Insomnia symptoms as a predictor of incident treatment for depression: Prospective cohort study of 40,791 men and women

Role of dietary fiber and lifestyle modification in gut health and sleep quality

Dietary fiber has an immense role in the gut microbiome by modulating juvenile growth, immune system maturation, glucose, and lipid metabolism. Lifestyle changes might disrupt gut microbiota symbiosis, leading to various chronic diseases with underlying inflammatory conditions, obesity, and its associated pathologies. An interventional study of 16 weeks examined the impact of psyllium husk fiber with and without lifestyle modification on gut health and sleep quality in people with central obesity (men = 60 and women = 60), those aged from 40 to 60 years, those having WC ≥ 90 cm (men) and WC ≥ 80 cm (women), and no history of any chronic disease or regular medication. The participants were subgrouped into three intervention groups, namely, the psyllium husk fiber (PSH) group, the lifestyle modification (LSM) group, and the LSM&PSH group and control group with equal gender bifurcation (men = 15 and women = 15). A 24-h dietary recall, gastrointestinal tract (GIT) symptoms, and sleep quality analysis data were collected on validated questionnaires. The analyses of variance and covariance were used for baseline and post-intervention, respectively. Student's t-test was applied for pre- and post-intervention changes on the variable of interest. The intervention effect on GIT health was highly significant (P < 0.001). The mean GIT scores of the LSM, PSH, and LSM&PSH groups were 2.99 ± 0.14, 2.49 ± 0.14, and 2.71 ± 0.14, respectively, compared to the mean GIT scores of the control group. No significant (P = 0.205) effect of either intervention was observed on sleep quality. The study concluded that psyllium husk fiber significantly improved the GIT symptoms, while no significant effect of the intervention was observed on sleep quality analysis.

Sleep During Menopause

Postmenopause is defined retrospectively after 12 consecutive months of amenorrhea. It represents the end of the reproductive period and ovarian failure. A decrease in estrogen leads to several changes in the short and long term. Among the early changes, vasomotor symptoms (hot flashes) are particularly common, occurring in about 70% of women. In addition, there are changes in mood, anxiety, depression, and insomnia. Insomnia occurs in almost 60% of postmenopausal women. Psychosocial aspects may also affect sleep. Proper diagnosis may lead to adequate treatment of sleep disturbances during menopause. Hormonal or other complementary therapies can improve sleep quality.

Prospective associations between joint categories of physical activity and insomnia symptoms with onset of poor mental health in a population-based cohort

BACKGROUND

Physical inactivity and insomnia symptoms are independently associated with increased risk of depression and anxiety; however, few studies jointly examine these risk factors. This study aimed to prospectively examine the joint association of physical activity (PA) and insomnia symptoms with onset of poor mental health in adults.

METHODS

Participants from the 2013 to 2018 annual waves of the Household Income and Labour Dynamics in Australia panel study who had good mental health (Mental Health Inventory-5 >54) in 2013, and who completed at least 1 follow-up survey (2014-2018), were included (n = 10,977). Poor mental health (Mental Health Inventory-5 ≤ 54) was assessed annually. Baseline (2013) PA was classified as high/moderate/low, and insomnia symptoms (i.e., trouble sleeping) were classified as no insomnia symptoms/insomnia symptoms, with 6 mutually exclusive PA-insomnia symptom groups derived. Associations of PA-insomnia symptom groups with onset of poor mental health were examined using discrete-time proportional-hazards logit-hazard models.

RESULTS

There were 2322 new cases of poor mental health (21.2%). Relative to the high PA/no insomnia symptoms group, there were higher odds (odds ratio and 95% confidence interval (95%CI)) of poor mental health among the high PA/insomnia symptoms (OR = 1.87, 95%CI: 1.57-2.23), moderate PA/insomnia symptoms (OR = 1.93, 95%CI: 1.61-2.31), low PA/insomnia symptoms (OR = 2.33, 95%CI: 1.96-2.78), and low PA/no insomnia symptoms (OR = 1.14, 95%CI: 1.01-1.29) groups. Any level of PA combined with insomnia symptoms was associated with increased odds of poor mental health, with the odds increasing as PA decreased.

CONCLUSION

These findings highlight the potential benefit of interventions targeting both PA and insomnia symptoms for promoting mental health.

Associations between Aircraft Noise Exposure and Self-Reported Sleep Duration and Quality in the United States-Based Prospective Nurses' Health Study Cohort

BACKGROUND

Sleep disruption is linked with chronic disease, and aircraft noise can disrupt sleep. However, there are few investigations of aircraft noise and sleep in large cohorts.

OBJECTIVES

We examined associations between aircraft noise and self-reported sleep duration and quality in the Nurses' Health Study, a large prospective cohort.

METHODS

Aircraft nighttime equivalent sound levels (Lnight) and day-night average sound levels (DNL) were modeled around 90 U.S. airports from 1995 to 2015 in 5-y intervals using the Aviation Environmental Design Tool and linked to geocoded participant residential addresses. Lnight exposure was dichotomized at the lowest modeled level of 45 A-weighted decibels [dB(A)] and at multiple cut points for DNL. Multiple categories of both metrics were compared with < 45 dB(A). Self-reported short sleep duration (< 7 h/24-h day) was ascertained in 2000, 2002, 2008, 2012, and 2014, and poor sleep quality (frequent trouble falling/staying asleep) was ascertained in 2000. We analyzed repeated sleep duration measures using generalized estimating equations and sleep quality by conditional logistic regression. We adjusted for participant-level demographics, behaviors, comorbidities, and environmental exposures (greenness and light at night) and examined effect modification.

RESULTS

In 35,226 female nurses averaging 66.1 years of age at baseline, prevalence of short sleep duration and poor sleep quality were 29.6% and 13.1%, respectively. In multivariable models, exposure to Lnight ≥ 45 dB(A) was associated with 23% [95% confidence interval (CI): 7%, 40%] greater odds of short sleep duration but was not associated with poor sleep quality (9% lower odds; 95% CI: - 30 % , 19%). Increasing categories of Lnight and DNL ≥ 45 dB(A) suggested an exposure-response relationship for short sleep duration. We observed higher magnitude associations among participants living in the West, near major cargo airports, and near water-adjacent airports and among those reporting no hearing loss.

