ABSTRACT
BACKGROUND
Insufficient sleep among students is a major school health problem. School‐based sleep education programs tailored to reach large number of students may be one of the solutions. A ...systematic review and meta‐analysis was conducted to summarize the programs' effectiveness and current status.
METHODS
Electronic databases were searched up until May 2015. Randomized controlled trials of school‐based sleep intervention among 10‐ to 19‐year‐old students with outcome on total sleep duration were included. Methodological quality of the studies was assessed using the Cochrane's risk of bias assessment.
RESULTS
Seven studies were included, involving 1876 students receiving sleep education programs and 2483 attending classes‐as‐usual. Four weekly 50‐minute sleep education classes were most commonly provided. Methodological quality was only moderate, with a high or an uncertain risk of bias in several domains. Compared to classes‐as‐usual, sleep education programs produced significantly longer weekday and weekend total sleep time and better mood among students at immediate post‐treatment, but the improvements were not maintained at follow‐up.
CONCLUSIONS
Limited by the small number of studies and methodological limitations, the preliminary data showed that school‐based sleep education programs produced short‐term benefits. Future studies should explore integrating sleep education with delayed school start time or other more effective approaches.
Abstract Objectives To compare the psychometric properties of the Chinese versions of Insomnia Severity Index (ISI), Athens Insomnia Scale (AIS) and Sleep Quality Index (SQI) for assessment and ...screening of insomnia in adolescents. Methods This is a school-based survey of 1516 adolescents aged 12–19 years. Sleep-wake habit questionnaire, ISI, AIS, SQI, Epworth Sleepiness Scale (ESS) and 12-item General Health Questionnaire (GHQ-12) were administered. Insomnia Interview Schedule was used to assess the severity of insomnia symptoms and DSM-IV-TR diagnosis of insomnia. Results The Cronbach’s alpha of ISI, AIS and SQI were 0.83, 0.81 and 0.65, respectively, and the 2-week test–retest reliability were 0.79, 0.80 and 0.72. All three scales had a 2-factor structure, and their scores were significantly correlated with sleep-wake variables, ESS and GHQ-12 scores, smoking and drinking habits, and academic performance. The areas under curve of ISI, AIS and SQI for detecting clinical insomnia were 0.85, 0.80 and 0.85, respectively. The optimal cut-offs for ISI, AIS and SQI were a total score of nine (sensitivity/specificity: 0.87/0.75), seven (sensitivity/specificity: 0.78/0.74) and five (sensitivity/specificity: 0.83/0.79), respectively. Conclusion The Chinese versions of ISI, AIS and SQI are reliable and valid instruments. The ISI and AIS appear to have better psychometric properties than the SQI.
Summary Polysomnographic studies have been performed to examine the sleep abnormalities in schizophrenia, but the results are inconsistent. An updated systematic review, meta-analysis, and moderator ...analysis was conducted. Major databases were searched without language restriction from 1968 to January 2014. Data was analyzed using the random-effects model and summarized using the Hedges’s g. Thirty-one studies with 574 patients and 515 healthy controls were evaluated. Limited by the number of studies and a lack of patient-level data, moderator analysis was restricted to medication status, duration of medication withdrawal, and illness duration. We showed that patients with schizophrenia have significantly shorter total sleep time, longer sleep onset latency, more wake time after sleep onset, lower sleep efficiency, and decreased stage 4 sleep, slow wave sleep, and in the duration and latency of rapid eye movement sleep compared to healthy controls. The findings on delta waves and sleep spindles were inconsistent. Moderator analysis could not find any abnormalities in sleep architecture in medication-naïve patients. Patients with antipsychotic withdrawal for longer than eight weeks were shown to have less sleep architectural abnormalities, compared to shorter duration of withdrawal, but the abnormalities in sleep continuity were similar. Slow wave sleep deficit was found in patients with schizophrenia for more than three years, while sleep onset latency was increased in medication-naïve, medication-withdrawn, and medicated patients. Our study showed that polysomnographic abnormalities are present in schizophrenia. Illness duration, medication status, and duration of medication withdrawal are several of the clinical factors that contribute to the heterogeneity between studies.
