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Cited by 212Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMindfulness and Compassion Interventions

The effect of non-pharmacological sleep interventions on depression symptoms: a meta-analysis of randomised controlled trials

Open access
Gee, Brioney, Orchard, Faith, Clarke, Emmet, Joy, Ansu, Clarke, Tim, Reynolds, Shirley·2019·Sleep Medicine Reviews
DOI 10.1016/j.smrv.2018.09.004
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Abstract

Poor sleep is a significant risk factor for depression across the lifespan and sleep problems have been hypothesised to contribute to the onset and maintenance of depression symptoms. However, sleep problems are usually not a direct target of interventions for depression. A range of non-pharmacological treatments can reduce sleep problems but it is unclear whether these interventions also reduce other depression symptoms. The aim of this review was to examine whether non-pharmacological interventions for sleep problems are effective in reducing symptoms of depression. We carried out a systematic search for randomised controlled trials of non-pharmacological sleep interventions that measured depression symptoms as an outcome. Forty-nine trials (n = 5908) were included in a random effects meta-analysis. The pooled standardised mean difference for depression symptoms after treatment for sleep problems was -0.45 (95% CI: -0.55,-0.36). The size of the effect on depression symptoms was moderated by the size of the effect on subjective sleep quality. In studies of participants with mental health problems, sleep interventions had a large effect on depression symptoms (d = -0.81, 95% CI: -1.13,-0.49). The findings indicate that non-pharmacological sleep interventions are effective in reducing the severity of depression, particularly in clinical populations. This suggests that non-pharmacological sleep interventions could be offered as a treatment for depression, potentially improving access to treatment.

AI snapshot

Written from the paper’s full text.

TL;DR

This meta-analysis of 49 randomised controlled trials (n=5908) found that non-pharmacological sleep interventions reduce depression symptoms, with a small-to-moderate pooled effect. The effect was larger in participants with mental health problems and was moderated by improvement in subjective sleep quality.

Key findings

  • Non-pharmacological sleep interventions reduced depression symptoms versus controls not designed to improve sleep: pooled standardised mean difference = -0.45 (95% CI -0.55, -0.36, p<0.001, k=49), with moderate heterogeneity (I²=56%).
  • In 7 studies recruiting participants with clinical mental health problems, the effect on depression symptoms was large: SMD = -0.81 (95% CI -1.13, -0.49, p<0.001), with small heterogeneity (I²=27%).
  • The effect on depression symptoms was significantly moderated by the effect on subjective sleep quality: β=0.447 (95% CI 0.29, 0.60, p<0.001); residual variation was non-significant (χ²=41.89, p=0.306).
  • Publication bias assessment suggested possible slight inflation in some smaller studies, but Rosenthal’s failsafe N was 3593.46.

Methods

  • Systematic review and random-effects meta-analysis conducted per PRISMA, registered with PROSPERO; searched PsycINFO, Medline, CINAHL, and CENTRAL from inception to 1 May 2018, plus hand-searching.
  • Included randomised controlled trials of non-pharmacological interventions specifically designed to improve sleep (amount, quality, or timing), with a control condition not designed to improve sleep and depression symptoms measured by a validated instrument.
  • Data from 49 articles were meta-analysed; planned subgroup analyses examined mental health comorbidity and age group, a post-hoc subgroup examined depression measure, and random-effects meta-regression tested subjective sleep quality as a moderator.

Limitations

  • The paper states that depression measures typically include sleep items, and lack of item-level data meant it could not isolate effects on non-sleep depression symptoms; many studies excluded people with elevated depression or major depression history, possibly reducing the pooled effect; it could not assess whether participants received depression treatment or mood management; nine eligible trials could not be included due to insufficient depression outcome data; and it only assessed outcomes immediately post-intervention.
  • The paper also notes that few studies could blind participants and research personnel, and most papers had insufficient information to determine risk of bias from allocation concealment or selective reporting.
  • Evident from the text: heterogeneity was moderate overall and in several subgroups, and the review was restricted to trials that measured depression symptoms as an outcome, which may limit generalisability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.smrv.2018.09.004

Cites

113 of 113 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 23 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The residual variation was non-significant (χ2=41.89, p=0.306).

    “The residual variation was non-significant (χ 2 =41.89, p=0.306) suggesting the statistical heterogeneity in the size of the effect of the studied sleep interventions on depression symptoms can be explained by variation in their effect on subjective sleep quality.”
    Quote in the paperSubstantial claim
  • Findingown data

    The size of the effect on depression symptoms was moderated by the size of the effect on subjective sleep quality.

