Study Uncovers Associations of Depression and Hospital-Treated Sleep and Health Conditions

Philipp Frank, PhD

Credit: University College London

A new study linked depression with an increased risk of sleep disorders requiring hospital treatment, and other conditions. During a 5-year follow-up, severe or moderately severe depression was associated with the incidence of 29 non-overlapping conditions requiring hospital treatment.¹

After adjusting for confounders followed by multiple testing, 25 associations were confirmed in the analysis of the Finnish cohorts.

More specifically, the adjusted hazard ratio (HR) for sleep disorders was 5.97, with a 95% confidence interval (CI) of 3.27-10.89 among patients with depression. In addition, the results included diabetes, ischemic heart disease, chronic obstructive bronchitis, bacterial infections, back pain, and osteoarthritis.

The Study

Philipp Frank, PhD, Research Department of Epidemiology and Public Health, University College London, and investigators conducted an outcome-wide prospective multicohort study designed to examine the association between depression and physical conditions requiring hospital treatment.

The primary analysis was based on data from the UK Biobank, a large population-based study in the United Kingdom.

Investigation data were from April-September 2022, and the analyses were repeated in an independent data set of 2 cohorts in Finland, including a population-based study and an occupational cohort.

The study population included individuals aged 40-69 years at baseline from the UK Biobank (n=130,652) along with 2 cohorts (n=109,781), for a total analytical sample of 240,433 individuals.

Investigators assessed depression using self-report measures and categorized it as recurrent severe major depression, recurrent moderate major depression, single major depressive episode, or no depression.

The study’s main outcome measure was hospitalization for any of 77 common health conditions identified through linkage data to national hospital and mortality registries.

The Results

The highest cumulative incidence was observed for endocrine and related internal organ diseases, musculoskeletal diseases, and diseases of the circulatory system and blood. Investigators reported the cumulative incidence was lower for hospital-treated mental, behavioral, and neurological disorders.

Data demonstrated depression was also associated with disease progression in people with prevalent heart disease or diabetes, and for 12 conditions, there was evidence of a bidirectional relationship.

According to the study, these findings are important because sleep disorders are common among people with depression, but it's unclear how the direction of the relationship progresses.

The evidence indicated that depression may be a risk factor for multiple physical conditions, including sleep disorders, that require hospital treatment.

Investigators acknowledged the study did not provide information on the specific types of sleep disorders that were included in the analysis, and sleep disorders can range from insomnia and sleep apnea to restless leg syndrome and narcolepsy, among others.

In addition to the prevalence of sleep problems, the results show the most common causes of hospitalization in people with depression were endocrine, musculoskeletal, and vascular diseases, not psychiatric disorders.

These findings suggest that depression should be considered as a target for the prevention of physical and mental disease by highlighting the importance of addressing depression as a risk factor for physical illness and emphasizing the need for a holistic approach to healthcare.

References:

1. Frank P, Batty GD, Pentti J, et al. Association Between Depression and Physical Conditions Requiring Hospitalization. JAMA Psychiatry. Published online May 03, 2023. doi:10.1001/jamapsychiatry.2023.0777