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

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 access

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.

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.

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Integrity signals

Registry

Crossref · 10.1016/j.smrv.2018.09.004

Cites

113 of 113 references verified0 citation errors · 0 not checkable

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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

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  • It may state two separate claims as one. 15
  • Probably not a substantial claim. 27
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.”
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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
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
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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