Direct and Indirect Relationships Between Impaired Sleep, Obesity Risk Factors and Overweight and Obesity

PurposeThe relationship between impaired sleep and overweight/obesity may be explained by sleep-disrupting behaviour that are practised by overweight people (e.g. night-eating, insufficient physical activity [PA], electronic device use) and stress/affective distress. Thus, we evaluated whether sleep parameters predicted overweight/obesity after taking into account the behaviour and affective state.MethodsOnline questionnaires asked about sleep quality, night-eating, PA, electronic device use and stress/affective distress at T1 (baseline) and T2 (3-months later). Height, weight and waist and hip circumference were measured. PA and sleep were assessed over 24-hours on two occasions using actigraphy in 161 participants at T1 and T2.ResultsAt T1, high body mass index (BMI)/waist-to-hip ratio (WHR) and obesity category were together related to more sleep disturbances (subjective) and longer awake time (objective), after controlling covariates (e.g. watching TV) and demographics (e.g. older age, male gender). At T2, high WHR was predicted by older age and male gender after controlling T1 WHR, demographics and covariates. Mediational analyses showed that sleep disturbances mediated nocturnal indigestion (NI) to BMI, poor subjective sleep quality mediated NI to WHR and high daytime dysfunction mediated NI to obesity category relationships.ConclusionMore time spent awake during the night (experienced as more sleep disturbances) was related to overweight/obesity indices even after taking into account other obesity risk factors (e.g. night-eating, insufficient PA, affect) and demographics. Mediational results suggest that NI parsimoniously explained the impaired sleep - overweight/obesity relationship.Level of Evidence: Level III, evidence obtained from well-designed cohort.

Night-eating, Overweight/obesity and Sleep Quality

PurposeImpaired sleep has been reported to be a consequence of overweight/obesity. However, sleep-disrupting behaviour that tend to coexist with overweight/obesity are also independent risk factors for impaired sleep such as night-eating, alcohol use, insufficient physical activity (PA), electronic device use and stress/affective distress. Thus, it is unclear whether night-eating and measures of body fatness will still predict sleep quality once concurrent behaviour and affective state are taken into account. MethodsOnline questionnaires asked participants about sleep quality, night-eating, alcohol use, electronic device use and stress/affective distress at T1 (baseline) and T2 (3-months later). Height, weight and waist and hip circumference was measured at T1 and objective physical activity (PA) was assessed over 24-hours (using actigraphy) in 161 participants at T1 and T2. ResultsAt T1, night-eating was related to poorer subjective sleep quality, longer sleep onset latency, lower sleep efficacy, more sleep disturbances and daytime dysfunction and obesity category was related to daytime dysfunction after controlling demographics and covariates. At T2, high BMI predicted lower sleep efficacy after controlling T1 sleep components, demographics and covariates. ConclusionNight-eating and obesity category were associated with multiple impairments in sleep quality, but only high BMI predicted sleep quality at T2. Thus, night-eating and measures of body fatness predicted sleep quality components at T1 and T2 even after co-existing behaviour and emotional states were taken into account.Level of EvidenceLevel III, evidence obtained from well-designed cohort.

The Link between Chronic Pain and Depression in Low Income Country, Pakistan

Objective: To examine the relationships of chronic pain related variables (interference, support, pain severity, life control, affective distress, significant other’s responses to participant’s pain and general activity level) with depression in chronic pain patients. Method: Cross-sectional survey research was used in this study. The study was carried out on outdoor patients coming in government, semi-government and private hospitals of Lahore city (n=6) from January 2016 to June 2016. Sample consisted of 186 chronic pain patients (mean age=46.92) with organic, identifiable chronic pain problems were recruited through purposive sampling. A personal history questionnaire, West Haven-Yale Multidimensional Pain Inventory (WHYMPI) developed by Kerns, Turk, and Rudy (1985), and Depression subscale of Symptom Checklist Revised developed by Rahman and Sitwat (1990) were administered to the participants. Results: Descriptive analyses, Pearson product moment correlation coefficient, independent samples t-test and stepwise regression with backward elimination method were used to analyze the data. It was revealed that all chronic pain related variables had significant relationships with depressive symptoms. Moreover, interference, affective distress and negative responses were found to be positive predictors while life-control was the negative predictor of depressive symptoms. It was also found that women reported more depressive symptoms than men. Conclusion: The study affirmed the relationships between chronic pain related variables and depressive symptoms and also highlighted the importance of significant other’s support and response to participant pain. The results thus emphasized the significance of familial factors with regard to the presence of depressive symptoms in chronic pain patients. Continuous...

