1
|
Ryan AT, Brenner LA, Ulmer CS, Mackintosh MA, Greene CJ. The Use of Evaluation Panels During the Development of a Digital Intervention for Veterans Based on Cognitive Behavioral Therapy for Insomnia: Qualitative Evaluation Study. JMIR Form Res 2023; 7:e40104. [PMID: 36877553 PMCID: PMC10028512 DOI: 10.2196/40104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Individuals enrolling in the Veterans Health Administration frequently report symptoms consistent with insomnia disorder. Cognitive behavioral therapy for insomnia (CBT-I) is a gold standard treatment for insomnia disorder. While the Veterans Health Administration has successfully implemented a large dissemination effort to train providers in CBT-I, the limited number of trained CBT-I providers continues to restrict the number of individuals who can receive CBT-I. Digital mental health intervention adaptations of CBT-I have been found to have similar efficacy as traditional CBT-I. To help address the unmet need for insomnia disorder treatment, the VA commissioned the creation of a freely available, internet-delivered digital mental health intervention adaptation of CBT-I known as Path to Better Sleep (PTBS). OBJECTIVE We aimed to describe the use of evaluation panels composed of veterans and spouses of veterans during the development of PTBS. Specifically, we report on the methods used to conduct the panels, the feedback they provided on elements of the course relevant to user engagement, and how their feedback influenced the design and content of PTBS. METHODS A communications firm was contracted to recruit 3 veteran (n=27) and 2 spouse of veteran (n=18) panels and convene them for three 1-hour meetings. Members of the VA team identified key questions for the panels, and the communications firm prepared facilitator guides to elicit feedback on these key questions. The guides provided a script for facilitators to follow while convening the panels. The panels were telephonically conducted, with visual content displayed via remote presentation software. The communications firm prepared reports summarizing the panelists' feedback during each panel meeting. The qualitative feedback described in these reports served as the raw material for this study. RESULTS The panel members provided markedly consistent feedback on several elements of PTBS, including recommendations to emphasize the efficacy of CBT-I techniques; clarify and simplify written content as much as possible; and ensure that content is consistent with the lived experiences of veterans. Their feedback was congruent with previous studies on the factors influencing user engagement with digital mental health interventions. Panelist feedback influenced multiple course design decisions, including reducing the effort required to use the course's sleep diary function, making written content more concise, and selecting veteran testimonial videos that emphasized the benefits of treating chronic insomnia symptoms. CONCLUSIONS The veteran and spouse evaluation panels provided useful feedback during the design of PTBS. This feedback was used to make concrete revisions and design decisions consistent with existing research on improving user engagement with digital mental health interventions. We believe that many of the key feedback messages provided by these evaluation panels could prove useful to other digital mental health intervention designers.
Collapse
Affiliation(s)
- Arthur Thomas Ryan
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Department of Veterans Affairs, Aurora, CO, United States
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Lisa Anne Brenner
- Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Department of Veterans Affairs, Aurora, CO, United States
- Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Christi S Ulmer
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, United States
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Margaret-Anne Mackintosh
- National Center for Posttraumatic Stress Disorder Dissemination and Training Division, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - Carolyn J Greene
- University of Arkansas for Medical Sciences Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| |
Collapse
|
2
|
Schmied EA, Jun HJ, Glassman LH, Pippard N, Walter KH. Investigating the effects of suicide exposure among a clinical sample of active duty service members. J Trauma Stress 2023; 36:310-324. [PMID: 36728175 DOI: 10.1002/jts.22909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/16/2022] [Accepted: 12/05/2022] [Indexed: 02/03/2023]
Abstract
Suicide exposure warrants further investigation as a risk factor for suicide among military service members. This study aimed to examine associations among suicide exposure, suicidal ideation (SI), and psychological symptoms in a clinical sample of service members (N = 1,565, 64.4% suicide-exposed) and identify how one's relationship with the deceased impacts suicidality and psychological health in exposed individuals. A secondary analysis of cross-sectional survey data was conducted. Generalized linear regression analyses were used to identify associations between suicide exposure and both current SI and psychological symptoms among all participants; the associations between suicide exposure characteristics and psychological symptoms were only examined among exposed individuals. Exposure was not significantly associated with higher SI, β = .007, SE = .16, p = .965, but was associated with PTSD, β = 1.60, SE = 0.49, p = .001; anxiety, β = .68, SE = .31, p = .031; and insomnia symptoms, β = .98, SE = .25, p < .001. Among participants who had been exposed, high/long impact of exposure was positively associated with SI, β = 0.94, SE = .26, p < .001, and psychological symptoms, PTSD: β = 2.32, SE = .77, p = .002; anxiety: β = 1.39, SE = .50, p = .005; insomnia: β = .96, SE = .39, p = .015. Results illustrate the significant issue of suicide exposure within the military and show consideration of suicide exposure as a potential risk factor for adverse psychological outcomes is warranted.
