SPARK Healthy Sleep

SPARK-Healthy Sleep is a digital mental health intervention designed to help college students who may be at risk for psychosis and experience sleep problems. About 1 in 4 college students report psychotic-like experiences (such as hearing voices or feeling paranoid), and these students often have poor sleep quality, which can worsen their mental health symptoms. This study tests whether a single-session digital intervention can improve sleep and reduce mental health stigma in at-risk college students. The intervention is delivered through a smartphone app and takes about 30 minutes to complete. It includes educational content about mental health being on a continuum (not just "normal" vs "abnormal"), strategies to reduce stigma around seeking help, and evidence-based sleep improvement techniques based on cognitive behavioral therapy for insomnia. The study will recruit 115 college students from Indiana University-Indianapolis who score high on measures of psychotic-like experiences and poor sleep quality. Half will receive the intervention immediately (experimental group), while the other half will wait three weeks before receiving it (control group). All participants will complete questionnaires about sleep, mental health symptoms, social functioning, and stigma at the beginning of the study and after two weeks. The main goals are to determine if the intervention is feasible and acceptable to students, and whether it shows preliminary effectiveness in improving sleep quality, reducing stigma, and improving overall mental health outcomes. A subset of participants will also complete interviews about their experience using the intervention. This research addresses important barriers to mental health care for college students, including stigma and limited access to services. If successful, this digital approach could provide a scalable way to help at-risk students improve their mental health and potentially prevent more serious problems from developing.

Study Overview SPARK-Healthy Sleep is a randomized controlled pilot study testing a single-session digital mental health intervention for college students at risk for psychosis who experience sleep difficulties. The study evaluates feasibility, acceptability, and preliminary effectiveness of a smartphone-delivered intervention combining stigma reduction and cognitive behavioral therapy for insomnia (CBT-I) principles. Study Design This is a pragmatic randomized controlled trial with a wait-list control design. Participants are randomized 1:1 to immediate intervention or 3-week delayed intervention, stratified by race, gender, and age. The study is unblinded given the nature of the digital intervention. Participants and Recruitment Target enrollment: 115 college students from Indiana University-Indianapolis (aiming for 100 completers). Recruitment occurs through the SONA research participation system and mass emails to the student body. Inclusion Criteria: Age ≥18 years, Current college enrollment, English fluency, Prodromal Questionnaire-Brief endorsement score ≥7, Pittsburgh Sleep Quality Index score \>5, Pass validity screening questions Exclusion Criteria: Previous psychotic disorder diagnosis, Unable to provide informed consent Intervention Description SPARK-Healthy Sleep is delivered via Qualtrics platform in approximately 30 minutes. The intervention consists of five modules: Introduction: Welcome, safety information, single-session concept introduction Stigma Resistance: Mental health continuum education, stress-vulnerability model, interactive exercises Sleep Regulation: CBT-I principles, sleep hygiene education, cognitive restructuring, behavioral strategies Planning: Personalized sleep plan development, goal-setting exercises Recap: Summary, resource provision, follow-up instructions The intervention incorporates videos, interactive text responses, and personalized feedback based on participant inputs. Assessment Schedule Screening Assessment: Online consent process Demographics questionnaire Schizotypal Personality Questionnaire-Brief Updated Prodromal Questionnaire-Brief Pittsburgh Sleep Quality Index Additional measures: Academic satisfaction, life satisfaction, loneliness, digital mental health interest Baseline Assessment (Week 0): Comprehensive battery including sleep quality, stigma measures, affect, paranoid ideation, social functioning, depression, emotion regulation, and cognitive testing Intervention installation and orientation for experimental group Follow-up Assessment (Week 2): Repeat of baseline measures System usability and intervention acceptability measures Intervention access provided to control group Qualitative Interviews: Semi-structured interviews with 10 participants selected across engagement levels Audio recorded with permission Focus on user experience, barriers, and improvement suggestions Primary Outcomes Feasibility: Intervention completion rates (target ≥80%), system usability scores Acceptability: Intervention appropriateness ratings, prompt completion rates Usage data: Time spent, modules completed, interaction frequency Secondary Outcomes Sleep quality (Pittsburgh Sleep Quality Index) Mental health stigma (Internalized Stigma Mental Health Inventory) Paranoid ideation (Community Assessment of Psychic Experiences) Negative affect (Positive and Negative Affect Schedule) Functional outcomes: Social functioning, depression, emotion regulation, executive functioning Statistical Analysis Plan Sample Size: Power analysis indicates n=50 per arm provides adequate power (0.80) to detect medium effects (α=0.05). Primary Analysis: Descriptive statistics for feasibility and acceptability outcomes. Target thresholds: ≥80% completion rates and high usability/appropriateness ratings. Secondary Analysis: 2x2 mixed-effects ANOVA examining intervention effects over time (baseline, follow-up) and between conditions (immediate vs. delayed intervention). Within-group effect sizes calculated to quantify intervention impact. Bonferroni corrections applied for multiple comparisons. Missing Data: Multiple imputation for missing at random data. Intent-to-treat analysis with sensitivity analyses for different missingness patterns. Qualitative Analysis: Thematic content analysis of interview transcripts to identify implementation barriers and improvement recommendations. Data Management and Quality Assurance Data Collection: All data collected via password-protected Qualtrics surveys stored on secure IU research servers. Quality Control: Range checks in Qualtrics Double entry for critical variables Regular data backup verification Monthly data quality review by PI Safety Monitoring: Automated flags for concerning responses on depression and psychosis measures 24-hour PI notification protocol Established referral pathways to campus counseling and first-episode psychosis services Resource information provided to all participants Data Storage: De-identified data stored indefinitely on encrypted servers. Separate master list links participant IDs to identifying information, accessible only to PI and study team. This pilot study will provide essential feasibility data and preliminary effect size estimates for future larger-scale randomized controlled trials examining longer-term outcomes and broader implementation across college campuses.