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Contents lists available at ScienceDirect

Asian Journal of Psychiatry

journal homepage: www.elsevier.com/locate/ajp

Impact of weak social ties and networks on poor sleep quality:

A case study of Iranian employees
Ebrahim Masoudnia *
Department of Sociology, Faculty of Humanities, University of Guilan, Iran

A R T I C L E I N F O A B S T R A C T

Article history: The poor sleep quality is one of the major risk factors of somatic, psychiatric and social disorders and
Received 9 March 2015 conditions as well as the major predictors of quality of employees’ performance. The previous studies in
Received in revised form 14 September 2015 Iran had neglected the impacts of social factors including social networks and ties on adults sleep quality.
Accepted 4 October 2015
Thus, the aim of the current research was to determine the relationship between social networks and
Available online xxx
adult employees’ sleep quality. This study was conducted with a correlational and descriptive design.
Data were collected from 360 participants (183 males and 177 females) who were employed in Yazd
Keywords:
public organizations in June and July of 2014. These samples were selected based on random sampling
Social ties
Social networks
method. In addition, the measuring tools were the Pittsburgh Sleep Quality Index (PSQI) and Social
Sleep quality Relations Inventory (SRI). Based on the results, the prevalence rate of sleep disorder among Iranian adult
Adult employees employees was 63.1% (total PSQI > 5). And, after controlling for socio-demographic variables, there was
significant difference between individuals with strong and poor social network and ties in terms of
overall sleep quality (p < .01), subjective sleep quality (p < .01), habitual sleep efficiency (p < .05), and
daytime dysfunction (p < .01). The results also revealed that the employees with strong social network
and ties had better overall sleep quality, had the most habitual sleep efficiency, and less daytime
dysfunction than employees with poor social network and ties. It can be implied that the weak social
network and ties serve as a risk factor for sleep disorders or poor sleep quality for adult employees.
Therefore, the social and behavioral interventions seem essential to improve the adult’s quality sleep.
ß 2015 Elsevier B.V. All rights reserved.

1. Introduction disorder, cardiovascular disease, endocrine disease, and in-

Sleep disorders are one of the most prevalent mental disorders
from which almost 10–30% of people suffer around the world
(Ram et al., 2010; Thorpy, 2004). And, it is the second most
common type of complaints after pain (Mahowald et al., 1997).
These disorders can clinically have important outcomes and
overall health. Sleep disorders which are associated with
psychiatric problems such as high rates of depression, anxiety,
poor performance, mood disorder, and substance abuse may
cause medical conditions or psychiatric problems or may
exacerbate them (Breslau et al., 1996; Pearson et al., 2006; Roth
et al., 2006). The National Health Interview Survey conducted by
Pearson et al. (2006) showed that people with insomnia
symptoms experienced anxiety and depression five times higher
than those without insomnia symptoms. Different symptoms are
reported by different studies, such as the comorbidity of sleep
* Correspondence address: The University of Guilan, P.O. Box 1841, Rasht, Iran.
E-mail addresses: masoudnia@guilan.ac.ir, masoudniae@gmail.com
creased perception of pain (Thorpy, 2004; Lockley et al., 2007;
Copinschi, 2005), hypertension, congestive heart failure, diabetes
and obesity (Suka et al., 2003; Pearson et al., 2006), the risk of
death from all causes (Tamakoshi et al., 2004), mental and
physical disorders (Taira et al., 2002), and poor quality of life of
individuals and families and the healthcare costs (Montgomery
and Dennis, 2004). In fact, for worker adults, poor sleep quality
can reduce their efficiency and effectiveness in organization. On
the same line, several studies have shown that the sleep
disorders, including the insomnia, the shift work sleep disorder
(SWSD), and the obstructive sleep apnea can influence on
employment outcomes (Swanson et al., 2011). Also, following
Daley et al. (2008), Kleinman et al. (2009), and Erman et al.
(2008), decreased productivity and absenteeism are among the
most common occupational injuries in patients with symptoms
of insomnia. Furthermore, some studies have concluded that
people with symptoms of disruptive sleep apnea (OSA) have more
difficulties in concentrating, learning, and higher rates of
accidents and occupational injuries in comparison with normal
participants (Lindberg et al., 2001; Spengler et al., 2004).

http://dx.doi.org/10.1016/j.ajp.2015.10.005
1876-2018/ß 2015 Elsevier B.V. All rights reserved.

