Instructor, Psychiatry and Behavioral Sciences
Treating Insomnia in Depression: Insomnia Related Factors Predict Long-Term Depression Trajectories
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY
2018; 86 (3): 282–93
Insomnia and major depressive disorders (MDD) often co-occur, and such comorbidity has been associated with poorer outcomes for both conditions. However, individual differences in depressive symptom trajectories during and after treatment are poorly understood in comorbid insomnia and depression. This study explored the heterogeneity in long-term depression change trajectories, and examined their correlates, particularly insomnia-related characteristics.Participants were 148 adults (age M ± SD = 46.6 ± 12.6, 73.0% female) with insomnia and MDD who received antidepressant pharmacotherapy, and were randomized to 7-session Cognitive Behavioral Therapy for Insomnia or control conditions over 16 weeks with 2-year follow-ups. Depression and insomnia severity were assessed at baseline, biweekly during treatment, and every 4 months thereafter. Sleep effort and beliefs about sleep were also assessed.Growth mixture modeling revealed three trajectories: (a) Partial-Responders (68.9%) had moderate symptom reduction during early treatment (p value < .001) and maintained mild depression during follow-ups. (b) Initial-Responders (17.6%) had marked symptom reduction during treatment (p values < .001) and low depression severity at posttreatment, but increased severity over follow-up (p value < .001). (c) Optimal-Responders (13.5%) achieved most gains during early treatment (p value < .001), continued to improve (p value < .01) and maintained minimal depression during follow-ups. The classes did not differ significantly on baseline measures or treatment received, but differed on insomnia-related measures after treatment began (p values < .05): Optimal-Responders consistently endorsed the lowest insomnia severity, sleep effort, and unhelpful beliefs about sleep.Three depression symptom trajectories were observed among patients with comorbid insomnia and MDD. These trajectories were associated with insomnia-related constructs after commencing treatment. Early changes in insomnia characteristics may predict long-term depression outcomes. (PsycINFO Database Record
View details for PubMedID 29504795
View details for PubMedCentralID PMC5841584
The Impact of Sleep Improvement on Food Choices in Adolescents With Late Bedtimes
JOURNAL OF ADOLESCENT HEALTH
2017; 60 (5): 570–76
The aim was to investigate the effect of sleep improvement on desire for and intake of weight gain-promoting foods in adolescents with late bedtimes.A sample of 42 adolescents with late bedtimes was enrolled in an intervention designed to improve sleep. Their desire for and intake of food in the morning was assessed at before and after treatment.Adolescents with earlier bedtimes at post-treatment relative to pretreatment increased their caloric intake of low glycemic index, fruit, and dairy foods at post-treatment. This effect was not observed in adolescents who did not improve their bedtime at post-treatment.These findings suggest that advancing bedtimes earlier can improve breakfast choices, an important meal for obesity prevention during adolescence.
View details for DOI 10.1016/j.jadohealth.2016.11.018
View details for Web of Science ID 000401110800014
View details for PubMedID 28111011
View details for PubMedCentralID PMC5558152
Evidence for a Possible Link between Bedtime and Change in Body Mass Index
2015; 38 (10): 1523-1527
The aim of the current study was to examine the longitudinal relationship between bedtimes and body mass index (BMI) from adolescence to adulthood in a nationally representative sample.Three waves of data from the National Longitudinal Study of Adolescent Health were used to assess the bedtimes and BMI of 3,342 adolescents between 1994 and 2009. Hypotheses were tested with hierarchical linear models using a two-level, random intercept and slopes model.Later average bedtime during the workweek, in hours, from adolescence to adulthood was associated with an increase in BMI over time (b = 0.035 kg/m(2) per min later bedtime per 6 years; standard error = 0.016; t = 2.12, degrees of freedom = 3,238, P < 0.05). These results remained significant after controlling for demographic characteristics and baseline BMI. Although sleep duration, screen time, and exercise frequency did not attenuate the relationship between workday bedtime and BMI over time, fast-food consumption was recognized as a significant partial mediator of the relationship between bedtimes and BMI longitudinally.The results highlight bedtimes as a potential target for weight management during adolescence and during the transition to adulthood.
View details for DOI 10.5665/sleep.5038
View details for Web of Science ID 000362684500002
View details for PubMedID 26194568
Insomnia as a Transdiagnostic Process in Psychiatric Disorders
CURRENT PSYCHIATRY REPORTS
2014; 16 (9)
Insomnia is a major public health concern, and is highly comorbid with a broad range of psychiatric disorders. Although insomnia has historically been considered a symptom of other disorders, this perspective has shifted. Epidemiological and experimental studies suggest that insomnia is related to the onset and course of several psychiatric disorders. Furthermore, several randomized controlled trials show that cognitive behavioral therapy for insomnia delivered to individuals who meet diagnostic criteria for insomnia and another psychiatric disorder improves the insomnia as well as the symptoms of the comorbid psychiatric disorder. Taken together, these results encompassing a range of methodologies have provided encouraging evidence and point toward insomnia as a transdiagnostic process in psychiatric disorders.
