Effect of Sleep Disturbance Symptoms on Treatment Outcome in Blended Cognitive Behavioral Therapy for Depression (E-COMPARED Study): Secondary Analysis
BackgroundSleep disturbance symptoms are common in major depressive disorder (MDD) and have been found to hamper the treatment effect of conventional face-to-face psychological treatments such as cognitive behavioral therapy. To increase the dissemination of evidence-based tr...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
JMIR Publications
2022-03-01
|
| Series: | Journal of Medical Internet Research |
| Online Access: | https://www.jmir.org/2022/3/e30231 |
| _version_ | 1797735174604062720 |
|---|---|
| author | Esben Skov Jensen Nicolai Ladegaard Angelina Isabella Mellentin David Daniel Ebert Ingrid Titzler Ricardo Araya Arlinda Cerga Pashoja Jean-Baptiste Hazo Jérôme Holtzmann Roman Cieslak Ewelina Smoktunowicz Rosa Baños Rocio Herrero Azucena García-Palacios Cristina Botella Thomas Berger Tobias Krieger Trine Theresa Holmberg Naira Topooco Gerhard Andersson Annemieke van Straten Lise Kemmeren Annet Kleiboer Heleen Riper Kim Mathiasen |
| author_facet | Esben Skov Jensen Nicolai Ladegaard Angelina Isabella Mellentin David Daniel Ebert Ingrid Titzler Ricardo Araya Arlinda Cerga Pashoja Jean-Baptiste Hazo Jérôme Holtzmann Roman Cieslak Ewelina Smoktunowicz Rosa Baños Rocio Herrero Azucena García-Palacios Cristina Botella Thomas Berger Tobias Krieger Trine Theresa Holmberg Naira Topooco Gerhard Andersson Annemieke van Straten Lise Kemmeren Annet Kleiboer Heleen Riper Kim Mathiasen |
| author_sort | Esben Skov Jensen |
| collection | DOAJ |
| description |
BackgroundSleep disturbance symptoms are common in major depressive disorder (MDD) and have been found to hamper the treatment effect of conventional face-to-face psychological treatments such as cognitive behavioral therapy. To increase the dissemination of evidence-based treatment, blended cognitive behavioral therapy (bCBT) consisting of web-based and face-to-face treatment is on the rise for patients with MDD. To date, no study has examined whether sleep disturbance symptoms have an impact on bCBT treatment outcomes and whether it affects bCBT and treatment-as-usual (TAU) equally.
ObjectiveThe objectives of this study are to investigate whether baseline sleep disturbance symptoms have an impact on treatment outcomes independent of treatment modality and whether sleep disturbance symptoms impact bCBT and TAU in routine care equally.
MethodsThe study was based on data from the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment Versus Treatment-as-Usual) study, a 2-arm, multisite, parallel randomized controlled, noninferiority trial. A total of 943 outpatients with MDD were randomized to either bCBT (476/943, 50.5%) or TAU consisting of routine clinical MDD treatment (467/943, 49.5%). The primary outcome of this study was the change in depression symptom severity at the 12-month follow-up. The secondary outcomes were the change in depression symptom severity at the 3- and 6-month follow-up and MDD diagnoses at the 12-month follow-up, assessed using the Patient Health Questionnaire-9 and Mini-International Neuropsychiatric Interview, respectively. Mixed effects models were used to examine the association of sleep disturbance symptoms with treatment outcome and treatment modality over time.
ResultsOf the 943 patients recruited for the study, 558 (59.2%) completed the 12-month follow-up assessment. In the total sample, baseline sleep disturbance symptoms did not significantly affect change in depressive symptom severity at the 12-month follow-up (β=.16, 95% CI –0.04 to 0.36). However, baseline sleep disturbance symptoms were negatively associated with treatment outcome for bCBT (β=.49, 95% CI 0.22-0.76) but not for TAU (β=–.23, 95% CI −0.50 to 0.05) at the 12-month follow-up, even when adjusting for baseline depression symptom severity. The same result was seen for the effect of sleep disturbance symptoms on the presence of depression measured with Mini-International Neuropsychiatric Interview at the 12-month follow-up. However, for both treatment formats, baseline sleep disturbance symptoms were not associated with depression symptom severity at either the 3- (β=.06, 95% CI −0.11 to 0.23) or 6-month (β=.09, 95% CI −0.10 to 0.28) follow-up.