Please cite this article in press as: Masoudnia, E., Impact of weak social ties and networks on poor sleep quality: A case study of Iranian
employees. Asian J. Psychiatry (2015), http://dx.doi.org/10.1016/j.ajp.2015.10.005
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Epidemiological studies have indicated to the prevalence of
sleep disorders in the world from 15% to 45.3% (Buysse et al., 1991;
Hoffman, 2003; Sukegawa et al., 2003). In fact, no statistics are
available about the prevalence of the sleep disorders in the Iranian
employees’ population, but among the general population, the
prevalence of the sleep disturbances has been reported as ranging
from 10% to 71% (Mousavi et al., 2011; Torabi et al., 2013;
Masoudnia, 2012). In addition, the use of different measurement
tools by researchers was one of the possible reasons for the
differences in the reported rates of sleep disorders. Some studies
(e.g., Mousavi et al., 2011), applied the self-report questionnaires
such as the Sleep and Daytime Habit Questionnaires (SDHQ). And,
some other studies (e.g., Torabi et al., 2013), measured the sleep
disorder by using the structured interviews. Furthermore, the
difference in the population under study was realized as other
possible reasons for the difference in reported prevalence of sleep
disorders. Some researches were done on a patient population
(Nohu et al., 2008; Derakhshanpour et al., 2014). Other studies
conducted on healthy people (e.g., Masoudnia, 2012; Panaghi et al.,
2004). Obviously, physical or psychological symptoms can lead to
sleep disorders.
The etiology of sleep disorder is very complex. Some studies
have investigated the effects of different variables on the quality of
sleep or insomnia, such as age (Doi et al., 2001; Livingston et al.,
1993; Morgan et al., 1988), gender (Rodin et al., 1988; Cheek et al.,
2004), physical condition (Morgan et al., 1988), life situations
(Livingston et al., 1993; Rodin et al., 1988), health status (Morgan
et al., 1988), lifestyle behaviors including smoking, coffee or
alcohol consumption (Hoffman, 2003; Cheek et al., 2004; Gislason
et al., 1993), exercise (Cheek et al., 2004; Li et al., 2004a,b), and
some psychiatric disorders such as depression (Hsu, 2001; Lin
et al., 2003). However, one variable that has received less attention
in the social etiology of sleep disruption is the impact of social
networks and ties on the quality of sleep. Social networks are
defined as stable but evolving relational fabrics constituted by
family members, friends and acquaintances, work and study
connections, and relations that evolve out of each individual
participation in formal and informal organizations (Belvis et al.,
2008). Moreover, social networks means that most people in order
to access to information, resources and situations, rely on personal
relationships and on their relatives. On the same line, social
scientists used social networks to comprehend the complexities of
relationships between the members of social systems (Antonucci
and Akyiyama, 1987; Hall and Wellman, 1985). Also, the impacts
and the importance of social networks and social ties on health and
illness experiences, as well as the quality of life have been
demonstrated in several studies (Cohen, 2004; Uchino, 2004; Hall
and Wellman, 1985; Jang et al., 2002; Sapp et al., 2003). And, the
results of limited researches about the relationship between social
networks and quality of sleep indicate a significant effect on the
quality of sleep and incidence of sleep disorders. In one study,
Cacioppo et al. (2002a) investigated the quality and quantity of
sleep among the people without social ties and the people with
social ties by using Pittsburgh Sleep Quality Index (PSQI). The
results of the mentioned study revealed that although, both
individuals without social ties and the individuals with social
bonding have the same amount of hours of sleep, the lonely
individuals show evidence of poorer sleep quality, poorer sleep
efficiency, longer sleep latency, more daily dysfunction, and more
time awake after sleep onset in comparison with not lonely
individuals. In another research, Cacioppo et al. (2002b) found out
that people who slept alone had less productivity, went to sleep a
little later, had rapid eye movement latency, and were more
frequent awakening during sleep in comparison with not lonely
individuals. In addition, Cacioppo et al. (2002a,b) examined the
association between social relationship and sleep, in which the
Please cite this article in press as: Masoudnia, E., Impact of weak social ties and networks on poor sleep quality: A case study of Iranian
employees. Asian J. Psychiatry (2015), http://dx.doi.org/10.1016/j.ajp.2015.10.005
Quality of sleep was assessed by using self-report or using the
Nightcap sleep system. It was found out that the individuals who
report high levels of loneliness had also the reduced sleep
efficiency. In another study, Hawkley et al. (2010), by using the
