The impact of COVID-19 on Italian adolescents' sleep and its association with psychological factors.

Insomnia and circadian dysregulation during adolescence represent important risk factors for emotional and psychological problems. Recent studies have shown that the coronavirus disease 2019 (COVID-19) pandemic has been linked to a high prevalence of behavioural sleep problems in the general population. This study aimed to provide two pictures of two different time points of the pandemic regarding the prevalence of sleep problems in adolescents and their association with psychological health variables. Two different independent large samples of Italian adolescents aged 13-17 years were recruited at two pandemic time points. A total of 1,146 adolescents at Time 1 (T1; April 2020) and 1,406 at Time 2 (T2; April 2021) took part in the study. Measures of insomnia symptoms, sleep hygiene, chronotype, psychological distress and emotion regulation were collected. Prevalence of insomnia was 12.13% at T1 and 23.19% at T2. Furthermore, high levels of poor sleep habits (late bedtime, poor sleep hygiene, use of electronic devices at bedtime) were also detected at both time points. Insomnia symptoms strongly correlated with poor sleep hygiene, higher psychological distress, and emotional suppression at both time points. Results highlighted an alarming picture for two large samples at two different time points of the pandemic that showed a potential negative impact of the COVID-19 pandemic, in both the first outbreak and in the later phase of the pandemic, on sleep habits, psychological distress and insomnia symptoms in adolescents. This strongly suggests the need for monitoring these variables and their interaction in the post-pandemic period and to develop and promote interventions for insomnia and circadian disturbances during adolescence.

Influence of time-of-day on joint Navon effect.

The shared attention theory suggests that people devote greater cognitive resources to those features co-attended simultaneously with others, determining better performance in several types of tasks. When co-actors performed a go/no-go Navon task attending different features of target letters, the performance was impaired, reflecting a joint Navon effect (the representation of a co-actor's attentional focus made it more difficult to select and apply one's own focus of attention), probably due to asynchronous co-attention with a decrease in cognitive resources involved. Researches in chronobiology and chronopsychology demonstrated that not only selective attention (involved in a Navon task), but also cognitive resources have a daily fluctuations, mainly paralleling the circadian rhythm of body temperature (i.e. increasing values from the morning to evening with a subsequent decline in the night). The study was conducted to assess whether the presence of joint attention, as measured by the joint Navon effect, was influenced by the time-of-day. Sixteen pairs of participants sitting next to each other were required to respond to the identity letters in a go/no-go Navon task twice: in the morning (09:00-10:00) and early afternoon (13:00-14:00). The results showed a joint Navon effect in the morning session only, suggesting that joint attention was affected by the time-of-day effect on cognitive resources.

Synchrony effect on joint attention.

Research on joint attention has demonstrated that individuals are sensitive to a coactor's attentional relation to jointly attended stimuli. Within a chronobiological approach, a study was conducted to assess whether the presence of joint attention, as measured by the joint Navon effect, was influenced by the synchrony effect. Pairs of participants sitting next to each other were required to respond to the identity letters in a go/no-go Navon task. The joint Navon task was performed by morning, intermediate and evening types (81 pairs) at different times of day (09:00-10:00; 13:00-14:00; 17:00-18:00). The joint Navon effect on task performance was highlighted at the optimal time of day (in the morning for morning types, in the early afternoon for intermediate types and in the evening for evening types), but it disappeared or decreased at the non-optimal time of day, with the exception of evening types. The results demonstrated that joint attention was affected by the synchrony effect.

What patients' complaints and praise tell the health practitioner: implications for health care quality. A qualitative research study.

