Self-efficacy in Insomnia Symptom Management after Digital CBT-I Mediates Insomnia Severity during the COVID-19 Pandemic

Digital health technologies and self-efficacy in Parkinson's: a scoping review

OBJECTIVE

Prior research has identified that people with Parkinson's reporting lower levels of self-efficacy exhibit worsening motor and non-motor symptomology, reduced quality of life, and self-management. Our key objective was to conduct a scoping review examining the impact of digital health technologies on self-efficacy in people with Parkinson's.

DESIGN

A scoping review using Arksey and O'Malley's (2005) framework was undertaken.

DATA SOURCES

MEDLINE, Embase, PsychINFO, CINAHL, Web of Science, IEEE Xplore, and Google Scholar principally for grey literature were searched from 1 January 2008 to the 24th of July 2024.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Primary studies which incorporated digital health technologies, measured self-efficacy and had a sample population of people with Parkinson's were searched.

DATA EXTRACTION AND SYNTHESIS

Following identification of potentially eligible records, two independent reviewers undertook title and abstract screening, followed by full-text screening. Data was extracted using our earlier published data extraction sheet which incorporated the Practical Reviews in Self-Management Support (PRISMS) taxonomy, and the template for intervention description and replication (TIDieR) checklist. Data was extracted from a Microsoft Excel spreadsheet and synthesised by describing themes, demographic data and numerical data.

RESULTS

From 33 165 unique records following screening and independent review by two reviewers, 11 eligible records were found. Of these five elevated self-efficacy to a statistically significant level, five did not and one lowered self-efficacy. Of the studies which raised self-efficacy to a statistically significant level, all adopted a multimodal approach with a variety of devices. Thematically, these devices were focused on physical activity, falls/falls prevention, or both. The level of heterogeneity precluded comparisons between studies.

CONCLUSIONS

This scoping review identified significant knowledge and evidence gaps in the literature, and the limited number of eligible studies make these findings not generalisable. Future self-management research might benefit from also considering self-efficacy.

Emotion Regulation Self-Efficacy as a Mechanism of Alliance and Outcomes in a Brief, Transdiagnostic Digital Mental Health Intervention: L'auto-efficacité de la régulation des émotions en tant que mécanisme d'alliance et de résultats dans une brève intervention transdiagnostique numérique en santé mentale

OBJECTIVES

Digital mental health interventions have shown promise for alleviating various forms of psychopathology, including depression and anxiety. However, the mechanisms of such interventions remain largely unexplored. The purpose of this study was to investigate a potential mechanistic process through which one hybrid digital mental health intervention (i.e., the Digital Clinic) might operate. We hypothesized that emotion regulation (ER) self-efficacy at the treatment midpoint may mediate the relationship between alliance (i.e., therapeutic alliance and digital alliance) and outcome (i.e., co-morbid symptoms of depression and anxiety) at the treatment endpoint.

METHODS

Data used in this study came from the Digital Clinic, a brief transdiagnostic telehealth treatment program augmented by a dual-purpose digital phenotyping and intervention smartphone app. Recruited primarily from primary care, participants were 82 adults (73% White, 64% cisgender women, mean age 41) receiving outpatient treatment in the northeastern United States. All constructs were measured with validated scales, including The Working Alliance Inventory-Short Revised (WAI-SR) for therapeutic alliance, the Digital Working Alliance Inventory (DWAI) for digital alliance, the PROMIS Self-Efficacy for Managing Emotions Short Form scale for ER self-efficacy, and the Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS) for co-morbid symptoms of depression and anxiety.

RESULTS

Significant reductions in co-morbid symptoms of depression and anxiety and significant increases in ER self-efficacy were found from baseline to treatment endpoint. Therapeutic and digital alliance at the midpoint each predicted reductions in co-morbid symptoms of depression and anxiety at the endpoint through ER self-efficacy, controlling for baseline scores.

CONCLUSIONS

Findings suggest that ER self-efficacy may be a proximal predictor of clinical improvement that may be enhanced by therapeutic and digital alliance. Future controlled research is essential to improve knowledge of the mechanisms of digital mental health interventions and to enhance their effectiveness.

