scholarly journals Digital Cognitive Behavioral Therapy for Insomnia for Adolescents With Mental Health Problems: Feasibility Open Trial

10.2196/14842 ◽  
2020 ◽  
Vol 7 (3) ◽  
pp. e14842
Author(s):  
Bethany Cliffe ◽  
Abigail Croker ◽  
Megan Denne ◽  
Jacqueline Smith ◽  
Paul Stallard
Keyword(s):  
Mental Health ◽  
Young People ◽  
Health Services ◽  
Cognitive Behavioral Therapy ◽  
Mental Health Problems ◽  
Behavioral Therapy ◽  
Health Problems ◽  
Anxiety And Depression ◽  
Severity Scale ◽  
Insomnia Severity

Background Insomnia in adolescents is common, persistent, and associated with poor mental health including anxiety and depression. Insomnia in adolescents attending child mental health services is seldom directly treated, and the effects of digital cognitive behavioral therapy (CBT) for insomnia (CBTi) on the mental health of adolescents with significant mental health problems are unknown. Objective This open study aimed to assess the feasibility of adding supported Web-based CBT for insomnia to the usual care of young people aged 14 to 17 years attending specialist child and adolescent mental health services (CAMHS). Methods A total of 39 adolescents with insomnia aged 14 to 17 years attending specialist CAMHS were assessed and offered digital CBTi. The digital intervention was Sleepio, an evidence-based, self-directed, fully automated CBTi that has proven effective in multiple randomized controlled trials with adults. Self-report assessments of sleep (Sleep Condition Indicator [SCI], Insomnia Severity Scale, and Web- or app-based sleep diaries), anxiety (Revised Child Anxiety and Depression Scale [RCADS]), and depression (Mood and Feelings Questionnaire [MFQ]) were completed at baseline and post intervention. Postuse interviews assessed satisfaction with digital CBTi. Results Average baseline sleep efficiency was very poor (53%), with participants spending an average of 9.6 hours in bed but only 5.1 hours asleep. All participants scored less than 17 on the SCI, with 92% (36/39) participants scoring 15 or greater on the Insomnia Severity Scale, suggesting clinical insomnia. Of the 39 participants, 36 (92%) scored 27 or greater on the MFQ for major depression and 20 (51%) had clinically elevated symptoms of anxiety. The majority of participants (38/49, 78%) were not having any treatment for their insomnia, with the remaining 25% (12/49) receiving medication. Sleepio was acceptable, with 77% (30/39) of the participants activating their account and 54% (21/39) completing the program. Satisfaction was high, with 84% (16/19) of the participants finding Sleepio helpful, 95% (18/19) indicating that they would recommend it to a friend, and 37% (7/19) expressing a definite preference for a digital intervention. Statistically significant pre-post improvements were found in weekly diaries of sleep efficiency (P=.005) and sleep quality (P=.001) and on measures of sleep (SCI: P=.001 and Insomnia Severity Index: P=.001), low mood (MFQ: P=.03), and anxiety (RCADS: P=.005). Conclusions Our study has a number of methodological limitations, particularly the small sample size, absence of a comparison group and no follow-up assessment. Nonetheless, our findings are encouraging and suggest that digital CBTi for young people with mental health problems might offer an acceptable and an effective way to improve both sleep and mental health. International Registered Report Identifier (IRRID) RR2-10.2196/11324

scholarly journals Digital cognitive behaviour therapy for insomnia (CBTi) for adolescents with mental health problems. Results from a feasibility open trial. (Preprint)

2019 ◽  
Author(s):  
Bethany Cliffe ◽  
Abigail Croker ◽  
Megan Denne ◽  
Jacqueline Smith ◽  
Paul Stallard
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Problems ◽  
Health Problems ◽  
Anxiety And Depression ◽  
Severity Scale ◽  
Sleep Condition ◽  
Condition Indicator ◽  
Insomnia Severity

