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Scholarly Works (6 results)

  • Thesis
  • Peer Reviewed
UC Berkeley Electronic Theses and Dissertations (2019)

Background. Adolescence is associated with a shift toward an evening circadian preference, which is linked to increased risk across health domains. This study examined the influence of inflammation on sleep, circadian functioning, and health at pretreatment and following participation in a psychosocial intervention targeting sleep and health.

Method. Participants were 165 (96 female, average age = 14.7 years) adolescents randomized to receive 6-sessions of a psychosocial intervention targeting sleep and health. Sleep and circadian outcomes included weeknight total sleep time (TST), weeknight bedtime, and the Children's Morningness-Eveningness Preferences Scale. Health domains included emotional, cognitive, behavioral, social, and physical health. Sleep, circadian, and health outcomes were assessed at pretreatment, posttreatment, 6-month follow-up, and 12-month follow-up. Inflammatory markers were soluble tumor necrosis factor receptor 2 (sTNF-R2), interleukin (IL)-6, and C-reactive protein (CRP) measured at pretreatment.

Results. At pretreatment, shorter TST was associated with more emotional domain risk among adolescents with higher CRP. For adolescents with lower IL-6 at pretreatment, a greater evening circadian preference was associated with more behavioral risk. Inflammation also influenced treatment effects. Lower pretreatment sTNF-R2 was related to a decrease in self-reported evening circadian preference following treatment and through follow-up. Lower pretreatment IL-6 was associated with reduced behavioral and physical domain risk following treatment and through follow-up.

Conclusions. These findings support a growing body of literature showing that biological factors such as inflammation may influence sensitivity to positive and negative experiences on outcomes across key domains of health during adolescence.

Keywords: Adolescent; Circadian Rhythm; Health; Inflammation; Sleep.

    Cover page: The influence of inflammation on sleep, circadian functioning, and risk among adolescents with an evening circadian preference
    • Article
    • Peer Reviewed
    UC Berkeley Previously Published Works (2018)

    Purpose

    A shift toward an evening circadian preference and the onset of mood problems often occur during adolescence. Although these changes are linked to poorer outcomes, few studies have considered how positive and negative affect are related to the circadian rhythm during adolescence. This study examined the relationship between evening and morning affect ratings and dim light melatonin onset (DLMO), a measure of endogenous circadian rhythm. Age and sex were tested as moderators.

    Methods

    This study is based on a subset of 163 (94 female, age = 14.7) adolescents with an evening circadian preference from a National Institute of Child Health and Human Development-funded study. Participants provided saliva for melatonin analysis and rated evening and morning affect.

    Results

    Higher evening negative affect was related to a later DLMO. Evening positive affect was not significantly related to DLMO timing. Age but not sex was a significant moderator such that higher negative and lower positive affect were related to a later DLMO for 10- to 13-year-olds, whereas higher positive affect was related to a later DLMO for 17- to 18-year-olds. DLMO was not significantly related to morning affect ratings.

    Conclusions

    There is evidence that higher negative and lower positive affect may be related to the shift toward an evening circadian preference observed in adolescents, particularly for younger adolescents.
      Cover page: Dim Light Melatonin Onset and Affect in Adolescents With an Evening Circadian Preference
      • Article
      • Peer Reviewed
      UC Berkeley Previously Published Works (2019)

      Objective

      Existing research has demonstrated that patient ratings of usefulness and ratings of utilization of treatment elements are associated with treatment outcome. Few studies have examined this relationship among adolescents and with an extended follow-up. This study examined the extent to which elements of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) were rated by youth as useful and utilized 6-months and 12-months after treatment.

      Method

      Participants were 64 adolescents with an evening circadian preference who were given TranS-C as a part of their participation in a NICHD-funded study. At 6-month and 12-month follow-up, they completed the Usefulness Scale, the Utilization Scale, a 7-day sleep diary assessing total sleep time (TST) and bedtime, and the Children's Morningness-Eveningness Preference Scale (CMEP).

      Results

      On average, adolescents rated treatment elements as moderately useful and they utilized the treatment elements occasionally. Ratings of usefulness were associated with TST at 6-month follow-up, but not with bedtime or CMEP. Ratings of utilization were associated with a change in bedtime from 6-month to 12-month follow-up, but not with TST or CMEP. Ratings of usefulness and utilization were associated with selected treatment outcome measures at both follow-ups.