Collapse
Affiliation(s)
- Emily A Schmied
- School of Public Health, San Diego State University, San Diego, California, USA.,Institute for Behavioral and Community Health, San Diego State University, San Diego, California, USA
| | - Hee-Jin Jun
- School of Public Health, San Diego State University, San Diego, California, USA.,Institute for Behavioral and Community Health, San Diego State University, San Diego, California, USA
| | - Lisa H Glassman
- Leidos, Inc., San Diego, California, USA.,Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, California, USA.,University of California, San Diego, La Jolla, California, USA
| | - Nicole Pippard
- University of California, San Diego-San Diego State University Joint Doctoral Program, Public Health, University of California, San Diego, California, USA
| | - Kristen H Walter
- School of Public Health, San Diego State University, San Diego, California, USA.,Health and Behavioral Sciences Department, Naval Health Research Center, San Diego, California, USA
| |
Collapse
|
3
|
Cui Y, Zhang X, Liu N, Liu Q, Zhang L, Zhang Y. A correlation study of military psychological stress, optimistic intelligence quotient, and emotion regulation of Chinese naval soldiers. SOCIAL BEHAVIOR AND PERSONALITY 2022. [DOI: 10.2224/sbp.11485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Psychological stress is closely related to the mental and physical health of soldiers. We explored the relationships between stress, optimistic intelligence, and emotion regulation in Chinese Navy personnel (N = 452), who completed the General Information Questionnaire, the Psychological
Stress Self-Evaluation Test, the Chinese Adult Optimistic Intelligence Quotient Questionnaire, and the Emotion Regulation Questionnaire in this cross-sectional study. Results show that stress was negatively correlated with perceived happiness and the ability to respond positively to negative
events, and positively correlated with emotional regulation, cognitive reappraisal, and expressive suppression. These findings indicate that comprehensive measures using positive psychology techniques should be taken to reduce stress among naval soldiers to enhance their well-being and the
military's combat readiness.
