UA Open Access Publishing Fund / Background: Medical residency can be a time of increased psychological stress and sleep disturbance. We examine the prospective associations between self-reported sleep quality and resident wellness across a single training year. Methods: Sixty-nine (N69) resident physicians completed the Brief Resident Wellness Profile (M17.66, standard deviation [SD] 3.45, range: 017) and the Pittsburgh Sleep Quality Index (M6.22, SD 2.86, range: 1225) at multiple occasions in a single training year. We examined the 1-month lagged effect of sleep disturbances on residents’ self-reported wellness. Results: Accounting for residents’ overall level of sleep disturbance across the entire study period, both the concurrent (within-person) within-occasion effect of sleep disturbance (B 0.20, standard error [SE]0.06, p0.003, 95% confidence interval [CI]: 0.33, 0.07) and the lagged within-person effect of resident sleep disturbance (B 0.15, SE0.07, p0.037, 95% CI: 0.29, 0.009) were significant predictors of decreased resident wellness. Increases in sleep disturbances are a leading indicatorof resident wellness, predicting decreased well-being 1 month later. Conclusions: Sleep quality exerts a significant effect on self-reported resident wellness. Periodic evaluation of sleep quality may alert program leadership and the residents themselves to impending decreases in psychological well-being.

bgelaye@hsph.harvard.edu / Article / Objective: To examine the independent and joint relationships of poor subjective sleep quality and antepartum depression with suicidal ideation among pregnant women. Methods: A cross-sectional study was conducted among 641 pregnant women attending prenatal care clinics in Lima, Peru. Antepartumdepression and suicidal ideationwere assessed using the Patient Health Questionnaire-9 scale. Antepartumsubjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Logistic regression procedures were performed to estimate odds ratios (aOR) and 95% confidence intervals (95% CI) adjusted for confounders. Results: Overall, the prevalence of suicidal ideation in this cohort was 16.8% and poor subjective sleep qualitywas more common among women endorsing suicidal ideation as compared to their counterpartswho did not (47.2% vs. 24.8%, Pb.001). After adjustment for confounders including maternal depression, poor subjective sleep quality (defined using the recommended criteria of PSQI global score of N5 vs. ≤5) was associated with a 1.7-fold increased odds of suicidal ideation (aOR=1.67; 95% CI 1.02–2.71). When assessed as a continuous variable, each 1-unit increase in the global PSQI score resulted in an 18% increase in odds for suicidal ideation, even after adjusting for depression (aOR=1.18; 95% CI 1.08–1.28). Women with both poor subjective sleep quality and depression had a 3.5-fold increased odds of suicidal ideation (aOR=3.48; 95% CI 1.96–6.18) as compared with those who had neither risk factor. Conclusion: Poor subjective sleep quality was associated with increased odds of suicidal ideation. Replication of these findings may promote investments in studies designed to examine the efficacy of sleep-focused interventions to treat pregnant women with sleep disorders and suicidal ideation. / This research was supported by an award fromtheNational Institutes of Health (NIH; R01-HD-059835, T37-MD000149 and K01MH100428). The NIH had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. The authors wish to thank the dedicated staff members of Asociacion Civil Proyectos en Salud (PROESA), Peru and Instituto Especializado Materno Perinatal, Peru, for their expert technical assistance with this research. / Revisión por pares

Indiana University-Purdue University Indianapolis (IUPUI) / Although the occupational callings literature has largely focused on positive outcomes of living a calling, there are some emerging findings that suggest that callings may have a “negative” side as well. Drawing upon past studies within the callings literature, as well as upon theoretical perspectives such as self-regulation theory, identity theory, and the Effort-Recovery model, I tested a theoretical model to examine psychological detachment as a mechanism that accounts for the relationship between living a calling (also referred to as one’s calling intensity) and two well-being outcomes: sleep quality and burnout. Further, I built on previous work in the callings literature by examining the moderating impact of two individual differences (trait mindfulness, perfectionism) on the relationship between calling intensity and psychological detachment. Study hypotheses were tested using a two-wave study design with 358 emergency medical professionals. Results revealed that for called emergency medical professionals, trait mindfulness strengthened the negative relationship between calling intensity and psychological detachment, which had downstream negative effects on sleep quality. In addition, one facet of perfectionism, namely perfectionistic strivings, exacerbated the negative indirect effect of calling intensity on sleep quality via psychological detachment. Ultimately, this study contributed to the occupational callings literature by examining the impact of differential levels of trait mindfulness and perfectionism on employee well-being. Implications for enhancing employee well-being are discussed.

No description available.

