Brief Interventions for Teen Sleep (BITS)

自杀是年轻人的第二大死因，最新的统计数据表明，自杀的风险不成比例 黑人青年中的自杀行为。不幸的是，很少有干预措施能有效防止青少年自杀。 思想和行为(STB)。专家强调，有效的性病预防干预的理想焦点是 近似性、健壮和可修改，对人口层面的影响具有广泛的可接受性和可及性。沉睡 困难可能是青年STB预防工作的一个特别有希望的目标。始终如一的研究 展示青少年睡眠障碍和性传播疾病之间的直接和暂时联系，并包括 在专家共识中，有一组自杀的警告信号。此外，两国之间睡眠的严重差距 黑人青年和他们的白人同龄人(例如，睡眠时间更短，睡眠质量更差，睡眠时间更多变)， 以及黑人青年健康睡眠的独特和具体障碍(例如种族歧视)直接 与抑郁症和性传播疾病的风险增加有关。然而，还没有针对睡眠困难的干预措施 在STB的高危青年中进行检查，也不是为黑人青年量身定做的。我们假设一种模块化的干预 使用循证原则针对一系列睡眠和昼夜节律困难，例如跨诊断 睡眠和昼夜节律干预(TSC)有望降低抑郁青少年患STB的风险。至 优化TSC对STB高危青年(包括黑人青年)的接受度、参与度和可扩展性 谁的精神健康服务更被污名化，我们将采用健康公平知情框架，以及 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)进行重点研究 与青年、照顾者和提供者组成的团体向TSC通报对抑郁青少年的执行情况，包括 黑人青年，然后通过快速迭代试点评估这些策略。然后我们将进行一次随机的 75名12-18岁高危青年(黑人占35%)中度抑郁和临床显著睡眠困难的试验 通过签名R01在儿科初级保健中识别。青年将采用2：1分配(至 实现数据最大化)到TSC+睡眠反馈(即，用户友好的图形表示 自然主义的客观和主观睡眠数据)或仅睡眠反馈。所有参与者都将完成目标 动态睡眠评估(通过手腕佩戴的活动记录仪)和主观每日睡眠日记数据(通过智能手机)， 并每周收到总结他们睡眠情况的报告(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。我们将研究TSC的可行性、可接受性 以及对睡眠的影响；次要结果包括抑郁和性传播疾病风险，评估时间为1、3和6个月。 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。这种干预有可能 通过解决导致黑人青年性传播疾病差异的一个潜在来源来促进卫生公平。

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.