Trajectories of Actigraphy-Derived Sleep Duration, Quality, and Variability from Childhood to Adolescence: Downstream Effects on Mental Health.

STUDY OBJECTIVES: We examined growth trajectories of four actigraphy-derived sleep parameters (sleep minutes, sleep efficiency, and variability in sleep minutes and efficiency across a week of assessments) across childhood and adolescence and examined individual differences in trajectories according to participants' race/ethnicity and sex. We also assessed the predictive effect of growth trajectories of sleep parameters on growth trajectories of mental health outcomes and moderation by race and sex. METHOD: Youth (N=199, 49% female, 65% White, 32% Black, 3% biracial) and their parents participated in five waves of data (M ages were 9, 10, 11, 17, and 18 across waves). Participants were from a diverse range of socioeconomic backgrounds. RESULTS: Across participants, sleep minutes, sleep efficiency, and variability in sleep minutes and efficiency demonstrated significant linear change across childhood and adolescence. Whereas sleep duration shortened over time, sleep efficiency improved. Youth exhibited increases in night-to-night variability in sleep minutes and reductions in night-to-night variability in sleep efficiency. Highlighting the importance of individual differences, some race- and sex-related effects emerged. Black youth and male youth experienced steeper declines in their sleep duration across development relative to their respective counterparts. Black youth also demonstrated smaller improvements in sleep efficiency and greater variability in sleep efficiency compared to White youth. Finally, trajectories of sleep efficiency and variability in sleep minutes predicted trajectories of internalizing symptoms and externalizing behaviors. CONCLUSIONS: Findings showed significant changes in developmental trajectories of four sleep parameters across childhood and adolescence. We discuss empirical and translational implications of the findings.

Do Sleep Problems Exacerbate the Mental Health Consequences of Discrimination Among Adults?

OBJECTIVE: An emerging literature suggests that sleep may play an important role in moderating the association between discrimination and mental health problems among adolescents. However, few if any studies have considered this topic among adults. Addressing this knowledge gap, the current study examined multiple sleep parameters as moderating variables in the association between discrimination and mental health problems among adults. METHODS: Participants were 874 adults residing in small towns and semirural contexts within the Southeastern region of the United States ( Mage = 41 years, SD = 7; 57% female; 31% Black, 69% White; 52% income-to-needs < 2). Sleep duration and night-to-night variability in duration were assessed using wrist actigraphy. Established self-report measures were used to assess global sleep problems, experiences of discrimination, and mental health problems (anxiety, depression, and externalizing symptoms). RESULTS: Experiences of discrimination were associated with more depression, anxiety, and externalizing problems. Two out of three sleep parameters were found to moderate the effects of discrimination on mental health. The association between discrimination and externalizing problems (but not anxiety or depression) was attenuated among those with less night-to-night variability in sleep duration. The associations between discrimination and anxiety and externalizing problems (but not depression) were attenuated among those with fewer global sleep problems. Less variability in sleep duration and fewer global sleep problems were also directly associated with lower levels of depression, anxiety, and externalizing problems. CONCLUSIONS: Greater consistency in sleep duration from night-to-night, and fewer overall sleep problems appear to mitigate risk of mental health problems among adults, particularly in contexts where discrimination is prevalent.

Maternal psychological control and adolescent adjustment: Sleep as a moderator.

Maternal psychological control has been linked consistently to poorer adjustment for adolescents, however, studies of variability in the association between psychological control and adjustment are rare. Sleep serves crucial bioregulatory functions that promote well-being and protect youths against poor adjustment associated with negative family environments. We hypothesised that the link between maternal psychological control and adolescent maladjustment would be strongest for youths with poorer actigraphy-based sleep. The current study included 245 adolescents (Mage = 15.79 years, 52.2% girls, 33.1% Black/African American and 66.9% White/European American; 43% at or below the poverty line). Adolescents reported on their mothers' psychological control toward them, as well as their internalising and externalising symptoms (aggressive and rule breaking behaviours). Several sleep variables were derived: minutes, onset time, and variability in each parameter over 1 week. For youths with shorter, less consistent sleep (both mean levels and variability in minutes and onset), maternal psychological control was associated with adjustment difficulties, especially externalising symptoms. This association was not significant for youth obtaining longer, more consistent sleep. The results were most evident for variability in sleep minutes and onset as moderators of effects. The findings suggest that longer and more consistent sleep is an important protective factor in the context of more controlling parenting.

