O'Sullivan Michelle, Rahim Masuma, Hall Christopher
School of Psychology, University of Surrey, Surrey, UK: Surrey & Borders Partnership Mental Health NHS Foundation Trust, Surrey, UK.
South-West London & St George's Mental Health NHS Trust, London, UK.
J Clin Sleep Med. 2015 Jan 15;11(2):111-6. doi: 10.5664/jcsm.4452.
Poor sleep quality, particularly insomnia, has been identified as a frequent problem among individuals with mental health difficulties. Comorbid sleep difficulties adversely affect quality of life and functioning, and have been associated with the causation and maintenance of a number of psychiatric disorders, as well as increasing the risk of relapse. The study objectives were to ascertain clinician knowledge related to insomnia, investigate sleep quality among service users in a community mental health setting in the UK, and evaluate service provision of evidence-based interventions for sleep difficulties.
A cross-sectional design was used. Nineteen clinicians completed a questionnaire on their clinical practice. Seventy-three service users completed the Pittsburgh Sleep Quality Index and provided self-report data on interventions received and associated satisfaction.
Clinical staff demonstrated deficits in knowledge of insomnia symptomatology. Sixty-four percent (95% CI 54% to 74%) of service users were identified as poor sleepers on the PSQI. Sixty-one percent of poor sleepers had not been offered support for sleep difficulties. The most common support received was prescribed psychotropic medication (32%). Cognitive behavioral therapy was the intervention rated as most helpful but was only received by 6%.
This study highlights inadequaciesin providing evidence-based interventions for sleep difficulties. Key recommendations include training clinicians in the identification of sleep difficulties and provision of evidence-based interventions, provision of cost-effective transdiagnostic group interventions, and formalizing assessment and treatment pathways for service users with sleep difficulties.
睡眠质量差，尤其是失眠，已被确认为心理健康有问题的个体中常见的问题。合并存在的睡眠困难会对生活质量和功能产生不利影响，并且与多种精神障碍的病因及维持有关，还会增加复发风险。本研究的目标是确定临床医生关于失眠的知识，调查英国社区心理健康环境中服务使用者的睡眠质量，并评估针对睡眠困难的循证干预措施的服务提供情况。
采用横断面设计。19名临床医生完成了一份关于其临床实践的问卷。73名服务使用者完成了匹兹堡睡眠质量指数，并提供了关于所接受干预措施及相关满意度的自我报告数据。
临床工作人员在失眠症状学知识方面存在欠缺。在匹兹堡睡眠质量指数上，64%（95%可信区间54%至74%）的服务使用者被认定为睡眠质量差。61%睡眠质量差的人未获得针对睡眠困难的支持。最常获得的支持是开具的精神药物（32%）。认知行为疗法是被评为最有帮助的干预措施，但只有6%的人接受过。
本研究凸显了在为睡眠困难提供循证干预措施方面的不足。主要建议包括培训临床医生识别睡眠困难并提供循证干预措施，提供具有成本效益的跨诊断团体干预措施，以及为有睡眠困难的服务使用者规范评估和治疗途径。