Collapse
Affiliation(s)
- Yi Cui
- Department of Nursing, Air Force Medical University, People's Republic of China
| | - Xinchi Zhang
- School of Stomatology, Air Force Medical University, People's Republic of China
| | - Na Liu
- Department of Nursing, Air Force Medical University, People's Republic of China
| | - Qin Liu
- Department of Nursing, Air Force Medical University, People's Republic of China
| | - Lanfang Zhang
- Department of Nursing, Air Force Medical University, People's Republic of China
| | - Yinling Zhang
- Department of Nursing, Air Force Medical University, People's Republic of China
| |
Collapse
|
4
|
Hermes ED, Rosenheck RA, Burrone L, Dante G, Lukens C, Martino S. The Implementation and Effectiveness of Digital Cognitive Behavioral Therapy for Insomnia in Primary Care: A Pilot Study. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211053659. [PMID: 37090002 PMCID: PMC9978641 DOI: 10.1177/26334895211053659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Digital interventions delivering Cognitive Behavioral Therapy for insomnia (Digital CBTi) may increase utilization of effective care for a common and serious condition. A low-intensity implementation strategy may facilitate digital CBTi use in healthcare settings. This pilot study assessed the feasibility of implementing a digital CBTi in Veterans Health Administration (VA) primary care through iterative modifications to a low-intensity implementation strategy, while evaluating clinical outcomes of a specific digital CBTi program. Methods A self-directed digital CBTi was implemented in the primary care clinics of a single VA facility using a cohort trial design that iteratively modified an implementation strategy over three 8-month phases. The phase 1 implementation strategy included (1) provider education; (2) point-of-care information via pamphlets; and (3) provider referral to digital CBTi through phone calls or messages. Phases 2 and 3 maintained these activities, while (1) adding a clinic-based coach who performed initial patient education and follow-up support contacts, (2) providing additional recruitment pathways, and (3) integrating the referral mechanism into provider workflow. Implementation outcomes included provider adoption, patient adoption, and acceptability. Clinical outcomes (insomnia severity, depression severity, and sedative hypnotic use) were compared among enrollees at baseline and 10 weeks. Results Across all phases 66 providers (48.9%) made 153 referrals, representing 0.38% of unique clinic patients. Of referrals, 77 (50.3%) enrolled in the study, 45 (29.4%) engaged in the program, and 24 (15.7%) completed it. Provider and patient adoption did not differ meaningfully across phases. Among enrollees, digital CBTi was acceptable and the Insomnia Severity Index decreased by 4.3 points (t = 6.41, p < 0.001) and 13 (18.6%) reached remission. The mean number of weakly sedative-hypnotic doses decreased by 2.2 (35.5%) (t = 2.39, p < 0.02). Conclusions Digital CBTi implementation in VA primary care is feasible using low-intensity implementation strategy, resulting in improved clinical outcomes for users. However, iterative implementation strategy modifications did not improve adoption. The trial was registered at clinicaltrials.gov (NCT03151083).
Collapse
Affiliation(s)
- Eric D.A. Hermes
- VA Connecticut Healthcare System, West Haven, CT
- Department of Psychiatry, Yale University School of Medicine
| | - Robert A. Rosenheck
- VA Connecticut Healthcare System, West Haven, CT
- Department of Psychiatry, Yale University School of Medicine
| | | | - Greg Dante
- VA Connecticut Healthcare System, West Haven, CT
| | | | - Steve Martino
- VA Connecticut Healthcare System, West Haven, CT
- Department of Psychiatry, Yale University School of Medicine
| |
Collapse
|
5
|
Scott J, Kallestad H, Vedaa O, Sivertsen B, Etain B. Sleep disturbances and first onset of major mental disorders in adolescence and early adulthood: A systematic review and meta-analysis. Sleep Med Rev 2021; 57:101429. [PMID: 33549912 DOI: 10.1016/j.smrv.2021.101429] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023]
Abstract
Despite several high-quality reviews of insomnia and incidence of mental disorders, prospective longitudinal relationships between a wider range of sleep disturbances and first onset of a depressive, bipolar, or psychotic disorders during the peak age range for onset of these conditions has not been addressed. Database searches were undertaken to identify publications on insomnia, but also on other sleep problems such as hypersomnia, short sleep duration, self-identified and/or generic 'sleep problems' and circadian sleep-wake cycle dysrhythmias. We discovered 36 studies that were eligible for systematic review and from these publications, we identified 25 unique datasets that were suitable for meta-analysis (Number>45,000; age ∼17). Individuals with a history of any type of sleep disturbance (however defined) had an increased odds of developing a mood or psychotic disorder in adolescence or early adulthood (Odds ratio [OR]:1.88; 95% Confidence Intervals:1.67, 2.25) with similar odds for onset of bipolar disorders (OR:1.72) or depressive disorders (OR:1.62). The magnitude of associations differed according to type of exposure and was greatest for sleep disturbances that met established diagnostic criteria for a sleep disorder (OR: 2.53). However, studies that examined observer or self-rated symptoms, also reported a significant association between hypersomnia symptoms and the onset of a major mental disorder (OR:1.39). Overall study quality was moderate with evidence of publication bias and meta-regression identified confounders such as year of publication. We conclude that evidence indicates that subjective, observer and objective studies demonstrate a modest but significant increase in the likelihood of first onset of mood and psychotic disorders in adolescence and early adulthood in individuals with broadly defined sleep disturbances. Although findings support proposals for interventions for sleep problems in youth, we suggest a need for greater consensus on screening strategies and for more longitudinal, prospective studies of circadian sleep-wake cycle dysrhythmias in youth.
