience may induce sleep problems in a population already at risk. Sleep deprivation, long shifts and insomnia in hospital staff have been associated with individual, organizational and public health hazards. These include increased risk of mental and somatic disorders, altered immune responses, medical errors, misunderstandings, drowsy driving and burnout. In March 2020, the World Health Organization called for providing access to mental health and counselling for health professionals involved in the COVID-19 outbreak. To answer this call, we propose practical advice for the management of sleep problems (sleep deprivation, insomnia and shift work) that can be included in supportive interventions. The advice is based on psychobiological principles of sleep regulation and on guidelines for the treatment of insomnia and was implemented within an initiative offering psychological support to the staff of three university hospitals in Rome.

The relationship between perfectionism and eating-related symptoms in adolescents: A systematic review.

The clinical significance of two major aspects of perfectionism, perfectionistic strivings (PS) and perfectionistic concerns (PC), in eating disorders (EDs) symptoms was well-established among adults. However, no systematic review has assessed evidence examining associations between both unidimensional and multidimensional perfectionism and EDs in early and middle adolescence. For this aim, three online databases (PsycINFO, Medline and PsycArticle) were searched for articles published until January 2019, and observational studies were considered. Study quality was systematically appraised, and results were summarized using a narrative synthesis approach. Fifty-one cross-sectional and 28 longitudinal studies were included. Most studies supported the relationship between perfectionism and EDs, with the majority adopting a unidimensional approach for assessing perfectionism. Among studies that employed multidimensional measures of perfectionism, the majority (n = 11) of evidence supported the relationship between eating symptoms and PC, while fewer (n = 5) studies provided significant unique associations with PS. These findings are consistent with the body of research suggesting the strength of the relationship between PC and EDs was greater than between PS and EDs. It was recommended that preventive interventions should be primarily focused on reducing self-critical perfectionism, since it resulted to be the most relevant perfectionistic dimension in the development of eating symptoms in adolescents.

Eating self-efficacy: validation of a new brief scale.

PURPOSE: Eating self-efficacy (ESE) is the belief in one's ability to self-regulate eating. Social and emotional situations may be differently challenging depending on the individual eating habits, body mass index and affects. Several ESE scales have been developed but most of them focus on weight management, dieting or healthy eating. The aim of the study was to validate a new brief scale assessing ESE in situations in which people face social or emotional pressures for excessive food intake. METHODS: Study 1: A sample of 412 volunteer females (age M = 25.44 ± 5.03) completed a first 25-item version of the scale. Exploratory factor analysis (EFA) was conducted for selecting a subgroup of items composing the ESE brief scale (ESEBS). Study 2 assessed its psychometric properties through a Confirmatory Factor Analysis (CFA), analyzing the responses of 410 volunteer adults (273 females, 137 males). RESULTS: EFA of Study 1 evidenced a bifactorial structure. Four items for each factor were selected, explaining 63% of the variance. Study 2 confirmed the good fit of the bifactorial model (CFI = 0.9589; χ2 (19) = 62.852, p < 0.001; RMSEA = 0.075; SRMR = 0.040) and provided support for the measurement invariance of the scale across gender. The internal consistency was as follows: Social (α = 0.786), Emotional (α = 0.820). The concurrent validity of the subscales was demonstrated by significant latent negative correlations with measures of eating disorders and emotional eating. CONCLUSIONS: The 8-items ESEBS appears as a valid and reliable instrument to assess eating self-efficacy related to social and emotional situations. Future studies should evaluate its potential use in non-clinical and clinical research and interventions. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.

Poor Cognitive Inhibition Predicts Rumination About Insomnia in a Clinical Sample.

