1
|
Sukiennik O, Waite P, Percy R, Orchard F. Changes to sleep patterns and insomnia symptoms following cognitive behavioural therapy for anxiety disorders in adolescents. Behav Cogn Psychother 2024:1-13. [PMID: 38586945 DOI: 10.1017/s1352465824000195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND It is unclear whether treatment for an anxiety disorder improves sleep. This study examined baseline sleep characteristics of adolescents with an anxiety disorder, comparing weekdays and weekends, and whether there were significant improvements in sleep following cognitive behaviour therapy (CBT). AIMS To improve our understanding of sleep problems in adolescents with an anxiety disorder and examine whether CBT for the treatment of the anxiety disorder improves sleep. METHOD Data was gathered from 179 participants with an anxiety disorder (11-17 years old) who had previously engaged with the out-patient child and adolescent mental health service. Baseline self-report measures of anxiety and depression symptoms, sleep patterns and experiences of insomnia were examined. Of this group, 135 participants had baseline data. A subset (n=73) had outcome data, which was used to examine changes in sleep following CBT. RESULTS At baseline, adolescents reported significantly less total sleep and more night-time waking on weekdays than weekends. Following treatment for their anxiety disorder, adolescents' weekday sleep patterns significantly improved for sleep onset latency and total sleep time, whereas weekend sleep patterns only showed improvements for sleep onset latency. No significant improvements were reported for symptoms of insomnia. CONCLUSIONS The study relied upon subjective measurement of sleep and there was no control group; however, the findings provide promising results that CBT for adolescent anxiety disorders can improve some sleep problems. Further research is needed to understand discrepancies between subjective and objective sleep, and to explore avenues for the delivery of support for sleep problems.
Collapse
Affiliation(s)
- Olivia Sukiennik
- Surrey and Borders Partnership NHS Foundation Trust, Mind Matters Surrey, UK
| | - Polly Waite
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ray Percy
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | | |
Collapse
|
2
|
Harris HK, Kook M, Boedeker P, Gusick AG, Lyons-Warren AM, Goin-Kochel RP, Murali C, Berry LN, Storch EA. The Impact of Cognitive Behavioral Therapy on Sleep Problems in Autistic Children with Co-occurring Anxiety. J Autism Dev Disord 2024:10.1007/s10803-024-06309-2. [PMID: 38557905 DOI: 10.1007/s10803-024-06309-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE This study seeks to examine the relationship between anxiety-symptom severity and sleep behaviors in autistic children receiving cognitive behavioral therapy (CBT). METHODS We conducted a secondary-data analysis from a sample of 93 autistic youth, 4 to 14 years, participating in 24 weeks of CBT. Clinicians completed the Pediatric Anxiety Rating Scale (PARS) and parents completed the Children's Sleep Habits Questionnaire, Abbreviated/Short Form (CSHQ-SF) at baseline, mid-treatment, post-treatment and 3 months post-treatment. Mediation analysis evaluated the role of anxiety symptoms in mediating the effect of time in treatment on sleep. RESULTS There was a negative association between time in treatment and scores on the CSHQ-SF (b = - 3.23, SE = 0.493, t = - 6.553, p < 0.001). Increased time in treatment was associated with decreased anxiety (b = - 4.66, SE = 0.405, t = - 11.507, p < 0.001), and anxiety symptoms decreased with CSHQ-SF scores (b = 0.322, SE = 0.112, t = 2.869, p = 0.005). The indirect effect of time in treatment on CSHQ-SF scores through PARS reduction was negative, but not statistically significant. CONCLUSION Increased time in CBT was associated with decreased anxiety severity and improved sleep behaviors. Reductions in anxiety symptoms may mediate improvements in sleep problems, but larger sample sizes are necessary to explore this further.
Collapse
Affiliation(s)
- Holly K Harris
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
- Division of Developmental-Behavioral Pediatrics, Meyer Center for Developmental Pediatrics and Autism, 8080 North Stadium Drive, Suite 100, Houston, TX, 77054, USA.
| | - Minjee Kook
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Peter Boedeker
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Education, Innovation and Technology, Baylor College of Medicine, Houston, TX, USA
| | - Andrew G Gusick
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Ariel M Lyons-Warren
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, Houston, TX, USA
| | - Robin P Goin-Kochel
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Autism Program, Meyer Center for Developmental and Behavioral Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Chaya Murali
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Leandra N Berry
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Autism Program, Meyer Center for Developmental and Behavioral Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
3
|
Mehra LM, Hajcak G, Meyer A. The associations among sleep-related difficulties, anxiety, and error-related brain activity in youth. Biol Psychol 2024; 188:108790. [PMID: 38580098 PMCID: PMC11162828 DOI: 10.1016/j.biopsycho.2024.108790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/14/2024] [Accepted: 04/01/2024] [Indexed: 04/07/2024]
Abstract
Given the high prevalence of anxiety disorders and their associated impairment, elucidating neural mechanisms related to these disorders has been increasingly prioritized. The error-related negativity (ERN) has been identified as a neural marker that indexes risk for anxiety across development. The ERN seems to confer risk for developing anxiety, especially in the context of stressful life events. The present study sought to examine sleep-related difficulties as another stressful factor that might impact the ERN. In a sample of 221 girls, aged 8 to 15 years old, we first examined the relationship between longer-term (i.e., over the past month) and shorter-term (i.e., over the past week) sleep difficulties and the ERN. We then investigated whether specific sleep difficulties uniquely predict the ERN. In exploratory analyses, we assessed whether sleep difficulties moderate the relationship between the ERN and anxiety. Results indicated that youth who report longer-term lower sleep duration, longer-term worse sleep, and shorter-term lower sleep duration on school days over the past week have a larger (i.e., more negative) ERN. Additionally, only shorter-term sleep duration on school days over the past week uniquely predicted the ERN. Finally, an elevated ERN predicted greater clinical anxiety in the context of longer-term sleep difficulties. Future studies should clarify the direction of these associations via longitudinal designs.
