使用智能手机传递的自助认知行为疗法治疗失眠症相关的抑郁症：一项平行组随机对照试验。

Treating depression with a smartphone-delivered self-help cognitive behavioral therapy for insomnia: a parallel-group randomized controlled trial.

机构信息

The University of Hong Kong, Hong Kong.

Chinese University of Hong Kong, Hong Kong.

出版信息

Psychol Med. 2023 Apr;53(5):1799-1813. doi: 10.1017/S0033291721003421. Epub 2021 Aug 23.

DOI:10.1017/S0033291721003421

PMID:37310329

Abstract

BACKGROUND

Despite its efficacy in treating comorbid insomnia and depression, cognitive behavioral therapy for insomnia (CBT-I) is limited in its accessibility and, in many countries, cultural compatibility. Smartphone-based treatment is a low-cost, convenient alternative modality. This study evaluated a self-help smartphone-based CBT-I in alleviating major depression and insomnia.

METHODS

A parallel-group randomized, waitlist-controlled trial was conducted with 320 adults with major depression and insomnia. Participants were randomized to receive either a 6-week CBT-I via a smartphone application, , or waitlist condition. The primary outcomes included depression severity, insomnia severity, and sleep quality. The secondary outcomes included anxiety severity, subjective health, and acceptability of treatment. Assessments were administered at baseline, post-intervention (week 6) follow-up, and week 12 follow-up. The waitlist group received treatment after the week 6 follow-up.

RESULTS

Intention to treat analysis was conducted with multilevel modeling. In all but one model, the interaction between treatment condition and time at week 6 follow-up was significant. Compared with the waitlist group, the treatment group had lower levels of depression [Center for Epidemiologic Studies Depression Scale (CES-D): Cohen's = 0.86, 95% CI (-10.11 to -5.37)], insomnia [Insomnia Severity Index (ISI): Cohen's = 1.00, 95% CI (-5.93 to -3.53)], and anxiety [Hospital Anxiety and Depression Scale - Anxiety subscale (HADS-A): Cohen's = 0.83, 95% CI (-3.75 to -1.96)]. They also had better sleep quality [Pittsburgh Sleep Quality Index (PSQI): Cohen's = 0.91, 95% CI (-3.34 to -1.83)]. No differences across any measures were found at week 12, after the waitlist control group received the treatment.

CONCLUSION

is an efficacious sleep-focused self-help treatment for major depression and insomnia.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04228146. Retrospectively registered on 14 January 2020. http://www.w3.org/1999/xlink">https://clinicaltrials.gov/ct2/show/NCT04228146.

摘要

背景

尽管认知行为疗法治疗失眠合并抑郁的疗效确切，但它在许多国家的可及性和文化适应性方面仍然存在局限性。基于智能手机的治疗是一种低成本、方便的替代模式。本研究评估了一种基于智能手机的自助认知行为疗法治疗失眠合并抑郁的疗效。

方法

采用平行组随机、等待对照试验，纳入 320 名失眠合并抑郁的成年人。参与者被随机分为智能手机应用的 6 周认知行为疗法组或等待对照组。主要结局包括抑郁严重程度、失眠严重程度和睡眠质量。次要结局包括焦虑严重程度、主观健康和治疗的可接受性。评估在基线、干预后（第 6 周）随访和第 12 周随访时进行。等待对照组在第 6 周随访后接受治疗。

结果

意向治疗分析采用多层次建模。除了一个模型外，治疗组与第 6 周随访时的时间之间的交互作用在所有模型中均有统计学意义。与等待对照组相比，治疗组的抑郁程度[流行病学研究中心抑郁量表（CES-D）：Cohen's = 0.86，95%置信区间（-10.11 至 -5.37）]、失眠[失眠严重程度指数（ISI）：Cohen's = 1.00，95%置信区间（-5.93 至 -3.53）]和焦虑[医院焦虑和抑郁量表-焦虑分量表（HADS-A）：Cohen's = 0.83，95%置信区间（-3.75 至 -1.96）]均较低。他们的睡眠质量也更好[匹兹堡睡眠质量指数（PSQI）：Cohen's = 0.91，95%置信区间（-3.34 至 -1.83）]。在等待对照组接受治疗后的第 12 周，所有测量指标均无差异。