Early predictors of impaired sleep: a study on life course socioeconomic conditions and sleeping problems in older adults.

Objectives: This study aimed to assess how childhood socioeconomic conditions are associated with sleeping problems in older adults and how this association may be mediated by socioeconomic conditions across the lives of individuals using a life course perspective. Since the life course opportunities differ systematically between men and women, attention was given to gender differences in the association.Methods: Data from 23,766 individuals aged over 50 years of the longitudinal Survey of Health, Ageing and Retirement in Europe (SHARE) were used. Logistic mixed-effect models were estimated to examine the associations between childhood socioeconomic conditions and the presence of sleeping problems.Results: For women, the analyses showed an association between childhood socioeconomic conditions and sleeping problems. For men, only current socioeconomic conditions were found to be relevant for sleep. The importance of childhood socioeconomic conditions for sleeping problems did not affect the evolution of sleeping problems over ageing.Conclusion: In this study no empirical support was found for processes of cumulative advantage/disadvantage or age-as-leveler. However, childhood does seem to be a critical period for the sleep of women, because the association with childhood socioeconomic conditions remains even when the circumstances later in life are considered. These findings, in particular the gender differences in the association, underline the importance of tracking life course patterns in the study of sleeping problems in older adults.

Associations of regrets and coping strategies with job satisfaction and turnover intention: international prospective cohort study of novice healthcare professionals.

AIMS OF THE STUDY: (1) To assess the associations of care-related regrets with job satisfaction and turnover intention; and (2) to examine whether these associations are partially mediated by coping strategies. METHODS: Data came from ICARUS, a prospective international cohort study of novice healthcare professionals working in acute care hospitals and clinics from various countries (e.g., Australia, Austria, Botswana, Canada, Denmark, France, Haiti, Ireland, Kenya, the United Kingdom and United States). Care-related regrets (number of regrets and regret intensity), coping strategies, job satisfaction and turnover intention were assessed weekly for 1 year. RESULTS: 229 young healthcare professionals (2387 observations) were included in the analysis. For a given week, experiencing a larger number of care-related regrets was associated with decreased job satisfaction, and experiencing more intense care-related regrets was associated with increased turnover intention. These associations were partially mediated by coping strategies. Maladaptive emotion-focused strategies were associated with decreased job satisfaction and increased turnover intention, whereas adaptive problem-focused strategies showed the opposite pattern. CONCLUSIONS: Our results revealed that care-related regrets and maladaptive coping strategies are associated with job dissatisfaction and the intention to quit patient care. Helping healthcare professionals to cope with these emotional experiences seems essential to prevent early job quitting.  .

Too Imperfect to Fall Asleep: Perfectionism, Pre-sleep Counterfactual Processing, and Insomnia.

Previous research suggests that certain dimensions of perfectionism are associated with insomnia. However, the exact processes whereby perfectionism may influence sleep have as yet remained unexplored. The present study tested the hypothesis that perfectionistic individuals are particularly prone to engage in counterfactual thinking and to experience counterfactual emotions (regret, shame, and guilt) at bedtime, which have been shown to impair sleep. One hundred eighty university students completed questionnaires on perfectionism, counterfactual processing, and insomnia severity. Analyses revealed that three dimensions of perfectionism were significantly related to insomnia severity: Concern over mistakes and doubts about action showed positive correlations, whereas organization showed a negative correlation. Moreover, the frequency of counterfactual thoughts and emotions at bedtime largely mediated the effects of these dimensions of perfectionism on insomnia severity. These findings highlight how personality-related patterns of behavior may translate into affective arousal at bedtime, thereby increasing the risk of insomnia.

"We Won't Retire Without Skeletons in the Closet": Healthcare-Related Regrets Among Physicians and Nurses in German-Speaking Swiss Hospitals.

Physicians and nurses are expected to systematically provide high-quality healthcare in a context marked by complexity, time pressure, heavy workload, and the influence of nonclinical factors on clinical decisions. Therefore, healthcare professionals must eventually deal with unfortunate events to which regret is a typical emotional reaction. Using semistructured interviews, 11 physicians and 13 nurses working in two different hospitals in the German-speaking part of Switzerland reported a total of 48 healthcare-related regret experiences. Intense feelings of healthcare-related regrets had far-reaching repercussions on participants' health, work-life balance, and medical practice. Besides active compensation strategies, social capital was the most important coping resource. Receiving superiors' support was crucial for reaffirming professional identity and helped prevent healthcare professionals from quitting their job. Findings suggest that training targeting emotional coping could be beneficial for quality of life and may ultimately lead to lower job turnover among healthcare professionals.

