Abstract：
BACKGROUND: Sleep disturbance may impact response to psychological treatment for depression. Understanding how sleep disturbance changes during the course of psychological treatment, and identifying the risk factors for sleep disturbance response may inform clinical decision-making.
METHODS: This analysis included 18,915 patients receiving high-intensity psychological therapy for depression from one of eight London-based Improving Access to Psychological Therapies (IAPT) services between 2011 and 2020. Distinct trajectories of change in sleep disturbance were identified using growth mixture modelling. The study also investigated associations between identified trajectory classes, pre-treatment patient characteristics, and eventual treatment outcomes from combined PHQ-9 and GAD-7 metrics used by the services.
RESULTS: Six distinct trajectories of sleep disturbance were identified: two demonstrated improvement, while one showed initial deterioration and the other three groups displayed only limited change in sleep disturbance, each with varying baseline sleep disturbance. Associations with trajectory class membership were found based on: gender, ethnicity, employment status, psychotropic medication use, long-term health condition status, severity of depressive symptoms, and functional impairment. Groups that showed improvement in sleep had the best eventual outcomes from depression treatment, followed by groups that consistently slept well.
CONCLUSIONS: Single item on sleep disturbance used, no data on treatment adherence.
CONCLUSIONS: These findings reveal heterogeneity in the course of sleep disturbance during psychological treatment for depression. Closer monitoring of changes in sleep disturbance during treatment might inform treatment planning. This includes decisions about when to incorporate sleep management interventions, and whether to change or augment therapy with interventions to reduce sleep disturbance.
METHODS: This analysis included 18,915 patients receiving high-intensity psychological therapy for depression from one of eight London-based Improving Access to Psychological Therapies (IAPT) services between 2011 and 2020. Distinct trajectories of change in sleep disturbance were identified using growth mixture modelling. The study also investigated associations between identified trajectory classes, pre-treatment patient characteristics, and eventual treatment outcomes from combined PHQ-9 and GAD-7 metrics used by the services.
RESULTS: Six distinct trajectories of sleep disturbance were identified: two demonstrated improvement, while one showed initial deterioration and the other three groups displayed only limited change in sleep disturbance, each with varying baseline sleep disturbance. Associations with trajectory class membership were found based on: gender, ethnicity, employment status, psychotropic medication use, long-term health condition status, severity of depressive symptoms, and functional impairment. Groups that showed improvement in sleep had the best eventual outcomes from depression treatment, followed by groups that consistently slept well.
CONCLUSIONS: Single item on sleep disturbance used, no data on treatment adherence.
CONCLUSIONS: These findings reveal heterogeneity in the course of sleep disturbance during psychological treatment for depression. Closer monitoring of changes in sleep disturbance during treatment might inform treatment planning. This includes decisions about when to incorporate sleep management interventions, and whether to change or augment therapy with interventions to reduce sleep disturbance.
摘要：
背景：睡眠障碍可能会影响抑郁症心理治疗的反应。了解心理治疗过程中睡眠障碍的变化，确定睡眠障碍反应的危险因素可以为临床决策提供信息。
方法：该分析包括2011年至2020年期间，来自伦敦八项改善获得心理治疗（IAPT）服务之一的18,915名接受高强度心理治疗的抑郁症患者。使用生长混合模型确定了睡眠障碍变化的不同轨迹。该研究还调查了确定的轨迹类别之间的关联，治疗前患者特征，以及服务使用的PHQ-9和GAD-7综合指标的最终治疗结果。
结果：确定了六个不同的睡眠障碍轨迹：两个显示出改善，其中一组表现为初始恶化，而其他三组仅表现出有限的睡眠障碍变化，每个人都有不同的基线睡眠障碍。与轨迹类成员的关联基于：性别，种族,失业状况,抗抑郁药物的使用，长期健康状况，抑郁症状的严重程度，和功能损害。显示睡眠改善的团体从抑郁症治疗中获得了最好的最终结果，其次是一直睡得很好的群体。
结论：使用关于睡眠障碍的单个项目，没有关于治疗依从性的数据。
结论：这些发现揭示了抑郁症心理治疗过程中睡眠障碍的异质性。治疗期间更密切地监测睡眠障碍的变化可能会告知治疗计划。这包括决定何时纳入睡眠管理干预措施，以及是否通过干预措施改变或增加治疗以减少睡眠障碍。
方法：该分析包括2011年至2020年期间，来自伦敦八项改善获得心理治疗（IAPT）服务之一的18,915名接受高强度心理治疗的抑郁症患者。使用生长混合模型确定了睡眠障碍变化的不同轨迹。该研究还调查了确定的轨迹类别之间的关联，治疗前患者特征，以及服务使用的PHQ-9和GAD-7综合指标的最终治疗结果。
结果：确定了六个不同的睡眠障碍轨迹：两个显示出改善，其中一组表现为初始恶化，而其他三组仅表现出有限的睡眠障碍变化，每个人都有不同的基线睡眠障碍。与轨迹类成员的关联基于：性别，种族,失业状况,抗抑郁药物的使用，长期健康状况，抑郁症状的严重程度，和功能损害。显示睡眠改善的团体从抑郁症治疗中获得了最好的最终结果，其次是一直睡得很好的群体。
结论：使用关于睡眠障碍的单个项目，没有关于治疗依从性的数据。
结论：这些发现揭示了抑郁症心理治疗过程中睡眠障碍的异质性。治疗期间更密切地监测睡眠障碍的变化可能会告知治疗计划。这包括决定何时纳入睡眠管理干预措施，以及是否通过干预措施改变或增加治疗以减少睡眠障碍。
