Sakurako S. Okuzono’s research while affiliated with Massachusetts Department of Public Health and other places

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Publications (30)


Flowchart of the analytic sample
Optimism and Longevity Among Japanese Older Adults
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  • Publisher preview available

August 2022

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133 Reads

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1 Citation

Sakurako S. Okuzono

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Koichiro Shiba

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Background: Optimism has been linked to better physical health across various outcomes, including greater longevity. However, most evidence is from Western populations, leaving it unclear whether these relationships may generalize to other cultural backgrounds. Using secondary data analysis, we evaluated the associations of optimism among older Japanese adults. Methods: Data were from a nationwide cohort study of Japanese older adults aged ≥65 years (Japan Gerontological Evaluation Study; n = 10,472). In 2010, optimism and relevant covariates (i.e., sociodemographic factors, physical health conditions, depressive symptoms, and health behaviors) were self-reported. Optimism was measured using the Japanese version of the Life Orientation Test-Revised (LOT-R). Lifespan was determined using mortality information from the public long-term care insurance database through 2017 (7-year follow-up). Accelerated failure time models examined optimism (quintiles or standardized continuous scores) in relation to percent differences in lifespan. Potential effect modification by gender, income, and education was also investigated. Results: Overall, 733 individuals (7%) died during the follow-up period. Neither continuous nor categorical levels of optimism were associated with lifespan after progressive adjustment for covariates (e.g., in fully-adjusted models: percent differences in lifespan per 1-SD increase in continuous optimism scores= -1.2%, 95%CI: -3.4, 1.1 higher versus lower optimism quintiles= -4.1%, 95%CI: -11.2, 3.6). The association between optimism and lifespan was null across all sociodemographic strata as well. Conclusion: Contrary to the existing evidence from Western populations, optimism was unrelated to longevity among Japanese older adults. The association between optimism, as evaluated by the LOT-R, and longevity may differ across cultural contexts.

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Long-Term Associations between Disaster-Related Home Loss and Health and Well-Being of Older Survivors: Nine Years after the 2011 Great East Japan Earthquake and Tsunami

July 2022

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42 Reads

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18 Citations

Environmental Health Perspectives

Background: Little research has examined associations between disaster-related home loss and multiple domains of health and well-being, with extended long-term follow-up and comprehensive adjustment for pre-disaster characteristics of survivors. Objectives: We examined the longitudinal associations between disaster-induced home loss and 34 indicators of health and well-being, assessed ∼9y post-disaster. Methods: We used data from a preexisting cohort study of Japanese older adults in an area directly impacted by the 2011 Japan Earthquake (n=3,350 and n=2,028, depending on the outcomes). The study was initiated in 2010, and disaster-related home loss status was measured in 2013 retrospectively. The 34 outcomes were assessed in 2020 and covered dimensions of physical health, mental health, health behaviors/sleep, social well-being, cognitive social capital, subjective well-being, and prosocial/altruistic behaviors. We estimated the associations between disaster-related home loss and the outcomes, using targeted maximum likelihood estimation and SuperLearner. We adjusted for pre-disaster characteristics from the wave conducted 7 months before the disaster (i.e., 2010), including prior outcome values that were available. Results: After Bonferroni correction for multiple testing, we found that home loss (vs. no home loss) was associated with increased posttraumatic stress symptoms (standardized difference=0.50; 95% CI: 0.35, 0.65), increased daily sleepiness (0.38; 95% CI: 0.21, 0.54), lower trust in the community (-0.36; 95% CI: -0.53, -0.18), lower community attachment (-0.60; 95% CI: -0.75, -0.45), and lower prosociality (-0.39; 95% CI: -0.55, -0.24). We found modest evidence for the associations with increased depressive symptoms, increased hopelessness, more chronic conditions, higher body mass index, lower perceived mutual help in the community, and decreased happiness. There was little evidence for associations with the remaining 23 outcomes. Discussion: Home loss due to a disaster may have long-lasting adverse impacts on the cognitive social capital, mental health, and prosociality of older adult survivors. https://doi.org/10.1289/EHP10903.


