The effect of bright light on sleep in nursing home patients with dementia

Background: Up to 70% of nursing home patients with dementia suffer from disrupted sleep, often characterized by multiple awakenings at night and excessive daytime sleep. Sleep disruption may have negative effects on the cognition, mood, behaviour, and well-being of nursing home patients, while also representing a challenge for nursing home staff. However, few sleep scales are developed and validated specifically for the nursing home setting. Sleep problems among nursing home patients are frequently treated by medications, which are associated with severe side effects, including daytime sleepiness, and an increased risk of falls. Thus, there is a need for non-pharmacological interventions to improve sleep in this population. Bright light treatment (BLT) may represent such an intervention, providing increased light exposure aiming to impact sleep, circadian rhythmicity, mood, and/or behaviour. Light is the most important zeitgeber to the circadian system, and consequently has a significant impact on sleep-wake behaviour. Unfortunately, studies have reported low indoor light levels in nursing homes, which in combination with dementia-related neuropathology and age-related reductions in light sensitivity, are likely to contribute to sleep problems in this population. The aim of this thesis was to investigate whether increasing daytime light exposure, by means of BLT, can improve sleep in nursing home patients with dementia, and also to address methodological challenges in this field of research. Methods: Paper 1 is a systematic review of the literature, focusing on the methodological features of the included studies, in addition to their findings. Paper 2 and 3 are based on data from the DEM.LIGHT trial; a cluster-randomized placebo-controlled trial conducted in Norwegian nursing homes, including 69 patients. The intervention comprised a diurnal cycle of ambient light with a maximum of 1,000 lux and 6,000 Kelvin (K) from 10:00-15:00, administered using light emitting diode (LED) light. Before and after this interval, the light levels gradually increased/decreased in lux and K. In the placebo condition, standard light levels were maintained at 150-300 lux and approximately 3,000 K throughout the day. The intervention and placebo lights were installed in the common rooms of the included nursing home units. Outcomes were measured at baseline and at follow-up at week 8, 16, and 24. Paper 2 was a validation study of a proxy-rated sleep scale, using the baseline data from the DEM. LIGHT trial. Actigraphy was used as the reference standard. Paper 3 reported on the sleep outcomes of the trial, which were the primary outcomes. Results: Paper 1 found that there are promising, though inconsistent, results regarding the effect of BLT on sleep and circadian rhythmicity in dementia. Large heterogeneity in terms of interventions, study designs, population characteristics, and outcome measurement tools may explain some of the inconsistencies of results across studies. Paper 2 showed that the proxy-rated Sleep Disorder Inventory (SDI) had satisfactory internal consistency and convergent validity. Using actigraphy as the reference standard, the SDI was termed clinically useful, and we suggested a cut-off score of five or more as defining disrupted sleep in nursing home patients with dementia. These results should be interpreted keeping in mind that actigraphy have some important weaknesses, such as underestimating wake time. Paper 3 evaluated the effects of the BLT on sleep and found an improvement in sleep according to the SDI scores in the intervention group, as compared to the control group, from baseline to week 16 and baseline to week 24. There was no effect in terms of sleep measured by actigraphy. Conclusion: In summary, this thesis found that the evidence for an effect of BLT on sleep in nursing home patients with dementia is promising, but equivocal. Importantly, the research field faces some important methodological challenges, such as accurately measuring sleep. The SDI may represent a valid tool to measure sleep in the nursing home setting, which may be used both by researchers and by practitioners. Although the results of this thesis are not conclusive regarding the effect of BLT on sleep in nursing home patients with dementia, it may represent a step forward in understanding the potential value of BLT in this population, and may lay the ground for further investigation. The lack of an improvement on the SDI at week 8 indicates that the effect of BLT may take a long time to manifest in this population.Doktorgradsavhandlin

A Review of the Relationship Between Social Media Use and Online Prosocial Behavior Among Adolescents

Social media (SoMe) activity constitutes a large part of the lives of adolescents. Even though the behavior on SoMe is complex, the research on SoMe has mostly focused on negative effects, bad content, and online antisocial behavior (OAB). Less research has been conducted on online prosocial behavior (OPB), and to what extent OPBs are widespread is relatively unknown. A review was conducted to investigate to what extent OPB is related to SoMe use among adolescents based on studies published from 2014 to May 2021. To be included, the studies had to be quantitative, non-experimental, have participants aged 13–18, include measures of SoMe and OPB, and be published in peer-reviewed journals with full text available in English, Swedish, Danish or Norwegian. A research was conducted in databases PsychINFO, Ovid MEDLINE(R), EMBASE, COCHRANE Database of Systematic Reviews, Web of Science, Sociological Abstracts, Sociological Services Abstracts, and Eric. Two studies met the eligibility criteria. Both studies found an association between OPB and SoMe use. Methodological issues, however, were identified through a quality assessment using an adapted version of the Newcastle-Ottawa Scale (NOS) for cross-sectional studies, and the small samples in the studies prevent us from drawing any firm conclusions. Possible reasons for the scarcity of eligible studies and directions for future research are discussed.publishedVersio

