Cognitive behavior therapy for older adults with insomnia and depression : A randomized controlled trial in community mental health services

- Sadler, Paul, McLaren, Suzanne, Klein, Britt, Harvey, Jack, Jenkins, Megan

  • Authors: Sadler, Paul , McLaren, Suzanne , Klein, Britt , Harvey, Jack , Jenkins, Megan
  • Date: 2018
  • Type: Text , Journal article
  • Relation: Sleep Vol. 41, no. 8 (2018), p. 1-12
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  • Description: Study Objectives: To investigate whether cognitive behavior therapy was effective for older adults with comorbid insomnia and depression in a community mental health setting, and explore whether an advanced form of cognitive behavior therapy for insomnia produced better outcomes compared to a standard form of cognitive behavior therapy for insomnia. Methods: An 8-week randomized controlled clinical trial was conducted within community mental health services, Victoria, Australia. Seventy-two older adults (56% female, M age 75 ± 7 years) with diagnosed comorbid insomnia and depression participated. Three conditions were tested using a group therapy format: cognitive behavior therapy for insomnia (CBT-I, standard), cognitive behavior therapy for insomnia plus positive mood strategies (CBT-I+, advanced), psychoeducation control group (PCG, control). The primary outcomes were insomnia severity (Insomnia Severity Index) and depression severity (Geriatric Depression Scale). Primary and secondary measures were collected at pre (week 0), post (week 8), and follow-up (week 20). Results: CBT-I and CBT-I+ both generated significantly greater reductions in insomnia and depression severity compared to PCG from pre to post (p < .001), which were maintained at follow-up. Although the differences between outcomes of the two treatment conditions were not statistically significant, the study was not sufficiently powered to detect either superiority of one treatment or equivalence of the two treatment conditions. Conclusion: CBT-I and CBT-I+ were both effective at reducing insomnia and depression severity for older adults. Mental health services that deliver treatment for comorbid insomnia with cognitive behavior therapy may improve recovery outcomes for older adults with depression. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR); URL: https://www.anzctr.org.au; Trial ID: ACTRN12615000067572; Date Registered: December 12, 2014.

A psychological pathway from insomnia to depression among older adults

- Sadler, Paul, McLaren, Suzanne, Jenkins, Megan

  • Authors: Sadler, Paul , McLaren, Suzanne , Jenkins, Megan
  • Date: 2013
  • Type: Text , Journal article
  • Relation: International Psychogeriatrics Vol. 25, no. 8 (2013), p. 1375-1383
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  • Description: Background: Higher levels of insomnia predict greater depression severity among older adults; however. The psychological mechanisms underlying this relationship are unclear. This study tested a path model that explored whether dysfunctional beliefs about sleep and hopelessness mediate. The relationship from insomnia to depression. It was hypothesized that insomnia would predict depression, both directly and indirectly, via dysfunctional beliefs about sleep and hopelessness. Methods: A community sample of 218 independent-living Australian older adults aged from 65 to 96 years completed a self-report questionnaire package. From the initial 218 participants, 171 completed a measure of depression three months later. Results: Path analysis demonstrated that maladaptive sleep beliefs and hopelessness partly explained how insomnia influenced depression, irrespective of the presence of obstructive sleep apnea and/or restless legs syndrome. Conclusions: An older adult's beliefs about sleep and sense of hopelessness were important psychological factors that helped explain how insomnia related to depression. © 2013 International Psychogeriatric Association.
  • Description: 2003011128
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