BackgroundInsomnia is highly prevalent among perimenopausal women and exerts detrimental effects on physical health, psychological well-being, and overall quality of life. However, its underlying mechanisms remain incompletely understood. This cross-sectional study aimed to identify factors associated with insomnia in perimenopausal women.MethodsA total of 187 perimenopausal women aged 45–55 years were enrolled. Insomnia, anxiety, and depression severity were assessed using the Insomnia Severity Index (ISI), Generalized Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9), respectively. Serum levels of relevant amino acids and hormones were measured. Spearman correlation and linear regression analyses were performed to examine the associations among prolactin levels, tryptophan levels, insomnia, anxiety, and depression. Moderation analysis was further conducted to evaluate the potential moderating role of tryptophan in these relationships.ResultsSerum prolactin levels were positively associated with scores of ISI, GAD-7, and PHQ-9. Furthermore, prolactin levels were positively correlated with the severity of sleep-onset difficulties, sleep maintenance problems, noticeability of impairment, and sleep-related distress. Of note, serum tryptophan levels significantly moderated the association between prolactin levels and ISI scores (β = 0.227, 95% CI = 0.04–0.41, p = 0.0148). To wit, he positive relationship between prolactin levels and insomnia severity was stronger in perimenopausal women with higher serum tryptophan levels compared with those with lower levels.ConclusionsThe moderating effect of serum tryptophan on the relationship between prolactin levels and insomnia in perimenopausal women helps us understand the neuroendocrine mechanisms underlying perimenopausal insomnia and may inform future research on targeted preventive and therapeutic strategies.
Effects of bifrontal-transcranial direct current stimulation combined with music listening on sleep quality, cortical activation and functional connectivity in patients with insomnia: a randomised controlled trial by fNIRS
BackgroundAlthough music listening and transcranial direct current stimulation (tDCS) alone have certain effects in the treatment of insomnia, the sleep regulatory effects and neural mechanisms of the combined treatment in patients with insomnia disorder (ID) are unclear. This study aimed to investigate the efficacy of combined bifrontal-tDCS (F3: anode, F4: cathode) with music listening in patients with ID using functional near-infrared spectroscopy (fNIRS).Methods76 ID patients were randomly divided into an intervention group (n=38) and a control group (n=38), and received 4 weeks of a total of 20 sessions of music + tDCS therapy and music + sham tDCS therapy (30-second stimulation with fade-in/fade-out to mimic somatic sensations), respectively. The Pittsburgh Sleep Quality Index Scale (PSQI), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), and Perceived Stress Scale (PSS-14) were compared between the two groups before and after treatment. Oxy-haemoglobin (HbO2) concentration and functional connectivity (FC) were assessed during the verbal fluency task using fNIRS.ResultsCompared with the control group, the PSQI total score (mean difference: -2.57 points, 95% CI: -4.43 to -0.71, p = 0.001), PSQI sub-scores except “sleep disturbance and daytime dysfunction”, SDS and SAS scores of the intervention group improved significantly after treatment. It was observed by fNIRS that the HbO2 concentration in the medial prefrontal cortex (mPFC), left dorsolateral prefrontal cortex (DLPFC), right ventrolateral prefrontal cortex, and right superior frontal cortex (SFC) increased significantly after treatment in the intervention group but was not superior to the control group. In addition, the FC enhancement of left SFC-left DLPFC and left SFC-mPFC after treatment was significantly better in the intervention group than in the control group, and the PSQI improvement was positively correlated with the FC enhancement of channel-averaged and left SFC-right DLPFC.ConclusionsCombining bifrontal-tDCS with music listening is more helpful in improving sleep quality and prefrontal functional connectivity in ID patients compared with music listening alone. For ID patients, music electrical stimulation headphones may be a safe, effective, and convenient new treatment strategy.Clinical trial registrationhttps://www.chictr.org.cn/, identifier ChiCTR2400086233.