Collapse
Affiliation(s)
- Lushna M Mehra
- Department of Psychology, Florida State University, 1107 W Call St, Tallahassee, FL 32304, USA.
| | - Greg Hajcak
- School of Education and Counseling, Santa Clara University, 455 El Camino Real, Guadalupe Hall, Santa Clara, CA 95053, USA
| | - Alexandria Meyer
- School of Education and Counseling, Santa Clara University, 455 El Camino Real, Guadalupe Hall, Santa Clara, CA 95053, USA
| |
Collapse
|
4
|
Crowe K, Spiro-Levitt C. Sleep-Related Problems and Pediatric Anxiety Disorders. Psychiatr Clin North Am 2024; 47:213-228. [PMID: 38302208 DOI: 10.1016/j.psc.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Sleep-related problems are highly prevalent among childhood and adolescent anxiety disorders. The objective of this review was to summarize the relevant clinical research literature as it pertains to the nature of the association between sleep-related problems and youth anxiety, developmental factors relevant to this association, and intervention efforts to target comorbid sleep challenges and anxiety. Limitations of the literature and future directions are discussed.
Collapse
Affiliation(s)
- Katherine Crowe
- Home for Anxiety, Repetitive Behaviors, OCD, and Related Disorders (HARBOR), 1518 Walnut Street, Suite 1506, Philadelphia, PA 19102, USA.
| | - Carolyn Spiro-Levitt
- Department of Child and Adolescent Psychiatry at Hassenfeld Children's Hospital at New York University (NYU) Langone, 1 Park Avenue, Seventh Floor, New York, NY 10016, USA
| |
Collapse
|
5
|
Kwa ZY, Li J, Loh DL, Lee YY, Liu G, Zhu L, Pikkarainen M, He H, Mali VP. An Intelligent Customer-Driven Digital Solution to Improve Perioperative Health Outcomes Among Children Undergoing Circumcision and Their Parents: Development and Evaluation. JMIR Form Res 2024; 8:e52337. [PMID: 38363589 PMCID: PMC10907943 DOI: 10.2196/52337] [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: 09/05/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Circumcision as a common elective pediatric surgery worldwide is a stressful and anxiety-inducing experience for parents and children. Although current perioperative interventions proved effective, such as reducing preoperative anxiety, there are limited holistic solutions using mobile apps. OBJECTIVE This paper aims to describe the development and primary evaluation of an intelligent customer-driven smartphone-based app program (ICory-Circumcision) to enhance health outcomes among children undergoing circumcision and their family caregivers. METHODS Based on the review of the literature and previous studies, Bandura's self-efficacy theory was adopted as the conceptual framework. A multidisciplinary team was built to identify the content and develop the apps. Semistructured interviews were conducted to evaluate the ICory-Circumcision. RESULTS The ICory-Circumcision study was carried out from March 2019 to January 2020 and comprised 2 mobile apps, BuddyCare app and Triumf Health mobile game app. The former provides a day-by-day perioperative guide for parents whose children are undergoing circumcision, while the latter provides emotional support and distraction to children. In total, 6 participants were recruited to use the apps and interviewed to evaluate the program. In total, 4 main categories and 10 subcategories were generated from content analysis. CONCLUSIONS ICory-Circumcision seemed to lean toward being useful. Revisions to ICory-Circumcision are necessary to enhance its contents and features before advancing to the randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov NCT04174404; https://clinicaltrials.gov/ct2/show/NCT04174404.
