Insomnia and the risk of depression: a meta-analysis of prospective cohort studies

Abstract

BackgroundObservational studies suggest that insomnia might be associated with an increased risk of depression with inconsistent results. This study aimed at conducting a meta-analysis of prospective cohort studies to evaluate the association between insomnia and the risk of depression.MethodsRelevant cohort studies were comprehensively searched from the PubMed, Embase, Web of Science, and China National Knowledge Infrastructure databases (up to October 2014) and from the reference lists of retrieved articles. A random-effects model was used to calculate the pooled risk estimates and 95 % confidence intervals (CIs). The I 2 statistic was used to assess the heterogeneity and potential sources of heterogeneity were assessed with meta-regression. The potential publication bias was explored by using funnel plots, Egger’s test, and Duval and Tweedie trim-and-fill methods.ResultsThirty-four cohort studies involving 172,077 participants were included in this meta-analysis with an average follow-up period of 60.4 months (ranging from 3.5 to 408). Statistical analysis suggested a positive relationship between insomnia and depression, the pooled RR was 2.27 (95 % CI: 1.89–2.71), and a high heterogeneity was observed (I 2 = 92.6 %, P < 0.001). Visual inspection of the funnel plot revealed some asymmetry. The Egger’s test identified evidence of substantial publication bias (P <0.05), but correction for this bias using trim-and-fill method did not alter the combined risk estimates.ConclusionsThis meta-analysis indicates that insomnia is significantly associated with an increased risk of depression, which has implications for the prevention of depression in non-depressed individuals with insomnia symptoms.

Sleep apnea, psychopathology, and mental health care

“…These associations were substantially higher than those seen in previous studies examining simply sleep disturbances (e.g., insomnia or disturbed sleep) and psychopathology. For example, meta-analyses have shown insomnia to be associated with a 2.27 times increased pooled risk for depression, 25 and a 1.94 times increased adjusted risk of suicide ideation, 14 below those observed in our study (3.11 for depression, 2.75 for suicide ideation). It is possible that there may be additive effects that magnify the risk for psychopathology among those with sleep apnea beyond the resulting impaired sleep inherent in the disorder.…”

The prevalence and clinical risk factors of insomnia in the Chinese elderly based on comprehensive geriatric assessment in Chongqing population

“…Insomnia is one of the most frequent prodromal features of depression, with sleep symptoms that precede depression in 40% of cases . Non‐depressed subjects with insomnia have a twofold risk of developing depression, which is consistent with a previous report . In contrast, depression had the strongest effect on insomnia, which has implications that the prevention of depression might alleviate insomnia .…”

Insomnia treatment in the context of alcohol use disorder: A systematic review and meta-analysis

“…We hypothesized that insomnia treatment would improve sleep quality among patients with AUD. Given the associations between insomnia symptoms and both relapse to alcohol use (Brower, 2015) and symptoms of depression (Li et al, 2016), we also hypothesized that insomnia treatment would improve rates of alcohol abstinence and symptoms of depression among patients with AUD. Finally, because behavioral treatment has been associated with longer-term improvements in insomnia than pharmacological treatment (Mitchell et al, 2012), we hypothesized that behavioral treatment of insomnia would be more effective than pharmacological treatment in improving sleep- and alcohol-related outcomes.…”