Michael N. Mitchell

In-Group Identification, Social Dominance Orientation, and Differential Intergroup Social Allocation

Abstract Three varieties of differential intergroup social allocation were examined in a sample of American students as a function of degree of in-group legitimacy, self-esteem, sex, and social dominance orientation within a standard minimal-groups experimental paradigm. The results are consistent with both social identity theory and much previous research in this area: The greater the in-group identification, the greater the allocation of social value in favor of the in-group. The results are also consistent with the expectations of social dominance theory and show that, even after the effects of gender, self-esteem, and in-group identification were considered, the greater the social dominance orientation, the greater the allocation of social value in favor of the in-group. For two of the three indexes of social value, there was a statistically significant interaction between in-group identification and social dominance orientation. Subjects showing strong acceptance of their in-group classification and ...

Social Hierarchy and the Death Penalty: A Social Dominance Perspective

This study examines the social factors related to use of the death penalty. In Study 1, the number of executions in each of the 50 states of the United States since 1976 was predicted from: (1) degree of social hierarchy, (2) Old Confederacy status, (3) political conservatism, (4) degree of violent crime, (5) income, (6) population size, (7) population density, (8) degree of education, (9) proportion of population which is white, and (10) proportion of whites murdered. Social hierarchy and conservatism were consistently and significantly related to use of executions. Study 2 predicted execution use in 147 countries from: (1) degree of social hierarchy, (2) number of murders, (3) size of government, (4) area, (5) education, (6) gross national product, and (7) population size. The degree of social hierarchy and number of murders were significantly related to execution use. While some of these results were predicted by the symbolic motives model or the deterrence model, it is argued that social dominance theory offers a more comprehensive explanation of the results as a whole.

Poor Self-Reported Sleep Quality Predicts Mortality within One Year of Inpatient Post-Acute Rehabilitation among Older Adults

STUDY OBJECTIVE To evaluate the association between self-reported sleep quality among older adults during inpatient post-acute rehabilitation and one-year survival. DESIGN Prospective, observational cohort study. SETTING Two inpatient post-acute rehabilitation sites (one community and one Veterans Administration). PARTICIPANTS Older patients (aged ≥ 65 years, n = 245) admitted for inpatient post-acute rehabilitation. INTERVENTIONS None. MEASUREMENTS AND RESULTS Within one year of post-acute rehabilitation, 57 participants (23%) were deceased. Cox proportional hazards models showed that worse Pittsburgh Sleep Quality Index (PSQI) total scores during the post-acute care stay were associated with increased mortality risk when controlling for amount of rehabilitation therapy received, comorbidities, and cognitive functioning (Hazard ratio [95% CI] = 1.11 [1.02-1.20]). Actigraphically estimated sleep was unrelated to mortality risk. CONCLUSIONS Poorer self-reported sleep quality, but not objectively estimated sleep parameters, during post-acute rehabilitation was associated with shorter survival among older adults. This suggests self-reported poor sleep may be an important and potentially modifiable risk factor for negative outcomes in these vulnerable older adults. Studies of interventions to improve sleep quality during inpatient rehabilitation should therefore be undertaken, and the long-term health benefits of improved sleep should be explored.

Cognitive Behavioral Therapy for Insomnia in Older Veterans Using Nonclinician Sleep Coaches: Randomized Controlled Trial

To test a new cognitive behavioral therapy for insomnia (CBT‐I) program designed for use by nonclinicians.

