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The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TSC) in Community Mental Health: Evaluating Self-Reported Psychiatric Disorders as a Predictor of Symptoms and Treatment Outcome

مداخله‌ی فراتشخیصی برای اختلال خواب و ریتم شبانه‌روزی (TSC) در سلامت روان جامعه: ارزیابی اختلالات روان‌پزشکی خودگزارش‌شده به‌عنوان پیش‌بینی‌کننده‌ی نشانه‌ها و پیامد درمان

Tanya B. Horwitz, Laurel D. Sarfan, Anne E. Milner, Joshua Varghese, Catherine A. Callaway, Allison G. Harvey

Community Mental Health Journal 2026
https://doi.org/10.1007/s10597-026-01719-1

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چکیده

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.

چکیده به فارسی

این مطالعه به بررسی میزان تأثیر تعداد اختلالات روان‌پزشکی و هم‌ابتلایی‌های خاص در بیماران دریافت‌کننده‌ی مداخله‌ی فراتشخیصی برای اختلال خواب و ریتم شبانه‌روزی (TSC) بر شدت نشانه‌ها/ناتوانی و پیامد درمان پرداخت. این تحلیل ثانویه از زیرمجموعه‌ای از ۴۸۹ بیمار در مراکز سلامت روان جامعه (CMHCs) با بیماری روانی شدید (SMI) و مشکلات خواب/ریتم شبانه‌روزی که در کارآزمایی تصادفی‌شده‌ی کنترل‌شده‌ی TSC شرکت کرده بودند، استفاده کرد. از میان این بیماران، ۲۵۳ نفر TSC فوری دریافت کردند و ۲۳۶ نفر مراقبت معمول به‌دنبال درمان با تأخیر (UC-DT) دریافت کردند. برخی بیماران TSC استاندارد (N = 149) و برخی دیگر TSC تطبیق‌یافته (N = 340) دریافت کردند. نمرات بیماران در آغاز/پیش از درمان و پس از درمان برای نشانه‌های روان‌پزشکی، اختلال خواب، ناتوانی مرتبط با خواب، سلامت کلی خواب و ناتوانی عملکردی تحلیل شد. همچنین داده‌های خودگزارش‌شده‌ی بیماران درباره‌ی سابقه‌ی تشخیص‌های روان‌پزشکی مورد استفاده قرار گرفت. در آغاز مطالعه، بیماران با اختلالات بیشتر به‌طور معناداری نمرات نشانه‌های روان‌پزشکی بدتری داشتند (b = 2.27, SE = 0.39, p<.001)، اختلال خواب به‌طور حاشیه‌ای بیشتر (b = 0.57, SE = 0.32, p=.073) (اما فقط در سطح اسمی)، ناتوانی مرتبط با خواب به‌طور معناداری بیشتر (b = 1.25, SE = 0.34, p<.001)، سلامت کلی خواب به‌طور معناداری بدتر (b=-0.20, SE = 0.06, p=.001)، و ناتوانی عملکردی به‌طور معناداری بیشتر (b = 0.32, SE = 0.11, p=.005) داشتند. تعداد اختلالات روان‌پزشکی با پیامد درمان یا تفاوت در منافع بین TSC استاندارد و تطبیق‌یافته ارتباطی نداشت. در تحلیل مستقل، همه‌ی گروه‌های شایع اختلالات روان‌پزشکی در گروه TSC فوری نسبت به گروه UC-DT در اختلال خواب و ناتوانی مرتبط با خواب بهبود معنادار بیشتری نشان دادند. این نتایج بر شواهد قوی مبنی بر این‌که درمان فراتشخیصی خواب رویکردی مهم برای درمان جمعیت‌های مبتلا به SMI همراه با مشکلات خواب/ریتم شبانه‌روزی است، می‌افزاید.

ترجمه‌ی خودکار برای آشنایی سریع؛ برای نقل و ارجاع، متن اصلی ملاک است.

موضوع‌ها و کلیدواژه‌ها

درمانروان‌پزشکیسلامت روانCircadian rhythmComorbidityIntervention (counseling)mental healthMental illnessکارآزمایی تصادفی‌شده‌ی کنترل‌شدهSleep (system call)Sleep disorder

ارجاع

Horwitz, T. B., Sarfan, L. D., Milner, A. E., Varghese, J., Callaway, C. A., & Harvey, A. G. (2026). The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TSC) in Community Mental Health: Evaluating Self-Reported Psychiatric Disorders as a Predictor of Symptoms and Treatment Outcome. Community Mental Health Journal. https://doi.org/10.1007/s10597-026-01719-1

(Horwitz et al., 2026)

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  1. با احترام و بدون توهین، تحقیر، برچسب‌زنی یا حمله‌ی شخصی با دیگران گفتگو کنید.
  2. از نوشتن هرگونه اطلاعات هویتی یا قابل‌شناسایی مراجعان، بیماران یا اشخاص ثالث، از جمله نام، شماره‌ی تماس، تصویر، نشانی، محل کار یا جزئیات منحصربه‌فرد پرونده خودداری کنید.
  3. اگر درباره‌ی یک تجربه‌ی بالینی سؤال می‌کنید، اطلاعات را تا حد ممکن بی‌نام و کلی بیان کنید تا امکان شناسایی فرد وجود نداشته باشد.
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  6. انتشار تبلیغات، معرفی خدمات شخصی، شماره‌ی تلفن، شناسه‌ی شبکه‌های اجتماعی، پیوند تبلیغاتی یا درخواست جذب مراجع در این بخش مجاز نیست.
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