daily diary assessments showed that the loneliness could predict
the weakness of daytime functioning independently of the amount
of sleep at the previous night. Also, Friedman et al. (2005) showed
that the subjective sleep quality, the higher habitual sleep
efficiency, and the less sleep latency were associated with higher
social relationship and social participation.
In spite of the importance of sleep and the effects of social
networks on the health, the information about the relationship
between social networks and quality of sleep is very limited. In
other words, although sleep is one of the important determining
factor of individual performances, little research has been done in
the area of social knowledge about sleep. Over the past few
decades, sleep researchers believed that sleep patterns were more
influenced by biological processes (Beebe, 2008; Carskadon, 2002).
In the meantime, the role of social contexts is largely ignored in the
studies of sleep patterns. According to our knowledge, on one hand,
no study examined the impact of social networks and ties on sleep
quality, especially for employed population in Iran. Some studies
(Nasrollah Nia et al., 2014) have shown that the rate of labor
productivity and efficiency in Iran, especially in the public sector, is
very low. Therefore, the etiology of lower labor productivity in Iran
is seems necessary. One of the major factors that determine the
labor quality performance and productivity is sleep hygiene. On
the other hand, low quality of sleep can have many negative effects
on the efficiency and quality of the staff. Therefore, identifying the
social factors and the variables affecting the disorder can provide
the grounds for social and behavioral interventions, with the aim of
improving the quality of sleep, and consequently, improving their
performance. So, the current study aimed to determine the
relationship between social networks and ties and quality of sleep
among Iranian employed population.
2. Methods
2.1. Design and participants
This study was performed with a correlational and descriptive
design. Data were collected from 360 adults who were employed in
10 public organizations in Yazd, Iran, in June and July 2014. These
organizations were located in a particular geographic area for
public offices in Student Blvd., Yazd. In this particular space,
10 public organizations were located. In fact, the investigation was
carried out on all of the 10 spaces. These organizations had
different activities, including economic, political, cultural, educa-
tional, social and rehabilitation, and technical activities. Due to
lack of access to employee population of public organizations, a
multi-stage cluster sampling was used to select the required
samples. In this way, two office units in each organization were
selected randomly. The number of selected clusters was 20. Then,
all staff of the selected 20 units were studied. Moreover, social
network inventory and Pittsburgh Sleep Quality Index (PSQI) were
given to the selected samples by trained interviewers. The criterion
of selecting the sample for this study were being employed in
public organization and being older than 20 years. To determine
the sample size, we used the modified Cochran’s sample size
formula. First, because of the unavailability of the variance in sleep
quality in adults, a pre-test was performed on 30 samples. Also, the
amount of variance sleep disorder was obtained .234. On the same
line, confidence interval (CI) in this study was 95% (a = .05). In the
next step, by using Cochran’s sample size formula, 360 adults were
selected.
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2.2. Measures
2.2.1. Demographic and medical details
Socio-demographic variables included details on age (20–61
years old), gender, educational level (under higher education and
academic degree), marital status (not married vs. married), and
history of sleep disorders (yes, no). Also, a medical variable that
was the history of sleep disorders (yes, no) was measured. With the
exception of age, all the socio-demographic and disease history
variables were dichotomous.
The Pittsburgh Sleep Quality Index (PSQI) (Buysse et al., 1989):
This index is composed of 19 self-report items that discriminates
poor sleep from good sleep by measuring seven sleep features
during the previous month which includes seven component
scores-subjective sleep quality (which is measured with one item
and assessing how one rates one’s overall sleep quality (two
items)), sleep latency (which refers to the time taken to fall asleep
(two items)), sleep duration (which is the number of minutes in the
record scored as sleep (one item), habitual sleep efficiency (refers
to the ratio of the total sleep time to the time in bed (three items)),
sleep disturbance (which measures the frequency with which
various situations have troubled one’s sleep and consists of nine
items representing different situations (nine items)), use of sleep
