The effects of a sleep‐focused smartphone application on insomnia and depressive symptoms: a randomised controlled trial and mediation analysis
Background Rates of depression are increasing among adolescents. A novel way to reduce depression is by improving sleep. We evaluated whether an app‐based intervention for insomnia improved sleep and depression, and whether changes in insomnia mediated changes in depression. Methods We conducted a 2...
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| Veröffentlicht in: | Journal of child psychology and psychiatry 2023-09, Vol.64 (9), p.1324-1335 |
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| container_title | Journal of child psychology and psychiatry |
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| creator | Werner‐Seidler, Aliza Li, Sophie H. Spanos, Samantha Johnston, Lara O'Dea, Bridianne Torok, Michelle Ritterband, Lee Newby, Jill M. Mackinnon, Andrew J. Christensen, Helen |
| description | Background
Rates of depression are increasing among adolescents. A novel way to reduce depression is by improving sleep. We evaluated whether an app‐based intervention for insomnia improved sleep and depression, and whether changes in insomnia mediated changes in depression.
Methods
We conducted a 2‐arm single‐blind randomised controlled trial at the Black Dog Institute in Australia. Adolescents 12–16 years experiencing insomnia symptoms were randomly allocated to receive Sleep Ninja, an app‐delivered cognitive behavioural therapy program for insomnia, or to an active control group involving weekly text message sleep tips. Assessments took place at baseline, 6 weeks (post‐intervention) and 14 weeks (post‐baseline). Co‐primary outcomes were symptoms of insomnia and depression at post‐intervention (primary endpoint). Intent‐to‐treat analyses were conducted. The trial is registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12619001462178.
Results
Between October 25, 2019, and September 6, 2020, 264 participants were randomised to receive Sleep Ninja (n = 131) or to the control group (n = 133). Relative to the control group, those allocated to the intervention reported a greater reduction in insomnia symptoms at 6 weeks (95% CI: −2.96 to −0.41, d = .41) and 14 weeks (95% CI: −3.34 to −0.19, d = .39), and a greater reduction in depression symptoms at 6 weeks (95% CI: −3.46 to −0.56, d = .28) but not 14 weeks (p |
| doi_str_mv | 10.1111/jcpp.13795 |
| format | Article |
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Rates of depression are increasing among adolescents. A novel way to reduce depression is by improving sleep. We evaluated whether an app‐based intervention for insomnia improved sleep and depression, and whether changes in insomnia mediated changes in depression.
Methods
We conducted a 2‐arm single‐blind randomised controlled trial at the Black Dog Institute in Australia. Adolescents 12–16 years experiencing insomnia symptoms were randomly allocated to receive Sleep Ninja, an app‐delivered cognitive behavioural therapy program for insomnia, or to an active control group involving weekly text message sleep tips. Assessments took place at baseline, 6 weeks (post‐intervention) and 14 weeks (post‐baseline). Co‐primary outcomes were symptoms of insomnia and depression at post‐intervention (primary endpoint). Intent‐to‐treat analyses were conducted. The trial is registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12619001462178.
Results
Between October 25, 2019, and September 6, 2020, 264 participants were randomised to receive Sleep Ninja (n = 131) or to the control group (n = 133). Relative to the control group, those allocated to the intervention reported a greater reduction in insomnia symptoms at 6 weeks (95% CI: −2.96 to −0.41, d = .41) and 14 weeks (95% CI: −3.34 to −0.19, d = .39), and a greater reduction in depression symptoms at 6 weeks (95% CI: −3.46 to −0.56, d = .28) but not 14 weeks (p < 1). Change in insomnia mediated change in depression. No adverse events were reported.
