0414 Insomnia as an Emerging Determinant of Depression and Anxiety in the United States: Population Projections Through 2050

Abstract Introduction Insomnia is highly prevalent in the United States (U.S.) and is strongly associated with mental health morbidity, particularly depression and anxiety disorders. However, the long term population burden of insomnia and its potential contribution to future trends in depression and anxiety have not been quantified. Understanding these trajectories is important for informing population health planning and developing prevention strategies that can improve mental health outcomes. Methods We projected U.S. trends in insomnia, depression, and anxiety from 2020 to 2050 using an empirically calibrated population simulation in five year cycles. The model incorporated demographic aging along with age and sex specific incidence, remission, comorbidity, and mortality. Baseline prevalences of insomnia at 16.2 percent and severe insomnia at 7.9 percent were drawn from recent United States and global data sets. Incidence probabilities were taken from longitudinal cohort studies and adjusted with scaling factors to maintain epidemiologic plausibility. Remission rates and chronicity progression were based on published longitudinal evidence. Associations between insomnia and mental health outcomes were parameterized using published odds ratios near three point five for depression and two point six for anxiety. These were converted to risk ratios to reduce bias given non rare baseline risks. Depression and anxiety parameters were drawn from established U.S. epidemiologic sources. Results In 2020, insomnia was 16.5 percent and severe insomnia was 8.1 percent. By 2050, insomnia increased by 46 percent and severe insomnia increased by 80 percent, reaching 24.1 percent and 14.6 percent. During the same period, depression increased from 5.9 percent to 9.4 percent and anxiety increased from 13.6 percent to 19.3 percent. Among individuals with insomnia, comorbid depression and anxiety reached 12 to 13 percent and 26 to 29 percent. In 2050, insomnia contributed to a 10 to 15 percent higher prevalence of depression and a 15 to 20 percent higher prevalence of anxiety relative to a scenario without insomnia. Conclusion By 2050, the rising prevalence of insomnia, particularly severe insomnia, is projected to elevate the future burden of depression and anxiety. Early identification, long term management, and population level prevention of insomnia may help improve mental health outcomes in the U.S.. Support (if any) Resmed