Digital Cognitive-Behavioral Therapy for Insomnia (dCBT-I) to Reduce Suicide Risk among Youth Following Discharge from Acute Hospitalization

失眠数字认知行为疗法 (dCBT-I) 可降低青少年急性住院出院后的自杀风险

• 批准号: 10285897
• 负责人: Catherine Rose Glenn
• 金额: $ 25.87万
• 依托单位: RUTGERS, THE STATE UNIV OF N.J.
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10285897
• 关键词: 18 year old; Acute; Address; Adolescence; Adolescent; Adult; Aftercare; Cause of Death; Cellular Phone; Clinical; Clinical Sciences; Clinical Trials; Cognitive Therapy; Depression and Suicide; Development; Distal; Effectiveness; Enrollment; Feeling suicidal; Goals; Health Services Accessibility; Hospitalization; Hospitals; Individual; Intervention; Interview; Link; Mediating; Mental Depression; Modernization; Outcome; Parents; Persons; Phase; Population; Provider; Psychiatric therapeutic procedure; Psychopathology; Public Health; Randomized; Reporting; Research; Risk Behaviors; Risk Reduction; Sampling; Schedule; Severities; Site; Sleep Disorders; Sleeplessness; Suicide; Suicide attempt; Suicide prevention; Symptoms; Testing; Time; Travel; Universities; Visit; Waiting Lists; Youth; acceptability and feasibility; base; cost; digital; digital intervention; effective intervention; feasibility testing; follow up assessment; follow-up; high risk; high risk population; hospital readmission; prevent; programs; psychiatric symptom; psychosocial; reducing suicide; smartphone Application; suicidal adolescent; suicidal behavior; suicidal risk; suicide rate; treatment as usual

PROJECT SUMMARY Suicidal thoughts and behaviors (STBs) are major public health concerns among adolescents. STBs have their initial onset during adolescence and rates increase drastically during this developmental period. To reduce risk for STBs in youth, research identifying modifiable targets for intervention is greatly needed. Sleep problems, and particularly insomnia—the most common sleep problem in adolescents, may be one such promising treatment target. Insomnia has been consistently and uniquely linked to STBs (i.e., beyond depression), is associated with STBs over the short term (e.g., days, weeks), and is very treatable. Cognitive behavioral therapy for insomnia (CBT-I) is a brief (4-8 session) intervention with proven efficacy (medium-large effects) for reducing insomnia severity in adolescents and adults. In addition, CBT-I has been found to reduce a range of co-occurring psychiatric symptoms in adolescents (e.g., depression) and suicide ideation in adults. Although CBT-I is an empirically supported treatment (EST) that is highly recommended for treating insomnia, many adolescents do not have access to this intervention. Digital (smartphone-based) versions of CBT-I (dCBT-I) have demonstrated efficacy similar to in-person CBT-I and are accessible to youth, especially during high-risk periods where the need for treatment is critical. One of the highest risk times for STBs is the three months after discharge from acute psychiatric care, which is also a time when youth may have limited access to ESTs (due to long waitlists, high costs, difficulty traveling to treatment). Digital versions of ESTs, like dCBT-I, are highly accessible and may fill this significant treatment gap. The goal of this project is to test a brief (6- session), empirically supported, and highly accessible version of dCBT-I, called SleepioTM, in suicidal adolescents with co-occurring insomnia during the high-risk post-hospitalization period. The SleepioTM program includes the primary components of in-person CBT-I in a highly accessible digital format (via smartphone app). Although CBT-I has demonstrated efficacy in adults and adolescents with insomnia and has been found to reduce suicide ideation among adults, it has not yet been tested with suicidal adolescents—a high-risk group that is typically excluded from CBT-I trials. The overall project goal will be achieved through the following aims: Examine the feasibility and acceptability of delivering dCBT-I, SleepioTM, to suicidal adolescents with co-occurring insomnia during the post-hospitalization period (Aim 1), and examine the effectiveness of dCBT-I for reducing insomnia severity (Aim 2; treatment target) and suicide (STB) outcomes (Aim 3; distal clinical outcome). In line with the National Action Alliance for Suicide Prevention priorities, this project addresses key questions: “What interventions are effective [for reducing STB risk]? What prevents individuals from engaging in STBs?” The current project represents a unique opportunity to extend an EST to a high-risk population who are in critical need but have limited access to care. This program of research has the potential to significantly advance clinical science and to modernize the way the field treats suicidal youth.

项目摘要 自杀思想和行为（STB）是青少年的主要公共卫生问题。 STBS 在青少年期间初始发作，并且在此发育期间速度急剧增加。到 降低了青年中STB的风险，非常需要研究确定可修改的干预目标的研究。睡觉 问题，尤其是失眠症 - 青少年最常见的睡眠问题，可能就是这样一个 有希望的治疗目标。失眠一直始终如一地与STB相关（即 抑郁症），在短期内（例如，天，几周）与STB有关，非常可治疗。 失眠的行为疗法（CBT-I）是一项简短的（4-8个疗程）干预措施，有效性（中等大小） 效果）减少青少年和成人的失眠严重程度。此外，已经发现CBT-I减少 成年人的青少年（例如抑郁症）和自杀想法的一系列共同出现的精神病症状。 尽管CBT-I是一种经验支持的治疗（EST），强烈建议用于治疗失眠，但 许多青少年无法访问此干预措施。 CBT-I的数字（基于智能手机）版本 （DCBT-I）表现出类似于面对面CBT-I的效率，年轻人可以使用，尤其是在 高危治疗需求至关重要的高风险时期。 STB的最高风险时间之一是三个 急性精神病护理出院后的几个月，这也是青年访问有限的时期 向ESTS（由于候补名单，高昂的成本，难以接受治疗）。 EST的数字版本，例如DCBT-I， 高度可访问，可能填补这一重大的治疗差距。该项目的目的是测试简短（6- 会议），在自杀中得到经验支持和高度访问的DCBT-I（称为Sleepiotm） 在高危后院期间，患有同时发生失眠的青少年。睡眠计划 在高度可访问的数字格式（通过智能手机应用程序）中包括面对面CBT-I的主要组件。 尽管CBT-I在失眠症的成年人和青少年中表现出效率，并且已被发现是 减少成年人的自杀想法，尚未对自杀青少年进行测试 - 高危人群 通常将其排​​除在CBT-I试验中。总体项目目标将通过以下目的实现： 检查将DCBT-I，Sleemiotm的可行性和可接受性与自杀青少年一起 在院后期（AIM 1）的同时发生失眠，并检查 DCBT-1用于降低失眠严重程度（AIM 2；治疗靶标）和自杀（STB）结果（AIM 3； 远端临床结果）。根据国家预防自杀的重点联盟一致，该项目 解决关键问题：“哪些干预措施有效[降低STB风险]？是什么防止个人 从参与STB？”当前的项目代表了将EST扩展到高风险的独特机会 急需但获得护理机会有限的人口。该研究计划具有潜力 大大提高临床科学并现代化现场珍宝自杀青年的方式。