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  • 1.
    Bauducco, Serena
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Flink, Ida
    Örebro University, School of Law, Psychology and Social Work.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Preventing sleep deficit in adolescents: Long-term effects of a quasi-experimental school-based intervention study2020In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, no 1, article id e12940Article in journal (Refereed)
    Abstract [en]

    Adolescents are at risk of sleep deficit, which has serious consequences for their daytime functioning. However, school-based interventions to improve sleep have shown limited success. This might be due to the content of the programmes (e.g., not targeting central factors such as daytime stress and technology use) or because changes have not been captured due to a lack of long-term follow-ups. Hence, the aim of this study was to evaluate the long-term effects of a school-based sleep education curriculum including time-management training. The study used a quasi-experimental design. Participants were 3,622 adolescents (mean age 13.7, 48% girls); 286 were in the intervention group and 3,336 were followed as a natural control group. Data were collected before the intervention and at a 1-year follow-up. We divided participants into three groups according to baseline sleep duration (calculated from self-reported bed- and wake times, minus sleep onset latency): insufficient (<7 hr), borderline (7-8 hr) and adequate (>8 hr). Adolescents in the intervention group were ~2 times less likely to report insufficient sleep at follow-up as compared to controls. Sleep knowledge improved significantly in the intervention group but there were no changes in emotional sleep hygiene (e.g., bedtime worry) and perceived stress. Surprisingly, technology use increased and behavioural sleep hygiene worsened in the intervention group. Although the mechanisms of change need further investigation, the results of this study point to potential long-term benefits of school-based sleep programmes.

  • 2.
    Hysing, Mari
    et al.
    Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health AS, Bergen, Norway.
    Harvey, Allison G.
    Department of Psychology, University of California, Berkeley CA, USA.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Askeland, Kristin G.
    Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health AS, Bergen, Norway; Domain for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway; Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
    Sivertsen, Børge
    Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health AS, Bergen, Norway; Domain for Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway; Department of Psychiatry, Haugesund Sjukehus Helse Fonna, Haugesund, Norway.
    Sleep and academic performance in later adolescence: results from a large population-based study2016In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 25, no 3, p. 318-324Article in journal (Refereed)
    Abstract [en]

    The aim of the current study was to assess the association between sleep duration and sleep patterns and academic performance in 16-19 year-old adolescents using registry-based academic grades. A large population-based study from Norway conducted in 2012, the youth@hordaland-survey, surveyed 7798 adolescents aged 16-19 years (53.5% girls). The survey was linked with objective outcome data on school performance. Self-reported sleep measures provided information on sleep duration, sleep efficiency, sleep deficit and bedtime differences between weekday and weekend. School performance [grade point average (GPA)] was obtained from official administrative registries. Most sleep parameters were associated with increased risk for poor school performance. After adjusting for sociodemographic information, short sleep duration and sleep deficit were the sleep measures with the highest odds of poor GPA (lowest quartile). Weekday bedtime was associated significantly with GPA, with adolescents going to bed between 22:00 and 23:00 hours having the best GPA. Also, delayed sleep schedule during weekends was associated with poor academic performance. The associations were somewhat reduced after additional adjustment for non-attendance at school, but remained significant in the fully adjusted models. In conclusion, the demonstrated relationship between sleep problems and poor academic performance suggests that careful assessment of sleep is warranted when adolescents are underperforming at school. Future studies are needed on the association between impaired sleep in adolescence and later functioning in adulthood.

  • 3.
    Jansson-Fröjmark, Markus
    et al.
    Örebro University, School of Law, Psychology and Social Work. Stockholm University, Stockholm, Sweden.
    Harvey, Allison G.
    Psychology Department, Berkeley University, Berkeley CA, USA.
    Flink, Ida K.
    Örebro University, School of Law, Psychology and Social Work.
    Psychometric properties of the Insomnia Catastrophising Scale2012In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 21, no Suppl. 1, p. 168-168Article in journal (Refereed)
    Abstract [en]

    Objectives:  Few questionnaires have been developed and validated to specifically index insomnia-specific cognitive mechanisms. The purpose of this study was to investigate the psychometric properties of a newly developed instrument, the Insomnia Catastrophising Scale (ICS). We seek to examine the factorial validity and internal consistency, discriminative and convergent validity along with associations with anxiety, depression, sleep parameters, and daytime impairment.

    Methods: Participants (n = 1803) from a randomly selected sample of the general population completed a survey that probed demographics, night-time symptoms, daytime impairment, anxiety and depression.  The ICS was also administered. Excluding those with a sleep disorder other than insomnia, the study sample consisted of 1558 participants.  

    Results: Of the twenty original ICS items, three were removed due to low communality. Exploratory factor analysis of the eleven items indexing night-time catastrophising indicated a one-factor solution (59.1% variance), strong primary loadings, and high internal consistency (α = .92). Analysis of the six items indexing daytime catastrophising indicated a one-factor solution (70.1% variance), strong primary loadings, and high internal consistency (α = .91). The internal consistency for the total ICS was .95. At scale-, subscale-, and item-levels significant mean differences were noted between three groups which differed on insomnia symptomatology; the insomnia disorder group (n = 113) reported significantly higher scores than the poor sleep (n = 247) and normal sleep groups (n = 1157), and the poor sleep group exhibited significantly higher scores than the normal sleep group. Receiver operating characteristics analyses indicated that when using an optimal cut-off for the ICS, the sensitivity was 84.1% (detecting those with insomnia disorder) and specificity was 81.5% (detecting those with normal sleep). The ICS was significantly associated with anxiety and depression (ρ = .44-.54), total wake time (η = .38), total sleep time (η = .29), sleep quality (ρ = .49), and daytime impairment (ρ = .57).

