Associate Professor Nick Glozier1
Professor Helen Christensen2
Professor Kathleen Griffiths3
Associate Professor Sharon Naismith4
1 Central Clinical School & Brain & Mind Research Institute
2 Black Dog Institute
3 Australian National University
4 University of Sydney
$391,364 – This project is funded through donation from the Movember Foundation
National Priority Driven Research Program
Project completion year
Men with symptoms of depression and anxiety, particularly in the oldest and youngest age groups, seek help far less than women for a given threshold or condition. Depression can be treated in this age group, with similar effects seen from medication and psychotherapy interventions, and recent studies have demonstrated that collaborative approaches can be more successful. Multimodal approaches selecting participants likely to do less well with standard interventions can be an important element, particularly if accessible and compatible.
Insomnia symptoms are commonly recognised and a major source of help-seeking in primary care with less of a gender difference. Insomnia is seen as a less stigmatising disorder than depression. Recently, an accessible internet-based intervention for insomnia has been shown to work effectively in both genders and lead to a significant reduction in depressive and anxious symptoms compared to wait list controls.
This project will test this intervention in a pilot randomised controlled trial (RCT) evaluating adjunctive insomnia treatment in older men with depression and insomnia symptoms.
It is a pilot randomised controlled trial of 80 men aged 50+ who will be recruited from the Brain & Mind Research Institute (BMRI) clinics, primary care, and male focussed community settings and invited to undertake internet-based screening. Those reporting distressing levels of depression and insomnia symptoms will be invited to a clinical assessment and information session, and informed consent will be gained. The blinded clinician will use Beyond Blue guideline approaches to managing the depressive anxious symptoms in collaboration with the GP and/or referral on for psychotherapy.
Participants will be randomised to a nine-week, internet -based CBTi program treating insomnia (SHUTi) or a nine-week, known credible but ineffective health promotion control program (Healthwatch). Sleep, mental health, cognitive function and usage parameters will be assessed at baseline, post intervention and six months either within the program or by blinded researchers. A focus will be on the requirements for support during this intervention, process and adherence evaluation of the intervention.
Anticipated practical outcomes, community benefits
The outcomes of this trial will be readily applicable for translation into health care and include:
- the demonstration of the effect (or not) of a scalable adjunctive insomnia based intervention for older men with depression and insomnia problems
- the evaluation of the impact of this adjunctive treatment upon anxiety, sleep parameters, cognition and disability.
- identification of processes and or specific target groups that may require refining of the program.
- adherence and persistence issues with the program with respect to the target group.
- identification of any harmful effects of such an adjunct.
By utilising the Beyond Blue guidelines for all participants within the control group, the impact of treatment of older men under these guidelines will also be evaluated.
Finally, the study provides the required information to determine whether and how to conduct a definitive RCT. Many interventions, particularly if they have minimal likelihood of harm, were often adopted prior to definitive RCTs, e.g. certain alcohol reduction and out benefit/harm approach will inform this recommendation.