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  • Title: Insomnia symptoms as a predictor of incident treatment for depression: prospective cohort study of 40,791 men and women.
    Author: Salo P, Sivertsen B, Oksanen T, Sjösten N, Pentti J, Virtanen M, Kivimäki M, Vahtera J.
    Journal: Sleep Med; 2012 Mar; 13(3):278-84. PubMed ID: 22177343.
    Abstract:
    OBJECTIVE: To examine the quantity and quality of insomnia symptoms as predictors of treatment for depression in the largest cohort study to date. METHODS: Forty thousand seven hundred and ninety-one Finnish public sector employees (mean age 43.9 years, 81% female), free of depression at baseline, participated in this prospective observational cohort study. Participants responded to the survey in 2000-2002 or 2004 and the mean follow-up was 3.3 years. Self-reported sleep was linked to comprehensive individual-level health registers to assess treatment for depression (antidepressant medication, commencements of psychotherapy or hospitalization due to depression). RESULTS: One thousand seven hundred and three participants fulfilled any of our set criteria for depression-related treatment. After adjustments for baseline characteristics, insomnia symptoms five to seven nights/week were associated with an increased risk of incident treatment for depression, hazard ratio 1.64 (95% confidence interval 1.44-1.86). Hazard ratio for symptoms two to four nights/week was 1.46 (1.29-1.64). Difficulties initiating or maintaining sleep and non-refreshing sleep increased the risk when analyzed separately. Those reporting all four symptoms at least twice a week had 2.09-fold (1.75-2.49) risk. The findings did not materially change after excluding depression cases within the first two years of the follow-up. CONCLUSIONS: These data suggest an association between insomnia symptoms and moderately increased risk of clinically significant depression outcomes. Insomnia should be considered as a component in prediction models for new-onset depression.
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