Objective: Cognitive-behavioral therapy for insomnia (CBT-I) is an effective insomnia treatment but has yet to be applied to adolescents with sleep disruption following concussion. This pilot study evaluated CBT-I to improve insomnia in adolescents with protracted concussion recovery. Setting: Tertiary pediatric hospital. Participants: Participants (N = 24) were 12 to 18 years old (M = 15.0, SD = 1.4), 15.1 weeks (SD = 9.2) postinjury, and presenting with sleep disruption and persistent postconcussion symptoms. Design: A single-blind, parallel-group randomized controlled trial (RCT) design comparing 6 weeks of CBT-I and a treatment-as-usual control group. Outcomes were measured before treatment, at treatment completion, and 4 weeks after completion. Main Measures: Primary outcome was Insomnia Severity Index. Secondary outcomes included Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes about Sleep Scale, 7-night sleep diary, PROMIS Depression, PROMIS Anxiety, and Health and Behavior Inventory. Results: Adolescents who received CBT-I demonstrated large and clinically significant improvements in insomnia ratings at posttreatment that were maintained at follow-up. They also reported improved sleep quality, fewer dysfunctional beliefs about sleep, better sleep efficiency, shorter sleep-onset latency, and longer sleep time compared with those with treatment as usual. There was also a modest reduction in postconcussion symptoms. Conclusion: In this pilot RCT, 6 weeks of CBT-I produced significant improvement in sleep in adolescents with persistent postconcussion symptoms. A larger trial is warranted.
Aim: To investigate sleep behaviours of youth at-risk for serious mental illness (SMI).Methods: This study included 243 youth, ages 12 to 25:42 healthy controls, 41 asymptomatic youth at-risk for mental illness (stage 0); 53 help-seeking youth experiencing distress (stage 1a) and 107 youth with attenuated syndromes (stage 1b). The Pittsburgh Sleep Quality Index was used to assess sleep dysfunction. Results: Stage 1b individuals indicated the greatest deficit in global sleep dysfunction (F = 26.18, P < .0001). Stages 1a and 1b reported significantly worse subjective sleep quality, a longer sleep latency, increased use of sleep medications as well as greater daytime dysfunction compared to the asymptomatic groups.Conclusion: Research investigating sleep behaviours of youth considered to be atrisk for SMI is limited. This study provides early evidence that sleep disturbances are worse for individuals considered to be at higher risk of illness development.
Background: Sleep disturbances are common across many mental health disorders, with evidence suggesting a bidirectional relationship. Furthermore, there is evidence of a significant association between sleep disruption and worse symptomology in disorders such as anxiety, depression, and psychosis. Additionally, research has demonstrated the negative impact of stress and stressful life events on psychiatric illness progression. However, little is known about possible links between sleep disturbance and these psychiatric symptoms, ongoing stress, stressful life events and functioning, especially in adolescence and early adulthood, a time when many mental illnesses first begin. Exploring these relationships may allow for a better understanding of the role sleep disruption plays in the early stages of illness. Objective: The objective of this study is to investigate potential correlates of sleep disturbance in youth experiencing subthreshold psychiatric symptoms. Methods: This study included 160 youth, ages 12 to 25 who were help seeking due to experiencing distress, mild symptoms of anxiety or depression, and/or attenuated syndromes such as clinical high risk for psychosis. Youth meeting criteria for full psychiatric diagnoses were excluded. The Pittsburgh Sleep Quality Index was used to assess sleep disruption. A range of clinical symptoms were assessed using the Scale for Assessment of Psychosis-Risk Symptoms, The Calgary Depression Scale for Schizophrenia and the Generalized Anxiety Disorder 7-Item Scale. Current stress was assessed with the Daily Stress Inventory, and the K10 Distress Scale. Past history of major stress was measured with a Childhood Trauma and Abuse Scale, and the Life Events scale. Fourthly, functioning was assessed with the Global Functioning Scale: Social and Role. Results: Global sleep quality was most highly realted to subthreshold symptoms of anxiety (r=0.425, p<0.01), depression (r=0.420, p<0.01), and disorganized symptoms of psychosis (r=0.232, p<0.05). Additionally, global sleep was related to total distress (r=0.356, p<0.01), daily stress (r=0.268, p<0.01), and stressful life events (r=0.291, p<0.01). Social functioning did not reveal any significant correlations with sleep, however, role functioning (r=0.170, p<0.05) did exhibit a relationship with global sleep quality. Finally, bullying (r=0.196, p<0.05) and trauma (r=0.266, p<0.01) were significantly correlated with global sleep quality scores. Conclusion: This study provides early evidence for the interaction that sleep disruption may have with stress, trauma, bullying, and subthreshold psychiatric symptomology in youth. Further research is required to increase the understanding of these relationships early on in youth psychiatric illness progression.
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