Objective/Background: According to the Cognitive Model of Insomnia disorder, rumination about lack of sleep and its diurnal consequences plays a crucial role in maintaining insomnia. Consolidated evidence shows that rumination is related to poor executive functions, which are cognitive control processes impacted by insomnia. Despite this evidence, no studies so far investigated the relationship between executive functions and rumination in individuals with insomnia. The aim of this pilot study was to cover this gap by investigating whether poor executive functions are associated with rumination in a sample of individuals with a diagnosis of insomnia disorder. Participants: Thirty young adults (22.67 ± 3.68 years, 73.3% females) diagnosed with insomnia disorder by clinical psychologists with expertise in behavioral sleep medicine completed the study. Methods: Measures of insomnia, depression, emotion regulation, and rumination about the daytime consequences of insomnia were collected. Executive functions were assessed using a Task Switching paradigm, measuring cognitive inhibition and set-shifting with cognitive flexibility. Results: Hierarchical multiple regression analysis revealed that higher depression (ß = 0.781, p < 0.001) and cognitive reappraisal (ß = 0.329, p = 0.016), and poorer cognitive inhibition (ß = -0.334, p = 0.014), significantly predicted higher rumination. Conclusions: Rumination about symptoms of insomnia in a clinical sample is associated with impaired inhibitory but not switching capacities above and beyond the role played by traditional predictors such as depression and emotion regulation strategies. If replicated, present preliminary results suggest the need to target cognitive inhibition deficits in insomnia treatment.

Is poor sleep associated with obesity in older adults? A narrative review of the literature.

INTRODUCTION: To address the worldwide epidemic of obesity, a sizable literature implicates sleep problems in the onset of obesity in younger populations. However, less is known about how this process may operate among older adults, which is of concern, given demographic shifts that have resulted in a much higher proportion of developed nations around the world reaching late life. METHODS: We offer a current review of the literature studying older adults and examining associations between sleep quality and obesity in this population. We consider both subjective and objectively measured sleep as well as both cross-sectional and longitudinal studies offering stronger causal inference. RESULTS: We discuss seemingly contradictory literature showing that shorter sleep duration as well as longer sleep duration are associated with obesity risk, then review studies that tested for non-linear relationships and reported a U-shape pattern, suggesting that too much or too little sleep is detrimental. Besides sleep duration, we discuss evidence showing that other forms of sleep dysfunction related to night-time awakenings, REM sleep, slow-wave sleep, and daytime sleepiness, which are indicators of sleep quality, are also linked to obesity. Specific psychological and physiological mediators and moderators, suggesting possible mechanisms whereby sleep problems may affect obesity in older adults, are described. CONCLUSION: We conclude by discussing areas, where additional research could help clarify this association, considering such factors as medical comorbidities common in late life, and health-related behaviors that may stem from poor sleep (such as disordered eating behavior). Such insights will have great value for clinical practice. LEVEL OF EVIDENCE: Level V, narrative review.

Inflammation as a mediator between adverse childhood experiences and adult depression: A meta-analytic structural equation model.

Exposure to adverse childhood experiences (ACEs) confers a higher risk of developing depression in adulthood, yet the mediation of inflammation remains under debate. To test this model, we conducted a systematic review and two-stage structural equation modelling meta-analysis of studies reporting correlations between ACEs before age 18, inflammatory markers and depression severity in adulthood. Scopus, Pubmed, Medline, PsycInfo, and CINAHL were searched up to 2 October 2023. Twenty-two studies reporting data on C-reactive protein (CRP, n = 12,935), interleukin-6 (IL-6, n = 4108), tumour necrosis factor-α (TNF-α, n = 2256) and composite measures of inflammation (n = 1674) were included. Unadjusted models revealed that CRP (ß = 0.003, 95 % LBCI 0.0002 to 0.0068), IL-6 (ß = 0.003, 95 % LBCI 0.001 to 0.006), and composite inflammation (ß = 0.009, 95 % LBCI 0.004 to 0.018) significantly mediated the association between ACEs and adult depression. The mediation effects no longer survived after adjusting for BMI; however, a serial mediation model revealed that BMI and IL-6 sequentially mediated the association between ACEs and depression (ß = 0.002, 95 % LBCI 0.0005 to 0.0046), accounting for 14.59 % and 9.94 % of the variance of IL-6 and depressive symptoms, respectively. Due to the cross-sectional nature of assessment of inflammation and depression findings should be approached with caution; however, results suggest that complex interactions of psychoneuroimmunological and metabolic factors underlie the association between ACEs and adulthood depression.

Associations between immune biomarkers and symptoms of anxiety, depression, and insomnia in paediatric inflammatory bowel disease: A preliminary longitudinal analysis.

