Background A growing body of evidence supports the efficacy of measurement-based care (MBC) for children and adolescents experiencing mental health concerns, particularly anxiety and depression. In recent years, MBC has increasingly transitioned to web-based spaces in the form of digital mental health interventions (DMHIs), which render high-quality mental health care more accessible nationwide. Although extant research is promising, the emergence of MBC DMHIs means that much is unknown regarding their effectiveness as a treatment for anxiety and depression, particularly among children and adolescents. Objective This study uses preliminary data from children and adolescents participating in an MBC DMHI administered by Bend Health Inc, a mental health care provider that uses a collaborative care model to assess changes in anxiety and depressive symptoms during participation in the MBC DMHI. Methods Caregivers of children and adolescents participating in Bend Health Inc for anxiety or depressive symptoms reported measures of their children’s symptoms every 30 days throughout the duration of participation in Bend Health Inc. Data from 114 children (age 6-12 years) and adolescents (age 13-17 years) were used for the analyses (anxiety symptom group: n=98, depressive symptom group: n=61). Results Among children and adolescents participating in care with Bend Health Inc, 73% (72/98) exhibited improvements in anxiety symptoms and 73% (44/61) exhibited improvement in depressive symptoms, as indicated by either a decrease in symptom severity or screening out of completing the complete assessment. Among those with complete assessment data, group-level anxiety symptom T-scores exhibited a moderate decrease of 4.69 points (P=.002) from the first to the last assessment. However, members’ depressive symptom T-scores remained largely stable throughout their involvement. Conclusions As increasing numbers of young people and families seek DMHIs over traditional mental health treatments due to their accessibility and affordability, this study offers promising early evidence that youth anxiety symptoms decrease during involvement in an MBC DMHI such as Bend Health Inc. However, further analyses with enhanced longitudinal symptom measures are necessary to determine whether depressive symptoms show similar improvements among those involved in Bend Health Inc.

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Background Attention-deficit/hyperactivity disorder (ADHD) and associated behavioral disorders are highly prevalent in children and adolescents, yet many of them do not receive the care they need. Digital mental health interventions (DMHIs) may address this need by providing accessible and high-quality care. Given the necessity for high levels of caregiver and primary care practitioner involvement in addressing ADHD symptoms and behavioral problems, collaborative care interventions that adopt a whole-family approach may be particularly well suited to reduce symptoms of inattention, hyperactivity, and opposition in children and adolescents. Objective The purpose of this study is to use member (ie, child and adolescent) data from Bend Health, Inc, a collaborative care DMHI that uses a whole-family approach to address child and adolescent mental health concerns, to (1) determine the effects of a collaborative care DMHI on inattention, hyperactivity, and oppositional symptoms in children and adolescents and (2) assess whether the effects of a collaborative care DMHI vary across ADHD subtypes and demographic factors. Methods Caregivers of children and adolescents with elevated symptoms of inattention, hyperactivity, or opposition assessed their children’s symptom severity approximately every 30 days while participating in Bend Health, Inc. Data from 107 children and adolescents aged 6-17 years who exhibited clinically elevated symptoms at baseline were used to assess symptom severity across monthly assessments (inattention symptom group: n=91, 85.0%; hyperactivity symptom group: n=48, 44.9%; oppositional symptom group: n=70, 65.4%). The majority of the sample exhibited elevated symptoms of at least 2 symptom types at baseline (n=67, 62.6%). Results Members received care for up to 5.52 months and attended between 0 and 10 coaching, therapy, or psychiatry sessions through Bend Health, Inc. For those with at least 2 assessments, 71.0% (n=22) showed improvements in inattention symptoms, 60.0% (n=9) showed improvements in hyperactivity symptoms, and 60.0% (n=12) showed improvements in oppositional symptoms. When considering group-level change over time, symptom severity decreased over the course of treatment with Bend Health, Inc, for inattention (average decrease=3.51 points, P=.001) and hyperactivity (average decrease=3.07 points, P=.049) but not for oppositional symptoms (average decrease=0.70 points, P=.26). There was a main effect of the duration of care on symptom severity (P<.001) such that each additional month of care was associated with lower symptom scores. Conclusions This study offers promising early evidence that collaborative care DHMIs may facilitate improvements in ADHD symptoms among children and adolescents, addressing the growing need for accessible and high-quality care for behavioral health problems in the United States. However, additional follow-up studies bolstered by larger samples and control groups are necessary to further establish the robustness of these findings.

