JMIR Publications

ABSTRACT

Background:

Insomnia is a common and persistent symptom in major depressive disorder (MDD), associated with poorer outcomes and reduced quality of life (QoL). Despite its prevalence, recent patient-reported data on the burden of insomnia symptoms in MDD remain limited.

Objective:

This study aimed to assess the burden of insomnia among individuals with MDD experiencing insomnia symptoms (MDDIS), and its impact on patient-perceived disease burden and QoL.

Methods:

A non-interventional, cross-sectional online survey was conducted from October 2022 to February 2023 in adults with self-reported MDD and insomnia symptoms, residing in the US or one of five European countries (EU5: France, Germany, Italy, Spain, and the UK). Participants completed validated questionnaires (PHQ-9 for depression severity; ISI for insomnia severity) and provided data on demographics, clinical history, treatment experience, and perceptions. Descriptive statistics were used to summarize results, and subgroup analyses were conducted based on depression status and severity.

Results:

Among 1,250 participants (US: 500; EU5: 750), most were cisgender women (72% in the US and 85% in EU5), aged ~48 years, with a long history of MDD. 60% reported having moderate to severe insomnia symptoms. Despite widespread use of antidepressants and sleep-related medications, insomnia symptoms persisted, with more than half of patients reporting 8 to 15 insomnia nights over two weeks. Insomnia symptoms were strongly related with depression severity and the presence of a current depressive episode. Nearly all participants reported negative consequences for daily functioning, including irritability, cognitive impairment, and reduced productivity, and approximately two-thirds identified sleep disturbances as having a major impact on their daily lives. Satisfaction with current treatments—particularly their effectiveness on sleep—was low, and 65–71% of patients expressed a desire for alternative therapies.

Conclusions:

Insomnia symptoms are highly prevalent and burdensome among patients with MDD, severely affecting daily life and perceived treatment success. It remains undertreated despite high medication use. These findings emphasize the need for integrated treatment strategies targeting both mood and sleep symptoms. Given its role in depression relapse, suicidality, and treatment resistance, addressing insomnia symptoms in MDD should be a clinical priority.