The association between mental health, chronic disease and sleep duration in Koreans: a cross-sectional study

Comparing the Effects of Adequate and Insufficient Sleep on the Mental Health, Behavioral Outcomes, and Daily Lives of South Korean Adolescents

Background/Objectives: Adequate sleep is critical for adolescents' physical and mental health. However, academic demands and lifestyle habits lead to insufficient sleep among many adolescents. This study examined the relationship between sleep patterns and general characteristics, health behaviors, and mental health among South Korean adolescents. Methods: Data were obtained from the Korea Youth Risk Behavior Survey conducted by the Korea Disease Control and Prevention Agency, involving 21,283 students aged between 13 and 18 years. Self-reported sleep duration was categorized as adequate (8-10 h) or insufficient (less than 8 h on both weekdays and weekends), and 20 independent variables across demographic, socioeconomic, lifestyle, health-related behavioral, and psychological factors were analyzed. Multiple logistic regression analyses were conducted to evaluate the effects of insufficient sleep. Results: Insufficient sleep was more prevalent among female students (odds ratio [OR]: 2.064) and older students (OR: 16.588 for Grade 12 vs. Grade 7) and was associated with higher stress levels (OR: 4.338 for almost always vs. never), suicidal ideation (OR: 1.826), and unhealthy behaviors such as alcohol consumption (OR: 2.009), smoking (OR: 1.998), and smartphone overdependence (OR: 2.313 for severe vs. normal). In contrast, adolescents with adequate sleep reported greater happiness (OR: 4.167 for very much vs. not at all) and better academic performance (OR: 1.377 for very high vs. very low). Conclusions: The findings show that insufficient sleep significantly affects adolescent well-being, highlighting the need for tailored interventions and increased societal awareness. Future research should explore the mechanisms underlying gender differences and weekday-weekend sleep disparities to enhance sleep quality in this population.

Mental Health in Young Adult University Students During COVID-19 Lockdown: Associations with Physical Activity, Sedentary Behaviors and Sleep Quality

This study analyzed associations between physical activity (PA), sedentary behaviors (SB), sleep, and mental health indicators in young adults during the COVID-19 lockdown (15 January-19 April 2021). The participants were 549 Portuguese university students (18-30 years, 57.7% male). Mental health was assessed using the DASS-21 for depression, anxiety, stress, and DASS-21 total score (DASSt). Physical activity (vigorous, moderate, walking) was measured with the IPAQ, while SB (e.g., sitting, screen time) and sleep were evaluated using self-reported measures and the Pittsburgh Sleep Quality Index (PSQI). Multiple linear regressions showed that sleep quality (β = 2.116), sitting time (ST; β = 0.451), vigorous PA (VPA; β = -0.005), and computer use for work/study (β = 0.444) were significantly associated with overall mental health, DASSt (R2 = 0.358). Sleep quality, sitting, and VPA were also linked to depression (R2 = 0.308), anxiety (R2 = 0.275), and stress (R2 = 0.338). Computer use for work/study was additionally associated with anxiety and stress. Overall, poor sleep quality, increased sitting, and computer use for work/study, alongside lower VPA, showed significant associations with poorer mental health outcomes. These findings highlight the importance of sleep, PA, and limiting sedentary behaviors, particularly during lockdowns, in mitigating mental health issues among Portuguese young adults.

Mapping the 9-year sleep trajectory and its implications for chronic disease risks among middle-aged and older adults

OBJECTIVE

To identify the 9-year trajectories of sleep duration and to assess the relationship between time-dependent sleep duration and sleep trajectories with 14 chronic diseases in adults.

METHODS

This study used five waves of data of the China Health and Retirement Longitudinal Survey. Participants with complete sleep duration data and at least one record of 14 chronic diseases were included. The group-based trajectory model was used to identify sleep trajectories from 2011 to 2020. Time-dependent survival analysis and logistic regression were used to examine the relationship between time-dependent sleep duration and sleep trajectories with chronic diseases.

RESULTS

A total of 9063 participants were included, with a mean (standard deviation, SD) sleep duration of 6.37 (1.83) h/d. Sleeping <7 h/d predicted higher risks of 11 chronic diseases at follow-up, with hazard ratios (HR) and 95 % confidence intervals (CI) ranging from 1.71 (1.26-2.33) for psychiatric disease to 1.15 (1.04-1.27) for dyslipidemia. Five sleep trajectories were identified and labeled as group 1-5 based on ascending order of sleep duration. Consistently sleeping <4 h/d (group 1) and 4-6 h/d predicted higher risks of most chronic diseases, with the highest HR (95 %CI) of 3.50 (1.73-6.92) and 2.94 (1.82-4.49) for psychiatric diseases, respectively. Consistently sleeping 6-7 h/d (group 3) predicted higher risks of digestive diseases and arthritis. Decreasing sleep (group 4) predicted higher risks of psychiatric diseases and memory-related diseases.

CONCLUSIONS

Consistently sleeping <6 h/d predicted higher risks of most chronic diseases, especially psychiatric diseases. Digestive disease and arthritis were more sensitive to consistently inadequate sleep.

Sleep and nighttime behavior disorders in older adults: associations with hypercholesterolemia and hypertriglyceridemia at baseline, and a predictive analysis of incident cases at 12 months follow-up

INTRODUCTION

Sleep disorders, particularly insomnia and obstructive sleep apnea, are associated with dyslipidemia in the general population. The study's aim was to explore the association between pathological Cholesterol and Triglyceride levels, and sleep and nighttime behavior disorders (SNBD) in older adults, whether they might predict SNBD onset, and to emphasize the role of body mass index (BMI) in this association.