medication (which inquires about how often one has taken
medicine to aid sleep (one item)), and daytime dysfunction (which
measures daily problems related to sleep, such as having trouble
staying awake or having enough enthusiasm to get things done
(two items)) – that are aggregated into a global score with a range
of 0–21, with higher scores reflecting greater overall sleep
disturbance (Bush et al., 2012). The Pittsburgh Sleep Quality Index
subscales are scored on a Likert format, and from 0 (no problem) to
3 (severe problem). Validity and reliability of the Pittsburgh Sleep
Quality Index have been confirmed in several studies (e.g., Ohayon,
1994; Backhaus et al., 2002). In addition, Buysse et al. (1989)
reported sensitivity and specificity of the Pittsburgh Sleep Quality
Index, respectively, 89.6 and 86.5 and its reliability was reported
equal to 83.0. They also obtained reliability of the PSQI scale as
85.0, using test–retest method. Furthermore, the sensitivity and
the specificity of the Pittsburgh Sleep Quality Index in Tsay and
Chen’s study (2004) were reported as 90% and 87%. In Iran, using
test–retest method, the reliability and the validity of the Pittsburgh
Sleep Quality Index were obtained .88 (Hossein Abadi et al., 2008).
Also, the validity of the PSQI was confirmed by Soleymani et al.
(2008), through the content validity method. In the present study,
using Cronbach’s alpha, the reliability of the PSQI was reported .82.
2.2.2. Social Relations Inventory (SRI)
In this study, in order to assess the social networks, Iranian
version of Social Relations Questionnaire was made which was
based on the Iranian values and norms of social relations. Some
items of the SRI were similar to Social Network Index such as,
contact with close friends and relatives, and membership in a
religious group (Berkman and Syme, 1979). The Social Relations
Inventory includes six items and it measures five aspects of a
person’s social relationships with others. These aspects include
contact with close friends (during the week, how much time do you
spend with your close friends?), contact with family members
(during the week, how much time do you spend with your family
members?), contact with relatives (during the week, how much
time do you spend with your relatives?), membership in religious
groups (how much do you cooperate with local religious bodies?),
Participation in the administration of the mosques (how much do
you participate in administration of mosques?), and participation
in religious rituals (how much do you participate in programs and
events that are held in the mosques?). Moreover, a five-point scale
(very low, low, medium, high, very high) was used to rate the
Please cite this article in press as: Masoudnia, E., Impact of weak social ties and networks on poor sleep quality: A case study of Iranian
employees. Asian J. Psychiatry (2015), http://dx.doi.org/10.1016/j.ajp.2015.10.005
3
relationship with others and the range score of SNI was 6–30. Using
content validity method, the cutoff point of 17 was obtained for
Social Relations Inventory and the cut-off point on this scale was
17. In this method, the SRI was given to five experts in social
epidemiology and consequently the cut-off point of 17 was
confirmed by all the experts. The respondents whose scores were
below 17 were defined as having limited social networks and the
respondents whose scores were higher than 17 were defined as
having an extensive social network. The content validity of SRI was
recognized for this study in response to the suggestions offered by
the experts and the Cronbach’s a for the SRI was .74.
2.3. The statistical analysis
The data were analyzed using SPSS for Windows (version 20). In
fact, univariate analyses were conducted to test the individual
relationships of demographic and predictor variables with sleep
quality. Also, the descriptive statistics were used to describe
demographic characteristics. In descriptive statistics the level, the
frequency, the percentage, the mean, and the standard deviation
were used to describe participants’ demographic data, PSQI
subscales. Pearson correlation coefficient was used to assess the
correlation between the variables. The values were also considered
statistically significant at p-value < .05. And, the control variables
and social ties/networks were regressed on sleep quality using a
hierarchical multiple regression.
3. Findings
3.1. Socio-demographic characteristics of samples
Three hundred and sixty adults (58% male and 49.2% female)
who were employed in 10 public organizations in Yazd, Iran, were
studied (Table 1). The range of the age of the respondents was
between 20 and 61 years (6.4  1.13). Most of the respondents
(72.5%) had academic education and the others had under diploma
education degree. Regarding the marital status, most of the
participants (75.8%) were married and the others (27.5%) were
single. Also, 16.4% of the respondents reported that they had
