Bidirectional associations between insomnia, posttraumatic stress disorder, and depressive symptoms among adolescent earthquake survivors: a longitudinal multiwave cohort study

Author:

Geng Fulei123,Liang Yingxin4,Li Yuanyuan123,Fang Yi123,Pham Tien Sy15,Liu Xianchen16ORCID,Fan Fang123

Affiliation:

1. School of Psychology, South China Normal University, Guangzhou, Guangdong, People’s Republic of China

2. Center for Studies of Psychological Application, South China Normal University, Guangzhou, Guangdong, People’s Republic of China

3. Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, South China Normal University, Guangzhou, Guangdong, People’s Republic of China

4. School of Biological Sciences, Faculty of Science, University of Hong Kong, Pokfulam, Hong Kong

5. Department of Social Work, Hue University of Sciences, Hue, Thua Thien Hue, Vietnam

6. University of Tennessee Health Science Center, Memphis, TN

Abstract

Abstract Study Objectives To assess insomnia symptoms in adolescents with probable posttraumatic stress disorder (PTSD) and to determine whether there are longitudinal and reciprocal associations between insomnia, PTSD, and depressive symptoms. Methods Participants were 1,492 adolescent survivors who had been exposed to the 2008 Wenchuan earthquake in China. Insomnia, PTSD, and depressive symptoms were measured at 12 months (T1, n = 1407), 18 months (T2, n = 1335), and 24 months (T3, n = 1361) postearthquake by self-report questionnaires. Generalized estimating equation (GEE) models were used to examine the cross-sectional and longitudinal associations of insomnia with PTSD and depression. Results Insomnia, PTSD, and depressive symptoms were common among adolescent survivors. Among participants with probable PTSD, approximately 47% (48.5%, T1; 48.1%, T2; and 44.2%, T3) reported difficulty falling asleep or difficulty maintaining sleep. Cross-sectional analyses showed that insomnia co-occurred with PTSD (odds ratio [OR] = 2.04) and depressive symptoms (OR = 2.10). Longitudinal analyses revealed that probable PTSD (OR = 1.50) and depression (OR = 1.42) predicted the incidence of insomnia; in turn, insomnia predicted the incidence of depression (OR = 1.65) over time. Furthermore, PTSD predicted (OR = 3.11) and was predicted (OR = 3.25) by depressive symptoms. Conclusions There is a bidirectional relationship between insomnia, PTSD, and depressive symptoms. This suggests that insomnia, PTSD, and depression are intertwined over time.

Funder

National Natural Science Foundation of China

Key Institute of Humanities and Social Sciences

Guangdong Province Universities and Colleges Pearl River

Publisher

Oxford University Press (OUP)

Subject

Physiology (medical),Neurology (clinical)

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