Psychosocial factors and patient and healthcare delays in large (class T3-T4) oral, oropharyngeal, and laryngeal carcinomas.

BACKGROUND: Psychosocial factors and socioeconomic status have been associated with incidence, survival, and quality of life among patients with head and neck cancer. We investigated the association between different psychosocial factors, socioeconomic status, and patient delays in T3-T4 oral, oropharyngeal, and laryngeal cancer. PATIENTS AND METHODS: We conducted a nationwide prospective questionnaire-based study (n = 203) over a 3-year period. RESULTS: We found no association between psychosocial factors (depression, social isolation, loneliness, and cynical hostility) and patient delay. Depression was three times more common among head and neck cancer patients compared with the general Finnish population. Head and neck cancer patients had lower educational levels and employment status, and were more often current smokers and heavy drinkers. CONCLUSIONS: Although we found no association between patient delay and psychosocial factors, patients diagnosed with a large head and neck cancer appeared to have a lower socioeconomic status and higher risk for developing depression, which should be considered in clinical practice.

School achievement in adolescence and the risk of mental disorders in early adulthood: a Finnish nationwide register study.

School grades in adolescence have been linked to later psychiatric outcomes, but large-scale nationwide studies across the spectrum of mental disorders are scarce. In the present study, we examined the risk of a wide array of mental disorders in adulthood, as well as the risk of comorbidity, associated with school achievement in adolescence. We used population-based cohort data comprising all individuals born in Finland over the period 1980-2000 (N = 1,070,880) who were followed from age 15 or 16 until a diagnosis of mental disorder, emigration, death, or December 2017, whichever came first. Final grade average from comprehensive school was the exposure, and the first diagnosed mental disorder in a secondary healthcare setting was the outcome. The risks were assessed with Cox proportional hazards models, stratified Cox proportional hazard models within strata of full-siblings, and multinomial regression models. The cumulative incidence of mental disorders was estimated using competing risks regression. Better school achievement was associated with a smaller risk of all subsequent mental disorders and comorbidity, except for eating disorders, where better school achievement was associated with a higher risk. The largest associations were observed between school achievement and substance use disorders. Overall, individuals with school achievement more than two standard deviations below average had an absolute risk of 39.6% of a later mental disorder diagnosis. By contrast, for individuals with school achievement more than two standard deviations above average, the absolute risk of a later mental disorder diagnosis was 15.7%. The results show that the largest mental health burden accumulates among those with the poorest school achievement in adolescence.

Association between depression and the likelihood of having children: a nationwide register study in Finland.

BACKGROUND: Depression may be associated with a lower likelihood of having children, but the findings are inconsistent. Previous population-based studies on this topic are limited. OBJECTIVE: We examined associations between depression and the likelihood of having children, the number of children, and the parental age at first birth. We also evaluated whether these associations differ for people with low, middle, and high educational levels. STUDY DESIGN: We conducted a nationwide register cohort study including all individuals born in Finland from 1960 to 1980 (n=1,408,951). Depression diagnoses were identified from the Care Register for Health Care (containing records of inpatient hospital episodes for the period 1969 to 2017 and of specialist outpatient visits for the period 1996 to 2017). The main outcomes-having biological children, the number of biological children, and the parental age at first birth-were identified from the Population Register of Statistics Finland and were defined either in the last year of the follow-up in 2017 or the last year alive or living in Finland. The association between depression and the likelihood of having children was examined using a logistic regression analysis; the association between depression and the number of children was evaluated using Poisson regression analyses, and the association between depression and the age at first birth was evaluated using a linear regression analysis. All analyses were conducted separately for men and women. RESULTS: For both men and women, secondary care-treated depression was associated with a lower likelihood of having children (odds ratio, 0.66; 95% confidence interval, 0.64-0.67 for men; odds ratio, 0.84; 95% confidence interval, 0.82-0.85 for women) and with having fewer children (incidence rate ratio, 0.86; 95% confidence interval, 0.86-0.87 for men; incidence rate ratio, 0.96; 95% confidence interval, 0.96-0.96 for women). Depression was associated with a slightly lower parental age at first birth (33.1 vs 34.0; P<.001 for men; 31.3 vs 32.1; P<.001 for women). Dose-response associations between the severity of depression and a decreased likelihood of having children, as well as having fewer children, were observed. Earlier onset of depression was related to a lower likelihood of having children and to having fewer children. Among men and women in middle- and high-level educational groups, depression was associated with a lower likelihood of having children and with having fewer children. Among men with a low level of education, no associations were observed. Among women with a low level of education, depression was associated with a higher likelihood of having children and with having more children. CONCLUSION: Both men and women with secondary care-treated depression have a lower likelihood of having children and have fewer children. Our findings suggest that depression may be one of the factors that contribute to the likelihood of having children, which should be addressed by policy makers.