Longitudinal relations between interpartner aggression and internalizing symptoms among couples: The moderating role of sleep.

Recipients of interpartner aggression often experience internalizing symptoms. However, individual differences exist, and elucidation of factors that attenuate or exacerbate risk are needed to explicate relations and better inform interventions aimed at reducing mental health sequelae of interpartner aggression. Sleep problems compromise coping abilities and are known to exacerbate risk for mental health problems in the context of family risk. We examined whether sleep problems moderated the extent to which the recipients of interpartner aggression experience internalizing symptoms over time. At the first wave, 194 couples participated (M age [women] = 41.81 years, SD = 5.85; M age [men] = 43.75 years, SD = 6.74; 71% White/European American, 26% Black/African American, 3% other race/ethnicity). Two years later, couples returned for a second wave. Psychological and physical forms of interpartner aggression were measured using self- and partner-reports. Sleep duration (minutes) and sleep quality (efficiency) were derived using actigraphy, and subjective sleep/wake problems were also assessed. Individuals self-reported on their own internalizing symptoms. After controlling for autoregressive effects, sleep moderated the extent to which the recipients of interpartner aggression experienced internalizing symptoms longitudinally. Lower sleep efficiency and more subjective sleep/wake problems among women exacerbated the extent to which interpartner aggression forecasted their internalizing symptoms. Lower sleep efficiency among men magnified relations between interpartner aggression and their internalizing symptoms. Findings help understand the multiplicative influence that family risk and sleep problems have on mental health over time.

Coping Responses in the Context of Family Stress Moderate the Association Between Childhood Anxiety and Adolescent Depressive Symptoms.

Anxiety and depressive symptoms are common and highly interrelated. A relatively consistent temporal pattern of anxious and depressive symptoms has emerged from previous studies, such that the development of anxiety tends to precede and predict the development of depression rather than the other way around. Whether high levels of childhood anxiety predict depressive symptoms in late adolescence may depend, in part, on the ways in which children cope with stressful events. Accordingly, the present study used latent intercept models to examine involuntary and voluntary coping responses to familial stress as potential moderators of the association between childhood anxiety and adolescent depressive symptoms. Two hundred twenty-seven participants completed questionnaires measuring demographic variables as well as anxiety, depressive symptoms, and coping responses at a minimum of one time point over four waves of data collection (T1 Mage = 10.26 years, T2 Mage = 15.77 years, T3 Mage = 16.75 years, T4 Mage = 17.68 years). We found that childhood anxiety was positively associated with adolescent depressive symptoms when children reported higher levels of involuntary responses to family stress (e.g., rumination or physiological arousal) in conjunction with either lower levels of voluntary engaged responses (e.g., problem solving or emotion regulation) or higher levels of voluntary disengaged responses (e.g., avoidance or denial). These results shed light on the conditions under which childhood anxiety is associated with adolescent depressive symptoms and underscore the need for continued longitudinal and developmental research on this topic.

Family income as a moderator of relations between sleep and physical health during adolescence.

OBJECTIVES: Sleep duration, quality, and consistency are associated with overall physical health in adolescence, yet the effects of sleep on development may be not uniform because both sleep and physical health vary systematically along gradients of family income. To understand "for whom" sleep may be particularly beneficial, the present study tested family income as a moderator of relations between youth sleep and physical health. METHODS: Three hundred twenty-three youth (M age=17.39years; 53% female; 41% Black, 59% White) wore wrist actigraphs for 1week at home. Four well-recognized sleep parameters were derived: minutes, efficiency, long wake episodes, and variability in minutes across the week. Parents reported family income, and mothers rated adolescents' physical health. In independent path models, physical health was regressed onto each indicator of sleep, family income, and Sleep × Family Income interactions to test potential moderation effects. RESULTS: Associations between sleep and physical health were moderated by family income. Lower sleep efficiency, more long wake episodes, and more variability in sleep minutes were associated with poorer physical health among adolescents from lower-income families. At optimal levels of all sleep variables, income-based differences in physical health were mitigated. Youth from higher-income families tended to have better physical health regardless of their sleep. CONCLUSIONS: Findings build evidence that sleep has relations with physical health for low-income youth in particular. Clinicians and other service providers working with youth might benefit from considering the role of sleep in prevention and interventions programs geared toward improving health.

