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Can stressful life events moderate the association between insomnia and depressive symptoms in the elderly?


Complaints of insomnia symptoms, vulnerability to stressful life events, and depressive symptoms commonly affect the elderly. The association between depression and sleep problems is known in the literature, however, the role of stressful life events in this relationship has been little investigated.


To analyze the intensity of stressful life events as a moderating factor between insomnia and depressive symptoms in the elderly.


Cross-sectional study with 689 community-dwelling elderly people who answered the Elders Life Stress Inventory (ELSI), the Geriatric Depression Scale (GDS) and four questions about insomnia symptoms from the Nottingham Health Profile. The answers to these four questions allowed to form groups using a cluster analysis obtaining: "good sleepers", "sleep onset disturbance", "bad sleepers", "early awakening". An analysis was performed to check the moderating effect of the intensity of stressful life events in the association between insomnia symptoms and depressive symptoms (GDS score). The data were analyzed in the SPSS software using the PROCESS macro for the moderation analysis, considering a significance level of 5%.


689 elderly people participated (mean age 72 years, 31.7% men, 19.6% with depressive symptoms and 50.7% with absence of insomnia symptoms). The increase of a standard deviation in the intensity attributed to stressful life events translates into a mean increase of 1.24 points in the GDS score for the elderly of the "early awakening" cluster when compared with those of the "good sleepers" cluster.


The intensity attributed by the elderly of the "early awakening" cluster to stressful events experienced in their lives constitutes a moderating factor, which increases the reports of depressive symptoms. It is suggested to routinely include an evaluation of the occurrence of stressful life events in the elderly complaining of insomnia symptoms, especially in those who report "early awakening", as the main complaint, as well as to incorporate forms of psychological support to the elderly who manifest greater susceptibility to these events. In addition, it is suggested to incorporate, or in some cases maintain, a scale that evaluates depressive symptoms in their health care.


Aged, Sleep, Depression.


Área Clínica


UNICAMP - Universidade Estadual de Campinas - São Paulo - Brasil


Carola Rosas, Cleber de Souza Oliveira, Carla Renata Silva Andrechuk, Cristina Kano Inazumi, Mayza Luzia dos Santos Neves, Natália Amorim Ramos Felix, Henrique Ceretta Oliveira, Anita Liberalesso Neri, Maria Filomena Ceolim