PAD-S/CSA as a candidate shared representation layer for computational psychotherapy: minimal architecture and a staged validation roadmap
Psychotherapy schools often describe overlapping process phenomena in non-interoperable vocabularies. This pluralism is clinically valuable but computationally costly: datasets become difficult to compare, clinically load-bearing distinctions are collapsed into convenience labels, and artificial intelligence (AI) systems inherit annotation schemes rather than a clinically interpretable intermediate representation. Building on the Perceive–Assess–Dose–Safeguard (PAD-S) framework and the Conflict-Square Algorithm (CSA), this theory article asks a narrower question than the prior PAD-S and CSA papers: can the same variables be formulated as a candidate shared representation layer between heterogeneous observation models and school-specific intervention policies? The proposed layer projects a high-dimensional biopsychosocial state into four clinically observable process coordinates—defensive/avoidant organization (DEF), anxiety/arousal and tolerance (ANX), progression toward direct experience and action (PRO), and self-attack/shame processes (SUP)—plus a safety threshold that constrains admissible intervention intensity. The contribution is architectural rather than empirical: it isolates the representational role from earlier decision-grammar and transcript-coding roles; clarifies the distinction between observations, representation, and policy; specifies a minimal falsifiable family of state-transition models; illustrates translation across four pragmatic therapy families; and defines a staged validation order from reliability and function linkage to transcript-level predictive operationalization and only then sparse equation discovery. The framework should therefore be read as a candidate shared representation layer for computational psychotherapy and computational psychiatry rather than as a therapy protocol, a fitted predictive model, a complete generative theory, or an autonomous decision system. No new dataset, fitted classifier, transcript-level predictive result, or discovered equation is reported here. The article aims instead to state what would count for or against PAD-S/CSA as a clinically interpretable interface for later empirical modeling.
The Impact of Digital Detox Training on Screen Use, Sleep Quality, and Healthy Lifestyle Behaviors in Adolescents
Conditions: Digital Screen Addiction and Sleep Quality in Adolescents
Interventions: Behavioral: Digital Detox Intervention
Sponsors: Şırnak Üniversitesi
Completed
Interventions: Behavioral: Digital Detox Intervention
Sponsors: Şırnak Üniversitesi
Completed
Enhancing Sleep and Mental Health: Longitudinal, Observational, Real-World Study From a Digital Mental Health Platform
Background: Poor sleep is closely linked to mental health challenges and workplace burnout. Mental health and workplace stressors can impair sleep, while good sleep quality supports cognitive and emotional resources to cope with daily challenges. Despite positive outcomes of maintaining good sleep, many people struggle to get enough restorative sleep at night. Given the bidirectional relationship between sleep and mental health, evidence-based digital mental health solutions may offer an accessible and scalable approach to improving sleep quality. Objective: This study examines whether engagement with an employer-sponsored, multimodal digital mental health platform is associated with improvements in sleep quality over time, and whether changes in sleep quality are associated with concurrent changes in mental health and burnout outcomes. Methods: This 12-month prospective, observational study followed working adults who were newly registered to an employer-sponsored digital mental health platform (Modern Health). The platform leveraged technology (mobile and web) to connect employees with comprehensive provider-led and self-guided care through therapy, coaching, on-demand digital resources, and group psychoeducational sessions. Participants [N=578; 61.1% (n=353) women; mean age 33.88, SD 8.73 years; 40.3% (n=233) people of color] completed measures of self-rated sleep quality, depression, anxiety, and burnout (exhaustion, cynicism, and professional efficacy) at baseline and after 3 and 12 months of accessing the platform. Upon registering for the platform, participants were given an initial care recommendation, but could flexibly engage in any combination of services. Participants in this study engaged with at least one care modality, including therapy, coaching, psychoeducation sessions, and self-guided mental health resources. We examined perceived sleep quality and associations with other study variables at baseline, changes in perceived sleep quality over time, and whether changes in sleep quality correlated with concurrent changes in mental health and burnout. Results: At baseline, 42% (243/578) reported poor sleep quality and were more likely to have higher levels of depression, anxiety, and burnout. A generalized linear mixed-effects model showed that each additional month of platform access was related to an increased odds of having good sleep quality by 3.7% (=.02). Linear mixed-effects models found that higher sleep quality over time was associated with lower depression, anxiety, exhaustion, cynicism, and efficacy (all <.001). Among participants reporting poor sleep quality at baseline, 44% (62/141) reported good sleep quality at 12 months. Within this subgroup, paired sample tests showed significant reductions in depression (−48.3%) and anxiety (−38.3%), and increased cynicism, burnout, though cynicism levels remained below the cutoff for high burnout (23.9%; all <.01). Conclusions: Use of an employer-sponsored digital mental health platform was associated with meaningful improvements in self-reported sleep quality over 12 months. These gains were associated with significant reductions in depression, anxiety, and burnout symptoms, highlighting broader well-being benefits of comprehensive mental health care.
