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Objective: Racial disparities in sleep may be consequential among college students given high rates of dysfunctional sleep among this population. The present study sought to investigate whether disparities in sleep explain existing mental health disparities., Method: Data included secondary analysis of a college risk behaviors and health study (n = 1242, mean age = 18.5). Race was dichotomized as White or Black, excluding all others, with participants completing measures of sleep at baseline and measures of depression and anxiety at follow-up 1 to 2 years later., Results: Compared to White students, Black students were more likely to report lower rates of depression and anxiety, but poorer sleep outcomes. Mediation analyses revealed that sleep partially mediated (suppressed) the association between race and depressive and anxiety symptoms., Conclusions: Results indicate that disparities in sleep may play an important role in the association between race and mental health symptoms among college students. Future health disparity research would benefit from exploring the potentially bidirectional relationship between sleep and mental health symptoms among college students., (© 2020 Wiley Periodicals LLC.)

Objective: This article positions the special issue on telepsychology amidst the COVID-19 pandemic, which has dramatically accelerated the adoption and dissemination of telepsychology., Method: The article makes general observations about the themes emerging in the special issue with considerations for application, training, theory-driven research, and policy. It then presents as a case example the rapid deployment during the pandemic of telepsychology doctoral training and services at the Virginia Commonwealth University (VCU) Primary Care Psychology Collaborative., Results: Facilitators to VCU telepsychology deployment included trainee and supervisor resources, strong telepsychology training, and prior experience. Barriers to overcome included limited clinic capacity, scheduling, technology, and accessibility and diversity issues. Lessons learned involved presenting clinical issues, supervision, and working with children and adolescents., Conclusions: Telepsychology is crucial for psychological service provision, during the COVID-19 pandemic more than ever, and that is unlikely to change as psychologists and patients increasingly continue to appreciate its value., (© 2020 Wiley Periodicals LLC.)

Objective: The integration of psychological and behavioral health services into safety net primary care clinics has been viewed as a step toward reducing disparities in mental health treatment and addressing behavioral factors in chronic diseases. Though it is posited that integrated behavioral health (IBH) reduces preventable medical costs, this premise has yet to be tested in a safety net primary care clinic., Method: Retrospective pre- and posttreatment analysis with quasi-experimental control group was constructed using propensity score matching. Participants included 1,440 adult patients at a safety net primary care clinic, 720 of whom received IBH services, and 720 of whom received medical treatment only., Results: Analysis showed that rates of preventable inpatient utilization decreased significantly among IBH-treated patients compared to no change among control patients., Conclusion: IBH was associated with decreased rates of preventable inpatient visits. IBH may present opportunities to deliver improved holistic patient care while reducing unnecessary inpatient medical utilization., (© 2016 Wiley Periodicals, Inc.)

Objective: To test cognitive-behavioral therapy for insomnia (CBT-I) in patients who not only receive psychiatric treatment in a outpatient psychiatry clinic but also continue to experience chronic insomnia despite receiving pharmacological treatment for sleep. CBT-I included an optional module for discontinuing hypnotic medications., Method: Patients were randomized to 5 sessions of individual CBT-I (n = 13) or treatment as usual (n = 10). Sleep parameters were assessed using sleep diaries at pre- and posttreatment. Questionnaires measuring depression, anxiety, and health-related quality of life were also administered., Results: CBT-I was associated with significant improvement in sleep, with 46% obtaining normal global sleep ratings after treatment. However, no changes in secondary outcomes (depression, anxiety, quality of life) were obtained and no patients elected to discontinue their hypnotic medications., Conclusions: Patients with complex, chronic psychiatric conditions can obtain sleep improvements with CBT-I beyond those obtained with pharmacotherapy alone; however, sleep interventions alone may not have the same effect on mental health outcomes in samples with more severe and chronic psychiatric symptoms and dependency on hypnotic medications., (© 2015 Wiley Periodicals, Inc.)

Objective: To examine the effect of cognitive-behavioral therapy for insomnia (CBT-I) on the underreporting of sleep relative to objective measurement, a common occurrence among individuals with insomnia., Method: Pre-treatment and post-treatment self-report measures of sleep were compared with those obtained from home-based polysomnography (PSG) in 60 adults (mean age = 69.17; 42 women) with comorbid insomnia. The self-report data were published previously in a randomized controlled trial demonstrating the efficacy of CBT-I compared with a placebo treatment., Results: Self-report measures significantly underestimated sleep at pre-treatment and CBT-I led to a correction in this discrepancy. There were no significant changes in PSG after CBT-I. Path analysis showed that an increase in an objective proxy measure of sleep quality (i.e., decreased stage N1 sleep) after CBT-I was significantly related to improvements in self-report of sleep, with full mediation by reductions in discrepancy., Conclusions: This is the first CBT-I outcome study to analyze discrepancy changes and demonstrate that these changes account for a significant portion of self-report outcome. In addition, improved sleep quality as measured by a decrease in percentage of stage N1 sleep following treatment may be one mechanism that explains why sleep estimation is more accurate following CBT-I., (© 2012 Wiley Periodicals, Inc.)

The efficacy of cognitive-behavioral therapy for insomnia (CBT-I) to improve both short- and long-term outcomes in both uncomplicated and comorbid insomnia patients has been repeatedly and conclusively demonstrated. Further demonstrations of efficacy, per se, in additional comorbid insomnia populations are likely not the best use of limited energy and resources. Rather, we propose that future CBT-I research would be better focused on three key areas: (a) increasing treatment efficacy, particularly for more clinically relevant outcomes; (b) increasing treatment effectiveness and potential for translation into the community, with a particular focus on variants of CBT-I and alternative delivery modalities within primary healthcare systems; and (c) increasing CBT-I practitioner training and dissemination., (© 2013 Wiley Periodicals, Inc.)