A Study Of Sleep Quality And The Effect Of Mindfulness-based Intervention Among Hospitalized Patients With Anxiety Or Depressive Disorders

Objective:To analyze the status and related factors of sleep among hospitalized patients with anxiety or depressive disorders,and analyze the relationship between mindfulness level and sleep quality;Further,to test the preliminary effect of a short-term mindfulness-based intervention on the improvement of sleep quality among hospitalized patients,in order to provide the basis for the development of targeted sleep interventions.Methods:This research includes two parts:a cross-sectional study and a non-randomized controlled experimental study.First,during December 2016 and January 2018,276 hospitalized patients diagnosed with anxiety or depressive disorders at a tertiary mental health institution in Shandong province were recruited.A self-developed information questionnaire,the Pittsburgh Sleep Quality Index(PSQI),Generalized Anxiety Disorder 7-item scale(GAD-7),the Patient Health Questionnaire(PHQ-9)and the Mindfulness Attention Awareness Scale(MAAS)were used to evaluate sleep quality,anxiety symptoms,depressive symptoms,and mindfulness levels.Secondly,a total of 80 hospitalized patients diagnosed with anxiety or depressive disorders were recruited and divided into control group and intervention group.A four-week mindfulness intervention based on body scanning was used,and the sleep quality of patients in the two groups was assessed using PSQI after intervention.SPSS 22.0 statistical software was used for data processing,and main statistical analytical methods included descriptive,statistics,correlation analysis,hierarchical regression analysis,repeated measure analysis of variance.The PROCESS 2.16 Macro package was used to analyze the moderating effect of baseline mindfulness level.Results:1.Social demographic and clinical information among the hospitalized patientsThe age range of patients was 18?70 years old,99(35.9%)of the patients with anxiety disorder(35.9%)and 177(64.1%)of the patients with depressive disorder.The number of male patients was 157(56.9%),and 122(44.2%)patients were married;the degree of education is junior college and above,accounting for 53.3%;63.4%were break-even regarding family economy,and 48.9%were employed.Non-smokers or non-drinkers were 235(85.1%)and 222(80.4%).62.0%were in the normal range of BMI,and 63.4%of the patients were in chronic onset of disease.The duration of the disease was 0.5?42 years,and the inter quartile range was 3(1,6.5).2.The status and characteristics of sleep quality in hospitalized patientsThe score range of PSQI was 1?21,with an average of 9.78(standard deviation 4.79),and 213 patients(77.2%)with PSQI exceeded 5 points.The incidence of sleep disturbance in patients with depressive disorder(83.1%)was higher(?2=9.68,P<0.01)than with anxiety disorder(66.7%).In addition,thorough comparing the distributions of sleep component scores,we found that patients with depressive disorders were worsen in sleep latency(?2 = 8.39,P = 0.04)and sleep medication use(?2 = 11.66,P<0.01),and difficulty falling asleep(?2 = 9.43,P = 0.02)than those with anxiety disorders.3.Analysis of related factors of sleep quality in the hospitalized patientsThe results of independent sample t-test and one-way analysis of variance showed the global PSQI scores were statistically different in terms of marital status,level of education and occupational status(P<0.01).Specifically,patients who were unmarried,with education level of high school,and the current status was student,had lower PSQI scores.Spearman correlation analysis showed that,apart from the daytime dysfunction component,the the global PSQI scores and other sleep component scores were significantly correlated with age(rs = 0.15?0.40,P<0.01);And the global PSQI scores and each component scores were associated with GAD scores(rs = 0.54,P<0.01)and PHQ scores(rs = 0.61,P<0.01),Additionally,daytime dysfunction component was related to GAD scores(rs = 0.55)and PHQ scores(rs = 0.64)more tighter than other sleep quality components.Additionally,Spearman correlation analysis indicated that MAAS scores was negatively related to the global PSQI scores in the hospitalized patients with anxiety or depressive disorders(rs =-0.41,P<0.01),and daytime dysfunction component was related to MAAS scores(rs =-0.50)tighter than other sleep quality components.Further,the hierarchical linear regression showed that trait mindfulness was significantly related to PSQI scores(p =-0.406,P<0.001,?R2 = 0.161)when controlling the influence of demographic and clinical factors(e.g.age,education level,marital status,occupational status,diagnosis of disease).4.The effect of mindfulness intervention on sleep qualityChanged scores were statistically significant only in sleep onset latency in the control group(P = 0.01).While patients in the intervention group,apart from sleep efficiency and sleep medication use,the difference of changed scores in other sleep parameters were statistically significant(P<0.05).The analysis of intervention effect indicated the PSQI scores,subjective sleep quality,sleep latency and daytime functional impairment had improved,as the interaction term of group and time was statistically significant(P<0.05),and the effect of mindfulness based intervention on on sleep onset latency was significant for patients with depression(P<0.05).5.The moderating effect of baseline scores of mindfulnessHierarchical regression analysis showed that mindfulness x group interaction could significantly predict the changed PSQI scores(?=-0.309,P = 0.043,?R2 =60.037),indicating that the moderating effect of baseline mindfulness levels did existed.Additionally,for patients with lower mindfulness level,mindfulness intervention can significantly predict the improvement of sleep after intervention(?=0.451,P=0.002).However,the effect of mindfulness intervention on the improvement of sleep in patients with higher mindfulness level was not significant(?= 0.046,P = 0.733).In addition,the Johnson-Neyman technique showed when the baseline MAAS score was>64.59,the effect of mindfulness intervention on the improvement of sleep quality was not significant.Conclusion:1.Hospitalized patients with anxiety or depressive disorders had poor sleep quality,and the incidence of sleep disturbance in patients with depression was higher than that in patients with anxiety disorders,and it was more prominent in the difficulty of falling asleep.2.Patient's age,education level,marital status,occupational status,symptoms of anxiety and depression were related factors affecting the quality of sleep,and there was no difference exist in patients with the two different disease diagnoses.3.The level of mindfulness was significantly positively correlated with their sleep quality in hospitalized patients with anxiety or depressive disorders,and the correlation between mindfulness and daytime dysfunction was higher than that of other sleep components.4.This study demonstrated that brief mindfulness based-intervention could significantly improve the quality of sleep,specifically showing improvement in subjective sleep quality,sleep duration,and daytime dysfunction.In addition,it seemed that the intervention effect was more effective in patients with lower baseline mindfulness.