Impact of extremely low frequency electromagnetic fields exposure on sleep quality and mental health in a Tunisian power plant: a cross-sectional study
IntroductionExtremely low-frequency electromagnetic fields (ELF-EMFs) are ubiquitous in our daily life. They may have an impact not only on physical health but also on mental health.ObjectivesTo assess the impact of occupational exposure to the ELF-EMFs on sleep quality, depression, anxiety and stress among workers at the Tunisian Electricity and Gas Company (TEGC).MethodsThis was a cross-sectional study. The study population included two groups: an exposed group (EG), consisting of power plant employees, and a non-exposed group (NEG), consisting of administrative workers. Exposure to ELF-EMFs was assessed via spot measurements using a magnetometer. Sleep quality, depression, anxiety and stress were assessed by the French versions of the Pittsburgh Sleep Quality Index (PSQI) and the Depression, Anxiety and Stress Scale (DASS-21).ResultsSeventy-seven participants in the EG and 88 participants in the NEG were included in the study. The median value of the ELF-EMFs was 5.86 μT at the power plant [min 0.1, max 40.34 μT]. According to the PSQI global score, 64.9% of the EG had poor sleep quality versus 29.5% of the NEG. Depression was registered in 24.7% of EG and in 3.4% of NEG. Anxiety was noted in 23.4% of the EG and in none of the NEG. Stress was found in 46.8% of the EG and none of the NEG. After multivariate analysis, ELF-EMF exposure was significantly associated with poor sleep quality and depression.ConclusionThe present study revealed that ELF-EMFs can affect sleep and mental health. Further studies are needed to explain the mechanism involved.
Impact of Prescribed and Self-Selected Music Interventions on Stress, Sleep, Heart Rate Variability, and Brain Connectivity in Surgeons Using 7-Tesla Functional Magnetic Resonance Imaging and Wearable Actigraphy: Multimodal Feasibility Randomized Controlled Trial
<strong>Background:</strong> Stress, sleep deprivation, and burnout are significant safety risks for acute care surgeons, negatively impacting performance, well-being, and clinical outcomes. <strong>Objective:</strong> This pilot randomized controlled trial aimed to measure neurophysiological effects of prescribed music (PM) and self-selected music (SSM) on surgeon stress, burnout, and neurophysiological responses using a multimodal protocol that integrated functional magnetic resonance imaging (fMRI), wearable biosensor monitoring, and psychological self-assessments. <strong>Methods:</strong> Full-time attending surgeons at a quaternary care hospital were invited to participate in a 3-armed trial (1:1:1 block allocation). Intervention groups were instructed to listen to 30 minutes (minimum 15 minutes) of either PM or SSM daily at bedtime for 6 weeks, reflecting real-world conditions. PM comprised original compositions based on elements promoting perceived relaxation from a prior study. The control arm avoided music in the 30 minutes before bed. Allocation was concealed from the recruiting investigator; the fMRI technicians, the statistician, and lead investigators were blinded until analyses were completed. Functional connectivity patterns were measured using fMRI at baseline and 6 weeks while participants listened to simulated intensive care unit noise, PM, and SSM. Secondary outcomes included continuous actigraphy for sleep quality and self-reported anxiety, sleep quality, and burnout using validated scales (State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, and Maslach Burnout Inventory). <strong>Results:</strong> A total of 22 surgeons were assessed; demands of fMRI and data collection schedule led 3 to decline and 2 (allocated to PM) not to finish baseline measures; 6 PM, 5 SSM, and 6 controls received allocated intervention; 2 PM participants