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Matsuda E, Kikutani M. Impacts of sleep disturbance and work-related life stress on depression among Japanese and Chinese workers. PLoS One 2024; 19:e0305936. [PMID: 38935694 PMCID: PMC11210821 DOI: 10.1371/journal.pone.0305936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/07/2024] [Indexed: 06/29/2024] Open
Abstract
The present study investigated how life stress and sleep disturbance impact depressive symptoms among Chinese (N = 185) and Japanese (N = 464) workers. Based on a hypothesis that sleep disturbance can cause depression, a statistical model is established, expecting that work-related life stress indirectly increases depressive symptoms by worsening sleep disturbance rather than initiating depression directly. The study also examined the buffering effects of social support on depression. The extent of depressive symptoms, sleep disturbance symptoms (insomnia, hypersomnia, and nightmare), work-related stressors, and available social support were measured. The result revealed that the extent of depression was equivalent for both groups, but the Chinese reported more stress, less social support, and more severe sleep disturbance symptoms than the Japanese. Despite those differences, the statistical model fitted both groups well, suggesting that addressing sleep disturbance at the earliest opportunity can effectively prevent depression onset for workers.
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Affiliation(s)
- Eiko Matsuda
- Department of Social Psychology, Faculty of Sociology, Toyo University, Bunkyo-ku, Tokyo, Japan
| | - Mariko Kikutani
- Institute of Liberal Arts and Science, Kanazawa University, Kanazawa, Ishikawa, Japan
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Siteneski A, Gómez Mieles VS, Romero Riaño PA, Montes Escobar K, Lapo-Talledo GJ, Dueñas-Rodriguez AV, Palma Cedeño MA, Villacis Lascano YC, Echeverria Zurita LO. High levels of anxiety and depression in women farmers from Ecuador: A cross-section study in Coastal and Highlands regions. Int J Soc Psychiatry 2024:207640241260017. [PMID: 38915219 DOI: 10.1177/00207640241260017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND Previous studies have shown that women farmers are particularly vulnerable to mental health disorders such as depression and anxiety. AIMS This study aimed to investigate the prevalence of anxiety and depression in women farmers from Ecuador Coastal and Highlands regions. METHOD General Anxiety Disorder‑7 (GAD‑7) and Patient Health Questionnaire‑9 (PHQ‑9) were applied. In addition, self-reported number of children, days off, hours of work, pesticide use, sleep habits and years of work in agriculture, were also collected. This cross-sectional study occurred during 2023 with 443 women, for Coastal (197) and Highlands (246), respectively. Multivariable binary logistic regression models were performed to obtained adjusted odds ratios (aOR) and their 95% confidence intervals (95% CI). RESULTS 34.5% of Coastal women had depression, while 27.2% of Highlands women had depression. 20.3% of coastal women farmers had anxiety, while in the Highlands 24.8% had anxiety. Coastal mestizo and montubio women exhibited lower probability of depression, but this was not significant in the Highlands. Coastal women farmers that did not have children showed lower odds of depression (aOR 0.05, 95% CI [0.01, 0.34]). A lower likelihood of depression was observed in coastal women that worked more than 8 hours (aOR 0.22, 95% CI [0.07, 0.72]). Women from the Highlands that had shortened sleep duration exhibited lower odds of depression and anxiety. CONCLUSIONS A higher proportion of depressed women farmers was observed in the Coast region and slightly higher numbers of anxiety cases in the Highlands. The number of children may cause workload and is correlated with depression in Coastal women.
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Affiliation(s)
- Aline Siteneski
- School of Medicine, Faculty of Health Sciences, Universidad Técnica de Manabí, Portoviejo, Manabí, Ecuador
- Research Institute, Universidad Técnica de Manabí, Portoviejo, Manabí, Ecuador
| | | | - Paola Andrea Romero Riaño
- Faculty of Health Sciences and Human Well-being, Universidad Indoamerica, Ambato, Tungurahua, Ecuador
| | - Karime Montes Escobar
- Department of Mathematics and Statistics, Faculty of Basic Sciences, Universidad Técnica de Manabí, Portoviejo, Ecuador
| | - German Josuet Lapo-Talledo
- School of Medicine, Faculty of Health Sciences, Universidad Técnica de Manabí, Portoviejo, Manabí, Ecuador
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Mijnster T, Boersma GJ, van Veen MM, Liemburg E, Cath D, Pijnenborg GHM, De Jong PJ, Lancel M. Sleep disorders in a naturalistic cohort of Dutch psychiatric outpatients: prevalence rates and associations with psychopathology symptom severity and well-being. J Sleep Res 2024; 33:e14009. [PMID: 37533279 DOI: 10.1111/jsr.14009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/30/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023]
Abstract
Sleep problems are very common in individuals with a mental disorder. Given the abundant evidence indicating the negative impact of disturbed sleep on mental health outcome, insight into the prevalence of all types of sleep disorders in specific mental disorders and neurodevelopmental conditions is of practical importance. Therefore, we estimated the prevalence of six types of sleep disorders with the Holland Sleep Disorders Questionnaire in an overall mental health sample (n = 1082) and separately for different mental and neurodevelopmental conditions. Furthermore, associations between specific sleep disorders, psychopathology and well-being were studied. The impact of the total number of sleep disorders on these associations was examined. Overall, 46.2% of all participants scored above the cut-off for having a sleep disorder. Specifically, 26.8% scored on insomnia, 12.1% on sleep breathing disorders, 9.7% on hypersomnia, 13.7% on circadian rhythm sleep-wake disorders, 11.2% on parasomnia, and 17.9% on sleep-related movement disorders. Most sleep disorders were associated with greater severity of psychopathology and lower well-being. These associations got stronger with an increasing number of sleep disorders. Our study revealed higher suspected prevalence of most sleep disorders in a mental disorder sample compared to the general population. Moreover, the presence of sleep disorder(s) was strongly associated with symptom severity and reduced well-being. These findings extend the notion that early detection and treatment of sleep disorders in mental health populations is essential for psychiatric outcome.
