수면지표기반 불면증 디지털 치료기의 효과와 안전성: 무작위, 이중 맹검 전향적 연구

서론: 본 연구에서는 수면지표기반 불면증 디지털 치료기의 효과와 안전성을 평가하고, 이를 불면증 인지행동치료를 바탕으로 한 디지털 치료기와 서로 비교하고자 하였다. 방법: 본 연구는 무작위, 이중 맹검 전향적 연구로서, 서울아산병원에서 2022년 12월부터 2023년 1월까지 모집된 50명의 환자들을 대상으로 하였다. 참가자들은 수면지표기반 불면증 디지털 치료기 집단과 불면증 인지행동치료를 바탕으로 한 디지털 치료기 집단으로 무작위 배정되었고, 평가는 1개월간 매주 한 번씩 이루어졌다. 일차 결과지표는 4주째의 불면증 심각도 지수였으며, 이차 결과지표는 4주째에 불면증 심각도 지수가 15 미만인 참가자들의 비율이었다. 통계 분석을 위해 선형 혼합 모형과 일반화 추정 방정식을 이용하였다. 결과: 두 집단 모두 치료 기간동안 불면증 심각도 지수의 유의한 향상을 보였다. 4주째의 불면증 심각도 지수와, 4주째에 불면증 심각도 지수가 15 미만으로 감소한 참가자들의 비율 모두 두 집단 사이 유의한 차이가 나타나지 않았다. 그러나, 2주째에는 두 가지 결과지표 모두 수면지표기반 불면증 디지털 치료기 집단에서 불면증 인지행동치료를 바탕으로 한 디지털 치료기 집단에 비해 더 우수하게 나타났다. 두 집단 모두에서 치료 이후 이상반응은 보고되지 않았다. 결론: 수면지표기반 불면증 디지털 치료기는 불면증 환자들에게 있어 불면증 인지행동치료를 바탕으로 한 디지털 치료기만큼 안전하고 효과적이며, 더 빠른 치료 효과를 보인다. |Introduction This study aimed to evaluate the effectiveness and safety of the digital Sleep-Index Based Treatment for Insomnia (dSIBT-I) for patients with insomnia and compare it with those of the digital Cognitive Behavioral Therapy for Insomnia (dCBT-I). Methods This randomized prospective study was conducted at Asan Medical Center. Fifty patients with insomnia were recruited between December 2022 and January 2023 and randomly assigned to the dSIBT-I group or the dCBT-I group. Outcomes were assessed weekly for a 1-month period. The primary outcome was Insomnia Severity Index (ISI) score at Week 4, whereas the secondary outcome was the proportion of participants whose ISI scores were less than 15 at Week 4. We conducted linear mixed model and generalized estimating equation analyses. Results Both the dSIBT-I group and the dCBT-I group showed significant improvements in ISI scores during the therapy. There was no significant difference between the two groups in terms of ISI scores at Week 4 and the proportion of participants whose ISI scores were reduced to less than 15 at Week 4. However, at Week 2, the dSIBT-I group showed better results than the dCBT-I group in the two outcomes. No treatment-emergent adverse events were reported in both groups. Conclusion The dSIBT-I is as safe and effective as the dCBT-I for patients with insomnia with more rapid treatment effects.Maste

Utility of the Stress and Anxiety to Viral Epidemic-3 Items as a Tool for Assessing Work-Related Stress, and Relationship With Insomnia and Burnout of Healthcare Workers During the COVID-19 Pandemic

