Sleep as a mediator of the relationship between social class and health in higher education students

A substantial body of research indicates that higher education students from lower social class backgrounds tend to have poorer health than those from higher social class backgrounds. To investigate sleep as a potential mediator of this relationship, online survey responses of students from five large Australian universities, one Irish university and one large Australian technical college were analysed in three studies (Study 1 N = 628; Study 2 N = 376; Study 3 N = 446). The results revealed that sleep quality, sleep duration, sleep disturbances, pre-sleep worries and sleep schedule variability mediated the relationship between social class and physical and mental health. Sleep remained a significant mediator when controlling for related variables and other mediators. Thus, the findings suggest that sleep partly explains social class differences in health. We discuss the importance of addressing sleep issues among students from lower social class backgrounds.     

Factors associated with self-rated health status among university students from 26 low,middle and high income countries

The aim of this study was to investigate self-reported health status and associated factors in low, middle and high income countries. Using anonymous questionnaires, data were collected in a cross-sectional survey from 19 811 undergraduate university students (mean age=20.8, SD=2.8) from 27 universities in 26 countries across Asia, Africa and the Americas. Results indicate that the overall self-rated health status score was 3.0 (range 1–5). Generally, university students from study countries of the Caribbean, South America and North Africa, Near East and Central Asia had greater self-rated health status scores than students from study countries in Asia. In multivariate stepwise linear regression analysis, older age, coming from an upper middle income or high income country, higher personal control, better mental health (not having sleep problems, and having no or fewer PTSD symptoms), and having normal weight predicted better self-rated health status. Paradoxically, a poor healthy dietary score and low physical activity were also associated with better self-rated health status. In comparing self-rated health status across a large sample of students across many countries, associations were found between sociodemographic, psycho-social and health related variables and self-rated health status.     

Implementation of Universal Behavioral Health Screening in a University Health Setting

Universal screening at university health centers can facilitate early identification and treatment of behavioral health problems common among college students. This article describes the (a) process of implementing behavioral health screening at a university health center and (b) results of universal screening for depression, suicidal ideation, alcohol misuse, tobacco use, and sleep problems. We discuss the decision points involved in screening, including what to screen for, whom to screen, how to implement the screening measure, and how to deal with patients who screen positive. During the Spring and Fall 2010 academic semesters, 4,126 screening questionnaires were completed by students (62 % female) accessing a university health center. Each semester, 9–13 % of students screened positive for depression, 2.5–3 % for suicidal ideation, and 33–38 % for alcohol misuse, while 10 % wanted help with smoking cessation and 12–13 % with sleep problems. The results suggest that behavioral health screening in a university health center can help identify students with behavioral health concerns to increase access to care.     

Multiple health risk behaviours and posttraumatic stress disorder symptoms among university students from 22 countries

The goal of the study was to investigate multiple health risk behaviours in relation to PTSD symptoms in a sample of university students from 22 countries. Using anonymous questionnaires, data were collected from 16804 undergraduate university students (mean age 20.8, SD?=?2.8) from 23 universities in 22 countries in Africa, Asia, Caribbean and South America. Results indicate that overall, 20.9% of the university students screened positive for PTSD, and the overall mean of health risk behaviours (range from 1–10) was 2.7 for university students from all countries. Logistic regression adjusted for sociodemographic characteristics and social support found that each of the ten individual health risk behaviours was significantly associated with PTSD symptoms. In addition, logistic regression with multiple health risk behaviours found a steady increase from 1 (Odds Ratio (OR): 1.37, CI 1.05–1.77) to 5 or more (OR: 3.57, CI 2.75–4.64) health risk behaviours in association with PTSD symptoms, adjusted for age, gender, economic family background and social support.     