Collapse
Affiliation(s)
- Zhi Yin Kwa
- Department of Nursing, National University Hospital, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | - Jinqiu Li
- Nursing Department, Zhuhai Campus, Zunyi Medical University, Zhuhai, China
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dale Lincoln Loh
- National University Health System, Singapore, Singapore
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
| | - Yang Yang Lee
- National University Health System, Singapore, Singapore
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
| | - Guangyu Liu
- Integrated Health Promotion, Ministry of Health Office for Healthcare Transformation, Singapore, Singapore
| | - Lixia Zhu
- Hôpital Chinois de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Minna Pikkarainen
- Department of Health Technology and Rehabilitation and Department of Product Design, Oslo Metropolitan University, Oslo, Norway
- Martti Ahtisaari Institute, Oulu Business School, University of Oulu, Oulu, Finland
| | - Honggu He
- National University Health System, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vidyadhar Padmakar Mali
- National University Health System, Singapore, Singapore
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
| |
Collapse
|
6
|
Viswanathan M, Wallace IF, Cook Middleton J, Kennedy SM, McKeeman J, Hudson K, Rains C, Vander Schaaf EB, Kahwati L. Screening for Anxiety in Children and Adolescents: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 328:1445-1455. [PMID: 36219404 DOI: 10.1001/jama.2022.16303] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Anxiety in children and adolescents is associated with impaired functioning, educational underachievement, and future mental health conditions. Objective To review the evidence on screening for anxiety in children and adolescents to inform the US Preventive Services Task Force. Data Sources PubMed, Cochrane Library, PsycINFO, CINAHL, and trial registries through July 19, 2021; references, experts, and surveillance through June 1, 2022. Study Selection English-language, randomized clinical trials (RCTs) of screening; diagnostic test accuracy studies; RCTs of cognitive behavioral therapy (CBT) or US Food and Drug Administration-approved pharmacotherapy; RCTs, observational studies, and systematic reviews reporting harms. Data Extraction and Synthesis Two reviewers assessed titles/abstracts, full-text articles, and study quality and extracted data; when at least 3 similar studies were available, meta-analyses were conducted. Main Outcomes and Measures Test accuracy, symptoms, response, remission, loss of diagnosis, all-cause mortality, functioning, suicide-related symptoms or events, adverse events. Results Thirty-nine studies (N = 6065) were included. No study reported on the direct benefits or harms of screening on health outcomes. Ten studies (n = 3260) reported the sensitivity of screening instruments, ranging from 0.34 to 1.00, with specificity ranging from 0.47 to 0.99. Twenty-nine RCTs (n = 2805) reported on treatment: 22 on CBT, 6 on pharmacotherapy, and 1 on CBT, sertraline, and CBT plus sertraline. CBT was associated with gains on several pooled measures of symptom improvement (magnitude of change varied by outcome measure), response (pooled relative risk [RR], 1.89 [95% CI, 1.17 to 3.05]; n = 606; 6 studies), remission (RR, 2.68 [95% CI, 1.48 to 4.88]; n = 321; 4 studies), and loss of diagnosis (RR range, 3.02-3.09) when compared with usual care or wait-list controls. The evidence on functioning for CBT was mixed. Pharmacotherapy, when compared with placebo, was associated with gains on 2 pooled measures of symptom improvement-mean difference (Pediatric Anxiety Rating Scale mean difference, -4.0 [95% CI, -5.5 to -2.5]; n = 726; 5 studies; and Clinical Global Impression-Severity scale mean difference, -0.84 [95% CI, -1.13 to -0.55]; n = 550; 4 studies) and response (RR, 2.11 [95% CI, 1.58 to 2.98]; n = 370; 5 studies)-but was mixed on measures of functioning. Eleven RCTs (n = 1293) reported harms of anxiety treatments. Suicide-related harms were rare, and the differences were not statistically significantly different. Conclusions and Relevance Indirect evidence suggested that some screening instruments were reasonably accurate. CBT and pharmacotherapy were associated with benefits; no statistically significant association with harms was reported.
Collapse
Affiliation(s)
- Meera Viswanathan
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Ina F Wallace
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Jennifer Cook Middleton
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Sara M Kennedy
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Joni McKeeman
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Kesha Hudson
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Caroline Rains
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Emily B Vander Schaaf
- Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill
| | - Leila Kahwati
- RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| |
Collapse
|
7
|
Effect of early intervention for anxiety on sleep outcomes in adolescents: a randomized trial. Eur Child Adolesc Psychiatry 2022; 31:1-15. [PMID: 33961115 PMCID: PMC9532314 DOI: 10.1007/s00787-021-01795-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022]
Abstract
The potential effect of early intervention for anxiety on sleep outcomes was examined in a sample of adolescents with anxiety (N = 313, mean 14.0 years, SD = 0.84, 84% girls, 95.7% Norwegians). Participants were randomized to one of three conditions: a brief or a standard-length cognitive-behavioral group-intervention (GCBT), or a waitlist control-group (WL). Interventions were delivered at schools, during school hours. Adolescents with elevated anxiety were recruited by school health services. Questionnaires on self-reported anxiety symptoms, depressive symptoms, and sleep characteristics were administered at pre- and post-intervention, post-waitlist, and at 1-year follow-up. Adolescents reported reduced insomnia (odds ratio (OR) = 0.42, p < 0.001) and shorter sleep onset latency (d = 0.27, p < 0.001) from pre- to post-intervention. For insomnia, this effect was maintained at 1-year follow-up (OR = 0.54, p = 0.020). However, no effect of GCBT on sleep outcomes was found when comparing GCBT and WL. Also, no difference was found in sleep outcomes between brief and standard-length interventions. Adolescents defined as responders (i.e., having improved much or very much on anxiety after GCBT), did not differ from non-responders regarding sleep outcomes. Thus, anxiety-focused CBT, delivered in groups, showed no effect on sleep outcomes. Strategies specifically targeting sleep problems in adolescents should be included in GCBT when delivered as early intervention for adolescents with elevated anxiety.Trial registry Clinical trial registration: School Based Low-intensity Cognitive Behavioral Intervention for Anxious Youth (LIST); http://clinicalrials.gov/ ; NCT02279251, Date: 11.31. 2014.
