title: Is insomnia a perpetuating factor for late-life depression in the IMPACT cohort?
abstract: OBJECTIVE
  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 andlor 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.
  
  
  METHODS
  Data were drawn from Project IMPACT, a multisite intervention study, which enrolled 1801 elderly patients with MDD 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.
  
  
  METHODS
  Eighteen primary clinics in 5 states.
  
  
  METHODS
  Older adults (60+) with depression.
  
  
  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.
authors.affiliation: Department of Psychiatry, University of Rochester Medical Center, Rochester NY, USA. Wilfred_Pigeon@urmc.rochester.edu
authors.forename: Wilfred R
authors.initials: WR
authors.lastname: Pigeon
authors.forename: Mark
authors.initials: M
authors.lastname: Hegel
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
authors.forename: Ming-Yu
authors.initials: MY
authors.lastname: Fan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sateia
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Lyness
authors.forename: Cindy
authors.initials: C
authors.lastname: Phillips
authors.forename: Michael L
authors.initials: ML
authors.lastname: Perlis
mesh_terms: D017668:Age of Onset; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology