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Liu L, Hao M, Yu H, Tian Y, Yang C, Fan H, Zhao X, Geng F, Mo D, Xia L, Liu H. The associations of brain-derived neurotrophic factor (BDNF) levels with psychopathology and lipid metabolism parameters in adolescents with major depressive disorder. Eur Arch Psychiatry Clin Neurosci 2025:10.1007/s00406-025-01984-3. [PMID: 39998568 DOI: 10.1007/s00406-025-01984-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 02/12/2025] [Indexed: 02/27/2025]
Abstract
Brain-derived neurotrophic factor (BDNF) is crucial for the growth, differentiation and maintenance of neuronal systems, which is closely associated with major depressive disorder (MDD). The objective of this study was to investigate the BDNF levels and their associations with psychopathology and lipid metabolism parameters in adolescents with MDD. From January to December 2021, the study included 141 adolescents with MDD and 90 healthy controls (HCs). The Center for Epidemiological Studies Depression Scale (CES-D), the Insomnia Severity Index Scale (ISI), the Epworth Sleepiness Scale (ESS) and the Positive and Negative Suicidal Ideation Scale (PANSI) were used to assess depressive symptoms, insomnia, excessive daytime sleepiness, and suicidal ideation, respectively. BDNF levels and lipid metabolism parameters were also measured. Compared to HCs, adolescents with MDD had significantly lower BDNF levels (p < 0.001). In patients, BDNF levels were positively correlated with age, BMI, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C); and negatively correlated with the scores of CES-D and ISI (all p < 0.05). The results of the multivariate linear regression analyses indicated that BDNF levels were positively associated with age (β = 0.198, t = 2.447, p = 0.016), first-episode MDD (β = 0.176, t = 2.234, p = 0.027) and TC level (β = 0.240, t = 3.048, p = 0.003), and negatively associated with the scores of ESS (β = -0.171, t = -2.203, p = 0.029) and ISI (β = -0.231, t = -2.996, p = 0.003). Of note, the associations between BDNF and psychopathology were observed only in female and first-episode patients. BDNF levels were decreased in adolescents with MDD. Patients with low BDNF levels were in a more severe psychiatric state and had changes in lipid metabolism parameters. This study provided preliminary evidence that BDNF may play a role in the onset and progression of MDD.
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Affiliation(s)
- Lewei Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000, Anhui Province, China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, Anhui Province, China
| | - Mingru Hao
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, China
| | - Haiyun Yu
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, China
| | - Yinghan Tian
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000, Anhui Province, China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, Anhui Province, China
| | - Cheng Yang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000, Anhui Province, China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, Anhui Province, China
| | - Haojie Fan
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, China
| | - Xin Zhao
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, China
| | - Feng Geng
- Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Daming Mo
- Department of Psychiatry, Hefei Fourth People's Hospital, Hefei, Anhui Province, China
| | - Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000, Anhui Province, China.
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, China.
- Anhui Psychiatric Center, Anhui Medical University, Hefei, Anhui Province, China.
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000, Anhui Province, China.
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, China.
- Anhui Psychiatric Center, Anhui Medical University, Hefei, Anhui Province, China.
- Anhui Provincial Key Laboratory for Brain Bank Construction and Resource Utilization, Hefei, Anhui Province, China.
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Wescott DL, Hasler BP, Foust JE, Roecklein KA. Circadian realignment and depressed mood: A systematic review. Sleep Med Rev 2025; 79:102022. [PMID: 39608218 PMCID: PMC11751730 DOI: 10.1016/j.smrv.2024.102022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 08/23/2024] [Accepted: 11/03/2024] [Indexed: 11/30/2024]
Abstract
Chronotherapeutic interventions aimed at realigning the circadian system can improve depression. This systematic review evaluated the current evidence for circadian realignment as an antidepressant mechanism. A comprehensive search was conducted in studies that implemented a chronotherapeutic intervention in samples with depression and/or delayed sleep/circadian timing using PubMed, EMBASE, Cochrane Central Register of Controlled Trials (Wiley), Europe PMC, and PsycINFO. The Downs and Black checklist was used to evaluate study quality. There were 58 studies included, of which 23 studies reported the association between realignment and depression. Circadian realignment was associated with improved depression in studies that included participants with baseline delays and elevated depression. Randomized clinical trials measuring circadian phase markers are needed to further elucidate circadian realignment as an antidepressant mechanism.
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Affiliation(s)
- Delainey L Wescott
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Brant P Hasler
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jill E Foust
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Duo LL, Rao GF. Wuling capsule combined with sertraline in the therapy of anxiety and depression with insomnia in adolescents. World J Psychiatry 2024; 14:1860-1867. [PMID: 39704352 PMCID: PMC11622017 DOI: 10.5498/wjp.v14.i12.1860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 10/15/2024] [Accepted: 11/11/2024] [Indexed: 11/27/2024] Open
Abstract
BACKGROUND The treatment of adolescent patients with anxiety, depression and insomnia is challenging, and there is no ideal treatment method. AIM To evaluate the clinical efficacy of Wuling capsule combined with sertraline in the treatment of adolescent anxiety, depression and insomnia. METHODS Eighty adolescent patients with anxiety, depression with insomnia who were admitted to our hospital from April 1, 2022 to March 30, 2024. And the subjects were randomly classified into the control group (n = 40) and the observational group (n = 40). The control group was treated with a combination of sertraline and placebo. The observation group was treated with Wuling capsule in addition to sertraline. The two groups were cured continuously for 8 weeks. Insomnia severity index (ISI), Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were used to evaluate the clinical symptoms before treatment and at 2, 4, 6 and 8 weeks after treatment. The Treatment Emergent Symptom Scale (TESS) was used to evaluate adverse reactions during treatment. RESULTS There was no obvious difference in HAMD, HAMA and ISI scores between the two groups before treatment (P > 0.05). After treatment, the HAMD, HAMA and ISI scores of patients in both groups decreased compared with before treatment, and HAMD, HAMA and ISI scores of patients in the observation group were remarkedly lower than those in the control group at each time point after treatment (P < 0.05). Compared with the control group, the TESS score of the study group were sharply lower (t = 18.239, P < 0.001). CONCLUSION Wuling capsule can further alleviate the insomnia symptoms of adolescents with anxiety and depression, and the efficacy and safety are high. It is recommended to promote the application.
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Affiliation(s)
- Li-Li Duo
- Department of Psychiatry, Taizhou Integrated Traditional Chinese and Western Medicine Hospital, Taizhou 317500, Zhejiang Province, China
| | - Gao-Feng Rao
- Department of Rehabilitation, Taizhou Integrated Traditional Chinese and West Medicine Hospital, Taizhou 317500, Zhejiang Province, China
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Liu L, Tian Y, Fan H, Wang J, Chen C, Liu Z, Geng F, Mo D, Luo X, Wen X, Zhao X, Hao M, Xia L, Liu H. Associations between internet addiction and suicidal ideation in depressed adolescents: the mediating effect of insomnia as well as sex differences. BMC Psychiatry 2024; 24:929. [PMID: 39695507 DOI: 10.1186/s12888-024-06357-z] [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] [Received: 07/13/2024] [Accepted: 11/28/2024] [Indexed: 12/20/2024] Open
Abstract
BACKGROUND Insomnia may mediate the association between internet addiction (IA) and suicidal ideation (SI). However, such association has not been thoroughly investigated in adolescents with major depressive disorder (MDD). Thus, our study aimed to explore whether insomnia significantly affects the association between IA and SI in adolescents with MDD, as well as any sex differences. METHODS From January 2021 to September 2023, this cross-sectional study included 502 adolescents with MDD and 123 healthy controls (HCs). The Clinical Global Impression-Severity (CGI-S), the Internet Addiction Test (IAT), the Insomnia Severity Index Scale (ISI) and the Positive and Negative Suicidal Ideation Scale (PANSI) were used to assess subjects' severity of depression, IA, insomnia and SI. And we employed the PROCESS macro program to examine the mediating role of insomnia between IA and SI. RESULTS Compared to HCs, adolescents with MDD had significantly higher levels of SI and their prevalence of IA and insomnia were 50.0% and 35.7%. In patients, PANSI scores correlated negatively with age and age of onset, and positively with disease duration as well as the scores of the CGI-S, IAT, and ISI (all p < 0.01). Moreover, above-mentioned correlations were more significant in girls. Mediation analyses showed that insomnia mediated the effect of IA on SI, and the total, direct, and indirect effects were 0.197 (95% CI: 0.132-0.262), 0.157 (95% CI: 0.096-0.218) and 0.040 (95% CI: 0.014-0.068), respectively. In female patients, the total, direct, and indirect effects were 0.224 (95% CI: 0.151-0.296), 0.191 (95% CI: 0.124-0.257) and 0.033 (95% CI: 0.002-0.068), respectively. In male patients, insomnia acted as a fully mediated effect between IA and SI, with an effect value of 0.045 (95% CI: 0.008-0.093). CONCLUSION Depressed adolescents have higher suicide risk, and SI is significantly associated with IA and insomnia, especially in girls. Moreover, insomnia may mediate the association between IA and SI. However, given the small sample size of this study and the limitations of assessment tools used, the results need to be viewed with caution. Regardless, clinical interventions should be strengthened for IA and insomnia in adolescents with MDD to reduce suicide risk.