Collapse
|
8
|
Tan WJ, Ng MSL, Poon SH, Lee TS. Treatment Implications of Sleep-Related Problems in Pediatric Anxiety Disorders: A Narrative Review of the Literature. Child Psychiatry Hum Dev 2021; 54:659-664. [PMID: 34724133 DOI: 10.1007/s10578-021-01277-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 10/19/2022]
Abstract
Pediatric anxiety disorders and sleep-related problems (SRPs) are highly prevalent and are associated with serious health or psychopathological consequences. This narrative review aims to provide an overview of the current evidence of the associations between anxiety disorders and SRPs, to examine how this relationship may affect treatment, and to evaluate future directions for the field. Despite their strong bi-directional relationship, SRPs are often neglected in pediatric anxiety literature. There is little consensus on the conceptualization and related measurements of SRPs, which has led to methodological limitations and difficulties. Furthermore, available research suggests that anxiety treatment alone may be inadequate as clinically impairing SRPs were still present post-treatment, which may, in turn, diminish effects of therapy. Understanding the implications of the relationship between anxiety and SRPs on treatment outcomes may be helpful in recognizing opportunities for high impact and enduring interventions.
Collapse
Affiliation(s)
- Wan Jie Tan
- Duke-NUS Medical School, Neuroscience and Behavioral Disorders Program, 8 College Rd, Singapore, 169857, Singapore.
| | - Melissa S L Ng
- Duke-NUS Medical School, Neuroscience and Behavioral Disorders Program, 8 College Rd, Singapore, 169857, Singapore
| | - Shi Hui Poon
- Duke-NUS Medical School, Neuroscience and Behavioral Disorders Program, 8 College Rd, Singapore, 169857, Singapore
| | - Tih Shih Lee
- Duke-NUS Medical School, Neuroscience and Behavioral Disorders Program, 8 College Rd, Singapore, 169857, Singapore
| |
Collapse
|
9
|
Identifying and integrating active ingredients for mental health. Lancet Psychiatry 2021; 8:741-743. [PMID: 34419174 DOI: 10.1016/s2215-0366(21)00283-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 12/24/2022]
|
10
|
Murphy SE, Capitão LP, Giles SLC, Cowen PJ, Stringaris A, Harmer CJ. The knowns and unknowns of SSRI treatment in young people with depression and anxiety: efficacy, predictors, and mechanisms of action. Lancet Psychiatry 2021; 8:824-835. [PMID: 34419187 DOI: 10.1016/s2215-0366(21)00154-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/15/2021] [Accepted: 04/01/2021] [Indexed: 01/12/2023]
Abstract
The use of SSRIs for the treatment of depression and anxiety in young people is increasing. However, the effects of SSRIs in adolescence, a time when there are substantial changes in neural, cognitive, and social functioning, are not well understood. Here, we review evidence from clinical trials about the benefits and risks of SSRIs in young people and consider their mechanisms of action, as shown through human experimental work and animal models. We emphasise key outstanding questions about the effects of SSRIs in youth, identified through gaps in the literature and in consultation with young people with lived experience. It is crucial to characterise the mechanisms underpinning risks and benefits of SSRIs in this age group to progress the field, and to narrow the chasm between the widespread use of SSRIs in youth and the science on which this use is based.
Collapse
Affiliation(s)
- Susannah E Murphy
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Liliana P Capitão
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Sophie L C Giles
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Philip J Cowen
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Argyris Stringaris
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Catherine J Harmer
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
| |
Collapse
|
11
|
Bai S, Ricketts EJ, Thamrin H, Piacentini J, Albano AM, Compton SN, Ginsburg GS, Sakolsky D, Keeton CP, Kendall PC, Peris TS. Longitudinal Study of Sleep and Internalizing Problems in Youth Treated for Pediatric Anxiety Disorders. Res Child Adolesc Psychopathol 2021; 48:67-77. [PMID: 31506757 DOI: 10.1007/s10802-019-00582-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The current study examined prospective bidirectional links between dysregulated sleep, and anxiety and depression severity across 4 years, among youth with a history of anxiety disorder. Participants were 319 youth (age 11-26 years), who previously participated in a large multisite randomized controlled trial for the treatment of pediatric anxiety disorders, Child/Adolescent Anxiety Multimodal Study (CAMS), and subsequently enrolled in a naturalistic follow-up, Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), an average of 6.5 years later. They participated in four annual visits that included self-report items of dysregulated sleep and semi-structured multi-informant interviews of anxiety and depression. Dysregulated sleep was bidirectionally associated with clinician-rated anxiety and depression symptom severity across adolescence and young adulthood. However, these bidirectional relationships were attributable to youth mean levels of dysregulated sleep, and anxiety and depression severity over the 4 years. Elevations in dysregulated sleep at each visit, relative to mean levels, did not predict worse anxiety or depression severity 1 year later. Likewise visit-specific elevations in anxiety and depression severity, as opposed to average levels, did not predict higher levels of dysregulated sleep at the next visit. Having higher levels of dysregulated sleep or more severe internalizing problems across the four-year period, as opposed to reporting a relative increase in symptom severity at a particular visit, posed greater risk for poor mental health. Interventions should continue to assess and treat persistent sleep problems alongside anxiety and depression.
Collapse
Affiliation(s)
- Sunhye Bai
- Human Development and Family Studies, The Pennsylvania State University, 216 Health and Human Development, University Park, PA, 16802, USA. .,Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
| | - Emily J Ricketts
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Hardian Thamrin
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | | | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Courtney P Keeton
- Department of Psychiatry and Behavioral Services, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Tara S Peris
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| |
Collapse
|
12
|
Abstract
Sleep-related problems are highly prevalent among childhood and adolescent anxiety disorders. The objective of this review was to summarize the relevant clinical research literature as it pertains to the nature of the association between sleep-related problems and youth anxiety, developmental factors relevant to this association, and intervention efforts to target comorbid sleep challenges and anxiety. Limitations of the literature and future directions are discussed.
