Digital Cognitive-Behavioral Therapy for Insomnia (dCBT-I) to Reduce Suicide Risk among Youth Following Discharge from Acute Hospitalization

项目总结 自杀想法和行为(STB)是青少年中主要的公共卫生问题。机顶盒 最初发病在青春期，在这一发育期发病率急剧上升。至 为了减少青年中STB的风险，迫切需要研究确定可修改的干预目标。沉睡 问题，特别是失眠--青少年最常见的睡眠问题--可能就是这样的 有希望的治疗目标。失眠一直与性传播疾病有独特的联系(也就是， 抑郁症)，在短期内(例如，几天、几周)与性传播疾病有关，并且非常可以治疗。认知 失眠的行为疗法(CBT-I)是一种短暂的(4-8次)干预，已证实有效(中大型 效果)，以减轻青少年和成年人的失眠严重程度。此外，CBT-I已被发现可减少 青少年同时出现的一系列精神症状(如抑郁症)和成人的自杀意念。 尽管CBT-I是强烈推荐用于治疗失眠的经验性支持疗法(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)已显示出与面对面CBT-I类似的效果，年轻人可以使用，特别是在 需要治疗的高风险时期。性传播疾病风险最高的时间之一是三个 在急性精神病护理出院后几个月，这也是年轻人获得机会有限的时期 EST(由于等待名单长、费用高、难以前往治疗)。EST的数字版本，如dCBT-I， 非常容易获得，并可能填补这一重大的治疗缺口。该项目的目标是测试一个简短的(6- SleepioTM)，经验支持和高度可访问的dCBT-I版本，在自杀中 高危住院后失眠的青少年。SleepioTM计划 包括高度可访问的数字格式的面对面CBT-I的主要组件(通过智能手机应用程序)。 尽管CBT-I已经证明对患有失眠的成年人和青少年有效，并被发现 减少成年人的自杀意念，它还没有在自杀的青少年--一个高危群体中进行测试 这通常被排除在CBT-I试验之外。项目总体目标将通过以下目标实现： 检查给自杀青少年提供dCBT-I，SleepioTM的可行性和可接受性 入院后并发失眠(目标1)，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； 远期临床结果)。根据全国预防自杀优先行动联盟，该项目 回答关键问题：“哪些干预措施[对降低性病风险]有效？是什么阻止了个人 不再从事STB了吗？当前的项目是将EST扩展到高风险的独特机会 有迫切需要但获得护理的机会有限的人口。这项研究计划有潜力 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。

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.