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Affiliation(s)
- Teus Mijnster
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Gretha J Boersma
- Forensic Psychiatric Hospital, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
| | - Maaike M van Veen
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
| | - Edith Liemburg
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daniëlle Cath
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Specialist Trainings, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
| | - Gerdina H M Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Peter J De Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Marike Lancel
- Centre of Expertise on Sleep and Psychiatry, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
- Forensic Psychiatric Hospital, GGZ Drenthe Mental Health Institute, Assen, The Netherlands
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Kundu S, Acharya SS. Linkage of premature and early menopause with psychosocial well-being: a moderated multiple mediation approach. BMC Psychol 2023; 11:228. [PMID: 37559104 PMCID: PMC10413596 DOI: 10.1186/s40359-023-01267-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE Menopause occurring before the age of 40 is premature and between 40 and 44 years age is early, since the natural age of menopause lies between 45 and 50. The endocrine changes that come with menopause include an erratic decline in estrogen levels which affects the brain. Thus, leading to changes in cognitive function in the longer term due to the menopausal transition. The study aims to explore the effect of premature and early menopause on cognitive health, and psychosocial well-being. The moderated multiple mediation hypothesis of the study is that the effect of premature or early menopause is mediated by depression and insomnia, while all the pathways are moderated by smoking habits. DATA AND METHODS The study utilized Longitudinal Aging Study in India (LASI), 2017-2018, Wave 1 data. The sample of 31,435 women were aged 45 and above and did not undergo hysterectomy. A moderated multiple mediation model was used to understand the association between premature or early menopause (X), insomnia (M1), depression (M2), moderator (W), and cognitive health (Y), while controlling for possible confounders. RESULTS Premature menopause was negatively associated with cognition (β:-0.33; SE:0.12; p < 0.05), whereas positively associated with insomnia (β:0.18; SE:0.03; p < 0.001) and depression (β:0.25; SE:0.04; p < 0.001). There is a moderating effect of smoking or tobacco consumption has a significant moderating effect on the pathways among premature menopause, depression, insomnia and cognition. When the same model was carried out for early menopause (40-44 years), the results were not significant. CONCLUSIONS The findings emphasize the fact that smoking is associated with premature menopause, depression and insomnia. Women who experienced premature menopause has lower cognitive scores, depressive symptoms and insomnia symptoms, which were higher among those who consumed tobacco. The study, strongly recommends the dissemination of information on the negative effects of tobacco consumption and making more informed choices to maintain a healthy life. More research into various methods and therapy is needed to determine the relationship between the age of early menopause and their psychosocial well-being.
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Affiliation(s)
- Sampurna Kundu
- Centre of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University, Delhi, 110067, India.
| | - Sanghmitra Sheel Acharya
- Centre of Social Medicine and Community Health, School of Social Sciences, Jawaharlal Nehru University, Delhi, 110067, India
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Drinčić T, van Dalfsen JH, Kamphuis J, Jentsch MC, van Belkum SM, Meddens MJM, Penninx BWJH, Schoevers RA. The Relationship between Insomnia and the Pathophysiology of Major Depressive Disorder: An Evaluation of a Broad Selection of Serum and Urine Biomarkers. Int J Mol Sci 2023; 24:ijms24098437. [PMID: 37176140 PMCID: PMC10179282 DOI: 10.3390/ijms24098437] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/20/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
Insomnia exhibits a clinically relevant relationship with major depressive disorder (MDD). Increasing evidence suggests that insomnia is associated with neurobiological alterations that resemble the pathophysiology of MDD. However, research in a clinical population is limited. The present study, therefore, aimed to investigate the relationship between insomnia and the main pathophysiological mechanisms of MDD in a clinical sample of individuals with MDD. Data were extracted from three cohorts (N = 227) and included an evaluation of depression severity (Quick Inventory of Depressive Symptomatology, QIDS-SR16) and insomnia severity (QIDS-SR16 insomnia items) as well as serum and urine assessments of 24 immunologic (e.g., tumour necrosis factor α receptor 2 and calprotectin), neurotrophic (e.g., brain-derived neurotrophic factor and epidermal growth factor), neuroendocrine (e.g., cortisol and aldosterone), neuropeptide (i.e., substance P), and metabolic (e.g., leptin and acetyl-L-carnitine) biomarkers. Linear regression analyses evaluating the association between insomnia severity and biomarker levels were conducted with and without controlling for depression severity (M = 17.32), antidepressant use (18.9%), gender (59.0% female; 40.5% male), age (M = 42.04), and the cohort of origin. The results demonstrated no significant associations between insomnia severity and biomarker levels. In conclusion, for the included biomarkers, current findings reveal no contribution of insomnia to the clinical pathophysiology of MDD.
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Affiliation(s)
- Tina Drinčić
- Department of Psychiatry, University Medical Centre Groningen, Hanzeplein 1, 9713 RB Groningen, The Netherlands
| | - Jens H van Dalfsen
- Department of Psychiatry, University Medical Centre Groningen, Hanzeplein 1, 9713 RB Groningen, The Netherlands
| | - Jeanine Kamphuis
- Department of Psychiatry, University Medical Centre Groningen, Hanzeplein 1, 9713 RB Groningen, The Netherlands
| | - Mike C Jentsch
- Department of Psychiatry, University Medical Centre Groningen, Hanzeplein 1, 9713 RB Groningen, The Netherlands
| | - Sjoerd M van Belkum
- Department of Psychiatry, University Medical Centre Groningen, Hanzeplein 1, 9713 RB Groningen, The Netherlands
| | | | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam University Medical Centre (VUmc), De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University Medical Centre Groningen, Hanzeplein 1, 9713 RB Groningen, The Netherlands
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Gao L, Yang J, Liu J, Xin T, Liu Y. Activities of Daily Living and Depression in Chinese Elderly of Nursing Homes: A Mediation Analysis. Psychol Res Behav Manag 2023; 16:29-38. [PMID: 36636291 PMCID: PMC9831252 DOI: 10.2147/prbm.s394787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose This study aimed to explore the role of sleep quality as a mediator in the activities of daily living (ADLs) and depression. Patients and Methods Participants (N=645; age≥60) were included in six nursing homes in Weifang, Shandong Province, using convenience sampling. Participants completed questionnaires to assess sleep quality, ADLs, and depression. Depression condition was assessed by the Patient Health Questionnaire (PHQ-9), ADLs was assessed by the Barthel Index (BI), and sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Mediation analysis was carried out by SPSS PROCESS. Results ADLs (r=0.449, P<0.01) and sleep quality (r=0.450, P<0.01) were found to be positively associated with depression among the elderly. Sleep quality plays a significant mediating role in the influence of ADLs on depression in the elderly in nursing homes (Bootstrap 95% CI [0.076, 0.139]), The pathway from ADLs to sleep quality to depression yielded a medium effect size of 20.23%. Conclusion ADLs help to explain how sleep quality partly mediates depression among the elderly in nursing homes. It is therefore recommended that timely detection and efficient interventions should focus on promoting physical function and improving sleep quality among the elderly in nursing homes.