Collapse
Affiliation(s)
- Katherine Crowe
- Home for Anxiety, Repetitive Behaviors, OCD, and Related Disorders (HARBOR), 1518 Walnut Street, Suite 1506, Philadelphia, PA 19102, USA.
| | - Carolyn Spiro-Levitt
- Department of Child and Adolescent Psychiatry at Hassenfeld Children's Hospital at New York University (NYU) Langone, 1 Park Avenue, Seventh Floor, New York, NY 10016, USA
| |
Collapse
|
13
|
Mills JA, Strawn JR. Antidepressant Tolerability in Pediatric Anxiety and Obsessive-Compulsive Disorders: A Bayesian Hierarchical Modeling Meta-analysis. J Am Acad Child Adolesc Psychiatry 2020; 59:1240-1251. [PMID: 31682918 PMCID: PMC8028746 DOI: 10.1016/j.jaac.2019.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/24/2019] [Accepted: 10/28/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To compare adverse events (AEs), suicidality, and AE-related discontinuation in double-blind, placebo-controlled trials of pediatric patients with obsessive-compulsive disorder (OCD) and anxiety disorders treated with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). METHOD MEDLINE, PubMed, Web of Science, PsycINFO, and Embase were searched for peer-reviewed, English-language articles from inception through March 1, 2019. We identified prospective, randomized SSRI and SNRI studies in patients <18 years of age with OCD or generalized, separation, or social anxiety disorders. AE rates were extracted and medication-placebo differences were examined using Bayesian hierarchical models, then posterior estimates of relative risk (RR) were determined for each AE by medication class and disorder. RESULTS Data were included from 18 trials (2,631 patients) and 7 medications (16 SSRI and 4 SNRI trials). Compared with placebo, SSRIs were associated with a greater likelihood of AE-related discontinuation (RR 3.59, credible interval [CrI] 0.019-0.067, p = .0003), activation (RR 2.39, CrI 0.048-0.125, p = .003), sedation (RR 1.94, CrI 0.035-0.157, p = .002), insomnia (RR 1.93, CrI 0.040-0.149, p = .001), abdominal pain (RR 1.53, CrI 0.032-0.164, p = .005), and headache (RR 1.24, CrI 0.003-0.139, p = .04). Activation was more common with SSRIs (versus SNRIs, RR 1.32, CrI 0.018-0.114, p = .007). Neither SSRIs nor SNRIs were associated with treatment-emergent suicidality. CONCLUSION In pediatric OCD and anxiety disorders, SSRIs (compared with placebo) are associated with distinct AEs and greater AE-related discontinuation, although their tolerability does not differ between anxiety disorders and OCD. Compared with SNRIs, SSRIs are more likely to produce activation. Class-related AEs are important for clinicians to consider, particularly in light of data suggesting differences in class-related efficacy. Whereas SSRIs are superior to SNRIs and the treatment of choice for anxiety, for youths who become activated on SSRIs, SNRIs might represent a good second choice given their reported efficacy and lower risk of activation.
Collapse
Affiliation(s)
- Jeffrey A Mills
- Carl H. Lindner College of Business, University of Cincinnati, Ohio
| | - Jeffrey R Strawn
- College of Medicine, University of Cincinnati, and the Cincinnati Children's Hospital Medical Center, Ohio.
| |
Collapse
|
14
|
Wilson C, Carpenter J, Hickie I. The Role of the Sleep-Wake Cycle in Adolescent Mental Illness. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00145-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
15
|
Alfano CA. (Re)Conceptualizing Sleep Among Children with Anxiety Disorders: Where to Next? Clin Child Fam Psychol Rev 2019; 21:482-499. [PMID: 30136070 DOI: 10.1007/s10567-018-0267-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Children with anxiety disorders (AD) characteristically complain of sleep problems and the extent to which cognitive behavioral treatments (CBT) for childhood anxiety produce sleep-based improvements is a topic of increasing interest. The current paper reviews available evidence for subjective sleep complaints and objective sleep alterations in children and adolescents with AD, including investigations of potential changes in sleep following anxiety-focused CBT. Despite pervasive complaints of poor sleep, the empirical literature provides minimal evidence for actual sleep-wake alterations in this population of youth and evidence for sleep-based changes following treatment for anxiety is minimal. In line with calls for more comprehensive models of the role of sleep in developmental psychopathology, several fundamental gaps in understanding are described and highlighted as essential avenues for clarifying the nature and consequences of poor quality sleep among youth with clinical levels of anxiety. In a second section of the paper, an emerging body of novel, translational research investigating more intricate sleep-anxiety relationships is introduced with potential implications for both etiological models and treatment design and delivery.
