Search

Yu Itoh,1 Masahiro Takeshima,1 Yoshitaka Kaneita,2 Naohisa Uchimura,3 Yuichi Inoue,4 Makoto Honda,5 Wataru Yamadera,6 Norio Watanabe,7 Shingo Kitamura,8 Isa Okajima,9 Naoko Ayabe,10 Kyoko Nomura,11 Kazuo Mishima1 1Department of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, Japan; 2Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan; 3Department of Neuropsychiatry, Kurume University, Fukuoka, Japan; 4Department of Somnology, Tokyo Medical University, Tokyo, Japan; 5Sleep Disorders Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; 6Division of Bioregulatory Medicine, Department of Katsushika Medical Center, The Jikei University, Tokyo, Japan; 7Health Promotion and Human Behavior, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan; 8Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan; 9Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan; 10Department of Regional Studies and Humanities, Faculty of Education and Human Studies, Akita University, Akita, Japan; 11Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, JapanCorrespondence: Kazuo MishimaDepartment of Neuropsychiatry, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita, 010-8543, JapanTel +81-18-884-6122Fax +81-18-884-6445Email mishima@med.akita-u.ac.jpPurpose: Large-scale natural disasters have an enormous physical and mental impact, immediately after they occur, on people living near the central disaster areas. It is known that, in the early stages, a seismic disaster triggers high rates of symptoms for insomnia, depression, and anxiety. However, little information is available about their medium- to long-term clinical outcomes. In this study, we conducted a repeated cross-sectional nationwide questionnaire survey to clarify changes in the prevalence of insomnia and its background factors after the Great East Japan Earthquake, a huge earthquake with a moment magnitude of 9.0 that occurred on March 11, 2011.Methods: We conducted a repeated cross-sectional survey in November 2009 (pre-earthquake, 1224 participants), July 2011 (4 months post-earthquake, 1259 participants), and August 2012 (18 months post-earthquake, 1289 participants) using stratified random sampling from 157 Japanese sites.Results: Compared to 2009, the prevalence of insomnia statistically increased nationwide immediately post-disaster (11.7% vs 21.2%; p < 0.001) but significantly decreased in 2012 compared to immediately after the earthquake (10.6% vs 21.2%; p < 0.001). In 2011, insomnia was most frequent in the central disaster area. Multivariable logistic regression models demonstrated the association between the following factors and increased risk of insomnia: being a woman (odds ratio [OR] 1.48, 95% confidence interval [CI]: 1.00– 2.19), being employed in 2009 (OR 1.74, 95% CI: 1.15– 2.62), and being of younger age group (20– 64 years) in 2011 (OR 1.64, 95% CI: 1.12– 2.42) and 2012 (OR 2.50 95% CI: 1.47– 4.23). Post-earthquake, the prevalence of insomnia symptoms in men increased, while the gender difference decreased and was no longer statistically significant. Additionally, insomnia was associated with psychological distress (scores ≥ 5 on the Kessler Psychological Distress Scale) in 2011 and 2012.Conclusion: This study demonstrated that the prevalence of insomnia was significantly higher after the earthquake. Moreover, individuals with insomnia were more likely to experience psychological distress after the earthquake that continued until 2012.Keywords: disaster, earthquakes, insomnia, psychological stress

The purpose of this research was the development of a wastewater treatment technique using catalytic oxidation in superheated steam. The target substance was isopropyl alcohol (IPA). The experiment was carried out using a plug-flow reactor filled with MnO2 catalyst. The optimum decomposition condition was determined, and the kinetics of the catalytic oxidation reaction were analyzed. The experimental results were expressed as total organic carbon (TOC) removal. The dependences of the TOC removal on the reaction temperature and residence time were investigated. The TOC removal increased with the reaction temperature and residence time. It was 99.8% at 300°C, 0.9 MPa, 11 s, and oxidant ratio of 1.2. On the other hand, the TOC removal was constant for a long residence time at low reaction temperatures of 200 and 230°C. This was because acetone and acetic acid were produced via the oxidation of IPA, and they were detected as TOC. The reaction kinetics were examined using the pseudo-first-order reaction model; the TOC removal correlated well with this model. Based on the results of the kinetics, the activation energy (Ea) for TOC decomposition was determined from the Arrhenius equation; it was 56.1 kJ/mol. These results indicate that catalytic oxidation in superheated steam is useful for wastewater treatment.

Bio-oil is often extracted from biomass using liquid solvent or supercritical carbon dioxide. However, extraction using these methods has several disadvantages. In this study, expanded hexane with carbon dioxide is examined as a new extraction solvent. The objective of this study is to develop a new technique for the extraction of bio-oil from biomass using expanded hexane with carbon dioxide; rice bran is used as the raw biomass. The extraction was carried out at 25— 27°C, 5.0—5.3 MPa, and 0.78—0.94 mole fraction of carbon dioxide in expanded hexane. At 26°C, 5.1 MPa, 0.87 of mole fraction of carbon dioxide, the oil yield was 1.6 times greater than that with normal liquid hexane because of the low viscosity and high permeability of expanded hexane. Furthermore, the phosphorus concentration in the extracted oil was 9.5 ppm. This was very low, compared with that in rice bran,in which it is approximately 350 ppm. This was because the solvent power of expanded hexane to extract neutral lipid decreased slightly while that to extract polar components decreased significantly. As a result, expanded hexane with carbon dioxide could extract the phosphorus-free bio-oil in high yield under mild conditions.

Medication adherence is important for the appropriate drug-based treatment in patients with chronic diseases, especially those with cardiovascular diseases (CVDs). The purpose of the present study was to evaluate medication adherence among patients with CVDs using subjective and objective measurements. We enrolled outpatients who visited Fukuoka University Chikushi Hospital from June to December 2022. As a subjective measurement, we used a self-reported questionnaire developed by Ueno et al., which consists of 12 questionnaire items grouped into the following four domains: medication compliance (subjective compliance), collaboration with health care providers (collaboration), willingness to access and use information about medication (willingness), and acceptance to take medication and how taking medication fits a patient's lifestyle (acceptance). The pill counting method was used as an objective measurement to calculate the medication adherence rate; Poor Adherence was defined as a medication adherence rate of <100%. Ninety-four patients were analyzed. No statistically significant differences were observed between the patients in the Good and Poor Adherence groups classified by pill counting, an objective indicator; in the subjective evaluation index Ueno scale scores of subjective compliance, collaboration, willingness, and acceptance domains; and in the total score. A multivariate analysis revealed that obesity (odds ratio, 3.527; 95% confidence interval, 1.387-9.423; p = 0.008) was an independent factor associated with Poor Adherence. In conclusion, we found a discrepancy between subjective and objective measurements for the evaluation of medication adherence. Furthermore, obesity was an independent factor associated with poor medication adherence assessed by the pill counting method; thus, patients with CVD and obesity require a careful follow-up.

