bluuebunny/crossref_metadata_2025_split huggingface dataset:
733 PTSD and Sleep Disorders in Medical Learners and Healthcare Providers
Authors: Tinsley Meagan , Hunt Grace , Alvarez Mark , Gremillion Rachel , Jumonville Allison , Ghaffar Yahya , Champagne Kristin , Derouen Alyssa , Knox Brianne , Bokun Kevin , Allen Mariah , Ninh Michael , Harper Daniel , Chernyshev Oleg 
Published: May 2021

Abstract

Introduction
Medical student mental health and wellness has been an increasingly hot topic over the past decade. Much of the research, however, has remained focused more on anxiety and depression and less on other less common but just as detrimental mental health disorders such as PTSD, bipolar disorder, OCD and others. In addition to the more traditional psychological stresses medical students experience, they also experience physical consequences of their training, often with sleep patterns suffering most initially.

Methods
The questionnaire consists of thirty-five questions, compromising of demographic questions, questions relating to USMLE exams and education, the STOP-Bang Questionnaire, Epworth Sleepiness Scale, Fatigue Severity Scale and PTSD DSM-V Questionnaire. This survey was sent out between March and April of 2020 and was distributed to all medical students and residents with an LSU Health Shreveport email address via RedCAP, an encrypted electronic survey tool.

Results
A total of 78 participants responded to our survey, with 91.1% identifying as medical students and the rest as residents. 64.1%, identified as female, 34.6% identified as male and 1.3% declined to answer. While 43% of our participants found their educational experience emotionally traumatizing, 75% of them felt that preparing and/or taking USMLE exams was emotionally traumatizing. In regards the portions of our questionnaire that served as sleep disorder screening questions, the average score for the STOP-Bang was 1.48 (SD +/- 1.15) the average score for the ESS was 6.85 (SD +/- 4.72) and the average score for the FSS was 32.04 (SD +/- 11.99). It should be noted that, while the average score of the PTSD screening portion was 20.34 (SD +/- 17.47), 18 participants scored above 38, the minimum score needed to qualify for a PTSD diagnosis.

Conclusion
These results suggest some correlations that warrant further future study. It is worrisome that while less than half of our participants stated their educational experience as harrowing, 75% stated preparing for and/or taking these required exams was emotionally traumatizing. The possible connections suggested here between USMLE exams and an increase in fatigue, lack of motivation and PTSD symptoms urge us to look more closely at the impact of the USMLE.
Support (if any):
734 Prevalence and Correlates of Insomnia in Veterans with and without Military Sexual Trauma Receiving Care within a VA Med Center
Authors: Makar Karen , Rivera Louis , Mazur Rena , Aguiar Taylor , Krouse Ryan , Chakravorty Subhajit 
Published: May 2021

Abstract

Introduction
A prior study showed a higher prevalence of insomnia among younger Veterans with military sexual trauma (MST) before receiving care at a VA Medical Center (VAMC). We extend the literature to investigate the prevalence and correlates of insomnia in male Veterans with and without MST currently receiving care within a VAMC.

Methods
We evaluated cross-sectional data from a survey within the Philadelphia VAMC (N=138) using the following instruments: Insomnia Severity Index (ISI) total score for insomnia; Sexual Harassment Scale (DRRI-2) to screen for MST; PTSD checklist for DSM-5 (PCL-5) PTSD symptoms; Quick Inventory of Depressive Symptomatology-Self report (QIDS-SR) to evaluate depressive symptoms; Alcohol Use Disorder Identification Test (AUDIT-C) to assess for harmful drinking; and, the nightmare question from the PCL-5 scale to screen for persistent nightmares. The association between ISI total score and variables were assessed separately in individuals with and without MST, using bivariate and multivariable analyses.

