Background: Although approximately 13% of adolescents suffer from Major Depressive Disorder (MDD), and many adolescents have reported sleep disturbances, the relationship between sleep disturbances and MDD in adolescents is poorly understood. Thus, our objective was to study how adolescent MDD was related to sleep disturbances in a crosssectional study, and the potential role of inflammation linking adolescent MDD to sleep disturbances. Methods: Ninety-two female and male, African American and White, adolescents aged 15 to 18 years completed the study. Adolescents were diagnosed with MDD according to the Diagnostic and Statistical Manual of Mental Disorders-5 as confirmed by the MINI International Diagnostic Interview. The severity of depression was assessed using the Quick Inventory of Depressive Symptomatology. Sleep disturbance was measured using the Pediatric Sleep Questionnaires (PSQ). Blood sample was collected from each participant for measuring the inflammatory factors. Results: Compared with the controls (n=39), adolescents with MDD (n=53) had greater PSQ scores (0.32 ± 0.02 vs. 0.10 ± 0.02). In adolescents with MDD, PSQ scores were correlated with the severity of depressive symptoms (r=0.31, p<0.05). In addition, tumor necrosis factor-a levels were greatly elevated in the MDD group (2.4 ± 0.1 vs. 1.8 ± 0.1 pg/ml) compared with the controls. Severity of depressive symptoms was best predicted by PSQ scores, medications, and childhood experiences. Conclusions: Sleep disturbance measured by the PSQ is associated with severe depressive symptoms in adolescents, and one potential pathway may be through elevated tumor necrosis factor-a. Further research is warranted to probe a cause and effect relationship among sleep disturbances, MDD, and chronic inflammation.

Cognitive behavioral therapy for insomnia (CBT-I) has shown promising results in the adult population. However, there is not enough evidence for children and adolescents. Hence, we evaluated the current evidence of CBT-I in the treatment of anxiety and depression in children and adolescents. Published randomized clinical trials published before June 2020 were searched from PubMed, Cochrane Library of database, clinicaltrials.gov, and Google Scholar. Out of seven included studies, six studies assessed the effect of CBT-I on depression, and five assessed the effect on anxiety. In this review, most studies in this review showed a strong effect of CBT-I on symptoms of depression. Although a positive effect of CBT-I on anxiety was noted, only a small number of studies have considered this management. These findings should be considered preliminary, and further large-scale studies are warranted to further explore this finding further.

Introduction. Insomnia is an important symptom associated with major depressive disorder (MDD). In addition, it is one of the risk factors for suicide. Studies have shown the relationship be-tween insomnia and suicidal behavior in patients with MDD. However, this association has not been evaluated in a large sample of hospitalized patients. Objectives. To evaluate the suicidal be-havior in MDD patients with insomnia compared to those without insomnia. Methods. From the National Inpatient Sample (NIS 2006–2015) database using the ICD-9 code, patients’ data were obtained with the primary diagnosis of MDD and comorbid diagnosis of insomnia disorders (MDD+I). These patients were compared with MDD patients without insomnia disorders (MDD–I) by performing a 1:2 match for the primary diagnosis code. Suicidal ideation/attempt da-ta were compared between the groups by multivariate logistic regression analysis. Results. After the diagnostic code matching, 139061 patients were included in the MDD+I group and 276496 patients in the MDD–I group. MDD+I patients were older (47 years vs. 45 years, p < 0.001) com-pared to the MDD–I group. The rate of suicidal ideation/attempt was 56.0% in the MDD+I group and 42.0% in the MDD–I group (p < 0.001). After adjusting for age, sex, race, borderline personal-ity disorders, anxiety disorders, and substance use disorders, ‘insomnia’ was associated with 1.71 times higher odds of suicidal behavior among MDD patients admitted to the hospital. (Odds ratio: 1.71, 95% confidence interval 1.60–1.82, p < 0.001). Conclusions. Insomnia among MDD patients is significantly associated with the risk of suicide. MDD patients with insomnia need to be closely monitored for suicidal behavior.