Symptoms of Depression and Insomnia in Older Age: A Within-individual Analysis over 20 years

Overview

Journal J Am Geriatr Soc

Specialty Geriatrics

Date 2022 Apr 6

PMID 35383906

Authors

Annelies Brouwer

Peter M van de Ven

Almar Kok

Frank J Snoek

Aartjan T F Beekman

Marijke A Bremmer

Affiliations

Soon will be listed here.

Abstract

Background: Depression and insomnia often co-occur, and precede one another. Possibly, insomnia gives rise to depression, and vice versa. We tested whether insomnia symptoms of an older individual are associated with later depressive symptoms in that older individual, and vice versa.

Methods: We performed a longitudinal analysis of data from a prospective cohort study in a large sample of community-dwelling older people (N = 3081), with measurements every three years, over a time period of 20 years. The within-individual longitudinal reciprocal relationship between symptoms of depression (Center for Epidemiological Studies Depression Scale), and symptoms of insomnia (three-item questionnaire, including difficulty initiating sleep, nightly awakenings, and early morning awakening) was modeled by means of a bivariate linear growth model. We tested whether symptoms of insomnia were associated with symptoms of depression three years later, and vice versa.

Results: Severity of symptoms of depression and insomnia and their within-individual average change over time were moderately correlated (correlation of intercepts: rho 0.41, 95% CI: 0.36 to 0.46 p < 0.001; correlation of slopes: rho 0.39, 95% CI: 0.25 to 0.52, p < 0.001). Symptoms of depression were not found to be associated with an additional risk of higher symptoms of insomnia three years later, and vice versa (p = 0.329 and p = 0.919, respectively). Similar results were found when analyses were corrected for covariates.

Conclusions: In older individuals, depression and insomnia are associated and tend to increase concurrently over time, but constitute no additional risk for one another over repeated three-year intervals. These findings contradict previous research that suggests that depression and insomnia are risk factors for one another over time. The current study stands out due to the longitudinal within-individual statistical approach, but is limited by the three-year interval between measures.

Citing Articles

Association of insomnia symptoms and trajectories with the risk of functional disability: a prospective cohort study.

Huang Q, Xie J, Chen H, Yan H, Gao J, Li Z BMC Geriatr. 2024; 24(1):492.

PMID: 38840066 PMC: 11151719. DOI: 10.1186/s12877-024-05108-9.

The Impacts of Spirituality and Religious Participation on the Emotional Well-Being of Widowed Older Adults in Southeast Nigeria.

Ukeachusim C, Okwor C, Eze E, Okoli A, Ugwu C, Ebimgbo S Innov Aging. 2024; 8(4):igad128.

PMID: 38572404 PMC: 10986753. DOI: 10.1093/geroni/igad128.

Symptoms of depression and insomnia in older age: A within-individual analysis over 20 years.

Brouwer A, van de Ven P, Kok A, Snoek F, Beekman A, Bremmer M J Am Geriatr Soc. 2022; 70(7):2051-2059.

PMID: 35383906 PMC: 9541249. DOI: 10.1111/jgs.17765.

References

Ohayon M . Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2003; 6(2):97-111. DOI: 10.1053/smrv.2002.0186. View

Curran P, Obeidat K, Losardo D . Twelve Frequently Asked Questions About Growth Curve Modeling. J Cogn Dev. 2011; 11(2):121-136. PMC: 3131138. DOI: 10.1080/15248371003699969. View

Belmaker R, Agam G . Major depressive disorder. N Engl J Med. 2008; 358(1):55-68. DOI: 10.1056/NEJMra073096. View

Schaakxs R, Comijs H, Lamers F, Kok R, Beekman A, Penninx B . Associations between age and the course of major depressive disorder: a 2-year longitudinal cohort study. Lancet Psychiatry. 2018; 5(7):581-590. DOI: 10.1016/S2215-0366(18)30166-4. View

Nierenberg A, Keefe B, Leslie V, Alpert J, Pava J, Worthington 3rd J . Residual symptoms in depressed patients who respond acutely to fluoxetine. J Clin Psychiatry. 1999; 60(4):221-5. DOI: 10.4088/jcp.v60n0403. View

