Association of breakfast skipping with habitual dietary intake and BMI in female rotating shift workers.

OBJECTIVE: Higher BMI, lower quality of diet and a higher percentage of breakfast-skippers have been reported among rotating shift (RS) workers compared with day shift (DS) workers. As such, this study examined the association between breakfast skipping, habitual food consumption and BMI in RS workers. DESIGN: Japanese nurses were studied using a self-administered questionnaire that assessed the height, weight, breakfast consumption habits, dietary consumption, physical activity, sleep habits, chronotype and demographic characteristics of the participants. SETTING: A cross-sectional study was conducted in a population of nurses in Japan. Dietary and health-related questionnaires were mailed to 5536 nurses aged 20-59 years, working at 346 institutions. PARTICIPANTS: A total of 3646 nurses at 274 institutions responded to the questionnaire. After removing those who met the exclusion criteria, 2450 participants were included in the statistical analysis. RESULTS: The RS breakfast-skippers had lower total energy intake, diet quality and higher BMI than DS workers, whereas the RS breakfast-consumers had a higher total energy intake and BMI than the DS workers. In the RS workers, breakfast skipping on the days of DS and the end days of evening/night shift was associated with a poorer diet quality. Additionally, breakfast skipping on the days of DS was positively associated with BMI, independent of the total energy intake and diet quality. CONCLUSIONS: Breakfast skipping on workdays may contribute to a difference in dietary intake and BMI between RS workers and DS workers and may increase BMI in RS workers, independent of dietary intake.

Longitudinal relationships of psychotic-like experiences with suicidal ideation and self-harm in adolescents.

Research in adolescents suggests associations between psychotic-like experiences (PLEs) and self-injurious thoughts and behaviors (SITBs), but insights into their temporal relationship, which may inform prediction, have been limited. Psychological distress (PD; symptoms of depression and anxiety) has been related to both PLEs and SITBs, and may modulate this relationship. Given that PLEs have been linked to the development of several mental disorders, and the relationships between SITBs and suicide, it is important to better understand their relationship. The present study sought to investigate these factors using a longitudinal school-based design. Adolescents (n = 1685, ages 12-18) completed annual self-report assessments (6 time points) on PLEs, SITBs (suicidal ideation (SI) and self-harm (SH)), as well as PD. The longitudinal associations between PLEs and SITBs were analyzed, employing two cross-lagged panel models (CLPMs), with and without adjustment for PD. Unadjusted CLPMs revealed significant bidirectional temporal associations between PLEs and SITBs (both SI and SH), suggesting that PLEs both predicted and were predicted by SITBs. When adjusting for PD, the effect of SI on PLEs remained significant, but not PLEs on SI; bidirectional associations between PLEs and SH also remained significant. A bidirectional longitudinal relationship where both PLEs and SITBs can precede (and perhaps predict) each other was suggested in adolescents. PD may play a particular role in situations where PLEs are followed by SI. Heightened awareness about relationships between these phenotypes may be an important step toward facilitating timely interventions for both mental disorders and suicide.

A survey of mental health literacy in Japanese high school teachers.

BACKGROUND: School teachers are well-positioned to recognize mental health problems in their students and to help them seek appropriate help. Therefore, teachers need to have high levels of mental health literacy (MHL). In East Asia, however, few studies have examined MHL levels in teachers. In this study, MHL levels were investigated in Japanese teachers. METHODS: Teachers (n = 665) from 27 Japanese high schools answered a self-administered questionnaire which assessed (a) knowledge about mental health/illnesses, (b) correct recognition of specific illnesses (depression, schizophrenia and panic disorder), (c) confidence in helping students with depressive symptoms, and (d) confidence in teaching mental health knowledge to students. RESULTS: The average proportion of correct answers to the knowledge questions (n = 20) was 58.1%. The proportion of those who correctly answered about the presence of a sharp increase of mental illnesses in adolescence was 51.7%. Few teachers correctly answered about the life-time prevalences of major mental illness in general (21.9%), depression (37.8%) and schizophrenia (19.8%). Depression, schizophrenia and panic disorder in vignette were correctly recognized by 54.1, 35.3 and 78.0% of teachers, respectively. Correct recognition was significantly lower in male than in female teachers. Only a small proportion of teachers had confidence in helping depressed students (19.9%) and in teaching mental health knowledge to students (11.1%). CONCLUSIONS: MHL in Japanese high school teachers appears to be low. Education programs should be developed and implemented to improve teacher MHL with the aim of helping them to support students suffering from mental health problems.