Results
The mean(SD) age was 55.2(12.8) years. They were likely to identify themselves as African-American (44.2%), and had a high school diploma (39.1%). MST was endorsed by 31.9% of the Veterans. Insomnia was more prevalent in those with MST [N=42(95.4%)] than those without [N=77(81.9%)]. Individuals with MST had higher ISI (19.9±5.0 Vs 16.7±7.2) and PCL-5 (48.4±14.4 Vs 38.1±19.7) total scores, than individuals without. Among those with MST, the bivariate analysis showed significant associations with PCL-5 (β=0.2, p&lt;0.0001), QIDS (β=0.5, p=0.01), AUDIT-C (β=0.5, p=0.008), and nightmares (β=3.9, p=0.03). In the multivariable model, ISI total score was only associated with the PCL-5 total score (β=0.3, R2=0.18, p=0.0005). Among those without MST, the bivariate analysis showed significant associations between ISI total score and age (β=-0.1, p=0.02), total scores on the PCL-5 (β=0.2, p&lt;0.0001), QIDS (β=0.9, p&lt;0.00001), and nightmare (β=6.7, p&lt;0.0001). In the multivariable model (R2=0.5, p&lt;0.00001), the ISI total score was associated with PCL-5 (β=0.1, p=0.01), and QIDS (β=0.7, p=&lt;0.0001) total scores.

Conclusion
There is a higher prevalence of insomnia among Veterans with MST currently receiving care within the VHA. Treatment of insomnia and PTSD is critical to improve their well-being and prevent complications.

Support (if any)
The study was supported by VA grant IK2CX000855 (S.C.).
735 Neighborhood Stress Predicts Fear of Sleep Independently of Posttraumatic Stress Disorder
Authors: Poindexter Milan , Stokes Alicia , Mellman Thomas 
Published: May 2021

Abstract

Introduction
Chronic insufficient sleep is linked to a variety of adverse health outcomes, with African Americans reporting and objectively receiving poorer sleep outcomes in comparison to their non-Hispanic white counterparts. African Americans live disproportionately in low-income and disordered neighborhoods that increase one’s risk of experiencing a traumatic event and interfere with sleep. It has been demonstrated that posttraumatic stress disorder disrupts sleep in part due to its association with sleep-related fears. However, less research has evaluated the additional contribution of perceived neighborhood stress on the sleep-related fears African Americans experience in their sleep environments.

Methods
The present study features a nonclinical sample of 163 African American participants (ages 18–35) who reside in DC to investigate whether PTSD severity (Clinician Administered PTSD Scale for DSM-5 Severity Score, CAPS-5) and perceived neighborhood stress (City Stress Index, CSI) are predictive of sleep-related fears (Fear of Sleep Inventory, FoSI).

Results
After controlling for gender, hierarchical linear regression analyses revealed that PTSD severity and perceptions of the neighborhood environment accounted for approximately 33% of the variance in sleep-related fears (∆R2 = .329, p = .000). Regression coefficients suggest that subjective perceptions of the neighborhood (β = .388) may be a stronger predictor of sleep-related fears than PTSD severity (β = .300)

Conclusion
Results from this study have implications for future interventions that involve improving coping skills among African Americans in the context of their sleep environments.

Support (if any)
5R01HL136626 from the National Heart Lung and Blood Institute
741 Sleep and postpartum depression in healthy fathers: Perceptions of sleep quality predict severity of symptoms
Authors: Kalogeropoulos Christopher , Burdayron Rebecca , Laganière Christine , Beliveau Marie-Julie , Dubois-Comtois Karine , Pennestri Marie-Helene 
Published: May 2021

Abstract

Introduction
Research on the link between sleep quality and depression in the postpartum period has focused primarily on mothers. Although fathers also experience poorer postpartum sleep and are at risk of developing depressive symptoms, they remain understudied. To date, the limited research focusing on paternal sleep and depression has relied on subjective measures of sleep, without objective verification. The current study implemented a multi-measure approach using subjective and objective indices to explore the relationship between sleep and depressive symptoms in fathers at 6 months postpartum.

Methods
Fifty-four healthy fathers participated in this cross-sectional study. Paternal sleep was assessed for 2 weeks utilizing: 1) a self-report daily sleep diary, 2) a self-report perceived sleep quality rating, and 3) actigraphy. Subjective indices via the sleep diary measured participants’ perception of their total nocturnal sleep duration and total number of awakenings (self-reported sleep duration and fragmentation). Perceived sleep quality ratings measured participants’ perceptions of how well they thought they slept. Objective sleep variables measured through actigraphy included: total nocturnal sleep duration, number of awakenings, sleep efficiency, and wake after sleep onset (WASO). Paternal depressive symptoms were assessed with the Center for Epidemiologic Studies – Depression Scale (CES-D).

