Introduction: The global disease burden of major depressive disorder urgently requires prevention in high-risk individuals, such as recently discovered insomnia subtypes. Previous studies targeting insomnia with fully automated eHealth interventions to prevent depression are inconclusive: dropout was high and likely biased, and depressive symptoms in untreated participants on average improved rather than worsened. Objective: This randomized controlled trial aimed to efficiently prevent the worsening of depressive symptoms by selecting insomnia subtypes at high risk of depression for internet-based circadian rhythm support (CRS), cognitive behavioral therapy for insomnia (CBT-I), or their combination (CBT-I+CRS), with online therapist guidance to promote adherence. Methods: Participants with an insomnia disorder subtype conveying an increased risk of depression (n = 132) were randomized to no treatment (NT), CRS, CBT-I, or CBT-I+CRS. The Inventory of Depressive Symptomatology – Self Report (IDS-SR) was self-administered at baseline and at four follow-ups spanning 1 year. Results: Without treatment, depressive symptoms indeed worsened (d = 0.28, p = 0.041) in high-risk insomnia, but not in a reference group with low-risk insomnia. Therapist-guided CBT-I and CBT-I+CRS reduced IDS-SR ratings across all follow-up assessments (respectively, d = –0.80, p = 0.001; d = –0.95, p #x3c; 0.001). Only CBT-I+CRS reduced the 1-year incidence of clinically meaningful worsening (p = 0.002). Dropout during therapist-guided interventions was very low (8%) compared to previous automated interventions (57–62%). Conclusions: The findings tentatively suggest that the efficiency of population-wide preventive strategies could benefit from the possibility to select insomnia subtypes at high risk of developing depression for therapist-guided digital CBT-I+CRS. This treatment may provide effective long-term prevention of worsening of depressive symptoms. Trial registration: the Netherlands Trial Register (NL7359).
Psychother Psychosom

中文翻译：

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使用治疗师指导的数字认知、行为和昼夜节律支持干预措施治疗抑郁症高风险失眠症，以防止抑郁症状恶化：一项随机对照试验

简介：重度抑郁症的全球疾病负担迫切需要对高危人群进行预防，例如最近发现的失眠亚型。以前针对失眠症采用全自动电子健康干预措施预防抑郁症的研究尚无定论：辍学率很高且可能存在偏见，未经治疗的参与者的抑郁症状平均得到改善而不是恶化。目的：这项随机对照试验旨在通过选择抑郁症高风险的失眠亚型进行基于互联网的昼夜节律支持（CRS）、失眠症认知行为疗法（CBT-I）或它们的组合，从而有效地预防抑郁症状的恶化。 CBT-I+CRS），提供在线治疗师指导以促进依从性。方法：患有失眠症亚型且抑郁症风险增加的参与者 ( n = 132) 被随机分配至不治疗 (NT)、CRS、CBT-I 或 CBT-I+CRS。抑郁症状清单 - 自我报告 (IDS-SR) 在基线和 1 年的四次随访中自我管理。结果：未经治疗，高危失眠症患者的抑郁症状确实恶化（d = 0.28，p = 0.041），但在低风险失眠症的参考组中没有。治疗师指导的 CBT-I 和 CBT-I+CRS 降低了所有后续评估中的 IDS-SR 评分（分别为d = –0.80，p = 0.001；d = –0.95，p#x3c; 0.001)。只有 CBT-I+CRS 降低了 1 年有临床意义的恶化的发生率（p = 0.002）。与之前的自动干预（57-62%）相比，治疗师指导干预期间的辍学率非常低（8%）。结论：研究结果初步表明，在治疗师指导的数字 CBT-I+CRS 中，选择具有发生抑郁症高风险的失眠亚型的可能性可能会受益于全人群预防策略的效率。这种治疗可以有效地长期预防抑郁症状的恶化。试用注册：荷兰试用注册（NL7359）。
心理治疗师