Brief Interventions for Teen Sleep (BITS)

青少年睡眠简短干预措施 (BITS)

• 批准号: 10435007
• 负责人: TINA R GOLDSTEIN
• 金额: $ 20.02万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-07-17 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10435007
• 关键词: Address; Adolescent; Adult; Age; American; Attitude; Behavior; Belief; Black race; Caregivers; Categories; Cause of Death; Cellular Phone; Childhood; Complex; Consensus; Consolidated Framework for Implementation Research; Data; Diagnostic; Enrollment; Feedback; Feeling suicidal; Focus Groups; Future; Hypersomnias; Intervention; Interview; Link; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methodology; Methods; Outcome; Participant; Population; Prevention; Primary Health Care; Provider; Qualitative Methods; Race; Randomized; Reporting; Research; Risk; Risk Behaviors; Severities; Sleep; Sleep disturbances; Sleeplessness; Source; Stigmatization; Suicide; Teenagers; Testing; Wrist; Youth; actigraphy; aged; behavioral study; brief intervention; child depression; circadian; clinically significant; cohort; diaries; evidence base; experience; health equity; human centered design; implementation framework; implementation intervention; implementation science; pediatrician; peer; poor sleep; prevent; preventive intervention; racial discrimination; randomized trial; secondary outcome; sleep difficulty; sleep quality; statistics; suicidal adolescent; suicidal behavior; suicidal risk; usability; user-friendly

Suicide is the second leading cause of death in youth, and the latest statistics indicate disproportionate risk for suicidal behavior among Black youth.2. Unfortunately, few interventions effectively prevent youth suicidal thoughts and behaviors (STBs). Experts emphasize that ideal foci for effective STB prevention interventions are proximal, robust and modifiable, with broad acceptability and accessibility for population-level impact. Sleep difficulties may be a particularly promising target for youth STB prevention efforts. Studies consistently demonstrate a direct and temporal link between sleep disturbances in adolescents and STBs and are included among the expert consensus set of warning signs for suicide. Furthermore, gross disparities in sleep between Black youth and their White peers (e.g., shorter sleep duration, poorer sleep quality, more variable sleep timing), as well as unique and specific barriers to healthy sleep for Black youth (e.g., racial discrimination) are directly linked to elevated risk for depression and STBs. Yet, no intervention targeting sleep difficulties has been examined among youth at-risk for STBs nor tailored to Black youth. We posit a modularized intervention that targets a range of sleep and circadian difficulties using evidence-based principles, such as the Transdiagnostic Sleep and Circadian Intervention (TSC), holds promise to decrease risk for STBs in depressed adolescents. To optimize TSC acceptability, engagement, and scalability for youth at-risk for STBs, including Black youth, among whom mental health services are more stigmatized, we will employ the health equity-informed framework, and draw upon the expertise in implementation science and qualitative methods among our team and the larger Center. We will apply the Consolidated Framework for Implementation Research (CFIR) in conducting focus groups with youth, caregivers and providers to inform TSC implementation with depressed adolescents, including Black youth, and then evaluate these strategies through rapid iterative pilots. We will then conduct a randomized trial of 75 at-risk youth age 12-18 (35% Black) with moderate depression and clinically significant sleep difficulties identified in pediatric primary care via the Signature R01. Youth will be randomized using 2:1 allocation (to maximize data on implementation) to TSC+Sleep Feedback (i.e., user-friendly graphical representations of naturalistic objective and subjective sleep data) or Sleep Feedback Only. All participants will complete objective ambulatory sleep assessment (via wrist-worn actigraph) and subjective daily sleep diary data (via smartphone), and receive weekly reports summarizing their sleep (Sleep Feedback). TSC clinicians will personalize TSC strategies through use of the adolescent’s Sleep Feedback data. We will examine TSC feasibility, acceptability and impact on sleep; secondary outcomes include depression and STB risk, assessed at 1,3, and 6 months. Resultant data supporting promise of TSC will inform a larger randomized trial. This intervention has the potential to advance health equity by addressing one potential source contributing to disparities in STB in Black youth.

自杀是青少年死亡的第二大原因，最新统计数据表明，自杀的风险不成比例。 黑人青年的自杀行为。2。不幸的是，很少有干预措施能够有效预防青少年自杀 思想和行为（STB）。专家强调，有效预防性传播感染的干预措施的理想重点是 邻近性、稳健性和可修改性，对人口层面的影响具有广泛的可接受性和可及性。睡觉 困难可能是青年STB预防工作特别有希望的目标。坚持不懈地学习 证明青少年睡眠障碍与 STB 之间存在直接和时间上的联系，并被纳入其中 专家共识中的一组自杀警告信号。此外，不同人之间的睡眠存在巨大差异 黑人青年和白人同龄人（例如，睡眠时间较短、睡眠质量较差、睡眠时间变化较大）， 以及黑人青少年健康睡眠的独特和具体障碍（例如种族歧视）直接 与抑郁症和 STB 风险升高有关。然而，目前还没有针对睡眠困难的干预措施 在有 STB 风险的青少年中进行了检查，也不针对黑人青少年。我们提出模块化干预 使用循证原则（例如跨诊断法）针对一系列睡眠和昼夜节律困难 睡眠和昼夜节律干预 (TSC) 有望降低抑郁青少年的 STB 风险。到 优化 TSC 对 STB 面临风险的青少年（包括黑人青少年）的可接受性、参与度和可扩展性 对于那些心理健康服务受到更多侮辱的人，我们将采用健康公平知情框架，并且 利用我们团队和更大的团队在实施科学和定性方法方面的专业知识 中心。我们将应用实施研究综合框架（CFIR）来开展重点研究 由青少年、照顾者和提供者组成的团体，为抑郁青少年的 TSC 实施提供信息，包括 黑人青年，然后通过快速迭代试点来评估这些策略。然后我们将进行随机 对 75 名 12-18 岁高危青少年（35% 黑人）进行的试验，他们患有中度抑郁症和临床上显着的睡眠困难 通过 Signature R01 在儿科初级保健中进行识别。青少年将按照 2:1 的比例进行随机分配（ 最大化实施数据）到 TSC+睡眠反馈（即，用户友好的图形表示 自然客观和主观睡眠数据）或仅睡眠反馈。所有参与者将完成目标 动态睡眠评估（通过腕戴式活动记录仪）和主观每日睡眠日记数据（通过智能手机）， 并收到总结他们睡眠情况的每周报告（睡眠反馈）。 TSC 临床医生将个性化 TSC 通过使用青少年的睡眠反馈数据来制定策略。我们将审查 TSC 的可行性、可接受性 以及对睡眠的影响；次要结局包括抑郁症和 STB 风险，在 1、3 和 6 个月时进行评估。 支持 TSC 承诺的结果数据将为更大规模的随机试验提供信息。这种干预有潜力 通过解决导致黑人青年 STB 差异的一个潜在根源来促进健康公平。