In this Papers Podcast, Dr. Si-Jing Chen discusses her JCPP paper ‘Subtyping at-risk adolescents for predicting response toward insomnia prevention program’ (https://doi.org/10.1111/jcpp.13904). Si-Jing is the first author of the paper.
There is an overview of the paper, methodology, key findings, and implications for practice.
Discussion points include:
- Insomnia prevalence and impact in adolescences.
- Insight into the brief cognitive-behavioural prevention insomnia programme.
- Why the cognitive-behavioural sleep intervention was predominantly more effective for anxiety than depression.
- Implications of findings for CAMH professionals, and how the findings can be translated into practice.
In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are The Journal of Child Psychology and Psychiatry (JCPP); The Child and Adolescent Mental Health (CAMH) journal; and JCPP Advances.
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Dr. Sijing Chen is a postdoctoral researcher at the at the Department of Psychiatry at The Chinese University of Hong Kong and the School of Psychology at Université Laval. Dr. Chen completed her doctoral training in the field of Medical Sciences from the Chinese University of Hong Kong in 2021. Her PhD research project is designed to investigate the effect of e-CBT-I on improving insomnia and preventing depression in youth. In addition, Dr. Chen is proficient at performing systematic review and meta-analysis. Her research interest lies in exploring the associations of sleep disturbances with psychiatric disorders, neurodegenerative diseases, and physical disorders by using meta-analytic methods, conducting randomized controlled trials, and analyzing longitudinal data. She has published several papers in the field of psychiatry and sleep medicine, such as JAMA Netw Open, J Child Psychol Psychiatry, Sleep Med Rev, Sleep, and J Affect Disord.
Transcript
[00:00:01.339] Jo Carlowe: Hello, welcome to the Papers Podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Jo Carlowe, a Freelance Journalist with a specialism in psychology. In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are the Journal of Child Psychology and Psychiatry, commonly known as JCPP, the Child and Adolescent Mental Health, known as CAMH, and JCPP Advances.
Today, I’m interviewing Dr Si-Jing Chen, Postdoctoral Fellow at the Department of Psychiatry at the Chinese University of Hong Kong. Si-Jing is the First Author of the paper, “Subtyping At-Risk Adolescents for Predicting Response Towards Insomnia Prevention Programme,” published in the JCPP. This paper will be the focus of today’s podcast. If you’re a fan of our Papers Podcast series, please subscribe on your preferred streaming platform, let us know how we did, with a rating or review, and do share with friends and colleagues.
Si-Jing, thanks for joining me. Can you start with an introduction about who you are and what you do?
[00:01:10.600] Dr. Si-Jing Chen: Hi, Jo, thank you for your kind introduction. It is my pleasure to join you today. I’m Si-Jing Chen. Currently, I worked in the Department of Psychiatry at the Chinese University of Hong Kong and the School of Psychology at the Laval University, as a Postdoctoral Researcher. My research interest lies in exploring the associations of sleep disturbances with psychiatric disorders, neurodegenerative diseases and physical disorders, by using meta-analytic methods, conducting randomised controlled trials and analysing longitudinal data.
[00:01:49.899] Jo Carlowe: Right, thank you very much. So, today, we’re going to look at your paper about insomnia prevention. To help set the scene for us, can you tell us a bit about insomnia in adolescents? So, what is the prevalence and what is its impact?
[00:02:06.130] Dr. Si-Jing Chen: Sure. Insomnia is the most prevalent sleep disorder in adolescents. According to our previous study, insomnia affects more than 10% of the adolescent population, with a surge in late adolescence. In addition, adolescent insomnia has significant adverse impacts on future health and functioning, and it has been found to precipitate and to maintain to a rise emotional and behavioural problems. For example, our previous research show that insomnia during adolescence has a high chronicity, which is associated with a increased risk of developing depression and suicidal ideation.
[00:02:51.269] Jo Carlowe: Thank you, Si-Jing. Let’s turn now to the paper itself. So, this is “Subtyping At-Risk Adolescents for Predicting Response Towards Insomnia Prevention Programme,” published in the JCPP. Can you give us a brief overview of the paper? What did you look at and why?
