“ CORRELATION OF DEPRESSION SCALE TO INSOMNIA IN ELDERLY “

Depression is a common mental disorder that presents with depressed mood, loss of
interest or pleasure, decreased energy, feelings of guilt or low self-worth, disturbed sleep or
appetite, and poor concentration. Moreover, depression often comes with symptoms of anxiety.
These problems can become chronic or recurrent and lead to substantial impairments in an
individual’s ability to take care of his or her everyday responsibilities. At its worst, depression
can lead to suicide. Almost 1 million lives are lost yearly due to suicide, which translates to 3000
suicide deaths every day. For every person who completes a suicide, 20 or more may attempt to
end his or her life (Marcus, 2012).
Depression is suspected to be strongly associated with sleeping difficulties. The Who
study on global burden of diseases predictec depression would be the second greatest Burden of
Disease in 2020 in developed countries.1 These countries therefore urgently need to address the
issue of depression. Depression is prevalent among the aged, and it is known that its prevalence
rises after the age of 50 among Japanese people. It is reported that insomnia can be a precursor
or risk factor in depression and that depression could result in insomnia. Thus, the two diseases
apparently have a bidirectional relationship.3 Furthermore, insomnia is listed as a major
diagnostic feature of depression in the Diagnostic and Statistical Manual of Mental Disorders,
4th Ed (DSM-IV), attesting to the close association of the two diseases, (Yakoyama et al, 2010).
Depression in elderly is often overlooked as a clinical diagnosis, since it is assumed to be
a normal response to aging, physical losses or other life events. It causes excess disability and
has an adverse interaction with physical health. In study revealed a high rate of depression in
elderly people which could be attributed to factors like single or widowed marital status, low
socio-economic status, presence of chronic diseases, physical inactivity, lack of social
participation and inadequate sleep, ,(Pracheth et al, 2012)
The combined odds ratios ranged from 1.0 to 3.3.Greater heterogeneity was observed
among studies evaluating lower education, disability, poor health status, cognitive impairment,
prior depression, and new medical illness as risk factors for depression. On the basis of the
combined odds ratios (and their 95% credible intervals) and the posterior distributions of the
odds ratios (pooled odds ratio >1), the following were found to be significant risk factors for
depression: bereavement, sleep disturbance, disability, prior depression, and female gender.
Higher age, lower education level, being unmarried, and poor social support did not appear to be
risk factors. Poor health, cognitive impairment, living alone, and new medical illness were
uncertain risk factors, (G. Cole & Dendukuri, 2003)
The same approach was used to examine the effect of depression on the development of
insomnia. Depression reported at both HUNT2 and HUNT3 (presumably chronic or recurrent
depression symptoms) yielded a near seven-fold increased risk of developing insomnia in
HUNT3 (OR = 6.71, 95% CI = 5.46Y8.26) adjusting for age, sex, and education (Table 3). The
OR was reduced to 4.96 (95% CI = 3.65Y6.75) when adjusting for somatic symptoms, somatic
diagnoses, and life-style factors. Further adjustment for anxiety only slightly reduced the
association (OR = 4.34, 95% CI = 3.14Y5.99). In comparison, participants with depression in
HUNT2, irrespective of depression status in HUNT3, had an OR of 3.27 (95% CI = 2.80Y3.82),
(Sivertsen et al, 2012).
While depression is the leading cause of disability for both males and females, the burden
of depression is 50% higher for females than males (WHO, 2012). In fact, depression is the
leading cause of disease burden for women in both high-income and low- and middle-income
countries (WHO, 2012). Research in developing countries suggests that maternal depression may
be a risk factor for poor growth in young children (WHO, 2012). This risk factor could mean that
maternal mental health in low-income countries may have a substantial influence on growth
during childhood, with the effects of depression affecting not only this generation but also the
next (Marcus, 2012)
Insomnia has historically been regarded as a symptom of depressive illness. Accordingly,
sleep problems are included as a symptom of depression in both major diagnostic classification
