Behavioural, medical & environmental interventions to improve sleep quality for mental health inpatients in secure settings: A systematic review & meta-analysis

Despite the bidirectional relationship between sleep and mental health, the effect of interventions to improve sleep quality for inpatients from secure psychiatric settings has not been examined. The current work aimed to identify the effect of interventions for improving sleep quality for these inpatients and identify moderating factors. Eligible studies involved secure psychiatric inpatients (adult) and included a quantitative measure of sleep as primary outcome. The Cochrane Library, Scopus, PubMed and ProQuest were searched; last searched October 2021. 12,409 abstracts were screened for inclusion. The systematic review included 38 studies. The meta-analysis included 22 studies (36 trials).Sleep Quality, Insomnia Severity, Total Sleep Time and Sleep Efficiency were outcomes. The total pooled effect size for all interventions (random-effects model) was d=0.54, (p<0.0001,95% CI:0.30,0.77). Subset-analyses indicated the pooled effect sizes for behavioural interventions as d=0.65, (p<0.01,95% CI:0.16,1.14), medical interventions as d=0.58, (p<0.001,95% CI:0.25,0.91),environmental interventions as d=0.19, (p=0.38,95% CI:-0.24,0.62). Based upon duration, interventions of a five-to-ten-week period were most effective, d=0.92, (p<0.005,95% CI:0.29,1.55). Males reported a greater improvement in sleep than females. Sleep quality interventions in this population are effective. Behavioural interventions: Cognitive Behavioural Therapy for insomnia and physical activity, are most impactful. Clinical practitioners should consider implementing behavioural interventions, of a five-to-ten-week period.