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Bauducco S, Pillion M, Bartel K, Reynolds C, Kahn M, Gradisar M. A bidirectional model of sleep and technology use: A theoretical review of How much, for whom, and which mechanisms. Sleep Med Rev 2024; 76:101933. [PMID: 38657359 DOI: 10.1016/j.smrv.2024.101933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 03/01/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024]
Abstract
The link between technology and sleep is more complex than originally thought. In this updated theoretical review, we propose a new model informed by the growing body of evidence in the area over the past 10 years. The main theoretical change is the addition of bi-directional links between the use of technology and sleep problems. We begin by reviewing the evidence to date for the originally proposed mechanisms of bright light, arousal, nighttime sleep disruptions, and sleep displacement. Then, in support of the new direction of effect (sleep problems preceding technology use), we propose two new mechanisms: technology before sleep might be used as a time filler and/or as an emotional regulation strategy to facilitate the sleep-onset process. Finally, we present potential moderators of the association between technology and sleep, in recognition of protective and vulnerability factors that may mitigate or exacerbate the effects of technology on sleep and vice versa. The goal of this theoretical review is to update the field, guide future public health messages, and to prompt new research into how much technology and sleep affect each other, for whom it may be problematic, and which mechanisms may explain their association.
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Affiliation(s)
- Serena Bauducco
- Örebro University, School of Behavioural, Social and Legal Sciences, Sweden; Flinders University, College of Education, Psychology and Social Work, Australia.
| | - Meg Pillion
- Flinders University, College of Education, Psychology and Social Work, Australia
| | - Kate Bartel
- WINK Sleep Pty Ltd, Adelaide, Australia; Riverland Academy of Clinical Excellence, Riverland Mallee Coorong Local Health Network, Australia; Flinders University, College of Medicine and Public Health, Australia
| | - Chelsea Reynolds
- Flinders University, College of Education, Psychology and Social Work, Australia; WINK Sleep Pty Ltd, Adelaide, Australia
| | - Michal Kahn
- Tel Aviv University, School of Psychological Sciences, Israel
| | - Michael Gradisar
- WINK Sleep Pty Ltd, Adelaide, Australia; Sleep Cycle AB, Gothenburg, Sweden
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Wüllner S, Hermenau K, Krutkova M, Petras IK, Hecker T, Siniatchkin M. Mobile applications in adolescent psychotherapy during the COVID-19 pandemic: a systematic review. Front Public Health 2024; 12:1345808. [PMID: 38420028 PMCID: PMC10899334 DOI: 10.3389/fpubh.2024.1345808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024] Open
Abstract
Background To bridge the gap in adolescent psychotherapy created by the increasing need for mental health interventions and the limited possibilities of in-person treatment during the pandemic, many health care providers opted to offer online mental health care programs. As a result, the number of mental health apps available in app stores experienced a sharp increase during the COVID-19 pandemic. Objective The aim of the current review is to provide an overview of feasibility and effectiveness studies testing mobile applications in adolescent psychotherapy during the peak phase of the COVID-19 pandemic. Methods We conducted a literature search in Pubmed, PsychInfo, Google Scholar, OpenSIGLE and OpenGREY for papers published from June 2020 to June 2023. Studies were included if they evaluated app-based interventions intended for psychotherapeutic treatment and targeted adolescents between 12 and 27 years of age with symptoms of psychological disorders. The quality of each study was assessed using the Systematic Assessment of Quality in Observational Research (SAQOR). Effectiveness outcomes were analyzed by vote counting and calculating a binomial probability test. Results The search yielded 31 relevant studies that examined 27 different apps with a total of 1,578 adolescent participants. Nine articles were primary effectiveness studies and 22 focused on feasibility measures as primary outcome. There was evidence that mental health apps influenced adolescents' psychotherapy, with 83% of the studies with effectiveness outcomes favoring the intervention (p = 0.002). Sixty-one percent of the included studies were rated at low or very low quality. Conclusions The pandemic has given apps a firm and important role in healthcare that will probably continue to expand in the future. To ensure that mental health apps are truly effective and beneficial for adolescents' psychotherapy, we need a standardized measurement of quality features of mental health apps and higher quality app evaluation studies. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=406455, PROSPERO International Prospective Register of Systematic Reviews [CRD42023406455].