Self-Rated Health and Sick Leave among Nurses and Physicians: The Role of Regret and Coping Strategies in Difficult Care-Related Situations.

Moral distress - such as feeling strong regret over difficult patient situations - is common among nurses and physicians. Regret intensity, as well as the coping strategies used to manage regrets, may also influence the health and sickness absence of healthcare professionals. The objective of this study was to determine if the experience of regret related to difficult care-related situations is associated with poor health and sick leave and if coping strategies mediate these associations. Two cross-sectional surveys were conducted in Switzerland (Geneva, 2011 and Zurich, 2014). Outcomes were self-rated health (SRH) and sick leave in the last 6 months. We examined the associations of regret intensity with the most important care-related regret, number of recent care-related regrets, and coping strategies, using regressions models. Among 775 respondents, most reported very good SRH and 9.7% indicated absence from work during four working days or more. Intensity of the most important regret was associated with poor SRH among nurses and physicians, and with higher sick leave among nurses. Maladaptive emotion-focused strategies were associated with poor SRH among nurses, whereas adaptive emotion-focused strategies were positively associated with higher SRH and lower sick leave among physicians. Because care-related regret is an integral part of clinical practice in acute care hospitals, helping physicians and, especially, nurses to learn how to deal with negative events may yield beneficial consequences at the individual, patient care, and institutional level.

Validation of the German version of two scales (RIS, RCS-HCP) for measuring regret associated with providing healthcare.

BACKGROUND: The regret intensity scale (RIS) and the regret coping scale for healthcare professionals (RCS-HCP) working in hospitals assess the experience of care-related regrets and how healthcare professional deal with these negative events. The aim of this study was to validate a German version of the RIS and the RCS-HCP. METHODS: The RIS and RCS-HCP in German were first translated into German (forward- and backward translations) and then pretested with 16 German-speaking healthcare professionals. Finally, two surveys (test and 1-month retest) administered the scales to a large sample of healthcare professionals from two different hospitals. RESULTS: Of the 2142 eligible healthcare professionals, 494 (23.1%) individuals (108 physicians) completed the cross-sectional web based survey and 244 completed the retest questionnaire. Participants (n = 165, 33.4% of the total sample) who reported not having experienced a regret in the last 5 years, had significantly more days of sick leave during the last 6 months. These participants were excluded from the subsequent analyses. The structure of the scales was similar to the French version with a single dimension for the regret intensity scale (Cronbach's alpha: 0.88) and three types of coping strategies for the regret coping scale (alphas: 0.69 for problem-focused strategies, 0.67 for adaptive strategies and 0.86 for the maladaptive strategies). Construct validity was good and reproduced the findings of the French study, namely that higher regret intensity was associated with situations that entailed more consequences for the patients. Furthermore, higher regret intensity and more frequent use of maladaptive strategies were associated with more sleep difficulties and less work satisfaction. CONCLUSIONS: The German RIS and RCS-HCP scales were found valid for measuring regret intensity and regret coping in a population of healthcare professionals working in a hospital. Reporting no regret, which corresponds to the coping strategy of suppression, seems to be a maladaptive strategy because it was associated with more frequent sick day leaves.

Healthcare-Related Regret among Nurses and Physicians Is Associated with Self-Rated Insomnia Severity: A Cross-Sectional Study.

To examine the association between healthcare-related regrets and sleep difficulties among nurses and physicians, we surveyed 240 nurses and 220 physicians at the University Hospitals of Geneva. Regret intensity and regret coping were measured using validated scales. Sleep difficulties were measured using the Insomnia Severity Index (ISI), and an additional question assessed the frequency of sleeping pill use. After controlling for sex, profession, years of experience, rate of employment, and depression as well as for all other regret-related variables, the following variables remained significantly associated with self-rated severity of insomnia: regret intensity (slope = 1.32, p = 0.007, 95%CI: [0.36; 2.29], std. coefficient = 0.16) and maladaptive (e.g., rumination) emotion-focused coping (slope = 1.57, p = 0.002, 95%CI: [0.60; 2.55], std. coefficient = 0.17) remained significant predictors of self-rated insomnia severity. If these cross-sectional associations represent causal effects, the development of regret-management programs may represent a promising approach to mitigating sleep difficulties of healthcare professionals.

