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Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies

荟萃分析 萧条(经济学) 优势比 失眠症 精神科 流行病学 置信区间 医学 临床心理学 人口 心理学 内科学 环境卫生 宏观经济学 经济
作者
Chiara Baglioni,Gemma Battagliese,Bernd Feige,Kai Spiegelhalder,Christoph Nissen,Ulrich Voderholzer,Caterina Lombardo,Dieter Riemann
出处
期刊:Journal of Affective Disorders [Elsevier BV]
卷期号:135 (1-3): 10-19 被引量:2299
标识
DOI:10.1016/j.jad.2011.01.011
摘要

In many patients with depression, symptoms of insomnia herald the onset of the disorder and may persist into remission or recovery, even after adequate treatment. Several studies have raised the question whether insomniac symptoms may constitute an independent clinical predictor of depression. This meta-analysis is aimed at evaluating quantitatively if insomnia constitutes a predictor of depression. PubMed, Medline, PsycInfo, and PsycArticles databases were searched from 1980 until 2010 to identify longitudinal epidemiological studies simultaneously investigating insomniac complaints and depressed psychopathology. Effects were summarized using the logarithms of the odds ratios for insomnia at baseline to predict depression at follow-up. Studies were pooled with both fixed- and random-effects meta-analytic models in order to evaluate the concordance. Heterogeneity test and sensitivity analysis were computed. Twenty-one studies met inclusion criteria. Considering all studies together, heterogeneity was found. The random-effects model showed an overall odds ratio for insomnia to predict depression of 2.60 (confidence interval [CI]: 1.98–3.42). When the analysis was adjusted for outliers, the studies were not longer heterogeneous. The fixed-effects model showed an overall odds ratio of 2.10 (CI: 1.86–2.38). The main limit is that included studies did not always consider the role of other intervening variables. Non-depressed people with insomnia have a twofold risk to develop depression, compared to people with no sleep difficulties. Thus, early treatment programs for insomnia might reduce the risk for developing depression in the general population and be considered a helpful general preventive strategy in the area of mental health care.
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