Changes in sleep quality and levels of psychological distress during the adaptation to university: The role of childhood adversity

Stress-related sleep disturbances are common, and poor sleep quality can negatively affect health. Previous work indicates that early-life adversity is associated with compromised sleep quality later in life, but it is unknown whether it predicts greater declines in sleep quality during stressful life transitions. We propose and test a conceptual model whereby individuals who reported experiencing greater levels of child maltreatment would experience greater psychological distress during a stressful life transition, which in turn would contribute to greater declines in sleep quality, relative to their quality of sleep before the stressful transition. Controlling for potential confounding variables (e.g., age, gender), structural equation modelling demonstrated that psychological distress experienced during a stressful transition (i.e., beginning life at university) mediated the relationship between childhood emotional neglect and changes in sleep quality. The hypothesized model demonstrated a good overall fit to the data, χ ² (15) = 17.69, p = .279, CFI = .99, TLI = .97, SRMR = .04, RMSEA = .04 (90% CI <0.001–0.09). Emotional neglect (β = .22) was positively associated with psychological distress which in turn was positively associated with poor sleep quality (β = .31) during a stressful transition. Future research should aim to understand the specific stressors in the university environment that are most challenging to individuals who faced early-life emotional maltreatment. These findings will help inform interventions to facilitate adaptation to a new environment and improve sleep quality for these university students.     

Emerging adults’ sleep patterns and attentional capture: the pivotal role of consistency

College students face consistent cognitive demands and often get insufficient and/or irregular sleep. The current study investigated associations of sleep duration and sleep variability with attentional performance. Sleep duration variability was expected to moderate the association between duration and cognitive functioning. College students’ (n = 83) natural sleep patterns were recorded via wristband actigraphy across three consecutive nights during an academic term. The association between sleep duration and attentional capture was strongest for those whose sleep was the most consistent across the three nights preceding the attentional task (i.e., low sleep duration variability). For those with low sleep duration variability, less sleep was associated (B = ?0.25) with reduced ability to ignore irrelevant cues and redirect attention to target locations. In other words, consistently low sleep duration was associated with compromises in attention. Our results indicate the importance of consistent sleep routines as well as sufficient sleep duration in order to optimize attentional performance in college students.     

Associations between multiple health risk behaviors and mental health among Chinese college students

Although there is substantial evidence that health risk behaviors increase risks of premature morbidity and mortality, little is known about the multiple health risk behaviors in Chinese college students. Here, we investigated the prevalence of multiple health risk behaviors and its relation to mental health among Chinese college students. A cross-sectional study was conducted in Wuhan, China from May to June 2012. The students reported their health risk behaviors using self-administered questionnaires. Depression and anxiety were assessed using the self-rating depression scale and self-rating anxiety scale, respectively. A total of 2422 college students (1433 males) aged 19.7 ± 1.2 years were participated in the study. The prevalence of physical inactivity, sleep disturbance, poor dietary behavior, Internet addiction disorder (IAD), frequent alcohol use and current smoking was 62.0, 42.6, 29.8, 22.3, 11.6 and 9.3%, respectively. Significantly increased risks for depression and anxiety were found among students with frequent alcohol use, sleep disturbance, poor dietary behavior and IAD. Two-step cluster analysis identified two different clusters. Participants in the cluster with more unhealthy behaviors showed significantly increased risk for depression (odds ratio (OR): 2.21; 95% confidence interval (CI): 1.83, 2.67) and anxiety (OR: 2.32; 95%CI: 1.85, 2.92). This study indicates that a relatively high prevalence of multiple health risk behaviors was found among Chinese college students. Furthermore, the clustering of health risk behaviors was significantly associated with increased risks for depression and anxiety.     

Loneliness: Its correlates and associations with health risk behaviours among university students in 25 countries

The aim of this cross-national study was to assess factors associated with loneliness and to determine the degree to which loneliness affects health status and risk behaviours among university students. Data were collected from 17 886 university students in 25 countries (females = 58.6%, from Africa = 33.5%). In multivariable logistic regression, loneliness was predicted by lower family wealth, living in a low or lower middle income country, and antecedent childhood. Moreover, psychosocial factors of perceived lack of control, low organised religious activity, high non-organised religious activity, high intrinsic religiosity, and low social support were associated with loneliness. Lonely students were also likely to self-report poor subjective health status, sleeping problems, short sleep duration, tobacco use, heavy internet use, aggressive behaviour, injury, and sexual risk behaviour. University students with loneliness may be assisted by preventive health interventions aimed at enhancing their subjective well-being.     

‘I feel better when…’: An analysis of the memory-experience gap for peoples’ estimates of the relationship between health behaviours and experiences

Objective: People often overestimate how strongly behaviours and experiences are related. This memory-experience gap might have important implications for health care settings, which often require people to estimate associations, such as “my mood is better when I exercise”. This study examines how subjective correlation estimates between health behaviours and experiences relate to calculated correlations from online reports and whether subjective estimates are associated with engagement in actual health behaviour.