DISCUSSION

Aircraft noise was associated with short sleep duration in female nurses, modified by individual and airport characteristics. https://doi.org/10.1289/EHP10959.

Sleep disorders and non-sleep circadian disorders predict depression: a systematic review and meta-analysis of longitudinal studies

Patients with depression often suffer from sleep disorders and non-sleep circadian disorders. However, whether they precede and predict subsequent depression is unclear. We conducted a meta-analysis of studies on sleep disorders and non-sleep circadian disorders. We found insomnia, hypersomnia, short and long sleep duration, obstructive sleep apnea, restless legs syndrome and eveningness orientation at baseline all led to subsequent depression. Those with propensity to late meal patterns, heightened levels of cortisol in awakening response and low robustness of rest-activity rhythm at baseline had higher risks for later depression. Among insomnia subtypes, difficulty initiating sleep and difficulty maintaining sleep predicted future depression. Notably, persistent insomnia at baseline contributed to more than two-fold risk of incident depression compared to insomnia. Moreover, insomnia symptom numbers showed dose-dependent relationship with the incident depression. In conclusion, different types of sleep disorders and non-sleep circadian disorders were proven to be risk factors of subsequent depression, and mechanisms underlying the relationship between sleep disorders, non-sleep circadian disorders and subsequent depression should be further elucidated in the future.

Are Sleep Problems Related to Psychological Distress in Healthy Aging during the COVID-19 Pandemic? A Review

The SARS-CoV-2 pandemic, characterized by home confinement and other restrictive measures to reduce the spread of the infection, led to significant changes in people's habits and lifestyle. One of the most common problems is the worsening of sleep quality or quantity, which could have negative effects on psychological wellbeing, particularly in older adults. The purposes of the present literature review considering healthy aging subjects are (a) to examine the existing research on sleep alterations during the current pandemic and (b) to highlight possible relationships between sleep problems and psychological distress. A systematic search strategy was implemented according to PRISMA guidelines in the international literature online databases, up to 1 July 2021. After identification and screening phases, 11 articles were included in this review. The studies found possible associations between sleep problems and mood changes-particularly in terms of depression and anxiety. In addition, altered sleep patterns seemed to be related to changes in individual aspects, lifestyle, and attitudes adopted by older adults during the COVID-19 lockdown. Thus, the pandemic could affect the sleep and psychological wellbeing of the older population, even in healthy aging.

Sleep quality, depressive symptoms, and transplant outcomes: Follow-up analyses from the ADAPT prospective pilot study

BACKGROUND

Previous studies suggested that depressive symptoms and sleep quality may be important for long-term clinical outcomes following cardiothoracic transplant. Few studies, however, have systematically examined objective markers of these behavioral factors among ambulatory transplant recipients, or their association with clinical outcomes.

METHODS

We examined sleep quality and depressive symptoms with subsequent clinical outcomes (hospitalizations and death) in a sample of 66 lung or heart transplant recipients using a single-center, prospective cohort study. Recipients were assessed at approximately 6 months post-transplant and completed one week of actigraphy assessment to examine sleep quality and self-report measures of mood (Centers for Epidemiologic Studies of Depression [CESD]). Recipients were followed for clinical outcomes.

RESULTS

At 6-months following transplantation, recipients spent the majority of daytime activity at a sedentary level (61% of daily activity [SD = 10]) and elevated depressive symptoms were common (subclinical = 17%, mild = 12%, or moderate = 8%). Over a median follow-up of 4.5 years (IQR = 0.9, 5.1), 51 participants (77%) had at least one unplanned hospitalization and 11 (17%) participants died. In addition, sleep efficiency measurements suggested that a subset of participants exhibited suboptimal sleep (mean efficiency = 87% [SD = 7]). Poorer sleep quality, indexed by lower sleep efficiency and greater sleep fragmentation, was associated with greater depressive symptoms (r's = 0.37-0.50, P < .01). Better sleep quality at 6-months (HR = 0.75 [0.60, 0.95], P = .015), including sleep efficiency (HR = 0.74 [0.56, 0.99], P = .041) and sleep fragmentation (HR = 0.71 [0.53, 0.95], P = .020) were associated with lower risk of hospitalization or death. Compared with individuals without elevated depressive symptoms or sleep difficulties, individuals with either factor (HR = 1.72 [1.05, 2.81], P = .031) or both factors (HR = 2.37 [1.35, 4.18], P = .003) exhibited greater risk of clinical events in adjusted analyses.

CONCLUSIONS

Sleep quality is associated with depressive symptoms among cardiothoracic transplant recipients and enhances the prognostic association between biobehavioral risk factors and clinical outcomes.

Associations of daily weather and ambient air pollution with objectively assessed sleep duration and fragmentation: a prospective cohort study

OBJECTIVE

Given the lack of studies examining the associations between daily weather and air pollution with nightly objective sleep over multiple weeks, we quantified these associations in a prospective cohort of healthy participants with episodic migraine.

METHODS

Ninety-eight participants completed daily electronic diaries and wore an actigraph for an average of 45 ds, and a total 4406 nights of data were collected. Nightly sleep characteristics including duration, wake after sleep onset (WASO), and efficiency were assessed using wrist actigraphy. Daily weather parameters and air pollution levels were collected from local weather station and ground-level air quality monitors. We used linear fixed effects models adjusting for participant, day of the week, and day of the year (for weather analysis), and additionally adjusted for temperature and relative humidity (for air pollution analysis).

RESULTS

The participants were 35 ± 12 yrs old and 86 were women. A 10 °F higher daily average temperature was associated with 0.88 (95% CI: 0.06, 1.70) minutes longer WASO and 0.14% (95% CI: -0.01%, 0.30%) lower sleep efficiency on that night. A 14 parts per billion (ppb) (interquartile range) higher daily maximum eight-h ozone was associated with 7.51 (95% CI: 3.23, 11.79) minutes longer sleep duration on that night. Associations did not differ between cold (October-March) and warm (April-September) seasons.

