Sleep disturbances and depressive symptoms: an investigation of their longitudinal association in a representative sample of the UK general population.

BACKGROUND: It has been argued that sleep disturbances are a risk factor for depression but previous longitudinal studies have had limitations and not addressed alternative explanations. The aim of this study was to examine the longitudinal association between sleep disturbances and depressive symptoms in a nationally representative sample. METHOD: Data from the 18-month follow-up of the UK National Psychiatric Morbidity survey were used (n = 2406). Sleep disturbances, depressive and other psychiatric symptoms (fatigue, concentration problems, irritability, anxiety and pain symptoms) were assessed using the Revised Clinical Interview Schedule (CIS-R). The bidirectional association between symptoms was investigated with logistic regression analyses and path analysis. RESULTS: Sleep disturbances and depressive symptoms were correlated with each other cross-sectionally (r = 0.52, p < 0.001). In the longitudinal analysis, sleep disturbances at baseline did not predict depressive symptoms at follow-up [odds ratio (OR) 1.27, 95% confidence interval (CI) 0.51-3.19] and the same was observed for the reciprocal association (OR 0.87, 95% CI 0.56-1.35). In the path analysis, the reciprocal model did not have a better fit compared to the simpler first-order model without cross-lagged paths. The path from sleep disturbances at baseline to depressive symptoms at follow-up had a minimal contribution to the explained variance of the latter (<1%). CONCLUSIONS: Previous studies may have overestimated the importance of sleep disturbances as an independent risk factor of depression. The strong cross-sectional association is compatible with sleep disturbances being either a prodromal or a residual symptom of depression and this may have implications for recognition and treatment of depression.

Prevalence of women's worries, anxiety, and depression during pregnancy in a public hospital setting in Greece.

Many studies have examined the prevalence and risk factors of postnatal depression. However, only a few studies have explored the prevalence of anxiety and depressive symptoms in pregnancy. The aim of this study was to investigate the prevalence of worries, antenatal anxiety (AA), and antenatal depression (AD). The sample of this study consisted of 163 pregnant women with gestational age from 11 to 26 weeks. Worries were measured with Cambridge Worry Scale (CWS), anxiety was measured with State-Trait Anxiety Inventory (STAI), and depression was measured with Center for Epidemiologic Studies-Depression scale (CES-D). Depressive symptoms were found in 32.7% of the participants and 44.4% had STAI scores indicating anxiety symptoms of clinical significance. The mean score for total CWS was 26 (SD = 12.3). It is noteworthy that the most important worries in the study sample were "the possibility of something going wrong with the baby", "giving birth", and "financial problems". The prevalence of antenatal anxiety and depression identified in this study is of concern. Screening for antenatal anxiety and depressive symptoms with validated instruments is crucial.

Psychometric properties and factor structure of the Fertility Problem Inventory in a sample of infertile women undergoing fertility treatment.

OBJECTIVE: to examine the psychometric properties of the Fertility Problem Inventory (FPI) originally developed by Newton et al. (1999); as there are no data concerning the factorial structure of the FPI, a special focus is placed on construct validity through factor analysis. SETTING: public hospital in Athens, Greece. DESIGN: a cross-sectional study. PARTICIPANTS: 108 women undergoing fertility treatment with in-vitro fertilisation. METHODS: the FPI was 'forward-backward' translated from English to Greek. The translated instrument was then administered to a set of infertile women for pilot testing. Principal axis factoring with promax rotation was used to test the factor structure of the FPI. Measures of anxiety State Trait Anxiety Inventory, depression (Center for Epidemiologic Studies--Depression Scale) and mood states Profile of Mood States were used to assess the convergent validity of the FPI. Cronbach's α was used to measure internal consistency of the FPI scales. FINDINGS: exploratory factor analysis suggested four factors. The majority of relationship and sexual concern items grouped into one solid factor, named 'spousal concern'. The original scales of social concern, need for parenthood and rejection of childfree lifestyle were reproduced after rearranging nine cross-loading items. Construct validity was confirmed by computing correlations between the derived FPI scales and conceptually similar constructions of anxiety, depression and mood states. Internal consistency reliability was satisfactory. CONCLUSION: the FPI was found to have a relatively stable factor structure and satisfactory reliability, and convergent and discriminant validity. The FPI may enable researchers and clinicians to apply a reliable measure that focuses on various/many dimensions of infertility-related stress.

Impact of cancer patients' disease awareness on their family members' health-related quality of life: a cross-sectional survey.

BACKGROUND: Conflicting results exist concerning disease knowledge and patients' quality of life (QOL) while there is very limited information concerning the impact of awareness on caregivers' health-related quality of life. The aim of this study was to explore the influence of disease awareness on both cancer patients and their caregivers during the period of chemotherapy. MATERIALS AND METHODS: Two hundred and twelve cancer patient-caregiver dyads completed the QOL SF-36 instrument on the day of chemotherapy. Hierarchical multiple linear regression analysis was performed. RESULTS: Physical component parameters were significantly higher in the family members (p<0.001), while their mental component was lower than cancer patients. Younger patients, females, and of higher educational status were more frequently aware of their disease status while patients with gastrointestinal cancer were more likely to be unaware. Disease knowledge seems to exert a negative influence on patients' physical and mental parameters while lack of awareness affects adversely caregivers' vitality, social function, emotional role, and mental health. Multiple regression analysis confirmed disease awareness affected reversely patients' and caregivers' mental QOL while the counter-influence of the dyad was revealed. CONCLUSIONS: A holistic approach to cancer management should be followed. Patient's treatment is the major medical concern, but health system and professionals should be involved in the mental and physical support of caregivers as well. Tailored interventions that focus on the support of the dyad patient-caregiver should be developed.

Factors contributing to the development of burnout in oncology nursing.

The purpose of this study was to determine whether oncology nurses experience higher levels of burnout compared to nurses working in general hospitals, and to further identify the personal and environmental factors that contribute to the development of emotional exhaustion, depersonalization and lack of personal accomplishment. Seven tools, measuring a selected set of demographic, psychological and occupational variables, were administered to 217 female nurses who worked in oncological hospitals and 226 nurses who worked in general hospitals in the area of Athens. Measures used in the study included the Maslach Burnout Inventory, the Hardiness Scale, the Ways of Coping Scale, the Life Style Scale, the Type A Behaviour Scale, a Job Stress Questionnaire and a General Information Questionnaire. No statistically significant difference was revealed in the degree of burnout experienced by nurses in oncology and those in general hospitals. Multiple linear regression analysis suggested that personality characteristics seem to predict a greater percentage of the variability of the burnout experienced than occupational and demographic variables. A sense of personal control over the things that happen in life and in the work environment was found to protect nurses from emotional exhaustion, depersonalization and lack of personal accomplishment.

An investigation of hostile and alexithymic characteristics in breast cancer patients.

Two measures of personality characteristics, the Personality Deviance Scale and the Toronto Alexithymia Scale, were administered to a total sample of 448 women and a subsample of 100 women, respectively, attending two breast-screening centers in Athens. The relative risk of breast cancer between women with low denigratory attitudes towards others and women with high scores in this scale was 2.31. Statistically significant relations were not noted between the mean scores of alexithymia factors and breast cancer diagnosis. Our findings point to the conclusion that breast cancer patients can be distinguished from healthy women on the basis of their cognitive activity, characterized by rare denigratory thoughts.