Why the study?
Insomnia and depression are common co-morbidities associated with mild traumatic brain injury, prompting an examination of insomnia trajectories and their temporal relationship with depressive symptoms during recovery.
Depressive symptoms may lead to worsening insomnia during the subacute recovery period after mild traumatic brain injury, with a subset of patients experiencing persistent new-onset insomnia for over 5 years.
Insomnia and depression are common co-morbidities associated with mild traumatic brain injury (mTBI). Data from Transforming Research and Clinical Knowledge in TBI, a longitudinal cohort study of TBI and orthopedic controls (OTC), were used to examine insomnia trajectories and the temporal relationship between insomnia and depressive symptoms during recovery. mTBI ( n = 1,557) and OTC ( n = 226) adult patients with no psychiatric or sleep disorder history were assessed at 2 weeks and 3, 6, and 12 months post-injury, and at three long-term assessments between 2 and 10 years post-injury. Latent class growth analysis identified five insomnia trajectory classes during the first year post-injury, revealing 25% with persistent insomnia, 4% improving, and 71% below the clinical cutoff. A random intercept cross-lagged panel model tested the lagged effects between insomnia and depression. In addition to being longitudinally correlated (φ = 0.74, p < 0.001), depressive symptomatology operated as a leading indicator of worsening insomnia from 3 to 6 months post-injury (β = 0.20, p = 0.001) across the whole sample. The multigroup model revealed less insomnia (α = −0.31, p = 0.006) and depressive symptoms (α = −0.52, p < 0.001) in OTC relative to mTBI. From 1 to 5–10 years post-injury, mTBI low insomnia classes remained stable, while the highest class improved moderately (−5.50, 95% confidence interval: −7.84, −3.16, p < 0.001). Our findings suggest depressive symptoms may lead to worsening insomnia during the subacute recovery period and that a subset of patients with mTBI may suffer from new-onset insomnia that persists for more than 5 years.
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McGee et al. (2025) studied this question.
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