title: Change in quality of life after brief behavioral therapy for insomnia in concurrent depression: analysis of the effects of a randomized controlled trial.
abstract: OBJECTIVE
  The efficacy of cognitive behavioral therapy for insomnia (CBT-I) has been suggested for insomnia concomitant with depression, but its impact on quality of life (QoL) has not been adequately evaluated. The study aimed to determine which aspects of QoL could be affected by CBT-I and how any changes in QoL were mediated by changes in insomnia and depression.
  
  
  METHODS
  We conducted a 4-week randomized controlled trial with 4-week follow-up in outpatient clinics in Japan. Thirty-seven patients with DSM-IV diagnosis of major depressive disorder concomitant with chronic insomnia were randomly assigned to the treatment-as-usual (TAU) alone arm or the TAU with brief behavioral therapy for insomnia (TAU plus psychotherapy) arm using modified CBT-I consisting of 4 weekly individual sessions. We evaluated QoL using norm-based scoring of the Short Form-36 at baseline and at 8 weeks. We also examined associations between QoL subscales and remission in insomnia or depression while controlling for baseline scores of the entire sample.
  
  
  RESULTS
  We tested group effects while controlling for baseline scores. TAU plus psychotherapy resulted in significantly better scores on physical functioning (p = 0.006), social functioning (p = 0.002), and mental health (p = 0.041) subscales than TAU alone at 8 weeks. Patients with either remitted insomnia or depression showed higher QoL scores than non-remitted patients; scores approximated those within the normal range.
  
  
  CONCLUSIONS
  For patients with insomnia in depression, adding CBT-I to TAU can produce substantive benefits in some aspects of QoL.
  
  
  BACKGROUND
  ClinicalTrials.gov Identifier: NCT00610259, http://www.clinicaltrials.gov/.
authors.affiliation: Department of Neuropsychiatry, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Shimodera
authors.affiliation: Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology & Psychiatry, Tokyo, Japan ; Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Watanabe
authors.affiliation: Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan.
authors.forename: Toshi A
authors.initials: TA
authors.lastname: Furukawa
authors.affiliation: Department of Psychiatric and Mental Health Nursing, Nagoya City University School of Nursing, Nagoya, Japan.
authors.forename: Fujika
authors.initials: F
authors.lastname: Katsuki
authors.affiliation: Department of Neuropsychiatry, Kochi Medical School, Kochi University, Kochi, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Fujita
authors.affiliation: Health Care Center, Japan Advanced Institute of Science and Technology, Ishikawa, Japan.
authors.forename: Megumi
authors.initials: M
authors.lastname: Sasaki
authors.affiliation: Behavioral Sleep Medicine Program, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Perlis
mesh_terms: D001521:Behavior Therapy / Q000379:methods*; D003865:Major Depressive Disorder / Q000150:complications / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011614:Psychotherapy, Brief / Q000379:methods*; D011788:Quality of Life / Q000523:psychology*; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires
keywords: Depressive disorder; behavior therapy; quality of life; sleep initiation and maintenance disorders
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