251
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Hysing M, Harvey AG, Bøe T, Heradstveit O, Vedaa Ø, Sivertsen B. Trajectories of sleep problems from adolescence to adulthood. Linking two population-based studies from Norway. Sleep Med 2020; 75:411-417. [PMID: 32971382 DOI: 10.1016/j.sleep.2020.08.035] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 01/04/2023]
Abstract
STUDY OBJECTIVE The aim of the study is to assess stability and predictors of insomnia and sleep duration from adolescence to early adulthood. METHODS A longitudinal sample of 1257 individuals from three age cohorts were assessed from linked population-based studies, the youth@hordaland study from 2012 (age 16-18) and the SHoT2018 study (age 22-25). Identical measures of insomnia symptoms and sleep duration were analysed. RESULTS The stability of insomnia was high from adolescence to young adulthood, 50% of those with insomnia symptoms in adolescence still had insomnia symptoms six years later (adjusted IRR = 2.01; (CI 95%; 1.5-2.44)). Short sleep duration was also stable, with 67.8% of the adolescents in the lowest sleep duration quartile still remaining in the lowest quartile six years later. The overall rate of insomnia symptoms, long wake after sleep onset (WASO), and oversleeping increased from adolescence to young adulthood. Also, we observed a reduction in sleep efficiency and later rise times. There was no significant change in sleep onset latency (SOL). CONCLUSION Insomnia symptoms and short sleep duration are prevalent during both adolescence and young adulthood. Considerable individual stability and a rising rate of insomnia symptoms were observed over time. These findings underscore the importance of early identification and timely interventions to prevent chronic sleep problems.
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Affiliation(s)
- Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway.
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, USA
| | - Tormod Bøe
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Ove Heradstveit
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway; Center for Alcohol and Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Øystein Vedaa
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Voss District Psychiatric Hospital, NKS Bjørkeli, Voss, Norway; Department of Research and Development, St Olavs University Hospital, Trondheim, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Research & Innovation, Helse-Fonna HF, Haugesund, Norway
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252
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Sin J, Galeazzi G, McGregor E, Collom J, Taylor A, Barrett B, Lawrence V, Henderson C. Digital Interventions for Screening and Treating Common Mental Disorders or Symptoms of Common Mental Illness in Adults: Systematic Review and Meta-analysis. J Med Internet Res 2020; 22:e20581. [PMID: 32876577 PMCID: PMC7495259 DOI: 10.2196/20581] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/30/2020] [Accepted: 07/14/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Digital interventions targeting common mental disorders (CMDs) or symptoms of CMDs are growing rapidly and gaining popularity, probably in response to the increased prevalence of CMDs and better awareness of early help-seeking and self-care. However, no previous systematic reviews that focus on these novel interventions were found. OBJECTIVE This systematic review aims to scope entirely web-based interventions that provided screening and signposting for treatment, including self-management strategies, for people with CMDs or subthreshold symptoms. In addition, a meta-analysis was conducted to evaluate the effectiveness of these interventions for mental well-being and mental health outcomes. METHODS Ten electronic databases including MEDLINE, PsycINFO, and EMBASE were searched from January 1, 1999, to early April 2020. We included randomized controlled trials (RCTs) that evaluated a digital intervention (1) targeting adults with symptoms of CMDs, (2) providing both screening and signposting to other resources including self-care, and (3) delivered entirely through the internet. Intervention characteristics including target population, platform used, key design features, and outcome measure results were extracted and compared. Trial outcome results were included in a meta-analysis on the effectiveness of users' well-being and mental health outcomes. We also rated the meta-analysis results with the Grading of Recommendations, Assessment, Development, and Evaluations approach to establish the quality of the evidence. RESULTS The electronic searches yielded 21 papers describing 16 discrete digital interventions. These interventions were investigated in 19 unique trials including 1 (5%) health economic study. Most studies were conducted in Australia and North America. The targeted populations varied from the general population to allied health professionals. All interventions offered algorithm-driven screening with measures to assess symptom levels and to assign treatment options including automatic web-based psychoeducation, self-care strategies, and signposting to existing services. A meta-analysis of usable trial data showed that digital interventions improved well-being (3 randomized controlled trials [RCTs]; n=1307; standardized mean difference [SMD] 0.40; 95% CI 0.29 to 0.51; I2=28%; fixed effect), symptoms of mental illness (6 RCTs; n=992; SMD -0.29; 95% CI -0.49 to -0.09; I2=51%; random effects), and work and social functioning (3 RCTs; n=795; SMD -0.16; 95% CI -0.30 to -0.02; I2=0%; fixed effect) compared with waitlist or attention control. However, some follow-up data failed to show any sustained effects beyond the post intervention time point. Data on mechanisms of change and cost-effectiveness were also lacking, precluding further analysis. CONCLUSIONS Digital mental health interventions to assess and signpost people experiencing symptoms of CMDs appear to be acceptable to a sufficient number of people and appear to have enough evidence for effectiveness to warrant further study. We recommend that future studies incorporate economic analysis and process evaluation to assess the mechanisms of action and cost-effectiveness to aid scaling of the implementation.
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Affiliation(s)
- Jacqueline Sin
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
- Population Health Research Institute, St George's, University of London, London, United Kingdom
| | - Gian Galeazzi
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elicia McGregor
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Jennifer Collom
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Anna Taylor
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Barbara Barrett
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Vanessa Lawrence
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Claire Henderson
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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253
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Zhou ES, Recklitis CJ. Internet-delivered insomnia intervention improves sleep and quality of life for adolescent and young adult cancer survivors. Pediatr Blood Cancer 2020; 67:e28506. [PMID: 32568460 DOI: 10.1002/pbc.28506] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/13/2020] [Accepted: 05/31/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Insomnia is common among adolescent and young adult (AYA) cancer survivors. Cognitive-behavioral therapy for insomnia (CBT-I) is considered the gold standard treatment. Standard CBT-I was designed for adults and not adapted to the unique medical, psychosocial, and developmental needs of AYA cancer survivors, which can exacerbate their insomnia. Further, the vast majority of cancer centers do not have a behavioral sleep medicine expert on staff. Our study objective was to examine the efficacy of an Internet-delivered CBT-I program that was tailored for AYA cancer survivors (NCT03279055). PROCEDURE Twenty-two AYA cancer survivors (mean age 20.4; range 14-25) with insomnia enrolled in an automated CBT-I program modified for AYA cancer survivors following stakeholder feedback. Participants were blood cancer (54.5%) and solid tumor (45.5%) survivors, an average of 9.7 years postdiagnosis. Sleep health, fatigue, and quality of life were assessed at baseline and at two follow up timepoints (8 and 16 weeks postbaseline). RESULTS Significant improvements in insomnia severity, daytime sleepiness, fatigue, and quality of life were reported at both follow up timepoints. However, most participants (72.7%) did not complete all of the six study sessions, with a mean completion rate of 3.2 sessions. Participants who completed at least two sessions reported better sleep (insomnia severity index total score) than those who did not. CONCLUSIONS An Internet-delivered insomnia intervention adapted for AYA cancer survivors was efficacious. This has important implications for access to evidence-based clinical care for this growing population. Future efforts should study stepped care models of care and ways to improve treatment adherence.
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Affiliation(s)
- Eric S Zhou
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
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254
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Gao C, Scullin MK. Sleep health early in the coronavirus disease 2019 (COVID-19) outbreak in the United States: integrating longitudinal, cross-sectional, and retrospective recall data. Sleep Med 2020; 73:1-10. [PMID: 32745719 PMCID: PMC7320269 DOI: 10.1016/j.sleep.2020.06.032] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/13/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The outbreak of coronavirus disease 2019 (COVID-19) caused substantial changes in lifestyle, responsibilities, and stressors. Such dramatic societal changes might cause overall sleep health to decrease (stress view), to remain unchanged (resilience view), or even to improve (reduced work/schedule burden view). METHODS We addressed this question using longitudinal, cross-sectional, and retrospective recall methodologies in 699 American adult participants in late March 2020, two weeks following the enactment of social distancing and shelter-in-place policies in the United States. RESULTS Relative to baseline data from mid February 2020, cross-sectional and longitudinal analyses demonstrated that average sleep quality was unchanged, or even improved, early in the pandemic. However, there were clear individual differences: approximately 25% of participants reported that their sleep quality had worsened, which was explained by stress vulnerability, caregiving, adverse life impact, shift work, and presence of COVID-19 symptoms. CONCLUSIONS Therefore, the COVID-19 pandemic has detrimentally impacted some individuals' sleep health while paradoxically benefited other individuals' sleep health by reducing rigid work/school schedules such as early morning commitments.
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Affiliation(s)
- Chenlu Gao
- Baylor University, Department of Psychology and Neuroscience, Waco, TX, USA
| | - Michael K Scullin
- Baylor University, Department of Psychology and Neuroscience, Waco, TX, USA.
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255
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Marino C, Andrade B, Aitken M, Bonato S, Haltigan JD, Wang W, Szatmari P. Do insomnia and/or sleep disturbances predict the onset, relapse or worsening of depression in community and clinical samples of children and youth? Protocol for a systematic review and meta-analysis. BMJ Open 2020; 10:e034606. [PMID: 32868348 PMCID: PMC7462160 DOI: 10.1136/bmjopen-2019-034606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 07/13/2020] [Accepted: 07/21/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Disturbed sleep represents a potentially important modifiable risk factor for the development of depression in children and youth. This protocol for a systematic review proposes to investigate whether insomnia and/or sleep disturbances predict child and youth depression in community and clinical-based samples. METHODS AND ANALYSIS The protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. English-written, longitudinal studies that quantitatively estimated the prediction of depression by insomnia and/or sleep disturbances in individuals 5-24 years of age will be included. EMBASE, MEDLINE, PsychINFO, Scopus and Web of Science and grey literature will be searched from 1980 to the present. For the selection of studies, two reviewers will be involved. Data extraction will be conducted by one author and checked independently by a second author. Risk of bias will be appraised using the Research Triangle Institute Item Bank tool. Heterogeneity will be measured using the I2 statistics. Meta-analysis will be carried out if ≥3 results are available and if outcome measures can be pooled. The choice between a random-effect or fixed-effect model will be based both on the I2 statistics and the participant and study characteristics of the combined studies. Results of the meta-analyses will be summarised by a forest plot. Analyses will be performed in subgroups stratified by key variables defined depending on the amount and type of information retrieved.A narrative synthesis will be conducted in place of the meta-analysis should the pooling of data not be possible. Quality of evidence will be rated using the Grading of Recommendations Assessment, Development and Evaluation guidelines.As this is a protocol for systematic review and meta-analysis of published data, ethics review and approval are not required. The findings will be published in a peer-reviewed journal and disseminated at scientific conferences and in patient advocacy organisations. PROSPERO REGISTRATION NUMBER CRD42019136729.
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Affiliation(s)
- Cecilia Marino
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Brendan Andrade
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Madison Aitken
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Bonato
- Library Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - John D Haltigan
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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256
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Low-intensity sleep intervention in a youth mental health service: a case series analysis. Behav Cogn Psychother 2020; 49:62-75. [PMID: 32843122 DOI: 10.1017/s135246582000051x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is increasing evidence of a strong association between sleep and mental health in both adolescents and adults. CBT for insomnia is being applied to good effect with adults with mental health difficulties but there are few studies examining its applicability to adolescents within mental health services. METHOD We carried out a case series analysis (n = 15) looking at the feasibility, accessibility and impact of a low-intensity sleep intervention for young people (14-25 years) being seen by a secondary care Youth Mental Health team in the UK. The intervention was based on cognitive behavioural therapy for insomnia (CBTi) and acceptance and commitment therapy (ACT) approaches and involved six individual sessions delivered on a weekly basis by a graduate psychologist. Routine outcome measures were used to monitor insomnia, psychological distress and functioning with assessments at baseline, session 3, session 6 and at 4 weeks after end of intervention. All participants scored in the clinical range for insomnia at the start of the study. RESULTS High uptake, attendance and measure completion rates were observed. Large effect sizes were observed for insomnia, psychological distress and functioning. Twelve of the fifteen participants (80%) no longer scored above threshold for insomnia at follow-up. All seven under-18s no longer met threshold for clinical 'caseness' on the Revised Child Anxiety and Depression Scale (RCADS) at follow-up. DISCUSSION The findings suggest that the intervention was well accepted by young people and feasible to apply within a secondary care setting. Strong effect sizes are encouraging but are probably inflated by the small sample size, uncontrolled design and unblinded assessments.
