A comprehensive investigation of the association between menopause symptoms and problematic eating behavior in peri- and post-menopause cisgender women.

Midlife individuals assigned female at birth are at risk for problematic eating behavior, associated with negative health outcomes. Little is known about how menopausal symptoms may increase risk in this population. The current study aimed to understand how a comprehensive range of menopause symptoms were globally associated with problematic eating behaviors. A total of 281 cisgender women (176 post-menopause, 105 peri-menopause) from the United States aged 40 to 64 were recruited utilizing Prolific, an online survey platform. Participants answered questionnaires about menopause symptoms and problematic eating. Participants were selected using demographic and health information provided in a screener survey. Participants also completed the Eating Disorder Questionnaire (EDE-Q), Women's Health Questionnaire (WHQ), Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder-7 (GAD-7), and Pittsburgh Sleep Quality Index (PSQI). Using Structural Equation Modeling, menopause symptoms explained 16.7 percent of the variance in problematic eating. Higher frequency and severity of anxiety, depression, sleep concerns, cognitive complaints, pain, and vasomotor symptoms was associated with greater frequency and severity of problematic eating behaviors, ß = .40, p < .001. Invariance testing showed no significant differences between peri- and postmenopausal women. These findings support the association between menopause symptoms and problematic eating in Midlife cisgender women and highlight the need for continued investigation.

Applying the Somatic Symptom Disorder Diagnosis to Individuals with Fibromyalgia: Strengths and Limitations.

Amidst broad changes to the somatic disorder diagnoses, DSM-IV pain disorder was absorbed into DSM-5's somatic symptom disorder (SSD) as a specifier. However, clinical research testing of its use for the chronic pain population has been limited and its utility remains inconclusive. Using the exemplar of fibromyalgia, this article evaluates the validity, reliability, clinical utility, and acceptability of the SSD pain specifier. The diagnosis appears to have moderate validity but low specificity for the fibromyalgia population. The pain specifier has neither undergone sufficient field testing nor been evaluated for use by medical providers, with available data suggesting low reliability. Further research is needed to establish clinical utility via assessment of differential treatment outcomes. Concerns about social, legal, and economic consequences of classifying pain patients with a mental health diagnosis are outstanding. The current SSD criteria should be used with caution among the fibromyalgia patient population until its application for chronic pain has been further researched.

Race as a Potential Moderator of the Association between Dysfunctional Beliefs about Sleep and Global Sleep Health.

OBJECTIVES: Dysfunctional beliefs about sleep are associated with components of sleep health, but their association with global sleep health is understudied. Beliefs about sleep may systematically vary by race, which may influence the association between dysfunctional beliefs about sleep and global sleep health. This study aimed to investigate whether race influences the association between dysfunctional beliefs about sleep and global sleep health. METHODS: Data were collected as part of an online survey. Participants were Black (n = 181) and White (n = 179) adults who were matched on age, self-reported sex, and level of education. Global sleep health was measured using the RU-SATED and dysfunctional beliefs about sleep were measured using the DBAS-16. Moderation analyses were conducted to investigate whether race moderated the association between DBAS-16 total and subscale scores and RU-SATED total scores. RESULTS: Race moderated the associations between DBAS-16 total score and subscale scores and RU-SATED total score (b = 0.54, p < .001). Higher DBAS-16 scores were significantly associated with lower RU-SATED scores in the white sample, while this association was not significant in the Black sample, except for the Sleep Expectations subscale, where the association was not significant in the White sample, and it was significant in the Black sample. CONCLUSIONS: These findings highlight that the association between dysfunctional beliefs about sleep and global sleep health may systematically vary by race which may have implications for promoting sleep health equity in racial minority populations through clinical and advocacy work. Future studies are needed to investigate what specific factors may be impacting these unique associations.

Interrupted lullabies: the association between menopausal symptoms and sleep variability in peri- and post-menopausal women.