Collapse
Affiliation(s)
- Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK; Universite de Paris, Paris, France; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Havard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway; Department of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway
| | - Oystein Vedaa
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Mental Health Care, St. Olavs University Hospital, Trondheim, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Voss District Psychiatric Hospital, NKS Bjorkeli, Voss, Norway
| | - Borge Sivertsen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Research and Innovation, Helse-Fonna HF, Haugesund, Norway
| | - Bruno Etain
- Universite de Paris, Paris, France; AP-HP Paris Nord, GH Saint-Louis-Lariboisiere-Fernand-Widal, Departement de Psychiatrie et de Medicine Addictologique, DMU Neurosciences, Paris, France; Inserm UMRS 1144, Paris, France
| |
Collapse
|
6
|
Mental Health Care Utilization and Psychiatric Diagnoses in a Sample of Military Suicide Decedents and Living Matched Controls. J Nerv Ment Dis 2020; 208:646-653. [PMID: 32502074 PMCID: PMC7483990 DOI: 10.1097/nmd.0000000000001192] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article examines mental health care utilization and psychiatric diagnoses among US military personnel who died by suicide. We employed an existing electronic health record dataset including 800 US military suicide decedents and 800 matched controls. Suicide decedents were more likely to have received outpatient and inpatient mental health care and to have been diagnosed with depression, bipolar, and nonaffective psychotic disorders. Younger decedents and those in the US Marine Corps were less likely to receive MH care before suicide. Given that approximately half of the suicide decedents in our sample had no mental health care visits before their death, our study suggests the need for programs to increase treatment engagement by at-risk individuals. Such programs could address barriers to care such as stigma regarding mental illness and concerns that seeking mental health care would damage a service member's career.
Collapse
|
7
|
Short NA, Schmidt NB. Developing and Testing a Novel, Computerized Insomnia and Anxiety Intervention to Reduce Safety Aids Among an at-Risk Student Sample: A Randomized Controlled Trial. Behav Ther 2020; 51:149-161. [PMID: 32005332 DOI: 10.1016/j.beth.2019.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/21/2019] [Accepted: 05/24/2019] [Indexed: 11/16/2022]
Abstract
Anxiety and insomnia disorders are two of the most common and costly mental health conditions. They are frequently comorbid, but current treatments do not target both. To streamline treatment, we developed a computerized intervention targeting a transdiagnostic factor, safety aids (cognitive or behavioral strategies used to cope with distress that paradoxically exacerbate symptoms). We conducted a randomized controlled trial to determine the acceptability and efficacy of this brief one-session intervention. Young adult undergraduates (N = 61) with elevated subclinical anxiety and insomnia were randomized to receive the anxiety-insomnia intervention or a physical health control condition. Participants were followed for 1 month and completed self-report measures. Analyses indicated that participants found the intervention acceptable, credible, and engaging. Analyses revealed the active intervention reduced sleep- and anxiety-related safety aids, with medium to large effect sizes. Findings suggest that targeting safety aids for anxiety and insomnia is acceptable and effective in reducing the target mechanism, safety aids, as well as worry. Future research should replicate these findings within a clinical sample and with a longer-term follow-up.