A quasi-cluster randomized controlled trial of a classroom-based mental health literacy educational intervention to promote knowledge and help-seeking/helping behavior in adolescents.

INTRODUCTION: School-based education is a potentially effective approach for improving mental health literacy (MHL) in adolescents. This study evaluated the effects of the "Short MHL Program (SMHLP)", a brief (50 min), school teacher-led program, on MHL in adolescents in a quasi-cluster randomized controlled trial. METHODS: A total of 975 high school first graders (age 15-16) in Japan were allocated to classes such that gender and academic achievement ratios were almost equivalent at the time of admission to the high school. They were assigned at the class level to the SMHLP (n = 364 from 10 classes) or a control group (n = 611 from 17 classes). The program consisted of a 50-minute session and was delivered by a school teacher. The students completed a self-report questionnaire at 3 time points: pre-, (immediately) post- and 2-month follow-up. Outcomes included "Knowledge about mental health/illnesses", "Recognition of the necessity to seek help", "Intention to seek help", and "Intention of helping peers". Mixed effects modeling was employed for analyses. RESULTS: Scores of all outcomes were significantly improved in the intervention group compared to the control group post-intervention (p < .001). These improvements were maintained at 2-months follow-up for all outcomes (p < .001-.05). Questionnaire scores did not differ between groups at baseline. CONCLUSIONS: The effect of the SMHLP was confirmed in grade 10 students. Brief, yet effective programs can be a viable option to promote understanding of mental health problems and have the potential to be incorporated into regular school curriculum. ".

Appetite loss as a potential predictor of suicidal ideation and self-harm in adolescents: A school-based study.

Suicide is a leading cause of death in adolescents, but detection of its risk is often challenging. Many mental illnesses share the common symptom of appetite loss and it is also known that people who suffer from these illnesses are at greater risk of suicide. However, the relationship between appetite loss and suicide risk has yet to be examined. For adolescents in particular, questions about appetite loss may be easier to answer than sensitive questions regarding mental health. The present study aims to investigate the association of appetite loss with suicidal ideation and self-harm in adolescents. Rates of adolescents with suicidal ideation or self-harm associated with appetite-loss were examined in 18,250 Japanese junior and senior high school students (aged 12-18) using a self-report questionnaire. Insomnia, a physical symptom which has previously been associated with suicide risk, was also controlled for in the analysis. Results showed that rates of adolescents with suicidal ideation or self-harm significantly increased according to the degree of self-reported appetite loss. Similar results were observed for insomnia. Odds ratios (ORs) for suicidal ideation and self-harm were 5.5 and 4.1 for adolescents with appetite loss compared to those without it, and the ORs were 5.5 and 3.5 for those with insomnia compared to those without it, respectively, adjusting for sex and age (p < 0.001). ORs remained statistically significant after adjusting for depression/anxiety (General Health Questionnaire-12 score). In conclusion, self-reported appetite loss was highly associated with suicidal ideation and self-harm in adolescents; adolescents reporting physical symptoms such as loss of appetite or insomnia should be given careful attention.

Effects of school-based mental health literacy education for secondary school students to be delivered by school teachers: A preliminary study.

