Research Spotlights: January 2022

The effect of the COVID-19 pandemic on sleep and mental health of health care workers

The COVID-19 pandemic has strained healthcare systems and healthcare workers. In recent publications, researchers supported by the NHLBI, American Heart Association, and Robert Wood Johnson Foundation assessed the effect of the COVID-19 pandemic on the sleep patterns of health care workers (HCW) in New York City (NYC) and the downstream effects of sleep disturbances on their mental health. During the pandemic, health care workers have been under immense stress, leading many to leave their jobs, which has left many hospitals understaffed. With fewer health care workers on the job, the remaining staff must work more and longer shifts, which can worsen stress and sleep problems. Previous research has indicated the poor sleep may also trigger symptoms of depression and anxiety.

During the pandemic's first peak in NYC (April 2020), researchers conducted a series of surveys of 813 health care workers' (80.6% female, 59.0% White, 12.1% Hispanic, and 56.0% nurses) sleep habits and psychological symptoms. In the first study researchers found that over 70% of health care workers had at least moderate insomnia symptoms during the pandemic's first peak. Additionally, this effect appeared to be lasting, with almost 4 out of 10 HCWs still experiencing from insomnia symptoms 10 weeks later, despite work schedules having returned to near normal. In a subsequent study of NYC HCWs, researchers found that HCWs who reported poor sleep (less than 6 hours per night) also reported higher levels of stress, anxiety, and depression than those who slept 6 hours or more per night. HCWs reporting poor sleep were twice as likely to report symptoms of depression, 50% more likely to report psychological distress, and 70% more likely to report anxiety than HCWs reporting better sleep.

The results of these studies indicate that sleep, which is a modifiable behavior, may serve as an intervention target to help mitigate the stress, anxiety, and depression that can arise from lack of sleep. However, future studies are needed to determine the directionality of the relationship between psychological distress and poor sleep among HCWs. Regardless, there may be several potential interventions, from cognitive-behavioral therapy for insomnia to increasing break room rest areas, and/or installing nap pods for HCWs. Improved sleep certainly will not alleviate all the stress that HCWs confront but may help to improve mental and physical health.

Diaz F, Cornelius T, Bramley S, Venner H, Shaw K, Dong M, Pham P, McMurry CL, Cannone DE, Sullivan AM, Lee SAJ, Schwartz JE, Shechter A, Abdalla M. The association between sleep and psychological distress among New York City healthcare workers during the COVID-19 pandemic. J Affect Disord. 2022 Feb 1;298(Pt A):618-624. doi: 10.1016/j.jad.2021.10.033. Epub 2021 Oct 22. PMID: 34695497; PMCID: PMC8532501.

Abdalla M, Chiuzan C, Shang Y, Ko G, Diaz F, Shaw K, McMurry CL, Cannone DE, Sullivan AM, Lee SAJ, Venner HK, Shechter A. Factors Associated with Insomnia Symptoms in a Longitudinal Study among New York City Healthcare Workers during the COVID-19 Pandemic. Int J Environ Res Public Health. 2021 Aug 26;18(17):8970. doi: 10.3390/ijerph18178970. PMID: 34501560; PMCID: PMC8431387.

Education’s protective effect against midlife mental health challenges may be decreasing for Americans

Historically, Americans with more education tend to have more favorable health outcomes compared to Americans with less education. Although the education gradient still exists, recent data trends indicate that U.S. middle-aged adults, regardless of education, are reporting lower mental and physical health compared to the same-aged peers several decades ago. This begs the question: Is this education-health differential in cohorts also true in other countries during the same time period? A study sponsored by the NIA aimed to address this question.

Using nationally representative longitudinal panel data from five different nations (United States, Australia, Germany, South Korea, and Mexico), the researchers look at historical improvements in physical and mental health for people in their 40s and early 50s. On average, with exception of mental health, the researchers found improvements in physical health in all the countries observed. However, they found that, on average, later-born midlife cohorts in the U.S. and Australia reported poorer overall mental health and wellbeing. In contrast, later-born cohorts in Germany, South Korea, and Mexico showed improvements in mental health over the same time period.

The authors noted that future research should more closely examine factors including gender and race differences, individual-level access to psychosocial resources (e.g., social support, control beliefs), and national-level factors, such as changes in family leave, access to health care, and neighborhood and economic indicators. They also highlight the need for research on low- and middle-income countries. The findings from this research may help to develop both policies and interventions to help promote health and wellbeing across the lifespan, with a particular focus on resources that support middle-aged adults.

Infurna FJ, Staben OE, Lachman ME, Gerstorf D. Historical change in midlife health, well-being, and despair: Cross-cultural and socioeconomic comparisons. Am Psychol. 2021 Sep;76(6):870-887. doi: 10.1037/amp0000817. PMID: 34914427.

AI may help improve doctor-patient communication

Physician-patient communication is one of the most significant aspects of the health care process. An integral part of care is the achievement of “shared meaning” or “mutual understanding” between the physician and patient to encourage positive outcomes with diseases that require consistent regimens such as Type II diabetes. Precision medicine initiatives strive to develop tailored treatment plans for patients based on factors such as genetic makeup and lifestyle. Implementing precision medicine plans require communication between physician and patient to ensure positive outcomes. This NLM, NIDDK, and NSF funded study sought to understand physicians use of simple language versus their adaptation of written language to match the health literacy (HL) of patients and whether physicians’ tendency to use either strategy is associated with patient understanding.

Data acquired from the Employing Computational Linguistics to Improve Patient-Physician Secure email Exchange (ECLIPPSE) which contains SMs (electronic patient portal messages), were used with the application of machine learning and natural language processing to measure patient’s health literacy and physician’s language complexity. A retrospective analysis was conducted assessing dyadic concordance/discordance between physicians’ linguistic complexity and patients’ health literacy (HL) patients’ understanding of their physician, and communication strategies used by physicians to understand how their written language complexity matches the health literacy level of the patient. Associations between physicians’ communication strategies and patient understanding were examined and the dyad level concordance and strategy to produce shared meaning were explored.

Patients with low HL experienced concordance at a significantly lower rate than high HL patients. Among low HL patients, dyadic discordance was independently associated with patient reports of poor comprehension of their physicians. Physicians were found to adapt their communication strategies based on the HL of the patient. Low HL patients that experienced optimal understanding were cared for by physicians that used adaptive strategies with their patient. This research provides evidence that physician adoption of strategies tailored to patient health literacy level can help eliminate HL-related disparities in patient understanding. This study provides evidence to support efforts encouraging tailored physician communication strategies based on patient health literacy levels to improve communication and understanding during patient interactions, and in turn, produce better health outcomes. In conclusion, the researchers suggest that “the ‘Precision Medicine’ construct should be expanded to include the domain of ‘Precision Communication.’”

Schillinger D, Duran ND, McNamara DS, Crossley SA, Balyan R, Karter AJ. Precision communication: Physicians' linguistic adaptation to patients' health literacy. Sci Adv. 2021;7(51):eabj2836. doi:10.1126/sciadv.abj2836