Aim: The aim of the study was to identify the clinical significance of anxiety in those with depression, the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) defined criteria for an anxious distress specifier for major depressive disorder (MDD). The Clinically Useful Depression Outcome Scale (CUDOS) supplemented with questions for the DSM-5 anxious distress specifier (CUDOS-A) is a self-report instrument to assess the clinical significance of anxiety in addition to assess symptoms and the severity of depression. This study aimed to evaluate the psychometric properties of the Japanese version of the CUDOS-A., Methods: An observational, prospective study was conducted with 131 MDD outpatients and 200 healthy controls. The Japanese version of the CUDOS-A, along with other measures, was administered to assess depressive symptoms, anxiety, social function, and biological rhythm. Reliability and validity analyses were performed, including internal consistency, test-retest reliability, convergent validity, and contrasted-groups validity., Results: The Japanese version of the CUDOS-A demonstrated excellent internal consistency (Cronbach's alpha = 0.96) and test-retest reliability (ICC = 0.78). Significant positive correlations were found between the CUDOS-A and measures of depression, anxiety, social function, and biological rhythm (all, p < 0.001), supporting its convergent validity. The CUDOS-A effectively differentiated between patients with MDD and healthy controls (p < 0.001), indicating good contrasted-groups validity., Conclusions: The Japanese version of the CUDOS-A is a useful measure for research and for clinical practice, enabling the efficient assessment of anxious distress in individuals with depression., (© 2024 The Author(s). Neuropsychopharmacology Reports published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Neuropsychopharmacology.)

Objective: Nonrestorative sleep (NRS) is unrefreshing sleep that is harmful to mental and physical health. Although few studies have reported the relationship between NRS and sleep problems, none have evaluated this relationship by age group. This study aimed to determine whether NRS could be associated with insomnia severity, sleep debt, and social jetlag and whether this relationship would vary with age., Methods: The 1592 participants were allocated into age groups: 18-25 years (n = 317), 26-40 years (n = 405), 41-65 years (n = 454), and >65 years (n = 416). The study used Restorative Sleep Questionnaire to assess NRS, Athens Insomnia Scale to assess insomnia severity, Sleep Debt Index to assess sleep debt, and the absolute difference in midpoints of sleep between weekdays and days off to assess social jetlag., Results: Logistic regression analysis was performed to determine the association between NRS and sleep problems. In the 18-25-year group, insomnia severity, sleep debt of ≥2 h, and social jetlag of ≥2 h; in the 26-40-year group, insomnia severity and sleep debt of ≥2 h; in the 41-65-year group, insomnia severity and sleep debt of ≥2 h; and in the >65-year group, insomnia severity were significantly associated with NRS., Conclusion: NRS was associated with insomnia severity in all age groups, with sleep debt in the young and working-age groups and social jetlag in the young age group. Different approaches to improving the NRS are required for different age groups., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: YT received lecture fees from Yoshitomi Yakuhin Co. for projects unrelated to the submitted work. RI and NM declare no conflicts of interest relevant to the content of this article. IO received grants from NEC Solution Innovators Co. Ltd. and Infocom Co.; lecture fees from Otsuka Pharmaceutical Co. Ltd., MSD K·K., and Eisai Co. Ltd.; and consultation fees from NEC Solution Innovators Co. Ltd. and Suntory Wellness Ltd., for projects unrelated to the submitted work. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: It is unclear how primary care physicians manage insomnia after the introduction of novel hypnotics such as orexin receptor antagonists and melatonin receptor agonists. This Web-based questionnaire survey aimed to examine treatment strategies for insomnia in Japanese primary care practice., Methods: One-hundred-and-seventeen primary care physicians were surveyed on the familiarity of each management option for insomnia on a binary response scale (0 = "unfamiliar"; 1 = "familiar") and how they managed insomnia using a nine-point Likert scale (1 = "I never prescribe/perform it"; 9 = "I often prescribe/perform it"). Physicians who were unfamiliar with a management option were deemed to have never prescribed or performed it., Results: Regarding medication, most physicians were familiar with novel hypnotics. Suvorexant was the most used hypnotic, followed by lemborexant and ramelteon. These novel hypnotics averaged 4.8-5.4 points and 4.0-4.7 points for sleep onset and sleep maintenance insomnia, respectively. By contrast, most benzodiazepines were seldom used below two points. Regarding psychotherapy, only approximately 40% of the physicians were familiar with cognitive behavioral therapy for insomnia (CBT-I) and they rarely implemented it, at an average of 1.5-1.6 points. More physicians were familiar with single-component psychotherapies (i.e., relaxation, sleep restriction therapy, and stimulus control) compared to CBT-I, and 48-74% of them implemented it slightly more often, with scores ranging from 2.6 to 3.4 points., Conclusion: This study suggests that Japanese primary care physicians seldom use CBT-I to treat insomnia. In addition, they use novel sleep medications more frequently than benzodiazepines in terms of pharmacotherapy. The use and availability of CBT-I in Japanese primary care might be facilitated by: educating primary care physicians, implementing brief or digital CBT-I, and/or developing collaborations between primary care physicians and CBT-I specialists., (© 2024. The Author(s).)

