Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Relationship between insomnia and depression in a community sample depends on habitual sleep duration

Abstract

Sleep disturbances, such as short sleep duration and insomnia, are core features of depression. However, it is unclear if sleep duration and insomnia have an interactive effect on depression severity or individual symptoms. Data were drawn from a community sample (N = 1007) containing responses on the Insomnia Severity Index, Patient Health Questionnaire–9 (PHQ-9), and average sleep duration. Regression analyses determined the prevalence risks (PR) of symptoms of depression based on insomnia severity and sleep duration. Depression severity was related to insomnia severity (PR 1.09, p < 0.001) and short sleep duration (PR 1.52, p < 0.001), but the interaction between the two was negative (PR 0.97, p < 0.001). Insomnia severity increased the prevalence risk of all individual depression symptoms between 8 and 15%, while sleep duration increased the prevalence risk of appetite dysregulation (PR 1.86, p < 0.001), fatigue (PR 1.51, p < 0.001), difficulty concentrating (PR 1.61, p = 0.003), feelings of failure (PR 1.58, p = 0.002), and suicidal behavior (PR 2.54, p = 0.01). The interaction of sleep duration and insomnia was negative and ranged between 3 and 6%. In clinically significant depression (PHQ >=10), only insomnia severity increased the prevalence risk of depression severity (PR 1.02, p = 0.001). Insomnia and short sleep predict prevalent depression, but their interactive effect was negative. Thus, while insomnia had a greater association with depression severity and symptoms, this association was dependent on habitual sleep duration.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. 1.

    American Psychiatric Association. and American Psychiatric Association. DSM-5 Task Force., Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. 2013, Washington, American Psychiatric Association. xliv, p. 947

  2. 2.

    Franzen PL, Buysse DJ. Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues Clin Neurosci. 2008;10(4):473–81.

  3. 3.

    Alvaro PK, Roberts RM, Harris JK. A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep. 2013;36(7):1059–68.

  4. 4.

    Li L, et al. Insomnia and the risk of depression: a meta-analysis of prospective cohort studies. BMC Psychiatry. 2016;16(1):375.

  5. 5.

    Baglioni C, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011;135(1–3):10–9.

  6. 6.

    Zhai L, Zhang H, Zhang D. Sleep duration and depression among adults: a meta-analysis of prospective studies. Depress Anxiety. 2015;32(9):664–70.

  7. 7.

    Biddle DJ, et al. Insomnia symptoms and short sleep duration predict trajectory of mental health symptoms. Sleep Med. 2019;54:53–61.

  8. 8.

    Jackowska M, Poole L. Sleep problems, short sleep and a combination of both increase the risk of depressive symptoms in older people: a 6-year follow-up investigation from the english longitudinal study of ageing. Sleep Med. 2017;37:60–5.

  9. 9.

    Szklo-Coxe M, et al. Prospective associations of insomnia markers and symptoms with depression. Am J Epidemiol. 2010;171(6):709–20.

  10. 10.

    Fernandez-Mendoza J, et al. Insomnia and incident depression: role of objective sleep duration and natural history. J Sleep Res. 2015;24(4):390–8.

  11. 11.

    Perlis ML, et al. Which depressive symptoms are related to which sleep electroencephalographic variables? Biol Psychiatry. 1997;42(10):904–13.

  12. 12.

    Bernert RA, et al. Sleep disturbances as an evidence-based suicide risk factor. Curr Psychiatry Rep. 2015;17(3):554.

  13. 13.

    Knutson KL. Impact of sleep and sleep loss on glucose homeostasis and appetite regulation. Sleep Med Clin. 2007;2(2):187–97.

  14. 14.

    Kalmbach DA, et al. Reciprocal dynamics between self-rated sleep and symptoms of depression and anxiety in young adult women: a 14-day diary study. Sleep Med. 2017;33:6–12.

  15. 15.

