scholarly journals 663 Improved Sleep After a Brief Intervention for Insomnia Mediates Improvements in Depression Symptoms During the COVID-19 Pandemic

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A259-A259
Author(s):  
Kathleen O’Hora ◽  
Mateo Lopez ◽  
Allison Morehouse ◽  
Andrea Cordero ◽  
Raquel Osorno ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Outcome Measures ◽  
Symptom Severity ◽  
Post Treatment ◽  
Symptom Improvement ◽  
Depression Symptoms ◽  
Insomnia Symptom ◽  
The Impact ◽  
Insomnia Symptoms ◽  
Rate Of Improvement

Abstract Introduction The COVID-19 Pandemic and mitigation efforts have led to drastic increases in acute insomnia symptoms, which left untreated may contribute to increased risk for other negative mental health outcomes, including depression. However, the impact of treating acute insomnia symptoms on future depression outcomes remains unknown. Moreover, whether sleep improvements as a result of an insomnia treatment mediate subsequent reduction of depression symptoms similarly remains unknown. Methods At this writing, 44 individuals experiencing insomnia symptoms (Insomnia Severity Index; ISI ≥ 10) that began during the COVID-19 pandemic have been randomized to receive a brief, telehealth Cognitive Behavioral Therapy for Insomnia (CBTI) waitlist control. Treatment was delivered in 4 sessions over a 5-week period. CBTI is the gold-standard behavioral intervention for chronic insomnia and has been applied successfully via telemedicine. Outcome measures were depressive symptoms as measured by the Patient Health Questionnare-9 (PHQ-9) minus the sleep item and insomnia symptom severity as measured by the ISI. Both outcome measures were collected at baseline (week 0), throughout treatment phase (weeks 2–6), and at the post-treatment (week 7). Linear mixed models determined the impact of treatment on depression and insomnia symptom severity. Mediation was tested using the MacArthur framework. Results There was a significant Group x Time interaction, with CBTI leading to a greater rate of improvement in ISI (b = -1.14, p < 0.001) and PHQ-9 (b = -0.61, p = 0.002) than the control. Critically, the rate of improvement in insomnia symptoms to the last session of treatment, was associated with the subsequent improvement in depressive symptoms post-treatment (b = 2.06, p = 0.017). In contrast, depressive symptom improvement was not associated with insomnia symptom improvement (b = 4.28, p = 0.102). Conclusion This preliminary data suggests that brief CBTI can reduce pandemic onset insomnia and other depressive symptoms. The preliminary mediation results further suggest that sleep may be an important treatment target for reducing situational depressive symptoms and supports the need to examine the physiological mechanisms of sleep using high-density EEG in a larger sample. Support (if any):

Internet-delivered Cognitive Behaviour Therapy for Depressive Symptoms: An Exploratory Examination of Therapist Behaviours and their Relationship to Outcome and Therapeutic Alliance

2016 ◽  
Vol 44 (6) ◽  
pp. 625-639 ◽  
Author(s):  
Luke H. Schneider ◽  
Heather D. Hadjistavropoulos ◽  
Y. Nichole Faller
Keyword(s):  
Depressive Symptoms ◽  
Therapeutic Alliance ◽  
Cognitive Behaviour Therapy ◽  
Qualitative Content Analysis ◽  
Post Treatment ◽  
Symptom Improvement ◽  
Behaviour Therapy ◽  
Self Disclosure ◽  
Cognitive Behaviour ◽  
The Impact

Background: A previous study of therapist-assisted Internet-delivered cognitive behaviour therapy (ICBT) for generalized anxiety (Paxling et al., 2013) identified eight distinct therapist behaviours in ICBT (task reinforcement, self-efficacy shaping, task prompting, alliance bolstering, psychoeducation, empathetic utterances, deadline flexibility, and self-disclosure). It is unknown how generalizable these behaviours are across ICBT programs. Aims: We systematically examined the frequency of these eight therapist behaviours and additional newly identified behaviours in e-mails sent to patients during the course of ICBT for depressive symptoms. We also conducted exploratory analyses to examine relationships between therapist behaviours, symptom improvement, and therapeutic alliance. Method: Data was obtained from a previously published open trial (Hadjistavropoulos et al., 2014). A total of 1013 e-mails sent from therapists (n = 24) to patients (n = 41) during ICBT for depressive symptoms were analyzed. Therapist behaviours were correlated with symptom change scores and ratings of therapeutic alliance at mid- and post-treatment. Results: Therapist behaviours described by Paxling et al. were reliably identified in the e-mails using qualitative content analysis; the frequencies of these behaviours differed, however, from the Paxling et al. study and three additional therapist behaviours were identified (administrative statements, questionnaire feedback, asking clarifying questions). Several therapist behaviours (e.g. administrative statements, task prompting) were associated with lower symptom improvement at post-treatment. Questionnaire feedback and task reinforcement were associated with higher patient ratings of therapeutic alliance. Conclusions: The study provides partial support for the generalizability of therapist-assistance across ICBT programs. Experimental research is needed to examine the impact of varying therapist-assistance on patient outcomes.

