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首页> 外文期刊>Journal of clinical sleep medicine: JCSM : official publication of the American Academy of Sleep Medicine >Circadian Preference as a Moderator of Depression Outcome Following Cognitive Behavioral Therapy for Insomnia Plus Antidepressant Medications: A Report From the TRIAD Study
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Circadian Preference as a Moderator of Depression Outcome Following Cognitive Behavioral Therapy for Insomnia Plus Antidepressant Medications: A Report From the TRIAD Study

机译：失眠加抗抑郁药的认知行为疗法后，昼夜节律作为抑郁结果的调节剂：来自TRIAD研究的报告

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Study Objectives:We previously presented results from a randomized controlled trial that examined the effects of antidepressant medication plus cognitive behavioral therapy for insomnia (CBT-I) among patients with major depressive disorder (MDD) and insomnia. The current secondary analysis aims to examine whether circadian preference moderated the reduction in depression and insomnia symptom severity during this trial.Methods:A total of 139 adult participants with MDD and insomnia disorder were treated with antidepressant medication and randomized to receive 7 sessions of CBT-I or a control therapy (CTRL). Circadian preference (eveningness) was measured using the Composite Scale of Morningness (CSM). Depression symptom severity was assessed using the Hamilton Depression Rating Scale (HDRS); insomnia symptom severity was assessed using the Insomnia Severity Inventory (ISI). The moderating role of circadian preference on changes in HRSD and ISI was assessed via latent growth models within the framework of structural equation modeling.Results:Greater evening preference was associated with smaller reduction in HDRS (P = .03) from baseline to week 6 across treatment groups. The interaction between CSM and treatment group was also significant (P = .02), indicating that participants with greater evening preference in the CTRL group had significantly smaller HDRS reduction than those with greater evening preference in the CBT-I group. Circadian preference did not share significant associations with ISI (all P .30).Conclusions:Individuals with MDD and insomnia who have an evening preference are at increased risk for poor response to pharmacological depression treatment augmented with either CBT-I or CTRL behavioral insomnia treatment. However, evening types have better depression outcomes when treated with CBT-I than with CTRL for insomnia.
机译：研究目标：我们先前提供了一项随机对照试验的结果，该试验研究了抗抑郁药物加认知行为疗法对重度抑郁症（MDD）和失眠患者的失眠（CBT-1）的影响。当前的二级分析旨在检查在此试验中，昼夜节律是否能缓解抑郁症和失眠症状的严重程度。方法：对总共139名患有MDD和失眠症的成年受试者进行抗抑郁药治疗，并随机接受7疗程的CBT-我还是对照疗法（CTRL）。使用早晨综合评分（CSM）测量昼夜节律（晚上）。使用汉密尔顿抑郁量表（HDRS）评估抑郁症状的严重程度。使用失眠严重程度调查表（ISI）评估失眠症状的严重程度。在结构方程模型的框架内，通过潜在增长模型评估了昼夜节律对HRSD和ISI变化的调节作用。结果：从基线到第6周，较大的夜间偏爱与HDRS的降低较小（P = .03）相关治疗组。 CSM与治疗组之间的相互作用也很显着（P = .02），这表明CTRL组夜间偏爱较大的参与者与CBT-1组夜间偏爱较大的参与者相比，HDRS的减少幅度明显较小。昼夜节律与ISI没有显着相关性（所有P> .30）。治疗。但是，对于失眠症，使用CBT-1治疗时，夜间类型的抑郁效果要好于CTRL。

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