The Relations Between Sleep, Personality, Behavioral Problems, and School Performance in Adolescents.

According to recent meta-analyses, adolescents across different countries and cultures do not get the recommended amount of sleep. Extracurricular activities, part-time jobs, and use of electronic devices in the evening delay bedtime in adolescents. Early school start times also shorten the time for sleep. Insufficient sleep in adolescents has been associated with weakened emotional-behavioral regulation and poor academic achievement. Multicomponent intervention programs have been developed on the basis of cognitive-behavioral therapy for insomnia to improve sleep in youth.

Effect of numbering of return envelopes on participation, explicit refusals, and bias: experiment and meta-analysis.

BACKGROUND: Tracing mail survey responses is useful for the management of reminders but may cause concerns about anonymity among prospective participants. We examined the impact of numbering return envelopes on the participation and the results of a survey on a sensitive topic among hospital staff. METHODS: In a survey about regrets associated with providing healthcare conducted among hospital-based doctors and nurses, two randomly drawn subsamples were provided numbered (N = 1100) and non-numbered (N = 500) envelopes for the return of completed questionnaires. Participation, explicit refusals, and item responses were compared. We also conducted a meta-analysis of the effect of questionnaire/envelope numbering on participation in health surveys. RESULTS: The participation rate was lower in the "numbered" group than in the "non-numbered" group (30.3% vs. 35.0%, p = 0.073), the proportion of explicit refusals was higher in the "numbered" group (23.1% vs 17.5%, p = 0.016), and the proportion of those who never returned the questionnaire was similar (46.6% vs 47.5%, p = 0.78). The means of responses differed significantly for 12 of 105 items (11.4%), which did not differ significantly from the expected frequency of type 1 errors, i.e., 5% (permutation test, p = 0.078). The meta-analysis of 7 experimental surveys (including this one) indicated that numbering is associated with a 2.4% decrease in the survey response rate (95% confidence interval 0.3% to 4.4%). CONCLUSIONS: Numbered return envelopes may reduce the response rate and increase explicit refusals to participate in a sensitive survey. Reduced participation was confirmed by a meta-analysis of randomized health surveys. There was no strong evidence of bias.

Validation of a 10-item care-related regret intensity scale (RIS-10) for health care professionals.

BACKGROUND: Regret after one of the many decisions and interventions that health care professionals make every day can have an impact on their own health and quality of life, and on their patient care practices. OBJECTIVES: To validate a new care-related regret intensity scale (RIS) for health care professionals. RESEARCH DESIGN: Retrospective cross-sectional cohort study with a 1-month follow-up (test-retest) in a French-speaking University Hospital. SAMPLE: A total of 469 nurses and physicians responded to the survey, and 175 answered the retest. MEASURES: RIS, self-report questions on the context of the regret-inducing event, its consequences for the patient, involvement of the health care professionals, and changes in patient care practices after the event. We measured the impact of regret intensity on health care professionals with the satisfaction with life scale, the SF-36 first question (self-reported health), and a question on self-esteem. RESULTS: On the basis of factor analysis and item response analysis, the initial 19-item scale was shortened to 10 items. The resulting scale (RIS-10) was unidimensional and had high internal consistency (α=0.87) and acceptable test-retest reliability (0.70). Higher regret intensity was associated with (a) more consequences for the patient; (b) lower life satisfaction and poorer self-reported health in health care professionals; and (c) changes in patient care practices. Nurses reported analyzing the event and apologizing, whereas physicians reported talking preferentially to colleagues, rather than to their supervisor, about changing practices. CONCLUSIONS: The RIS is a valid and reliable measure of care-related regret intensity for hospital-based physicians and nurses.

Cognitive and affective control in insomnia.