Design: Seven-month online study on physical activity, sleep, affect and stress, with 61 online assessments.

Main Outcome Measures: University students (N = 168) retrospectively estimated correlations between physical activity, sleep, positive affect and stress over the seven-month study period.

Results: Correlations between experiences and behaviours (online data) were small (r = ?.12–.14), estimated correlations moderate (r = ?.35–.24). Correspondence between calculated and estimated correlations was low. Importantly, estimated correlations of physical activity with stress, positive affect and sleep were associated with actual engagement in physical activity.

Conclusion: Estimation accuracy of relations between health behaviours and experiences is low. However, association estimates could be an important predictor of actual health behaviours. This study identifies and quantifies estimation inaccuracies in health behaviours and points towards potential systematic biases in health settings, which might seriously impair intervention efficacy.     

Influence of school-level and family-level variables on Chinese college students’ aggression

With the frequent occurrence of campus violence, scholars have devoted increasing attention to college students’ aggression. This study aims to estimate the prevalence of aggression in Chinese university students and identify factors that could influence their aggression. We can thus find methods to reduce the incidence of college students’ aggression in the future. A multi-stage stratified sampling procedure was used to select university students (N = 4565) aged 16–25 years in Harbin. The Aggression Questionnaire, the Adolescent Self-Rating Life Events Checklist and the Social Support Revalued Scale were used to collect data. Females reported lower levels of aggression than males (p < .001). A multiple linear regression analysis was conducted to determine the influence of factors of aggression, and the model was highly significant (R² = .233, Ad R² = .230, p < .01). The results show that the aggression is affected by gender, family-level and school-level variables. Aggression scores are significantly correlated with not only family-level or school-level variables independently, but their combination as well. We find that the risk factors for aggression include a dissatisfying profession, higher levels of study pressure, poor parental relationships, poor interpersonal relationships, the presence of siblings, punishment, health maladjustment, less subjective support, and lower levels of utilization of social support.     

Alcohol use affects sleep duration among military couples

Alcohol misuse and sleep disorders are highly comorbid, prevalent among service members and their romantic partners, and affected by relationship interdependence. As most military health research focuses on either service members or their spouses, the current study examined dyadic effects of alcohol use on sleep cycle duration in dating and married military couples (N = 149 dyads), using data from the National Longitudinal Study of Adolescent Health. Person-level results from a series of multilevel path models showed partial support for our focal hypothesis implicating high alcohol use in shortened average sleep duration for the service members and their romantic partners. Specifically, partners of service members who drank more regularly had shorter average sleep durations, as did female service members who drank more alcohol per drinking occasion. At the couple-level, a partner effect indicated that service members’ lower depressive symptoms were associated with their partner’s shorter average sleep durations. In addition, when service members reported relatively high alcohol-related problems, their partner tended to have a shorter average sleep duration. In contrast, when service members’ partners reported relatively high alcohol-related problems, they had a longer average sleep duration. This suggests the consequences of problematic alcohol use for service members’ partners depended on each dyad member’s drinking patterns. Taken together, these findings underscore the importance of viewing military couples as a dyadic unit in research studies and clinical interventions.     

Personality,hedonic balance and the quality and quantity of sleep in adulthood

Objective: Sufficient and good-quality sleep is important for individual functioning. This study explored associations between personality and sleep duration and sleep quality in adulthood. The mediating role of hedonic balance and the moderating roles of age and sex were also explored.

Method: A nationally representative sample of Australian adults (n = 14,065; M_age = 44.4 years; 53.1% women) completed self-report measures of personality, sleep, hedonic balance and demographic variables (e.g. health status, employment status) in late 2013.

Results: After controlling for demographic variables, we found that high neuroticism was associated with poorer sleep quality, and both long and short sleep durations (a curvilinear relationship). Small effects were also observed relating high extraversion and low openness to better sleep quality. Hedonic balance mediated all linear and non-linear associations between personality and sleep. Additional moderator analyses showed that high openness was more strongly related to poor sleep quality among men and young adults. High neuroticism was more strongly related to poor sleep quality among men.

Conclusion: Findings indicate that personality is important for sleep in adulthood and that hedonic balance features a prominent role in this association.     