Innate immunity may influence the onset of affective symptoms and alter sleep patterns in chronic inflammatory conditions. Here, we tested the prospective associations between baseline serum C-reactive protein (CRP), albumin, and CRP/albumin ratio (CAR, i.e., an emerging biomarker of disease activity), and self-reported symptoms of anxiety, depression, and insomnia at 1-year follow up in paediatric inflammatory bowel disease (n = 17). After controlling for baseline values, CAR (ρ = 0.591, p = 0.026) predicted anxiety symptoms, while albumin predicted both anxiety (ρ = -0.687, p = 0.007) and insomnia symptoms (ρ = -0.648, p = 0.012). Current findings preliminarily suggest that inflammation may influence anxiety and sleep disturbance in paediatric IBD.

Inflammation as an aetiological trigger for depressive symptoms in a prospective cohort of patients with inflammatory bowel disease.

OBJECTIVE: Inflammatory bowel disease (IBD) is often comorbid with mood disorders and depressive symptoms. The aetiology of depressive symptoms in IBD, however, remains largely unknown. Consistent with the inflammatory hypothesis of depression, the aim of this study was to explore the prospective associations between inflammatory biomarkers and depressive symptoms in a cohort of IBD patients with and without a previous clinical diagnosis of mood disorder. METHOD: IBD clinical activity was determined using the Harvey-Bradshaw Index for CD and the Partial Mayo score for UC; serum C-reactive protein (CRP) and faecal calprotectin (fCAL) were used as biomarkers of systemic and intestinal inflammation, respectively. Participants were administered the Hospital Anxiety and Depression Scale-depression (HADS-D) at baseline and 1-year follow-up. RESULTS: Eighty-four participants (50 ± 16 years; 75% UC and 25% CD) were included in the main analyses. Longitudinal moderated regression models showed that baseline CRP significantly predicted follow-up HADS-D scores among individuals with a previous mood disorder diagnosis (ß = 0.843, p < .001), but not among individuals without (ß = -0.013, p = .896), after controlling for baseline HADS-D scores, body mass index, IBD phenotype, sex, and perceived stress. Likely due to lower power, results on FCAL (n = 31) were not statistically significant. CONCLUSION: This study suggests that IBD patients with previous diagnosis of mood disorder may be at higher risk of inflammation-related depressive symptoms.

Inflammatory hypotheses of sleep disturbance - depression link: Update and research agenda.

Studies in human and experimental animal models support a role of inflammation in the aetiology of depression, yet the precise role played by sleep disturbance (i.e., difficulties falling or maintaining sleep) is poorly understood. Consistent evidence from prospective epidemiological studies suggests sleep disturbance as a predictor of major depression episodes and depression recurrence. In parallel, up to 20% of individuals with sleep disturbance have low-grade peripheral inflammation (i.e., CRP>3 mg/l), and preliminary longitudinal evidence showed that sleep disturbance may even predict the levels of inflammation. Therefore, it is possible that sleep disturbance may increase inflammation, which in turn may contribute (i.e., mediate) to the onset - or worsening - of depression. Alternatively, sleep disturbance may serve as a vulnerability factor and increase the risk of developing depressive symptoms when facing an immune challenge. The aim of this review was to summarise the state of the science on the role of sleep disturbance in contributing to depression-related inflammation. A research agenda is also proposed to advance the study of sleep disturbance in the psychoneuroimmunology of depression.

Psychosocial and behavioural predictors of immune response to influenza vaccination: a systematic review and meta-analysis.

High variability of influenza vaccine efficacy requires the identification of modulators of immunisation that may be targeted as adjuvants in health psychology interventions. Psychosocial and behavioural variables such as psychological stress, greater negative and lower positive affectivity, poor sleep, loneliness, and lack of social support, have been associated with abnormal immune and inflammatory responses and negative health outcomes, yet their effects in modulating vaccine efficacy are yet to be fully understood. We conducted an updated systematic review of longitudinal and experimental studies examining the effects of such variables in predicting immune response to influenza vaccine. PubMed, Medline, PsycINFO, CINAHL and Scopus were searched up to November 2022. Twenty-five studies met the inclusion criteria for qualitative synthesis and 16 provided data for meta-analysis. Low positive and high negative affect were associated with low antibodies and weak cell-mediated immunity following vaccination in qualitative synthesis. Literature on sleep disturbance, loneliness and social support was limited and yielded inconsistent results. Psychological stress was associated with poorer antibody response in meta-analysis. In conclusion, findings from this review suggest a need for further longitudinal and experimental studies on these factors to support their inclusion as target variables in vaccine adjuvant interventions.