Self-rated work ability as a risk factor for disability retirement.

BACKGROUND: Simple and efficient survey measures to predict staying in or leaving work are needed. We examined the association of single-item self-rated work ability (SRWA) with disability retirement in two large population-based samples and compared the association of SRWA to two other scales, work ability score (WAS) and self-rated health (SRH), used earlier in studies. METHODS: The study population comprised 6034 participants aged 35-58 from the population-based Health 2000 and FinHealth 2017 cohort studies, pooled together. SRWA, WAS and SRH were all classified in three categories: poor, limited and good. A 36-month follow-up for disability retirement via linkage to electronic records was included in the analysis. RESULTS: Of the participants, 195 retired during the follow-up. All three measures strongly predicted disability retirement. Hazard ratio (HR) for poor SRWA (vs. good) was 8.48 [95% confidence interval (CI) 5.41-13.28], WAS 7.99 (95% CI 5.62-11.37) and SRH 5.96 (95% CI 4.17-8.51). HR for limited SRWA (vs. good) was 4.35 (95% CI 3.21-5.91), WAS 3.54 (95% CI 2.49-5.04) and SRH 2.27 (95% CI 1.59-3.23). Taking into account gender, age, education and mental health narrowed the gap between poor and limited vs. good work ability as predictors of disability retirement, but the differences remained clear. CONCLUSIONS: Limited or poor self-rated work ability or health are strong predictors of disability retirement. The SRWA measure is a useful survey-measure of work ability in community-based surveys.

Psychosocial work characteristics and sleep quality among early career registered nurses: a cross-sectional latent profile analysis.

BACKGROUND: Individual psychosocial work characteristics have been associated with health and well-being of registered nurses. However, it is yet to be determined whether different types of psychosocial work characteristics form patterned profiles and how these profiles are associated with the health and well-being. The purpose of this study was to identify latent psychosocial work characteristic profiles, including procedural, interactional and distributive justice, job demand and job control, and examine whether the profiles are associated with sleep quality among early career registered nurses. METHODS: We conducted a cross-sectional study comprising 632 early career registered nurses. Data were collected between November and December 2018 using an electronic survey with internationally validated measures including the Organizational Justice Scale, the Nurse Stress Index Scale, the Job Content Questionnaire, and the Sleep Problems Questionnaire. Latent profile analysis was used to identify groups with similar psychosocial work characteristic profiles. Multinomial and linear regression analyses were used to examine the association between latent work characteristics profiles and sleep quality. RESULTS: Analysis yielded four profiles. The profiles were named based on the descriptions of classes as high strain/low justice, medium strain/high justice, medium strain/medium justice, and low strain/high justice. The low strain/high justice profile group (p = < 0.001) and the medium strain/high justice profile group (p = 0.002) had statistically significantly better sleep quality compared to the high strain/low justice profile group. CONCLUSIONS: High procedural and interactional justice may alleviate strain in early career registered nurses and protect them against sleep problems. Promoting organizational justice in early career stages seems an efficient way to enhance registered nurses' well-being and sleep quality.

Nursing informatics competence profiles and perceptions of health information system usefulness among registered nurses: A latent profile analysis.