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Affiliation(s)
- Lewei Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000, Anhui Province, China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, 238000, Anhui Province, China
| | - Yinghan Tian
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000, Anhui Province, China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, 238000, Anhui Province, China
| | - Haojie Fan
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000, Anhui Province, China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, 238000, Anhui Province, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230000, Anhui Province, China
| | - Jiawei Wang
- Department of Psychiatry, Bozhou People's Hospital, Bozhou, 236800, Anhui, China
| | - Changhao Chen
- Department of Psychiatry, Suzhou Second People's Hospital, Suzhou, 234099, Anhui, China
| | - Zhiwei Liu
- Department of Psychiatry, Fuyang Third People's Hospital, Fuyang, 236044, Anhui, China
| | - Feng Geng
- Department of Psychology and Sleep Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, 230000, Anhui Province, China
| | - Daming Mo
- Department of Psychiatry, Hefei Fourth People's Hospital, Hefei, 230000, Anhui Province, China
| | - Xiangfen Luo
- Department of Psychiatry, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, 233040, Anhui, China
| | - Xiangwang Wen
- Department of Psychiatry, Ma'anshan Fourth People's Hospital, Ma'anshan, 243031, Anhui, China
| | - Xin Zhao
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000, Anhui Province, China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, 238000, Anhui Province, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230000, Anhui Province, China
| | - Mingru Hao
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000, Anhui Province, China
- Anhui Psychiatric Center, Anhui Medical University, Hefei, 238000, Anhui Province, China
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, 230000, Anhui Province, China
| | - Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000, Anhui Province, China.
- Anhui Psychiatric Center, Anhui Medical University, Hefei, 238000, Anhui Province, China.
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, 64 Chaohu North Road, Hefei, 238000, Anhui Province, China.
- Anhui Psychiatric Center, Anhui Medical University, Hefei, 238000, Anhui Province, China.
- Anhui Provincial Key Laboratory for Brain Bank Construction and Resource Utilization, Hefei, 230000, Anhui Province, China.
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Mei Z, Cai C, Luo S, Zhang Y, Lam C, Luo S. The efficacy of cognitive behavioral therapy for insomnia in adolescents: a systematic review and meta-analysis of randomized controlled trials. Front Public Health 2024; 12:1413694. [PMID: 39628800 PMCID: PMC11613502 DOI: 10.3389/fpubh.2024.1413694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 10/31/2024] [Indexed: 12/06/2024] Open
Abstract
Objective The objective of this systematic review and meta-analysis was to evaluate the overall efficacy of cognitive behavioral therapy for insomnia (CBT-I) in treating insomnia in adolescents, and to examine the efficacy of CBT-I on different sleep-related outcomes in this population. Methods Randomized controlled trials (RCTs) of CBT-I on insomnia in adolescents were identified using electronic databases and manual searches. The Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess risk of bias in RCTs. A standardized mean difference (SMD) with a 95% confidence interval (CI) was used to combine effect sizes. A sensitivity analysis was performed for each outcome using a stepwise elimination method to assess whether the pooled results were significantly affected by individual studies. Results The analysis included 8 RCTs involving a total of 599 participants. The meta-analysis indicated that marked and statistically significant improvements in insomnia (SMD = -1.06; 95% CI -1.65 to -0.47; p < 0.01), sleep onset latency (SMD = -0.99; 95% CI -1.65 to -0.32; p < 0.01), total sleep time (SMD = 0.50; 95% CI 0.10 to 0.90; p = 0.01), and sleep efficiency (SMD = 0.57; 95% CI 0.26 to 0.87; p < 0.01) were observed at post-treatment time point following CBT-I. At follow-up time point, a statistically significant improvement in insomnia (SMD = -0.79; 95% CI -1.42 to -0.17; p = 0.01) was observed following CBT-I. Conclusion CBT-I was effective in improving insomnia in adolescents and some sleep-related outcomes, including sleep onset latency, total sleep time, and sleep efficiency. CBT-I was characterized by low risk and high therapeutic benefits and could serve as alternative or adjuvant approaches to medication for the treatment of insomnia. Considering the advantages in terms of safety and efficacy, CBT-I should be the preferred intervention for the treatment of insomnia in adolescents. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, CRD42024526102.
