Non-Pharmacological Interventions for Sleep & Depression - Essay Sample

Depression leads to poor sleep (Hou, Hu, Liang, & Mo, 2014). The main purpose of this review was to determine whether non-pharmacological interventions for sleep problems can be used effectively in the reduction of symptoms for depression (Gee, Orchard, Clarke, Joy, Clarke, & Reynolds, 2019). This review considered depression symptoms as an outcome.

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Was there a published protocol for this review?

There was a published protocol for this review as it was registered with the PROSPERO registry before the search strategy was implemented. The search strategy was directed to identify any trials which might have been reported in a peer-reviewed journal in the English language (Gee, Orchard, Clarke, Joy, Clarke, & Reynolds, 2019).

What are the inclusion criteria for this review?

For this review, the inclusion criteria were divided into five parts. These were randomized control trials, measurement of depression symptoms using a validated instrument, use of a non-pharmacological intervention designed to improve sleep, reporting of the trial in the English language in a peer-reviewed journal (Gee, Orchard, Clarke, Joy, Clarke, & Reynolds, 2019).

What types of studies were included?

The articles that were included in this study were Randomised Controlled Trials which dealt with non-pharmacological sleep interventions. The excluded studies did not meet this criterion.

What databases/search engines were searched?

There were several search engines and databases that were searched. These included databases such as PsycINFO, Medline, CENTRAL and CINAHL. These searches were conducted since the inception of the databases until 1st May 2018 (Gee, Orchard, Clarke, Joy, Clarke, & Reynolds, 2019).

Were the search terms suitable for this review?

For this review, different search times were used which the authors considered appropriate. Some of the search terms which were used included sleep treatment, insomnia, sleep, sleep disorders, and intervention, therapy, treatment, education, hygiene, help, mood and depression (Gee, Orchard, Clarke, Joy, Clarke, & Reynolds, 2019).

What were the search limits applied?

To ensure that the research was narrowed, limiters were used. These limiters restricted the search to English language publications and clinical trial publications. The authors also hand searched the reference lists of eligible articles as well as key review papers in an effort to identify any eligible articles which might have been missed by the electronic search (Gee, Orchard, Clarke, Joy, Clarke, & Reynolds, 2019).

Does the PRISMA flowchart adequately describe how articles were identified, screened, assessed for eligibility, appraised, and selected for inclusion in the review?

The PRISMA flowchart adequately describes the ways in which articles were identified, screened, assessed for eligibility, appraised, and selected for inclusion in the review (Gee, Orchard, Clarke, Joy, Clarke, & Reynolds, 2019). The flowchart shows the number of records identified electronically and those that were identified through hand searching. The flowchart also shows the number of records that were left upon the removal of duplicates. The duplicates were removed so that only single copies of each article would be left. After that, the titles and abstracts were screened with the records being excluded. After the screening of the titles and abstracts, full texts which were 124 in number, were assessed for eligibility (Gee, Orchard, Clarke, Joy, Clarke, & Reynolds, 2019). During this process, 63 full texts were excluded. The reason for the exclusion was that some of the records gave control conditions designed to improve sleep; others did not measure depression as an outcome and others did not have an intervention that was designed to improve sleep. There were others that were excluded for other reasons and the number of these was 11.

After this exclusion, 61 articles were left for inclusion. However, some were excluded because there were some whose samples overlapped with others, and some did not provide sufficient depression data. Upon this exclusion, 49 studies were left which were used in the meta-analysis.

What critical appraisal instrument(s) was/were used to determine the methodological quality of the articles? Were these instruments appropriate?

The methodological quality of the articles was determined by the country, participants, intervention, depression measures, and sleep measure. Some of the countries considered for the inclusion of the article were Australia, Canada, Taiwan, Netherlands, Germany, USA, UK, China, and Japan (Gee, Orchard, Clarke, Joy, Clarke, & Reynolds, 2019). Based on the participants, some of the participants who were included were adolescents with high anxiety and sleep difficulties, adults with heart failure, adults diagnosed with cancer, adults with sleep maintenance insomnia, adults with insomnia and chronic obstructive pulmonary disease and adult internet users with insomnia. The intervention measures considered for the inclusion of an article include mindfulness-based group sleep intervention, individual CBT-1, gradual sleep extension and sleep hygiene advice, online self-help CBT-1, self-help CBT-1 with telephone support, individual stimulus control sessions, self-help CBT-1 delivered via a book and television among others (Gee, Orchard, Clarke, Joy, Clarke, & Reynolds, 2019). The depression measures include HADS, CESD, BDI, MFQ, POMS-D, IDS-C, PHQ-9 among others.

