Investigating a Sleep Intervention for Adolescents Attending Mental Health Services

Fidelity was assessed using an intervention delivery checklist. Practitioners were categorised based on whether they delivered the intervention as intended or deviated. Of the 10 practitioners who completed training, only 3 practitioners delivered the intervention, but only 2 submitted fidelity data for this outcome.

Time frame: 1-4 months

Population: Practitioners who delivered the intervention and submitted recordings for fidelity assessment.

A total of 8 adolescents were referred between October 2023 and October 2024. Of these, 1 was ineligible, 4 declined participation / did not respond, and 3 provided consent and were enrolled.

Time frame: 1 year

Population: Adolescents referred to the study (N = 7 eligible participants)

Measured through attendance logs. This outcome reports the number of adolescent participants who completed each session of the 4-session intervention.

Time frame: Over 4 session intervention period (1 - 4 months) 1-4 months 1-4 months

Population: Adolescents

Measured through qualitative interviews conducted with mental health practitioners and service managers (N = 13) to explore their experiences of the intervention and feasibility of delivery in practice.

Time frame: Up to 9 months post-training

Population: Mental health practitioners who received training and service managers who overseen the implementation of the intervention.

Measured by Generalised Anxiety Disorder Assessment (GAD-7). The GAD-7 will be utilised to measure symptoms of anxiety. The measure consists of 7 items assessing anxiety symptoms over the previous 2 weeks. Scores range from 0-21, higher scores indicate greater symptom severity (5- mild, 10 - moderate, 15- severe). We intended to collect data at three time points: Baseline (2 weeks prior to intervention), Post-intervention (2 weeks after intervention), Follow-up (3 months after intervention) However, only 1 participant completed this measure at baseline. No post-intervention or follow-up GAD-7 data were submitted by participants.

Time frame: Baseline (2-weeks before intervention delivery)

Population: Baseline GAD-7 scores were submitted by 3 adolescent participants. No post-intervention or follow-up data were collected.

Measured by Morningness/eveningness scale for children (MESC). This 10-item measure will be used to assess circadian phase preference. Items are scored on from 1- 5 item scale and scores range from 10-42. Lower scores indicate greater eveningness (\<20) and higher scores indicate greater morningness (\>28). This item will be collected in the baseline assessment.

Time frame: Baseline only

Population: Adolescents

Symptoms of depression and anxiety were intended to be assessed using the Revised Child Anxiety and Depression Scale - 25 item version (RCADS-25), completed by adolescent participants at three time points: Baseline (2 weeks prior to intervention), Post-intervention (2 weeks after intervention), Follow-up (3 months after intervention) RCADS-25 provides total scores and subscale scores for anxiety and depression. The anxiety subscale includes 15 items and scores range from 0-45. The depression subscale comprises 10 items and scores range from 0-30. A total score can be calculated by summing the depression and anxiety subscales and the total scores range from 0-75. Higher scores on any subscale or the total score represent greater symptom severity. However, only baseline data were collected. No post-intervention or follow-up RCADS-25 data were submitted by any of the 3 adolescent participants

Time frame: Baseline (2-weeks before intervention delivery)

Population: Baseline RCADS-25 scores were submitted by 3 adolescent participants. No post-intervention or follow-up data were collected.

Depression symptoms were intended to be measured using the Patient Health Questionnaire-9 (PHQ-9) at three time points: Baseline (2 weeks prior to intervention), Post-intervention (2 weeks after intervention), Follow-up (3 months after intervention) The PHQ-9 consists of 9 items, each scored 0-3, with total scores ranging from 0-27. Higher scores indicate more severe depressive symptoms. However, only baseline PHQ-9 data were submitted by participants. No post-intervention or follow-up data were collected.

Time frame: Baseline (2-weeks before intervention delivery)

Population: Adolescents - Baseline only. None completed post-intervention or follow-up assesments.

Insomnia symptoms were intended to be measured using the Sleep Condition Indicator (SCI), completed by adolescent participants at three time points: Baseline (2 weeks prior to intervention), Post-intervention (2 weeks following intervention), Follow-up (3 months post-intervention) Sleep Condition Indicator scores range from 0-32, with higher scores indicating better sleep. A score \<16 suggests probable insomnia. However, only baseline SCI scores were collected from participants. No post-intervention or follow-up data were submitted.

Time frame: Baseline (2 weeks before intervention) Baseline (2 weeks before intervention) Baseline (2 weeks before intervention)

Population: Adolescents - Baseline only as none completed post-intervention or follow-up outcome measures.

Sleep outcomes were intended to be assessed using a consensus sleep diary completed by adolescent participants at three time points: baseline (2 weeks prior to intervention), post-intervention (2 weeks after intervention), and follow-up (3 months after intervention). However, only baseline data were completed by 3 participants. No post-intervention or follow-up sleep diary data were collected. This table summarizes baseline sleep outcomes only, based on the sleep efficiency score - a key sleep parameter calculated as: Sleep Efficiency (%) = (Total Sleep Time / Time in Bed) × 100 Higher scores indicate better sleep efficiency, with scores above 90% typically considered good.

Time frame: Baseline (2 weeks before intervention delivery)

Population: All 3 adolescent participants completed baseline sleep assessments. No participants completed post-intervention or follow-up assessments.

Satisfaction with the training was assessed through qualitative interviews with practitioner participants. This outcome includes only those who completed the training (10 out of 13 participants).

Time frame: Up to 9 months post-training

Population: All practitioners who completed training (n=10)