OBJECTIVE: In order to identify which health care aspects play a role in patient satisfaction and quality of health care, the present study analyses a large number of instances of complaint and praise. DESIGN AND SETTING: One thousand two hundred and thirty-five instances of complaint and one thousand five hundred thirty-six of praise submitted from patients or other souces (i.e. a patient's family member or a legal representative) to a northern-Italian hospital were analysed. MAIN OUTCOME MEASURES: We adopted Reader and colleagues' (2014) patients' complaint taxonomy, in conjunction with a detailed content analysis of relationship and communication of information aspects. RESULTS: The most frequent causes of complaint concerned care system management (68.1%), particularly the time taken to access treatment, and relationship aspects (52.8%). The importance of relationship aspects was confirmed by the expression of gratitude through praise (89%). The most critical factor of the relationship domain was effective communication of information to the patient (39.3%). Frequently patients complained of: (i) having received information that was inconsistent with the truth, (ii) having had difficulty in obtaining information, and (iii) untimely communication of information. Clinical aspects did not seem to be the main factors that triggered a complaint (36,8%), and, when indicated, they were almost always associated with relationship issues. CONCLUSIONS: This study indicates that not only complaints, but also instances of praise, are a potentially important source of information regarding health care aspects that play a role in patient satisfaction and quality of care. Our findings underline the relevance of relationship aspects in determining patients' satisfaction with the care received. In particular, health practitioners should focus their attention on how information is understood, translated and applied by patients.

24-h actigraphic monitoring of motor activity, sleeping and eating behaviors in underweight, normal weight, overweight and obese children.

PURPOSE: Within a chronobiological perspective, the present study aimed to describe 24 h of sleep-wake cycle, motor activity, and food intake patterns in different body mass index (BMI) categories of children through 7 days of actigraphic recording. METHODS: Height and weight were objectively measured for BMI calculation in a sample of 115 Italian primary schoolchildren (10.21 ± 0.48 years, 62.61 % females). According to BMI values, 2.60 % were underweight, 61.70 % were of normal weight, 29.60 % were overweight and 6.10 % were obese. Participants wore a wrist actigraph continuously for 7 days to record motor activity and describe sleep-wake patterns. In addition, participants were requested to push the event-marker button of the actigraph each time they consumed food to describe their circadian eating patterns. RESULTS: BMI group differences were found for sleep quantity (i.e. midpoint of sleep and amplitude), while sleep quality, 24-h motor activity and food intake patterns were similar between groups. Regression analyses showed that BMI was negatively predicted by sleep duration on schooldays. BMI was also predicted by motor activity and by food intake frequencies recorded at particular times of day during schooldays and at the weekend. CONCLUSIONS: The circadian perspective seems to provide promising insight into childhood obesity, but this aspect needs to be further explored.

Circadian typology and the Alternative Five-Factor Model of personality.

Two studies were carried out to explore the relationship between circadian typology and the Alternative Five-Factor Model of personality. In the first study, 379 participants (232 females) were administered the reduced version of the Morningness-Eveningness Questionnaire and the Zuckerman-Kuhlman Personality Questionnaire. Evening types reported higher impulsive sensation-seeking scores than morning and intermediate types, whereas morning types scored higher than evening types on activity factor. In the second study, the association between morningness and activity personality factor was verified through the objective-actigraphic monitoring of the rest-activity cycle. Actigraphy allowed us to operationalise both circadian typology, through the computing of midpoint of sleep (early values, expressed in hours and minutes, correspond to an advanced phase of the sleep/wake cycle), and activity factor by the means of motor activity recording. Fifty-one individuals (30 females) wore an actigraph on the nondominant wrist continuously for 1 week. A negative correlation was observed between midpoint of sleep and mean diurnal motor activity, demonstrating that an early phase of the sleep/wake cycle (i.e. morningness preference) was related to higher diurnal motor activity. Assessed both subjectively and objectively, the results of both studies highlight a significant relationship between morningness and activity personality factor.

The consensus sleep diary: quantitative criteria for primary insomnia diagnosis.