Sleep Disturbance Among Older Adults in Assisted Living Facilities

OBJECTIVES To evaluate whether objectively and subjectively measured sleep disturbances persist among older adults in assisted living facilities (ALFs) and to identify predictors of sleep disturbance in this setting. DESIGN Prospective, observational cohort study. SETTING AND PARTICIPANTS A total of 121 residents, age ≥ 65 years, in 18 ALFs in the Los Angeles area. MEASUREMENTS Objective (actigraphy) and subjective (Pittsburgh Sleep Quality Index) sleep measures were collected at baseline and 3- and 6-month follow-up. Predictors of baseline sleep disturbance tested in bivariate analyses and multiple regression models included demographics, Mini-Mental State Examination score, number of comorbidities, nighttime sedating medication use, functional status (activities of daily living; instrumental activities of daily living), restless legs syndrome, and sleep apnea risk. RESULTS Objective and subjective sleep measures were similar at baseline and 3- and 6-month follow-up (objective nighttime total sleep [hours] 6.3, 6.5, and 6.4; objective nighttime percent sleep 77.2, 77.7, and 78.3; and Pittsburgh Sleep Quality Index total score 8.0, 7.8, and 7.7, respectively). The mean baseline nighttime percent sleep decreased by 2% for each additional unit increase in baseline comorbid conditions (measured as the number of conditions), and increased by 4.5% for each additional unit increase in baseline activities of daily living (measured as the number of activities of daily living), in a multiple regression model. CONCLUSIONS In this study, we found that objectively and subjectively measured sleep disturbances are persistent among ALF residents and are related to a greater number of comorbidities and poorer functional status at baseline. Interventions are needed to improve sleep in this setting.

Association Between Sleep and Physical Function in Older Veterans in an Adult Day Healthcare Program

To examine whether sleep disturbance is associated with poor physical function in older veterans in an adult day healthcare (ADHC) program.

Efficacy of Cognitive Behavioral Therapy for Insomnia in Older Adults With Occult Sleep-Disordered Breathing.

Objectives The aims of the study were to determine whether mild, occult sleep-disordered breathing (SDB) moderates the efficacy of cognitive behavioral therapy for insomnia (CBTI) in older adults and to explore whether CBTI reduces the number of patients eligible for positive airway pressure (PAP) therapy. Methods Data were analyzed for 134 adults 60 years or older with insomnia and apnea-hypopnea index (AHI) of less than 15 who were randomized to a larger study of CBTI versus a sleep education control. Sleep outcomes (sleep onset latency, total wake time, wake after sleep onset, sleep efficiency, Pittsburgh Sleep Quality Index) were compared between CBTI and control at 6 months using repeated-measures analysis of variance adjusted for baseline values. AHI of 5 or greater versus less than 5 was included as an interaction term to evaluate changes in sleep outcomes. The number of participants at baseline and 6 months with mild SDB for whom insomnia was their only other indication for PAP was also compared between CBTI and control. Results AHI status (AHI ≥ 5 [75.5% of participants] versus AHI < 5) did not moderate improvements in sleep associated with CBTI (all p values ≥ .12). Nine (45.0%) of 20 participants with mild SDB for whom insomnia was their only other indication for PAP therapy at baseline no longer had another indication for PAP at 6 months, with no significant difference between CBTI and control. Conclusions CBTI improves sleep in older veterans with insomnia and untreated mild SDB. Larger trials are needed to assess whether CBTI reduces the number of patients with mild SDB eligible for PAP.

A Four-Session Sleep Intervention Program Improves Sleep for Older Adult Day Health Care Participants: Results of a Randomized Controlled Trial

Study Objective To test the effectiveness of a 4‐week behavioral Sleep Intervention Program (SIP: sleep compression, modified stimulus control, and sleep hygiene) compared to a 4‐week information‐only control (IC) among older adults attending a VA Adult Day Health Care (ADHC) program in a double‐blind, randomized, clinical trial. Methods Forty‐two individuals (mean age: 77 years, 93% male) enrolled in a VA ADHC program were randomized to receive SIP or IC. All completed in‐person sleep and health assessments at baseline, post‐treatment and 4‐months follow‐up that included 3 days/nights of wrist actigraphy, the Pittsburgh Sleep Quality Index (PSQI), and the Insomnia Severity Index (ISI). Mixed repeated measures analysis was used to compare sleep outcomes at post‐treatment and 4‐months follow‐up, with baseline values as covariates. Results SIP participants (n = 21) showed significant improvement on actigraphy sleep efficiency (p = .007), number of nighttime awakenings (p = .016), and minutes awake at night (p = .001) at post‐treatment, compared to IC participants (n = 21). Benefits were slightly attenuated but remained significant at 4‐month follow‐up (all ps < .05). There were no differences in total sleep time between groups. There was significant improvement on PSQI factor 3 (daily disturbances) at 4‐month follow‐up (p = .016), but no differences were observed between SIP and IC on other PSQI components or ISI scores at post‐treatment or 4‐month follow‐up. Conclusions A short behavioral sleep intervention may have important benefits in improving objectively measured sleep in older adults participating in ADHC. Future studies are needed to study implementation of this intervention into routine clinical care within ADHC.

