Sleep disturbances and depressive symptoms: an investigation of their longitudinal association in a representative sample of the UK general population.
BACKGROUND
It has been argued that sleep disturbances are a risk factor for depression but previous longitudinal studies have had limitations and not addressed alternative explanations. The aim of this study was to examine the longitudinal association between sleep disturbances and depressive symptoms in a nationally representative sample.


METHODS
Data from the 18-month follow-up of the UK National Psychiatric Morbidity survey were used (n = 2406). Sleep disturbances, depressive and other psychiatric symptoms (fatigue, concentration problems, irritability, anxiety and pain symptoms) were assessed using the Revised Clinical Interview Schedule (CIS-R). The bidirectional association between symptoms was investigated with logistic regression analyses and path analysis.


RESULTS
Sleep disturbances and depressive symptoms were correlated with each other cross-sectionally (r = 0.52, p < 0.001). In the longitudinal analysis, sleep disturbances at baseline did not predict depressive symptoms at follow-up [odds ratio (OR) 1.27, 95% confidence interval (CI) 0.51-3.19] and the same was observed for the reciprocal association (OR 0.87, 95% CI 0.56-1.35). In the path analysis, the reciprocal model did not have a better fit compared to the simpler first-order model without cross-lagged paths. The path from sleep disturbances at baseline to depressive symptoms at follow-up had a minimal contribution to the explained variance of the latter (<1%).


CONCLUSIONS
Previous studies may have overestimated the importance of sleep disturbances as an independent risk factor of depression. The strong cross-sectional association is compatible with sleep disturbances being either a prodromal or a residual symptom of depression and this may have implications for recognition and treatment of depression.
Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, UK. p.skapinakis@gmail.com
P
P
Skapinakis
D
D
Rai
F
F
Anagnostopoulos
S
S
Harrison
R
R
Araya
G
G
Lewis
D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology* / Q000523:psychology; D012959:Socioeconomic Factors; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult