Sleep difficulties and interventions: Exploring links between sleep and mental health in adolescents and assessing adherence to Cognitive Behavioural Therapy for Insomnia.

Cowie, Hannah (2021) Sleep difficulties and interventions: Exploring links between sleep and mental health in adolescents and assessing adherence to Cognitive Behavioural Therapy for Insomnia. Doctoral thesis, University of East Anglia.

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Abstract

Background: Insomnia is the most prevalent sleep disorder. The impact of chronic insomnia is far reaching. Cognitive Behavioural Therapy for Insomnia (CBT-I) has been shown to improve both sleep and mental health outcomes. Therefore, it is important to better understand the links between poor sleep and mental health and ensure CBT-I is tolerable.
Method: A systematic review and meta-analysis was conducted to determine rates of dropout, refusal, attendance, and adherence to CBT-I. An empirical study used survey data to explore associations between components of poor sleep, symptoms of depression and anxiety, and wellbeing in an adolescent sample.
Results: 62 studies were included in the systematic review. A proportion meta-analysis yielded a pooled estimated dropout of 9.79%. Subgroup analyses indicated significantly higher dropout in individual when compared to group CBT-I. The most common reason provided by those who dropped out was that CBT-I required too high of a time commitment. A proportion meta-analysis yielded a pooled estimate of 96.71% attendance. Refusal of CBT-I rates ranged from 8.57% to 41.67%. Adherence rates to homework tasks and treatment instructions ranged from 50-90%. The results from the empirical study indicated that anxiety symptoms were significantly positively correlated with sleep disturbance, daytime dysfunction and insomnia severity. Depression symptoms were significantly positively correlated with sleep disturbance, sleep latency, daytime dysfunction, sleep quality and insomnia severity. Wellbeing was significantly negatively correlated with daytime dysfunction and insomnia severity.
Conclusions: The results indicate that dropout from CBT-I was lower than other CBT interventions. Furthermore, the results indicate that certain components of poor sleep may impact more on anxiety, depression, and wellbeing. The findings suggest that mental health outcomes, as well as rates of dropout, refusal, attendance, and adherence to treatment should be routinely recorded and reported within CBT-I studies to improve the acceptability, efficacy, and efficiency of the intervention.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Jackie Webb
Date Deposited:	18 Nov 2021 13:40
Last Modified:	18 Nov 2021 13:40
URI:	https://ueaeprints.uea.ac.uk/id/eprint/82212
DOI:

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