OBJECTIVE: The aim of the study was to put forward quantitative criteria for the Consensus Sleep Diary, to differentiate people with insomnia from normal sleepers. METHODS: In this retrospective study, we analyzed 295 sleep diaries of patients with primary insomnia (43% were male, ages ranging between 17 and 76 years) collected in two clinical centers for insomnia and 536 sleep diaries of normal sleepers (47% were male, ages ranging between 15 and 82 years). We considered the following sleep parameters: time in bed, sleep onset latency, total sleep time, wake after sleep onset, sleep efficiency, number of awakenings, terminal wakefulness, and subjective feeling of rest. Using the Youden index, we calculated the quantitative criteria that performed best for each sleep parameter. Finally, we created receiver operating characteristic curves to test the accuracy of each identified criterion. RESULTS: Individuals with insomnia significantly differed from controls on all sleep indices (p < .001). Differentiation between individuals with insomnia from controls was optimal for terminal wakefulness (>15 minutes, area under the curve [AUC] = 0.83), wake after sleep onset (cutoff >20 minutes, AUC = 0.81), total sleep time (<390 minutes, AUC = 0.80), and particularly sleep efficiency (<87.5%, AUC = 0.92, sensitivity = 0.80, specificity = 0.90). Time in bed was the least differentiating variable (<500 minutes, AUC = 0.57). CONCLUSIONS: The quantitative criteria of the sleep diary in this study agree with the few available data in the literature. This confirms that the sleep diary could be a useful screening tool for assessing patients with primary insomnia.

Effects of dawn simulation on attentional performance in adolescents.

PURPOSE: This study aimed at examining the effects of 2 weeks of dawn simulation on attentional performance in adolescents. METHODS: On the whole, 56 adolescents (24 females and 32 males) took part to the study, with a mean age of 17.68 ± 0.97 years (age ranging between 15 and 20 years). Each adolescent was requested to participate for 5 consecutive weeks and the research design included the baseline and two counterbalanced conditions, dawn simulator and control (no dawn simulator). Attentional performance of adolescents was measured through the attention network test (ANT) that allowed assessing the efficiency of three separable attentional networks, namely alerting, orienting and executive. Overall, participants performed the ANT three times (i.e., one time for each condition), while sleep quality, sleep duration and sleep timing were concurrently monitored by means of actigraphy and were treated as potential confounders. RESULTS: The only improvement of the attentional performance attributable to the use of dawn simulator was observed for the efficiency of alerting network (45.97 ± 32.76 ms) that significantly increased in comparison to the baseline (31.57 ± 26.97 ms) (p < 0.05). On the contrary, the sleep quality, sleep quantity and sleep timing did not significantly change. CONCLUSION: These results show for the first time that, controlling for sleep quality, sleep duration and sleep timing, the use of dawn simulator across 2 weeks is able to determine an alerting effect in adolescents.

Remember to do: insomnia versus control groups in a prospective memory task.

Primary insomnia is characterized by difficulty in falling asleep and/or remaining asleep, by early morning awakening and/or nonrestorative sleep, and resultant daytime dysfunction in the absence of specific physical, mental, or substance-related causes. However, the studies on daytime cognitive functioning of insomnia patients report inconclusive results. This retrospective study aimed to compare the performance of insomnia patients (N = 54) to that of controls (N = 113) in a naturalistic prospective memory task. Task performance was defined by the percentage of times the event-marker button of an actigraph was pressed, at lights-off time and at wake-up time. The performance pattern in the prospective memory task was similar in both groups. In addition, the task was performed better at lights-off time than at wake-up time regardless of group. Post-hoc subgroup analysis showed that there were more insomnia patients who performed the task perfectly (i.e., 100%) than controls. Performance at wake-up time was significantly correlated to objective sleep quality (i.e., sleep efficiency) only in insomnia patients.

Psychometric goodness of the Mini Sleep Questionnaire.