Randomized controlled trial of digital cognitive behavior therapy for prenatal insomnia symptoms: Effects on postpartum insomnia and mental health

SLEEP ◽  
2021 ◽  
Author(s):  
Jennifer N Felder ◽  
Elissa S Epel ◽  
John Neuhaus ◽  
Andrew D Krystal ◽  
Aric A Prather
Keyword(s):  
Mental Health ◽  
Depressive Symptoms ◽  
Behavior Therapy ◽  
Cognitive Behavior Therapy ◽  
Symptom Severity ◽  
Standard Care ◽  
Anxiety Symptom ◽  
Controlled Trial ◽  
Cognitive Behavior ◽  
Insomnia Symptom

Abstract Study objectives To evaluate the effects of digital cognitive behavior therapy for insomnia (dCBT-I) delivered during pregnancy on subjective sleep outcomes, depressive symptoms, and anxiety symptoms through six months postpartum. Methods People up to 28 weeks gestation (N=208) with insomnia were randomized to six weekly sessions of dCBT-I or standard care. We report follow-up data at three and six months postpartum. The primary outcome was insomnia symptom severity. Secondary sleep outcomes included global sleep quality and insomnia caseness. Mental health outcomes included depressive and anxiety symptom severity. We evaluated between-condition differences in change from baseline for each postpartum timepoint and categorical outcomes. Results dCBT-I participants did not experience significantly greater improvements in insomnia symptom severity relative to standard care participants, but they did experience higher rates of insomnia remission and lower rates of insomnia caseness at six months postpartum. dCBT-I participants experienced greater improvements in depressive symptom severity from baseline to both postpartum timepoints, and in anxiety symptom severity from baseline to three months postpartum. The proportion of participants with probable major depression at three months postpartum was significantly higher among standard care (18%) than dCBT-I (4%, p=.006) participants; this between-condition difference was pronounced among the subset (n=143) with minimal depressive symptoms at baseline (18% vs 0%). Conclusion dCBT-I use during pregnancy leads to enduring benefits for postpartum insomnia remission. Findings provide strong preliminary evidence that dCBT-I use during pregnancy may prevent postpartum depression and anxiety, which is notable when considering the high frequency and importance of these problems.

Insomnia Symptom Severity is Associated with Increased Suicidality and Death by Suicide in a Sample of Patients with Psychiatric Disorders

SLEEP ◽  
2021 ◽  
Author(s):  
Zach Simmons ◽  
Gary Burlingame ◽  
Juergen Korbanka ◽  
Kevin Eastman ◽  
Douglas Thomas ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Suicidal Behavior ◽  
Symptom Severity ◽  
Suicide Attempts ◽  
Sleep Problems ◽  
Manner Of Death ◽  
Insomnia Symptom ◽  
History Of ◽  
Depressive Personality ◽  
Insomnia Symptoms

Abstract Study Objectives Insomnia is a risk factor for suicidal behavior including attempts and death by suicide. We investigated whether insomnia symptom severity was associated with suicidality and death by suicide in patients with psychiatric disorders. Methods The sample included 180 deceased patients with psychiatric disorders seen at Weber Human Services between 2008 and 2018 who completed the Outpatient Questionnaire-45.2 (OQ) prior to death. Insomnia symptom severity was assessed using item 41 from the OQ. Manner of death was determined by death records and autopsy reports. History of suicidality was determined through electronic medical records. Cases were grouped into 4 lifetime categories: non-suicidal (n=30), suicidal ideation (n=36), suicide attempt (n=95), and death by suicide (n=19). Demographic, medical, and psychiatric features of each group were compared using linear regression. Logistic regression was used to determine whether insomnia symptom severity was associated with lifetime suicidality severity grouping, adjusting for psychiatric disorders commonly linked to suicidality. Results Lifetime suicidality was associated with sleep problems, fatigue, headaches, and psychiatric disorders (i.e., depressive, personality, and trauma-related disorders). Referenced to the non-suicidal group, greater insomnia symptom severity was significantly associated with suicide attempts and death by suicide, with odds ratios (OR) of OR=2.67, p=0.011, and OR=5.53, p=0.002, respectively, even after adjusting important psychiatric diagnoses. Conclusions Results suggest that insomnia symptom severity endorsed during a clinical visit is associated with heightened suicidality, especially suicidal behavior. The presence of insomnia symptoms in patients with psychiatric disorders may indicate risk for suicide and is a target for suicide prevention.

