Insomnia Compromises Health, Quality of Life in Adults With Major Depressive Disorder

insomnia, sleep disorders
Investigators report the findings from a study assessing the impact of insomnia on clinical outcomes in patients with major depressive disorder.

Greater insomnia severity was found to be associated with worse clinical outcomes and poorer quality of life in adults with major depressive disorder (MDD), according to study data presented at Psych Congress 2021, held both online and in person in San Antonio, Texas, between October 29 and November 1.

Investigators extracted data from the 2019 National Health and Wellness Survey, a cross-sectional, general population survey administered annually in the United States. Respondents who reported a diagnosis of MDD and insomnia symptoms were included in analyses. Generalized linear models were used to assess the association between Insomnia Severity Index (ISI) score and clinical outcomes. Models were adjusted for age, sex, race/ethnicity, Charlson Comorbidity Index, marital status, body mass index, smoking status, alcohol use, insurance type, and depression severity assessed via the Patient Health Questionnaire-9.

The study cohort comprised 3278 patients with a mean age 44.8 ± 15.4 years, among whom 73% were women. The majority of patients were White (78%). Mean ISI score was 15.8 ± 5.5, reflecting moderate to severe insomnia symptoms. In regression models, higher ISI score was found to be associated with greater anxiety, greater daytime sleepiness, and a higher number of health care provider visits and emergency department visits in the past year (all P <.001). Greater ISI score was also found to be associated with poorer health-related quality of life, including a lower Mental Component Summary score (P =.006) and Physical Component Summary score (P <.001) on the 36-item Short Form health survey. Further, high ISI scores were found to be significantly associated with work and activity impairment (both P <.001), greater direct medical costs (P =.005), and greater indirect medical costs (P <.001).

As study limitations, the authors noted the cross-sectional design and risk for recall bias associated with self-report survey data.

Results from this large-scale study illustrate the significant impact of insomnia on patients with MDD. Insomnia affected mental health symptoms, health-related quality of life, employment, activity, and health care costs, even after adjusting for depression severity. “These results suggest that MDD treatments that better target insomnia symptoms in adults may improve clinical, economic and humanistic outcomes,” the investigators wrote.

Disclosure: This research was supported by Janssen Scientific Affairs, LLC. Please see the original reference for a full list of disclosures.

Findings of a study published in JAMA Network Open suggest written exposure therapy (WET) to be a more efficient treatment approach for post-traumatic stress disorder than cognitive processing therapy (CPT).

Active-duty United States military personnel (N=169) stationed at 2 bases in Texas seeking treatment for PTSD were recruited for this study between 2016 and 2020. Participants were randomized to receive cognitive processing therapy (n=84) or written exposure therapy (n=85). CPT comprised 12 biweekly 1-hour sessions which focused on trauma using progressive worksheets. WET comprised 5 weekly 45 minute to hour-long sessions during which time the participant wrote for 30 minutes about their trauma and the therapist checked whether the patient had any challenges completing the task.

The military personnel were 80.5% men, aged mean 33.65 (standard deviation [SD], 8.43) years, 34.9% were White, 33.7% were Black, 24.9% were Hispanic, 76.9% were married, 61.5% had some college, 0.7% had never been deployed, and they had been in the military for 155.31 (SD, 89.84) months.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) PTSD Scale scores were 36.71 (SD, 1.12) and 34.24 (SD, 1.13) at baseline for the WET and CPT cohorts, respectively. At 10 weeks, PTSD Scale scores had changed by -5.16 (SD, 1.17) and -9.12 (SD, 1.28) points for each group, respectively. By week 30, there was little difference in the score changes between cohorts (difference, 0.33; standard error [SE], 2.58).

At week 30, 37.5% of the CPT and 47.2% of the WET participants exhibited a reliable change in PTSD severity, as defined by a 12-point change in Clinician-Administered PTSD Scale for DSM-5 score.

Most participants (54%) experienced adverse events. The events were primarily psychiatric symptoms of anxiety, depression, and sleep disturbances.

CPT recipients were more likely to drop out of the study (45.2% vs 23.5%; odds ratio [OR], 2.69; 95% CI, 1.39-5.20).

This study was limited by its relatively high drop-out rate and the lack of long-term outcomes.

The study authors concluded, “the option of a brief PTSD treatment is likely to be of high value in the military setting, where military service operations may limit treatment engagement. One clear pattern of findings in this study is the high variability of treatment outcomes among service members. Better understanding of the factors associated with who does and who does not benefit from PTSD treatment is an important direction for the field.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Sloan DM, Marx BP, Resick PA, et al. Effect of written exposure therapy vs cognitive processing therapy on increasing treatment efficiency among military service members with post-traumatic stress disorder: a randomized noninferiority trial. JAMA Netw Open. 2022;5(1):e2140911. doi:10.1001/jamanetworkopen.2021.40911


Joshi K, Cambron-Mellott MJ, Daly E, Costantino H, Pfau A, Jha MK. Among US adults with major depressive disorder, higher severity of insomnia symptoms is independently associated with poorer clinical, economic and humanistic outcomes. Poster presented at: Psych Congress 2021, October 29-November 1, 2021; San Antonio, Texas. Poster 61.

This article originally appeared on Psychiatry Advisor