Conclusions
An app‐delivered program for insomnia could be a practical, non‐stigmatising and scalable way to reduce symptoms of insomnia and depression among adolescents experiencing difficulties getting enough good quality sleep.</description><identifier>ISSN: 0021-9630</identifier><identifier>EISSN: 1469-7610</identifier><identifier>DOI: 10.1111/jcpp.13795</identifier><identifier>PMID: 36991537</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>adolescent ; Adolescents ; app‐based intervention ; Australia ; Clinical research ; Clinical trials ; Cognitive behavioral therapy ; Cognitive-behavioral factors ; Control groups ; Critical incidents ; depression ; Depression - psychology ; Depression - therapy ; Humans ; Insomnia ; Intervention ; Mediation Analysis ; Mental depression ; Mobile Applications ; Original ; Single-Blind Method ; Sleep ; Sleep disorders ; Sleep disturbance ; Sleep Initiation and Maintenance Disorders - therapy ; Smartphone ; Stigma ; Teenagers ; Treatment Outcome</subject><ispartof>Journal of child psychology and psychiatry, 2023-09, Vol.64 (9), p.1324-1335</ispartof><rights>2023 The Authors. published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.</rights><rights>2023 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.</rights><rights>2023. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4495-d772a81f8aa60c5862a2d82f2e15e20f131f5578977a676a1cf7a740253472c93</citedby><cites>FETCH-LOGICAL-c4495-d772a81f8aa60c5862a2d82f2e15e20f131f5578977a676a1cf7a740253472c93</cites><orcidid>0000-0003-1731-210X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjcpp.13795$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjcpp.13795$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,1416,27923,27924,30998,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36991537$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Werner‐Seidler, Aliza</creatorcontrib><creatorcontrib>Li, Sophie H.</creatorcontrib><creatorcontrib>Spanos, Samantha</creatorcontrib><creatorcontrib>Johnston, Lara</creatorcontrib><creatorcontrib>O'Dea, Bridianne</creatorcontrib><creatorcontrib>Torok, Michelle</creatorcontrib><creatorcontrib>Ritterband, Lee</creatorcontrib><creatorcontrib>Newby, Jill M.</creatorcontrib><creatorcontrib>Mackinnon, Andrew J.</creatorcontrib><creatorcontrib>Christensen, Helen</creatorcontrib><title>The effects of a sleep‐focused smartphone application on insomnia and depressive symptoms: a randomised controlled trial and mediation analysis</title><title>Journal of child psychology and psychiatry</title><addtitle>J Child Psychol Psychiatry</addtitle><description>Background
Rates of depression are increasing among adolescents. A novel way to reduce depression is by improving sleep. We evaluated whether an app‐based intervention for insomnia improved sleep and depression, and whether changes in insomnia mediated changes in depression.
Methods
We conducted a 2‐arm single‐blind randomised controlled trial at the Black Dog Institute in Australia. Adolescents 12–16 years experiencing insomnia symptoms were randomly allocated to receive Sleep Ninja, an app‐delivered cognitive behavioural therapy program for insomnia, or to an active control group involving weekly text message sleep tips. Assessments took place at baseline, 6 weeks (post‐intervention) and 14 weeks (post‐baseline). Co‐primary outcomes were symptoms of insomnia and depression at post‐intervention (primary endpoint). Intent‐to‐treat analyses were conducted. The trial is registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12619001462178.
Results
Between October 25, 2019, and September 6, 2020, 264 participants were randomised to receive Sleep Ninja (n = 131) or to the control group (n = 133). Relative to the control group, those allocated to the intervention reported a greater reduction in insomnia symptoms at 6 weeks (95% CI: −2.96 to −0.41, d = .41) and 14 weeks (95% CI: −3.34 to −0.19, d = .39), and a greater reduction in depression symptoms at 6 weeks (95% CI: −3.46 to −0.56, d = .28) but not 14 weeks (p < 1). Change in insomnia mediated change in depression. No adverse events were reported.
