Treating Insomnia with High Risk of Depression Using Therapist-Guided Digital Cognitive, Behavioral, and Circadian Rhythm Support Interventions to Prevent Worsening of Depressive Symptoms: A Randomized Controlled Trial.

INTRODUCTION: The global disease burden of major depressive disorder urgently requires prevention in high-risk individuals, such as recently discovered insomnia subtypes. Previous studies targeting insomnia with fully automated eHealth interventions to prevent depression are inconclusive: dropout was high and likely biased, and depressive symptoms in untreated participants on average improved rather than worsened. OBJECTIVE: This randomized controlled trial aimed to efficiently prevent the worsening of depressive symptoms by selecting insomnia subtypes at high risk of depression for internet-based circadian rhythm support (CRS), cognitive behavioral therapy for insomnia (CBT-I), or their combination (CBT-I+CRS), with online therapist guidance to promote adherence. METHODS: Participants with an insomnia disorder subtype conveying an increased risk of depression (n = 132) were randomized to no treatment (NT), CRS, CBT-I, or CBT-I+CRS. The Inventory of Depressive Symptomatology - Self Report (IDS-SR) was self-administered at baseline and at four follow-ups spanning 1 year. RESULTS: Without treatment, depressive symptoms indeed worsened (d = 0.28, p = 0.041) in high-risk insomnia, but not in a reference group with low-risk insomnia. Therapist-guided CBT-I and CBT-I+CRS reduced IDS-SR ratings across all follow-up assessments (respectively, d = -0.80, p = 0.001; d = -0.95, p < 0.001). Only CBT-I+CRS reduced the 1-year incidence of clinically meaningful worsening (p = 0.002). Dropout during therapist-guided interventions was very low (8%) compared to previous automated interventions (57-62%). CONCLUSIONS: The findings tentatively suggest that the efficiency of population-wide preventive strategies could benefit from the possibility to select insomnia subtypes at high risk of developing depression for therapist-guided digital CBT-I+CRS. This treatment may provide effective long-term prevention of worsening of depressive symptoms. TRIAL REGISTRATION: the Netherlands Trial Register (NL7359).

Internet-guided cognitive, behavioral and chronobiological interventions in depression-prone insomnia subtypes: protocol of a randomized controlled prevention trial.

BACKGROUND: Major depressive disorder is among the most burdening and costly chronic health hazards. Since its prognosis is poor and treatment effectiveness is moderate at best, prevention would be the strategy of first choice. Insomnia may be the best modifiable risk factor. Insomnia is highly prevalent (4-10%) and meta-analysis estimates ±13% of people with insomnia to develop depression within a year. Among people with insomnia, recent work identified three subtypes with a particularly high lifetime risk of depression. The current randomized controlled trial (RCT) evaluates the effects of internet-guided Cognitive Behavioral Therapy for Insomnia (CBT-I), Chronobiological Therapy (CT), and their combination on insomnia and the development of depressive symptoms. METHODS: We aim to include 120 participants with Insomnia Disorder (ID) of one of the three subtypes that are more prone to develop depression. In a two by two factorial repeated measures design, participants will be randomized to CBT-I, CT, CBT-I + CT or treatment as usual, and followed up for one year. The primary outcome is the change, relative to baseline, of the severity of depressive symptoms integrated over four follow-ups spanning one year. Secondary outcome measures include a diagnosis of major depressive disorder, insomnia severity, sleep diaries, actigraphy, cost-effectiveness, and brain structure and function. DISCUSSION: Pre-selection of three high-risk insomnia subtypes allows for a sensitive assessment of the possibility to prevent the development and worsening of depressive symptoms through interventions targeting insomnia. TRIAL REGISTRATION: Netherlands Trial Register (NL7359). Registered on 19 October 2018.

Formal Modeling of the Resistance to Peer Influence Questionnaire: A Comparison of Adolescent Boys and Girls With and Without Mild-to-Borderline Intellectual Disability.