AIMS: To identify different nursing informatics competence (NIC) profiles in nurses, examine the factors associated with profile memberships and examine the associations of the derived profiles with the nurses' perception of the usefulness of a health information system (HIS). DESIGN: A cross-sectional study. METHODS: A sample of 3610 registered nurses responded to a nationwide survey in March 2020. A latent profile analysis was performed to identify NIC profiles based on three competence areas: nursing documentation, working in digital environment, and ethics and data protection. A multinomial logistic regression was carried out to examine the associations of demographic and background variables with the profile membership. Linear regression analyses were carried out to examine the association between the profile membership and perceived HIS usefulness. RESULTS: Three NIC profiles were identified and labelled as low, moderate and high competence groups. A younger age, recent graduation year, sufficient orientation and high-rated proficiency as an HIS user were associated with nurses belonging to a high or moderate competence group relative to a low competence group. Competence group membership was associated with perceived HIS usefulness. The high competence group consistently expressed the highest usefulness of the HIS and the low competence group the lowest. CONCLUSION: Tailored training and support should be provided for nurses with different levels of informatics competence, thereby facilitating their ability to respond to increasingly digitalized work. This could contribute to higher usefulness of the HIS in terms of supporting the nurses' work tasks and promoting the quality of care. IMPACT: This was the first study exploring latent profiles of informatics competence in nurses. Insights from this study are useful for nursing management to identify different competence profiles of their employees, provide support and training to meet their needs, and promote the successful use of an HIS.

Network dynamics of depressive symptoms in antidepressant medication treatment: secondary analysis of eight clinical trials.

Depression can be viewed as a network of depressive symptoms that tend to reinforce each other via feedback loops. Specific symptoms of depression may be differently responsive to antidepressant treatment, and some symptoms may be more important than others in the overall improvement of depression associated with treatment. We pooled prospective data from eight industry-sponsored placebo-controlled trials for paroxetine, fluoxetine and imipramine (total n = 3559) to examine whether improvements in specific depressive symptoms were more strongly related to improvements in other depressive symptoms among patients on active antidepressant treatment as compared to placebo. Depressive symptoms were assessed with the 17-item Hamilton Depression Rating Scale. Data on treatment was dichotomized into active treatment (receiving any antidepressant agent) vs. placebo. Time-lagged longitudinal analyses suggested that improvement in three symptoms-depressed mood, insomnia, and suicidality-had a broader overall impact on subsequent improvement in other depressive symptoms in the antidepressant condition compared to placebo (i.e., greater out-strength). Moreover, improvements in depressed mood and insomnia were more likely to follow the improvements in other symptoms in the antidepressant condition compared to placebo (i.e., greater in-strength). These results from clinical trial data suggest that depressed mood, insomnia, and suicidality may be particularly important in accounting for the remission and recovery in response to antidepressant treatment.

Long-term cumulative light exposure from the natural environment and sleep: A cohort study.

We analysed (A) the association of short-term as well as long-term cumulative exposure to natural light, and (B) the association of detailed temporal patterns of natural light exposure history with three indicators of sleep: sleep duration, sleep problems, and diurnal preference. Data (N = 1,962; 55% women; mean age 41.4 years) were from the prospective Young Finns Study, which we linked to daily meteorological data on each participant's neighbourhood natural light exposure using residential postal codes. Sleep outcomes were self-reported in 2011. We first examined associations of the sleep outcomes with cumulative light exposure of 5-year, 2-year, 1-year, and 2-month periods prior to the sleep assessment using linear and Poisson regression models adjusting for potential confounders. We then used a data-driven time series approach to detect clusters of participants with different light exposure histories and assessed the associations of these clusters with the sleep outcomes using linear and Poisson regression analyses. A greater cumulative light exposure over ≥1 year was associated with a shorter sleep duration (ß = -0.10, 95% confidence interval [CI] -0.15 to -0.04), more sleep problems (incident rate ratio [IRR] 1.04, 95% CI 1.0-1.07) and diurnal preference towards eveningness (ß = -0.09, 95% CI -0.14 to -0.03). The data-driven exposure pattern of "slowly increasing" light exposure was associated with fewer overall sleep problems (IRR 0.93, 95% CI 0.88-0.98) compared to a "recently declining" light exposure group representing the "average-exposure" group. These findings suggest that living in an area with relatively more intense light exposure for a longer period of time influences sleep.

Healthcare workers' heterogeneous mental-health responses to prolonging COVID-19 pandemic: a full year of monthly follow up in Finland.