A Longitudinal Study of Poor Sleep After Inpatient Post–Acute Rehabilitation: The Role of Depression and Pre-Illness Sleep Quality

OBJECTIVES To explore the unique impact of poor sleep and symptoms of depression on sleep quality for up to 1 year after inpatient post-acute rehabilitation among older adults. DESIGN Prospective longitudinal cohort study. SETTING Two inpatient post-acute rehabilitation facilities. PARTICIPANTS A total of 245 individuals older than 65 years (mean age = 80 years, 38% women). INTERVENTIONS None. MEASUREMENTS Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) during the post-acute care stay twice to evaluate pre-illness sleep quality and sleep quality during the post-acute care stay, and again at 3-, 6-, 9-, and 12-month follow-up. Demographics, symptoms of depression, cognitive functioning, and comorbidities were also assessed. RESULTS Across time points, sleep was significantly disturbed for many individuals. Nested regression models predicting PSQI total score at 3, 6, 9, and 12 months showed that variables entered in Block 1 (age, gender, cognitive functioning, and comorbidities) were significant predictors of poor sleep at 6-month follow-up but not at 3-, 9-, or 12-month follow-up. Depression (Block 2) and pre-illness PSQI total score (Block 3) were significant predictors of PSQI total score at all follow-up time points. PSQI total score during post-acute care (Block 4) explained a significant proportion of variance only at the 3-month follow-up. CONCLUSIONS This study confirms that chronic poor sleep is common among older adults during post-acute rehabilitation and resolution of sleep disturbance after acute health events may be a lengthy process. Our findings expand understanding of the role of depressive symptoms and preexisting sleep complaints in predicting poor sleep over time among these vulnerable older adults.

Predictors of Obstructive Sleep Apnea on Polysomnography after a Technically Inadequate or Normal Home Sleep Test.

STUDY OBJECTIVES Home sleep testing (HST) is an accepted alternative to polysomnography (PSG) for diagnosing obstructive sleep apnea (OSA) in high-risk populations. Clinical guidelines recommend PSG in cases where the HST is technically inadequate (TI) or fails to establish the diagnosis of OSA in patients with high pretest probability. This retrospective study evaluated predictors of OSA on PSG within patients who had a TI or normal HST. METHODS Electronic medical records were reviewed on 1,157 patients referred for HST at our sleep center. Two hundred thirty-eight patients had a TI or normal HST with subsequent PSG. Age, BMI, Epworth score, HST result, and PSG-based apnea-hypopnea index (AHI) were abstracted. RESULTS Two hundred thirty-eight consecutive patients with either a normal HST (n = 127) or TI HST (n = 111) underwent subsequent PSG. Of 127 who had a normal HST, 76% had a normal PSG and 24% had OSA (23 mild, 6 moderate, 1 severe). Of 111 who had a TI HST, 29% had a normal PSG and 71% had OSA (43 mild, 19 moderate, 17 severe). Individuals younger than 50 years old with a normal HST were more likely to have a normal PSG. Older age predicted diagnosis of OSA on PSG among individuals with a TI HST. CONCLUSION In this retrospective analysis of a clinical sample, when the HST is interpreted as normal in a younger patient population, the subsequent PSG is likewise normal in majority of the patients, although significant OSA is sometimes discovered. When a HST is read as TI, the majority of patients have OSA.