Are the included studies summarised adequately? (Study type, study population, location, interventions, outcomes, results)

Summarizing articles makes it easy to identify factors such as study population and outcomes (Guyatt, Cook, & Haynes, 2004). The included studies are adequately summarized although they do not contain all the items necessary for the summary of a study. Despite this, the items presented are adequate to understand the article. The summary includes the study population or the participants, interventions, location or country, outcomes and the results. To do this, two tables are used with one of the tables concentrating a lot on the results. For example, the study by Blake et al. was published in 2016 and is based in Australia. The participants for this study are adolescents aged 12-17 who have high anxiety and sleep difficulties. The intervention used is CBT/mindfulness-based group sleep intervention. The mean for this study is 13.65 while the standard deviation is 8.44. The same information is provided for all the other studies included. The information included in this table is enough to understand the content of each included study.

Are excluded studies listed with reasons for their exclusion?

This review contains numerous studies that have been excluded. However, the reasons for the exclusion have been provided. For example, some of the studies were excluded because they were duplicates. Others were excluded because their intervention was not designed to improve sleep. Additionally, studies that did not contain adequate depression data were excluded from the study.

How was the data abstracted and synthesized?

The analysis of the extracted data conducted at descriptive and explorative levels (Mir, 2010). In the descriptive analysis, data were tabulated quantitatively putting into consideration details such as participants and the location. The mean and standard deviation of each study was analyzed. Exploratively, two authors were used to determine themes that determined whether a study will be included in the review or not.

Is there an adequate critique of the studies reviewed, including a discussion of study limitations?

A proper critique should give an understanding of the purpose of the work, structure of the evidence, intended audience and the development of argument (van Straten, Cuijpers, Smit, Spermon & Verbeek, 2009). Based on this criterion, there is not an adequate critique of the studies reviewed and limitations. According to Akobeng (2005), a proper critique should entail a proper appraising of evidence of the studies. However, this is lacking in the studies reviewed. The limitations of the studies included are not discussed. Although the authors give a limitation of the review, it does not cover for the individual studies reviewed.

Were the levels of evidence reported in this systematic review? What is your assessment of the level of evidence included in this review?

There are different levels of evidence. They include Level 1: experimental designs, Level 2: Quasi-experimental designs, Level 3: Observational-analytical designs, Level 4: Observational- descriptive studies, and Level 5: Expert opinion and Bench research (Beal-Alvarez, & Cannon, 2014). Based on this knowledge, the level of evidence for this systematic review is Level 1. Level 1 evidence level entails a systematic review of Randomized Controlled Trials (RCTs) and study designs. The review uses RCTs studies.

How should the information from this systematic review be applied in clinical practice (knowledge transfer)

The application of information to clinical practice is part of knowledge transfer (Moher, Liberati, Tetzlaff, Altman, Altman & Antes, 2009). Knowledge transfer is a process that involves the use of cognitive resources coupled with interpersonal processes of knowledge transfer through which the findings of the research as well as evidence may be translated and successfully into the clinical practice (Noonan, Coursey, Edwards, Frances, Fritz, Henderson, & Strosahl, 1998). The information from this systematic review can be applied to clinical practice by making it known to the clinic stakeholders such as physicians, clinicians, and caretakers so that they can determine the best non-pharmacological sleep interventions on depression symptoms.

References

Akobeng, A. (2005). Evidence based child health 1: Principles of evidence based medicine, 90:837-840. doi: 10.1136/adc.2005.071761

Beal-Alvarez, J., & Cannon, J. (2014). Technology Intervention Research With Deaf and Hard of Hearing Learners: Levels of Evidence. American Annals of the Deaf, 158(5), 486-505. Retrieved February 17, 2020, from www.jstor.org/stable/26234923

Gee, B., Orchard, F., Clarke, E., Joy, A., Clarke, T., & Reynolds, S. (2019). The effect of non-pharmacological sleep interventions on depression symptoms: A meta-analysis of randomised controlled trials. Sleep Medicine Reviews, 43, 118-128. doi:10.1016/j.smrv.2018.09.004

Guyatt, G., Cook, D., & Haynes, B. (2004). Evidence Based Medicine Has Come A Long Way: The Second Decade Will Be As Exciting As The First. BMJ: British Medical Journal, 329(7473), 990-991. Retrieved February 17, 2020, from www.jstor.org/stable/25458418

Hou Y, Hu P, Liang Y, Mo Z. (2014). Effects of cognitive behavioral therapy on insomnia of maintenance hemodialysis patients. Cell Biochem Biophys, 69:531e7. https://doi.org/10.1007/s12013-014-9828-4.

Mir, N. (2010). Issues in clinical practice. BMJ: British Medical Journal, 341(7774), 622-622. Retrieved February 17, 2020, from www.jstor.org/stable/25738222

Moher D, Liberati A, Tetzlaff J, Altman DG, Altman D, Antes G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med, 6, e1000097. https://doi.org/10.1371/ journal.pmed.1000097

Noonan, D., Coursey, R., Edwards, J., Frances, A., Fritz, T., Henderson, M., Strosahl, K. (1998). Clinical Practice Guidelines. Journal of the Washington Academy of Sciences, 85(1), 114-124. Retrieved February 17, 2020, from www.jstor.org/stable/24530945

van Straten A, Cuijpers P, Smit F, Spermon M, Verbeek I. (2009). Self-help trea...