Longitudinal associations between insomnia symptoms and all-cause mortality among middle-aged and older adults: A population-based cohort study

To date, there is no scientific consensus on whether insomnia symptoms increase mortality risk. We investigated longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, and non-restorative sleep) and all-cause mortality among middle-aged and older adults during 14 years of follow-up. Data were obtained from 2004 through 2018 survey waves of the Health and Retirement Study in the United States for a population-representative sample of 15,511 respondents who were ≥50 years old in 2004. Respondents were interviewed biennially and followed through the end of the 2018 survey wave for the outcome. Marginal structural discrete-time survival analyses were employed to account for time-varying confounding and selection bias. Of the 15,511 cohort respondents (mean [±SD] age at baseline, 63.7 [±10.2] years; 56.0% females), 5,878 (31.9%) died during follow-up. At baseline (2004), 41.6% reported experiencing at least one insomnia symptom. Respondents who experienced one (HR=1.11; 95% CI: 1.03–1.20), two (HR=1.12; 95% CI: 1.01–1.23), three (HR=1.15; 95% CI: 1.05–1.27), or four (HR=1.32; 95% CI: 1.12–1.56) insomnia symptoms had on average a higher hazard of all-cause mortality, compared to those who were symptom-free. For each insomnia symptom, respondents who experienced difficulty initiating sleep (HR=1.12; 95% CI: 1.02–1.22), early-morning awakening (HR=1.09; 95% CI: 1.01–1.18), and nonrestorative sleep (HR=1.17; 95% CI: 1.09–1.26), had a higher hazard of all-cause mortality compared to those not experiencing the symptom. The findings demonstrate significant associations between insomnia symptoms and all-cause mortality, both on a cumulative scale and independently, except for difficulty maintaining sleep. Further research should investigate the underlying mechanisms linking insomnia symptoms and mortality.

Longitudinal Associations of Adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Lifestyle Recommendations with Quality of Life and Symptoms in Colorectal Cancer Survivors up to 24 Months Post-Treatment

Post-treatment adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations were associated with health-related quality of life (HRQoL), fatigue, and chemotherapy-induced peripheral neuropathy (CIPN) in colorectal cancer (CRC) survivors. In a prospective cohort among CRC survivors (n = 459), repeated home-visits were performed at 6 weeks, 6, 12, and 24 months post-treatment. Dietary intake, body composition, sedentary behaviour, and physical activity were assessed to construct a lifestyle score based on adherence to seven 2018 WCRF/AICR recommendations. Longitudinal associations of the lifestyle score with HRQoL, fatigue, and CIPN were analysed by confounder-adjusted linear mixed models. A higher lifestyle score was associated with better physical functioning and less activity-related fatigue, but not with CIPN. Adjustment for physical activity substantially attenuated observed associations, indicating its importance in the lifestyle score with regards to HRQoL. In contrast, adjustment for body composition and alcohol inflated observed associations, indicating that both recommendations had a counteractive influence within the lifestyle score. Our findings suggest that CRC survivors benefit from an overall adherence to the WCRF/AICR lifestyle recommendations in terms of HRQoL and fatigue, but not CIPN. Specific recommendations have a varying influence on these associations, complicating the interpretation and requiring further study.