Thase M, Rush A, Manber R, Kornstein S, Klein D, Markowitz J . Differential effects of nefazodone and cognitive behavioral analysis system of psychotherapy on insomnia associated with chronic forms of major depression. J Clin Psychiatry. 2002; 63(6):493-500. DOI: 10.4088/jcp.v63n0605. View

Pratt L, Brody D . Depression in the U.S. household population, 2009-2012. NCHS Data Brief. 2014; (172):1-8. View

Alvaro P, Roberts R, Harris J . A Systematic Review Assessing Bidirectionality between Sleep Disturbances, Anxiety, and Depression. Sleep. 2013; 36(7):1059-1068. PMC: 3669059. DOI: 10.5665/sleep.2810. View

Bastien C, Vallieres A, Morin C . Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001; 2(4):297-307. DOI: 10.1016/s1389-9457(00)00065-4. View

10.

Akhtar-Danesh N, Landeen J . Relation between depression and sociodemographic factors. Int J Ment Health Syst. 2008; 1(1):4. PMC: 2241832. DOI: 10.1186/1752-4458-1-4. View

11.

Cunningham J, Shapiro C . Cognitive Behavioural Therapy for Insomnia (CBT-I) to treat depression: A systematic review. J Psychosom Res. 2018; 106:1-12. DOI: 10.1016/j.jpsychores.2017.12.012. View

12.

Yon A, Scogin F, DiNapoli E, McPherron J, Arean P, Bowman D . Do manualized treatments for depression reduce insomnia symptoms?. J Clin Psychol. 2014; 70(7):616-30. DOI: 10.1002/jclp.22062. View

13.

Carney C, Segal Z, Edinger J, Krystal A . A comparison of rates of residual insomnia symptoms following pharmacotherapy or cognitive-behavioral therapy for major depressive disorder. J Clin Psychiatry. 2007; 68(2):254-60. DOI: 10.4088/jcp.v68n0211. View

14.

de la Torre-Luque A, de la Fuente J, Prina M, Sanchez-Niubo A, Haro J, Ayuso-Mateos J . Long-term trajectories of depressive symptoms in old age: Relationships with sociodemographic and health-related factors. J Affect Disord. 2018; 246:329-337. DOI: 10.1016/j.jad.2018.12.122. View

15.

Li S, Lam S, Chan J, Yu M, Wing Y . Residual sleep disturbances in patients remitted from major depressive disorder: a 4-year naturalistic follow-up study. Sleep. 2012; 35(8):1153-61. PMC: 3397819. DOI: 10.5665/sleep.2008. View

16.

Hamaker E, Kuiper R, Grasman R . A critique of the cross-lagged panel model. Psychol Methods. 2015; 20(1):102-16. DOI: 10.1037/a0038889. View

17.

Hoogendijk E, Deeg D, Poppelaars J, van der Horst M, Broese van Groenou M, Comijs H . The Longitudinal Aging Study Amsterdam: cohort update 2016 and major findings. Eur J Epidemiol. 2016; 31(9):927-45. PMC: 5010587. DOI: 10.1007/s10654-016-0192-0. View

18.

Cartwright R . Alcohol and NREM parasomnias: evidence versus opinions in the international classification of sleep disorders, 3rd edition. J Clin Sleep Med. 2014; 10(9):1039-40. PMC: 4153104. DOI: 10.5664/jcsm.4050. View

19.

Muniz-Terrera G, Robitaille A, Kelly A, Johansson B, Hofer S, Piccinin A . Latent growth models matched to research questions to answer questions about dynamics of change in multiple processes. J Clin Epidemiol. 2016; 82:158-166. PMC: 5325805. DOI: 10.1016/j.jclinepi.2016.09.001. View

20.

Blanken T, Benjamins J, Borsboom D, Vermunt J, Paquola C, Ramautar J . Insomnia disorder subtypes derived from life history and traits of affect and personality. Lancet Psychiatry. 2019; 6(2):151-163. DOI: 10.1016/S2215-0366(18)30464-4. View