BACKGROUND Insomnia in adolescents is common, persistent, and associated with poor mental health including anxiety and depression. Insomnia in adolescents attending child mental health services is seldom directly treated and the effects of digital CBTi on the mental health of adolescents with significant mental health problems is unknown. OBJECTIVE This paper reports an open study assessing the feasibility of adding supported online CBT for insomnia to the usual care of young people aged 14-17 years attending specialist child and adolescent mental health services. METHODS Thirty-nine adolescents aged 14-17 attending specialist child and adolescent mental health services with insomnia were assessed and offered digital CBTi. The digital intervention was Sleepio, an evidence based, self-directed, fully automated CBTi that has proven effective in multiple randomized controlled trials with adults. Self-report assessments of sleep (Sleep Condition Indicator, Insomnia Severity Scale, online sleep diaries), anxiety (Revised Child Anxiety and Depression Scale) and depression (Mood and Feelings Questionnaire) were completed at baseline and post-intervention. Post-use interviews assessed satisfaction with digital CBTi. RESULTS Average baseline sleep efficiency was very poor (52.9%) with participants spending an average of 9.6 hrs in bed but only 5.1 hrs asleep. All scored <17 on the Sleep Condition Indicator with 36/39 (92.3%) scoring ≥15 on the Insomnia Severity Scale, suggesting clinical insomnia. 36 (92.3%) scored ≥ 27 on the Mood and Feelings Questionnaire for major depression and 20 (51.3%) had clinically elevated symptoms of anxiety. The majority (76%) were not having any treatment for their insomnia, with the remaining 24% receiving medication. Sleepio was acceptable with 77% (30/39) activating their account and 67% (21/30) completing the program. Statistically significant pre-post improvements were found in weekly diaries of sleep efficiency (p=.005) and sleep quality (p=.001) and on measures of sleep (SCI; p=.001: ISI; p=.001), low mood (MFQ; p=.024) and anxiety (RCADS; p=.015). Satisfaction was high; with 89% finding Sleepio helpful, 94% would recommend it to a friend with 39% expressing a definite preference for a digital intervention. CONCLUSIONS Our study has a number of methodological limitations, particularly the small sample size, absence of a comparison group and follow-up assessment. Nonetheless, our findings are encouraging and suggest that digital CBTi for young people with mental health problems might offer an acceptable and an effective way to improve both sleep and mental health. CLINICALTRIAL N/a

Young service users from refugee backgrounds: their perspectives on barriers to accessing Australian mental health services

2017 ◽  
Vol 10 (1) ◽  
pp. 68-80 ◽  
Author(s):  
Madeleine Claire Valibhoy ◽  
Josef Szwarc ◽  
Ida Kaplan
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Health Professionals ◽  
Mental Health Problems ◽  
Health Problems ◽  
Explanatory Models ◽  
Service Users ◽  
Content Type

Purpose The purpose of this paper is to examine barriers to accessing mental health services, from the perspective of young people of refugee background who have been service users, and to suggest strategies to improve access to mental health services. Design/methodology/approach A qualitative study was conducted with 16 young people (aged 18-25), who had been refugees and who had attended mental health professionals in Australia. Interview transcripts were analysed thematically to examine participants’ perspectives on what hinders initial access to mental health services. Findings Stigma about mental health problems was particularly prominent. Many believed a high level of disturbance was the threshold for entering services, and for some there was no knowledge of such services’ existence. Options for assistance other than mental health services were often preferred, according to young people’s explanatory models. Apprehension was expressed that sessions would be uncomfortable, distressing or ineffective. The desire to be self-reliant functioned as a further barrier. Finally, structural obstacles and social exclusion deterred some young refugees from accessing services. Practical implications Implications include the need for service providers to be equipped to provide culturally sensitive, responsive services that ideally offer both practical and psychological assistance. Potential referrers, including health professionals and community leaders, could facilitate increased access if trained to recognise and address barriers. Finally, findings indicate potential content for awareness-raising initiatives for young refugees about mental health problems and services. Originality/value This paper is original in its sample, method, topic and findings; being drawn from the first known qualitative research exploring views of young mental health service users who have been refugees about barriers to accessing mental health services.

Mental Health of Adolescents in Custody: The Use of the ‘Adolescent Psychopathology Scale’ in a Tasmanian Context

2002 ◽  
Vol 36 (5) ◽  
pp. 603-609 ◽  
Author(s):  
Rosie Bickel ◽  
Alistair Campbell
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Mental Health Problems ◽  
Adolescent Psychopathology ◽  
Structured Interview ◽  
Health Problems ◽  
Individual Therapy ◽  
Interview Format