    “The size of the effect on depression symptoms was moderated by the size of the effect on subjective sleep quality.”
    • Also stated in: § Effect on subjective sleep quality · plain
      “The meta-regression revealed that the size of the effect on subjective sleep quality was a significant continuous moderator of the effect on depression symptoms (β=0.447,95% CI 0.29, 0.60, p<0.001).”
    Quote in the paperSubstantial claim
  • Findingown data

    The pooled standardised mean difference for depression symptoms after treatment for sleep problems was -0.45 (95% CI -0.55, -0.36) across 49 trials.

    “The pooled standardised mean difference for depression symptoms after treatment for sleep problems was -0.45 (95% CI: -0.55,-0.36).”
    • Also stated in: § RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS · plain
      “mean difference = -0.45,95% CI -0.55, -0.36, p<0.001, k=49).”
    Quote in the paperSubstantial claim
  • Findingown data

    The standardised mean difference was smallest in trials that used the BDI-II (-0.12, 95% CI -0.36, 0.13, p=0.34).

    “It was smallest in trials that used the BDI-II (-0.12, 95% CIs -0.36, 0.13, p=0.34).”
    Quote in the paperNot a substantial claim
  • Findingown data

    In studies of participants with mental health problems, sleep interventions had a large effect on depression symptoms (d=-0.81, 95% CI -1.13, -0.49).

    “In studies of participants with mental health problems, sleep interventions had a large effect on depression symptoms (d=-0.81,95% CI: -1.13,-0.49).”
    • Also stated in: § Comorbid mental health difficulties · plain
      “The subgroup analyses showed that the pooled effect on depression symptoms for these seven studies was large (standardised mean difference = -0.81,95% CI -1.13, -0.49, p<0.001, k=7)”
    • Also stated in: § RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS · plain
      “For participants with mental health problems, sleep interventions had a large effect on symptoms of depression.”
    Quote in the paperSubstantial claim
  • May combine two claims. 15
  • Classified as probably not a substantial claim. 27

  • May combine two claims.

    Findingown data

    Rosenthal's failsafe N was 3593.46, indicating that 3593 studies with zero effect sizes would be needed to nullify the pooled effect.

    “Rosenthal's failsafe N was 3593.46,indicating that 3593 studies with zero effect sizes would be needed to nullify the pooled effect.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The three studies that recruited adults over the age of 50 had the largest pooled effect size but wide confidence intervals (SMD=-0.60, 95% CI -1.12, -0.08, p=0.02, k=3) and moderate heterogeneity (I2=47%).

    “The three studies that recruited adults over the age of 50 had the largest pooled effect size but wide confidence intervals (standardised mean difference = -0.60,95% CI -1.12, -0.08, p=0.02, k=3) and moderate heterogeneity (I 2 =47%, χ 2 =3.76, df=2, p=0.15).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The pooled effect on depression symptoms for studies with adult participants was small to moderate (SMD=-0.46, 95% CI -0.57, -0.36, p<0.001, k=42) with moderate heterogeneity (I2=59%).

    “The pooled effect on depression symptoms for the studies with adult participants was small to moderate (standardised mean difference = -0.46,95% CI -0.57, -0.36, p<0.001, k=42) with moderate heterogeneity (I 2 =59%, χ 2 =100.75, df=41, p<0.001).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The four trials in adolescents had the smallest pooled effect on depression symptoms (SMD=-0.27, 95% CI -0.50, -0.04, p=0.02, k=4), with no statistical heterogeneity (I2=0%).

    “The four trials in adolescents had the smallest pooled effect on depression symptoms (standardised mean difference = -0.27,95% CI -0.50, -0.04, p=0.02, k=4), with no statistical heterogeneity (I 2 =0%, χ 2 =1.99, df=3, p=0.57).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Inspection of the funnel plot suggested that effect sizes might be slightly inflated in some smaller studies, with one small study a notable outlier.

    “Inspection of the funnel plot (Figure 4) suggestsed that effect sizes might be slightly inflated in some smaller studies, with one small study a notable outlier.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Control conditions included passive controls, such as medical treatment as usual and waitlist.

    “Control conditions included active interventions not specifically targeting sleep (e.g.dietary advice, exercise programmes), and passive controls, such as medical treatment as usual and waitlist.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    The included trials were all of psychological interventions.

    “The included trials were all of psychological interventions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Control conditions included active interventions not specifically targeting sleep (e.g. dietary advice, exercise programmes).

