Insomnia and pain have been shown to increase risk for development of depression and substance use disorders. Depression, substance use, stress, and pain are also strongly correlated with sleep impairment. No studies have examined associations between insomnia, pain, stress, substance use, and depression in a sample of nurses, who may experience these disturbances due to stressful work environments, intense physical demands, and rotating work schedules. Therefore, the present study examined if insomnia symptoms, pain symptoms, and perceived stress were associated with alcohol use and depressive symptoms in nurses, and if insomnia diagnosis moderated these associations. Participants were 400 nurses (92% female; 78% white, mean age = 39.51 ± 11.13) recruited from two hospitals for a parent study, “Sleep and Vaccine Response in Nurses (SAV-RN)” (R01AI128359-01, PIs: Taylor & Kelly). Participants completed measures of depression, pain, insomnia, and stress. Linear regression was used to assess the associations between insomnia symptoms, stress, and pain with depressive symptoms and substance use. Insomnia diagnosis (based on diagnostic cutoffs from questionnaire data) was examined as a moderator of the associations between pain, stress, depressive symptoms, and substance use. Greater insomnia symptoms were associated with consuming fewer drinks per week (p = .04), and greater perceived stress was associated with consuming more drinks per week (p = .01). Greater insomnia symptoms, perceived stress, and pain were each associated with greater depressive symptoms (ps < .001). Insomnia diagnosis moderated the association between perceived stress and depressive symptoms (β = 0.11, p = .05), such that nurses with insomnia disorder had a stronger positive relationship between perceived stress and depressive symptoms. Results suggest insomnia symptoms, stress, and pain were associated with greater mood disturbance. Greater stress was associated with greater substance use, which may reflect coping attempts. Nurses with insomnia may be particularly susceptible to increases in depressive symptoms under times of stress. Given that nurses are the first-line of care in hospital settings, it is essential to address these problems proactively and comprehensively. NIAID R01AI128359-01
Abstract Study Objectives Nurses are a group at high risk for nightmares, yet little is known about the rate of nightmare disorder and associated psychosocial factors in this group in part attributable to the lack of a self-report questionnaire to assess DSM-5 criteria for nightmare disorder. Aims of the current study were to (1) report on development and initial validity of a self-report measure of DSM-5 nightmare disorder, and (2) examine the rate and associated factors of nightmare disorder among nurses. Methods Nurses (N = 460) completed baseline measures online including Nightmare Disorder Index (NDI), psychosocial and demographic questionnaires. A subset (n = 400) completed 14 days of sleep diaries and actigraphy. Results NDI demonstrated satisfactory psychometric characteristics as indicated by good internal consistency (α = 0.80), medium inter-item correlations (r = 0.50), medium to large item-total (r = 0.55–0.85) and convergent correlations (0.32–0.45), and small to medium discriminant correlations (–0.12–0.33). Per NDI, 48.7% of nurses reported no nightmares in the past month, 43.9% met partial/subthreshold criteria and 7.4% met full criteria for probable nightmare disorder. Nurses with nightmare disorder demonstrated significantly poorer psychosocial functioning (i.e. posttraumatic stress, depression, anxiety, stress) than those with subthreshold nightmare symptoms, who had poorer functioning than those with no nightmares. Conclusions NDI is an efficient and valid self-report assessment of nightmare disorder. Nurses have high rates of nightmares and nightmare disorder which are associated with poorer psychosocial functioning. We recommend increased nightmare screening particularly for high-risk populations such as healthcare workers.