Background and Objective The aim of this study is to explore the usefulness of the Stress and Anxiety to Viral Epidemic-3 items (SAVE-3) scale as a tool for assessing work-related stress in healthcare workers. Methods There were 389 participants and all remained anonymous. The SAVE-9, the Patient Health Questionnaire-4, the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS-MP), the perceived stress scale (PSS), and single item insomnia measure were used. After checking whether the SAVE-3 scale is clustered into a sole factor from SAVE-9 scale based on principal component analysis with promax rotation, confirmatory factor analysis (CFA) was done on the 3 items of the SAVE-3 to examine the factorial validity for a unidimensional structure. Results The SAVE-3 was clustered with factor loadings from 0.664?0.752, and a CFA revealed that 3 items of the SAVE-3 cohered together into a unidimensional construct with fit for all of indices (comparative fit index = 1.00; Tucker Lewis index = 1.031; standardized root-mean-square residual = 0.001; root-mean-square-error of approximation = 0.00). The SAVE-3 scale showed acceptable reliability (Cronbach’s α = 0.56 and McDonald’s ω = 0.57) in this sample. A high SAVE-3 score correlated significantly with younger age (r = -0.12, p = 0.02), a high PSS score (r = 0.24, p < 0.001), a high total score for the MBI-HSS-MP (r = 0.35, p < 0.001) and all of its subscales (emotional exhaustion, r = 0.40, p < 0.001; personal accomplishment, r = -0.14, p < 0.005; depersonalization, r = 0.39, p < 0.001), and poor sleep quality (r = 0.15, p < 0.001). Conclusions Taken together, the data suggest that SAVE-3 is a reliable, valid, and usable scale for measuring work-related stress in healthcare workers during the COVID-19 epidemic

Schoolteachers' Resilience Does but Self-Efficacy Does Not Mediate the Influence of Stress and Anxiety Due to the COVID-19 Pandemic on Depression and Subjective Well-Being

Objectives: In the current coronavirus disease (COVID-19) pandemic, schoolteachers experience stress from addressing students or performing school tasks that may result in burnout. This study aimed to observe whether teachers' stress and anxiety due to the pandemic can influence their depression or psychological well-being and examine whether their resilience or self-efficacy mediates this association. Methods: During March 4-15, 2021, 400 teachers participated and responded voluntarily to an online survey that included the Stress and Anxiety to Viral Epidemics-9 items (SAVE-9), the Teacher-Efficacy Scale, the Brief Resilience Scale (BRS), the WHO-5 Well-Being Index, and the Patients Health Questionnaire-9 items. Results: High psychological well-being of teachers in COVID-19 pandemic era was expected by a low SAVE-9 score (aOR = 0.95; 95% CI, 0.91-0.99), a high level of self-efficacy (aOR = 1.03; 95% CI, 1.01-1.06), and a high BRS score (aOR = 1.18; 95% CI, 1.10-1.27). Moreover, teachers' resilience mediated the effects of stress and anxiety from the COVID-19 pandemic on their subjective well-being or depression. Conclusions: Schoolteachers' subjective well-being and depression were influenced by high levels of stress and anxiety of the viral epidemic, and their resilience mediated this relationship in this COVID-19 pandemic era

Resilience and Work-Related Stress May Affect Depressive Symptoms in Nursing Professionals during the COVID-19 Pandemic Era

Objective We aimed to investigate the effect of nursing professionals? resilience on their mental health, work-related stress, and anxiety in response to the COVID-19 pandemic. Methods We conducted an online survey in the Asan Medical Center and Ulsan University Hospital, South Korea. We extracted data of 824 nursing professionals who consented to participate, including demographic variables and the Stress and Anxiety to Viral Epidemics-9 (SAVE-9), PHQ-9, GAD-7, and Brief Resilience Scale scores. Results Resilience was negatively correlated with Patient Health Questionnaire-9 (PHQ-9) (rho=-0.23), Generalized Anxiety Scale-7 items (GAD-7) (rho=-0.25), Stress and Anxiety to Viral Epidem-ics-6 items (SAVE-6) (rho=-0.15), and Stress And anxiety to Viral Epidemics-3 items (SAVE-3) (rho=-0.13, all, p<0.001). Logistic regression analysis adjusting age, marital status, and years of employment revealed that high level of general anxiety [adjusted odds ratio (aOR)=1.40, 95% confidence interval (CI)=1.31?1.50], work-related stress during viral epidemics (aOR=1.16, 95% CI=1.03?1.29), and a low level of resilience (aOR=0.91, 95% CI=0.85?0.97) were expecting variables for the depression of healthcare workers. Conclusion Nursing professionals? level of resilience may be associated with low level of work-related stress and anxiety induced by a viral epidemic. We need to explore further the possibility of resilience as coping strategy of healthcare workers in this pandemic era. Psychiatry Investig 2021;18(4):357-36