    “Control conditions included active interventions not specifically targeting sleep (e.g.dietary advice, exercise programmes), and passive controls, such as medical treatment as usual and waitlist.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The remaining trials were of face-to-face interventions.

    “The remaining trials were of face-to-face interventions, 27 delivered individually and five delivered in a group format.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most participants were adults.

    “Most participants were adults; only four studies included young people aged under 18 (n=292) and none included children under 11 years.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    27 of the face-to-face interventions were delivered individually.

    “The remaining trials were of face-to-face interventions, 27 delivered individually and five delivered in a group format.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    5 of the face-to-face interventions were delivered in a group format.

    “The remaining trials were of face-to-face interventions, 27 delivered individually and five delivered in a group format.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The meta-analysis included data on 5908 participants, of whom 2731 were randomised to receive the trial sleep intervention.

    “The meta-analysis included data on 5908 participants, of whom 2731 were randomised to receive the trial sleep intervention.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    The effect of sleep interventions on depression symptoms appears to be larger in adults than in children and adolescents, though this may be an artefact of the participants recruited.

    “The effect on depression symptoms appears to be larger in adult than in children and adolescents but this may be an artefact of the participants who were recruited.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Only four studies included young people aged under 18 (n=292).

    “Most participants were adults; only four studies included young people aged under 18 (n=292) and none included children under 11 years.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The majority (39 out of 48 studies) were described by the study authors as CBT-I cognitive behavioural therapy (CBT) or CBT-informed interventions.

    “The majority (39 out of 48 studies) were described by the study authors as CBT-I cognitive behavioural therapy (CBT) or CBT-informed interventions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    None of the studies included children under 11 years.

    “Most participants were adults; only four studies included young people aged under 18 (n=292) and none included children under 11 years.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Sixteen studies trialled interventions delivered in a self-help format, online or via a mobile application.

    “Sixteen studies trialled interventions delivered in a self-help format, online or via a mobile application.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Non-pharmacological sleep interventions are effective in reducing the severity of depression, particularly in clinical populations.

    “The findings indicate that non-pharmacological sleep interventions are effective in reducing the severity of depression, particularly in clinical populations.”
    • Also stated in: § Discussion · plain
      “The meta-analysis showed that nonpharmacological sleep interventions reduce the severity of depression symptoms immediately post-intervention”
    • Also stated in: § Conclusions · plain
      “Non-pharmacological interventions designed to improve sleep have a positive impact on depression symptoms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The meta-analysis showed that non-pharmacological sleep interventions reduce the severity of depression symptoms immediately post-intervention, and this finding was robust to the possibility of publication bias.

    “The meta-analysis showed that nonpharmacological sleep interventions reduce the severity of depression symptoms immediately post-intervention, and this finding was robust to the possibility of publication bias.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A range of non-pharmacological psychological interventions have been found to be effective treatments for insomnia, including stimulus control therapy, relaxation training, sleep restriction therapy, biofeedback, paradoxical intention and multicomponent cognitive behavioural therapy for insomnia (CBT-I).

    “A range of nonpharmacological psychological interventions have been found to be effective treatments for insomnia, including stimulus control therapy, relaxation training, sleep restriction therapy, biofeedback, paradoxical intention and multicomponent cognitive behavioural therapy for insomnia (CBT-I) [35].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Morgenthaler, 2006, Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report, Sleep source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Titles and abstracts of all retrieved articles were screened by one reviewer, and a subsample of 10% was screened independently by a second reviewer to check that no potentially eligible articles were excluded.

    “The titles and abstracts of all retrieved articles were screened by one reviewer (BG).A subsample of 10% of articles (selected using a random number generator) was screened independently by a second reviewer (AJ) to check that no potentially eligible articles were excluded.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The authors of a recent review suggest that improvement in depression following CBT-I for insomnia may be mediated by improvement in insomnia symptoms.

    “The authors of a recent review of CBT-I for insomnia in adults with co-morbid major depressive disorder [39] suggest that improvement in depression following CBT-I for insomnia may be mediated by improvement in insomnia symptoms.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] Cunningham, 2018, Cognitive Behavioural Therapy for Insomnia (CBT-I) to treat depression: a systematic review, J Psychosom Res source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    We focused on outcomes immediately post-intervention so are unable to comment on the longevity of the effects on depression observed.

    “Also, we focused on outcomes immediately postintervention so are unable to comment on the longevity of the effects on depression observed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    Sleep problems are usually not a direct target of interventions for depression.

    “However, sleep problems are usually not a direct target of interventions for depression.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Full texts of all articles deemed potentially relevant were assessed for eligibility against the inclusion/exclusion criteria by two reviewers independently.