CONCLUSIONS

Higher daily ozone was associated with longer sleep duration and modest associations were observed between higher temperature and lower WASO and lower efficiency.

Pattern evolution of antidepressants and benzodiazepines use in a cohort

OBJECTIVE

In recent decades there has been an increase in the use of antidepressants (AD) and a decrease in the use of benzodiazepines (BDZ). Prevalence, cumulative incidence, and factors associated with the incidence of AD and BDZ use in a Brazilian population were estimated in this article.

METHODS

Data were collected with a self-administered questionnaire in a cohort of employees from a university in Rio de Janeiro. The prevalence of the use of AD and BDZ was calculated for 1999 (4,030), 2001 (3,574), 2006-07 (3,058), and 2012 (2,933). The cumulative incidences of the use of AD and BDZ between 1999 and 2007 were estimated by the Poisson models with robust variance estimates.

RESULTS

In 1999, the prevalence of the use of AD and BDZ were 1.4% (95%CI: 1.1–1.8) and 4.7% (95%CI: 4.1–5.4), respectively; in 2012, they were 5.4% (95%CI: 5.5–6.2) and 6.8% (95%CI: 6.0–7.8). The incidence of use, between 1999 and 2007, was 4.9% (95%CI: 4.2–5.7) for AD and 8.3% (95%CI: 7.3–9.3) for BDZ. The incidences of AD and BDZ use were higher among women and participants with a positive General Health Questionnaire.

CONCLUSION

In this population, the increase in the use of AD was not accompanied by a decrease in the use of BDZ, showing the prescriptions for psychotropic medication do not follow the currently recommended guidelines for treatment of common mental health disorders.

Evaluation and management of insomnia in women with breast cancer

PURPOSE

Insomnia is a common issue among patients with breast cancer with a potentially devastating impact on quality of life. It can be caused or exacerbated by multiple disease and treatment-related factors. Despite the prevalence and impact of insomnia, it is rarely addressed systematically in the oncology clinic. We conducted a comprehensive review of insomnia to guide clinical care of patient's with breast cancer and insomnia.

METHODS

This manuscript reviews the prevalence, etiology, emerging science and both non-pharmacologic and pharmacologic options for treatment of insomnia among patients with breast cancer.

RESULTS

Multiple factors contribute to insomnia among patients with breast cancer including endocrine therapy and hotflashes, pain and discomfort from local therapy, and fear of recurrence. If we do identify insomnia, there are treatment options and strategies available to help patients. In particular, there is now a considerable body of evidence supporting the use of psychosocial interventions and behavioral treatments, such as cognitive behavioral therapy for insomnia (CBT-I), yoga, and mind-body programs. It is also important for oncology providers to be educated regarding available pharmacologic therapies and emerging data for cannabis-based therapy.

CONCLUSION

This manuscript provides an up-to-date and comprehensive review of the prevalence, etiology, and treatment approaches available for insomnia for clinicians treating patients with breast cancer. We also address strategies and goals for cancer care delivery and future research.

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

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.

Effects of Whole-Body Vibration Exercises on Parameters Related to the Sleep Quality in Metabolic Syndrome Individuals: A Clinical Trial Study

Metabolic syndrome (MetS) is an undesirable clinical condition with physiological, biochemical, clinical, and metabolic factors that contribute to increased cardiovascular risks (CR). A poor sleep quality might be found in obese and MetS individuals. Whole-body vibration (WBV) exercise has been used on the management of MetS individuals. This clinical trial investigated the effect of WBV exercise on parameters related to the sleep quality in MetS individuals. After randomization, nine individuals (seven women and two men) were exposed to a fixed frequency (FF) and ten individuals (eight women and two men) were exposed to a variable frequency (VF). Both groups performed the protocol twice a week, for 6 weeks. All of the evaluations were performed before the first and after the last sessions. Anthropometric and cardiovascular parameters were measured before and after the 6-week intervention. Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Berlin Questionnaire were also used to evaluate the quality of the sleep. A significant (p ≤ 0.05) reduction of the waist circumference in the VFG and an increase of the heart rate were found in the FFG and VFG group. The score of the PSQI of the both groups decreased significantly (p = 0.01). The score of the ESS decreased (p = 0.04) only in the VF group. The scores of the Berlin Questionnaire were not altered in both groups. In conclusion, WBV intervention was capable in interfering with physiological mechanisms with effects on the WC and HR, leading to the improvement of the quality of sleep in MetS individuals. WBV exercise might be an important clinical intervention to the management of some factors associated with poor quality of sleep (FFG and VFG) and in the daytime sleepiness in MetS individuals with variable frequencies (5–16 Hz) (VFG).

Sleep Duration and Sleep Disturbances as Predictors of Healthy and Chronic Disease-Free Life Expectancy Between Ages 50 and 75: A Pooled Analysis of Three Cohorts

Background

The aim of this study was to examine the associations of sleep duration and sleep disturbances with healthy and chronic disease-free life expectancy (LE) between ages 50 and 75.

Methods

Data were drawn from repeated waves of three occupational cohort studies in England, Finland, and Sweden (n = 55,494) and the follow-up ranged from 6 to 18 years. Self-reported sleep duration was categorized into <7, 7-8.5, and ≥9 hours and sleep disturbances into no, moderate, and severe. Health expectancy was estimated with two health indicators: healthy LE based on years in good self-rated health and chronic disease-free LE based on years without chronic diseases. Multistate life table models were used to estimate healthy and chronic disease-free LE from age 50 to 75 years for each category of sleep measures in each cohort. Fixed-effects meta-analysis was used to pool the cohort-specific results into summary estimates.

Results

Persons who slept 7-8.5 hours could expect to live 19.1 (95% CI 19.0-19.3) years in good health and 13.5 (95% CI 13.2-13.7) years without chronic diseases between ages 50 and 75. Healthy and disease-free years were 1-3 years shorter for those who slept less than 7 hours or slept 9 hours or more. Persons who did not have sleep disturbances could expect to live 20.4 (95% CI 20.3-20.6) years in good health and 14.3 (95% CI 14.1-14.5) years without chronic diseases between ages 50 and 75. Healthy and disease-free years were 6-3 years shorter for those who reported severe sleep disturbances.

