By easing insomnia, emotional support apps also prevent depression
A challenge when quantifying mental health is that disorders often straddle multiple diagnoses. Insomnia has been identified as the second most common mental disorder in the EU, ranked between anxiety disorders and major depression. That study also found that less than one third of cases received treatment, suggesting a significant level of unmet need. Insomnia presents a primary epidemiological risk factor for other mental health problems. The odds of developing depression are doubled among those with sleep issues. Yet, the underlying mechanisms remain understudied. “Fortunately, not everyone with insomnia develops other mental health problems. By detecting the differences between those who do and those who don’t, we can identify those most at risk and prioritise them for preventive treatments,” explains Eus J. W. van Someren of the Netherlands Institute of Neuroscience and project coordinator of the INSOMNIA project.
Comparing restless sleepers
The project started by using big data assessed through an online citizen science platform to improve our understanding of insomnia. Profiles of insomniacs with an increased lifetime risk of depression were identified using latent class analysis. The team is now comparing high- and low-risk insomniacs on multiple measures of brain structure and function to identify underlying factors. Focusing on high-risk insomniacs, the team is also working to determine whether these combined measures could predict who would be most likely to develop depressive symptoms within a year. They expect to have results this autumn, but preliminary findings point to the involvement of the emotion regulation circuits of the brain rather than the sleep-regulating systems, as would be expected. If confirmed, this finding promises to finally reveal why insomnia is the primary risk factor for developing depression and other mental health problems, notably anxiety disorders and post-traumatic stress disorder.
Preventive measures
The INSOMNIA project also evaluated whether internet-supported home insomnia interventions were able to improve sleep and prevent depression. These were guided by trained psychologists and included several cognitive, behavioural and light exposure modules. “This approach greatly increased compliance compared to automated digital interventions. The combination of several online modules was found to be especially effective in preventing depressive symptoms in the 132 participants, at least for a year,” adds van Someren. Being able to identify people with a high risk of depression and prioritise them for preventive interventions benefits not only the individuals concerned, but also stretched mental health services. As well as developing a pioneering methodology for finding those vulnerable members of society, INSOMNIA’s preventive internet-based intervention can be scaled up for large populations. “While we are still scrutinising the data for further insights, which could change perspectives on how we best support mental health, the findings so far have already laid the groundwork for a more extensive array of innovative interventions to enhance overnight emotion regulation,” says van Someren.
Keywords
INSOMNIA, depression, mental health, sleep, emotion regulation, brain, anxiety