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Affiliation(s)
- Zhengyang Mei
- School of Physical Education, Southwest University, Chongqing, China
| | - Chenyi Cai
- School of Physical Education, Southwest University, Chongqing, China
| | - Shulai Luo
- School of Physical Education, Southwest University, Chongqing, China
| | - Yuanzhuo Zhang
- School of Physical Education, Southwest University, Chongqing, China
| | - Chifong Lam
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing, China
| | - Shi Luo
- School of Physical Education, Southwest University, Chongqing, China
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Rollinson R, Cole A, Gee B, Tofan I, Graham A, Hatton J, Lyons J, Reeve S, Wilson J, Beardsworth K, Clarke T. Delivering a sleep intervention across a youth mental health service using non-expert practitioners: A service evaluation. Early Interv Psychiatry 2024; 18:950-959. [PMID: 38703076 DOI: 10.1111/eip.13534] [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] [Received: 01/10/2024] [Revised: 03/26/2024] [Accepted: 04/08/2024] [Indexed: 05/06/2024]
Abstract
AIMS Poor sleep is highly prevalent in young people and increases risk of mental health difficulties, yet access to sleep interventions remains limited. This paper evaluates the use of a sleep intervention delivered by non-expert practitioners in a secondary care youth mental health service. METHOD Assistant psychologists were trained to deliver a six-session 1:1 cognitive-behavioural sleep intervention adapted for use with young people with mental health difficulties. A within-subject design assessed clinical outcomes relating to sleep (Insomnia Severity Index), psychological distress and personal goals (Goal Based Outcome Measures) at four time points. RESULTS High referral, intervention take-up (82.82%) and completion (70%) rates were reported, together with high baseline levels of insomnia (Insomnia Severity Index mean 20.47, SD 3.68) and poor sleep efficiency (56.36%, SD 17.23). Fifty-six young people (average age 19.2 years, SD 3.25) were included in the outcome analysis. Statistically and clinically significant improvements were seen across all outcome measures, with 68% no longer meeting clinical threshold (ISI ≥15) for insomnia at endpoint. CONCLUSIONS This study demonstrates exceptionally high levels of clinical need and engagement with a sleep intervention adapted specifically for young people with mental health difficulties. Whilst limited by the uncontrolled design, large improvements in insomnia and psychological distress support its effectiveness and utility in clinical settings. More robust implementation and evaluation is warranted in broader youth mental health services to promote earlier access.
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Affiliation(s)
- Rebecca Rollinson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Amber Cole
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Brioney Gee
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Ioana Tofan
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Adam Graham
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Jude Hatton
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Jonathan Lyons
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Sarah Reeve
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
- Cambridgeshire and Peterborough NHS FoundationTrust, Cambridge, Cambridgeshire, UK
| | - Jonathan Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | | | - Tim Clarke
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
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Crowther ME, Saunders WJ, Sletten TL, Drummond SPA, Bei B. Tailoring cognitive behavioural therapy for insomnia across contexts, conditions, and individuals: What do we know, where do we go? J Sleep Res 2023; 32:e14023. [PMID: 37641983 DOI: 10.1111/jsr.14023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
Cognitive behavioural therapy for insomnia (CBT-I) is considered the front-line treatment for insomnia. Despite the demonstrated effectiveness of CBT-I, it is necessary to consider how CBT-I may be tailored to different individuals. The purpose of the present review is to provide a summary of literature on tailoring CBT-I to different individuals and provide directions for future research. This review focused on the following domains of adaptation: (i) tailoring CBT-I components to individuals with comorbid mental or physical health conditions such as comorbid depression and pain; (ii) adapting CBT-I delivery for different contexts in which individuals exist, such as inpatient, educational, and different social/cultural settings, (iii) adapting CBT-I to specific individuals via case-formulation in clinical settings. We highlight current gaps in the exploration of tailored CBT-I, including a lack of research methodology to evaluate tailored interventions, a need for the integration of ongoing individualised assessment to inform treatment, and the necessary involvement of consumers and stakeholders throughout the research and treatment development process. Together, this review showed abundant adaptations in CBT-I already exist in the literature. Future research is needed in understanding when and how to apply adaptations in CBT-I and evaluate the benefits of these adaptations.