Results
Regression analyses showed that subjective sleep variables (measured by the sleep diary) and objective sleep variables (measured by actigraphy) did not significantly predict postpartum depressive symptoms in fathers (p &gt; .05). However, self-reported perceived sleep quality significantly predicted postpartum depressive symptom severity in fathers (R2 = .172, p = .034).

Conclusion
These findings advance our understanding of the link between sleep and depression in fathers. The results highlight the important role of fathers’ perceptions of sleep quality, rather than the actual quality or quantity of their sleep (measured through the sleep diary or actigraphy), in the development of postpartum depressive symptoms. The multi-measure approach to sleep implemented in this study expanded our knowledge about how different facets of sleep relate to depression. These findings have important implications for the development of clinical interventions targeting paternal sleep and mood in the months following childbirth.

Support (if any)
Social-Science and Humanities Research Council (SSHRC) and Fonds de recherche du Québec – Santé (FRQS)
747 Suicidal Ideation Associated with Cognitive Hyperarousal, Rumination and Insomnia in Depressed Perinatal Women
Authors: Arnett Lily , Kalmbach David , Ahmedani Brian , Gelaye Bizu , Drake Christopher , Cheng Philip 
Published: May 2021

Abstract

Introduction
This prospective study explored associations among clinical insomnia, nocturnal cognitive hyperarousal, and nocturnal perinatal-focused rumination with suicidal ideation (SI) in perinatal women with mild-to-moderate depression.

Methods
From late pregnancy through early postpartum, 39 women with depression completed 17 weekly surveys assessing insomnia, depression, suicidal ideation, perceived stress, and three cognitive arousal indices.

Results
Women with nocturnal cognitive hyperarousal at baseline, relative to those with low nocturnal cognitive arousal, were at greater risk for developing new onset SI in late pregnancy or early postpartum (33% vs 1%). Moreover, nocturnal perinatal-focused rumination was independently associated with SI. SI-risk was highest when women reported clinical insomnia combined with nocturnal cognitive hyperarousal (OR=5.66, p=.037) or perinatal-focused rumination (OR=11.63, p=.018). Daytime perseverative thinking was not uniquely associated with SI.

Conclusion
Cognitive hyperarousal and perinatal-focused rumination at night are uniquely associated with SI among perinatal women with depression. Moreover, insomnia augments the suicidogenicity of nighttime cognitive activity. Future research should determine whether alleviating nocturnal cognitive arousal, pregnancy- and fetal/infant-related concerns, and insomnia with psychotherapy reduces SI for women with perinatal depression.

Support (if any)
This study was funded by the American Academy of Sleep Medicine (198-FP-18, PI: Kalmbach). Dr. Cheng’s effort was supported by the National Heart, Lung, and Blood Institute (K23-HL13866, PI: Cheng).
754 Insomnia and Depression Symptoms in Primary Care Patients Referred for Mental Health Care
Authors: Vargas Ivan , Muench Alexandria , Seewald Mark , Livesey Cecilia , Press Matthew , Oslin David , Thase Michael , Perlis Michael 
Published: May 2021

Abstract

Introduction
Past epidemiological research indicates that insomnia and depression are both highly prevalent and tend to co-occur in the general population. The present study further assesses this association by estimating: (1) the concurrence rates of insomnia and depression in outpatients referred by their primary care providers for mental health care; and (2) whether the association between depression and insomnia varies by insomnia subtype (initial, middle, and late).

Methods
Data were collected from 3,174 patients (mean age=42.7; 74% women; 50% Black) who were referred to the integrated care program for assessment of mental health symptoms (2018–2020). All patients completed an Insomnia Severity Index (ISI) and a Patient Health Questionnaire (PHQ-9) during their evaluations. Total scores for the ISI and PHQ-9 were computed. These scores were used to categorize patients into diagnostic groups for insomnia (no-insomnia [ISI &lt; 8], subthreshold-insomnia [ISI 8–14], and clinically-significant-insomnia [ISI&gt;14]) and depression (no-depression [PHQ-914]). Items 1–3 of the ISI were also used to assess the association between depression and subtypes of insomnia.