AIM: The current study was conducted to evaluate the psychometric properties and analyze the convergent validity of the Italian version of the Mini Sleep Questionnaire (MSQ). In addition, it was aimed to put forward cut-off values to be used in screening protocols. METHODS: The MSQ was administered to 1830 participants (age range 18-87 years), of whom 1208 also completed the Sleep Disorder Questionnaire (age range 18-87 years). A subgroup of 187 (age range 18-71 years) participants was randomly chosen to test the test-retest reliability. A complete psychometric evaluation was performed on the MSQ. To study the validity of the tool, the Sleep Disorder Questionnaire was used as an external criterion to validate the MSQ. Using the Youden index, we calculated the cut-off values that performed best. Finally, we created receiver-operator curves to test the accuracy of each cut-off value identified. RESULTS: For the MSQ, Cronbach's alpha score was 0.77 while homogeneity was 0.26. Factorial analyses confirmed the presence of two dimensions: sleep (Cronbach's alpha 0.75; homogeneity 0.37) and wake (Cronbach's alpha 0.75; homogeneity 0.44). For each dimension, a cut-off value was identified (>16 and >14, respectively). Both cut-off values obtained an area under the curve higher than 0.80. CONCLUSIONS: Psychometric evaluation of the MSQ was satisfactory. The cut-off values analyzed in the present study showed good performance. On the whole, the results of this study suggest that the MSQ can be a useful screening tool.

Time consciousness: Silence, mindfulness, and subjective time perception.

Although recent theories of consciousness have emerged to define what consciousness is, an under-represented aspect within this field remains: time consciousness. However, the subjective passage of time is modulated by changing experiences within different situational contexts and by self-awareness. The experience of silence influences our awareness of self, space, and time, and it impacts on psychological well-being. The present review describes how self and time are influenced by different situations of silence (pure silence indoors and outdoors, the "just thinking" situation, and the combination of silence with deep relaxation). Also, the changes in time experience during a "forced" waiting situation due to the COVID-19 lockdown are presented in order to highlight the role of boredom in waiting situations and in situations in which we are alone with "our thoughts." Finally, in the context of the importance of creating silence through meditation practices, the alterations to one's sense of self and time during mindfulness meditation are reviewed. These studies are discussed within the framework of the cognitive models of prospective time perception, such as the attentional-gate model and the model of self-regulation and self-awareness.

A Comprehensive Assessment of Bedtime Routines and Strategies to Aid Sleep Onset in College Students: A Web-Based Survey.

College students often experience sleep-wake alterations. Different factors can contribute to insomnia symptoms in this population. The present study aims at investigating pre-sleep behaviours and strategies used to aid sleep onset in young college students and their association with insomnia symptoms. A total of 548 Italian college students (mean age = 23.48 years, range = 19-30 years, 80.5% female) completed a web-based survey on pre-sleep behaviours and sleep-onset facilitators, insomnia symptoms and sleep hygiene, anxiety and depression, and coping strategies. The use of electronic devices at bedtime and as a sleep-onset facilitator was predominant. Students using specific behaviours as sleep-onset facilitators were characterised by more psychological difficulties and poorer sleep. In multivariable linear regression analysis, the frequency of using medications and melatonin, regardless of motivations, was associated with higher insomnia symptoms. The use of specific sleep-onset facilitators positively correlated with the severity of insomnia symptoms. Many students engage in behaviours that are considered sleep-interfering and that are often employed in an attempt to facilitate sleep onset without benefits. Overall, the motivational factors behind pre-sleep behaviours need to be addressed in preventive programs targeting young college students.

The Italian Validation of the Zimbardo Time Perspective Inventory and Its Comparison with Three Time Perspective Inventories.

The Zimbardo time perspective inventory (ZTPI) is the most well-known and widely used measure of time perspective. However, the assessment of the psychometric properties of the ZTPI reveals several problems, and various short versions have been proposed to overcome these problems. In a large Italian sample (N = 2295; 1326 women; age range 18-74 years), the present study aimed to test a short version of the ZTPI (ZTPI-16) defined by high frequency items (i.e., "good" items), reviewing the items composition of previous alternative short versions of the scale. Beyond the assessment of the factorial structure of this new short ZTPI, we compared the ZTPI-16 to the original ZTPI (ZTPI-56) and another already validated version of the ZTPI in the Italian context, such as Zimbardo's Stanford time perspective inventory (ZTPI-22), the short version of the ZTPI (ZTPI-30), and the ZTPI-36 proposed analyzing the data from 24 countries. The results confirmed the psychometric problems of the ZTPI-56, whereas the ZTPI-16 reported adequate structural validity and reliability. Moderate-to-strong correlations between same temporal subscales in different ZTPI versions were also found. These data suggest that the review of the "good" items is a new direction in the development of ZTPI versions with good psychometric properties and comparable data among cultures.

