Chronic Insomnia as a Risk Factor for Developing Anxiety and Depression

Neckelmann, Dag; Mykletun, Arnstein; Dahl, Alv A.

doi:10.1093/sleep/30.7.873

Cited by 665Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesCOVID-19 and Mental Health

Chronic Insomnia as a Risk Factor for Developing Anxiety and Depression

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Neckelmann, Dag, Mykletun, Arnstein, Dahl, Alv A.·2007·Sleep

DOI 10.1093/sleep/30.7.873PMC PMC1978360

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Abstract

STUDY OBJECTIVE: To study prospectively the relations of insomnia to the development of anxiety disorders and depression in a population-based sample. DESIGN: Cohort study based on data from 2 general health surveys of the adult population. SETTING: Two general health surveys in the adult population in Nord-Trøndelag County of Norway, HUNT-1 performed in 1984-6 and HUNT-2 in 1995-7 PARTICIPANTS: Participants without significant anxiety and depression in HUNT-1 were categorized according to the presence and absence of insomnia in the 2 surveys (N=25,130). MEASUREMENTS AND RESULTS: Anxiety disorders and depression in HUNT-2 were assessed by the Hospital Anxiety and Depression Scale and analyzed using multivariate logistic regression analysis adjusted for age, gender, education, comorbid depression/anxiety, and history of insomnia. Anxiety disorders in HUNT-2 were significantly associated with the group with insomnia in HUNT-1 only (OR 1.6; 95% CI, 1.1-2.3), the group with insomnia in HUNT-2 only (OR 3.4; 95% CI, 3.1-3.8), as well as with the group with insomnia in both surveys (OR 4.9; 95% CI, 3.8-6.4). Depression in HUNT-2 was significantly associated with the group with insomnia in HUNT-2 only (OR 1.8; 95% CI, 1.6-2.0), but not with the groups with insomnia in HUNT-1 only or with insomnia in both surveys. CONCLUSIONS: Only a state-like association between insomnia and depression was found. In addition to being a state marker, insomnia may be a trait marker for individuals at risk for developing anxiety disorders. Results are consistent with insomnia being a risk factor for the development of anxiety disorders.

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There is a bidirectional relationship between sleep and anxiety, with anxiety able to precede poor sleep and vice versa.
“Research indicates a bidirectional relationship between sleep and anxiety with findings suggesting anxiety can precede poor sleep and vice versa.”
From Do non-pharmacological sleep interventions affect anxiety symptoms? A meta-analysis (2022) · cites this paper as Neckelmann et al., 2007
The Main Results report that chronic insomnia was associated with later development of anxiety disorders, supporting the poor-sleep-before-anxiety direction. The introduction suggests that psychopathological states can impair sleep, but does not establish that anxiety precedes later poor sleep. The claimed bidirectional temporal relationship therefore goes beyond what this paper reports. (LLM, conf=0.82)
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Authors: Neckelmann, D., Mykletun, A., & Dahl, A. A.
Affiliations: Haukeland University Hospital (NO)
Norwegian Institute of Public Health (NO)
University of Oslo (NO)
Corresponding author: Neckelmann, Dag
ORCID: Mykletun, Arnstein
Dahl, Alv A.
Venue: Sleep
Publisher: Oxford University Press (OUP)
Published: 2007-07
Volume: 30
Issue: 7
Pages: 873-880
ISSN: 0161-8105 (ISSN-L)
1550-9109
DOI: 10.1093/sleep/30.7.873
PMC: PMC1978360
OpenAlex: W1526225438
Cited by: 665
References: 46
Citations by year: 2026: 24 · 2025: 28 · 2024: 40 · 2023: 49 · 2022: 49 · 2021: 47 · 2020: 37 · 2019: 40 · 2018: 31 · 2017: 39 · 2016: 26 · 2015: 37 · 2014: 45 · 2013: 29 · 2012: 39
FWCI: 32.96
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: SLEEP (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: Norges Teknisk-Naturvitenskapelige Universitet
Norwegian Institute of Public Health
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: chronic insomnia, anxiety disorders, depression, risk factors, prospective cohort, mental health, HUNT study
MeSH terms: Adult, Aged, Anxiety Disorders, Chronic Disease, Depressive Disorder, Female, Humans, Sleep Initiation and Maintenance Disorders, Male, Middle Aged, Surveys and Questionnaires, Risk Factors

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Chronic Insomnia as a Risk Factor for Developing Anxiety and Depression

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