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The Effects of a Sleep-Focused Smartphone Application on Insomnia and Depressive Symptoms: A Randomised Controlled Trial and Mediation Analysis

20 Pages Posted: 25 Aug 2022

See all articles by Aliza Werner-Seidler

Aliza Werner-Seidler

University of New South Wales (UNSW) - Black Dog Institute

Sophie H. Li

University of New South Wales (UNSW) - Black Dog Institute

Samantha Spanos

Macquarie University - Department of Psychology

Lara Johnston

University of New South Wales (UNSW) - Black Dog Institute

Bridianne O'Dea

University of New South Wales (UNSW) - Black Dog Institute

Torok Michelle

University of New South Wales (UNSW) - Black Dog Institute

Lee Ritterband

University of Virginia - School of Medicine

Jill M. Newby

University of New South Wales (UNSW) - Black Dog Institute

Andrew J. Mackinnon

University of New South Wales (UNSW) - Black Dog Institute

Helen Christensen

University of New South Wales (UNSW)

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Abstract

Background: Rates of depression are increasing among adolescents. A novel way to reduce depression is by targeting sleep difficulties, which increase depressive risk. We evaluated whether an app-based intervention for sleep difficulties improved sleep and depression, and whether changes in sleep 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 sleep difficulties 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.

Outcomes: 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 – -0·41, d =0·41) and 14 weeks (95%CI: -3·34 – -0·19, d =0·39), and a greater reduction in depression symptoms at 6 weeks (95%CI: -3·46 – -0·56), d =0·28) but not 14 weeks (p <1). Change in insomnia mediated change in depression. No adverse events were reported.

Interpretation: 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 sleep difficulties.

Trial Registration Information: The trial is registered with the Australian and New Zealand Clinical Trials Registry, number ACTRN12619001462178.

Funding Information: This work was supported by a grant awarded to Aliza Werner-Seidler and the Black Dog Institute by Perpetual Impact. Funders had no role in the design, implementation or reporting of this study. AW-S is supported by NHMRC Fellowship #1197074, BO is supported by a MRFF Fellowship GNT193661, JN is supported by a NHMRC Fellowship #2008839, MT is supported by NHMRC Fellowship #2007731 and HC is supported by NHMRC Fellowship #1056964.

Declaration of Interests: No competing interests to declare.

Ethics Approval Statement: All procedures were approved by the University of New South Wales Human Research Ethics Committee (HC#190139). Participants completed consent forms and progressed through the screening process.

Keywords: sleep disturbance, depression, adolescent mental health

Suggested Citation

Werner-Seidler, Aliza and Li, Sophie H. and Spanos, Samantha and Johnston, Lara and O'Dea, Bridianne and Michelle, Torok and Ritterband, Lee and Newby, Jill M. and Mackinnon, Andrew J. and Christensen, Helen, The Effects of a Sleep-Focused Smartphone Application on Insomnia and Depressive Symptoms: A Randomised Controlled Trial and Mediation Analysis. Available at SSRN: https://ssrn.com/abstract=4200346 or http://dx.doi.org/10.2139/ssrn.4200346

Aliza Werner-Seidler (Contact Author)

University of New South Wales (UNSW) - Black Dog Institute ( email )

Sophie H. Li

University of New South Wales (UNSW) - Black Dog Institute ( email )

Samantha Spanos

Macquarie University - Department of Psychology ( email )

Lara Johnston

University of New South Wales (UNSW) - Black Dog Institute ( email )

Bridianne O'Dea

University of New South Wales (UNSW) - Black Dog Institute ( email )

Torok Michelle

University of New South Wales (UNSW) - Black Dog Institute ( email )

Lee Ritterband

University of Virginia - School of Medicine

Jill M. Newby

University of New South Wales (UNSW) - Black Dog Institute ( email )

Andrew J. Mackinnon

University of New South Wales (UNSW) - Black Dog Institute ( email )

Helen Christensen

University of New South Wales (UNSW) ( email )

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