METHODS

Alzheimer's Disease Neuroimaging Initiative (ADNI) population with complete Cholesterol, Triglyceride, SNBD, and neurocognitive data were included. Logistic regression was performed to study the association between hypercholesterolemia, hypertriglyceridemia, and SNBD at baseline and at 12 months. Relevant confounders, particularly BMI, were adjusted for.

RESULTS

Among the 2,216 included cases, 1,045 (47%) were females, and the median age was 73 years (IQR: 68, 78). At baseline, 357 (16%) had SNBD and 327 (18%) at 12 months; 187 of them were incident cases. There were more cases of baseline SNBD in the hypertriglyceridemia group than in those without (19% vs. 14%, P-value = 0.003). Similarly, more follow-up SNBD cases had hypertriglyceridemia at baseline (21% vs. 16%, P-value = 0.025). SNBD cases at baseline had significantly higher serum Triglyceride levels than those without (132 vs. 118mg/dL, P-value < 0.001). Only hypertriglyceridemia was significantly associated with baseline SNBD (crude OR = 1.43, 95%CI: 1.13,1.80, P-value = 0.003), even after adjustment for confounding factors (adj. OR = 1.36, 95%CI: 1.06,1.74, P-value = 0.016) and (BMI-adj. OR = 1.29, 95%CI: 1.00,1.66, P-value = 0.048). None of the dyslipidemia forms did predict incident cases at 12 months.

CONCLUSIONS

Hypertriglyceridemia, but not hypercholesterolemia, was associated with higher odds of SNBD. The association was independent of BMI. None of the dyslipidemia forms did predict incident SNBD over 12 months. Sleep disorders should motivate a systematic screening of dyslipidemia in older adults and vice versa.

Unveiling the Interplay Between Depressive Symptoms' Alleviation and Quality of Life Improvement in Major Depressive Disorder: A Network Analysis Based on Longitudinal Data

Background

Understanding the dynamic relationship between depressive symptoms and quality of life (QOL) is essential in improving long-term outcomes for patients with Major Depressive Disorder (MDD). While previous studies often relied on cross-sectional data, there is a pressing need for stronger evidence based on longitudinal data to better inform the development of effective clinical interventions. By focusing on key depressive symptoms, such interventions have the potential to ultimately enhance QOL in individuals with MDD.

Methods

This multi-center prospective study, conducted between 2016 and 2020, enrolled outpatients and inpatients diagnosed with MDD across twelve psychiatric hospitals in China. Longitudinal data on Patient Health Questionnaire - 9 (PHQ-9) and Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF) was analyzed using an Extended Bayesian Information Criterion (EBIC) graphical least absolute shrinkage and selection operator (gLASSO) network model to explore the connections between depressive symptom changes and QOL changes. Flow network was applied to investigate relationships between individual symptom changes and overall QOL score change, as well as daily functional independence.

Results

This study included 818 participants with complete data after 8-week antidepressant treatment. Apart from the overlapping items from PHQ-9 and Q-LES-Q-SF, the three edges between "mood" (delta-QLES2) and "anhedonia" (delta-DEP1), between "physical health" (delta-QLES1) and "sleep problems" (delta-DEP3), and between "physical health" (delta-QLES1) and "sad mood" (delta-DEP2) were the most strong bridges between the cluster of depressive symptoms alleviation and the cluster of QOL change. "Anhedonia" (delta-DEP1), "sad mood" (delta-DEP2) and "loss of energy" (delta-DEP4) had the highest bridge strength between the alleviations of depressive symptoms and the total score change of Q-LES-Q-SF. Anhedonia had the greatest connection with participants' satisfaction with function in daily life.

Conclusion

This study highlighted the potential for developing highly effective interventions by targeting on central symptoms, thereby to ultimately improve QOL for patients with MDD.

Association of sleep and generalized anxiety disorder in Korean adolescents

BACKGROUND

Generalized anxiety disorder (GAD) is a common anxiety disorder among adolescents, significantly impacting their concentration and learning capabilities. The connection between emotional well-being and sleep is well-established, and Korean adolescents are particularly prone to inadequate sleep. This study aimed to determine the association between sleep duration and GAD in Korean adolescents.

METHODS

This study was conducted using data from 106,513 adolescents aged 12-18 years. Data from the 2020-2022 Korea Youth Risk Behavior Survey were used. Sleep duration was classified into five groups, based on an average sleep duration of 7-7.9 h in adolescents. Social jet lag was defined as a misalignment between an individual's biological and social clocks. Differences in sleep duration between weekdays and weekends, social jet lag, and bedtime were each classified into three categories. Multiple logistic regression analysis was performed to evaluate the association between sleep duration and GAD.

RESULTS

Comparing the five groups classified based on sleep duration, adolescents in the groups that slept less experienced a significant increase in the odds of developing GAD (adjusted odds ratio [aOR]: boys: 1.10 in the 6.0-6.9-h group, 1.14 in the 5.0-5.9-h group, and 1.23 in the ≤ 4.9-h group; girls: 1.05 in the 6.0-6.9-h group, 1.19 in the 5.0-5.9-h group, 1.22 in the ≤ 4.9-h group). Adolescents with poor sleep quality experienced more frequent instances of inadequate sleep (aOR: boys: 2.51; girls: 2.43).

CONCLUSIONS

GAD is strongly associated with insufficient sleep. Consequently, it is imperative to assess and address GAD in adolescents with irregular sleep patterns.

