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Meta-Analysis
. 2016 Nov 5;16(1):375.
doi: 10.1186/s12888-016-1075-3.

Insomnia and the risk of depression: a meta-analysis of prospective cohort studies

Liqing Li  1   2 , Chunmei Wu  1   3 , Yong Gan  1 , Xianguo Qu  4 , Zuxun Lu  5
Affiliations
Meta-Analysis

Insomnia and the risk of depression: a meta-analysis of prospective cohort studies

Liqing Li et al. BMC Psychiatry. .

Abstract

Background: Observational studies suggest that insomnia might be associated with an increased risk of depression with inconsistent results. This study aimed at conducting a meta-analysis of prospective cohort studies to evaluate the association between insomnia and the risk of depression.

Methods: Relevant cohort studies were comprehensively searched from the PubMed, Embase, Web of Science, and China National Knowledge Infrastructure databases (up to October 2014) and from the reference lists of retrieved articles. A random-effects model was used to calculate the pooled risk estimates and 95 % confidence intervals (CIs). The I 2 statistic was used to assess the heterogeneity and potential sources of heterogeneity were assessed with meta-regression. The potential publication bias was explored by using funnel plots, Egger's test, and Duval and Tweedie trim-and-fill methods.

Results: Thirty-four cohort studies involving 172,077 participants were included in this meta-analysis with an average follow-up period of 60.4 months (ranging from 3.5 to 408). Statistical analysis suggested a positive relationship between insomnia and depression, the pooled RR was 2.27 (95 % CI: 1.89-2.71), and a high heterogeneity was observed (I 2 = 92.6 %, P < 0.001). Visual inspection of the funnel plot revealed some asymmetry. The Egger's test identified evidence of substantial publication bias (P <0.05), but correction for this bias using trim-and-fill method did not alter the combined risk estimates.

Conclusions: This meta-analysis indicates that insomnia is significantly associated with an increased risk of depression, which has implications for the prevention of depression in non-depressed individuals with insomnia symptoms.

Keywords: Depression; Epidemiology; Insomnia; Meta-analysis; Sleep disorders.

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Figures

Fig. 1
Fig. 1
Flow chart of study selection of insomnia in relation to depression
Fig. 2
Fig. 2
Forest plot of the association between insomnia and risk of depression
Fig. 3
Fig. 3
Funnel plot with pseudo 95 % confidence limits of insomnia and depression. The horizontal line represents the summary effect estimates, and the dotted lines are pseudo 95 % CIs
Fig. 4
Fig. 4
Filled funnel plot of RR from studies that investigated the association between insomnia and the risk of depression. The circles alone are real studies and the circles enclosed in boxes are ‘filled’ studies. The horizontal line represents the summary effect estimates, and the diagonal lines represent pseudo-95 % CI limits
See this image and copyright information in PMC

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