0439 Analysis of Responders to Self-Help Sleep Interventions in a Stepped-Care Clinical Trial Among Schoolteachers

Abstract

<p>Introduction <br></p><p>Schoolteachers often struggle with inadequate sleep or poor sleep quality, placing them at a heightened risk of depression and other mental health conditions. Cognitive behavioral treatment for insomnia (CBTi) has been found to be effective for alleviating depression while bypassing the associated stigma toward mental illnesses. Given the potential of CBTi, we tested the efficacy of delivering CBTi using a stepped-care approach among schoolteachers. <br></p><p>Methods <br></p><p>This study utilized preliminary data from a group of schoolteachers (N = 118) who received stepped care sleep treatment in an on-going assessor-blinded, randomized, waitlist-control trial. We examined the factors associated with clinical remission in sleep problems following self-help interventions (i.e., receiving sleep hygiene education as Step 1, and, if necessary, following with a 6-week self-help app-based CTBi (“proACT-S”) as Step 2). Remission was defined based on their responses after treatment (i.e., at the end of Step 1 or Step 2), classifying participants as responders (i.e., good sleepers) and non-responders (i.e., poor sleepers) using a cutoff value of 5 points on the Pittsburgh sleep quality index (PSQI). <br></p><p>Results <br></p><p>At baseline, participants reported mean scores of 10.7 on PSQI and 9.5 on The Kessler Psychological Distress Scale (K6), indicating poor sleep quality without noticeable mood symptoms. Out of 94 participants who completed end-of-treatment assessment, 16.0% achieved good sleep quality after receiving sleep hygiene education, while an additional 11.7% achieved good sleep quality through the completion of app-based self-help CBTi. Multivariate logistic regression with multiple imputations indicated that participants who reported poor sleep at baseline but without clinical-level insomnia (scored < 8 on Insomnia Severity Index) had a higher odds of good sleep quality at the post-treatment follow-up (aOR = 13.2, 95% CI = 5.0–152.9, p = .04) compared to those with moderated insomnia symptoms. This association was controlled for teachers’ mood and stress symptoms, along with other demographic factors. <br></p><p>Conclusion <br></p><p>For teachers who had poor sleep but without clinical-level insomnia, offering online psychoeducation and, if necessary, self-help CBTi may prevent them from developing clinical insomnia. <br></p><p>Support (if any) <br></p><p>This project is supported by the Health and Medical Research Fund from the Food and Health Bureau,HKSAR (project no: 18191811).<br></p>