When Non-Suicidal Self-Injury Predicts Non-Suicidal Self-Injury and Poor Sleep—Results from a Larger Cross-Sectional and Quasi-Longitudinal Study

Poor sleep is associated with a higher risk of non-suicidal self-injury (NSSI) as a proxy of unfavorable emotion regulation. In the present study, we tested the hypothesis that past non-suicidal self-injury was associated with current non-suicidal self-injury and with current subjective sleep patterns. To this end, a larger sample of young adults were assessed. A total of 2374 adults (mean age: 27.58 years; 39.6% females) completed a series of self-rating questionnaires covering sociodemographic information, past and current NSSIs, suicide attempts, and current sleep patterns, including experiencing nightmares. Past NSSIs predicted current NSSIs. Current sleep patterns had a modest impact on the association between past and current NSSIs. Compared to male participants, female participants did not report more sleep complaints or more current NSSIs, but more past NSSIs. Past NSSIs predicted the occurrences of nightmares and suicide attempts. The best predictor of current NSSI was the remembered past NSSI, while current poor sleep was only modestly associated with current NSSI. Further indicators of current NSSI and poor sleep were suicide attempts and nightmares within the last six months. Overall, it appears that poor emotion regulation should be considered as underlying factor to trigger and maintain non-suicidal self-injury-related behavior and poor sleep. Further, unlike previous studies, which focused on the possible influence of sleep patterns on NSSIs, the aim of the present study paradigm was to investigate NSSIs on sleep patterns

A Mixed-Method Modified Delphi Study toward Identifying Key Elements of Psychotherapy in Iran

In Iran, psychotherapy is regarded as an effective treatment for psychiatric disorders. However, no previous research has identified the key elements of psychotherapy that may be specific to Iranian society. The current study was conducted in an attempt to identify these elements.; A mixed-method modified Delphi approach was used, taking place over several stages during 2017-2018. The first stage involved interviewing 12 experts in psychotherapy to identify key elements of psychotherapy in Iran by thematic analysis. Then, successive Delphi rounds were conducted to obtain consensus (75% agreement) from 70 psychotherapy experts on these key elements.; Key elements of psychotherapy were grouped into the following themes: (1) systematic education/training; (2) psychotherapist competency; (3) psychotherapy reflective of Iranian societal needs; and (4) the substrate (scientific/ethical principles) of psychotherapy. Consensus was reached during two Delphi rounds. In Delphi round 1, 52.8% of the statements reached consensus, and all remaining statements reached consensus in round 2.; The key elements of psychotherapy in Iran are a set of conditions for the education and training of competent psychotherapists who can perform psychiatric interventions appropriate to Iranian society under supervised rules. These should serve as a framework for improving the current delivery of psychotherapy in Iran

Serum and Plasma Tumor Necrosis Factor Alpha Levels in Individuals with Obstructive Sleep Apnea Syndrome: A Meta-Analysis and Meta-Regression

Background: Obstructive sleep apnea syndrome (OSAS) is associated with a variety of inflammatory factors. Specifically, proinflammatory cytokines appear to be associated with the pathogenesis of OSAS. Methods: For the present meta-analysis and meta-regression on serum and plasma tumor necrosis factor alpha (TNF-α) levels in individuals with and without OSAS, we performed a systematic search without any restrictions of the PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases to find relevant articles published up to February 1st, 2020. Results: Fifty-five (adults: 29 studies on serum and 17 studies on plasma; children: 4 studies on serum and 5 studies on plasma) were included and analyzed. Always compared to age-matched healthy controls, the pooled MDs were as follows: adults, serum: 10.22 pg/mL (95% CI = 8.86, 11.58; P < 0.00001); adults, plasma 5.90 pg/mL (95% CI = 4.00, 7.80; P < 0.00001); children, serum: 0.21 pg/mL (95% CI = 0.05, 0.37; P = 0.01); children, plasma: 5.90 pg/mL (95% CI = 4.00, 7.80; P < 0.00001). Conclusions: Compared to healthy and age-matched controls, adult individuals with OSAS had significantly higher serum/plasma TNF-α levels. For children with OSAS, significantly higher levels were observed for TNF-α in serum, but not in plasma

Evaluation of Serum and Plasma Interleukin-6 Levels in Obstructive Sleep Apnea Syndrome: A Meta-Analysis and Meta-Regression

