CBT-I for prevention and early intervention in mental disturbances: A systematic review and meta-analysis

Insomnia is well-known to be both a risk factor and a prodrome for psychiatric disorders, including mood, anxiety and psychotic disorders, as well as for suicide risk. In this framework, targeting insomnia may constitute a preventive strategy or an early intervention against the development or the recurrence of psychiatric disorders. Cognitive behavioral therapy for insomnia (CBT-I) is considered the first line treatment for chronic insomnia, even when comorbid with psychiatric disorders. Accordingly, the present work aimed at systematically reviewing available data on the effects of CBT-I for prevention or early intervention of psychiatric disorders.

The available data on the effect of CBT-I on insomnia and mental health prevention/early intervention were systematically reviewed. We conducted a systematic search on PubMed, Scopus, Psychinfo electronic databases for English literature, published until March 2024, according to PRISMA Guidelines.

From the literature systematic search, 83 articles were eligible, and, at end, 11 studies were retained. Seven randomized controlled-trials examined the effects of CBT-I for the prevention of depressive symptoms, 1 for anxiety disorder, 1 for psychotic disorders, and 4 for suicidal risk. Results of meta-analyses on depressive symptoms showed that CBT-I for insomnia was effective in reducing depressive (z = -6.8466, p < 0.0001; RE Model = -0.5168 (95 % CI: 0.6648 to -0.3689); k = 6), and insomnia symptoms as well (z = -3.7126, p = 0.0002; RE Model = -0.8074 (95 % CI: 1.2336 to -0.3811); k = 5). Studies indicated some heterogeneities among them that may limit interpretations, with the impossibility of meta-analyzing suicidal, anxiety, and psychotic symptoms.

Currently data support the hypothesis that targeting insomnia with CBT-I may represent an early effective intervention in mental disorders, especially mood disorders.