Objective: Depression significantly impacts the job performance and attendance of workers, leading to increased absenteeism. Predicting occupational engagement for individuals with depression is of paramount importance. This study aims to determine the cut-off score which predicts continuous employment for patients with mood disorders using the Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR)., Methods: In a prospective observational trial conducted in Tokyo, 111 outpatients diagnosed with either major depressive disorder or bipolar depression were enrolled. Their employment statuses of these participants were tracked over a six-month period after their QIDS-SR scores were recorded. Based on their employment trajectories, participants were categorized into either continuous or non-continuous employment groups. Binary logistic regression was applied to examine the relationship between the QIDS-SR scores and employment outcomes, with adjustments for age, gender, and psychiatric diagnoses. Receiver operating characteristic curves were utilized to identify the optimal QIDS-SR cut-off values for predicting continuous employment., Findings: Binary logistic regression demonstrated that a lower score on the QIDS-SR was linked to an elevated likelihood of continuous employment (adjusted odds ratio 1.15, 95% CI: 1.06-1.26, p=0.001). The optimal cut-off point, determined by the Youden Index, was 10/11, showcasing a 63% sensitivity and 71% specificity., Conclusion: The results emphasize the potential of the QIDS-SR as a prognostic instrument for predicting employment outcomes among individuals with depressive disorders. These findings further underscore the importance of managing depressive symptoms to mild or lower intensities to ensure ongoing employment., Competing Interests: YM received honorarium from Sumitomo Pharma, Janssen Pharmaceutical, and Meiji Seika Pharma. HS received grants from Japan Society for the Promotion of Science, Japan Research Foundation Clinical Pharmacology, and Takeda Science Foundation, and honorarium from Eisai, Takeda Pharmaceutical, Otsuka Pharmaceutical, Meiji Seika Pharma, Shionogi Pharma, Yoshitomiyakuhin, Sumitomo Pharma, Kyowa Pharmaceutical, MSD, and Lundbeck Japan. YA received honorarium from Eisai, Sumitomo Pharma, Meiji Seik Pharma, and Viatris. YT received honorarium from Eisai, Sumitomo Pharma, Takeda Pharmaceutical, Meiji Seika Pharma, Shionogi, MSD, and Otsuka Pharmaceutical. IO received grants from NEC solution Innovators Ltd and Infocom Co, consulting fees from NEC solution Innovators Ltd and Suntory Wellness Ltd, and honorarium from Otsuka Pharmaceutical Co., Ltd., MSD LLC, and Eisai Co., Ltd. HT belongs to an endowed course funded by the Takeda Pharmaceutical Company Limited, and belongs to a department that accepts financial support from National Clinical Database, Johnson & Johnson K.K, Nipro Corporation, and Intuitive Surgical Sàrl. MM received honorarium from Yoshitomiyakuhin. TM received honorarium from Sumitomo Pharma. TT received honorarium from Takeda Pharmaceutical, Otsuka Pharmaceutical, Meiji Seika Pharma, Shionogi Pharma, Yoshitomiyakuhin, Sumitomo Pharma, Kyowa Pharmaceutical, MSD, Nippon Boehringer lngelheim, Mylan EPD, Mitsubishi Tanabe Pharma, Viatris, Mochida Pharmaceutical, Janssen Pharmaceutical, TEIJIN PHARMA, and Lundbeck Japan. KW is a consultant of Boehringer Ingelheim, Daiichi Sankyo, Eisai, Eli Lilly, Janssen Pharmaceutical, Kyowa Pharmaceutical, Lundbeck Japan, Luye Pharma, Mitsubishi Tanabe Pharma, Otsuka Pharmaceutical, Pfizer, Sumitomo Dainippon Pharma, Taisho Toyama Pharmaceutical, and Takeda Pharmaceutical., (Copyright © 2024 Matsumoto, Sakurai, Aoki, Takaesu, Okajima, Tachimori, Murao, Maruki, Tsuboi and Watanabe.)

Aim: The aim of this study was to investigate the association of psychological and chronobiological factors with the presence and severity of chronic insomnia by symptom subtypes and their impacts on daytime dysfunctions., Methods: Participants of the present web-based epidemiological study were classified as follows: difficulty initiating sleep (DIS) ( n  = 91); difficulty maintaining sleep (DMS) ( n  = 13); early morning awakening (EMA) ( n  = 48); DIS + DMS ( n  = 67); DIS + EMA ( n  = 23); DMS + EMA ( n  = 24); triplet of DIS, DMS, and EMA symptoms (TRP) ( n  = 69); and normal sleepers ( n  = 4590). The Insomnia Severity Index (ISI), Hospital Anxiety and Depression Scale (HADS), Munich Chronotype Questionnaire (MCTQ), insomnia-related psychological measures (including the Ford Insomnia Response to Stress Test [FIRST] and the Dysfunctional Beliefs and Attitudes about Sleep Scale [DBAS]), and the cognitive and somatic domains of the Pre-Sleep Arousal Scale (PSAS) were evaluated., Results: The presence of DIS and DIS + DMS were significantly associated with an evening preference, and EMA and EMA + DMS with a morning preference, while TRP showed no significant association with either chronotype. The increase in DBAS scores was associated with higher ISI scores in all subtypes. Meanwhile, the associations of each psychological measure varied among insomnia subtypes, with the association of PSAS cognitive arousal to DIS and PSAS somatic arousal to both DMS + EMA and TRP. Pathological HADS score was associated with all subtypes., Conclusion: Chronotypes may be associated with the presence of some insomnia subtypes; however, only psychological factors were speculated to contribute to the aggravation of all subtypes. All insomnia subtypes possibly contribute to the formation of depression., Competing Interests: Y. I. received honoraria for speaking from Eisai Co. Ltd. and MSD K.K. I. O. received grants from NEC Solution Innovators Co., Ltd. and Infocom Co.; lecture fees from Otsuka Pharmaceutical Co., Ltd., MSD LLC, and Eisai Co., Ltd.; and consultation fees from NEC Solution Innovators Co., Ltd. and Suntory Wellness Ltd. for projects unrelated to the submitted work. M. O. declares no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results., (© 2024 The Authors. Psychiatry and Clinical Neurosciences Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Psychiatry and Neurology.)

