0363 Insomnia Disorder As A Predictor Of Mental Disorders And Pain: A Meta-analytic Evaluation Of Longitudinal Epidemiological Studies

Abstract

Introduction: Previous research has identified insomnia as a predictor for the onset of major depression. The aim of this meta-analysis is to corroborate this finding and investigate whether insomnia as a disorder also predicts the onset of other mental disorders and pain. Methods: The databases PubMed, Medline, PsycInfo, and PsycArticles were searched for longitudinal studies investigating the predictive value of the presence of insomnia at baseline for the presence of psychopathology or pain at follow-up. Assuming that there is a distribution of true effect sizes rather than a single true effect size, the random-effects model was selected. Odds ratios were used as primary outcomes. The Quality in Prognosis Studies Risk of Bias Assessment Instrument for Prognostic Factor Studies was used as a measure of risk of bias for the individual studies and the file drawer test was used to determine potential publication bias. Results: Thirteen primary studies were included in the meta-analysis. Across all studies, the model found an odds ratio of 1.94, indicating that insomnia disorder is a significant predictor for later onset of psychopathology and pain. Subgroup analyses showed similar results, i.e. insomnia was identified as a predictor of depression, anxiety disorders, alcohol abuse, pain, and psychotic disorders. The overall risk of bias in the primary studies was rated as moderate, whereby most problems arose from insufficient documentation of attrition and reasons for dropout. The risk of bias resulting from outcome measurement and statistical analysis, in contrast, was low in most studies. The file drawer test suggested that there was no indication of publication bias. Conclusion: This meta-analysis provides evidence that insomnia increases the risk for future onset of psychopathology and pain in general. A future research agenda should include more prospective studies evaluating insomnia diagnosis at baseline and long-term follow-up intervals assessing a wide range of mental disorders. In addition, prospective long-term interventional studies investigating the efficacy of insomnia treatment for the prevention of mental disorders and pain are called for.