[00:03:09.209] Dr. Si-Jing Chen: Yes, sure. First, to provide some background here, I would like to talk a bit about our previous studied. In our previous study, we discover that a four-week cognitive-behavioural prevention programme was able to reduce the risk of developing insomnia among adolescents with a family history of insomnia and a sub-threshold insomnia symptoms by 71%. The current study is a secondary analysis of our original studies, where our aims was to fully evaluate who would benefit from the insomnia prevention programmes with the most meaningful improvement.
The main rationales for conducting this study lies in the increasing recognition of insomnia as a heterogeneous disease. Despite this recognition, the potential subgroup differences in response to sleep intervention remains largely unknowed, especially among the adolescent population. We believe that by evaluating subgroup differences in response to the insomnia prevention programmes amongst at-risk adolescents, we can enhance our understanding about the effects of the prevention programme on elevating sleep and the mood symptoms, as well as the specific needs of different individuals. The findings are expected to enable us to refined current intervention strategies and develop personalised insomnia prevention in a future study.
[00:04:45.590] Jo Carlowe: Great, thank you. That’s really helpful. Can you also tell us a little about the methodology used for this study?
[00:04:52.970] Dr. Si-Jing Chen: Yeah. In these studies, we used a model-based classroom technique called latent class analysis to identify subgroups of at-risk adolescents based on their baseline characteristics, including sleep, daytime and the mood profiles. By using latent class analysis, we were able to uncover the intersections of these characteristics and identified and observed subgroups, so-called latent classes.
[00:05:23.050] Jo Carlowe: Thank you. So, the paper refers to the use of a “brief cognitive-behavioural insomnia prevention programme.” Can you briefly describe what the prevention programme looks like? So, how does it work?
[00:05:36.850] Dr. Si-Jing Chen: Sure. Our prevention programme was adapted and modified according to the key components of cognitive-behavioural therapy for insomniacs, with the particular emphasis on the precipitating and the perpetuating factors that can lead to the onset of insomnia. In particular, behaviour and the cognitive strategies, including stimulus control, sleep hygiene, constructive worry technique and the relaxation were introduced, with the aim to foster good sleep habits and avoid negative behaviours or cognitions that might trigger the insomnia. The intervention was conducted in group format, with six to eight participants per group.
[00:06:24.150] Jo Carlowe: Great, thank you, okay. Can I just ask what ages of the participants were?
[00:06:27.919] Dr. Si-Jing Chen: They are adolescents. There’s about 12 to 18.
[00:06:30.740] Jo Carlowe: Hmmm hmm, a decade, across the range, and what key findings from the paper can you highlight for us?
[00:06:37.440] Dr. Si-Jing Chen: And the key findings of these studies are that adolescents at risk for insomnias can be classified into different subgroups, according to their psychological profiles. These subgroups associated with differential responses to insomnia prevention. In addition, the study demonstrated a brave cognitive-behavioural insomnia prevention programme is effective in preventing insomnia disorder, with additional benefits in reducing the risk of excessive daytime sleepiness and anxiety, particularly for those individuals with daytime impairments and mood symptoms.
[00:07:19.310] Jo Carlowe: In nine previous studies, you’ve found that the cognitive-behavioural sleep intervention predominantly led to greater improvements in anxiety than depression, compared with the controls. What is your take on this? Why is it more effective with anxiety than depression?
[00:07:36.360] Dr. Si-Jing Chen: And the insignificant intervention effects on depressions may be attributed to the relatively low level of depressive severity at baseline and among this sample size in the current study. These factors can lead to inadequate statistical power to detect significant group differences. Therefore, we cannot true the conclusion that the intervention is more effective with anxiety than depression, based on current findings. Future study with larger sample sizes are needed to fully investigate the possibility of preventing insomnia to reduce the risk of future depression.
[00:08:18.500] Jo Carlowe: Great. Thank you for clarifying on that. Si-Jing, is there anything else in the paper that you would like to highlight?