experienced sleep disorder and 6/83% stated that they did not have
the experience of sleep disorder. There was also a significant
relationship between the education and the quality of sleep
(t(358) = 2.44; p < .05). Additionally, those with under higher educa-
tion degree had poorer sleep quality compared to those with
academic education. There was also significant difference between
people with and without the history of sleep symptoms concerning
the quality of sleep (t(385) = 7.71; p < .01). And, the prevalence rate
of sleep disorder was 63.1%.
3.2. Descriptive statistics of measurements
The mean and the standard deviation of total score for sample
on PSQI subscales and the mean and the standard deviation of
global PSQI scores are shown in Table 2. As it is shown in the table,
the mean of global PSQI score for entire sample was 7.3  3.3.
Moreover, among observed components of the PSQI, the best sleep
quality (the lowest score) was observed for the use of sleeping
medication, and the worst quality was for the sleep latency.
3.3. Association between social ties/networks and quality of sleep
As it is shown in Table 3, the bivariate linear correlations were
used to examine the relationship between social ties/networks and
components of quality of sleep. According to the table, there was a
negative significant relationship between social ties/networks and
subjective sleep quality (r = .24, p < .01). In addition, people with
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Table 1 that it would take less time to fall asleep each night. There was also
Socio-demographic characteristics of the sample and their relationship with quality
a significant relationship between social ties/networks and
of life.
daytime dysfunction (r = .124, p < .05); in other words, people
n (%) Mean  SD Statistics p-Value with higher social ties/networks reported lower daytime dysfunc-
(sleep disorder)
tion during the previous month. Moreover, global PSQI scores were
Age (mean, SD) significantly associated with social ties/networks (r = .24,
33.5  8.7 R = .026 .616 p < .01). However, social ties/networks were not significantly
Gender
associated with other components of sleep quality, such as sleep
Male 183 (50.8) 7.1  4.3 T = 1.6
Female 177 (49.2) 7.7  4.3 .108 duration, habitual sleep efficiency, and use of sleeping medication.
Education
Under higher education 99 (27.5) 8.3  4.6 T = 2.44 .015* 3.3.1. Multiple regression analyses
Academic degree 261 (72.5) 7.04  4.1
So as to determine the contribution of control variables and
Marital status
Not married 88 (24.2) 8.1  .46 T = 1.64 .102
social ties in explaining the variance of sleep quality, the
Married 273 (75.8) 7.3  4.3 hierarchical multiple-regression analysis was performed in two
History of sleep disorders steps (Table 4). In fact, the socio-demographic variables (age,
No 301 (83.6) 6.9  2.8 T = 7.71 .000** gender, marital status and sleep disorder history) were controlled
Yes 59 (16.4) 10.4  3.9
in step 1, the step in which a significant proportion of the variance
Prevalence rate of 63.1
sleep disorder in sleep quality was generally explained (F = 13.9, R2 = .137,
*
adjusted R2 = .127, p < .01). The results showed that the control
p < .05.
**
p < .01. variables have explained for 12.7% of the variance of sleep quality.
And, the sleep disorder history was the only significant contributor
to the variance, which was explained (b = .36, p < .01). The
Table 2 variables of age, gender, and marital status in step 1 failed to
Functional impact of sleep problems: mean scores for the entire sample (n = 360) on
explain the variance of sleep quality. Also, based on the results,
PSQI subscales and global score.
social ties/networks explained an additional 8.5% of the variance in
M SD step 2 of the model (F = 14.7, R2 = .219, adjusted R2 = .212, p < .01).
Subjective sleep quality .90 .61 The overall model was significant, explaining 33.9% of the variance
Sleep latency 1.7 1.5 in total sleep quality.
Sleep duration 1.6 .95
Habitual sleep efficiency .52 .85
Sleep disturbance 1.1 .49 4. Discussion
Use of sleeping medication .21 .61
Daytime dysfunction 1.3 .91
Global PSQI scores 7.3 3.3 This study aimed to investigate the impact of deficiency of
social networks and ties on incidence of poor quality of sleep
among adult employees in a selected group of Iranian population.
Sleep disorder prevalence rate in adult employee was 63.1%. In the
high level of social ties reported better sleep quality during the other words, 63.1% of the population suffer from poor sleep quality.
previous month. On the same line, social ties/networks were also This rate was much higher than the reported rate of sleep disorders
significantly associated with sleep latency (r = .22, p < .01). In in the world (Buysse et al., 1991; Hoffman, 2003; Sukegawa et al.,
fact, participants who reported high level of social ties believed 2003). The rate of the sleep disorders in our study was compatible

