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Nocturnal insomnia symptoms and stress-induced cognitive intrusions in risk for depression: A 2-year prospective study.

ABSTRACT: Nearly half of US adults endorse insomnia symptoms. Sleep problems increase risk for depression during stress, but the mechanisms are unclear. During high stress, individuals having difficulty falling or staying asleep may be vulnerable to cognitive intrusions after stressful events, given that the inability to sleep creates a period of unstructured and socially isolated time in bed. We investigated the unique and combined effects of insomnia symptoms and stress-induced cognitive intrusions on risk for incident depression. 1126 non-depressed US adults with no history of DSM-5 insomnia disorder completed 3 annual web-based surveys on sleep, stress, and depression. We examined whether nocturnal insomnia symptoms and stress-induced cognitive intrusions predicted depression 1y and 2y later. Finally, we compared depression-risk across four groups: non-perseverators with good sleep, non-perseverators with insomnia symptoms, perseverators with good sleep, and perseverators with insomnia symptoms. Insomnia symptoms (? = .10-.13, p < .001) and cognitive intrusions (? = .19-.20, p < .001) predicted depression severity 1y and 2y later. Depression incidence across 2 years was 6.2%. Perseverators with insomnia had the highest rates of depression (13.0%), whereas good sleeping non-perseverators had the lowest rates (3.3%, Relative Risk = 3.94). Perseverators with sleep latency >30 m reported greater depression than good sleeping perseverators (t = 2.09, p < .04). Cognitive intrusions following stress creates a depressogenic mindset, and nocturnal wakefulness may augment the effects of cognitive arousal on depression development. Poor sleepers may be especially vulnerable to cognitive intrusions when having difficulty initiating sleep. As treatable behaviors, nighttime wakefulness and cognitive arousal may be targeted to reduce risk for depression in poor sleepers.

SUBMITTER: Kalmbach DA

PROVIDER: S-EPMC5810998 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Nocturnal insomnia symptoms and stress-induced cognitive intrusions in risk for depression: A 2-year prospective study.

Kalmbach David A DA Pillai Vivek V Drake Christopher L CL

PloS one 20180213 2

Nearly half of US adults endorse insomnia symptoms. Sleep problems increase risk for depression during stress, but the mechanisms are unclear. During high stress, individuals having difficulty falling or staying asleep may be vulnerable to cognitive intrusions after stressful events, given that the inability to sleep creates a period of unstructured and socially isolated time in bed. We investigated the unique and combined effects of insomnia symptoms and stress-induced cognitive intrusions on r ...[more]

PMID: 29438400

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Project description:Psychiatric distress and insomnia symptoms exhibit similar patterning by gender and socioeconomic position. Prospective evidence indicates a bi-directional relationship between psychiatric distress and insomnia symptoms so similarities in social patterning may not be coincidental. Treatment for insomnia can also improve distress outcomes. We investigate the extent to which the prospective patterning of distress over 20 years is associated with insomnia symptoms over that period.999 respondents to the Twenty-07 Study had been followed for 20 years from approximately ages 36-57 (73.2% of the living baseline sample). Psychiatric distress was measured using the GHQ-12 at baseline and at 20-year follow-up. Gender and social class were ascertained at baseline. Insomnia symptoms were self-reported approximately every five years. Latent class analysis was used to classify patterns of insomnia symptoms over the 20 years. Structural Equation Models were used to assess how much of the social patterning of distress was associated with insomnia symptoms. Missing data was addressed with a combination of multiple-imputation and weighting.Patterns of insomnia symptoms over 20 years were classified as either healthy, episodic, developing or chronic. Respondents from a manual social class were more likely to experience episodic, developing or chronic patterns than those from non-manual occupations but this was mostly explained by baseline psychiatric distress. People in manual occupations experiencing psychiatric distress however were particularly likely to experience chronic patterns of insomnia symptoms. Women were more likely to experience a developing pattern than men, independent of baseline distress. Psychiatric distress was more persistent over the 20 years for those in manual social classes and this effect disappeared when adjusting for insomnia symptoms. Irrespective of baseline symptoms, women, and especially those in a manual social class, were more likely than men to experience distress at age 57. This overall association for gender, but not the interaction with social class, was explained after adjusting for insomnia symptoms. Sensitivity analyses supported these findings.Gender and socioeconomic inequalities in psychiatric distress are strongly associated with inequalities in insomnia symptoms. Treatment of insomnia or measures to promote healthier sleeping may therefore help alleviate inequalities in psychiatric distress.