systems . Several studies have also shown that depression predicts new onset of insomnia
symptoms . However, the simplistic view of insomnia as a secondary condition to a somatic or
psychiatric problem has been challenged by a range of studies, particularly in the case of
depression. A large body of evidence has, for example, demonstrated that insomnia is also a
significant risk factor for the development of depression. In a recent meta-analysis of
longitudinal studies on the topic, (Baglioni et al). concluded that nondepressed participants with
insomnia have a two-fold risk of later depression, compared with those without insomnia.
Insomnia has been found to predict the onset of depression across different age groups, although
most studies found a stronger relationship in older adults (4,6Y13) compared with both the
general population (14Y23) and young adults and adolescents (24Y29). These studies suggest
that insomnia may be prodromal to depression, one of the earlier symptoms of a depressive
episode or an independent risk factor for depression, (Sivertsen et al, 2012).
In Studi by (Sivertsen et al, 2012) present findings are in accordance with most of the
existing studies concerning insomnia as a significant and independent risk factor for subsequent
onset of depression. Although it is difficult to compare effect sizes across studies because of
differences in age span, operationalization of exposure and outcome variables, follow-up time,
and so on, our result that insomnia increases the risk of later depression by more than four times
in the fully adjusted model is stronger than what previously has been reported in samples from
the general adult population. In the first meta-analysis in this field, Baglioni et al. (5) found a
fixed effect size of 2.1 (95% CI = 1.9Y2.4) after excluding study outliers. The stronger effects in
our study may be because of the fact that not all studies included in the meta-analysis used a
proxy of insomnia including a daytime impairment criterion. It is only to be expected that
insomnia symptoms are not as strongly associated with the onset of depression as insomnia
syndrome, for which also a daytime criterion (1,32,42) (Sivertsen et al, 2012).
Insomnia is not just a common symptom of various psychiatric or physical disorders, but
is itself categorized as a primary psychiatric disorder. Aside from the manifestations of difficulty
initiating sleep, fragmented sleep, early-morning wakenings, and overall poor sleep efficiency,
the subjective feeling of inadequate or non-restorative sleep the next morning, as well as
psychosocial distress or dysfunction caused, are even more crucial in the diagnosis of insomnia.
The duration of insomnia required for diagnosis as “chronic” has varied from as little as 1 month
to as long as 6 months, depending upon the criteria used. The increased incidence of chronic
insomnia has been related to concomitant medical and psychiatric disorders, which are
frequently present among the elderly. When insomnia becomes chronic, it will invariably
increase medical problems significantly, and impact a patient’s quality of life, cognitive and
psychosocial function adversely, while further exaggerating the already existing psychiatric or
medical conditions. Somatic comorbidities associated with aging are known to be risk factors for
insomnia and depression. Therefore, chronic insomnia will further aggravate the heavy burden of
medically ill elderly patients and their caregivers, (JCMA, 2012).
 REFERENCE

Marcus M, M Thagi Y, Mark V O, Dan C, Shekhar S. (2012). Depression A Global

Public Health Concern. WHO Department of Mental Health and Substance Abuse, Hal 6-
8.

SIVERTSEN B, PAULA S, ARNSTEIN M, MARY H, STALE P, STEINAR K, INGER

H N, SIMON O. (2012). The Bidirectional Association Between Depression and
Insomnia. American Psychosomatic Society, hal 1-8.

Yokoyama E, Yhositaka K, Yasuhiko S, Makoto U, Yoko M, Tetsuo T, Thakesi M,

Thakasi O. (2010). Association between Depression and Insomnia Subtypes. Nihon
University School of Medicine, Tokyo, Japan, Hal 1693-1702.

Pracheth R, SS Mayur, JV Chowti.(2013). GERIATRIC DEPRESSION SCALE: A

TOOL TO ASSESS DEPRESSION IN ELDERLY. International Journal of Medical
Science and Public Health, Hal 31-35.

Cole M. G, Dendukuri.(2003). Risk Factors for Depression. Am J Psychiatry, Hal 1147-

1156.

direct, S. S. (2012). Association between chronic insomnia and depression in elderly

adults. Journal of the Chinese Medical Association, Hal 195-196.