Effects of daily maladaptive coping on nightly sleep in mothers

Objective: We examined effects of daily rumination and suppression in response to stressors on objective and subjective sleep among mothers.

Design: Participants were 183 mothers, including chronically stressed mothers of children with an autism spectrum disorder (M-ASD; n = 92) and age-matched mothers of neurotypical children (M-NT; n = 91). In an intensive longitudinal design, participants provided reports of daily rumination and suppression, nightly objective actigraphy-defined sleep and nightly subjective sleep quality for seven consecutive days at baseline, 9 months and 18 months.

Main Outcome Measures: Total sleep time, sleep fragmentation, sleep onset latency, and subjective sleep quality.

Results: Among M-NT with above average depressive symptoms, higher daily rumination was associated with shorter total sleep time. Rumination was associated with more sleep fragmentation among M-NT at the trend level. Rumination was not associated with sleep onset latency among M-NT, or with any sleep outcomes among M-ASD. Suppression was not associated with any sleep outcomes.

Conclusion: We provide novel evidence of the effect of rumination on objectively measured sleep duration among M-NT. Coping was not related to sleep among M-ASD. Given the prevalence of poor sleep among mothers, future work should examine modifiable factors perpetuating sleep disturbance.     

Sleep hygiene behaviours: An application of the theory of planned behaviour and the investigation of perceived autonomy support,past behaviour and response inhibition

This study investigated the sleep hygiene behaviour of university students within the framework of the Theory of Planned Behaviour (TPB [Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.]), and examined the predictive validity of additional variables including perceived autonomy support, past behaviour and response inhibition. A total of 257 undergraduate students from an Australian university were administered two online questionnaires at two time points. At time 1, participants completed the TPB questionnaire and the Go/NoGo task as a measure of response inhibition. A week later at time 2, participants completed a questionnaire measuring the performance of sleep hygiene behaviours. Multiple and hierarchical regression analyses showed that the TPB model significantly predicted intention and behaviour. Although intention and perceived behavioural control were statistically significant in predicting behaviour, past behaviour and response inhibition accounted for more variance when added to the TPB model. Subjective norm was found to be the strongest predictor of intention implying the importance of normative influences in sleep hygiene behaviours. Response inhibition was the strongest predictor of behaviour, reinforcing the argument that the performance of health protective behaviours requires self-regulatory ability. Therefore, interventions should be targeted at enhancing self-regulatory capacity.     

Measurement invariance of the Utrecht Work Engagement Scale for Students: A study across secondary school pupils and university students

School engagement is a multidimensional construct characterized by vigour, dedication, and absorption towards academic work that is related to school achievement. This study aimed to examine the measurement invariance of a school engagement measure – the Utrecht Work Engagement Scale-Students (UWES-S) – across secondary school pupils and university students. Two samples of secondary school pupils (n = 251) and university students (n = 229) were used. The results supported the original three-factor structure (vigour, dedication and absorption) of the UWES-S instead of a two- or a one-factor structure in both samples. Evidence for the metric and scalar invariance of the measure across secondary school pupils and university students was also found. The university sample had higher scores in vigour and absorption but not in dedication. These findings demonstrate that the UWES-S can be used for developmental studies where school engagement and its relation with other variables needs to be compared across distinct educational levels.     

Factors related to life satisfaction among urban African American adults receiving care at a publicly-funded sexual health clinic

Life satisfaction is linked to premature morbidity and mortality and it may be compromised for individuals living in economically-disadvantaged, urban neighborhoods. The present study explores how behavioral and social-environmental health factors are associated with life satisfaction among a sample of African American young adults. Participants (N = 307, M_age = 26.6 years, 53% male) were recruited from a publicly-funded clinic for a randomized controlled trial (RCT). Data from the baseline assessment of the RCT, which included measures of sleep, depression, anxiety, social support, alcohol and drug use problems, city stress, and life satisfaction, were used for the current study. Correlation analyses assessed bivariate associations between life satisfaction and the demographic and health-related factors. Linear regression using backward elimination determined the best fitting model of factors associated with life satisfaction. Backward elimination resulted in the following variables remaining as significantly associated with life satisfaction: age (b = ?2.40, p = .017), anxiety (b = ?5.32, p < .001), and social support (b = 2.89, p = .004). Feeling rested upon waking also remained in the best fitting model, although this association did not achieve statistical significance (p = .099). The results suggest that African American adults who are younger, less anxious, and report adequate social support are more likely to report satisfaction with life. These findings add to the literature aimed at examining health and social factors impacting the well-being of African Americans living in low-income, urban communities.     