BACKGROUND: The COVID-19 pandemic strained healthcare workers but the individual challenges varied in relation to actual work and changes in work. We investigated changes in healthcare workers' mental health under prolonging COVID-19 pandemic conditions, and heterogeneity in the mental-health trajectories. METHODS: A monthly survey over a full year was conducted for employees of the HUS Helsinki University Hospital (n = 4804) between 4th June 2020 to 28th May 2021. Pandemic-related potentially traumatic events (PTEs), work characteristics (e.g., contact to COVID-19 patients), local COVID-19 incidence, and demographic covariates were used to predict Mental Health Index-5 (MHI-5) and Insomnia Severity Index (ISI) in generalized multilevel and latent-class mixed model regressions. RESULTS: Local COVID-19 log-incidence (odds ratio, OR = 1.21, with 95% CI = 1.10-1.60), directly caring for COVID-19 patients (OR = 1.33, CI = 1.10-1.60) and PTEs (OR = 4.57, CI = 3.85-5.43) were all independently associated with psychological distress, when (additionally) adjusting for age, sex, profession, and calendar time. Effects of COVID-19 incidence on mental health were dissociable from calendar time (i.e., evolved in time) whereas those on sleep were not. Latent mental-health trajectories were characterized by a large class of "stable mental health" (62% of employees) and minority classes for "early shock, improving" (14%) and "early resilience, deteriorating" mental health (24%). The minority classes, especially "early shock, improving", were more likely to live alone and be exposed to PTEs than the others. CONCLUSIONS: Healthcare workers faced changing and heterogeneous mental-health challenges as the COVID-19 pandemic prolonged. Adversity and mental ill-being may have accumulated in some employees, and factors like living arrangements may have played a role. Knowledge on employees' demographic and socioeconomic background, as well as further research on the factors affecting employees' resilience, may help in maintaining healthy and efficient workforce in the face of a prolonging pandemic.

Comparison of two different mindfulness interventions among health care students in Finland: a randomised controlled trial.

We investigated the short- and long-term effects of two different evidence-based mindfulness training on students' stress and well-being. A randomised controlled trial with three measurement points (baseline, post-intervention, and 4 months post-intervention) was conducted among undergraduate students of medicine, dentistry, psychology, and logopaedics at the University of Helsinki. The participants were randomly assigned into three groups: (1) face-to-face mindfulness training based on the Mindfulness Skills for Students course (n = 40), (2) a web-based Student Compass program using Mindfulness and Acceptance and Commitment therapy (n = 22), and (3) a control group that received mental health support as usual (n = 40). The primary outcome was psychological distress measured using the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM). Secondary outcomes included hair cortisol concentrations and a wide range of well-being indicators. Psychological distress increased in all the groups from baseline to post-intervention, but significantly less so in the intervention groups than in the control group. At 4-month follow-up, were found no differences between the primary outcomes of the control and intervention groups, but the participants who continued practising mindfulness at least twice a week were less stressed than the others. Our results suggest that participating in a mindfulness course may mitigate health care students' psychological distress during the academic year, but only if the participants continue practising mindfulness at least twice a week.

Subjective mental well-being among higher education students in Finland during the first wave of COVID-19.

AIMS: Increased mental health problems during the COVID-19 pandemic have become a major concern among young adults. Our aim was to understand which COVID-19-related questions predicted mental well-being during the outbreak. METHODS: Two cross-sectional datasets were used. The primary dataset was collected in May 2020 (n = 1001), during the initial COVID-19 outbreak, and the secondary in April 2019 (n = 10866), before the pandemic. Mental well-being was assessed with the Short Warwick-Edinburgh Mental Well-Being Scale. Relationships between mental well-being and COVID-19-related questions were investigated with lasso regression. As an exploratory analysis, two-way ANOVAs were used to compare mental well-being before and during the outbreak. RESULTS: Higher levels of mental well-being were associated with lower levels of academic stress and COVID-19-related worry, along with a higher satisfaction with the procedures and information provided by the higher education institutions and the government. COVID-19-related symptoms and infections did not have an impact on students' mental well-being during the outbreak. Small to moderate effect sizes across the time points were detected, indicating an overall decrease in mental well-being across age and gender during the outbreak. CONCLUSIONS: COVID-19 had an impact on higher education students' mental well-being. Higher education institutes may play a crucial role in protecting their students' well-being during uncertain times.

Changes in healthy and unhealthy working life expectancies among older working-age people in Finland, 2000-2017.

