Efficacy of digital CBT for insomnia to reduce depression across demographic groups: a randomized trial.
Efficacy of digital CBT for insomnia to reduce depression across demographic groups: a randomized trial.
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DOI：
10.1017/s0033291718001113
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发表时间：
2019-03
影响因子：
6.9
通讯作者：
Drake CL
中科院分区：
文献类型：
--
作者：
Cheng P;Luik AI;Fellman-Couture C;Peterson E;Joseph CLM;Tallent G;Tran KM;Ahmedani BK;Roehrs T;Roth T;Drake CL
抑郁症和抑郁症是高度共病的，并且相互加剧临床轨迹和结果。失眠的认知行为疗法（CBT-I）有效地降低了失眠和抑郁的严重程度，并且可以数字化提供。这可能会大大增加CBT-I的可及性，从而减少与失眠相关的健康差异;然而，数字CBT-I（dCBT-I）在一系列人口群体中的疗效尚未得到充分研究。这项随机安慰剂对照试验检查了dCBT-I在减少广泛的人口统计学群体中的失眠和抑郁症方面的疗效。在随机分配的1358名失眠症患者中，358名最终样本保留在dCBT-I条件下，300名保留在在线睡眠教育条件下。失眠和抑郁的严重程度作为因变量进行检查。种族、社会经济地位（SES;家庭收入和教育）、性别和年龄也作为治疗效果的独立调节因素进行了测试。与睡眠教育相比，dCBT-I条件下失眠和抑郁严重程度的降低更大，治疗后缓解率显着更高。人口统计学变量（即收入、种族、性别、年龄、教育）不是治疗效果的显著调节因素，表明dCBT-I在广泛的人口统计学群体中具有显著疗效。此外，虽然基于社会经济地位发现了损耗的差异，但损耗在白色和黑人参与者之间没有差异。结果提供的证据表明，dCBT-I的广泛传播可以有效地针对广泛人群中的失眠和共病抑郁症。
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 sub-stantially 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. 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. 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. 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.