Symposia
Sleep / Wake Disorders
Laurel D. Sarfan, Ph.D.
Postdoctoral Scholar
University of California, Berkeley
Berkeley, California
Heather Hilmoe, PhD
Graduate Student
California State University, Sacramento
Berkeley, California
Nicole B. Gumport, Ph.D.
Postdoctoral Fellow
Stanford University
Stanford, California
Allison G. Harvey, Ph.D.
Professor
University of California, Berkeley
BERKELEY, California
Sleep and circadian problems are intertwined with serious mental illness (SMI). Thus, optimizing treatments that target comorbid sleep and circadian problems and SMI is critical. This may be particularly important in community settings, where patients often present with complex comorbidities. Among adults with sleep and circadian problems and SMI, the present study conducted a secondary data analysis of the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) implemented in a community mental health center. TranS-C targets a range of sleep and circadian problems and SMI with 15 modules, seven of which are optional. In this ‘real world’ sample (N=121, 52.1% female, 43.0% African American or Black), we aimed to (1) elucidate patterns of comorbidity between sleep and circadian problems and SMI, and (2) determine whether TranS-C optional modules were delivered as intended based on participants’ sleep and circadian problems. Results from Aim 1 indicated that most participants ( > 85.0%) had full diagnoses or subdiagnostic symptoms of two or more sleep and circadian problems. Further, participants exhibited substantial heterogeneity across comorbidities between sleep and circadian problems and SMI diagnoses. Specifically, participants with a schizophrenia spectrum disorder (n=50), bipolar disorder (n=35), and major depressive disorder (n=26) exhibited 25, 24, and 21 patterns of sleep and circadian comorbidity, respectively. Interestingly, certain SMI diagnoses and sleep and circadian problems appeared to ‘hang together’ more frequently than others. Results from Aim 2 indicated that, in contrast to hypotheses, most participants did not receive the TranS-C optional modules designed to target their presenting sleep and circadian problems. Importantly, these discrepancies were observed despite thorough training and supervision of clinicians in TranS-C that included a full-day workshop, manuals, and weekly supervision. In sum, findings underscore sleep and circadian and SMI diagnostic complexity in the community and add to growing evidence that heterogeneity and comorbidity are the norm, rather than the exception. Moreover, findings reveal discrepancies between intended and ‘real world’ use of treatment modules. These results suggest that additional approaches may be needed to help clinicians deliver modularized treatments, such as TranS-C, with fidelity in community settings. Implications and future directions will be discussed in the context of community-based research.