title: Clinical and sociodemographic correlates of severe insomnia in psychotropic drug-free, Asian outpatients with major depressive disorder.
abstract: BACKGROUND
  Little has been known regarding the correlates of severe insomnia in major depressive disorder (MDD). This post-hoc analysis aimed to examine the sociodemographic and clinical correlates of severe insomnia in psychotropic drug-free, Asian adult outpatients with MDD.
  
  
  METHODS
  Participants were psychotropic drug-free patients with MDD, aged 18-65 years. By using the Symptom Checklist-90 Items, Revised (SCL-90-R), a score of 4 (severe distress) on any one of three insomnia items was defined as severe insomnia. Other measures included the Montgomery-Asberg Depression Rating Scale (MADRS), the Fatigue Severity Scale (FSS), the nine psychopathology subscales of SCL-90-R, the Physical and Mental Component Summaries of Short Form Health Survey (SF-36 PCS and SF-36 MCS), and the Sheehan Disability Scale (SDS).
  
  
  RESULTS
  Of 528 participants, their mean age being 39.5 (SD=13.26) years, 64.2% were females, and 239 (45.3%) had severe insomnia. The logistic regression model revealed that low educational qualifications (less than secondary school completion), high SCL-90-R Depression scores, high SCL-90-R Anxiety scores, and low SF-36 PCS scores were independently correlated with severe insomnia (p's<.05).
  
  
  CONCLUSIONS
  Insomnia was determined only by the patient's distress. Middle insomnia was not assessed. Psychotropic drug-free patients with MDD are not commonly seen in psychiatric practice.
  
  
  CONCLUSIONS
  Severe insomnia is common in patients with MDD. It is closely related with low educational qualification, subjective depression and anxiety severity, and poor physical health. These findings may implicate the treatment of comorbid MDD and severe insomnia, for example, sleep hygiene education, pharmacological treatment.
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. Electronic address: manit.s@cmu.ac.th.
authors.forename: Manit
authors.initials: M
authors.lastname: Srisurapanont
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Surinporn
authors.initials: S
authors.lastname: Likhitsathian
authors.affiliation: Institute of Mental Health, Woodbridge Hospital, Singapore.
authors.forename: Hong Choon
authors.initials: HC
authors.lastname: Chua
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
authors.forename: Pichet
authors.initials: P
authors.lastname: Udomratn
authors.affiliation: Department of Psychiatry, Kyungpook National University Hospital, Daegu, Republic of Korea.
authors.forename: Sungman
authors.initials: S
authors.lastname: Chang
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Narong
authors.initials: N
authors.lastname: Maneeton
authors.affiliation: Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Benchaluk
authors.initials: B
authors.lastname: Maneeton
authors.affiliation: National Health Research Institute, Department of Psychiatry, Taipei Medical University Shuang-Ho Hospital, Taiwan.
authors.forename: Chia-Hui
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Duke-NUS Graduate Medical School, Singapore; Singapore Clinical Research Institute, Singapore.
authors.forename: Edwin
authors.initials: E
authors.lastname: Shih-Yen Chan
authors.affiliation: Duke-NUS Graduate Medical School, Singapore; Singapore Clinical Research Institute, Singapore.
authors.forename: Dianne
authors.initials: D
authors.lastname: Bautista
authors.affiliation: Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Ahmad Hatim
authors.initials: AH
authors.lastname: Bin Sulaiman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000150:complications / Q000523:psychology; D044466:Asian People / Q000523:psychology* / Q000706:statistics & numerical data; D003863:Depression / Q000150:complications / Q000523:psychology; D003865:Major Depressive Disorder / Q000150:complications* / Q000523:psychology; D004522:Educational Status; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology* / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011619:Psychotropic Drugs / Q000627:therapeutic use; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000523:psychology; D055815:Young Adult
chemical_list: D011619:Psychotropic Drugs
keywords: Asian; Depressive disorders; Insomnia; SCL-90-R; Subjective