Effect of a self-care program among women with urinary incontinence: A quasi-experimental study.

Urinary incontinence is a multifactorial health problem that significantly affects women's quality of life. This quasi-experimental pre/post-test study aimed to evaluate the effect of a self-care program on women suffering from urinary incontinence. The study was conducted at the urodynamic unit within Ain Shams Maternity University Hospital, with a purposive sample of 100 women diagnosed with urinary incontinence, with no medical or surgical conditions, and who were not pregnant. A structured interview questionnaire and women's self-care practices checklists were used as study tools. The results showed that 72.0% of the study group and 68.0% of the control group were housewives. Significantly improved self-care practices and bladder retraining were observed in the study group compared to the control group post-intervention and during follow-up (p<0.001). Furthermore, the study group demonstrated a reduction in the severity of urinary incontinence and improved health practices, whereas the control group did not exhibit significant changes. These findings emphasize the significance of self-care programs in managing urinary incontinence and enhancing women's quality of life.

Parental drinking and observations of parent-child problem-solving discussions: Do drinking motives matter?

Alcohol is often used for emotion-regulation purposes, yet there has been little research on how emotion-regulation drinking motives relate to parenting. The present study addresses this gap by investigating possible interactions between parent drinking and drinking motives in the prediction of parenting and child affectivity during a problem-solving interaction. Participants included 199 two-parent families with a child between the ages of 6 and 12 years. Mothers and fathers self-reported their drinking and drinking motivations, and each parent separately took part in a 5-min parent-child problem-solving discussion about a topic that the parent identified as a frequent source of conflict. These discussions were later coded for parent rejection and coercion and child positive and negative affectivity. Father enhancement motives were independently related to father harsh parenting and indirectly related to lower child positive affect and greater child negative affect. Mother drinking to regulate positive and negative emotions interacted with mother drinking in association with mother harsh parenting, father harsh parenting, and child positive and negative affect during father-child interactions. Although the pattern of these interactions differed, the combination of mother greater drinking and coping or enhancement motives tended to have higher harsh parenting, child positive affect, and child negative affect. These findings indicate that parents' emotion-regulation motives for drinking warrant greater attention from researchers to understand the impact of parent drinking on parenting and emotional development of children. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Neighborhood environment and adolescent sleep: The role of family socioeconomic status.

OBJECTIVES: Socioeconomic status (SES) and neighborhood context are influential predictors of adolescent sleep, yet little is known about how they may interact to influence sleep. We examined multiple dimensions of family SES as moderators of associations between neighborhood risk and multiple sleep parameters. METHODS: Participants were 323 adolescents (Mage = 17.4 years, SD = 0.86; 48% male; 60% White/European American, 40% Black/African American). Sleep was assessed using 7 nights of actigraphy from which sleep duration (minutes from onset to wake time), efficiency, long wake episodes, and variability in minutes over the week were derived. Youth reported on their sleep/wake problems and sleepiness, as well as their perceptions of safety and violence in their neighborhoods. Parents reported on SES indices, including income-to-needs ratio and perceived financial stability. RESULTS: Lower SES (income-to-needs, perceived financial stability) was associated with lower sleep efficiency and more frequent long wake episodes. Lower neighborhood safety and greater community violence concerns were related to greater subjective sleep problems. Moderation effects illustrated two general patterns. For actigraphy-derived sleep variables, lower neighborhood safety was associated with poor sleep only among youth from lower-income families. For subjective sleep/wake problems and daytime sleepiness, associations between neighborhood risk and sleep difficulties were pronounced for higher SES youth, while lower SES youth had greater sleep problems regardless of neighborhood factors. CONCLUSIONS: Findings suggest that several dimensions of SES and neighborhood risk may be consequential for adolescents' sleep. Moderation effects highlight the significance of considering multiple contextual influences towards a better understanding of adolescents' sleep.

Social class discrimination during adolescence as a mediator of socioeconomic disparities in actigraphy-assessed and self-reported sleep.

