Digital CBT-I May Prevent Incident Depression
Insomnia is a modifiable risk factor for depression, and research has indicated that CBT-I reduces the severity of depression. Investigators also have shown that digitally delivered CBT-I effectively reduces insomnia and depression. Phillip C. Cheng, PhD, a researcher at the Henry Ford Health System in Detroit, and colleagues sought to determine whether digitally delivered CBT-I could prevent incident depression.
Phillip C. Cheng, PhD
The researchers randomized 658 people with insomnia to Sleepio, an Internet-based CBT-I treatment, or to a control condition of online sleep education. The study’s primary outcome was the Quick Inventory of Depressive Symptomatology (QIDS), and Dr. Cheng’s group defined depression as a score greater than 10 on the QIDS. The researchers also examined participants’ ISI scores and functional outcomes such as work productivity, social functioning, cognitive functioning, and resilience. Assessments were performed at baseline, after treatment, and at one year.
In all, 358 participants were randomized to Sleepio, and 300 were randomized to sleep education. The patient population was predominantly female, was racially diverse, and had a diversity of educational attainment. The demographics of the study arms did not differ significantly.
After treatment, the rate of incident depression was 11% in the sleep education group and 6.5% in the Sleepio group. The difference between arms was not statistically significant. At one year, the rate of incident depression was 22% in the sleep education group and 5.1% in the Sleepio group. The difference between arms at one year was statistically significant, as was the change in depression incidence over time in the sleep education group.
Among patients who did not develop depression, ISI score decreased to a value below the cutoff for insomnia, regardless of study arm. ISI score did not change significantly among participants who developed depression, however. Work productivity, social functioning, cognitive functioning, and resilience improved more in the Sleepio group than in the sleep education group.
The results indicate that “digitally delivered CBT-I may prevent incident depression in adults with insomnia,” said Dr. Cheng. Each episode of depression increases the risk of relapse of depression, which underscores the significance of preventing incident depression, he added. Digital CBT-I also appears to reduce the economic burden associated with depression, and further studies could clarify whether it improves resilience, Dr. Cheng concluded.
—Erik Greb
Suggested Reading
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Gehrman P, Shah MT, Miles A, et al. Feasibility of group cognitive-behavioral treatment of insomnia delivered by clinical video telehealth. Telemed J E Health. 2016;22(12):1041-1046.
Hagatun S, Vedaa Ø, Nordgreen T, et al. The short-term efficacy of an unguided internet-based cognitive-behavioral therapy for insomnia: a randomized controlled trial with a six-month nonrandomized follow-up. Behav Sleep Med. 2017 Mar 27 [Epub ahead of print].
Ye YY, Chen NK, Chen J, et al. Internet-based cognitive-behavioural therapy for insomnia (ICBT-i): a meta-analysis of randomised controlled trials. BMJ Open. 2016;6(11):e010707.