Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan.
Department of Medical Technology, School of Health Sciences, Tokyo University of Technology, Tokyo, Japan.
J Affect Disord. 2021 Feb 15;281:539-546. doi: 10.1016/j.jad.2020.12.040. Epub 2020 Dec 15.
Residual insomnia is associated with a risk of depression recurrence.
In this retrospective, longitudinal cohort study, the recurrence pattern of depression in patients with or without residual insomnia was assessed using a health insurance claims database. Patients who were diagnosed with major depressive disorder and prescribed antidepressants, between January 2006 and June 2017 in Japan, were enrolled in the study. Residual insomnia was defined by a prescription of hypnotics, and recurrence of depression by prescription of antidepressants. Main outcomes included time to recurrence and the 1-year recurrence rate. Factors associated with recurrence of depression were assessed by multivariate analyses. The effect of residual insomnia on the frequency of recurrence was assessed by Chi-square test.
Of the 30,381 patients analyzed, there were 4,166 and 26,215 patients with or without residual insomnia, respectively. Time to recurrence in patients with residual insomnia was significantly shorter compared with those without residual insomnia (p <0.001), with a 1-year recurrence rate (95% CI) of 43.4% (41.9-45.0) and 7.4% (7.1-7.7), respectively. The frequency of recurrence was significantly higher in patients with residual insomnia than in those without (p <0.0001). A higher risk of depression recurrence (odds ratio 9.98, 95% CI 9.22-10.81) was found for residual insomnia compared with other significant factors.
The diagnosis stated in the receipt data may not accurately reflect the patient's condition, and medication adherence was unknown but assumed.
Residual insomnia is a significant risk factor for depression recurrence in Japanese patients.
残留性失眠与抑郁复发风险相关。
在这项回顾性、纵向队列研究中，使用健康保险索赔数据库评估了有或无残留性失眠的患者的抑郁复发模式。研究纳入了 2006 年 1 月至 2017 年 6 月期间在日本被诊断为重度抑郁症并开具抗抑郁药处方的患者。残留性失眠的定义为开具催眠药物，抑郁复发的定义为开具抗抑郁药物。主要结局包括复发时间和 1 年复发率。通过多变量分析评估与抑郁复发相关的因素。通过卡方检验评估残留性失眠对复发频率的影响。
在分析的 30381 例患者中，分别有 4166 例和 26215 例患者存在或不存在残留性失眠。残留性失眠患者的复发时间明显短于无残留性失眠患者（p <0.001），1 年复发率（95%CI）分别为 43.4%（41.9-45.0）和 7.4%（7.1-7.7）。残留性失眠患者的复发频率明显高于无残留性失眠患者（p <0.0001）。与其他显著因素相比，残留性失眠与抑郁复发的风险显著增加（优势比 9.98，95%CI 9.22-10.81）。
收据数据中记录的诊断可能无法准确反映患者的病情，且药物依从性未知但被假定。
残留性失眠是日本患者抑郁复发的重要危险因素。
