Study ObjectivesSleep quality is associated with different aspects of psychopathology, but relatively little research has examined links between sleep quality and externalizing behaviors or callous-unemotional traits. We examined: (1) whether an association exists between sleep quality and externalizing behaviors; (2) whether anxiety mediates this association; (3) whether callous-unemotional traits are associated with sleep quality.MethodsData from two studies were used. Study 1 involved 1556 participants of the G1219 study aged 18–27 years (62% female). Questionnaire measures assessed sleep quality, anxiety, externalizing behaviors, and callous-unemotional traits. Study 2 involved 338 participants aged 18–66 years (65% female). Questionnaires measured sleep quality, externalizing behaviors, and callous-unemotional traits. In order to assess objective sleep quality, actigraphic data were also recorded for a week from a subsample of study 2 participants (n = 43).ResultsIn study 1, poorer sleep quality was associated with greater externalizing behaviors. This association was partially mediated by anxiety and moderated by levels of callous-unemotional traits. There was no significant relationship between sleep quality and callous-unemotional traits. In study 2, poorer sleep quality, as assessed via self-reported but not objective measures, was associated with higher levels of externalizing behaviors. Furthermore, in study 2, better sleep quality (indicated in both questionnaires and actigraphy measures: lower mean activity, and greater sleep efficiency) was associated with higher levels of callous-unemotional traits.ConclusionsSelf-reports of poorer sleep quality are associated with externalizing behaviors, and this association is partially mediated by anxiety. Callous-unemotional traits are not associated with poor sleep and may even be related to better sleep quality. This is an exceptional finding given that poor sleep quality appears to be a characteristic of most psychopathology.

Overlapping genetic influences have been implicated in diurnal preference and subjective sleep quality. Our overall aim was to examine overlapping concurrent and longitudinal genetic and environmental effects on diurnal preference and sleep quality over ~5 years. Behavioural genetic analyses were performed on data from the longitudinal British G1219 study of young adult twins and non-twin siblings. 1556 twins and siblings provided data on diurnal preference (MorningnessEveningness Questionnaire) and sleep quality (Pittsburgh Sleep Quality Index) and between phenotypes were largely accounted for by genetic factors (explaining between 60%-100% of the associations). All shared environmental effects were non-significant. Non-shared environmental influences played a smaller role on the associations between phenotypes (explaining between -.06%-40% of the associations). These results suggest that to some extent similar genes contribute to the stability of diurnal preference and sleep quality throughout young adulthood, but also that different genes play a part over this relatively short time-frame. While there was evidence of genetic overlap between phenotypes concurrently and longitudinally, the possible emergence of new genetic factors (or decline of previously associated factors) suggests that molecular genetic studies focussing on young adults should consider more tightly specified age-groups, given that genetic effects may be time-specific.

This study explored staff and service users' views on a selection of candidate wellbeing questionnaires for use by a UK-based healthcare provider, Nuffield Health, that is embarking on a programme to monitor the impact of their services on wellbeing. Ten stakeholder focus groups were conducted with 64 staff and service users, in addition to three in-depth telephone interviews with Nuffield Health Executive Board members. Focus groups and interviews were audio-recorded and transcripts examined using qualitative thematic analysis. Across focus groups, stakeholders commented on the importance of ensuring that data from wellbeing questionnaires provided actionable insight that can help to direct care and inform service improvements. Service users conceptualised their own wellbeing as a broad concept that encompassed more than just a mental state, and that was broadly aligned to the notion of feeling "in balance". Following the measurement process, service users were particularly interested to receive feedback on determinants of their own wellbeing, beyond those directly related to the services provided by Nuffield Health. Staff discussed the importance of embedding wellbeing measurement within a supportive service infrastructure and ensuring that appropriate training is available to help those with distinct wellbeing-related needs if identified through the monitoring process. Wellbeing is complex and subjective concept, and existing questionnaires used by Nuffield Health are inappropriate for measuring the independent impact of a health service on user wellbeing. Further work is required to pilot test alternative questionnaires that better reflect service users' intuitive understandings of their own wellbeing, and that can provide actionable data to inform ongoing service improvements.

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