Conclusions

Sleeping 7-8.5 hours and having no sleep disturbances between ages 50 to 75 are associated with longer healthy and chronic disease-free LE.

Back massage intervention for improving health and sleep quality among intensive care unit patients

BACKGROUND

A massage may relax muscles, improve blood circulation and reduce pain and anxiety while also improving sleep quality by increasing comfort. However, there is little research on whether a back massage improves sleep quality in intensive care unit (ICU) patients.

AIMS AND OBJECTIVES

This study examined the effects of a back massage on improving vital signs, sleep quality, anxiety and depression among ICU patients.

DESIGN

Adopting a quasi-experimental design, convenience sampling was used to recruit ICU patients from a medical centre in Southern Taiwan. The experimental group received back massages for three consecutive days (n = 30), while controls received usual care (n = 30).

METHODS

The Verran and Snyder-Halpern Scale and the Hospital Anxiety and Depression Scale were used, and subjective and objective sleep time (wrist actigraphy and sleep duration from nurse observations) was recorded. The effect of the intervention was examined using a generalized estimating equation model with a robust standard error and an exchangeable working correlation matrix adjusting for time.

RESULTS

The results show that subjective sleep quality scores in ICU patients were low. Mean observed sleep time (measured by nurses) was 3·9 h, but mean sleep time measured using wrist actigraphy was 5·9 h. Back massages improved breathing in patients, increased sleep quality reflected by both subjective and objective data and were associated with a significant change in anxiety.

CONCLUSIONS

These findings suggest that a 10-min back massage can improve sleep quality, sleep duration, breathing and anxiety in ICU patients.

RELEVANCE TO CLINICAL PRACTICE

The implementation of a back massage shows positive improvements in the sleep quality of ICU patients. The training and theory of massage interventions should be further applied when developing courses in critical care nursing.

Association between sleep quality and metabolic syndrome: A systematic review and meta-analysis

Sleep quality has been suggested to play an important role in development of metabolic syndrome (MetS). However, the results have been inconsistent. A systematic review of observational studies aimed to evaluate the association between sleep quality and MetS. A comprehensive search was conducted in PubMed and EMBASE. The pooled odd ratios (ORs) were calculated using random effects models. The construction of funnel plot was used to explore publication bias, with further application of Egger's test. 22 studies were included. The pooled finding showed that overall sleep quality had a significant positive association with MetS (OR 1.37, 95% CI 1.15-1.64), with substantial heterogeneity (I² = 62.4%, P < 0.1). Similarly, the complaints of sleep, including difficulty in falling sleep (OR 1.18, 95% CI 1.05-1.33), difficulty in maintaining sleep (OR 1.15, 95% CI 1.02-1.30) and sleep inefficiency (OR 1.40, 95% CI 1.04-1.89) were proved to be associated with the risk of MetS. Our results indicated the overall sleep quality as well as sleep complaints have significant positive associations with MetS. Further studies based on a longitudinal design using validated tools that measure both objective and subjective components of sleep quality are needed to explore the causal relationship between sleep quality and MetS.

Sleep behavior and depression: Findings from the China Kadoorie Biobank of 0.5 million Chinese adults

BACKGROUND

Mixed results have shown the association between sleep behavior and depression, but evidence relating the joint effect of sleep duration and sleep disturbances is limited, especially in Chinese population.

METHODS

A total of 512,891 adults aged 30-79 years from China Kadoorie Biobank (CKB) were included. Depression was defined by Composite International Diagnostic Inventory-short form (CIDI-SF). Sleep duration and sleep disturbances, including difficulty initiating and maintaining sleep (DIMS), early morning awakening (EMA), daytime dysfunction (DDF) and any sleep disturbances (ASD), were obtained by a self-reported questionnaire. Logistic regression was applied to examine the association between sleep behavior and depression.

RESULTS

About 23.1% of participants reported short sleep duration (≤ 6h), and 5.1% reported long sleep duration (> 9h). Compared with normal sleep duration (7-9h), both groups were associated greater likelihood of having depression (short sleep: OR = 2.32, 95%CI: 2.14-2.51; long sleep: OR = 1.56, 96%CI: 1.34-1.81). Participants reported sleep disturbances were significantly associated with depression (odds ratios ranged from 3.31 to 4.17). Moreover, the associations tended to be stronger for those who reported both abnormal sleep duration and sleep disturbances (p for interactions < 0.05), especially for those who slept long.

LIMITATIONS

The cross-sectional nature of the study design limits the interpretation of the results.

CONCLUSIONS

Abnormal sleep duration and sleep disturbances were associated with depression. The associations were stronger for abnormal sleep duration accompanied with sleep disturbances, especially for a long duration. More attention should be paid on these persons in clinical practice.

Depression and insomnia as mediators of the relationship between distress and quality of life in cancer patients

BACKGROUND

Distress in cancer patients leads to poorer quality of life (QOL) and negatively impacts survival. For efficient management of a patient's disease course, the interrelationships among distress, depression, insomnia, and QOL must be understood. This study aimed to investigate whether depression and insomnia mediate the relationship between distress and QOL in cancer patients.

METHODS

Cancer patients referred to a specialized psycho-oncology clinic (n=208) participated in this study. Distress, depression, insomnia, and QOL were measured with the following questionnaires: Distress Thermometer, Hospital Anxiety and Depression Scale, Insomnia Severity Index, and Functional Assessment of Cancer Therapy-General. Structural equation modeling and path analysis were performed to analyze the mediating effects of depression and insomnia on the relationship between distress and QOL.

