Longitudinal Course of Depression Scores with and without Insomnia in Non-Depressed Individuals: A 6-Year Follow-Up Longitudinal Study in a Korean Cohort

Stanford University, Department of Psychiatry
Sleep (Impact Factor: 4.59). 03/2013; 36(3):369-76. DOI: 10.5665/sleep.2452
Source: PubMed


This is a population-based longitudinal study that followed insomnia symptoms over a 6-year period in non-depressed individuals. The purpose of the study was to (1) investigate the longitudinal course of depression based on number of insomnia episodes; and (2) describe longitudinal associations between insomnia and depression, and insomnia and suicidal ideation.
Population-based longitudinal study.
Community-based sample from the Korean Genome and Epidemiology Study (KoGES).
1,282 non-depressed individuals (44% male, mean age 52.3 ± 7.14 years).
This study prospectively assessed insomnia, depression, and suicidal ideation with 4 time points. Individuals were classified into no insomnia (NI), single episode insomnia (SEI), and persistent insomnia (PI; ≥ insomnia at 2+ time points) groups based on number of times insomnia was indicated. Mixed effects modeling indicated that depression scores increased significantly faster in the PI group compared to the NI (P < 0.001) and SEI (P = 0.02) groups. Additionally, the PI group had significantly increased odds of depression as compared to NI or SEI (OR 2.44, P = 0.001) groups, with 18.7% meeting criteria for depression compared to the NI (5.3%) and SEI (11.6%) groups at end point. The PI group also had significantly increased odds of suicidal ideation as compared to NI or SEI (OR 1.86, P = 0.002) groups.
Persistent insomnia significantly increases the rate in which depression occurs over time in non-depressed individuals, which ultimately leads to higher risk for depression. Additionally, having persistent insomnia also increased the risk of suicidal ideation. CITATION: Suh S; Kim H; Yang HC; Cho ER; Lee SK; Shin C. Longitudinal course of depression scores with and without insomnia in non-depressed individuals: a 6-year follow-up longitudinal study in a Korean cohort. 2013;36(3):369-376.