Poor sleep is a reality for many midlife women experiencing menopause. Although much empirical attention has been allocated toward ameliorating vasomotor symptoms and related consequences, less focus has been given toward sleep, specifically sleep variability, in menopausal women. The present study aimed to determine the association between menopausal symptoms and night-to-night sleep variability among peri- and post-menopausal women. Participants were 220 menopausal women (42.3 percent peri-menopausal, 57.7 percent post-menopausal) aged 40 to 64 from the United States recruited via Prolific, and online platform. The current study conducted secondary analyses on data collected as part of a larger investigation on midlife women from the United States. A structural equation model assessed associations between a latent menopausal symptom construct, composed of several Women's Health Questionnaire domains, and a latent sleep variability construct, composed of sleep diary indices. Menopausal symptoms were associated with latent sleep variability (ß = 0.49, p < .05); greater experience of menopausal symptoms was associated with more night-to-night sleep variability (medium effect size). Waking after sleep onset (WASO) was the sole significant indicator of the latent sleep factor. The findings highlight the importance of menopausal symptoms for sleep variability, specifically wakefulness. As such, wakefulness may be an important target for sleep interventions for menopausal women. The findings further suggest a need for more research and interventions targeted toward understanding and ameliorating the impact of menopausal symptoms on night-to-night wakefulness overall.

Examining negative affect, sleep duration, and using food to cope as predictors of weight in midlife women.

Midlife women are vulnerable to developing obesity. Behavioral and psychosocial factors including sleep duration, stress eating, and negative emotionality are risk factors. However, little is known about the complex daily interplay between sleep, eating, emotion, and weight among midlife women. The current study examined how daily sleep, using food to cope, and negative emotionality are associated with weight using a daily process research design. An archival analysis was performed using the Midlife in the United States-II study (MIDUS II). The sample consisted of 489 midlife women (40-64 years of age). Variables included ecological momentary assessments of daily sleep duration, using food to cope, and negative affect (means and intraindividual variability) and a standardized measurement of BMI. Sleep duration variability was a significant predictor of BMI, albeit the model only accounted for .8% of the variance in BMI (b = .019, p < .05). In the final adjusted model, sleep duration variability, using food to cope, age, and physical activity were all significant predictors of BMI F(5, 559) = 21.503, p < .001, R2 = .161, ⨂R2 = .024, p = .001. Variability in negative affect, mean sleep duration or negative affect and the interactions between sleep duration (mean, variability) and negative affect (mean, variability) were not significant. Greater variability in sleep duration and greater use of food to cope predicted higher BMI in this sample across age and physical activity levels. Results highlight that daily health and psychosocial factors play an important role in weight.

Links between Savoring, Rumination, and Sleep-Related Experiences across Adulthood: Implications for Older Adults.

OBJECTIVES: Sleep problems are pervasive, particularly in older adults. Much work examines psychological factors that adversely affect sleep; fewer studies examine those with a positive effect. Savoring is a form of positive repetitive thought that is linked to several aspects of health but has been understudied in relation to sleep. We examined cross-sectional associations of both savoring and rumination with subjective sleep experiences, and assessed if these associations vary by age. METHODS: Adults and older adults (N = 216) ranging from 20-80 years in age (M = 44.9 ± 15.6 years) completed an online survey of validated measures of savoring, rumination, sleep disturbance, and sleep-related impairment. RESULTS: Higher levels of savoring were significantly associated with lower levels of sleep-related impairment but not sleep disturbance in regression analyses. Higher levels of rumination were significantly associated with higher levels of sleep disturbance and sleep-related impairment. Associations of savoring and rumination with sleep-related experiences did not vary by age. CONCLUSIONS: Savoring and rumination are relevant to sleep-related experiences in adults ranging from younger to older. Further investigation of the potential positive impact of savoring on sleep-related experiences is needed. CLINICAL IMPLICATIONS: Engagement in savoring and rumination should be considered when assessing sleep and sleep-related impairment in adults.

Sleep Health as Measured by RU SATED: A Psychometric Evaluation.

