Investigating the link between depression and restless legs syndrome: a controlled comparison of mood and motor restlessness in restless legs syndrome, with primary
insomnia and good sleeper controls.
D Clin Psy thesis, University of Glasgow.
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Background: Restless legs Syndrome is a sensorimotor disorder characterised by unpleasant sensations in the legs when at rest and only relieved by movement. RLS is associated with deterioration in quality of life and depression is a common comorbid problem.
Methods: The present study aimed to establish whether RLS is a risk factor for depressive symptoms by comparing 3 groups - RLS patients (RLS), a primary insomnia group (PI), and non-restless good sleeper controls (NRC). Fifteen participants were recruited to each group. To elucidate the mechanisms of the observed comorbidity between RLS and Depression, measures of mood/affect prior to, during and immediately following a Suggested Immobilization Test (SIT) were employed. The BDI-II measured depressive symptoms retrospectively over the previous two-week period. A mood visual analogue scale (VAS) was rated by participants during the SIT at 5-minute intervals. The Positive and Negative Affect Schedule (PANAS) retrospectively measured affect experienced by participants during the SIT. In addition, new actigraphy techniques were utilised to measure Periodic Leg Movements during Sleep (PLMS) over 3 nights at home – an objective measure of RLS severity.
Results: The groups did not differ on demographic data except for age which was added as a covariate to further analyses. The RLS group had higher levels of negative affect following the SIT than the PI and NRC groups (both p<.05). The RLS group also had higher levels of positive affect than the PI and NRC groups (both p<.05). The level of sensory discomfort felt in the legs during the SIT was strongly associated with negative affect in the RLS group (r=.853, p<.001). PLMS were not found to be associated with BDI-II scores.
Conclusions: It appears that sleep quality and depressive symptoms as measured by the BDI-II were similar in the RLS and PI groups. There were some limitations of the study but tentative conclusions were made. The role of emotional arousal in RLS, shown by the high correlation between sensory discomfort and negative affect, potentially demonstrates a qualitative difference in the restlessness experienced by this group and further studies are required.
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