View details for DOI 10.1007/s11920-014-0471-y
View details for Web of Science ID 000341827400009
View details for PubMedID 25030972
Basic Sleep and Circadian Science as Building Blocks for Behavioral Interventions: A Translational Approach for Mood Disorders
2014; 128 (3): 360-370
Sleep and circadian functioning has been of particular interest to researchers focused on improving treatments for psychiatric illness. The goal of the present paper is to highlight the exciting research that utilizes basic sleep and circadian science as building blocks for intervention in the mood disorders. The reviewed evidence suggests that the sleep and circadian systems are a) disrupted in the mood disorders and linked to symptoms, b) open systems that can be modified, c) the focus of interventions which have been developed to effectively treat sleep disturbance within mood disorders, and d) intimately linked with mood, such that improvements in sleep are associated with improvements in mood. Although significant positive treatment effects are evident, more research is needed to fill the gap in our basic understanding of the relationship between sleep and mood.
View details for DOI 10.1037/a0035892
View details for Web of Science ID 000349168900010
View details for PubMedID 24773429
Children at risk for depression: Memory biases, self-schemas, and genotypic variation
JOURNAL OF AFFECTIVE DISORDERS
2014; 159: 66-72
Daughters of depressed mothers are at increased risk for developing a depressive disorder. We know relatively little, however, about the specific factors that contribute to this elevated risk. The present study investigated the effects of familial risk for depression and the 5-HTTLPR and COMT Val158Met polymorphisms, which have been associated with risk for depression, on biases in endorsement of and memory for positive and negative adjectives.Following a negative mood induction, 60 girls between the ages of 10 and 14 who had recurrent depressed mothers (high risk for depression) and 91 age-matched daughters of never-disordered mothers (low risk for depression) completed a Self-Referent Encoding Task in which they decided whether negative and positive adjectives described them. Following the task they were asked to recall as many of the adjectives as they could.Despite the absence of significant group differences in endorsement of positive or negative adjectives, high-risk girls with the COMT Val158Met Val/Val polymorphism recalled more positive (but not negative) words that they had endorsed than did high-risk girls who were homozygous for the Met allele. COMT was not associated with recall of valenced adjectives in low-risk girls. Across risk groups, 5-HTTLPR polymorphism was not associated with recall of valenced adjectives.Even with over 150 participants, there were relatively small numbers in some of the cells of this study, limiting its statistical power.These results suggest that assessing the interaction of familial risk status and COMT polymorphism is important in understanding the development of depressive disorders.
View details for DOI 10.1016/j.jad.2014.02.020
View details for Web of Science ID 000333398400011
View details for PubMedID 24679392
View details for PubMedCentralID PMC4000236
The Effects of Bedtime and Sleep Duration on Academic and Emotional Outcomes in a Nationally Representative Sample of Adolescents
JOURNAL OF ADOLESCENT HEALTH
2014; 54 (3): 350-356
The overall aim of this study was to clarify and better characterize the sleep/circadian patterns of adolescents in a nationally representative sample.We used three waves of data from the National Longitudinal Study of Adolescent Health to assess sleep/circadian patterns of 2,700 adolescents in grades seven through 12.Late school year bedtime was associated with shorter total sleep time cross-sectionally, whereas late summertime bedtime was not. Moreover, late school year bedtime was not associated with late summertime bedtime cross-sectionally. Late school year bedtime in Wave I (1994-1995) was associated with worse educational outcomes and emotional distress 6-8 years later. In addition, late summertime bedtime in Wave II (1996) was associated with more emotional distress at Wave III (2001-2002). Short total sleep time was not associated longitudinally with changes in emotional and academic functioning. Across Waves I and II, more than three quarters of adolescents who went to sleep at 11:15 a.m. or later during the school year or 1:30 a.m. or later during the summer reported sleeping fewer than the recommended 9 hours.These findings underscore the significance of evaluating and monitoring bedtime in adolescents and the importance of intervention strategies that target bedtimes in an effort to reduce associated functional impairments, and improve academic and emotional outcomes.
View details for DOI 10.1016/j.jadohealth.2013.09.004
View details for Web of Science ID 000331722800017
View details for PubMedID 24225447
Circadian rhythms and psychiatric illness
CURRENT OPINION IN PSYCHIATRY
2013; 26 (6): 566-571
The present review provides a conceptual introduction to sleep and circadian research in psychiatric illness, and discusses recent experimental and intervention findings in this area.In this review, studies published since January 2011 on circadian disturbance and psychiatric illness have been summarized.Exciting new results have increasingly utilized objective and validated instruments to measure the circadian system in experimental studies. Since 2011, treatment research has still predominantly utilized self-report measures as outcome variables. However, research in the treatment domain for sleep/circadian disturbances comorbid with psychiatric illness has advanced the field in its work to broaden the validation of existing sleep treatments to additional patient populations with comorbid sleep/circadian disruptions and address how to increase access to and affordability of treatment for sleep and circadian dysfunction for patients with psychiatric disorders, and how to combine psychosocial treatments with psychopharmacology to optimize treatment outcomes.
View details for DOI 10.1097/YCO.0b013e328365a2fa
View details for Web of Science ID 000326814800008
View details for PubMedID 24060916