Collapse
Affiliation(s)
- Candice A Alfano
- Sleep and Anxiety Center of Houston (SACH), Department of Psychology, University of Houston, 126 Heyne Bldg, Houston, TX, 77204, USA.
| |
Collapse
|
16
|
Adams D, Clark M, Simpson K. The Relationship Between Child Anxiety and the Quality of Life of Children, and Parents of Children, on the Autism Spectrum. J Autism Dev Disord 2019; 50:1756-1769. [DOI: 10.1007/s10803-019-03932-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
17
|
Carpenter AL, Pincus DB, Furr JM, Comer JS. Working From Home: An Initial Pilot Examination of Videoconferencing-Based Cognitive Behavioral Therapy for Anxious Youth Delivered to the Home Setting. Behav Ther 2018; 49:917-930. [PMID: 30316490 PMCID: PMC6190606 DOI: 10.1016/j.beth.2018.01.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/07/2018] [Accepted: 01/20/2018] [Indexed: 12/17/2022]
Abstract
Progress in evidence-based treatments for child anxiety has been hampered by limited accessibility of quality care. This study utilized a multiple baseline design to evaluate the pilot feasibility, acceptability, and preliminary efficacy of real-time, Internet-delivered, family-based cognitive-behavioral therapy for child anxiety delivered to the home setting via videoconferencing. Participants included 13 anxious youth (mean age = 9.85) with a primary/co-primary anxiety disorder diagnosis. Eleven participants (84.6%) completed treatment and all study procedures. Consistent with hypotheses, the intervention was feasible and acceptable to families (i.e., high treatment retention, high client satisfaction, strong therapeutic alliance, and low barriers to participation). Moreover, the novel videoconferencing treatment format showed preliminary efficacy: 76.9% of the intention-to-treat (ITT) sample and 90.9% of treatment completers were treatment responders (i.e., Clinical Global Impressions-Improvement Scale = 1 or 2 at posttreatment), and 69.2% of the ITT sample and 81.8% of treatment completers were diagnostic responders (as per the Anxiety Disorders Interview for Children). Gains were largely maintained at 3-month follow-up evaluation. Outcome patterns within and across subjects are discussed, as well as limitations and the need for further controlled evaluations. With continued support, videoconferencing treatment formats may serve to meaningfully broaden the reach of quality care for youth anxiety disorders.
Collapse
Affiliation(s)
| | - Donna B Pincus
- Center for Anxiety and Related Disorders, Boston University
| | - Jami M Furr
- Center for Children and Families, Florida International University
| | - Jonathan S Comer
- Center for Children and Families, Florida International University
| |
Collapse
|
18
|
McMakin DL, Ricketts EJ, Forbes EE, Silk JS, Ladouceur CD, Siegle GJ, Milbert M, Trubnick L, Cousins JC, Ryan ND, Harvey AG, Dahl RE. Anxiety Treatment and Targeted Sleep Enhancement to Address Sleep Disturbance in Pre/Early Adolescents with Anxiety. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 48:S284-S297. [PMID: 29873503 DOI: 10.1080/15374416.2018.1463534] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sleep disturbance is prevalent in anxious youth and prospectively predicts poor emotional adjustment in adolescence. Study 1 examined whether anxiety treatment improves subjective and objective sleep disturbance in anxious youth. Study 2 examined whether a sleep intervention called Sleeping TIGERS can further improve sleep following anxiety treatment. Study 1 examined 133 youth (ages 9-14; 56% female; 11% ethnic/racial minority) with generalized, social, or separation anxiety over the course of anxiety treatment (cognitive behavioral treatment or client-centered treatment). Sleep-related problems (parent-, child-report) and subjective (diary) and objective (actigraphy) sleep patterns were assessed across treatment in an open trial design. Study 2 included 50 youth (ages 9-14; 68% female; 10% ethnic/racial minority) who continued to report sleep-related problems after anxiety treatment and enrolled in an open trial of Sleeping TIGERS. Pre- and postassessments duplicated Study 1 and included the Focal Interview of Sleep to assess sleep disturbance. Study 1 demonstrated small reductions in sleep problems and improvements in subjective sleep patterns (diary) across anxiety treatment, but outcomes were not deemed clinically significant, and 75% of youth stayed above clinical cutoff. Study 2 showed clinically significant, large reductions in sleep problems and small changes in some subjective sleep patterns (diary). Anxiety treatment improves, but does not resolve, sleep disturbance in peri-pubertal youth, which may portend risk for poor emotional adjustment and mental health. The open trial provides preliminary support that Sleeping TIGERS can improve sleep in anxious youth to a clinically significant degree.
Collapse
Affiliation(s)
| | - Emily J Ricketts
- b Department of Psychiatry , University of California , Los Angeles
| | | | | | | | - Greg J Siegle
- a Department of Psychiatry , University of Pittsburgh
| | | | | | | | - Neal D Ryan
- a Department of Psychiatry , University of Pittsburgh
| | - Allison G Harvey
- d Department of Psychology , University of California , Berkeley
| | - Ronald E Dahl
- e School of Public Health , University of California , Berkeley
| |
Collapse
|
19
|
Poznanski B, Cornacchio D, Coxe S, Pincus DB, McMakin DL, Comer JS. The Link Between Anxiety Severity and Irritability Among Anxious Youth: Evaluating the Mediating Role of Sleep Problems. Child Psychiatry Hum Dev 2018; 49:352-359. [PMID: 29222620 DOI: 10.1007/s10578-017-0769-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although recent studies have linked pediatric anxiety to irritability, research has yet to examine the mechanisms through which youth anxiety may be associated with irritability. Importantly, sleep related problems (SRPs) have been associated with both child anxiety and irritability, but research has not considered whether the link between youth anxiety and irritability may be accounted for by SRPs. The present study investigated whether SRPs mediated the relationship between anxiety severity and irritability in a large sample of treatment-seeking anxious youth (N = 435; ages 7-19 years, M = 12.7; 55.1% female). Anxiety severity, SRPs and irritability showed significant pairwise associations, and the indirect effect of youth anxiety severity on irritability, via SRPs, was positive and significant. The present analysis is the first to examine youth anxiety, irritability, and SPRs in a single model in a sample of anxious youth, and provides preliminary evidence that SRPs partially mediate links between child anxiety and irritability.