Objective/Background: Sleep health is a multidimensional construct of sleep and wakefulness that operationalizes optimal sleep as more than the absence disease. Despite its importance to public health promotion efforts, empirical research examining sleep health is currently limited, possibly due to the lack of empirically validated measures. Therefore, the purpose of the current study was to evaluate the psychometric properties of a previously proposed six-item sleep health scale (RU- SATED). Participants: A sample of 3,401 adults (Mean Age = 42.77, 47.8% female) completed an online survey of sleep and health. Methods: Participants completed the RU-SATED scale, as well as other sleep-related measures including the Insomnia Severity Index (ISI) and the Sleep Self-Efficacy Scale (SSE). Results: An exploratory factor analysis (EFA) revealed a two-factor structure. A confirmatory factor analysis (CFA) using this two-factor structure demonstrated adequate to good model fit indices (X 2 = 45.96, df = 8, p < .01; RMSEA = .04; CFI = .98; NFI = .98; TLI = .97). Cronbach's α was .64 and the average interitem correlation was .22. RU-SATED was negatively associated with insomnia severity and positively associated with both self-reported sleep and sleep self-efficacy. Conclusions: RU-SATED appears to be a valid instrument for the assessment of sleep health among adults that is related to, but distinct from, other established sleep constructs. Future research may benefit from examining the test-retest reliability of the measure and assessing the predictive validity of sleep health as it relates to health-related outcomes.

Sleep Discrepancy in a Randomized Controlled Trial of Brief Behavioral Therapy for Chronic Insomnia in Older Adults.

Background/Objective: Some older adults with insomnia experience sleep discrepancy, often characterized by greater subjective sleep difficulties and shorter subjective sleep duration than the estimates derived from objective measures. The present study examined whether a brief behavioral therapy for insomnia (BBTi) is efficacious for reducing sleep discrepancy in older adults. Methods: This study is a secondary analysis of a randomized controlled trial of BBTi for community dwelling older adults with chronic insomnia (N = 62). Thirty-two participants received BBTi, delivered in four individual face-to-face sessions. Thirty received the self-monitoring control (SMC). They all completed daily sleep diaries and wore an actigraph from baseline to posttreatment, and for 2 weeks at 3-month follow-up. Sleep discrepancy was calculated by subtracting diary from actigraphy estimates of sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). Mixed modeling was used to analyze data. SOL discrepancy decreased significantly in BBTi participants compared to SMC participants. The decreases in SOL discrepancy were explained by changes in diary-assessed SOL and subjective sleep quality but not changes in actigraphy-assessed SOL. Although WASO discrepancy and TST discrepancy decreased from baseline to posttreatment and follow-up, the Time by Group interaction effects were not significant indicating that BBTi participants did not experience greater reductions in WASO discrepancy and TST discrepancy than SMC participants. In conclusion, BBTi is efficacious for reducing SOL discrepancy in older adults with chronic insomnia.

Sleep Disturbance Mediates the Association Between Loneliness and Health in Older Americans.

BACKGROUND: As the research documenting loneliness as a risk factor for morbidity and mortality continues to grow, it becomes increasingly critical to understand the mechanics of this relationship. This study assessed whether sleep disturbance mediates the relationship between loneliness and health. METHOD: Data came from the 2006, 2010, and 2014 waves of the Health and Retirement Study, a longitudinal study of older Americans; participants ≥ 65 who completed the Psychosocial and Lifestyle Questionnaire in 2006 were included (n = 5067). Measures include the Hughes loneliness scales, a modified version of the Jenkins sleep scale, and self-reported health. Cross-lagged mediation models (i.e., path analysis) were used to model the relationships between loneliness, sleep disturbance, and self-reported health over the 8-year span. RESULTS: Loneliness predicted subsequent sleep disturbance, which in turn predicted subsequent self-reported health. Moreover, there was evidence of both direct and indirect effects (via sleep disturbance) of loneliness on self-reported health. These effects remained after controlling for demographics, isolation, and depression. CONCLUSION: Sleep disturbance partially mediates the relationship between loneliness and self-reported health over 8 years. These findings are not attributable to isolation or depression. Further research is necessary to develop and assess a more comprehensive model of how loneliness shapes health. This study indicates that targeting sleep disturbance may mitigate the health risks of loneliness in older Americans.