The impact of changes in distress tolerance on PTSD symptom severity post-treatment among veterans in residential trauma treatment

2017 ◽  
Vol 47 ◽  
pp. 99-105 ◽  
Author(s):  
Anne N. Banducci ◽  
Kevin M. Connolly ◽  
Anka A. Vujanovic ◽  
Jennifer Alvarez ◽  
Marcel O. Bonn-Miller
Keyword(s):  
Symptom Severity ◽  
Distress Tolerance ◽  
Ptsd Symptom ◽  
Post Treatment ◽  
Trauma Treatment ◽  
Ptsd Symptom Severity ◽  
The Impact

scholarly journals Preventing depression in final year secondary students: School-based randomized controlled trial

2020 ◽  
Author(s):  
Y Perry ◽  
A Werner-Seidler ◽  
A Calear ◽  
A Mackinnon ◽  
C King ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Depressive Symptoms ◽  
Secondary Students ◽  
Controlled Trial ◽  
School Level ◽  
Control Group ◽  
Depression Symptoms ◽  
Randomized Controlled ◽  
Control Intervention ◽  
The Impact

Background: Depression often emerges for the first time during adolescence. There is accumulating evidence that universal depression prevention programs may have the capacity to reduce the impact of depression when delivered in the school environment. Objective: This trial investigated the effectiveness of SPARX-R, a gamified online cognitive behavior therapy intervention for the prevention of depression relative to an attention-matched control intervention delivered to students prior to facing a significant stressor-final secondary school exams. It was hypothesized that delivering a prevention intervention in advance of a stressor would reduce depressive symptoms relative to the control group. Methods: A cluster randomized controlled trial was conducted in 10 government schools in Sydney, Australia. Participants were 540 final year secondary students (mean 16.7 [SD 0.51] years), and clusters at the school level were randomly allocated to SPARX-R or the control intervention. Interventions were delivered weekly in 7 modules, each taking approximately 20 to 30 minutes to complete. The primary outcome was symptoms of depression as measured by the Major Depression Inventory. Intention-to-treat analyses were performed. Results: Compared to controls, participants in the SPARX-R condition (n=242) showed significantly reduced depression symptoms relative to the control (n=298) at post-intervention (Cohen d=0.29) and 6 months post-baseline (d=0.21) but not at 18 months post-baseline (d=0.33). Conclusions: This is the first trial to demonstrate a preventive effect on depressive symptoms prior to a significant and universal stressor in adolescents. It demonstrates that an online intervention delivered in advance of a stressful experience can reduce the impact of such an event on the potential development or exacerbation of depression.

179 Insomnia Symptoms in Latinx emerging adults: The role of perceived discrimination

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A73-A73
Author(s):  
Pablo Soto ◽  
Joseph Dzierzewski ◽  
Mayra Ramos ◽  
Natalie Dautovich ◽  
Rosalie Corona
Keyword(s):  
Depressive Symptoms ◽  
Gender Identity ◽  
Emerging Adulthood ◽  
Emerging Adults ◽  
Perceived Discrimination ◽  
Cultural Factors ◽  
Depression Symptoms ◽  
Symptom Presentation ◽  
Final Model ◽  
Insomnia Symptoms

