Department of Psychiatry, Washington University School of Medicine, 4444 Forest Park Avenue, St. Louis, MO, 63108, USA.
Department of Psychology, Washington University, St. Louis, MO, USA.
Eur Child Adolesc Psychiatry. 2021 Sep;30(9):1463-1474. doi: 10.1007/s00787-020-01641-1. Epub 2020 Sep 15.
In school-aged children, adolescents, and adults, more than 72% of individuals diagnosed with major depression report co-occurring sleep problems, but little is known about sleep problems in the context of preschool-onset major depressive disorder (PO-MDD). The current study examined the prevalence of various sleep problems in a sample of young children diagnosed with PO-MDD and explored how the treatment of depression, using a modification of parent-child interaction therapy focused on emotional development (PCIT-ED), affects sleep problems. Participants included 229 preschoolers (ages 3-6 years) who met criteria for PO-MDD and participated a single-blind, randomized control trial comparing PCIT-ED to a waitlist control condition. Children were randomly assigned to either PCIT-ED (n = 114) or the waitlist condition (n = 115). Children were assessed at baseline, immediately after PCIT-ED, and 3 months after treatment completion for parent-reported sleep problems across the domains of insomnia, hypersomnia, daytime fatigue, and a total sleep problem index. In our sample, 45% of children had at least one subthreshold sleep problem, 38.4% had at least one threshold sleep problem, and 72.5% had at least one sleep problem (either threshold or subthreshold). Treatment with PCIT-ED significantly reduced sleep problems, including insomnia, daytime fatigue, and total sleep problems, compared to a waitlist condition, even when controlling for child depression. This reduction was maintained at a 3-month follow-up. Sleep problems are a prevalent co-occurring condition with PO-MDD. Interventions such as PCIT-ED that also effectively reduce sleep problems may be particularly beneficial for recovery from PO-MDD.Clinical trial registration information: a randomized control trial of PCIT-ED for preschool depression; https://clinicaltrials.gov/NCT02076425 .
在学龄儿童、青少年和成年人中，超过 72%的被诊断患有重度抑郁症的个体报告存在共病睡眠问题，但对于学龄前起病的重度抑郁症（PO-MDD）背景下的睡眠问题知之甚少。本研究在一组被诊断患有 PO-MDD 的幼儿样本中检查了各种睡眠问题的患病率，并探讨了使用针对情绪发展的亲子互动治疗（PCIT-ED）的修改版治疗抑郁症如何影响睡眠问题。参与者包括 229 名符合 PO-MDD 标准并参加单盲、随机对照试验的学龄前儿童（年龄 3-6 岁），该试验比较了 PCIT-ED 与候补对照条件。儿童被随机分配到 PCIT-ED 组（n = 114）或候补组（n = 115）。儿童在基线、PCIT-ED 后即刻以及治疗完成后 3 个月进行评估，评估父母报告的睡眠问题，包括失眠、嗜睡、日间疲劳和总睡眠问题指数的各个领域。在我们的样本中，45%的儿童至少存在一种亚阈值睡眠问题，38.4%至少存在一种阈值睡眠问题，72.5%至少存在一种睡眠问题（无论是阈值还是亚阈值）。与候补组相比，PCIT-ED 治疗显著减少了睡眠问题，包括失眠、日间疲劳和总睡眠问题，即使控制了儿童的抑郁程度。这种减少在 3 个月的随访中得以维持。睡眠问题是与 PO-MDD 共病的常见问题。像 PCIT-ED 这样的干预措施，也能有效地减少睡眠问题，可能对 PO-MDD 的康复特别有益。临床试验注册信息：PCIT-ED 治疗学龄前抑郁症的随机对照试验；https://clinicaltrials.gov/NCT02076425。
