Effectiveness of app-based cognitive behavioral therapy for insomnia on preventing major depressive disorder in youth with insomnia and subclinical depression: A randomized clinical trial

作者：Sijing Chen, Jianyu Que, Ngan Yin Chan, Le Shi, Shirley Xin Li, Joey Wing Yan Chan, Weizhen Huang, Xie Chen, Chi Ching Tsang, Ya‐Lun Ho, Charles M. Morin, Jihui Zhang, Lin Lü, Yun Kwok Wing · 发表于：PLoS Medicine · 年份：2025 · DOI：10.1371/journal.pmed.1004510 · 被引用次数：25 · 研究领域：Sleep and related disorders、Digital Mental Health Interventions、Mobile Health and mHealth Applications

BACKGROUND: Increasing evidence suggests that insomnia plays an important role in the development of depression, supporting insomnia intervention as a promising approach to prevent depression in youth. This randomized controlled trial evaluated the effectiveness of app-based cognitive behavioral therapy for insomnia (CBT-I) in preventing future onset of major depressive disorder (MDD) in youth. METHODS AND FINDINGS: This was a randomized, assessor-blind, parallel group-controlled trial in Chinese youth (aged 15-25 years) with insomnia disorder and subclinical depressive symptoms. Participants were randomly assigned (1:1) to 6-week app-based CBT-I or 6-week app-based health education (HE) delivered through smartphones. Online assessments and telephone clinical interviews were conducted at baseline, post-intervention, 6- and 12-month follow-ups. The primary outcome was time to onset of MDD. The secondary outcomes included depressive symptoms and insomnia at both symptom and disorder levels. Between September 9, 2019, and November 25, 2022, 708 participants (407 females [57%]; mean age, 22.1 years [SD = 1.9]) were randomly allocated to app-based CBT-I group (n = 354) or app-based HE group (n = 354). Thirty-seven participants (10%) in the intervention group and 62 participants (18%) in the control group developed new-onset MDD throughout the 12-month follow-up, with a hazard ratio of 0.58 (95% confidence interval 0.38-0.87; p = 0.008). The number needed to treat to prevent MDD at...