Treatment of Insomnia and Depression in Elders (TIDE) (TIDE)
Insomnia and depression are two of the most prevalent mental health disorders and often co-occur.
Health disparities in rural America and among African-Americans are well documented. The investigators propose an R34 exploratory project to test the feasibility of delivering high-fidelity insomnia and depression psychological services to an underserved population. Treatment of Insomnia and Depression in Elders (TIDE) is a pilot study that will treat rural, predominantly African-American older adults who present to their primary care physician with co-occurring insomnia/depression. Stage 1 will be an uncontrolled case study series (n = 10) focusing on treatment development/refinement and patient acceptability. In stage 2, feasibility will be experimentally tested with 46 participants randomized to integrated cognitive-behavior therapy (CBT) + usual care or to usual care only in an effectiveness pilot study. The treatment will combine/integrate compact CBT for insomnia (including relaxation, sleep restriction, and stimulus control) and for depression (including cognitive therapy and behavioral activation). The experimental intervention comprises delivering CBT services by videoconferencing to patients in primary care settings who live in rural areas. Treatment will be evaluated by pre, post, and follow-up self report instruments on insomnia, depression, and quality of life. In addition, the stage 1 pilot will use investigator designed quantitative and qualitative measures to evaluate critical process variables including patient acceptability of the video format, patient acceptability of the treatments, and obstacles to adherence. Depending on stage 1 data, these measures may be incorporated into stage 2 as well. Several innovative features of this exploratory project include: intervening with CBT on both disorders hoping to gain a synergy by their combined presentation; use of telehealth to deliver treatment to distant locations; translation of efficacy findings to an effectiveness trial; treatment will be delivered in the primary care setting, the preferred locale of rural, older adults; the study will extend knowledge of the range of CBT applications by enrolling under-represented groups with respect to ethnicity, literacy, and financial resources.
The primary aims of this project are (1) to determine the feasibility and maximal therapy characteristics of integrated CBT for co-occurring insomnia/depression in both the case study series (stage 1) and the experimental investigation (stage 2), (2) collect pilot data on whether participants receiving integrated CBT + usual care show comparable or greater reductions in insomnia symptoms compared to participants receiving usual care at posttreatment and follow-up, and (3) collect pilot data on whether participants receiving integrated CBT + usual care show comparable or greater reductions in depression symptoms compared to participants receiving usual care at posttreatment and follow-up.
調査の概要
研究の種類
入学 (予想される)
段階
- 適用できない
連絡先と場所
研究場所
-
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Alabama
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Tuscaloosa、Alabama、アメリカ、35487
- UATuscaloosa
-
-
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- 50 years of age or older,
- resident of the Black Belt or adjacent counties and receiving services from one of our primary care collaborators
- absence of significant cognitive impairment as indicated by a score of 24 or higher (17 or higher for those with only an eighth grade education) on the Mini-Mental Status Examination (MMSE; Folstein, Folstein, & McHugh, 1975
- not currently receiving psychological treatment,
- absence of serious suicidality
- concurrent psychiatric/medical disorders are not automatic disqualifiers unless they prevent participants from attending CBT therapy sessions or impede data collection,
- a referral from their primary care physician indicating presence of both insomnia and depression symptoms of sufficient significance to warrant initiation or continuance of primary care treatment for newly emergent or residual symptoms. Persons who are currently receiving pharmacotherapy for insomnia and/or depression must evidence residual symptoms of both disorders of sufficient magnitude to be evaluated as clinically significant and warranting further treatment by their primary care physician.
Exclusion Criteria:
- age is below 50
- not receiving services from one of our primary care collaborators
- significant cognitive impairment is present as indicated by a score of 23 or lower (16 or lower for those with only an eighth grade education) on the MMSE
- currently receiving psychological treatment
- presence of serious suicidality
- intrusive and unstable concurrent psychiatric/medical disorders
- primary care physician declines to refer
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
---|---|
実験的:CBT
Cognitive behavior therapy for both insomnia and depression featuring stimulus control and cognitive therapy.
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CBT treatment is an abbreviated protocol based on manualized, evidence-based treatments for geriatric insomnia (Lichstein & Morin, 2000) and geriatric depression (Thompson, Gallagher-Thompson, & Dick, 1995).
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アクティブコンパレータ:Treatment as Usual
No additional treatment besides regular care.
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Standard Care - Treatment as usual
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Insomnia Severity Index
時間枠:3-month follow-up (23weeks post-treatment)
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Insomnia Measure
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3-month follow-up (23weeks post-treatment)
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Hamilton Depression Scale
時間枠:10 weeks Post-treatment
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Depression measure
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10 weeks Post-treatment
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Hamilton Depression Scale
時間枠:3 Month follow-up (23 weeks post treatment)
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Depression Measure
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3 Month follow-up (23 weeks post treatment)
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Insomnia Severity Index
時間枠:10 weeks Post-treatment
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Insomnia Measure
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10 weeks Post-treatment
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
GDS
時間枠:Pre-Treatment (Baseline/Week 0)
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Self-reported Geriatric Depression Scale
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Pre-Treatment (Baseline/Week 0)
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SOL
時間枠:Pre-Treatment (Baseline/Week 0)
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self-reported Sleep Onset Latency
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Pre-Treatment (Baseline/Week 0)
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WASO
時間枠:Pre-Treatment (Baseline/Week 0)
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Wake-time After Sleep Onset
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Pre-Treatment (Baseline/Week 0)
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SOL
時間枠:10 weeks Post-treatment
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Self-reported Sleep onset latency
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10 weeks Post-treatment
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SOL
時間枠:3-month follow-up (23weeks post-treatment)
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Self-reported Sleep onset latency
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3-month follow-up (23weeks post-treatment)
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GDS
時間枠:10 weeks Post-treatment
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Self Reported Geriatric Depression Scale
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10 weeks Post-treatment
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GDS
時間枠:3-month follow-up (23weeks post-treatment)
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Self-reported Geriatric Depression Scale
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3-month follow-up (23weeks post-treatment)
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WASO
時間枠:10 weeks Post-treatment
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Wake-time After Sleep Onset
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10 weeks Post-treatment
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WASO
時間枠:3-month follow-up (23weeks post-treatment)
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Wake-time After Sleep Onset
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3-month follow-up (23weeks post-treatment)
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協力者と研究者
捜査官
- 主任研究者:Kenneth L. Lichstein, Ph.D.、University of Alabama, Tuscaloosa
- 主任研究者:Forrest Scogin, Ph.D.、University of Alabama, Tuscaloosa
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (見積もり)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
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