Inquiring about insomnia may facilitate diagnosis of depression in the primary care setting

Aim Depression is often undiagnosed in primary care. Asking about sleep status is much easier than asking about mood. This study was conducted to examine the relation between insomnia and depression. Methods New patients aged 35–64 years were recruited from internal medicine clinics in Japan. Self-administered questionnaires were employed. Depression was evaluated by the Zung Self-Rating Depression Scale and the Profile of Mood States. Sleep status was investigated using the Pittsburgh Sleep Quality Index. Likelihood ratios of insomnia for depression were calculated. To assess the relation between insomnia and depression independent of confounding factors, adjusted odds ratios and 95% confidence intervals were calculated using multiple logistic regression analyses. Results Among 598 subjects, 153 (25.6%) were assessed as having depression. “Very bad sleep quality, with difficulty falling asleep within 30 min ≥3/week” showed a positive likelihood ratio of 20.36 (95%CI: 2.53-164) while “not very good sleep quality” had a negative likelihood ratio of 0.32 (0.14-0.72). Adjusted for sex, age, underlying diseases, life events, lifestyle habits, and relationship problems, significant odds ratios for depression were observed for “difficulty falling asleep within 30 min ≥3/week” (2.53, 95% confidence interval:1.07–5.98), “waking up in the middle of the night or early morning ≥3/week” (3.09, 1.58-6.05) and “fairly bad sleep quality” (3.65, 1.34–9.96). Conclusion Inquiring about the weekly frequency of difficulty “falling asleep within 30 min” and “waking up in the middle of the night or early morning”, and “sleep quality” may help to diagnose depression.