The impact of depression diagnosis on diabetes and lifetime hyperglycaemia

Aims The aim of this study was to evaluate longitudinal associations between the mean and variability of HbA1c levels in individuals with type 2 diabetes (T2D) and major depressive disorder (MDD). Methods Individuals with T2D from the UK Biobank with linked primary care records were analysed. An HbA1c measurement within +/- 6-months of T2D diagnosis was taken as baseline, with subsequent HbA1c measurements used as the outcome in generalised least squares regression to evaluate longitudinal associations with a three-level MDD diagnosis variable (MDD controls, pre-T2D MDD cases and post-T2D MDD cases). Results Using 7,968 T2D individuals, we show that MDD has utility in explaining mean HbA1c levels (p=6.53E-08). This is attributable to MDD diagnosis interacting with baseline T2D medication (p=3.36E-04) and baseline HbA1c (p=2.66E-05), but not with time- when all else is equal, the temporal trend in expected HbA1c did not differ by MDD diagnosis. However, joint consideration with baseline T2D medication showed that each additional medication prescribed was associated with a +4 mmol/mol (2.5%) increase in expected HbA1c across follow up for post-T2D MDD cases, relative to pre-T2D MDD cases and MDD controls. Furthermore, variability in HbA1c increased across time for post-T2D MDD cases but decreased for MDD controls and pre-T2D MDD cases. Conclusions These findings suggest closer monitoring of individuals with both T2D and MDD is essential to improve their diabetic control, particularly for those who develop MDD after T2D diagnosis.

Parsing between- and within-person effects: Longitudinal associations between irritability and internalizing and externalizing problems from early childhood through adolescence

Introduction: This report examines between- and within-person associations between youth irritability and concurrent and prospective internalizing and externalizing symptoms from early childhood through adolescence. Distinguishing between- and within-person longitudinal associations may yield distinct, clinically relevant information about pathways to multifinality from childhood irritability. Methods: Children’s irritability and co-occurring symptoms were assessed across five waves between ages 3 and 15 years using the mother-reported Child Behavior Checklist (N = 605, 46% female). Parental history of depressive disorders was assessed with a clinical interview. Results: Results demonstrated that between- and within-person irritability were uniquely associated with concurrent depressive, anxiety, and defiance symptoms, but not ADHD. Prior wave within-person irritability also predicted next wave depressive, anxiety, and defiance symptoms, controlling for prior symptoms; these prospective associations were bidirectional. Child sex and parental depressive disorders moderated associations. Discussions: Findings identify pathways from within- and between-person irritability to later internalizing and externalizing psychopathology. Results demonstrate the importance of parsing within- and between-person effects to understand nuanced relations among symptoms over childhood.

Indirect aggression, anxiety, and empathy: Disaggregating between and within person longitudinal associations during childhood and adolescence

Although indirectly aggressive behavior and anxiety symptoms can co-occur, it is unclear whether anxiety is an antecedent or outcome of indirect aggression at the individual level and whether other personality traits can contribute to these longitudinal associations. Therefore, the between- and within-person associations among indirect aggression, anxiety symptoms, and empathic concern were examined across adolescence from ages 11 to 16 in a cohort of individuals followed annually (N = 700; 52.9% girls; 76.0% White) controlling for direct aggression and demographic variables. Results of autoregressive latent trajectory models with structured residuals supported an acting out model at the within-person level. Specifically, anxiety symptoms positively predicted indirect aggression and indirect aggression negatively predicted empathic concern at each adjacent time point. These findings suggest that methods of reducing worries about the self and increasing healthy self-confidence could prevent indirect aggression and help build concern and compassion toward others.

Negative emotionality and peer status: Evidence for bidirectional longitudinal influences during the elementary school years

Prior research indicates that high negative emotionality in combination with low peer status is conducive of clinically identified problems in childhood. This three-wave longitudinal study examined how negative emotionality and peer status are linked over time in middle and late childhood. Participants were recruited from second grade ( n = 90, mean age = 8.85) and fourth grade ( n = 119, mean age = 10.81) and were followed across a period of 2 years. Cross-lagged structural models examining concurrent and longitudinal associations between teacher-reported negative emotionality and peer ratings of likability were analyzed separately for externalizing emotion (anger) and internalizing emotion (sadness and fear). Both analyses provided support for a conceptual model in which high negative emotionality lowers peer status, and low peer status, in turn, through a feedback loop, increases negative emotionality over time. Bidirectional influences are interpreted as reflecting a transactional process involving the effects of negative emotionality on social behavior. The findings highlight the need for active efforts to help children with high negative emotionality gain acceptance from classmates.