Low social support and disturbed sleep : epidemiological and psychological perspectives

Abstract: The Swedish work force underwent dramatic changes during an economic crisis in the 1990s. In the aftermath, sick leave increased at an unprecedented rate and stress-related disorders, such as burnout, depression, and sleep disturbances replaced earlier work-related diagnoses. Sleep disturbances have been demonstrated to both precede and succeed mental and physical illnesses, including burnout, depression, anxiety, and cardiovascular disease. Disturbed sleep is also a common complaint in Sweden as well as in the rest of the Western world. Sleep has been shown to easily be disturbed by cognitive, emotional, and physiological arousal (stress). However, several studies have demonstrated that social support has a protective effect against the adverse effects of stress as well as a generally beneficial effect on health. Other studies, though, suggest that lack of social support may increase the risk for mental and physical ill-health. The purpose of this thesis was therefore to investigate the association between social support and disturbed sleep; foremost in working populations.Epidemiological methods were applied to investigate the association between social support and disturbed sleep. Three studies were used; a cross-sectional (MONICA, n = 1,179), a longitudinal (WOLF, n = 2,479), and a case-referent (SHEEP and VHEEP in conjunction, n = 6,231) study. The data was obtained by questionnaires, and social support was operationalized as network and emotional support. Disturbed sleep was defined as difficulties falling asleep, difficulties maintaining sleep, repeated awakenings, and disturbed sleep. Gender was taken into consideration throughout the studies.Foremost, low network support was found to increase the risk for contracting disturbed sleep. Which source the network support was derived from did not alter the association between low network support and disturbed sleep—low network support at work increased the risk for disturbed sleep as did low network outside work. Prolonged low network support and impaired emotional support did also increase the risk for sleep disturbances in men who were under strain at work. Furthermore, open coping buffered against low network support in the association with disturbed sleep five years later in women, whereas low network support increased the risk for developing disturbed sleep at a later date when interacting with covert coping both in women and in men. Moreover, disturbed sleep was shown to mediate low network support in myocardial infarction in women.In conclusion, the association between social support and disturbed sleep is complex and includes both interactions with other personality variables and mediating associations. Previous research on negative effects of low social support was confirmed as was previously observed gender differences in social support.