bluuebunny/crossref_metadata_2025_split huggingface dataset:
0956 Diurnal Variation in Anxiety and Activity Is Influenced by Chronotype and Probable Anxiety-related Disorder Status
Authors: Cox Rebecca , Wright Kenneth , Axelsson John , Balter Leonie 
Published: April 2024

Abstract

Introduction
Anxiety symptoms can vary extensively within a given day. One factor that may influence these variations is chronotype. Evening chronotypes prefer to engage in activities (e.g., sleep, physical and social activity) later in the day and are more likely to suffer from anxiety-related disorders. We here wanted to determine how chronotype influences diurnal variation in anxiety symptoms and to what degree such effects are amplified in individuals with a probable anxiety-related disorder.

Methods
We examined the diurnal variation in anxiety symptoms and daily activities in morning and evening chronotypes with and without probable generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD) in a community sample of adults (N=407; n=318 female, n=87 male, n=2 non-binary; Mage=32.1 ±8.9). Participants reported symptoms and activities during six diurnal sessions between ~08:00-00:00. Chronotype was measured by the reduced Morningness-Eveningness Questionnaire. Diurnal patterns of individual anxiety symptoms and activities and influence of probable GAD or OCD status and chronotype were tested by fitting generalized additive mixed effects models. Models were built with increasing complexity, including time of day, chronotype, and probable GAD/OCD and their interactions.

Results
Anxiety symptoms were higher in the evening and engagement in daily activities were lower in the morning in evening chronotypes (p's&lt;.05), and these findings were most pronounced in those with probable GAD or OCD (p's&lt;.05). Evening chronotypes with probable GAD or OCD reported worse anxiety symptoms in the evening and engaged less in daily activities in the morning and evening than their morning chronotype counterparts (p's&lt;.05).

Conclusion
The highest levels of anxiety symptoms are experienced in the evening. The worst evening anxiety symptoms were reported in evening chronotypes, despite preferring this time of day. Personalized treatment approaches should consider that anxiety symptoms are typically highest in the evening and that this is particularly true in evening chronotypes with a high risk for having GAD or OCD.

Support (if any)
NIH T32HL149646 (RCC, KPW); SU-Region Stockholm (nr FoUI-980356, LB, JA); Rut and Arvid Wolff Memorial Foundation (nr FS-2021:0008, LB)
0959 Sleep and Pharmacotherapy in Treatment-Resistant Late-life Depression: Findings from the OPTIMUM Clinical Trial
Authors: Mak Michael , Gebara Marie Anne , Lenze Eric , Blumberger Daniel , Brown Patrick , Cristancho Pilar , Flint Alastair , Karp Jordan , Lavretsky Helen , Miller J Philip , III Charles Reynolds , Roose Steven , Mulsant Benoit , Stahl Sarah 
Published: April 2024

Abstract

Introduction
Adults with treatment-resistant late-life depression (TRLLD) have high rates of sleep problems. However, little is known about the occurrence and change in sleep during pharmacotherapy of TRLLD or how sleep affects treatment response. We investigated the bidirectional relationship between sleep and treatment outcomes in the Optimizing Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM) study, the largest comparative effectiveness trial of pharmacotherapy for TRLLD to date.

Methods
This analysis examined: (1) occurrence of reduced sleep in 634 participants in the OPTIMUM randomized controlled trial; (2) how their sleep changed during pharmacotherapy; and (3) whether treatment outcomes differed among participants with consistent insufficient sleep [n = 164], worsened sleep [n = 62], or with improved sleep [n = 158]). We used item #4 (scale 0 – 6) from the Montgomery-Asberg Depression Rating Scale (MADRS) to assess insufficient sleep, representing reduced sleep duration or depth compared to usual sleep pattern. Scores &gt;2 indicate a meaningful reduction in duration or sleep depth. Patients who scored &gt;2 on item #4 throughout the trial were classified as having consistent insufficient sleep; patients who reported an increased score (and &gt;2 at trial end) were classified as having worsened sleep; and patients who reported a decreased scores (and ≤2 at trial end) were classified as having improved sleep. Treatment response was defined as a &gt; 50% reduction in the total MADRS score (minus item #4 ) at trial end.

