Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-27T08:24:35.279Z Has data issue: false hasContentIssue false
  • English
  • Français

Trajectories of change and long-term outcomes in a randomised controlled trial of internet-based insomnia treatment to prevent depression

Published online by Cambridge University Press:  02 January 2018

Philip J. Batterham ,
Helen Christensen ,
Andrew J. Mackinnon ,
John A. Gosling ,
Frances P. Thorndike ,
Lee M. Ritterband ,
Nick Glozier  and
Kathleen M. Griffiths
Philip J. Batterham*
Affiliation:
Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
Helen Christensen
Affiliation:
Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
Andrew J. Mackinnon
Affiliation:
Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
John A. Gosling
Affiliation:
Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
Frances P. Thorndike
Affiliation:
BeHealth Solutions, Charlottesville, VA, USA
Lee M. Ritterband
Affiliation:
Behavioural Health and Technology Lab, Department of Psychiatry and Neurobehavioural Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA
Nick Glozier
Affiliation:
Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
Kathleen M. Griffiths
Affiliation:
Research School of Psychology, The Australian National University, Canberra, ACT, Australia
*
Philip J. Batterham, Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Acton ACT 2601, Australia. E-mail: [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
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.

Type
Paper
Information
BJPsych Open , Volume 3 , Issue 5 , September 2017 , pp. 228 - 235
Copyright
Copyright © The Royal College of Psychiatrists 2017

Footnotes

Declaration of interest

P.J.B. has received grants from the National Health and Medical Research Council (NHMRC) during the conduct of the study. H.C. has received grants from the NHMRC and the Australian Research Council during the conduct of the study. L.M.R. receives research funding from the National Institutes of Health (NIH) that, in part, focuses on insomnia. F.P.T. and L.M.R. have equity ownership in BeHealth Solutions (Charlottesville, VA, USA), a company that develops and makes available products related to the research reported in this manuscript. BeHealth Solutions has licensed the SHUTi program and the software platform on which it was built from the University of Virginia. The terms of this arrangement have been reviewed and approved by the University of Virginia in accordance with its conflict of interest policy. N.G. has received grants from the NHMRC during the conduct of the study and personal fees from Lundbeck, Servier and Janssen outside the submitted work.

