Department of Psychiatry, Yonsei University College of Medicine, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea.
Center for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea.
JMIR Mhealth Uhealth. 2020 Aug 24;8(8):e17755. doi: 10.2196/17755.
As an evidence-based psychotherapy for treating insomnia, cognitive behavioral therapy for insomnia (CBT-I), which helps people with sleep problems to change their unhelpful sleep-related beliefs and habits, has been well-established in older adults. Recently, the utilization of mobile CBT-I apps has been getting attention from mental health professionals and researchers; however, whether mobile CBT-I apps are usable among older users has yet to be determined.
The aims of this study were to explore the relationships between subjective sleep quality and subjective memory complaints and depressive symptoms; to explore the relationship between perceived difficulty in mobile app use and usability of the mobile phone-based self-help CBT-I app, named MIND MORE, in urban community-dwelling Korean older adults; to compare changes in subjective sleep quality from pre-intervention to post-intervention, during which they used the mobile app over a 1-week intervention period; and evaluate adherence to the app.
During the 2-hour training program delivered on 1 day titled "Overcoming insomnia without medication: How to use the 'MIND MORE' mobile app for systematic self-management of insomnia" (pre-intervention), 41 attendants were asked to gain hands-on experience with the app facilitated by therapists and volunteer workers. They were then asked to complete questionnaires on sociodemographic characteristics, subjective evaluation of mental health status (ie, depression, memory loss and impairment, and sleep problems), and app usability. For the 1-week home-based self-help CBT-I using the app (post-intervention), 9 of the 41 program attendants, who had already signed up for the pre-intervention, were guided to complete the given questionnaires on subjective evaluation of sleep quality after the 1-week intervention, specifically 8 days after the training program ended.
Due to missing data, 40 of 41 attendants were included in the data analysis. The main findings of this study were as follows. First, poor subjective sleep quality was associated with higher ratings of depressive symptoms (40/40; ρ=.60, P<.001) and memory complaints (40/40; ρ=.46, P=.003) at baseline. Second, significant improvements in subjective sleep quality from pre-intervention to post-intervention were observed in the older adults who used the MIND MORE app only for the 1-week intervention period (9/9; t=3.74, P=.006). Third, apart from the program attendants who did not have a smartphone (2/40) or withdrew from their MIND MORE membership (3/40), those who attended the 1-day sleep education program adhered to the app from at least 2 weeks (13/35, 37%) to 8 weeks (2/35, 6%) without any further contact.
This study provides empirical evidence that the newly developed MIND MORE app not only is usable among older users but also could improve subjective sleep quality after a 1-week self-help intervention period.
认知行为疗法（CBT-I）是一种基于循证的失眠治疗方法，可帮助有睡眠问题的人改变无益的与睡眠相关的信念和习惯，在老年人中已得到广泛应用。最近，移动 CBT-I 应用程序的使用引起了心理健康专业人员和研究人员的关注；然而，移动 CBT-I 应用程序是否适用于老年用户尚未确定。
本研究旨在探讨主观睡眠质量与主观记忆主诉和抑郁症状之间的关系；探讨在城市社区居住的韩国老年人中，感知移动应用程序使用难度与基于手机的自助 CBT-I 应用程序（名为 MIND MORE）的可用性之间的关系；比较在使用移动应用程序进行 1 周干预期间，主观睡眠质量从干预前到干预后的变化；并评估对应用程序的依从性。
在为期 2 小时的培训课程中，名为“无需药物即可克服失眠：如何使用‘MIND MORE’移动应用程序对失眠进行系统的自我管理”（干预前），41 名参与者被要求在治疗师和志愿者的帮助下获得应用程序的实际操作经验。然后，他们被要求完成关于社会人口统计学特征、心理健康状况主观评估（即抑郁、记忆丧失和损伤以及睡眠问题）和应用程序可用性的问卷。在使用该应用程序进行为期 1 周的家庭自助 CBT-I 干预（干预后）期间，已报名参加干预前的 41 名参与者中的 9 名被引导在 1 周干预后完成给定的睡眠质量主观评估问卷，具体时间是在培训课程结束 8 天后。
由于数据缺失，仅 41 名参与者中的 40 名被纳入数据分析。本研究的主要发现如下。首先，较差的主观睡眠质量与更高的抑郁症状评分（40/40；ρ=.60，P<.001）和记忆主诉（40/40；ρ=.46，P=.003）相关。其次，仅在干预期间使用 MIND MORE 应用程序的老年人中，主观睡眠质量从干预前到干预后显著改善（9/9；t=3.74，P=.006）。第三，除了没有智能手机的参与者（2/40）或退出 MIND MORE 会员资格的参与者（3/40）外，那些参加为期 1 天的睡眠教育计划的参与者至少坚持使用该应用程序 2 周（13/35，37%）至 8 周（2/35，6%），而无需进一步联系。
本研究提供了实证证据，表明新开发的 MIND MORE 应用程序不仅在老年用户中可用，而且在 1 周自助干预后还可以改善主观睡眠质量。