AIMS: Improving knowledge and beliefs about mental health (or mental health literacy [MHL]) may promote appropriate help-seeking by adolescents who are suffering from mental health problems. We developed a concise, school-staff-led MHL program and examined its effects. METHODS: The participants comprised 118 grade-9 students (61 boys and 57 girls). The program consisted of two 50-min sessions, and was given by a schoolteacher. The effects of the program were evaluated before, immediately after and 3 months after the program, using a self-report questionnaire. RESULTS: Knowledge of mental health/illnesses and desirable behavior for help-seeking were significantly improved immediately after (post-test, P < 0.001, and P < 0.001, respectively) and 3 months after the program (3-month follow up, P < 0.001 and P < 0.001, respectively), compared with the test before the delivery of the program (pre-test, Wilcoxon signed rank test). Proportions of the correct diagnoses of vignette cases of major depression and schizophrenia were significantly (P < 0.001) elevated from 38.3% and 19.1% (pre-test) to 94.7% and 93.6% (post-test), and 91.5% and 86.2% (3-month follow up). Intentions to seek help and to provide peers with help with mental health problems were also significantly (P < 0.001) elevated at post-test and at 3 months compared with the pre-test. CONCLUSIONS: A concise, school-staff-led program may have a significant effect on the improvement of MHL in secondary school students.

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.

Effects of bright light exposure on the behavioral and psychological symptoms of dementia and the burden on caregivers in institutionalized elderly with cognitive decline.

AIM: The purpose of this study was to examine the effects of bright light exposure on behavioral and psychological symptoms of dementia (BPSD), including sleep disturbances and the burden on caregivers in institutionalized elderly with cognitive decline. METHODS: The subjects included eight people with cognitive decline (mean [SD] age, 79.9 [9.1] years) living in geriatric healthcare facilities for the elderly. BPSD and the burden on caregivers were measured over three weeks using the CMAI (Cohen-Mansfield Agitation Inventory), NPI-NH (Neuropsychiatric Inventory-Nursing Home Version) and J-ZBI (Modified Japanese Version of the Zarit Caregiver Burden Interview) at the end of each week. During the second week, the subjects received either 12,000 K (white) or 2,400 K (orange) of light corresponding to approximately 2,000 lux from a light-emitting diode (LED) device, measured before the eyes in the gaze direction, from 9 : 00 to 9 : 30 during occupational tasks, such as origami and coloring. Differences in the variables obtained at the different weeks were assessed using ANOVA with multiple comparisons. RESULTS: The scores for the severity of BPSD, including sleep disturbances and the burden on caregivers, on the NPI-NH significantly (P<0.05) improved following the treatment with white light exposure, while the scores for the MMSE and J-ZBI did not change over the three-week study period. CONCLUSIONS: These results suggest that exposure to white bright light during occupational tasks in the morning may have a benefit in improving BPSD, including sleep disturbances and the burden on caregivers.

Reduced heart rate variability is related to fluctuations in psychological stress levels in daily life.

Laboratory-based studies have shown that psychological stress caused by response to various stressors triggers acute changes in the cardiovascular system. A better understanding is needed of the emerging evidence on temporal associations between psychological stress and cardiovascular responses in natural settings. This study examined the association of psychological stress and heart rate variability (HRV) in daily life, at high resolution over 2 weeks, taking the effect of physical activity into account. Participants (n = 34) completed ecological momentary assessments (EMA) 6 times per day, reporting levels of perceived stress, low-arousal negative affect (LNA), and high-arousal negative affect. Chest-mounted heart-rate monitors were worn to assess HRV. Multilevel models were used to examine the association between psychological stress levels and preceding/subsequent HRV. Reduced time domain HRV measures (mean and standard deviation of R-wave to R-wave intervals) during the prior hour predicted higher levels of perceived stress. Frequency domain HRV measures higher low to high frequency (LF/HF) and lower HF to total power (HF nu) ratios during the preceding 10 min predicted higher perceived stress levels, suggesting the dominance of sympathetic nervous system activity. EMA reports of higher perceived stress levels were associated with reduced time domain HRV measures during the following 10 min. On the other hand, higher LNA were related to increased HRV measures, such as lower LF/HF and higher HF nu during the following hour. The dynamic associations observed may have therapeutic implications for 'just-in-time' interventions in the management of daily stress and cardiovascular health.

Association between number of confidants and adolescent anxiety/depression: a school-based study.

