Bem-estar de estudantes universitários: efeitos de uma intervenção baseada em mindfulness sobre o sono e ritmos biológicos
Data
2022-08-02
Autores
Vallim, Julia Ribeiro da Silva 
Orientadores
D'Almeida, Vânia
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Estudantes universitários são uma população exposta a condições que prejudicam sua saúde física e mental como a irregularidade nos padrões de sono e exposição inadequada à luz, cujas consequências incluem alta prevalência de sintomas de ansiedade, depressão, alterações de sono e desajuste circadiano. Evidências têm demonstrado que as intervenções baseadas em mindfulness promovem saúde e bem-estar ao desenvolver no praticante habilidades que lhe resguardam de eventos mentais negativos. Alguns trabalhos demonstram que a prática regular também é capaz de melhorar a qualidade de sono e reduzir as queixas associadas a esse comportamento. Dessa forma, o objetivo deste trabalho foi caracterizar o bem-estar subjetivo de estudantes universitários e avaliar os efeitos do Programa de Promoção da Saúde Baseado em Mindfulness sobre o sono e ritmos circadianos, visto que umas das atuações do sistema de temporização é sobre a regulação da propensão ao sono. Essa tese foi dividida em dois estudos: o Estudo 1, transversal, no qual 615 estudantes preencheram um formulário eletrônico que continha questões sobre fatores sociodemográficos e comportamentais que poderiam estar relacionados com o bem-estar subjetivo. Foi aplicado um modelo de mediação para avaliar o efeito dos fatores sociodemográficos sobre variáveis comportamentais mediadoras e sobre o desfecho principal, o bem-estar subjetivo.
O Estudo 2, longitudinal, randomizado, controlado, com dois braços paralelos (Programa de Promoção da Saúde Baseado em Mindfulness e Psico-educação em Sono). As intervenções constituíram-se de oito encontros semanais (um por semana), com duração de uma hora, as avaliações foram feitas em três momentos: pré-intervenção (dez dias antes do início da intervenção), durante (entre a terceira e quarta semanas) e pós-intervenção (uma semana após o término da intervenção). As medidas incluíram questionários validados com base no autorrelato sobre a qualidade de sono, estresse, bem-estar e saúde mental, e objetivas, pelo uso da actigrafia e pela quantificação de parâmetros circadianos. No Estudo 1 observamos que alguns fatores estavam associados com maior bem-estar subjetivo: preferências circadianas matutinas, identificação com o gênero masculino, saúde mental preservada e prática de pilates ou yoga. Já as variáveis que mediaram o bem-estar subjetivo foram: estresse percebido, qualidade subjetiva de sono, sintomas de depressão e afetos positivos. Já no Estudo 2 não observamos efeitos significativos do Programa de Promoção da Saúde Baseado em Mindfulness sobre a qualidade subjetiva e objetiva de sono, estimada pela actigrafia, e sobre a ritmicidade circadiana, quando comparados os três momentos de avaliação e com o grupo controle. No entanto, o Programa foi capaz de aumentar o bem-estar subjetivo dos estudantes e, a depender do desfecho, o cronotipo foi moderador de alguns efeitos de ambas as intervenções. Houve uma maior adaptação dos estudantes com tendências vespertinas ao Programa de Promoção da Saúde Baseado em Mindfulness (ex. aumento do bem-estar subjetivo que se manteve no follow-up de seis meses) e a Psico-educação em Sono (ex. aumento do MESOR, avanço do M10c e aumento da razão noite/dia da excreção de 6-sulfatoximelatonina). Nosso objetivo de caracterização do bem-estar subjetivo de estudantes universitários foi contemplado, assim como pudemos descrever os efeitos do Programa de Promoção da Saúde Baseado em Mindfulness sobre o sono e ritmos circadianos.