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257
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Soh HL, Ho RC, Ho CS, Tam WW. Efficacy of digital cognitive behavioural therapy for insomnia: a meta-analysis of randomised controlled trials. Sleep Med 2020; 75:315-325. [PMID: 32950013 DOI: 10.1016/j.sleep.2020.08.020] [Citation(s) in RCA: 268] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/12/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Although cognitive behavioural therapy for insomnia (CBT-I) has been recommended the initial therapy for insomnia, its clinical usage remains limited due to the lack of therapists. Digital CBT-I (dCBT-I) can potentially circumvent this problem. This meta-analysis aims to evaluate the short-term and long-term efficacy of dCBT-I for adults with insomnia. METHODS Systematic search of PubMed, EMBASE, PsycINFO, and CENTRAL from inception till 5 March 2020 was conducted. Randomised controlled trials (RCTs) comparing dCBT-I with controls (wait-list/treatment-as-usual/online education) in adults with insomnia were eligible. The primary outcome was insomnia severity index (ISI) at post-intervention, short-term follow-up (ranging 4 weeks to 6 months) and 1-year follow-up. Mean differences were pooled using the random-effects model. RESULTS 94 articles were assessed full-text independently by two team members and 33 studies were included in this meta-analysis. 4719 and 4645 participants were randomised to dCBT-I and control respectively. dCBT-I significantly reduces ISI at post-intervention with mean difference -5.00 (95% CI -5.68 to -4.33, p < 0.0001) (I2 = 79%) compared to control. The improvements were sustained at short-term follow-up, -3.99 (95% CI -4.82 to -3.16, p < 0.0001) and 1-year follow-up, -3.48 (95% CI -4.21 to -2.76, p < 0.0001). Compared to dCBT-I, face-to-face CBT-I produced greater improvement in ISI, 3.07 (95% CI 1.18 to 4.95, p = 0.001). However, this was within the non-inferiority interval of 4 points on ISI. CONCLUSION This meta-analysis provides strong support for the effectiveness of dCBT-I in treating insomnia. dCBT-I has potential to revolutionise the delivery of CBT-I, improving the accessibility and availability of CBT-I content for insomnia patients worldwide.
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Affiliation(s)
- Hui Ling Soh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Roger C Ho
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, 119077, Singapore; Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119077, Singapore.
| | - Cyrus S Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119077, Singapore; Department of Psychological Medicine, National University Health System, Singapore
| | - Wilson W Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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258
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Henry AL, Miller CB, Emsley R, Sheaves B, Freeman D, Luik AI, Littlewood DL, Saunders KEA, Kanady JC, Carl JR, Davis ML, Kyle SD, Espie CA. Insomnia as a mediating therapeutic target for depressive symptoms: A sub-analysis of participant data from two large randomized controlled trials of a digital sleep intervention. J Sleep Res 2020; 30:e13140. [PMID: 32810921 PMCID: PMC8150672 DOI: 10.1111/jsr.13140] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 01/04/2023]
Abstract
Insomnia predicts the onset of depression, commonly co-presents with depression and often persists following depression remission. However, these conditions can be challenging to treat concurrently using depression-specific therapies. Cognitive behavioural therapy for insomnia may be an appropriate treatment to improve both insomnia and depressive symptoms. We examined the effects of a fully-automated digital cognitive behavioural therapy intervention for insomnia (Sleepio) on insomnia and depressive symptoms, and the mediating role of sleep improvement on depressive symptoms in participants from two randomized controlled trials of digital cognitive behavioural therapy for insomnia. We also explored potential moderators of intervention effects. All participants met criteria for probable insomnia disorder and had clinically significant depressive symptomatology (PHQ-9 ≥ 10; n = 3,352). Individuals allocated to treatment in both trials were provided access to digital cognitive behavioural therapy. Digital cognitive behavioural therapy significantly improved insomnia (p < .001; g = 0.76) and depressive symptoms (p < .001; g = 0.48) at post-intervention (weeks 8-10), and increased the odds (OR = 2.9; 95% CI = 2.34, 3.65) of clinically significant improvement in depressive symptoms (PHQ-9 < 10). Improvements in insomnia symptoms at mid-intervention mediated 87% of the effects on depressive symptoms at post-intervention. No variables moderated effectiveness outcomes, suggesting generalizability of these findings. Our results suggest that effects of digital cognitive behavioural therapy for insomnia extend to depressive symptoms in those with clinically significant depressive symptomatology. Insomnia may, therefore, be an important therapeutic target to assist management of depressive symptoms.
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Affiliation(s)
- Alasdair L Henry
- Big Health Inc., San Francisco, California, USA.,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Christopher B Miller
- Big Health Inc., San Francisco, California, USA.,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Bryony Sheaves
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Donna L Littlewood
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | | | | | | | | | - Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Colin A Espie
- Big Health Inc., San Francisco, California, USA.,Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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259
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Muzni K, Groeger JA, Dijk DJ, Lazar AS. Self-reported sleep quality is more closely associated with mental and physical health than chronotype and sleep duration in young adults: A multi-instrument analysis. J Sleep Res 2020; 30:e13152. [PMID: 32783404 DOI: 10.1111/jsr.13152] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 06/07/2020] [Accepted: 06/11/2020] [Indexed: 12/21/2022]
Abstract
Sleep and circadian rhythms are considered to be important determinants of mental and physical health. Epidemiological studies have established the contribution of self-reported sleep duration, sleep quality and chronotype to health outcomes. Mental health and sleep problems are more common in women and men are more likely to be evening types. Few studies have compared the relative strength of these contributions and few studies have assessed these contributions separately in men and women. Furthermore, sleep and circadian characteristics are typically assessed with a limited number of instruments and a narrow range of variables is considered, leaving the understanding of the relative contribution of different predictors somewhat fractionary. We compared sleep quality, sleep duration and chronotype as predictors for self-reported mental and physical health and psychological characteristics in 410 men and 261 women aged 18 to 30. To ascertain that results were not dependent on the use of specific instruments we used a multitude of validated instruments including the Morningness-Eveningness-Questionnaire, Munich-ChronoType-Questionnaire, Pittsburgh-Sleep-Quality-Index, British-Sleep-Survey, Karolinska-Sleep-Diary, Insomnia-Severity-Index, SF-36-Health Survey, General-Health-Questionnaire, Dutch-Eating-Behaviour-Questionnaire, Big-Five-Inventory, Behaviour-Inhibition-System-Behaviour-Activation-System, and the Positive-Affect-Negative-Affect-Schedule. Relative contributions of predictors were quantified as local effect sizes derived from multiple regression models. Across all questionnaires, sleep quality was the strongest independent predictor of health and in particular mental health and more so in women than in men. The effect of sleep duration and social jetlag was inconspicuous. A greater insight into the independent contributions of sleep quality and chronotype may aid the understanding of sleep-health interactions in women and men.
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Affiliation(s)
- Khyla Muzni
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - John A Groeger
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Derk-Jan Dijk
- Surrey Sleep Research Centre, University of Surrey, Guildford, UK.,UK Dementia Research Institute, University of Surrey, Guildford, UK
| | - Alpar S Lazar
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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260
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Cho CH, Lee T, Lee JB, Seo JY, Jee HJ, Son S, An H, Kim L, Lee HJ. Effectiveness of a Smartphone App With a Wearable Activity Tracker in Preventing the Recurrence of Mood Disorders: Prospective Case-Control Study. JMIR Ment Health 2020; 7:e21283. [PMID: 32755884 PMCID: PMC7439135 DOI: 10.2196/21283] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/19/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Smartphones and wearable devices can be used to obtain diverse daily log data related to circadian rhythms. For patients with mood disorders, giving feedback via a smartphone app with appropriate behavioral correction guides could play an important therapeutic role in the real world. OBJECTIVE We aimed to evaluate the effectiveness of a smartphone app named Circadian Rhythm for Mood (CRM), which was developed to prevent mood episodes based on a machine learning algorithm that uses passive digital phenotype data of circadian rhythm behaviors obtained with a wearable activity tracker. The feedback intervention for the CRM app consisted of a trend report of mood prediction, H-score feedback with behavioral guidance, and an alert system triggered when trending toward a high-risk state. METHODS In total, 73 patients with a major mood disorder were recruited and allocated in a nonrandomized fashion into 2 groups: the CRM group (14 patients) and the non-CRM group (59 patients). After the data qualification process, 10 subjects in the CRM group and 33 subjects in the non-CRM group were evaluated over 12 months. Both groups were treated in a similar manner. Patients took their usual medications, wore a wrist-worn activity tracker, and checked their eMoodChart daily. Patients in the CRM group were provided with daily feedback on their mood prediction and health scores based on the algorithm. For the CRM group, warning alerts were given when irregular life patterns were observed. However, these alerts were not given to patients in the non-CRM group. Every 3 months, mood episodes that had occurred in the previous 3 months were assessed based on the completed daily eMoodChart for both groups. The clinical course and prognosis, including mood episodes, were evaluated via face-to-face interviews based on the completed daily eMoodChart. For a 1-year prospective period, the number and duration of mood episodes were compared between the CRM and non-CRM groups using a generalized linear model. RESULTS The CRM group had 96.7% fewer total depressive episodes (n/year; exp β=0.033, P=.03), 99.5% shorter depressive episodes (total; exp β=0.005, P<.001), 96.1% shorter manic or hypomanic episodes (exp β=0.039, P<.001), 97.4% fewer total mood episodes (exp β=0.026, P=.008), and 98.9% shorter mood episodes (total; exp β=0.011, P<.001) than the non-CRM group. Positive changes in health behaviors due to the alerts and in wearable device adherence rates were observed in the CRM group. CONCLUSIONS The CRM app with a wearable activity tracker was found to be effective in preventing and reducing the recurrence of mood disorders, improving prognosis, and promoting better health behaviors. Patients appeared to develop a regular habit of using the CRM app. TRIAL REGISTRATION ClinicalTrials.gov NCT03088657; https://clinicaltrials.gov/ct2/show/NCT03088657.