Development and Evaluation of the MAINTAIN Instrument, Selecting Patients Suitable for Secondary or Tertiary Preventive Manual Care – The Nordic Maintenance Care Program

BackgroundChiropractic Maintenance Care (MC) has been found to be effective for patients classified as dysfunctional (high pain severity, marked interference with everyday life due to pain, high affective distress, low perception of life control, and low activity levels) by the Swedish equivalent of the West Haven-Yale Multidimensional Pain Inventory (MPI-S). Although displaying good psychometric properties such as validity and reliability, the instrument was not designed to be used in clinical practice to screen patients for stratified care pathways. To effectively be able to screen for individuals suitable for MC, the aim was to develop a clinical instrument with the intent of identifying dysfunctional patients with acceptable sensitivity, specificity, and discriminant ability.MethodsData from 249 patients with a complete MPI dataset from an RCT that investigated the effect and cost-effectiveness of MC with a 12-month follow-up was used in this cross-sectional analysis. The MPI’s data was used to develop a short screening instrument to identify dysfunctional patients, with a summary measure, based on the original instrument. Different cutoffs were considered with regards to sensitivity, specificity, and discriminant ability and compared to the original instrument’s classification of dysfunctional patients. The instrument was then tested in 3 other existing datasets to assess validity across populations.ResultsUsing an explorative approach, the MAINTAIN instrument with 10 questions (0-6 Likert responses) with 5 dimensions (pain severity, interference, life control, affective distress, and support) was developed, generating an algorithm-based score ranging from -12 to 48. Reporting a MAINTAIN score of 18 or higher, 146 out of the 249 patients were classified as dysfunctional with 95.8% sensitivity and 64.3% specificity. At a score of 22 or higher, 109/249 were classified as dysfunctional with 81.1% sensitivity and 79.2% specificity. Discriminant ability (area under the curve (AUC)) was estimated to 0.87 (95% CI: 0.83, 0.92; p <0.001) and Youden’s index was highest (0.70) at a score of 20. The discriminant ability is similar and acceptable across populations with minor differences in optimal thresholds for identifying dysfunctional individuals.ConclusionThe MAINTAIN instrument had an acceptable performance with regards to identifying dysfunctional patients and may be used as a decision aid in clinical practice. By using 2 thresholds, patients can be categorized into “low probability (-12 to 17)”, “moderate probability (18 to 21)”, and “high probability (22 to 48)” of having a good outcome from maintenance care for Low Back Pain (LBP).Trial registrationClinical trials.gov; NCT01539863; registered February 28, 2012; https://clinicaltrials.gov/ct2/show/NCT01539863

Effectiveness of mindfulness-based stress reduction and attachment-based compassion therapy for the treatment of depressive, anxious and adjustment disorders in mental health settings: A randomized controlled trial

Objectives: To study the effectiveness of Attachment-Based Compassion Therapy (ABCT) for reducing affective distress in a sample of outpatients with depressive, anxiety or adjustment disorders, and to explore its action mechanisms.Methods: This randomised controlled trial involved assessment time points of pre-treatment, post-treatment, and 6-months follow-up. A total of 90 patients from three mental health units in Castellón (Spain) were recruited and randomly assigned to ‘ABCT + treatment as usual (TAU)’, ‘Mindfulness-based stress reduction (MBSR) + TAU’, or ‘TAU’ alone. Affective distress, as measured by the ‘Depression, Anxiety and Stress Scales’ (DASS-21) was the main outcome; self-compassion and mindfulness were also assessed. Multilevel mixed-effects models were performed to estimate the efficacy of the programme, and path analysis were conducted to study the potential mechanistic role of mindfulness and self-compassion.Results: ABCT was not superior to MBSR in any outcome or assessment point. ABCT was superior to TAU both post-treatment (B=-13.20; 95% CI: -19.57, -6.84) and at 12-month follow-up (B=-7.20; 95% CI: -13.63, -0.76) for reducing DASS-21, and MBSR was superior to TAU both post-treatment (B=-11.51; 95% CI: -17.97, -5.05) and at 12-month follow-up (B=-8.59; 95% CI -15.09, -2.10), with large effects (d≥0.90). Changes produced in DASS-21 by ABCT were mediated by self-compassion, while changes produced by MBSR were mediated by both mindfulness and self-compassion.Conclusion: ABCT is efficacious for reducing affective distress in patients with anxiety, depressive or adjustment disorders, although its effect is not superior to MBSR’s. Self-compassion seems to be a significant mediator of the effects of ABCT.