Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia.
Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia; Department of Psychology, University of Oregon, Eugene, OR, USA; The Sleep Health Foundation, Blacktown, New South Wales, Australia.
J Affect Disord. 2023 Feb 1;322:52-62. doi: 10.1016/j.jad.2022.11.021. Epub 2022 Nov 11.
Insomnia is a risk factor for affective disorders. This study examined whether individuals with insomnia symptoms early in the pandemic, either pre-existing or new-onset, were more vulnerable to anxiety and depressive symptoms over time than those who maintained normal sleep. Additionally, sleep-related factors such as pre-sleep arousal were assessed for their influence on clinically significant anxiety and depression risk.
Using a global online survey with 3-, 6-, and 12-month follow-ups between April 2020 and May 2021, data from 2069 participants (M = 46.16 ± 13.42 years; 75.3 % female) with pre-existing, new-onset, or no insomnia symptoms was examined using mixed-effects and logistic regression models.
New-onset and pre-existing insomnia predicted persistent anxiety and depressive symptoms longitudinally (p's < 0.001), over other known risk factors, including age, sex, and previous psychiatric diagnoses. Anxiety and depressive symptoms in both insomnia groups remained above clinically significant thresholds at most time points, whereas normal sleepers remained subclinical. Pre-sleep arousal was found to increase the risk of clinically significant anxiety (OR = 1.05) and depressive symptoms (OR = 1.09) at 12-months. Sleep effort contributed to anxiety (OR = 1.06), whereas dysfunctional sleep-related beliefs and attitudes predicted clinically significant depression (OR = 1.22).
Insomnia group categorization was based on self-report at baseline supported by a validated measure. High participant attrition was observed at 3-months (53 %; n = 971), but retention remained steady till 12-months (63 %, n = 779).
Insomnia is a modifiable risk factor for persistent anxiety and depressive symptoms that needs to be addressed in mental healthcare. Additionally, pre-sleep arousal may be an important transdiagnostic process linking insomnia with affective disorders.
失眠是情感障碍的一个风险因素。本研究旨在探讨在大流行早期（不论是预先存在的还是新出现的）出现失眠症状的个体是否比保持正常睡眠的个体更容易随着时间的推移出现焦虑和抑郁症状，以及评估与睡眠相关的因素（如睡前觉醒）对临床显著的焦虑和抑郁风险的影响。
本研究使用全球在线调查，于 2020 年 4 月至 2021 年 5 月期间进行了 3、6 和 12 个月的随访，共纳入了 2069 名参与者（M=46.16±13.42 岁；75.3%为女性），这些参与者分为预先存在的、新出现的或没有失眠症状的三组，使用混合效应和逻辑回归模型进行分析。
新出现的和预先存在的失眠症状在纵向预测持续性焦虑和抑郁症状方面具有显著预测作用（p 值均<0.001），超过了年龄、性别和以前的精神科诊断等其他已知风险因素。在大多数时间点，两组失眠患者的焦虑和抑郁症状均高于临床显著阈值，而正常睡眠者则保持亚临床状态。研究发现，睡前觉醒会增加 12 个月时临床显著焦虑（OR=1.05）和抑郁症状（OR=1.09）的风险。睡眠努力与焦虑有关（OR=1.06），而与睡眠相关的不良信念和态度则预测临床显著的抑郁（OR=1.22）。
失眠组的分类是基于基线时的自我报告，并辅以验证过的测量工具。在 3 个月时观察到高参与者流失率（53%；n=971），但在 12 个月时保持稳定（63%，n=779）。
失眠是持续性焦虑和抑郁症状的一个可改变的风险因素，需要在精神保健中加以解决。此外，睡前觉醒可能是将失眠与情感障碍联系起来的一个重要的跨诊断过程。