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Affiliation(s)
- Lunan Gao
- School of Nursing, Weifang Medical University, Weifang, People’s Republic of China
| | - Jinhong Yang
- Department of Oncology, Weifang People’s Hospital, Weifang, People’s Republic of China
| | - Jiang Liu
- School of Nursing, Weifang Medical University, Weifang, People’s Republic of China
| | - Tingting Xin
- School of Nursing, Weifang Medical University, Weifang, People’s Republic of China
| | - Yuxiu Liu
- School of Nursing, Weifang Medical University, Weifang, People’s Republic of China,Correspondence: Yuxiu Liu, School of Nursing, Weifang Medical University, No. 7166 Baotong Western Street, Weifang, People’s Republic of China, Tel +8618663608162, Email
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7
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[Sleep disorders reduce the therapeutic success of inpatient psychosomatic treatments for depressive disorders]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2021; 67:271-289. [PMID: 34524061 DOI: 10.13109/zptm.2021.67.3.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Sleep disorders reduce the therapeutic success of inpatient psychosomatic treatments for depressive disorders Objective: What influence do difficulties in falling and staying asleep in patients with depressive disorders have on the success of psychosomatic treatment? Method: The Data were collected in a naturalistic, multicenter observational study (STOP-D) at the beginning (T1), the end (T2) and six months later after discharge (T3). The sample consisted of female patients with depressive disorders (N = 487) who were treated for M = 61.7 days (SD = 26.8). An insomnia scale with a total of seven items was created subsequently to T1 from Items of the Beck Depression Inventory (BDI-I), from the Hamilton Depression Scale (HAMD) and from the Global Severe Index (GSI) from the Symptom Checklist 90 (SCL-90-R). Then groups were formed on changes in insomnia symptoms from T1 to T2. These two groups "sleep improver" and "sleep deteriorators" were tested by analysis of variance. Results: The subsequently constructed insomnia scale showed good psychometric characteristics in the performed analyses. Patients who reported an improvement in their sleep disturbances during inpatient psychosomatic treatment had significantly lower depression scores in the self-evaluation inventories (BDI-I und SCL-90-R) than patients without improvements in their sleep patterns. This effect was even more pronounced for the catamnestic period. Discussion: Insomnia symptoms in depressed female patients can be an important indicator of the effect of inpatient psychosomatic treatment and can have negative impact on the sustainability of the therapy success.
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8
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Yan S, Tian Z, Zhao H, Wang C, Pan Y, Yao N, Guo Y, Wang H, Li B, Cui W. A meta-analysis: Does vitamin D play a promising role in sleep disorders? Food Sci Nutr 2020; 8:5696-5709. [PMID: 33133571 PMCID: PMC7590291 DOI: 10.1002/fsn3.1867] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Sleep disorders, one of the most common problems in the general population, have been related to a series of harmful health consequences. Vitamin D appears to be associated with sleep disorders. However, the difference in vitamin D levels between sleep disorder subjects and people without a sleep disorder is unclear. Simultaneously, the influence of vitamin D replenishment on sleep disorders remains controversial. METHODS PubMed, MEDLINE, Web of Science, and Cochrane Library were searched for literatures published until October 2019. Using a random effects model, a meta-analysis was conducted to calculate the standard mean difference to evaluate the difference in vitamin D concentrations between sleep disorder subjects and normal people and the efficacy of vitamin D supplementation on sleep disorders. RESULTS Our study found that the serum vitamin D levels in the sleep disorder subjects were lower than that in the normal people (SMD = -0.75 ng/ml, 95% CI = -0.93, -0.57 ng/ml). Moreover, the Pittsburgh Sleep Quality Index (PSQI)in the subjects with vitamin D supplementation was lower than that in the controls (SMD = -0.45, 95% CI = -0.76, -0.13). CONCLUSIONS Vitamin D could play a promising role in sleep disorders. More data are required to confirm the efficacy of vitamin D supplementation for improving sleep disorders.
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Affiliation(s)
- Shoumeng Yan
- Department of Epidemiology and BiostatisticsSchool of Public HealthJilin UniversityChangchunP. R. China
| | - Zhenwei Tian
- Department of Emergency and critical careThe Second Hospital of Jilin UniversityChangchunP. R. China
| | - Hantong Zhao
- Department of Epidemiology and BiostatisticsSchool of Public HealthJilin UniversityChangchunP. R. China
| | - Changcong Wang
- Department of Epidemiology and BiostatisticsSchool of Public HealthJilin UniversityChangchunP. R. China
| | - Yingan Pan
- Department of Epidemiology and BiostatisticsSchool of Public HealthJilin UniversityChangchunP. R. China
| | - Nan Yao
- Department of Epidemiology and BiostatisticsSchool of Public HealthJilin UniversityChangchunP. R. China
| | - Yinpei Guo
- Department of Epidemiology and BiostatisticsSchool of Public HealthJilin UniversityChangchunP. R. China
| | - Han Wang
- Department of Epidemiology and BiostatisticsSchool of Public HealthJilin UniversityChangchunP. R. China
| | - Bo Li
- Department of Epidemiology and BiostatisticsSchool of Public HealthJilin UniversityChangchunP. R. China
| | - Weiwei Cui
- Department of Nutrition and Food HygieneSchool of Public HealthJilin UniversityChangchunP. R. China
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Riemann D, Krone LB, Wulff K, Nissen C. Sleep, insomnia, and depression. Neuropsychopharmacology 2020; 45:74-89. [PMID: 31071719 PMCID: PMC6879516 DOI: 10.1038/s41386-019-0411-y] [Citation(s) in RCA: 330] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 12/23/2022]
Abstract
Since ancient times it is known that melancholia and sleep disturbances co-occur. The introduction of polysomnography into psychiatric research confirmed a disturbance of sleep continuity in patients with depression, revealing not only a decrease in Slow Wave Sleep, but also a disinhibition of REM (rapid eye movement) sleep, demonstrated as a shortening of REM latency, an increase of REM density, as well as total REM sleep time. Initial hopes that these abnormalities of REM sleep may serve as differential-diagnostic markers for subtypes of depression were not fulfilled. Almost all antidepressant agents suppress REM sleep and a time-and-dose-response relationship between total REM sleep suppression and therapeutic response to treatment seemed apparent. The so-called Cholinergic REM Induction Test revealed that REM sleep abnormalities can be mimicked by administration of cholinomimetic agents. Another important research avenue is the study of chrono-medical timing of sleep deprivation and light exposure for their positive effects on mood in depression. Present day research takes the view on insomnia, i.e., prolonged sleep latency, problems to maintain sleep, and early morning awakening, as a transdiagnostic symptom for many mental disorders, being most closely related to depression. Studying insomnia from different angles as a transdiagnostic phenotype has opened many new perspectives for research into mechanisms but also for clinical practice. Thus, the question is: can the early and adequate treatment of insomnia prevent depression? This article will link current understanding about sleep regulatory mechanisms with knowledge about changes in physiology due to depression. The review aims to draw the attention to current and future strategies in research and clinical practice to the benefits of sleep and depression therapeutics.
