Double-blind randomized controlled study of the efficacy, safety and tolerability of eszopiclone vs placebo for the treatment of patients with post-traumatic stress disorder and insomnia.

BACKGROUND: Sleep disturbance is a core feature of post-traumatic stress disorder (PTSD). Given the relationship between sleep disturbance and PTSD, there has been a relative paucity of studies examining the potential therapeutic impact of using pharmacotherapy to target sleep disturbance in patients with PTSD. Eszopiclone (ESZ) is a non-benzodiazepine y-aminobutyric acid-A receptor agonist indicated for the treatment of sleep and may affect sleep in patients with PTSD. AIM: To evaluate the efficacy of ESZ vs placebo (PBO) for patients with PTSD and insomnia. METHODS: The study was a 12-wk, double blind, randomized controlled trial with 3 mg of ESZ (n = 13) or PBO (n = 12). RESULTS: Patients in both arms experienced significant improvement in PTSD symptoms as assessed by the Clinician-Administered PTSD Scale for DSM-IV (CAPS): ESZ (t11 = -3.12, P = 0.005) and PBO (t11 = -3.5, P = 0.002) and by self-report with the Short PTSD Rating Interview (ESZ t11 = -3.38, P = 0.003 and PBO t11 = -4.48, P = 0.0005). There were no significant differences between treatments on the CAPS (t22 = -0.13, P = 0.70) or the Short PTSD Rating Interview (t22 = -0.58, P = 0.56). Similarly, both treated groups improved on sleep measures as assessed by the Pittsburgh Sleep Quality Index with PTSD Addendum (PSQI) and on total sleep time (TST) and sleep latency assessed by actigraphy with no significant differences between groups (PSQI t22 = -0.24, P = 0.81; total sleep time t10 = 0.13, P = 0.90 and sleep latency t10 = 0.68, P = 0.50). There was a significant correlation between improvement in sleep and overall improvement in PTSD as measured by change scores on the PSQI and CAPS, r(8) = 0.79, P = 0.01 for ESZ treated subjects, but not for those treated with PBO r(9) = 0.16, P = 0.69. Adverse events of ESZ were consistent with the known profile of the medication including dysgeusia (30%, mild), sedation (20%, mild) and headache (20%, moderate to severe). CONCLUSION: Results do not support the hypothesis of a specific positive effect of ESZ compared to PBO for measures of PTSD and associated sleep disturbance.

Predictors of Intervention Interest Among Individuals With Short Sleep Duration.

STUDY OBJECTIVES: Over one-third of the United States population sleeps less than the recommended 7 hours a night, which increases risk for chronic diseases. The aim of this study was to evaluate the acceptability of sleep extension interventions and preferences in sleep extension interventions among adults with short sleep duration. METHODS: Participants aged 18 to 65 years with self-reported sleep duration ≤ 6.5 hours completed an online survey including reported sleep behaviors, barriers to adequate sleep, interest in sleep extension interventions, and a sleep disturbance questionnaire. Data were analyzed using chi-square and binary logistic regression. RESULTS: Participants (n = 92; 61 females; mean age = 45.6 years, standard deviation = 13.5) reported an average sleep duration of 5:49 (standard deviation = 0:49). More than half of the participants reported current health comorbidities (64%), including insomnia (n = 12, 13%) and sleep apnea (n = 9, 10%). Many participants (38%) reported sleep disturbance. The most common barrier to adequate sleep included insomnia or other sleep problems (55%). Most respondents (84%) indicated an interest in increasing sleep duration. Of the treatment options suggested, most (84% of those interested) were interested in a wrist-worn device. Participants with insomnia or other sleep disorders were more likely to be interested in extending sleep, (χ² = 12.86, P < .001) and in a wrist-worn device (χ² = 5.24, P = .022). Higher Patient-Reported Outcomes Measurement Information System sleep disturbance t scores were also associated with interest in monitoring sleep with a wrist-worn device (b = .18, P < .001). CONCLUSIONS: Sleep extension interventions using wearable technology are attractive to individuals with short sleep duration, particularly those with greater sleep disturbance and comorbid sleep disorders. CITATION: Adkins EC, DeYonker O, Duffecy J, Hooker SA, Baron KG. Predictors of intervention interest among individuals with short sleep duration. JClin SleepMed. 2019;15(8):1143-1148.

Digital Mental Health Interventions for Depression, Anxiety, and Enhancement of Psychological Well-Being Among College Students: Systematic Review.