Conclusions
An app‐delivered program for insomnia could be a practical, non‐stigmatising and scalable way to reduce symptoms of insomnia and depression among adolescents experiencing difficulties getting enough good quality sleep.</description><subject>adolescent</subject><subject>Adolescents</subject><subject>app‐based intervention</subject><subject>Australia</subject><subject>Clinical research</subject><subject>Clinical trials</subject><subject>Cognitive behavioral therapy</subject><subject>Cognitive-behavioral factors</subject><subject>Control groups</subject><subject>Critical incidents</subject><subject>depression</subject><subject>Depression - psychology</subject><subject>Depression - therapy</subject><subject>Humans</subject><subject>Insomnia</subject><subject>Intervention</subject><subject>Mediation Analysis</subject><subject>Mental depression</subject><subject>Mobile Applications</subject><subject>Original</subject><subject>Single-Blind Method</subject><subject>Sleep</subject><subject>Sleep disorders</subject><subject>Sleep disturbance</subject><subject>Sleep Initiation and Maintenance Disorders - therapy</subject><subject>Smartphone</subject><subject>Stigma</subject><subject>Teenagers</subject><subject>Treatment Outcome</subject><issn>0021-9630</issn><issn>1469-7610</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNp9kc1qFTEYhoMo9ljdeAEScCOFqfnPxI3Iof5RsIu6DjGTeHLITGIyp3J2XoLeoldiTqcWdWEIJJAnD-_HC8BjjE5xW8-3NudTTKXid8AKM6E6KTC6C1YIEdwpQdEReFDrFiEkKO_vgyMqlMKcyhX4cblx0Hnv7Fxh8tDAGp3LP79998nuqhtgHU2Z8yZNDpqcY7BmDmmCbYeppnEKBpppgIPLxdUarhys-zHPaawvmq20tzSGg8imaS4pxnadSzDx-tvohrAIzWTivob6ENzzJlb36OY8Bh9fn12u33bnH968W7867yxjineDlMT02PfGCGR5L4ghQ088cZg7gjym2HMueyWlEVIYbL00kiHCKZPEKnoMXi7evPvUUljX0pmocwlt4L1OJui_X6aw0Z_TlcZIcUJ72QzPbgwlfdm5Ous2qHUxmsmlXdVEKqIQZkw09Ok_6DbtSpu4UT1jjCqM-kadLJQtqdbi_G0ajPShan2oWl9X3eAnf-a_RX932wC8AF9DdPv_qPT79cXFIv0FJ3q4FQ</recordid><startdate>202309</startdate><enddate>202309</enddate><creator>Werner‐Seidler, Aliza</creator><creator>Li, Sophie H.</creator><creator>Spanos, Samantha</creator><creator>Johnston, Lara</creator><creator>O'Dea, Bridianne</creator><creator>Torok, Michelle</creator><creator>Ritterband, Lee</creator><creator>Newby, Jill M.</creator><creator>Mackinnon, Andrew J.</creator><creator>Christensen, Helen</creator><general>Blackwell Publishing Ltd</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1731-210X</orcidid></search><sort><creationdate>202309</creationdate><title>The effects of a sleep‐focused smartphone application on insomnia and depressive symptoms: a randomised controlled trial and mediation analysis</title><author>Werner‐Seidler, Aliza ; Li, Sophie H. ; Spanos, Samantha ; Johnston, Lara ; O'Dea, Bridianne ; Torok, Michelle ; Ritterband, Lee ; Newby, Jill M. ; Mackinnon, Andrew J. ; Christensen, Helen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4495-d772a81f8aa60c5862a2d82f2e15e20f131f5578977a676a1cf7a740253472c93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>adolescent</topic><topic>Adolescents</topic><topic>app‐based intervention</topic><topic>Australia</topic><topic>Clinical research</topic><topic>Clinical trials</topic><topic>Cognitive behavioral therapy</topic><topic>Cognitive-behavioral factors</topic><topic>Control groups</topic><topic>Critical incidents</topic><topic>depression</topic><topic>Depression - psychology</topic><topic>Depression - therapy</topic><topic>Humans</topic><topic>Insomnia</topic><topic>Intervention</topic><topic>Mediation Analysis</topic><topic>Mental depression</topic><topic>Mobile Applications</topic><topic>Original</topic><topic>Single-Blind Method</topic><topic>Sleep</topic><topic>Sleep disorders</topic><topic>Sleep disturbance</topic><topic>Sleep Initiation and Maintenance Disorders - therapy</topic><topic>Smartphone</topic><topic>Stigma</topic><topic>Teenagers</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Werner‐Seidler, Aliza</creatorcontrib><creatorcontrib>Li, Sophie H.