ConclusionsBaseline sleep disturbance symptoms may have a negative impact on long-term treatment outcomes in bCBT for MDD. This effect was not observed for TAU. These findings suggest that special attention to sleep disturbance symptoms might be warranted when MDD is treated with bCBT. Future studies should investigate the effect of implementing modules specifically targeting sleep disturbance symptoms in bCBT for MDD to improve long-term prognosis. |
| first_indexed | 2024-03-12T12:55:18Z |
| format | Article |
| id | doaj.art-106c62da79be42df90d7e419ada7c377 |
| institution | Directory Open Access Journal |
| issn | 1438-8871 |
| language | English |
| last_indexed | 2024-03-12T12:55:18Z |
| publishDate | 2022-03-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | Journal of Medical Internet Research |
| spelling | doaj.art-106c62da79be42df90d7e419ada7c3772023-08-28T21:07:22ZengJMIR PublicationsJournal of Medical Internet Research1438-88712022-03-01243e3023110.2196/30231Effect of Sleep Disturbance Symptoms on Treatment Outcome in Blended Cognitive Behavioral Therapy for Depression (E-COMPARED Study): Secondary AnalysisEsben Skov Jensenhttps://orcid.org/0000-0002-9689-3776Nicolai Ladegaardhttps://orcid.org/0000-0002-7404-0203Angelina Isabella Mellentinhttps://orcid.org/0000-0002-6515-2852David Daniel Eberthttps://orcid.org/0000-0001-6820-0146Ingrid Titzlerhttps://orcid.org/0000-0002-8963-2324Ricardo Arayahttps://orcid.org/0000-0002-0420-5148Arlinda Cerga Pashojahttps://orcid.org/0000-0002-7029-947XJean-Baptiste Hazohttps://orcid.org/0000-0002-1834-4413Jérôme Holtzmannhttps://orcid.org/0000-0002-1387-0051Roman Cieslakhttps://orcid.org/0000-0002-2413-5343Ewelina Smoktunowiczhttps://orcid.org/0000-0002-1748-3876Rosa Bañoshttps://orcid.org/0000-0003-0626-7665Rocio Herrerohttps://orcid.org/0000-0001-6987-6607Azucena García-Palacioshttps://orcid.org/0000-0001-9250-8714Cristina Botellahttps://orcid.org/0000-0001-8783-6959Thomas Bergerhttps://orcid.org/0000-0002-2432-7791Tobias Kriegerhttps://orcid.org/0000-0001-5137-0755Trine Theresa Holmberghttps://orcid.org/0000-0001-8379-0906Naira Topoocohttps://orcid.org/0000-0001-5972-3041Gerhard Anderssonhttps://orcid.org/0000-0003-4753-6745Annemieke van Stratenhttps://orcid.org/0000-0001-6875-2215Lise Kemmerenhttps://orcid.org/0000-0002-5386-3112Annet Kleiboerhttps://orcid.org/0000-0001-8040-5697Heleen Riperhttps://orcid.org/0000-0002-8144-8901Kim Mathiasenhttps://orcid.org/0000-0001-6067-8866 BackgroundSleep disturbance symptoms are common in major depressive disorder (MDD) and have been found to hamper the treatment effect of conventional face-to-face psychological treatments such as cognitive behavioral therapy. To increase the dissemination of evidence-based treatment, blended cognitive behavioral therapy (bCBT) consisting of web-based and face-to-face treatment is on the rise for patients with MDD. To date, no study has examined whether sleep disturbance symptoms have an impact on bCBT treatment outcomes and whether it affects bCBT and treatment-as-usual (TAU) equally. ObjectiveThe objectives of this study are to investigate whether baseline sleep disturbance symptoms have an impact on treatment outcomes independent of treatment modality and whether sleep disturbance symptoms impact bCBT and TAU in routine care equally. MethodsThe study was based on data from the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment Versus Treatment-as-Usual) study, a 2-arm, multisite, parallel randomized controlled, noninferiority trial. A total of 943 outpatients with MDD were randomized to either bCBT (476/943, 50.5%) or TAU consisting of routine clinical MDD treatment (467/943, 49.5%). The primary outcome of this study was the change in depression symptom severity at the 12-month follow-up. The secondary outcomes were the change in depression symptom severity at the 3- and 6-month follow-up and MDD diagnoses at the 12-month follow-up, assessed using the Patient Health Questionnaire-9 and Mini-International Neuropsychiatric Interview, respectively. Mixed effects models were used to examine the association of sleep disturbance symptoms with treatment outcome and treatment modality over time. ResultsOf the 943 patients recruited for the study, 558 (59.2%) completed the 12-month follow-up assessment. In the total sample, baseline sleep disturbance symptoms did not significantly affect change in depressive symptom severity at the 12-month follow-up (β=.16, 95% CI –0.04 to 0.36). However, baseline sleep disturbance symptoms were negatively associated with treatment outcome for bCBT (β=.49, 95% CI 0.22-0.76) but not for TAU (β=–.23, 95% CI −0.50 