Background: This study aimed to clarify the reliability and validity of the Japanese version of the Insomnia Catastrophizing Scale (ICS) and to examine the relationship between insomnia severity and insomnia-related cognitive factors., Methods: A total of 786 participants were recruited via an online survey and classified into the insomnia group (n = 342) and healthy group (n = 444). The insomnia group comprised individuals who self-reported meeting the diagnostic criteria for chronic insomnia disorder in the third edition of the International Classification of Sleep Disorders., Results: The ICS is used to independently assess nighttime (ICS-N) and daytime (ICS-D) catastrophic thoughts, and item response theory revealed that each ICS-N and ICS-D item can adequately assess catastrophic thoughts during the night and day, respectively. The internal consistency and test-retest reliability of the ICS-N and ICS-D were good. Further, the ICS-N and ICS-D had a significant positive correlation with insomnia severity, hyperarousal, sleep-related safety behaviors, dysfunctional beliefs about sleep, and anxiety symptoms. Multiple regression analyses with insomnia severity as the dependent variable in the insomnia group demonstrated that catastrophic thoughts were more strongly associated with insomnia severity than sleep-related safety behaviors and dysfunctional beliefs about sleep. The interaction between nighttime catastrophic thoughts and sleep-related safety behaviors increased insomnia severity., Conclusions: The Japanese versions of ICS-N and ICS-D were found to be superior in measuring insomnia-related catastrophic thoughts and to have high reliability and validity. Furthermore, these findings more clearly demonstrate that the catastrophic thoughts may be an important associated factor of insomnia., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Isa Okajima reports financial support was provided by Japan Society for the Promotion of Science. Isa Okajima reports a relationship with NEC Solution Innovators Ltd that includes: consulting or advisory and funding grants. Isa Okajima reports a relationship with Infocom Co that includes: funding grants. Isa Okajima reports a relationship with Otsuka Pharmaceutical Co Ltd that includes: speaking and lecture fees. Isa Okajima reports a relationship with MSD KK that includes: speaking and lecture fees. Isa Okajima reports a relationship with Eisai Co Ltd that includes: speaking and lecture fees. Isa Okajima reports a relationship with Suntory Wellness Ltd that includes: consulting or advisory. Yuta Takano reports a relationship with Yoshitomi Yakuhin Corporation that includes: speaking and lecture fees., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Although cognitive behavioral therapy for insomnia (CBT-I) is recommended as a first-line treatment, its efficacy for workers with insomnia remains unclear. This systematic review and meta-analysis aimed to determine the effectiveness of CBT-I in the management of insomnia symptoms in workers. We searched the literature in three electronic databases, namely PubMed, PsycINFO, and Embase, and included 21 studies in the meta-analysis. Compared with the control group, CBT-I overall resulted in significant improvements in terms of severity of insomnia (g = -0.91), sleep onset latency (g = -0.62), wakefulness after sleep onset (g = -0.60), early morning awakening (g = -0.58), and sleep efficiency (g = 0.71). However, there was no improvement in the total sleep time relative to that in the control group. Furthermore, CBT-I significantly alleviated depressive (g = -0.37) and anxiety (g = -0.35) symptoms and fatigue (g = -0.47) compared with the control group. Our study findings suggest that both web-based and face-to-face CBT-I are effective interventions for managing insomnia symptoms in daytime workers, although it is important to note that only face-to-face CBT-I achieved clinically meaningful changes. The effectiveness of CBT-I for shift workers could not be determined., Competing Interests: Declaration of competing interest Yuta Takano, Rui Ibata, Naho Machida, and Ayaka Ubara declare no conflicts of interest relevant to this study. Isa Okajima received grants from NEC Solution Innovators Co., Ltd. and Infocom Co.; lecture fees from Otsuka Pharmaceutical Co., Ltd., MSD K.K., and Eisai Co., Ltd.; and consultation fees from NEC Solution Innovators Co., Ltd. and Suntory Wellness Ltd. for projects unrelated to the submitted work., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: This study aimed to validate the Japanese version of the Restorative Sleep Questionnaire Weekly version (RSQ-W-J) and estimate the RSQ-W-J cut-off score to identify the degree of non-restorative sleep (NRS) that interferes with daytime function., Methods: An online survey was conducted, and 513 participants (241 men, 272 women; mean age, 47.88 ± 16.66 years) completed the questionnaires. The RSQ-W-J, Multidimensional Fatigue Inventory, Athens Insomnia Scale, Patient Health Questionnaire-9, Epworth Sleepiness Scale, Sleep Debt Index, NRS and the degree of daytime dysfunction, and the diagnostic criteria for chronic insomnia were used as implementation scales., Results: The RSQ-W-J was confirmed to have a single-factor structure. Both the Cronbach α coefficient and test-retest reliability of RSQ-W-J were high (α = 0.91; intraclass correlation coefficient [ICC] agreement  = 0.85). The RSQ-W-J was significantly negatively correlated with the scales of fatigue, insomnia, depressive symptoms, daytime sleepiness, and sleep debt. In addition, the RSQ-W-J scores of the insomnia group, in which participants met the diagnostic criteria for chronic insomnia, NRS group, in which participants had NRS only, and sleep debt group, in which participants had sleep debt, were significantly lower than those in the normal sleep group. Furthermore, the insomnia group scored significantly lower than the sleep debt group. The RSQ-W-J cut-off score, which indicates whether or not NRS interferes with daytime function, was estimated to be 45.8 points., Conclusions: The RSQ-W-J was shown to be useful for comprehensively measuring the degree of restorative sleep., Competing Interests: Declaration of competing interest Authors declare none., (Copyright © 2023. Published by Elsevier B.V.)