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Affiliation(s)
- Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Lukas B Krone
- Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
- Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, UK
| | - Katharina Wulff
- Departments of Radiation Sciences & Molecular Biology, Umea University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine (WCMM), Umea University, Umeå, Sweden
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
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10
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van Dalfsen JH, Markus CR. The involvement of sleep in the relationship between the serotonin transporter gene-linked polymorphic region (5-HTTLPR) and depression: A systematic review. J Affect Disord 2019; 256:205-212. [PMID: 31181376 DOI: 10.1016/j.jad.2019.05.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 04/01/2019] [Accepted: 05/27/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recent meta-analyses stimulate an ongoing debate whether 5-HTTLPR modulates the risk for depression including a more pronounced association between stress and depression in the short (S) allele relative to the long (L) allele. Elucidating the pathways by which 5-HTTLPR contributes to depression could resolve this controversy. Insomnia independently contributes to the onset and course of negative affective symptoms and, hence, represents one of the primary risk factors for depression. To evaluate the relevance of this relationship for the interaction between 5-HTTLPR and stress in depression, the present review investigated the moderating influence of 5-HTTLPR on the relationship between stress and sleep quality as well as on the relationship between sleep and affective symptomatology. METHODS A systematic search was performed in the PubMed and PsycINFO databases to include a complete outline of studies investigating the relationships of interest. RESULTS Results of the included articles reveal that the 5-HTTLPR S-allele relative to the L-allele increases the risk for stress-related sleep quality reductions and promotes the negative affective consequences of inadequate sleep. LIMITATIONS The apparent involvement of sleep in the association between 5-HTTLPR and depression remains to be more directly (empirically) examined and studies exploring the influence of 5-HTTLPR on sleep quality produced inconsistent results. CONCLUSIONS The reviewed findings support the involvement of sleep in the interaction between 5-HTTLPR and stress in depression. This could have important implications for the inconsistent findings characterizing this field of research and may provide valuable insight into the pathophysiological mechanisms underlying genetic contributions to depression.
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Affiliation(s)
- Jens H van Dalfsen
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.
| | - C Rob Markus
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
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Wilson S, Anderson K, Baldwin D, Dijk DJ, Espie A, Espie C, Gringras P, Krystal A, Nutt D, Selsick H, Sharpley A. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update. J Psychopharmacol 2019; 33:923-947. [PMID: 31271339 DOI: 10.1177/0269881119855343] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This British Association for Psychopharmacology guideline replaces the original version published in 2010, and contains updated information and recommendations. A consensus meeting was held in London in October 2017 attended by recognised experts and advocates in the field. They were asked to provide a review of the literature and identification of the standard of evidence in their area, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. Each presentation was followed by discussion, aiming to reach consensus where the evidence and/or clinical experience was considered adequate, or otherwise to flag the area as a direction for future research. A draft of the proceedings was circulated to all speakers for comments, which were incorporated into the final statement.
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Affiliation(s)
- Sue Wilson
- 1 Centre for Psychiatry, Imperial College London, London, UK
| | - Kirstie Anderson
- 2 Regional Sleep Service, Freeman Hospital, Newcastle Upon Tyne, UK
| | - David Baldwin
- 3 Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Derk-Jan Dijk
- 4 Sleep Research Centre, University of Surrey, Guildford, UK
| | - Audrey Espie
- 5 Psychology Department, NHS Fife, Dunfermline, UK
| | - Colin Espie
- 6 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Paul Gringras
- 7 Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrew Krystal
- 8 Psychiatry and Behavioral Science, University of California, San Francisco, CA, USA
| | - David Nutt
- 1 Centre for Psychiatry, Imperial College London, London, UK
| | - Hugh Selsick
- 9 Royal London Hospital for Integrated Medicine, London, UK
| | - Ann Sharpley
- 10 Department of Psychiatry, University of Oxford, Oxford, UK
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Kim S, Suh S. Social Support as a Mediator Between Insomnia and Depression in Female Undergraduate Students. Behav Sleep Med 2019; 17:379-387. [PMID: 28783373 DOI: 10.1080/15402002.2017.1363043] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objectives/Background: Despite findings that insomnia and depression have a bidirectional relationship, the exact psychological mechanisms that link these disorders are largely unknown. The goal of this study was to identify whether social support mediates the relationship between insomnia and depression. Methods: The study sample (N = 115) consisted of females only, and all participants (mean age 21.77 ± 1.80) completed self-report measures of insomnia severity, depression, and social support. Results: Insomnia severity was significantly associated with low levels of social support (B = -1.04, SE = .27, p < .001) and high levels of depression (B = .18, SE = 0.05, p < .001). Social support mediated the effects of insomnia on depression (95% CI [.03, .15]). However, social support did not mediate the effects of depression on insomnia (95% CI [-.01, .32]). Conclusions: These findings suggest that interpersonal factors such as social support may be an important factor to consider in female insomnia patients in the context of preventing depression in this population.
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Affiliation(s)
- Soohyun Kim
- a Department of Psychology , Sungshin Women's University , Seoul , Korea
| | - Sooyeon Suh
- a Department of Psychology , Sungshin Women's University , Seoul , Korea.,b Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , California
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Blom K, Jernelöv S, Rück C, Lindefors N, Kaldo V. Three-Year Follow-Up Comparing Cognitive Behavioral Therapy for Depression to Cognitive Behavioral Therapy for Insomnia, for Patients With Both Diagnoses. Sleep 2017; 40:3888606. [PMID: 28655183 DOI: 10.1093/sleep/zsx108] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This 3-year follow-up compared insomnia treatment to depression treatment for patients with both diagnoses. Forty-three participants were randomized to either treatment, in the form of Internet-delivered therapist-guided cognitive behavior therapy (CBT), and 37 (86%) participants provided primary outcome data at the 3-year follow-up. After 3 years, reductions on depression severity were similar in both groups (between-group effect size, d = 0.33, p = .45), while the insomnia treatment had superior effects on insomnia severity (d = 0.66, p < .05). Overall, insomnia treatment was thus more beneficial than depression treatment. The implication for practitioners, supported by previous research, is that patients with co-occurring depression and insomnia should be offered CBT for insomnia, in addition to medication or psychological treatment for depression.