Summary Self-help cognitive-behavioral therapy (CBT) is an increasingly popular treatment option for insomnia. The objective of this meta-analysis was to compile an up-to-date evaluation on the ...efficacy, adherence, acceptability and dropout rate of self-help CBT for insomnia. We systematically searched six key electronic databases up until May 2013. Two researchers independently selected relevant publications, extracted data, and evaluated methodological quality according to the Cochrane criteria. Twenty randomized controlled trials were included; 10 of which were published after the last review up until January 2007. Meta-analysis of self-help CBT vs. waiting-list, routine care or no treatment was performed. Results showed that self-help CBT improved sleep, sleep-related cognitions and anxiety and depressive symptoms. Effect sizes for sleep-diary-derived sleep efficiency, sleep onset latency, and wake after sleep onset at immediate posttreatment were 0.80, 0.66, and 0.55, respectively. The average dropout rate of self-help CBT at immediate posttreatment was 14.5%, which was not significantly different from the 16.7% in therapist-administered CBT. Subgroup analyses supported the added benefit of telephone consultation. In conclusion, self-help CBT is efficacious and acceptable as an entry level of a stepped care model for insomnia. In places where face-to-face treatments are unavailable or too costly, self-help CBT can be considered as a compromise.
Highlights • We estimate prevalence of insomnia in the general population using a validated scale. • Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), Diagnostic and ...Statistical Manual of Mental Disorders, 5th Edition (DSM-5), International Classification of Diseases, 10th Revision (ICD-10), and International Classification of Sleep Disorders, 2nd Edition (ICSD-2) insomnia diagnoses at 22.1%, 10.8%, 4.7%, and 15.1%, respectively. • Prevalence of insomnia disorder is similar for Hong Kong and the United States. • Among the insomnia symptoms, non-restorative sleep is the most affected by quantitative criteria.
•The pathogenesis and progression of depression may depend on different lifestyle determinants related to depression.•The lifestyle medicine approach may be of great potential to be implemented as an ...entry-level community intervention to prevent depression and an adjunctive intervention in managing major depression.•The number of lifestyle factors adopted was a significant moderator for the effect of multi-component lifestyle medicine interventions on depression.•The clinical effect of multi-component lifestyle interventions tend to be stronger in major depression.•Smartphone-delivered lifestyle medicine interventions are needed to increase accessibility and support intervention compliance.
The treatment effect of multi-component LM interventions on depressive symptoms has not yet been examined.
We systematically searched six databases from inception to February 2020 to identify randomized controlled trials (RCTs) involving any multi-component LM interventions (physical activity, nutritional advice, sleep management, and/or stress management) on depressive symptoms relative to care as usual (CAU), waitlist (WL), no intervention (NI), or attention control (AC) comparisons.
Fifty studies with 8,479 participants were included. Multi-component LM interventions reduced depressive symptoms significantly relative to the CAU (p >.001; d = 0.20) and WL/NI (p > .01; d = 0.22) comparisons at immediate posttreatment. However, no significant difference was found when compared with AC. The intervention effects were maintained in the short-term (1- to 3-month follow-up) relative to the CAU comparison (p > .05; d = 0.25), but not in the medium- and long-term. The moderator analyses examining the effect of multi-component LM interventions compared with CAU suggested that the number of lifestyle factors adopted was a significant moderator. Although disease type was not a significant moderator, there was a tendency that the clinical effect of multi-component LM interventions was stronger (d = 0.45) in those diagnosed with major depression. No publication bias was detected.
Low number of RCTs available in some subgroup analyses prevented from finding meaningful effects. Results may not be extended to major depression, because data on secondary depression were captured.
Multi-component LM interventions appeared to be effective in mitigating depressive symptoms; however, the magnitude of the clinical effect was small. Future research is needed to assess more comprehensive and individualized LM interventions which have a greater emphasis on motivational and compliance aspects and focus solely on individuals with depression.
