Cognitive behavioral therapy for insomnia (CBT-I) has an overall benefit in the prevention of incident and recurrent major depression in older adults with insomnia disorder, according to a study published online Nov. 24 in JAMA Psychiatry.
Michael R. Irwin, M.D., from University of California in Los Angeles, and colleagues examined whether treatment of insomnia disorder with CBT-I versus sleep education therapy (SET; active control) prevents major depressive disorder in older adults. The analysis included 291 participants randomly assigned to two months of CBT-I (156 participants) or SET (135 participants) and 24 months of follow-up.
The researchers found that incident or recurrent major depression occurred in 19 participants (12.2 percent) in the CBT-I group and in 35 participants (25.9 percent) in the SET group, with an overall benefit (hazard ratio, 0.51) consistent across subgroups. In CBT-I participants, remission of insomnia disorder continuously sustained before a depression event or during follow-up was more likely versus the SET participants (26.3 versus 19.3 percent). There was an 82.6 percent decreased likelihood of depression among those in the CBT-I group with sustained remission of insomnia disorder (hazard ratio, 0.17) versus the SET group without sustained remission of insomnia disorder.
“Community-level screening for insomnia concerns in older adults and wide delivery of CBT-I-based treatment for insomnia could substantially advance public health efforts to treat insomnia and prevent depression in this vulnerable older adult population,” the authors write.