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Affiliation(s)
- Kerstin Blom
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Susanna Jernelöv
- Section of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Nils Lindefors
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Hökby S, Hadlaczky G, Westerlund J, Wasserman D, Balazs J, Germanavicius A, Machín N, Meszaros G, Sarchiapone M, Värnik A, Varnik P, Westerlund M, Carli V. Are Mental Health Effects of Internet Use Attributable to the Web-Based Content or Perceived Consequences of Usage? A Longitudinal Study of European Adolescents. JMIR Ment Health 2016; 3:e31. [PMID: 27417665 PMCID: PMC4963606 DOI: 10.2196/mental.5925] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Adolescents and young adults are among the most frequent Internet users, and accumulating evidence suggests that their Internet behaviors might affect their mental health. Internet use may impact mental health because certain Web-based content could be distressing. It is also possible that excessive use, regardless of content, produces negative consequences, such as neglect of protective offline activities. OBJECTIVE The objective of this study was to assess how mental health is associated with (1) the time spent on the Internet, (2) the time spent on different Web-based activities (social media use, gaming, gambling, pornography use, school work, newsreading, and targeted information searches), and (3) the perceived consequences of engaging in those activities. METHODS A random sample of 2286 adolescents was recruited from state schools in Estonia, Hungary, Italy, Lithuania, Spain, Sweden, and the United Kingdom. Questionnaire data comprising Internet behaviors and mental health variables were collected and analyzed cross-sectionally and were followed up after 4 months. RESULTS Cross-sectionally, both the time spent on the Internet and the relative time spent on various activities predicted mental health (P<.001), explaining 1.4% and 2.8% variance, respectively. However, the consequences of engaging in those activities were more important predictors, explaining 11.1% variance. Only Web-based gaming, gambling, and targeted searches had mental health effects that were not fully accounted for by perceived consequences. The longitudinal analyses showed that sleep loss due to Internet use (ß=.12, 95% CI=0.05-0.19, P=.001) and withdrawal (negative mood) when Internet could not be accessed (ß=.09, 95% CI=0.03-0.16, P<.01) were the only consequences that had a direct effect on mental health in the long term. Perceived positive consequences of Internet use did not seem to be associated with mental health at all. CONCLUSIONS The magnitude of Internet use is negatively associated with mental health in general, but specific Web-based activities differ in how consistently, how much, and in what direction they affect mental health. Consequences of Internet use (especially sleep loss and withdrawal when Internet cannot be accessed) seem to predict mental health outcomes to a greater extent than the specific activities themselves. Interventions aimed at reducing the negative mental health effects of Internet use could target its negative consequences instead of the Internet use itself. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN): 65120704; http://www.isrctn.com/ISRCTN65120704?q=&filters=recruitmentCountry:Lithuania&sort=&offset= 5&totalResults=32&page=1&pageSize=10&searchType=basic-search (Archived by WebCite at http://www.webcitation/abcdefg).
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Affiliation(s)
- Sebastian Hökby
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
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15
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Crönlein T, Langguth B, Eichhammer P, Busch V. Impaired Recognition of Facially Expressed Emotions in Different Groups of Patients with Sleep Disorders. PLoS One 2016; 11:e0152754. [PMID: 27073852 PMCID: PMC4830526 DOI: 10.1371/journal.pone.0152754] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 03/18/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction Recently it has been shown that acute sleep loss has a direct impact on emotional processing in healthy individuals. Here we studied the effect of chronically disturbed sleep on emotional processing by investigating two samples of patients with sleep disorders. Methods 25 patients with psychophysiologic insomnia (23 women and 2 men, mean age: 51.6 SD; 10.9 years), 19 patients with sleep apnea syndrome (4 women and 15 men, mean age: 51.9; SD 11.1) and a control sample of 24 subjects with normal sleep (15women and 9 men, mean age 45.3; SD 8.8) completed a Facial Expressed Emotion Labelling (FEEL) task, requiring participants to categorize and rate the intensity of six emotional expression categories: anger, anxiety, fear, happiness, disgust and sadness. Differences in FEEL score and its subscales among the three samples were analysed using ANOVA with gender as a covariate. Results Both patients with psychophysiologic insomnia and patients with sleep apnea showed significantly lower performance in the FEEL test as compared to the control group. Differences were seen in the scales happiness and sadness. Patient groups did not differ from each other. Conclusion By demonstrating that previously known effects of acute sleep deprivation on emotional processing can be extended to persons experiencing chronically disturbed sleep, our data contribute to a deeper understanding of the relationship between sleep loss and emotions.
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Affiliation(s)
- Tatjana Crönlein
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
- * E-mail:
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Peter Eichhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Volker Busch
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
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Blom K, Jernelöv S, Kraepelien M, Bergdahl MO, Jungmarker K, Ankartjärn L, Lindefors N, Kaldo V. Internet treatment addressing either insomnia or depression, for patients with both diagnoses: a randomized trial. Sleep 2015; 38:267-77. [PMID: 25337948 DOI: 10.5665/sleep.4412] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 07/03/2014] [Indexed: 01/18/2023] Open
Abstract
STUDY OBJECTIVES To compare treatment effects when patients with insomnia and depression receive treatment for either insomnia or depression. DESIGN A 9-w randomized controlled trial with 6- and 12-mo follow-up. SETTING Internet Psychiatry Clinic, Stockholm, Sweden. PARTICIPANTS Forty-three adults in whom comorbid insomnia and depression were diagnosed, recruited via media and assessed by psychiatrists. INTERVENTIONS Guided Internet-delivered cognitive behavior therapy (ICBT) for either insomnia or depression. MEASUREMENTS AND RESULTS Primary outcome measures were symptom self-rating scales (Insomnia Severity Index [ISI] and the Montgomery Åsberg Depression Rating Scale [MADRS-S]), assessed before and after treatment with follow-up after 6 and 12 mo. The participants' use of sleep medication and need for further treatment after completion of ICBT was also investigated. The insomnia treatment was more effective than the depression treatment in reducing insomnia severity during treatment (P = 0.05), and equally effective in reducing depression severity. Group differences in insomnia severity were maintained during the 12-mo follow-up period. Post treatment, participants receiving treatment for insomnia had significantly less self-rated need for further insomnia treatment (P < 0.001) and used less sleep medication (P < 0.05) than participants receiving treatment for depression. The need for depression treatment was similar in both groups. CONCLUSIONS In this study, Internet-delivered treatment with cognitive behavior therapy (ICBT) for insomnia was more effective than ICBT for depression for patients with both diagnoses. This indicates, in line with previous research, that insomnia when comorbid with depression is not merely a symptom of depression, but needs specific treatment. TRIAL REGISTRATION The trial was registered at Clinicaltrials.gov, registration ID: NCT01256099.
