J Korean Med Sci.  2021 Mar;36(9):e30. 10.3346/jkms.2021.36.e30.

The Mediating Effect of Insomnia on the Relationship between Panic Symptoms and Depression in Patients with Panic Disorder

• Hong S
• Kim S
• Park DH
• Ryu SH
• Ha JH
• Jeon HJ

• KMID: 2513583
• DOI: http://doi.org/10.3346/jkms.2021.36.e30

Abstract

Background
This study aimed to determine if sleep disturbances may mediate the relationship between panic symptoms and depression in patients with panic disorder (PD).
Methods
Electronic medical records were retrospectively reviewed for 110 consecutive patients with diagnosed PD in an outpatient clinic between October 2018 and December 2019. Measurements include the PD Severity Scale, Beck Depression Inventory-II (BDI-II) and Insomnia Severity Index (ISI). Statistical analyses were performed to assess any potential relationship between PD, insomnia and depression.
Results
Of the PD patients, 88 (80%) and 89 (80.9%) had comorbid depression (BDI-II ≥ 14) and insomnia (Korean version of the ISI ≥ 8), respectively. In a mediation model using insomnia as the mediating variable, the total effect of panic symptom severity on depression was significant (t = 7.23, P < 0.001). There were significant effects of panic symptoms on insomnia (t = 4.62,P < 0.001) and of insomnia on depression (t = 6.69, P < 0.001). The main effect of panic symptom severity on depression was also significant, after controlling for the effect of insomnia (t = 5.10, P < 0.001), suggesting partial mediation.
Conclusion
Both depressive symptoms and insomnia are common in patients with PD and depression was partially mediated by insomnia in these patients. These results suggest that an intervention for insomnia in patients with PD might help prevent the development of depression.

Keyword

Panic Disorder; Insomnia; Depression; Mediator; Comorbidity

Figure

• 

  Fig. 1 A mediation model of insomnia in the relationship between panic symptom and depression. Regression coefficients are unstandardized; a, effect of panic symptoms on insomnia; b, effect of insomnia on depression; c, total effect of panic symptom severity on depression; c′, main effect of panic symptom severity on depression after controlling for the effect of insomnia.***P < 0.001.

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