Effect of Sleep Disturbance Symptoms on Treatment Outcome in Blended Cognitive Behavioral Therapy for Depression (E-COMPARED Study): Secondary Analysis

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Effect of Sleep Disturbance Symptoms on Treatment Outcome in Blended Cognitive Behavioral Therapy for Depression (E-COMPARED Study) : Secondary Analysis. / Jensen, Esben Skov; Ladegaard, Nicolai; Mellentin, Angelina Isabella et al.

In: Journal of Medical Internet Research, Vol. 24, No. 3, e30231, 03.2022.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

Harvard

Jensen, ES, Ladegaard, N, Mellentin, AI, Ebert, DD, Titzler, I, Araya, R, Cerga Pashoja, A, Hazo, JB, Holtzmann, J, Cieslak, R, Smoktunowicz, E, Baños, R, Herrero, R, García-Palacios, A, Botella, C, Berger, T, Krieger, T, Holmberg, TT, Topooco, N, Andersson, G, van Straten, A, Kemmeren, L, Kleiboer, A, Riper, H & Mathiasen, K 2022, '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, vol. 24, no. 3, e30231. https://doi.org/10.2196/30231

APA

Jensen, E. S., Ladegaard, N., Mellentin, A. I., Ebert, D. D., Titzler, I., Araya, R., Cerga Pashoja, A., Hazo, J. B., Holtzmann, J., Cieslak, R., Smoktunowicz, E., Baños, R., Herrero, R., García-Palacios, A., Botella, C., Berger, T., Krieger, T., Holmberg, T. T., Topooco, N., ... Mathiasen, K. (2022). 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, 24(3), [e30231]. https://doi.org/10.2196/30231

CBE

Jensen ES, Ladegaard N, Mellentin AI, Ebert DD, Titzler I, Araya R, Cerga Pashoja A, Hazo JB, Holtzmann J, Cieslak R, et al. 2022. 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. 24(3):Article e30231. https://doi.org/10.2196/30231

MLA

Vancouver

Author

Jensen, Esben Skov ; Ladegaard, Nicolai ; Mellentin, Angelina Isabella et al. / Effect of Sleep Disturbance Symptoms on Treatment Outcome in Blended Cognitive Behavioral Therapy for Depression (E-COMPARED Study) : Secondary Analysis. In: Journal of Medical Internet Research. 2022 ; Vol. 24, No. 3.

Bibtex

@article{c1582025bb714012807d574898bea336,
title = "Effect of Sleep Disturbance Symptoms on Treatment Outcome in Blended Cognitive Behavioral Therapy for Depression (E-COMPARED Study): Secondary Analysis",
abstract = "BACKGROUND: Sleep 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. OBJECTIVE: The 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. METHODS: The 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. RESULTS: Of 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. CONCLUSIONS: Baseline 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.",
keywords = "bCBT, blended care, cognitive behavioral therapy, digital health, digital intervention, major depressive disorder, mental health, mobile phone, sleep disorder, sleep disturbance",
author = "Jensen, {Esben Skov} and Nicolai Ladegaard and Mellentin, {Angelina Isabella} and Ebert, {David Daniel} and Ingrid Titzler and Ricardo Araya and {Cerga Pashoja}, Arlinda and Hazo, {Jean Baptiste} and J{\'e}r{\^o}me Holtzmann and Roman Cieslak and Ewelina Smoktunowicz and Rosa Ba{\~n}os and Rocio Herrero and Azucena Garc{\'i}a-Palacios and Cristina Botella and Thomas Berger and Tobias Krieger and Holmberg, {Trine Theresa} and Naira Topooco and Gerhard Andersson and {van Straten}, Annemieke and Lise Kemmeren and Annet Kleiboer and Heleen Riper and Kim Mathiasen",
note = "Publisher Copyright: {\textcopyright}Esben Skov Jensen, Nicolai Ladegaard, Angelina Isabella Mellentin, David Daniel Ebert, Ingrid Titzler, Ricardo Araya, Arlinda Cerga Pashoja, Jean-Baptiste Hazo, J{\'e}r{\^o}me Holtzmann, Roman Cieslak, Ewelina Smoktunowicz, Rosa Ba{\~n}os, Rocio Herrero, Azucena Garc{\'i}a-Palacios, Cristina Botella, Thomas Berger, Tobias Krieger, Trine Theresa Holmberg, Naira Topooco, Gerhard Andersson, Annemieke van Straten,",
year = "2022",
month = mar,
doi = "10.2196/30231",
language = "English",
volume = "24",
journal = "Journal of Medical Internet Research",
issn = "1439-4456",
publisher = "JMIR Publications",
number = "3",

}

RIS

TY - JOUR

T1 - Effect of Sleep Disturbance Symptoms on Treatment Outcome in Blended Cognitive Behavioral Therapy for Depression (E-COMPARED Study)

T2 - Secondary Analysis

AU - Jensen, Esben Skov

AU - Ladegaard, Nicolai

AU - Mellentin, Angelina Isabella

AU - Ebert, David Daniel

AU - Titzler, Ingrid

AU - Araya, Ricardo

AU - Cerga Pashoja, Arlinda

AU - Hazo, Jean Baptiste

AU - Holtzmann, Jérôme

AU - Cieslak, Roman

AU - Smoktunowicz, Ewelina

AU - Baños, Rosa

AU - Herrero, Rocio

AU - García-Palacios, Azucena

AU - Botella, Cristina

AU - Berger, Thomas

AU - Krieger, Tobias

AU - Holmberg, Trine Theresa

AU - Topooco, Naira

AU - Andersson, Gerhard

AU - van Straten, Annemieke

AU - Kemmeren, Lise

AU - Kleiboer, Annet

AU - Riper, Heleen

AU - Mathiasen, Kim

N1 - Publisher Copyright: ©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,

PY - 2022/3

Y1 - 2022/3

N2 - BACKGROUND: Sleep 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. OBJECTIVE: The 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. METHODS: The 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. RESULTS: Of 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. CONCLUSIONS: Baseline 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.

AB - BACKGROUND: Sleep 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. OBJECTIVE: The 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. METHODS: The 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. RESULTS: Of 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. CONCLUSIONS: Baseline 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.

KW - bCBT

KW - blended care

KW - cognitive behavioral therapy

KW - digital health

KW - digital intervention

KW - major depressive disorder

KW - mental health

KW - mobile phone

KW - sleep disorder

KW - sleep disturbance

UR - http://www.scopus.com/inward/record.url?scp=85126685822&partnerID=8YFLogxK

U2 - 10.2196/30231

DO - 10.2196/30231

M3 - Journal article

C2 - 35311687

AN - SCOPUS:85126685822

VL - 24

JO - Journal of Medical Internet Research

JF - Journal of Medical Internet Research

SN - 1439-4456

IS - 3

M1 - e30231

ER -