RESULTS

Distress exerted nearly equal direct (ß=-0.291, p=0.002) and indirect (mediated by depression and insomnia) (ß=-0.299, p=0.003) negative effects on QOL. Depression exhibited the largest direct negative effect on QOL. The indirect effects of distress on QOL through depression alone, through insomnia alone, and through an insomnia to depression pathway were all significant (ß=-0.122, p=0.011; ß=-0.102, p=0.002; and ß=-0.075, p<0.001, respectively).

LIMITATIONS

The cross-sectional analyses limit the measurement of causal relationships between each variable.

CONCLUSIONS

Depression and insomnia, both individually and as part of an interrelated pathway, partially mediate the relationship between distress and QOL. Appropriate interventions to alleviate insomnia and depression may mitigate the negative impacts of distress on QOL in cancer patients.

Tamper-Resistant Mobile Health Using Blockchain Technology

Background

Digital health technologies, including telemedicine, mobile health (mHealth), and remote monitoring, are playing a greater role in medical practice. Safe and accurate management of medical information leads to the advancement of digital health, which in turn results in a number of beneficial effects. Furthermore, mHealth can help lower costs by facilitating the delivery of care and connecting people to their health care providers. Mobile apps help empower patients and health care providers to proactively address medical conditions through near real-time monitoring and treatment, regardless of the location of the patient or the health care provider. Additionally, mHealth data are stored in servers, and consequently, data management that prevents all forms of manipulation is crucial for both medical practice and clinical trials.

Objective

The aim of this study was to develop and evaluate a tamper-resistant mHealth system using blockchain technology, which enables trusted and auditable computing using a decentralized network.

Methods

We developed an mHealth system for cognitive behavioral therapy for insomnia using a smartphone app. The volunteer data collected with the app were stored in JavaScript Object Notation format and sent to the blockchain network. Thereafter, we evaluated the tamper resistance of the data against the inconsistencies caused by artificial faults.

Results

Electronic medical records collected using smartphones were successfully sent to a private Hyperledger Fabric blockchain network. We verified the data update process under conditions where all the validating peers were running normally. The mHealth data were successfully updated under network faults. We further ensured that any electronic health record registered to the blockchain network was resistant to tampering and revision. The mHealth data update was compatible with tamper resistance in the blockchain network.

Conclusions

Blockchain serves as a tamperproof system for mHealth. Combining mHealth with blockchain technology may provide a novel solution that enables both accessibility and data transparency without a third party such as a contract research organization.

Development and validation of the Maugeri Sleep Quality and Distress Inventory (MaSQuDI-17)

Objectives

The aim of this study was to develop and validate a questionnaire designed to measure the impact of sleep impairment on emotional distress in patients with various sleep disorders.

Methods

Five experts created an item data-bank pertaining to sleep-related psychological symptoms and somatic perceptions. Fifty patients in two focus groups examined each item for: a) word clarity (indicating any ambiguity of interpretation) and b) appropriateness for the target population. This process permitted to identify 36 appropriate items. Classical Test Theory and Rasch Analysis were used to further refine the questionnaire, yielding the final 17-item set. Concurrent validation of the new scale was tested with the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and the Anxiety and Depression questionnaires.

Results

Starting from the initial item data-bank, a 17-item questionnaire, the Maugeri Sleep Quality and Distress Inventory (MaSQuDI–17), was produced. Parallel Analysis on the MaSQuDI–17 confirmed the presence of a single dimension; exploratory factor analysis showed salient loading for each item, explaining 58.7% of total variance. Item-remainder correlation ranged from 0.72 to 0.39 and Cronbach alpha was 0.896. Rasch analysis revealed satisfactory psychometric properties of the new scale: the rating structure performed according to expectations, model fit was good and no item dependencies emerged. The scale presented good convergent validity and scores significantly distinguished healthy subjects from OSAS or Insomnia or BSD (p < 0.001).

Conclusions

MaSQuDI –17 shows good psychometric qualities, and can be used to assess the impact of sleep disorders such as Insomnia, OSAS, Central Hypersomnia and BSD on emotional stress.

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

BACKGROUND

Observational 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.

METHODS

Relevant 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.

RESULTS

Thirty-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.

CONCLUSIONS

This 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.

Nurse practitioner job content and stress effects on anxiety and depressive symptoms, and self-perceived health status

AIM

We explored the impact of job content and stress on anxiety, depressive symptoms and self-perceived health status among nurse practitioners (NPs).

BACKGROUND

Taiwan's NP roles vary between hospitals as a result of the diverse demands and complex tasks that cause job-related stress, potentially affecting the health of the NP.

METHODS

This study utilised a cross-sectional descriptive design with 161 NPs from regional hospitals participating. Data collection involved demographics, the Taiwan Nurse Stress Checklist, the Job Content Questionnaire, the Beck Anxiety Inventory, the Beck Depression Inventory, a General Health Status Checklist and salivary cortisol tests.

RESULTS

NPs reported moderate job stress, similar job control to nurses, mild anxiety and depression, and below-average self-perceived health. Being a licensed NP, personal response, competence, and incompleteness of the personal arrangements subscales of job stress, and anxiety predicted self-perceived health after adjusting for other covariates.

CONCLUSIONS

Job stress and anxiety affect NP health.

IMPLICATIONS FOR NURSING MANAGEMENT

NPs are a valuable resource, and the healthcare system demand is growing. Reasonable NP staffing, working hours, proper promotion systems, the causes of job stress, job content clarification and practical work shift scheduling need to be considered. The occupational safety and physical and psychological health of NPs are strongly associated with the quality of patient care.

Prospective study of predictors and consequences of insomnia: personality, lifestyle, mental health, and work-related stressors

OBJECTIVE

To prospectively investigate the reciprocal relationships between personality traits, lifestyle factors, mental health, sleepiness, and work-related stressors against insomnia.

METHODS

A total of 799 Norwegian shift-working nurses (mean age 33.2 years, 90% female) participated in this prospective cohort study. They were assessed on self-report instruments (Bergen Insomnia Scale, Diurnal Type Scale, Hospital Anxiety and Depression Scale, Negative Acts Questionnaire-Revised, Work-Family Interface Scale, among others) in 2008/2009 (wave 1) and 2011 (wave 3). Structural equation modeling was employed to investigate the bidirectional relationship between a wide range of individual and work-related variables and insomnia.