were withdrawn for nonadherence and missing follow-up data and 1 control missed follow-up collection due to scheduling (final analysis set after missing data: PM: n=4, SSM: n=5, control: n=5). One control participant experienced transient vertigo in fMRI. Trends in fMRI data indicated that both intervention groups experienced less negative emotional arousal and anxiety, with physical tension reduced in the PM group. The PM group exhibited reduced stress response in the frontal lobes when exposed to intensive care unit alarms, suggesting diminished attentional response to the high-stress auditory environment, compared to control. However, lack of statistical significance and baseline variability entail cautious interpretation. Observations of sleep quality were mixed, and no statistically significant differences in stress surveys were observed. <strong>Conclusions:</strong> Both music interventions trended toward positive changes in neurophysiological responses, suggesting potential benefits in reducing surgeon stress. However, due to the small sample, mixed or nonsignificant results, and the exploratory nature of this study, findings should be considered preliminary. Further research with larger, diverse cohorts is required to confirm trends, refine both the intervention approach and recruitment strategies, and determine whether objective compositional elements or personally selected music drive the mechanisms of potential positive effects. <strong>Trial Registration:</strong> ClinicalTrials.gov NCT05980429; https://clinicaltrials.gov/study/NCT05980429
Psychometric validation of the revised Chinese version of the Dimensional Anhedonia Rating Scale in psychiatric outpatients
ObjectiveTo refine the Chinese version of the Dimensional Anhedonia Rating Scale (DARS) and evaluate the psychometric properties of the Revised Chinese DARS (RC-DARS) in a large sample of first-visit psychiatric outpatients.MethodsThe study was conducted in two sequential phases at a specialized psychiatric hospital. In Phase I (n = 277), the existing Chinese DARS underwent semantic and cultural refinement in accordance with ISPOR and TRAPD guidelines, incorporating cognitive interviews and back-translation procedures. In Phase II (n = 788), the RC-DARS was administered alongside the Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Pittsburgh Sleep Quality Index (PSQI), and the MMPI Suicide Ideation Subscale (MMPI-SI). Exploratory and confirmatory factor analyses were conducted using common-factor extraction and the WLSMV estimator for ordinal indicators. Internal consistency, gender-based measurement invariance, and convergent validity were evaluated.ResultsExploratory analyses supported a four-factor domain structure. Confirmatory factor analysis demonstrated good model fit for the domain-based model (χ²/df = 3.81, CFI = 0.98, TLI = 0.97, RMSEA = 0.08, SRMR = 0.05), with substantially superior fit relative to an alternative reward-processing model. Internal consistency was excellent (Cronbach’s α = 0.95; McDonald’s ω = 0.96). Multi-group analyses supported configural, metric, and scalar invariance across gender (ΔCFI < 0.01). RC-DARS total scores were significantly negatively correlated with depressive symptoms (r = −0.443), anxiety (r = −0.317), sleep disturbance (r = −0.494), and suicide risk (r = −0.312) (all p <.001). Individuals with severe depressive symptoms exhibited significantly lower RC-DARS scores than those below the clinical threshold.ConclusionsThe RC-DARS demonstrates robust psychometric properties in a first-visit outpatient sample. The revision primarily enhances semantic precision and structural differentiation without materially altering score distributions. The scale may serve as a refined instrument for dimensional assessment of anhedonia in similar clinical contexts, pending longitudinal and multi-site validation.