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Affiliation(s)
- Chul-Hyun Cho
- Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.,Department of Psychiatry, Chungnam National University Sejong Hospital, Sejong, Republic of Korea.,Korea University Chronobiology Institute, Seoul, Republic of Korea
| | - Taek Lee
- Department of Convergence Security Engineering, College of Knowledge-based Services Engineering, Sungshin Women's University, Seoul, Republic of Korea
| | - Jung-Been Lee
- Department of Computer Science, Korea University College of Information, Seoul, Republic of Korea
| | - Ju Yeon Seo
- Korea University Chronobiology Institute, Seoul, Republic of Korea.,Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee-Jung Jee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Serhim Son
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyonggin An
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Leen Kim
- Korea University Chronobiology Institute, Seoul, Republic of Korea
| | - Heon-Jeong Lee
- Korea University Chronobiology Institute, Seoul, Republic of Korea.,Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
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261
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Veale D, Ali S, Papageorgiou A, Gournay K. The psychiatric ward environment and nursing observations at night: A qualitative study. J Psychiatr Ment Health Nurs 2020; 27:342-351. [PMID: 31823429 DOI: 10.1111/jpm.12583] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 12/03/2019] [Accepted: 12/06/2019] [Indexed: 01/23/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Nursing observations at night are conducted on psychiatric wards to ensure the safety and well-being of patients as well as to reduce the risk of suicide or severe harm. To our knowledge, no studies have examined the lived experience of the psychiatric ward environment and of nursing observations at night. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The main complaint from patients was the constant interruption of their sleep, as most of the patients in this study were observed 2-4 times an hour. Their sleep was interrupted by (a) the light from torches shone into their faces by staff checking on their safety, (b) the noises produced by the opening and closing of bedroom/ward doors, and/or (c) staff talking to each other during the observation. Patients also reported that they found having somebody enter the room in the middle of the night intimidating and unsettling. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Poor sleep has been associated with an increase in suicide risk and mental health problems. Identifying practices that promote sleep hygiene is vital. The study could be used to develop a Quality Improvement Project to improve patients' sleep and perhaps reduce duration of stay. ABSTRACT: Introduction A fundamental component of nursing care is observations at night to ensure the well-being of patients. However, there is no literature on the lived experience by inpatients of such observations or of the general environment of a psychiatric ward at night. Aim/Question This study aims (a) to understand the lived experience of being an inpatient on a psychiatric ward at night with a focus on intermittent observations and (b) contribute to developing a tool to monitor the psychiatric ward environment for use in quality improvement projects. Method Semi-structured interviews were conducted with twelve inpatients from five psychiatric wards who had experienced intermittent observations at night. These interviews were subsequently transcribed and analysed using content analysis. Results Environmental disturbances including light and noise, invasion of privacy and safety considerations on the ward all contributed to sleep disturbance. The unintended consequences of disturbances caused by intermittent night observations, and by staff in general and other patients formed the core of the inpatients' experience. We developed a clinical tool that could be used to identify the factors that are relevant on an individual ward. Discussion Participants interviewed unanimously agreed that poor sleep quality had a significant negative impact on their psychological and social well-being. These were discussed in relation to the environment and the experience of observations at night. Implications for nursing practice Deprivation of inpatients' sleep is currently under-reported, and the usefulness of intermittent observations at night in psychiatric wards is questioned. Much could be done to adjust the environment at night to support quality sleep and improve psychiatric symptoms. This paper aims to highlight the lived experience of patients to help bring improvements.
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Affiliation(s)
- David Veale
- The Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Sabriha Ali
- The Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Andriani Papageorgiou
- The Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
| | - Kevin Gournay
- The Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK
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262
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Vedaa Ø, Kallestad H, Scott J, Smith ORF, Pallesen S, Morken G, Langsrud K, Gehrman P, Thorndike FP, Ritterband LM, Harvey AG, Stiles T, Sivertsen B. Effects of digital cognitive behavioural therapy for insomnia on insomnia severity: a large-scale randomised controlled trial. LANCET DIGITAL HEALTH 2020; 2:e397-e406. [DOI: 10.1016/s2589-7500(20)30135-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 05/13/2020] [Accepted: 05/20/2020] [Indexed: 01/15/2023]
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263
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Sanderson VA, Vandyk AD, Graham ID, Lightfoot S, Murawsky M, Sikora L, Jacob JD. Post-secondary students with symptoms of psychosis: A mixed-methods systematic review. Int J Ment Health Nurs 2020; 29:590-607. [PMID: 32039562 DOI: 10.1111/inm.12700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 11/29/2022]
Abstract
Post-secondary students are at a heightened risk of psychosis, yet little is known about this population. The aim of this study was to conduct a mixed-methods systematic review of psychosis among post-secondary students, including student characteristics, overall prevalence, risk factors, interventions, and their reported experiences. Procedures were modelled on the Joanna Briggs Institute approach, while PRISMA guided conduct and reporting. A librarian created a systematic search of nine databases, and quality was assessed using JBI Critical Appraisal Tools. We pooled and analysed data according to objectives and recorded data using synthesis tables and narrative summaries. 26 articles published between 2006 and 2018 are included. The average age of participants was 21 years, and most identified as female and Caucasian. The prevalence of psychosis was often measured in a way that limited comparison across studies. Risk factors associated with symptoms of psychosis included substance use, depression, and younger age. Other risk factors trending towards a relationship included racial discrimination and anxiety. Protective factors included self-esteem and self-concept clarity. Five interventions were studied, with mixed results, and only three studies reported on the experience of students. While five promising interventions are identified, inadequate testing and replication limit confidence in their effectiveness and there is a notable deficit in qualitative evidence exploring the experiences of these students. Integrating knowledge on risk factors, interventions, and experiences of students with psychosis will help tailor and facilitate their health care while protecting their right to education.
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Affiliation(s)
| | | | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sophie Lightfoot
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Lindsey Sikora
- Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada
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264
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Depression prevention in digital cognitive behavioral therapy for insomnia: Is rumination a mediator? J Affect Disord 2020; 273:434-441. [PMID: 32560938 DOI: 10.1016/j.jad.2020.03.184] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 11/23/2022]
Abstract
Background There has been growing support for digital Cognitive Behavioral Therapy (dCBT-I) as a scalable intervention that both reduces insomnia and prevents depression. However, the mechanisms by which dCBT-I reduces and prevents depression is less clear. Methods This was a randomized controlled trial with two parallel arms: dCBT-I (N=358), or online sleep education as the control condition (N=300). Outcome variables were measured at pre-treatment, post-treatment, and one-year follow-up, and included the Insomnia Severity Index (ISI), the Quick Inventory of Depressive Symptomatology (QIDS-SR16), and the Perseverative Thinking Questionnaire (PTQ). The analyses tested change in PTQ scores as a mediator for post-treatment insomnia, post-treatment depression, and incident depression at one-year follow-up. Results Reductions in rumination (PTQ) were significantly larger in the dCBT-I condition compared to control. Results also showed that reductions in rumination significantly mediated the improvement in post-treatment insomnia severity (proportional effect = 11%) and post-treatment depression severity (proportional effect = 19%) associated with the dCBT-I condition. Finally, reductions in rumination also significantly mediated the prevention of clinically significant depression via dCBT-I (proportional effect = 42%). Limitations Depression was measured with a validated self-report instrument instead of clinical interviews. Durability of results beyond one-year follow-up should also be tested in future research. Conclusions Results provide evidence that rumination is an important mechanism in how dCBT-I reduces and prevents depression.
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265
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Saruhanjan K, Zarski AC, Bauer T, Baumeister H, Cuijpers P, Spiegelhalder K, Auerbach RP, Kessler RC, Bruffaerts R, Karyotaki E, Berking M, Ebert DD. Psychological interventions to improve sleep in college students: A meta-analysis of randomized controlled trials. J Sleep Res 2020; 30:e13097. [PMID: 32672865 DOI: 10.1111/jsr.13097] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 05/04/2020] [Accepted: 05/10/2020] [Indexed: 11/30/2022]
Abstract
Sleep disturbances and insomnia are common in college students, and reduce their quality of life and academic performance. The aim of this meta-analysis was to evaluate the efficacy of psychological interventions aimed at improving sleep in college students. A meta-analysis was conducted with 10 randomized controlled trials with passive control conditions (N = 2,408). The overall mean effect size (Hedges' g) of all sleep-related outcomes within each trial was moderate to large (g = 0.61; 95% confidence interval: 0.41-0.81; numbers-needed-to-treat = 3). Effect sizes for global measures of sleep disturbances were g = 0.79; 95% confidence interval: 0.52-1.06; and for sleep-onset latency g = 0.65; 95% confidence interval: 0.36-0.94. The follow-up analyses revealed an effect size of g = 0.56; 95% confidence interval: 0.45-0.66 for the combined sleep-related outcomes based on three studies. No significant covariates were identified. These results should be interpreted cautiously due to an overall substantial risk of bias, and in particular with regard to blinding of participants and personnel. Nevertheless, they provide evidence that psychological interventions for improving sleep are efficacious among college students. Further research should explore long-term effects and potential moderators of treatment efficacy in college students.
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Affiliation(s)
- Karina Saruhanjan
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Anna-Carlotta Zarski
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Tobias Bauer
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Harald Baumeister
- Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ronny Bruffaerts
- Center for Public Health Psychiatry, Universitair Psychiatrisch Centrum, KU Leuven, Leuven, Belgium
| | - Eirini Karyotaki
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Matthias Berking
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - David Daniel Ebert
- Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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266
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Scott AJ, Flowers O, Rowse G. Do specific types of sleep disturbances represent risk factors for poorer health-related quality of life in inflammatory bowel disease? A longitudinal cohort study. Br J Health Psychol 2020; 26:90-108. [PMID: 32634291 DOI: 10.1111/bjhp.12457] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/12/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Poor global sleep quality is commonly reported in people with inflammatory bowel disease (IBD) and is linked to poorer health-related quality of life (HRQoL). However, understanding is currently limited by a lack of: (1) longitudinal research and (2) research investigating the impact of specific types of problems sleeping on IBD-related outcomes, particularly on HRQoL. DESIGN Observational longitudinal cohort study. METHODS N = 276 participants with IBD completed measures at baseline (T1) and 4 weeks later at T2. Four specific sleep disturbances associated with IBD including sleep apnoea, insomnia, restless legs, and nightmares were measured alongside depression, anxiety and stress, and HRQoL. RESULTS After controlling for participant demographics and clinical characteristics, T1 depression, anxiety, stress, and T1 HRQoL, more severe symptom severity of sleep apnoea (B = -0.30, p < .05) and insomnia symptoms (B = -0.23, p < .05) at T1 significantly predicted poorer HRQoL at T2. However, the experience of restless legs (B = -0.03, p > .87) and nightmares (B = -0.14, p > .11) at T1 did not predict HRQoL. CONCLUSION Symptoms synonymous with sleep apnoea and insomnia might represent modifiable risk factors that provide independent contributions to HRQoL over time in those with IBD. These findings suggest that interventions designed to improve sleep apnoea and insomnia could confer benefits to HRQoL in those with IBD. However, more longitudinal research is needed to understand the contribution of sleep disturbances over the longer term, as well as more randomized controlled trials testing the effect of improving sleep on IBD-related outcomes.
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Affiliation(s)
- Alexander J Scott
- School of Health & Related Research (ScHARR), University of Sheffield, UK
| | - Olivia Flowers
- School of Health & Related Research (ScHARR), University of Sheffield, UK
| | - Georgina Rowse
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, UK
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267
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Waite F, Sheaves B, Isham L, Reeve S, Freeman D. Sleep and schizophrenia: From epiphenomenon to treatable causal target. Schizophr Res 2020; 221:44-56. [PMID: 31831262 PMCID: PMC7327507 DOI: 10.1016/j.schres.2019.11.014] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Sleep disturbance is a common clinical issue for patients with psychosis. It has been identified as a putative causal factor in the onset and persistence of psychotic experiences (paranoia and hallucinations). Hence sleep disruption may be a potential treatment target to prevent the onset of psychosis and reduce persistent psychotic experiences. The aim of this review is to describe developments in understanding the nature, causal role, and treatment of sleep disruption in psychosis. METHOD A systematic literature search was conducted to identify studies, published in the last five years, investigating subjective sleep disruption and psychotic experiences. RESULTS Fifty-eight papers were identified: 37 clinical and 21 non-clinical studies. The studies were correlational (n = 38; 20 clinical, 18 non-clinical), treatment (n = 7; 1 non-clinical), qualitative accounts (n = 6 clinical), prevalence estimates (n = 5 clinical), and experimental tests (n = 2 non-clinical). Insomnia (50%) and nightmare disorder (48%) are the most prevalent sleep problems found in patients. Sleep disruption predicts the onset and persistence of psychotic experiences such as paranoia and hallucinations, with negative affect identified as a partial mediator of this relationship. Patients recognise the detrimental effects of disrupted sleep and are keen for treatment. All psychological intervention studies reported large effect size improvements in sleep and there may be modest resultant improvements in psychotic experiences. CONCLUSIONS Sleep disruption is a treatable clinical problem in patients with psychosis. It is important to treat in its own right but may also lessen psychotic experiences. Research is required on how this knowledge can be implemented in clinical services.
