In:
Psychotherapy and Psychosomatics, S. Karger AG, Vol. 91, No. 3 ( 2022), p. 168-179
Abstract:
〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 The global disease burden of major depressive disorder urgently requires prevention in high-risk individuals, such as recently discovered insomnia subtypes. Previous studies targeting insomnia with fully automated eHealth interventions to prevent depression are inconclusive: dropout was high and likely biased, and depressive symptoms in untreated participants on average improved rather than worsened. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 This randomized controlled trial aimed to efficiently prevent the worsening of depressive symptoms by selecting insomnia subtypes at high risk of depression for internet-based circadian rhythm support (CRS), cognitive behavioral therapy for insomnia (CBT-I), or their combination (CBT-I+CRS), with online therapist guidance to promote adherence. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Participants with an insomnia disorder subtype conveying an increased risk of depression ( 〈 i 〉 n 〈 /i 〉 = 132) were randomized to no treatment (NT), CRS, CBT-I, or CBT-I+CRS. The Inventory of Depressive Symptomatology – Self Report (IDS-SR) was self-administered at baseline and at four follow-ups spanning 1 year. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Without treatment, depressive symptoms indeed worsened ( 〈 i 〉 d 〈 /i 〉 = 0.28, 〈 i 〉 p 〈 /i 〉 = 0.041) in high-risk insomnia, but not in a reference group with low-risk insomnia. Therapist-guided CBT-I and CBT-I+CRS reduced IDS-SR ratings across all follow-up assessments (respectively, 〈 i 〉 d 〈 /i 〉 = –0.80, 〈 i 〉 p 〈 /i 〉 = 0.001; 〈 i 〉 d 〈 /i 〉 = –0.95, 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). Only CBT-I+CRS reduced the 1-year incidence of clinically meaningful worsening ( 〈 i 〉 p 〈 /i 〉 = 0.002). Dropout during therapist-guided interventions was very low (8%) compared to previous automated interventions (57–62%). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 The findings tentatively suggest that the efficiency of population-wide preventive strategies could benefit from the possibility to select insomnia subtypes at high risk of developing depression for therapist-guided digital CBT-I+CRS. This treatment may provide effective long-term prevention of worsening of depressive symptoms. 〈 b 〉 〈 i 〉 Trial registration: 〈 /i 〉 〈 /b 〉 the Netherlands Trial Register (NL7359).
Type of Medium:
Online Resource
ISSN:
0033-3190
,
1423-0348
Language:
English
Publisher:
S. Karger AG
Publication Date:
2022
detail.hit.zdb_id:
1472321-9
SSG:
5,2
SSG:
15,3
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