BACKGROUND: Having no or few confidants is found to be associated with more severe mental health problems and a higher prevalence of depression in adults, but research examining this association in adolescents is scarce. Social relationships may be particularly critical during adolescence, as it is an important developmental period during which vulnerability to mental health problems increases. The present study examined the relationship between having no or few confidants and anxiety/depressive symptoms in adolescents. METHODS: Cross-sectional self-report survey targeting 7-12th grade students (age range: 12-18) was conducted in public junior and senior high schools in Mie and Kochi, Japan. Data from 17,829 students (49.7% boys) were analyzed. Associations between anxiety/depressive symptoms (12-item General Health Questionnaire; score range: 0-12) and the number of confidants (None, 1-3, or ≥ 4) were examined using multilevel regression analyses. The analyses were stratified by gender and school level (junior/senior high), and adjusted for experiences of being physically abused and bullied and the interactions of these experiences with the number of confidants. RESULTS: Having no or 1-3 confidants was associated with more anxiety/depressive symptoms, compared to having ≥ 4 confidants (p < 0.001) in all stratified groups. Having no confidants was associated with more anxiety/depressive symptoms than having 1-3 confidants (p < 0.001); in senior high boys, no difference was observed between having no confidants and having 1-3 confidants. In addition, in senior high boys, victims of bullying who have confidants reported significantly less anxiety/depressive symptoms than the victims who have no confidants (p < 0.01). CONCLUSIONS: Adolescents who had no or few confidants had more anxiety/depressive symptoms. Attention needs to be paid to better identify these adolescents, and avenues to support them need to be established.

A survey of mental health literacy in parents and guardians of teenagers.

Introduction: Parents and guardians (hereafter caregivers) of teenagers need high levels of mental health literacy (MHL) to manage mental health problems arising in teenagers in their care. Previous studies assessing MHL levels in caregivers of teenagers have reported mixed results, making it difficult to clearly estimate caregiver MHL levels. This study aimed to investigate MHL levels in Japanese caregivers of regular teenagers. Methods: Responses from caregivers (n = 1,397) of students entering junior and senior high schools to a self-administered online questionnaire were analyzed. The questionnaire assessed (a) knowledge about mental health/illnesses and (b) attitudes towards mental health problems in teens in their care (e.g., recognition of depression as a medical illness and intention to engage in helping behaviors). Results: The average proportion of correct answers to the knowledge questions (n = 7) was 55.4%; about one tenth (9.2%) of caregivers correctly answered only one or none of the questions. Few caregivers correctly answered about the life-time prevalence of any mental illnesses (46.1%) and appropriate sleep duration for teenagers' health (16.5%). The proportions of caregivers who had the intention to listen to the teen in their care, consult another person, and seek professional medical help if the teen suffered from depression were 99.5%, 91.5% and 72.7%, respectively. Conclusions: Many teenagers' caregivers appeared to be willing to help the teens in their care if they were suffering from mental health problems. However, there was much room for improvement in knowledge on mental health/illnesses and intention to seek help from medical professionals. Efforts toward better education should be made.

Effects of feeding schedule changes on the circadian phase of the cardiac autonomic nervous system and serum lipid levels.

PURPOSE: The purpose of this study was to investigate whether scheduling meals earlier in the day affects the circadian phase of the cardiac autonomic nervous system as assessed by heart rate variability (HRV) and serum lipid levels. METHODS: Healthy men aged 21.4 ± 0.5 years (n = 14) with a habit of regularly skipping breakfast participated in this parallel trial involving altered feeding schedules. Participants in the early mealtime group (EM group, n = 8) were asked to eat three meals at 8:00, 13:00, and 18:00, and the control group (n = 6) ate at 13:00, 18:00, and 23:00 for 2 weeks. On the measurement day before and after intervention, fasting blood samples and 24-h electrocardiograph recordings were collected. Spectral analysis was used for approximate 10-min HRV segments. Low frequency (LF) power, high frequency (HF) power, and the ratio of HF to total power (%HF) were calculated to assess sympathovagal balance. Acrophases of the circadian rhythm of HRV variables were obtained by nonlinear least squares regression. RESULTS: Triglyceride and total and LDL cholesterol levels were significantly decreased in the EM group when compared with the control group (p = 0.035, 0.008, and 0.004, respectively). Acrophases for HRV variables were advanced in the EM group and their difference between before and after the intervention in LF power (-3.2 ± 1.2 h) and %HF (-1.2 ± 0.5 h) reached significant level, respectively (p < 0.05). CONCLUSIONS: Timing of meals was a key factor in regulating circadian phases of the cardiac autonomic nervous system and lipid metabolism.