Causal diagram representing 4-way decomposition of the relationship between ACEs, low adult SES and late-life depression
Early childhood adversity and late-life depressive symptoms: unpacking mediation and interaction by adult socioeconomic status

June 2022

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165 Reads

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27 Citations

Social Psychiatry and Psychiatric Epidemiology

Purpose Adverse childhood experiences (ACEs) have been linked to diminished health achievement across the life course. However, few studies have rigorously investigated the role of adult socioeconomic status (SES) as a mediator and an effect modifier of the association between ACEs and late-life depression. We used a four-way decomposition analysis to examine the relative contributions of mediation and interaction by low adult SES to the association between ACEs and late-life depression. Methods Data came from two waves (2013 and 2016) of the Japan Gerontological Evaluation Study, a nationwide cohort of older people (n = 7271). ACEs were determined as ≥ 2 experiences of the following: parental loss, parental divorce, parental mental illness, domestic violence, physical abuse, psychological neglect, psychological abuse, and economic disadvantage. Low adult SES was defined as earning < 2 million yen of income and < 10 years of schooling. Depressive symptoms were assessed using the Geriatric Depression Scale. Results Controlled direct effect (coefficient 0.28; 95% CI 0.08–0.46) accounted for 69.1% of the total effect, which was greater than the other three estimates for the decomposed effects (reference interaction 20.8%, mediated interaction 5.7%, and pure indirect effect 4.4%). Adult SES accounted for 10.1% (via mediation) and 26.5% (via exposure–mediator interaction) of the total association between ACEs and depressive symptoms, respectively. Conclusion ACEs appeared to be a strong and independent determinant of depressive symptoms in later life. Nonetheless, the interaction between ACEs and adult SES indicates that achieving high adult SES could mitigate the adverse effect of ACEs on late-life depression.


Figure 1. Person-level results from multilevel structural equation model on the indirect effects of optimism in relation to negative affect via daily stressor exposure. Unstandardized regression coefficients (95% Bayesian credible interval [BCI]) representing the difference in outcome per unit change in the predictor are shown for each regression path. Bold indicates estimates for which the 95% BCI does not overlap with zero.
Figure 2. Person-level results from multilevel structural equation model on the indirect effects of optimism in relation to positive affect via daily stressor exposure. Unstandardized parameter estimates (95% Bayesian credible interval [BCI]) representing the difference in outcome per unit change in the predictor are shown for each regression path. Bold indicates estimates for which the 95% BCI does not overlap with zero.
Optimism, Daily Stressors, and Emotional Well-Being Over Two Decades in a Cohort of Aging Men

March 2022

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151 Reads

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9 Citations

The Journals of Gerontology Series B Psychological Sciences and Social Sciences

Objectives: Growing evidence supports optimism as a health asset, yet how optimism influences well-being and health remains uncertain. We evaluated 1 potential pathway-the association of optimism with daily stress processes-and tested 2 hypotheses. The stressor exposure hypothesis posits that optimism would preserve emotional well-being by limiting exposure to daily stressors. The buffering hypothesis posits that higher optimism would be associated with lower emotional reactivity to daily stressors and more effective emotional recovery from them. Methods: Participants were 233 men from the Veterans Affairs Normative Aging Study who completed the Minnesota Multiphasic Personality Inventory-2 Revised Optimism-Pessimism scale in 1986/1991 and participated in up to three 8-day daily diary bursts in 2002-2010 (age at first burst: M = 76.7, SD = 6.5). Daily stressor occurrence, positive affect (PA), and negative affect (NA) were assessed nightly. We evaluated the hypotheses using multilevel structural equation models. Results: Optimism was unrelated to emotional reactivity to or recovery from daily stressors. Higher optimism was associated with higher average daily PA (B = 2.31, 95% Bayesian credible interval [BCI]: 1.24, 3.38) but not NA, independent of stressor exposure. Lower stressor exposure mediated the association of higher optimism with lower daily NA (indirect effect: B = -0.27, 95% BCI: -0.50, -0.09), supporting the stressor exposure hypothesis. Discussion: Findings from a sample of older men suggest that optimism may be associated with more favorable emotional well-being in later life through differences in stressor exposure rather than emotional stress response. Optimism may preserve emotional well-being among older adults by engaging emotion regulation strategies that occur relatively early in the emotion-generative process.