Insomnia is a prevalent disabling chronic disorder. The aim of this paper is fourfold: (a) to review evidence suggesting that dysfunctional forms of cognitive control, such as thought suppression, worry, rumination, and imagery control, are associated with sleep disturbance; (b) to review a new budding field of scientific investigation - the role of dysfunctional affect control in sleep disturbance, such as problems with down-regulating negative and positive affective states; (c) to review evidence that sleep disturbance can impair next-day affect control; and (d) to outline, on the basis of the reviewed evidence, how the repetitive-thought literature and the affective science literature can be combined to further understanding of, and intervention for, insomnia.

Regrets associated with providing healthcare: qualitative study of experiences of hospital-based physicians and nurses.

BACKGROUND: Regret is an unavoidable corollary of clinical practice. Physicians and nurses perform countless clinical decisions and actions, in a context characterised by time pressure, information overload, complexity and uncertainty. OBJECTIVE: To explore feelings associated with regretted clinical decisions or interventions of hospital-based physicians and nurses and to examine how these regrets are coped with. METHOD: Qualitative study of a volunteer sample of 12 physicians and 13 nurses from Swiss University Hospitals using semi-structured interviews and thematic analysis RESULTS: All interviewees reported at least one intense regret, which sometimes led to sleep problems, or taking sickness leave. Respondents also reported an accumulation effect of small and large regrets, which sometimes led to quitting one's unit or choosing another specialty. Respondents used diverse ways of coping with regrets, including changing their practices and seeking support from peers and family but also suppression of thoughts related to the situation and ruminations on the situation. Another coping strategy was acceptance of one's limits and of medicine's limits. Physicians reported that they avoided sharing with close colleagues because they felt they could lose their credibility. CONCLUSIONS: Since regret seems related to both positive and negative consequences, it is important to learn more about regret coping among healthcare providers and to determine whether training in coping strategies could help reduce negative consequences such as sleep problems, absenteeism, or turnover.

Nocturnal regrets and insomnia in elderly people.

Despite their importance for general health, emotion-related factors have rarely been considered in the etiology of late-life insomnia. This study explored the relations between impulsivity, regret experiences, use of different thought-control strategies, and insomnia severity in a sample of older adults whose age ranged from 51 to 98 years. Results revealed that: (a) regret frequency varies across the hours of the day, with a peak in the evening when people are trying to fall asleep; (b) individuals scoring high on impulsive urgency are particularly prone to experience nocturnal regrets; (c) nocturnal regrets are associated with insomnia severity, independently of other well-known risk factors such as depression, sleep-interfering medical conditions, and medications; and (d) the thought-control strategies of self-attacking, thought suppression, and worry are positively associated with the frequency of nocturnal regrets and insomnia severity. These findings indicate that dysfunctional regret regulation plays an important role for sleep disturbances in elderly people.

Young poor sleepers mobilize extra effort in an easy memory task: evidence from cardiovascular measures.

Insomniacs often complain of memory deficits, yet objective measures have not consistently corroborated their subjective impressions. A possible explanation for the partial gap between self-report and behavioral measures of memory impairment is that insomniacs recruit extra effort to compensate for the consequences of poor sleep. The present study investigated whether subjective insomnia severity would predict objective effort mobilization, as indexed by cardiovascular measures, in an easy memory task. Seventy-seven university students, mostly women, with a mean age of 22 years were asked to memorize four strings of four random letters in 5 min while cardiovascular measures were obtained. After taking an immediate recall test, participants completed the Insomnia Severity Index, the Multidimensional Fatigue Inventory, and a questionnaire on last night's sleep and today's fatigue. Finally, they were given a surprise delayed recall test. Analyses indicated that self-reported insomnia severity was associated with an increase in systolic blood pressure during the learning phase. Regarding memory performance, insomnia severity was unrelated to immediate recall but related to a decrement in delayed recall. These findings reveal for the first time that subjective insomnia severity predicts objective effort mobilization in an easy memory task, suggesting that young poor sleepers recruit extra resources to cope with everyday cognitive challenges.

Linking impulsivity to dysfunctional thought control and insomnia: a structural equation model.

