A Sleep Promotion Program for Depressed Adolescents in Pediatric Primary Care

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Abstract Adolescent depression is highly prevalent, impairing, costly, and associated with risk of suicide. Though universal screening for adolescent depression is recommended in pediatric primary care, primary care providers report limited time and few resources to manage mental health concerns in that setting. Short sleep duration and sleep- wake irregularity are consistently and significantly associated with adolescent depression and are considered key mechanisms of disease; thus, these sleep parameters are critical intervention targets for depressed youth. Efficacious behavioral strategies for disturbed adolescent sleep and daily rhythms lead to improved sleep and depression. However, little work has translated what is efficacious in a research environment for use in pediatric primary care, even though integrated behavioral health in primary care is rapidly expanding and associated with improved patient outcomes. We developed a brief, scalable, behavioral Sleep Promotion Program (SPP) for adolescents with short sleep duration and sleep-wake irregularity, which relies on one individual session and smartphone technology to deliver evidence-based strategies. In response to PAR-21-131, in this R34 we propose 1) translating SPP for implementation in pediatric primary care, including optimizing the smartphone features for depressed adolescents and 2) developing feasible and acceptable provider training. After refining our procedures through an open trial, we will 3) test the feasibility and 4) initial effectiveness of the SPP program and provider training via pilot randomized controlled trial (RCT); and 5) identify factors that facilitate and impede implementation. We will first conduct interviews with depressed adolescents and staff/providers who work in pediatric primary care (n=12 each group). Interviews will focus on barriers to implementation in primary care; developing feasible and acceptable provider training; and enhancing engagement in SPP smartphone technology components among depressed youth. We will conduct an open trial (n=8) to iteratively refine provider training, implementation procedures, and SPP program, per participant and staff feedback. We will then conduct a pilot RCT (n=50) comparing SPP to Sleep Psychoeducation, a brief session on healthy sleep habits. Participants will be adolescents (12-18 years) with short sleep duration, sleep-wake irregularity, and depression; these features will also serve as primary outcomes assessed at baseline, post-intervention and 3-month follow- up. We will measure changes in provider sleep knowledge and capacity to deliver SPP. We hypothesize SPP program and provider training procedures will be feasible, acceptable, and appropriate. We hypothesize greater improvements in sleep duration, sleep-wake regularity and depressive symptoms among youth receiving SPP. Provider sleep knowledge will significantly improve and treatment integrity will be reached. Feedback from youth and providers involved in the RCT will help to identify implementation factors. This R34 will enhance the relevance of effectiveness and implementation research via deployment-focused studies, consistent with NIMH Strategic Plan Objective 3.3.C, and will inform a larger trial testing the effectiveness and implementation of SPP.