Insomnia Compromises Health, Quality of Life in Adults With Major Depressive Disorder

insomnia, sleep disorders
Investigators report the findings from a study assessing the impact of insomnia on clinical outcomes in patients with major depressive disorder.

The following article is a part of conference coverage from Psych Congress 2021 , held October 29th through November 1, 2021, in San Antonio, Texas. The team at Psychiatry Advisor will be reporting on the latest news and research conducted by leading experts in psychiatry. Check back for more from the Psych Congress 2021.


Greater insomnia severity was found to be associated with worse clinical outcomes and poorer quality of life in adults with major depressive disorder (MDD), according to study data presented at Psych Congress 2021, held both online and in person in San Antonio, Texas, between October 29 and November 1.

Investigators extracted data from the 2019 National Health and Wellness Survey, a cross-sectional, general population survey administered annually in the United States. Respondents who reported a diagnosis of MDD and insomnia symptoms were included in analyses. Generalized linear models were used to assess the association between Insomnia Severity Index (ISI) score and clinical outcomes. Models were adjusted for age, sex, race/ethnicity, Charlson Comorbidity Index, marital status, body mass index, smoking status, alcohol use, insurance type, and depression severity assessed via the Patient Health Questionnaire-9.

The study cohort comprised 3278 patients with a mean age 44.8 ± 15.4 years, among whom 73% were women. The majority of patients were White (78%). Mean ISI score was 15.8 ± 5.5, reflecting moderate to severe insomnia symptoms. In regression models, higher ISI score was found to be associated with greater anxiety, greater daytime sleepiness, and a higher number of health care provider visits and emergency department visits in the past year (all P <.001). Greater ISI score was also found to be associated with poorer health-related quality of life, including a lower Mental Component Summary score (P =.006) and Physical Component Summary score (P <.001) on the 36-item Short Form health survey. Further, high ISI scores were found to be significantly associated with work and activity impairment (both P <.001), greater direct medical costs (P =.005), and greater indirect medical costs (P <.001).

As study limitations, the authors noted the cross-sectional design and risk for recall bias associated with self-report survey data.

Results from this large-scale study illustrate the significant impact of insomnia on patients with MDD. Insomnia affected mental health symptoms, health-related quality of life, employment, activity, and health care costs, even after adjusting for depression severity. “These results suggest that MDD treatments that better target insomnia symptoms in adults may improve clinical, economic and humanistic outcomes,” the investigators wrote.

Disclosure: This research was supported by Janssen Scientific Affairs, LLC. Please see the original reference for a full list of disclosures.


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Joshi K, Cambron-Mellott MJ, Daly E, Costantino H, Pfau A, Jha MK. Among US adults with major depressive disorder, higher severity of insomnia symptoms is independently associated with poorer clinical, economic and humanistic outcomes. Poster presented at: Psych Congress 2021, October 29-November 1, 2021; San Antonio, Texas. Poster 61.