The associations of insomnia symptoms and clinical features as well as blood metabolic parameters in adolescents with major depressive disorders.

Background: Adolescents with major depressive disorder (MDD) frequently experience insomnia (difficulty initiating, maintaining sleep or early awakening). This prevalent symptom may associate with depression, negative life events, childhood maltreatment (CM), and blood metabolic parameters. We investigated associations between insomnia, clinical features, and blood metabolic parameters in adolescents with MDD .

Methods: From January 2021 to December 2022, 361 adolescents with MDD aged 12-18 were included in this cross-sectional study. We used the Center for Epidemiological Studies Depression Scale (CES-D), the Insomnia Severity Index Scale (ISI), the Adolescent Self-rating Life Events Checklist (ASLEC), and the Childhood Trauma Questionnaire (CTQ) to assess depression, insomnia, negative Life events, and CM. Additionally, we measured blood metabolic parameters Levels in 150 subjects. Finally, logistic regression analyses and receiver operating characteristic (ROC) curve analyses were conducted.

Results: Among adolescents with MDD, the prevalence of insomnia was 37.4%. Compared with the non-insomnia, patients in the insomnia had a greater propensity to live in families with abnormal parental marital status, to have attempted suicide, and to exhibite higher scores on a series of scales. Further logistic regression analyses revealed that abnormal parental marital status (OR = 2.012, 95% CI = 1.127-3.592), CES-D score (OR = 1.093, 95% CI = 1.063-1.124), healthy adaptation (OR = 1.130, 95% CI = 1.402-1.226), and emotional neglect (OR = 0.941, 95% CI = 0.889-0.996) were independently associated with insomnia. When metabolic parameters were included, thyroid-stimulating hormone (TSH) (OR = 1.730, 95% CI = 1.170-2.558) and 25-hydroxyvitamin D [25(OH)D] (OR = 0.851, 95% CI = 0.758-0.954) were also identified as independent factors influencing insomnia. Additionally, ROC curve analyses showed that the model based solely on clinical features had good predictive performance for insomnia (AUC = 0.777, 95% CI = 0.730-0.825, P < 0.001). When metabolic parameters were included, the predictive performance of the model was further improved (AUC = 0.777, 95% CI = 0.730-0.825, P < 0.001).

Conclusion: Among adolescents with MDD, insomnia are widespread and may correlate with depression, negative Life events, CM, TSH, and 25(OH)D. Therefore, it is necessary to consider these factors comprehensively in clinical interventions.