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Affiliation(s)
- Felicity Waite
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK; Sleep and Circadian Neuroscience Institute, University of Oxford, UK.
| | - Bryony Sheaves
- Department of Psychiatry, University of Oxford, UK,Oxford Health NHS Foundation Trust, UK,Sleep and Circadian Neuroscience Institute, University of Oxford, UK
| | - Louise Isham
- Department of Psychiatry, University of Oxford, UK,Oxford Health NHS Foundation Trust, UK
| | | | - Daniel Freeman
- Department of Psychiatry, University of Oxford, UK,Oxford Health NHS Foundation Trust, UK,Sleep and Circadian Neuroscience Institute, University of Oxford, UK
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268
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Ferrarelli F. Sleep disturbances in schizophrenia and psychosis. Schizophr Res 2020; 221:1-3. [PMID: 32471787 PMCID: PMC7316597 DOI: 10.1016/j.schres.2020.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 01/12/2023]
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269
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Sleep and psychotic symptoms: An actigraphy and diary study with young adults with low and elevated psychosis proneness. Schizophr Res 2020; 221:12-19. [PMID: 31796308 DOI: 10.1016/j.schres.2019.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/18/2019] [Accepted: 09/22/2019] [Indexed: 12/16/2022]
Abstract
Experimental research has shown that poor sleep triggers psychotic experiences, even in healthy participants. This warrants an in-depth investigation of this mechanism in a naturalistic environment, an exploration of which particular aspects of poor sleep trigger psychotic symptoms, and a test for reverse effects of symptoms on sleep. For this purpose, we conducted a 14-day ambulatory assessment study with 82 young adults (age: M = 21.24 years, SD = 1.54; 64.6% female), half of which were characterized by elevated psychosis proneness. Objective sleep parameters (actigraphically-measured sleep time, wake after sleep onset, sleep efficiency), self-reported sleep parameters (feeling rested, dream recall, dream valence), and psychotic symptoms (paranoid symptoms, hallucinatory experiences) were assessed once per day. Using multilevel regressions (928 data points), we found that shorter sleep time and negative dream valence predicted paranoid symptoms, whereas feeling less rested and dream recall predicted hallucinatory experiences. In participants with elevated psychosis proneness, associations with the aforementioned sleep parameters were increased for hallucinatory experiences but not for paranoid symptoms. Finally, we found bidirectional associations between poor sleep and paranoid symptoms but only unidirectional associations between poor sleep and hallucinatory experiences. The findings corroborate the relevance of sleep disturbance as a predictor of psychotic experiences. Future studies should further investigate the potential of sleep interventions to prevent psychotic symptoms and disorders.
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270
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Wodarski JS. The Multi-factorial Complexity of Social Work Practice and Implications for Interventions. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2020; 17:385-391. [PMID: 32508278 DOI: 10.1080/26408066.2020.1774457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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271
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Freeman D, Sheaves B, Waite F, Harvey AG, Harrison PJ. Sleep disturbance and psychiatric disorders. Lancet Psychiatry 2020; 7:628-637. [PMID: 32563308 DOI: 10.1016/s2215-0366(20)30136-x] [Citation(s) in RCA: 263] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/22/2020] [Accepted: 03/17/2020] [Indexed: 01/10/2023]
Abstract
Signs of mental ill health that cut across psychiatric diagnostic categories at high rates are typically viewed as non-specific occurrences, downgraded in importance and disregarded. However, problems not associated with particular diagnoses should be expected if there is shared causation across mental health conditions. If dynamic networks of interacting symptoms are the reality of mental health presentations, then particularly disruptive and highly connected problems should be especially common. The non-specific occurrence might be highly consequential. One non-specific occurrence that is often overlooked is patients' chronic difficulty in getting good sleep. In this Review, we consider whether disrupted sleep might be a contributory causal factor in the occurrence of major types of mental health disorders. It is argued that insomnia and other mental health conditions not only share common causes but also show a bidirectional relationship, with typically the strongest pathway being disrupted sleep as a causal factor in the occurrence of other psychiatric problems. Treating insomnia lessens other mental health problems. Intervening on sleep at an early stage might be a preventive strategy for the onset of clinical disorders. Our recommendations are that insomnia is assessed routinely in the occurrence of mental health disorders; that sleep disturbance is treated in services as a problem in its own right, yet also recognised as a pathway to reduce other mental health difficulties; and that access to evidence-based treatment for sleep difficulties is expanded in mental health services.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK; Health National Health Service Foundation Trust, Oxford, UK.
| | - Bryony Sheaves
- Department of Psychiatry, University of Oxford, Oxford, UK; Health National Health Service Foundation Trust, Oxford, UK
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Oxford, UK; Health National Health Service Foundation Trust, Oxford, UK
| | - Allison G Harvey
- Department of Psychology, University of California, Berkeley, CA, USA
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford, UK; Health National Health Service Foundation Trust, Oxford, UK
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272
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Fear of Missing Out, Mental Wellbeing, and Social Connectedness: A Seven-Day Social Media Abstinence Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124566. [PMID: 32599962 PMCID: PMC7345987 DOI: 10.3390/ijerph17124566] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 01/13/2023]
Abstract
Smartphones aid the constant accessibility of social media (SM) applications, and these devices and platforms have become a key part of our everyday lives and needs. Previous research has focused on the psychological impact of social media use (SMU) and SM abstinence has only received limited attention. Therefore, employing a combination of an experimental within-subjects mixed methodology using surveys to obtain both quantitative and qualitative data, this study aimed to compare psychosocial factors of fear of missing out (FoMO), mental wellbeing (MWB), and social connectedness (SC) before and after seven days of SM abstinence. Results revealed that participants (N = 61) experienced a significant increase in MWB and SC, and a significant decrease in FoMO and smartphone use following SM abstinence. There was a significant positive relationship between MWB and SC change scores and a significant negative relationship between SC and FoMO change scores. There were no significant differences in levels of SMU before abstinence or across genders in FoMO, MWB, and SC change scores. Thematic analysis revealed coping, habit, and boredom as motivations for SMU, and notification distractions presenting a challenge for successful abstinence from SM. Participants indicated that abstinence resulted in the perceived need to fill their time with non-SM applications. Finally, thematic analysis revealed mixed experiences of perceived connectivity in the absence of SMU. Findings present implications for the importance of unplugging from SM for temporary periods because scrolling through SM to fill time is a key motivator of SMU, and notifications encourage SMU and trigger FoMO.
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273
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Ashton A, Jagannath A. Disrupted Sleep and Circadian Rhythms in Schizophrenia and Their Interaction With Dopamine Signaling. Front Neurosci 2020; 14:636. [PMID: 32655359 PMCID: PMC7324687 DOI: 10.3389/fnins.2020.00636] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/22/2020] [Indexed: 12/31/2022] Open
Abstract
Sleep and circadian rhythm disruption (SCRD) is a common feature of schizophrenia, and is associated with symptom severity and patient quality of life. It is commonly manifested as disturbances to the sleep/wake cycle, with sleep abnormalities occurring in up to 80% of patients, making it one of the most common symptoms of this disorder. Severe circadian misalignment has also been reported, including non-24 h periods and phase advances and delays. In parallel, there are alterations to physiological circadian parameters such as body temperature and rhythmic hormone production. At the molecular level, alterations in the rhythmic expression of core clock genes indicate a dysfunctional circadian clock. Furthermore, genetic association studies have demonstrated that mutations in several clock genes are associated with a higher risk of schizophrenia. Collectively, the evidence strongly suggests that sleep and circadian disruption is not only a symptom of schizophrenia but also plays an important causal role in this disorder. The alterations in dopamine signaling that occur in schizophrenia are likely to be central to this role. Dopamine is well-documented to be involved in the regulation of the sleep/wake cycle, in which it acts to promote wakefulness, such that elevated dopamine levels can disturb sleep. There is also evidence for the influence of dopamine on the circadian clock, such as through entrainment of the master clock in the suprachiasmatic nuclei (SCN), and dopamine signaling itself is under circadian control. Therefore dopamine is closely linked with sleep and the circadian system; it appears that they have a complex, bidirectional relationship in the pathogenesis of schizophrenia, such that disturbances to one exacerbate abnormalities in the other. This review will provide an overview of the evidence for a role of SCRD in schizophrenia, and examine the interplay of this with altered dopamine signaling. We will assess the evidence to suggest common underlying mechanisms in the regulation of sleep/circadian rhythms and the pathophysiology of schizophrenia. Improvements in sleep are associated with improvements in symptoms, along with quality of life measures such as cognitive ability and employability. Therefore the circadian system holds valuable potential as a new therapeutic target for this disorder.
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Affiliation(s)
- Anna Ashton
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Aarti Jagannath
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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274
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Abstract
At the core of human thought, for the majority of individuals in the developed nations at least, there is the tacit assumption that as a species we are unfettered by the demands imposed by our biology and that we can do what we want, at whatever time we choose, whereas in reality every aspect of our physiology and behaviour is constrained by a 24 h beat arising from deep within our evolution. Our daily circadian rhythms and sleep/wake cycle allow us to function optimally in a dynamic world, adjusting our biology to the demands imposed by the day/night cycle. The themes developed in this review focus upon the growing realization that we ignore the circadian and sleep systems at our peril, and this paper considers the mechanisms that generate and regulate circadian and sleep systems; what happens mechanistically when these systems collapse as a result of societal pressures and disease; how sleep disruption and stress are linked; why sleep disruption and mental illness invariably occur together; and how individuals and employers can attempt to mitigate some of the problems associated with working against our internal temporal biology. While some of the health costs of sleep disruption can be reduced, in the short-term at least, there will always be significant negative consequences associated with shift work and sleep loss. With this in mind, society needs to address this issue and decide when the consequences of sleep disruption are justified in the workplace.
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Affiliation(s)
- Russell G. Foster
- Sleep and Circadian Neuroscience Institute (SCNi) and Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, OMPI, Sir William Dunn School of Pathology, University of Oxford, South Parks Road, Oxford OX1 3RE, UK
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275
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Goodwin GM. Why sleep matters for young people who may get depressed. Interface Focus 2020; 10:20190115. [PMID: 32382407 PMCID: PMC7202387 DOI: 10.1098/rsfs.2019.0115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2020] [Indexed: 12/26/2022] Open
Abstract
Depression and anxiety are negative emotional states familiar to us all through personal experience. Less familiar are severe states of depression, in particular, which can actually shorten the lives of sufferers by over a decade. The relationship of these very severe states of illness to the milder cases more common earlier in development is important. Most patients who have suffered from depression will suffer from further episodes during their lifetime, and an early onset may make recurrence more likely. A number of factors increase the risk for depression, including family history, stressful life events, early life experiences, personality (particularly the traits of neuroticism and perfectionism) and mood lability (marked ups and downs). Sleep disturbance may both provoke and/or signal the onset of mood disorder. Sleep is therefore doubly important as a gateway to treatment. Understanding more about how sleep interacts with the established risk factors would allow vulnerable young people to be identified earlier for more effective intervention. Early identification of sleep disorder and depression allows psychological treatments to be used, which are less effective once a full depressive episode and a cascade of neurobiological and psychological effects have occurred.