Physical activity and sleep moderate the relationship between stress and screen time in college-aged adults

For undergraduate students, excessive screen time is associated with poorer mental health and greater perceived stress. Objective: The purpose of the present investigation was to determine the potential moderating influence of physical activity and sleep on the relationship between screen time and stress. Participants & Methods: A cross-sectional sample of 513 undergraduate students between Fall 2017 & Spring 2020 were given a questionnaire to assess perceived stress level, physical activity engagement, screen time, and sleep. Results: Stepwise hierarchical regression analyses identified that screen time, sleep, and the three-way interaction between screen time, sleep, and physical activity were associated with stress. Post-hoc decomposition revealed that higher levels of physical activity and sleep both mitigated the relationship between screen time and stress. Conclusions: Findings suggest that modifiable health behaviors such as physical activity and sleep may be important factors for managing the negative effects of screen time on stress in college-aged adults.

High serum Cholesterol and Triglyceride levels in older adults: associations with sleep and nighttime behavior disorders at baseline and a prediction analysis of incidental cases at 12 months follow-up

Introduction

This study explored the association between dyslipidemia and sleep and nighttime behavior disorders (SNBD) in the elderly.

Methods

ADNI population with complete Cholesterol, Triglyceride, SNBD, and neurocognitive data were included. Logistic regression was performed to study the association between dyslipidemia and SNBD at baseline and 12 months. Relevant confounders were adjusted for.

Results

Among the 2,216 included cases, 1,045 (47%) were females, and the median age was 73 (IQR: 68, 78). At baseline, 357 (16%) had SNBD, and 327 (18%) at 12 months; 187 were incident cases.There were more cases of baseline SNBD in the hypertriglyceridemia group than in those without (19% vs. 14%, p-value=0.003). Similarly, more follow-up SNBD cases had hypertriglyceridemia at baseline (21% vs. 16%, p-value=0.025). SNBD cases at baseline had significantly higher serum Triglyceride levels than those without (132 vs. 118mg/dL, p-value<0.001).Only hypertriglyceridemia was significantly associated with baseline SNBD (crude OR=1.43, 95%CI: 1.13,1.80, p-value=0.003), even after adjustment for confounding factors (adj.OR=1.36, 95%CI: 1.06,1.74, p-value=0.016) and (BMI-adj.OR=1.29, 95%CI: 1.00,1.66, p-value=0.048). None of the dyslipidemia forms did predict incident cases at 12 months.

Conclusions

Hypertriglyceridemia, but not hypercholesterolemia, was associated with higher odds of SNBD. None of the dyslipidemia forms predicted incidental SNBD over 12 months.

Urban-rural disparities in depressive symptoms and related factors among offspring of advanced maternal mothers: A national cross-sectional study in China

BACKGROUND

Urbanization remains an important factor affecting the mental health of people. Currently, there is insufficient research on depression among the offspring of women who have children at an advanced maternal age (AMA). The objective of this study is to investigate the urban and rural disparities in depressive symptoms among the offspring of AMA and related influencing factors.

METHODS

In this study, a total of 1273 offspring born to AMA were selected from the fourth wave of the China Health and Retirement Longitudinal Study (CHARLS) database. The questionnaire used in the study included demographic information and the Center for Epidemiologic Studies Depression Scale (CESD). Chi-square tests and logistic regression analysis were employed to examine the urban-rural differences.

RESULTS

The likelihood of developing depressive symptoms of the offspring of AMA in rural areas was 1.633 times higher (AOR = 1.633; 95%CI: 1.211-2.202) compared to their urban counterparts. Several factors including gender, education, marital status, disability, chronic diseases, and sleep duration showed a linkage with depression among rural based offspring of AMA. For the urban offspring of AMA, only disability and sleep duration exhibited a significant association with depressive symptoms.

LIMITATIONS

This study cannot establish a causal relationship between depressive symptoms and the influencing factors for the offspring of AMA. Age range and variables of the respondents needs further consideration.

CONCLUSIONS

This study has brought to light the elevated risk of depressive symptoms among rural-based offspring of AMA. Thus, emphasizing the urgent need for targeted interventions and measures to address the negative impact.

Association of sleep duration and risk of mental disorder: a systematic review and meta-analysis

BACKGROUND

The effects of sleep duration on the development of mental illness remain controversial. Therefore, it is necessary to identify the effects of long or short sleep duration on psychological disorders, which could reveal new ways for preventing and treating mental health conditions cheaply.

METHODS

Identifying published papers was accomplished by using the following five English databases on March 16, 2022: PubMed, MEDLINE, Embase, Web of Science databases, and Scopus. Cross-sectional and cohort studies were considered if they evaluated the association of sleep duration with all kinds of mental illness in adults. We excluded case reports, editorials, narrative reviews, and studies without detailed information on sleep duration. Summary effect-size estimates were expressed as risk ratios (RRs) or odds ratios (ORs) with 95% confidence intervals and were evaluated using random-effect models. Mantel-Haenszel's random-effects model was used to estimate the inconsistency index (I2) and Tau2 index (measurement of heterogeneity).

RESULTS

A total of 52 studies were included in this analysis, consisting of 14 cohort studies and 38 cross-sectional studies. These studies involved a combined sample size of 1,407,891 participants who met the inclusion criteria. Cohort (adjusted RR = 1.42, 95% CI: 1.26-1.60, P < .001, I2 = 37.6%, Tau2 = 0.014) and cross-sectional studies (adjusted OR = 1.67, 95% CI: 1.57-1.77, P < .001, I2 = 79.7%, Tau2 = 0.060) concluded that short sleep duration increased mental disorder risks. The same conclusions were acquired in the subgroup analysis, especially for depression (adjusted RR = 1.43, 95% CI: 1.24-1.65, P < .001, I2 = 80.4%, Tau2 = 0.082), anxiety (adjusted RR = 1.30, 95% CI: 1.04-1.63, P = .002, I2 = 0.0%, Tau2 = 0.000), and PTSD (adjusted RR = 1.35, 95% CI: 1.04-1.76, P = .022, I2 = 24.1%, Tau2 = 0.013) in cohort studies. The results of subgroup analysis indicated that long sleep duration was not a risk factor for depression (adjusted RR = 1.15, 95% CI: 0.98-1.34, P = .088, I2 = 63.4%, Tau2 = 0.045) and anxiety (adjusted RR = 1.37, 95% CI: 0.93-2.03, P = .114, I2 = 0.0%, Tau2 = 0.000).

