Gupta Ravi, Lahan Vivekananda
Department of Psychiatry and Sleep Clinic, Himalayan Institute of Medical Sciences, Doiwala, Dehradun, India.
Indian J Psychol Med. 2011 Jul;33(2):123-8. doi: 10.4103/0253-7176.92056.
Insomnia is a common problem that is known to occur during depression. However, literature still debates whether insomnia is part of depression or a separate entity.
Subjects presenting with depressive disorder according to DSM-IV-Text Revision criteria were recruited after seeking informed consent. Clinical interview was performed with the help of Mini International Neuropsychiatric Interview Plus. Their demographic data and depression related history were recorded. Depression severity was assessed by using Hamilton Rating Scale for Depression. Diagnosis of insomnia was made with the help of International Classification of Sleep Disorders-2 criteria. Type of insomnia, its duration, and its relationship with depressive illness were specifically asked. If any subject fulfilled criteria for more than one type of insomnia, both were recorded. Statistical analysis was done with the help of statistical package for social sciences (SPSS) version 17.0. χ(2) test, independent sample t test, and Pearson's correlation were performed.
A total of 54 subjects were enrolled in this study. Primary insomnia was seen in 40.7% cases and secondary insomnia in 58.8% cases; 27.3% subjects did not experience insomnia along with depressive disorder. In the primary insomnia category, adjustment insomnia was most prevalent (63.6%), and in secondary insomnia group, insomnia due to depressive disorder was most frequent (59.3%). Interestingly, primary insomnia often followed an onset of depressive illness (P=0.04), while secondary insomnia preceded it (c(2) =11.1; P=0.004). The presence of either type of insomnias was not influenced by duration of depressive illness, number of depressive episodes, and duration of current depressive episode. On the other hand, duration of insomnia was positively correlated with total duration of depressive illness (P=0.003), number of episodes (P=0.04), and duration of current depressive episode (P<0.001).
Primary insomnia is common in subjects with depression, and it usually follows depressive illness. On the other hand, secondary insomnia often precedes the onset of depressive illness. Duration of insomnia positively correlates with duration and frequency of depressive episodes.
失眠是抑郁症期间常见的问题。然而，文献中仍在争论失眠是抑郁症的一部分还是一个独立的实体。
根据《精神疾病诊断与统计手册》第四版修订版标准，在获得知情同意后招募患有抑郁症的受试者。借助迷你国际神经精神访谈升级版进行临床访谈。记录他们的人口统计学数据和与抑郁症相关的病史。使用汉密尔顿抑郁量表评估抑郁严重程度。借助《国际睡眠障碍分类》第二版标准诊断失眠。特别询问了失眠类型、持续时间及其与抑郁症的关系。如果任何受试者符合多种失眠类型的标准，则两者都记录下来。借助社会科学统计软件包（SPSS）17.0版进行统计分析。进行了χ²检验、独立样本t检验和Pearson相关性分析。
本研究共纳入54名受试者。原发性失眠见于40.7%的病例，继发性失眠见于58.8%的病例；27.3%的受试者在患有抑郁症的同时未出现失眠。在原发性失眠类别中，适应性失眠最为普遍（63.6%），在继发性失眠组中，抑郁症所致失眠最为常见（59.3%）。有趣的是，原发性失眠通常在抑郁症发病后出现（P = 0.04），而继发性失眠则在抑郁症发病之前出现（χ² = 11.1；P = 0.004）。任何一种失眠类型的存在均不受抑郁症病程、抑郁发作次数和当前抑郁发作持续时间的影响。另一方面，失眠持续时间与抑郁症总病程（P = 0.003）、发作次数（P = 0.04）和当前抑郁发作持续时间（P < 0.001）呈正相关。
原发性失眠在抑郁症患者中很常见，且通常在抑郁症发病后出现。另一方面，继发性失眠往往在抑郁症发病之前出现。失眠持续时间与抑郁发作的持续时间和频率呈正相关。