OBJECTIVE: To examine social class discrimination as a mediator of socioeconomic disparities in sleep outcomes in an adolescent sample. METHODS: Sleep was assessed from established actigraphy (efficiency, long wake episodes, duration) and self-report (sleep/wake problems, daytime sleepiness) measures among 272 high school students in the Southeastern region of the United States (35% low income; 59% White, 41% Black, 49% female, Mean age = 17.3, SD = 0.8). Social class discrimination was assessed using a new measure, the Social Class Discrimination Scale (SCDS; 22-items), and an established measure, the Experiences of Discrimination Scale (EODS; 7-items). Socioeconomic disadvantage (SED) was measured as an aggregate of six indicators. RESULTS: The SCDS was associated with sleep efficiency, long wake episodes, sleep/wake problems and daytime sleepiness (but not sleep duration), and significantly mediated the socioeconomic gradient in each sleep outcome. Black males experienced higher levels of social class discrimination than Black females, White males, or White females. A race by gender moderation effect was evident for two of the five sleep outcomes (sleep efficiency and long wake episodes) suggesting a stronger association between social class discrimination and sleep problems for Black females than White females but no clear race differences among males. The EODS was not associated with objective sleep outcomes or SED but was associated with self-reported sleep and showed a similar pattern of moderation effects. CONCLUSIONS: Findings suggest that social class discrimination may contribute to socioeconomic disparities in sleep problems, with some variability across measures and demographic groups. Results are discussed in light of evolving trends in socioeconomic health disparities.

Effect of Enhanced Recovery After Surgery Protocol on Postoperative Outcomes of Women Undergoing Abdominal Hysterectomy.

Background: Enhanced recovery after surgery protocol is a standardized, multidisciplinary approach for shorter hospital stay without negatively affecting patient outcomes. The aim of this research was to evaluate the effect of enhanced recovery after surgery protocol on postoperative outcomes of women undergoing abdominal hysterectomy. Design: A quasi-experimental design was adopted to fulfil the aim of this research. Setting: The research was conducted at Obstetric and Gynecological Department in Benha University Hospital. Sample: A purposive sample of 148 women undergoing abdominal hysterectomy divided into two groups. Data collection: Three tools were used: Tool (I) structured questionnaire sheet. Tool (II) post-operative pain assessment scale (numerical rating scale). Tool (III) post-operative outcomes assessment sheet. Results: There was a highly statistically significant difference between the studied groups regarding all postoperative outcomes (p = .000). The women in the study group experienced less mean score of pain compared to those in control group on both 2nd and 3rd day after surgery. Also, there was a statistically significant difference between the studied groups regarding postoperative complication and readmission (p = .000). Conclusion: Women undergoing abdominal hysterectomy who received enhanced recovery after surgery protocol had better postoperative outcomes than women who received routine perioperative care.

Socioeconomic Disparities, Nighttime Bedroom Temperature, and Children's Sleep.

We investigated associations between family income-to-needs, nighttime bedroom temperature (NBT), and children's sleep. Using a sample of 46 children (M age = 11.5), we recorded NBT and objective sleep parameters via actigraphy nightly for one week to evaluate within- (night-to-night) and between-person associations. We found consistent evidence for a curvilinear association between NBT and sleep variables at the between-person level, indicating that children who slept in rooms that were "too hot" or "too cold" experienced poorer sleep. Moreover, children in lower income-to-needs families had more extreme NBTs. There was some evidence that family income-to-needs is indirectly related to sleep via NBT, but with interpretational caveats. These findings point to NBT as a potentially modifiable variable, which has implications for practical applications to mitigate effects of socioeconomic disparities on children's sleep.

Longitudinal associations between coping and peer victimization: Moderation by gender and initial peer victimization.

Stress coping theories suggest that the effectiveness of coping depends on the level of stress experienced. Existing research shows that efforts to cope with high levels of peer victimization may not prevent subsequent peer victimization. Additionally, associations between coping and peer victimization often differ between boys and girls. The present study included 242 participants (51% girls; 34% Black, 65% White; Mage = 15.75 years). Adolescents reported on coping with peer stress at age 16 and on overt and relational peer victimization at ages 16 and 17. Greater use of primary control engaged coping (e.g., problem-solving) was associated positively with overt peer victimization for boys with higher initial overt victimization. Primary control coping was also associated positively with relational victimization regardless of gender or initial relational peer victimization. Secondary control coping (e.g., cognitive distancing) was associated negatively with overt peer victimization. Secondary control coping was also associated negatively with relational victimization for boys. Greater use of disengaged coping (e.g., avoidance) was associated positively with overt and relational peer victimization for girls with higher initial victimization. Gender differences and the context and level of stress should be considered in future research and interventions related to coping with peer stress.