CONCLUSIONS

Short sleep duration, not long sleep duration, is an independent predictor of developing mental disorders, particularly anxiety and depression.

Association between sleep duration and depression in menopausal women: a population-based study

Aims

This research investigated menopausal women older than 50 years to find whether there were any independent relationships between the duration of sleep they got and their prevalence of depression.

Methods

National Health and Nutrition Examination Survey (NHANES) datasets from 2011-2020 were utilized in a cross-sectional study. Using multivariate linear regression models, the linear relationship between sleep duration and depression in menopausal women was investigated. Fitted smoothing curves and thresholds impact evaluation were used to investigate the nonlinear relationship. Then, subgroup analyses were performed according to smoking, drinking alcohol, diabetes, hypertension, heart disease, and moderate activities.

Results

This population-based study included a total of 3,897 menopausal women (mean age 65.47 ± 9.06 years) aged≥50 years; 3,159 had a depression score <10, and 738 had a depression score≥10. After controlling for all covariates, the prevalence of depression was 17% higher among participants with short sleep duration [OR=1.17, 95%CI=(0.65, 1.70), P<0.0001] and 86% [OR=1.86, 95%CI=(1.05, 2.66), P<0.0001] compared to participants with normal sleep duration. In subgroup analyses stratified by smoking and diabetes, the sleep duration and depression scores of non-smokers [β=-0.18, 95%CI= (-0.33, -0.02), P=0.0241] and diabetics were independently negatively correlated [β=-0.32, 95%CI= (-0.63, -0.01), P=0.0416]. Using a two-segment linear regression model, we discovered a U-shaped relationship between sleep duration and depression scores with an inflection point of 7.5 hours. Less than 7.5 hours of sleep was associated with an increased risk of developing depression [β=-0.81, 95%CI= (-1.05, -0.57), P<0.001]. However, sleeping more than 7.5 hours per night increased the risk of depression considerably [β=0.80, 95%CI= (0.51, 1.08), P<0.001].

Conclusions

Depression is associated with sleep duration in menopausal women. Insufficient or excessive sleep may increase the risk of depression in menopausal women.

Validation of the Chinese version of the Brief Pain Inventory in patients with knee osteoarthritis

BACKGROUND

Knee osteoarthritis (KOA) primarily presents with symptoms of pain and compromised functionality. Pain is a subjective manifestation that necessitates the employment of reliable evaluation tools for practical assessment, thereby enabling the formulation of appropriate interventional strategies. The Brief Pain Inventory (BPI) is a widely utilized questionnaire for evaluating the status of chronic pain. The purpose of the present study is to translate the short form of BPI into Chinese version (BPI-CV) and conduct cross-cultural adaptation to evaluate the psychometric characteristics of BPI-CV in KOA patients.

METHODS

BPI-CV was translated and cross-culturally adapted according to internationally recognized guidelines. A cohort comprising 150 patients diagnosed with KOA successfully completed the demographic questionnaire, BPI-CV, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the EuroQoL Group's five-dimension questionnaire (EQ-5D). Internal consistency and test-retest analysis were used to evaluate the reliability. The internal consistency of the scale items was evaluated by calculating the Cronbach's α value (> 0.7). We chose to employ two scales commonly used in the evaluation of KOA patients: the disease-specific WOMAC scale and the universal EQ-5D scale. Construct validity was determined through Pearson correlation analysis, comparing BPI scores with those obtained from the WOMAC and EQ-5D scales. Exploratory factor analysis was used to structural validity.

RESULTS

The BPI-CV was well accepted with no ceiling or floor effect. Cronbach's α for assessing internal consistency was 0.894. Test-retest reliability was excellent with an ICC of 0.852 (95%CI 0.785-0.905). The BPI-CV showed moderate to strong correlations with the pain dimension (r = 0.496-0.860) and the functional interference dimension (r = 0.517-0.712) of the WOMAC and the EQ-5D (r = 0.527-0.743). Three factors resulted using exploratory factor analysis: pain severity, activity interference, and emotional interference, accounting for 79.0% of the total variance. Standard error of measurement was 0.539.

CONCLUSION

BPI-CV has good feasibility, reliability, and validity. It can be recommended for KOA patients in mainland China.

Exploring associations between eHealth literacy, cyberchondria, online health information seeking and sleep quality among university students: A cross-section study

Background

University students are increasingly inclined to use the Internet for health-related purposes, and their sleep problems are becoming increasingly prominent. Currently, the relationship between sleep quality and online health-related searches is poorly understood. The aim of this study was to exam the associations of sleep quality, Internet use, eHealth literacy, online health information seeking and cyberchondria in the sample of Chinese university students.

Methods

A total of 2744 students completed self-reported questionnaires online containing the Pittsburgh Sleep Quality Index (PSQI), eHealth Literacy Scale, Online Health Information Seeking, Cyberchondria Severity Scale (CSS) and questions regarding sleep duration, Internet use, health status, and demographic information.