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Affiliation(s)
- Kerstin Blom
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
| | - Susanna Jernelöv
- Karolinska Institutet, Department of Clinical Neuroscience, Section of Psychology, Stockholm, Sweden
| | - Martin Kraepelien
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
| | - Malin Olséni Bergdahl
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
| | - Kristina Jungmarker
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
| | - Linda Ankartjärn
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
| | - Nils Lindefors
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
| | - Viktor Kaldo
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
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17
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Primeau MM, Tal JZ, O’Hara R. Depression. Sleep Med 2015. [DOI: 10.1007/978-1-4939-2089-1_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Association between depressive symptoms and changes in sleep condition in the grieving process. Support Care Cancer 2014; 23:1925-31. [PMID: 25487842 DOI: 10.1007/s00520-014-2548-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/30/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE Bereaved families often suffer from insomnia and depression. However, the associations between depressive state and changes in sleep condition during the grieving process have not been investigated. This study aimed to clarify the prevalence of insomnia symptoms and to explore associations between present depressive state and changes in sleep condition in the grieving process in bereaved families of Japanese patients with cancer. METHODS A cross-sectional, multicenter survey was conducted in 103 certified palliative care units. A questionnaire asking insomnia symptoms and depressive symptoms by the Center for Epidemiological Studies Depression Scale (CES-D) was mailed to bereaved families (N = 987). The association between present depressive state (CES-D ≥7) and sleep conditions in the grieving process were analyzed. RESULTS A total of 561 families were enrolled for analysis. Fifty-three percent of family members were considered to be in a depressive state at the time of the investigation. Prevalence of past insomnia was 86.5% at "within a few weeks before the patient's death" (T1) and 84.5% at "within 6 months after the patient's death" (T2) in all bereaved family members. However, in contrast to decreased severity of insomnia between T1 and T2 in the non-depressive group (p < 0.05), severity of insomnia was unchanged in the depressive group during this period (p = 0.139). CONCLUSIONS Insomnia symptoms are highly prevalent and may be associated with posthumous depressive state in bereaved Japanese families. These results suggest the need for careful observation of changes in sleep condition during the grieving process.
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Riemann D, Baglioni C, Feige B, Spiegelhalder K. [Insomnia--state of the science]. DER NERVENARZT 2014; 85:43-9. [PMID: 24346426 DOI: 10.1007/s00115-013-3892-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Diagnostic systems such as the international classification of diseases (ICD-10) or the diagnostic and statistical manual of mental disorders (DSM IV) have frequently been criticized as not adequately reflecting the complexity and heterogeneity of insomnia. Progress was made through the introduction of the international classification of sleep disorders (ICSD-2) and the research diagnostic criteria (RDC). The DSM-5 introduced the new category of insomnia disorder, thus relinquishing the traditional dichotomy of primary versus secondary insomnia. Recent basic research indicates that genetic and epigenetic factors are involved in the etiology of insomnia; the so-called three P model (i.e. predisposing, precipitating and perpetuating factors) and the hyperarousal concept have gained much attention in trying to explain the pathophysiology of insomnia. With respect to the cognitive-behavioral therapy of insomnia (CBT-I), a plethora of empirical evidence supports the first-line character of this type of treatment for insomnia. Unfortunately, CBT-I is still administered to only a minority of afflicted patients, probably due to a lack of resources in the healthcare system. As a consequence, stepped-care models to improve insomnia therapy encompass self-help programs, internet-based treatment avenues, community-centered activities (specially trained nurses) and as a last resort medical specialists/psychotherapists and sleep experts to deal with insomnia.
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Affiliation(s)
- D Riemann
- Abteilung für Klinische Psychologie und Psychophysiologie/Schlafmedizin der Klinik für Psychiatrie und Psychotherapie, Universitätsklinik Freiburg, Hauptstr. 5, 79104, Freiburg, Deutschland,
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20
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Scott D, Paterson JL, Happell B. Poor sleep quality in Australian adults with comorbid psychological distress and physical illness. Behav Sleep Med 2014; 12:331-41. [PMID: 24180418 DOI: 10.1080/15402002.2013.819469] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A population-based questionnaire study of 1,818 Australian adults investigated associations of sleep quality with psychological distress and comorbid physical health disorders. The Kessler Psychological Distress Scale and the Behavioral Risk Factor Surveillance System assessed psychological distress and physical health. The Pittsburgh Sleep Quality Index assessed sleep quality. Participants with physical illness or psychological distress had increased odds for reporting poor sleep quality, compared to those with no illness (odds ratios [ORs] = 2.22, for both; 95% confidence intervals [CIs] = 1.53-3.23 and 3.54-10.36, respectively), but those with comorbid illness had markedly higher odds for poor sleep quality (OR = 11.99, 95% CI = 7.90-18.20). Adults with comorbid psychological distress and physical health disorders are at substantially increased risk of poor sleep quality.
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Affiliation(s)
- David Scott
- a NorthWest Academic Centre The University of Melbourne , St. Albans , Australia
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21
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Bonnet MH, Burton GG, Arand DL. Physiological and medical findings in insomnia: Implications for diagnosis and care. Sleep Med Rev 2014; 18:111-22. [DOI: 10.1016/j.smrv.2013.02.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 01/29/2013] [Accepted: 02/16/2013] [Indexed: 12/28/2022]
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22
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Kouwenhoven SE, Gay CL, Bakken LN, Lerdal A. Depressive symptoms in acute stroke: A cross-sectional study of their association with sociodemographics and clinical factors. Neuropsychol Rehabil 2013; 23:658-77. [DOI: 10.1080/09602011.2013.801778] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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23
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Gulyani S, Salas RE, Gamaldo CE. Sleep medicine pharmacotherapeutics overview: today, tomorrow, and the future (Part 1: insomnia and circadian rhythm disorders). Chest 2013. [PMID: 23208340 DOI: 10.1378/chest.12-0465] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Over the past 10 years, significant strides have been made in the understanding, development, and availability of sleep disorder therapeutics. In this review series, we discuss the current evidence surrounding the mechanisms of actions, indications, efficacy, and adverse side effects associated with the available armamentarium of sleep over-the-counter and pharmacotherapeutics. This article is the first of a two-part series that covers the therapeutics for insomnia and circadian rhythm disorders.