Introduction: Cognitive-behavioral therapy for insomnia (CBT-I) is recommended as the first-line treatment for insomnia, but low accessibility and relatively high cost limits the dissemination of the treatment. Several forms of digital CBT-I have been developed to increase the accessibility and shown to be effective; however, the treatment effect may be restricted by the lack of interaction within the treatment. The current study examines whether the therapeutic effects of self-help digital CBT-I could be enhanced by adding simple rule-based personalized feedback., Method: Ninety-two young adults with self-reported insomnia were randomly assigned to three groups: a self-help group (SH, n = 31), who received an eight-session email-delivered CBT-I program; a feedback group (FB, n = 31), who went through the same CBT-I program with personalized feedback; and a waitlist group (WL, n = 30). The Insomnia Severity Index (ISI) was used as the primary outcome measure, and the 16-item version of the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16), Sleep Hygiene Practice Scale (SHPS), and sleep diary were used as the secondary outcome measures. Treatment satisfaction and adherence were also compared between the treatment groups., Results: Both the SH and FB groups showed significantly more improvements in insomnia severity, sleep-related beliefs, and sleep hygiene behaviors than the WL group. Sleep onset latency and sleep efficiency in the sleep diary were also significantly improved after treatment. None of these effects significantly differed between the two treatment groups. Nonetheless, participants in the FB group reported higher treatment satisfaction than those in the SH group., Conclusion: This study supports the effectiveness of email-delivered self-help CBT-I for young adults with insomnia. Furthermore, while adding simple personalized feedback may not have an additional effect on sleep per se, it can enhance treatment satisfaction. This simple intervention shows promise in addressing sleep disturbance in young adults., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Delayed sleep-wake phase disorder (DSWPD) is a sleep disorder in which the habitual sleep-wake timing is delayed, resulting in difficulty in falling asleep and waking up at the desired time. Patients with DSWPD frequently experience fatigue, impaired concentration, sleep deprivation during weekdays, and problems of absenteeism, which may be further complicated by depressive symptoms. DSWPD is typically prevalent during adolescence and young adulthood. Although there are no studies comparing internationally, the prevalence of DSWPD is estimated to be approximately 3% with little racial differences between Caucasians and Asians. The presence of this disorder is associated with various physiological, genetic and psychological as well as behavioral factors. Furthermore, social factors are also involved in the mechanism of DSWPD. Recently, delayed sleep phase and prolonged sleep duration in the young generation have been reported during the period of COVID-19 pandemic-related behavioral restrictions. This phenomenon raises a concern about the risk of a mismatch between their sleep-wake phase and social life that may lead to the development of DSWPD after the removal of these restrictions. Although the typical feature of DSWPD is a delay in circadian rhythms, individuals with DSWPD without having misalignment of objectively measured circadian rhythm markers account for approximately 40% of the cases, wherein the psychological and behavioral characteristics of young people, such as truancy and academic or social troubles, are largely involved in the mechanism of this disorder. Recent studies have shown that DSWPD is frequently comorbid with psychiatric disorders, particularly mood and neurodevelopmental disorders, both of which have a bidirectional association with the pathophysiology of DSWPD. Additionally, patients with DSWPD have a strong tendency toward neuroticism and anxiety, which may result in the aggravation of insomnia symptoms. Therefore, future studies should address the effectiveness of cognitive-behavioral approaches in addition to chronobiological approaches in the treatment of DSWPD., Competing Interests: KF reported personal fees from Eisai., Ltd. and MSD outside the submitted work. YT reported lecture fees from Takeda Pharmaceutical, Sumitomo Pharma, Otsuka Pharmaceutical, Meiji Seika Pharma, Kyowa Pharmaceutical, Eisai, MSD, and Yoshitomi Pharmaceutical outside the submitted work. KM reported personal fees from Eisai, Meiji Seika Pharma, MSD, Otsuka Pharmaceutical, Takeda Pharmaceutical, and Yoshitomi Pharmaceutical outside the submitted work. AS reported personal fees from Eisai and Sumitomo Pharma outside the submitted work. IO reported grants from NEC Solution Innovators Co., Ltd. and Infocom Co.; personal fees from Otsuka Pharmaceutical MSD, and Eisai.; and consultation fees from NEC Solution Innovators Co., Ltd. and Suntory Wellness Ltd. outside the submitted work. YK reported lecture fees from Eisai outside the submitted work. YI reported personal fees from Eisai, Otsuka Pharmaceutical, Takeda Pharmaceutical, Astellas Pharma Inc., and MED K.K. and grants from Philips Japan Co., Ltd., Koike Medical Co., Ltd., and Teijin Pharma Ltd. outside the submitted work. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Futenma, Takaesu, Komada, Shimura, Okajima, Matsui, Tanioka and Inoue.)