Results

The prevalence of poor sleep quality (PSQI >7) among the university students was 19.9% and 15.6% students slept less than 7 h per day. As time spent on online daily and playing phone before bed increased, the prevalence of sleep disturbance gained. Sleep disturbance was significantly associated with cyberchondria (OR = 1.545, p = 0.001), health status [good (OR = 0.625, p = 0.039), poor (OR = 3.128, p = 0.010), and fair (OR = 1.932, p = 0.001)]. Sleep quality, online health information seeking and eHealth literacy positively influenced with cyberchondria. Compared to 7-8 h sleep duration, online health information seeking (OR = 0.750, p = 0.012) was significantly associated with ≥8 h sleep duration.

Conclusion

Our findings highlighted poor health status, too much time spent on online daily and high cyberchondria level might decrease sleep quality in the sample of Chinese university students, further suggesting the need for developing interventions based on online health-related searches for improving sleep quality among university students.

Anxiety prevalence and its association with physical activity in patients with non-communicable diseases during COVID-19 lockdown: a cross-sectional study in Shanghai, China

BACKGROUND

Quarantine due to the COVID-19 pandemic may have created great psychological stress among vulnerable populations. We aimed to investigate the prevalence of anxiety and explore the association between physical activities (PA) and anxiety risk in people with non-communicable diseases during the period of COVID-19 lockdown.

METHODS

We conducted a cross-sectional telephone survey from February 25 to April 20, 2020, the period of COVID-19 lockdown in Shanghai. Up to 8000 patients with type 2 diabetes and/or hypertension were selected using multi-stage cluster random sampling. PA level was measured based on the International Physical Activity Questionnaire using Metabolic Equivalent for Task scores, while symptoms of anxiety were assessed by the 7-item Generalized Anxiety Disorder scale. Multiple logistic regression analyses were performed to evaluate the associations of type and level of PA with the risk of anxiety.

RESULTS

Of a total 4877 eligible patients, 2602 (53.4%) reported with anxiety, and 2463 (50.5%), 123 (2.5%) and 16 (0.3%) reported with mild, moderate, and severe anxiety. The prevalence of anxiety was higher in the females, the elders, non-smokers, non-drinkers, and patients with diabetes, and the associations of anxiety with sex, age, smoking, drinking and diagnosis of diabetes were significant. A significant negative association was observed for housework activities (OR 0.53, 95%CI: [0.45, 0.63], p < 0.001) and trip activities (OR 0.55, 95%CI: [0.48, 0.63], p < 0.001) with anxiety, but no significant was found for exercise activities (OR 1.06, 95%CI: [0.94, 1.20], p = 0.321). Compared with patients with a low PA level, those with a moderate (OR 0.53, 95%CI: [0.44, 0.64], p < 0.001) or a high PA level (OR 0.51, 95%CI: [0.43, 0.51], p < 0.001) had a lower prevalence of anxiety.

CONCLUSION

This study demonstrates a higher prevalence of anxiety in patients with hypertension, diabetes, or both during the COVID-19 lockdown. The negative associations of housework and trip activities with anxiety highlight the potential benefit of PA among patients with non-communicable diseases.

Relationship satisfaction moderates links between poor sleep quality and psychological distress among couples coping with type 1 diabetes

OBJECTIVES

We examined links between sleep quality and psychological distress among couples dealing with type 1 diabetes (T1D) across cross-sectional and daily diary methods and investigated whether relationship satisfaction moderated these associations.

METHODS

199 persons with T1D and their spouses completed survey questionnaires reporting their own sleep quality, depressive symptoms, and relationship satisfaction. They also completed 14-day diaries reporting their own sleep quality and negative affect. Multi-level actor-partner interdependence models examined associations between sleep quality and psychological distress.

RESULTS

Cross-sectional and daily diary data revealed an association between poorer sleep quality and higher psychological distress for both persons with T1D and their spouses (ie, actor effects). Some partner effects were found. For example, poorer sleep quality of persons with T1D was associated with greater negative affect for spouses (within persons). Relationship satisfaction moderated the effects of sleep quality on psychological distress. For example, participants' poorer overall daily sleep quality was associated with greater negative affect for those with lower relationship satisfaction but not for those with higher relationship satisfaction (ie, actor effects). In contrast, partners' poorer overall daily sleep quality was associated with participants' greater negative affect for those with higher relationship satisfaction but not for those with lower relationship satisfaction (ie, partner-effects).

CONCLUSION

Links between sleep quality and psychological distress occur both within and between persons. Relationship satisfaction moderates the effect of poorer sleep quality on psychological distress in a nuanced way.

Factors Associated with Over-the-Counter Analgesic Overuse among Individuals Experiencing Headache

The prevalence of chronic daily headache (CDH) worldwide is 4−5%. Treatment for CDH with prophylaxis and abortive medications is often delayed, increasing disease severity. Consequently, increased usage of over-the-counter (OTC) analgesics can lead to medication overuse headache (MOH). This study aimed to assess factors affecting OTC analgesic overuse causing headaches. Methodology: A cross-sectional structured survey was conducted using voluntary response sampling. Among 1177 respondents, 459 individuals with headache were enrolled in the study. Results: Most participants were female (73.5%), almost half were aged 20−39 years (48.1%), and over half used OTC analgesics (56%). A significant association was found between OTC analgesic overuse and factors, such as chronic disease (p = 0.007), working status (p = 0.015), smoking (p = 0.02), headache frequency >15 days per month (p = 0.000), migraine-type headache (p = 0.01), preventive medicine use (p = 0.018), and emergency department visit (p = 0.018). Conclusion: OTC analgesic overuse among individuals with headache is affected by several factors, including the presence of chronic diseases, working status, smoking, and migraine-type headaches. However, preventive medicine and emergency department visits were considered to have protective effects. Health care providers should screen patients for MOH, increase their awareness, and follow MOH guidelines to treat chronic headache.