Social determinants of sleep disturbance in safety-net primary care: unmet needs, classist discrimination, and anxiety.

BACKGROUND: The 3P model proposes that predisposing, precipitating, and perpetuating factors all play a role in sleep disturbance. OBJECTIVE: The purpose of the current study is to investigate social determinants of sleep disturbance by applying the 3P model to a safety-net primary care setting, specifically by evaluating the role of classism and unmet needs as precipitating factors for sleep disturbance, and anxiety as a perpetuating factor for sleep disturbance. METHODS: Participants (N = 210) were a convenience sample of racially/ethnically diverse adults over the age of 18 (age M = 44.7 years) recruited from a safety-net primary care clinic in an urban area. The study employed a cross-sectional design. Participants completed a survey assessing sleep disturbances, anxiety, unmet needs, classism, social support, and a researcher-generated demographic form. RESULTS AND CONCLUSIONS: The unmet need for affordable long-term housing and greater experiences of classism were associated with more sleep disturbance, suggesting that both acted as precipitating factors. In a structural equation model with adequate fit indices, anxiety mediated the relationships with sleep disturbance for both the unmet need for affordable long-term housing and classism, suggesting that it serves as a perpetuating factor. Medical providers are recommended to explore these potential needs in safety-net primary care when patients present with sleep disturbance or anxiety. Assisting with connections to long-term housing and helping patients counteract and cope with classist discrimination may be effective in improving sleep in safety-net primary care.

Effects of Brief Behavioral Treatment for Insomnia on Daily Associations between Self-Reported Sleep and Objective Cognitive Performance in Older Adults.

OBJECTIVE: Behavioral treatments for insomnia improve sleep in older adults, but research documenting their effects on cognitive performance is mixed. We explored whether a brief behavioral treatment for insomnia (BBTi) impacts daily associations between sleep parameters and next day cognition. METHODS: Sixty-two older adults (Mage = 69.45 years, SD = 7.71) with insomnia completed either 4 weeks of BBTi or self-monitoring control (SMC). At baseline, post-treatment, and 3 month follow-up, participants completed 14 days of diaries measuring sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE), as well as daily cognitive tests measuring processing speed (i.e., symbol digit modalities test, SDMT), and reasoning (i.e., letter series). At each time period, associations between sleep parameters and daily cognition, controlling for age, education, insomnia duration, use of sleep medications, and depression (i.e., Beck Depression Inventory-2nd Edition scores), were examined through multilevel modeling. RESULTS: At post-treatment, we observed an interactive fixed effect of treatment condition (i.e., BBTi/SMC) and TST on daily SDMT and letter series performance. For BBTi, longer TST was associated with better letter series performance, and did not predict SDMT performance. For SMC, longer TST was associated with worse SDMT, and was not associated with letter series performance. Greater WASO (regardless of group) was associated with better SDMT performance at post-treatment. Associations were not maintained at follow-up. CONCLUSIONS: Sleep duration may play an important role in BBTi-related improvements in daily higher order cognition. Maintenance of these associations may be facilitated by booster sessions following post-treatment. CLINICAL TRIAL IDENTIFIER: NCT02967185.

Mental health and sleep disparities in an urban college sample: A longitudinal examination of White and Black students.

OBJECTIVE: Racial disparities in sleep may be consequential among college students given high rates of dysfunctional sleep among this population. The present study sought to investigate whether disparities in sleep explain existing mental health disparities. METHOD: Data included secondary analysis of a college risk behaviors and health study (n = 1242, mean age = 18.5). Race was dichotomized as White or Black, excluding all others, with participants completing measures of sleep at baseline and measures of depression and anxiety at follow-up 1 to 2 years later. RESULTS: Compared to White students, Black students were more likely to report lower rates of depression and anxiety, but poorer sleep outcomes. Mediation analyses revealed that sleep partially mediated (suppressed) the association between race and depressive and anxiety symptoms. CONCLUSIONS: Results indicate that disparities in sleep may play an important role in the association between race and mental health symptoms among college students. Future health disparity research would benefit from exploring the potentially bidirectional relationship between sleep and mental health symptoms among college students.