Results
Rates of insomnia were as follows: 34.6% for subthreshold-insomnia, 35.5% for clinically-significant insomnia, and 28.9% for mild-depression and 26.9% for clinically-significant-depression. 92% of patients with clinically significant depression reported at least subthreshold levels of insomnia. While the majority of patients with clinical depression reported having insomnia, the proportion of patients that endorsed these symptoms were comparable across insomnia subtypes (percent by subtype: initial insomnia 63%; middle insomnia 61%; late insomnia 59%).

Conclusion
According to these data, the proportion of outpatients referred for mental health evaluations that endorse treatable levels of insomnia is very high (approximately 70%). This naturally gives rise to at least two questions: how will such symptomatology be addressed (within primary or specialty care) and what affect might targeted treatment for insomnia have on health were it a focus of treatment in general?

Support (if any)
Vargas: K23HL141581; Perlis: K24AG055602
758 Circadian rest-activity signatures in women with major depressive disorder
Authors: Yang Hui-Wen , Chellappa Sarah , Gaba Arlen , Cajochen Christian , Hu Kun 
Published: May 2021

Abstract

Introduction
Patients with major depressive disorder (MDD) show disrupted circadian rhythms and sleep, including reduced daytime physical activity and poor sleep quality. However, previous findings are masked by psychotropic medication intake, co-morbid diseases and years of chronic mental illness. Here, we aim at identifying circadian motor activity patterns in unmedicated women at the onset of MDD.

Methods
Twelve young unmedicated women with MDD (Mean+-SD: 24.9+-5.2y; range: 18-33y) and eight age-matched healthy women (Mean+-SD: 24.5+-3.2y; range: 20-31y) participated in our study. Activity recordings were collected using wrist-worn wearable devices (actigraphs) for ~7 days in real-life settings. Cosinor analyses were performed to assess the amplitude and phase of the 24-h rest-activity activity rhythms. Non-parametric analyses were used to quantify interdaily stability and intradaily variability of the rest-activity rhythm. Furthermore, we calculated the mean activity level and scaling exponent alpha, which quantifies the temporal correlation in activity fluctuations, per 3-h bins across the 24-h sleep-wake cycle.

Results
Women with MDD showed a significantly higher amplitude of the 24-h rest-activity activity rhythm (Mean+-SD: 332.7+-120.8 arbitrary units) than the controls (179.7+-122.9; p=0.002), elicited by higher activity levels during the daytime (0-12h after habitual wake-up time; p&lt;0.01). In contrast, women with MDD showed a trend for lower interdaily stability levels than controls (respectively, 0.41+-0.07 and 0.46+-0.08; p=0.05). Interestingly, a significant interaction effect of “group” and “time since habitual wake” was elicited for scaling exponent alpha (p&lt;0.001). Accordingly, women with MDD had higher alpha values during habitual sleep (0–6 hours before habitual wake-up time) than controls (respectively, 1.18+-0.22 and 1.12+-0.22).

Conclusion
Unmedicated women at the onset of MDD had altered circadian motor activity patterns, as indexed by higher amplitude particularly during daytime while awake, less stable 24-h activity rhythms, and highly correlated activity patterns during sleep that closely resemble those typically occurring during wakefulness. These findings suggest that MDD per se may be associated with impaired rest-activity profiles. Ultimately, the use of wearable devices might hold important prospects for the early detection of individuals at risk for mood disorders.

Support (if any)
Swiss National Science Foundation Grants START #3100–055385.98, 3130-0544991.98 and 320000-108108; NIH RF1AG064312, RF1AG059867
759 Sleep and Mental Health in New Mothers with a History of Depression: Preliminary Data from Late Pregnancy to 1-month Postpartum
Authors: Okun Michele , Feliciano Leilani , Karp Harvey , Lindsay Keston 
Published: May 2021

Abstract

Introduction
Perinatal women report more sleep disruptions than non-pregnant women. This phenomenon is exaggerated among women with a history of depression, as sleep complaints are one of the most frequent symptoms of depression. Understanding the change in sleep and mental health from late pregnancy to postpartum may provide insights into prevention and intervention. Presented here are preliminary data from new mothers regarding sleep and mental health.