Associations of chronic diarrheal symptoms and inflammatory bowel disease with sleep quality: A secondary analysis of NHANES 2005-2010

Objective

Poor sleep quality is highly prevalent in patients with chronic diarrheal symptoms or inflammatory bowel disease (IBD). This study aimed to evaluate the associations of chronic diarrheal symptoms and IBD with sleep quality in the general US population.

Methods

14,696 adults (≥20 years) from the National Health and Nutrition Examination Survey (2005-2010) were included in the study. Chronic diarrheal symptoms and IBD were defined by self-reports. Sleep quality was assessed by sleep disorder, sleep trouble, and sleep duration. Multivariable logistic regression models were used to examine the associations.

Results

After adjustment of a series of covariates, we found that participants with chronic diarrheal symptoms or IBD had higher odds of sleep disorder [chronic diarrheal symptoms: odds ratio (OR) = 1.20, 95% confidence interval (CI) = 1.04-1.38; IBD: OR = 3.86, 95% CI = 1.92-7.77] and sleep trouble (chronic diarrheal symptoms: OR = 1.19, 95% CI = 1.09-1.30; IBD: OR = 2.32, 95% CI = 1.30-4.14), respectively. Sleep duration for participants with IBD was significantly shorter than that for those without IBD (β = -0.39, 95% CI = -0.78 to 0.01, P = 0.045). Subgroup analyses revealed that the associations of chronic diarrheal symptoms and IBD with sleep disorder and sleep trouble were more pronounced among women.

Conclusions

In this large sample of US adults, we found that chronic diarrheal symptoms and IBD were significantly associated with sleep quality, particularly in women. The findings highlight the importance of managing bowel health to promote high quality of sleep; and thus, improve quality of life in this subpopulation.

Gender Disparity and the Association Between Socioeconomic Status, Mental Health, and the Need for Long-Term Services and Support Among the Older Koreans

BACKGROUND

Population aging-the inevitable increase in the percentage of older adults-is occurring all around the world as the fertility rate declines and life expectancy rises. This study examined the relationship between socioeconomic status (SES), mental health, and the need for long-term services and support (LTSS) among Korean older adults. It also aimed to provide evidence-based information for South Korea's long-term support services and programs.

METHODS

This study used the data on older adults aged over 60 years from the 2018 Korean Longitudinal Study of Aging (KLoSA). Ultimately, 5,527 older adults were included in the database (42.6% men, 57.4% women). To clarify the association between SES, mental health, and the need for LTSS among older Korean men and women, chi-squared test, t-test, and structural equation modeling (SEM) were performed.

RESULTS

The SEM analysis showed that a significant, negative association was observed between SES and the need for LTSS among these older adults-the higher SES groups would generally have less need for LTSS. Mental health had a strong, negative impact on the need for LTSS-better mental health status of the older individuals would indicate a lower need for LTSS, and the effect was stronger among older men. Meanwhile, the positive relationship between SES and mental health was verified-the higher the SES of these older adults the better their mental health.

CONCLUSIONS

Gender- and social class-sensitive impacts of mental health on the need for LTSS were observed in this study. These findings could provide an evidence-based reference for interventions targeting different genders and social classes in Korea's long-term care system, such as the enhancement of social welfare and mental health status of the older adults.

Nighttime Sleep Awakening Frequency and Its Consistency Predict Future Academic Performance in College Students

Although the relationship between sleep and academic performance has been extensively examined, how sleep predicts future academic performance (e.g., 2-3 years) remains to be further investigated. Using wearable smartwatches and a self-report questionnaire, we tracked sleep activities of 45 college students over a period of approximately half a month to see whether their sleep activities predicted their academic performance, which was estimated by grade point average (GPA). Results showed that both nighttime sleep awakening frequency and its consistency in the tracking period were not significantly correlated with the GPA for the courses taken in the sleep tracking semester (current GPA). However, both nighttime sleep awakening frequency and its consistency inversely predicted the GPA for the rest of the courses taken after that semester (future GPA). Moreover, students with more difficulty staying awake throughout the day obtained lower current and future GPAs, and students with higher inconsistency of sleep quality obtained lower future GPA. Together, these findings highlight the importance of nighttime sleep awakening frequency and consistency in predicting future academic performance, and emphasize the necessity of assessing the consistency of sleep measures in future studies.

Evidence for causal effects of sleep disturbances on risk for osteoarthritis: a univariable and multivariable Mendelian randomization study

OBJECTIVE

To disentangle whether sleep disturbances have a causal effect on the risk of osteoarthritis (OA) using genetically based approaches.

METHOD

We performed univariable and multivariable Mendelian randomization (MR) analyses using publicly released genome-wide association studies summary statistics to estimate the causal associations of sleep disturbances with OA risk. The inverse-variance weighted (IVW) method was utilized as primary MR analysis, whereas complementary methods including weighted median, weighted mode, MR-Egger regression, and MR pleiotropy residual sum and outlier (MR-PRESSO) were applied to detect and correct for the presence of pleiotropy.

RESULTS

There were 228 independent instrumental variables (IVs) for insomnia and 78, 27 and 8 IVs for sleep duration, short sleep duration and long sleep duration, respectively. Univariable MR analysis suggested that genetically determined insomnia or short sleep duration exerted a causal effect on overall OA in an unfavorable manner (Insomnia: OR = 1.22, 95%CI = 1.15-1.30, P = 8.05 × 10^-10; Short sleep duration: OR = 1.04, 95%CI = 1.02-1.07, P = 2.20 × 10^-3). More compelling, increasing genetic liability to insomnia or short sleep duration was also associated with OA risk, after accounting for effects of insomnia or short sleep duration on body mass index, type 2 diabetes and depression individually, and in a combined model considering all three confounders.