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Affiliation(s)
- Sarah Wüllner
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, Bielefeld University, Medical School East Westphalia, Bielefeld, Germany
| | - Katharin Hermenau
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, Bielefeld University, Medical School East Westphalia, Bielefeld, Germany
| | - Mariya Krutkova
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, Bielefeld University, Medical School East Westphalia, Bielefeld, Germany
| | - Ira-Katharina Petras
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, Bielefeld University, Medical School East Westphalia, Bielefeld, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics of Children and Adolescents, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | - Tobias Hecker
- Institute for Interdisciplinary Conflict and Violence Research, Bielefeld University, Bielefeld, Germany
- Department of Psychology, Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
| | - Michael Siniatchkin
- University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Protestant Hospital Bethel, Bielefeld University, Medical School East Westphalia, Bielefeld, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics of Children and Adolescents, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
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Rosenberg L, Rigney G, Jemcov A, van Voorst D, Corkum P. Usability of an eHealth sleep education intervention for university students. Digit Health 2024; 10:20552076241260480. [PMID: 38846369 PMCID: PMC11155311 DOI: 10.1177/20552076241260480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/09/2024] Open
Abstract
Background It has been estimated that more than one-third of university students suffer from insomnia. Few accessible eHealth sleep education programmes exist for university students and of the ones that do exist, fewer were developed using a user-centred approach, which allows for student input to be systematically collected and utilized to provide students with a programme that they consider to be easy to use and implement and to be effective. Better Nights, Better Days-Youth (BNBD-Youth) is a four-session eHealth sleep education programme designed for youth but previously only evaluated in younger adolescents (ages 14-18 years). Aims The purpose of this study is to evaluate the usability of the BNBD-Youth programme with university students using Morville's User Experience Honeycomb framework to determine if this programme would meet the needs of university students and if so what modifications would be needed. Methods Canadian undergraduate students (n = 46) completed the BNBD-Youth programme. Students completed online usability questionnaires based on the seven dimensions of Morville's User Experience Honeycomb (i.e. useful, usable, valuable, credible, desirable, accessible and findable) after each session and after completion of the programme. Open- and closed-ended questions were used to obtain both quantitative and qualitative responses. Results Average quantitative ratings were positive across user experience dimensions, ranging from 3.43 to 4.46 (out of 5). Qualitative responses indicated overall positive experiences with the programme. The only constructive feedback that met the criteria for revising the programme was to include more interactive features in Session 4. Conclusions This study demonstrates that university students found BNBD-Youth to be a usable programme for older youth. Demonstrating usability is an essential step in developing a programme with a user-centred design that university students will want to use in the future. Once the BNBD-Youth programme is revised to create the BNBD-University (BNBD-Uni) programme, additional usability and effectiveness testing will be conducted.
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Affiliation(s)
- Lindsay Rosenberg
- Department of Psychology & Neuroscience, Faculty of Science, Dalhousie University, Halifax, NS, Canada
| | - Gabrielle Rigney
- Appleton Institute, School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, South Australia, Australia
| | - Anastasija Jemcov
- Department of Psychology & Neuroscience, Faculty of Science, Dalhousie University, Halifax, NS, Canada
| | - Derek van Voorst
- Department of Psychology & Neuroscience, Faculty of Science, Dalhousie University, Halifax, NS, Canada
| | - Penny Corkum
- Department of Psychology & Neuroscience, Faculty of Science, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Pediatrics, IWK Health Centre, Halifax, NS, Canada
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Tougas M, Rigney G, Chambers C, Smith I, Mugford J, Keeler L, Rajda M, Corkum P. Focus Groups to Inform User-Centered Development of an eHealth Sleep Intervention for Adolescents: Perspectives of Youth with Insomnia Symptoms, with and without Pain. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1692. [PMID: 37892355 PMCID: PMC10605192 DOI: 10.3390/children10101692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION Adolescence is a developmental stage that often coincides with increasing sleep problems. Focus groups were conducted to inform development of an adolescent eHealth sleep intervention by exploring opinions about (1) healthy sleep practices, and (2) using an eHealth intervention. METHODS Adolescents 14-18 years old experiencing symptoms of insomnia based on the Insomnia Sleep Index, with and without recurrent pain, and associated stakeholders (i.e., parents, school personnel, and health care providers) were recruited. Across six online focus groups, 24 adolescents with insomnia participated (14 pain-free, 10 with recurrent pain; 10 male, 14 female). Across seven online focus groups, 22 stakeholders participated, including 8 parents, 9 school professionals, and 5 health care providers (10 male, 8 female). Using a content analysis, subthemes were induced from transcripts. RESULTS Most healthy sleep practices were perceived as reasonable for adolescents to implement, except avoiding technology before bed and using bedrooms only for sleep. Three primary barriers to sleep practices were identified, including a variable schedule due to lifestyle factors, technology at night, and academics interfering with sleep, and only in the pain group, the barrier related to pain was identified. Content addressing adolescent-specific barriers was considered important to include in a sleep intervention. Desirable eHealth components included interactive features, videos, audio, and pictures to present information. A common barrier to using an eHealth sleep intervention was the program feeling too academic, with accessibility of the sleep information and strategies as a common facilitator. CONCLUSIONS This research represents the first step in a user-centered approach to developing an adolescent eHealth sleep intervention. These results provide insights from a range of perspectives on guiding adolescents to follow healthy sleep practices. Next, these findings will be integrated in the development of an eHealth intervention for adolescents with and without recurrent pain.