References

1 Ferrari, AJ, Charlson, FJ, Norman, RE, Patten, SB, Freedman, G, Murray, CJ, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med 2013; 10: e1001547.CrossRefGoogle ScholarPubMed
2 van Zoonen, K, Buntrock, C, Ebert, DD, Smit, F, Reynolds, CF 3rd, Beekman, AT, et al. Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions. Int J Epidemiol 2014; 43: 318–29.CrossRefGoogle ScholarPubMed
3 Gulliver, A, Griffiths, KM, Christensen, H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry 2010; 10: 113.Google Scholar
4 Harvey, AG. A transdiagnostic approach to treating sleep disturbance in psychiatric disorders. Cogn Behav Ther 2009; 38 (Suppl 1): 35–42.Google Scholar
5 Ford, DE, Kamerow, DB. Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA 1989; 262: 1479–84.Google Scholar
6 Franzen, PL, Buysse, DJ. Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues Clin Neurosci 2008; 10: 473–81.Google Scholar
7 Taylor, DJ, Lichstein, KL, Weinstock, J, Sanford, S, Temple, JR. A pilot study of cognitive-behavioural therapy of insomnia in people with mild depression. Behav Ther 2007; 38: 49–57.CrossRefGoogle ScholarPubMed
8 Batterham, PJ, Glozier, N, Christensen, H. Sleep disturbance, personality and the onset of depression and anxiety: prospective cohort study. Aust N Z J Psychiatry 2012; 46: 1089–98.Google Scholar
9 Baglioni, C, Battagliese, G, Feige, B, Spiegelhalder, K, Nissen, C, Voderholzer, U, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord 2011; 135: 10–9.Google Scholar
10 Dew, MA, Reynolds, CF 3rd, Houck, PR, Hall, M, Buysse, DJ, Frank, E, et al. Temporal profiles of the course of depression during treatment. Predictors of pathways toward recovery in the elderly. Arch Gen Psychiatry 1997; 54: 1016–24.CrossRefGoogle ScholarPubMed
11 Dombrovski, AY, Cyranowski, JM, Mulsant, BH, Houck, PR, Buysse, DJ, Andreescu, C, et al. Which symptoms predict recurrence of depression in women treated with maintenance interpersonal psychotherapy? Depress Anxiety 2008; 25: 1060–6.CrossRefGoogle ScholarPubMed
12 Cohrs, S. Sleep disturbances in patients with schizophrenia: impact and effect of antipsychotics. CNS Drugs 2008; 22: 939–62.Google Scholar
13 Goldstein, TR, Bridge, JA, Brent, DA. Sleep disturbance preceding completed suicide in adolescents. J Consult Clin Psychol 2008; 76: 84–91.CrossRefGoogle ScholarPubMed
14 Bernert, RA, Kim, JS, Iwata, NG, Perlis, ML. Sleep disturbances as an evidence-based suicide risk factor. Curr Psychiatry Rep 2015; 17: 554.Google Scholar
15 Stinson, K, Tang, N, Harvey, A. Barriers to treatment seeking in primary insomnia in the United Kingdom: a cross-sectional perspective. Sleep 2006; 29: 1643–6.Google Scholar
16 Zachariae, R, Lyby, MS, Ritterband, LM, O’Toole, MS. Efficacy of internet-delivered cognitive-behavioural therapy for insomnia – a systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev 2016; 30: 1–10.Google Scholar
17 Ashworth, DK, Sletten, TL, Junge, M, Simpson, K, Clarke, D, Cunnington, D, et al. A randomized controlled trial of cognitive behavioural therapy for insomnia: an effective treatment for comorbid insomnia and depression. J Couns Psychol 2015; 62: 115–23.Google Scholar
18 Manber, R, Edinger, JD, Gress, JL, San Pedro-Salcedo, MG, Kuo, TF, Kalista, T. Cognitive behavioural therapy for insomnia enhances depression outcome in patients with comorbid major depressive disorder and insomnia. Sleep 2008; 31: 489–95.Google Scholar
19 Wagley, JN, Rybarczyk, B, Nay, WT, Danish, S, Lund, HG. Effectiveness of abbreviated CBT for insomnia in psychiatric outpatients: sleep and depression outcomes. J Clin Psychol 2013; 69: 1043–55.Google Scholar
20 Watanabe, N, Furukawa, TA, Shimodera, S, Morokuma, I, Katsuki, F, Fujita, H, et al. Brief behavioural therapy for refractory insomnia in residual depression: an assessor-blind, randomized controlled trial. J Clin Psychiatry 2011; 72: 1651–8.Google Scholar
21 Ritterband, LM, Thorndike, FP, Gonder-Frederick, LA, Magee, JC, Bailey, ET, Saylor, DK, et al. Efficacy of an internet-based behavioural intervention for adults with insomnia. Arch Gen Psychiatry 2009; 66: 692–8.Google Scholar
22 Christensen, H, Batterham, PJ, Gosling, JA, Ritterband, LM, Griffiths, KM, Thorndike, FP, et al. Effectiveness of an online insomnia program (SHUTi) for prevention of depressive episodes (the GoodNight Study): a randomised controlled trial. Lancet Psychiatry 2016; 3: 333–41.Google Scholar
23 Spitzer, RL, Kroenke, K, Williams, JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA 1999; 282: 1737–44.CrossRefGoogle ScholarPubMed
24 Griffiths, KM, Farrer, L, Christensen, H. The efficacy of internet interventions for depression and anxiety disorders: a review of randomised controlled trials. Med J Aust 2010; 192: S4–11.Google Scholar
25 Hunkeler, EM, Katon, W, Tang, L, Williams, JW Jr, Kroenke, K, Lin, EH, et al. Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care. BMJ 2006; 332: 259–63.CrossRefGoogle ScholarPubMed