Mental Health Literacy Programs for Parents of Adolescents: A Systematic Review.

Introduction: Many mental illnesses begin during adolescence. Parents of adolescents need to have sufficient mental health literacy (MHL) to recognize mental health problems in their children and to assist them with help-seeking. Although several educational programs have been developed to enhance parental MHL, their effectiveness has not been established. This study provides a systematic review for the effectiveness of MHL programs in parents of adolescents. Methods: PubMed, PsycINFO, CINAHL, ERIC and Web of Science were searched from the earliest date possible until February 2022; references of studies which met eligibility criteria were also screened. Studies that assessed quantitative change in at least one of the following components of parental MHL were included: knowledge of mental health/illnesses; stigma toward people with mental health problems; confidence in helping children with mental health problems, and intention, knowledge or behavior of helping children with mental health problems. Risk of bias (ROB) for each outcome within the included studies was rated using the revised Cochrane risk-of-bias tool for randomized trials for randomized controlled trials (RCTs), and the Risk of Bias Assessment Tool for Nonrandomized Studies for nonrandomized studies. Results: Nine studies (four RCTs, three controlled before-and-after studies, and two case series), reported in 10 articles, were included. Mental health knowledge and/or confidence was significantly improved in several studies, while no studies observed significant improvement in stigma and/or intention/behavior of helping children. ROB was high in five out of nine studies (10 out of 18 outcomes) and unclear in the others. Conclusions: A limited number of studies have evaluated effects of MHL program in parents and inconsistent quality contributes to difficulty in establishing their overall effectiveness. More studies with appropriate methods of recruitment, measurement and analysis, and transparent reporting are needed. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193072, Identifier: CRD42020193072.

The longitudinal relationship between sleep length and psychotic-like experiences in adolescents.

The longitudinal relationship between psychotic-like experiences (PLEs) and short habitual sleep in adolescents remains to be investigated. We examined the effect of habitual sleep length (time-in-bed: TIB) on the risk of subsequent year PLEs and vice versa, in grade 7-12 students (ages: 12-18, n = 1,685) followed over 6 years. Yearly longitudinal data were analyzed using cross-lagged panel models. Shorter weekday TIB was associated with a higher risk of subsequent year PLEs; PLEs did not affect subsequent year TIB. Compared to a TIB of 8-9 h, 5-6 h increased PLEs likelihood 1.8 times; <5 h increased this 6-fold.

Nonlinear associations between sleep patterns and sarcopenia risks in older adults.

STUDY OBJECTIVES: Despite considering it as a common geriatric condition, sarcopenia is linked to various behavioral factors that may be changeable. As sleep is one of the important routines in physiological homeostasis, further investigating the underlying relationships of sleep behavior with sarcopenia is urgently needed. We examined the association between sleep parameters (ie, sleep duration, bedtime, wake time, or midsleep time) and sarcopenia risks in older adults, in the total sample and age group subsamples. METHODS: A total of 1,068 older adults in Taiwan were included. Data on bedtime, wake time, and sleep duration were collected through telephone interview. Midsleep time was calculated by the midpoint of bedtime and wake time. Sarcopenia was screened by the SARC-F questionnaire composed of 5 questions (the strength, assistance in walking, rising from a chair, climbing stairs, and falls) as well as higher scores was related to greater risks. Generalized additive models were conducted to examine the nonlinear relationships between sleep parameters and sarcopenia risks. RESULTS: The covariate-adjusted analysis showed that a reverse J-shaped relationship for sleep duration and sarcopenia risk (P < .001) and a significant association for wake time and the SARC-F score (P = .009) in total sample, with considering age-related interaction. No associations were found in the other sleep parameters (bedtime and midsleep time) and sarcopenia in older adults. Similar associations were observed between wake time and the SARC-F score across age groups, while diverse associations of sleep duration with the SARC-F score were found in different age groups. CONCLUSIONS: The sleep pattern is significantly associated with sarcopenia risks in aging adults. Improving inappropriate sleep behaviors in older adults is suggested to prevent a decline in muscle function and promote healthy aging. CITATION: Huang W-C, Lin C-Y, Togo F, et al. Nonlinear associations between sleep patterns and sarcopenia risks in older adults. J Clin Sleep Med. 2022;18(3):731-738.