RESULTS

Languidity (β = 0.18***), anxiety (β = 0.11**), depression (β = 0.14***), exposure to bullying behavior (β = 0.08*), and negative spillover between work and family life (work to family, β = 0.08*; family to work, β = 0.07*) predicted increased symptoms of insomnia over time. Morningness (β = -0.09*) and positive spillover from work to family (β = -0.11**) predicted less symptoms of insomnia over time. No support was found for night work as a predictor of increased insomnia. Insomnia was a precursor for anxiety (β = 0.11**), but not for depression (*p <0.05, **p <0.01, ***p <0.001).

CONCLUSION

The data suggested that insomnia more often emerges as a consequence of individual and work-related factors than as a precursor to them. The scope of factors causing insomnia, and factors protecting against it, should be further investigated. Insomnia should be considered in prediction models for mental illnesses and as an outcome of adverse work-related experiences.

The Association between Psychological Distress and Self-Reported Sleep Duration in a Population-Based Sample of Women and Men

Mental health and sleep are intricately linked. This study characterized associations of psychological distress with short (≤6 hours) and long (≥9 hours) sleep duration among adults aged ≥18 years. 2013 Behavioral Risk Factor Surveillance System data (n = 36,859) from Colorado, Minnesota, Nevada, Tennessee, and Washington included the Kessler 6 (K6) scale, which has been psychometrically validated for measuring severe psychological distress (SPD); three specifications were evaluated. Overall, 4.0% of adults reported SPD, 33.9% reported short sleep, and 7.8% reported long sleep. After adjustment, adults with SPD had 1.58 (95% CI: 1.45, 1.72) and 1.39 (95% CI: 1.08, 1.79) times higher probability of reporting short and long sleep duration, respectively. Using an ordinal measure showed a dose-response association with prevalence ratios of 1.00, 1.16, 1.38, 1.67, and 2.11 for short sleep duration. Each additional point added to the K6 scale was associated with 1.08 (95% CI: 1.07, 1.10) and 1.02 (95% CI: 1.00, 1.03) times higher probability of reporting short and long sleep duration, respectively. Some results were statistically different by gender. Any psychological distress, not only SPD, was associated with a higher probability of short sleep duration but not long sleep duration. These findings highlight the need for interventions.

Insomnia symptoms and subsequent psychotropic medication: a register-linked study with 5-year follow-up

PURPOSE

This study examined the associations of insomnia symptoms with subsequent psychotropic medication, reflecting mental health.

METHODS

Postal baseline surveys among 40- to 60-year-old employees of the city of Helsinki, Finland, were collected in 2000-2002 (N = 6,227, response rate 67%, 78% women) and longitudinally linked with national register data on prescribed reimbursed medication. Insomnia symptoms at baseline comprised difficulties in initiating and maintaining sleep, and non-restorative sleep. All purchased psychotropic medication 5-7 years prior to and 5 years after baseline was included. Outcomes were any psychotropic medication; antidepressants; and anxiolytics, hypnotics, and sedatives. Covariates included socio-demographic and work-related factors, health behaviors, lifetime mental disorders, and prior psychotropic medication. Logistic regression analysis was used to calculate odds ratios (OR) and their 95% confidence intervals (CI).

RESULTS

Insomnia symptoms were associated with higher frequency of subsequent psychotropic medication prescriptions. The associations were strongest for frequent insomnia symptoms (women OR 3.55, 95% CI 2.64-4.77; men OR 4.64, 95% CI 2.49-8.66, adjusted for age and prior medication), but also rare and occasional symptoms were associated with psychotropic medication. Further adjustments had negligible effects.

CONCLUSIONS

Insomnia symptoms were associated with prescribed psychotropic medication during follow-up in a dose-response manner. Attention should be given to the prevention of insomnia symptoms to curb subsequent mental problems.

Correlations between depression behaviors and sleep parameters after repeated corticosterone injections in rats

AIM

Disrupted sleep may be a prodromal symptom or a predictor of depressive disorders. In this study we investigated the relationship between depression symptoms and disrupted sleep using a novel model of stress-mimicked sleep disorders in rats.

METHODS

SD rats were injected with corticosterone (10, 20 or 40 mg/kg, sc) or vehicle for 7 d. Their sleep-wake behavior was monitored through implanted EEG and EMG electrodes. Their depressive behaviors were assessed using forced swim test, open field test and sucrose preference test.

RESULTS

The corticosterone-treated rats showed significantly reduced sleep time, disinhibition of rapid-eye-movement (REM) sleep and altered power spectra during non-REM sleep. All depressive behavioral tests did not show significant difference across the groups. However, individual correlation analysis revealed statistically significance: the immobility time (despair) was negatively correlated with REM sleep latency, slow wave sleep (SWS) time ratio, SWS bouts and delta power density, and it was positively correlated with REM sleep bouts and beta power density. Meanwhile, sucrose preference (anhedonia) was positively correlated with total sleep time and light sleep bouts, and it was negatively correlated with the REM sleep time ratio.

CONCLUSION

In stress-mimicked rats, sleep disturbances are a predictor of depressive disorders, and certain symptoms of depression may be related to the disruption of several specific sleep parameters.