Beyond antipsychotics: the role of medication and nonmedication factors in female sexual dysfunctions in schizophrenia.

To date, few studies have investigated male sexual dysfunctions (FSDs) in schizophrenia in non-Western countries, with most studies focusing on the sexual side effects of antipsychotic medications. Therefore, we aimed to screen for FSD in a sample of Egyptian females with schizophrenia, compare them to controls and to investigate demographic and clinical parameters associated with FSD. We conducted a cross-sectional study of 72 medicated and unmedicated females with schizophrenia (27 unmedicated and 45 medicated) and 24 controls. They were assessed using the Female Sexual Function Index (FSFI) and data were collected for demographic and clinical parameters. We found that females with schizophrenia had significantly lower scores on the FSFI compared to controls and that 93.1% of females with schizophrenia reached the threshold for FSD (FSFI score ≤26), compared to 87.5% of controls. Medicated and unmedicated subjects did not differ significantly in most domains of the FSFI. Age, duration of illness, positive and negative syndrome Scale total, positive and negative symptom scores correlated significantly with the majority of domains of the FSFI. Rates of FSD are very high in both schizophrenia and controls and correlate in schizophrenia with a number of demographic and clinical parameters, suggesting that FSDs are not restricted to the side effects of medications. There is a need to screen for sexual function in routine practice, and for developing active strategies to tackle sexual dysfunctions.

Attachment to Mother and Father, Sleep, and Well-Being in Late Middle Childhood.

The security of attachment has been related to several advantageous developmental outcomes, such as good sleep quality and higher well-being indicators. However, few studies concern the associations between attachment dimensions to both parents, sleep, and well-being in late middle childhood. Our study aims to expand knowledge in this area, clarifying the above-mentioned associations by considering the secure base and safe haven dimensions of attachment. We also investigate the role of sleep as a mediator of the relationship between attachment and well-being. The 258 participants (49.2% girls, mean age = 11.19, SD = 0.85) completed self-report questionnaires regarding attachment (KSS), sleep (SSR), and well-being (CHIP-CE). The results show significant associations between attachment to both parents (0.40 ** ≤ r ≤ 0.61 **) and between attachment security, sleep (-0.21 ** ≤ r ≤ -0.35 **) and child well-being (0.42 ** ≤ r ≤ 0.47 **). Besides, sleep quality partially mediated the relations between all attachment dimensions to both parents and well-being. The results are discussed in light of attachment theory, focusing on the comparison between attachment to mother and father as a valid framework to unravel differences in child well-being, with sleep as a process that can help to explain the mechanisms through which attachment security enables subjective perceptions of well-being.

Parental Problem Drinking and Maladaptive Personality Features in Children: The Role of Marital Conflict.

The personality characteristics of children of exposed to parental problem drinking have been of interest to clinicians and researchers for several decades, but personality research on this population often focuses on identifying a unique cluster of adult personality traits. The current study adopts a cutting-edge dimensional approach to understanding personality pathology as extreme variants of the five factor model, and examines pathways of risk to personality pathology through marital conflict and emotional insecurity. Participants were 199 two-parent families with a child between the ages of 6 and 12 years. Parents completed questionnaire measures of their problem drinking, marital conflict, child emotional insecurity (i.e., emotional reactivity to conflict), and child maladaptive personality traits. Structural equation models found an indirect pathway from mother and father problem drinking to pathological child disagreeableness, introversion, emotional instability, and compulsivity via greater mother destructive marital conflict behavior and child emotional reactivity to conflict. There was also some evidence that this pathway of effects was stronger for girls than for boys. Findings support the use of a dimensional approach to understanding maladaptive personality among individuals exposed to parental problem drinking.

Relationship between family income and trajectories of adjustment in adolescence: Sleep and physical activity as moderators.

