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: 10677795
• 负责人: Catherine Rose Glenn
• 金额: $ 23.35万
• 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/10677795
• 关键词: 18 year old; Acute; Address; Adolescence; Adolescent; Adult; Aftercare; Cause of Death; Cellular Phone; Clinical; Clinical Sciences; Clinical Trials; Cognitive Therapy; Development; Diagnostic; Distal; Effectiveness; Enrollment; Exclusion; 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; Qualifying; Randomized; Recommendation; 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; cost; digital; digital delivery; digital intervention; effective intervention; effectiveness evaluation; 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 自杀想法和行为（STBs）是青少年的主要公共卫生问题。个stb 在青春期初次发病，在这一发育期发病率急剧上升。到 为了减少青少年性传播疾病的风险，非常需要进行研究，确定可修改的干预目标。睡眠 问题，特别是失眠-青少年最常见的睡眠问题，可能是这样一个问题。 有希望的治疗目标。Incubator一直与STB（即，超出 抑郁症），在短期内与STB相关（例如，几天，几周），并且非常容易治疗。认知 失眠的行为疗法（CBT-I）是一种简短的（4-8次）干预，已证实有效（中-大 影响），以减少青少年和成人失眠的严重程度。此外，已发现CBT-I可减少 青少年中一系列共同出现的精神症状（例如，抑郁症）和自杀意念。 虽然CBT-I是一种强烈推荐用于治疗失眠的经验支持治疗（EST）， 许多青少年无法获得这种干预。CBT-I的数字（基于智能手机）版本 （dCBT-I）已证明与面对面CBT-I相似的疗效，并且可供年轻人使用，特别是在 需要治疗的高风险时期。STB的最高风险时间之一是三个 从急性精神病护理出院后的几个月，这也是年轻人可能接触有限的时间， （由于等待名单长、费用高、前往治疗的困难）。EST的数字版本，如dCBT-I， 非常容易获得，可能会填补这一重大的治疗空白。这个项目的目标是测试一个简短的（6- 会话），经验支持，高度可访问的dCBT-I版本，称为SleepioTM，在自杀 住院后高危期内合并失眠的青少年。SleepioTM计划 包括以高度可访问的数字格式（通过智能手机应用程序）的CBT-I的主要组成部分。 虽然CBT-I已证明对成人和青少年失眠有效， 减少成年人的自杀意念，但尚未对自杀倾向的高危人群进行测试。 这通常被排除在CBT-I试验之外。项目的总体目标将通过以下目标实现： 检查向有自杀倾向的青少年提供dCBT-I SleepioTM的可行性和可接受性， 在住院后期间（目的1）同时发生失眠，并检查 dCBT-I用于降低失眠严重程度（目标2;治疗目标）和自杀（STB）结局（目标3; 远端临床结果）。根据国家预防自杀行动联盟的优先事项，该项目 解决关键问题：“什么干预措施是有效的[减少STB风险]？是什么阻止了个体 参与STB？”目前的项目是一个独特的机会，扩大环境试验，以高风险， 有迫切需要但获得护理的机会有限的人口。这项研究计划有可能 以显著推进临床科学，并使该领域治疗自杀青年的方式现代化。