Insomnia as a risk factor for ill health: results from the large population-based prospective HUNT Study in Norway

Insomnia co-occurs with many health problems, but less is known about the prospective associations. The aim of the current study was to investigate if insomnia predicts cumulative incidence of mental and physical conditions. Prospective population-based data from the two last Nord-Trøndelag Health Studies (HUNT2 in 1995–97 and HUNT3 in 2006–08), comprising 24 715 people in the working population, were used to study insomnia as a risk factor for incidence of physical and mental conditions. Insomnia was defined according to the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Insomnia at HUNT2 was a significant risk factor for incidence of a range of both mental and physical conditions at HUNT3 11 years later. Most effects were only slightly attenuated when adjusting for confounding factors, and insomnia remained a significant risk factor for the following conditions in the adjusted analyses: depression [odds ratio (OR): 2.38, 95% confidence interval (CI): 1.91–2.98], anxiety (OR: 2.08, 95% CI: 1.63–2.64), fibromyalgia (OR: 2.05, 95% CI: 1.51–2.79), rheumatoidarthritis (OR: 1.87, 95% CI: 1.29–2.52), whiplash (OR: 1.71, 95% CI: 1.21–2.41), arthrosis (OR: 1.68, 95% CI: 1.43–1.98), osteoporosis (OR:1.52, 95% CI: 1.14–2.01, headache (OR: 1.50, 95% CI: 1.16–1.95,asthma (OR: 1.47, 95% CI: 1.16–1.86 and myocardial infarction (OR:1.46, 95% CI: 1.06–2.00). Insomnia was also associated significantly with incidence of angina, hypertension, obesity and stroke in the crude analyses, but not after adjusting for confounders. We conclude that insomnia predicts cumulative incidence of several physical and mental conditions. These results may have important clinical implications, and whether or not treatment of insomnia would have a preventive value for both physical and mental conditions should be studied further.

Sleep difficulties and the development of depression and anxiety: a longitudinal study of young Australian women

Previous longitudinal studies have demonstrated that poor sleep may precede depression and anxiety. The current study examined the association between self-reported sleeping difficulties and new onset depression and anxiety in young women. A nationally representative sample of 9,683 young women from the Australian Longitudinal Study of Women's Health was analyzed. Women were surveyed in 2000 (aged 22 to 25 years), 2003, 2006, and 2009. Generalized estimating equations were used to examine the association between sleeping difficulties in 2000 and new-onset depression (excluding postnatal depression) and anxiety at each subsequent survey. Significant increased risk of new onset depression (odds ratio (OR)=2.6 in 2003; OR=4.4 in 2006; OR=4.4 in 2009) and anxiety (OR=2.4 in 2006; OR=2.9 in 2009) was found at each follow-up survey in women who reported sleeping difficulties "often" in 2000. Further research is needed to uncover the mechanisms underlying the link between sleep problems and mental health.

Can insomnia in pregnancy predict postpartum depression? A longitudinal, population-based study

Background

Insomnia and depression are strongly interrelated. This study aimed to describe changes in sleep across childbirth, and to evaluate whether insomnia in pregnancy is a predictor of postpartum depression.

Methods

A longitudinal, population-based study was conducted among perinatal women giving birth at Akershus University Hospital, Norway. Women received questionnaires in weeks 17 and 32 of pregnancy and eight weeks postpartum. This paper presents data from 2,088 of 4,662 women with complete data for insomnia and depression in week 32 of pregnancy and eight weeks postpartum. Sleep times, wake-up times and average sleep durations were self-reported. The Bergen Insomnia Scale (BIS) was used to measure insomnia. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depressive symptoms.

Results

After delivery, sleep duration was reduced by 49 minutes (to 6.5 hours), and mean sleep efficiency was reduced from 84% to 75%. However, self-reported insomnia scores (BIS) improved from 17.2 to 15.4, and the reported prevalence of insomnia decreased from 61.6% to 53.8%. High EPDS scores and anxiety in pregnancy, fear of delivery, previous depression, primiparity, and higher educational level were risk factors for both postpartum insomnia and depression. Insomnia did not predict postpartum depression in women with no prior history of depression, whereas women who recovered from depression had residual insomnia.

Limitations

Depression and insomnia were not verified by clinical interviews. Women with depressive symptoms were less likely to remain in the study.

Conclusions

Although women slept fewer hours at night after delivery compared to during late pregnancy, and reported more nights with nighttime awakenings, their self-reported insomnia scores improved, and the prevalence of insomnia according to the DSM-IV criteria decreased. Insomnia in pregnancy may be a marker for postpartum recurrence of depression among women with previous depression.

Insomnia symptoms and subsequent cardiovascular medication: a register-linked follow-up study among middle-aged employees

Sleep disturbances have been associated with an increased risk of cardiovascular disease outcomes. The associations of insomnia with hypertension and dyslipidaemia, the main modifiable cardiovascular risk factors, are less studied. We especially lack understanding on the longitudinal effects of insomnia on dyslipidaemia. We aimed to examine the associations of insomnia symptoms with subsequent prescribed medication for hypertension and dyslipidaemia using objective register-based follow-up data. Baseline questionnaire surveys among 40-60-year-old employees of the City of Helsinki, Finland, were conducted in 2000-2002 (n = 6477, response rate 67%, 78% women) and linked to a national register on prescribed reimbursed medication 5-7 years prior to and 5 years after baseline. Associations between the frequency of insomnia symptoms (difficulties in initiating and maintaining sleep, non-restorative sleep) and hypertension and dyslipidaemia medication during the follow-up were analysed using logistic regression analysis (odds ratios with 95% confidence intervals). Analyses were adjusted for pre-baseline medication, sociodemographic and work-related factors, health behaviours, mental health, and diabetes. Frequent insomnia symptoms were reported by 20%. During the 5-year follow-up, 32% had hypertension medication and 15% dyslipidaemia medication. Adjusting for age, gender and pre-baseline medication, frequent insomnia symptoms were associated with hypertension medication (odds ratio 1.57, 95% confidence interval 1.23-2.00) and dyslipidaemia medication (odds ratio 1.59, 95% confidence interval 1.19-2.12). Occasional insomnia symptoms were also associated with cardiovascular medication, though less strongly. Further adjustments had negligible effects. To conclude, insomnia should be taken into account in the prevention and management of cardiovascular disease and related risk factors.

