Sleep quality and the biological stress system during an internet-based intervention for major depressive disorder
Introduction: Poor sleep quality is a persistent and debilitating symptom of major depressive disorder (MDD), with dysregulations in the biological stress system constituting a potential underlying physiological mechanism. Accordingly, a psychotherapeutic intervention may affect the interplay betwee...
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Elsevier
2025-11-01
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| Series: | Comprehensive Psychoneuroendocrinology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666497625000335 |
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| author | Sebastian Laufer Johannes Bohn Sinha Engel Hannah Klusmann Nadine Skoluda Urs M. Nater Christine Knaevelsrud Sarah Schumacher |
| author_facet | Sebastian Laufer Johannes Bohn Sinha Engel Hannah Klusmann Nadine Skoluda Urs M. Nater Christine Knaevelsrud Sarah Schumacher |
| author_sort | Sebastian Laufer |
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| description | Introduction: Poor sleep quality is a persistent and debilitating symptom of major depressive disorder (MDD), with dysregulations in the biological stress system constituting a potential underlying physiological mechanism. Accordingly, a psychotherapeutic intervention may affect the interplay between sleep quality, MDD and the biological stress system.We examined how basal cortisol, and alpha-amylase levels correspond to perceived sleep quality during an internet-based intervention for MDD. Furthermore, we investigated how changes in sleep quality during the intervention relate to changes in these biological stress system markers. We hypothesized that: 1) short-term and long-term sleep quality would improve during the intervention, 2a) across assessment time points, poor sleep quality would be associated with higher cortisol and alpha-amylase concentrations, and 2b) pre-to-post intervention improvements in sleep quality (treatment response) would be associated with pre-to-post decreases in both biological markers, compared to non-response. Methods: We analyzed forty-one participants (age: 35 ± 12y; females: 82.6 %) suffering from mild to moderate MDD. The cognitive behavioral internet-based intervention consisted of seven weekly writing-based modules with individualized feedback. Participants collected 12 saliva samples at home over two consecutive weekdays at pre-, mid-, and post-intervention. Outcome parameters of the cortisol and alpha-amylase diurnal profiles were the awakening responses, the total diurnal output, and the diurnal slopes. Self-reported sleep quality was retrospectively assessed for the night before (short-term) and for the two-week period preceding saliva collection (long-term). Treatment response was determined using the reliable change index of the pre-to-post, two-week sleep quality difference scores. Hypotheses 1 and 2a were tested using random intercept hierarchical linear models, Hypothesis 2b was tested using linear regressions with age, biological sex, BMI and medication use on the day of sampling as covariates. Results: Long-term sleep quality increased significantly from pre-to post-intervention (d = 0.78; p < 0.001), partially confirming Hypothesis 1. Contrary to the expected effect of Hypothesis 2a, poor long-term sleep quality at pre-intervention was associated with a blunted cortisol awakening response (CAR; p < 0.05). Post-hoc analyses showed an association of pre-to-post CAR changes and pre-intervention sleep quality (p < 0.01) indicating that individuals with higher pre-intervention sleep problems, on average, exhibited a pre-to-post increase in the CAR. The responder analyses showed that individuals with a marked pre-to-post sleep quality increase (i.e., responders) showed a higher increase in the CAR, compared to non-responders (p < 0.05), which again ran contrary to the effect proposed in Hypothesis 2b. Discussion: Prior to psychotherapeutic treatment MDD patients with poor sleep quality showed a blunted CAR, pointing to hypocortisolemia in these individuals. Furthermore, intervention-induced changes in sleep quality may lead to a normalization of the CAR. |
| format | Article |
| id | doaj-art-4523aa4378bf45acb9df526e69ea299c |
| institution | Kabale University |
| issn | 2666-4976 |
| language | English |
| publishDate | 2025-11-01 |
| publisher | Elsevier |
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| series | Comprehensive Psychoneuroendocrinology |
| spelling | doaj-art-4523aa4378bf45acb9df526e69ea299c2025-08-20T05:07:55ZengElsevierComprehensive Psychoneuroendocrinology2666-49762025-11-012410031410.1016/j.cpnec.2025.100314Sleep quality and the biological stress system during an internet-based intervention for major depressive disorderSebastian Laufer0Johannes Bohn1Sinha Engel2Hannah Klusmann3Nadine Skoluda4Urs M. Nater5Christine Knaevelsrud6Sarah Schumacher7Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany Schwendener Straße 27, 14195, Berlin, Germany; Clinical Psychology and Psychotherapy, Institute for Mental Health and Behavioral Medicine, Faculty of Health, HMU Health and Medical University, Olympischer Weg 1, 14471 Potsdam, Germany; Corresponding author. Health and Medical University Olympischer Weg 1 14471, Potsdam, Germany.Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany Schwendener Straße 27, 14195, Berlin, GermanyUniversity of Hildesheim, Institute for Psychology, Department of Experimental Psychopathology, Universitätsplatz 1, 31141 Hildesheim, GermanyClinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany Schwendener Straße 27, 14195, Berlin, GermanyDepartment of Clinical Psychology and Health Psychology, Faculty of Psychology, University of Vienna, Austria, Liebiggasse 5, 1010 Vienna, Austria; Research Platform the Stress of Life (SOLE) – Processes and Mechanisms Underlying Everyday Life Stress, AustriaDepartment of Clinical Psychology and Health Psychology, Faculty of Psychology, University of Vienna, Austria, Liebiggasse 5, 1010 Vienna, Austria; Research Platform the Stress of Life (SOLE) – Processes and Mechanisms Underlying Everyday Life Stress, AustriaClinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany Schwendener Straße 27, 14195, Berlin, GermanyClinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany Schwendener Straße 27, 14195, Berlin, Germany; Clinical Psychology and Psychotherapy, Institute for Mental Health and Behavioral Medicine, Faculty of Health, HMU Health and Medical University, Olympischer Weg 1, 14471 Potsdam, GermanyIntroduction: Poor sleep quality is a persistent and debilitating symptom of major depressive disorder (MDD), with dysregulations in the biological stress system constituting a potential underlying physiological mechanism. Accordingly, a psychotherapeutic intervention may affect the interplay between sleep quality, MDD and the biological stress system.We examined how basal cortisol, and alpha-amylase levels correspond to perceived sleep quality during an internet-based intervention for MDD. Furthermore, we investigated how changes in sleep quality during the intervention relate to changes in these biological stress system markers. We hypothesized that: 1) short-term and long-term sleep quality would improve during the intervention, 2a) across assessment time points, poor sleep quality would be associated with higher cortisol and alpha-amylase concentrations, and 2b) pre-to-post intervention improvements in sleep quality (treatment response) would be associated with pre-to-post decreases in both biological markers, compared to non-response. Methods: We analyzed forty-one participants (age: 35 ± 12y; females: 82.6 %) suffering from mild to moderate MDD. The cognitive behavioral internet-based intervention consisted of seven weekly writing-based modules with individualized feedback. Participants collected 12 saliva samples at home over two consecutive weekdays at pre-, mid-, and post-intervention. Outcome parameters of the cortisol and alpha-amylase diurnal profiles were the awakening responses, the total diurnal output, and the diurnal slopes. Self-reported sleep quality was retrospectively assessed for the night before (short-term) and for the two-week period preceding saliva collection (long-term). Treatment response was determined using the reliable change index of the pre-to-post, two-week sleep quality difference scores. Hypotheses 1 and 2a were tested using random intercept hierarchical linear models, Hypothesis 2b was tested using linear regressions with age, biological sex, BMI and medication use on the day of sampling as covariates. Results: Long-term sleep quality increased significantly from pre-to post-intervention (d = 0.78; p < 0.001), partially confirming Hypothesis 1. Contrary to the expected effect of Hypothesis 2a, poor long-term sleep quality at pre-intervention was associated with a blunted cortisol awakening response (CAR; p < 0.05). Post-hoc analyses showed an association of pre-to-post CAR changes and pre-intervention sleep quality (p < 0.01) indicating that individuals with higher pre-intervention sleep problems, on average, exhibited a pre-to-post increase in the CAR. The responder analyses showed that individuals with a marked pre-to-post sleep quality increase (i.e., responders) showed a higher increase in the CAR, compared to non-responders (p < 0.05), which again ran contrary to the effect proposed in Hypothesis 2b. Discussion: Prior to psychotherapeutic treatment MDD patients with poor sleep quality showed a blunted CAR, pointing to hypocortisolemia in these individuals. Furthermore, intervention-induced changes in sleep quality may lead to a normalization of the CAR.http://www.sciencedirect.com/science/article/pii/S2666497625000335Alpha-amylaseCortisolDepressionSleepInternet-based interventionPsychotherapy |
| spellingShingle | Sebastian Laufer Johannes Bohn Sinha Engel Hannah Klusmann Nadine Skoluda Urs M. Nater Christine Knaevelsrud Sarah Schumacher Sleep quality and the biological stress system during an internet-based intervention for major depressive disorder Comprehensive Psychoneuroendocrinology Alpha-amylase Cortisol Depression Sleep Internet-based intervention Psychotherapy |
| title | Sleep quality and the biological stress system during an internet-based intervention for major depressive disorder |
| title_full | Sleep quality and the biological stress system during an internet-based intervention for major depressive disorder |
| title_fullStr | Sleep quality and the biological stress system during an internet-based intervention for major depressive disorder |
| title_full_unstemmed | Sleep quality and the biological stress system during an internet-based intervention for major depressive disorder |
| title_short | Sleep quality and the biological stress system during an internet-based intervention for major depressive disorder |
| title_sort | sleep quality and the biological stress system during an internet based intervention for major depressive disorder |
| topic | Alpha-amylase Cortisol Depression Sleep Internet-based intervention Psychotherapy |
| url | http://www.sciencedirect.com/science/article/pii/S2666497625000335 |
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