The Association Between Self-Reported Screen Time, Social Media Addiction, and Sleep Among Norwegian University Students

The aim of this study was to assess the relationship between daily screen time and sleep, evening screen time and sleep, and between social media addiction and sleep in a student population. This cross-sectional study is based on data from a national survey of all college and university students in Norway (the SHoT2018 study; n = 49,051). The sleep outcomes were sleep duration, sleep onset latency, sleep efficiency, and insomnia operationalized according to formal DSM-5 criteria. The results show a strong negative association between time spent on screen-based devices and sleep quality and quantity, and where screen use in bed had more consistent negative associations with sleep. Furthermore, there were higher rates of insomnia among those with higher levels of addiction, and curvilinear relationships with sleep duration, sleep onset latency, and sleep efficiency. Those with higher levels of addiction also had more evening screen time. The findings suggest that screen use plays an important role in students' sleep quantity and quality, where evening screen time has a stronger relationship with sleep compared to total daily screen time. The results also suggest a role of social media addiction, and addictive social media use may be a target for intervention in order to reduce evening screen time.publishedVersio

Lower Subjective Socioeconomic Status Is Associated With Increased Risk of Reporting Negative Experiences on Social Media. Findings From the “LifeOnSoMe”-Study

Objectives: To investigate the association between subjective socioeconomic status (SES) and a) frequency and daily duration of social media use, and b) self-reported negative experiences on social media platforms. Methods: The present study is based on the cross-sectional school-based “LifeOnSoMe”-study (N = 3,415) recruiting high school students aged 16 years or more in Bergen, Norway. Subjective SES was the independent variable and measured by perceived family affluence. The dependent variables included self-reported amount of social media use, and eight different types of negative experiences on social media. Self-reported age, gender, country of birth and type study were used as covariates. Statistical analyses included multinomial logistic regression and negative binomial regression models. Results: For amount of social media use, we only found relatively weak and inconsistent associations with SES. In contrast, the associations between SES and separate variables gauging negative experiences were robust in crude models as well as in models adjusted for age and gender. The number of different negative experiences were increased by 1.25 times for those with low and by 1.10 times for those with medium socioeconomic status, compared to those with high socioeconomic status in fully adjusted models. For composite measures of “negative acts and exclusion” and “unwanted attention from others,” the difference between low and high SES was equivalent to a small-to-moderate effect size even after adjustments for age, gender, country of birth, type of study and amount of social media use. Conclusions: In the present study, we found consistent and strong support for an association between SES and negative experiences on social media even after adjustments for age, gender, country of birth, type of study, and amount of social media use. The potential link between SES and negative experiences on social media as reported in this study is likely to have a public health impact. As the reported findings are novel, they need to be replicated in forthcoming studies based on other study populations. Future research should also focus on other aspects of SES and negative experiences, as well as endeavor to investigate potential longitudinal associations.publishedVersio

Commonly reported negative experiences on social media are associated with poor mental health and well-being among adolescents: results from the “LifeOnSoMe”-study

IntroductionCyberbullying has been extensively studied and is associated with adverse mental health outcomes in adolescents. However, adolescents may also experience a range of other negative experiences, such as name-calling, threats, exclusion, and unwanted attention or contact from others. Few studies have investigated how adolescents’ mental health is affected by these relatively common and less severe types of negative experiences on social media (SOME). To assess the association between mental health outcomes and two aspects of negative experiences on SOME; unwanted attention and negative acts and exclusion.MethodsThis study is based on a survey conducted in 2020/21 consisting of 3,253 Norwegian adolescents (56% female, Mage = 17 years). Eight statements about negative experiences on SOME were asked and combined into two composite measures: “Unwanted attention from others” and “Negative acts and exclusion.” Dependent variables in regression models were symptoms of anxiety, symptoms of depression, and mental well-being. Covariates in all models included age, gender, subjective socioeconomic status, and amount of SOME-use.ResultsBoth “negative acts and exclusion” and “unwanted attention from others” on SOME were consistently positively associated with self-reported symptoms of depression and anxiety, and negatively associated with mental well-being in both crude and adjusted analysis.DiscussionThe results are indicative of an important relationship between experiencing negative events on SOME, even presumably less severe events, and worse mental health and well-being. Future research should extricate the potential causal relationship between negative experiences on SOME and mental health, as well as exploring potential precipitating and intermediating factors

