Introduction: Insomnia is a highly prevalent disorder in Chilean adults. The literature suggests the existence of specific insomnia symptom patterns (ISPs). Although depression is an important antecedent of insomnia, few studies have assessed its relationship with ISPs in Chilean adults. The aim of this study was to identify ISPs and determine their association with depressive symptomatology in Chilean adults. Method: Participants were 523 Chilean adults selected by non-probabilistic convenience sampling. Variables were measured using self-report scales. Identification of ISPs was performed using latent profile analysis. Results: Five ISPs emerged, which were labelled as ‘No insomnia’, ‘Infrequent insomnia’, ‘Non-restorative sleep with irregular awakening’, ‘Insomnia with regular awakening’, and ‘Recurrent insomnia’. Using the ‘No insomnia’ pattern as a reference, depressive symptoms significantly increased the likelihood of having each of the other ISPs. Conclusion: Depressive symptoms may play a key role in the heterogeneity of insomnia in Chilean adults. The findings could be an important contribution to the design of tailored interventions for the treatment of insomnia in this population.

Keywords:
Insomnia, sleep disturbances, depressive symptoms, depression, depressive symptomatology.

18_RLP_56_24124_ISP_Chile_NP_13-11-2024

Álamo, C., Antúnez, Z., Baader, T., Kendall, J., Barrientos, M., & de la Barra, D. (2020). The sustained increase of mental health symptoms in Chilean university students over three years. Revista Latinoamericana de Psicología, 52, 71-80. https://doi.org/10.14349/rlp.2020.v52.8

Asparouhov, T., & Muthén, B. O. (2012). Using Mplus TECH11 and TECH14 to test the number of latent classes. In Mplus Web Notes, 14, 1-19. https://www.statmodel.com/examples/webnotes/webnote14.pdf

Baader, T., Molina, J., Venezian, S., Rojas, C., Farías, R., Fierro Freixenet, C., Backenstrass, M., & Mundt, C. (2012). Validación y utilidad de la encuesta PHQ-9 (Patient Health Questionnaire) en el diagnóstico de depresión en pacientes usuarios de atención primaria en Chile. Revista Chilena de Neuro-Psiquiatría, 50(1), 10-22. https://doi.org/10.4067/S0717-92272012000100002

Bar, M., Schrieber, G., Gueron-Sela, N., Shahar, G., & Tikotzky, L. (2020). Role of Self-Criticism, Anxiety, and Depressive Symptoms in Young Adults’ Insomnia. International Journal of Cognitive Therapy, 13(1), 15–29. https://doi.org/10.1007/s41811-019-00058-2

Barrera-Herrera, A., Riffo-Álvarez, C., Fernández-Hernández, D., Ortiz-Peña, F., & Salazar-Fernández, C. (2023). Cuestionario Oviedo del Sueño: Evidencias de Validez y Confiabilidad en Universitarios Chilenos. Revista Iberoamericana de Diagnóstico y Evaluación – e Avaliação Psicológica, 68(2), 51-65. https://doi.org/10.21865/RIDEP68.2.04

Benjamins, J. S., Migliorati, F., Dekker, K., Wassing, R., Moens, S., Blanken, T. F., te Lindert, B. H. W., Sjauw Mook, J., & Van Someren, E. J. W. (2017). Insomnia heterogeneity: Characteristics to consider for data-driven multivariate subtyping. Sleep Medicine Reviews, 36, 71–81. https://doi.org/10.1016/j.smrv.2016.10.005

Berlin, K., Williams, N., & Parra, G. (2014). An introduction to latent variable mixture modeling (Part 1): Overview and cross-sectional latent class and latent profile analyses. Journal of Pediatric Psychology, 39(2), 174–187. https://doi.org/10.1093/jpepsy/jst084

Bobes, J., García-Portilla, M., Saiz, P., Bascarán, M., Iglesias, C., & Fernández, J. (2000). Propiedades psicométricas del cuestionario Oviedo de sueño. Psicothema, 12(1), 107–112. https://www.psicothema.com/pi?pii=260

Carpi, M., Marques, D. R., Milanese, A., & Vestri, A. (2022). Sleep Quality and Insomnia Severity among Italian University Students: A Latent Profile Analysis. Journal of Clinical Medicine, 11(14), 4069. https://doi.org/10.3390/jcm11144069

