Journal
JOURNAL OF SLEEP RESEARCH
Volume 30, Issue 1, Pages -Publisher
WILEY
DOI: 10.1111/jsr.13140
Keywords
cognitive behavioural therapy; depression; internet; sleep
Categories
Funding
- Wellcome Trust [098461/Z/12/Z]
- Big Health Inc.
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust
- King's College London
- NIHR Oxford Health Biomedical Research Centre [BRC-1215-20005]
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Insomnia and depression are closely related, and cognitive behavioral therapy can help improve both conditions. Digital cognitive behavioral therapy has significant effects on insomnia and depressive symptoms, showing promise as a treatment option for individuals with clinically significant depressive symptoms.
Insomnia predicts the onset of depression, commonly co-presents with depression and often persists following depression remission. However, these conditions can be challenging to treat concurrently using depression-specific therapies. Cognitive behavioural therapy for insomnia may be an appropriate treatment to improve both insomnia and depressive symptoms. We examined the effects of a fully-automated digital cognitive behavioural therapy intervention for insomnia (Sleepio) on insomnia and depressive symptoms, and the mediating role of sleep improvement on depressive symptoms in participants from two randomized controlled trials of digital cognitive behavioural therapy for insomnia. We also explored potential moderators of intervention effects. All participants met criteria for probable insomnia disorder and had clinically significant depressive symptomatology (PHQ-9 >= 10;n = 3,352). Individuals allocated to treatment in both trials were provided access to digital cognitive behavioural therapy. Digital cognitive behavioural therapy significantly improved insomnia (p g = 0.76) and depressive symptoms (p g = 0.48) at post-intervention (weeks 8-10), and increased the odds (OR = 2.9; 95% CI = 2.34, 3.65) of clinically significant improvement in depressive symptoms (PHQ-9 < 10). Improvements in insomnia symptoms at mid-intervention mediated 87% of the effects on depressive symptoms at post-intervention. No variables moderated effectiveness outcomes, suggesting generalizability of these findings. Our results suggest that effects of digital cognitive behavioural therapy for insomnia extend to depressive symptoms in those with clinically significant depressive symptomatology. Insomnia may, therefore, be an important therapeutic target to assist management of depressive symptoms.
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