CBT-I for prevention and early intervention in mental disturbances: A systematic review and meta-analysis

Abstract

Insomnia is well-known to be both a risk factor and a prodrome for psychiatric disorders, including mood, anxiety and psychotic disorders, as well as for suicide risk. In this framework, targeting insomnia may constitute a preventive strategy or an early intervention against the development or the recurrence of psychiatric disorders. Cognitive behavioral therapy for insomnia (CBT-I) is considered the first line treatment for chronic insomnia, even when comorbid with psychiatric disorders. Accordingly, the present work aimed at systematically reviewing available data on the effects of CBT-I for prevention or early intervention of psychiatric disorders.

Method: The available data on the effect of CBT-I on insomnia and mental health prevention/early intervention were systematically reviewed. We conducted a systematic search on PubMed, Scopus, Psychinfo electronic databases for English literature, published until March 2024, according to PRISMA Guidelines.

Results: From the literature systematic search, 83 articles were eligible, and, at end, 11 studies were retained. Seven randomized controlled-trials examined the effects of CBT-I for the prevention of depressive symptoms, 1 for anxiety disorder, 1 for psychotic disorders, and 4 for suicidal risk. Results of meta-analyses on depressive symptoms showed that CBT-I for insomnia was effective in reducing depressive (z = -6.8466, p < 0.0001; RE Model = -0.5168 (95 % CI: 0.6648 to -0.3689); k = 6), and insomnia symptoms as well (z = -3.7126, p = 0.0002; RE Model = -0.8074 (95 % CI: 1.2336 to -0.3811); k = 5). Studies indicated some heterogeneities among them that may limit interpretations, with the impossibility of meta-analyzing suicidal, anxiety, and psychotic symptoms.

Conclusions: Currently data support the hypothesis that targeting insomnia with CBT-I may represent an early effective intervention in mental disorders, especially mood disorders.

Keywords: CBT-I; Depression; Insomnia; Prevention; Suicide risk.