      Conclusions

      These findings have implications for understanding mechanisms of change following treatment.
        Cover page: Usefulness and utilization of treatment elements from the Transdiagnostic Sleep and Circadian Intervention for adolescents with an evening circadian preference
        • Article
        • Peer Reviewed
        UC Berkeley Previously Published Works (2020)
        BACKGROUND: This study examined the 6-month follow-up outcomes of the Transdiagnostic Sleep and Circadian Intervention (TranS-C), compared to Psychoeducation about sleep and health (PE). METHODS: Adolescents (mean [SD] = 14.77 [1.84] years) with eveningness chronotype and at-risk in at least one of five health domains were randomized to receive TranS-C (n = 89) or PE (n = 87) at a university-based clinic. Primary outcomes were average weeknight total sleep time and bedtime calculated from sleep diary, a questionnaire measure of circadian preference, and composite risks in five health domains. Secondary outcomes were selected sleep diary indices, sleepiness, and self- and parent-reported sleep, parent-reported risks in five health domains. RESULTS: Relative to PE, TranS-C showed treatment effects through 6-month follow-up on only one primary outcome; namely eveningness circadian preference. TranS-C also showed treatment effects on two sleep and circadian secondary outcomes, including the Pittsburgh Sleep Quality Index and sleep-diary measured weeknight-weekend discrepancy in wakeup time. TranS-C did not show treatment effects on self-report or parent-report composite risks in five health domains. PE showed benefit, relative to TranS-C, from posttreatment to 6-month follow-up for reducing parent-reported behavioral health risk (secondary outcome). CONCLUSIONS: In at-risk adolescents, the evidence supports the TranS-C treatment effects over six months on improving sleep and circadian functioning on selected outcomes but not on reducing risk in five health domains.
          Cover page: A transdiagnostic sleep and circadian intervention for adolescents: six-month follow-up of a randomized controlled trial.
          • Article
          • Peer Reviewed
          UC Berkeley Previously Published Works (2018)

          Objective

          Proinflammatory cytokines are associated with bipolar disorder (BD), but less is known about how cytokines function during the interepisode period. This study examined cytokines, mood symptoms, and sleep in individuals with interepisode BD with complaints of insomnia. We also investigated the effects of a BD-specific modification of cognitive behavior therapy for insomnia (CBTI-BP) on cytokine levels.

          Methods

          Twenty-two adults with interepisode BD type I and insomnia were drawn from a subset of a National Institute of Mental Health funded study. Participants were randomly allocated to CBTI-BP (n = 11) or psychoeducation (n = 11). Participants completed a sleep diary, rated self-report measures of mania and depression, and provided samples assayed for interleukin (IL)-6 and tumor necrosis factor soluble receptor 2 (sTNF-R2).

          Results

          IL-6 was associated with mania symptoms (rs = 0.44, p = .041) and total sleep time (rs = -0.49, p = .026). IL-6 was related to depression symptoms at the trend level (rs = 0.43, p = .052). sTNF-R2 was not significantly related to mood or sleep measures. From pretreatment to posttreatment, CBTI-BP compared with psychoeducation was associated with a nonsignificant, large effect size decrease in IL-6 (z = -1.61, p = .13, d = -0.78) and a nonsignificant, small-medium effect size decrease in sTNF-R2 (z = -0.79, p = .44, d = -0.38).

          Conclusions

          These findings provide preliminary evidence that IL-6 is related to mania symptoms and shorter total sleep time in interepisode BD. A treatment that targets sleep in BD could potentially decrease IL-6 although replication is warranted.
            Cover page: Proinflammatory Cytokines, Mood, and Sleep in Interepisode Bipolar Disorder and Insomnia
            • Article
            • Peer Reviewed
            UC Berkeley Previously Published Works (2016)
            Patients exhibit poor memory for treatment. A novel Memory Support Intervention, derived from basic science in cognitive psychology and education, is tested with the goal of improving patient memory for treatment and treatment outcome. Adults with major depressive disorder (MDD) were randomized to 14 sessions of cognitive therapy (CT)+Memory Support (n = 25) or CT-as-usual (n = 23). Outcomes were assessed at baseline, post-treatment and 6 months later. Memory support was greater in CT+Memory Support compared to the CT-as-usual. Compared to CT-as-usual, small to medium effect sizes were observed for recall of treatment points at post-treatment. There was no difference between the treatment arms on depression severity (primary outcome). However, the odds of meeting criteria for 'response' and 'remission' were higher in CT+Memory Support compared with CT-as-usual. CT+Memory Support also showed an advantage on functional impairment. While some decline was observed, the advantage of CT+Memory Support was evident through 6-month follow-up. Patients with less than 16 years of education experience greater benefits from memory support than those with 16 or more years of education. Memory support can be manipulated, may improve patient memory for treatment and may be associated with an improved outcome.
              Cover page: Improving outcome for mental disorders by enhancing memory for treatment
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