A Neural Network Model of Risk and Protective Factors for Poor Sleep Quality in Healthcare Providers: Role of Aggression and Self-regulation
Authors
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Shakiba Rezaei
Department of Psychology, Kermanshah Branch, Islamic Azad University, Kermanshah, Iran
https://orcid.org/0009-0000-6628-4366
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Azita Chehri
Department of Psychology, Kermanshah Branch, Islamic Azad University, Kermanshah, Iran.
https://orcid.org/0000-0002-8488-4784
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Saeede Sadat Hosseini
Department of Psychology, Kermanshah Branch, Islamic Azad University, Kermanshah, Iran.
https://orcid.org/0000-0003-3894-6582
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Mokhtar Arefi
Department of Psychology, Kermanshah Branch, Islamic Azad University, Kermanshah, Iran.
https://orcid.org/0000-0002-1844-1926
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Hassan Amiri
Department of Psychology, Kermanshah Branch, Islamic Azad University, Kermanshah, Iran.
https://orcid.org/0000-0002-4485-9437
DOI:
https://doi.org/10.22100/ijhs.v10i2.1063Keywords:
Aggression, Adolescents, Self-regulation, Sleep qualityAbstract
Background: Although the literature discusses the benefits of good sleep on physiological, psychological, and physical health, poor sleep quality is common among healthcare providers. The present study aimed to predict poor sleep quality among healthcare providers based on multiple risk factors (aggression, gender, and age) and the protective factor of self-regulation using a neural network model.
Methods: Using multistage cluster sampling, a group of 400 healthcare workers (70% female, with an age average of 32 years) from Kermanshah city in western Iran were selected for the cross-sectional study. Data were collected using the Pittsburgh Sleep Quality Index (PSQI), the Buss-Perry Aggression Questionnaire (BPAQ), and the Self-Regulation Questionnaire (SRQ). A neural network model and receiver operating characteristic (ROC) curve were used for data analysis.
Results: Four hidden units were found in a single hidden layer extracted using the current model. More than 84% of the training and testing models accurately predicted good and poor sleepers. The neural network model's good predictive value was indicated by the Area under the ROC Curve (AUC=0.863). The results imply that self-regulation (0.30), anger (0.20), physical aggression (0.19), verbal aggression (0.11), hostility (0.10), age (0.06), and sex (0.05) have normalized importance values ranging from 18% to 100%, making them significant predictors of both the good and poor sleep subgroups.
Conclusions: The present neural network-based algorithm, which considers the risk and protective factors of poor sleep quality, could be effectively used by healthcare providers.
References
Bahremand M, Komasi S. Which symptoms are the psychopathological core affecting the manifestation of pseudo-cardiac symptoms and poor sleep quality in young adults? Symptoms of personality disorders versus clinical disorders. Front Psychol. 2022;13:1011737. doi: 10.3389/fpsyg.2022.1011737
Clement-Carbonell V, Portilla-Tamarit I, Rubio-Aparicio M, Madrid-Valero JJ. Sleep quality, mental and physical health: A differential relationship. Int J Environ Res Public Health. 2021;18(2):460. doi: 10.3390/ijerph18020460
Tahmasian M, Samea F, Khazaie H, Zarei M, Kharabian Masouleh S, Hoffstaedter F, Camilleri J, Kochunov P, Yeo BT, Eickhoff SB, Valk SL. The interrelation of sleep and mental and physical health is anchored in grey-matter neuroanatomy and under genetic control. Commun Biol. 2020;3(1):171. doi: 10.1038/s42003-020-0892-6
