Journal of affective disorders · 2025
Examining the burden of major depressive disorder with moderate-to-severe insomnia symptoms in five European countries.
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Riise Jesper Gottorp, Cambron-Mellott M Janelle, Zhang Zhiheng, Huber Véronique, Pfau Alanna, Yue Leiyu, Dwibedi Nilanjana, Olopoenia Abisola, Geoffroy Pierre A
Аннотация
BACKGROUND: Insomnia is a core and prevalent symptom of major depressive disorder (MDD). However, the impact of insomnia on health-related outcomes among patients with MDD remains inadequately understood. This study evaluated the clinical, humanistic, and economic burden of adults with MDD with moderate-to-severe insomnia symptoms (MDDIS) compared to adults with MDD and no-or-mild insomnia symptoms (other-MDD) and adults in the general population without MDD (non-MDD).
METHODS: Data from the European (France, Germany, UK, Italy, Spain) 2020 National Health and Wellness Survey were utilized to identify participants who self-reported a diagnosis of depression, stratified by insomnia status (MDDIS: Insomnia Severity Index [ISI] score ≥ 15; other-MDD: insomnia not experienced in past 12 months or ISI score < 15), and those who did not (i.e. non-MDD). Matched bivariate analyses compared MDDIS with other-MDD and non-MDD.
RESULTS: The study included 1888 MDDIS, 3905 other-MDD, and 52,074 non-MDD participants. In adjusted analyses, MDDIS participants reported greater severity of depressive and anxiety symptoms, daytime sleepiness, more healthcare provider, psychiatrist and emergency room visits, hospitalizations, and 6-month per-person direct medical costs compared to other-MDD and non-MDD (all P < 0.01) and greater medication non-adherence compared to other-MDD (P < 0.001). MDDIS participants reported poorer mental and physical functioning, poorer health-related quality of life, higher work and activity impairment, and higher annualized per-person indirect costs compared to other-MDD and non-MDD (all P < 0.001).
LIMITATIONS: The cross-sectional nature of the study limits causal inferences.
CONCLUSIONS: This study highlights the severe global burden of MDDIS and the importance of addressing insomnia symptoms with targeted interventions in the treatment of MDD.
METHODS: Data from the European (France, Germany, UK, Italy, Spain) 2020 National Health and Wellness Survey were utilized to identify participants who self-reported a diagnosis of depression, stratified by insomnia status (MDDIS: Insomnia Severity Index [ISI] score ≥ 15; other-MDD: insomnia not experienced in past 12 months or ISI score < 15), and those who did not (i.e. non-MDD). Matched bivariate analyses compared MDDIS with other-MDD and non-MDD.
RESULTS: The study included 1888 MDDIS, 3905 other-MDD, and 52,074 non-MDD participants. In adjusted analyses, MDDIS participants reported greater severity of depressive and anxiety symptoms, daytime sleepiness, more healthcare provider, psychiatrist and emergency room visits, hospitalizations, and 6-month per-person direct medical costs compared to other-MDD and non-MDD (all P < 0.01) and greater medication non-adherence compared to other-MDD (P < 0.001). MDDIS participants reported poorer mental and physical functioning, poorer health-related quality of life, higher work and activity impairment, and higher annualized per-person indirect costs compared to other-MDD and non-MDD (all P < 0.001).
LIMITATIONS: The cross-sectional nature of the study limits causal inferences.
CONCLUSIONS: This study highlights the severe global burden of MDDIS and the importance of addressing insomnia symptoms with targeted interventions in the treatment of MDD.