Brief Interventions for Teen Sleep (BITS)

自杀是青年死亡的第二大原因，最新的统计数据表明， 黑人青年的自杀行为不幸的是，很少有干预措施能有效预防青少年自杀。 思想和行为（STBs）。专家强调，有效预防STB干预的理想重点是 近距离、强有力和可修改，具有广泛的可接受性和可获得性，对人口一级产生影响。睡眠 困难可能是预防青少年性传播疾病工作的一个特别有希望的目标。研究一致 证明了青少年睡眠障碍与STBs之间的直接和时间联系，并被纳入 自杀的警告信号之一。此外， 黑人青年和他们的白色同龄人（例如，更短的睡眠持续时间、更差的睡眠质量、更易变的睡眠定时）， 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高风险有关。然而，没有针对睡眠困难的干预措施， 在有性病风险的青年中进行检查，也不适合黑人青年。我们采用模块化干预， 针对一系列睡眠和昼夜节律的困难，使用基于证据的原则，如跨诊断 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的可接受性，参与度和可扩展性，为STBs的风险青年，包括黑人青年， 对于精神卫生服务受到更多侮辱的人，我们将采用健康公平知情框架， 利用我们的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， 与青少年、照顾者和提供者一起组成小组，向抑郁青少年提供TSC实施情况，包括 黑人青年，然后通过快速迭代试点评估这些策略。然后我们将进行随机 一项对75名12-18岁（35%为黑人）患有中度抑郁症和临床显著睡眠困难的高危青少年的试验 通过签名R 01在儿科初级保健中识别。青少年将采用2：1分配（至 最大化关于实现的数据）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）， 并接收每周总结他们睡眠的报告（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的策略。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STB风险，在1、3和6个月时进行评估。 支持TSC前景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，促进健康公平。

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.