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Affiliation(s)
- Michelle Tougas
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada (G.R.); (C.C.); (I.S.); (J.M.); (L.K.)
| | - Gabrielle Rigney
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada (G.R.); (C.C.); (I.S.); (J.M.); (L.K.)
- Appleton Institute, School of Health, Medical and Applied Sciences, CQUniversity, Adelaide, SA 5034, Australia
| | - Christine Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada (G.R.); (C.C.); (I.S.); (J.M.); (L.K.)
- Department of Pediatrics, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Isabel Smith
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada (G.R.); (C.C.); (I.S.); (J.M.); (L.K.)
- Department of Pediatrics, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Joshua Mugford
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada (G.R.); (C.C.); (I.S.); (J.M.); (L.K.)
| | - Laura Keeler
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada (G.R.); (C.C.); (I.S.); (J.M.); (L.K.)
| | - Malgorzata Rajda
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Penny Corkum
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada (G.R.); (C.C.); (I.S.); (J.M.); (L.K.)
- Department of Pediatrics, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 4R2, Canada;
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Levenson JC, Williamson AA. Bridging the gap: leveraging implementation science to advance pediatric behavioral sleep interventions. J Clin Sleep Med 2023; 19:1321-1336. [PMID: 36722616 PMCID: PMC10315605 DOI: 10.5664/jcsm.10476] [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: 08/25/2022] [Revised: 01/05/2023] [Accepted: 01/05/2023] [Indexed: 02/02/2023]
Abstract
STUDY OBJECTIVES This review synthesizes the pediatric behavioral sleep intervention (BSI) evidence base, summarizes challenges in translating BSIs from research to practice, and provides recommendations for integrating implementation science methods to advance pediatric BSI research. METHODS We briefly review the common behavioral sleep disturbances among youth, discuss the pediatric BSIs with well-established evidence, and identify gaps in pediatric BSI research. We then identify contributors to the dearth of research evaluating pediatric BSIs in accessible settings and present a model for applying implementation science strategies to address identified gaps across the continuum of translational research. RESULTS Relatively few BSI trials include older children and adolescents. Similarly, there is limited research evaluating BSIs among racially and ethnically minoritized children and families and/or those of lower socioeconomic status backgrounds. Access to scalable and easily disseminable tools to treat pediatric sleep disturbances early in their development is crucial for promoting positive child outcomes. To address these gaps, researchers should apply implementation science theories, models, and frameworks to design new interventions for implementation, adapt existing interventions with end users and settings in mind, conduct hybrid effectiveness-implementation trials, and test implementation strategies. CONCLUSIONS Given the prevalence and consequences of poor sleep across developmental periods, pediatric BSIs must be effective as well as adaptable, scalable, and easily disseminable. Implementation science theories, models, and frameworks can enhance access to, engagement in, and the implementation and dissemination of scalable BSIs across diverse pediatric care settings and heterogeneous populations. CITATION Levenson JC, Williamson AA. Bridging the gap: leveraging implementation science to advance pediatric behavioral sleep interventions. J Clin Sleep Med. 2023;19(7):1321-1336.