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Affiliation(s)
- Guy M. Goodwin
- University Department of Psychiatry, Oxford Health NHS Trust, Warneford Hospital, Oxford OX3 7JX, UK
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276
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Delorme TC, Srivastava LK, Cermakian N. Are Circadian Disturbances a Core Pathophysiological Component of Schizophrenia? J Biol Rhythms 2020; 35:325-339. [DOI: 10.1177/0748730420929448] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Schizophrenia is a multifactorial disorder caused by a combination of genetic variations and exposure to environmental insults. Sleep and circadian rhythm disturbances are a prominent and ubiquitous feature of many psychiatric disorders, including schizophrenia. There is growing interest in uncovering the mechanistic link between schizophrenia and circadian rhythms, which may directly affect disorder outcomes. In this review, we explore the interaction between schizophrenia and circadian rhythms from 2 complementary angles. First, we review evidence that sleep and circadian rhythm disturbances constitute a fundamental component of schizophrenia, as supported by both human studies and animal models with genetic mutations related to schizophrenia. Second, we discuss the idea that circadian rhythm disruption interacts with existing risk factors for schizophrenia to promote schizophrenia-relevant behavioral and neurobiological abnormalities. Understanding the mechanistic link between schizophrenia and circadian rhythms will have implications for mitigating risk to the disorder and informing the development of circadian-based therapies.
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Affiliation(s)
- Tara C. Delorme
- Integrated Program in Neuroscience, McGill University, Montréal, Québec, Canada
- Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Lalit K. Srivastava
- Douglas Mental Health University Institute, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Nicolas Cermakian
- Douglas Mental Health University Institute, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
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277
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Sleep disturbance-related depressive symptom and brain volume reduction in shift-working nurses. Sci Rep 2020; 10:9100. [PMID: 32499549 PMCID: PMC7272417 DOI: 10.1038/s41598-020-66066-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/12/2020] [Indexed: 12/19/2022] Open
Abstract
Disturbed sleep is the most common effect of shift work. A large corpus of research indicates an association between sleep disturbance and depressive symptom in shift workers. In this study, we proposed the mediating role of grey matter (GM) structure in the relationship between sleep disturbance and depressive symptom. We collected structural MRI (sMRI) data as well as assessing the level of sleep disturbance and depressive symptom with the Pittsburgh Sleep disturbance Index and Zung Self-Rating Depression Scale, respectively, in 20 shift-working nurses and 19 day-working nurses. The shift-working nurses reported greater severity of sleep disturbance and depressive symptom, and furthermore, they exhibited reduced GM volume in the left postcentral gyrus (PostCG), right PostCG, right paracentral lobule, and left superior temporal gyrus (STG), compared to the day-working nurses. For each of the four brain regions, we formulated a mediation hypothesis by developing a mediation model that represents a causal chain between GM volume, sleep disturbance, and depressive symptom. Tests of the hypothesis on the mediation of GM volume revealed that inter-individual variations in left PostCG volume and left STG volume accounted for the influence of sleep disturbance on depressive symptom. These results suggest that structural alterations in PostCG and STG play an intervening role in the development of depressive symptom following sleep disturbance. We propose the need of considering neuroanatomical abnormalities in explaining and understanding symptomatic changes induced by sleep disturbance.
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278
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Thornton L, Osman B, Wescott AB, Sunderland M, Champion K, Green O, Kay-Lambkin F, Slade T, Newton N, Chapman C, Teesson M, Mills K, Birrell L, Lubans D, Van de Ven P, Torous J, Parmenter B, Gardner L. Measurement properties of smartphone approaches to assess key lifestyle behaviours: protocol of a systematic review. Syst Rev 2020; 9:127. [PMID: 32493467 PMCID: PMC7271443 DOI: 10.1186/s13643-020-01375-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/29/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Six core behavioural risk factors (poor diet, physical activity, sedentary behaviour, alcohol misuse, smoking and unhealthy sleep patterns) have been identified as strong determinants of chronic disease, such as cardiovascular disease, diabetes and cancers. Smartphones have the potential to provide a real-time, pervasive, unobtrusive and cost-effective way to measure health behaviours and deliver instant feedback to users. Despite this, validity of using smartphones to measure these six key behaviours is largely unknown. The proposed systematic review aims to address this gap by identifying existing smartphone-based approaches to measure these health behaviours and critically appraising, comparing and summarizing the quality of their measurement properties. METHODS A systematic search of the Ovid MEDLINE, Embase (Elsevier), Cochrane Library (Wiley), PsychINFO (EBSCOhost), CINAHL (EBSCOHost), Web of Science (Clarivate), SPORTDiscus (EBSCOhost) and IEEE Xplore Digital Library databases will be conducted from January 2007 to March 2020. Eligible studies will be those written in English that measure at least one of the six health behaviours of interest via a smartphone and report on at least one measurement property. The primary outcomes will be validity, reliability and/or responsiveness of these measurement approaches. A secondary outcome will be the feasibility (e.g. user burden, usability and cost) of identified approaches. No restrictions will be placed on the participant population or study design. Two reviewers will independently screen studies for eligibility, extract data and assess the risk of bias. The study methodological quality (or bias) will be appraised using an appropriate tool. Our results will be described in a narrative synthesis. If feasible, random effects meta-analysis will be conducted where appropriate. DISCUSSION The results from this review will provide important information about the types of smartphone-based approaches currently available to measure the core behavioural risk factors for chronic disease and the quality of their measurement properties. It will allow recommendations on the most suitable and effective measures of these lifestyle behaviours using smartphones. Valid and reliable measurement of these behaviours and risk factor opens the door to targeted and real-time delivery of health behaviour interventions, providing unprecedented opportunities to offset the trajectory toward chronic disease. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42019122242.
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Affiliation(s)
- Louise Thornton
- The Matilda Centre, The University of Sydney, Sydney, New South Wales, Australia.
| | - Bridie Osman
- The Matilda Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Annie B Wescott
- Galter Health Sciences Library & Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew Sunderland
- The Matilda Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Katrina Champion
- The Matilda Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Olivia Green
- The Matilda Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Frances Kay-Lambkin
- The Matilda Centre, The University of Sydney, Sydney, New South Wales, Australia.,Priority Research Centre for Brain and Mental Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Tim Slade
- The Matilda Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nickie Newton
- The Matilda Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Cath Chapman
- The Matilda Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Maree Teesson
- The Matilda Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Mills
- The Matilda Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Birrell
- The Matilda Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - David Lubans
- The Matilda Centre, The University of Sydney, Sydney, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Pepijn Van de Ven
- Department of Electronics and Computer Engineering, The University of Limerick, Limerick, Ireland
| | - John Torous
- Beth Israel Deaconness Medical Center, Harvard Medical School, Boston, MA, USA
| | - Belinda Parmenter
- School of Medical Sciences, The University of New South Wales, Sydney, New South Wales, Australia
| | - Lauren Gardner
- The Matilda Centre, The University of Sydney, Sydney, New South Wales, Australia
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279
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van der Zweerde T, Lancee J, Ida Luik A, van Straten A. Internet-Delivered Cognitive Behavioral Therapy for Insomnia. Sleep Med Clin 2020; 15:117-131. [DOI: 10.1016/j.jsmc.2020.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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280
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Williams MG, Stott R, Bromwich N, Oblak SK, Espie CA, Rose JB. Determinants of and barriers to adoption of digital therapeutics for mental health at scale in the NHS. ACTA ACUST UNITED AC 2020. [DOI: 10.1136/bmjinnov-2019-000384] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectivesAlthough it is widely acknowledged that digital therapeutics will play a significant role in the future delivery of healthcare, the method by which these innovations may be commissioned by the National Health Service, at scale, remains unclear. This study explores English health commissioners’ experiences of, and attitudes towards, adopting digital healthcare innovations.Methods37 commissioners and decision-makers from a range of sectors within the health profession were invited to participate in structured interviews to gather relevant examples of experience and opinions. 14 commissioners participated and the notes from the resulting interviews were interpreted using qualitative content analysis. Controlled interpretation was applied to the categorised responses, paraphrasing and classifying into themes.ResultsCommon determinants and barriers to adoption of digital mental health expressed during the interview process included commissioners’ lack of familiarity with technology, information governance, digital literacy of users and decision-makers.ConclusionsRecognition of identified barriers may be helpful for innovators when developing engagement and market access strategies and suggest areas for focus and further development within the commissioning process to accommodate digital health solutions.
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281
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Cliffe B, Croker A, Denne M, Stallard P. Clinicians' use of and attitudes towards technology to provide and support interventions in child and adolescent mental health services. Child Adolesc Ment Health 2020; 25:95-101. [PMID: 32307835 DOI: 10.1111/camh.12362] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Technology can increase child and adolescent mental health service (CAMHS) capacity by supporting and delivering interventions, yet it has not been widely adopted by CAMHS child mental health professionals. Uptake can either be facilitated or obstructed by child mental health professionals' attitudes, which remain largely unknown. METHOD One hundred fifty-four CAMHS child mental health professionals completed a questionnaire about their use of, and attitudes towards, using technology with children and adolescents. RESULTS Child mental health professionals perceived themselves as generally competent at using technology, especially younger child mental health professionals, and perceived it to be helpful in their clinical work. A number of benefits of its use were identified such as accessibility, convenience and appeal, and it was primarily perceived as a preventative/psychoeducational tool rather than a replacement for face-to-face therapy. Older technologies (helplines and websites) were most frequently used, whereas newer technologies (computer games) were rarely used. Child mental health professionals were unsure what resources were available and whether technology is safe, private or reliable. CONCLUSIONS Despite positive attitudes towards technology, newer technologies were rarely used by child mental health professionals. An overall lack of knowledge about resources along with concerns about safety and reliability may account for the slow uptake of technology within CAMHS. These issues need addressing to maximise implementation, perhaps through training or workshops.
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Affiliation(s)
| | - Abigail Croker
- Child and Family Service, Temple House Practice, Keynsham, UK
| | - Megan Denne
- Child and Family Service, Temple House Practice, Keynsham, UK
| | - Paul Stallard
- Department for Health, University of Bath, Bath, UK.,Child and Family Service, Temple House Practice, Keynsham, UK
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282
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Abstract
The concept of sleep health provides a positive holistic framing of multiple sleep characteristics, including sleep duration, continuity, timing, alertness, and satisfaction. Sleep health promotion is an underrecognized public health opportunity with implications for a wide range of critical health outcomes, including cardiovascular disease, obesity, mental health, and neurodegenerative disease. Using a socioecological framework, we describe interacting domains of individual, social, and contextual influences on sleep health. To the extent that these determinants of sleep health are modifiable, sleep and public health researchers may benefit from taking a multilevel approach for addressing disparities in sleep health. For example, in addition to providing individual-level sleep behavioral recommendations, health promotion interventions need to occur at multiple contextual levels (e.g., family, schools, workplaces, media, and policy). Because sleep health, a key indicator of overall health, is unevenly distributed across the population, we consider improving sleep health a necessary step toward achieving health equity.
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Affiliation(s)
- Lauren Hale
- Program in Public Health; and Department of Family, Population, and Preventive Medicine; Renaissance School of Medicine, Stony Brook University, Stony Brook, New York 11794-8338, USA;
| | - Wendy Troxel
- Division of Behavior and Policy Sciences, RAND Corporation, Pittsburgh, Pennsylvania 15213, USA;
| | - Daniel J Buysse
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA;
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283
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Kalmbach DA, Cheng P, O'Brien LM, Swanson LM, Sangha R, Sen S, Guille C, Cuamatzi-Castelan A, Henry AL, Roth T, Drake CL. A randomized controlled trial of digital cognitive behavioral therapy for insomnia in pregnant women. Sleep Med 2020; 72:82-92. [PMID: 32559716 DOI: 10.1016/j.sleep.2020.03.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/18/2020] [Accepted: 03/12/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Despite high rates of prenatal insomnia, efficacious treatment options for this population are quite limited. Early evidence from randomized controlled trials (RCTs) support the efficacy of face-to-face cognitive-behavioral therapy for insomnia (CBTI) for prenatal insomnia. Yet, as many patients are unable to access this specialist-driven care, a critical need exists to increase its accessibility. This RCT examined the efficacy internet-based digital CBTI in pregnant women with insomnia. METHODS Single-site RCT. A total of 91 pregnant women (29.03 ± 4.16 years) nearing/entering the third trimester who screened positive for clinical insomnia on the Insomnia Severity Index (ISI) were randomized to digital CBTI or digital sleep education control. The ISI, Pittsburgh Sleep Quality Index (PSQI), Edinburgh Postnatal Depression Scale (EPDS), and Pre-Sleep Arousal Scale's Cognitive factor (PSAS-C) served as study outcomes, which were collected before treatment and after treatment during pregnancy, then six weeks after childbirth. RESULTS From pre to posttreatment, CBTI patients reported reductions in ISI (-4.91 points, p < 0.001) and PSQI (-2.98 points, p < 0.001) and increases in nightly sleep duration by 32 min (p = 0.008). Sleep symptoms did not change during pregnancy in the control group. After childbirth, CBTI patients, relative to controls, slept longer by 40 min per night (p = 0.01) and reported better sleep maintenance. No pre or postnatal treatment effects on depression or cognitive arousal were observed. CONCLUSIONS Digital CBTI improves sleep quality and sleep duration during pregnancy and after childbirth. To better optimize outcomes, CBTI should be tailored to meet the changing needs of women as the progress through pregnancy and early parenting. NAME: Insomnia and Rumination in Late Pregnancy and the Risk for Postpartum Depression. URL: clinicaltrials.gov. Registration: NCT03596879.
