Sleep Deprivation Impairs Productivity in Adults With Mood Disorders: A Scoping Review

BACKGROUND: Sleep problems resulting in sleep deprivation (SD) affect 50%–80% of individuals living with mood disorders (Harvard Health Publications, 2010). Evidently, sleep problems may precipitate the onset of mood disorders, while sleep intervention may, in turn, improve mood disorder symptoms (Harvard Health Publications, 2010). Nonetheless, sleep remains understudied in occupational therapy (Eklund & Leufstadius, 2007; Green, 2008), including the impact SD may have in restricting occupational performance in individuals with mood disorders.

PURPOSE: This study identified and synthesized the current knowledge on the effects of SD (i.e., insufficient sleep over time resulting in physical or psychiatric symptoms affecting routine tasks; Fulke & Vaughn, 2009) on the paid and unpaid productive occupations of adults with mood disorders.

METHOD: The researchers conducted a scoping review of existing primary studies (Arksey & O’Malley, 2005). Search terms and Boolean operators were devised in consultation with a research librarian, including terms related to sleep deprivation AND mood disorders AND productivity. Seven databases were searched (CINAHL, PubMed, MEDLINE, PsycINFO, EMBASE, Cochrane Library and Dissertations, Theses Global), and footnote chasing was used to ensure content saturation. Studies were included if they were published in English from 2005 to 2015, participants were age ≥18 yr, >50% had a diagnosed mood disorder, and outcomes focused on SD and the performance of productive occupations. Studies were excluded if they focused on other primary diagnoses (e.g., obstructive sleep apnea). Two researchers independently evaluated each included study and extracted the location, design, sample characteristics, aims, outcome measures, and results. Data sets were later merged for summary, consensus, and reporting of results.

RESULTS: While 55 studies were identified for full-text review, only eight met the inclusion criteria with full team consensus. An overarching theme of decreased performance in productivity-related occupations emerged in those with mood disorders and SD (vs. without SD). Moreover, the research team identified four themes demonstrating an increase in (1) health care utilization and associated costs (e.g., greater number of emergency room visits), (2) functional impairment (e.g., physical, psychological, social), (3) work impairment (e.g., absenteeism and presenteeism), and (4) a decrease in health-related quality of life (e.g., health status, role participation, social relationships). Gaps in the literature included a lack of qualitative studies to understand the lived experiences of individuals, limited focus on productive occupations outside of paid employment (e.g., volunteering, parenting, homemaking), and lack of occupation-based outcome measures (vs. functional measures).

CONCLUSION: This study identifies that adults with mood disorders and SD (vs. without SD) experience increased health care utilization and costs, decreased functional abilities, decreased work performance, and decreased health-related quality of life. This study sets the foundation for developing a systematic literature review to discern the determinants of SD on productivity in adults with mood disorders. Further, to address identified gaps in the literature, development of additional primary studies using both qualitative and quantitative methods with occupation-based frameworks would prove useful in development of a rich understanding of client experiences and influences on occupational performance in this population.

References

Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8, 19–32. https://doi.org/10.1080/1364557032000119616

Eklund, M., & Leufstadius, C. (2007). Relationships between occupational factors and health and well-being in individuals with persistent mental illness living in the community. Canadian Journal of Occupational Therapy, 74, 303–313. https://doi.org/10.1177/000841740707400403

Fulke, P., & Vaughn, S. (Eds.). (2009). Sleep deprivation: Causes, effects and treatment. New York: Nova Science.

Green, A. (2008). Sleep, occupation and the passage of time. British Journal of Occupational Therapy, 71, 339–347. https://doi.org/10.1177/030802260807100808

Harvard Health Publications. (2010). Sleep and mental health. Retrieved from http://www.health.harvard.edu/newsletter_article/Sleep-and-mental-health