CONCLUSIONS

Findings suggested consisted evidence for an adverse effect of increased insomnia or short sleep duration on OA risk. Strategies to mitigate sleep disturbances may be one of the cornerstones protects against OA.

A 10-year Trend of Sleeping Patterns, Geographical, and Community Disparities Among Chinese Older Adults

This study examined the trend and geographical/community disparities of sleeping patterns among Chinese older adults. We included older adults from four waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS; n = 25,672; age ≥65). We used a multivariable logistic regression model to examine sleep quality (not good versus good), and a multinomial logistic regression model to assess daily sleep duration (7–8 hr, <7 hr, >8 hr). Older adults from the Central/South and the West regions were less likely to report good sleep quality (AOR [adjusted odds ratio] = .63, 95% CI: .55, .72 and AOR = .80, 95% CI: .70, .93, respectively) while the Northeastern residents reported better sleep quality (AOR = 1.51, 95% CI: 1.27, 1.79), compared with Northern residents. Older adults from Central/South and West were more likely to obtain less than 7 hr of sleep. Public health interventions are necessary to improve the sleep of Chinese older adults.

Burnout, daytime sleepiness and sleep quality among technical-level Nursing students

Objective:

to evaluate the association of the burnout syndrome with daytime sleepiness and sleep quality among technical-level Nursing students.

Method:

a cross-sectional, analytical and quantitative study, conducted with 213 students from four technical Nursing courses in a city of Paraná, Brazil. Data collection was carried out using an instrument containing characterization information, the Maslach Burnout Inventory - Student Survey, the Epworth Sleepiness Scale and the Pittsburgh Sleep Quality Index. The data were analyzed using descriptive statistics and logistic regression.

Results:

the prevalence values of the burnout syndrome, excessive daytime sleepiness and poor sleep quality were 4.7%, 34.7% and 58.7%, respectively. Excessive daytime sleepiness significantly increased the chances of high emotional exhaustion (OR^adj: 5.714; p<0.001) and high depersonalization (OR^adj: 4.259; p<0.001). Poor sleep quality, especially sleep disorders, was associated with all dimensions of the syndrome (p<0.05).

Conclusion:

high levels of the burnout syndrome dimensions were associated with excessive daytime sleepiness and poor sleep quality. Educational institutions should include sleep hygiene and psychosocial support in their student health promotion programs.

Lifestyle-related behaviors and depressive symptoms in college students

This study sought to examine the association between lifestyle-related behaviors and depressive symptoms among college students. This cross-sectional study analyzed baseline data of a dynamic-cohort study from a public university in Central-Western Brazil, in all 21 undergraduate full-time courses. Students up to 25 years old who were enrolled for the first time in a university were included in the study, except pregnant and/or nursing women. All students who met the eligibility criteria were invited to participate in the study. From a total of 1,212 eligible students, 1,038 were included (85.6%). All participants answered a self-administered questionnaire on smoking, alcohol consumption, screen time, sleep duration, and meal patterns. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Multivariate Poisson regression models stratified by sex were used to estimate the associations. Depressive symptoms was observed in 31.6% (males 23.6%; females 39.9%; p-value chi-square test = 0.01) of the students. Smoking, drinking spirits, and having irregular meal habits were directly associated with depressive symptoms in both males and females. The co-occurrence of two risk behaviors (men: aPR = 2.23, 95%CI: 1.25; 3.99; women: aPR = 1.54, 95%CI: 1.03; 2.30) and three or more risk behaviors (men: aPR = 3.42, 95%CI: 1.90; 6.16; women: aPR = 2.09, 95%CI: 1.39; 3.15) increased the occurrence of depressive symptoms among the students. Lifestyle-related unhealthy behaviors were associated with an increased occurrence of depressive symptoms among college students. These findings suggest the need of interventions encouraging changes in lifestyle to promote mental health and to improve the quality of life in this group.

Associations between health indicators and sleep duration of American adults: NHANES 2011-16

BACKGROUND

This study aimed to investigate associations between health indicators and sleep duration in the general population.

METHODS

This cross-sectional data from the National Health and Nutrition Examination Survey. Self-reported sleep duration was classified into short sleep (<7 h/day), regular sleep (7-8 h/day) and long sleep duration (>8 h/day). Health indicators included lifestyle indicators (smoking, alcohol use and physical inactivity), general health indicators (waist circumference and self-reported health condition) and chronic conditions [overweight/obesity, hypertension, diabetes, high cholesterol, chronic low back pain (CLBP) and oral health problems]. A series of multinomial logistic regression analysis were performed, controlling for confounders (age, sex, marital status, ethnic background, education level and poverty-to-income ratio).

RESULTS

Data of 12 835 participants were analyzed. The mean (SD) age of participants was 50.0 (±17.4) years, and 50.6% were women. After adjusting for all health indicators, current smoking (OR: 1.37; 95% CI: 1.17-1.61), a poor (OR: 1.52; 95% CI: 1.23-1.88) health condition, CLBP (OR: 1.40; 95% CI: 1.16-1.69) and oral health problems (OR: 1.28; 95% CI: 1.10-1.49) were associated with short sleep duration. No independent association with long sleep duration was observed in this study.

CONCLUSIONS

The results confirm that lifestyle indicators (current smoking and physical inactivity), general health indicators (self-reported health condition) and presence of some chronic conditions (CLBP and oral health problems) are associated with short sleep duration. The results did not confirm that any health indicator was associated with long sleep duration.