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Affiliation(s)
- David A Kalmbach
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA.
| | - Philip Cheng
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Louise M O'Brien
- Departments of Obstetrics & Gynecology and Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Leslie M Swanson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Roopina Sangha
- Department of Obstetrics & Gynecology, Henry Ford Health System, Detroit, MI, USA
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | | | - Alasdair L Henry
- Big Health Inc, San Francisco, CA, USA; Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Thomas Roth
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA
| | - Christopher L Drake
- Thomas Roth Sleep Disorders & Research Center, Henry Ford Health System, Detroit, MI, USA
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284
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Kyle SD, Hurry MED, Emsley R, Marsden A, Omlin X, Juss A, Spiegelhalder K, Bisdounis L, Luik AI, Espie CA, Sexton CE. The effects of digital cognitive behavioral therapy for insomnia on cognitive function: a randomized controlled trial. Sleep 2020; 43:5777024. [DOI: 10.1093/sleep/zsaa034] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/07/2020] [Indexed: 11/14/2022] Open
Abstract
AbstractStudy ObjectivesWe sought to examine the impact of digital cognitive behavioral therapy (dCBT) for insomnia on both self-reported cognitive impairment and objective cognitive performance.MethodsThe Defining the Impact of Sleep improvement on Cognitive Outcomes (DISCO) trial was an online, two-arm, single-blind, randomized clinical trial of dCBT versus wait-list control. Participants were aged 25 years and older, met DSM-5 diagnostic criteria for insomnia disorder, and reported difficulties with concentration or memory. Assessments were carried out online at baseline, and 10 and 24 weeks post-randomization. The primary outcome measure was self-reported cognitive impairment, assessed with the British Columbia Cognitive Complaints Inventory (BC-CCI). Secondary outcomes included tests of cognitive performance, insomnia symptoms, cognitive failures, fatigue, sleepiness, depression, and anxiety.ResultsFour hundred and ten participants with insomnia were recruited and assigned to dCBT (N = 205) or wait-list control (N = 205). At 10 weeks post-randomization the estimated adjusted mean difference for the BC-CCI was −3.03 (95% CI: −3.60, −2.47; p < 0.0001, d = −0.86), indicating that participants in the dCBT group reported less cognitive impairment than the control group. These effects were maintained at 24 weeks (d = −0.96) and were mediated, in part, via reductions in insomnia severity and increased sleep efficiency. Treatment effects in favor of dCBT, at both 10 and 24 weeks, were found for insomnia severity, sleep efficiency, cognitive failures, fatigue, sleepiness, depression, and anxiety. We found no between-group differences in objective tests of cognitive performance.ConclusionsOur study shows that dCBT robustly decreases self-reported cognitive impairment at post-treatment and these effects are maintained at 6 months.
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Affiliation(s)
- Simon D Kyle
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Madeleine E D Hurry
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Antonia Marsden
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Ximena Omlin
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Amender Juss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Kai Spiegelhalder
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg, Germany
| | - Lampros Bisdounis
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Annemarie I Luik
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Big Health Ltd, London, UK
| | - Claire E Sexton
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford, UK
- Global Brain Health Institute, Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA
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285
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Kyle SD, Madigan C, Begum N, Abel L, Armstrong S, Aveyard P, Bower P, Ogburn E, Siriwardena A, Yu LM, Espie CA. Primary care treatment of insomnia: study protocol for a pragmatic, multicentre, randomised controlled trial comparing nurse-delivered sleep restriction therapy to sleep hygiene (the HABIT trial). BMJ Open 2020; 10:e036248. [PMID: 32139496 PMCID: PMC7059413 DOI: 10.1136/bmjopen-2019-036248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/29/2020] [Accepted: 02/03/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Insomnia is a prevalent sleep disorder that negatively affects quality of life. Multicomponent cognitive-behavioural therapy (CBT) is the recommended treatment but access remains limited, particularly in primary care. Sleep restriction therapy (SRT) is one of the principal active components of CBT and could be delivered by generalist staff in primary care. The aim of this randomised controlled trial is to establish whether nurse-delivered SRT for insomnia disorder is clinically and cost-effective compared with sleep hygiene advice. METHODS AND ANALYSIS In the HABIT (Health-professional Administered Brief Insomnia Therapy) trial, 588 participants meeting criteria for insomnia disorder will be recruited from primary care in England and randomised (1:1) to either nurse-delivered SRT (plus sleep hygiene booklet) or sleep hygiene booklet on its own. SRT will be delivered over 4 weekly sessions; total therapy time is approximately 1 hour. Outcomes will be collected at baseline, 3, 6 and 12 months post-randomisation. The primary outcome is self-reported insomnia severity using the Insomnia Severity Index at 6 months. Secondary outcomes include health-related and sleep-related quality of life, depressive symptoms, use of prescribed sleep medication, diary and actigraphy-recorded sleep parameters, and work productivity. Analyses will be intention-to-treat. Moderation and mediation analyses will be conducted and a cost-utility analysis and process evaluation will be performed. ETHICS AND DISSEMINATION Ethical approval was granted by the Yorkshire and the Humber - Bradford Leeds Research Ethics Committee (reference: 18/YH/0153). We will publish our primary findings in high-impact, peer-reviewed journals. There will be further outputs in relation to process evaluation and secondary analyses focussed on moderation and mediation. Trial results could make the case for the introduction of nurse-delivered sleep therapy in primary care, increasing access to evidence-based treatment for people with insomnia disorder. TRIAL REGISTRATION NUMBER ISRCTN42499563.
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Affiliation(s)
- Simon D Kyle
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Claire Madigan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nargis Begum
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Lucy Abel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stephanie Armstrong
- School of Health and Social Care, Community and Health Research Unit, College of Social Science, University of Lincoln, Lincoln, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Bower
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Emma Ogburn
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Aloysius Siriwardena
- School of Health and Social Care, Community and Health Research Unit, College of Social Science, University of Lincoln, Lincoln, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
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286
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Cliffe B, Croker A, Denne M, Smith J, Stallard P. Digital Cognitive Behavioral Therapy for Insomnia for Adolescents With Mental Health Problems: Feasibility Open Trial. JMIR Ment Health 2020; 7:e14842. [PMID: 32134720 PMCID: PMC7078631 DOI: 10.2196/14842] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/21/2019] [Accepted: 12/16/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Insomnia in adolescents is common, persistent, and associated with poor mental health including anxiety and depression. Insomnia in adolescents attending child mental health services is seldom directly treated, and the effects of digital cognitive behavioral therapy (CBT) for insomnia (CBTi) on the mental health of adolescents with significant mental health problems are unknown. OBJECTIVE This open study aimed to assess the feasibility of adding supported Web-based CBT for insomnia to the usual care of young people aged 14 to 17 years attending specialist child and adolescent mental health services (CAMHS). METHODS A total of 39 adolescents with insomnia aged 14 to 17 years attending specialist CAMHS were assessed and offered digital CBTi. The digital intervention was Sleepio, an evidence-based, self-directed, fully automated CBTi that has proven effective in multiple randomized controlled trials with adults. Self-report assessments of sleep (Sleep Condition Indicator [SCI], Insomnia Severity Scale, and Web- or app-based sleep diaries), anxiety (Revised Child Anxiety and Depression Scale [RCADS]), and depression (Mood and Feelings Questionnaire [MFQ]) were completed at baseline and post intervention. Postuse interviews assessed satisfaction with digital CBTi. RESULTS Average baseline sleep efficiency was very poor (53%), with participants spending an average of 9.6 hours in bed but only 5.1 hours asleep. All participants scored less than 17 on the SCI, with 92% (36/39) participants scoring 15 or greater on the Insomnia Severity Scale, suggesting clinical insomnia. Of the 39 participants, 36 (92%) scored 27 or greater on the MFQ for major depression and 20 (51%) had clinically elevated symptoms of anxiety. The majority of participants (38/49, 78%) were not having any treatment for their insomnia, with the remaining 25% (12/49) receiving medication. Sleepio was acceptable, with 77% (30/39) of the participants activating their account and 54% (21/39) completing the program. Satisfaction was high, with 84% (16/19) of the participants finding Sleepio helpful, 95% (18/19) indicating that they would recommend it to a friend, and 37% (7/19) expressing a definite preference for a digital intervention. Statistically significant pre-post improvements were found in weekly diaries of sleep efficiency (P=.005) and sleep quality (P=.001) and on measures of sleep (SCI: P=.001 and Insomnia Severity Index: P=.001), low mood (MFQ: P=.03), and anxiety (RCADS: P=.005). CONCLUSIONS Our study has a number of methodological limitations, particularly the small sample size, absence of a comparison group and no follow-up assessment. Nonetheless, our findings are encouraging and suggest that digital CBTi for young people with mental health problems might offer an acceptable and an effective way to improve both sleep and mental health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/11324.
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Affiliation(s)
- Bethany Cliffe
- Department of Health, University of Bath, Bath, United Kingdom
| | - Abigail Croker
- Child and Adolescent Mental Health Service, Oxford Health NHS Foundation Trust, Temple House, Keynsham, United Kingdom
| | - Megan Denne
- Child and Adolescent Mental Health Service, Oxford Health NHS Foundation Trust, Temple House, Keynsham, United Kingdom
| | - Jacqueline Smith
- Child and Adolescent Mental Health Service, Oxford Health NHS Foundation Trust, Temple House, Keynsham, United Kingdom
| | - Paul Stallard
- Department of Health, University of Bath, Bath, United Kingdom
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287
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Pionke R, Gidzgier P, Nelson B, Gawęda Ł. Prevalence, dimensionality and clinical relevance of self-disturbances and psychotic-like experiences in Polish young adults: a latent class analysis approach. Int J Methods Psychiatr Res 2020; 29:e1809. [PMID: 31808220 PMCID: PMC7051838 DOI: 10.1002/mpr.1809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/23/2019] [Accepted: 09/20/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES We aimed to investigate latent classes of psychotic-like experiences (PLEs) and self-disturbances (SD) and to explore mutual overlapping between derived subgroups. Further, our goal was to investigate class membership relationship with an exposure to childhood trauma and different psychopathological factors such as cognitive biases, depression, insomnia, psychiatric diagnosis and lifetime suicidality. METHODS Participants consist of 3167 non-clinical adults. We performed two latent class analyses (LCA), for PLEs and SD separately, to identify subgroups of individuals with different profiles on PLEs and SD. Associations between psychopathological factors and latent class membership were examined using multinomial logistic regression analysis. RESULTS LCA produced 5 classes within SD and 3 classes within PLEs. Class of the highest endorsement of SD showed 53% overlap with class of the highest endorsement of PLEs. The highest risk of belonging to High Class for both SD and PLEs was associated in particular with depression, cognitive biases and insomnia. Trauma emerged as a significant predictor only for PLEs classes. CONCLUSIONS Our findings confirm that high PLEs and SD co-occur and are concentrated in a relatively small number of individuals, at least in the general population. Their combination may capture the highest risk of psychosis in the general population.