College students are a population exposed to conditions that impair their physical and mental health, such as sleep irregularity and inadequate exposure to light, whose implications include a high prevalence of anxiety symptoms, depression, sleep alterations, and circadian misalignment. Evidence has shown that mindfulness-based interventions promote health and well-being by developing skills that protect the practitioner from negative mental events. Some studies show that regular practice also improves sleep quality and reduces complaints associated with this behavior. Thus, the purpose of this study was to characterize the subjective well-being of college students and evaluate the effects of the Mindfulness-Based Health Promotion Program on sleep and circadian rhythms, since one of the actions of the timing system is the regulation of sleep propensity. This thesis was divided into two studies: Study 1, a cross-sectional one, in which 615 students filled an electronic form containing questions about sociodemographic and behavioral factors that could be related to subjective well-being. A mediation model was applied to assess the effect of sociodemographic factors on mediating behavioral variables and on the primary outcome, subjective well-being. Study 2 was a longitudinal, randomized, controlled trial with two parallel arms (Mindfulness-Based Health Promotion Program and Sleep Psychoeducation). Interventions consisted of eight weekly (one per week), one-hour meetings, and assessments were made at three-time points: pre-intervention (ten days before the start of the intervention), during (between the third and fourth weeks), and post-intervention (one week after the end of the intervention). Measures included validated questionnaires based on self-reports of sleep quality, stress, well-being, and mental health, and objective measures by actigraphy and quantification of secretion of circadian phase markers. In Study 1 we observed that some factors were associated with greater subjective well-being: morning circadian preferences, identification with the male gender, preserved mental health, and practice of pilates or yoga. The variables that mediated subjective well-being were perceived stress, subjective sleep quality, depression symptoms, and positive affect. In Study 2, we did not observe significant effects of the Mindfulness-Based Health Promotion Program on the subjective and objective sleep quality, estimated by actigraphy, and on the circadian markers, between and within groups. However, the Program was effective in increasing students' subjective well-being, and chronotype moderated some effects of both interventions, depending on the outcome. There was a greater adaptation of students with eveningness tendencies to the Mindfulness-Based Health Promotion Program (e.g. increased subjective well-being that persisted at six-month follow-up) and to Sleep Psychoeducation (e.g., increased MESOR, advanced M10c, and increased night/day ratio of 6-sulfatoxymelatonin excretion). We met our initial goal of characterizing the subjective well-being of college students, and we were able to describe the effects of the Mindfulness-Based Health Promotion Program on sleep and circadian rhythms.
College students are a population exposed to conditions that impair their physical and mental health, such as sleep irregularity and inadequate exposure to light, whose implications include a high prevalence of anxiety symptoms, depression, sleep alterations, and circadian misalignment. Evidence has shown that mindfulness-based interventions promote health and well-being by developing skills that protect the practitioner from negative mental events. Some studies show that regular practice also improves sleep quality and reduces complaints associated with this behavior. Thus, the purpose of this study was to characterize the subjective well-being of college students and evaluate the effects of the Mindfulness-Based Health Promotion Program on sleep and circadian rhythms, since one of the actions of the timing system is the regulation of sleep propensity. This thesis was divided into two studies: Study 1, a cross-sectional one, in which 615 students filled an electronic form containing questions about sociodemographic and behavioral factors that could be related to subjective well-being. A mediation model was applied to assess the effect of sociodemographic factors on mediating behavioral variables and on the primary outcome, subjective well-being. Study 2 was a longitudinal, randomized, controlled trial with two parallel arms (Mindfulness-Based Health Promotion Program and Sleep Psychoeducation). Interventions consisted of eight weekly (one per week), one-hour meetings, and assessments were made at three-time points: pre-intervention (ten days before the start of the intervention), during (between the third and fourth weeks), and post-intervention (one week after the end of the intervention). Measures included validated questionnaires based on self-reports of sleep quality, stress, well-being, and mental health, and objective measures by actigraphy and quantification of secretion of circadian phase markers. In Study 1 we observed that some factors were associated with greater subjective well-being: morning circadian preferences, identification with the male gender, preserved mental health, and practice of pilates or yoga. The variables that mediated subjective well-being were perceived stress, subjective sleep quality, depression symptoms, and positive affect. In Study 2, we did not observe significant effects of the Mindfulness-Based Health Promotion Program on the subjective and objective sleep quality, estimated by actigraphy, and on the circadian markers, between and within groups. However, the Program was effective in increasing students' subjective well-being, and chronotype moderated some effects of both interventions, depending on the outcome. There was a greater adaptation of students with eveningness tendencies to the Mindfulness-Based Health Promotion Program (e.g. increased subjective well-being that persisted at six-month follow-up) and to Sleep Psychoeducation (e.g., increased MESOR, advanced M10c, and increased night/day ratio of 6-sulfatoxymelatonin excretion). We met our initial goal of characterizing the subjective well-being of college students, and we were able to describe the effects of the Mindfulness-Based Health Promotion Program on sleep and circadian rhythms.