Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health research institute, Amsterdam, the Netherlands.
Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands.
J Am Geriatr Soc. 2022 Jul;70(7):2051-2059. doi: 10.1111/jgs.17765. Epub 2022 Apr 6.
Depression and insomnia often co-occur, and precede one another. Possibly, insomnia gives rise to depression, and vice versa. We tested whether insomnia symptoms of an older individual are associated with later depressive symptoms in that older individual, and vice versa.
We performed a longitudinal analysis of data from a prospective cohort study in a large sample of community-dwelling older people (N = 3081), with measurements every three years, over a time period of 20 years. The within-individual longitudinal reciprocal relationship between symptoms of depression (Center for Epidemiological Studies Depression Scale), and symptoms of insomnia (three-item questionnaire, including difficulty initiating sleep, nightly awakenings, and early morning awakening) was modeled by means of a bivariate linear growth model. We tested whether symptoms of insomnia were associated with symptoms of depression three years later, and vice versa.
Severity of symptoms of depression and insomnia and their within-individual average change over time were moderately correlated (correlation of intercepts: rho 0.41, 95% CI: 0.36 to 0.46 p < 0.001; correlation of slopes: rho 0.39, 95% CI: 0.25 to 0.52, p < 0.001). Symptoms of depression were not found to be associated with an additional risk of higher symptoms of insomnia three years later, and vice versa (p = 0.329 and p = 0.919, respectively). Similar results were found when analyses were corrected for covariates.
In older individuals, depression and insomnia are associated and tend to increase concurrently over time, but constitute no additional risk for one another over repeated three-year intervals. These findings contradict previous research that suggests that depression and insomnia are risk factors for one another over time. The current study stands out due to the longitudinal within-individual statistical approach, but is limited by the three-year interval between measures.
抑郁和失眠常同时发生，并互为前驱症状。可能是失眠导致抑郁，反之亦然。我们检验了老年人的失眠症状是否与该老年人随后的抑郁症状相关，反之亦然。
我们对一项大型社区居住老年人前瞻性队列研究的数据进行了纵向分析（N=3081），每三年测量一次，历时 20 年。使用双变量线性增长模型，对抑郁症状（流行病学研究中心抑郁量表）和失眠症状（包括入睡困难、夜间觉醒和清晨早醒的三个项目问卷）的个体内纵向相互关系进行建模。我们检验了失眠症状是否与三年后的抑郁症状相关，反之亦然。
抑郁和失眠症状的严重程度及其随时间的个体内平均变化中度相关（截距相关：rho0.41，95%CI：0.36 至 0.46，p<0.001；斜率相关：rho0.39，95%CI：0.25 至 0.52，p<0.001）。未发现抑郁症状与三年后失眠症状加重的风险增加相关，反之亦然（p=0.329 和 p=0.919）。校正协变量后，分析结果相似。
在老年人中，抑郁和失眠相关，且随时间推移往往同时加重，但在重复的三年间隔内彼此不会增加风险。这些发现与之前提示抑郁和失眠随时间互为风险因素的研究结果相悖。本研究的独特之处在于采用了个体内的纵向统计方法，但受限于测量间隔为三年。