Obstructive sleep apnea syndrome (OSAS) is considered a low-grade chronic inflammatory disease. Interleukin-6 (IL-6) is one of the most significant inflammatory markers and an excellent proxy for the inflammatory/immune system. The present meta-analysis and meta-regression aimed at comparing plasma and serum levels of IL-6 between individuals (children and adults) with OSAS and healthy controls. Four databases, PubMed/Medline, Scopus, Cochrane Library, and Web of Science, were comprehensively searched to retrieve articles published up to December, 2019, with no further restrictions. RevMan 5.3 software was used to calculate the crude mean difference (MD) and 95% confidence interval (CI). The results of funnel plots and meta-regression were analyzed by the CMA 2.0 software. Sixty-three studies (57 with adults; six with children) were included in the present meta-analysis. For adults, 37 studies reported significantly higher serum IL-6 levels and 20 reported significantly higher plasma IL-6 levels for those with OSAS than for healthy controls [pooled MD of 2.89 pg/ml (; P; < 0.00001) and pooled MD of 2.89 pg/ml (; P; < 0.00001), respectively]. The pooled analysis of serum and plasma IL-6 levels in children with OSAS compared with controls revealed that only the MD of plasma IL-6 levels was significant (MD = 0.84 pg/ml,; P; = 0.004). Results of the meta-regression showed that greater age was associated with higher serum IL-6 levels. Egger's test revealed a publication bias across the studies for serum and plasma IL-6 levels (; P; = 0.00044 and; P; = 0.01445, respectively). In summary, the meta-analysis and meta-regression confirmed that, compared to healthy controls, individuals with OSAS (children and adults) had higher serum/plasma IL-6 levels

Psychometric Properties of the Persian Pittsburgh Sleep Quality Index for Adolescents

Both cross-sectional and longitudinal studies show that poor sleep is a health concern related to further psychological and physiological issues during adolescence. To assess subjective sleep quality and sleep patterns among adults, the Pittsburgh Sleep Quality Index (PSQI) is a well and internationally established tool. Here, we established the psychometric properties of the Persian version of the PSQI for adolescents.; A total of 1477 adolescents (mean age: 15.47 years; 53.2% females) took part in the study. They completed a booklet on sociodemographic information, the Persian version of the PSQI for adolescents, and the Adolescent Sleep Hygiene Scale (ASHS). We relied on classical test reliability approaches of exploratory and confirmatory factor analyses.; Classical exploratory factor analysis yielded the seven-factor solution, with concurrent confirmation and overlap with the dimensions of the ASHS, although correlation coefficients were small to medium. A further factor analysis yielded a four-factor solution, explaining 72% of the variance of the PSQI. Further, three out of these four factors predicted the ASHS overall score.; The Persian version of the PSQI for adolescents showed satisfactory psychometric properties. It follows that the Persian PSQI is a suitable tool to assess sleep quality and sleep patterns among adolescents

Associations between morning salivary cortisol and blood cortisol in individuals with Obstructive Sleep Apnea Syndrome: A meta-analysis

Background: Obstructive sleep apnea syndrome (OSAS) may be associated with an increase in hypothalamic-pituitary-adrenocortical axis activity (HPA AA). We reviewed research comparing morning salivary and blood (serum and plasma) cortisol concentrations of individuals with OSAS to those of healthy controls. Methods: We made a systematic search without any restrictions of the PubMed/Medline, Scopus, Cochrane Library, and Web of Science databases for relevant articles published up to August 25, 2019. Results: Sixteen studies were analyzed in this meta-analysis; five studies compared morning salivary concentrations, five compared serum concentrations, four compared plasma cortisol concentrations, and two compared both salivary and plasma concentrations. In pediatric samples, compared to healthy controls, those with OSAS had significantly lower saliva morning cortisol concentrations (MD = -0.13 µg/dl; 95% CI: 0.21, -0.04; P = 0.003). In contrast, no significant differences were observed for serum cortisol concentrations, plasma cortisol concentrations, or salivary morning cortisol concentrations between adults with and without OSAS (p = 0.61, p = 0.17, p = 0.17). Conclusion: Cortisol concentrations did not differ between adults with OSAS and healthy controls. In contrast, morning salivary cortisol concentrations were lower in children with OSAS, compared to healthy controls. Given that a reduced HPA AA is observed among individuals with chronic stress, it is conceivable that children with OSAS are experiencing chronic psychophysiological stress

Prediction of sleep quality and insomnia severity by psychological disorders and acute stress among earthquake survivors in Sarpol-e Zahab, Iran, 2017

Background: Psychological and health outcomes of natural disasters such as earthquakes affect survivors and health services for a long time. In the present study, posttraumatic stress disorders (PTSD), symptoms of psychopathology, sleep quality, and insomnia disorder were investigated among survivors of earthquake occurred at the Western Iran on November 12, 2017. Materials and Methods: This study was conducted on 1031 adult participants from rural and urban areas of Sarpol-e Zahab, a city in Kermanshah Province (Western Iran), who suffered from mental health problems due to the earthquake, a magnitude-7.3 quake, occurred in the Western Iran in 2017. Participants completed the Symptom Checklist 90, Insomnia Severity Index, Pittsburgh Sleep Quality Index, and Self-Rating Scale for PTSD. Data were analyzed using Pearson correlation and multivariate regression analysis by Statistical Package for Social Sciences Software (Version 21). Results: A positive correlation was observed between insomnia severity and all psychopathological symptoms. There was a positive correlation between sleep quality and somatization, obsessive compulsive disorder, depression, and psychoticism. In addition, acute stress was positively correlated with insomnia severity and sleep quality. Conclusion: According to the results of the present study, it is recommended that psychological disorders in earthquake victims be considered to enhance their sleep quality

The prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients:a systematic review and meta-regression

BACKGROUND: Stress, anxiety, and depression are some of the most important research and practice challenges for psychologists, psychiatrists, and behavioral scientists. Due to the importance of issue and the lack of general statistics on these disorders among the Hospital staff treating the COVID-19 patients, this study aims to systematically review and determine the prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients. METHODS: In this research work, the systematic review, meta-analysis and meta-regression approaches are used to approximate the prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients. The keywords of prevalence, anxiety, stress, depression, psychopathy, mental illness, mental disorder, doctor, physician, nurse, hospital staff, 2019-nCoV, COVID-19, SARS-CoV-2 and Coronaviruses were used for searching the SID, MagIran, IranMedex, IranDoc, ScienceDirect, Embase, Scopus, PubMed, Web of Science (ISI) and Google Scholar databases. The search process was conducted in December 2019 to June 2020. In order to amalgamate and analyze the reported results within the collected studies, the random effects model is used. The heterogeneity of the studies is assessed using the I 2 index. Lastly, the data analysis is performed within the Comprehensive Meta-Analysis software. RESULTS: Of the 29 studies with a total sample size of 22,380, 21 papers have reported the prevalence of depression, 23 have reported the prevalence of anxiety, and 9 studies have reported the prevalence of stress. The prevalence of depression is 24.3% (18% CI 18.2-31.6%), the prevalence of anxiety is 25.8% (95% CI 20.5-31.9%), and the prevalence of stress is 45% (95% CI 24.3-67.5%) among the hospitals' Hospital staff caring for the COVID-19 patients. According to the results of meta-regression analysis, with increasing the sample size, the prevalence of depression and anxiety decreased, and this was statistically significant (P < 0.05), however, the prevalence of stress increased with increasing the sample size, yet this was not statistically significant (P = 0.829). CONCLUSION: The results of this study clearly demonstrate that the prevalence of stress, anxiety and depression within front-line healthcare workers caring for COVID-19 patients is high. Therefore, the health policy-makers should take measures to control and prevent mental disorders in the Hospital staff

Effects of treatment of sleep disorders on sleep, psychological and cognitive functioning and biomarkers in individuals with HIV/AIDS and under methadone maintenance therapy

Poor sleep is a major complaint of people with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) and undergoing methadone maintenance therapy (MMT). We tested the impact of three different sleep-improving interventions (trazodone; sleep hygiene training; sleep hygiene training + trazodone) on sleep, psychological functioning and biomarkers in males with HIV and undergoing MMT.; A total of 75 male outpatients (mean age: 39.6 years) participated in a 12 week intervention. Participants were randomly assigned to one of the following conditions: trazodone 50 mg/d (TRAZ); sleep hygiene training (SHT); sleep hygiene training and trazodone (SHT + TRAZ). At baseline, and six and 12 weeks later, participants completed questionnaires covering subjective sleep and daytime sleepiness, and symptoms of depression and anxiety. In parallel, their cognitive performance (working memory; sustained attention) was assessed. Biomarkers (cortisol, BNDF, CD4; +; ) were assessed at baseline and at the end of the study.; Over time, sleep disturbances decreased and daytime functioning and overall sleep quality improved. More specifically, both sleep disturbances and daytime functioning improved in the two SHT conditions from baseline to week 6. Daytime functioning remained stable from week 6 to week 12. Over time, in all conditions symptoms of depression and anxiety declined from baseline to week 6 and remained lower from week 6 to week 12. Daytime sleepiness, symptoms of insomnia and sleep-disordered breathing remained unchanged. Sustained attention performance improved over time from baseline to week 6 and remained high through to week 12. Biomarkers remained unchanged.; In males with HIV and undergoing MMT, treating sleep disturbances over a period of six to 12 weeks had a positive impact on aspects of sleep disturbance, symptoms of depression and anxiety, and cognitive performance. The results indicate that sleep hygiene training, either as stand-alone or in combination with trazodone, can produce positive results

Sleep Disorders in Methadone Maintenance Treatment Volunteers and Opium-‎dependent Patients

Background‎: The relationship between substance use and sleep is bidirectional. Substance use directly causes sleep disturbances, and sleep problems are a critical factor in substance-use relapse. Methods: This study evaluated sleep disorders in 65 methadone maintenance treatment (MMT) patients, and 61 opium-dependent patients who did not receive any treatment between September 2011 and July 2012 in Kermanshah, Iran. Both groups filled out the Pittsburgh Sleep Quality Index (PSQI) and Global Sleep Assessment Questionnaire (GSAQ).Findings: Sleep disorders were remarkably similar in both groups: 78.5% of MMT patients and 87.7% of opium-dependent patients suffered from sleep problems. Sleep disorders in the opium-dependent group were remarkably higher and more prominent.Conclusion: Compared to opium, MMT does not have as many negative effects on sleep and is more effective in mitigating sleep problems