Objective: To investigate the incidence of mental health problems based on the DSM-IV [ 1 ] among adolescents in custody in Tasmania, using the Adolescent Psychopathology Scale (APS) [ 2 ]. Methods: The APS was administered to 50 adolescents admitted consecutively to a youth detention centre in Tasmania, Australia, using a structured interview format. Results: In this sample 46% scored positively for a mood disorder, 36% for posttraumatic stress disorder (PTSD), and 32% for an anxiety disorder excluding PTSD. Conclusions: Tasmania is no exception to the rule that adolescents in custody have a high proportion of mental health problems. This study confirmed findings of previous studies that detained adolescents had a roughly equivalent level of mental health problems as young people referred to mental health services and five times more than adolescents in the community. Therefore, all detained adolescents should be assessed for mental health problems as their risk is equivalent to that of young people referred to mental health services in the community. Youth detention centres are able to provide significant opportunities for individual therapy and group programmes for young people with mental health problems. However, to achieve a realization of this potential, detention facilities need to develop philosophies and procedures, which facilitate the development of therapeutic, as opposed to ‘punishing’, environments.

scholarly journals The prevalence, incidence and risk factors of mental health problems and mental health services use before and 9 months after the COVID-19 outbreak among the general Dutch population. A 3-wave prospective study

2021 ◽  
Author(s):  
Peter G. van der Velden ◽  
Miquelle Marchand ◽  
Marcel Das ◽  
Ruud Muffels ◽  
Mark Bosmans
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Problems ◽  
Sleep Problems ◽  
Health Problems ◽  
Anxiety And Depression ◽  
Health Services Use ◽  
Mental Health Services Use

AbstractObjectivesGain insight in the effects of the COVID-19 pandemic on the prevalence, the incidence and risk factors of mental health problems among the Dutch general population and different age groups in November-December 2020, compared to the prevalence, incidence, and risk factors in the same period in 2018 and 2019. More specifically, the prevalence, incidence and risk factors of anxiety and depression symptoms, sleep problems, fatigue, disabilities due to health problems, use of medicines for sleep problems, medicines for anxiety and depression, and mental health services use.MethodsWe extracted data from the LISS (Longitudinal Internet studies for the Social Sciences) panel that is based a probability sample of the Dutch population of 16 years and older by Statistics Netherlands. We used three waves of the longitudinal Health module held in November-December 2018 (T1), November-December 2019 (T2) and November-December 2020 (T3), and selected respondents who were 18 years and older at T1. Data were weighted using 16 demographics profiles of the Dutch adult population (Nstudy sample=4,064). The course of mental health problems was examined with repeated measures multivariate logistic regression analyses, and the differences in incidence with multivariate logistic regression analyses. In both types of analyses, we controlled for sex, age, marital status, employment status, education level and physical disease.ResultsThe repeated measures multivariate logistic regression analyses among the total study sample did not reveal a significant increase in the prevalence of anxiety and depression symptoms, sleep problems, fatigue, disabilities due to health problems, use of medicines for sleep problems, medicines for anxiety and depression, and mental health services use in November- December 2020, compared to November-December 2018 and 2019 (that is, T3 did not differ from T1 and T2). Among the four different age categories (18-34, 35-49, 50-64, and 65 years old and older respondents), 50-64 years respondents had a significantly lower prevalence of anxiety and depression symptoms at T3 than at T1 and T2, while T1 and T2 did not differ. A similar pattern among 65+ respondents was found for mental health services use. We found no indications that the incidence of examined health problems at T2 (no problem at T1, problem at T2) and T3 (no problem at T2, problem at T3) differed. Risk factors for mental health problems at T2 were mostly similar to risk factors at T3; sex and age were less associated with sleep problems at T3, compared to T2 .ConclusionsThe prevalence, incidence and risk factors of examined mental health problems examined nine months after the COVID-19 outbreak appear to be very stable across the end of 2018, 2019 and 2020 among the Dutch adult population and different age categories, suggesting that the Dutch adult population (20 years and older) in general is rather resilient given all disruptions due to this pandemic.

scholarly journals Mental health services for young people: matching the service to the need

2013 ◽  
Vol 202 (s54) ◽  
pp. s1-s2 ◽  
Author(s):  
Max Birchwood ◽  
Swaran P. Singh
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Mental Health Problems ◽  
Public Mental Health ◽  
Health Problems ◽  
Adult Services ◽  
Service Engagement ◽  
Policy Frameworks

SummaryIt is now known that the onset of severe and recurring mental health problems begins for the most part before the age of 25: this provides a clear focus for preventive strategies and public mental health that are a feature of many health policy frameworks. The present distinction between child and adolescent mental health services and adult services at 16 or 18 does not fit easily with these data and the now well-documented problems of transition suggest that a fundamental review of services for young people is overdue. This supplement provides an overview of the epidemiological, conceptual and service structures for young people with emergent and existing mental health problems, and asks the question, ‘How should we design services for young people to promote prevention and service engagement, and to improve outcomes?’

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