Prevalence, course, and comorbidity of insomnia and depression in young adults. Sleep

Department ofPsychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Sleep (Impact Factor: 4.59). 05/2008; 31(4):473-80. DOI: 10.5167/uzh-10110
Source: PubMed


(1) To describe the prevalence and prospective course of insomnia in a representative young-adult sample and (2) to describe the cross-sectional and longitudinal associations between insomnia and depression.
Longitudinal cohort study.
Community of Zurich, Switzerland.
Representative stratified population sample.
The Zurich Study prospectively assessed psychiatric, physical, and sleep symptoms in a community sample of young adults (n=591) with 6 interviews spanning 20 years. We distinguished 4 duration-based subtypes of insomnia: 1-month insomnia associated with significant distress, 2- to 3-week insomnia, recurrent brief insomnia, and occasional brief insomnia. The annual prevalence of 1-month insomnia increased gradually over time, with a cumulative prevalence rate of 20% and a greater than 2-fold risk among women. In 40% of subjects, insomnia developed into more chronic forms over time. Insomnia either with or without comorbid depression was highly stable over time. Insomnia lasting 2 weeks or longer predicted major depressive episodes and major depressive disorder at subsequent interviews; 17% to 50% of subjects with insomnia lasting 2 weeks or longer developed a major depressive episode in a later interview. "Pure" insomnia and "pure" depression were not longitudinally related to each other, whereas insomnia comorbid with depression was longitudinally related to both.
This longitudinal study confirms the persistent nature of insomnia and the increased risk of subsequent depression among individuals with insomnia. The data support a spectrum of insomnia (defined by duration and frequency) comorbid with, rather than secondary to, depression.

Download full-text


Available from: Wulf Rössler
  • Source
    • "It has been noted that restricted sleep affects various physiological parameters including metabolic hormones and neuroinflammatory markers (Banks & Dinges 2007). SD thus hastens neuroinflammation and, subsequently, neurodegenerative processes (Buysse et al. 2008;Germain et al. 2008;Roane & Taylor 2008).Ikegami et al. (2010)reported that recovery sleep restores brain antioxidant balance and ameliorates the adverse effects of SD. The aim of this study was to test the hypothesis that chronically insufficient sleep sensitizes the brain to neurodegenerative processes, leading to cell death in specific brain regions, while rehabilitation or recovery sleep after SD ameliorates the neurodegenerative changes in the brain. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Neurodegenerative changes following sleep deprivation (SD) result in debilitating behavioral and cognitive dysfunction. SD causes gradual cognitive impairment and later results in neurodegeneration. These changes are thought to be the consequences of cellular disorganization and degeneration in selected brain areas – the hippocampus, prefrontal cortex, amygdala, and hypothalamus. We investigated the histological changes in mice exposed to 6 days SD and to the effects of 2 days of recovery sleep in the brain regions listed above. Cytological changes, total viable cell count in hippocampal subregions, Bcl-2 expression, and degenerative changes like cell morphology and membrane integrity of neurons were evaluated. Results demonstrated that prolonged SD decreased the count of viable and healthy cells and caused a decrease in Bcl-2 positive cells and an increase in degenerated cells with pyknotic morphology, chromatolysis and darkly stained cytoplasm. Degenerative changes were ameliorated by 2 days of recovery sleep or rehabilitation after SD. Data suggest that chronic SD constitutes a severe threat to the brain and leads to neurodegeneration, while rehabilitation or recovery sleep ameliorates or protects the brain from neurodegenerative challenges.
    Full-text · Article · Jan 2016 · Biological Rhythm Research
    • "[24] This study has also shown that subjects of insomnia with or without depression did not differ with reference to the dysfunctional beliefs and presleep cognitive themes, confirming the results of earlier studies which have shown that cognitive processes did not differ across insomnia groups. [10,11,25] Thus, with the available recent evidences, insomnia should be considered as a co‑morbid illness with psychiatric and medical disorders, rather than a symptom or residue of depression and should be energetically treated. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Presleep thoughts may vary between patients of insomnia with or without depression. They are important for cognitive behavior therapy for insomnia (CBT‑I), but they have never been systemically examined in Indian population. Materials and Methods: Patients with insomnia (>1 month) who were willing to undergo CBT‑I were included in this study after obtaining informed consent. They were requested to fill a sleep diary and return after 15 days. At the time of intake, diagnosis of depression and anxiety disorders was made according to Diagnostic and Statistical Manual ‑ IV‑Text Revision. They were encouraged to provide information regarding presleep thoughts through open‑ended and then, close‑ended questions. Dysfunctional attitudes and beliefs about sleep were assessed with Hindi version of “dysfunctional beliefs and attitudes scale‑brief version”. Hindi version of “insomnia severity index” was used to assess the severity of insomnia. Subjects were divided into two‑groups ‑ insomnia without depression (I) and insomnia with major depressive disorder (I‑MDD+). Statistical Analysis: It was done with the help of SPSS v 21.0. Descriptive statistics was calculated. Proportions between groups were tested with Chi‑square analysis and categorical variables were compared using independent sample t‑test. Results: This study included a total of 63 subjects, out of which 60% were women. Mean age of the whole group was 41.7 ± 11.8 years. About 40% of all the subjects were diagnosed as having I‑MDD+. Forty‑one percent of the subjects had clinically significant anxiety. Both groups ‑ I and I‑MDD+ had comparable proportion of female subjects (χ2 = 0.002; P = 0.96) and there was no difference regarding precipitating factors for insomnia (χ2 = 0.97; P = 0.61). They were also comparable with regards to sleep‑related measures, themes of presleep thoughts, and dysfunctional beliefs and attitudes about sleep and insomnia severity. Major themes of presleep thoughts included family issues and health issues. Only a small proportion had recurrent thoughts related to insomnia and its consequences. Conclusion: Insomnia is a co‑morbid illness with depression and it needs to be separately addressed during therapy. CBT‑I should include the element of problem‑solving technique, especially when we are dealing with the Indian population
    No preview · Article · Jan 2016 · Indian Journal of Psychiatry
    • "" Babson, Trainor, Feldner, and Blumenthal (2010) also found that total sleep deprivation is associated with next-day low positive affect, as defined by feeling slowed down, bored, withdrawn, and needing extra effort to get moving. Franzen, Siegle, and Buysse (2008) found that one night of sleep deprivation led to lower subjective reports of positive mood as well. Objective measures of emotional reactivity (based on pupil dilation while viewing positive, neutral, and negative visual stimuli) did not differ between the sleep-deprived and nonsleep-deprived participants when viewing positive images, however. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This chapter discusses the bidirectional association between sleep duration or quality and sadness, which is broadly defined as low positive affect. Regarding the impact of sleep on sadness and depression, observational and experimental studies suggest that poor sleep quality and insufficient sleep lead to low positive affect among depression-free individuals, but individuals with depression respond to the challenge of sleep deprivation with transient mood elevation. Regarding the impact of low mood on sleep, studies generally find little to no evidence supporting the hypothesis that, among people without depression, a low arousal negative affect, such as sadness, predicts poor sleep the next night. On the other hand, people with depression experience greater sleep abnormalities than do people without depression, including difficulties initiating and maintaining sleep and disturbances in rapid eye movement (REM) sleep. The chapter also discusses how depression and sad mood could contribute to the severity of insomnia, circadian rhythm sleep-wake disorders, and sleep apnea.
    No preview · Chapter · Dec 2015
Show more