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

Philip J. Batterham*, Helen Christensen, Andrew J. MacKinnon, John A. Gosling, Frances P. Thorndike, Lee M. Ritterband, Nick Glozier, Kathleen M. Griffiths

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    62 Citations (Scopus)

    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.

    Original languageEnglish
    Pages (from-to)228-235
    Number of pages8
    JournalBJPsych Open
    Volume3
    Issue number5
    DOIs
    Publication statusPublished - 1 Sept 2017

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