Leggett Amanda N, Sonnega Amanda J, Lohman Matthew C
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
University of Michigan, Ann Arbor, MI, USA.
Int J Geriatr Psychiatry. 2018 Jun 25. doi: 10.1002/gps.4923.
Insomnia and depressive symptoms are commonly reported by adults and have independently been found to be associated with mortality, though contrasting findings are reported. Given the high comorbidity and interrelatedness between these symptoms, we tested whether insomnia symptoms explain risk of death independent of depressive symptoms. We examined insomnia symptoms and depressive symptoms, in addition to other health and demographic covariates, as predictors of all-cause mortality.
The sample included 15 418 adults aged 51 and older drawn from a nationally representative, population-based study of adults in the United States, the Health and Retirement Study. Cox survival models were used to analyze time to death between the 2002 and 2014 study waves (5 waves). Controlling for health and demographic covariates, in 3 separate models, depressive symptoms and insomnia symptoms were independently and then together considered as risk factors for all-cause mortality (drawn from the National Death Index).
After adjustment for covariates, insomnia symptoms (HR = 1.10, CI:1.07-1.13) and depressive symptoms (HR = 1.14, CI:1.12-1.16) each were associated with a greater hazard of death. When considered together, however, depressive symptoms fully accounted for the association between insomnia symptoms and mortality.
Though their effects are small relative to health and demographic characteristics, both insomnia symptoms and depressive symptoms were associated with a greater hazard of death. Yet depressive symptoms accounted for the insomnia association when both were considered in the model. Screening for depression and providing validated treatments may reduce mortality risk in old adults with depressive symptoms.
成年人中失眠和抑郁症状较为常见，且已独立发现它们与死亡率相关，不过也有相互矛盾的研究结果报道。鉴于这些症状之间的高共病性和相互关联性，我们检验了失眠症状是否能独立于抑郁症状解释死亡风险。除其他健康和人口统计学协变量外，我们还研究了失眠症状和抑郁症状作为全因死亡率预测指标的情况。
样本包括从美国一项具有全国代表性的基于人群的成年人研究——健康与退休研究中选取的15418名51岁及以上成年人。使用Cox生存模型分析2002年至2014年研究波次（5个波次）之间的死亡时间。在3个单独的模型中，控制健康和人口统计学协变量，将抑郁症状和失眠症状分别独立以及共同视为全因死亡率（源自国家死亡指数）的危险因素。
在对协变量进行调整后，失眠症状（风险比[HR]=1.10，置信区间[CI]：1.07 - 1.13）和抑郁症状（HR =1.14，CI：1.12 - 1.16）各自都与更高的死亡风险相关。然而，当两者共同考虑时，抑郁症状完全解释了失眠症状与死亡率之间的关联。
尽管相对于健康和人口统计学特征而言，它们的影响较小，但失眠症状和抑郁症状均与更高的死亡风险相关。然而，在模型中同时考虑这两者时，抑郁症状解释了失眠与死亡率之间的关联。筛查抑郁症并提供经过验证的治疗方法可能会降低有抑郁症状老年人的死亡风险。
