ASSOCIATION OF MAJOR DEPRESSIVE DISORDER WITH INSOMNIA SYMPTOMS WITH HEALTHCARE RESOURCE USE AND CARDIOVASCULAR AND METABOLIC CONDITIONS – ANALYSIS OF NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY

Background

Insomnia is one of the key symptoms of major depressive disorder (MDD). MDD with insomnia symptoms is associated with increased risk of relapse and poor health-related quality of life.1,2 To better characterize the burden of MDD with insomnia symptoms, we examined their association with healthcare resource utilization, and cardiovascular and metabolic (CVM) conditions using nationally representative data from the National Health and Nutrition Examination Survey (NHANES).

Methods

In this cross-sectional study, adults (age ≥18 years) with MDD (defined as Patient Health Questionnaire-9 [PHQ-9] score ≥10) were identified from the NHANES database (20132018). MDD with insomnia symptoms (MDDIS) was defined as having MDD and reporting trouble sleeping to a healthcare professional; MDD w/o IS was defined as not having reported trouble sleeping. Adults with missing information for PHQ-9 and the sleep question were excluded. Study outcomes included healthcare resource utilization (inpatient stay, office visits [all-cause]), work productivity, and CVM conditions (such as hypertension, diabetes, and obesity). MDDIS and MDD w/o IS were balanced using propensity score-based inverse probability of treatment weighting (IPTW), controlling for baseline demographics. Study outcomes were compared between MDDIS and MDD w/o IS using descriptive statistics and weighted (IPTW and sample weights) logistic regression models. The findings reported here include sample counts and weighted percentages.

Results

From a sample of 15,574 adults, 1,383 (8.2%) had MDD (PHQ-9 ≥10) and 853 (5.4%) had MDDIS. Among patients with MDD, 853 (66%) were MDDIS and 530 (34%) were MDD w/o IS. MDDIS versus MDD w/o IS patients were older (mean, 49.0 vs 43.3 years), White (68.3% vs 53.5%), married (39.5% vs 29.8%) and college educated (17.1% vs 13.4). Results from weighted logistic regression analyses found that MDDIS patients had significantly (p < 0.05) higher odds than MDD w/o IS for ≥3 office visits (67.8% vs 38.9%, odds ratio [OR]: 3.30), hospitalization (21.1% vs 12.2%, OR: 1.93), mental health professional visit (40.0% vs 20.9%, OR: 2.52) and inability to work due to health reasons (57.7% vs 36.4%, OR: 2.38). For CVM conditions, patients with MDDIS versus MDD w/o IS had significantly higher (p < 0.05) odds for heart attack (7.4% vs 4.3%, OR: 1.76) and hypertension (64.7% vs 46.6%, OR: 2.10). Findings for obesity (54.4% vs. 44.4%; OR: 1.50) and diabetes (21.7% vs. 17.6%; OR: 1.29) were not statistically significant but showed a similar trend.

Conclusion

MDDIS was associated with higher healthcare resource utilization, reduced work productivity, and poorer CVM health. Study findings indicate that burden of MDDIS extends beyond mental health, contributing to broader clinical and societal impacts. There remains a critical need for therapies that effectively address both depressive and insomnia symptoms in patients with MDD. Sponsorship: Johnson and Johnson.