Table 3
Bivariate correlations between the social ties/networks and sleep quality (n = 360).

1 2 3 4 5 6 7 8 9

Social ties/networks 1.00

Subjective sleep quality .24** 1.00
Sleep latency .22** .39** 1.00
Sleep duration .05 .23** .036 1.00
Habitual sleep efficiency .09 .33** .23** .4** 1.00
Sleep disturbance .014 .15** .14** .05 .051 1.00
Use of sleeping medication .04 .17** .19** .049 .091 .19** 1.00
Daytime dysfunction .124* .32** .16** .08 .19** .12** .17** 1.00
Global PSQI scores .24** .65** .69** .47** .62** .31** .41** .53** 1.00
*
p < .05.
**
p < .01.

Table 4
Hierarchical multiple-regression of sleep quality.

Step Variables b DR2 Adjusted DR2 F change

1 Socio-demographic
Age .008 .137 .127 13.9**
Gender .015
Marital status .91
Sleep disorder history .36**

2 Social ties/networks .246** .219 .212 14.7**

2 2
Total: F(5,351) = 13.85; p < .01; R = .356; adjusted R = .339.
**
p < .01.

Please cite this article in press as: Masoudnia, E., Impact of weak social ties and networks on poor sleep quality: A case study of Iranian
employees. Asian J. Psychiatry (2015), http://dx.doi.org/10.1016/j.ajp.2015.10.005
G Model
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E. Masoudnia / Asian Journal of Psychiatry xxx (2015) xxx–xxx
with the reported rates of the previous researches conducted in
Iranian context (e.g., Mousavi et al., 2011; Torabi et al., 2013;
Masoudnia, 2012). In general, the results of this study showed that,
the prevalence rate of sleep disorders is very high in Iran. In other
words, the incorrect pattern of the time to sleep in Iranian culture,
staying up till late at night, job stress, and improper sleep habits are
the major causes of the high rates of sleep disorders in Iranian
worker adults. The previous studies have shown the impact of social
and demographic factors on the quality of sleep and sleep disorders,
factors such as age (Dodge et al., 1995; Weyerer and Dilling, 1991;
Stein et al., 2008), gender (Dodge et al., 1995; Weyerer and Dilling,
1991; Stein et al., 2008), education (Bixler et al., 1979; Sutton et al.,
2001; Li et al., 2002), marital status (Ohayon, 1996; Ishigooka et al.,
1999; Doi et al., 2000). The differences in the methods of measuring
sleep quality could be one possible reason for this difference. In the
current study, among the socio-demographic factors, there was only
a significant association between the level of education and the
quality of sleep; in other words, people with lower education
suffered from sleep disorders more than those with academic
education. This result did not confirm the findings of Chen and Wang
(1995) and Yao et al. (2008) who found out that people with higher
education levels had poorer sleep quality compared with those with
lower educational levels. It seems higher education creates a more
favorable change in the factors such as knowledge, attitude, lifestyle
and psychosocial conditions associated with sleep patterns and
consequently, it leads to better quality of sleep.
The results of the current study showed significant association
between deficiency of social networks and ties and incidence of
sleep disorder among adult employees; In other words, total PSQI
mean score for people with poor social ties was higher than those
with strong social ties. This indicates that people with stronger and
broader social ties and those who had more positive relationships
with their family members, friends network, and religious
institutions had better overall sleep quality. Also, there were
significant differences between the two groups of adults with
strong social ties and poor social ties in terms of subjective sleep
quality, sleep efficiency, and daytime dysfunction. Poor subjective
sleep quality was associated with deficiency and lower levels of
social ties. People with strong ties had more favorable subjective
sleep quality than those with poor social ties, and most of those
with weak social ties described their sleep quality during the past
month favorable. Better habitual sleep efficiency was associated