Abstract Introduction The accurate estimation of sleep is critical for understanding who is most at risk for sleep disorders and associated disease outcomes. Individuals who overestimate sleep disturbances may be at increased risk for insomnia. A few studies have shown demographic differences in the accuracy of sleep estimation when comparing subjective and objective measures; however, the previous literature is inconsistent and focuses primarily on older adults. We sought to replicate these studies in a large sample of nurses using 14 days of sleep diary and actigraphy measures. Methods Participants were 392 nurses (91.8% female; 77.8% white, mean age = 39.54) recruited for a larger study. Participants completed 14 days of actigraphy and sleep diaries to prospectively assess total sleep time (TST) and sleep efficiency (SE). Discrepancy between diary and actigraphy measures was calculated by subtracting actigraphy measures from diary measures. Linear regression was used to examine how age, race (0 = race other than white, 1 = white), gender (1 = male, 2 = female), ethnicity (1= non-Hispanic/Latinx, 2 = Hispanic/Latinx) predicted degree of sleep discrepancy. Results The average discrepancy between diary and actigraphy TST was 30.29 minutes (SD = 29.28), and the average discrepancy between diary and actigraphy SE was 4.16% (SD = 5.66). Race and ethnicity did not predict amount of TST or SE discrepancy. However, younger individuals had more discrepancy in both TST (b = -0.48, p < .001) and SE (b = -0.09, p < .001). Men also had a greater discrepancy in both TST (b = -10.90, p < .05) and SE (b = -2.56, p < .05). Conclusion Men and younger individuals had greater discrepancies between diary and actigraphy measures of sleep. This is in contrast to some previous research showing that elderly women tend to display greater discrepancies between subjective and objective measures of sleep. It is essential that future research explore the discrepancies between subjective and objective measures of sleep in larger and more demographically diverse samples. Establishing a better understanding of this relationship is crucial, as it may have significant implications for the diagnosis and treatment of insomnia. Support NIH/NIAID R01AI128359-01
Abstract Introduction Insomnia, shiftwork (i.e., circadian rhythm disruptions) and insufficient sleep are common among nurses and healthcare workers. Each of these sleep problems can contribute to physical (e.g., inflammation, musculoskeletal pain, cardiovascular disease and heart rate variability, indigestion, and menstrual cycle irregularity) and mental (e.g., depression, anxiety, suicidality) health problems as well as daytime fatigue and sleepiness among nurses and may contribute to burnout and job change. Methods Participants (N=458) were nurses recruited for a parent study, “Sleep and Vaccine Response in Nurses (SAV-RN)” (Taylor & Kelly: R01AI128359-01). Most identified as female (90.5%), White/Caucasian (77.2%), and non-Hispanic (88.6%) with an average age of 39.03 (SD = 11.07). Participants completed baseline measures online via Qualtrics survey. The Sleep Condition Indicator (SCI; Espie et al., 2014) was used to identify a probable diagnosis of insomnia (score of ≤16 = Insomnia; endorsement of each of the primary DSM-5 criteria on the measure). In addition, a checklist of current major health conditions (high blood pressure, sleep apnea, GI issues, HIV/AIDS, cancer, etc.) was also completed. A Chi square test of Independence was conducted using SPSS to determine if insomnia detected by the SCI was associated with reported health conditions. Results At baseline, 25.4% of nurses had a probable insomnia diagnosis. Insomnia was associated with a greater likelihood of diagnosed sleep apnea, cancer (all types), high blood pressure, chronic pain, gastrointestinal problems, an autoimmune disease, and/or an endocrine problem at Month 11 of the study (all ps <.05). Data cleaning is ongoing, but similar analyses will be presented examining shift work sleep disorder and insufficient sleep (i.e., average < 6hrs per night) as individual and simultaneous predictors of physical and mental health at baseline and change from baseline to Month 11 (if available). Conclusion These results help to identify associations between insomnia and health conditions in nurses and may contribute to future research that supports evidence-based intervention and prevention strategies for this population. While evidence-based interventions for sleep disturbances and insomnia exist (CBT-I), accessibility and feasibility of scaling such interventions to reach the nursing community at large remains challenging. Support (if any):
Stressors and worries related to the COVID-19 pandemic have contributed to the onset and exacerbation of psychological symptoms such as posttraumatic stress disorder (PTSD). Using a microlongitudinal framework, we uniquely investigated bidirectional associations between daily-level PTSD symptoms and COVID-19 worries.
Abstract Introduction Nurses may experience frequent nightmares due to stressful work environments. Some studies estimate that 35% of nurses experience nightmares related to experiences at work. Nightmares may also exacerbate stress among nurses, although this has yet to be tested empirically. We examined daily bidirectional associations between stress severity and nightmare occurrence and severity, and whether posttraumatic stress disorder (PTSD) symptoms moderated those relationships. Methods 392 nurses (mean age = 39.54 years; SD = 11.15; 92% female; 78% White) were recruited for a larger study on sleep and vaccine response. For 14 days, upon awakening, nurses completed daily sleep diaries to assess previous-day stress severity (0 = not at all, 4 = extremely), as well as nightmare occurrence (0 = no nightmare, 1 = nightmare occurred) and nightmare severity (0 = not at all, 3 = very). PTSD symptoms were assessed at baseline using the PTSD Checklist of DSM-5 (PCL-5). Multilevel models were used to examine bidirectional, within-person associations between daily stress and nightmares, and cross-level moderation by baseline PTSD symptoms. Results Approximately 10.5% of nurses met criteria for PTSD based on PCL-5 scores. 47.2% of nurses reported at least one nightmare across the two weeks. Days with greater stress severity were associated with higher odds of experiencing a nightmare (OR = 1.22, p = 0.001), as well as greater nightmare severity that night (b = 0.09, p = 0.033). Nightmare occurrence (b = 0.15, p < 0.001) was associated with greater next-day stress severity. PTSD symptoms did not moderate daily stress and nightmare associations. Conclusion Nurses face intense occupational demands and frequent exposure to potentially traumatic events. Our results indicated nightmares and stress may occur in a bidirectional fashion among nurses. Results were similar regardless of nurses’ PTSD status. Future studies should explore whether targeting nightmares and stress may improve nurses’ health and well-being. Given the essential role that nurses play in maintaining patient health and safety, it is critical to understand the causes and consequences of their sleep-related disturbances. Support (if any):