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Affiliation(s)
- Renata Pionke
- Psychopathology and Early Intervention Lab, II Department of Psychiatry, The Medical University of Warsaw, Poland
| | - Piotr Gidzgier
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Łukasz Gawęda
- Clinical Neuroscience Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
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288
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Cattaneo G, Bartrés-Faz D, Morris TP, Solana Sánchez J, Macià D, Tormos JM, Pascual-Leone A. The Barcelona Brain Health Initiative: Cohort description and first follow-up. PLoS One 2020; 15:e0228754. [PMID: 32045448 PMCID: PMC7012435 DOI: 10.1371/journal.pone.0228754] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 01/22/2020] [Indexed: 11/19/2022] Open
Abstract
The Barcelona Brain Health Initiative is a longitudinal cohort study that began in 2017 and aims to understand and characterize the determinants of brain health maintenance in middle aged adults. A cohort of 4686 individuals between the ages of 40 and 65 years free from any neurological or psychiatric diseases was established, and we collected extensive demographic, socio-economic information along with measures of self-perceived health and lifestyles (general health, physical activity, cognitive activity, socialization, sleep, nutrition and vital plan). Here we report on the baseline characteristics of the participants, and the results of the one-year follow-up evaluation. Participants were mainly women, highly educated, and with better lifestyles compared with the general population. After one year 60% of participants completed the one-year follow-up, and these were older, with higher educational level and with better lifestyles in some domains. In the absence of any specific interventions to-date, these participants showed small improvements in physical activity and sleep, but decreased adherence to a Mediterranean diet. These changes were negatively associated with baseline scores, and poorer habits at baseline were predictive of an improvement in lifestyle domains. Of the 2353 participants who completed the one-year follow-up, 73 had been diagnosed with new neurological and neuropsychiatric diseases. Changes in vital plan at follow-up, as well as gender, sleep quality and sense of coherence at baseline were shown to be significant risk factors for the onset of these diagnoses. Notably, gender risk factor decreased in importance as we adjusted by sleep habits, suggesting its potential mediator effects. These findings stress the importance of healthy lifestyles in sustaining brain health, and illustrate the individual benefit that can be derived from participation in longitudinal observational studies. Modifiable lifestyles, specifically quality of sleep, may partially mediate the effect of other risk factors in the development of some neuropsychiatric conditions.
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Affiliation(s)
- Gabriele Cattaneo
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - David Bartrés-Faz
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Timothy P. Morris
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Javier Solana Sánchez
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Dídac Macià
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Josep M. Tormos
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Alvaro Pascual-Leone
- Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, United States of America
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289
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Blanchard JJ, Andrea A, Orth RD, Savage C, Bennett ME. Sleep disturbance and sleep-related impairment in psychotic disorders are related to both positive and negative symptoms. Psychiatry Res 2020; 286:112857. [PMID: 32087449 PMCID: PMC7416463 DOI: 10.1016/j.psychres.2020.112857] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 02/06/2020] [Indexed: 12/17/2022]
Abstract
A large literature indicates that sleep disturbances are associated with paranoia and other positive symptoms in psychotic disorders. However, few studies have examined the potential association between sleep disturbances and negative symptoms and the results have been inconsistent. The current study examined the hypothesis that sleep problems would be associated with more severe positive and negative symptoms in a transdiagnostic sample of individuals with psychosis (N = 90). Further, we examined whether sleep would be related to negative symptoms above and beyond the contribution of paranoia, other positive symptoms, and depression-anxiety. Results replicated prior research in finding that both sleep disturbance and sleep-related impairment were related to more severe paranoia, other positive symptoms and depression-anxiety. Consistent with our hypothesis, more severe sleep disturbance and sleep-related impairment were related to greater negative symptoms; this was evident across both motivation-pleasure deficits and diminished expression. Sleep variables remained significantly related to motivation-pleasure deficits even after controlling for other non-negative symptoms. These results indicate the broad symptom impact of sleep disturbances and may suggest a novel treatment target to improve negative symptoms.
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Affiliation(s)
- Jack J Blanchard
- Department of Psychology, University of Maryland, College Park, MD 20742, USA.
| | - Alexandra Andrea
- Department of Psychology, University of Maryland, College Park, MD 20742, USA
| | - Ryan D Orth
- Department of Psychology, University of Maryland, College Park, MD 20742, USA
| | - Christina Savage
- Department of Psychology, University of Maryland, College Park, MD 20742, USA
| | - Melanie E Bennett
- Department of Psychiatry, University of Maryland School of Medicine, 737 W. Lombard Street, Suite 551 Baltimore, MD 21201, USA; Department of Psychiatry, Baltimore VA Medical Center, 10 North Greene Street, Baltimore, MD 21201, USA
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290
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Is digital cognitive behavioural therapy for insomnia effective in treating sub-threshold insomnia: a pilot RCT. Sleep Med 2020; 66:174-183. [DOI: 10.1016/j.sleep.2019.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/25/2019] [Accepted: 10/21/2019] [Indexed: 11/21/2022]
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291
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Yang L, Kang Y, Zhang W, Zhang B. [Application and research progress of internet-based cognitive behavioral therapy for insomnia disorder]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:142-146. [PMID: 32376547 DOI: 10.12122/j.issn.1673-4254.2020.01.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Insomnia disorder is one of the most common sleep disorders with an increasing incidence to cause substantial economic losses and social burden. The therapy for insomnia disorder mainly includes medication treatment and cognitive behavioral therapy. Medications are associated with various adverse effects and can be easily addictive. Cognitive behavioral therapy has been proposed as the first-line treatment for insomnia disorder. But due to the disadvantages of face-to-face cognitive behavioral therapy including a high cost and the lack of standardization, internet-based cognitive behavioral therapy has emerged as an alternative with an almost equivalent efficacy to face-to-face cognitive behavioral therapy and better effects than medication. This review summarizes the basic principles of cognitive behavioral therapy for insomnia and discusses the development, forms, effects as well as the advantages and disadvantages of internet-based cognitive behavioral therapy.
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Affiliation(s)
- Lulu Yang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Yinzhi Kang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Wanling Zhang
- Shenzhen Mental Health Center/Shenzhen Kangning Hospital, Shenzhen 518118, China
| | - Bin Zhang
- Department of Psychiatry, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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292
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Goodday SM, Atkinson L, Goodwin G, Saunders K, South M, Mackay C, Denis M, Hinds C, Attenburrow MJ, Davies J, Welch J, Stevens W, Mansfield K, Suvilehto J, Geddes J. The True Colours Remote Symptom Monitoring System: A Decade of Evolution. J Med Internet Res 2020; 22:e15188. [PMID: 31939746 PMCID: PMC6996723 DOI: 10.2196/15188] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/25/2019] [Accepted: 10/22/2019] [Indexed: 01/04/2023] Open
Abstract
The True Colours remote mood monitoring system was developed over a decade ago by researchers, psychiatrists, and software engineers at the University of Oxford to allow patients to report on a range of symptoms via text messages, Web interfaces, or mobile phone apps. The system has evolved to encompass a wide range of measures, including psychiatric symptoms, quality of life, and medication. Patients are prompted to provide data according to an agreed personal schedule: weekly, daily, or at specific times during the day. The system has been applied across a number of different populations, for the reporting of mood, anxiety, substance use, eating and personality disorders, psychosis, self-harm, and inflammatory bowel disease, and it has shown good compliance. Over the past decade, there have been over 36,000 registered True Colours patients and participants in the United Kingdom, with more than 20 deployments of the system supporting clinical service and research delivery. The system has been adopted for routine clinical care in mental health services, supporting more than 3000 adult patients in secondary care, and 27,263 adolescent patients are currently registered within Oxfordshire and Buckinghamshire. The system has also proven to be an invaluable scientific resource as a platform for research into mood instability and as an electronic outcome measure in randomized controlled trials. This paper aimed to report on the existing applications of the system, setting out lessons learned, and to discuss the implications for tailored symptom monitoring, as well as the barriers to implementation at a larger scale.
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Affiliation(s)
- Sarah M Goodday
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- 4YouandMe, Seattle, WA, United States
| | - Lauren Atkinson
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Center for Human Brain Activity, University of Oxford, Oxford, United Kingdom
| | - Guy Goodwin
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Kate Saunders
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Matthew South
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Clare Mackay
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Mike Denis
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Chris Hinds
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Mary-Jane Attenburrow
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Jim Davies
- Big Data Institute, University of Oxford, Oxford, United Kingdom
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - James Welch
- Big Data Institute, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - William Stevens
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Karen Mansfield
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Juulia Suvilehto
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - John Geddes
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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293
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Sleep disturbance: a potential target to improve symptoms and quality of life in those living with psychosis. Ir J Psychol Med 2020; 39:329-334. [PMID: 31931896 DOI: 10.1017/ipm.2019.58] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Sleep has been shown to impact on both physical and mental health, and sleep problems present a considerable burden for individuals and society. There appears to be a complex bidirectional relationship between sleep disturbance and psychiatric symptoms, each potentially influencing the other. In particular, sleep disorders have been associated with more severe symptoms and are predictive of relapse in those with psychotic disorders. This article discusses the relationship between psychosis and insomnia, sleep apnoea, nightmares, circadian rhythm abnormalities and the impact of medications on these relationships. We also discuss the clinical implications of the relationship between sleep disturbance and psychotic disorders along with potential targets for intervention.
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294
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Goldstein-Piekarski AN, Holt-Gosselin B, O'Hora K, Williams LM. Integrating sleep, neuroimaging, and computational approaches for precision psychiatry. Neuropsychopharmacology 2020; 45:192-204. [PMID: 31426055 PMCID: PMC6879628 DOI: 10.1038/s41386-019-0483-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/21/2019] [Accepted: 07/22/2019] [Indexed: 12/13/2022]
Abstract
In advancing precision psychiatry, we focus on what imaging technology and computational approaches offer for the future of diagnostic subtyping and personalized tailoring of interventions for sleep impairment in mood and anxiety disorders. Current diagnostic criteria for mood and anxiety tend to lump different forms of sleep disturbance together. Parsing the biological features of sleep impairment and brain circuit dysfunction is one approach to identifying subtypes within these disorders that are mechanistically coherent and offer targets for intervention. We focus on two large-scale neural circuits implicated in sleep impairment and in mood and anxiety disorders: the default mode network and negative affective network. Through a synthesis of existing knowledge about these networks, we pose a testable framework for understanding how hyper- versus hypo-engagement of these networks may underlie distinct features of mood and sleep impairment. Within this framework we consider whether poor sleep quality may have an explanatory role in previously observed associations between network dysfunction and mood symptoms. We expand this framework to future directions including the potential for connecting circuit-defined subtypes to more distal features derived from digital phenotyping and wearable technologies, and how new discovery may be advanced through machine learning approaches.
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Affiliation(s)
- Andrea N Goldstein-Piekarski
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA
- Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA
| | - Bailey Holt-Gosselin
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA
| | - Kathleen O'Hora
- Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA
| | - Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA, 94305, USA.
- Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA.