Chaput, J.-P., Dutil, C., Featherstone, R., Ross, R., Giangregorio, L., Saunders, T. J., Janssen, I., Poitras, V. J., Kho, M. E., Ross-White, A., Zankar, S., & Carrier, J. (2020). Sleep timing, sleep consistency, and health in adults: a systematic review. Applied Physiology, Nutrition, and Metabolism, 45(10 (Suppl. 2)), S232–S247. https://doi.org/10.1139/apnm-2020-0032

Crawford, M. R., Chirinos, D. A., Iurcotta, T., Edinger, J. D., Wyatt, J. K., Manber, R., & Ong, J. C. (2017). Characterization of patients who present with insomnia: Is there room for a Symptom Cluster-Based approach? Journal of Clinical Sleep Medicine, 13(07), 911-921. https://doi.org/10.5664/jcsm.6666

Duarte, F., & Jiménez-Molina, Á. (2022). a longitudinal nationwide study of psychological distress during the COVID-19 pandemic in Chile. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.744204

Durán, S., Rosales, G., Moya, C., & García, P. (2017). Insomnio, latencia al sueño y cantidad de sueño en estudiantes universitarios chilenos durante el periodo de clases y exámenes. Revista Salud Uninorte, 33(2), 75-85. https://doi.org/10.14482/sun.33.2.10533

Edinger, J. D., Arnedt, J. T., Bertisch, S. M., Carney, C. E., Harrington, J. J., Lichstein, K. L., Sateia, M. J., Troxel, W. M., Zhou, E. S., Kazmi, U., Heald, J. L., & Martin, J. L. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: An American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. Journal of Clinical Sleep Medicine, 17(2), 263-298. https://doi.org/10.5664/jcsm.8988

Ferguson, S. L., G. Moore, E. W., & Hull, D. M. (2020). Finding latent groups in observed data: A primer on latent profile analysis in Mplus for applied researchers. International Journal of Behavioral Development, 44(5), 458-468. https://doi.org/10.1177/0165025419881721

Gordon, N. P., Yao, J. H., Brickner, L. A., & Lo, J. C. (2022). Prevalence of sleep-related problems and risks in a community-dwelling older adult population: A cross-sectional survey-based study. BMC Public Health, 22(1), 2045. https://doi.org/10.1186/s12889-022-14443-8

Harvey, A. G. (2002). A cognitive model of insomnia. Behaviour Research and Therapy, 40(8), 869-893. https://doi.org/10.1016/S0005-7967(01)00061-4

Ibáñez-del Valle, V., Silva, J., Castelló-Domenech, A.-B., Martinez-Martinez, M., Verdejo, Y., Sanantonio-Camps, L., & Cauli, O. (2018). Subjective and objective sleep quality in elderly individuals: The role of psychogeriatric evaluation. Archives of Gerontology and Geriatrics, 76, 221-226. https://doi.org/10.1016/j.archger.2018.03.010

Jiménez-Molina, Á., Reyes, P., & Rojas, G. (2021). Determinantes socioeconómicos y brechas de género de la sintomatología depresiva en Chile. Revista Médica de Chile, 149(4), 533-542. https://doi.org/10.4067/s0034-98872021000400533

Kline, R. (2023). Principles and practice of structural equation modeling. The Guilford Press.

Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

Liu, X., Yang, Y., Liu, Z., & Jia, C. (2022). Associations between insomnia, daytime sleepiness, and depressive symptoms in adolescents: A three-wave longitudinal study. Journal of Clinical Medicine, 11(23), 6912. https://doi.org/10.3390/jcm11236912

Marcoulides, G., & Schumacker, R. (2001). New developments and techniques in structural equation modeling. Taylor & Francis.

Martínez, P., Jiménez-Molina, Á., Mac-Ginty, S., Martínez, V., & Rojas, G. (2021). Salud mental en estudiantes de educación superior en Chile: una revisión de alcance con meta-análisis. Terapia Psicológica, 39(3), 405-426. https://doi.org/10.4067/S0718-48082021000300405

Masalan, A., Del Río, C., Yánez, C., Araya, X., & Molina, Y. (2018). Intervención cognitivo-conductual para trastornos del sueño en adultos mayores. Enfermería Universitaria, 15(1), 6-16. https://doi.org/10.22201/eneo.23958421e.2018.1.62901

McFarlane, S. J., Garcia, J. E., Verhagen, D. S., & Dyer, A. G. (2020). Alarm tones, music and their elements: Analysis of reported waking sounds to counteract sleep inertia. Plos One, 15(1), e0215788. https://doi.org/10.1371/journal.pone.0215788

Morrell, H. E. R., Cohen, L. M., & McChargue, D. E. (2010). Depression vulnerability predicts cigarette smoking among college students: Gender and negative reinforcement expectancies as contributing factors. Addictive Behaviors, 35(6), 607-611. https://doi.org/10.1016/j.addbeh.2010.02.011

Muthén, L., & Muthén, B. (2017). Mplus User’s Guide Eighth Edition. Muthén & Muthén.

