To the Editor The study by Irwin et al1 found that cognitive behavioral therapy for insomnia (CBT-I) had an overall benefit in the prevention of incident and recurrent major depression compared with sleep education therapy (SET) in older adults with insomnia disorder. The authors used a predefined analysis to compare treatment groups as a function of sustained remission of insomnia disorder to test the superiority of CBT-I over SET in remission of insomnia disorder. We suggested that mediation analysis might be used to clarify the role of insomnia remission in the association between CBT-I and SET and the prevention of depression.
Lin Y, Lin S, Chen I. The Direct Effect of Cognitive Behavioral Therapy for Insomnia on Depression Prevention and the Mediation Effect via Insomnia Remission. JAMA Psychiatry. 2022;79(5):514–515. doi:10.1001/jamapsychiatry.2022.0149
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