The Zurich study

VIII. Insomnia: Association with Depression, Anxiety, Somatic Syndromes, and Course of Insomnia
  • Margarete Vollrath
  • Werner Wicki
  • Jules Angst


The association of three subtypes of insomnia with psychic and functional syndromes, and the course of insomnia over 7 years were examined in a Swiss cohort of young adults interviewed three times. Specific associations were found between repeated brief insomnia (RBI) and recurrent brief depression (RBD). Continued insomnia (CI) was associated with major depression. All three subtypes of insomnia were associated with anxiety disorders; 52% of insomniacs were free of concurrent anxiety and depression. Insomnia — especially RBI and CI — was also associated with a number of functional complaints, but not with the consumption of alcohol, medicine, or illegal drugs. Insomniacs with RBI and occasional insomnia (OI) experienced more life events and interpersonal conflicts than controls. These findings support the subdivision of insomnia into different subtypes. The longitudinal analysis showed that insomnia tends to reoccur. For subjects with insomnia either at age 21 or 23 years, there was a higher risk of further insomnia at follow-ups. The specific subtype of insomnia at the first occurrence was not predictive for the outcome: all subtypes of insomnia enhance the risk of relapses in a similar way. Insomnia at age 21 is no precursor of the first onset of a depressive or anxiety disorder within a 2-year follow-up. With respect to the course of insomnia over 7 years, the subtypes did not differentiate.

Key words

Insomnia Epidemiology Anxiety Depression Course Follow-up 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Angst J (1988) Recurrent brief depression. A new concept of mild depression. In: Abstracts of the XVIth CINP Congress, Munich, 1988. Psychopharmacology [Suppl] 96:123Google Scholar
  2. Angst J, Vollrath M, Koch R, Dobler-Mikola A (1989a) The Zurich Study. VII. Insomnia: symptoms, classification and prevalence. Eur Arch Psychiatry Neurol Sci 238:285–293Google Scholar
  3. Angst J, Vollrath M, Merikangas KR, Ernst C (1989b) Comorbidity of anxiety and depression in the Zurich Cohort Study of Young Adults. In: Maser JD, Cloninger CR (eds) Comorbidity of mood and anxiety disorders. American Psychiatric Press, Washington, DC (in press)Google Scholar
  4. Association of Sleep Disorders Centers (ASDC), Sleep Disorders Classification Committee, Association for the Psychophysiological Study of Sleep (1979) DIMS: Disorders of initiating and maintaining sleep (insomnias). In: Sleep, vol 2, no 1. Raven Press, New York, pp 21–27Google Scholar
  5. Bischofberger A, Thomaier K (1982) Normierung einer Life-Event-Skala. Unveröffentlichte Lizentiatsarbeit, Psychologisches Institut der Universität ZürichGoogle Scholar
  6. Gislason T, Almqvist M (1987) Somatic diseases and sleep complaints. An epidemiological study of 3201 Swedish men. Acta Med Scand 221:475–481Google Scholar
  7. Hay D, Milne RM, Gilleard CJ (1986) Hypnotic drugs, old people and their habits: a general practice study. Health Bull (Edinb) 44:218–222Google Scholar
  8. Healey ES, Kales A, Monroe LJ, Bixler EO, Chamberlin K, Soldatos CR (1981) Onset of insomnia: role of life-stress events. Psychosom Med 43:439–451Google Scholar
  9. Hicks RA, Kilcourse J, Sinnott MA (1983) Type A-B behavior and caffeine use in college students. Psychol Rep 52:338Google Scholar
  10. Holmes TH, Rahe RH (1967) The social readjustment rating scale. J Psychosom Res 11:213–218Google Scholar
  11. Kales A, Caldwell AB, Soldatos CR, Bixler EO, Kales JD (1983) Psychobehavioral correlates of insomnia. II. Pattern specificity and consistency with the Minnesota Multiphasic Personality Inventory. Psychosom Med 45:341–356Google Scholar
  12. Krauth J, Lienert GA (1973) Die Konfigurationsfrequenzanalyse (KFA) und ihre Anwendung in Psychologie und Medizin. Ein multivariates nicht-parametrisches Verfahren zur Aufdeckung von Typen und Syndromen. Karl Alber, Freiburg, MünchenGoogle Scholar
  13. Mellinger GD, Balter MB, Uhlenhuth EH (1985) Insomnia and its treatment. Prevalence and correlates. Arch Gen Psychiatry 42:225–232Google Scholar
  14. Partinen M, Eskelinen L, Tuomi K (1985) Epidemiology of insomnia: environmental factors. In: Koella WP, Rüther E, Schulz H (eds) Sleep '84. Gustav Fischer, Stuttgart New York, pp 42–44Google Scholar
  15. Pearlin LI, Schooler C (1978) The structure of coping. J Health Soc Behav 19:2–21Google Scholar
  16. SAS (1985) User's Guide: Statistics, 5th edn. SAS Institute, Cary, NCGoogle Scholar
  17. Schallberger U (1976) Die hierarchische Konfigurationsfrequenzanalyse. Eine Einführung in die Methode und ihre Anwendung, mit einem Computerprogram und Datenbeispielen. Psychologisches Institut der Universität, ZürichGoogle Scholar
  18. Shirlow MJ, Mathers CD (1985) A study of caffeine consumption and symptoms: indigestion, palpitations, tremor, headache and insomnia. Int J Epidemiol 14:239–248Google Scholar
  19. Strauch I, Meier B, Steiger B (1987) Einschlafstörungen in der Adoleszenz — Ergebnisse einer Längsschnittbefragung. Schweiz Z Psychol 46:115–121Google Scholar
  20. Tennant C, Andrews G (1976) A scale to measure the stress of life events. Aust NZ J Psychiatry 10:27–32Google Scholar
  21. Tennant C, Andrews G (1977) A scale to measure the stress of life events. Aust NZ J Psychiatry 11:163–167Google Scholar
  22. Tsoi WF, Tay GE (1986) Sleep, personality and mental health. Singapore Med J 27:49–53Google Scholar

Copyright information

© Springer-Verlag 1989

Authors and Affiliations

  • Margarete Vollrath
    • 1
  • Werner Wicki
    • 1
  • Jules Angst
    • 1
  1. 1.Research DepartmentPsychiatric University Hospital, ZurichZurichSwitzerland

Personalised recommendations