Prevention of Incident and Recurrent Major Depression in Older Adults With Insomnia: A Randomized Clinical Trial.
Prevention of Incident and Recurrent Major Depression in Older Adults With Insomnia: A Randomized Clinical Trial.
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DOI：
10.1001/jamapsychiatry.2021.3422
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发表时间：
2022-01-01
期刊：
影响因子：
25.8
通讯作者：
Olmstead R
中科院分区：
文献类型：
--
作者：
Irwin MR;Carrillo C;Sadeghi N;Bjurstrom MF;Breen EC;Olmstead R
治疗失眠是否能预防60岁或60岁以上无抑郁症但有失眠症的社区居住成年人的抑郁症？在这项随机临床试验中，291名60岁或以上的失眠症患者接受了2个月的失眠症认知行为治疗（CBT-I），与活性对照药物睡眠教育治疗相比，在36个月的随访期间，抑郁症的发生和复发的可能性降低。接受CBT-I的成年人持续失眠缓解导致抑郁症的可能性降低，而接受睡眠教育治疗的成年人则没有失眠缓解。治疗失眠可能有助于预防老年人的抑郁症。患有失眠症的老年人患抑郁症的风险很高。抑郁症的预防是迫切需要的，而这些努力一直被忽视的老年人。研究失眠症的认知行为疗法（CBT-I）治疗与积极的比较条件，睡眠教育疗法（SET）相比，是否可以预防老年人的重度抑郁症。这项评估者设盲、平行组、单中心随机临床试验评估了431人的社区样本，并招募了291名60岁或60岁以上的失眠症患者，他们在过去一年中没有严重抑郁症或重大健康事件。研究招募于2012年7月1日至2015年4月30日进行。对试验方案进行了修改，将随访时间从24个月延长至36个月，并于2018年7月完成随访。数据分析于2019年3月1日至2020年3月30日进行。参与者被随机分配到2个月的CBT-I（n = 156）或SET（n = 135）。主要结局是通过访谈和精神疾病诊断与统计手册（第五版）标准诊断的发生重度抑郁症的时间。次要结局是抑郁事件发生前或随访期间失眠障碍的持续缓解。在291名随机参与者中（平均[SD]年龄，70.1 [6.7]岁; 168 [57.7%]女性; 7例[2.4%]亚裔、32例[11.0%]黑人、3例[1.0%]太平洋岛民、241例[82.8%]白色、6例[2.1%]多种族和2例[0.7%]未知），156例随机分配至CBT-I，135例随机分配至SET。共有140名参与者（89.7%）完成了CBT-I，130名参与者（96.3%）完成了SET（χ2 = 4.9，P = 0.03），CBT-I组有114名参与者（73.1%）完成了24个月随访，SET组有117名参与者（86.7%）完成了24个月随访（χ2 = 8.4，P = 0.004）。方案修改后，92 CBT-I组和SET组分别有81名（59.0%）和77名（57.0%）患者同意延长随访时间（χ2 = 0.7，P = 0.41），完成了36个月的随访（χ2 = 0.8，P = 0.39）。CBT-I组中有19名参与者（12.2%）和SET组中有35名参与者（25.9%）发生了事件或复发性重性抑郁症，总体获益（风险比，0.51; 95%，CI 0.29-0.88; P = 0.02）在各亚组中一致。与SET参与者（26 [19.3%]，P = 0.03）相比，CBT-I参与者（41 [26.3%]）在抑郁事件发生前或随访期间持续失眠障碍的缓解更有可能。与没有持续缓解失眠障碍的SET组相比，CBT-I组持续缓解失眠障碍的患者抑郁的可能性降低了82.6%（风险比，0.17; 95%，CI 0.04-0.73; P = 0.02）。这项随机临床试验的结果表明，用CBT-I治疗失眠在预防患有失眠症的老年人的事件和复发性重度抑郁症方面具有总体益处。社区一级对老年人失眠问题的筛查和广泛提供基于CBT-I的失眠治疗可以大大促进公共卫生工作，以治疗失眠和预防这一脆弱的老年人群体的抑郁症。ClinicalTrials.gov 标识符：NCT 01641263这项针对没有抑郁症但患有失眠症的成年人的随机临床试验评估了失眠治疗是否可以预防抑郁症。
Does treatment of insomnia prevent depression in community-dwelling adults 60 years or older without depression but with insomnia? In this randomized clinical trial of 291 adults 60 years or older with insomnia disorder, 2 months of cognitive behavioral therapy for insomnia (CBT-I) resulted in a decreased likelihood of incident and recurrent depression during 36 months of follow-up compared with an active comparator control, sleep education therapy. Sustained insomnia remission in adults undergoing CBT-I resulted in a decreased likelihood of depression vs no insomnia remission in adults receiving sleep education therapy. Treatment of insomnia may be beneficial in the prevention of depression in older adults. Older adults with insomnia have a high risk of incident and recurrent depression. Depression prevention is urgently needed, and such efforts have been neglected for older adults. To examine whether treatment of insomnia disorder with cognitive behavioral therapy for insomnia (CBT-I) compared with an active comparator condition, sleep education therapy (SET), prevents major depressive disorder in older adults. This assessor-blinded, parallel-group, single-site randomized clinical trial assessed a community-based sample of 431 people and enrolled 291 adults 60 years or older with insomnia disorder who had no major depression or major health events