INTRODUCTION: Poor sleep quality is a significant risk factor for the development of postpartum depression. This thesis examined the impact of a post-delivery intervention which promoted and protected sleep during the immediate postpartum period on maternal mood, sleep quality, and anxiety. METHODS: 41 women with lifetime or current mood and/or anxiety disorders (12 receiving the intervention) were enrolled in this prospective naturalistic cohort study from the third trimester of pregnancy until 24 weeks postpartum. Depression, the primary outcome, was measured using the Edinburgh Postnatal Depression Scale at 12 weeks postpartum. Remaining outcomes (sleep quality and anxiety) were measured using self-report questionnaires (Insomnia Severity Index and State-Trait Anxiety Inventory, respectfully), and objective measures (i.e., actigraphy for sleep quality). RESULTS: There were no significant differences between the comparison and intervention group in depressive symptomatology at postpartum week 12 (primary outcome). On our secondary outcomes, we found that there were no significant differences in subjective and objective sleep quality at postpartum week two, or anxiety symptomatology at postpartum week eight between the two groups. There were also no significant differences in breastfeeding rates between the two groups at postpartum week 24. CONCLUSION AND FUTURE DIRECTIONS: Floor effects, specialized perinatal psychiatric treatment for a specific population, and low statistical power offer explanations for the observed null results. Strengths of our study include diagnosis of mood/anxiety disorders using the gold-standard (i.e., clinician diagnosis), and use of objective sleep measures. Future studies may benefit from implementing this intervention in resource-poor settings, using adequately powered research designs. / Thesis / Master of Science (MSc) / While the arrival of a child is a celebrated and joyous occasion, it can also be a source of duress and anguish, particularly for the mother. Postpartum depression is a mood disorder experienced by 10-15% of mothers after childbirth. One of the strongest risk factors for the development of postpartum depression is disrupted postpartum sleep quality. This thesis examined the impact of an intervention designed to protect and promote sleep of mothers during the postpartum period in an effort to improve mood, sleep quality, and anxiety symptomatology. By improving maternal mental health, not only do women benefit, but their children, their partners, and the healthcare system.

Background: Sleep is commonly disrupted following pediatric concussion. Recently, post-concussion sleep quality has been identified as a potential factor that may influence recovery length. However, few studies have examined this relationship using objective sleep measures in a pediatric population. Nor, have any studies examined the trajectory of objective sleep parameters after pediatric concussion. Objectives: The purpose of this thesis is to: 1) Provide a review of current literature regarding pediatric concussion, healthy sleep quality, and sleep quality in the context of concussion and recovery from concussion; 2) Examine how objective sleep outcomes are affected and change post-concussion in children and adolescents; 3). Explore how post-concussion sleep quality parameters are related to length of recovery, quality of life (QOL), and depression symptomatology; and 4) Discusses the results from the two studies in the context of current literature and of each other. Methods: Sleep quality was inferred from the outcomes of five objective sleep parameters. Sleep parameters were measured using actigraphy in children and adolescents with concussion following return to school (RTA) and return to activity (RTA) protocols. Sleep data during the initial 4 weeks of recovery was assessed as an outcome, as a predictor of recovery length, and as a correlate of quality of life (QOL) and depression symptomatology Results: Most objective post-concussion sleep quality parameters were adversely affected by concussion but show trajectories indicating improvement throughout the initial 4 weeks of recovery. Sleep quality parameters were not associated with time to complete return to school or activity protocols. Sleep parameters were not strongly correlated with QOL or depression symptomatology outcomes. Conclusions: These results indicate that objective post-concussion sleep quality is impaired following concussion, but these outcomes do not appear to be associated with recovery, QOL or depression symptomatology. Other factors, or improvements in sleep quality may better explain recovery outcomes. / Thesis / Master of Science (MSc) / Children and adolescents are at risk for experiencing changes in sleep following concussion that result in poor sleep quality. Given the important role of sleep in maintaining our overall health, sleep likely plays a role in recovery. However, this relationship is poorly understood. The purpose of this dissertation is to identify how sleep changes following concussion and how these changes affect sleep quality and recovery. Study results reveal that the sleep parameters in the initial 4 weeks following concussion are significantly affected by concussion, suggesting that the sleep quality of children and adolescents is poorer than healthy youth. However, sleep quality does appear to improve with time. Further analyses found sleep quality does not appear to be related to recovery length or outcomes. Thus, the sleep quality of youth may be negatively impacted by concussion, but this may not directly influence recovery.

No description available.