Effect of transcranial magnetic stimulation on prognosis in patients with postherpetic neuralgia and comorbid depression undergoing interventional neuromodulation therapy: protocol for a randomized double-blind placebo-controlled trial
BackgroundPostherpetic neuralgia (PHN) is often accompanied by depression, creating a vicious cycle that exacerbates symptoms and contributes to suboptimal treatment outcomes, even with interventional therapies. Repetitive transcranial magnetic stimulation (rTMS) has demonstrated potential in alleviating both pain and mood disturbances. However, its efficacy in enhancing prognosis when used alongside interventional neuromodulation therapy for PHN accompanied by depression remains inadequately explored and requires further investigation.ObjectiveThis study aims to generate preliminary evidence on the efficacy and safety of rTMS in enhancing prognosis and alleviating pain in patients with PHN and mild to moderate depression undergoing interventional neuromodulation therapy.MethodsThis study is a single-center, randomized, double-blind, placebo-controlled trial involving 174 adult patients with PHN. Participants will be randomly assigned, stratified by interventional neuromodulation therapy, to either the rTMS group (n=87) or the control group (n=87). Both groups will undergo either 10 Hz rTMS or sham stimulation for five consecutive days. The primary outcome is the incidence of poor prognosis at 3 months post-discharge. Secondary outcomes include the incidence of poor prognosis at 6 months post-discharge; Visual Analog Scale (VAS) sleep scores; short-form McGill Pain Questionnaire (SF-MPQ) scores; Self-Rating Depression Scale (SDS) scores; patient satisfaction; Pain Disability Index (PDI) scores; Multidimensional Fatigue Inventory-20 (MFI-20) scores; pregabalin oral doses; and the need for tramadol or antidepressants. Safety outcomes will include assessments of headache, pain at the stimulation site, neck pain, insomnia, muscle soreness, dizziness, nausea, tinnitus, irritability, tachycardia (heart rate > 100 bpm), and epilepsy. Data will be analyzed using a modified intention-to-treat approach.DiscussionThis study aims to provide preliminary evidence on the efficacy and safety of 10 Hz rTMS in improving prognosis and alleviating pain in PHN patients with mild to moderate depression undergoing interventional pain management.Trial registrationhttps://www.chictr.org.cn/bin/project/edit?pid=261070, identifier ChiCTR2500096978.
Vitamin A status is associated with sleep, clock genes, and symptoms in children with autism spectrum disorder
BackgroundVitamin A signals through retinoic acid receptors and may influence neurodevelopment and the expression of clock genes. However, the biological pathway linking vitamin A status to sleep disturbance in ASD remains insufficiently defined. This study aimed to examine associations between vitamin A status and sleep problems, core symptoms, and clock genes in children with ASD, and to explore the mechanistic role of RARβ in regulating core clock genes.MethodsThis observational study included 361 children with ASD. Clinical symptoms were assessed using the Children’s Sleep Habits Questionnaire (CSHQ); the Childhood Autism Rating Scale (CARS) and the Social Responsiveness Scale (SRS). Peripheral blood mononuclear cell (PBMC) mRNA levels of RARβ and clock genes (BMAL1 and CLOCK) were quantified by qPCR. RARβ expression was knocked down in mice by stereotaxic injection of adeno-associated virus.ResultsChildren with lower vitamin A levels exhibited more severe sleep problems and autistic symptoms. Vitamin A levels showed a weak positive correlation with the expression of RARβ and BMAL1. RARβ knockdown reduced the expression of RARβ and clock genes in mouse brain tissue. Chromatin immunoprecipitation quantitative PCR (ChIP-qPCR) confirmed RARβ occupancy at a predicted CLOCK regulatory region.ConclusionThis study provided evidence that vitamin A status was linked to sleep problems, symptom severity, and expression of clock genes in the morning in ASD. We also found that RARβ signaling may regulate the expression of clock genes. This finding provides new insights into the mechanisms underlying sleep disturbances in ASD, but further functional studies are needed to confirm these findings.