Supporting autonomy in long-term care: Lessons from nursing assistants.

Maximizing nursing home (NH) resident autonomy is a person-centered care (PCC) best practice. The purpose of this study was to identify and describe specific autonomy-supportive techniques used by nursing assistants (NAs) in three NH neighborhoods at one Veterans Affairs medical center. Thirteen interviews and approximately 80 h of behavioral observation of NAs were conducted across the three NH neighborhoods. Data were analyzed using thematic analysis. Ten autonomy-supportive tactics were identified: assisting, monitoring, encouraging, bargaining, informing, providing instructions, persuading, asking, providing options, and redirecting. Although all tactics honored some degree of resident autonomy, some were more restrictive than others. Results from the study elucidate specific actions NAs can take to promote resident autonomy, even when cognitive or physical limitations are present or there is potential concern for safety, and thereby support PCC best practice.

Geographic variation in mental health care disparities among racially/ethnically diverse adults with psychiatric disorders.

PURPOSE: The main purpose of this paper is to examine geographic variation in unmet need for mental health care among racially/ethnically diverse adults with psychiatric disorders in the US. METHODS: Drawn from the Collaborative Psychiatric Epidemiology Surveys (CPES; 2001-2003), adults with any past year psychiatric disorder diagnosis (n = 3211) from diverse racial/ethnic backgrounds were selected for analyses. Using weighted data, descriptive analyses and logistic regression analyses were conducted. RESULTS: Two-thirds of the total sample had unmet mental health care need, which differed significantly by race/ethnicity (p < .001). Logistic regression analyses show regional variation of the effect of race/ethnicity in unmet need: after adjusting for covariates, Latinos in the South, Blacks and Latinos in the Midwest, and Latinos and Asians in the West had higher unmet need than non-Hispanic Whites, whereas no significant racial/ethnic effects were found in the Northeast. CONCLUSIONS: Findings suggest that geographic region plays an important role in the sufficient use of mental health services among racial/ethnic minorities. Further research should elucidate reasons for geographic disparities in mental health care among racial/ethnic minority adults to reduce disparities.

Affective mediators of the association between pleasant events and global sleep quality in community-dwelling adults.

This study explored the association of engagement in pleasant events and global sleep quality, as well as examined the intermediary roles of positive affect and depressive symptoms in this association. Data were derived from the Midlife in the United States-II study. The sample consisted of 1054 community-dwelling adults. Participants completed the Pittsburgh Sleep Quality Index and indicated the frequency and enjoyableness of experiences on a positive events scale. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Positive affect was measured using the Mood and Symptoms Questionnaire. Regression analyses indicated more frequent engagement in pleasant events was associated with better global sleep quality. Depressive symptoms, but not positive affect, partially mediated the association between pleasant events and global sleep quality. The findings suggest that behavioral engagement in pleasant events may be related to global sleep quality via depressive symptoms, but not positive affect. These findings highlight the potential for engagement in pleasant activities to influence both mood and sleep.

Daily Social Contact in Relation to Sleep: The Role of Age.

OBJECTIVES: To examine how social contact during daily activities differs by age and relates to sleep outcomes. METHODS: Fifty younger (M = 19.9 years, SD = 2.76) and 48 older (M = 67.6 years, SD = 6.63), community-dwelling adults completed the Social Rhythm Metric-17 and daily sleep diary online for 14 days. RESULTS: Younger adults completed a greater proportion of activities with active others than older adults. Age significantly interacted with the proportion of activities completed alone, ß = -.77, p = .04. Alone activities negatively predicted total sleep time in older, not younger adults. DISCUSSION: Social contact, or lack thereof, is important for sleep, particularly for older adults who may be more prone to aloneness due to life course events.

Improving home-based providers' communication to primary care providers to enhance care coordination.