Abstract P224: Optimism And Favorable Cardiovascular Health Maintenance Among African Americans: The Jackson Heart Study

March 2022

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9 Reads

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2 Citations

Circulation

Background: Higher optimism is associated with maintaining favorable cardiovascular health (FCH) among White adults, but evidence for this relationship is limited among African American adults, whose cardiovascular disease risk is higher than Whites. We investigated whether higher optimism is associated with more FCH over ~12 years among African American adults. Methods: Data were drawn from African-American women (n=2,730) and men (n=1,479) in the Jackson Heart Study (age=20-93 years). Participants free of CVD at baseline (2000–2004) were included in the analyses. Optimism was measured using the Life Orientation Test-Revised at the baseline period, and examined as a binary variable due to its skewed distribution. FCH was characterized according to whether participants had healthy status on each of five components of cardiovascular functioning (i.e., blood pressure, lipids, body mass index, type 2 diabetes, and smoking status) repeatedly assessed 3 times over ~ 12 years of follow-up; measures were obtained either from a clinical visit or via self-report. Linear mixed-effects models examined whether optimism predicted FCH level over time or FCH change rate, adjusting for covariates such as sociodemographic characteristics, depressive symptoms, and health behaviors. In secondary analyses, we evaluated potential effect modification by sex and income as well as the likelihood of meeting the recommendation for each FCH component separately in relation to optimism using generalized estimating equations with the Poisson distribution. Results: Adjusting for all covariates, higher (vs. lower) optimism was associated with better FCH pooled across time (β=0.10, 95% confidence interval=0.02–0.17) but not with the rate of change in FCH level. We did not find sufficient evidence for effect modification by sex and income (p-interactions<0.05), which may be due to lack of power. In the analyses examining FCH sub-components, optimism was not associated with the rate of change in meeting the guidelines, except smoking; unexpectedly, participants with higher optimism had a slower rate of change towards non-smoking (p-interaction=0.03). However, this is likely driven by large differences at baseline: optimistic participants’ non-smoking proportion changed from 89.3% (baseline) to 93.2 % (visit 3) vs. 84.8% (baseline) to 92.9% (visit 3) in participants with lower optimism. In the analyses examining FCH sub-components without time-interaction, higher vs. lower optimistic participants had a higher likelihood of not being diabetic (RR=1.03, 95% confidence interval=0.99-1.07) in the fully adjusted model. Conclusions: Optimism may contribute to establishing future patterns of FCH in adulthood, but other factors may be more strongly related to how slowly or quickly favorable FCH declines over time.


Figure 1. Flow of Samples Selection (n=6,441 for the Outcomes Based on the Follow-up Survey in 2016 and n=8,041 for the Outcomes Based on the Long -term Care Insurence Database). LTCI: Long-term care insurence.
Antecedents of Ikigai in 2013, Japan gerontological evaluation study (n = 6,441).
Ikigai and subsequent health and wellbeing among Japanese older adults: Longitudinal outcome-wide analysis

February 2022

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408 Reads

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42 Citations

The Lancet Regional Health - Western Pacific

Background: Having a purpose in life has been linked to improved health and wellbeing; however, it remains unknown whether having "Ikigai"-a related but broader concept in Japan-is also beneficial for various physical and psychosocial outcomes. Methods: Using data from a nationwide longitudinal study of Japanese older adults aged ≥65 years, we examined the associations between having Ikigai in 2013 and a wide range of subsequent outcomes assessed in 2016 across two databases (n = 6,441 and n = 8,041), including dimensions of physical health, health behavior, psychological distress, social wellbeing, subjective wellbeing, and pro-social/altruistic behaviors. We adjusted for sociodemographic characteristics and the outcome values (whenever data were available) in the prior wave (2010). Findings: Having Ikigai (vs. not having Ikigai) was associated with a 31% lower risk of developing functional disability [95% confidence interval (CI) for risk ratio: 0.58, 0.82] and 36% lower risk of developing dementia [95% CI for risk ratio: 0.48, 0.86] during the three-year follow-up. Having Ikigai was associated with decreased depressive symptoms and hopelessness as well as higher happiness, life satisfaction, instrumental activity of daily living, and certain social outcomes (e.g., more frequent participation in hobby clubs). Some of these associations were stronger for men than women, and among individuals with high socioeconomic status (p-values for effect measure modification < 001). Interpretation: Having Ikigai may promote health and wellbeing outcomes among Japanese older adults, but particularly men and individuals with high socioeconomic status. Funding: NIH, John Templeton Foundation, JSPS, AMED, MHLW, MEXT, and WPE Foundation.


