Place of chronic insomnia in the course of depressive and anxiety disorders

J Psychiatr Res. 2003 Jan-Feb;37(1):9-15. doi: 10.1016/s0022-3956(02)00052-3.


Background: Insomnia is frequent in the general population and is often related to a psychiatric illness. However, little is known about how the chronicity of insomnia affects this relation and how often subjects with chronic insomnia have antecedents of psychiatric disorders.

Methods: A total of 14,915 subjects aged from 15 to 100 years representative of the general population of the United Kingdom, Germany, Italy, and Portugal were interviewed by telephone using the Sleep-EVAL system. The questionnaire assessed current psychiatric disorders according to the DSM-IV classification and a series of questions assessed the psychiatric history. Insomnia was considered as chronic when it lasted for 6 months or more.

Results: The prevalence for insomnia accompanied with impaired daytime functioning was 19.1% and significantly increased with age. More than 90% of these subjects had a chronic insomnia. About 28% of subjects with insomnia had a current diagnosis of mental disorders and 25.6% had a psychiatric history. A DSM-IV insomnia disorder was found in 6.6% of the sample. Presence of severe insomnia, diagnosis of primary insomnia or insomnia related to a medical condition, and insomnia that lasted more than one year were predictors of a psychiatric history. In most cases of mood disorders, insomnia appeared before (> 40%) or in the same time (> 22%) than mood disorder symptoms. When anxiety disorders were involved, insomnia appeared mostly in the same time (>38%) or after (> 34%) the anxiety disorder.

Conclusions: The study shows that psychiatric history is closely related to the severity and chronicity of current insomnia. Moreover, chronic insomnia can be a residual symptom of a previous mental disorder and put these subjects to a higher risk of relapse.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anxiety Disorders / classification
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / etiology*
  • Chronic Disease
  • Cross-Sectional Studies
  • Depressive Disorder / classification
  • Depressive Disorder / diagnosis
  • Depressive Disorder / etiology*
  • Diagnosis, Differential
  • Diagnostic and Statistical Manual of Mental Disorders
  • Europe / epidemiology
  • Female
  • Health Surveys
  • Humans
  • Interviews as Topic / methods
  • Male
  • Middle Aged
  • Prevalence
  • Sleep Initiation and Maintenance Disorders / classification*
  • Sleep Initiation and Maintenance Disorders / complications*
  • Sleep Initiation and Maintenance Disorders / diagnosis
  • Sleep Initiation and Maintenance Disorders / prevention & control
  • Surveys and Questionnaires
  • Time Factors