Who benefits from indirect prevention and treatment of depression using an online intervention for insomnia? Results from an individual-participant data meta-Analysis

Background. Major depressive disorder (MDD) is highly prevalent and burdensome for individuals and society. While there are psychological interventions able to prevent and treat MDD, uptake remains low. To overcome structural and attitudinal barriers, an indirect approach of using online insomnia interventions seems promising because insomnia is less stigmatized, predicts MDD onset, is often comorbid and can outlast MDD treatment. This individual-participant-data meta-Analysis evaluated the potential of the online insomnia intervention GET.ON Recovery as an indirect treatment to reduce depressive symptom severity (DSS) and potential MDD onset across a range of participant characteristics. Methods. Efficacy on depressive symptom outcomes was evaluated using multilevel regression models controlling for baseline severity. To identify potential effect moderators, clinical, sociodemographic, and work-related variables were investigated using univariable moderation and random-forest methodology before developing a multivariable decision tree. Results. IPD were obtained from four of seven eligible studies (N = 561); concentrating on workers with high work-stress. DSS was significantly lower in the intervention group both at post-Assessment (d =-0.71 [95% CI-0.92 to-0.51]) and at follow-up (d =-0.84 [95% CI-1.11 to-0.57]). In the subsample (n = 121) without potential MDD at baseline, there were no significant group differences in onset of potential MDD. Moderation analyses revealed that effects on DSS differed significantly across baseline severity groups with effect sizes between d =-0.48 and-0.87 (post) and d =-0.66 to-0.99 (follow-up), while no other sociodemographic, clinical, or work-related characteristics were significant moderators. Conclusions. An online insomnia intervention is a promising approach to effectively reduce DSS in a preventive and treatment setting.