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May 2, 20260 citations

Effects of a phone-based, CBT-I-centered digital intervention on sleep and depressive symptoms in real-world clinical settings.

Key Points

This study investigates treatment response factors for a phone-based CBT-I digital intervention in patients with depressive disorders, focusing on sleep improvement and its effects on depression.
307 outpatients with depressive disorders received a phone-based CBT-I intervention via a mobile app alongside routine pharmacotherapy.
Participants were assessed using PSQI, PHQ-9, PHQ-15, and ESS, with treatment response defined as a ≥ 50% reduction in PHQ-9 score.
Analyses included univariate and multivariate logistic regression to evaluate associations with treatment response and residual symptoms.
Younger age (< 30 years) and longer disease duration (> 3 years) were linked to worse treatment outcomes at weeks 8 and 12 (P < 0.05).
At week 12, residual symptoms correlated significantly with younger age, longer disease duration, poorer sleep quality, greater somatic symptom burden, and increased daytime sleepiness.
Multivariate analyses identified younger age, longer disease duration, and family history of depression as independent risks for residual symptoms.

Abstract

OBJECTIVE: This study aimed to investigate Item s associated with treatment response to a phone-based, CBT-I-centered digital intervention in patients with depressive disorders, with a primary focus on sleep-related improvement and its association with changes in depressive symptoms. METHODS: A total of 307 outpatients with depressive disorders were enrolled from a sleep disorders clinic and received a phone-based, CBT-I-centered digital intervention delivered via a mobile application, in addition to routine pharmacotherapy. The intervention primarily targeted sleep disturbances and incorporated CBT techniques and psychoeducation. Participants completed demographic questionnaires and were assessed using the Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9(PHQ-9), Patient Health Questionnaire-15 (PHQ-15), and Epworth Sleepiness Scale (ESS).Treatment response was defined as a ≥ 50% reduction in total PHQ-9 score. Item s influencing treatment response at weeks 8 and 12, as well as Item s associated with residual symptoms at week 12, were analyzed. RESULTS: Univariate analyses showed that age and education level were significantly associated with treatment response at both weeks 8 and 12 (P 3 years) were independently associated with poorer treatment outcomes at both follow-up points.At week 12, residual symptoms were significantly associated with younger age, longer disease duration, poorer sleep quality (higher PSQI scores), greater somatic symptom burden (PHQ-15), and increased daytime sleepiness (ESS).Multivariate analyses identified younger age, longer disease duration, and family history of depression as independent risk Item s for residual symptoms. CONCLUSION: This real-world study suggests that a CBT-I-centered digital intervention primarily targeting sleep disturbances may be associated with concurrent improvements in depressive symptoms among patients with depression. Younger patients and those with longer illness duration appear to be at higher risk for poorer outcomes and persistent residual symptoms. CLINICAL TRIAL REGISTRATION NUMBER: ChiCTR2500103629.

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