    “The full texts of all articles deemed potentially relevant were obtained and assessed for eligibility against the inclusion/exclusion criteria by two reviewers independently (BG and one of FO, EC, AJ, TC or SR).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The size of the effect on depression is moderated by the effect on subjective sleep quality and is largest for participants experiencing sleep problems in the context of mental health difficulties.

    “The size of the effect on depression is moderated by the effect on subjective sleep quality and is largest for participants experiencing sleep problems in the context of mental health difficulties.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    We were unable to assess whether participants in the included trials were offered treatment for depression or provided with mood management techniques before or after their participation in the sleep interventions trialled as this was not consistently reported.

    “We were also unable to assess whether participants in the included trials were offered treatment for depression or provided with mood management techniques before or after their participation in the sleep interventions trialled as this was not consistently reported.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The review was conducted in accordance with guidance in the PRISMA statement.

    “The review was conducted in accordance with guidance in the 'preferred reporting items for systematic reviews and meta-analyses' (PRISMA) statement [44].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Moher, 2009, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, PLoS Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Previous meta-analyses suggest that both internet-delivered and group-based CBT-I have small but significant effects on depression symptoms.

    “The results of previous meta-analyses suggest that both internet-delivered [36] and group-based [37] CBT-I have small but significant effects on depression symptoms, despite these symptoms not being specifically targeted.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [36] Ye, 2015, Internet-based cognitive behavioral therapy for insomnia (ICBT-i) improves comorbid anxiety and depression—a meta-analysis of randomized controlled trials, PLoS One source

      Not checked in the free run.

    • cites [37] Koffel, 2015, A meta-analysis of group cognitive behavioral therapy for insomnia, Sleep Med Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The methodological quality of included studies was assessed by one reviewer using the Cochrane collaboration's risk of bias tool, and for a random subsample of 10% of included studies the risk of bias assessment was independently verified by a second reviewer.

    “The methodological quality of included studies was assessed by one reviewer (AJ) using the Cochrane collaboration's risk of bias tool [45].For a random subsample of 10% of included studies, the risk of bias assessment was independently verified by a second reviewer (BG) and discrepancies resolved through discussion.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [45] Higgins, 2008

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Data were extracted independently by two reviewers and cross-checked to ensure accuracy.

    “Data were extracted independently by two reviewers (BG and EC) and cross-checked to ensure accuracy.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    It is possible that relatively low levels of depression before treatment for sleep problems reduced the overall effect of treatment on depression symptoms.

    “Thus, while we cannot be certain what effect this had on the pooled effect size, it is possible that relatively low levels of depression before treatment for sleep problems reduced the overall effect of treatment on depression symptoms.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent network meta-analysis found that only individual, face-to-face CBT-I had a significant effect on depression symptoms when compared to a placebo condition.

    “However, a recent network meta-analysis of behavioural and cognitive behavioural interventions for adults with insomnia [38] found that only individual, face-to-face CBT-I had a significant effect on depression symptoms when compared to a placebo condition.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [38] Ballesio, 2018, The effectiveness of behavioural and cognitive behavioural therapies for insomnia on depressive and fatigue symptoms: a systematic review and network meta-analysis, Sleep Med Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The measures of depression used in the studies had sound psychometric properties.

    “The measures of depression used in the studies had sound psychometric properties, and where young people under 18 were included, had been validated for use with adolescents.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There are a range of non-specific factors that might account for the effect of sleep-interventions on depression, for instance increased motivation or hope as a result of developing a therapeutic relationship or participation in a therapeutic process.

    “However, there are also a range of non-specific factors that might account for the effect of sleep-interventions on depression, for instance increased motivation or hope as a result of developing a therapeutic relationship or participation in a therapeutic process [43].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Mulder, 2017, Common versus specific factors in psychotherapy: opening the black box, Lancet Psychiatr source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The protocol was registered with the PROSPERO registry prior to implementation of the search strategy.

    “The protocol was registered with the PROSPERO registry prior to implementation of the search strategy and can be accessed at: http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017054940.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Offering non-pharmacological sleep interventions to users of mental health services who are experiencing concomitant mood and sleep problems may lead to significant improvements in depression symptoms as well as sleep quality.

    “Offering nonpharmacological sleep interventions to users of mental health services who are experiencing concomitant mood and sleep problems may lead to significant improvements in depression symptoms as well as sleep quality.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Users of mental health services who are experiencing concomitant mood and sleep problems are similar to the participants in the included trials.
38 of 38

  • The paper relies on this without support.