Methods
Preliminary examination of sleep and psychological data from 22 women enrolled in a study to assess the efficacy of the SNOO on infant and maternal sleep during the first 6 months of life. Participants were eligible if they had a history of, but no active depression as assessed by the Edinburgh Postnatal Depression Scale (EPDS). Data are from late pregnancy and at 1-month postpartum. Questionnaires included the Pittsburgh Sleep Quality Index (PSQI), Insomnia Symptom Questionnaire (ISQ), Epworth Sleepiness Scale (ESS), Flinders Fatigue Scale (FFS), and the Generalized Anxiety Disorder scale (GAD). Paired t-tests or chi-square tests were used to assess change over the first month postpartum. Linear regressions were done to determine whether sleep in late pregnancy was associated with depression and anxiety scores.

Results
Participants were 30 ± 2.2 years of age and 72.7% were White. In the first month postpartum, sleep was negatively impacted. Clinical insomnia increased (4 (18.2%) vs 5 (22.7%); X2 = 7.61, p = .006), sleep quality (PSQI) worsened (6.13 ± 3.54 vs 8.89 ± 3.54; t = -3.03, p =n .006), daytime sleepiness was higher (4.77 ± 2.51 vs 6.64 ±3.44; t = -3.31, p = .003), and fatigue was greater (9.55 ± 4.73 vs 13.36 ± 5.86; t = -3.21, p = .004). Likewise, depression and generalized anxiety increased (p’s &lt; .01). Insomnia in late pregnancy was associated with more depression (β = .542, p = .009) and more anxiety (β = .510, p = .015).

Conclusion
Pregnant women with a history of depression are at risk for more sleep disturbances, and therefore more likely to be at significant risk for a recurrent depressive episode. Improving sleep in the perinatal period could have a positive impact.

Support (if any)
Happiest Baby Inc.
764 Neural activation accompanying fear conditioning and extinction in Generalized Anxiety Disorder with and without Insomnia Disorder
Authors: Seo Jeehye , Oliver Katelyn , Daffre Carolina , Lasko Natasha , Pace-Schott Edward 
Published: May 2021

Abstract

Introduction
We examined associations of sleep quality with neural responses to fear conditioning and extinction in individuals with Generalized Anxiety Disorder (GAD) with (INS) and without (NOI) Insomnia Disorder (ID). We hypothesized fear-related regions would show greater, and emotion-regulatory regions lesser activity in INS versus NOI and across both groups with decreasing sleep quality.

Methods
Participants were assigned to either an INS group with Insomnia Severity Index (ISI) ≥ 13 (N=21) or NOI with ISI ≤ 12 (N=14). Two weeks of actigraphy and sleep diaries were followed by a 2-session protocol with fMRI. During Session 1, mild electric shock produced conditioned fear to 2 different colors (CS+s) but not a third (CS-) (Fear Conditioning). Immediately afterward, one CS+ (CS+E) but not the other (CS+U) was extinguished (Extinction Learning). All 3 stimuli were presented 24h later (Extinction Recall). An acclimation/diagnostic ambulatory polysomnography (PSG) night was followed by PSGs before Session 1 and between Sessions 1 and 2. Using SPM8, t-tests compared groups, and multiple regressions predicted anterior cerebral activations (as a whole and as ROIs) using ISI, actigraph and diary sleep efficiency (SE) and latency (SOL), and sleep architecture.

Results
Beginning Fear Conditioning, differential activation to the reinforced stimulus (CS+&gt;CS-) in the right insula was greater in INS than NOI, and greater actigraph SE predicted greater prefrontal activation. Change in activation to the CS+ across Extinction Learning (late CS+&gt;early CS+) did not differentiate groups or correlate with sleep measures. During Extinction Recall, NOI versus INS showed less activation in bilateral amygdala ROIs (CS+E&gt;CS-) but more activation in prefrontal regulatory regions (CS+U&gt;CS-) and bilateral insula ROIs (both contrasts). Greater activation of prefrontal emotion-regulatory areas was associated with greater REM% (CS+E&gt;CS+U and CS+E&gt;CS-), lesser ISI (CS+E&gt;CS- and CS+U&gt;CS-), and greater actigraph SE (CS+U&gt;CS). However for CS+E&gt;CS+U, lesser diary SE and greater ISI were associated with greater prefrontal activity.

Conclusion
Results, on balance, suggest that persons with GAD and ID activated more fear-related and less prefrontal emotion-regulatory regions during fear conditioning and extinction recall than those with GAD alone. Across groups, greater REM% and sleep quality were associated with greater activity of emotion-regulatory areas.

Support (if any)
Funding: R21MH115279, R01MH109638