Collapse
Affiliation(s)
- Bridget Poznanski
- Center for Children and Families, Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA
| | - Danielle Cornacchio
- Center for Children and Families, Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA
| | - Stefany Coxe
- Center for Children and Families, Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA
| | - Donna B Pincus
- Center for Anxiety and Related Disorders, Department of Psychological and Brain Studies, Boston University, 648 Beacon Street, 6th Floor, Boston, MA, 02215, USA
| | - Dana L McMakin
- Center for Children and Families, Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA
| | - Jonathan S Comer
- Center for Children and Families, Department of Psychology, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA. .,Department of Psychology, The Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, USA.
| |
Collapse
|
20
|
Strawn JR, Dobson ET. Individuation for a DSM-5 disorder: Adult separation anxiety. Depress Anxiety 2017; 34:1082-1084. [PMID: 29211944 DOI: 10.1002/da.22703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/30/2017] [Indexed: 01/07/2023] Open
Affiliation(s)
- Jeffrey R Strawn
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH, USA.,Department of Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eric T Dobson
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
21
|
Mullin BC, Simon SL. Managing Insomnia Symptoms Among Adolescents With Anxiety Disorders. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23794925.2017.1359704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Benjamin C. Mullin
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stacey L. Simon
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
22
|
Wallace ML, McMakin DL, Tan PZ, Rosen D, Forbes EE, Ladouceur CD, Ryan ND, Siegle GJ, Dahl RE, Kendall PC, Mannarino A, Silk JS. The role of day-to-day emotions, sleep, and social interactions in pediatric anxiety treatment. Behav Res Ther 2016; 90:87-95. [PMID: 28013054 DOI: 10.1016/j.brat.2016.12.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 11/22/2016] [Accepted: 12/16/2016] [Indexed: 01/23/2023]
Abstract
Do day-to-day emotions, social interactions, and sleep play a role in determining which anxious youth respond to supportive child-centered therapy (CCT) versus cognitive behavioral therapy (CBT)? We explored whether measures of day-to-day functioning (captured through ecological momentary assessment, sleep diary, and actigraphy), along with clinical and demographic measures, were predictors or moderators of treatment outcome in 114 anxious youth randomized to CCT or CBT. We statistically combined individual moderators into a single, optimal composite moderator to characterize subgroups for which CCT or CBT may be preferable. The strongest predictors of better outcome included: (a) experiencing higher positive affect when with one's mother and (b) fewer self-reported problems with sleep duration. The composite moderator indicated that youth for whom CBT was indicated had: (a) more day-to-day sleep problems related to sleep quality, efficiency, and waking, (b) day-to-day negative events related to interpersonal concerns, (c) more DSM-IV anxiety diagnoses, and (d) college-educated parents. These findings illustrate the value of both day-to-day functioning characteristics and more traditional sociodemographic and clinical characteristics in identifying optimal anxiety treatment assignment. Future studies will need to enhance the practicality of real-time measures for use in clinical decision making and evaluate additional anxiety treatments.
Collapse
Affiliation(s)
- Meredith L Wallace
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15260, USA; Department of Statistics, University of Pittsburgh, 230 South Bouquet Street, Pittsburgh, PA 15260, USA.
| | - Dana L McMakin
- Department of Psychology, Florida International University, 11200 S. W. 8th Street, Miami, FL 33199, USA.
| | - Patricia Z Tan
- Department of Psychiatry, University of California, 757 Westwood Plaza, Los Angeles, CA 90095, USA.
| | - Dana Rosen
- Department of Psychology, University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA 15260, USA.
| | - Erika E Forbes
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15260, USA.
| | - Cecile D Ladouceur
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15260, USA.
| | - Neal D Ryan
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15260, USA.
| | - Greg J Siegle
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15260, USA.
| | - Ronald E Dahl
- School of Public Health, University of California, 50 University Hall, Berkeley, CA 94720, USA.
| | - Philip C Kendall
- Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122, USA.
| | - Anthony Mannarino
- Allegheny General Hospital, Four Allegheny Center, Pittsburgh, PA 15212, USA.
| | - Jennifer S Silk
- Department of Psychology, University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA 15260, USA.