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Affiliation(s)
- Meagan E Crowther
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - William J Saunders
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Tracey L Sletten
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Sean P A Drummond
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Bei Bei
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
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Mathews A, Gibbons N, Harrison E, C Ukoumunne O, Stallard P. A feasibility study to explore the use of digital treatment of sleep as a first-step intervention to improve adolescent mental health. Behav Sleep Med 2023; 21:172-184. [PMID: 35435785 DOI: 10.1080/15402002.2022.2063866] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Cognitive behavior therapy for insomnia (CBTi), delivered face-to-face or digitally, can improve the mental health of adults. Although insomnia is common in adolescents, the effects of digital CBTi on adolescent mental health have seldom been investigated. OBJECTIVES The aims of this study were to explore: (i) the acceptability of a digital CBTi intervention, Sleepio, as a first-step intervention for adolescents referred to specialist mental health services (CAMHS), (ii) the impact on sleep and mental health and (iii) subsequent CAMHS interventions. METHOD Sleepio is a computerized CBTi intervention comprised of six sequentially delivered sessions. Digital Sleepio was offered to new referrals to CAMHS with poor sleep and mental health problems. Results. Of the 75 eligible adolescents, 70 (93%; 95% CI: 85% to 98%) accepted Sleepio with 59 starting the programme and consenting to participate in the study. Of these, 37 (63%; 95% CI: 49% to 75%) completed at least half of the programme. There were post-intervention improvements in sleep, mood, and anxiety; the improvement in sleep was greater for those who completed at least half the programme compared to those who did not. Of those who completed all the programme, 55% (15/29) did not need any subsequent specialist CAMHS input. Of the 11 adolescents who accepted but never started Sleepio, none engaged with other CAMHS interventions and were subsequently discharged. CONCLUSION Our study has a number of limitations, in particular the absence of a control group and the loss of follow-up data for programme drop-outs. Nonetheless, these results suggest that digital CBTi may offer a novel and acceptable way of improving the sleep and mental health of adolescents with insomnia. A fully powered randomized controlled trial is required to obtain definitive estimates of the effects of the intervention.
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Affiliation(s)
| | - Naomi Gibbons
- Oxford Health NHS Foundation Trust, Child and Adolescent Mental Health Services
| | - Emma Harrison
- Oxford Health NHS Foundation Trust, Child and Adolescent Mental Health Services
| | | | - Paul Stallard
- Department of Health, University of Bath, Bath, UK.,Oxford Health NHS Foundation Trust, Child and Adolescent Mental Health Services
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Sleep problems predict next-day suicidal thinking among adolescents: A multimodal real-time monitoring study following discharge from acute psychiatric care. Dev Psychopathol 2021. [DOI: 10.1017/s0954579421000699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractSuicidal thoughts and behaviors (STBs) are major public health concerns among adolescents, and research is needed to identify how risk is conferred over the short term (hours and days). Sleep problems may be associated with elevated risk for STBs, but less is known about this link in youth over short time periods. The current study utilized a multimodal real-time monitoring approach to examine the association between sleep problems (via daily sleep diary and actigraphy) and next-day suicidal thinking in 48 adolescents with a history of STBs during the month following discharge from acute psychiatric care. Results indicated that specific indices of sleep problems assessed via sleep diary (i.e., greater sleep onset latency, nightmares, ruminative thoughts before sleep) predicted next-day suicidal thinking. These effects were significant even when daily sadness and baseline depression were included in the models. Moreover, several associations between daily-level sleep problems and next-day suicidal thinking were moderated by person-level measures of the construct. In contrast, sleep indices assessed objectively (via actigraphy) were either not related to suicidal thinking or were related in the opposite direction from hypothesized. Together, these findings provide some support for sleep problems as a short-term risk factor for suicidal thinking in high-risk adolescents.
