Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-18T08:01:29.347Z Has data issue: false hasContentIssue false
  • English
  • Français

Sleep disturbances and depressive symptoms: an investigation of their longitudinal association in a representative sample of the UK general population

Published online by Cambridge University Press:  28 May 2012

P. Skapinakis ,
D. Rai ,
F. Anagnostopoulos ,
S. Harrison ,
R. Araya  and
G. Lewis
P. Skapinakis*
Affiliation:
Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, UK Department of Psychiatry, University of Ioannina, School of Medicine, Greece
D. Rai
Affiliation:
Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, UK
F. Anagnostopoulos
Affiliation:
Department of Psychology, Panteion University, Athens, Greece
S. Harrison
Affiliation:
Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, UK
R. Araya
Affiliation:
Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, UK
G. Lewis
Affiliation:
Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, UK
*
*Address for correspondence: P. Skapinakis, M.D., M.P.H., Ph.D., University of Bristol, Academic Unit of Psychiatry, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

It has been argued that sleep disturbances are a risk factor for depression but previous longitudinal studies have had limitations and not addressed alternative explanations. The aim of this study was to examine the longitudinal association between sleep disturbances and depressive symptoms in a nationally representative sample.

Method

Data from the 18-month follow-up of the UK National Psychiatric Morbidity survey were used (n = 2406). Sleep disturbances, depressive and other psychiatric symptoms (fatigue, concentration problems, irritability, anxiety and pain symptoms) were assessed using the Revised Clinical Interview Schedule (CIS-R). The bidirectional association between symptoms was investigated with logistic regression analyses and path analysis.

Results

Sleep disturbances and depressive symptoms were correlated with each other cross-sectionally (r = 0.52, p < 0.001). In the longitudinal analysis, sleep disturbances at baseline did not predict depressive symptoms at follow-up [odds ratio (OR) 1.27, 95% confidence interval (CI) 0.51–3.19] and the same was observed for the reciprocal association (OR 0.87, 95% CI 0.56–1.35). In the path analysis, the reciprocal model did not have a better fit compared to the simpler first-order model without cross-lagged paths. The path from sleep disturbances at baseline to depressive symptoms at follow-up had a minimal contribution to the explained variance of the latter (<1%).

Conclusions

Previous studies may have overestimated the importance of sleep disturbances as an independent risk factor of depression. The strong cross-sectional association is compatible with sleep disturbances being either a prodromal or a residual symptom of depression and this may have implications for recognition and treatment of depression.