in past year. Study recruitment was performed from July 1, 2012, to April 30, 2015. The trial protocol was modified to extend follow-up from 24 to 36 months, with follow-up completion in July 2018. Data analysis was performed from March 1, 2019, to March 30, 2020. Participants were randomized to 2 months of CBT-I (n = 156) or SET (n = 135). The primary outcome was time to incident major depressive disorder as diagnosed by interview and Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria. Secondary outcome was sustained remission of insomnia disorder before depression event or duration of follow-up. Among 291 randomized participants (mean [SD] age, 70.1 [6.7] years; 168 [57.7%] female; 7 [2.4%] Asian, 32 [11.0%] Black, 3 [1.0%] Pacific Islander, 241 [82.8%] White, 6 [2.1%] multiracial, and 2 [0.7%] unknown), 156 were randomized to CBT-I and 135 to SET. A total of 140 participants (89.7%) completed CBT-I and 130 (96.3%) participants completed SET (χ2 = 4.9, P = .03), with 114 (73.1%) completing 24 months of follow-up in the CBT-I group and 117 (86.7%) in the SET group (χ2 = 8.4, P = .004). After protocol modification, 92 (59.0%) of the CBT-I participants and 86 (63.7%) of the SET participants agreed to extended follow-up (χ2 = 0.7, P = .41), with 81 (51.9%) of the CBT-I participants and 77 (57.0%) of the SET group completing 36 months of follow-up (χ2 = 0.8; P = .39). Incident or recurrent major depression occurred in 19 participants (12.2%) in the CBT-I group and in 35 participants (25.9%) in the SET group, with an overall benefit (hazard ratio, 0.51; 95%, CI 0.29-0.88; P = .02) consistent across subgroups. Remission of insomnia disorder continuously sustained before depression event or during follow-up was more likely in CBT-I participants (41 [26.3%]) compared with the SET participants (26 [19.3%], P = .03). Those in the CBT-I group with sustained remission of insomnia disorder had an 82.6% decreased likelihood of depression (hazard ratio, 0.17; 95%, CI 0.04-0.73; P = .02) compared with those in the SET group without sustained remission of insomnia disorder. The findings of this randomized clinical trial indicate that treatment of insomnia with CBT-I has an overall benefit in the prevention of incident and recurrent major depression in older adults with insomnia disorder. Community-level screening for insomnia concerns in older adults and wide delivery of CBT-I–based treatment for insomnia could substantially advance public health efforts to treat insomnia and prevent depression in this vulnerable older adult population. ClinicalTrials.gov Identifier: NCT01641263 This randomized clinical trial of adults without depression but with insomnia assesses whether insomnia treatment can prevent depression.
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影响因子：
5.6
作者：
Irwin, Michael R.;Olmstead, Richard;Nicassio, Perry
通讯作者：
Nicassio, Perry
影响因子：
3.9
作者：
Ashworth, Damon K.;Sletten, Tracey L.;Rajaratnam, Shantha M. W.
通讯作者：
Rajaratnam, Shantha M. W.
影响因子：
5.6
作者：
Arnedt, J. Todd;Conroy, Deirdre A.;Eisenberg, Daniel
通讯作者：
Eisenberg, Daniel
DOI：
10.1176/appi.ajp.2008.07121882
发表时间：
2008-12
期刊：
The American journal of psychiatry
影响因子：
--
作者：
Cho HJ;Lavretsky H;Olmstead R;Levin MJ;Oxman MN;Irwin MR
通讯作者：
Irwin MR
影响因子：
10.5
作者：
Andreas, Sylke;Schulz, Holger;Haerter, Martin
通讯作者：
Haerter, Martin