Juárez-Rojop IE, Fresán A, Genis-Mendoza AD, Cerino-Palomino C, Nolasco-Rosales GA, González-Castro TB, López-Narváez ML, Olan F, Villar-Soto M, Tovilla-Zárate CA, Nicolini H. Prevalence of poor sleep quality and associated factors in individuals with rheumatoid arthritis: A cross-sectional study. Medicina (Kaunas). 2023;59(9):1633. doi: 10.3390/medicina59091633
Khazaie H, Zakiei A, Rezaei M, Komasi S, Brand S. Sleep pattern, common bedtime problems, and related factors among first-grade students: Epidemiology and predictors. Clin Epidemiol Global Health. 2019;7(4):546-51. doi: 10.1016/j.cegh.2018.12.007
Khoshakhlagh AH, Al Sulaie S, Yazdanirad S, Orr RM, Dehdarirad H, Milajerdi A. Global prevalence and associated factors of sleep disorders and poor sleep quality among firefighters: A systematic review and meta-analysis. Heliyon. 2023;9(2):e13250. doi: 10.1016/j.heliyon.2023.e13250
Sheppard N, Hogan L. Prevalence of insomnia and poor sleep quality in the prison population: A systematic review. J Sleep Res. 2022;31(6):e13677. doi: 10.1111/jsr.13677
Zhang YS, Jin Y, Rao WW, Jiang YY, Cui LJ, Li JF, Li L, Ungvari GS, Ng CH, Li KQ, Xiang YT. Prevalence and socio-demographic correlates of poor sleep quality among older adults in Hebei province, China. Sci Rep. 2020;10(1):12266. doi: 10.1038/s41598-020-68997-x
Aliyu I, Mohammed II, Lawal TO, Gudaji M, Garba N, Monsudi KF, Michael GC, Peter ID. Assessment of sleep quality among medical doctors in a tertiary hospital in a semi-rural setting. J Neurosci Rural Pract. 2018;9(4):535-540. doi: 10.4103/jnrp.jnrp_91_18
Binjabr MA, Alalawi IS, Alzahrani RA, Albalawi OS, Hamzah RH, Ibrahim YS, Buali F, Husni M, BaHammam AS, Vitiello MV, Jahrami H. The worldwide prevalence of sleep problems among medical students by problem, country, and COVID-19 status: A systematic review, meta-analysis, and meta-regression of 109 studies involving 59427 participants. Curr Sleep Med Rep. 2023:1-19. doi: 10.1007/s40675-023-00258-5
Rao WW, Li W, Qi H, Hong L, Chen C, Li CY, Ng CH, Ungvari GS, Xiang YT. Sleep quality in medical students: a comprehensive meta-analysis of observational studies. Sleep Breath. 2020;24(3):1151-1165. doi: 10.1007/s11325-020-02020-5
Zeng LN, Yang Y, Wang C, Li XH, Xiang YF, Hall BJ, Ungvari GS, Li CY, Chen C, Chen LG, Cui XL, An FR, Xiang YT. Prevalence of poor sleep quality in nursing staff: A meta-analysis of observational studies. Behav Sleep Med. 2020;18(6):746-759. doi: 10.1080/15402002.2019.1677233
Akbari V, Hajian A, Mirhashemi MS. Evaluating of sleep quality in shift-work nurses. Iran J Sleep Disored Ther. 2016;5(225):2167-0277.
Haseli A, Egdampur F, Qaderi K, Kaffashian MR, Delpisheh A. Nurses and midwives' sleep quality and its associated factors during the early COVID-19 pandemic in Iran. Heliyon. 2023;9(4):e15068. doi: 10.1016/j.heliyon.2023.e15068
Janatmakan Amiri A, Morovatdar N, Soltanifar A, Rezaee R. Prevalence of sleep disturbance and potential associated factors among medical students from Mashhad, Iran. Sleep Disord. 2020;2020:4603830. doi: 10.1155/2020/4603830
Kudrnáčová M, Kudrnáč A. Better sleep, better life? testing the role of sleep on quality of life. PLoS One. 2023;18(3):e0282085. doi: 10.1371/journal.pone.0282085
Albinsaleh AA, Al Wael WM, Nouri MM, Alfayez AM, Alnasser MH, Alramadan MJ. Prevalence and factors associated with poor sleep quality among visitors of primary healthcare centers in Al-Ahsa, Kingdom of Saudi Arabia: An analytical cross-sectional study. Cureus. 2023;15(7):e42653. doi: 10.7759/cureus.42653