BACKGROUND: Raising the statutory retirement age has been a common policy response to population ageing, but health problems may restrict labour force participation in older ages. We examined the development of healthy and unhealthy working life expectancies in Finland from 2000 to 2017 using different measures of health problems. METHODS: Healthy and unhealthy working life expectancies were calculated for the age range 50-65 years using the Sullivan method. The health measures were limiting long-standing illness, self-rated health, mental health problems and self-assessed work ability. RESULTS: Healthy working life expectancy was highest when health was measured by work ability. From 2000 to 2017, working years in full ability between the ages 50-65 increased from 6.2 (95% confidence interval 5.9-6.4) to 8.2 (8.0-8.5). Healthy working life expectancy increased also when measured by the other indicators. Unhealthy working years also increased, except when health problems were measured by limiting long-standing illness. The share of years in work increased both within the healthy and the unhealthy years, the increase being larger or equally large for the latter. Within the healthy and unhealthy years measured by the other three indicators, the share of working years increased irrespective of whether work ability was full or limited, but the increase was larger for limited work ability. CONCLUSIONS: In Finland, healthy working life expectancy has increased irrespective of how health is measured but also working with health problems has become more prevalent. The estimates for healthy working years are highest when a direct measure of work ability is used.

Parental psychological problems were associated with higher screen time and the use of mature-rated media in children.

AIM: Parents' psychological problems may affect children's screen time, but research has been scarce. We examined the association between parental psychological problems and children's screen media behaviours in a nationally representative sample. METHODS: The participants were from the Adolescent Brain Cognitive Development study, recruited by probability sampling from the USA population. Children reported their use of TV, videos, video games, social media and mature-rated media. The parents (85% mothers) reported psychological problems using the Adult Self-Report questionnaire. RESULTS: In 10,650 children (5112 girls, 5538 boys) aged 9.9 ± 0.6 years, the presence of parental psychological problems was associated with children spending more daily time on screen media and with meeting the recommendation of ≤2 daily hours less often than children whose parents did not have psychological problems. Parental psychological problems were associated with children's TV watching, video watching and gaming but not with using social media. Parental internalising problems were associated with children watching mature-rated movies (odds ratio [OR] = 1.14, 95% confidence interval [CI] = 1.00, 1.30) and playing mature-rated games (OR = 1.27, 95% CI = 1.11, 1.45). CONCLUSION: Presence of parental psychological problems is associated with higher screen time and use of mature-rated media in children. This cross-sectional study was not able to examine causal associations.

The association between stress attributed to information systems and the experience of workplace aggression: a cross-sectional survey study among Finnish physicians.

BACKGROUND: Physicians commonly suffer from workplace aggression and its negative consequences. Previous studies have shown that stressors such as job demands increase the risk of inappropriate treatment at workplace. Poorly functioning, and constantly changing information systems form a major work stressor for physicians. The current study examined the association between physicians' stress attributed to information systems (SAIS) and their experiences of workplace aggression. Workplace aggression covered physical and non-physical aggression, perpetrated by coworkers, patients, patient's relatives, or supervisors. METHODS: A cross-sectional survey study was conducted. The participants included 2786 physicians (67.4% women) who were sampled randomly from the registry of Finnish Medical Association, which covers almost all of the Finnish physician population. First, bivariate associations were studied among participant characteristics, SAIS and workplace aggression. Logistic regression analysis was then used to further determine how SAIS was associated with the likelihood of experiencing different types of aggression. RESULTS: Higher levels of SAIS were associated with higher likelihood of aggression with regard to all types of aggression, except non-physical aggression perpetrated by patients or relatives. The demographic factors (work-sector, gender, age) did not have a noticeable influence on the association between SAIS and aggression. CONCLUSIONS: The present results build on previous evidence on the prevalence of SAIS and its negative effects on healthcare workers. Since SAIS may increase the risk of experiencing aggression, it is possible that SAIS also endangers the wellbeing of physicians and thereby the quality of patient care. Resourcing time and training during introduction of a new IS could alleviate time pressure and thus stress attributed to managing new information systems. The role of organizational climate and general workload in arousing SAIS and aggression should be examined in future studies.

The Interplay of Work, Digital Health Usage, and the Perceived Effects of Digitalization on Physicians' Work: Network Analysis Approach.