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Affiliation(s)
- Seema Gulyani
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
| | - Rachel E Salas
- Department of Neurology, Johns Hopkins University, Baltimore, MD
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24
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Harper DG, Plante DT, Jensen JE, Ravichandran C, Buxton OM, Benson KL, O'Connor SP, Renshaw PF, Winkelman JW. Energetic and cell membrane metabolic products in patients with primary insomnia: a 31-phosphorus magnetic resonance spectroscopy study at 4 tesla. Sleep 2013; 36:493-500. [PMID: 23564996 DOI: 10.5665/sleep.2530] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Primary insomnia (PI) is a sleep disorder characterized by difficulty with sleep initiation, maintenance, and/or the experience of nonrestorative sleep combined with a subsequent impairment of daytime functioning. The hyperarousal hypothesis has emerged as the leading candidate to explain insomnia symptoms in the absence of specific mental, physical, or substance-related causes. We hypothesized that the cellular energetic metabolites, including beta nucleoside triphosphate, which in magnetic resonance spectroscopy approximates adenosine triphosphate (ATP), and phosphocreatine (PCr), would show changes in PI reflecting increased energy demand. DESIGN AND SETTING Matched-groups, cross-sectional study performed at two university-based hospitals. PATIENTS Sixteen medication-free individuals (eight males, eight females; mean ± standard deviation (SD) age = 37.2 ± 8.4 y) with PI and 16 good sleepers (nine males, seven females; mean ± SD age = 37.6 ± 4.7 y). MEASUREMENTS Diagnosis was established for all individuals by unstructured clinical interview, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID), sleep diary, and actigraphy. Polysomnography was collected in individuals with PI. Phosphorous magnetic resonance spectroscopy (31P MRS) data were collected on all individuals at 4 Tesla. We assessed cell membrane (anabolic precursors and catabolic metabolites) and bioenergetic (ATP, phosphocreatine) metabolites in gray matter and white matter to determine their relationship to the presence and severity of PI. RESULTS Individuals with PI showed lower phosphocreatine in gray matter and an unexpected decrease of phosphocholine, a precursor of the cell membrane compound phosphatidylcholine, in white matter. In addition, there was a trend toward a negative association between polysomnographically determined wake after sleep onset and gray matter beta-nucleoside triphosphate and white matter phosphocholine in the primary insomnia group. CONCLUSIONS These results support the hyperarousal hypothesis in PI based on lower phosphocreatine in gray matter in the PI group.
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Affiliation(s)
- David G Harper
- Geriatric Psychiatry Program, Harvard Medical School, Boston, MA, USA.
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25
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Baglioni C, Spiegelhalder K, Nissen C, Hirscher V, Frase L, Feige B, Unbehaun T, Riemann D. Insomnische Störungen. SOMNOLOGIE 2013. [DOI: 10.1007/s11818-013-0602-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Skapinakis P, Rai D, Anagnostopoulos F, Harrison S, Araya R, Lewis G. Sleep disturbances and depressive symptoms: an investigation of their longitudinal association in a representative sample of the UK general population. Psychol Med 2013; 43:329-339. [PMID: 22640482 DOI: 10.1017/s0033291712001055] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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.
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Affiliation(s)
- P Skapinakis
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, UK.
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27
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Sánchez-Ortuño MM, Edinger JD. Cognitive-behavioral therapy for the management of insomnia comorbid with mental disorders. Curr Psychiatry Rep 2012; 14:519-28. [PMID: 22865156 DOI: 10.1007/s11920-012-0312-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Insomnia is frequently comorbid with psychiatric conditions, mostly depression and anxiety disorders. Because disturbed sleep is a symptom of most major mental disorders, it has been traditionally assumed that effective treatment of the psychiatric condition will resolve the coincident insomnia also. However, insomnia often persists after successful treatment of the comorbid mental disorder, suggesting that insomnia often warrants separate treatment attention. Cognitive-behavioral therapy (CBT) is a well established and efficacious treatment for insomnia. Most evidence supporting the efficacy of CBT comes from studies conducted with patients suffering from primary insomnia, yet over the past 20 years there has been growing support for the use of cognitive-behavioral insomnia intervention for patients with comorbid psychiatric conditions. Overall, promising results have been obtained from these studies, not only with regard to insomnia improvement but also concurrent improvements in comorbid psychiatric conditions. In this article we review recent studies in this area with particular focus on treatment of insomnia in the context of depression, post-traumatic stress disorder, and alcohol dependence.
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Banovic I, Gilibert D, Jebrane A, Cosnes J. Diagnostic profiles determined by the C.A.R.T procedure: IBD patients and fatigue. J Health Psychol 2012; 17:500-508. [DOI: 10.1177/1359105311419268] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Fatigue is common in IBD. It remains a complex phenomenon with primary factors related to the disease and secondary factors (depression, anxiety, sleep disturbances, pain) whose respective importance and organization are difficult to determine. By using the C.A.R.T. procedure, the diagnostic variables of 108 IBD-related fatigue patients were determined globally, according to their sex and the clinical activity of their disease. Results underline the diversity of diagnostic profiles in which psychological variables have significant influence. It is important to consider fatigue according to profiles that best illustrate its complexity and allow for identifying better potentially remediable factors.
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Affiliation(s)
- Ingrid Banovic
- Laboratoire IPSé (EA 4432)-Paris Ouest-Nanterre- La Défense, France
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29
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Manber R, Bernert RA, Suh S, Nowakowski S, Siebern AT, Ong JC. CBT for insomnia in patients with high and low depressive symptom severity: adherence and clinical outcomes. J Clin Sleep Med 2012; 7:645-52. [PMID: 22171204 DOI: 10.5664/jcsm.1472] [Citation(s) in RCA: 184] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To evaluate whether depressive symptom severity leads to poorer response and perceived adherence to cognitive behavioral therapy for insomnia (CBTI) and to examine the impact of CBTI on well-being, depressive symptom severity, and suicidal ideation. DESIGN Pre- to posttreatment case replication series comparing low depression (LowDep) and high depression (HiDep) groups (based on a cutoff of 14 on the Beck Depression Inventory [BDI]). PARTICIPANTS 127 men and 174 women referred for the treatment of insomnia. INTERVENTIONS Seven sessions of group CBTI. MEASUREMENTS AND RESULTS Improvement in the insomnia severity, perceived energy, productivity, self-esteem, other aspects of wellbeing, and overall treatment satisfaction did not differ between the HiDep and LowDep groups (p > 0.14). HiDep patients reported lower adherence to a fixed rise time, restricting time in bed, and changing expectations about sleep (p < 0.05). HiDep participants experienced significant reductions in BDI, after removing the sleep item. Levels of suicidal ideation dropped significantly among patients with pretreatment elevations (p < 0.0001). CONCLUSION Results suggest that pre- to post CBTI improvements in insomnia symptoms, perceived energy, productivity, self-esteem, and other aspects of well-being were similar among patients with and without elevation in depressive symptom severity. Thus, the benefits of CBTI extend beyond insomnia and include improvements in non-sleep outcomes, such as overall well-being and depressive symptom severity, including suicidal ideation, among patients with baseline elevations. Results identify aspects of CBTI that may merit additional attention to further improve outcomes among patients with insomnia and elevated depressive symptom severity.
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Affiliation(s)
- Rachel Manber
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Science, Stanford, CA 94301-5597, USA.
