Prevalence of Poor Sleep Quality and its Association with Lifestyle Habits, Competition-Based Activities, and Psychological Distress in Japanese Student-Athletes During the COVID-19 Pandemic.

Objectives The present study clarified the prevalence of poor sleep quality and its relation to lifestyle habits, competitive-based activities, and psychological distress among Japanese student-athletes in the initial pandemic period (2020) and 1 year later (2021). Methods In the present study, student-athletes were defined as individuals belonging to university athletic clubs. The data of two cross-sectional surveys (2020: n = 961 and 2021: n = 711) were collected from student-athletes in 6 universities in Japan. First, the prevalence of poor sleep quality (Pittsburgh sleep quality index score > 5) was investigated. Relationships between poor sleep quality and lifestyle habits, competition-based activities, and psychological distress were then explored using multivariate logistic regression analysis adjusted for age, sex, and body mass index. Results The prevalence of poor sleep quality was 33.6% in 2020 and 36.6% in 2021. Poor sleep quality in 2020 was related to late bedtime, taking supplements before bed, part-time job (no late night), stressors of expectations and pressure from others, and psychological distress, whereas that in 2021 was related to early wake-up time, skipping breakfast, taking caffeinated drinks before bed, use of smartphone/cellphone after lights out, stressors of motivation loss, and psychological distress. Conclusions In both 2020 and 2021, one-third of student-athletes had poor sleep quality and psychological distress was its common risk factor. Lifestyle habits and competition stressors associated with poor sleep quality were pandemic-specific in 2020, but similar to the prepandemic period in 2021.

The association between changes in depression/anxiety and trajectories of psychotic-like experiences over a year in adolescence.

BACKGROUND: Recent cross-sectional studies suggest that psychotic-like experiences (PLEs) are associated with depression and anxiety in adolescents. While longitudinal studies have observed that adolescents suffer more severe symptoms of depression/anxiety when PLEs persist, it remains unclear whether depression/anxiety worsens or improves with PLE emergence or remission, respectively. In this prospective school-based study, we investigated the association between longitudinal changes in depression/anxiety and one-year PLE trajectories in adolescence. METHODS: Nine hundred and twelve adolescents participated in the baseline assessment of PLEs and depression/anxiety; 887 (97.3%) adolescents completed the follow-up assessment one year later. Multilevel analysis was conducted to evaluate the change in depression/anxiety, evaluated using the General Health Questionnaire-12 (GHQ-12), during the year according to PLE trajectory, adjusting for baseline depression/anxiety, gender, age, substance use and victimization. RESULTS: Sixteen percent of adolescents reported PLEs at baseline, with 56% of them remitting at follow-up. At follow-up, PLEs were experienced by 6.6% of adolescents not experiencing PLEs at baseline (incident PLE group). After adjusting for covariates, GHQ-12 score worsened significantly during the year in students with incident trajectories (regression coefficient for time, α1=1.91, 95% CI: 1.04-2.77), but in those showing remission, GHQ-12 score did not significantly improve (α1=-0.20, 95% CI: -0.97-0.56). CONCLUSIONS: Greater awareness about PLEs and their trajectories in school health care settings may be a key towards the prevention and treatment of adolescent depression and anxiety.

Annual longitudinal survey at up to five time points reveals reciprocal effects of bedtime delay and depression/anxiety in adolescents.

OBJECTIVE: To investigate the longitudinal relationship between sleep habits and mental health in adolescents. METHODS: Multipoint observation data of up to five years were employed from a prospective cohort study of sleep habits and mental health status conducted from 2009 to 2013 in a unified junior and senior high school (grades 7-12) in Tokyo, Japan. A total of 1078 students answered a self-report questionnaire, including items on usual bed and wake-up times on school days, and the Japanese version of the 12-item General Health Questionnaire (GHQ-12). RESULTS: Latent growth model (LGM) analysis, which requires three or more time point data, showed that longitudinal changes in bedtime and GHQ-12 score (or score for depression/anxiety) were significantly and moderately correlated (correlation coefficient = 0.510, p < 0.05). Another result of interest was that, using an autoregressive cross-lagged (ARCL) model, bedtime and the depression/anxiety score had reciprocal effects the following year: ie, bedtime significantly affects the following year's depression/anxiety, and vice versa. In addition, the analysis provided estimates of mutually predicted changes: one-hour bedtime delay may worsen the GHQ-12 score by 0.2 points, and one-point worsening of the score may delay bedtime by 2.2 minutes. CONCLUSIONS: By using up to five multiple time point data, the present study confirms the correlational and reciprocally longitudinal relationship between bedtime delay and mental health status in Japanese adolescents. The results indicate that preventing late bedtime may have a significant effect on improving mental health in adolescents.

Associations between sleep habits and mental health status and suicidality in a longitudinal survey of monozygotic twin adolescents.

Several epidemiological studies have indicated that there is a relationship between sleep habits, such as sleep duration, bedtime and bedtime regularity, and mental health status, including depression and anxiety in adolescents. However, it is still to be clarified whether the relationship is direct cause-and-effect or mediated by the influence of genetic and other traits, i.e. quasi-correlation. To examine this issue, we conducted a twin study using a total of 314 data for monozygotic twins from a longitudinal survey of sleep habits and mental health status conducted in a unified junior and senior high school (grades 7-12), located in Tokyo, Japan. Three-level hierarchical linear model analysis showed that both bedtime and sleep duration had significant associations with the Japanese version of the 12-item General Health Questionnaire (GHQ-12) score, suicidal thoughts and the experience of self-harm behaviours when genetic factors and shared environmental factors, which were completely shared between co-twins, were controlled for. These associations were statistically significant even after controlling for bedtime regularity, which was also associated significantly with the GHQ-12 score. These suggest that the associations between sleep habits and mental health status were still statistically significant after controlling for the influence of genetic and shared environmental factors of twins, and that there may be a direct cause-and-effect in the relationship in adolescents. Thus, late bedtime and short sleep duration could predict subsequent development of depression and anxiety, including suicidal or self-injury risk. This suggests that poor mental health status in adolescents might be improved by health education and intervention concerning sleep and lifestyle habits.

Psychosocial factors associated with suicidal ideation in clinical patients with depression.

BACKGROUND: Depression is a major risk factor for suicide, but few studies have examined psychosocial risk factors for suicide in clinical patients with depression. The purpose of this study was to investigate psychosocial factors which could be associated with suicidal ideation in clinical patients with depression including: sick-leave, help-seeking behavior, and reluctance to admit mental health problems. METHODS: A multi-center cross-sectional survey using self-report questionnaire was conducted at 54 outpatient psychiatric clinics in Tokyo in 2012. Adult outpatients who were diagnosed by psychiatrists as mood disorders (F30-F39) in the International Classification of Diseases-10 (ICD-10) were included in the study. Those who met the criteria for current hypomanic or manic episode were excluded from the study. RESULTS: A total of 189 patients with depression participated in the survey. Multivariable logistic regression analysis showed that taking sick-leave and having sought help from family were associated with decreased odds of current suicidal ideation. Moderate or more severe depression was associated with increased odds of suicidal ideation, and reluctance to admit own mental health problem tended to increase odds of suicidal ideation. LIMITATIONS: Living status and suicidal ideation before consultation with psychiatrist were not investigated. Severity of suicidal ideation and comorbid psychiatric disorders were not assessed. CONCLUSIONS: Importance of treatment of more severe depression for suicide prevention was confirmed. Industrial health staffs should consider the possibility of positive effect of taking sick-leave when they see employees with depression. Promoting help-seeking for family and reducing stigma of mental illness may be effective for suicide prevention.