Does insomnia treatment prevent depression?
Does insomnia treatment prevent depression?
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DOI：
10.1093/sleep/zsad104
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发表时间：
2023-04-08
期刊：
影响因子：
5.6
通讯作者：
Gehrman, Philip R.
中科院分区：
文献类型：
--
作者：
Boland, Elaine M.;Goldschmied, Jennifer R.;Gehrman, Philip R.
全球重度抑郁症（MDD）的发病率正在上升，部分原因是2019年冠状病毒病大流行，导致疾病负担加重。人们早就知道失眠与抑郁症有着错综复杂的联系，这表现在抑郁症的严重程度更高，治疗反应更低。此外，失眠是新发抑郁症的一个重要危险因素。因此，治疗失眠是预防事件和复发MDD的合理目标。本系统综述旨在评价失眠治疗对抑郁症发作的预防作用的现有证据。数据库检索得到186项研究，其中6项符合纳入本综述的标准。所有研究都将失眠的认知行为治疗（CBT-I）作为目标干预措施，并且大多数治疗都是通过数字平台进行的。其中四项研究发现，与对照组相比，接受CBT-I治疗的患者的MDD发病率显着降低。其余两项研究未能在初步分析中证实这些影响，但次要分析表明有预防作用的证据。在样本选择、结果和随访期方面，研究之间存在显著的方法学异质性，限制了得出确切结论的能力。总体而言，证据表明失眠治疗可以降低MDD发作的风险，但需要进一步的研究。
Rates of major depressive disorder (MDD) are increasing globally, in part due to the coronavirus disease 2019 pandemic, contributing to disease burden. It has long been known that insomnia is intricately connected with depression as indicated by greater depression severity and lower treatment response. Furthermore, insomnia is a significant risk factor for new-onset depression. Treatment of insomnia is thus a logical target for prevention of incidents and recurrent MDD. This systematic review sought to evaluate the current evidence for the preventive effects of insomnia treatment on depression onset. A database search yielded 186 studies, six of which met criteria for inclusion in this review. All of the studies utilized cognitive behavioral treatment for insomnia (CBT-I) as the target intervention and most delivered treatment via a digital platform. Four of the studies found significantly lower rates of MDD onset in those who received CBT-I compared to a control condition. The two remaining studies failed to confirm these effects in primary analyses but secondary analyses suggested evidence of a preventive effect. There was significant methodologic heterogeneity across studies in terms of sample selection, outcomes, and follow-up periods, limiting the ability to draw firm conclusions. The evidence overall is in the direction of insomnia treatment reducing the risk for onset of MDD, but further research is warranted.