Gender composition of pairs influences joint action effect.

Research on joint action has demonstrated that individuals are sensitive to a coactor's attentional relation to jointly attend stimuli. It has also been suggested that some features are necessary to resolve the discrimination problem (i.e., self-own and other-own actions). In the present study, we aimed to test whether the gender composition of interacting pairs modulated the joint action effect. Same- (female-female or male-male) and mixed- (female-male) gender pairs performed a joint version of flanker tasks in Experiment 1 (90 participants, 50% males), while in Experiment 2 (154 participants, 50% males) Navon tasks were performed. In Experiment 1, a higher joint flanker effect in same-gender pairs than in mixed-gender pairs, and this joint effect was similar to the classical flanker effect reported by males and females in a classical procedure of the task (70 participants, 50% males). In Experiment 2, the same-gender pairs reported a joint Navon effect, which was reversed in mixed-gender pairs. In conclusion, our findings support how the gender composition of interacting pairs plays a role in joint attentional tasks.

A systematic review and meta-analysis of the association between young adults' sleep habits and substance use, with a focus on self-medication behaviours.

Young adults (18-30 years) are vulnerable to sleep-wake disturbances and substance use, which are bi-directionally associated. The present work aims to organise the literature that deals with the association between sleep and substance use in young adults, also considering self-medication behaviours. We adopted a framework that accounts for the multidimensionality of sleep and the effect of different substances. We considered sleep disturbances (insomnia symptoms, sleep quality), sleep health dimensions (duration, satisfaction, efficiency, timing, daytime alertness), circadian characteristics (chronotype). Substances were alcohol, caffeine, nicotine, cannabis, others. We included 46 studies. The use of caffeine and nicotine was associated with higher odds of sleep disturbances. No significant effect was detected for sleep duration. In narrative findings, daytime dysfunction was associated with alcohol and caffeine use, and poor sleep satisfaction with nicotine use. Few evidence were available for the other sleep health dimensions. Evening chronotype was associated with alcohol, caffeine, and nicotine use. Few studies focused on cannabis or self-medication. Longitudinal results were inconclusive. We found a distinct pattern of associations between different substances and different sleep outcomes. Further investigation considering the multidimensionality of sleep would create a better understanding of the complex relationship between substance use and sleep health in young adults.

Season of birth and mood seasonality in late childhood and adolescence.

A significant season of birth effect on mood seasonality has been detected in young adults, with higher sensitivity to seasonal changes for people born during spring or summer months (long photoperiod) than those born during autumn or winter months (short photoperiod). The aim of this study was to verify whether the birth season effect on mood seasonality is already present in late childhood and adolescence. To this end, the Seasonal Pattern Assessment Questionnaire for Children and Adolescents (SPAQ-CA) was administered to 1523 Italian participants (870 females, 653 males), ranging from 10 to 17 years of age. The Global Seasonality Score (GSS) was computed as a measure of mood seasonality. Analysis of covariance showed a significant season of birth effect on GSS; although no comparisons were significant when Tukey's posthoc test for unequal samples was performed, it was observed that adolescents born in summer achieved the highest scores while those born in winter obtained the lowest. The present data point out that a significant season of birth effect on mood seasonality is already present in late childhood and adolescence.

Circadian type and mood seasonality in adolescents.

The aim of the present study was to investigate, for the first time, the relationship between circadian preference and mood seasonality in adolescents. To this end, 1539 participants (881 female; 658 male) completed the Morningness-Eveningness Questionnaire for Children and Adolescents and the Seasonal Pattern Assessment Questionnaire for Children and Adolescents to determine circadian preference and mood seasonality, respectively. Evening types achieved significantly higher mood seasonality scores than intermediate and morning types, as intermediates did than morning types. Agreeing with previous studies on young adults and adults, the present data indicate a significant relationship between eveningness and higher mood seasonality in adolescents.

