The role of anxiety and depression in the development of insomnia: Cross-sectional and prospective analyses

Abstract

The purpose of this study was to examine the associations between anxiety, depression and insomnia, and to investigate whether anxiety and depression are related to future insomnia. This study employed a combination of a cross-sectional and a prospective design. From a randomly selected sample from the general population (N ¼ 3600), 1936 participants filled out a baseline and 1-year follow-up survey on insomnia, anxiety and depression. Odds ratios (ORs) estimations were used to investigate the associations between anxiety, depression, and insomnia. In the cross-sectional study, anxiety (OR: 4.61) and depression (OR: 2.42) showed moderate to strong associations with insomnia. However, the prospective study showed that anxiety (OR: 3.35) was more strongly related than depression (OR: 1.96) to the development of insomnia 1 year later. While anxiety seems to play a key role in the development of insomnia, depression may be considered as a possible precipitating mechanism but even more likely as a consequence of insomnia.

A bidirectional relationship between anxiety and depression, and insomnia? A prospective study in the general population

“…Earlier studies on the direction of risk between depression and insomnia are somewhat more conflicting. While this study and two previous prospective studies [7,10] suggest that depression may act as a risk factor for future insomnia, two retrospective studies [8,9] indicate that depression is not associated with the risk of developing insomnia in the future. Overall, evidence on whether depression is a risk factor for future insomnia is thus not clear.…”

“…The findings of this study are in parallel with and extend previous research on the bidirectional relationship between anxiety and depression, and insomnia. Two retrospective investigations [8,9] and two prospective studies [7,10] have previously investigated the direction of risk between, on one hand, anxiety and depression and, on the other hand, insomnia. The results from this study, in combination with evidence from previous research, suggest clearly that anxiety may be a risk factor for future insomnia, but also that insomnia may increase the risk for future anxiety [7][8][9][10]14].…”

“…Two retrospective investigations [8,9] and two prospective studies [7,10] have previously investigated the direction of risk between, on one hand, anxiety and depression and, on the other hand, insomnia. The results from this study, in combination with evidence from previous research, suggest clearly that anxiety may be a risk factor for future insomnia, but also that insomnia may increase the risk for future anxiety [7][8][9][10]14]. Findings are also consistent as to whether insomnia may be a risk factor for future depression [12][13][14]; congruous results show that insomnia increases the risk of developing depression.…”

“…Although there is a lack of research on the role of anxiety in insomnia, a few studies suggest that anxiety may be a risk factor for future insomnia [7][8][9][10]. The relationship between depression and future insomnia is more conflicting; while two longitudinal studies found evidence for depression as a risk factor for developing insomnia [7,10], two studies demonstrated that prior depression was not associated with the onset of insomnia based on retrospective reports [8,9]. A final possibility is that insomnia may act as a risk factor for anxiety and depression [11].…”

The Relationship Between Sleep and Anxiety in Older Adults

“…Although a more detailed discussion is beyond the scope of this review [9,14], some data exist concerning these possibilities among adolescents and young adults. Briefly, anxiety precedes insomnia for most adolescent sufferers [15], whereas the two problems act as risk factors for each other in young adults [14,16,17]. These patterns are not conclusive for any one causal model but provide evidence that the sequelae of anxiety and insomnia symptoms potentially shift over the life span.…”