| |
Collapse
|
23
|
Mullin BC, Pyle L, Haraden D, Riederer J, Brim N, Kaplan D, Novins D. A Preliminary Multimethod Comparison of Sleep Among Adolescents With and Without Generalized Anxiety Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:198-210. [PMID: 27736237 DOI: 10.1080/15374416.2016.1220312] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Previous studies suggest that youth with anxiety disorders experience their sleep as more disrupted and unsatisfying than their healthy peers. However, it is unclear whether these subjective complaints align with objective measures of sleep quantity and quality. The purpose of this preliminary study was to assess subjective and objective sleep parameters, and their relationships with anxiety symptomatology, among adolescents (62.8% female, 81.4% Caucasian), ages 12 to 18 (M = 15.29 years), with generalized anxiety disorder (n = 26) and controls without any psychopathology (n = 17). We measured sleep over 7 nights using sleep diaries and actigraphy and collected self- and parent-report questionnaires pertaining to sleep, anxiety, and depression. Repeated-measures mixed models were used to examine relationships between nightly sleep duration and morning anxiety. We found a number of differences in sleep between our anxious and healthy participants. Via sleep diary, our anxious participants had longer sleep onset latencies and lower satisfaction with sleep relative to controls, whereas via actigraphy we found longer sleep onset latencies but greater overall sleep duration among anxious versus control participants. Actigraphic measures of sleep disturbance were associated with parent-report of anxiety and depression. Our mixed-model analyses revealed that decreases in nightly sleep duration were associated with increased morning anxiety, but only among our participants with generalized anxiety disorder. Findings suggest that sleep disturbance among anxious adolescents can be detected using both subjective and objective measures and that, for these individuals, fluctuations in sleep duration may have real consequences for daytime anxiety.
Collapse
Affiliation(s)
| | - Laura Pyle
- a School of Medicine, University of Colorado
| | | | | | | | | | | |
Collapse
|
24
|
Hansen BH, Alfstad KÅ, van Roy B, Henning O, Lossius MI. Sleep problems in children and adolescents with epilepsy: Associations with psychiatric comorbidity. Epilepsy Behav 2016; 62:14-9. [PMID: 27448238 DOI: 10.1016/j.yebeh.2016.06.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 02/07/2023]
Abstract
Sleep problems are common in pediatric epilepsy and may influence seizure control, daytime functioning, and overall quality of life. Knowledge of factors contributing to sleep problems is likely to improve treatment. The aim of this study was to investigate associations between psychiatric comorbidity and parent-reported and self-reported sleep problems in a sample of children and adolescents with epilepsy. Participants were children and adolescents (N=94), aged 10-19years, with generalized or focal epilepsy who had been referred to a tertiary epilepsy treatment center in Norway. Participants underwent a thorough clinical assessment and 24h of EEG registration. Information on sleep problems was obtained from parents using the Children's Sleep Habit Questionnaire (CSHQ) and from self-reporting using the Sleep Self-Report (SSR) questionnaire. Psychiatric diagnoses were established using the semistructured psychiatric interview Schedule for Affective Disorders and Schizophrenia - Present and Lifetime Version (Kiddie-SADS-PL). Both the total and subdomain CSHQ and SSR scores were high in comparison with scores from population-based samples. Having one or more psychiatric disorder(s) was significantly associated with elevated scores on both the CSHQ and the SSR. With the exception of parent-reported parasomnias, associations between sleep problems and psychiatric disorders remained significant after adjusting for relevant epilepsy variables. Psychiatric comorbidity explained about one-third of the variance of the reported sleep problems in children and adolescents with epilepsy.
Collapse
Affiliation(s)
| | - Kristin Å Alfstad
- National Centre for Epilepsy, Department of Children and Youth, Division for Clinical Neuroscience, Oslo University Hospital, Norway
| | - Betty van Roy
- Pediatric Division, Akershus University Hospital, Lørenskog, Norway
| | - Oliver Henning
- National Centre for Epilepsy, Department of Clinical Neurophysiology, Division for Clinical Neuroscience, Oslo University Hospital, Norway
| | - Morten I Lossius
- National Centre for Epilepsy, Department of Children and Youth, Division for Clinical Neuroscience, Oslo University Hospital, Norway
| |
Collapse
|
25
|
Donovan CL, Spence SH, March S. Does an Online CBT Program for Anxiety Impact Upon Sleep Problems in Anxious Youth? JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:211-221. [PMID: 27492674 DOI: 10.1080/15374416.2016.1188700] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This study aimed to assess whether the transdiagnostic therapy elements of an online cognitive behaviour therapy anxiety program also impact on sleep-related problems (SRPs) in anxious youth. Participants were drawn from two previously published studies evaluating online cognitive behaviour therapy for child anxiety (BRAVE-ONLINE). The study included 63 children 7-12 years of age (M = 9.49, SD = 1.37) and 71 adolescents 12-18 years of age (M = 13.90, SD = 1.68). SRPs, severity of anxiety diagnosis, anxiety symptoms, number of diagnoses, depressive symptoms, and global functioning were assessed at pre-, post-, and 6-month follow-up assessment points. SRPs were positively related to anxiety symptoms and severity for children and were positively related to depression for adolescents. SRPs did not differ between male and female participants, between children and adolescents, or between those who had generalised anxiety disorder in their profile and those who did not. Finally, children but not adolescents participating in the online program demonstrated a significantly greater reduction in SRPs from pre- to posttreatment compared to the waitlist group, and these gains were maintained at 6-month follow-up. Treatment focusing on child anxiety alone may reduce SRPs in children but not adolescents. Although further research is clearly needed, clinicians should ensure that they assess for SRPs in their teenage clients and directly target SRPs in treatment where required.
Collapse
Affiliation(s)
- Caroline L Donovan
- a School of Applied Psychology, Building Healthy Communities and the Menzies Health Institute Queensland , Griffith University
| | - Susan H Spence
- a School of Applied Psychology, Building Healthy Communities and the Menzies Health Institute Queensland , Griffith University
| | - Sonja March
- b School of Psychology, Counselling and Community , University of Southern Queensland
| |
Collapse
|