Optimism and risk of mortality among African-Americans: The Jackson heart study

December 2021

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32 Reads

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5 Citations

Preventive Medicine

Optimism is associated with reduced mortality risk among Whites, but evidence for this relationship is limited among African-Americans, whose life expectancy is shorter than Whites. This study examined the association between optimism and mortality rate in African-Americans. Data were from African-American women (n = 2652) and men (n = 1444) in the United States from the Jackson Heart Study. Optimism was measured using the Life Orientation Test-Revised at the baseline period (2000–2004), and mortality data were obtained until 2018. Using Cox proportional hazards models, we estimated hazard ratios (HRs) of mortality by optimism level, controlling for sociodemographic factors, depressive symptoms, health conditions, and health behaviors. In secondary analyses, we evaluated potential effect modification by sex, age, income, and education. Higher optimism was related to lower mortality rates (HR = 0.85, 95% confidence interval [CI] = 0.74, 0.99), controlling for sociodemographic factors and depressive symptoms. After further adjusting for health conditions and health behaviors, associations were slightly attenuated (HR = 0.89; 95%CI = 0.77, 1.02). Stronger associations between optimism and mortality were observed in men, among those with higher income or education, and with age ≤ 55 (all p's for interaction terms <0.06). In summary, optimism was associated with lower mortality rates among African-Americans in the Jackson Heart Study. Effect modification by sociodemographic factors should be further explored in additional research considering optimism and mortality in diverse populations. Positive factors, such as optimism, may provide important health assets that can complement ongoing public health efforts to reduce health disparities, which have traditionally focused primarily on risk factors.


Optimism and Telomere Length among African American Adults in the Jackson Heart Study

December 2020

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50 Reads

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2 Citations

Psychoneuroendocrinology

Background Optimism is linked with greater longevity in both White and African American populations. Optimism may enhance longevity by slowing cellular aging, for which leukocyte telomere shortening is a biomarker. However, limited studies have examined the association of optimism with leukocyte telomere length among African Americans. Methods Data are from 723 men and 1,244 women participating in the Jackson Heart Study (age=21-93 years). We used multivariable linear regression models to conduct cross-sectional analyses examining whether higher optimism was associated with longer mean absolute leukocyte telomere length (assayed with Southern blot analysis). Models adjusted for sociodemographic characteristics, depressive symptomatology, health conditions, and health behavior-related factors. We also considered potential effect modification by key factors. Results In the age-adjusted model, optimism, measured as a continuous variable, was not associated with leukocyte telomere length (β=0.01, 95%CI: -0.02, 0.04). This association remained null in the fully-adjusted model (β=0.02, 95%CI: -0.02, 0.05) and was also null when considering optimism as a binary measure (higher vs. lower optimism). We found no evidence of effect modification by sex, age, body mass index, income, or chronic conditions. Conclusions Optimism was not associated with leukocyte telomere length among African American adults. Future studies should investigate alternate biological and behavioral mechanisms that may explain the optimism-health association.



Spanking and subsequent behavioral problems in toddlers: A propensity score-matched, prospective study in Japan