Results
About half (51%, n= 323) of participants with TRLLD reported reduced or insufficient sleep before treatment. At trial end, consistent insufficient sleep and worsened sleep were each associated with treatment non-response. Improve sleep was not a significant predictor of treatment response, however participants with consistent sufficient sleep or improved sleep were three times more likely to experience treatment response compared to patients with insufficient sleep and worsened sleep.

Conclusion
Insufficient or reduced sleep are modifiable factors that may improve treatment outcomes in TRLLD. Given that sleep complaints including insomnia are associated with greater risk of depressive relapse and treatment non-response, a tailored treatment plan for those at greatest risk of sleep disturbance with concomitant depression may facilitate better outcomes.

Support (if any)
0961 Association of Sleep Disturbance and Depression with Effort-based Decision Making and Delay Discounting in Veterans
Authors: Boland Elaine , Larson Olivia , Kelley Nicholas , Nusslock Robin , Thase Michael , Sayers Steven , Convery Jillian , Wolf Daniel , Gehrman Philip 
Published: April 2024

Abstract

Introduction
Insomnia symptoms are associated with negative depression treatment outcomes including longer time to recovery, greater risk of depression relapse, and treatment non-response. A theoretical model has hypothesized that insomnia influences depression by impacting reward processes central to depression (e.g., effort-based decision making and delay discounting). The present study examined the cross-sectional relationships of insomnia and depression symptoms with behavioral measures of these constructs.

Methods
Eighty-nine veterans (Mage = 47.3, 60.2% male) with a range of insomnia and depression symptoms were administered the Hamilton Rating Scale for Depression (HRSD), the Insomnia Severity Index (ISI), and one week of sleep diaries and wrist actigraphy. Participants then completed a delay discounting task (DDT) along with two measures of effort-based decision making: the Effort Expenditure for Rewards Task (EEfRT) and the Progressive Ratio Task (PRT). Nine models were analyzed: linear regressions examined associations of insomnia (ISI and sleep efficiency from diaries and actigraphy) and depression jointly, with PRT and DDT outcomes; generalized estimating equations were conducted for EEfRT outcomes.

Results
Higher insomnia scores predicted greater delay discounting (B = 0.065, p = .02) while depression scores did not. Diary and actigraphy-measured sleep efficiency did not significantly predict delay discounting, however greater depression symptoms predicted greater delay discounting in those models (p’s &lt;.006). Higher insomnia scores predicted greater effort on the PRT (B = 0.027, p = .01) whereas lower depression scores predicted greater effort (B = -.039, p &lt;.001). Sleep diary efficiency and depression were likewise significant (p = .047 and .011 respectively) but only depression was significant in actigraphy models. Neither depression nor insomnia significantly predicted EEfRT outcomes.

Conclusion
Although greater depression symptoms were associated with diminished effort on the PRT task and reduced willingness to wait for rewards, insomnia symptoms showed differential relationships to these processes. Insomnia symptoms may represent heightened arousal that, even in the context of depression symptoms, may contribute to difficulty with disengagement in certain reward-relevant tasks. Future research is needed to disentangle the relative contributions of insomnia and depression to reward-relevant behavior.

Support (if any)
This study was supported by the Department of Veterans Affairs, CSR&D (Boland, IK2 CX001501).
0963 An Investigation of Sleep Disturbance, Depression, and Anxiety Among Emerging Adults
Authors: Washington Jasmine , Milligan Nia , Brownlow Janeese 
Published: April 2024

Abstract

Introduction
Sleep disturbances are highly comorbid with psychiatric disorders. Data indicates high comorbidity rates between insomnia and depression and anxiety disorders. However, limited data exist regarding whether sleep disturbance is an independent risk factor for or outcome of psychiatric disorders among emerging adults. This study explored relationships between insomnia, depression, and generalized anxiety.

Methods
Data were obtained from emerging adults (N=105; Mean age=20.28 (SD=1.9); 81% Female) who completed self-report measures. The Beck depression inventory (BDI-II) assessed for the presence and intensity of overall depressive symptoms. A cutoff score of greater than 20 was derived to determine probable depression. The Generalized Anxiety Disorder (GAD-7) scale assessed for severity and diagnosis of GAD. A cutoff score of 10 or greater was used to determine probable GAD. The Insomnia Severity Index assessed for the nature, severity, and impact of insomnia symptoms, with higher scores indicating greater symptom severity. All statistical analyses were conducted using IBM SPSS version 29.