Caregiving for a dementia patient is a stressful experience and can last for years. The exposure to stress over time can lead to negative health outcomes in caregivers (e.g. depression) and can decrease their ability to provide care. Caregivers need resources such as good sleep quality and mastery to have the physical, emotional, and mental energy to perform the caregiving role. The purpose of this study was to explore the relationships between the resources of sleep quality, mastery, and the outcomes of perceived stress, and depression in informal caregivers of community-dwelling persons with dementia (PWD). The data presented were from a cross-sectional non-experimental study with interviews conducted with 80 informal caregivers of PWD utilizing a demographic questionnaire for the caregiver, an assessment of the frequency of behavior and psychiatric symptoms (BPSD) of dementia, the Dementia Severity Rating Scale to assess the caregiver’s perception of the PWD’s cognitive and functional abilities, the Pittsburgh Sleep Questionnaire to asses the caregiver’s sleep, a combined global and domain-specific mastery instrument, the Perceived Stress Scale and the Center for Epidemiologic Depression Scale to measure outcomes. The results of this study found that male and female caregivers shared a similar caregiving experience, similar levels of mastery, depression, and stress but, female caregivers had poorer sleep than male caregivers. Caregivers experienced a higher rate of sleep disruptions by the PWD than previous studies and these disruptions were related to poorer perceived sleep quality and poor global sleep. There was a direct relationship between mastery and perceived stress, mastery and depression, sleep quality and stress, sleep quality and depression, but not a statistically significant relationship between mastery and sleep quality in this sample. Sleep quality was not found to have an indirect effect on stress or depression through mastery. The contribution of these findings to nursing knowledge is the establishment of the direct relationship between sleep quality and stress, and mastery and stress to be considered in future intervention research. Further exploration is needed to understand the relationship of mastery and sleep quality. / text

STUDY OBJECTIVES: We sought to evaluate the construct validity and factor structure of the Spanish-language version of the Pittsburgh Sleep Quality Index (PSQI) among pregnant Peruvian women. METHODS: A cohort of 642 women were interviewed at ≤ 16 weeks of gestation. During interview, we ascertained information about lifestyles, demographics, sleep characteristics, and mood symptoms. Stress induced sleep disturbance, depressive symptoms, and anxiety symptoms were evaluated using the Ford Insomnia Response to Stress Test (FIRST), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) assessment scales, respectively. Consistency indices, exploratory and confirmatory factor analyses, correlations, and logistic regressions were used. RESULTS: Both exploratory and confirmatory factor analyses indicated a three-factor solution: sleep quality, sleep efficiency, and sleep medication. We observed significantly positive correlations of the PSQI with the FIRST (0.42), the PHQ-9 (0.49), and the GAD-7 (0.46). Poor sleepers (PSQI global score > 5) had significantly increased odds of experiencing stress-induced sleep disturbance (odds ratio, OR = 3.57; 95% CI: 2.40, 5.31), depression (OR = 5.48; 95% CI: 3.58, 8.37), and generalized anxiety disorder (OR = 4.57; 95% CI: 3.08, 6.76). CONCLUSION: The Spanish-language version of the PSQI instrument was found to have good construct validity among pregnant Peruvian women. Consistent with some other studies, the PSQI was found to have a three-factor structure. Further assessment and validation studies are needed to determine whether the three, factor-specific scoring of the PSQI is favored over the PSQI global score in diverse populations.

Firefighters experience stressful job demands. Many of them work in shifts that can extend to 96-hour rotations. Firefighters also tend to suffer from poor sleep quality and psychological distress; however, there are conflicting findings on how these factors may relate to each other. The purpose of this quantitative survey study was to examine the relation between symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), and alcohol abuse to shift duration in firefighters who work 24-hour shifts compared to those who work 48-hour shifts, with sleep quality as a mediating variable. The repair and restoration theory of sleep was the theoretical framework. One hundred forty-three adult firefighters employed in the midwestern region of the United States completed a demographic questionnaire, the Pittsburgh Sleep Quality Index, and the Psychiatric Diagnostic Screening Questionnaire using an online survey to help ensure anonymity. The results of a multivariate analysis of covariance indicated that anxiety [F (1, 140) = 4.042, p = .042; F (1, 140) = 4.521, p = .035] and alcohol abuse [F (1, 140) = 12.497, p = .001; F (1, 140) = 12.686, p =.001] were both significantly related to shift duration before and after controlling for sleep quality, with individuals in the longer shifts reporting more distress. PTSD was not significantly different between the groups; however, a trend emerged for longer shifts to be related to more distress after controlling for sleep quality. The findings of this research may be used to promote social change by improving the lives of firefighters and the communities they serve, as well as educating decision makers with information needed to address potential mental health burdens of shiftwork in this population.