April 2017

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580 Reads

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45 Citations

Child Abuse & Neglect

Harsh or frequent spanking in early childhood is an established risk factor for later childhood behavioral problems as well as mental disorder in adulthood in Western societies. However, few studies have been conducted in Asian populations, where corporal punishment is relatively accepted. Moreover, the impacts of occasional spanking on subsequent behavioral problems remain uncertain. This study sought to investigate prospectively the association between the frequency of spanking of toddlers and later behavioral problems in Japanese children using national birth cohort data. We used data from the Longitudinal Survey of Newborns in the 21st Century, a population-based birth cohort data set collected by the Japanese Ministry of Health, Labour, and Welfare (N=29,182). Frequency of spanking ("never", "sometimes" and "always") and child behavioral problems were assessed via a caregiver questionnaire when the child was 3.5 years old and again at 5.5 years. Propensity score matching was used to examine the association between frequency of spanking and child behavioral problems, adjusting for parental socioeconomic status, child temperament and parenting behaviors. Compared to children who were never spanked, occasional spanking ("sometimes") showed a higher number of behavioral problems (on a 6-point scale) (coefficient: 0.11, 95% CI: 0.07-0.15), and frequent spanking ("always") showed an even larger number of behavioral problems compared with "sometimes" (coefficient: 0.08, 95% CI:0.01-0.16). Spanking of any self-reported frequency was associated with an increased risk for later behavioral problems in children.


Citations (20)


... Psychological and social factors play a significant role in the varying prevalence of insomnia during pregnancy, with psychological factors often being linked to some social factors. Pan Chen and Eric S Kim suggest that enhancing overall well-being can be an effective way to alleviate negative psychological symptoms (77,78). Therefore, enhancing the focus on women during pregnancy is crucial for safeguarding their health (79). ...

Reference:

Evaluating the global prevalence of insomnia during pregnancy through standardized questionnaires and diagnostic criteria: a systematic review and meta-analysis
Connected communities: Perceived neighborhood social cohesion during adolescence and subsequent health and well-being in young adulthood-An outcome-wide longitudinal approach
  • Citing Article
  • July 2024

Journal of Community Psychology

... One study did not find a significant relationship between overall COI scores and anxiety and depression scores in a sample of adolescents aged 13-16 years old [37]. Another study using the Adolescent Brain Cognitive Development (ABCD) Study sample at baseline (youths aged 9-10) examined both the Area Deprivation Index (ADI) quintiles and the COI quintiles to examine relations with Child Behavior Checklist (CBCL) scores [38]. Greater neighborhood resources were associated with fewer externalizing symptoms, but adjusting for child-and family-level factors rendered the association between the COI and externalizing nonsignificant. ...

Comparing two measures of neighborhood quality and internalizing and externalizing behaviors in the adolescent brain cognitive development study

Social Psychiatry and Psychiatric Epidemiology

... Disasters occur in Indonesia, both natural and non-natural disasters (Bachri et al., 2024;Danar, 2024;Herbanu et al., 2024;Lumban-Gaol et al., 2024;Niman et al., 2024;Oktora, 2024;Opabola & Galasso, 2024;Setiawan & Mahendra, 2024;Setyonugroho & Maki, 2024). Disaster nutrition is an interesting topic of current issues to develop (Aslam, 2024;Fatmah, 2024;Lassa, 2024;Le, 2024;Marzban, 2024;Yazawa, 2024). Given the importance of disaster mitigation, preventive measures such as disaster training are a necessity. ...

Association of disaster-related damage with inflammatory diet among older survivors of the Great East Japan Earthquake and Tsunami
  • Citing Article
  • January 2024

The British journal of nutrition

... 6 The most cited study relevant to the scale of climate anxiety in the South is subtitled a 'global survey'. 7 This project recruited 15 543 young people (aged [16][17][18][19][20][21][22][23][24][25], of whom results were reported for 10,000. Participants were from 10 nations, including four in the South (Brazil, India, Nigeria and the Philippines). ...

A systematic review of the effects of chronic, slow-onset climate change on mental health
  • Citing Article
  • January 2024

Nature Mental Health

... Previous studies have conceptualized regulatory flexibility as the amount of the numerical variability observed in the frequency use of distinct strategies (Cheng et al., 2014;Blanke et al., 2020). For instance, using a standard deviation-based algorithm , 2024bBlanke et al., 2020), lower variability (displaying high evenness in scores across strategies) suggests all strategies are used at a fairly equal frequency across situations, greater variability (displaying high unevenness in scores across strategies) suggests only a few strategies are frequently used, and moderate variability (displaying moderate unevenness in scores across strategies) suggests several strategies are used with varied frequencies and possibly reflects an effort to find the best strategy for each situation. Emerging research shows the predictive value of such variability in long-term health outcomes, such as longevity , 2024b. ...