Post-Pandemic Insomnia in Healthcare Workers: A Prospective Study including Sociodemographic, Occupational and Psychosocial Variables

Background/Objectives: Previous research points to the prevalence of insomnia during the COVID-19 pandemic among healthcare workers (HCWs). However, longitudinal studies on its evolution, including the post-pandemic stage, are less abundant, with a special lack of research about possible psychosocial risk factors. The aim of the current study is to analyze the evolution of insomnia in Spanish HCWs from the beginning of the pandemic until two years later, examining the influence of sociodemographic, occupational and psychosocial variables. Methods: This was a prospective longitudinal design with three data collection periods in which insomnia was assessed using the Insomnia Severity Index (ISI), in addition to sociodemographic, occupational and psychosocial (i.e., social support, self-efficacy, resilience and cognitive fusion) variables in HCWs (n = 216) who were in direct contact with COVID-19 patients. Results: High scores were observed for insomnia, with a clear decrease throughout the periods studied (F = 30.198, p < 0.001). An association was observed between insomnia and certain sociodemographic and occupational variables (i.e., work category, p = 0.001; availability of Personal Protective Equipment (PPE), p < 0.001; workload, p < 0.001; worry about self or family contagion, p = 0.002, p = 0.003, respectively). Insomnia had negative relationships with social support (p = 0.014), self-efficacy (p < 0.001) and resilience (p < 0.001) and positive relationships with cognitive fusion (p < 0.001). Interaction effects between the evolution of insomnia and social support from friends (p = 0.024, ƞ2 = 0.34) and between the evolution of insomnia and cognitive fusion (p = 0.047; ƞ2 = 0.25) were found. Conclusions: Social support, self-efficacy and resilience act as buffers for insomnia. Cognitive fusion acts as a clear precipitator of insomnia as well as directly influencing its evolution. Social support from friends also affects the evolution of insomnia. Within the specific circumstances of the COVID-19 pandemic, a long-term effect of social support from friends and a short-term effect of cognitive fusion on the evolution of insomnia was observed. The findings emphasize the need to implement specific interventions to promote the mental well-being of HCWs, particularly in crisis contexts that involve an increase in occupational stress, emphasizing the role of certain psychosocial variables as protective factors.

General Self-Efficacy in Association With Insomnia Symptoms and Suicidal Ideation Among Chinese Community-Based Population

Previous studies supported the association between insomnia symptoms and suicidal ideation in patients with mental or psychological diseases. This study aimed to examine the associations between insomnia symptoms, general self-efficacy, and suicidal ideation among community-based adult population. Standardized questionnaire was distributed to 2051 community-dwelling adults in Lishui district of Jiangsu Province in China, to assess their socio-demographics, insomnia symptoms, general self-efficacy, and suicidal ideation. Multiple binary logistic regression or linear regression and mediation analysis with bootstrap resampling method were performed. Results showed that the weighted prevalence of lifetime suicidal ideation was 6.38%. Insomnia symptom was associated with higher odds of suicidal ideation after adjusting for sociodemographics and mental health status (odds ratio [OR] = 2.85, and the OR of insomnia symptom with suicidal ideation decreased but remained significant after additionally adjusting for general self-efficacy (OR = 2.62). Participants with insomnia symptom were also significantly associated with lower general self-efficacy (β = -0.96), whereas higher general self-efficacy was associated with a lower odds of suicidal ideation (OR = 0.92). In conclusion, general self-efficacy was associated with both insomnia symptom and suicidal ideation among the community-dwelling adult population.

Clinical efficacy and safety of Guipi decoction combined with escitalopram oxalate tablets in patients with depression

BACKGROUND

Depression is a widespread mental health condition that requires effective treatment. In the treatment of depression, traditional Chinese medicine (TCM) offers obvious advantages, fewer adverse reactions, and a lower recurrence rate.

AIM

To evaluate the clinical benefits of Guipi decoction combined with escitalopram oxalate tablets for individuals with depression.