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295
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Sevilla-Cermeño L, Rautio D, Andrén P, Hillborg M, Silverberg-Morse M, Lahera G, Mataix-Cols D, Fernández de la Cruz L. Prevalence and impact of insomnia in children and adolescents with body dysmorphic disorder undergoing multimodal specialist treatment. Eur Child Adolesc Psychiatry 2020; 29:1289-1299. [PMID: 31760510 PMCID: PMC7497371 DOI: 10.1007/s00787-019-01442-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 11/12/2019] [Indexed: 11/25/2022]
Abstract
Pediatric body dysmorphic disorder (BDD) is challenging to treat. This study aimed to establish the prevalence of insomnia in youth with BDD and explore its impact on clinical outcomes. Sixty-six children and adolescents with BDD consecutively referred to a specialist clinic completed a range of clinical measures, including the Yale-Brown Obsessive-Compulsive Scale Modified for BDD-Adolescent Version (BDD-YBOCS-A), and the Insomnia Severity Index (ISI). Patients with clinical insomnia (ISI score ≥ 9) were compared to the rest of the sample on socio-demographic and clinical features. Fifty-six patients who received multimodal treatment were re-assessed post-treatment. A mixed-model ANOVA was performed to compare treatment outcomes between the insomnia vs. no insomnia groups, and Chi-squared tests were used to compare response and remission rates. According to the ISI, 48% of the sample qualified as having insomnia at baseline. These participants showed significantly higher self-reported BDD symptom severity, more depressive symptoms, and more functional impairment in daily activities. Patients with insomnia improved less on the BDD-YBOCS-A than those without insomnia, although the difference did not reach statistical significance. The rates of responders and remitters were lower in the insomnia group, compared to the non-insomnia group. Insomnia is prevalent in pediatric BDD, and is associated with more severe psychopathology and worse functioning in daily activities. Furthermore, youth experiencing BDD and insomnia may benefit from multimodal treatment to a lesser extent than those without insomnia. If these results are replicated in larger samples, treatment refinements for pediatric BDD could include specific modules to directly target insomnia.
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Affiliation(s)
- Laura Sevilla-Cermeño
- Karolinska Institutet, Department of Clinical Neuroscience, Child and Adolescent Psychiatry Research Center, Gävlegatan 22 (Entré B), Floor 8, 113 30, Stockholm, Sweden.
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
- Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, Spain.
| | - Daniel Rautio
- Karolinska Institutet, Department of Clinical Neuroscience, Child and Adolescent Psychiatry Research Center, Gävlegatan 22 (Entré B), Floor 8, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Per Andrén
- Karolinska Institutet, Department of Clinical Neuroscience, Child and Adolescent Psychiatry Research Center, Gävlegatan 22 (Entré B), Floor 8, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Maria Hillborg
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | | | - Guillermo Lahera
- Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, Spain
| | - David Mataix-Cols
- Karolinska Institutet, Department of Clinical Neuroscience, Child and Adolescent Psychiatry Research Center, Gävlegatan 22 (Entré B), Floor 8, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Karolinska Institutet, Department of Clinical Neuroscience, Child and Adolescent Psychiatry Research Center, Gävlegatan 22 (Entré B), Floor 8, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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296
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Blanchard JJ, Savage CLG, Orth RD, Jacome AM, Bennett ME. Sleep Problems and Social Impairment in Psychosis: A Transdiagnostic Study Examining Multiple Social Domains. Front Psychiatry 2020; 11:486. [PMID: 32547433 PMCID: PMC7270336 DOI: 10.3389/fpsyt.2020.00486] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/12/2020] [Indexed: 12/11/2022] Open
Abstract
Psychotic disorders are characterized by profound social impairment. An accumulation of research has explored the contribution of symptoms, cognitive functioning, and behavioral skills deficits to this social dysfunction. Recent research indicates that sleep disturbance has significant social implications in nonclinical populations-this research suggests that sleep problems may also be relevant to understanding social impairment in psychosis. This study adopted a symptom-oriented dimensional approach to examine how sleep disturbance and sleep-related impairment are related to multiple social domains within a transdiagnostic sample (N = 90). This sample included individuals with a variety of psychotic disorders (n = 75) along with healthy non-clinical participants (n = 15) to ensure sampling across the full range of sleep problems and social functioning. Social domains spanned self-reported perceptions of social relationships, social functioning in the community, and behavioral assessments of social competence. We hypothesized that greater sleep disturbance and sleep-related impairment would be associated with more negative or problematic perceptions of social relationships (i.e., less social support, less companionship, and greater distress), poorer social functioning in the community, smaller social networks, and poorer behavioral ratings of social competency. Results supported these hypotheses indicating that sleep disturbance and sleep-related impairment have widespread deleterious impacts on perceptions of social relationships, social functioning, and competence. Sleep disturbance retained associations with perceptions of social relationships, social functioning, and social competence even after controlling for total symptoms or cognitive functioning. These findings indicate that sleep problems may have important implications for fully understanding the causes of social impairment in psychosis.
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Affiliation(s)
- Jack J Blanchard
- Department of Psychology, University of Maryland, College Park, College Park, MD, United States
| | - Christina L G Savage
- Department of Psychology, University of Maryland, College Park, College Park, MD, United States
| | - Ryan D Orth
- Department of Psychology, University of Maryland, College Park, College Park, MD, United States
| | - Anyela M Jacome
- Department of Psychology, University of Maryland, College Park, College Park, MD, United States
| | - Melanie E Bennett
- Department of Psychiatry, University of Maryland, Baltimore, Baltimore, MD, United States.,Department of Psychiatry, Baltimore VA Medical Center, Baltimore, MD, United States
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297
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Järnefelt H, Härmä M, Sallinen M, Virkkala J, Paajanen T, Martimo KP, Hublin C. Cognitive behavioural therapy interventions for insomnia among shift workers: RCT in an occupational health setting. Int Arch Occup Environ Health 2019; 93:535-550. [PMID: 31853633 PMCID: PMC7260280 DOI: 10.1007/s00420-019-01504-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/02/2019] [Indexed: 02/07/2023]
Abstract
Introduction The aim of the study was to compare the effectiveness of cognitive behavioural therapy interventions for insomnia (CBT-I) to that of a sleep hygiene intervention in a randomized controlled design among shift workers. We also studied whether the features of shift work disorder (SWD) affected the results. Methods A total of 83 shift workers with insomnia disorder were partially randomized into a group-based CBT-I, self-help CBT-I, or sleep hygiene control intervention. The outcomes were assessed before and after the interventions and at 6-month follow-up using questionnaires, a sleep diary, and actigraphy. Results Perceived severity of insomnia, sleep-related dysfunctional beliefs, burnout symptoms, restedness, recovery after a shift, and actigraphy-based total sleep time improved after the interventions, but we found no significant differences between the interventions. Mood symptoms improved only among the group-based CBT-I intervention participants. Non-SWD participants had more mental diseases and symptoms, used more sleep-promoting medication, and had pronounced insomnia severity and more dysfunctional beliefs than those with SWD. After the interventions, non-SWD participants showed more prominent improvements than those with SWD. Conclusions Our results showed no significant differences between the sleep improvements of the shift workers in the CBT-I interventions and of those in the sleep hygiene control intervention. Alleviation of mood symptoms seemed to be the main added value of the group-based CBT-I intervention compared to the control intervention. The clinical condition of the non-SWD participants was more severe and these participants benefitted more from the interventions than the SWD participants did. Trial registration ClinicalTrials.gov, NCT02523079.
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Affiliation(s)
- Heli Järnefelt
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland. .,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.
| | - Mikko Härmä
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
| | - Mikael Sallinen
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland.,Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Jussi Virkkala
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland.,Department of Clinical Neurophysiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Teemu Paajanen
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
| | - Kari-Pekka Martimo
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
| | - Christer Hublin
- Finnish Institute of Occupational Health (FIOH), Topeliuksenkatu 41 b, 00250, Helsinki, Finland
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298
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Prichard JR. Sleep Predicts Collegiate Academic Performance: Implications for Equity in Student Retention and Success. Sleep Med Clin 2019; 15:59-69. [PMID: 32005350 DOI: 10.1016/j.jsmc.2019.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
College students show high levels of insufficient sleep, excessive daytime sleepiness, sleep schedule irregularity, poor sleep quality, and inadequate sleep hygiene. This article describes the evidence linking poor sleep with impaired academic performance; discusses mediating environmental, behavioral, and demographic factors that correlate with sleep; and highlights examples of successful health promotion initiatives on college campuses. Given that students who are traditionally minoritized on college campuses tend to have worse sleep, improving sleep health emerges as an important issue for retention, equity, and inclusion.
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Affiliation(s)
- J Roxanne Prichard
- University of St. Thomas, 2115 Summit Avenue, JRC LL56, St Paul, MN 55105, USA.
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299
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The association between excessive screen-time behaviors and insufficient sleep among adolescents: Findings from the 2017 youth risk behavior surveillance system. Psychiatry Res 2019; 281:112586. [PMID: 31629305 DOI: 10.1016/j.psychres.2019.112586] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 12/21/2022]
Abstract
Although studies have examined the association between television viewing and poor sleep quality, few studies have considered the association between excessive screen-time behaviors and insufficient sleep among adolescents drawing on a large nationally representative sample. The objective of this study was to examine the association between excessive screen-time behaviors and insufficient sleep among adolescents. Data for this study came from the 2017 Youth Risk Behavior Survey. A sample of 14,603 adolescents aged 14-18 years (51.5% female) was analyzed using logistic regression with insufficient sleep as the outcome variable and excessive screen-time behaviors as the main explanatory variable. Of the 14,603 adolescents, almost three out of four (74.8%) had less than 8 h of sleep on an average school night, and about 43% engaged in excessive screen-time behaviors on an average school day. Controlling for all other predictors, odds were 1.34 times higher for adolescents who engaged in excessive screen-time behaviors to have insufficient sleep when compared to adolescents who did not engage in excessive screen-time behaviors (AOR = 1.34, p < .001, 95% CI = 1.22-1.48). School-based behavior interventions that focus on reduction in excessive screen-time and sedentary behaviors might be beneficial in reducing excessive screen-time behaviors and consequently improve sleep quality among adolescents.
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300
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Cheng P, Kalmbach DA, Tallent G, Joseph CL, Espie CA, Drake CL. Depression prevention via digital cognitive behavioral therapy for insomnia: a randomized controlled trial. Sleep 2019; 42:zsz150. [PMID: 31535688 PMCID: PMC6783888 DOI: 10.1093/sleep/zsz150] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/15/2019] [Indexed: 12/21/2022] Open
Abstract
STUDY OBJECTIVES Insomnia is a common precursor to depression; yet, the potential for insomnia treatment to prevent depression has not been demonstrated. Cognitive behavioral therapy for insomnia (CBT-I) effectively reduces concurrent symptoms of insomnia and depression and can be delivered digitally (dCBT-I); however, it remains unclear whether treating insomnia leads to sustained reduction and prevention of depression. This randomized controlled trial examined the efficacy of dCBT-I in reducing and preventing depression over a 1-year follow-up period. METHODS Patients with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) insomnia disorder were randomly assigned to receive dCBT-I or an attentional control. The follow-up sample included 358 patients in the dCBT-I condition and 300 patients in the online sleep education condition. The primary outcome measure was relative rate ratios for depression at 1-year follow-up. Insomnia responses to treatment were also tested as predictors of incident depression at the 1-year follow-up. RESULTS At 1-year follow-up, depression severity continued to be significantly lower in the dCBT-I condition relative to control. In addition, the number of individuals who reported no depression at 1-year follow-up was 51% higher in the dCBT-I condition relative to control. In those with minimal to no depression at baseline, the incident rate of moderate-to-severe depression at 1-year follow-up was reduced by half in the dCBT-I condition relative to the control condition. CONCLUSION dCBT-I showed robust effects as an intervention that prevents depression. Future research should examine dose-response requirements and further characterize mechanisms of action of dCBT-I for depression prevention. CLINICAL TRIAL Sleep to Prevent Evolving Affective Disorders; NCT02988375.
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Affiliation(s)
- Philip Cheng
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI
| | - David A Kalmbach
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI
| | - Gabriel Tallent
- Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI
| | | | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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