Pizarro-Mena, R. A., Duran-Aguero, S., & Silva, A. (2022). Social outbreak and its association with insomnia and daytime sleepiness in Chile. Sleep Science, 15(01), 26-33. https://doi.org/10.5935/1984-0063.20210023

Poon, S.-H., Quek, S.-Y., & Lee, T.-S. (2021). Insomnia disorders: Nosology and classification past, present, and future. The Journal of Neuropsychiatry and Clinical Neurosciences, 33(3), 194-200. https://doi.org/10.1176/appi.neuropsych.20080206

Porcu, M., & Giambona, F. (2017). Introduction to latent class analysis with applications. Journal of Early Adolescence, 37(1), 129-158. https://doi.org/10.1177/0272431616648452

Ram, N., & Grimm, K. J. (2009). Methods and measures: Growth mixture modeling: A method for identifying differences in longitudinal change among unobserved groups. International Journal of Behavioral Development, 33(6), 565-576. https://doi.org/10.1177/0165025409343765

Raman, S., Hyland, P., & Coogan, A. N. (2022). Temporal associations between insomnia and depression symptoms in adults during the COVID-19 pandemic: A cross-lagged path modelling analysis. Psychiatry Research, 312, 114533. https://doi.org/10.1016/j.psychres.2022.114533

Riemann, D., Benz, F., Dressle, R. J., Espie, C. A., Johann, A. F., Blanken, T. F., Leerssen, J., Wassing, R., Henry, A. L., Kyle, S. D., Spiegelhalder, K., & Van Someren, E. J. W. (2022). Insomnia disorder: State of the science and challenges for the future. Journal of Sleep Research, 31(4), e13604. https://doi.org/10.1111/jsr.13604

Riemann, D., Espie, C. A., Altena, E., Arnardottir, E. S., Baglioni, C., Bassetti, C. L. A., Bastien, C., Berzina, N., Bjorvatn, B., Dikeos, D., Dolenc Groselj, L., Ellis, J. G., Garcia-Borreguero, D., Geoffroy, P. A., Gjerstad, M., Gonçalves, M., Hertenstein, E., Hoedlmoser, K., Hion, T., … Spiegelhalder, K. (2023). The European insomnia guideline: An update on the diagnosis and treatment of insomnia 2023. Journal of Sleep Research, 32(6), e14035. https://doi.org/10.1111/jsr.14035

Riquelme, R., Rezende, L. F. M., Marques, A., Drenowatz, C., & Ferrari, G. (2022). Association between 24-h movement guidelines and cardiometabolic health in Chilean adults. Scientific Reports, 12(1), 5805. https://doi.org/10.1038/s41598-022-09729-1

Sarsembayeva, D., Schreuder, M. J., & Hartman, C. A. (2024). Mapping insomnia symptoms and circadian preferences to mental health problems in men and women across the lifespan. Psychiatry Research, 331, 115689. https://doi.org/10.1016/j.psychres.2023.115689

Sateia, M. J. (2014). International classification of sleep disorders-Third Edition. Chest, 146(5), 1387–1394. https://doi.org/10.1378/chest.14-0970

Servicio Nacional para la Prevención y Rehabilitación del Consumo de Drogas y Alcohol [SENDA]. (2021). Décimo Cuarto Estudio Nacional de Drogas en Población General de Chile, 2022. Observatorio Nacional de Drogas. https://www.senda.gob.cl/wp-content/uploads/2023/12/ENPG-2022-Principales-Resultados.pdf

Spurk, D., Hirschi, A., Wang, M., Valero, D., & Kauffeld, S. (2020). Latent profile analysis: A review and “how to” guide of its application within vocational behavior research. Journal of Vocational Behavior, 120(May), 103445. https://doi.org/10.1016/j.jvb.2020.103445