Collapse
Affiliation(s)
- Nicole A Short
- Florida State University; Medical University of South Carolina
| | | |
Collapse
|
8
|
Wang HE, Campbell-Sills L, Kessler RC, Sun X, Heeringa SG, Nock MK, Ursano RJ, Jain S, Stein MB. Pre-deployment insomnia is associated with post-deployment post-traumatic stress disorder and suicidal ideation in US Army soldiers. Sleep 2019; 42:5228726. [PMID: 30508139 DOI: 10.1093/sleep/zsy229] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Indexed: 01/22/2023] Open
Abstract
Study Objectives Insomnia is prevalent among military personnel and may increase risk of mental disorders and suicidal ideation. This study examined associations of pre-deployment insomnia with post-deployment post-traumatic stress disorder (PTSD) and suicidal ideation among US Army soldiers. Methods Soldiers from three Brigade Combat Teams completed surveys 1-2 months before deploying to Afghanistan in 2012 (T0), on return from deployment (T1), 3 months later (T2), and 9 months later (T3). Logistic regression was performed to estimate associations of pre-deployment (T0) insomnia with post-deployment (T2 or T3) PTSD and suicidal ideation among respondents who completed surveys at all waves (n = 4645). A hierarchy of models incorporated, increasing controls for pre-deployment risk factors and deployment experiences. Results Pre-deployment insomnia was associated with increased risk of post-deployment PTSD (adjusted odds ratio [AOR] = 3.14, 95% confidence interval [CI] = 2.58% to 3.82%, p < .0005) and suicidal ideation (AOR = 2.78, 95% CI = 2.07% to 3.74%, p < .0005) in models adjusting for sociodemographic characteristics and prior deployment history. Adjustment for other pre-deployment risk factors and deployment experiences attenuated these associations; however, insomnia remained significantly associated with post-deployment PTSD (AOR = 1.50, 95% CI = 1.19% to 1.89%, p = .001) and suicidal ideation (AOR = 1.43, 95% CI = 1.04% to 1.95%, p = .027). Subgroup models showed that pre-deployment insomnia was associated with incident PTSD (AOR = 1.55, 95% CI = 1.17% to 2.07%, p = .003) and suicidal ideation (AOR = 1.67, 95% CI = 1.16% to 2.40%, p = .006) among soldiers with no pre-deployment history of these problems. Conclusions Pre-deployment insomnia contributed to prediction of post-deployment PTSD and suicidal ideation in Army soldiers, suggesting that detection of insomnia could facilitate targeting of risk mitigation programs. Future studies should investigate whether treatment of insomnia helps prevent PTSD and suicidal ideation among deployed service members.
Collapse
Affiliation(s)
- Hohui E Wang
- Department of Psychiatry, University of California San Diego, La Jolla, CA
| | | | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA
| | - Steven G Heeringa
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Matthew K Nock
- Department of Psychology, Harvard University, Cambridge, MA
| | - Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA.,VA San Diego Healthcare System, San Diego, CA
| |
Collapse
|
9
|
A randomized, placebo-controlled trial using a novel PAP delivery platform to treat patients with OSA and comorbid PTSD. Sleep Breath 2019; 24:1001-1009. [PMID: 31691105 DOI: 10.1007/s11325-019-01936-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/16/2019] [Accepted: 09/07/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Positive airway pressure (PAP) adherence is poor in comorbid OSA/PTSD. SensAwake™ (SA) is a wake-sensing PAP algorithm that lowers pressure when wake is detected. We compared auto-PAP (aPAP) with and without SA for comorbid OSA/PTSD. METHODS Prospective, randomized crossover study comparing aPAP to aPAP + SA. We enrolled patients with OSA/PTSD who were PAP naïve. Four weeks after randomization, the patients were crossed over to the alternate treatment