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Becker SP, Dvorsky MR, Breaux R, Cusick CN, Taylor KP, Langberg JM. Prospective Examination of Adolescent Sleep Patterns and Behaviors Before and During COVID-19. Sleep 2021; 44:6149938. [PMID: 33631014 PMCID: PMC7928571 DOI: 10.1093/sleep/zsab054] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/19/2021] [Indexed: 12/19/2022] Open
Abstract
Study Objectives To prospectively examine changes in adolescent sleep before and during the COVID-19 pandemic in adolescents with and without ADHD. Methods Participants were 122 adolescents (ages 15–17; 61% male; 48% with ADHD). Parents reported on adolescents’ sleep duration and difficulties initiating and maintaining sleep (DIMS); adolescents reported on sleep patterns, sleep duration, delayed sleep/wake behaviors, and daytime sleepiness before (September 2019 to February 2020) and during (May–June 2020) COVID-19. Adolescents also reported on their health behaviors, COVID-19-related negative affect, and difficulties concentrating due to COVID-19. Results Parents reported adolescents had more DIMS during COVID-19 than before COVID-19, with clinically elevated rates increasing from 24% to 36%. Both bedtimes and waketimes shifted later during COVID-19, and adolescents reported more delayed sleep/wake behaviors. Adolescents also reported less daytime sleepiness and longer school night sleep duration during COVID-19. In considering differences between adolescents with and without ADHD, adolescents with ADHD did not experience an increase in school night sleep duration and were less likely to obtain recommended sleep duration during COVID-19. In the full sample, controlling for ADHD status, COVID-19-related sadness/loneliness was associated with increases in DIMS, and spending less time outside and more COVID-19-related worries/fears were associated with increases in delayed sleep/wake behaviors during COVID-19. Conclusions COVID-19 had negative and positive impacts on adolescent sleep. Adolescents with ADHD did not experience the benefit of increased school night sleep duration during COVID-19 like adolescents without ADHD. Negative affect and health behaviors may be useful intervention targets for reducing negative impacts of COVID-19 for adolescent sleep.
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Affiliation(s)
- Stephen P Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Melissa R Dvorsky
- Division of Psychology and Behavioral Health, Children's National Hospital, Washington, DC, USA
| | - Rosanna Breaux
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA
| | - Caroline N Cusick
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Katherine P Taylor
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Joshua M Langberg
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
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11
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Low-intensity sleep intervention in a youth mental health service: a case series analysis. Behav Cogn Psychother 2020; 49:62-75. [PMID: 32843122 DOI: 10.1017/s135246582000051x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is increasing evidence of a strong association between sleep and mental health in both adolescents and adults. CBT for insomnia is being applied to good effect with adults with mental health difficulties but there are few studies examining its applicability to adolescents within mental health services. METHOD We carried out a case series analysis (n = 15) looking at the feasibility, accessibility and impact of a low-intensity sleep intervention for young people (14-25 years) being seen by a secondary care Youth Mental Health team in the UK. The intervention was based on cognitive behavioural therapy for insomnia (CBTi) and acceptance and commitment therapy (ACT) approaches and involved six individual sessions delivered on a weekly basis by a graduate psychologist. Routine outcome measures were used to monitor insomnia, psychological distress and functioning with assessments at baseline, session 3, session 6 and at 4 weeks after end of intervention. All participants scored in the clinical range for insomnia at the start of the study. RESULTS High uptake, attendance and measure completion rates were observed. Large effect sizes were observed for insomnia, psychological distress and functioning. Twelve of the fifteen participants (80%) no longer scored above threshold for insomnia at follow-up. All seven under-18s no longer met threshold for clinical 'caseness' on the Revised Child Anxiety and Depression Scale (RCADS) at follow-up. DISCUSSION The findings suggest that the intervention was well accepted by young people and feasible to apply within a secondary care setting. Strong effect sizes are encouraging but are probably inflated by the small sample size, uncontrolled design and unblinded assessments.