BACKGROUND: College students are increasingly reporting common mental health problems, such as depression and anxiety, and they frequently encounter barriers to seeking traditional mental health treatments. Digital mental health interventions, such as those delivered via the Web and apps, offer the potential to improve access to mental health treatment. OBJECTIVE: This study aimed to review the literature on digital mental health interventions focused on depression, anxiety, and enhancement of psychological well-being among samples of college students to identify the effectiveness, usability, acceptability, uptake, and adoption of such programs. METHODS: We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092800), and the search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) from the date of inception to April 2019. Data were synthesized using a systematic narrative synthesis framework, and formal quality assessments were conducted to address the risk of bias. RESULTS: A total of 89 studies met the inclusion criteria. The majority of interventions (71/89, 80%) were delivered via a website, and the most common intervention was internet-based cognitive behavioral therapy (28, 31%). Many programs (33, 37%) featured human support in the form of coaching. The majority of programs were either effective (42, 47%) or partially effective (30, 34%) in producing beneficial changes in the main psychological outcome variables. Approximately half of the studies (45, 51%) did not present any usability or acceptability outcomes, and few studies (4, 4%) examined a broad implementation of digital mental health interventions on college campuses. Quality assessments revealed a moderate-to-severe risk of bias in many of the studies. CONCLUSIONS: Results suggest that digital mental health interventions can be effective for improving depression, anxiety, and psychological well-being among college students, but more rigorous studies are needed to ascertain the effective elements of these interventions. Continued research on improving the user experience of, and thus user engagement with, these programs appears vital for the sustainable implementation of digital mental health interventions on college campuses.

Reviewing the data security and privacy policies of mobile apps for depression.

BACKGROUND: Mobile apps have become popular resources for mental health support. Availability of information about developers' data security procedures for health apps, specifically those targeting mental health, has not been thoroughly investigated. If people are to use and trust these tools for their mental health, it is crucial we evaluate the transparency and quality around the data practices of these apps. The present study reviewed data security and privacy policies of mobile apps for depression. METHODS: We reviewed mobile apps retrieved from iTunes and Google Play stores in October 2017, using the term "depression", and evaluated the transparency of data handling procedures of those apps. RESULTS: We identified 116 eligible mobile phone apps. Of those, 4% (5/116) received a transparency score of acceptable, 28% (32/116) questionable, and 68% (79/116) unacceptable. Only a minority of the apps (49%) had a privacy policy. The availability of policies differed significantly by platform, with apps from iTunes more likely to have a policy than from the Google Play store. Mobile apps collecting identifiable information were significantly more likely to have a privacy policy (79%) compared to those collecting only non-identifiable information (34%). CONCLUSION: The majority of apps reviewed were not sufficiently transparent with information regarding data security. Apps have great potential to scale mental health resources, providing resources to people unable or reluctant to access traditional face-to-face care, or as an adjunct to treatment. However, if they are to be a reasonable resource, they must be safe, secure, and responsible.

Discovery of and Interest in Health Apps Among Those With Mental Health Needs: Survey and Focus Group Study.

BACKGROUND: A large number of health apps are available directly to consumers through app marketplaces. Little information is known, however, about how consumers search for these apps and which factors influence their uptake, adoption, and long-term use. OBJECTIVE: The aim of this study was to understand what people look for when they search for health apps and the aspects and features of those apps that consumers find appealing. METHODS: Participants were recruited from Northwestern University's Center for Behavioral Intervention Technologies' research registry of individuals with mental health needs. Most participants (n=811) completed a survey asking about their use and interest in health and mental health apps. Local participants were also invited to participate in focus groups. A total of 7 focus groups were conducted with 30 participants that collected more detailed information about their use and interest in health and mental health apps. RESULTS: Survey participants commonly found health apps through social media (45.1%, 366/811), personal searches (42.7%, 346/811), or word of mouth (36.9%, 299/811), as opposed to professional sources such as medical providers (24.6%, 200/811). From the focus groups, common themes related to uptake and use of health apps included the importance of personal use before adoption, specific features that users found desirable, and trusted sources either developing or promoting the apps. CONCLUSIONS: As the number of mental health and health apps continue to increase, it is imperative to better understand the factors that impact people's adoption and use of such technologies. Our findings indicated that a number of factors-ease of use, aesthetics, and individual experience-drove adoption and use and highlighted areas of focus for app developers and disseminators.

Exploring the potential of technology-based mental health services for homeless youth: A qualitative study.

Homelessness has serious consequences for youth that heighten the need for mental health services; however, these individuals face significant barriers to access. New models of intervention delivery are required to improve the dissemination of mental health interventions that tailor these services to the unique challenges faced by homeless youth. The purpose of this study was to better understand homeless youths' use of technology, mental health experiences and needs, and willingness to engage with technology-supported mental health interventions to help guide the development of future youth-facing technology-supported interventions. Five focus groups were conducted with 24 homeless youth (62.5% female) in an urban shelter. Youth were 18- to 20-years-old with current periods of homelessness ranging from 6 days to 4 years. Transcripts of these focus groups were coded to identify themes. Homeless youth reported using mobile phones frequently for communication, music, and social media. They indicated a lack of trust and a history of poor relationships with mental health providers despite recognizing the need for general support as well as help for specific mental health problems. Although initial feelings toward technology that share information with a provider were mixed, they reported an acceptance of tracking and sharing information under certain circumstances. Based on these results, we provide recommendations for the development of mental health interventions for this population focusing on technology-based treatment options. (PsycINFO Database Record