Sleep Complaints Among Adults With Major Depressive Episode Are Associated With Increased Risk of Incident Psychiatric Disorders: Results From a Population-Based 3-Year Prospective Study

ABSTRACT

Objective: Sleep alterations have been suggested as a cause and consequence of psychiatric disorders. In this context, we evaluated the incidence of psychiatric disorders following sleep complaints in adults with major depressive episode (MDE).

Methods: In a large, nationally representative 3-year prospective survey, the National Epidemiologic Survey on Alcohol and Related Conditions conducted in 2001–2002 (Wave 1) and 2004–2005 (Wave 2), we used structural equation modeling to examine shared and specific effects of trouble falling asleep, early morning awakening, and hypersomnia on incidence of common comorbid DSM-IV disorders among patients with MDE. The analyses adjusted for sociodemographic and clinical characteristics, including sedative or tranquilizer use.

Results: Among participants with MDE at Wave 1, 3-year incidence rates were dysthymia = 2.9%, general anxiety disorder = 8.2%, panic disorder = 3.4%, social anxiety disorder = 4.0%, specific phobia = 3.0%, alcohol use disorder = 8.1%, nicotine dependence = 6.2%, cannabis use disorder = 2.7%, and other drug use disorder = 4.9%. Participants with 3-year incident psychiatric disorders commonly had trouble falling asleep (67.6% for cannabis use disorder to 76.4% for panic disorder), early morning awakening (43.3% for cannabis use disorder to 55.6% for dysthymia), and hypersomnia (51.3% for nicotine use disorder to 72.1% for social anxiety disorder). The effects of the incident general psychopathology factor, representing mechanisms related to incidence of all psychiatric disorders, were exerted almost exclusively through a factor representing shared effect across all sleep complaints. Sleep complaints were associated with increased risk of incident psychiatric disorders, independent of sociodemographic and clinical characteristics.

Conclusions: These findings suggest that sleep complaints should be clinically assessed in all psychiatric disorders, as these prodromal symptoms might constitute transdiagnostic biomarkers and therapeutic targets for prevention.