Purpose: There is a lack of evidence regarding answers for clinical questions about treating insomnia disorder. This study aimed to answer the following clinical questions: (1) how to use each hypnotic and non-pharmacological treatment differently depending on clinical situations and (2) how to reduce or stop benzodiazepine hypnotics using alternative pharmacological and non-pharmacological treatments., Methods: Experts were asked to evaluate treatment choices based on 10 clinical questions about insomnia disorder using a nine-point Likert scale (1 = "disagree" to 9 = "agree"). The responses of 196 experts were collected, and the answers were categorized into first-, second-, and third-line recommendations., Results: The primary pharmacological treatment, lemborexant (7.3 ± 2.0), was categorized as a first-line recommendation for sleep initiation insomnia, and lemborexant (7.3 ± 1.8) and suvorexant (6.8 ± 1.8) were categorized as the first-line recommendations for sleep maintenance insomnia. Regarding non-pharmacological treatments for primary treatment, sleep hygiene education was categorized as the first-line recommendation for both sleep initiation (8.4 ± 1.1) and maintenance insomnia (8.1 ± 1.5), while multicomponent cognitive behavioral therapy for insomnia was categorized as the second-line treatment for both sleep initiation (5.6 ± 2.3) and maintenance insomnia (5.7 ± 2.4). When reducing or discontinuing benzodiazepine hypnotics by switching to other medications, lemborexant (7.5 ± 1.8) and suvorexant (6.9 ± 1.9) were categorized as first-line recommendations., Conclusion: Expert consensus indicates that orexin receptor antagonists and sleep hygiene education are recommended as first-line treatments in most clinical situations to treat insomnia disorder., Competing Interests: YT has received lecture fees from Takeda Pharmaceutical, Sumitomo Dainippon Pharma, Otsuka Pharmaceutical, Meiji Seika Pharma, Kyowa Pharmaceutical, Eisai, MSD, and Yoshitomi and research funding from Otsuka Pharmaceutical, Meiji Seika Pharma, MSD, and Eisai outside the submitted work. HS has received grants from the Takeda Science Foundation and manuscript and speaker fees from Eisai, Takeda Pharmaceutical, Otsuka Pharmaceutical, Meiji Seika Pharma, Shionogi Pharma, Yoshitomiyakuhin, Sumitomo Pharma, Kyowa Pharmaceutical, and Lundbeck Japan outside the submitted work. MT has received speaker’s honoraria from Takeda Pharmaceutical, Otsuka Pharmaceutical, Daiichi Sankyo Company, Sumitomo Pharma, Meiji Seika Pharma, Viatris Pharmaceuticals Japan, MSD, Eisai, and Yoshitomi Pharmaceutical and research grants from Otsuka Pharmaceutical, Eisai, Shionogi Pharma, and the Japanese Ministry of Health, Labour and Welfare (Grant Number: R3-21GC1016) outside the submitted work. KIe has received speaker’s honoraria from Eisai and research grants from the Japanese Ministry of Health, Labour, and Welfare (Grant Number: 18K15434, 22K15678) and the Japan Agency for Medical Research and Development (Grant Number: 21fk0108486h0001) outside the submitted work. KMa has received speaker’s honoraria from Eisai, Meiji Seika Pharma, MSD, Otsuka Pharmaceutical, Yoshitomi Pharmaceutical, and Takeda Pharmaceutical outside the submitted work. TU received speaker’s honoraria from Eisai. AS has received lecture fees from Dainippon Sumitomo Seiyaku and Eisai outside the submitted work. IO received grants from NEC Solution Innovators Co., Ltd., and Infocom Co., lecture fees from Otsuka Pharmaceutical, MSD K.K., Eisai and consultation fees from NEC Solution Innovators Co., Ltd., and Suntory Wellness Ltd., outside the submitted work. NK has received speaker’s honoraria from Eisai, Takeda Pharmaceutical, MSD, Otsuka Pharmaceutical, Shionogi Pharma, and Janssen Pharmaceutical. HY has received speaker’s honoraria from Eisai, Mochida Pharmaceutical, Takeda Pharmaceutical, and MSD outside the submitted work. MS has received research grants from Mochida Pharmaceutical and Shionogi Pharma, research grants, and speaker’s honorarium from EA Pharma, Eisai, Otsuka Pharmaceutical, Sumitomo Pharma, and Takeda Pharmaceutical, speaker’s honorarium from Meiji Seika Pharma, MSD, Viatris, and Yoshitomi Pharmaceutical, and payment for expert testimony from Mochida Pharmaceutical outside the submitted work. KK has received research grants from Otsuka Pharmaceutical and Shionogi Pharma, research grants and speaker’s honorarium from Meiji Seika Pharma, Eisai, MSD, Takeda Pharmaceutical, and Tsumura, and speaker’s honorarium from Yoshitomi Pharmaceutical, and Sumitomo Pharma outside the submitted work. ES has received speaker’s honoraria from Mochida Pharmaceutical, Kyowa Pharmaceutical Industry, Astellas, Kyorin, and Dainippon Pharma, and research funding from Sumitomo Pharma outside the submitted work. KMi has received speaker’s honoraria from Eisai, Nobelpharma, Takeda Pharmaceutical, and MSD. Moreover, KMi has received research grants from Eisai, Sumitomo Pharma, Takeda Pharmaceutical, AMED (Grant Number: JP21dk0307103KM) and the Japanese Ministry of Health, Labour and Welfare (Grant Number: 19GC1012, 21GC0801) outside the submitted work. KW has received manuscript fees or speaker’s honoraria from Eisai, Eli Lilly, Janssen Pharmaceutical, Kyowa Pharmaceutical, Lundbeck Japan, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, MSD, Otsuka Pharmaceutical, Pfizer, Shionogi Pharma, Sumitomo Pharma, and Takeda Pharmaceutical and received research/grant support from Daiichi Sankyo, Eisai, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, MSD, Otsuka Pharmaceutical, Pfizer, Sumitomo Pharma, and Takeda Pharmaceutical. Moreover, KW was a consultant of Boehringer Ingelheim, Daiichi Sankyo, Eisai, Eli Lilly, Janssen Pharmaceutical, Kyowa Pharmaceutical, Lundbeck Japan, Luye Pharma, Mitsubishi Tanabe Pharma, Otsuka Pharmaceutical, Pfizer, Sumitomo Dainippon Pharma, Taisho Toyama Pharma-ceutical, and Takeda Pharmaceutical outside the submitted work. KIn has received personal fees/grant support from Eisai, Eli Lilly, Janssen Pharmaceutical, Meiji Seika Pharma, Mitsubishi Tanabe Pharma, Mochida, MSD, Novartis, Otsuka Pharmaceutical, Shionogi Pharma, Sumitomo Pharma, and Yoshitomiyakuhin outside the submitted work. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Takaesu, Sakurai, Aoki, Takeshima, Ie, Matsui, Utsumi, Shimura, Okajima, Kotorii, Yamashita, Suzuki, Kuriyama, Shimizu, Mishima, Watanabe and Inada.)

We aimed to examine the reliability and validity of the Parental Acceptance and Action Questionnaire-Japanese version (PAAQ-J). We considered a total of 2000 mothers with infants and toddlers aged 0-3 years and evaluated their scores on the PAAQ-J Acceptance and Action Questionnaire-II (AAQ-II) and Hospital Anxiety and Depression Scale (HADS). We conducted an exploratory factor analysis, creating a PAAQ-J with 12 items and three factors (α = 0.80): Inaction-Behavior, Inaction-Cognition, and Unwillingness, with α of 0.84, 0.72 and 0.68, respectively. The test-retest reliability examination results showed that the interclass correlation coefficient was 0.49, with 95% CI between 0.44 and 0.54. The correlation coefficient of PAAQ-J was 0.57, 0.32, and 0.33 with AAQ-II, and HADS-depression and HADS-anxiety, respectively. PAAQ-J's validity to adequately evaluate an individual's avoidance of experiences regarding childcare and their psychological flexibility was proven. Since the original PAAQ was for 6-18-year-old children with anxiety symptoms, it is necessary to examine its reliability and validity not only for infants and toddlers, but also for parents of older children and adolescents in the future.

Background: The coronavirus disease 2019 (COVID-19) pandemic has greatly changed our daily life. Owing to the imposed restrictions, many educational facilities have introduced remote teaching. This study aims to clarify the association between remote teaching and Japanese university students' sleeping habits., Methods: The participants were medical students at Aichi Medical University. We used data from an ongoing longitudinal sleeping habits survey. For the participants who enrolled in the university during 2018-2020, multilevel analyses of sleep duration during weekdays and weekends across 3 years were conducted, adjusting for sex, grade, place of stay, sleep problems and lifestyle habits., Results: Among the students enrolled in the university, the data of 677 in 2018, 657 in 2019, and 398 in 2020 was available for analysis. The mean sleep duration during weekdays (in minutes) was 407.6 ± 60.3 in 2018, 406.9 ± 63.0 in 2019, and 417.3 ± 80.9 in 2020. The mean sleep duration during weekends (in minutes) was 494.5 ± 82.5 in 2018, 488.3 ± 87.9 in 2019, and 462.3 ± 96.4 in 2020. Multilevel analysis conducted for the 684 participants who enrolled during 2018-2020 showed that sleep duration during weekdays was associated with the place of stay and survey year. Moreover, students reported significantly longer sleep duration during weekdays in 2020 than in 2019, but no significant difference in sleep duration was found between 2018 and 2019. The other multilevel analysis found sleep duration during weekends to be associated with the survey year, sex and always doing something before going to bed. Sleep duration during weekends was shorter in 2020 than in 2019 and longer for male students and students who always do something before going to bed. Ten students were reported to have a delayed sleep phase in 2020., Conclusions: Students' sleep duration increased during weekdays and decreased during weekends in 2020. This difference could be explained by the COVID-19 pandemic and the introduction of remote teaching., (© 2023. The Author(s).)

