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Sleep-related Problems in Those Who Suffer with Depression
The purpose of this paper is to write a literature review conveying the relationship and significance of fatigue and sleep-related problems in adults who have been diagnosed with depression.
According to the CDC (2018), adult women age 20 and over are twice as likely as men to suffer with depression, and non-Hispanic Asian adults have the lowest prevalence of depression in the United States. In their research, Broström, Wahlin, Alehagen, Ulander, & Johansson (2018) found that men with depression tend to possess more self-stigma, and women are more apt to seek assistance with depressive symptoms. According to the National Sleep Foundation, sleep-related problems are extremely common among those with depression. However, the American Psychiatric Association’s Workplace Mental Health division found that as many as half of members of the general public have untreated depression (APA, 2019). Depression diagnoses increased 18% from 2005 to 2015, and depression is the number one cause of disability (World Health Organization [WHO], 2019). Worldwide, depression is diagnosed in 322 million people (WHO, 2019). Risk factors for depression include personal or family history of depression, trauma, stress, or major life changes, and physical illness or medication (National Institute of Mental Health [NIMH], 2019).
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Sleep-related problems can be secondary to mental health conditions including depression, yet mental health conditions can be made worse by sleep problems (NAMI, 2015). Fatigue increases the release of cytokines, in turn affecting one’s mental, physical, and social aspects of life (Joshwa and Campbell, 2017). According to Greenstein, with the National Alliance on Mental Illness (NAMI, 2017), continuous fatigue causes lack of energy and concentration, which results in guilt over non-productivity and then social isolation. Depression is a mental illness that negatively affects the whole of a person: how a person thinks, feels, and acts, including decreased ability to function well no matter the aspect of life (APA, 2019). In the workplace, untreated depression results in presenteeism, where employees are physically present yet not engaged emotionally or mentally, or absenteeism, where employees physically miss days of work. Employee performance is affected by depression in many ways, including focus and decision-making, time management, completion of physical tasks, social interactions, and communication (APA, 2019). Interestingly, this same organization found that 62% of total costs from Major Depressive Disorder were the result of co-occurring disorders such as sleep disturbance (APA, 2019).
The World Health Organization (WHO) reports that depression is the leading cause of ill health and disability worldwide (2019). The APA’s Mental Health Workplace Mental Health division found that depression costs an average of $44 billion in lost productivity per year (2019). Approximately 20 million Americans are affected, not to mention that insomnia has been found to be very common in those with depression (National Sleep Foundation, 2019).
The purpose of this paper is to increase knowledge regarding the bi-directional relationship between sleep-related problems and depression and their effect on quality of life.
Sleep disturbances can either be a consequence or a precursor of depression and may predict onset and recurrence of depressive symptoms (Brostrom et al., 2018). The research performed by Bossola, Di Stasio, Giungi, Rosa, and Tazza (2015) resulted in similar findings: fatigue may lead to the development of depressive symptoms. Regarding the pathophysiology of sleep and depression, Bossola et al. (2015) found that depression is associated with higher serum levels of pro-inflammatory cytokines, which in turn may cause transmission of key neurotransmitters (such as serotonin and noradrenaline) to be reduced. Notably, a relationship between fatigue and inflammatory markers has been found in patients with mood disorders (Bossola et al., 2015).
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Brostrom et al. (2018) also found that difficulty in initiating and maintaining sleep can cause depressive symptoms, which results in fatigue and reduced capacity. This constant sleepiness then leads to social inhibition and negative relationships with others, as well as a lack of trust in one’s own ability to handle life’s daily requirements (Brostrom, 2018). As stated by Blackburn (2017), lack of sleep can even result in death. Daytime sleepiness, regardless of the reason, leads to reduced cognitive performance and increased risk for traffic accidents (Brostrom, 2018).
Regarding depression’s impact on the economy, major depressive disorder costs $210.5 billion per year; 50% of this cost has to do with absenteeism and presenteeism (APA, 2019). Direct medical costs related to depression account for 45% of the annual total (APA, 2019). Presenteeism due to depression causes an average of 32 days per year being missed at work (APA, 2019). Thus, untreated depression affects the health and productivity of employees, not to mention the companies’ financial status.
In conclusion, since sleep disturbances can either be a consequence or a precursor of depression, it is important that signs and symptoms of depression as well as sleep-related problems be recognized (and perhaps screened) for all patients. Quality of life is highly affected by both sleep-related problems and depression, and one’s ability to work, have a family, and be successful in relationships with others is highly important.
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