BACKGROUND: In health care, the benefits of digitalization need to outweigh the risks, but there is limited knowledge about the factors affecting this balance in the work environment of physicians. To achieve the benefits of digitalization, a more comprehensive understanding of this complex phenomenon related to the digitalization of physicians' work is needed. OBJECTIVE: The aim of this study was to examine physicians' perceptions of the effects of health care digitalization on their work and to analyze how these perceptions are associated with multiple factors related to work and digital health usage. METHODS: A representative sample of 4630 (response rate 24.46%) Finnish physicians (2960/4617, 64.11% women) was used. Statements measuring the perceived effects of digitalization on work included the patients' active role, preventive work, interprofessional cooperation, decision support, access to patient information, and faster consultations. Network analysis of the perceived effects of digitalization and factors related to work and digital health usage was conducted using mixed graphical modeling. Adjusted and standardized regression coefficients are denoted by b. Centrality statistics were examined to evaluate the relative influence of each variable in terms of node strength. RESULTS: Nearly half of physicians considered that digitalization has promoted an active role for patients in their own care (2104/4537, 46.37%) and easier access to patient information (1986/4551, 43.64%), but only 1 in 10 (445/4529, 9.82%) felt that the impact has been positive on consultation times with patients. Almost half of the respondents estimated that digitalization has neither increased nor decreased the possibilities for preventive work (2036/4506, 45.18%) and supportiveness of clinical decision support systems (1941/4458, 43.54%). When all variables were integrated into the network, the most influential variables were purpose of using health information systems, employment sector, and specialization status. However, the grade given to the electronic health record (EHR) system that was primarily used had the strongest direct links to faster consultations (b=0.32) and facilitated access to patient information (b=0.28). At least 6 months of use of the main EHR was associated with facilitated access to patient information (b=0.18). CONCLUSIONS: The results highlight the complex interdependence of multiple factors associated with the perceived effects of digitalization on physicians' work. It seems that a high-quality EHR system is critical for promoting smooth clinical practice. In addition, work-related factors may influence other factors that affect digital health success. These factors should be considered when developing and implementing new digital health technologies or services for physicians' work. The adoption of digital health is not just a technological project but a project that changes existing work practices.

Organizational justice among registered nurses: A scoping review.

AIMS: This study aimed to describe and summarize research concerning organizational justice among registered nurses. BACKGROUND: Over the recent decades, a number of studies have explored organizational justice. Perceived high organizational justice among employees has been found to correlate with multiple beneficial outcomes, such as job satisfaction, commitment and improved physical and mental health. By contrast, low organizational justice is related to poor productivity, atmosphere at work, health and well-being. DESIGN: This study is a scoping review. DATA: Seven databases were used to search for peer-reviewed publications published between January 2015 and August 2019. REVIEW METHOD: This scoping review utilized Arksey and O'Malley's methodological framework. RESULTS: High organizational justice has been found to improve registered nurses' work-related outcomes, health and well-being. Low organizational justice has been linked to undesired work-related outcomes and health problems. CONCLUSION: Nurse managers play a key role in promoting organizational justice. Further research is needed to study the relationship between organizational justice and the quality of patient care and safety. There is need for longitudinal studies to understand the effects and nature of organizational justice in the nursing workforce.

Clinical symptoms of anxiety disorders as predictors of political attitudes: A prospective cohort study.

Conservative political ideologies have been suggested to correlate with elevated sensitivity to threat. However, it is unclear whether the associations between threat sensitivity and political attitudes can be observed with clinical measures of mental health. We examined how anxiety disorders predicted attitudes on several political issues. Participants were 7253 individuals from the 1958 British Birth Cohort study. Symptoms of generalised anxiety disorder, phobia and panic were assessed in a clinical interview at age 44, and opinions about political issues were self-reported by the participants 6 years later. Anxiety symptoms were associated with higher concerns about economic inequality, preservation of the environment, distrust in politics and lower work ethic. No associations were observed with racist or authoritarian attitudes, or support for traditional family values. We also assessed how political attitudes at ages 33 and 42 predicted anxiety disorder symptoms at age 44, revealing a possible bidirectional association between concern for economic inequality and anxiety disorder symptoms. These findings do not support an association between conservative political attitudes and elevated threat sensitivity. Rather, elevated anxiety may increase concerns about social inequality and the environment.

