Disassembling insomnia symptoms and their associations with depressive symptoms in a community sample: The differential role of sleep symptoms, daytime symptoms, and perception symptoms of insomnia
Abstract
Objective Insomnia and depression are closely related. However, few studies have investigated whether certain insomnia symptoms differentially relate to certain depressive symptoms. The present study aimed to examine relationship between specific types of insomnia symptoms (sleep symptoms, daytime symptoms, and perception symptoms) and specific symptoms of depression.Design Cross-sectional, observational study data from the Sleep, Health, Activity, Diet and Environment and Social Factors (SHADES) Survey.Setting Community-level population.Participants A total of 1003 community-based adults aged 22-60 from the Philadelphia area.Measurements Insomnia symptoms were represented by scores of sleep symptoms, daytime symptoms and perception symptoms, derived from the Insomnia Severity Index (ISI). Depression symptoms were assessed with the items of the Patient Health Questionnaire 9 (PHQ-9).Results A Confirmatory Factor Analysis (CFA) supported the three-factor model based on ISI data. Binary logistic regressions examined independent associations between the three insomnia symptom types and individual depression symptoms. Sleep symptoms were more strongly associated with physiological aspects of depressive symptoms (appetite symptoms, psychomotor symptoms, and suicidal ideation). The daytime symptoms, on the other hand, were significantly associated with almost all depressive symptoms, except for appetite. Moreover, daytime symptoms were exclusively related to cognitive symptoms of depression (eg, trouble concentrating). The perception symptoms were independently associated with mood symptoms, tiredness, appetite, and judgment of oneself as a failure, but not with psychomotor, cognitive and suicidal ideation symptoms.Conclusion Daytime symptoms and perception symptoms of insomnia were more strongly associated with a full range of depressive symptoms than sleep symptoms. The sleep symptoms were mainly associated with more physiological symptoms of depression, implicating more biological mechanisms. Further research is needed regarding how these types of insomnia symptoms differentially related to multiple health consequences.
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The ISI 'nocturnal' score has recently been investigated in other insomnia research and has previously been utilized in several COMISA treatment studies.
“This ‘nocturnal’ score has also recently been investigated in other insomnia research [66,67], and has previously been utilized in several COMISA treatment studies [52,63,64].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [66]
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- Authors
- Ji, X., Bastien, C. H., Ellis, J. G., Hale, L., & Grandner, M. A.
- Affiliations
- Université Laval (CA)
- Northumbria University (GB)
- Stony Brook University (US)
- University of Arizona (US)
- Corresponding author
- Grandner, Michael A.
- Venue
- Sleep Health
- Publisher
- Elsevier BV
- Published
- 2019-08
- Volume
- 5
- Issue
- 4
- Pages
- 376-381
- ISSN
- 2352-7218 (ISSN-L)
- OpenAlex
- W2932469887
- Cited by
- 37
- References
- 36
- Citations by year
- 2026: 2 · 2025: 8 · 2024: 7 · 2023: 3 · 2022: 6 · 2021: 2 · 2020: 5 · 2019: 4
- FWCI
- 4.99
- Type
- journal article
- Language
- en
- Update notices
- erratum (2020-12-01)
- Open access
- closed
- Locations
- Sleep Health (publishedVersion)
- PubMed (publishedVersion)
- Northumbria Research Link (Northumbria University) (submittedVersion)
- Funders
- National Institute of Environmental Health Sciences (R21ES022931)
- Canadian Institutes of Health Research (49500, 86571)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Keywords
- insomnia, depressive symptoms, insomnia symptoms, daytime dysfunction, sleep symptoms, Insomnia Severity Index, PHQ-9, appetite, suicidal ideation, psychomotor symptoms, cognitive symptoms, mood symptoms, community-dwelling adults
- MeSH terms
- Adult, Cross-Sectional Studies, Depression, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Philadelphia, Young Adult
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