Depression and sleep quality in older adults: a meta-analysis

The literature emphasizes depression and poor sleep quality as problems that affect many elderly individuals. However, these problems have been related in few studies and there is no meta-analysis performed so far on this relationship. The present research reviewed the studies performed on the subjective sleep quality in order to understand how it relates to depression in older adults. The review was conducted in January 2016 and comprised publications between 2005 and 2015. Based on the electronic databases Web of Science and EBSCO, we used the keywords ‘sleep quality’, ‘depression’, and ‘older’ to identify the empirical studies performed. After assessing the collected studies, we selected those that presented the elderly as participants, resulting in nine papers (N = 3069). A random-effects method was used to evaluate the relationship between depression and sleep. We found that an older person’s lack of good sleep quality is significantly related with depression. The main limitation of this study was the difficulty in collecting a greater number of studies. Future research should consider the importance of additional variables (e.g. moderators) in order to understand and investigate viable interventions for prevention and health promotion in the elderly.     

The utility of the Pittsburgh Sleep Quality Index in US military personnel

Sleep disturbances are endemic in military personnel with nonclinical populations averaging 6 hours of sleep. The Pittsburgh Sleep Quality Index (PSQI), however, has not been validated in this population. It is thus unknown if the PSQI can differentiate clinically significant sleep disorders from sleep disturbances resulting from military duties with restricted sleep periods. After a clinical evaluation and polysomnogram, participants (N = 148) were classified as having insomnia only, obstructive sleep apnea (OSA) only, comorbid insomnia and OSA (CIO), service-related illnesses only (SRI–; pain, depression, posttraumatic stress disorder, traumatic brain injury), and controls. Military personnel in the insomnia only, and the CIO groups had higher PSQI scores (13.5 ± 2.8 and 14.7 ± 3.5, respectively) compared to the controls (8.9 ± 3.9). A cut-off score of ≥10 was optimal (90% sensitivity and 69% specificity) for determining clinically significant insomnia (≥12 for CIO; 84% sensitivity, 77% specificity). In military personnel, a PSQI score >5 is not necessarily indicative of a clinically significant sleep disorder. The use of elevated cut-off PSQI scores are likely better suited to differentiate military personnel who require further clinical evaluation versus a more conservative sleep improvement protocol.     

Occupational Therapy Services to Promote Occupational Performance,Performance Satisfaction,and Quality of Life in University Freshmen: A Pilot Study

Mental health impacts success for many university students. Occupational therapists can intervene during the transition to university to promote mental health. A 5-week, occupation-based group was provided to a group of freshmen university students to encourage short-term improvements in occupational performance (OP), performance satisfaction (PS), and quality of life (QOL). Statistically significant results were obtained for OP and PS (p < 0.05). However, no significant results were obtained when assessing QOL (p > 0.05). Further research, including long term follow-up, about the impact of occupation-based groups with transitioning freshmen is recommended.     

Depression and literacy are important factors for missed appointments

Multiple variables are related to missed clinic appointments. However, the prevalence of missed appointments is still high suggesting other factors may play a role. The purpose of this study was to investigate the relationship between missed appointments and multiple variables simultaneously across a health care system, including patient demographics, psychiatric symptoms, cognitive functioning and literacy status. Chart reviews were conducted on 147 consecutive patients who were seen by a primary care psychologist over a six month period and completed measures to determine levels of depression, anxiety, sleep, cognitive functioning and health literacy. Demographic information and rates of missed appointments were also collected from charts. The average rate of missed appointments was 15.38%. In univariate analyses, factors related to higher rates of missed appointments included younger age (p = .03), lower income (p = .05), probable depression (p = .05), sleep difficulty (p = .05) and limited reading ability (p = .003). There were trends for a higher rate of missed appointments for patients identifying as black (p = .06), government insurance (p = .06) and limited math ability (p = .06). In a multivariate model, probable depression (p = .02) and limited reading ability (p = .003) were the only independent predictors. Depression and literacy status may be the most important factors associated with missed appointments. Implications are discussed including regular screening for depression and literacy status as well as interventions that can be utilized to help improve the rate of missed appointments.