A long and resilient life: the role of coping strategies and variability in their use in lifespan among women
  • Citing Article
  • November 2023

Anxiety, Stress, and Coping

... AI/AN families living in cities that border tribal reservations may experience this to a greater extent, as the residents from the dominant cultural group may have closer historical and political relations with the nearby tribe, and greater access to stereotypes about American Indian or Indigenous peoples [66]. Lack of community belonging, prejudice, and discrimination are related to poor child mental health and lower academic achievement for adolescents and young adults in both AI/AN reservation communities and other minoritized communities [67][68][69], with some evidence of negative impacts on EF and related skills [70,71]. Parent's experiences of racial discrimination can also manifest as vicarious racism and have been shown to impact their children's mental health and cognitive development [72]. ...

Resilience in development: Neighborhood context, experiences of discrimination, and children's mental health
  • Citing Article
  • August 2023

Development and Psychopathology

... Symptoms of anxiety and depression were measured by the 7-item Generalized Anxiety Disorder Scale (GAD-7) [29], and the 9-item Patient Health Questionnaire-9 (PHQ-9) [30], respectively, with a cut-off point for caseness of ≥ 5. In a sub-analyses for assessing the risks associated with varying degrees of anxiety and depression, we re-classified the GAD-7 and PHQ-9 scores into three categories: normal (0-4), mild (5)(6)(7)(8)(9), and moderate to severe (≥ 10). In line with our previous work [23], stress-related disorder was defined as experiencing a probable acute stress disorder (i.e., a dissociation cluster score of ≥ 9 and a total score ≥ 28 encompassing reexperiencing, avoidance, and arousal clusters, measured by the 19-item Acute Stress Disorder Scale [31]) at recruitment and/or probable posttraumatic stress disorder (PTSD, endorsing at least moderate levels for 1 intrusion symptom, 1 avoidance symptom, 2 negative alterations in cognitions and mood, and hyperarousal symptoms, according to the 20-item Posttraumatic Stress Disorder Checklist for DSM-5 ), at any follow-up. ...

Do Adverse Childhood Experiences Modify the Association Between Disaster-Related Trauma and Cognitive Disability?

American Journal of Epidemiology

... And our results manifest that migrant owners were associated with poorer self-rated health compared with migrant renters, which is consistent with previous literature (Jia et al., 2023;Zhou & Guo, 2023b). Also, in line with past literature Lee et al., 2023), social integration could improve health status. As hypothesized (H1), our results demonstrated that the association between housing tenure and self-rated health was partly mediated by social integration after adjustment for sociodemographic and socioeconomic factors. ...

Social integration and risk of mortality among African-Americans: the Jackson heart study

Social Psychiatry and Psychiatric Epidemiology

... Post-disaster sleep problems are thought to interfere with the brain's ability to process memories and emotions, potentially slowing the recovery process for individuals suffering from PTSD. Many PTSD patients use alcohol and other substances to cope with sleep disturbances, which can negatively affect both sleep and PTSD symptoms [10,26]. Additionally, the environmental and social problems resulting from earthquakes, such as the destruction of homes, hospitals, and schools, the challenges of survival in temporary shelters, and ongoing aftershocks in the area, are believed to have a more severe impact on PTSD and sleep hygiene in this population compared to other populations who are experiencing traumatic events. ...

Bidirectional associations between posttraumatic stress symptoms and sleep quality among older survivors of the 2011 Great East Japan Earthquake and Tsunami
  • Citing Article
  • April 2023

Sleep

... For instance, emerging evidence examines long-term consequences of parent-child separation, a common type of ACE, on cardiovascular health in adults. 37 Fourth, because of the cross-sectional design, the study cannot support causality between ACEs and sleep duration. Finally, although not inherently a limitation of our study, it is important to note that the NSCH data we used did not have participants falling into all of the sleep duration categories (none aligned with scores of 70 or 90). ...

Parent-child separation and cardiometabolic outcomes and risk factors in adulthood: A systematic review
  • Citing Article
  • March 2023

Psychoneuroendocrinology