Summary Over the past decade, researchers have shifted focus from the manic and depressive episodes to the interepisode period in the study of sleep–wake disturbance in bipolar disorder. The ...objective of this systematic review was to compile and synthesize studies that employed sleep diary, actigraphy, polysomnography, and questionnaires to compare sleep–wake patterns in people with interepisode bipolar disorder or high-risk individuals vs. normal controls and/or people with primary insomnia. We searched key databases until June 2013. Our search identified 21 eligible studies, yielding 24 sleep–wake variables. A total of 531 people with interepisode bipolar disorder, 157 high-risk individuals, 678 normal controls and 67 adults with primary insomnia were evaluated. Using a random-effects model, our analyses suggest that adults with interepisode bipolar disorder appear worse than normal controls in most variables and comparable to adults with primary insomnia in certain aspects. Sleep onset latency, wake after sleep onset, and variability of sleep–wake variables were most consistently impaired in interepisode bipolar disorder. In comparison with controls, high-risk individuals were found to have higher variability in sleep efficiency and lower relative amplitude. The findings provide a foundation for the search for candidate endophenotypes and the development of novel interventions for bipolar disorder.
Stepped care is an increasingly popular treatment model for common mental health disorders, given the large discrepancy between the demand and supply of healthcare service available. In this review, ...we aim to compare the efficacy and cost-effectiveness of stepped care prevention and treatment with care-as-usual (CAU) or waiting-list control for depressive and/or anxiety disorders. 5 databases were utilized from its earliest available records up until April 2015. 10 randomized controlled trials were included in this review, of which 6 examined stepped care prevention and 4 examined stepped care treatment, specifically including ones regarding depressive and/or anxiety disorders. Only trials with self-help as a treatment component were included. Results showed stepped care treatment revealed a significantly better performance than CAU in reducing anxiety symptoms, and the treatment response rate of anxiety disorders was significantly higher in stepped care treatment than in CAU. No significant difference was found between stepped care prevention/treatment and CAU in preventing anxiety and/or depressive disorders and improving depressive symptoms. In conclusion, stepped care model appeared to be better than CAU in treating anxiety disorders. The model has the potential to reduce the burden on existing resources in mental health and increase the reach and availability of service.
Self-help cognitive-behavioral therapy for insomnia (CBT-I) is an acceptable, low-intensity treatment in a stepped care model for insomnia. We tested the application of self-help CBT-I in a Chinese ...population. 312 participants with self-report of insomnia associated with distress or daytime impairment 3 or more nights per week for at least 3 months were randomized to self-help CBT-I with telephone support (SHS), self-help CBT-I (SH) and waiting-list (WL). The program was Internet-based with treatment materials delivered once per week, and lasted for 6 consecutive weeks, while the telephone support was limited to 15 min weekly. Mixed-effects analyses found significant group by time interaction in sleep and sleep-related cognitions at immediate and 4-week posttreatment. Post-hoc pairwise comparison with WL revealed that both SHS and SH had significantly higher sleep efficiency at immediate (p = .004 and p = .03, respectively) and 4-week posttreatment (p = .002 and p = .02, respectively) and lower insomnia and dysfunctional beliefs scores. The SHS group had additional improvements in sleep onset latency and sleep quality. Benefits with self-help CBT-I were maintained at 12-week posttreatment, but attrition rate was about 35%. Internet-based self-help CBT-I was effective and acceptable for treating insomnia in the Chinese population. A brief telephone support further enhanced the efficacy.
•Web-based self-help CBT is efficacious for insomnia in a Chinese community sample.•Weekly brief phone support enhances CBT efficacy, but not improve adherence.•50% of the CBT recipients attain sleep efficiency ≥85% at immediate posttreatment.•Benefits of the 6-week self-help program are maintained at 12-week posttreatment.•Attrition rate in the self-help group is 35%, comparable to the waitlist group.
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