The association of insomnia with anxiety disorders and depression: Exploration of the direction of risk

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Abstract

The purpose of this study is to explore the direction of the association between insomnia and anxiety disorders and major depression among a community-based sample of adolescents to better understand their potential etiologic relationships. Data come from a community-based sample of 1014 youth aged 13–16. Structured interviews were conducted to assess DSM-IV diagnoses. Retrospectively reported ages of onset were used in Proportional Hazards models to estimate increased risk of one disorder associated with prior onset of the others. The lifetime associations of DSM-IV insomnia with each anxiety disorder and with depression were moderate (OR = 3.2–6.8). Among those with comorbid disorders, anxiety disorders preceded insomnia 73% of the time, while insomnia occurred first in 69% of comorbid insomnia and depression cases. Any prior anxiety disorder was associated with an increased risk of insomnia adjusting for gender, race/ethnicity, and depression prior to insomnia (HR = 3.5). However, prior insomnia was not significantly associated with onset of anxiety disorders. Prior depression was not associated with onset of insomnia, but prior insomnia was associated with onset of depression adjusting for gender, race/ethnicity, and any prior anxiety disorder (HR = 3.8). These results suggest distinct natural courses of development between DSM-IV insomnia, anxiety, and depression during adolescence. Additionally insomnia may have independent, and potentially etiologically distinct, directional associations with anxiety disorders versus depression.

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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