Primary insomnia: a risk factor to develop depression?

doi:10.1016/S0165-0327(02)00072-1

Journal of Affective Disorders

Volume 76, Issues 1–3, September 2003, Pages 255-259

https://doi.org/10.1016/S0165-0327(02)00072-1 Get rights and content

Abstract

Background: Chronic insomnia afflicts approximately 5–10% of the adult population in Western industrialized countries. Insomnia may be secondary, i.e. triggered and/or maintained by psychiatric/organic illnesses, the intake of prescribed/illicit drugs or alcohol, or by a combination of these factors. Insomnia can also occur as primary insomnia, caused by a psychophysiological hyperarousal process. In the present review a literature search was undertaken to identify longitudinal epidemiological studies which investigate the question whether primary insomnia at baseline predicts the development of depression at follow-up measurements. Methods: medline search for the medical subject headings insomnia and depression; identification of longitudinal epidemiological studies with at least two measurement points 1 year apart measuring insomnia and depression and indicating explicit criteria for both disorders. Results: Eight relevant epidemiological studies were identified. Almost unambigously insomnia at baseline significantly predicted an increased depression risk at follow-up 1–3 years later. Conclusion: As insomniac symptoms alone seem to be of predictive value for the development of depression in the succeeding years, it would be worthwhile to investigate if early adequate treatment is able to prevent psychiatric sequelae of primary insomnia.

Section snippets

Introduction and rationale

In this article the consequences of insomnia for psychiatric morbidity (depression) will be reviewed. The emphasis will be on the chronic primary insomniac patient in order to delineate the effects of ‘pure’ insomnia. Many articles have been published claiming a significant impact of insomnia on psychosocial/psychiatric functioning and physical health (overview see Roth et al., 1999). Most of this work has been performed without differentiating insomnia according to its subtype, i.e. at least

Methods

A literature search was performed by using medline (1966–2000) for the medical subject headings (exploded modus) insomnia and depression. From the resulting database only studies were selected for the analysis which fulfilled the following criteria

(a)
Epidemiological study
(b)
Longitudinal design with at least two measurement points with an intervening interval of at least 1 year
(c)
Explicit criteria for insomnia definition
(d)
Explicit criteria for definition of depression

Abstracts resulting from the literature

Results

Eight studies (see Table 1) were identified being pertinent to the issue of interest. The studies are not uniform in design and are heterogeneous with respect to the samples studied and concerning the utilized diagnostic instruments. Furthermore, different statistical methods were applied to disentangle the relationship between insomnia and depression.

Only one study (Ford and Kamerow, 1989) looked at the full age spectrum of adult subjects in the general population. The study utilized the

Discussion and conclusion

Summarizing, a growing data base indicates that the occurrence of isolated insomnia symptoms for a period of more than 2 weeks at a certain time point is predictive for an increased depression risk in the following 1–3 years. This applies when looking at the total adult population or when looking at segments of the population. Studies using a 1–3 year follow-up, however, cannot fully exclude that the insomnia at baseline is just an early prodrome of the ensuing depression. Two studies mentioned

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Brief reportPrimary insomnia: a risk factor to develop depression?

Abstract

Section snippets

Introduction and rationale

Methods

Results

Discussion and conclusion

Psychiatry Res.

Sleep Med. Review

Biol. Psychiatry

Psychiatry Res.

Biol. Psychiatry

J. Affect. Disord.

J. Affect. Disord.

Biol. Psychol.

Lancet

J. Psychosom. Res.