Depression, Insomnia
Conditions
Keywords
CBT, Psychiatry, Inpatient care, Sleep
Brief summary
Disturbed sleep occurs in almost all patients in psychiatric inpatient care, and although it is well known that comorbid sleep disorders in depression often persist after treatment of depression and also increase the risk of new depressive episodes, the availability of effective, evidence-based treatments for sleep disorders in hospitalised patients is very limited. The overall goal of the current project is to translate, adapt and evaluate an acute psychological sleep treatment based on cognitive behavioural therapy for insomnia (CBT-I) for patients hospitalized with depression and comorbid sleep problems in the specialized psychiatric inpatient care in the Stockholm Region. The main hypothesis for the study is that acute psychological sleep stabilization (APS) reduces self-reported sleep complains compared to care as usual reinforced with sleep hygiene advice, and secondary hypotheses are that APS also leads to reduced depressive symptoms and earlier discharge. The project includes a pilot study, which will be followed by a randomized, controlled trial of APS compared to care as usual with structured sleep hygiene (minimal active control) and treatment effect is evaluated every three days during the hospital stay and 1,2,4 and 12 weeks after randomization. APS will be performed by existing staff in the department with the support of a psychologist.
Interventions
BEHAVIORALAcute psychological sleep stabilization
See above (arm description)
BEHAVIORALSleep hygiene education
See above (arm description)
Sponsors
Region Stockholm
Karolinska Institutet
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Admitted to the psychiatric inpatient care (Psykiatri Sydväst) * Depressive symptoms / confirmed depressive episode (uni- or bipolar) * Reports or is observed to have sleep problems in the form of insomnia, hypersomnia or delayed circadian phase * Knowledge of Swedish or English that is deemed sufficient to undergo the treatment * Consent to be included in the study and is judged to have understood what the study entails (care according to the Compulsory Psychiatric Care Act is not in itself an exclusion criterion)
Exclusion criteria
* Dementia * Intellectual disability * Severe somatic comorbidity with life expectancy \<6 months * Ongoing mania / mixed-state * Complex problems that make APS impossible or inappropriate * Expected discharge within 3 days
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Insomnia Severity Index | 2 weeks post randomization (secondary timepoints include day 4, 7, 10 and week 4 and 12) | A self-report measure of insomnia symptoms. 7-item, self-rated questionnaire measuring insomnia severity. Total score 0-28, higher score indicates more severe sleep problems. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Patient Health Questionnaire (PHQ-9) | Day 4, 7, 10 14 and week 4 and 12 post randomisation | Self-reported depressive symptoms. PHQ-9 is a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression. Total score 0-27, higher score indicates more severe depressive symptoms. |
| Generalised Anxiety Disorder 7-item scale (GAD-7) | Day 4, 7, 10 14 and week 4 and 12 post randomisation | Self-reported anxiety symptoms. A seven-item instrument that is used to measure or assess the severity of generalised anxiety disorder/symptoms. Total score 0-27. Higher scores indicative of more severe problem. |
| European Quality of Life 5 Dimensions scale (EQ-5D) | Week 2, 4 and 12 post randomisation | Self-reported quality of life. An instrument which evaluates the generic quality of life developed in Europe and widely used. The scale comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Sleep Diary | 0-14 days post randomisation | Participants will report their bedtime, risetime, amount of sleep daily using a simplified version of a sleep diary. We will look at total sleep time, sleep efficiency, and timing of sleep. |
| Actigraphy | 0-14 days post randomisation | An actigraph is placed on the participant's arm for 2 weeks. It measures participants' arm-movements. An algorithm can be used to estimate sleep from movement data.Data from actigraphs will be reported and analysed |
| Side effects of treatment | Day 7 and 14 post randomisation | Patients will be asked to report any side-effects of the treatment with an open question |
| Treatment Credibility Scale | Day 4 post randomisation | A five-item version of Credibility/Expectancy Questionnaire, total score ranging from 0-50. Higher scores indicative of higher credibility. |
Countries
Sweden
Outcome results
None listed