Context Sleep loss in men increases cortisol and decreases testosterone, and sleep restriction by 3–4 h/night induces insulin resistance. Objective We clamped cortisol and testosterone and determined the effect on insulin resistance. Design and Setting Randomized double-blind, in-laboratory crossover study. Participants 34 healthy young men. Intervention 4 nights of sleep restriction (SR) of 4 hours/night under two treatment conditions in random order: dual hormone clamp (cortisol and testosterone fixed), or matching placebo (cortisol and testosterone not fixed). Main Outcome Measures Fasting blood samples, and an additional 23 samples for a 3-hour oral glucose tolerance test (OGTT), were collected before and after SR under both treatment conditions. Cytokines and hormones were measured from the fasting samples. Overall insulin sensitivity was determined from the OGTT by combining complementary measures: homeostasis model assessment of insulin resistance of the fasting state; Matsuda Index of the absorptive state, and; minimal model of both fasting and absorptive states. Results SR alone induced hyperinsulinemia, hyperglycemia and overall insulin resistance (P&lt;0.001 for each). Clamping cortisol and testosterone alleviated the development of overall insulin resistance (p=0.046) and hyperinsulinemia (p=0.014) by 50%. Interleukin-6, high sensitivity C-reactive protein, peptide YY, and ghrelin did not change, whereas tumor necrosis factor-α and leptin changed in directions that would have mitigated insulin resistance with SR alone. Conclusions Fixing cortisol-testosterone exposure mitigates the development of insulin resistance and hyperinsulinemia, but not hyperglycemia, from sustained SR in men. The interplay between cortisol and testosterone may be important as a mechanism by which SR impairs metabolic health.

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Summary Sleep deprivation consistently decreases vigilant attention, which can lead to difficulty in performing a variety of cognitive tasks. However, sleep‐deprived individuals may be able to compensate for degraded vigilant attention by means of top‐down attentional control. We employed a novel task to measure the degree to which individuals overcome impairments in vigilant attention by using top‐down attentional control, the Flexible Attentional Control Task (FACT). The FACT is a two‐choice task that has trials with valid, invalid, and neutral cues, along with an unexpected switch in the probability of cue validity about halfway in the task. The task provides indices that isolate performance components reflecting vigilant attention and top‐down attentional control. Twelve healthy young adults completed an in‐laboratory study. After a baseline day, the subjects underwent 39 hours of total sleep deprivation (TSD), followed by a recovery day. The FACT was administered at 03:00, 11:00, and 19:00 during sleep deprivation (TSD condition) and at 11:00 and 19:00 after baseline sleep and at 11:00 after recovery sleep (rested condition). When rested, the subjects demonstrated both facilitation and interference effects on cued trials. While sleep deprived, the subjects showed vigilant attention deficits on neutral cue trials, and an impaired ability to reduce these deficits by using predictive contextual cues. Our results indicate that the FACT can dissociate vigilant attention from top‐down attentional control. Furthermore, they show that during sleep deprivation, contextual cues help individuals to compensate partially for impairments in vigilant attention, but the effectiveness of top‐down attentional control is diminished.

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Introduction Military operations frequently take place in complex, volatile, and ambiguous environments, where important information may be uncertain. These circumstances are often highly stressful, and fatiguing due to sustained operations, shift work, sleep loss, and the taxing nature of the work. As a crucial part of their preparation for leading U.S. Navy sailors, prospective executive officers (PXOs) in the Surface Warfare community receive training at the Surface Warfare Schools Command (SWSC). At the request of SWSC, the NPS research team was asked to assess the stress loads of SWO students during their expanded 10-week training course, which included the implementation of a stress inoculation training (SIT) program. Methods SWOs (N=50) attending the Prospective Executive Officer (PXO) Course at SWSC participated in a quasi-experimental longitudinal study. They completed questionnaires three times during the PXO course: at the beginning of the study, at the mid-point, and at the end of the course. Standardized tools were used to assess perceived stress levels (Perceived Stress Scale – PSS), depression symptoms (Patient Health Questionnaire – PHQ-8), anxiety (General Anxiety Disorder questionnaire – GAD-7), and mood (Profile of Mood States – POMS). Sleep attributes were assessed by wearable devices (ŌURA rings). Results Overall, the scores of SWOs on the PSS, PHQ-8, GAD-7, and POMS were lower or equivalent to scores reported for the general population. However, reported levels of perceived stress increased significantly from the beginning to the end of the PXO course (average PSS=9 vs 12). However, PHQ-8, GAD-7, and POMS scores remained stable across the three time points. On average, PXOs received 6.6 ± 0.65 hours of sleep per night on weeknights at SWSC, with about one additional hour of sleep on weekends. Conclusion These findings indicate that, while SWOs experienced an increase in perceived stress during the PXO course, their overall well-being is not substantively different from the general population. Participants appear to use weekends for additional restorative sleep, obtaining adequate amounts of sleep on weekends. We did not observe evidence of impairments in mental or physical wellness of SWOs attending the PXO course at SWSC. Support (if any)