According to cognitive models of insomnia, excessive mental activity at bedtime may be viewed as an important impediment to the process of falling asleep. A further assumption of these models is that 'cognitive arousal' may be perpetuated and exacerbated by counterproductive strategies of thought management. As yet, little is known about factors that may predispose people to rely on these strategies when confronted with thoughts that keep them awake at night. This study examined the relations between impulsivity, use of different thought-control strategies and insomnia severity. A sample of 391 university students completed the UPPS Impulsive Behavior Scale, the Thought Control Questionnaire Insomnia-Revised and the Insomnia Severity Index. Correlation analyses revealed that two facets of impulsivity (urgency and lack of perseverance), two strategies of thought control (aggressive suppression and worry) and insomnia severity were positively associated. Follow-up structural equation modeling analyses showed that the two mentioned thought-control strategies mediated the effects of the two facets of impulsivity on sleep problems. These findings extend existing cognitive accounts of insomnia by suggesting how predisposing and perpetuating factors may be related: specific personality traits may incline individuals to respond with dysfunctional thought-control strategies to unwanted mental activity at night.

Anatomy of the White Bear Suppression Inventory (WBSI): a review of previous findings and a new approach.

The White Bear Suppression Inventory (WBSI; Wegner & Zanakos, 1994) was originally designed to assess people's inclination toward thought suppression. In this article, we provide a detailed review of previous findings on the structure of this instrument and present a study that took a new statistical approach. It involved an exploratory factor analysis of the French WBSI using the weighted least squares mean and variance estimator as well as parametric item response theory analyses. Results clearly supported a 2-factor structure with a "suppression" and an "intrusion" dimension. Follow-up regression analyses revealed that intrusion significantly predicted anxiety and depression scores, whereas suppression did not.

The aftermath of rash action: sleep-interfering counterfactual thoughts and emotions.

A consistent body of evidence suggests that excessive cognitive activity at bedtime is a key factor in insomnia. It is generally assumed that sleep-interfering cognitions are affect laden, but still little is known about the precise nature of the affective processes that are involved. The present study sought to explore the role of counterfactual thinking and counterfactual emotions (regret, shame, and guilt) in insomnia as a function of impulsivity. It was hypothesized that when retiring for the night, individuals scoring high on urgency review their rash daytime behavior and are therefore likely to engage in counterfactual thinking and to experience associated feelings of regret, shame, and guilt. A sample of 101 undergraduate students completed three questionnaires: the UPPS Impulsive Behavior Scale, the Bedtime Counterfactual Processing Questionnaire, and the Insomnia Severity Index. Results indicated that both urgency and counterfactual processing were related to insomnia severity and that the effect of urgency on insomnia was mediated by counterfactual processing. These findings reveal for the first time that impulsivity relates to counterfactual cognitive-affective processing and that this type of processing contributes to sleep disturbances.

Facets of impulsivity are differentially linked to insomnia: evidence from an exploratory study.

This study investigated the association between insomnia and four facets of impulsivity as distinguished by Whiteside and Lynam (2001): urgency, (lack of) premeditation, (lack of) perseverance, and sensation seeking. A sample of 233 university students completed the UPPS Impulsive Behavior Scale, the Insomnia Severity Index, and a short questionnaire on sleep-related mentation. Correlational analyses revealed that urgency was related to insomnia severity and insomnia-related impairments in daytime functioning, and that lack of perseverance was related to insomnia-related impairments in daytime functioning. Follow-up analyses showed that the frequency of disturbing thoughts and visions during the pre-sleep period partially mediated the relation between urgency and sleep-initiation problems, and that the frequency of disturbing dreams and nightmares partially mediated the relation between urgency and sleep-maintenance problems. These findings suggest that the facets of impulsivity are differentially linked to insomnia and that urgency is associated with sleep-interfering nighttime mentation.

Dreaming of white bears: the return of the suppressed at sleep onset.

The present study examined the effects of thought suppression on sleep-onset mentation. It was hypothesized that the decrease of attentional control in the transition to sleep would lead to a rebound of a suppressed thought in hypnagogic mentation. Twenty-four young adults spent two consecutive nights in a sleep laboratory. Half of the participants were instructed to suppress a target thought, whereas the other half freely thought of anything at all. To assess target thought frequency, three different measures were used in the wake state and mentation reports were repeatedly prompted by a computer at sleep onset. In support of the hypothesis, results revealed a reversal of target thought frequency at sleep onset: Participants instructed to suppress reported fewer target thoughts than did controls before falling asleep, but more target thoughts afterwards.