[00:08:23.460] Dr. Si-Jing Chen: Yes, there are some additional findings I would like to highlight. First, we found that those adolescents comorbid with mood and sleepiness symptoms represented the highest risk group of developing full-blowned insomnia disorder within the one-year follow-up period. Although we observed significant improvements of the intervention group compared to the control group, in terms of insomnia severity and the incidence of insomnia disorder, improvements in this high-risk subgroup were still suboptimal. This suggests that additional booster sessions or models especially targeting mood problems might be needed for high-risk adolescents with more prominent sleep and the mood symptoms.
Second, we found that as daytime sleepiness is a notable feature for subgrouping at-risk adolescents and a key factor associated with intervention responses, this finding has not been thoroughly reported in previous studies.
[00:09:29.930] Jo Carlowe: What are the implications of your findings for CAMH professionals?
[00:09:34.240] Dr. Si-Jing Chen: Our findings indicate that a brief cognitive-behavioural insomnia prevention programme is effective in preventing insomnia disorders, with additional benefits in reducing the risk of daytime sleepiness and anxiety, particularly for those with daytime impairments and the mood symptoms. Therefore, future development of insomnia prevention programme should consider these specific insomnia phenotypes, with a viewed of develop personalised cared for different subgroups.
[00:10:08.529] Jo Carlowe: Hmmm hmm. Your findings demonstrate, then, that timely intervention is effective in preventing insomnia disorder and reducing symptoms. How do you envisage your findings being translated into practice?
[00:10:20.769] Dr. Si-Jing Chen: I think there are several steps that can be taken to translate our findings into practice. Firstly, it is crucial to integrate cognitive-behavioural insomnia prevention programmes into routined mental healthcares for adolescents, as this programme has been demonstrated to be effective by our study. Therefore, efforts should be made to ensure that insomnia prevention programmes is available and accessible to adolescents, particularly in primary cares and the broaders community.
Secondly, healthcare providers and the practitioners should be aware of the presence of subgroups amongst at-risk adolescents that might respond differently to insomnia prevention. This finding may guide clinical judgment and help develop personalised prevention. For example, adolescents with prominent mood and sleepiness symptoms may benefit from additional treatment component specially targeting mood symptoms. Furthermores, in order to facilitate the implementations of evident-based insomnia prevention programmes in mental healthcare settings, further adaption of our current programmes may be needed to move forwards to a Stepped Cared framework.
[00:11:41.230] Jo Carlowe: That’s very good, thank you. Are you planning any follow-up research, or is there anything else in the pipeline that you would like to share with us?
[00:11:49.660] Dr. Si-Jing Chen: Now, actually, we have conducted a three-yeared follow-up and the manuscript is currently in preparations. In this follow-up study, we found that the beneficial effects of the insomnia prevention programme did not sustained over the three-year follow-up period. The implications of this finding aligns with the current study, suggesting that booster sessions during the follow-up period may be necessary to maintain the long-term preventive effects. In additions, we have plans to further our research on the identification of different subtypes of sleep and the circadian problems in adolescents.
Furthermore, we plan to investigate the possibility of preventing sleep problems through the adoption of transdiagnostic sleep and circadian intervention, with personalised components to reduce future psychopathologies.
[00:12:46.410] Jo Carlowe: Fantastic. So, lots in the pipeline.
[00:12:49.120] Dr. Si-Jing Chen: Yeah.
[00:12:50.769] Jo Carlowe: And finally, Si-Jing, what is your take home message for our listeners?
[00:12:55.029] Dr. Si-Jing Chen: And the take home messages would be that based on our findings, adolescents at risk for insomnia can be classified into different subgroups according to their psychological profiles, which are associated with differential responses to insomnia preventions. A brief cognitive-behavioural insomnia prevention programme is more effective in preventing insomnia and reducing the risk of daytime sleepiness and anxiety among the adolescents with a higher level of daytime sleepiness, anxiety and the depressive symptoms. So, these findings suggest the need for furthers phenotyping at-risk adolescents to develop personalised intervention.
[00:13:39.029] Jo Carlowe: Great, wonderful. Thank you so much. For more details on Dr Si-Jing Chen, please visit the ACAMH website, www.acamh.org, and Twitter @ACAMH. ACAMH is spelt A-C-A-M-H, and don’t forget to follow us on your preferred streaming platform, let us know if you enjoy the podcast, with a rating or review, and do share with friends and colleagues.