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Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, Lombardo C, Riemann D. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord 2011; 135:10-9. [PMID: 21300408 DOI: 10.1016/j.jad.2011.01.011] [Citation(s) in RCA: 1559] [Impact Index Per Article: 119.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 01/10/2011] [Accepted: 01/11/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND In many patients with depression, symptoms of insomnia herald the onset of the disorder and may persist into remission or recovery, even after adequate treatment. Several studies have raised the question whether insomniac symptoms may constitute an independent clinical predictor of depression. This meta-analysis is aimed at evaluating quantitatively if insomnia constitutes a predictor of depression. METHODS PubMed, Medline, PsycInfo, and PsycArticles databases were searched from 1980 until 2010 to identify longitudinal epidemiological studies simultaneously investigating insomniac complaints and depressed psychopathology. Effects were summarized using the logarithms of the odds ratios for insomnia at baseline to predict depression at follow-up. Studies were pooled with both fixed- and random-effects meta-analytic models in order to evaluate the concordance. Heterogeneity test and sensitivity analysis were computed. RESULTS Twenty-one studies met inclusion criteria. Considering all studies together, heterogeneity was found. The random-effects model showed an overall odds ratio for insomnia to predict depression of 2.60 (confidence interval [CI]: 1.98-3.42). When the analysis was adjusted for outliers, the studies were not longer heterogeneous. The fixed-effects model showed an overall odds ratio of 2.10 (CI: 1.86-2.38). LIMITATIONS The main limit is that included studies did not always consider the role of other intervening variables. CONCLUSIONS Non-depressed people with insomnia have a twofold risk to develop depression, compared to people with no sleep difficulties. Thus, early treatment programs for insomnia might reduce the risk for developing depression in the general population and be considered a helpful general preventive strategy in the area of mental health care.
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Affiliation(s)
- Chiara Baglioni
- Department of Psychiatry & Psychotherapy, University of Freiburg Medical Center, Hauptstrasse 5, 79104 Freiburg, Germany.
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OGEIL RP, RAJARATNAM SMW, BROADBEAR JH. Ecstasy and sleep disturbance: Progress towards elucidating a role for the circadian system. Sleep Biol Rhythms 2011. [DOI: 10.1111/j.1479-8425.2011.00510.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Clinical implications of the causal relationship between insomnia and depression: how individually tailored treatment of sleeping difficulties could prevent the onset of depression. EPMA J 2011. [PMID: 23199164 PMCID: PMC3405397 DOI: 10.1007/s13167-011-0079-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Major depression commonly co-occurs with symptoms of insomnia. However, the underlying psychobiological mechanisms which can explain this relationship are still not well understood. Hyperarousal and negative emotionality have been proposed to be possible mediating factors. Several studies have suggested that insomnia could be a predictor of depression. A recent meta-analysis conducted by our group showed that people with insomnia have a two-fold risk to develop depression, compared to people with no sleep difficulties. Thus, early diagnosis and treatment of insomnia could, at least partially, prevent the development of future depression, by identifying people at risk for depression and deliver personalized intervention protocols to improve individual outcome. Modifications of existing treatment modules are needed, as adding sleep protocols to the treatment of depression and affective regulation protocols to the treatment of insomnia, enhance the accessibility for the treatment of insomnia, and develop sleep education protocols in early periods of life.
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UCHIYAMA M, INOUE Y, UCHIMURA N, KAWAMORI R, KURABAYASHI M, KARIO K, WATADA H. Clinical significance and management of insomnia. Sleep Biol Rhythms 2011. [DOI: 10.1111/j.1479-8425.2011.00496.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Belleville G, Cousineau H, Levrier K, St-Pierre-Delorme MÈ. Meta-analytic review of the impact of cognitive-behavior therapy for insomnia on concomitant anxiety. Clin Psychol Rev 2011; 31:638-52. [PMID: 21482322 DOI: 10.1016/j.cpr.2011.02.004] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 02/07/2011] [Accepted: 02/08/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Concomitant anxiety and insomnia is a frequent problem encountered by mental health professionals. PRIMARY OBJECTIVE To assess the impact of cognitive-behavior therapy for insomnia (CBT-I) on associated anxiety. METHOD Systematic search for clinical trials of CBT-I in PsycInfo, Medline, and Proquest Dissertations and Theses. RESULTS Of the 216 CBT-I trials reviewed, 72 (33.3%) reported data on anxiety. The combined effect size (ES) of CBT-I on anxiety was 0.406 [95% CI 0.318-0.493], indicating a small to moderate effect of CBT-I on concomitant anxiety. Anxiety and anxiety-related constructs were measured with 31 different questionnaires or questionnaire subscales, the majority of which were used only once in the sample of studies. CONCLUSIONS CBT-I has only a moderate impact on anxiety in individuals who present insomnia with or without a comorbid anxiety disorder. A careful evaluation of residual anxiety should be conducted subsequent to CBT-I. Further research should focus on standardizing the assessment of anxiety in insomnia research.
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Affiliation(s)
- Geneviève Belleville
- École de Psychologie, Université Laval, Pavillon Félix-Antoine-Savard, Québec, Canada .
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Louie GH, Tektonidou MG, Caban-Martinez AJ, Ward MM. Sleep disturbances in adults with arthritis: prevalence, mediators, and subgroups at greatest risk. Data from the 2007 National Health Interview Survey. Arthritis Care Res (Hoboken) 2011; 63:247-60. [PMID: 20890980 PMCID: PMC3461323 DOI: 10.1002/acr.20362] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the prevalence of sleep disturbances in adults with arthritis in a nationally representative sample, mediators of sleep difficulties, and subgroups of individuals with arthritis at greatest risk. METHODS Using data on US adults ages≥18 years participating in the 2007 National Health Interview Survey, we computed the prevalence of 3 measures of sleep disturbance (insomnia, excessive daytime sleepiness, and sleep duration<6 hours) among persons with arthritis. We used logistic regression analysis to examine if the association of arthritis and sleep disturbances was independent of sociodemographic characteristics and comorbidities, and to identify potential mediators. We used classification trees to identify subgroups at higher risk. RESULTS The adjusted prevalence of insomnia was higher among adults with arthritis than those without arthritis (23.1% versus 16.4%; P<0.0001), but was similar to those with other chronic diseases. Adults with arthritis were more likely than those without arthritis to report insomnia (unadjusted odds ratio 2.92, 95% confidence interval 2.68-3.17), but adjustment for sociodemographic characteristics and comorbidities attenuated this association. Joint pain and limitation due to pain mediated the association between arthritis and insomnia. Among adults with arthritis, those with depression and anxiety were at highest risk for sleep disturbance. Results for excessive daytime sleepiness and sleep duration<6 hours were similar. CONCLUSION Sleep disturbance affects up to 10.2 million US adults with arthritis, and is mediated by joint pain and limitation due to pain. Among individuals with arthritis, those with depression and anxiety are at greatest risk.
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Affiliation(s)
- Grant H Louie
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA.
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