Trajectories of change and long-term outcomes in a randomised controlled trial of internet-based insomnia treatment to prevent depression
Date
2017
Authors
Batterham, Philip
Christensen, Helen
Mackinnon, Andrew
Gosling, John
Thorndike, Francis
Ritterband, Lee
Glozier, Nick
Griffiths, Kathleen
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Volume Title
Publisher
Royal College of Psychiatrists
Abstract
Background
Insomnia treatment using an internet-based cognitive–behavioural therapy for insomnia (CBT-I) program reduces depression symptoms, anxiety symptoms and suicidal ideation. However, the speed, longevity and consistency of these effects are unknown.
Aims
To test the following: whether the efficacy of online CBT-I was sustained over 18 months; how rapidly the effects of CBT-I emerged; evidence for distinct trajectories of change in depressive symptoms; and predictors of these trajectories.
Method
A randomised controlled trial compared the 6-week Sleep Healthy Using the Internet (SHUTi) CBT-I program to an attention control program. Adults (N=1149) with clinical insomnia and subclinical depression symptoms were recruited online from the Australian community.
Results
Depression, anxiety and insomnia decreased significantly by week 4 of the intervention period and remained significantly lower relative to control for >18 months (between-group Cohen’s d=0.63, 0.47, 0.55, respectively, at 18 months). Effects on suicidal ideation were only short term. Two depression trajectories were identified using growth mixture models: improving (95%) and stable/deteriorating (5%) symptoms. More severe baseline depression, younger age and limited comfort with the internet were associated with reduced odds of improvement.
Conclusions
Online CBT-I produced rapid and long-term symptom reduction in people with subclinical depressive symptoms, although the initial effect on suicidal ideation was not sustained.
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British Journal of Psychiatry Open
Type
Journal article
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Open Access
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Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license
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