    Conclusion: The ICS can be considered as a reliable and valid questionnaire for indexing insomnia-specific catastrophising. The use of the ICS is recommended in research and clinical settings for assessing insomnia-related catastrophising.  

  • 4.
    Jansson-Fröjmark, Markus
    et al.
    Örebro University, School of Law, Psychology and Social Work. Stockholm University, Stockholm, Sweden.
    Harvey, Allison G.
    Psychology Department, Berkeley University, San Francisco, USA.
    Norell-Clarke, Annika
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven J.
    Örebro University, School of Law, Psychology and Social Work.
    Associations between psychological factors and night-time/daytime symptomatology in insomnia2012In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 21, no Suppl. 1, p. 168-169Article in journal (Refereed)
    Abstract [en]

    Objectives: Cognitive models of insomnia underscore cognitive mechanisms as important in the maintenance of insomnia. The aim of this study was to examine psychological factors in insomnia and the association between psychological mechanisms with night-time and daytime symptoms.

    Methods: In a cross-sectional examination, participants (n = 2327) from a randomly selected sample of the general population completed a survey on demographic parameters, night-time symptoms, daytime impairment, health outcomes, and psychological factors intended to index five cognitive processes (Harvey, 2002). Excluding those with a sleep disorder other than insomnia, the study sample consisted of 1890 participants.  

    Results: Relative to poor and normal sleepers, the insomnia group scored higher on worry, beliefs, physiologic arousal, monitoring/attentional bias, and safety behaviours relative to the other two groups, and the poor sleepers exhibited a similar pattern relative to the normal sleepers. High total wake time was associated with more worry, physiologic arousal, and safety behaviours (26.3% variance), low sleep restoration with more worry, unhelpful beliefs, and monitoring/attentional bias (28.2% variance), and low sleep quality with higher scores on all the psychological mechanisms (35.8% variance). Elevated daytime symptoms were related to more unhelpful beliefs and monitoring/attentional bias (44.3% variance).

    Conclusion: The findings show that psychological factors discriminate those with insomnia from those with poor or normal sleep. The results also indicate that psychological factors are linked to insomnia-specific night-time and daytime symptomatology.

  • 5.
    Jansson-Fröjmark, Markus
    et al.
    Örebro University, School of Law, Psychology and Social Work. Dept Psychol, Stockholm Univ, Stockholm, Sweden.
    Norell-Clarke, Annika
    Örebro University, School of Law, Psychology and Social Work.
    Linton, Steven
    Örebro University, School of Law, Psychology and Social Work.
    The role of emotion dysregulation in insomnia: longitudinal findings from a large community sample2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, p. 133-134Article in journal (Other academic)
  • 6.
    Norell-Clarke, Annika
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Jansson-Fröjmark, Markus
    Örebro University, School of Law, Psychology and Social Work. Stockholm University, Stockholm, Sweden.
    Holländare, Fredrik
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiat Res Ctr, Örebro, Sweden.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiat Res Ctr, Örebro, Sweden.
    An investigation of dysfunctional beliefs as a mediator of cognitive behavioural therapy for insomnia in a sample with insomnia and depression2014In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 23, p. 217-217Article in journal (Other academic)
  • 7.
    Tucker, P.
    et al.
    Stockholm University, Stockholm, Sweden.
    Bejerot, Eva
    Stockholm University, Stockholm, Sweden.
    Åkerstedt, T.
    Stockholm University, Stockholm, Sweden.
    Sleep quality as a mediator in the relationship between doctors' worktime control and patient safety2012In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 21, no Suppl. 1, p. 273-273Article in journal (Other academic)
    Abstract [en]

    Objective: Poorer worktime control is associated with greater sleep disturbances. The fatigue that results from poor quality sleep may pose a threat job performance. Thus the current study seeks to determine whether the relationship between doctors' worktime control and their perceptions of the risk of medical error is mediated by sleep quality.

    Method: A representative sample of doctors in Sweden (N = 1534) completed a questionnaire about working conditions, wellbeing and patient safety (response rate 53.1%). Worktime control was measured by two items which asked respondents: (1) whether they could influence their work hours; and (2) whether they had access to flexitime (response options ‘‘yes’’, ‘‘yes, to some extent’’ and ‘‘no’’). Concerns about patient safety were measured by two items which asked respondents: (1) how much they worried about the risk of making mistakes (five response options from ‘‘no, never’’ to ‘‘yes, constantly’’); and (2) how often they felt that their workload increased the risk of malpractice (four response options from ‘‘daily’’ to ‘‘less than once a month’’). Sleep quality was measured by the Karolinska Sleep Quality Index (KSQI), calculated as the mean score of responses to four items which asked participants how often they had experienced each of the following sleep symptoms in the last three months: difficulty falling asleep, repeated awakenings with difficulty falling back to sleep, too early (final) awakening and interrupted / restless sleep (range of possible scores: 1 – Never; 5 – Always/5 times or more per week).

    Results: There were significant associations between both worktime control measures, both patient safety measures and scores on the KSQI. Mediation analyses (Sobel test for mediation) indicated that the associations between each worktime control measure and each patient safety measure were mediated by sleep quality (P < 0.0001 in each case).

    Conclusion: Worktime control allows doctors to optimise the fit between the demands of their work schedule, and their own personal needs and circumstances. In doing so, it facilitates sleep and recovery between duty periods, thereby enhancing job performance and promoting patient safety.

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