Abstract Introduction An individual’s culture presents unique risk and protective factors related to sleep outcomes. Similarly, emerging adulthood also represents a unique developmental period as it relates to sleep. The study of cultural factors during emerging adulthood is critical for better understanding the development of sleep dysfunction in vulnerable segments of the population. The present study investigated the association between perceived discrimination and insomnia symptoms in Latinx emerging adults. We hypothesized that perceived discrimination would result in higher insomnia symptom presentation above and beyond anxiety and depressive symptoms. Methods Participants included 198 (73.7% female; mean age=18.96) college-aged individuals self-identifying as Hispanic/Latinx who completed an online survey that assessed perceived racial/ethnic discrimination (Everyday Discrimination Scale; EDS), anxiety symptoms (General Anxiety Disorder Scale; GAD-7), depression symptoms (Patient Health Questionnaire; PHQ-9), and insomnia symptoms (Insomnia Severity Index; ISI). A three-block hierarchical regression was used to assess the impact of perceived discrimination on the presentation of insomnia symptomology above and beyond demographic characteristics and anxiety and depressive symptoms. Results The final model significantly predicted insomnia symptom presentation, F(5, 191)=26.379, p<.001, R2=.408. When age and gender identity were entered into the model they did not significantly predict insomnia symptoms F(2, 194)=.199, p=.82, R2=.002. Blocks 2, anxiety and depression symptoms (∆R2=.388), and 3, perceived discrimination (∆R2=.018), accounted for significant change in variance. In the final model, perceived discrimination significantly predicted insomnia symptoms (β=.151) above and beyond age (β=.016), gender identity (β= -.085), anxiety (β= -.075), and depression (β=.621). Conclusion Results suggest that discrimination among Hispanic/Latinx emerging adults is a unique contributor that may explain some of the higher prevalence rates of insomnia symptomology in this segment of the population. As such, it would be beneficial to tailor existing approaches aimed at improving sleep outcomes by accounting for stressors that could result from or influence discrimination against the individual and incorporate other cultural factors into treatment protocols. Support (if any) National Institute on Aging (K23AG049955, PI: Dzierzewski).

scholarly journals THE EARLY BIRD GETS THE WORM, NOT ANXIETY OR DEPRESSION: HOW INSOMNIA SYMPTOMS PREDICT ANXIETY AND DEPRESSION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S45-S45
Author(s):  
Courtney J Bolstad ◽  
Anisha L Thomas ◽  
Michael R Nadorff
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Anxiety Symptoms ◽  
Anxiety And Depression ◽  
Depression And Anxiety ◽  
Regression Analyses ◽  
Symptoms Of Depression ◽  
Early Bird ◽  
The Impact ◽  
Insomnia Symptoms

Abstract Symptoms of insomnia are associated with symptoms of depression and anxiety in older adults, yet less is known about the impact of specific forms of insomnia (i.e. onset, maintenance, and terminal insomnia). We explored how insomnia type predicted symptoms of anxiety and depression in older adults (n = 133; mean age 69, range 65-89). We hypothesized that onset and maintenance insomnia would have stronger relations to depression and anxiety than terminal insomnia. Regression analyses indicated that onset insomnia was the only significant predictor of anxiety symptoms, and maintenance was the only significant predictor of depressive symptoms. Thus, our findings suggest that despite overlap between depression and anxiety, insomnia may have different mechanisms of affecting each disorder. Implications for the treatment of anxiety and depressive symptoms by addressing insomnia problems will be discussed.

scholarly journals The Role of Ethnicity in Expression, Prevalence, and Severity of Generalized Anxiety Disorder and their Overlap with Depressive Symptoms: Epidemiological Evidence from a Rapidly Developing Middle Eastern Country

2021 ◽  
Author(s):  
Salma M. Khaled ◽  
Monica Zolezzi
Keyword(s):  
Depressive Symptoms ◽  
Anxiety Disorder ◽  
Generalized Anxiety Disorder ◽  
Middle Eastern ◽  
Depression Symptoms ◽  
Generalized Anxiety ◽  
Middle Eastern Country ◽  
Eastern Country ◽  
Symptom Profile ◽  
The Impact

Abstract IntroductionQatar is a small but high-income Middle Eastern country with a large influx of migrants each year. However, the impact of changing population structure and urbanization on prevalence of generalized anxiety symptoms remains unexplored to date. Materials & MethodsA total of 2,640 participants interviewed by phone using the Generalized Anxiety Disorder (GAD-7) and the Patient Health Questionnaire (PHQ-2). Bivariate and multinomial logistic regression analyses were conducted to explore the associations of ethnicity (Arab versus Non-Arab) with severity and symptom profile of GAD and overlap with depressive symptoms. ResultsThe point prevalence of mild, moderate, and severe symptoms were 13.4% (95% CI: 11.9 – 15.0), 2.7% (95% CI: 2.0 – 3.5), and 0.9% (95% CI: 0.6– 1.4), respectively. Arab ethnicity was associated with mild GAD (OR=1.78, p=0.009) and moderate-to-severe GAD (OR=2.36, p=0.044). Relative to non-migrants, migrant types were not significantly associated with mild or with moderate-to- severe GAD. Interactions between depressive symptoms and ethnicity were evident and statistically significant for the association with mild GAD versus no GAD (OR=0.34, p=0.003). ConclusionsEthnicity moderated the association of depression symptoms and GAD severity, with potential implications for early screening and community intervention.