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12
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Cliffe B, Croker A, Denne M, Smith J, Stallard P. Digital Cognitive Behavioral Therapy for Insomnia for Adolescents With Mental Health Problems: Feasibility Open Trial. JMIR Ment Health 2020; 7:e14842. [PMID: 32134720 PMCID: PMC7078631 DOI: 10.2196/14842] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/21/2019] [Accepted: 12/16/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Insomnia in adolescents is common, persistent, and associated with poor mental health including anxiety and depression. Insomnia in adolescents attending child mental health services is seldom directly treated, and the effects of digital cognitive behavioral therapy (CBT) for insomnia (CBTi) on the mental health of adolescents with significant mental health problems are unknown. OBJECTIVE This open study aimed to assess the feasibility of adding supported Web-based CBT for insomnia to the usual care of young people aged 14 to 17 years attending specialist child and adolescent mental health services (CAMHS). METHODS A total of 39 adolescents with insomnia aged 14 to 17 years attending specialist CAMHS were assessed and offered digital CBTi. The digital intervention was Sleepio, an evidence-based, self-directed, fully automated CBTi that has proven effective in multiple randomized controlled trials with adults. Self-report assessments of sleep (Sleep Condition Indicator [SCI], Insomnia Severity Scale, and Web- or app-based sleep diaries), anxiety (Revised Child Anxiety and Depression Scale [RCADS]), and depression (Mood and Feelings Questionnaire [MFQ]) were completed at baseline and post intervention. Postuse interviews assessed satisfaction with digital CBTi. RESULTS Average baseline sleep efficiency was very poor (53%), with participants spending an average of 9.6 hours in bed but only 5.1 hours asleep. All participants scored less than 17 on the SCI, with 92% (36/39) participants scoring 15 or greater on the Insomnia Severity Scale, suggesting clinical insomnia. Of the 39 participants, 36 (92%) scored 27 or greater on the MFQ for major depression and 20 (51%) had clinically elevated symptoms of anxiety. The majority of participants (38/49, 78%) were not having any treatment for their insomnia, with the remaining 25% (12/49) receiving medication. Sleepio was acceptable, with 77% (30/39) of the participants activating their account and 54% (21/39) completing the program. Satisfaction was high, with 84% (16/19) of the participants finding Sleepio helpful, 95% (18/19) indicating that they would recommend it to a friend, and 37% (7/19) expressing a definite preference for a digital intervention. Statistically significant pre-post improvements were found in weekly diaries of sleep efficiency (P=.005) and sleep quality (P=.001) and on measures of sleep (SCI: P=.001 and Insomnia Severity Index: P=.001), low mood (MFQ: P=.03), and anxiety (RCADS: P=.005). CONCLUSIONS Our study has a number of methodological limitations, particularly the small sample size, absence of a comparison group and no follow-up assessment. Nonetheless, our findings are encouraging and suggest that digital CBTi for young people with mental health problems might offer an acceptable and an effective way to improve both sleep and mental health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/11324.
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Affiliation(s)
- Bethany Cliffe
- Department of Health, University of Bath, Bath, United Kingdom
| | - Abigail Croker
- Child and Adolescent Mental Health Service, Oxford Health NHS Foundation Trust, Temple House, Keynsham, United Kingdom
| | - Megan Denne
- Child and Adolescent Mental Health Service, Oxford Health NHS Foundation Trust, Temple House, Keynsham, United Kingdom
| | - Jacqueline Smith
- Child and Adolescent Mental Health Service, Oxford Health NHS Foundation Trust, Temple House, Keynsham, United Kingdom
| | - Paul Stallard
- Department of Health, University of Bath, Bath, United Kingdom
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13
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Quartly-Scott GI, Miller CB, Hawes DJ. A brief behavioral treatment for unresolved insomnia in adolescents: a single-case multiple baseline pilot study, evaluating self-reported outcomes of efficacy, safety, and acceptability. J Clin Sleep Med 2019; 16:97-105. [PMID: 31957660 DOI: 10.5664/jcsm.8132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Insomnia is a significant problem for many adolescents and often is associated with detrimental effects on physical and mental health. Drawing on emerging models of intervention in the adult literature, this pilot study investigated the efficacy, safety, and acceptability of a novel, brief (3-week) behavioral intervention among adolescents with unresolved chronic insomnia. METHODS A multiple baseline (staggered start) A-B with follow-up single-case design (n = 2) was used to evaluate intervention outcomes across treatment and at 2-month follow-up in the domains of sleep, mood and affect, fatigue, and parent-child conflict. Outcomes were indexed with multi-informant data collected using adolescent reports on mood/affect and sleep diaries, and parent reports on parent-child conflict. RESULTS Posttreatment and 2-month follow-up data indicated improvements in self-reported sleep quality, including sleep onset latency and increased sleep efficiency. Indicators related to participant mood, stress, and parent-child interactions remained relatively stable over the course of treatment, suggesting that the sleep restriction component of the intervention did not produce adverse effects for the adolescents or their families. CONCLUSIONS A brief 3-week intervention adapted from the adult literature was associated with improved sleep-wake cycles in adolescents with chronic insomnia. Change during the treatment phase was particularly rapid and maintained over time. In conjunction with low observed risk and adverse effects, the potential for this treatment to provide a safe, acceptable, and cost-effective manualized treatment for adolescent insomnia warrants larger-scale clinical evaluation. CLINICAL TRIAL REGISTRATION Registry: Australian New Zealand Clinical Trials Registry; Title: Does a one month brief behavioral treatment improve sleep for high school adolescents (ages 12-17): an open label pilot study; Identifier: ACTRN12618000835246; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375102.