Sleep debt is associated with presenteeism and mental health; however, the association of sleep debt with presenteeism and well-being in the context of work-related social factors (commuting time, workdays, and working hours) has not been fully elucidated. This study aimed to examine whether work-related social factors are associated with presenteeism and well-being via sleep debt. The participant group comprised 872 full-time and 526 part-time workers (mean age: 44.65 ± 12.37 and 48.47 ± 12.93 years, respectively). For both the full-time and part-time workers, increased sleep debt was significantly associated with presenteeism (β = -0.171; β = -0.160) and low well-being (β = -0.135; β = -0.153). Notably, commuting time was significantly associated with increased sleep debt in full-time workers (β = 0.09). In contrast, the number of workdays was significantly associated with increased sleep debt in part-time workers (β = -0.102). Working hours were not significantly associated with sleep debt for both full- and part-time workers. These results reveal that sleep debt might lead to various risks among workers, elucidating the work-related social factors related to sleep debt. They also highlight the importance of considering work-related social factors when addressing sleep debt.

It has recently been noted that a reduction in sleep reactivity, characterized as the trait-like degree to which exposure to stress interferes with sleep, and anxiety sensitivity are associated with reduced insomnia severity. This study aimed to examine whether sleep reactivity and anxiety sensitivity are associated with insomnia-related depression and anxiety among city government employees in Japan. This cross-sectional study included 1810 city government employees of Koka City, Japan (mean age (standard deviation): 45.33 (12.20) years) who completely answered the scales for sleep reactivity, anxiety sensitivity, anxiety, and depression. Stepwise multiple regression analysis adjusted for demographic data showed that anxiety sensitivity (β = 0.39) was significantly linked to anxiety, and sleep reactivity (β = 0.36) was significantly linked to depression in individuals with insomnia. Additionally, the results of a logistic regression analysis adjusted for demographic data showed that anxiety sensitivity and sleep reactivity were relevant factors for anxious insomnia (OR = 12.69) and depressive insomnia (OR = 8.73), respectively. Whereas both sleep reactivity (OR = 14.67) and anxiety sensitivity (OR = 6.14) were associated with combined insomnia. These findings indicate that sleep reactivity is strongly associated with depressive symptoms, and anxiety sensitivity is strongly associated with anxiety symptoms in individuals with insomnia.

Purpose: We conducted an exploratory study to identify risk factors of dropout in an 8-week e-mail-based cognitive-behavioral therapy for insomnia (REFRESH) to improve sleep among university students with insomnia symptoms., Methods: University and graduate students in Hong Kong and Korea who scored higher than 10 on the Insomnia Severity Index participated in REFRESH., Results: Of 158 participants from Hong Kong (n = 43) and Korea (n = 115), 90 (57%) did not complete all 7 sessions, while 52 of 90 (57.8%) dropped out prior to the fourth session. ROC analysis was conducted on the entire sample of 158 participants with intervention completion vs. dropout (non-completion) as the outcome variable. Predictors of dropout were wake time after sleep onset (WASO) < 7.1 min on the weekly sleep diary and expectations for sleep (a subscale of dysfunctional beliefs and attitudes about sleep; DBAS) < 18 at baseline., Conclusions: These findings indicate that shorter WASO and less expectations for sleep at baseline were associated with risk of dropout from e-mail delivered self-help CBT-I-based intervention. Our results highlight the importance of identifying and tailoring treatment formats to students based on their presenting sleep characteristics., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: The objectives of this study were to develop a Japanese version of the Hyperarousal Scale (HAS-J) and investigate its factor structure, reliability, and validity, as well as to calculate a cutoff score for the HAS-J and assess different levels of hyperarousal in insomnia patients and community dwellers., Methods: We recruited 224 outpatients receiving insomnia treatment (56.3% women; mean age 51.7 ± 15.6 years) and 303 community dwellers aged 20 years or older (57.8% women; mean age 43.9 ± 15.2 years). Exploratory and confirmatory factor analysis was performed to examine the factor structure of the HAS-J. Cronbach's α and McDonald's ω were then used to test internal consistency. To examine the scale's validity, we determined correlations between the HAS-J and other indexes and compared HAS-J scores between insomnia patients and community dwellers. We also compared HAS-J scores between two community-dweller groups (normal and poor sleepers) and two insomnia patient groups (with and without alleviation after treatment)., Results: Following exploratory and confirmatory factor analysis, a 20-item measure emerged comprising three factors: "Introspectiveness and Reactivity," "Neuroticism," and "Insomnia." Confirmatory factor analysis showed a generally good fit for the model of the three-factor structure suggested by the exploratory factor analysis loadings (χ 2 (163) = 327.423, (p <  0.001), CFI = 0.914, GFI = 0.872, AGFI = 0.835, RMSEA = 0.067). In insomnia patients, internal consistency indicated sufficient reliability of the HAS-J. Correlation analysis showed weak to moderate positive correlations of the HAS-J score with other indexes, indicating concurrent validity of the HAS-J. All HAS-J subscale scores were significantly higher in insomnia patients than in community dwellers. Additionally, the total score in patients with alleviation of insomnia was comparable to that in poor sleepers and significantly higher than that in normal sleepers., Conclusions: This study demonstrated the reliability and validity of the HAS-J, indicating that it is useful as a clinical scale of hyperarousal. The high level of hyperarousal in insomnia patients who were assessed to be in remission by the Insomnia Severity Index suggests a risk of insomnia recurrence in these patients., (© 2022. The Author(s).)

