Emerging evidence indicates that insomnia significantly contributes to depression, highlighting the potential of insomnia interventions in the prevention of depression in youth.¹ A pioneering study conducted by The Chinese University of Hong Kong (CUHK) and Peking University (PKU) Sixth Hospital found that an app-based cognitive behavioral therapy for insomnia (CBT-I) reduced the risk of major depressive disorder (MDD) in young individuals.¹ This first-of-its-kind research in Asia reported a 52% remission rate for insomnia and a 42% reduction in MDD incidence among participants using digital CBT-I compared to the control group.¹ These findings support app-based CBT-I as an effective strategy for addressing depression in youth.¹

Youth depression is a persistent and recurrent condition that can have long-term consequences, impacting various aspects of life.² It is linked to negative outcomes such as academic and social impairments, poor health, and an increased risk of suicide, highlighting the need for effective prevention strategies.² Recognizing insomnia as a significant risk factor for depression, researchers from CUHK and PKU sought to explore whether an app-based CBT-I could help prevent MDD in young individuals with insomnia.^1,3

The randomized controlled trial included 708 Chinese youths aged 15-25 with insomnia disorder and subclinical depression, with university students comprising 90% of the participants.¹ The participants were randomized 1:1 into the digital CBT-I intervention group (n=354) and the control group with app-based health education  (n=354).¹ The app-based CBT-I program, delivered through smartphones, is a structured, self-paced, and interactive intervention that includes six sequential modules based on established CBT-I treatment protocols.¹

Over the 12-month follow-up, only 10% of participants in the CBT-I group developed new-onset MDD, compared to 18% in the control group (HR=0.58; 95% CI: 0.38-0.87; p=0.008).¹ Additionally, participants in the app-based CBT-I group had significantly higher insomnia remission rates than the control group (52% vs. 28%; RR=1.83 [95% CI: 1.49-2.24]; p<0.001).¹ Among participants in the CBT-I group, 94% completed at least 1 session, and 85% completed six sessions of the program.¹ There were no reported adverse events associated with the interventions.¹ Mediation analyses revealed that improvements in insomnia symptoms accounted for 74%-78% of the intervention's effect in reducing depressive symptoms, indicating that the impact on depression was primarily driven by insomnia relief.¹

The success of this study paves the way for further exploration of digital mental health tools as Professor Wing, Yun-Kwok, Choh-Ming Li Professor of Psychiatry, Chairman of the Department of Psychiatry at CU Medicine, and Director of the Li Chiu Kong Family Sleep Assessment Unit remarked: “These findings highlight the importance of developing digital mental health therapeutics to meet the significant clinical demand, the pivotal role of prevention and early intervention in reducing the burden of youth depression, and the need for evidence-based digital mental health interventions. Future studies should explore how to integrate digital insomnia interventions into clinical practice, particularly in primary care, and examine how to adapt this novel treatment to advance the field toward personalized prevention and early intervention in the community.”

In conclusion, the findings from CUHK and PKU underscore the importance of targeting insomnia for MDD prevention and demonstrate the effectiveness of digital CBT-I in lowering the likelihood of depression onset at both symptom and disorder levels.¹ The intervention also alleviated daytime fatigue and promoted morningness, enhancing overall well-being.¹ Given that young individuals are more inclined to engage with digital health solutions, app-based CBT-I offers a viable alternative to traditional therapy, encouraging help-seeking behavior among youth.^1,4 Ongoing research will be key to its integration into clinical settings and to expand its accessibility.¹