The vulnerability to stress-related insomnia was measured by the Ford Insomnia Response to Stress Test (FIRST). 30 The average score is computed, with a higher score representing a greater level of dysfunctional belief. Adolescents’ sleep-related beliefs and expectations were measured by the 16-item Dysfunctional Beliefs and Attitudes about Sleep (DBAS). 29 A higher score indicated a better sleep practice. Sleep hygiene practices were measured by the Adolescent Sleep Hygiene Scale revised. Social jet lag was defined as a difference between weekday and weekend midpoint sleep. Participants were asked to complete a 7-day sleep diary that recorded total sleep time, time in bed, sleep-onset latency, and wake after sleep onset. The diagnosis of psychiatric and sleep disorders was assessed by the adolescent version of the Mini International Neuropsychiatric Interview 26 and Diagnostic Interview for Sleep Patterns and Sleep Disorders, 27 respectively. Adolescents who reported any of the following conditions were excluded from the study: (1) current or past history of neuropsychiatric disorder(s), (2) medical condition, sleep disorders (eg, delayed sleep phase syndrome), or (3) use of medication(s) known to interfere with sleep continuity or quality. The inclusion criteria included (1) ethnic Chinese youth aged 12 to 18 years old, (2) having at least 1 biological parent with current or a lifetime history of insomnia disorder, and (3) presence of subthreshold insomnia symptoms (ie, having insomnia symptoms at least once per month but <3 times a week in the past month).
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Family history of insomnia was collected by self-reported questionnaire used to assess parents’ lifetime and current insomnia disorder on the basis of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria. The follow-up assessments were completed in January 2019. Participants were recruited from local secondary schools and community in Hong Kong from July 2015 to December 2017. Nonetheless, there is a lack of prevention study for insomnia. For example, offspring with family history of insomnia are at a higher risk of developing insomnia than those without, 13– 17 making them an ideal target for the preventive intervention. 8 Although the evidence for effective treatments for insomnia in adolescents is increasing, the delay and low prevalence rate of help-seeking behavior, 9, 10 together with the limited accessibility of the effective treatment and persistence course of established insomnia, argue for the need of early intervention and preventive measures, 11, 12 particularly among at-risk adolescents.
5 Insomnia tends to run a chronic course with considerable personal distress and health care burden, 6, 7 predisposing the development of psychiatric and medical comorbidities. 3, 4 Adolescence is also a vulnerable period for the emergence of insomnia, affecting >10% of adolescents. 1, 2 Thus, an emerging body of research has focused on the efficacy of preventive strategies for physical and mental problems, especially in at-risk adolescents. 02) compared with the control group.Īdolescence is a critical period accompanied by dramatic neurobiological, physical, behavioral, and emotional changes, predisposing youth to mental and physical illnesses. The intervention group also reported fewer depressive symptoms at 12-month follow-up ( P =. 02), and increased total sleep time ( P =. 04), better sleep hygiene practices ( P =. 03) at postintervention and throughout the 12-month follow-up. 03) and reduced vulnerability to stress-related insomnia ( P =. The intervention group had decreased insomnia symptoms ( P =. There was a lower incidence rate of insomnia disorder (both acute and chronic) in the intervention group compared with the control group (5.8% vs 20.7% P =. A total of 242 adolescents with family history of insomnia and subthreshold insomnia symptoms were randomly assigned to an intervention group ( n = 121 mean age = 14.7 ± 1.8 female: 51.2%) or control group ( n = 121 mean age = 15.0 ± 1.7 female: 62.0%).
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