Harvey Allison G, Agnew Emma R, Hache Rafael Esteva, Spencer Julia M, Diaz Marlen, Patino Estephania Ovalle, Milner Anne, Dong Lu, Kilbourne Amy M, Buysse Daniel J, Callaway Catherine A, Sarfan Laurel D
University of California Berkeley.
RAND Corporation.
Res Sq. 2024 Dec 24:rs.3.rs-5422372. doi: 10.21203/rs.3.rs-5422372/v1.
To determine if the use of theory, data and end-user perspectives to guide an adaptation of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) yields better outcomes and improves the "fit" of TranS-C to community mental health centers (CMHCs), relative to the standard version.
Ten counties in California were cluster-randomized by county to Adapted or Standard TranS-C. Within each county, adults who exhibited sleep and circadian dysfunction and serious mental illness (SMI) were randomized to immediate TranS-C or Usual Care followed by Delayed Treatment with TranS-C (UC-DT). Facilitation was the implementation strategy. The participants were 93 CMHC providers who delivered TranS-C (Standard = 30; Adapted = 63) and 396 CMHC patients (Standard = 74; Adapted = 124; UC-DT = 198). Patient assessments were completed at pre-treatment, post-treatment, and six months after treatment (6FU). Provider assessments were completed at post-training, mid-treatment, and post-treatment.
TranS-C (combining Adapted and Standard), relative to UC-DT before delayed treatment with TranS-C, was associated with improvement from pre- to post-treatment in sleep disturbance ( = -10.91, < 0.001, = -1.52), sleep-related impairment ( = -9.52, < 0.001, = -1.06), sleep health composite ( = 1.63, < 0.001, = 0.95), psychiatric symptoms ( = -6.72, < 0.001, = -0.52), and overall functional impairment ( = -5.12, < 0.001, = -0.71). TranS-C's benefits for functional impairment and psychiatric symptoms were mediated by improvements in sleep and circadian problems. Adapted versus Standard TranS-C did not differ on provider ratings of fit and better fit did not mediate the relation between TranS-C condition and patient outcome.
TranS-C can be delivered by CMHC providers. Although Adapted and Standard TranS-C both fit the CMHC context, several advantages emerged for the adapted version.
为了确定相对于标准版本，运用理论、数据和最终用户视角来指导对睡眠与昼夜节律功能障碍的跨诊断干预（TranS-C）进行调整是否能产生更好的效果，并提高TranS-C与社区心理健康中心（CMHC）的“适配性”。
加利福尼亚州的10个县被按县进行整群随机分组，分为调整版或标准版TranS-C。在每个县内，表现出睡眠和昼夜节律功能障碍以及严重精神疾病（SMI）的成年人被随机分为立即接受TranS-C治疗或常规护理，随后延迟接受TranS-C治疗（UC-DT）。促进是实施策略。参与者包括93名提供TranS-C治疗的CMHC提供者（标准组 = 30；调整组 = 63）和396名CMHC患者（标准组 = 74；调整组 = 124；UC-DT组 = 198）。在治疗前、治疗后以及治疗后六个月（6FU）完成患者评估。在培训后、治疗中期和治疗后完成提供者评估。
与在延迟接受TranS-C治疗前的UC-DT相比，TranS-C（结合调整版和标准版）与从治疗前到治疗后的睡眠障碍改善相关（= -10.91，< 0.001，= -1.52）、睡眠相关损害改善相关（= -9.52，< 0.001，= -1.06）、睡眠健康综合指标改善相关（= 1.63，< 0.001，= 0.95）、精神症状改善相关（= -6.72，< 0.001，= -0.52）以及整体功能损害改善相关（= -5.12，< 0.001，= -0.71）。TranS-C对功能损害和精神症状的益处是由睡眠和昼夜节律问题的改善介导的。调整版与标准版TranS-C在提供者对适配性的评分上没有差异，且更好的适配性并未介导TranS-C治疗条件与患者结局之间的关系。
CMHC提供者可以提供TranS-C。虽然调整版和标准版TranS-C都适合CMHC的环境，但调整版出现了几个优势。