Objectively measured chronotype and social jetlag are associated with habitual dietary intake in undergraduate students.

This study aimed to investigate the associations between objectively measured sleep timing and habitual dietary intake among university students. We hypothesized that a later chronotype and larger social jetlag (SJL) are associated with an undesirable dietary intake. The 82 healthy university students included in this study were asked to undertake a seven-day wrist activity recording. All the participants also completed a self-administered questionnaire during the recording period, including questions on demographic characteristics and habitual dietary intakes. Dietary intake and the score for adherence to the Japanese Food Guide Spinning Top (food guide score) over the previous month were evaluated using a self-reported diet history questionnaire. Nocturnal sleep timing and total sleep time for each night were estimated using the recorded wrist activity. Chronotype was calculated as weekend (WE) mid-sleep time corrected for catch-up sleep on weekdays (WDs). SJL was calculated by subtracting WD mid-sleep time from WE mid-sleep time. Multivariable linear regression showed that a later chronotype was significantly (P < .05) associated with a lower consumption of eggs, greater consumption of grains, and lower food guide score. Multivariable linear regression also showed significant (P < .05) associations of a larger value in SJL with a lower total energy intake, lower consumption of grains, and greater consumption of sugar and confectioneries. The results suggest that chronotype and SJL may be differently associated with undesirable dietary intake in young adults. These findings have important implications for developing novel strategies, focusing on sleep timing, for improving dietary intakes and preventing lifestyle-related diseases.

A Pilot Study of Temporal Associations Between Psychological Stress and Cardiovascular Response.

Psychological stress (PS) in daily life can trigger acute changes in cardiovascular function and may lead to increased risk of cardiovascular problems. Prior laboratory-based studies provide little evidence on temporal changes in the associations between PS and cardiovascular responses in natural settings. We hypothesized that daily PS would be associated with higher heart rate (HR) and lower heart rate variability (HRV). Using smartphones, ten participants (four females, 21.1±1.1 years) completed ecological momentary assessment (EMA) 6 times a day for two weeks regarding their current affective state. Participants rated levels of PS, as well as 3 high-arousal negative affect (HNA: Anxious, Annoyed, and Upset), and 3 low-arousal negative affect (LNA: Sluggish, Bored, and Sad) states. They also wore a chest-mounted heart-rate monitor and a wrist accelerometer to monitor cardiovascular response and physical activity, respectively. HR and HRV variables in the time intervals (5, 30, 60 min) before and after EMA were used as indicators of cardiovascular response. Multilevel modeling was used to examine the association between affect and HR/HRV, controlling for physical activity. Higher HR and lower HRV were related to subsequent greater feelings of stress at the 5 and 30-min time intervals. No significant associations were observed between cardiovascular parameters and subsequent affective states, suggesting that the acute exaggerated cardiovascular responses occurred due to PS. Higher LNA was related to antecedent/subsequent lower HR or higher HRV within 2 hours, while HNA was unrelated to HR or HRV for all time intervals, suggesting that both high/low arousal NA were not related to exaggerated cardiovascular response. Understanding psychological feelings of stress and LNA may be helpful in the management of daily cardiovascular health.

Association between objectively measured sleep duration and physical function in community-dwelling older adults.