Ionescu CG, Popa-Velea O, Mihailescu AI, Talasman AA, Badarau IA. Somatic symptoms and sleep disorders: a literature review of their relationship, comorbidities and treatment. Healthcare. 2021;9(9):1128. doi: 10.3390/healthcare9091128
Kang JM, Lee JA, Jang JW, Kim YS, Sunwoo S. Factors associated with poor sleep quality in primary care. Korean J Fam Med. 2013;34(2):107-14. doi: 10.4082/kjfm.2013.34.2.107
Magnavita N, Di Stasio E, Capitanelli I, Lops EA, Chirico F, Garbarino S. Sleep problems and workplace violence: A systematic review and meta-analysis. Front Neurosci. 2019;13:997. doi: 10.3389/fnins.2019.00997
Rezaei F, Hemmati A, Rahmani K, Komasi S. Psychobiological personality traits related to sleep disorders and sexual dysfunction: A systematic review and meta-analysis. J Turkish Sleep Med. 2021;8(2):74-89. doi: 10.4274/jtsm.galenos.2021.04695
Zhou SJ, Wang LL, Wang TT, Wang JQ, Chen JX. Associations between experienced aggression, poor sleep, and suicide risk among Chinese adolescents. Sleep. 2022;45(6):zsac048. doi: 10.1093/sleep/zsac048
Komasi S, Rezaei F, Hemmati A, Rahmani K, Amianto F, Miettunen J. Comprehensive meta-analysis of associations between temperament and character traits in Cloninger's psychobiological theory and mental disorders. J Int Med Res. 2022;50(1):3000605211070766. doi: 10.1177/03000605211070766
World Health Organization. The VPA Approach. 2023. https://www.who.int/groups/violence-prevention-alliance/approach.
Rutherford A, Zwi AB, Grove NJ, Butchart A. Violence: a glossary. J Epidemiol Community Health. 2007;61(8):676-80. doi: 10.1136/jech.2005.043711
Buss AH, Perry M. The aggression questionnaire. J Pers Soc Psychol. 1992;63(3):452-9. doi: 10.1037/0022-3514.63.3.452
Komasi S, Saeidi M, Soroush A, Zakiei A. The relationship between brain behavioral systems and the characteristics of the five factor model of personality with aggression among Iranian students. J Inj Violence Res. 2016;8(2):67-74. doi: 10.5249/jivr.v8i2.696
Krahé B, Tomaszewska P, Kuyper L, Vanwesenbeeck I. Prevalence of sexual aggression among young people in Europe: A review of the evidence from 27 EU countries. Aggress Violent Behav. 2014;19(5):545-58. doi: 10.1016/j.avb.2014.07.005
Liu J, Lewis G, Evans L. Understanding aggressive behaviour across the lifespan. J Psychiatr Mental Health Nurs. 2013;20(2):156-68. doi: 10.1111/j.1365-2850.2012.01902.x
Wang Y, Fu Y, Ghazi P, Gao Q, Tian T, Kong F, Zhan S, Liu C, Bloom DE, Qiao J. Prevalence of intimate partner violence against infertile women in low-income and middle-income countries: a systematic review and meta-analysis. Lancet Glob Health. 2022;10(6):820-30. doi: 10.1016/S2214-109X(22)00098-5
Kamali K, Maleki A, Yazdi SAB, Faghihzadeh E, Hoseinzade Z, Hajibabaei M, Sharafi SE, Noorbala AA. The prevalence of violence and its association with mental health among the Iranian population in one year after the outbreak of COVID-19 disease. BMC Psychiatry. 2023;23(1):33. doi: 10.1186/s12888-022-04444-7
Poorolajal J, Ebrahimi B, Rezapur-Shahkolai F, Doosti-Irani A, Alizadeh M, Ahmadpoor J, Moradi L, Biderafsh A, Nikbakht F, Golmohammadi Z, Sarbazi E, Bahadivand S, Jahani Sayad Noveiri M, Rezaei M, Ghorbani Gholiabad S, Heidari S, Bagheri H, Ghalandari M, Kiani FZ, Fakhranirad N, Ghavi S, Seydkhani P. The epidemiology of aggression and associated factors among Iranian adult population: A national survey. J Res Health Sci. 2020;20(4):e00499. doi: 10.34172/jrhs.2020.34
Sariaslani P, Soroush A, Faridmarandi B, Moarref M, Komasi S. Aggressive behavior and its triggers among hospitalized stroke patients' entourages toward healthcare staff. J Clin Res Paramed Sci. 2022;11(2):e132226. doi: 10.5812/jcrps-132226
