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Introduction The COVID-19 pandemic has impacted individuals in many ways, including anecdotal reports of nightmares. However, little data exists regarding the experience of COVID-related nightmares, especially among the distressed population at the US-Mexico Border. This is especially relevant given the clinical importance of nightmares as risk factors for poor mental health and sleep disturbances. Methods Participants were N=155 individuals who completed the Nogales Cardiometabolic Health and Sleep (NOCHES) and were contacted about completing a COVID sub-study (95% Hispanic/Latino). Participants were asked for the number of nightmares that they have experienced since the pandemic started. They were also asked whether they had nightmares about confinement, claustrophobia, suffocation, oppression, drowning, failure, helplessness, natural disasters, anxiety, evil forces, war, separation from loved ones, being chased, sickness, death, COVID, and apocalypse. They were also asked whether they experienced, due to the pandemic, increased general, financial, food, housing, familial, relationship, and media-related stress. Each of these items was coded from 0 (“Strongly Disagree”) to 3 (“Strongly Agree”), with total scores ranging from 0-21. Regression analyses (linear for frequency and binary logistic for content) examined stress score as independent variable, adjusted for age, sex, financial status, education, and mental health (PHQ4). Results Those who experienced greater pandemic-related stress reported more nightmares (age/sex-adjusted B=0.23, p Conclusion Those who experienced more pandemic-related stress reported more nightmares, even after adjusting for depression/anxiety symptoms. In addition, those with more pandemic-related stress were more likely to have nightmares about COVID itself, as well as confinement and suffocation, being chased, failure, and sickness in general. Perhaps efforts to reduce pandemic-related stress will reduce these nightmare experiences, which may have beneficial effects on other areas of mental health. Support (if any) R01MD011600, R01DA051321

Introduction The COVID-19 pandemic has impacted many individuals at the vulnerable US-Mexico border region in a variety of ways. Fear, worry, and stress have increased for many, as has poor sleep. The present study evaluated the degree to which worsened sleep due to the pandemic impacted stress experiences. Methods Participants were N=155 individuals who completed the Nogales Cardiometabolic Health and Sleep (NOCHES) and were contacted about completing a COVID sub-study (95% Hispanic/Latino). They were asked the degree to which their sleep worsened due to the pandemic. They also reported the degree to which they agreed with statements regarding various pandemic-related stress experiences. These included infection-related stresses, stresses about community impact, personal psychosocial stresses, stresses about consequences of potential infection, media and society-related stresses, feelings of safety, and how the pandemic has impacted home life. Ordinal logistic regressions were used to determine whether changes in sleep were associated with agreement with statements about pandemic-related stress experiences, adjusted for age, sex, financial status, education, and mental health (PHQ4). Results Those who perceived that their sleep worsened were more likely to report greater endorsement of beliefs that they were infected (ordinal Odds Ratio [oOR]=2.82,p Conclusion Worse sleep due to the COVID-19 pandemic was associated with increased reports of stresses across a wide range of domains. Perhaps sleep health interventions could improve social and emotional health in these domains and reduce stress experiences and better cope with the pandemic. Alternatively, mental health interventions should perhaps be targeted to this population. Support (if any) R01MD011600, R01DA051321

Introduction Daytime sleepiness impairs daily functioning and may be directly related to insufficient nighttime sleep. Previous studies have assessed disparities in sleep duration and quality, but community-level disparities in daytime sleepiness using validated measures are lacking. Methods Data were from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study of N=1007 adults age 22-60. Daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). Predictors included age, sex, race/ethnicity, education, and social class (“Upper middle class or above,” “Middle class,” “Lower middle class,” “Poor,” or “Very Poor”). One-way ANOVAs evaluated group differences. Stepwise linear modeling evaluated ESS score relative to sociodemographic predictors. Final models included all variables entered together to evaluate independent effects. Finally, habitual sleep duration was entered as an additional covariate. Results ESS score was higher among racial/ethnic minorities (p=0.0006), men (p Conclusion There is a “sleepiness disparity” in the population associated with race/ethnicity and socioeconomics. Daytime sleepiness in the community is associated with being Black/African-American, having some college, and being “very poor.” The race/ethnicity difference in daytime sleepiness may be partially explained by differences in total sleep time. Support This work was supported by a grant from Jazz Pharmaceuticals. The SHADES study was funded by R21ES022931. Dr. Grandner is supported by R01MD011600.

This chapter is built on increasing evidence that individuals diagnosed with a wide range of currently recognized psychiatric diseases show significant increases in peripheral inflammatory biomarkers and CNS markers of immune activation, while simultaneously evincing reduced effectiveness of immune elements important for protection against pathogens. From this foundational assumption, a number of central unanswered questions regarding the relationship of immunity to emotional and cognitive functioning and behavior are explored. Tentative conclusions are reached that in addition to being impacted by mental events, immune activity may contribute to the development of a wide range of psychiatric disorders, and may tend to promote different disorders at different stages of the life course.

Importance Limitations of current antidepressants highlight the need to identify novel treatments for major depressive disorder. A prior open trial found that a single session of whole-body hyperthermia (WBH) reduced depressive symptoms; however, the lack of a placebo control raises the possibility that the observed antidepressant effects resulted not from hyperthermia per se, but from nonspecific aspects of the intervention. Objective To test whether WBH has specific antidepressant effects when compared with a sham condition and to evaluate the persistence of the antidepressant effects of a single treatment. Design, Setting, and Participants A 6-week, randomized, double-blind study conducted between February 2013 and May 2015 at a university-based medical center comparing WBH with a sham condition. All research staff conducting screening and outcome procedures were blinded to randomization status. Of 338 individuals screened, 34 were randomized, 30 received a study intervention, and 29 provided at least 1 postintervention assessment and were included in a modified intent-to-treat efficacy analysis. Participants were medically healthy, aged 18 to 65 years, met criteria for major depressive disorder, were free of psychotropic medication use, and had a baseline 17-item Hamilton Depression Rating Scale score of 16 or greater. Interventions A single session of active WBH vs a sham condition matched for length of WBH that mimicked all aspects of WBH except intense heat. Main Outcomes and Measures Between-group differences in postintervention Hamilton Depression Rating Scale scores. Results The mean (SD) age was 36.7 (15.2) years in the WBH group and 41.47 (12.54) years in the sham group. Immediately following the intervention, 10 participants (71.4%) randomized to sham treatment believed they had received WBH compared with 15 (93.8%) randomized to WBH. When compared with the sham group, the active WBH group showed significantly reduced Hamilton Depression Rating Scale scores across the 6-week postintervention study period (WBH vs sham; week 1: −6.53, 95% CI, −9.90 to −3.16, P P = .001; week 4: −4.50, 95% CI, −8.17 to −0.84, P = .02; and week 6: −4.27, 95% CI, −7.94 to −0.61, P = .02). These outcomes remained significant after evaluating potential moderating effects of between-group differences in baseline expectancy scores. Adverse events in both groups were generally mild. Conclusions and Relevance Whole-body hyperthermia holds promise as a safe, rapid-acting, antidepressant modality with a prolonged therapeutic benefit. Trial Registration clinicaltrials.gov Identifier:NCT01625546