STUDY OBJECTIVES: The aim of this research was to investigate the relationships between objectively measured sleep duration and physical function in older adults. METHODS: We recruited community-dwelling older adults aged ≥ 60 years old in Taipei City, Taiwan. Sleep duration was measured with accelerometers and recorded as the total hours of sleep per night for each participant. The following physical functions were assessed: 1) grip strength (measured by handgrip dynamometer), 2) balance (1-leg standing test), 3) lower body strength (5-timed chair stand), 4) basic mobility (timed up and go test), 5) gait speed (5-m walk test). The relationships between sleep duration and physical function outcomes were analyzed using generalized additive models, controlling for objectively measured sedentary behavior and moderate-to-vigorous physical activity, and other sociodemographic variables. RESULTS: A total of 121 older adults (men = 28.9%; mean age = 70.0 ± 5.0 years) was included in this study. A positive association of sleep duration with grip strength was found after adjusting for covariates (P = .005). No significant associations were observed between sleep duration and the other physical function outcomes. CONCLUSIONS: For older adults, lengthening their sleep duration may be helpful to enhance the grip strength. This result has implications for improving their health by targeting better performance in specific physical functions. Further studies of sleep duration and physical function among older adults should investigate the underlying mechanisms.

Association of depressive symptoms with habitual sleep duration and sleep timing in junior high school students.

This study aims to investigate independent associations of habitual sleep durations and sleep timings on weekdays and weekends with depressive symptoms in adolescents who have classes in the morning. We studied grade 7-9 students (942 males and 940 females, aged 12-15 years), who had classes in the morning, at public junior high schools in Japan in a cross-sectional design. The students answered a self-report questionnaire, which covers habitual sleep durations, bedtimes and wake-up times on weekdays and weekends, and depressive symptoms. The Short Mood and Feelings Questionnaire (SMFQ) was used to determine the level of depressive symptoms. The relationship between the variables on sleep habits and the SMFQ score were studied using multivariate linear regression and generalized additive models (GAM), controlling for sex, age and school. Multivariate linear regression analysis revealed that sleep duration on weekdays and relative mid-sleep time on weekdays (i.e. mid-sleep time on weekdays - mid-sleep time on weekends) were independently significantly (p < .001) associated with the SMFQ score. GAM analysis also revealed that sleep duration on weekdays (a reverse J-shaped relationship) and the relative mid-sleep time on weekdays (a negative monotonic/linear relationship) were independently significantly (p < .001) associated with the SMFQ score. These associations were confirmed in both males and females when they were analyzed separately. These results suggest that sleep duration on weekdays and the relative mid-sleep time on weekdays may be independently associated with the level of depressive symptoms in junior high school students who have classes in the morning. These findings may have important implications for the development of novel strategies for preventing mental health problems in adolescents.

Mental health literacy programs for school teachers: A systematic review and narrative synthesis.

AIM: The prevalence of mental disorders increases sharply during adolescence. Therefore, school teachers are in a good position to provide initial assistance to students with mental health problems. Although effects of a number of mental health literacy programs aimed at teachers have been reported, they have not yet been reviewed in a systematic manner. This study conducted a systematic review of the effectiveness of mental health literacy programs for teachers. METHODS: PubMed, PsycINFO, CINAHL, ERIC, Web of Science and reference lists of included studies were searched in September 2018. Studies that quantitatively measured at least one of the main components of mental health literacy, including (a) knowledge of mental illnesses, (b) stigma towards mental illnesses, (c) confidence in helping students, and (d) behaviour of helping students, were included regardless of study design. Risk of bias was rated for each included study according to the Cochrane tool for randomized studies and the Cochrane tool, for raondomized studies, and the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS), for nonrandomized studies. RESULTS: Sixteen studies met the inclusion criteria, including 1 randomized controlled trial (RCT), 2 cluster RCTs, 1 controlled before-and-after study and 12 case series. Most of the studies claimed significant improvement of knowledge, attitudes, behaviour and/or confidence. However, the overall quality for all outcomes was relatively low; 15 studies had high/unclear risk of bias due to lack of allocation concealment, not controlling for confounders, and/or inadequate analysis for attrition. CONCLUSIONS: More high quality evidence is required before the effectiveness of mental health literacy programs for teachers can be established.