Results
Approximately 36.2% of the sample had probable depression and 37.1% of the sample had probable generalized anxiety disorder. Data showed significant correlations between insomnia severity and probable depression (rpb=.316 p&lt;.001) and generalized anxiety disorder (rpb=.449, p&lt;.001), respectively. Linear regressions indicated that depressive symptoms (R2=.266, p&lt;.001) and generalized anxiety symptoms (R2=.301, p&lt;.001) were significant predictors for insomnia severity, respectively. Data also showed that insomnia severity significantly predicted depressive and generalized anxiety symptoms (R2=.355, p&lt;.001), with insomnia being a stronger predictor for generalized anxiety symptoms (β=.374, p&lt;.001) than depressive symptoms (β=.291, p=.004). Logistic regressions indicated that insomnia severity increased the odds of having both probable depression (X2=9.54, OR=1.14, p=.002) and generalized anxiety disorder (X2=17.30, OR=1.23, p&lt;.001).

Conclusion
Findings suggest that insomnia severity is a risk factor for both depressive and generalized anxiety symptom severity and probable diagnoses. Data also indicated that depressive and generalized anxiety symptoms were independent risk factors for insomnia severity. Given the results, longitudinal studies are needed to understand whether there is a bidirectional relationship between sleep disturbance, depression, and generalized anxiety among emerging adults.

Support (if any)
This study was funded by a Center Grant from the National Institutes of General Medical Sciences (Grant # P20GM103653).
0965 Investigating Cardiac Autonomic Activity During Sleep in Individuals with Major Depression and Bipolar Disorder
Authors: Leveille Chloe , Saad Mysa , Brabant Daniel , Birnie David , Lee Elliott , Douglass Alan , Northoff Georg , Nikolitch Katerina , Carrier Julie , Fogel Stuart , Higginson Caitlin , Kendzerska Tetyana , Robillard Rebecca 
Published: April 2024

Abstract

Introduction
Autonomic nervous system dysfunction and reduced heart rate variability (HRV) have been reported in individuals with mood disorders, a phenomenon likely to be influenced by sleep disturbances. Several studies have previously assessed HRV in individuals with major depression or bipolar disorder across the entire sleep period. This study investigated whether distinct heart rate (HR) and HRV profiles across wake, rapid eye movement (REM) sleep, and non-REM (NREM) sleep are linked to unipolar versus bipolar mood disorders in individuals with sleep complaints.

Methods
Polysomnographic data was retrospectively collated for 120 adult patients with sleep complaints and depressive symptoms referred to a specialized sleep clinic for sleep assessment [60 diagnosed with bipolar disorder (70% female, mean age= 43.4±11.6 years) and 60 age-matched cases diagnosed with a unipolar depressive disorder (68.3% female, mean age= 43.2±11.6 years)], and 60 age-matched healthy controls (68.3% female, mean age= 43.4±12.6 years). HR and time-based HRV parameters were computed on 30-second segments and averaged across the night for wake and sleep stages.

Results
Significant group by sleep stage interactions showed that the unipolar and bipolar groups had lower standard deviation of normal-to-normal intervals (SDNN) and vagal tone root mean square of successive R-R interval differences (RMSSD) compared to controls during NREM sleep ( p≤.001) and REM sleep (p≤.003), but not during wake (p&gt;.050). The unipolar group had significantly higher heart rate than controls regardless of sleep stages (all, p≤ .042), while the bipolar group had higher heart rate than controls only during NREM 2 (p=.012) and NREM 3 (p=.009) sleep. These interactions persisted after excluding individuals taking antipsychotic, lithium, anticonvulsant, and cardiovascular medications.

Conclusion
While additional research is required to account for manic and euthymic states, as well as the impact of psychotropic and cardiac medications, and potential confounders like variations in body mass index, the present findings suggest that the sleep-based autonomic signature of depressive states differs across different types of mood disorders and could potentially inform the development of biomarkers and therapeutic targets.