Keywords

Depressive disorderlongitudinal studiessleep disorders
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 2 , February 2013 , pp. 329 - 339
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Baglioni, C, Battagliese, G, Feige, B, Spiegelhalder, K, Nissen, C, Voderholzer, U, Lombardo, C, Riemann, D (2011). Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. Journal of Affective Disorders 135, 10–19.CrossRefGoogle ScholarPubMed
Baglioni, C, Spiegelhalder, K, Lombardo, C, Riemann, D (2010). Sleep and emotions: a focus on insomnia. Sleep Medicine Reviews 14, 227–238.CrossRefGoogle ScholarPubMed
Bair, MJ, Robinson, RL, Katon, W, Kroenke, K (2003). Depression and pain comorbidity: a literature review. Archives of Internal Medicine 163, 2433–2445.CrossRefGoogle ScholarPubMed
Benca, RM, Peterson, MJ (2008). Insomnia and depression. Sleep Medicine 9 (Suppl. 1), S3–S9.CrossRefGoogle ScholarPubMed
Breslau, N, Roth, T, Rosenthal, L, Andreski, P (1996). Sleep disturbance and psychiatric disorders: a longitudinal epidemiological study of young adults. Biological Psychiatry 39, 411–418.CrossRefGoogle ScholarPubMed
Buysse, DJ, Angst, J, Gamma, A, Ajdacic, V, Eich, D, Rossler, W (2008). Prevalence, course, and comorbidity of insomnia and depression in young adults. Sleep 31, 473–480.CrossRefGoogle ScholarPubMed
Cuijpers, P, van Straten, A, Smit, F, Mihalopoulos, C, Beekman, A (2008). Preventing the onset of depressive disorders: a meta-analytic review of psychological interventions. American Journal of Psychiatry 165, 1272–1280.CrossRefGoogle ScholarPubMed
Edinger, JD, Bonnet, MH, Bootzin, RR, Doghramji, K, Dorsey, CM, Espie, CA, Jamieson, AO, McCall, WV, Morin, CM, Stepanski, EJ; American Academy of Sleep Medicine Work Group (2004). Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine Work Group. Sleep 27, 1567–1596.CrossRefGoogle ScholarPubMed
Fava, GA, Grandi, S, Canestrari, R, Molnar, G (1990). Prodromal symptoms in primary major depressive disorder. Journal of Affective Disorders 19, 149–152.CrossRefGoogle ScholarPubMed
Fava, GA, Mangelli, L (2001). Assessment of subclinical symptoms and psychological well-being in depression. European Archives of Psychiatry and Clinical Neurosciences 251 (Suppl. 2), II47–II52.CrossRefGoogle ScholarPubMed
Fava, M, McCall, WV, Krystal, A, Wessel, T, Rubens, R, Caron, J, Amato, D, Roth, T (2006). Eszopiclone co-administered with fluoxetine in patients with insomnia coexisting with major depressive disorder. Biological Psychiatry 59, 1052–1060.CrossRefGoogle ScholarPubMed
Flora, DB, Curran, PJ (2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological Methods 9, 466–491.CrossRefGoogle ScholarPubMed
Ford, DE, Kamerow, DB (1989). Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? Journal of the American Medical Association 262, 1479–1484.CrossRefGoogle ScholarPubMed
Gold, PW, Chrousos, GP (2002). Organization of the stress system and its dysregulation in melancholic and atypical depression: high vs low CRH/NE states. Molecular Psychiatry 7, 254–275.CrossRefGoogle ScholarPubMed
Hertzog, C, Nesselroade, JR (1987). Beyond autoregressive models: some implications of the trait-state distinction for the structural modelling of developmental change. Child Development 58, 93–109.CrossRefGoogle ScholarPubMed
Holgado-Tello, FP, Chacon-Moscoso, S, Barbero-Garcia, I, Vila-Abad, E (2010). Polychoric versus Pearson correlations in exploratory and confirmatory factor analysis of ordinal variables. Quality and Quantity 44, 153–166.CrossRefGoogle Scholar
Hu, L, Bentler, PM (1998). Fit indices in covariance structure modeling: sensitivity to underparameterized model misspecification. Psychological Methods 3, 424–453.CrossRefGoogle Scholar
Jansson-Frojmark, M, Lindblom, K (2008). A bidirectional relationship between anxiety and depression, and insomnia? A prospective study in the general population. Journal of Psychosomatic Research 64, 443–449.CrossRefGoogle ScholarPubMed
Joreskog, K, Sorbom, D (1996). LISREL 8: User's Reference Guide. Scientific Software International: Chicago, IL.Google Scholar
Kline, RB (2011). Principles and Practice of Structural Equation Modeling, 3rd edn. Guilford Press: New York.Google Scholar
Kraepelin, E (1909). Psychiatrie. 8 Auflage. Leipzig: Barth. English translation: Dementia Praecox and Paraphrenia (1919). Reprinted by Krieger: Huntington, New York (1971).Google Scholar
Lewis, G, Pelosi, AJ, Araya, R, Dunn, G (1992). Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychological Medicine 22, 465–486.CrossRefGoogle ScholarPubMed
Morphy, H, Dunn, KM, Lewis, M, Boardman, HF, Croft, PR (2007). Epidemiology of insomnia: a longitudinal study in a UK population. Sleep 30, 274–280.Google Scholar
Neale, MC, Kendler, KS (1995). Models of comorbidity for multifactorial disorders. American Journal of Human Genetics 57, 935–953.Google ScholarPubMed
Neckelmann, D, Mykletun, VA, Dahl, VA (2007). Chronic insomnia as a risk factor for developing anxiety and depression. Sleep 30, 873–880.CrossRefGoogle ScholarPubMed
Overland, S, Glozier, N, Sivertsen, B, Stewart, R, Neckelmann, D, Krokstad, S, Mykletun, A (2008). A comparison of insomnia and depression as predictors of disability pension: the HUNT Study. Sleep 31, 875–880.CrossRefGoogle ScholarPubMed
Perlis, ML, Giles, DE, Buysse, DJ, Tu, X, Kupfer, DJ (1997). Self-reported sleep disturbance as a prodromal symptom in recurrent depression. Journal of Affective Disorders 42, 209–212.CrossRefGoogle ScholarPubMed
Riemann, D (2007). Insomnia and comorbid psychiatric disorders. Sleep Medicine 8 (Suppl. 4), S15–S20.CrossRefGoogle ScholarPubMed
Riemann, D (2009). Does effective management of sleep disorders reduce depressive symptoms and the risk of depression? Drugs 69 (Suppl. 2), 43–64.CrossRefGoogle ScholarPubMed
Singleton, N, Bumpstead, R, O'Brien, M, Lee, A, Meltzer, H (2001). Psychiatric Morbidity Among Adults Living in Private Households, 2000. The Stationery Office: London.Google Scholar
Singleton, N, Lewis, G (2003). Better or Worse: A Longitudinal Study of the Mental Health of Adults Living in Private Households in Great Britain. The Stationery Office: London.Google ScholarPubMed
Skapinakis, P, Lewis, G, Mavreas, V (2004). Temporal relations between unexplained fatigue and depression: longitudinal data from an international study in primary care. Psychosomatic Medicine 66, 330–335.CrossRefGoogle Scholar
Staner, L (2010). Comorbidity of insomnia and depression. Sleep Medicine Reviews 14, 35–46.CrossRefGoogle ScholarPubMed
Vollrath, M, Wicki, W, Angst, J (1989). The Zurich study. VIII. Insomnia: association with depression, anxiety, somatic syndromes, and course of insomnia. European Archives of Psychiatry and Neurological Sciences 239, 113–124.CrossRefGoogle ScholarPubMed
Supplementary material: File

Skapinakis supplementary material

Appendix

Download Skapinakis supplementary material(File)
File 88.6 KB