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Affiliation(s)
- Jessica C. Levenson
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ariel A. Williamson
- Sleep Center, Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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Gregory AM, Rutter MK, Madrid-Valero JJ, Bennett SD, Shafran R, Buysse DJ. Editorial: Therapies for mental health difficulties: finding the sweet spot between standardization and personalization. J Child Psychol Psychiatry 2023; 64:213-216. [PMID: 36636905 DOI: 10.1111/jcpp.13732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 01/14/2023]
Abstract
There are strong arguments for standardizing therapies for mental health difficulties in young people and for the development of digital therapies. At the same time, the importance of personalized treatments is also increasingly apparent. In this editorial, we discuss challenges and the continued need to find the sweet spot between standardization and personalization when it comes to therapies for mental health difficulties. We illustrate our discussion with reference to insomnia in adolescents/young adults as well as the chronic health condition type 1 diabetes.
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Affiliation(s)
- Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK.,Diabetes, Endocrinology and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Juan J Madrid-Valero
- Department of Health Psychology, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | | | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Daniel J Buysse
- Department of Psychiatry, Center for Sleep and Circadian Science, University of Pittsburgh, Pittsburgh, PA, USA
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Back to Basics: Lifestyle Interventions for Adolescent Depression. Harv Rev Psychiatry 2022; 30:283-302. [PMID: 36103683 DOI: 10.1097/hrp.0000000000000343] [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] [Indexed: 01/10/2023]
Abstract
LEARNING OBJECTIVES After completing this activity, practitioners will be better able to:• Discuss and better understand the recently adopted screening standards for adolescents with depression and the potential advantages of using "lifestyle medicine"• Set up a process for providing effective interventions for the increased number of patients with adolescent depression• Design or update their toolbox of treatment options for adolescents with depression based on the new literature and increased demand. ABSTRACT Recently adopted quality standards recommend that pediatricians screen adolescents for depression and that they document follow-up plans for those who screen positive. As a result of these new recommendations, pediatricians and other pediatric providers, as well as psychiatrists and other mental health professionals, may face an increasing number of referrals and a growing need for effective interventions for adolescent depression. Given the widely acknowledged scarcity of traditional mental health resources, the current study reviewed the rapidly expanding array of evidence-based, but nontraditional, interventions applicable to outpatient pediatric and mental health care settings. Many of these interventions come from a lifestyle medicine framework. Lifestyle medicine interventions are congruent with the cultures of pediatrics and outpatient psychiatry, and offer additional evidence-based tools for providers managing adolescent depression. These interventions can be implemented individually or within group or community settings, and may be used in conjunction with more common interventions such as psychotherapy or psychotropic medications.
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Carney CE, Carmona NE. Author Reply to: Additional Measurement Approaches for Sleep Disturbances. Comment on “Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study (MS 25392)” (Preprint). JMIR Form Res 2022; 6:e39198. [PMID: 35699990 PMCID: PMC9237758 DOI: 10.2196/39198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 11/26/2022] Open
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Law EF, Kim A, Ickmans K, Palermo TM. Sleep Health Assessment and Treatment in Children and Adolescents with Chronic Pain: State of the Art and Future Directions. J Clin Med 2022; 11:jcm11061491. [PMID: 35329817 PMCID: PMC8954024 DOI: 10.3390/jcm11061491] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 12/29/2022] Open
Abstract
Sleep is interrelated with the experience of chronic pain and represents a modifiable lifestyle factor that may play an important role in the treatment of children and adolescents with chronic pain. This is a topical review of assessment and treatment approaches to promote sleep health in children and adolescents with chronic pain, which summarizes: relevant and recent systematic reviews, meta-analyses, and methodologically sound prospective studies and clinical trials. Recommendations are provided for best practices in the clinical assessment and treatment of sleep health in youth with chronic pain. This overview can also provide researchers with foundational knowledge to build upon the best evidence for future prospective studies, assessment and intervention development, and novel clinical trials.
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Affiliation(s)
- Emily F. Law
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA;
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA 98121, USA;
- Correspondence:
| | - Agnes Kim
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA 98121, USA;
- Medical College of Georgia, Augusta University & University of Georgia Medical Partnership Campus, Augusta, GA 30912, USA
| | - Kelly Ickmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium;
- Movement & Nutrition for Health & Performance Research Group (MOVE), Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Tonya M. Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA;
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA 98121, USA;
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Tsai WT, Liu TL. Additional Measurement Approaches for Sleep Disturbances. Comment on "A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study" (Preprint). JMIR Form Res 2021; 6:e35959. [PMID: 35700003 PMCID: PMC9237760 DOI: 10.2196/35959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/04/2022] [Accepted: 05/05/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Wan-Tong Tsai
- Chung Shan Medical University, Taichung City, Taiwan
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