Peripheral brain-derived neurotrophic factor (BDNF) in insomnia: A systematic review and meta-analysis.

The brain-derived neurotrophic factor (BDNF) is associated with emotional and cognitive functioning, and it is considered a transdiagnostic biomarker for mental disorders. Literature on insomnia related BDNF changes yielded contrasting results and it has never been synthetized using meta-analysis. To fill this gap, we conducted a systematic review and meta-analysis of case-control studies examining the levels of peripheric BDNF in individuals with insomnia and healthy controls using the PRISMA guidelines. PubMed, Scopus, Medline, PsycINFO and CINAHL were searched up to Nov 2022. Nine studies met the inclusion criteria and were assessed using the Newcastle-Ottawa Scale. Eight studies reported sufficient data for meta-analysis. Random-effects models showed lower BDNF in subjects with insomnia (n = 446) than in controls (n = 706) (Hedge's g = -0.86, 95% CI: -1.39 to -0.32, p = .002). Leave-one-out sensitivity analysis confirmed that the pooled effect size was robust and not driven by any single study. However, given the small sample size, the cross-sectional nature of the measurement, and the high heterogeneity of included data, the results should be cautiously interpreted. Progress in the study of BDNF in insomnia is clinically relevant to better understand the mechanisms that may explain the relationship between disturbed sleep and mental disorders.

The Sleepiness-Depression Link in Obstructive Sleep Apnea: Preliminary Results on the Mediation of Impulsivity.

BACKGROUND: Emotional impulsivity has been found to be relevant in explaining the association between sleep problems and depressive symptoms, suggesting the potential role of impulsivity as a key underlying mechanism of this link. The objective of this study was to take a preliminary step in understanding the mediating role of impulsivity in the relation between excessive daytime sleepiness (EDS) and depression in patients with obstructive sleep apnea syndrome (OSAS) and to compare psychological and demographic characteristics between different levels of daytime sleepiness. METHODS: A total of 138 patients with OSAS underwent polygraphic cardiorespiratory monitoring and completed a series of questionnaires investigating perceived sleepiness, depression, impulsivity, and other psychological characteristics. A mediational model was tested in order to assess whether impulsivity mediated the relation between sleepiness and depressive symptoms while controlling for the effects of age, sex, BMI, and oxygen saturation parameters. RESULTS: the mediation model showed that there was a significant indirect effect of impulsivity in the sleepiness-depression link (αß = 0.084 [0.0243-0.1617]). CONCLUSIONS: The here-presented results showed that the sleepiness-depression link is not direct as previous studies asserted, but instead it may be better explained by impulsivity. Research and practical implications are discussed.

Differential Associations of Cognitive Emotion Regulation Strategies with Depression, Anxiety, and Insomnia in Adolescence and Early Adulthood.

While difficulties with emotion regulation (ER) are consistently linked to poor mental health in adulthood, findings in adolescence have been more mixed. Cognitive ER strategies, which involve the ability to manage emotions through mental processes, may be particularly important during different stages of development due to age-specific adjustments. We conducted two exploratory and cross-sectional studies to examine the relationships between cognitive ER strategies and mental health (i.e., depressive, anxiety, and insomnia symptoms) in two samples: 431 young adults (Mage = 20.66 ± 2.21; 70% women and 30% men) and 271 adolescents (Mage = 14.80 ± 0.0.59; 44.6% girls and 55.4% boys). The participants completed a group of questionnaires, including the Cognitive Emotion Regulation Questionnaire, the Insomnia Severity Index, the Beck Depression Inventory-II, the State-Trait Anxiety Inventory, and the Youth Self Report. We employed hierarchical multiple regressions to assess the unique contribution of cognitive ER strategies to mental health outcomes. Maladaptive strategies (such as rumination and catastrophizing) were consistently associated with impaired mental health in both samples, while adaptive strategies (such as positive refocusing and positive reappraisal) were only associated with better mental health in young adults. These findings support the importance of cognitive ER strategies as potential risk factors for psychopathology and suggest that interventions aimed at improving emotion regulation may be beneficial. The age-specific differences in the relationship between cognitive ER strategies and mental health may reflect the refinement of emotion regulation abilities across the lifespan.