Background: COVID-19-related anxiety, sleep problems, and loneliness may be risk factors for school refusal in children and adolescents. However, few studies have examined the mechanisms by which these risk factors cause school refusal. This study examined the process by which COVID-19-related anxiety, sleep problems, and loneliness cause school refusal, using structural equation modeling., Methods: In this cross-sectional questionnaire-based study, 256 (109 male, 147 female, mean age: 15.37 ± 0.48 years) senior high school students were asked to complete the Stress and Anxiety associated with Viral Epidemics-6 questionnaire to assess COVID-19-related anxiety, the Athens Insomnia Scale (AIS), Sleep Debt Index (SDI), and chronotype (MSFsc) to assess sleep problems, the Three-Item Loneliness Scale (TILS) to assess loneliness, and Feelings of School-Avoidance Scale (FSAS) to assess school refusal., Results: Structural equation modeling showed that sleep problems affected loneliness (β = 0.52) and feelings of school refusal (β = 0.37), and that loneliness affected feelings of school refusal (β = 0.47). There was no significant pathway of COVID-19-related anxiety on sleep problems, loneliness, or feelings of school refusal. The indirect effect of sleep problems on feelings of school refusal through loneliness was significant. The results of hierarchical multiple regression analysis showed that AIS (β = 0.30) and SDI (β = 0.13) scores were associated with TILS, and AIS (β = 0.26) and MSFsc (β = -0.14) scores were associated with FSAS scores., Conclusion: The findings of this study showed that sleep problems affected feelings of school refusal via both direct and indirect pathways through the exacerbation of loneliness. To prevent school refusal in adolescents, addressing the indirect pathway via loneliness could be effective in improving insomnia and sleep debt, while addressing the direct pathway could be effective in improving insomnia and chronotype., Competing Interests: IO received grants from NEC Solution Innovators Co., Ltd., and Infocom Co.; lecture fees from Otsuka Pharmaceutical Co., Ltd., MSD K.K., Eisai Co., Ltd.; and consultation fees from NEC Solution Innovators Co., Ltd. and Suntory Wellness Ltd. for projects unrelated to the submitted work. OS is employed by BiosPyxis Co., Ltd. YK was employed by Medimpl Corporation at the time of the study, and is employed by FiveVai, Inc. at time of publication. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Okajima, Honda, Semba, Kiyota and Tani.)

Background: Delayed sleep-wake phase disorder (DSWPD) is more prevalent among the younger generation. However, the prevalence of this disorder in Asia, particularly Japan, has not yet been elucidated. Furthermore, the impact of DSWPD morbidity on daytime functioning and factors associated with the presence of the disorder remain unclear., Methods: A web-based survey was conducted among youth aged 15-30 years. In total, 7,810 individuals completed the questionnaire. The questionnaire included items on sociodemographic variables as well as the Japanese version of the Biological Rhythms Interview of Assessment in Neuropsychiatry self-report (J-BRIAN-SR), which assesses the risk of DSWPD, sleep behaviors and possibly related lifestyle variables, productivity loss [WHO Health and Work Performance Questionnaire (HPQ)], and health-related quality of life (HRQOL). The risk of DSWPD was indicated by a J-BRIAN-SR score greater than or equal to 40 points and days of absence ≥4 days per month. After comparing these variables for participants at risk of DSWPD and those who were not, the factors associated with the risk of DSWPD were examined using logistic regression analysis, with sociodemographic and lifestyle variables as independent variables., Results: The overall prevalence of participants at risk DSWPDs was 4.3%. Compared with participants without DSWPD, those at risk of DSWPD presented significantly worse HPQ and HRQOL scores. The risk of DSWPD was positively associated with the presence of currently treated diseases, length of nighttime liquid crystal display (LCD) viewing, and being a high school/university students. It was negatively associated with habitual exercise., Conclusion: The risk of DSWPD seemed to be consistent with reports from Western countries, and individuals possibly affected by the disorder were thought to have deteriorated daytime functioning. In addition, lifestyle specific to youth, such as long-term LCD viewing at night and relatively loose social constraints, could be associated with the presence of DSWPD in this generation., Competing Interests: YI has received speaker's honoraria from Eisai Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Astellas Pharma Inc., and MSD K.K. and consultation fee from Eisai Co., Ltd. YK has received research funding from Otsuka Pharmaceutical Co., Ltd. and lecture fee from Takeda Pharmaceutical Co., Ltd. IO has received grants from NEC Solution Innovators and personal fees from Otsuka Pharmaceutical, MSD K.K., and Eisai Co., Ltd. for projects unrelated to the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor declared a past co-authorship with one of the authors YI., (Copyright © 2022 Tomishima, Komada, Tanioka, Okajima and Inoue.)

Purpose: The purpose of the study was to compare the efficacy of group-based therapy (GT) and email-delivered self-help (ESH) cognitive behavioral therapy for insomnia (CBT-I) with the wait-list (WL) control group in youths., Methods: The study involved an assessor-blind, parallel group randomized controlled trial in youths meeting the diagnostic criteria for insomnia disorder. Participants were randomized to one of the three groups (8-week GT, 8-week ESH, or WL). Participants in all three groups were assessed at baseline and after treatment (week 9 for the WL group). The two treatment groups were additionally assessed at one month and six months after the intervention. Treatment effects were examined using linear mixed models., Results: A total of 135 youths (mean age: 20.0 ± 2.5 years, female: 67.4%) were recruited. After treatment, both active treatment groups showed significant improvements in insomnia symptoms (GT vs. WL: Cohen's d = -1.03, ESH vs. WL: d = -.63), less presleep arousal (d = -.52 to -1.47), less sleep-related dysfunctional belief (d = -.88 to -1.78), better sleep hygiene practice (d = -.79 to -.84), and improved daytime functioning (d = -.56 to -.96) compared with the WL group. In addition, GT outperformed ESH in improving maladaptive sleep-related beliefs and mood symptoms at post-treatment and 6-month follow-up. A reduction of suicidality with moderate effect size favoring GT emerged at 6-month follow-up., Discussion: Our findings suggested that both group-based and email-delivered CBT-I were effective in treating youth insomnia, but group-based CBT-I showed superior effects on reducing maladaptive beliefs and mood symptoms., (Copyright © 2021 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)