26 Hollon, SD, Stewart, MO, Strunk, D. Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annu Rev Psychol 2006; 57: 285–315.CrossRefGoogle ScholarPubMed
27 Renaud, J, Brent, DA, Baugher, M, Birmaher, B, Kolko, DJ, Bridge, J. Rapid response to psychosocial treatment for adolescent depression: a two-year follow-up. J Am Acad Child Adolesc Psychiatry 1998; 37: 1184–90.Google Scholar
28 Masheb, RM, Grilo, CM. Rapid response predicts treatment outcomes in binge eating disorder: implications for stepped care. J Consult Clin Psychol 2007; 75: 639–44.CrossRefGoogle ScholarPubMed
29 Andrews, G, Cuijpers, P, Craske, MG, McEvoy, P, Titov, N. Computer therapy for the anxiety and depressive disorders is effective, acceptable and practical health care: a meta-analysis. PLoS One. 2010; 5: e13196.CrossRefGoogle ScholarPubMed
30 Muthen, B, Muthen, LK. Integrating person-centered and variable-centered analyses: growth mixture modeling with latent trajectory classes. Alcohol Clin Exp Res 2000; 24: 882–91.CrossRefGoogle ScholarPubMed
31 Pallesen, S, Bjorvatn, B, Nordhus, IH, Sivertsen, B, Hjornevik, M, Morin, CM. A new scale for measuring insomnia: the Bergen Insomnia Scale. Percept Mot Skills 2008; 107: 691–706.CrossRefGoogle ScholarPubMed
32 Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59 (Suppl 20): 22–33.Google Scholar
33 Morin, CM. Insomnia: Psychological Assessment and Management. Guilford Press, 1993.Google Scholar
34 Thorndike, FP, Saylor, DK, Bailey, ET, Gonder-Frederick, L, Morin, CM, Ritterband, LM. Development and perceived utility and impact of an internet intervention for insomnia. E J Appl Psychol Clin Soc Issues 2008; 4: 32–42.Google Scholar
35 Gosling, JA, Glozier, N, Griffiths, K, Ritterband, L, Thorndike, F, Mackinnon, A, et al. The GoodNight study – online CBT for insomnia for the indicated prevention of depression: study protocol for a randomised controlled trial. Trials 2014; 15: 56.Google Scholar
36 Griffiths, KM, Crisp, D, Christensen, H, Mackinnon, AJ, Bennett, K. The ANU WellBeing study: a protocol for a quasi-factorial randomised controlled trial of the effectiveness of an internet support group and an automated internet intervention for depression. BMC Psychiatry 2010; 10: 20.CrossRefGoogle Scholar
37 Carney, CE, Buysse, DJ, Ancoli-Israel, S, Edinger, JD, Krystal, AD, Lichstein, KL, et al. The consensus sleep diary: standardizing prospective sleep self-monitoring. Sleep 2012; 35: 287–302.Google Scholar
38 Glozier, N, Christensen, H, Naismith, S, Cockayne, N, Donkin, L, Neal, B, et al. internet-delivered cognitive behavioural therapy for adults with mild to moderate depression and high cardiovascular disease risks: a randomised attention-controlled trial. PLoS One 2013; 8: e59139.Google Scholar
39 Bastien, CH, Vallières, A, Morin, CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2001; 2: 297–307.CrossRefGoogle ScholarPubMed
40 Lindelow, M, Hardy, R, Rodgers, B. Development of a scale to measure symptoms of anxiety and depression in the general UK population: the psychiatric symptom frequency scale. J Epidemiol Community Health 1997; 51: 549–57.Google Scholar
41 Spitzer, RL, Kroenke, K, Williams, JW, Löwe, B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006; 166: 1092–7.Google Scholar
42 Verbeke, G, Molenberghs, G. Linear Mixed Models for Longitudinal Data. Springer, 2000.Google Scholar
43 Nylund, KL, Asparouhov, T, Muthen, BO. Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Struct Equat Model 2007; 14: 535–69.Google Scholar
44 Richards, D, Richardson, T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev 2012; 32: 329–42.Google Scholar
45 Newby, JM, McKinnon, A, Kuyken, W, Gilbody, S, Dalgleish, T. Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clin Psychol Rev 2015; 40: 91–110.Google Scholar
46 Spek, V, Cuijpers, P, Nyklicek, I, Riper, H, Keyzer, J, Pop, V. internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med 2007; 37: 319–28.Google Scholar
47 Calear, AL, Christensen, H. Review of internet-based prevention and treatment programs for anxiety and depression in children and adolescents. Med J Aust 2010; 192: S12–4.Google Scholar
48 Christensen, H, Batterham, PJ, O’Dea, B. E-health interventions for suicide prevention. Int J Environ Res Public Health 2014; 11: 8193–212.Google Scholar
49 Weitz, E, Hollon, SD, Kerkhof, A, Cuijpers, P. Do depression treatments reduce suicidal ideation? The effects of CBT, IPT, pharmacotherapy, and placebo on suicidality. J Affect Disord 2014; 167: 98–103.Google Scholar
50 Bernert, RA, Joiner, TE. Sleep disturbances and suicide risk: a review of the literature. Neuropsychiatr Dis Treat. 2007; 3: 735–43.Google Scholar
51 Bower, P, Kontopantelis, E, Sutton, A, Kendrick, T, Richards, DA, Gilbody, S, et al. Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data. BMJ 2013; 346: f540.Google Scholar
Supplementary material: PDF

Batterham et al. supplementary material

Supplementary Material

Download Batterham et al. supplementary material(PDF)
PDF 1.9 MB
Submit a response

eLetters

No eLetters have been published for this article.