The association of insomnia with anxiety disorders and depression: Exploration of the direction of risk
Section snippets
Sample
A sample of 1676 youth–parent pairs was randomly selected from all households with at least one adolescent ages 13–15 from a 400,000 member Health Maintenance Organization (HMO) in the Detroit metropolitan area. The target population was defined by Wayne, Oakland and Macomb counties, encompassing the city of Detroit and surrounding communities. Of this sample, 251 (15%) were ineligible for the study due to incorrect date of birth in the HMO database, inability to speak English, severe cognitive
Prevalence and lifetime associations
Of the 1014 adolescents 13–16 years of age who participated in this study 108 or 10.7% met DSM-IV criteria for insomnia during their lifetime. 17.0% of adolescents had a lifetime history of any anxiety disorder. 3.6% of adolescents had a lifetime history of major depression.
Between 24% and 43% of those with an anxiety disorder or major depression also met criteria for insomnia (see Table 2). The increased odds of lifetime anxiety disorders and major depression associated with insomnia ranged
Discussion
We examined the directionality and independence of the associations between DSM-IV insomnia and anxiety disorders, and between insomnia and major depression to better understand potential etiologic relationships between insomnia and these mental disorders. Moderate to strong lifetime associations were found between insomnia and anxiety disorders, ranging from OR = 3.2 for simple phobia to OR = 6.8 for OCD, as well as between insomnia and major depression (OR = 5.2). Examining the order in which
Conclusions
These results suggest that there may be predominant pathways for the relationships between DSM-IV insomnia and anxiety, and between insomnia and depression; one that goes from anxiety disorders to insomnia and another from insomnia to depression, with lesser or nonsignificant pathways from insomnia to anxiety disorders and from depression to insomnia. Additionally it appears that insomnia may have independent relationships with anxiety disorders and major depression. Longitudinal, twins-based
Acknowledgement
Work supported by NIH grant MH61358 (Dr. Johnson).
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