The DOI matches its Crossref record; 113 of the 113 references it cites were found in a registry or an index; none of the 23 sources its claims cite is checked for support yet.
The effect of non-pharmacological sleep interventions on depression symptoms: A meta-analysis of randomised controlled trials
Open accessAbstract
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.
Overview
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.
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Claims the paper makes
32 Own result · 16 Not checked yet · 14 Own method · 13 Own interpretation · 6 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Effect on subjective sleep quality
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Effect on subjective sleep quality · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Abstract
plaindirectn = 5,908- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It was smallest in trials that used the BDI-II (-0.12, 95% CIs -0.36, 0.13, p=0.34).”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Depression measure
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Comorbid mental health difficulties · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The standardised mean difference was largest for trials that measured depression using the PHQ-9 (-0.70, 95% CI -1.00, -0.41, p<0.001), followed by the BDI (-0.56, 95% CI -0.76, -0.36, p<0.001), the CESD (-0.45 95% CIs -0.67, -0.24, p<0.001), and the HADS (-0.34, 95% CIs -0.57, -0.11, p=0.003).”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Depression measure
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In comparison, the subgroup of studies that recruited participants without clinical mental health difficulties (k=42) found a small effect on depression symptoms (standardised mean difference = -0.41,95% CI -0.51, -0.31, p<0.001) and these effect sizes were more heterogeneous (I 2 =56%, χ 2 =93.45, df=41, p<0.001).”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Comorbid mental health difficulties
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was a positive linear relationship between the standardised mean difference of the sleep interventions on depression symptoms and the standardised mean difference for subjective sleep quality.”
- Also stated in: § RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS · boosted
“There was a strong association between the change in subjective sleep quality brought about by an intervention and its effect on depression symptoms.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Effect on subjective sleep quality
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS · boosted
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The statistical heterogeneity in effect sizes among studies was moderate (I 2 =56%, χ 2 =108.8,df=48, p<0.001).”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The standardised mean difference was largest for trials that measured depression using the PHQ-9 (-0.70, 95% CI -1.00, -0.41, p<0.001), followed by the BDI (-0.56, 95% CI -0.76, -0.36, p<0.001), the CESD (-0.45 95% CIs -0.67, -0.24, p<0.001), and the HADS (-0.34, 95% CIs -0.57, -0.11, p=0.003).”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Depression measure
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 15
- Probably not a substantial claim. 27
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Rosenthal's failsafe N was 3593.46,indicating that 3593 studies with zero effect sizes would be needed to nullify the pooled effect.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Publication bias
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Adolescents, adults and older adults
plainn = 3 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Adolescents, adults and older adults
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Adolescents, adults and older adults
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Publication bias
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > M A N U S C R I P T A C C E P T E D
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The included trials were all of psychological interventions.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > M A N U S C R I P T A C C E P T E D
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > M A N U S C R I P T A C C E P T E D
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The remaining trials were of face-to-face interventions, 27 delivered individually and five delivered in a group format.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > M A N U S C R I P T A C C E P T E D
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most participants were adults; only four studies included young people aged under 18 (n=292) and none included children under 11 years.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > M A N U S C R I P T A C C E P T E D
plainn = 5,908- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The remaining trials were of face-to-face interventions, 27 delivered individually and five delivered in a group format.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > M A N U S C R I P T A C C E P T E D
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The remaining trials were of face-to-face interventions, 27 delivered individually and five delivered in a group format.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > M A N U S C R I P T A C C E P T E D
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The meta-analysis included data on 5908 participants, of whom 2731 were randomised to receive the trial sleep intervention.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > M A N U S C R I P T A C C E P T E D
plainn = 5,908- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Additional information
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most participants were adults; only four studies included young people aged under 18 (n=292) and none included children under 11 years.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > M A N U S C R I P T A C C E P T E D
plainn = 4- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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 Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > M A N U S C R I P T A C C E P T E D
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most participants were adults; only four studies included young people aged under 18 (n=292) and none included children under 11 years.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > M A N U S C R I P T A C C E P T E D
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Sixteen studies trialled interventions delivered in a self-help format, online or via a mobile application.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > M A N U S C R I P T A C C E P T E D
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Abstract
plaindirectn = 5,908- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Also stated in: § Discussion · plain
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Discussion
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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].”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS 6
What the sources say
- Not checked yetcites [35] Morgenthaler, 2006, Practice parameters for the psychological and behavioral treatment of insomnia: an update. An american academy of sleep medicine report, Sleep source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Study selection
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > A C C E P T E D
What the sources say
- Not checked yetcites [39] Cunningham, 2018, Cognitive Behavioural Therapy for Insomnia (CBT-I) to treat depression: a systematic review, J Psychosom Res source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Also, we focused on outcomes immediately postintervention so are unable to comment on the longevity of the effects on depression observed.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, sleep problems are usually not a direct target of interventions for depression.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Study selection
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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 Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Conclusions
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Limitations
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The review was conducted in accordance with guidance in the 'preferred reporting items for systematic reviews and meta-analyses' (PRISMA) statement [44].”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Search strategy
What the sources say
- Not checked yetcites [44] Moher, 2009, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, PLoS Med source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS 6
What the sources say
- Not checked yetcites [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 yetcites [37] Koffel, 2015, A meta-analysis of group cognitive behavioral therapy for insomnia, Sleep Med Rev source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Data extraction and quality assessment
What the sources say
- Not checked yetcites [45] Higgins, 2008
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Data were extracted independently by two reviewers (BG and EC) and cross-checked to ensure accuracy.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Data extraction and quality assessment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Limitations
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > RUNNING HEAD: EFFECT OF NON-PHARMACOLOGICAL SLEEP INTERVENTIONS ON DEPRESSION SYMPTOMS 6
What the sources say
- Not checked yetcites [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
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Risk of bias
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“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].”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > A C C E P T E D
What the sources say
- Not checked yetcites [43] Mulder, 2017, Common versus specific factors in psychotherapy: opening the black box, Lancet Psychiatr source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Search strategy
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Additional information
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- 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.
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.”
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ The Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > M A N U S C R I P T A C C E P T E D
“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 Effect of Non-Pharmacological Sleep Interventions on Depression Symptoms: A Meta-Analysis of Randomised Controlled Trials > Characteristics of included studies
“Characteristics of the 49 trials included in the meta-analysis are summarised in Table 1”
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Insomnia disorder: State of the science and challenges for the future
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“…(Baglioni et al., 2016), and we also know that paying proper therapeutic respect to including insomnia-related components into the overall therapeutic concept will improve outcomes in general and speed up the therapeutic process (Gee et al., 2019; Hertenstein et al., 2022; Manber et al., 2008).”
Background
Metadata
- 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
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2019-02
- Volume
- 43
- Pages
- 118-128
- ISSN
- 1087-0792 (ISSN-L)
- 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
- green
- ueaeprints.uea.ac.uk
- 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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