OBJECTIVES: Health care system fragmentation is a pervasive problem. Research has not delineated concrete behavioral strategies to guide providers to communicate with personnel in other organizations to coordinate care. We addressed this gap within a particular context: home-based providers delivering depression care management (DCM) to older adults requiring coordination with primary care personnel. Our objective was to pilot test a communication protocol ('BRIDGE - BRinging Inter-Disciplinary Guidelines to Elders') in conjunction with DCM. METHOD: In an open pilot trial (N = 7), home-based providers delivered DCM to participants. Following the BRIDGE protocol, home-based providers made scripted telephone calls and sent structured progress reports to personnel in participants' primary care practices with concise information and requests for assistance. Home-based providers documented visits with participants, contacts to and responses from primary care personnel. A research interviewer assessed participant outcomes [Symptom Checklist-20 (depressive symptoms), World Health Organization Disability Assessment Schedule-12, satisfaction] at baseline, three months, and six months. RESULTS: Over 12 months, home-based providers made 2.4 telephone calls and sent 6.3 faxes to other personnel, on average per participant. Primary care personnel responded to 18 of 22 requests (81.8%; 2 requests dropped, 2 ongoing), with at least one response per participant. Participants' depressive symptoms and disability improved significantly at both post-tests with large effect sizes (d ranged 0.73-2.3). Participants were satisfied. CONCLUSION: Using BRIDGE, home-based providers expended a small amount of effort to communicate with primary care personnel, who responded to almost all requests. Larger scale research is needed to confirm findings and potentially extend BRIDGE to other client problems, professions, and service sectors.

Older adults display concurrent but not delayed associations between life stressors and depressive symptoms: a microlongitudinal study.

OBJECTIVES: The present study investigated the temporal association between life event stressors relevant to older adults and depressive symptoms using a micro-longitudinal design (i.e., monthly increments over a six-month period). Existing research on stress and depressive symptoms has not examined this association over shorter time periods (e.g., monthly), over multiple time increments, or within-persons. DESIGN: An in-person initial interview was followed by six monthly interviews conducted by telephone. SETTING: Community. PARTICIPANTS: Data were drawn from a study of 144 community-dwelling older adults with depressive symptoms. MEASUREMENTS: Stressful life events were measured using the Geriatric Life Events Scale (GALES), and depressive symptoms were assessed with the Short - Geriatric Depression Scale (S-GDS). RESULTS: Using multilevel modeling, 31% of the S-GDS' and 39% of the GALES' overall variance was due to within-person variability. Females and persons with worse health reported more depressive symptoms. Stressful life events predicted concurrent depressive symptoms, but not depressive symptoms one month later. CONCLUSIONS: The lack of a time-lagged relationship suggests that older adults with depressive symptoms may recover more quickly from life stressors than previously thought, although additional research using varying time frames is needed to pinpoint the timing of this recovery as well as to identify older adults at risk of long-term effects of life stressors.

Age differences in the role of cognitive versus somatic arousal in sleep outcomes.

The purpose of this study is twofold: (a) to determine whether daily or overall cognitive and somatic arousal better predict sleep and (b) to investigate age differences in the arousal-sleep relation. Fifty younger and 50 older adults completed the Pre-Sleep Arousal Scale and sleep diaries for 14 consecutive days. Analyses revealed mean arousal may better predict sleep regardless of age. However, daily arousal represents an important avenue of research as it may uncover lagged or coupling effects in the arousal-sleep relation. Significant age differences in the arousal-sleep relation suggest age-dependent associations between the type of arousal and sleep. Implications for assessment of sleep in older and younger adults are discussed.

Six-month utilization of psychotherapy by older adults with depressive symptoms.

We explored psychotherapy utilization patterns for community-dwelling older adults with depressive symptoms identified during a statewide initiative designed for identifying risk of substance misuse. Individuals screening negative for substance misuse, but positive for depressive symptoms, agreed to participate in monthly interviews conducted over 6 months (n = 144). Results showed that 39 (27%) received psychotherapy, of which nearly two-thirds reported four or fewer visits. Mental health counselors were the most frequently reported service providers (50-62.5%). Location of service varied considerably. This study documents low rates of psychotherapy use and few visits. Current efforts to increase psychotherapy access are discussed.