The effect of bright light on sleep in nursing home patients with dementia

Background: Up to 70% of nursing home patients with dementia suffer from disrupted sleep, often characterized by multiple awakenings at night and excessive daytime sleep. Sleep disruption may have negative effects on the cognition, mood, behaviour, and well-being of nursing home patients, while also representing a challenge for nursing home staff. However, few sleep scales are developed and validated specifically for the nursing home setting. Sleep problems among nursing home patients are frequently treated by medications, which are associated with severe side effects, including daytime sleepiness, and an increased risk of falls. Thus, there is a need for non-pharmacological interventions to improve sleep in this population. Bright light treatment (BLT) may represent such an intervention, providing increased light exposure aiming to impact sleep, circadian rhythmicity, mood, and/or behaviour. Light is the most important zeitgeber to the circadian system, and consequently has a significant impact on sleep-wake behaviour. Unfortunately, studies have reported low indoor light levels in nursing homes, which in combination with dementia-related neuropathology and age-related reductions in light sensitivity, are likely to contribute to sleep problems in this population. The aim of this thesis was to investigate whether increasing daytime light exposure, by means of BLT, can improve sleep in nursing home patients with dementia, and also to address methodological challenges in this field of research. Methods: Paper 1 is a systematic review of the literature, focusing on the methodological features of the included studies, in addition to their findings. Paper 2 and 3 are based on data from the DEM.LIGHT trial; a cluster-randomized placebo-controlled trial conducted in Norwegian nursing homes, including 69 patients. The intervention comprised a diurnal cycle of ambient light with a maximum of 1,000 lux and 6,000 Kelvin (K) from 10:00-15:00, administered using light emitting diode (LED) light. Before and after this interval, the light levels gradually increased/decreased in lux and K. In the placebo condition, standard light levels were maintained at 150-300 lux and approximately 3,000 K throughout the day. The intervention and placebo lights were installed in the common rooms of the included nursing home units. Outcomes were measured at baseline and at follow-up at week 8, 16, and 24. Paper 2 was a validation study of a proxy-rated sleep scale, using the baseline data from the DEM. LIGHT trial. Actigraphy was used as the reference standard. Paper 3 reported on the sleep outcomes of the trial, which were the primary outcomes. Results: Paper 1 found that there are promising, though inconsistent, results regarding the effect of BLT on sleep and circadian rhythmicity in dementia. Large heterogeneity in terms of interventions, study designs, population characteristics, and outcome measurement tools may explain some of the inconsistencies of results across studies. Paper 2 showed that the proxy-rated Sleep Disorder Inventory (SDI) had satisfactory internal consistency and convergent validity. Using actigraphy as the reference standard, the SDI was termed clinically useful, and we suggested a cut-off score of five or more as defining disrupted sleep in nursing home patients with dementia. These results should be interpreted keeping in mind that actigraphy have some important weaknesses, such as underestimating wake time. Paper 3 evaluated the effects of the BLT on sleep and found an improvement in sleep according to the SDI scores in the intervention group, as compared to the control group, from baseline to week 16 and baseline to week 24. There was no effect in terms of sleep measured by actigraphy. Conclusion: In summary, this thesis found that the evidence for an effect of BLT on sleep in nursing home patients with dementia is promising, but equivocal. Importantly, the research field faces some important methodological challenges, such as accurately measuring sleep. The SDI may represent a valid tool to measure sleep in the nursing home setting, which may be used both by researchers and by practitioners. Although the results of this thesis are not conclusive regarding the effect of BLT on sleep in nursing home patients with dementia, it may represent a step forward in understanding the potential value of BLT in this population, and may lay the ground for further investigation. The lack of an improvement on the SDI at week 8 indicates that the effect of BLT may take a long time to manifest in this population

Multisensory Integration of Emotional Stimuli: an fMRI of the Immediate and Enduring Effects of Emotional Film and Music