INTRODUCTION: Youth from lower-income families experience adjustment problems at higher rates than higher-income peers. While adolescents have little control over family income, they do have some agency over their sleep and physical activity, two factors that have been shown to mitigate the risk of maladjustment. To test this, sleep and physical activity were examined as moderators of the longitudinal relationship between family income (indexed by income-to-needs ratio) and trajectories of adolescent adjustment problems. METHODS: Participants included a socioeconomically diverse community sample of 252 US youth (53% female; 33% Black, 67% White) in 2012-2015. Actigraphy-based sleep duration and quality were indexed, respectively, by minutes (sleep onset to wake excluding awakenings) and efficiency (% minutes scored as sleep from onset to wake). Physical activity and adjustment were youth-reported. Outcomes included internalizing (anxious/depressive) and rule-breaking behavior. Latent growth models estimated trajectories of adjustment across ages 16 and 18 years conditional on family income, sleep, physical activity, and their interactions. RESULTS: Relationships between family income and change in internalizing symptoms were moderated by sleep minutes, and associations between income and change in internalizing symptoms and rule-breaking behavior were moderated conjointly by sleep efficiency and physical activity. CONCLUSIONS: Under conditions of high-quality sleep and more physical activity, adolescents with lower income reported fewer adjustment problems. Conversely, youth with both poor sleep and low physical activity were at the highest risk for maladjustment over time. Findings enhance understanding of individual differences in trajectories of mental health associated with bioregulation, health behaviors, and the sociocultural context.

Ethnic/racial discrimination and academic grades among adolescents: moderation by sleep regularity.

This study investigates how sleep regularity moderates the association between ethnic/racial discrimination and academic grades among diverse adolescents. The study included a 14-day, daily diary and actigraphy study of ninth-grade adolescents in the United States (N = 265; mean [SD] age 15.26 [0.62] years, 41.51% Asian, 21.13% Black, 37.35% Latinx, 71.32% female) who completed measures of demographic information and ethnic/racial discrimination (Daily Life Experiences Racism and Bother subscale). Sleep data were collected for 14 consecutive days with wrist actigraphy, and sleep regularity was calculated using the Sleep Regularity Index (SRI). Academic grades were provided by the Department of Education. Discrimination frequency was associated with lower academic grades, and the SRI moderated this association. Compared to adolescents who had moderate and regular SRI profiles, adolescents with irregular SRI (i.e., lower sleep regularity) had stronger negative associations between discrimination and grades. On the other hand, for adolescents who had moderate to high sleep regularity, there was no significant association between discrimination and grades. This study underscores the importance of sleep regularity for adolescents' academic achievement.

Attachment and prosocial behavior in middle childhood: The role of emotion regulation.

There is a lack of research on the development of prosocial behavior in middle childhood. The current study addressed this gap through the application of attachment theory; attachment security has been shown to promote prosocial behavior in early childhood, and emotion regulation may be an important intervening variable in this association. A sample of 199 children (aged 6-12 years) reported on their attachment internal working models for the mother-child and father-child relationships, parents reported on child emotion regulation and emotional lability/dysregulation, and children completed a sticker donation task to assess their prosocial behavior. Child emotional lability/dysregulation served as an intervening variable in the association between father-child attachment security (communication and trust) and greater sticker donation. Mother-child and father-child attachment security was also associated with child emotion regulation, but emotion regulation was not associated with sticker donation. Findings suggest that secure attachment may foster prosocial behavior toward peers in middle childhood primarily by reducing dysregulated responses to the distress of others.

Sleep and disparities in child and adolescent development.

Sleep is a robust predictor of child and adolescent development. Race/ethnicity, socioeconomic status (SES), and related experiences (e.g., discrimination) are associated with sleep, but researchers have just begun to understand the role of sleep in the development of racial/ethnic and SES disparities in broader psychosocial adjustment and cognitive functioning during childhood and adolescence. In this article, we discuss poor sleep as a potential mechanism contributing to the development of such disparities, and better sleep as a potential protective factor that diminishes such disparities. We conclude by offering recommendations for research to advance understanding of sleep as a key bioregulatory system that may underlie or protect against detrimental developmental outcomes related to socioeconomic adversity and belonging to a historically minoritized group.