to 0.05) at the 12-month follow-up, even when adjusting for baseline depression symptom severity. The same result was seen for the effect of sleep disturbance symptoms on the presence of depression measured with Mini-International Neuropsychiatric Interview at the 12-month follow-up. However, for both treatment formats, baseline sleep disturbance symptoms were not associated with depression symptom severity at either the 3- (β=.06, 95% CI −0.11 to 0.23) or 6-month (β=.09, 95% CI −0.10 to 0.28) follow-up. ConclusionsBaseline sleep disturbance symptoms may have a negative impact on long-term treatment outcomes in bCBT for MDD. This effect was not observed for TAU. These findings suggest that special attention to sleep disturbance symptoms might be warranted when MDD is treated with bCBT. Future studies should investigate the effect of implementing modules specifically targeting sleep disturbance symptoms in bCBT for MDD to improve long-term prognosis.https://www.jmir.org/2022/3/e30231 |
| spellingShingle | Esben Skov Jensen Nicolai Ladegaard Angelina Isabella Mellentin David Daniel Ebert Ingrid Titzler Ricardo Araya Arlinda Cerga Pashoja Jean-Baptiste Hazo Jérôme Holtzmann Roman Cieslak Ewelina Smoktunowicz Rosa Baños Rocio Herrero Azucena García-Palacios Cristina Botella Thomas Berger Tobias Krieger Trine Theresa Holmberg Naira Topooco Gerhard Andersson Annemieke van Straten Lise Kemmeren Annet Kleiboer Heleen Riper Kim Mathiasen Effect of Sleep Disturbance Symptoms on Treatment Outcome in Blended Cognitive Behavioral Therapy for Depression (E-COMPARED Study): Secondary Analysis Journal of Medical Internet Research |
| title | Effect of Sleep Disturbance Symptoms on Treatment Outcome in Blended Cognitive Behavioral Therapy for Depression (E-COMPARED Study): Secondary Analysis |
| title_full | Effect of Sleep Disturbance Symptoms on Treatment Outcome in Blended Cognitive Behavioral Therapy for Depression (E-COMPARED Study): Secondary Analysis |
| title_fullStr | Effect of Sleep Disturbance Symptoms on Treatment Outcome in Blended Cognitive Behavioral Therapy for Depression (E-COMPARED Study): Secondary Analysis |
| title_full_unstemmed | Effect of Sleep Disturbance Symptoms on Treatment Outcome in Blended Cognitive Behavioral Therapy for Depression (E-COMPARED Study): Secondary Analysis |
| title_short | Effect of Sleep Disturbance Symptoms on Treatment Outcome in Blended Cognitive Behavioral Therapy for Depression (E-COMPARED Study): Secondary Analysis |
| title_sort | effect of sleep disturbance symptoms on treatment outcome in blended cognitive behavioral therapy for depression e compared study secondary analysis |
| url | https://www.jmir.org/2022/3/e30231 |
| work_keys_str_mv | AT esbenskovjensen effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT nicolailadegaard effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT angelinaisabellamellentin effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT daviddanielebert effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT ingridtitzler effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT ricardoaraya effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT arlindacergapashoja effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT jeanbaptistehazo effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT jeromeholtzmann effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT romancieslak effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT ewelinasmoktunowicz effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT rosabanos effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT rocioherrero effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT azucenagarciapalacios effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT cristinabotella effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT thomasberger effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT tobiaskrieger effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT trinetheresaholmberg effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT nairatopooco effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT gerhardandersson effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT annemiekevanstraten effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT lisekemmeren effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT annetkleiboer effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT heleenriper effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis AT kimmathiasen effectofsleepdisturbancesymptomsontreatmentoutcomeinblendedcognitivebehavioraltherapyfordepressionecomparedstudysecondaryanalysis |