METHODS

In total, 80 patients diagnosed as having depression were enrolled in the study and divided into either an experimental group or a control group. All of the patients were orally administered escitalopram oxalate tablets. Additionally, the experimental group received Jiajian Guipi decoction and reduced Governor vessel fumigation over 4 wk. TCM syndrome scores, Hamilton depression rating scale (HAM-D) scores, self-rating depression scale (SDS) scores, and Pittsburgh sleep quality index scores were measured for the two groups and compared before and after the treatment. The two groups were monitored for any adverse reactions.

RESULTS

After 4 wk of treatment, both groups exhibited a significant reduction in TCM syndrome scores compared with their pre-treatment scores (P < 0.05). However, the experimental group exhibited significantly lower TCM syndrome scores than the control group (P < 0.05). Similarly, the post-treatment SDS and HAM-D-24 scores were significantly lower in both groups than the pre-treatment scores (P < 0.05), with the experimental group exhibiting lower scores than the control group (P < 0.05). The total treatment efficiency was significantly better in the experimental group (97.14%) than in the control group (77.78%) (P < 0.05). Furthermore, after 4 wk of treatment, the Pittsburgh sleep quality index scores for both groups were significantly lower than those before the treatment (P < 0.05), with the experimental group exhibiting lower scores than the control group (P < 0.05). The incidence of adverse reactions was significantly lower in the experimental group than in the control group (P < 0.05).

CONCLUSION

The combination of Guipi decoction and escitalopram oxalate tablets was found to be an effective and safe treatment for depression. This combination could reduce TCM syndrome scores, improve depressive symptoms, and enhance sleep quality.

Management of Chronic Insomnia Using Cognitive Behavior Therapy for Insomnia (CBT-I) During COVID-19 Pandemic: Does One Shoe Fit All?

Purpose

Insomnia is a highly prevalent disorder that is seen across all age groups causing significant morbidity to the patients. Its prevalence has further risen during COVID-19 pandemic. It is widely acknowledged that untreated insomnia can lead to significant health risks and socio-occupational dysfunction.

Methods

A narrative review was conducted following focused search of databases.

Results

Available guidelines mention two different approaches for the management of insomnia-pharmacological and non-pharmacological. Non-pharmacological therapies like multicomponent cognitive behavior therapy for insomnia (CBT-I) have been advocated for the management of acute as well as chronic insomnia in the literature as it has been found efficacious and useful. Multiple variants of CBT-I, e.g., digitally delivered CBT-I, brief CBT-I have been tested during pandemic owing to closure of clinics. However, there are certain issues to be considered while choosing CBT-I as therapy. For example, like other forms of psychotherapies, is there a need for assessing the candidature of patient before administering CBT-I; is CBT-I free of adverse effects as commonly thought; is CBT-I more efficacious than hypnotics; and at last, how to manage cases that are not candidate for CBT-I.

Conclusion

This narrative review addresses the scientific robustness of evidence for issues related to adherence, efficacy and adverse effects of non-pharmacological therapies. Available literature suggests that data related to adherence and efficacy of CBT-I suffer from methodological shortcomings and careful selection of patient is important for the successful therapy. At the same time, attempts have been made to shed light to the areas where CBT-I can be helpful in the management of insomnia.

Mental Health and Wellbeing in Young People in the UK during Lockdown (COVID-19)

This study aimed to assess the levels of mental wellbeing and potential for clinical need in a sample of UK university students aged 18-25 during the COVID-19 pandemic. We also tested the dose-response relationship between the severity of lockdown restrictions and mental wellbeing. We carried out a prospective shortitudinal study (one month between baseline and follow up) during the pandemic to do this and included 389 young people. We measured a range of facets of mental wellbeing, including depression, depressogenic cognition (rumination), wellbeing, stress and sleep disturbance. Our primary outcome was 'probable depression' as indexed by a score of ≥10 on the patient health questionnaire (PHQ-8). The prevalence of probable depression was significantly higher than pre-pandemic levels (55%) and did not decrease significantly over time (52%). Higher levels of lockdown severity were prospectively associated with higher levels of depressive symptoms. Nearly all students had at least one mental wellbeing concern at either time point (97%). The evidence suggests that lockdown has caused a wellbeing crisis in young people. The associated long-term mental, social, educational, personal and societal costs are as yet unknown but should be tracked using further longitudinal studies.