group, with final follow-up at eight weeks. Sleep questionnaires (ESS, ISI, FSS, and FOSQ-10) were assessed at baseline and follow-up. RESULTS We enrolled 85 patients with OSA/PTSD. aPAP reduced AHI to < 5/h in both groups. Our primary endpoint, average hours of aPAP adherence (total) after 4 weeks, was significantly increased in the SA group in our intention-to-treat (ITT) analysis (ß = 1.13 (95% CI 0.16-2.1); p = 0.02), after adjustment for ESS differences at baseline. After adjustment for ESS, SA (ITT analysis) also showed significant improvement in percentage of nights used for ≥ 4 h (ß = 14.9 (95% CI 1.02-28.9); p = 0.04). There were trends toward an increase in percentage nights used total (ß = 17.4 (95% CI - 0.1 to 34.9); p = 0.05), average hours of aPAP adherence (nights used) (ß = 1.04 (95% CI - 0.07 to 2.1); p = 0.07), and regular use (OR = 7.5 (95% CI 0.9-64.7); p = 0.07) after adjustment for ESS at baseline. After adjustment for ESS and days to cross over, SA by actual assignment did not show any effect on adherence variables. The ESS, ISI, FSS, and FOSQ-10 all showed significant improvements with PAP, but there were no differences in the magnitude of improvement in any score between groups. CONCLUSIONS Adherence to aPAP may be improved with the addition of SA and deserves further study. SA is as effective as standard aPAP for normalizing the AHI and improving sleep-related symptoms. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT02549508 https://clinicaltrials.gov/ct2/show/NCT02549508?term=NCT02549508&rank=1 "Comparison Study Using APAP With and Without SensAwake in Patients With OSA and PTSD".
Collapse
|
10
|
Chu C, Nota JA, Silverman AL, Beard C, Björgvinsson T. Pathways among sleep onset latency, relationship functioning, and negative affect differentiate patients with suicide attempt history from patients with suicidal ideation. Psychiatry Res 2019; 273:788-797. [PMID: 31207867 DOI: 10.1016/j.psychres.2018.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/28/2018] [Accepted: 11/06/2018] [Indexed: 01/27/2023]
Abstract
Depression, anxiety, sleep disturbances and poor relationship functioning often co-occur with the confluence of these factors contributing to greater suicide risk. This study investigated whether the pathways between depression, anxiety, sleep disturbances, and relationship functioning differentiated patients with suicide attempt history from those with suicidal ideation history. Patients seeking partial hospital treatment for severe psychiatric symptoms (N = 180) completed interviews assessing psychiatric and suicidal symptom histories, and self-report measures of sleep behaviors, anxiety, depression, and relationship functioning. Multiple sleep behaviors were examined: duration, sleep onset latency, and bedtime. Bias-corrected bootstrap mediation and moderated mediation analyses with suicide attempt as the moderator were used to evaluate pathways between variables. Among patients with ideation and attempt history, (1) sleep onset latency significantly mediated the association between depression and relationship functioning and that between anxiety and relationship functioning; (2) relationship functioning significantly mediated the association between depression and sleep onset latency and that between anxiety and sleep onset latency. These pathways were not significant among patients with suicidal ideation only. No other sleep behaviors were related to study variables. The reciprocal relationship between disrupted sleep onset latency and poor relationship functioning was specifically linked to more severe psychiatric symptoms among acute patients with suicide attempt histories.
Collapse
Affiliation(s)
- Carol Chu
- McLean Hospital/Harvard Medical School, Belmont, MA, United States; Department of Psychology, Harvard University, Cambridge, MA, United States.