Van Veen MM, Lancel M, Beijer E, Remmelzwaal S, Rutters F. The association of sleep quality and aggression: A systematic review and meta-analysis of observational studies. Sleep Med Rev. 2021;59:101500. doi: 10.1016/j.smrv.2021.101500
Van Veen MM, Lancel M, Şener O, Verkes RJ, Bouman EJ, Rutters F. Observational and experimental studies on sleep duration and aggression: A systematic review and meta-analysis. Sleep Med Rev. 2022;64:101661. doi: 10.1016/j.smrv.2022.101661
Deffenbacher JL, Oetting ER, Thwaites GA, Lynch RS, Baker DA, Stark RS, Thacker S, Eiswerth-Cox L. State-trait anger theory and the utility of the trait anger scale. J Counsel Psychol. 1996;43(2):131-148. doi: 10.1037/0022-0167.43.2.131
Velotti P, Garofalo C, Callea A, Bucks RS, Roberton T, Daffern M. Exploring anger among offenders: The role of emotion dysregulation and alexithymia. Psychiatr Psychol Law. 2016;24(1):128-138. doi: 10.1080/13218719.2016.1164639
Nicholson LR, Lewis R, Thomas KG, Lipinska G. Influence of poor emotion regulation on disrupted sleep and subsequent psychiatric symptoms in university students. South Afr J Psychol. 2021;51(1):6-20. doi: 10.1177/0081246320978527
Vandekerckhove M, Wang YL. Emotion, emotion regulation and sleep: An intimate relationship. AIMS Neurosci. 2017;5(1):1-17. doi: 10.3934/Neuroscience.2018.5.1
Tu JV. Advantages and disadvantages of using artificial neural networks versus logistic regression for predicting medical outcomes. J Clin Epidemiol. 1996;49(11):1225-31. doi: 10.1016/S0895-4356(96)00002-9
Pallant J. SPSS survival manual: A step by step guide to data analysis using SPSS for Windows (Version 12). 2nd edn. Australia: Allen & Unwin. 2005. Pp. 142-52.
Tabachnick BG, Fidell LS. Using multivariate statistics (6th ed.). Boston: Pearson. 2013.
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213. doi: 10.1016/0165-1781(89)90047-4
Khosravi A, Emamian MH, Hashemi H, Fotouhi A. Components of Pittsburgh Sleep Quality Index in Iranian adult population: an item response theory model. Sleep Med. 2021;X(3):100038. doi: 10.1016/j.sleepx.2021.100038
Samani S. Study of reliability and validity of the Buss and Perry's Aggression Questionnaire. Iran J Psychiatry Clin Psychol. 2008;13(4) :359-65.
Neal DJ, Carey KB. A follow-up psychometric analysis of the self-regulation questionnaire. Psychol Addict Behav. 2005;19(4):414-22. doi: 10.1037/0893-164X.19.4.414
Zakiei A, Khazaie H, Alimoradi M, Kadivarian A, Rajabi-Gilan N, Komasi S. A causal model for the control of risk factors for cardiovascular diseases using a new temperamental personality theory in the general population of Western Iran: The mediating role of self-regulation. J Practice Cardiovasc Sci. 2021;7(3):190-197. doi: 10.4103/jpcs.jpcs_62_21
Mandrekar JN. Receiver operating characteristic curve in diagnostic test assessment. J Thorac Oncol. 2010;5(9):1315-6. doi: 10.1097/JTO.0b013e3181ec173d
Komasi S, Rezaei F, Hemmati A, Nazari A, Nasiri Y, Faridmarandi B, Zakiei A, Saeidi M, Hopwood CJ. Clinical cut scores for the Persian version of the Personality Inventory for DSM-5. J Clin Psychol. 2023: 1-21. doi: 10.1002/jclp.23614
Stafford M, Bendayan R, Tymoszuk U, Kuh D. Social support from the closest person and sleep quality in later life: Evidence from a British birth cohort study. J Psychosom Res. 2017;98:1-9. doi: 10.1016/j.jpsychores.2017.04.014
Rosenman R, Tennekoon V, Hill LG. Measuring bias in self-reported data. Int J Behav Healthc Res. 2011;2(4):320-332. doi: 10.1504/IJBHR.2011.043414
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