Project description:STUDY OBJECTIVES:The current archival analyses examine the direct and indirect effects of cognitive behavioral therapy for insomnia (CBT-I) on depression in cancer survivors. METHODS:We report on 67 cancer survivors from a 2 × 2 randomized controlled trial of CBT-I and armodafinil for insomnia, after collapsing across the noneffective study medication conditions (armodafinil/placebo) to create CBT-I (yes/no). Depression and insomnia were assessed before, during the 7-week CBT-I intervention, at postintervention, and 3 months later by the Patient Health Questionnaire and the Insomnia Severity Index, respectively. RESULTS:Mean depression at baseline for all participants was 6.44 (standard error = 0.41, range 0-15). Paired t tests showed that depression improved from baseline to postintervention by 48% (P < .001) in the CBT-I group versus 15% (P = .016) in the non-CBT-I group. Analysis of covariance controlling for baseline found that participants receiving CBT-I had significantly less depression at postintervention (effect size = -0.62; P = .001), compared to those who did not receive CBT-I. These benefits were maintained at the 3-month follow-up. Spearman rank correlations showed that changes in insomnia severity from baseline to postintervention were significantly correlated with concurrent changes in depression (r = .73; P < .001). Path analysis revealed that improvement in depression was mediated by improvement in insomnia severity (P < .001). CONCLUSIONS:Our findings provide preliminary support that in cancer survivors, CBT-I reduces depression via improvement in insomnia. Further, this reduction in depression remained stable 3 months after completing CBT-I. This suggests that a CBT-I intervention has a meaningful effect on depression. CLINICAL TRIAL REGISTRATION:Registry: ClinicalTrials.gov; Title: Cognitive Behavioral Therapy +/- Armodafinil for Insomnia and Fatigue Following Chemotherapy; Identifier: NCT01091974; URL: https://clinicaltrials.gov/ct2/show/record/NCT01091974.

Project description:BackgroundBurnout is common among nurses and midwives. We examined whether an early career episode of burnout has long-term consequences on; a) cognitive functions, b) symptoms of depression, and/or c) insomnia for nurses a decade after graduation.MethodsSymptoms of burnout were investigated in an observational longitudinal study of three national cohorts of registered nurses (RNs). Nursing students were recruited from all 26 of Sweden's nursing programs. Burnout was subsequently measured through annual assessment over the first three years post graduation, with one long-term follow-up 11-15 years after graduation. A total of 2474 nurses (62%) consented to participate at follow-up. Burnout was measured using items from the Oldenburg Burnout Inventory, cognitive function by a study specific instrument, depressive symptoms by the Major Depression Inventory, and sleep problems using items from the Karolinska Sleep Questionnaire. We used logistic regression to identify factors associated with consequences of early career burnout, adjusting for concurrent levels at follow up.FindingsThe prevalence of nurses reporting high levels of burnout symptoms at least one of the first three years of working life was 299 (12·3%). High levels of burnout symptoms in early working life were significantly related to more frequent symptoms of cognitive dysfunction, depression, and impaired sleep a decade later when taking current burnout levels into account. After controlling for both current symptoms of burnout and the other outcome variables, nurses with early career burnout still reported more frequent problems with cognitive functions and sleep but not depression.InterpretationThe results of this study show that the detrimental processes caused by overwhelming or chronic stress start early on in nurses' careers and thus preventive efforts should preferably be introduced early on (e.g. as part of nursing education and onboarding programs).FundingAFA Insurance Grant [number 150284].

Dataset Information

Nocturnal insomnia symptoms and stress-induced cognitive intrusions in risk for depression: A 2-year prospective study.

Publications

Nocturnal insomnia symptoms and stress-induced cognitive intrusions in risk for depression: A 2-year prospective study.

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