| | - Jacob A Nota
- McLean Hospital/Harvard Medical School, Belmont, MA, United States
| | - Alexandra L Silverman
- Department of Psychology, University of Virginia, Charlottesville, VA, United States
| | - Courtney Beard
- McLean Hospital/Harvard Medical School, Belmont, MA, United States
| | | |
Collapse
|
11
|
Posttraumatic stress disorder clusters and suicidal ideation. Psychiatry Res 2018; 270:238-245. [PMID: 30269041 DOI: 10.1016/j.psychres.2018.09.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/04/2018] [Accepted: 09/14/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is associated with suicidal ideation and behavior. However, less is known about how the PTSD symptom clusters, namely alterations in arousal and reactivity (AAR), negative alterations in cognitions and mood (NACM), avoidance, and intrusion, uniquely relate to suicidal ideation. This study aimed to characterize the associations among suicidal ideation and these symptom clusters. METHODS Study 1 (n = 346) and Study 2 (n = 194) included community members and treatment-seeking adults at an anxiety specialty clinic, respectively. Participants completed measures of trauma exposure, PTSD symptoms, and suicidal ideation. RESULTS In both studies, suicidal ideation significantly and positively correlated with all PTSD factors. In Study 1, Wald tests of parameter constraints indicated that NACM and AAR had the strongest associations with suicidal ideation, followed by intrusion and avoidance. Results were replicated when restricting the sample to individuals with probable PTSD. In Study 2, suicidal ideation significantly and positively correlated with all PTSD factors; there were no differences in the strength of the suicidal ideation-PTSD factors relations. LIMITATIONS The studies were cross-sectional and relied on a single-item measure of suicidal ideation. DISCUSSION All PTSD factors significantly and positively correlated with suicidal ideation, and the NACM and AAR PTSD clusters were most strongly associated with suicidal ideation in Study 1. Therefore, clinicians should be cautious to thoroughly screen patients with elevations on these PTSD cluster scores for suicide risk.
Collapse
|
12
|
Speed KJ, Drapeau CW, Nadorff MR. Differentiating Single and Multiple Suicide Attempters: What Nightmares Can Tell Us That Other Predictors Cannot. J Clin Sleep Med 2018; 14:829-834. [PMID: 29734974 DOI: 10.5664/jcsm.7116] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 02/09/2018] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Although nightmares have been associated with suicidal behavior beyond well-known risk factors, the association between nightmares and multiple suicide attempts remains largely unexplored. This study addressed this gap in the literature by examining whether nightmares differentiated between individuals who reported single versus multiple suicide attempts. The individual contributions of nightmare frequency, distress/severity, and chronicity were also investigated to determine which variable contributed the most variance. METHODS Participants (n = 225) were recruited as part of a larger data collection through Amazon Mechanical Turk, an online crowdsourcing venue. Participants reported attempting suicide once (n = 107 individuals), multiple times (n = 118), or never (n = 791). Nightmare frequency, distress, and chronicity were assessed with the Disturbing Dreams and Nightmares Severity Index. RESULTS Nightmare frequency differentiated multiple from single suicide attempters, even after controlling for symptoms of depression, posttraumatic stress disorder, insomnia, nightmare severity/distress, nightmare chronicity, and age (P = .019). Comparison participants, those not reporting suicide attempts, reported a significantly lower level of nightmare frequency than those reporting single or multiple suicide attempts. CONCLUSIONS Inconsistent with past research, this study showed that nightmare frequency, and not nightmare chronicity or severity/distress, differentiated between single and multiple suicide attempters. This outcome suggests that the number of nightmares experienced may be more pertinent in predicting repeat suicide attempts than their duration or perceived severity. Study limitations include a cross-sectional design, a convenience sampling approach, a lack of control for previous treatment or length of time since last attempt, and a retrospective nightmare measure.
Collapse
Affiliation(s)
| | - Christopher W Drapeau
- Mississippi State University, Starkville, Mississippi.,Valparaiso University, Valparaiso, Indiana
| | - Michael R Nadorff
- Mississippi State University, Starkville, Mississippi.,Baylor College of Medicine, Houston, Texas
| |
Collapse
|
13
|
Abstract
PURPOSE We aimed to systematically review recent publications (01/2014-03/2017) with longitudinal designs allowing for the assessment of the prospective risk of insomnia on new onset mental illness in key conditions: anxiety, depression, bipolar disorder, posttraumatic stress disorder, substance use disorders, and suicide. RECENT FINDINGS A literature yielded 1859 unique articles meeting search criteria were identified; 16 articles met all selection criteria and reviewed with some studies reporting on more than one mental health outcome. Overall, the review supports the hypothesis that insomnia is a predictor of subsequent mental illness. The evidence is strongest for an insomnia-depression relationship. The new studies identified and reviewed add to a modest number of publications supporting a prospective role of insomnia in new onset mental illness in three areas: anxiety disorders, bipolar disorder, and suicide. The few selected new studies focused on SUD were mixed, and no studies focused on PTSD were identified that met the selection criteria. Treatment of insomnia may also be a preventive mental health strategy.
