使用治疗师指导的数字认知、行为和昼夜节律支持干预措施治疗伴有高抑郁风险的失眠症以预防抑郁症状恶化：一项随机对照试验

Treating Insomnia with High Risk of Depression Using Therapist-Guided Digital Cognitive, Behavioral, and Circadian Rhythm Support Interventions to Prevent Worsening of Depressive Symptoms: A Randomized Controlled Trial.

作者信息

Leerssen Jeanne, Lakbila-Kamal Oti, Dekkers Laura M S, Ikelaar Savannah L C, Albers Anne C W, Blanken Tessa F, Lancee Jaap, van der Lande Glenn J M, Maksimovic Teodora, Mastenbroek Sophie E, Reesen Joyce E, van de Ven Sjors, van der Zweerde Tanja, Foster-Dingley Jessica C, Van Someren Eus J W

机构信息

Department of Sleep and Cognition, Netherlands Institute for Neuroscience (NIN), Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.

Department of Integrative Neurophysiology, Center for Neurogenomics and Cognitive Research (CNCR), Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands.

出版信息

Psychother Psychosom. 2022;91(3):168-179. doi: 10.1159/000520282. Epub 2021 Dec 6.

DOI:10.1159/000520282

PMID:34872087

Abstract

INTRODUCTION

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.

OBJECTIVE

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.

METHODS

Participants with an insomnia disorder subtype conveying an increased risk of depression (n = 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.

RESULTS

Without treatment, depressive symptoms indeed worsened (d = 0.28, p = 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, d = -0.80, p = 0.001; d = -0.95, p < 0.001). Only CBT-I+CRS reduced the 1-year incidence of clinically meaningful worsening (p = 0.002). Dropout during therapist-guided interventions was very low (8%) compared to previous automated interventions (57-62%).

CONCLUSIONS

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.

TRIAL REGISTRATION

the Netherlands Trial Register (NL7359).

摘要

引言

重性抑郁障碍的全球疾病负担迫切需要在高危个体中进行预防，比如最近发现的失眠亚型。以往针对失眠采用全自动电子健康干预措施预防抑郁的研究尚无定论：脱落率很高且可能存在偏差，未接受治疗的参与者的抑郁症状平均有所改善而非恶化。

目的

这项随机对照试验旨在通过选择具有高抑郁风险的失眠亚型，为其提供基于互联网的昼夜节律支持（CRS）、失眠认知行为疗法（CBT-I）或两者结合（CBT-I+CRS），并在在线治疗师的指导下促进依从性，从而有效预防抑郁症状的恶化。

方法

将患有抑郁风险增加的失眠障碍亚型的参与者（n = 132）随机分为不治疗组（NT）、CRS组、CBT-I组或CBT-I+CRS组。在基线时以及为期1年的4次随访中，参与者自行填写抑郁症状量表-自评版（IDS-SR）。

结果

在未接受治疗的情况下，高危失眠患者的抑郁症状确实有所恶化（d = 0.28，p = 0.041），但低危失眠参考组则不然。在所有随访评估中，治疗师指导的CBT-I和CBT-I+CRS均降低了IDS-SR评分（分别为d = -0.80，p = 0.001；d = -0.95，p < 0.001）。只有CBT-I+CRS降低了具有临床意义的恶化的1年发生率（p = 0.002）。与之前的自动干预措施（57%-62%）相比，在治疗师指导的干预过程中，脱落率非常低（8%）。