with strong social ties; In other words, People with strong ties
reported more sleep efficacy and more effective sleep duration. On
the other hand, social ties deficiency was associated with daytime
functioning. According to the results, employees with deficiency
and poor relationships with others were suffering from daytime
functioning caused by insomnia or poor quality of sleep in
comparison with employees with strong social ties and they
declared that staying awake for breakfast or at the time of going to
work was difficult for them, and during the day, they had little
interest in carrying out their duties.
The results of the present study were consistent with the
findings of some previous studies, such as Cacioppo et al. (2002a,
2002b), Hawkley et al. (2010), Friedman et al. (2005). Cacioppo
et al. (2002a) found that although people with strong and poor ties
were similar in terms of quantity of sleep, those with poor social
ties had worse sleep quality, more sleep latency, and more daytime
dysfunction. Also, Cacioppo et al. (2002b) showed that individuals
with high levels of loneliness suffered from reduced sleep
efficiency. In addition, Hawkley and Cacioppo (2010) concluded
that lack of connection with others was associated with poor
daytime dysfunction. Also, Friedman et al. (2005) revealed that
higher social relationships and participation were associated with
better subjective sleep quality, more sleep efficiency, and lower
sleep latency. In another study, Cacioppo et al. (2002b) demon-
Please cite this article in press as: Masoudnia, E., Impact of weak social ties and networks on poor sleep quality: A case study of Iranian
employees. Asian J. Psychiatry (2015), http://dx.doi.org/10.1016/j.ajp.2015.10.005
5
strated the impact of sleeping alone on the weakened productivity,
late falling sleep, frequent awakenings, and rapid eye movement
latency. In general, the mentioned studies have shown that poor
sleep in adults is associated with higher levels of loneliness and
lack of connection with others. Also, these studies found out that
the relationship between sleep and social interactions may not
only involve the presence or absence loneliness but also it may
involve a result of the presence or absence of high levels of social
involvement.
The mechanisms through which the social relationships affect
the quality of sleep are numerous. For example, one hypothesis
focuses on the feelings of vulnerability. Hawkley and Cacioppo
(2010) showed that feelings of vulnerability leaded to increased
vigilance and this would result in reduced sleep quality.
Additionally, Umberson et al. (2010) discuss several mechanisms
by which, social networks and ties influence on the health
behaviors, such as sleep quality. According to them, first, we should
provide individuals with social support, then give them a sense
that that they are loved, listen to them, pay attention to them and
help them by advice and assistance when individuals encounter
life’s challenges. Second, social relationships should instill in them
a sense of responsibility or concern for others that is, in part,
manifested in behaviors that protect their health.
Another mechanism that could explain the effect of social ties
and relationship on sleep quality is social support. Most people
who have good family relationships and play a social role in the
society and communicate with their social networks and friends,
have better performance in terms of quality of sleep. This supports
the network consisting of friends and family as well as physical and
emotional resources that are available to a person through
personal relationships called social support. Some research has
also shown that social support system can serve as a protective
agent against the effects of stressful events on emotional and
mental health (Zhu et al., 2006). Several studies (e.g., Li et al.,
2004a,b; Sarason et al., 1991; Hu et al., 2003), have shown that
social support is defined as the perception of external support
available, which serves as an important variable in response to a