Collapse
|
14
|
Hom MA, Chu C, Schneider ME, Lim IC, Hirsch JK, Gutierrez PM, Joiner TE. Thwarted belongingness as an explanatory link between insomnia symptoms and suicidal ideation: Findings from three samples of military service members and veterans. J Affect Disord 2017; 209:114-123. [PMID: 27898373 PMCID: PMC5333761 DOI: 10.1016/j.jad.2016.11.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/27/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although insomnia has been identified as a robust predictor of suicidal ideation and behaviors, little is known about the mechanisms by which sleep disturbances confer risk for suicide. We investigated thwarted belongingness as an explanatory link between insomnia symptoms and suicidal ideation across three military service member and veteran samples. METHODS Data were collected among United States military service members and veterans (N1=937, N2=3,386, N3=417) who completed self-report measures of insomnia symptoms, thwarted belongingness, suicidal ideation, and related psychiatric symptoms (e.g., anxiety, hopelessness). Bias-corrected bootstrap mediation analyses were utilized to examine the indirect effects of insomnia symptoms on suicidal ideation through thwarted belongingness, controlling for related psychiatric symptoms. RESULTS Consistent with study hypotheses, thwarted belongingness significantly accounted for the relationship between insomnia and suicidal ideation across all three samples; however, insomnia symptoms did not significantly account for the relationship between thwarted belongingness and suicidal ideation, highlighting the specificity of our findings. LIMITATIONS This study utilized cross-sectional self-report data. CONCLUSIONS Insomnia may confer suicide risk for military service members and veterans, in part, through the pathway of thwarted belongingness. Additional prospective studies are warranted to further delineate this model of risk. Our results offer a potential therapeutic target for the prevention of suicide, via the promotion of belongingness, among service members and veterans experiencing insomnia symptoms.
Collapse
Affiliation(s)
- Melanie A Hom
- Department of Psychology, Florida State University, United States.
| | - Carol Chu
- Department of Psychology, Florida State University, United States
| | | | - Ingrid C Lim
- Office of the Army Surgeon General, United States
| | - Jameson K Hirsch
- Department of Psychology, East Tennessee State University, United States
| | - Peter M Gutierrez
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Denver Veterans Affairs Medical Center, United States; Department of Psychiatry, University of Colorado School of Medicine, United States
| | - Thomas E Joiner
- Department of Psychology, Florida State University, United States
| |
Collapse
|
15
|
Chiurliza B, Hagan CR, Rogers ML, Podlogar MC, Hom MA, Stanley IH, Joiner TE. Implicit Measures of Suicide Risk in a Military Sample. Assessment 2016; 25:667-676. [PMID: 27821459 DOI: 10.1177/1073191116676363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Suicide has become an issue of great concern within the U.S. military in recent years, with recent reports indicating that suicide has surpassed combat related deaths as the leading cause of death. One concern regarding suicide risk in the military is that existing self-report measures allow service members to conceal or misrepresent current suicidal ideation or suicide plans and preparations. Implicit association tests (IATs) are computer-based, reaction time measures that have been shown to be resilient to such masking of symptoms. The death/suicide implicit association test (d/s-IAT) is an empirically supported IAT that is specific to death and suicide. The present study examined whether the performance of 1,548 U.S. military service members on the d/s-IAT significantly predicted lifetime suicidal ideation and depression. Zero-inflated negative binomial regression analyses were used to test these associations. Results indicated that the d/s-IAT was neither associated with history of suicidal ideation nor history of depression.
Collapse
|