Responding appropriately in social contexts depends on the integration of emotional information from multiple sensory organs into a coherent construct of a situation. Research has identified a multisensory integration network of anterior superior temporal gyrus (aSTG), fusiform gyrus (FG), and amygdala (AMY; Pehrs et al., 2014; Pehrs et al. 2015). In the present study, largely based on Pehrs et al. (2014), two groups saw sad or happy film clips during fMRI scanning, coupled with alternating sad, happy or no music. The imaging results demonstrated increased STG activity during happy music and increased activity in default mode network (DMN) related areas during sad music. Incongruent audiovisual presentations were associated with increased activity in inferior temporal gyrus/temporal pole (ITG/TP) and medial prefrontal cortex (mPFC). The involvement of the aSTG-FG-AMY network in multisensory integration of emotional information was demonstrated with emotion-specific changes in connectivity. Congruent presentations of happy music and film were associated with increased coupling strength from FG to AMY, in contrast to previous findings of decreased coupling strength in the congruent condition (Pehrs et al., 2014). Sad visual stimuli produced increased network connectivity independent of the music, suggesting an increased information flow from AMY to FG, with aSTG as a mediator. Resting state data revealed attenuated connectivity between dorsal anterior cingulate cortex (dACC) and the posterior default mode network (DMN) in the group that had watched the sad film clips, showing enduring effects of emotional audiovisual stimuli on resting state activity

Social Media Use and Mental Health and Well-Being Among Adolescents – A Scoping Review

Introduction: Social media has become an integrated part of daily life, with an estimated 3 billion social media users worldwide. Adolescents and young adults are the most active users of social media. Research on social media has grown rapidly, with the potential association of social media use and mental health and well-being becoming a polarized and much-studied subject. The current body of knowledge on this theme is complex and difficult-to-follow. The current paper presents a scoping review of the published literature in the research field of social media use and its association with mental health and well-being among adolescents. Methods and Analysis: First, relevant databases were searched for eligible studies with a vast range of relevant search terms for social media use and mental health and well-being over the past five years. Identified studies were screened thoroughly and included or excluded based on prior established criteria. Data from the included studies were extracted and summarized according to the previously published study protocol. Results: Among the 79 studies that met our inclusion criteria, the vast majority (94%) were quantitative, with a cross-sectional design (57%) being the most common study design. Several studies focused on different aspects of mental health, with depression (29%) being the most studied aspect. Almost half of the included studies focused on use of non-specified social network sites (43%). Of specified social media, Facebook (39%) was the most studied social network site. The most used approach to measuring social media use was frequency and duration (56%). Participants of both genders were included in most studies (92%) but seldom examined as an explanatory variable. 77% of the included studies had social media use as the independent variable. Conclusion: The findings from the current scoping review revealed that about 3/4 of the included studies focused on social media and some aspect of pathology. Focus on the potential association between social media use and positive outcomes seems to be rarer in the current literature. Amongst the included studies, few separated between different forms of (inter)actions on social media, which are likely to be differentially associated with mental health and well-being outcomes.publishedVersio

How do Norwegian adolescents experience the role of social media in relation to mental health and well-being: a qualitative study

Background During the last decade, social media has permeated most parts of society. Adolescents are particularly active users of social media, and their use has been suggested as a contributing factor to mental health issues in this group. Quantitative studies have found associations between the frequency and/or duration of social media use and more mental health issues. However, most studies are cross-sectional and the identified associations are weak and of questionable practical significance. The aim of this study was to investigate adolescents’ lived experiences of using social media, focusing on both negative and positive aspects, using a qualitative approach. Qualitative research enables in-depth explorations of the experiences of individuals, nuance quantitative findings, and offer the perspective of adolescents into policies regarding social media use. Methods Experiences and perspectives of 27 adolescents from two senior high schools in Norway were gathered using focus group interviews (mean age 16.8, range 15–18). The data were analysed using thematic analysis. Results According to the participants, social media use catalyse changes to how people communicate and relate to each other (theme 1). Some changes were positive, in terms of facilitating social connectedness, while others were negative, such as people behaving worse than in face-to-face interactions. Further, social media use affected the participants at the individual level (theme 2); positively in terms of a sense of belonging and social support, and negatively in terms of perceived stress, body pressure, and displacing other activities such as sleep and homework. The motivations for using, or not using, social media were multifaceted (theme 3), reflecting the positive and negative aspects of social media in terms of interpersonal and personal consequences. Conclusion Social media was described as an important part of the participants’ everyday life, with both a positive and negative impact on their mental health and well-being. Considering the compelling nature of social media and adolescents’ relatively limited self-regulatory capacities, efforts to modify social media use should avoid relying on self-regulation, while also recognizing the importance of social media as an arena for peer interaction.publishedVersio