    Users of mental health services who are experiencing concomitant mood and sleep problems are similar to the participants in the included trials.

    “Offering nonpharmacological sleep interventions to users of mental health services who are experiencing concomitant mood and sleep problems may lead to significant improvements in depression symptoms as well as sleep quality.”
1 of 1

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Recent reviews suggest that treating insomnia in those with both depression and insomnia may lead to better long-term clinical outcomes (Bei et al., 2018; Gee et al., 2019).

    “Recent reviews suggest that treating insomnia in those with both depression and insomnia may lead to better long-term clinical outcomes (Bei et al ., 2018; Gee et al ., 2019).”

    From ACT-i, an insomnia intervention for autistic adults: A pilot study (2023) · cites this paper as Gee et al., 2019

    The Discussion (page unavailable) reports that non-pharmacological sleep interventions reduced depression symptoms immediately after treatment, with a larger effect among participants who also had mental health difficulties. But the Limitations (page unavailable) explicitly say the review focused on immediate post-intervention outcomes and could not assess how long the effects lasted. It therefore does not support the claim about better long-term clinical outcomes. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Non-pharmacological sleep interventions (predominantly CBT) produce large and significant reduction in depressive symptoms in mixed psychiatric sample with anxiety, depression, or PTSD (SMD=0.81, 95% CI 0.49-1.13).

    “In a pooled analysis of seven RCTs across a mixed psychiatric sample with anxiety, depression or PTSD, non-pharmacological sleep interventions - predominantly based on cognitive behavior therapy (CBT) - produced a large and significant reduction in depressive symptoms in comparison to control conditions (NIH=6, SMD=0.81, 95% CI: 0.49-1.13, I 2 =27%) 79 .”

    From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [79]

  • Sleep therapies have even larger effects on depression in those with mental illness compared to subclinical depressive symptoms.

    “Of note, whereas many trials have shown the alleviation of subclinical depressive symptoms following sleep interventions, the available evidence suggests that even larger effects of sleep therapies on depression are observed in those with mental illness 79-81,94 .”

    From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [79]

  • Gee et al. concluded that non-pharmacological treatment for insomnia is effective for reducing insomnia and has moderate to large effects on depression, especially in clinical populations.

    “Focusing on comorbid depression and insomnia in their meta-analysis, Gee et al. concluded that non-pharmacological treatment for insomnia is effective not only for the reduction of insomnia, but has moderate to large effects on depression especially in clinical populations [18].”

    From Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis (2022) · cites this paper as [18]

  • The results are in line with Gee et al.'s finding that CBT-I has the potential to exert effects beyond insomnia and improve depression.

    “Our results are also well in line with the finding by Gee et al. [18] that CBT-I has the potential to exert effects beyond insomnia and improve depression.”

    From Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis (2022) · cites this paper as [18]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • CBT intervention count uses a 48-study denominator

    Minor

    The figure legend describes the majority as 39 out of 48 studies, but the paper states that 49 trials were included in the meta-analysis. It does not explain why one included trial is absent from this count.

1 of 1

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Authors
Gee, B., Orchard, F., Clarke, E., Joy, A., Clarke, T., & Reynolds, S.
Affiliations
  • University of East Anglia (GB)
  • University of Reading (GB)
  • Norfolk and Suffolk NHS Foundation Trust (GB)
Corresponding author
Gee, Brioney
ORCID
Venue
Sleep Medicine Reviews
Publisher
Elsevier BV
Published
2019-02
Volume
43
Pages
118-128
ISSN
1087-0792 (ISSN-L)
DOI
10.1016/j.smrv.2018.09.004
OpenAlex
W2898866171
Semantic Scholar
435f778f6271d7e10ce668f9807a05a7a96041da
Cited by
212
References
112
Citations by year
2026: 25 · 2025: 28 · 2024: 33 · 2023: 30 · 2022: 42 · 2021: 29 · 2020: 18 · 2019: 7
FWCI
2.15
Type
journal article
Language
en
Open access
Licence
Locations
  • Sleep Medicine Reviews (publishedVersion)
  • PubMed (publishedVersion)
  • UEA Digital Repository (University of East Anglia) (acceptedVersion)
  • CentAUR (University of Reading) (submittedVersion)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
Keywords
non-pharmacological sleep intervention, depressive symptoms, sleep disorders, subjective sleep quality, depression treatment, mental illness
MeSH terms
Depression, Humans, Sleep Initiation and Maintenance Disorders, Sleep, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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