stress, plays an important role in alleviating response to stress,
maintains mental health and improves the quality of sleep.
According to some longitudinal studies (e.g., Sinokki et al., 2010)
and cross-sectional studies (e.g., Nordin et al., 2005, 2008; Pelfrene
et al., 2002), poor social support from others is associated with a
high risk for sleep disorders. Therefore, according to this
explanation, social support can improve sleep quality through
reducing the stress. Poor or lack of social support causes excessive
cognitive and emotional response to physiological stimuli, which
as a result lead to sleep disorders.
Anthropological findings also provide an explanation of the
relationship between social cohesion deficiency with poor sleep
quality. These findings suggest that the human brain evolved
under the conditions in which a close-knit social group facilitated
the constant vigilance against the predators at all the hours,
providing a sense of safety and security necessary for sleeping at
night (McKenna and Mack, 1992). According to the researchers
who carried out investigation on sleep, these anthropological
findings are related to human sleep in which conflict or weak
bonds with others trigger the anxiety that disrupts the sleeping;
conversely, the strong feelings of love and acceptance in one’s
social circles will create a sense of safety that is conducive to
healthy sleep (Dahl, 2002).
Regarding the limitations of the current study, one limitation
was that the study was conducted on a limited population in Iran.
In our opinion, this was the first study that was conducted to
explore the relationship between social ties and networks and
quality of sleep in Iranian adult employees. Therefore, to generalize
these results to the entire population, further studies should be
G Model
AJP-800; No. of Pages 7
6 E. Masoudnia / Asian Journal of Psychiatry xxx (2015) xxx–xxx
done on a wider population, particularly with regard to the
different ethnicities in Iran. Another limitation of the study was
that the effect of some psychological and clinical variables, such as
depression, anxiety, and physical health were not controlled.
Therefore, it suggests the subsequent researchers to control the
effect of more variables. Also, this study was conducted on all
the employees in the public agencies. Therefore, it suggests the
future researchers to control the effect of the type of organization
by comparing the public and private organizations employees. The
use of self-report questionnaire to measure the sleep disturbance
was another limitation of this study. Although, sleep disorders
which have been reported by people can be considered as
indicators for sleep disturbance, this method has little validity
in estimation of sleep disorders (WHO, 2004). Also, people’s
perceptions of insomnia are not necessarily identical with their
actual sleep time (Yen et al., 2008). Despite the mentioned
limitations, this study was the first study that revealed the
influence of social ties deficiency on poor sleep quality among
Iranian adult employees. In fact, the poor sleep quality and sleep
disorders can have a negative significant impact on the different
occupational and professional outcomes, such as decrease in
productivity and increased absenteeism in workplaces (Daley
et al., 2008; Kleinman et al., 2009; Erman et al., 2008), it can reduce
concentration and potential for learning, it can lead to increased
injuries and occupational accidents (Lindberg et al., 2001; Spengler
et al., 2004), it can cause the incidence of diseases such as ulcers,
depression (Drake et al., 2004), and other medical and psychiatric
conditions. Therefore, from the results of the current study, it can
be implied that it is necessary to reduce the deficiency of social ties
and to strengthen the social ties and networks of adult employees,
interventional actions done through informal relationships at work
and at home with the aim of improving the quality of sleep.
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