Chronic insomnia as a risk factor for developing anxiety and depression
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Updated: Jul 13, 2026

Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder
Published on: April 26, 2024
Dag Neckelmann1, Arnstein Mykletun, Alv A Dahl
1Department of Psychiatry, Clinic ofPsychosomatic Medicine, Haukeland University Hospital, Bergen, Norway. dag.neckelmann@helse-bergen.no
Study Objective:
To study prospectively the relations of insomnia to the development of anxiety disorders and depression in a population-based sample.
Design:
Cohort study based on data from 2 general health surveys of the adult population.
Setting:
Two general health surveys in the adult population in Nord-Trøndelag County of Norway, HUNT-1 performed in 1984-6 and HUNT-2 in 1995-7
Participants:
Participants without significant anxiety and depression in HUNT-1 were categorized according to the presence and absence of insomnia in the 2 surveys (N=25,130).
Measurements And Results:
Anxiety disorders and depression in HUNT-2 were assessed by the Hospital Anxiety and Depression Scale and analyzed using multivariate logistic regression analysis adjusted for age, gender, education, comorbid depression/anxiety, and history of insomnia. Anxiety disorders in HUNT-2 were significantly associated with the group with insomnia in HUNT-1 only (OR 1.6; 95% CI, 1.1-2.3), the group with insomnia in HUNT-2 only (OR 3.4; 95% CI, 3.1-3.8), as well as with the group with insomnia in both surveys (OR 4.9; 95% CI, 3.8-6.4). Depression in HUNT-2 was significantly associated with the group with insomnia in HUNT-2 only (OR 1.8; 95% CI, 1.6-2.0), but not with the groups with insomnia in HUNT-1 only or with insomnia in both surveys.
Conclusions:
Only a state-like association between insomnia and depression was found. In addition to being a state marker, insomnia may be a trait marker for individuals at risk for developing anxiety disorders. Results are consistent with insomnia being a risk factor for the development of anxiety disorders.
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