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. We 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.

Public Health Relevance

Co-occurring insomnia and depression is a highly prevalent mental health disorder. This combination is well represented in groups characterized by health disparities: rural, African-Americans. We propose an R34 exploratory project to test the feasibility of delivering high-fidelity insomnia and depression psychological services to these underserved populations.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Planning Grant (R34)
Project #
5R34MH086643-02
Application #
8196901
Study Section
Interventions Committee for Adult Disorders (ITVA)
Program Officer
Niederehe, George T
Project Start
2010-12-01
Project End
2013-11-30
Budget Start
2011-12-01
Budget End
2012-11-30
Support Year
2
Fiscal Year
2012
Total Cost
$208,881
Indirect Cost
$58,881
Name
University of Alabama in Tuscaloosa
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
045632635
City
Tuscaloosa
State
AL
Country
United States
Zip Code
35487
Lichstein, Kenneth L; Scogin, Forrest; Thomas, S Justin et al. (2013) Telehealth cognitive behavior therapy for co-occurring insomnia and depression symptoms in older adults. J Clin Psychol 69:1056-65
Geyer, James D; Lichstein, Kenneth L; Ruiter, Megan E et al. (2011) Sleep education for paradoxical insomnia. Behav Sleep Med 9:266-72
Scogin, Forrest; Morthland, Martin; Kaufman, Allan et al. (2011) Maintenance of quality of life improvements in diverse rural older adults. Psychol Aging 26:475-9