TY - JOUR
AU - Manber, R
AB - Abstract Introduction: We have previously reported that cognitive behavioural therapy for insomnia (CBT-I) was more efficacious than control therapy for insomnia among patients with comorbid depression, but did not lead to differential depression outcomes. This study explored the heterogeneity in the course of depression severity by identifying classes of change trajectories and examining their sleep correlates. Methods: 148 adults (age M ± SD = 46.6 ± 12.6, 73.0% female) with insomnia and major depressive disorders received antidepressant pharmacotherapy, and were randomized to 7-session CBT-I or control interventions over 16 weeks with 2-year follow-up. The Hamilton Rating Scale of Depression (HRSD) and Insomnia Severity Index (ISI) were administered at baseline, bi-weekly during, and every 4 months after treatment. Dysfunctional Beliefs and Attitudes about Sleep (DBAS) and Glasgow Sleep Effort Scale (GSES) were collected at baseline, mid-, and end-intervention. Results: Growth mixture models revealed three trajectories: (1) Partial-Responders (68.9%) had moderate symptom reduction during the first half of the intervention (p-value < .001), but continued to report mild depression severity throughout the remaining assessments. (2) Initial-Pronounced-Responders (17.6%) had significant symptom reduction during the intervention (p-values < .001), with low depression severity at post-treatment; their HRSD scores, however, increased over follow-up (p-value < .001) to levels comparable to the Partial-Responders. (3) Optimal-Pronounced-Responders (13.5%) achieved most gains during the first half of the intervention (p-value < .001), and continued to improve (p-value < .01) while maintaining low HRSD scores during follow-up. The classes did not differ significantly on baseline measures (demographics, ISI, DBAS, or GSES) or intervention received. They differed significantly on ISI, DBAS, and GSES after treatment began (p-values < .05); Optimal-Pronounced-Responders consistently scored the lowest on all three measures. Conclusion: In patients with comorbid insomnia and major depression, depressive symptom change trajectories during and after antidepressant treatment are heterogeneous, and linked to insomnia and sleep-related constructs after commencing treatment. Trajectories were not associated with intervention type. Early changes in insomnia symptoms may be useful for predicting longer-term outcomes in patients with depression. Support (If Any): MH078924, MH078961, MH079256 This content is only available as a PDF. © Sleep Research Society 2017. Published by Oxford University Press [on behalf of the Sleep Research Society]. All rights reserved. For permissions, please email: journals.permissions@oup.com © Sleep Research Society 2017. Published by Oxford University Press [on behalf of the Sleep Research Society]. All rights reserved. For permissions, please email: journals.permissions@oup.com
TI - 1093 TREATING DEPRESSION IN INSOMNIA: DISTINCTIVE PATTERNS OF DEPRESSIVE SYMPTOM CHANGE TRAJECTORIES AND THEIR CORRELATES, A REPORT FROM THE TRIAD STUDY
JF - SLEEP
DO - 10.1093/sleepj/zsx050.1092
DA - 2017-04-28
UR - https://www.deepdyve.com/lp/oxford-university-press/1093-treating-depression-in-insomnia-distinctive-patterns-of-Eyf13a27DY
SP - A407
EP - A408
VL - 40
IS - suppl_1
DP - DeepDyve
ER -