A Sleep Promotion Program for Depressed Adolescents in Pediatric Primary Care

摘要 青春期抑郁症非常普遍，损害很大，代价很高，并与自杀风险有关。虽然具有普遍性 初级保健提供者报告，建议在儿科初级保健中筛查青少年抑郁症 在这种情况下，管理心理健康问题的时间和资源有限。睡眠时间短，睡眠时间短- 醒觉不规律一直与青少年抑郁症显著相关，并被认为 疾病的关键机制；因此，这些睡眠参数是抑郁青年的关键干预目标。 针对青少年睡眠障碍和日常节律的有效行为策略可改善睡眠和 抑郁症。然而，很少有工作将研究环境中有效的东西转化为用于儿科的 初级保健，尽管初级保健中的综合行为健康正在迅速扩大并与 改善了患者的预后。我们开发了一个简短、可扩展的行为睡眠促进计划(SPP)，用于 睡眠时间短和睡眠-觉醒不规律的青少年，这依赖于一个单独的疗程和 智能手机技术，以提供基于证据的战略。为了响应PAR-21-131，在本R34中，我们 建议1)翻译SPP以在儿科初级保健中实施，包括优化智能手机 针对抑郁青少年的特点和2)制定可行和可接受的提供者培训。精炼后 我们的程序通过公开试验，我们将3)测试SPP计划的可行性和4)初步效果 和提供者通过试点随机对照试验(RCT)进行培训；以及5)确定促进和阻碍因素 实施。我们将首先对患有抑郁症的青少年和在 儿科初级保健(n=12)。访谈将集中在初级保健实施方面的障碍； 开发可行和可接受的提供商培训；并加强SPP智能手机的参与度 抑郁青年中的技术因素。我们将进行一项公开试验(n=8)，以迭代优化提供程序 培训、实施程序和SPP计划，每个参与者和员工反馈。然后我们将进行 一项试验性随机对照试验(n=50)，将SPP与睡眠心理教育进行比较，睡眠心理教育是关于健康睡眠习惯的简短会议。 参与者将是睡眠时间短、睡眠-觉醒不规律和抑郁的青少年(12-18岁)； 这些特征还将作为在基线、干预后和3个月随访时评估的主要结果。 向上。我们将衡量提供商睡眠知识和提供SPP的能力的变化。我们假设SPP 计划和提供商培训程序将是可行的、可接受的和适当的。我们假设的范围更大 接受SPP的青少年在睡眠时间、睡眠-觉醒规律性和抑郁症状方面的改善。 提供者的睡眠知识将显著提高，并将达到治疗的完整性。年轻人的反馈 参与RCT的提供者将帮助确定实施因素。这款R34将增强 通过以部署为重点的研究，与NIMH保持一致的有效性和实施研究的相关性 战略计划目标3.3.C，并将开展一项更大规模的试验，以测试战略规划的有效性和执行情况。

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.