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    • "In the present study , we also showed that the odds of incident depression increase as poor sleep or insomnia persist or worsen over time , which is consistent with the findings of previous studies ( Buysse et al . , 2008 ; Okajima et al . , 2012 ; Suh et al . , 2013 ; Zhang et al . , 2012 ) . We have previously shown that objective short sleep duration and mental health problems predict the persistence of insomnia as well as who amongst poor sleepers worsen into insomnia , whereas physical health problems predict who amongst normal sleepers evolve into insomnia ( Fernandez - Mendoza et al . , 2012b"
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    ABSTRACT: Longitudinal studies that have examined the association of insomnia with incident depression using objective sleep measures are very limited. The aim of this study was to examine the predictive role of the severity of insomnia for incident depression in a general population sample using psychometric and polysomnographic data. From a random, general population sample of 1741 individuals of the Penn State Adult Cohort, 1137 adults without depression were followed up with a structured telephone interview after 7.5 years. All subjects completed a full medical evaluation, 1-night polysomnogram and Multiphasic Minnesota Personality Inventory at baseline. The incidence of depression was 15%. Poor sleep (odds ratio = 1.5, P = 0.001) and insomnia (odds ratio = 1.9, P = 0.031) were significantly associated with incident depression. The odds of incident depression were highest (odds ratio = 2.2, P = 0.019) in insomnia with objective short sleep duration and independent of Multiphasic Minnesota Personality Inventory Ego Strength scores, an index of poor coping resources. The persistence of insomnia and worsening of poor sleep into insomnia significantly increased the odds of incident depression (odds ratios ranged from 1.8 to 6.3), whereas their full remission did not (odds ratio ranged from 1.2 to 1.8). Insomnia with short sleep duration is associated with incident depression independent of poor coping resources, whereas the association of insomnia with normal sleep duration with incident depression was mediated by poor coping resources. Persistence and worsening of poor sleep or insomnia, but not their full remission, are significant predictors of incident depression. These data suggest that there is a significant relationship between the severity of insomnia and incident depression. © 2015 European Sleep Research Society.
    Full-text · Article · Feb 2015 · Journal of Sleep Research
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    • "In a cross-sectional study, Grandner et al. (2012 [2]) reported that poor general health incurred a fivefold increase in risk for sleep disturbance , whereas moderate to severe depressed mood was associated with ORs of 13.0 and 16.0 in risk for sleep disturbance in women and men, respectively, in adjusted models. In a longitudinal investigation based on the Korean Genome and Epidemiology study (KoGES) of nondepressed adults at baseline, the course of depression over four time points was significantly more elevated in those with persistent insomnia than in those with a single insomnia episode or no insomnia [34]. In a subsequent study using the same database and following insomnia trajectories over three time points, persistent insomnia was best predicted by poor sleep quality, sleep-interfering behaviors, and mental impairment [35]. "
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    ABSTRACT: Objectives/Background: We assessed prevalence and correlates of insomnia; associations between changes in insomnia with incidence of physical, emotional, and mixed impairments (PI, EI, and MI, respectively); and age as a moderator in these relationships. Participants/Methods: TheWomen’s Health Initiative (WHI) clinical trial (CT) and observational study (OS) cohorts with 1- and 3-year follow-ups, respectively, were studied. Participants included 39,864 CT and 53,668 OS postmenopausal women free of PI or EI at baseline. Insomnia Rating Scale (IRS), with a cutoff score of ≥9 indicated insomnia. Normal–Normal, Abnormal–Abnormal, Normal–Abnormal, and Abnormal– Normal categories indicated change in insomnia over time. PI, EI, and MI were constructed using Short Form-36 (SF-36) Physical and Emotional subscales (cutoff ≤60) and the modified Center for Epidemiological Studies Depression scale (cutoff ≤0.06). Results: Among 93,532 women, 24.5% had insomnia at baseline. The highest odds ratios (ORs) for impairments were found in the Normal–Abnormal and Abnormal–Abnormal categories. In the CT cohort, Normal–Abnormal category, ORs were 1.86 (95% CI = 1.57–2.20) for PI, 4.11 (95% CI = 3.59–4.72) for EI, and 6.37 (95% CI = 4.65–8.74) for MI. Respective ORs for the OS cohort were 1.70 (95% CI = 1.51–1.89), 3.80 (95% CI = 3.39–4.25), and 4.41 (95% CI = 3.56–5.46). Interactions between changes in insomnia and age showed distinct albeit nonsignificant patterns. Conclusions: The results suggest that exposure to insomnia increases vulnerability to impairment. Future studies are needed to understand the directionality of these relationships.
    Full-text · Article · Jan 2015 · Sleep Medicine
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    • "However, considering that most insomnia symptoms persist over one year, our study is based on the assumption that our 2-year interval for each time point accurately reflects the natural history of insomnia. This is evident when comparing the longitudinal course of insomnia from our sample to Western samples [5] [25]. It is also worth noting that a major limitation to this study is that we were not able to evaluate the presence of obstructive sleep apnea, narcolepsy, or other common sleep disorders. "
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    ABSTRACT: The present study utilized a population-based sample investigating the following aims: (1) compare the longitudinal course of insomnia in middle-aged and older adults and (2) examine age-related differences on subjective complaint and objective performance in middle-aged and older adults based on the course of insomnia. 1657 middle-aged adults (48.16% male, mean age=55.35±4.03years) and 405 older adults (48.40% male, mean age=70.13±3.88years) from the Korean Genome and Epidemiology Study (KoGES) were classified into 4 groups - no insomnia (NI), single episode insomnia (SEI), remitted persistent insomnia (PI-R), and ongoing persistent insomnia (PI-O) based on their course of insomnia over 5 time points spaced two years apart. Their performance on the psychomotor vigilance task (PVT) and subjective daytime sleepiness were compared across different insomnia groups, and the results were compared between middle-aged adults and older adults. Analysis of covariance indicated that subjective daytime sleepiness was significantly different across the insomnia groups in middle-aged adults based on insomnia group (P=<.0001), but, did not affect objective vigilance performance. In contrast, older adults displayed significantly different PVT response time, but not daytime sleepiness, based on insomnia group (P=0.03). Insomnia impacts psychomotor performance and subjective sleepiness differently, based on age group. There may be underlying processes associated with the aging that amplifies the impact of insomnia on vigilance performance, yet lessens perceived sleepiness in older adults.
    Full-text · Article · Dec 2013 · Journal of psychosomatic research
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