Stubbs, B., Vancampfort, D., Firth, J., Solmi, M., Siddiqi, N., Smith, L., Carvalho, A. F., & Koyanagi, A. (2018). Association between depression and smoking: A global perspective from 48 low- and middle-income countries. Journal of Psychiatric Research, 103, 142-149. https://doi.org/10.1016/j.jpsychires.2018.05.018

Tang, N. K. Y., Saconi, B., Jansson‐Fröjmark, M., Ong, J. C., & Carney, C. E. (2023). Cognitive factors and processes in models of insomnia: A systematic review. Journal of Sleep Research, 32(6), e13923. https://doi.org/10.1111/jsr.13923

Valdés, J. M., Díaz, F. J., Christiansen, P. M., Lorca, G. A., Solorza, F. J., Alvear, M., Ramírez, S., Nuñez, D., Araya, R., & Gaete, J. (2022). Mental health and related factors among undergraduate students during SARS-CoV-2 pandemic: A cross-sectional study. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.833263

Wallace, D. M., & Wohlgemuth, W. K. (2019). Predictors of insomnia severity index profiles in United States veterans with obstructive sleep apnea. Journal of Clinical Sleep Medicine, 15(12), 1827-1837. https://doi.org/10.5664/jcsm.8094

Wang, J., & Wang, X. (2020). Structural equation modeling applications using Mplus. Wiley.

Weller, B. E., Bowen, N. K., & Faubert, S. J. (2020). Latent class analysis: A guide to best practice. Journal of Black Psychology, 46(4), 287-311. https://doi.org/10.1177/0095798420930932

Wu, T. T., Zou, Y. L., Xu, K. D., Jiang, X. R., Zhou, M. M., Zhang, S. B., & Song, C. H. (2023). Insomnia and multiple health outcomes: Umbrella review of meta-analyses of prospective cohort studies. Public Health, 215, 66-74. https://doi.org/10.1016/j.puhe.2022.11.021

Xiao, S., Liu, S., Zhang, P., Yu, J., A, H., Wu, H., Zhang, F., Xiao, Y., Ma, N., Zhang, X., Ma, X., Li, J., Wang, X., Shao, X., Liu, W., Zhang, X., Wu, W., Wang, L., Wu, R., He, Y., Xu, Z., … Zhang, B. (2021). The association between depressive symptoms and insomnia in college students in Qinghai province: The mediating effect of rumination. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.751411

Yang, J.-J., Cai, H., Xia, L., Nie, W., Zhang, Y., Wang, S., Shi, Y., Ng, C. H., Liu, H., & Xiang, Y.-T. (2021). The prevalence of depressive and insomnia symptoms, and their association with quality of life among older adults in rural areas in China. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.727939

Yasugaki, S., Okamura, H., Kaneko, A., & Hayashi, Y. (In Press). Bidirectional relationship between sleep and depression. Neuroscience Research. https://doi.org/10.1016/j.neures.2023.04.006

Zeng, L.-N., Zong, Q.-Q., Yang, Y., Zhang, L., Xiang, Y.-F., Ng, C. H., Chen, L.-G., & Xiang, Y.-T. (2020). Gender difference in the prevalence of insomnia: A meta-analysis of observational studies. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.577429

Zhang, S. X., Batra, K., Xu, W., Liu, T., Dong, R. K., Yin, A., Delios, A. Y., Chen, B. Z., Chen, R. Z., Miller, S., Wan, X., Ye, W., & Chen, J. (2022). Mental disorder symptoms during the COVID-19 pandemic in Latin America – a systematic review and meta-analysis. Epidemiology and Psychiatric Sciences, 31, e23. https://doi.org/10.1017/S2045796021000767

Zhang, X., Yang, Z., Du, L., Xiong, C., Wang, Z., Pan, Y., He, Q., Chen, S., & Cui, L. (2023). Associations of accelerometer-measured physical activity, sedentary behavior with self-reported insomnia in older women: Does pattern matter? Sleep Medicine, 104, 58-63. https://doi.org/10.1016/j.sleep.2023.02.015

Zhou, R. J., Bailey, B., & Strunk, D. R. (2024). Testing the reciprocal relationship between depressive symptoms and insomnia. Journal of Clinical Psychology, 80(6), 1391-1404. https://doi.org/10.1002/jclp.23670