Support (if any)
This project was supported by the Ottawa Region for Advanced Cardiovascular Research Excellence (ORACLE) funding program.
0967 Network Analysis of Depression and Insomnia Among Pregnant Women
Authors: Li Xiao , Sit Hao Fong , Ng Denise Ching Yiu , Wong Natalie Yuk Ching , Leung Wing Cheong , Lau So-ling , Chan Joey , Chan Ngan Yin , Lee Antoinette , Wing Yun Kwok , Manber Rachel , Li Shirley Xin 
Published: April 2024

Abstract

Introduction
Pregnancy is a vulnerable period of lifespan characterized by a myriad of physiological and psychological changes and challenges. Whilst the existing research has documented the intricate relationship between insomnia and depression among expectant mothers, the use of sum scores of the measures in previous studies might have limited the understanding of the underlying mechanisms and key symptoms contributing to the development and persistence of these conditions. The current study aimed to examine the inter-relationship between the symptoms of insomnia and depression during the antenatal period using a networking approach.

Methods
A total of 480 pregnant women were recruited from the outpatient clinics of local hospitals and the community in Hong Kong. Insomnia and depressive symptoms were assessed by the Insomnia Severity Index (ISI) and the Edinburgh Postnatal Depression Scale (EPDS), respectively. A cutoff score ≥ 10 on the ISI indicated probable insomnia, and a cutoff ≥ 13 on EPDS indicated probable depression. Network analyses, utilizing expected influence (EI) and bridge expected influence (BEI), were conducted to determine central symptoms and bridge symptoms.

Results
Among the 480 expectant mothers (mean age: 33.0 ± 4.4 years, mean gestation week: 24.2 ± 5.9), the prevalence of probable insomnia and depression was 73.95% and 45.83%, respectively. The values of skewness and kurtosis of all symptoms were acceptable (skewness: -0.74 - 1.21, kurtosis: 1.91 - 3.47). Distress about sleep problems (ISI5) had the highest EI value, followed by Sadness (EPDS8), Unable to enjoy things (anhedonia) (EPDS2), and Feeling scared or panicky (EPDS5). Four bridge symptoms were identified: Difficulty initiating sleep (ISI-DIS), Difficulty sleeping (EPDS7), Feeling anxious/worried (EPDS4), and Distress about sleep problems (ISI5), suggesting that these symptoms exert simultaneous influence on both antenatal insomnia and depression, acting as a bridge connecting these two sets of symptoms.

Conclusion
Central symptoms and bridge symptoms identified in this network analysis should be targeted in the development of prevention and intervention strategies to address insomnia and depression among pregnant women.

Support (if any)
This work was funded by the Health and Medical Research Fund (HMRF, Ref. 20212091), the Food and Health Bureau, Hong Kong SAR, China.
0974 Sleep Characteristics and Depression and Anxiety Symptoms Among Adults with Inflammatory Bowel Disease
Authors: Zhang Xiaoyu , Yoo Linda , Conley Samantha , Kamp Kendra 
Published: April 2024

Abstract

Introduction
Inflammatory Bowel Disease (IBD) is a chronic, immune-mediated condition, encompassing Crohn's disease (CD) and ulcerative colitis (UC). Up to 80% of individuals with IBD report poor sleep quality. However, there is limited information on factors that predict sleep characteristics in this population. This study aims to explore the associations between demographic, clinical, and psychological factors with sleep characteristics in adults with IBD.

Methods
We conducted a retrospective analysis of two IBD sleep studies. Participants aged 18-64 years old with a diagnosis of IBD were recruited from two academic medical centers and completed Patient-Reported Outcomes Measure Information System (PROMIS) depression and anxiety questionnaires and wore a wrist actigraph for 10 days continuously. We employed Independent T-Tests and Pearson’s correlation to assess the association of biologic treatment, IBD type, sex, depression, and anxiety on sleep efficiency (SE), total sleep time (TST), and sleep onset latency (SOL).

