Bidirectional Relationship Between Symptoms of Depression and Insomnia During the First Year of the COVID-19 Pandemic

A study found that during the first year of the COVID-19 pandemic, insomnia symptoms predicted depressive symptoms at 1 year and vice versa. These findings were published in Psychiatry Research.

For this analysis, data from the Irish arm of the COVID-19 Psychological Research Consortium (C19PRC) study were investigated. Participants were recruited using quota sampling to ensure a nationally representative sample and were asked to complete 5 waves of surveys over the first 12 months of the pandemic. The survey included components from the Sleep Condition Indicator (SCI), the Patient Health Questionnaire-9 (PHQ-9), and the General Anxiety Disorder 7-item scale (GAD-7).

At baseline (April-May 2020), participants (N=1032) were aged mean 44.86±15.74 years, 52% were women, 30% had possible insomnia, 26% had possible depression, and COVID-19 anxiety scores were 61.10 (standard error, 0.83) points. Participants who were lost during follow-up (March/April 2021; n=644) were more likely to be men (P=.01), older (P<.001), to have higher COVID-19 anxiety (P=. 007), and lower depression symptoms (P<.001).

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Insomnia and depression symptoms correlated at baseline (r, -0.555; P<.001) and follow-up (r, -0.610; P<.001). COVID-19 anxiety was correlated with insomnia (r, -0.259; P<.001), depression (r, 0.253; P<.001), and age (r, 0.097; P=.002). Age was correlated with insomnia (r, 0.175; P<.001) and depression (r, -0.367; P<.001).

The final model which incorporated COVID-19 anxiety, age, and gender as covariates, was best fit (Bayesian Information Criteria [BIC], -159.92; Akaike information criteria [AIC], -179.69) compared with the model using only COVID-19 anxiety as a covariate (BIC, -77.05; AIC, -86.93) or no covariates (BIC, 17,761,080; AIC, 17,691,931). In the best-fit model, COVID-19 anxiety predicted insomnia (β, -0.278; P<.001) and depression (β, 0.202; P<.001) symptoms and age had an effect on insomnia (β, 0.202; P <.001) and depression (β, -0.396; P<.001) symptoms.

Together, age, gender, and COVID-19 anxiety accounted for 11% of the variance in insomnia and 22% of the variance in depression at baseline.

This study was limited by the proportion of participants lost to follow-up and by the fact that it is unclear whether baseline symptoms were due to COVID-19 or preexisting symptomology.

“We found that insomnia and depression symptoms had strong concurrent morbidity as well as a significant longitudinal predictive relationship during the first year of the COVID-19 pandemic in Ireland. As COVID-19 shows signs of becoming endemic, identifying the long-term bidirectional risk of insomnia and depression present on each other might shed light on the etiology and persistence of both disorders during and after the pandemic, and have implications in terms of public health measures targeting improvement in sleep and psychological health,” concluded the study authors.


Raman S, Hyland P, Coogan AN. Temporal associations between insomnia and depression symptoms in adults during the COVID-19 pandemic: a cross-lagged path modeling analysis. Psychiatry Res. 2022;312:114533. doi:10.1016/j.psychres.2022.114533

This article originally appeared on Psychiatry Advisor

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