The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TSC) in Community Mental Health: Evaluating...

This study investigated the extent to which number of psychiatric disorders and specific comorbidities in patients receiving the Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TSC) predicted symptom/impairment severity and treatment outcome. This secondary analysis drew from a subset of 489 patients in Community Mental Health Centers (CMHCs) with serious mental illness (SMI) and sleep/circadian problems who had participated in a randomized controlled trial of TSC. Of these patients, 253 received Immediate TSC and 236 received usual care followed by delayed treatment (UC-DT). Some patients received Standard TSC (N = 149) while others received Adapted TSC (N = 340). Patients' baseline/pre-treatment and post-treatment scores for psychiatric symptoms, sleep disturbance, sleep-related impairment, overall sleep health, and functional impairment were analyzed. Patient-reported data on history of psychiatric diagnoses were also used. At baseline, patients with more disorders had significantly worse psychiatric symptom scores (b = 2.27, SE = 0.39, p<.001), marginally greater sleep disturbance (b = 0.57, SE = 0.32, p=.073) (but only at the nominal level), significantly greater sleep-related impairment (b = 1.25, SE = 0.34, p<.001), significantly worse overall sleep health (b=-0.20, SE = 0.06, p=.001), and significantly greater functional impairment (b = 0.32, SE = 0.11, p=.005). Number of psychiatric disorders was not associated with treatment outcome or differences in benefits between Standard and Adapted TSC. When analyzed independently, the most common psychiatric disorder groups all demonstrated significantly more improvement in the Immediate TSC group than in the UC-DT group on sleep disturbance and sleep-related impairment. These results build on strong evidence that transdiagnostic sleep treatment is an important approach to treating populations with comorbid SMI and sleep/circadian problems.