(PS5-C55) Perceptions of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction Among People Diagnosed with a Serious Mental Illness in a Community Mental Health Setting

 

Background: Implementation science aims to improve mental health services by bridging the gap between research and practice. This study investigated patient perceptions of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) implemented in a community mental health center (CMHC). The patients were experiencing sleep and circadian problems and serious mental illness (SMI). We sought to evaluate: (1) patients’ perceptions of TranS-C credibility and expected/perceived improvement, and (2) whether perceived credibility and expected improvement predicted treatment outcomes, including sleep problems, overall impairment, and psychiatric symptoms.

Methods: Data were drawn from an RCT assessing TranS-C implemented in CMHCs. Data were collected from adults (N = 61) with sleep and circadian problems and SMI at pre-treatment (PRE), post-treatment (POST), and six-month follow-up (6FU). Sleep problems were assessed with the PROMIS-Sleep Disturbance and PROMIS-Sleep Related Impairment scales. Overall impairment was assessed with the Sheehan Disability Scale, and psychiatric symptoms were assessed with the DSM-5 Cross Cutting Measure. Patient perceptions of TranS-C credibility and expected/perceived improvement were measured with the Credibility/Expectancy Questionnaire (CEQ) at PRE and POST. For Aim 1, descriptive statistics were calculated for each CEQ item at PRE and POST: a 1 to 9 scale was used for the first nine items, and a 0 to 100 scale was used for the last item assessing expected/perceived improvement. For Aim 2, multiple linear regression was used to test whether the CEQ at PRE predicted treatment outcomes at POST and 6FU, controlling for each outcome at PRE.

Results: For Aim 1, at PRE the means of the first nine CEQ items ranged from 7.31 to 7.91, and the mean for the last item assessing expected improvement was 72.00 (SD = 23.99). At POST, the means of the first nine CEQ items ranged from 4.59 to 8.26, and the mean for the last item assessing perceived improvement was 70.21 (SD = 22.98).

For Aim 2, greater CEQ at PRE predicted less sleep disruption at POST (b= -1.33, p = .02) and 6FU (b = -1.36, p = .004). CEQ at PRE did not significantly predict overall impairment POST (p = .32), but greater CEQ did predict less overall impairment at 6FU (b = -0.83, p = .02). CEQ at PRE did not significantly predict sleep related impairment at POST (p = .18), but greater CEQ did predict less sleep related impairment at 6FU (b = -1.60, p = .04). Greater CEQ at PRE significantly predicted less severe psychiatric symptoms at POST (b = -1.38, p = .03) and 6FU (b = -1.47, p = .01).

Conclusion: Patients perceived TranS-C as credible and expected substantial improvements at the start of treatment. At POST, perceptions of credibility were more variable. Critically, greater perceptions of TranS-C credibility and expected improvement at PRE predicted less severe sleep problems, overall impairment, and psychiatric symptoms at POST and 6FU. Thus, future investigations to identify factors that boost perceptions of credibility and expected improvement may enhance patient outcomes post treatment.