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Efficacy of digital CBT for insomnia to reduce depression across demographic groups: a randomized trial

Published online by Cambridge University Press:  24 May 2018

Philip Cheng ,
Annemarie I. Luik ,
Cynthia Fellman-Couture ,
Edward Peterson ,
Christine L.M. Joseph ,
Gabriel Tallent ,
Kieulinh Michelle Tran ,
Brian K. Ahmedani ,
Timothy Roehrs  and
Thomas Roth
...Show all authors
Philip Cheng*
Affiliation:
Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
Annemarie I. Luik
Affiliation:
Department of Clinical Neurosciences, University of Oxford, Oxford, UK
Cynthia Fellman-Couture
Affiliation:
Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
Edward Peterson
Affiliation:
Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
Christine L.M. Joseph
Affiliation:
Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
Gabriel Tallent
Affiliation:
Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
Kieulinh Michelle Tran
Affiliation:
Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
Brian K. Ahmedani
Affiliation:
Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
Timothy Roehrs
Affiliation:
Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
Thomas Roth
Affiliation:
Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
Christopher L. Drake
Affiliation:
Sleep Disorders and Research Center, Henry Ford Health System, Detroit, MI, USA
*
Author for correspondence: Philip Cheng, E-mail: pcheng1@hfhs.org
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Abstract

Background

Insomnia and depression are highly comorbid and mutually exacerbate clinical trajectories and outcomes. Cognitive behavioral therapy for insomnia (CBT-I) effectively reduces both insomnia and depression severity, and can be delivered digitally. This could substantially increase the accessibility to CBT-I, which could reduce the health disparities related to insomnia; however, the efficacy of digital CBT-I (dCBT-I) across a range of demographic groups has not yet been adequately examined. This randomized placebo-controlled trial examined the efficacy of dCBT-I in reducing both insomnia and depression across a wide range of demographic groups.

Methods

Of 1358 individuals with insomnia randomized, a final sample of 358 were retained in the dCBT-I condition and 300 in the online sleep education condition. Severity of insomnia and depression was examined as a dependent variable. Race, socioeconomic status (SES; household income and education), gender, and age were also tested as independent moderators of treatment effects.

Results

The dCBT-I condition yielded greater reductions in both insomnia and depression severity than sleep education, with significantly higher rates of remission following treatment. Demographic variables (i.e. income, race, sex, age, education) were not significant moderators of the treatment effects, suggesting that dCBT-I is comparably efficacious across a wide range of demographic groups. Furthermore, while differences in attrition were found based on SES, attrition did not differ between white and black participants.

Conclusions

Results provide evidence that the wide dissemination of dCBT-I may effectively target both insomnia and comorbid depression across a wide spectrum of the population.

Keywords

CBT-IdepressioninsomniaInternetClinical Trial Registry: clinicaltrials.govClinical Trial Identifier: NCT02988375
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 3 , February 2019 , pp. 491 - 500
Copyright
Copyright © Cambridge University Press 2018 

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