Insomnia as a predictor of mental disorders: a systematic review and meta-analysis
Open accessAbstract
Sleep is a highly conserved phenomenon in endotherms, and has a universal physiological function across all species. In mammals, sleep can be divided into two stages: rapid eye movement (REM) sleep and non-REM (NREM) sleep, which alternate in a cyclic manner. Humans spend about one-third of their lives asleep. Sufficient sleep is necessary for humans to sustain everyday functioning. Sleep plays an important role in regulating energy metabolism, immune defense, endocrine function, and the consolidation of memory process. With the development of social economy and the change of life style, sleep duration of the residents has gradually decreased and the incidence of sleep disturbances has increased. Sleep disturbances can lead to severe mental disorders, such as depression, anxiety disorders, dementia, and other mental diseases, and may increase the risk of physical diseases, such as chronic inflammation, heart disease, diabetes, hypertension, atherosclerosis and others. Maintaining good sleep is of great significance for developing social productive forces, promoting sustainable development of economic society, and is a necessary condition for carrying out the "Healthy China Strategy". The sleep research in China started in 1950s. After decades of development, researchers have made great progress in the molecular mechanisms of sleep and wakefulness, the pathogenesis of sleep disorders and the development of new therapies. With the advancement of science and technology and the public's attention to sleep, the level of clinical diagnosis and therapy of sleep disorders in China is gradually brought in line with international standards. The publication of diagnosis and treatment guidelines in the field of sleep medicine will promote the standardization of the construction. In the future, it is still necessary to promote the development of sleep medicine in the following aspects: Strengthening the professional training and discipline construction, improving the cooperation of sleep research, promoting the intelligent diagnosis and treatment of sleep disorders, and developing the new intervention strategies. Therefore, this review will comprehensively summarize the origin, current situation, and future expectations of sleep medicine in China, including discipline construction of sleep medicine, the number of sleep project grants, research findings, the status and progress of diagnosis and treatment of sleep disorders, and the development direction of sleep medicine.
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Clinically significant anxiety is common in people with insomnia.
“Clinically significant anxiety is common in people with insomnia (Hertenstein et al., 2019; Taylor et al., 2005)”
From Associations between psychological inflexibility processes, pre‐sleep arousal and sleep quality. (2025) · cites this paper as Hertenstein et al., 2019
The Main Results report that insomnia predicts the later onset of anxiety (OR 3.23), supporting an association. They do not report how common clinically significant anxiety is among people with insomnia, so the prevalence claim is not established. (LLM, conf=0.82)
Experimental — accuracy not yet measuredInsomnia is associated with heightened risk for all psychiatric disorders (OR=2.60, 95% CI 1.70-3.97), including depression (OR=2.83, 95% CI 1.55-5.17), anxiety (OR=3.23, 95% CI 1.52-6.85), and psychotic disorders.
“a subsequent meta-analysis examining the psychiatric outcomes of insomnia from studies with at least 12 months follow-up similarly found heightened risk in pooled analysis for all psychiatric disorders (n=19, N=133,967, OR=2.60, 95% CI: 1.70-3.97, I 2 =96.2%), along with statistically significant relations in all individual conditions examined, including for depression (n=10, OR=2.83, 95% CI: 1.55”
From A meta-review of "lifestyle psychiatry": the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders (2020) · cites this paper as [73]
A diagnosis of insomnia increases the probability of de novo onset of major depressive disorder and other mental disorders.
“A diagnosis of insomnia increases the probability of de novo onset of major depressive disorder and other mental disorders [2,3].”
From Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis (2022) · cites this paper as [3]
Insomnia is a predictor for de novo onset of depression and increases the risk for the onset of anxiety disorders and substance dependency.
“In addition, insomnia is not only a predictor for de novo onset of depression, but also increases the risk for the onset of anxiety disorders and substance dependency [3].”
From Cognitive behavioral therapy for insomnia in patients with mental disorders and comorbid insomnia: A systematic review and meta-analysis (2022) · cites this paper as [3]
Comorbid insomnia disorder worsens the course of mental disorders and reduces quality of life.
“Comorbid ID has been shown to worsen the course of mental disorders and to reduce quality of life [5].”
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References 58 · Cited by 1,201
Research works printed but not linked: 1
- Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283:2008-12.
- Authors
- Hertenstein, E., Feige, B., Gmeiner, T., Kienzler, C., Spiegelhalder, K., Johann, A., Jansson-Fröjmark, M., Palagini, L., Rücker, G., Riemann, D., & Baglioni, C.
- Affiliations
- Universitäre Psychiatrische Dienste Bern (CH)
- University of Freiburg (DE)
- University of Pisa (IT)
- Corresponding author
- Hertenstein, Elisabeth
- ORCID
- Venue
- Sleep Medicine Reviews
- Publisher
- Elsevier BV
- Published
- 2019-02
- Volume
- 43
- Pages
- 96-105
- ISSN
- 1087-0792 (ISSN-L)
- OpenAlex
- W2901538710
- Cited by
- 1,201
- References
- 58
- Citations by year
- 2026: 182 · 2025: 225 · 2024: 185 · 2023: 181 · 2022: 163 · 2021: 141 · 2020: 91 · 2019: 33
- FWCI
- 10.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Sleep Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, cc-by-nc-nd)
- FreiDok plus (Universitätsbibliothek Freiburg) (submittedVersion)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion)
- Open Access CRIS of the University of Bern
- 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
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- insomnia, depression, anxiety, alcohol abuse, psychosis, risk factors, mental disorder prevention
- MeSH terms
- Anxiety, Depression, Humans, Sleep Initiation and Maintenance Disorders, Prospective Studies
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