Items of the Resistance to Peer Influence Questionnaire (RPIQ) have a tree-based structure. On each item, individuals first choose whether a less versus more peer-resistant group best describes them; they then indicate whether it is "Really true" versus "Sort of true" that they belong to the chosen group. Using tree-based item response theory, we show that RPIQ items tap three dimensions: A Resistance to Peer Influence (RPI) dimension and two Response Polarization dimensions. We then reveal subgroup differences on these dimensions. That is, adolescents with mild-to-borderline intellectual disability, compared with typically developing adolescents, are less RPI and more polarized in their responses. Also, girls, compared with boys, are more RPI, and, when high RPI, more polarized in their responses. Together, these results indicate that a tree-based modeling approach yields a more sensitive measure of individuals' RPI as well as their tendency to respond more or less extremely.

Intolerance of Uncertainty Scale: Measurement invariance among adolescent boys and girls and relationships with anxiety and risk taking.

BACKGROUND AND OBJECTIVES: Adolescence-related increases in both anxiety and risk taking may originate in variability in Intolerance of Uncertainty (IU), rendering the study of IU of importance. We therefore studied the psychometric properties of the Intolerance of Uncertainty Scale-Short version (IUS-12), including its associations with trait anxiety and risk taking, among adolescents. METHODS: A sample of 879 Dutch adolescents, from diverse educational levels, and with an equal distribution of boys and girls, was classically tested. To obtain indices of IU, and self-reported trait anxiety and need for risk taking, questionnaires were administrated; to obtain an index of risk taking behavior, adolescents performed a risk taking task. RESULTS: Multi-group Confirmatory Factor Analyses revealed that the IUS-12 consists of a Prospective and an Inhibitory IU subscale, which are partially measurement invariant across sex. Cronbach's alphas and item-total correlations revealed that the IUS-12 and its subscales have reasonable-to-good internal consistency. Correlational analyses support convergent validity, as higher IUS-12 scores were related to, respectively, higher and lower levels of self-reported trait anxiety and need for risk taking. However, we found no relationship between IUS-12 scores and risk taking behavior, operationalized by performance on the risk taking task. LIMITATIONS: A community, instead of clinical, sample was included. Also, IU was measured by a paper-and-pencil version of the IUS-12, instead of a computerized version. CONCLUSIONS: The IUS-12 has good psychometric properties and may be a central measure to assess IU, which enables to explain the adolescence-related increase in both anxiety and risk taking.

Prevalence of Autism Spectrum Disorders in Ecuador: A Pilot Study in Quito.

This research presents the results of the first phase of the study on the prevalence of pupils with Autism Spectrum Disorder (ASD) in regular education in Quito, Ecuador. One-hundred-and-sixty-one regular schools in Quito were selected with a total of 51,453 pupils. Prevalence of ASD was assessed by an interview with the rector of the school or its delegate. Results show an extremely low prevalence of 0.11 % of pupils with any ASD diagnosis; another 0.21 % were suspected to have ASD, but were without a diagnosis. This low prevalence suggests that children and adolescents with ASD are not included in regular education in Quito. These results are discussed in the light of low diagnostic identification of ASD and low inclusion tolerance.

Cardiac and electro-cortical concomitants of social feedback processing in women.

This study provides a joint analysis of the cardiac and electro-cortical-early and late P3 and feedback-related negativity (FRN)-responses to social acceptance and rejection feedback. Twenty-five female participants performed on a social- and age-judgment control task, in which they received feedback with respect to their liking and age judgments, respectively. Consistent with previous reports, results revealed transient cardiac slowing to be selectively prolonged to unexpected social rejection feedback. Late P3 amplitude was more pronounced to unexpected relative to expected feedback. Both early and late P3 amplitudes were shown to be context dependent, in that they were more pronounced to social as compared with non-social feedback. FRN amplitudes were more pronounced to unexpected relative to expected feedback, irrespective of context and feedback valence. This pattern of findings indicates that social acceptance and rejection feedback have widespread effects on bodily state and brain function, which are modulated by prior expectancies.