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Insomnia May Predict Suicidal Ideation in Older Adults With Depression

May 27, 2020

Ongoing or worsening sleep difficulties in older adults with depression may signal increased risk of continued depression and suicidal ideation, according to a study published online in Sleep. 

“We can’t say that the sleep disturbances we’re seeing are necessarily causing the poor depression outcomes,” said study senior author Adam Spira, PhD, professor in the department of mental health at Johns Hopkins Bloomberg School of Public Health. “But the results suggest that older adults who are being treated for depression and whose sleep problems are persistent or worsening need further clinical attention.”

Researchers analyzed sleep and mental health data for 599 adults, aged 60 years or older, from 20 primary care practices in the Northeast United States. All study participants met criteria for major depression or clinically significant minor depression and were followed for 1 year. Researchers categorized patients into 3 groups based on their insomnia symptoms throughout the year: those whose sleep improved, those whose sleep stayed the same or improved just slightly, and those whose sleep worsened.

Impaired Mood Homeostasis Linked With Depression

Compared with older adults whose sleep improved, those with worsening sleep were 28.6 times as likely to have a diagnosis of major depression and 11.9 times as likely to have a diagnosis of clinically significant minor depression at the end of the year. They were also 10% more likely to report suicidal ideation. Patients with worsening sleep were also only half as likely to achieve depression remission as those whose sleep improved.

Findings for older adults with persistent sleep difficulties were similar, although reduced, as those with worsening insomnia, researchers reported.

The results also suggest, added Dr. Spira, that “treating sleep problems should be explored further as a potential means to improve depression outcomes in older people — as well as the poor cognitive and general health outcomes that have been tied to disturbed sleep in this population.” 

—Jolynn Tumolo


Gallo JJ, Hwang S, Truong C, Reynolds CF, Spira AP. Role of persistent and worsening sleep disturbance in depression remission and suicidal ideation among older primary care patients: the PROSPECT study. Sleep. 2020 April 2;[Epub ahead of print].

Persistent and worsening insomnia may predict persistent depression in older adults [press release]. Baltimore, Maryland: Johns Hopkins Bloomberg School of Public Health; April 30, 2020.

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