    Bouwmans ME, et al. Bidirectionality between sleep symptoms and core depressive symptoms and their long-term course in major depression. Psychosom Med. 2017;79(3):336–44.

  16. 16.

    Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA. 1999;282(18):1737–44.

  17. 17.

    Cepeda MS, et al. Clinical relevance of sleep duration: results from a cross-sectional analysis using NHANES. J Clin Sleep Med. 2016;12(6):813–9.

  18. 18.

    Grandner MA, et al. Dietary nutrients associated with short and long sleep duration. Data from a nationally representative sample. Appetite. 2013;64:71–80.

  19. 19.

    Watson NF, et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American academy of sleep medicine and sleep research society. Sleep. 2015;38(6):843–4.

  20. 20.

    Hirshkowitz M, et al. National sleep foundation’s updated sleep duration recommendations: final report. Sleep Health. 2015;1(4):233–43.

  21. 21.

    Aurora RN, et al. Habitual sleep duration and all-cause mortality in a general community sample. Sleep. 2016;39(11):1903–9.

  22. 22.

    Bastien CH, Vallieres A, Morin CM. Validation of the insomnia severity index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297–307.

  23. 23.

    Gilbody S, et al. Screening for depression in medical settings with the patient health questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med. 2007;22(11):1596–602.

  24. 24.

    Manea L, Gilbody S, McMillan D. A diagnostic meta-analysis of the patient health questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry. 2015;37(1):67–75.

  25. 25.

    Biddle DJ, et al. Accuracy of self-reported sleep parameters compared with actigraphy in young people with mental ill-health. Sleep Health. 2015;1(3):214–20.

  26. 26.

    Lichstein KL, et al. Actigraphy validation with insomnia. Sleep. 2006;29(2):232–9.

  27. 27.

    Williams JM, et al. Validity of actigraphy in young adults with insomnia. Behav Sleep Med. 2018;18(1):91–106. https://doi.org/10.1080/15402002.2018.1545653.

  28. 28.

    Dashti HS, et al. Short sleep duration and dietary intake: epidemiologic evidence, mechanisms, and health implications. Adv Nutr. 2015;6(6):648–59.

  29. 29.

    Shechter A, Grandner MA, St-Onge MP. The role of sleep in the control of food intake. Am J Lifestyle Med. 2014;8(6):371–4.

  30. 30.

    Ferrie JE, et al. Change in sleep duration and cognitive function: findings from the Whitehall II study. Sleep. 2011;34(5):565–73.

  31. 31.

    Perlis ML, et al. Nocturnal wakefulness as a previously unrecognized risk factor for suicide. J Clin Psychiatry. 2016;77(6):e726–33.

  32. 32.

    Salo P, et al. Insomnia symptoms as a predictor of incident treatment for depression: prospective cohort study of 40,791 men and women. Sleep Med. 2012;13(3):278–84.

  33. 33.

    Lim GY, et al. Prevalence of depression in the community from 30 countries between 1994 and 2014. Sci Rep. 2018;8(1):2861.

  34. 34.

    Ibrahim AK, et al. A systematic review of studies of depression prevalence in university students. J Psychiatr Res. 2013;47(3):391–400.

  35. 35.

    Murphy MJ, Peterson MJ. Sleep disturbances in depression. Sleep Med Clin. 2015;10(1):17–23.

Download references

Acknowledgements

None.

Funding

This work was supported by the National Institutes of Health (R21ES022931: K23HL110216).

Author information

Correspondence to Andrew S. Tubbs.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This study was approved by the IRB at the University of Pennsylvania.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tubbs, A.S., Gallagher, R., Perlis, M.L. et al. Relationship between insomnia and depression in a community sample depends on habitual sleep duration. Sleep Biol. Rhythms (2020). https://doi.org/10.1007/s41105-020-00255-z

Download citation

Keywords

  • Insomnia
  • Short sleep
  • Depression
  • Sleep duration