Maternal stress, well-being, and impaired sleep in mothers of children with developmental disabilities: a literature review

Having children with developmental disabilities (DDs) requires a high level of caregiving responsibilities, and existing studies support that mothers of children with DDs experience high levels of maternal stress as well as poor sleep and well-being. Given the fact that the number of children with DDs has increased, an up-to-date literature review is necessary to identify factors associated with maternal stress, sleep, and well-being. In addition, understanding these factors and their relationships may provide better strategies in designing effective interventions that can reduce the burden in mothers of children with DDs. This review summarized 28 scientific research papers that examined maternal stress, sleep, and well-being in mothers of children with DDs in past 12 years. The study findings indicate that mothers of children with DDs experience higher levels of stress than mothers of typically developing children, and it remains high over time. In addition, these mothers often encounter depressive symptoms as well as poor sleep quality. The study results also reveal that there is a bidirectional relationship between maternal stress and depressive symptoms as well as between poor sleep quality and depressive symptoms. For example, higher stress mothers experienced more depressive symptoms. Mothers of children with DDs with poor sleep quality are significantly associated with more depressive symptoms. Child behavior problems were significantly associated with both maternal stress and depressive symptoms, but cautious interpretation is warranted due to the shared variance between child behavior problems, maternal stress, and depressive symptoms. Methodological guidelines for future research involve the use of reliable and valid instruments for the measurement of child behavior problems, maternal stress, and sleep. Recommendations for future research are included.

A novel taping therapy for chronic insomnia: a report on two cases

OBJECTIVES

Here, we report two cases of chronic insomnia treated satisfactorily by re-using of patients' bioelectricity.

PATIENTS

First was a 46 years old male who had taken drugs for several years and depression drug for one year. He had heart beat and felt pressure pain on almost of chest. Second was a 64 years old male who had taken drugs for one year. In spite of the medication, he could not sleep at all and had glint eyes.

INTERVENTIONS

Method of treatment is to put the medical tape (Chimsband) on acupoints and pressure pain points in the chest, which can be traced down by finger pressing examination.

RESULTS

In the first case, the patient escaped from the medications after three weeks. Following seven weeks, depression was reduced remarkably. In the second case, the glint of eyes returned to normal after two treatments. After three treatments, the sleeping time was lengthened to 4h.

CONCLUSIONS

First, pressing chest can be used for tracing neurological symptoms; second, when the bioelectricity of the patient reacts to Chimsband, the symptoms could be ameliorated; third, there is a relationship between treating the neurological symptoms such as insomnia and attenuating pressure pain.

Is chronic insomnia a precursor to major depression? Epidemiological and biological findings

Insomnia has been found to be a clinical predictor of subsequent depression. Nevertheless the biological processes underlying this causal relationship are yet not fully understood. Both conditions share a common imbalance of the arousal system. Patients with insomnia present fragmented REM sleep, which probably interferes with basal processes of emotion regulation. The interaction between the arousal and the affective system with the persistence of the disorder could slowly alter also the cognitive system and lead to depression. Although preliminary results seem to support this hypothesis, data are still too few to make valid conclusions.

The bidirectional association between depression and insomnia: the HUNT study

OBJECTIVE

Depression and insomnia are closely linked, yet our understanding of their prospective relationships remains limited. The aim of the current study was to investigate the directionality of association between depression and insomnia.

METHODS

Data were collected from a prospective population-based study comprising the most recent waves of the Nord-Trøndelag Health Study (HUNT) (the HUNT2 in 1995-1997 and the HUNT3 in 2006-2008). A total of 24,715 persons provided valid responses on the relevant questionnaires from both surveys. Study outcomes were onset of depression or insomnia at HUNT3 in persons not reporting the other disorder in HUNT2.

RESULTS

Both insomnia and depression significantly predicted the onset of the other disorder. Participants who did not have depression in HUNT2 but who had insomnia in both HUNT2 and HUNT3 had an odds ratio (OR) of 6.2 of developing depression at HUNT3. Participants who did not have insomnia in HUNT2 but who had depression in both HUNT2 and HUNT3 had an OR of 6.7 of developing insomnia at HUNT3. ORs were only slightly attenuated when adjusting for potential confounding factors.

CONCLUSIONS

The results support a bidirectional relationship between insomnia and depression. This finding stands in contrast to the previous studies, which have mainly focused on insomnia as a risk factor for the onset of depression.

Resource utilization and costs associated with insomnia treatment in patients with major depressive disorder

OBJECTIVE

To estimate resource utilization and costs associated with insomnia treatment among newly treated patients with major depressive disorder (MDD).

METHOD

Data from the MarketScan(®) Research Databases (Commercial Claims and Encounters, Medicare Supplemental and Coordination of Benefits, and Health and Productivity Management) were analyzed. Patients aged ≥ 18 years with a first prescription claim for an antidepressant between January 1, 2006, and December 31, 2007 (index date), were included in the analysis if they had ≥ 1 MDD diagnosis (ICD-9-CM criteria) in the 12 months prior to the claim and 24 months of continuous insurance coverage. Patients were categorized into 2 groups on the basis of the presence or absence of insomnia medication during the 12 months following the index date. Multivariate analyses were conducted to compare all-cause and MDD-related hospitalization and emergency room (ER) visits and costs in the year following the index date between patients with and without insomnia medication. Covariates for adjustment included age, gender, region, health plan type, baseline comorbidities, and health care utilization.

RESULTS

The total sample size was 87,461 newly treated MDD patients with a mean (SD) age of 43.5 (15.1) years; 67% were women. Among newly treated patients, 10,339 (11.8%) took insomnia medication. Patients taking insomnia medication were significantly more likely to be hospitalized (OR = 1.84, 95% CI = 1.73-1.96 for all cause; OR = 1.50, 95% CI = 1.43-1.57 for MDD related; P < .0001) and to have ER visits (OR = 4.25, 95% CI = 3.65-4.95 for all cause; OR = 2.51, 95% CI = 2.24-2.81 for MDD related; P < .0001) than the patients not taking insomnia medication. Adjusted all-cause health care costs were $3,918 (95% CI = $3,599-$4,290) higher and MDD-related health care costs were $537 (95% CI = $492-$586) higher in the insomnia medication cohort compared with controls in the 12-months following the index date. Patients taking insomnia medication had $1,162 more indirect costs for short-term disability compared to the control group (95% CI = $746-$1,684).

CONCLUSIONS

The use of insomnia medications in newly treated patients with MDD appears to be associated with increased health care resource utilization and higher total and depression-related direct and indirect medical costs.