Blunden Sarah, McKellin William, Herdin Thomas, Ipsiroglu Osman S
Appleton Institute of Behavioral Science, Sleep and Circadian Group, Central Queensland University, Wayville, SA, Australia.
Department of Anthropology, University of British Columbia, Vancouver, BC, Canada.
Front Psychiatry. 2023 Mar 20;14:857717. doi: 10.3389/fpsyt.2023.857717. eCollection 2023.
"Poor sleep health" (PSH), defined as reduced amount of sleep and non-restorative sleep, affects cognitive, social and emotional development. Evidence suggests an association of sleep deprivation and mental health problems; however, there are no universal concepts allowing a first-tier screening of PSH at a community level. The focus of this narrative review is to highlight the cultural context of the current medicalized approach to PSH and to suggest social ecological strategies informing new and holistic community-based screening concepts. We present two conceptual screening frameworks; a "medical" and a merged "social emotional wellbeing framework" and combine them utilizing the concept of "ecologies." The first framework proposes the incorporation of "sleep" in the interpretation of "vigilance" and "inappropriate" labeled behaviors. In the first framework, we provide a logic model for screening the myriad of presentations and possible root causes of sleep disturbances as a tool to assess daytime behaviors in context with PSH. In the second framework, we provide evidence that informs screening for "social emotional wellbeing" in the context of predictive factors, perpetuating factors and predispositions through different cultural perspectives. The distinct goals of both frameworks are to overcome training-biased unidirectional thinking and medicalization of challenging, disruptive and/or disobedient behaviors. The latter has been explicitly informed by the critical discourse on colonization and its consequences, spearheaded by First Nations. Our "transcultural, transdisciplinary and transdiagnostic screening framework" may serve as a starting point from which adaptations of medical models could be developed to suit the purposes of holistic screening, diagnosis, and treatment of complex childhood presentations in different cultural contexts.
“睡眠健康不佳”（PSH）被定义为睡眠时间减少和睡眠无恢复感，会影响认知、社交和情感发展。有证据表明睡眠剥夺与心理健康问题之间存在关联；然而，目前尚无通用概念可用于在社区层面进行PSH的一级筛查。本叙述性综述的重点是强调当前PSH医学化方法的文化背景，并提出社会生态策略，为新的、基于社区的整体筛查概念提供信息。我们提出了两个概念性筛查框架；一个“医学”框架和一个合并的“社会情感幸福框架”，并利用“生态”概念将它们结合起来。第一个框架建议在对“警觉性”和带有“不适当”标签行为的解释中纳入“睡眠”。在第一个框架中，我们提供了一个逻辑模型，用于筛查睡眠障碍的各种表现和可能的根本原因，作为一种工具，在PSH背景下评估白天的行为。在第二个框架中，我们提供了证据，通过不同文化视角，为在预测因素、持续因素和易感性背景下筛查“社会情感幸福”提供信息。这两个框架的不同目标是克服受训练影响的单向思维以及对具有挑战性、破坏性和/或不服从行为的医学化处理。后者明确受到了原住民带头的关于殖民化及其后果的批判性论述的影响。我们的“跨文化、跨学科和跨诊断筛查框架”可以作为一个起点，在此基础上可以开发医学模型的改编版本，以适应在不同文化背景下对复杂儿童症状进行整体筛查、诊断和治疗的目的。
