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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: philip.batterham@anu.edu.au
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Abstract

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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.

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