Depression prevention via digital cognitive behavioral therapy for insomnia: a randomized controlled trial

• Published in: Sleep (New York, N.Y.) N.Y.), 2019-10, Vol.42 (10), p.1
• Main Authors: Cheng, Philip, Kalmbach, David A, Tallent, Gabriel, Joseph, Christine Lm, Espie, Colin A, Drake, Christopher L
• Format: Article
• Language: English
• Subjects: Adult; Antidepressive Agents - therapeutic use; Behavior modification; Behavioral health care; Care and treatment; Clinical trials; Cognitive behavioral therapy; Cognitive Behavioral Therapy - methods; Cognitive therapy; Depression - epidemiology; Depression - psychology; Depression - therapy; Depression, Mental; Editor's Choice; Female; Follow-Up Studies; Humans; Insomnia; Insomnia and Psychiatric Disorders; Male; Mental depression; Middle Aged; Prevention; Sleep - physiology; Sleep Initiation and Maintenance Disorders - epidemiology; Sleep Initiation and Maintenance Disorders - psychology; Sleep Initiation and Maintenance Disorders - therapy; Telemedicine - methods; Treatment Outcome
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/zsz150

Insomnia is a common precursor to depression; yet, the potential for insomnia treatment to prevent depression has not been demonstrated. Cognitive behavioral therapy for insomnia (CBT-I) effectively reduces concurrent symptoms of insomnia and depression and can be delivered digitally (dCBT-I); however, it remains unclear whether treating insomnia leads to sustained reduction and prevention of depression. This randomized controlled trial examined the efficacy of dCBT-I in reducing and preventing depression over a 1-year follow-up period. Patients with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) insomnia disorder were randomly assigned to receive dCBT-I or an attentional control. The follow-up sample included 358 patients in the dCBT-I condition and 300 patients in the online sleep education condition. The primary outcome measure was relative rate ratios for depression at 1-year follow-up. Insomnia responses to treatment were also tested as predictors of incident depression at the 1-year follow-up. At 1-year follow-up, depression severity continued to be significantly lower in the dCBT-I condition relative to control. In addition, the number of individuals who reported no depression at 1-year follow-up was 51% higher in the dCBT-I condition relative to control. In those with minimal to no depression at baseline, the incident rate of moderate-to-severe depression at 1-year follow-up was reduced by half in the dCBT-I condition relative to the control condition. dCBT-I showed robust effects as an intervention that prevents depression. Future research should examine dose-response requirements and further characterize mechanisms of action of dCBT-I for depression prevention. Sleep to Prevent Evolving Affective Disorders; NCT02988375.