</creatorcontrib><creatorcontrib>Spanos, Samantha</creatorcontrib><creatorcontrib>Johnston, Lara</creatorcontrib><creatorcontrib>O'Dea, Bridianne</creatorcontrib><creatorcontrib>Torok, Michelle</creatorcontrib><creatorcontrib>Ritterband, Lee</creatorcontrib><creatorcontrib>Newby, Jill M.</creatorcontrib><creatorcontrib>Mackinnon, Andrew J.</creatorcontrib><creatorcontrib>Christensen, Helen</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of child psychology and psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Werner‐Seidler, Aliza</au><au>Li, Sophie H.</au><au>Spanos, Samantha</au><au>Johnston, Lara</au><au>O'Dea, Bridianne</au><au>Torok, Michelle</au><au>Ritterband, Lee</au><au>Newby, Jill M.</au><au>Mackinnon, Andrew J.</au><au>Christensen, Helen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effects of a sleep‐focused smartphone application on insomnia and depressive symptoms: a randomised controlled trial and mediation analysis</atitle><jtitle>Journal of child psychology and psychiatry</jtitle><addtitle>J Child Psychol Psychiatry</addtitle><date>2023-09</date><risdate>2023</risdate><volume>64</volume><issue>9</issue><spage>1324</spage><epage>1335</epage><pages>1324-1335</pages><issn>0021-9630</issn><eissn>1469-7610</eissn><abstract>Background
Rates of depression are increasing among adolescents. A novel way to reduce depression is by improving sleep. We evaluated whether an app‐based intervention for insomnia improved sleep and depression, and whether changes in insomnia mediated changes in depression.
Methods
We conducted a 2‐arm single‐blind randomised controlled trial at the Black Dog Institute in Australia. Adolescents 12–16 years experiencing insomnia symptoms were randomly allocated to receive Sleep Ninja, an app‐delivered cognitive behavioural therapy program for insomnia, or to an active control group involving weekly text message sleep tips. Assessments took place at baseline, 6 weeks (post‐intervention) and 14 weeks (post‐baseline). Co‐primary outcomes were symptoms of insomnia and depression at post‐intervention (primary endpoint). Intent‐to‐treat analyses were conducted. The trial is registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12619001462178.
Results
Between October 25, 2019, and September 6, 2020, 264 participants were randomised to receive Sleep Ninja (n = 131) or to the control group (n = 133). Relative to the control group, those allocated to the intervention reported a greater reduction in insomnia symptoms at 6 weeks (95% CI: −2.96 to −0.41, d = .41) and 14 weeks (95% CI: −3.34 to −0.19, d = .39), and a greater reduction in depression symptoms at 6 weeks (95% CI: −3.46 to −0.56, d = .28) but not 14 weeks (p < 1). Change in insomnia mediated change in depression. No adverse events were reported.
Conclusions
An app‐delivered program for insomnia could be a practical, non‐stigmatising and scalable way to reduce symptoms of insomnia and depression among adolescents experiencing difficulties getting enough good quality sleep.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>36991537</pmid><doi>10.1111/jcpp.13795</doi><tpages>1335</tpages><orcidid>https://orcid.org/0000-0003-1731-210X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Applied Social Sciences Index & Abstracts (ASSIA); Wiley Online Library All Journals |
| subjects | adolescent Adolescents app‐based intervention Australia Clinical research Clinical trials Cognitive behavioral therapy Cognitive-behavioral factors Control groups Critical incidents depression Depression - psychology Depression - therapy Humans Insomnia Intervention Mediation Analysis Mental depression Mobile Applications Original Single-Blind Method Sleep Sleep disorders Sleep disturbance Sleep Initiation and Maintenance Disorders - therapy Smartphone Stigma Teenagers Treatment Outcome |
| title | The effects of a sleep‐focused smartphone application on insomnia and depressive symptoms: a randomised controlled trial and mediation analysis |
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