Is insomnia a perpetuating factor for late-life depression in the IMPACT cohort?
Is insomnia a perpetuating factor for late-life depression in the IMPACT cohort?
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DOI：
10.1093/sleep/31.4.481
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发表时间：
2008-04-01
期刊：
影响因子：
5.6
通讯作者：
Perlis, Michael L.
中科院分区：
文献类型：
--
作者：
Pigeon, Wilfred R.;Hegel, Mark;Perlis, Michael L.
研究目的：失眠和抑郁症是老年人的重要健康问题。持续失眠是新发和复发性重度抑郁症（MDD）发展的危险因素。不太清楚的是，持续失眠是否会导致重度抑郁症和/或精神障碍。本纵向研究在老年受试者干预研究的背景下探讨失眠与抑郁持续的关系。设计：数据来自IMPACT项目，这是一项多站点干预研究，纳入了1801例MIDD和/或心境恶劣的老年患者。在目前的研究中，根据基线和3个月时间点的失眠评分，受试者被分配到失眠状态组（持续失眠、中度失眠和无失眠）。进行逻辑回归以确定与无失眠参照组相比，持续失眠是否与6个月和12个月时持续抑郁和/或临床改善低于50%的风险增加有关。将中度失眠组与其他两组进行比较，以确定失眠类型与随后的抑郁之间是否存在剂量-反应关系。环境：在5个州的18个初级诊所。参与者：老年抑郁症患者（60岁以上）。测量和结果：总体而言，持续性失眠患者保持抑郁的可能性是无失眠患者的1.8 - 3.5倍。这一发现在接受常规治疗的抑郁症患者中比在接受强化治疗的患者中更为明显。研究结果在重度抑郁症患者身上也比单独患有精神障碍的患者更为明显。结论：这些发现表明，除了是抑郁症发作的一个危险因素外，持续失眠可能会使一些老年患者的疾病永久化，特别是那些在初级保健机构接受抑郁症标准治疗的患者。加强抑郁症护理可以部分减轻失眠对抑郁症的持续影响。
Study Objectives: Insomnia and depressive disorders are significant health problems in the elderly. Persistent insomnia is a risk factor for the development of new-onset and recurrent major depressive disorder (MDD). Less clear is whether persistent insomnia may perpetuate MDD and/or dysthymia. The present longitudinal study examines the relationship of insomnia to the continuation of depression in the context of an intervention study in elderly subjects.Design: Data were drawn from Project IMPACT, a multisite intervention study, which enrolled 1801 elderly patients with MIDD and/or dysthymia. In the current study, subjects were assigned to an insomnia-status group (Persistent, Intermediate, and No Insomnia) based on insomnia scores at both baseline and 3-month time points. Logistic regressions were conducted to determine whether Persistent Insomnia was prospectively associated with increased risk of remaining depressed and/or achieving a less than 50% clinical improvement at 6 and at 12 months compared with the No Insomnia reference group. The Intermediate Insomnia group was compared with the other 2 groups to determine whether a dose-response relationship existed between insomnia type and subsequent depression.Setting: Eighteen primary clinics in 5 states.Participants: Older adults (60+) with depression.Measurements and Results: Overall, patients with persistent insomnia were 1.8 to 3.5 times more likely to remain depressed, compared with patients with no insomnia. The findings were more robust in patients receiving usual care for depression than in patients receiving enhanced care. Findings were also more robust in subjects who had MDD as opposed to those with dysthymia alone.Conclusions: These findings suggest that, in addition to being a risk factor for a depressive episode, persistent insomnia may serve to perpetuate the illness in some elderly patients and especially in those receiving standard care for depression in primary care settings. Enhanced depression care may partially mitigate the perpetuating effects of insomnia on depression.