Is moderate depression associated with sleep stage architecture in adolescence? Testing the stage type associations using network and transition probability approaches.

BACKGROUND: Depression even at the subclinical level is often accompanied by sleep disturbances, but little is known about the dynamics of the sleep stages in relation to depressive symptoms. We examined whether the amount, associations, and transition probabilities of various sleep stages were associated with depressive symptoms in a community sample of adolescents. METHODS: The participants (N = 172, 59% girls, mean age 16.9 years) underwent overnight polysomnography and provided data on depressive symptoms (Beck Depression Inventory II). The association between depression status and total duration of each stage type was analyzed using ANOVA and survival analyses. The associations between the number of different sleep stage types were analyzed using graphical Gaussian models, mixed graphical models, and relative importance networks. A Markov chain algorithm was used to estimate the transition probabilities between each state and these probabilities were further compared between depression status groups. RESULTS: The associations between N1 and N3 were significantly stronger in both directions of the association (p-values for interactions 0.012 and 0.006) in those with more depressive symptoms. Similarly, a stronger association was observed from N1 to wake stage in those with more depressive symptoms (p-value for interaction 0.002). In those with more depressive symptoms, it was more likely to transition from N2 to N3 and from REM to N2 compared to others. CONCLUSIONS: These findings indicate that changes in sleep architecture are not limited to clinical depression and that the transitional dynamics of sleep stages are an important marker of subclinical depression.

Presleep physiological stress is associated with a higher cortical arousal in sleep and more consolidated REM sleep.

How sleep regulates physiological stress in healthy individuals is not well understood. We explored the associations between naturally occurring pre-sleep physiological arousal and EEG power spectral density together with rapid eye movement sleep (REMS) continuity. One hundred and fifty-four individuals (mean age 16.9, SD 0.1 years) collected five samples of saliva between the evening (mean time 18:20) and bedtime (mean 23:00) by using swabs, and underwent an overnight in-home polysomnography. We calculated spectral density for REMS and non-rapid eye movement sleep (non-REMS), and the number and duration of REMS arousals (<15 s) during sleep. An observational design allowed for measurement of natural variation in physiological and sleep arousal. Increasing cortisol levels toward bedtime were associated with higher EEG power spectral density at all frequency ranges in frontal locations, the highest association being for the beta1 frequency band. In central locations, the associations were pronounced for beta1 and beta2 bands. Higher overall cortisol levels in the evening were associated with less fragmented REMS. Presleep arousal was not associated with sleep staging. Physiological arousal toward bedtime was associated with EEG power spectral density values during sleep specifically at high EEG frequencies. This may represent a compensatory mechanism that serves as an adaptation to stress, since the REMS was more continuous along a higher physiological arousal level in the evening. Although causality cannot be inferred, a design with nonmanipulated physiological stress followed by naturally timed sleep at home provides new insights into stress regulation homeostasis.

The Contribution of Neighborhood Socioeconomic Disadvantage to Depressive Symptoms Over the Course of Adult Life: A 32-Year Prospective Cohort Study.

The association between socioeconomic disadvantage and increased risk of depressive symptoms in adulthood is well established. We tested 1) the contribution of early exposure to neighborhood socioeconomic disadvantage to later depressive symptoms throughout life, 2) the persistence of the potential association between early exposure and depressive symptoms, and 3) the contributions of other known risk factors to the association. Data were collected from the Young Finns Study, a prospective, population-based 32-year follow-up study that included participants aged 3-18 years at baseline in 1980. Participants were followed up with repeated measurements of depressive symptoms between 1992 and 2012 (n = 2,788) and linked to national grid data on neighborhood disadvantage via residential addresses. We examined the associations in mixed models separately for the 5-, 10-, 15-, and 20-year follow-ups. Living in a disadvantaged neighborhood during childhood and adolescence was associated with a higher level of depressive symptoms in adulthood during all follow-up periods (ß = 0.07, P = 0.001) than living in a nondisadvantaged area. Individual adulthood socioeconomic status mediated the associations. These findings suggest that living in a socioeconomically disadvantaged area during childhood and adolescence has a long-lasting negative association with mental health irrespective of family-related risks, partially due to socioeconomic adversity later in life.