scholarly journals Impact of Insomnia Symptoms on the Clinical Presentation of Depressive Symptoms: A Cross-Sectional Population Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Yun Ho Choi ◽  
Kwang Ik Yang ◽  
Chang-Ho Yun ◽  
Won-Joo Kim ◽  
Kyoung Heo ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Clinical Presentation ◽  
Severity Index ◽  
Population Based ◽  
Cross Sectional ◽  
Sleep Study ◽  
Patient Health ◽  
Clinically Significant ◽  
The Impact ◽  
Insomnia Symptoms

Objective: Insomnia and depression are prevalent disorders that often co-occur. This study aimed to investigate the impact of clinically significant insomnia symptoms on the prevalence and clinical presentation of clinically significant depressive symptoms and vice versa.Methods: This study used data from the Korean Headache-Sleep Study (KHSS), a nationwide cross-sectional population-based survey regarding headache and sleep. Clinically significant insomnia symptoms were defined as Insomnia Severity Index (ISI) scores ≥ 10 and clinically significant depressive symptoms were defined as Patient Health Questionnaire-9 (PHQ-9) scores ≥ 10, respectively. We referred clinically significant insomnia symptoms and clinically significant depressive symptoms as insomnia symptoms and depressive symptoms, respectively.Results: Of 2,695 participants, 290 (10.8%) and 116 (4.3%) were classified as having insomnia and depressive symptoms, respectively. The prevalence of depressive symptoms was higher among participants with insomnia symptoms than in those without insomnia symptoms (25.9 vs. 1.7%, respectively, P < 0.001). Among participants with depressive symptoms, the PHQ-9 scores were not significantly different between participants with and without insomnia symptoms (P = 0.124). The prevalence of insomnia symptoms was significantly higher among participants with depressive symptoms than in those without depressive symptoms (64.7 vs. 8.3%, respectively, P < 0.001). The ISI scores were significantly higher among participants with insomnia and depressive symptoms than in participants with insomnia symptoms alone (P < 0.001).Conclusions: Participants with depressive symptoms had a higher risk of insomnia symptoms than did those without depressive symptoms. The severity of depressive symptoms did not significantly differ based on insomnia symptoms among participants with depressive symptoms; however, the severity of insomnia symptoms was significantly higher in participants with depressive symptoms than in those without depressive symptoms.

scholarly journals Tablet-Based Screening of Depressive Symptoms in Quito, Ecuador: Efficiency in Primary Care

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Michelle Grunauer ◽  
David Schrock ◽  
Eric Fabara ◽  
Gabriela Jimenez ◽  
Aimee Miller ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Depressive Symptoms ◽  
Symptom Severity ◽  
Depression Symptoms ◽  
Health Questionnaire ◽  
Care Clinic ◽  
Health Care Clinics ◽  
Primary Health

Depression is a frequent yet overlooked occurrence in primary health care clinics worldwide. Depression and related health screening instruments are available but are rarely used consistently. The availability of technologically based instruments in the assessments offers novel approaches for gathering, storing, and assessing data that includes self-reported symptom severity from the patients themselves as well as clinician recorded information. In a suburban primary health care clinic in Quito, Ecuador, we tested the feasibility and utility of computer tablet-based assessments to evaluate clinic attendees for depression symptoms with the goal of developing effective screening and monitoring tools in the primary care clinics. We assessed individuals using the 9-item Patient Health Questionnaire, the Quick Inventory of Depressive Symptoms-Self-Report, the 12-item General Health Questionnaire, the Clinical Global Impression Severity, and a DSM-IV checklist of symptoms. We found that 20% of individuals had a PHQ9 of 8 or greater. There was good correlation between the symptom severity assessments. We conclude that the tablet-based PHQ9 is an excellent and efficient method of screening for depression in attendees at primary health care clinics and that one in five people should be assessed further for depressive illness and possible intervention.

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