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Affiliation(s)
| | - Christopher B Miller
- Nuffield Department of Clinical Neurosciences, Sleep and Circadian Neuroscience Institute, Sir William Dunn School of Pathology, University of Oxford, Oxford, United Kingdom
| | - David J Hawes
- Clinical Psychology Unit, School of Psychology, The University of Sydney, Sydney, Australia
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14
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Cliffe B, Croker A, Denne M, Stallard P. Supported Web-Based Guided Self-Help for Insomnia for Young People Attending Child and Adolescent Mental Health Services: Protocol for a Feasibility Assessment. JMIR Res Protoc 2018; 7:e11324. [PMID: 30545814 PMCID: PMC6315243 DOI: 10.2196/11324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/16/2018] [Accepted: 08/16/2018] [Indexed: 01/16/2023] Open
Abstract
Background Sleep disturbance in adolescents is common, with up to one-third reporting significant symptoms of insomnia. Research with adults has demonstrated that Web-based cognitive behavioral therapy for insomnia (CBTi) can improve both sleep and mental health. However, research with adolescents is lacking, and we know little about whether CBTi would have similar effects on this younger population. Objective This paper summarizes the protocol of a study to assess the feasibility of adding supported Web-based CBTi to the usual care of young people aged 14-17 years attending specialist Child and Adolescent Mental Health Services (CAMHS). Methods This is an open trial where we will recruit young people (N=50) aged 14-17 years attending specialist CAMHS with primary or comorbid symptoms of insomnia. In addition to their usual care, young people will be provided with Sleepio, a 6-session, Web-based CBTi self-help program for insomnia. Sleepio teaches a range of techniques including sleep hygiene, relaxation training, stimulus control, sleep restriction, and cognitive techniques that participants will be helped to apply through brief, weekly telephone support calls. Questionnaires and interviews will be completed at baseline and postintervention (8-10 weeks) and will assess sleep, symptoms of depression and anxiety, and acceptability of Sleepio and telephone support. Results Recruitment started in May 2018 and continued until the end of October 2018. Conclusions This study will provide preliminary evidence about whether supported Web-based CBTi is acceptable to young people with mental health problems and about the postintervention effects on sleep and symptoms of anxiety and depression. This information will determine whether a randomized trial to determine the effectiveness of Sleepio should be undertaken. International Registered Report Identifier (IRRID) DERR1-10.2196/11324
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Affiliation(s)
- Bethany Cliffe
- Department for Health, University of Bath, Bath, United Kingdom
| | - Abigail Croker
- Child and Family Service, Oxford Health National Health Services Foundation Trust, Keynsham, United Kingdom
| | - Megan Denne
- Child and Family Service, Oxford Health National Health Services Foundation Trust, Keynsham, United Kingdom
| | - Paul Stallard
- Department for Health, University of Bath, Bath, United Kingdom
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15
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Smith MT, McCrae CS, Cheung J, Martin JL, Harrod CG, Heald JL, Carden KA. Use of Actigraphy for the Evaluation of Sleep Disorders and Circadian Rhythm Sleep-Wake Disorders: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment. J Clin Sleep Med 2018; 14:1209-1230. [PMID: 29991438 DOI: 10.5664/jcsm.7228] [Citation(s) in RCA: 271] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on the use of actigraphy. METHODS The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine. A systematic review was conducted to identify studies that compared the use of actigraphy, sleep logs, and/or polysomnography. Statistical analyses were performed to determine the clinical significance of using actigraphy as an objective measure of sleep and circadian parameters. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence for making recommendations. RESULTS The literature search resulted in 81 studies that met inclusion criteria; all 81 studies provided data suitable for statistical analyses. These data demonstrate that actigraphy provides consistent objective data that is often unique from patient-reported sleep logs for some sleep parameters in adult and pediatric patients with suspected or diagnosed insomnia, circadian rhythm sleep-wake disorders, sleep-disordered breathing, central disorders of hypersomnolence, and adults with insufficient sleep syndrome. These data also demonstrate that actigraphy is not a reliable measure of periodic limb movements in adult and pediatric patients. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations.
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Affiliation(s)
| | | | - Joseph Cheung
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, California
| | - Jennifer L Martin
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California.,VA Greater Los Angeles Healthcare System, Geriatric Research, Education and Clinical Center, Los Angeles, California
| | | | | | - Kelly A Carden
- Saint Thomas Medical Partners-Sleep Specialists, Nashville, Tennessee
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