Addressing Structural Barriers to Improve Mental Health Outcomes: A Transdiagnostic Digital Sleep Intervention for Young People

Background: Sleep problems are linked to negative mental health outcomes, both of which rise in prevalence during adolescence and young adulthood. Existing evidence-based sleep treatments are effective but remain largely inaccessible for this age group. Young people also have lower agency over structural barriers affecting sleep (e.g., home environment, school start times).Method: Project Sleep is a digital single-session intervention (SSI) designed with feedback from young people to meet their unique sleep needs. Participants included individuals aged 13-25 with self-reported sleep problems (N=759, Mage=18.7; 48% white, 81% girls, 38% LGBTQ+). Socioeconomic status (SES) ranged from 1-10 (M=6.4, SD=1.7). Structural sleep barriers were reported by 45%: uncomfortable temperature (20%), exceess noise (17%), shared rooms (13%), excess light (10%), nighttime workers in the home (7%), unstable living conditions (2%). Participants rated perceived importance of sleep and making a change to sleep, readiness for change, and perceived control over sleep pre- and post-SSI. Moderation models assessed whether structural factors influenced outcomes. T-tests and correlations tested whether participants’ subjective feedback differed by structural barriers.Results: Those experiencing structural barriers improved similarly to peers. However, lower SES participants (p = .02) and those in high-noise environments (p = .01) experienced smaller gains in perceived control. Those living with nighttime workers improved less in sleep change importance (p = .002), and those in unstable living conditions (p = .02) and uncomfortable temperature environments (p = .04) improved less in sleep importance. Conversely, participants in shared rooms improved more in perceived control (p = .03). There were no differences in participants’ feedback about their experience of the SSI by structural barrier.Conclusions: This brief, accessible SSI provides proximal support for youth with structural sleep barriers, though could benefit from further adaptation. Future research will work with young people experiencing structural sleep barriers to better address their needs.