Morningness-Eveningness Preference, Time Perspective, and Passage of Time Judgments.

Recent studies have shown that making accurate passage of time judgments (POTJs) for long-time intervals is an important cognitive ability. Different temporal domains, such as circadian typology (biological time) and time perspective (psychological time), could have an effect on subjective POTJs, but few studies have investigated the reciprocal influences among these temporal domains. The present study is the first systematic attempt to fill this gap. A sample of 222 participants (53.20% females; 19-60 years) filled in the Zimbardo Time Perspective Inventory for the measurement of time perspective, the reduced version of the Morningness-Eveningness Questionnaire (rMEQ) for chronotypes, and an ad-hoc questionnaire assessing sleep habits during weekdays and the weekend (for social jetlag). The POTJ was measured using a modified version of a pictorial timeline presented at five different moments. Also, participants judged how different temporal expressions were related to the past, present, and future along a 7-point Likert scale. After confirming the association between eveningness and present-hedonism orientation and morningness and future-orientation, we found that evening-types produced higher scores for future expressions. The subjective POTJ expressed in minutes was predicted by Deviation from Balanced Time (DBTP), present-fatalism orientation, and social jetlag. Finally, the rMEQ score, past-positive orientation, and DBTP predicted the difference between subjective and objective POT. The results are discussed offering an explanation in terms of the interconnections between circadian typology, individual time perspective, and the sense of the POT, suggesting the multicomponent nature of the concept of time.

Circadian motor activity of non-dominant hand reaches acrophase later than dominant hand.

Motor activity during the first half of nocturnal sleep is lateralized to the non-dominant hand. What remains is to determine which account could explain this phenomenon: the more pronounced homeostatic deactivation of the dominant hemisphere or the circadian asymmetry in the hemispheric activation. To better understand the nature of these motor asymmetries, we performed an ecological study assessing the circadian motor activity in 34 evening, 52 intermediate, and 27 morning types. We observed a significant circadian phase delay of the 24-h motor activity pattern of the left hand in comparison to the right hand, regardless of chronotype. Moreover, we replicated higher motor activity in the left hand in comparison to the right hand in late evening that reached statistical significance only in evening and intermediate types. Analysing motor activity around bedtime and wake-up time, we observed a reverse pattern between circadian typologies: evening types showed higher activity in the left hand in comparison to the right hand before bedtime, while morning types showed significantly higher motor activity in the right hand in comparison to the left after wake-up time. Results support the hypothesis of a different circadian phase relationship between the two hemispheres.

Insomnia, Time Perspective, and Personality Traits: A Cross-Sectional Study in a Non-Clinical Population.

Insomnia disorder is considered a public health problem and additional studies should investigate predisposing and perpetuating factors. This study examined the relationship between Big Five personality traits, time perspective, and insomnia. In a cross-sectional study, 400 participants (227 women; age range 18-74 years) were administered the Big Five Inventory-10 items, the Zimbardo Time Perspective Inventory, and the Insomnia Severity Index (ISI). A measure of chronotype was also included for control purposes. The results show that insomniacs reported lower scores for conscientiousness and extraversion, and for past-positive (PP) and future (F) perspectives, whereas they obtained higher scores for past-negative (PN) perspectives and deviation from a balanced time perspective. The correlations confirmed these findings, but negative correlations between present-hedonistic (PH) perspective and ISI score, and between emotional stability and ISI score, were also found. The mediation analyses showed that F played an indirect role in the relationship between consciousness and ISI score, PN had an indirect effect on the relationship between emotional stability and ISI or between extraversion and insomnia, and PH had an indirect effect on the relationship between extraversion and ISI score. The current outcomes shed light on the mechanisms which serve to mediate the relationship between insomnia and personality traits.