Results
We included 58 participants with a mean age of 35.6 years (SD=12.1). 60.3% were female, and 60.3% were diagnosed with CD. The mean depression score was 51.3 (SD = 10.2) and the anxiety score was 52.2 (SD = 15.5). The mean SOL was 19.3 minutes (SD = 15.5), TST was 413.3 minutes (SD = 53.2), and SE was 83.5% (SD = 5.7). TST was significantly longer in females compared to males (427.4 vs. 391.9 minutes , p&lt; 0.05). SE was significantly higher among females compared to males (85.1% vs. 81.0%, p&lt; 0.001) and among individuals with Crohn's disease compared to Ulcerative colitis ((85.1% vs. 81.0%, p&lt; 0.01). SOL was longer among individuals with Ulcerative colitis compared to Crohn's disease (15.6 vs.25.0minutes , p&lt; 0.05). Depression and anxiety scores were not significantly correlated with any sleep characteristic.

Conclusion
Sleep continuity was poor in people with IBD. Given that we found sex and IBD type impacted sleep continuity, these factors should be considered in future precision sleep health interventions for this population.

Support (if any)
This study was funded by the University of Washington School of Nursing, NINR (K23 NR020044) (Kendra Kamp, and the American Nurses Foundation (Samantha Conley).
0976 A Brief Non-Pharmacological Insomnia Treatment for Military Suicidal Behaviors: A Sham-Controlled, Randomized Trial
Authors: Bernert Rebecca , Soltani Shamsi , Pham Savannah , Hom Melanie , Schatzberg Alan , Manber Rachel , Germain Anne , Krakow Barry , Brown Gregory , Neri Eric , Jo Booil , Tomlinson Megan , Hilberg Amanda 
Published: April 2024

Abstract

Introduction
Suicide represents a public health emergency among veterans, who die by suicide at alarming rates and show elevated sleep disturbances. Selective interventions for military suicide indication are scarce, and available treatments remains mismatched to the acute nature of a suicidal crisis. We sought to develop and test preliminary efficacy of a fast-acting, behavioral insomnia intervention for antisuicidal response in the context of a sham-controlled, randomized trial among veterans.

Methods
A multicomponent behavioral sleep intervention was developed, integrating: CBT for Insomnia (CBTi) and Imagery Rehearsal Treatment (IRT) within a rapid (4-session) format (SERVE: Sleep Enhancement for Returning Veterans). This was compared to active control, Arousal-Based Treatment of Insomnia (ABTI). Treatments were manualized and matched for therapist contact, materials (manuals, powerpoints, guidesheets), and passage of time. Raters were blind to treatment assignment. Inclusion criteria: (a) age&gt;18, (b) clinically-significant sleep disturbance (Insomnia Severity Index (ISI&gt;10)), (c) DSM-V-Defined Depression, or (d) current suicidal ideation (Columbia Suicidal Severity Rating Scale (CSSRS&gt;1)). A comprehensive data and safety monitoring plan supported standardized risk assessment, safety planning, and triage. Outcomes were assessed at Baseline and Posttreatment (1,3 mos) according to primary (suicidal ideation), secondary (sleep indices), and exploratory (mood, stress indices) outcomes.

Results
Recruitment occurred by way of comprehensive military partnerships, clinic referrals, and community flyering. Of n=753 new contacts, n=436 participants were screened for inclusion. Of these, n=112 were interviewed by full-battery eligibility assessment, resulting in n=77 veterans enrolled and randomized to: Active Treatment (n=39) vs. Active Control (n=38). Feasibility analyses supported high rates of acceptance, tolerability, and safety. For the full sample, t-tests revealed large posttreatment reductions in suicidal ideation (CSSRS, p&lt;.001; Depressive Symptom Inventory Suicidality Subscale (DSISS)), p&lt;.001), sleep, mood, and stress outcomes (ISI, p&lt;.01; DDNSI, p&lt;.01; QIDS-SR, p&lt;.01; PCL, p&lt;.001). Effects were significant compared to control (DSISS, p&lt;.01; ISI, p&lt;.01).

Conclusion
A brief, non-pharmacological insomnia intervention resulted in antisuicidal response and large posttreatment improvements in sleep and well-being. This is the first known report testing non-medication insomnia treatment within a sham-controlled, randomized trial for military suicidal behaviors, where results support feasibility, safety, and therapeutic impact to suicidal risk.

Support (if any)
Work was supported by NIH (K23MH093490), DOD/MOMRP/MSRC funding (W81XWH-10-2-0178)