Sleep problems and psychological well-being in patients with depression: A cross-sectional study of 7,051 individuals

Background and objectives: Psychological well-being is markedly reduced in patients with depression. This study examined the association between self-reported sleep problems and psychological well-being in a large cohort of patients with depression prior to treatment initiation. Methods: We included 7051 adults with a primary diagnosis of depression or dysthymia (ICD-10 F32, F33, or F34.1) enrolled in a standardized depression treatment program in the Capital Region of Denmark between 2007 and 2022. Sleep problems were assessed using the sleep item from the Major Depression Inventory (MDI), and psychological well-being was measured by the 5-item World Health Organization Well-Being Index (WHO-5). Associations were estimated using multivariable linear regression with robust standard errors, adjusting for demographic and clinical variables including depression severity, anxiety, medication use, and somatic comorbidities. Results: Sleep problems were highly prevalent, with only 5.5% of patients reporting no sleep problems. Complaints of too little sleep were more common than complaints of too much sleep. Self-reported sleep problems were associated with lower psychological well-being in a stepwise manner. Compared with patients without sleep problems, those reporting short sleep, long sleep or with both had lower well-being scores (β = -11.1, -9.8, and -12.5, respectively), and associations remained robust after multivariable adjustment. No interaction by sex was observed. Conclusion: In this large clinical sample of patients with depression, self-reported sleep problems were highly prevalent and associated with graduated lower psychological well-being.