Sleep Duration, Sleep Quality and Physical Activity, but Not Sedentary Behaviour, Are Associated with Positive Mental Health in a Multi-Ethnic Asian Population: A Cross-Sectional Evaluation

BACKGROUND

We assessed the associations of sleep, physical activity and sedentary behaviour with positive mental health (PMH) in the multi-ethnic population of Singapore.

METHODS

The Singapore Health 2 study is a nationally representative cross-sectional survey among residents aged 18-79 years. A PMH instrument was administered to 1925 participants to obtain total PMH and six sub-component scores. Self-rated sleep duration, sleep quality, sedentary behaviour and physical activity were assessed. Multivariable linear regression analyses were conducted.

RESULTS

The mean age of the participants was 40.1 (SD 14.3) years. Sleep duration (≥8 h/night: β = 0.17,95% CI: 0.02-0.32; 7-< 8 h/night: β = 0.17,95% CI: 0.03-0.30 versus <6 h/night, p = 0.002), sleep quality (very good: β = 0.45,95% CI: 0.29-0.60; fairly good: β = 0.20,95% CI: 0.06-0.33 versus very/fairly bad; ptrend < 0.001) and physical activity (high: β = 0.19,95% CI: 0.05-0.32; moderate: β = 0.15, 95% CI: 0.03-0.27 versus low; ptrend < 0.001) were directly associated with total PMH. Sedentary behaviour was not significantly associated with PMH. Sleep duration, sleep quality and physical activity were directly associated with the PMH sub-components 'emotional support' and 'personal growth and autonomy'.

CONCLUSIONS

Duration and quality of sleep and physical activity were directly associated with PMH in an urban Asian population. These findings support incorporating sleep and physical activity interventions to improve population mental health.

The relationship between sleep duration and health status in Qatar’s population

Knowledge of sleep duration correlates is limited to developed countries with a lack of studies in the Eastern Mediterranean Region (EMR). Qatar is a rapidly developing country in the EMR with three distinct population groups: Qatari nationals (QNs) or natives; higher income white-collar expatriates (WCEs), and blue-collar workers (BCEs) who are mostly male laborers from South Asia. The aim of this study was to explore the association between sleep duration, chronic health conditions, important lifestyle variables, and sociodemographic characteristics in a representative sample of Qatar’s general population. A total of 2523 surveys were administered over the phone and a final sample of 2500 was retained. The overall prevalence of sleeping < 7hrs was observed at 54%, while 42% of respondents reported sleeping 7–8hrs and 4% reported sleeping > 8hrs. Qatar’s population exhibited low prevalence of normal sleep duration and high prevalence of short sleep duration. Participants who reported the poorest health status had increased odds of sleeping < 7hrs (OR 1.38, P ​= ​0.04) compared with those who reported good health after adjustment for covariates. Additionally, participants with two or more diagnosed illnesses had higher odds of sleeping < 7hrs (OR 1.58, P ​= ​0.02) compared to healthy participants. An increase in odds of sleeping < 7hrs was also observed in participants with obesity (OR 1.58, P ​= ​0.02). Qatar’s population exhibited high prevalence of short sleep duration, which was significantly associated with poor rated health, obesity, and chronic illness independent of age, gender, or social class.

•

Our findings supported a high prevalence of short sleepers and low prevalence of long sleepers.

•

Qatar exhibited one of the lowest prevalence of normal sleep duration compared to other countries.

•

Short sleep duration was associated with poor rated health, obesity, and chronic illness but not depression.

Relationship Between Sleep Duration and Suicidal Ideation Among Farmers: Safety for Agricultural Injuries of Farmers Cohort Study of Jeju, Korea

Background

This study was conducted to identify the association between sleep duration and suicidal ideation among farmers in Korea.

Methods

We used Safety for Agricultural Injuries of Farmers cohort data collected from September 2015 to June 2018, which was an agricultural survey on the health and behaviors of adult farmers in Jeju island, Korea.

Results

A total of 964 participants were included in the analysis, and 3.7% of them were identified with having suicidal ideation. The frequencies of average daily sleep duration of <6 h (short sleep), 6-8 h (normal sleep), and >8 h (long sleep) were 24.4%, 70%, and 5.6%, respectively. Multivariate analyses revealed that short sleep duration was significantly associated with suicidal ideation compared with normal sleep duration (odds ratio = 2.49, 95% confidence interval = 1.07-5.77).

Conclusion

Our findings suggest that short sleep duration in farmers result in higher suicidal ideation. Because individuals who have suicidal ideation often commit suicide, careful monitoring is required to prevent suicide in farmers with short sleep duration.

Decomposing differences in depressive symptoms between older rural-to-urban migrant workers and their counterparts in mainland China

Background

There has been an increase in older rural-to-urban migrant workers (aged 50 and above) in mainland China, little known about their depressive symptoms. The aim of this study was to identify depressive symptoms among older rural-to-urban migrant workers, as well as explored the factors leading to differences in depressive symptoms between older rural-to-urban migrant workers and their rural counterparts (older rural dwellers) and urban counterparts (older urban residents) in mainland China. The results provided a comprehensive understanding of the depressive symptoms of older rural-to-urban migrant workers, and had great significance for improving the depressive symptoms for this vulnerable group.

Methods

Data were derived from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2015, and coarsened exact matching (CEM) method was employed to control confounding factors. This study employed a Chinese version 10-item short form of the Center for Epidemiologic Studies-Depression Scale (CES-D 10) to measure depressive symptoms, and used the Social-Ecological Model as a framework to explore influential factors related to depressive symptoms. Specifically, the approach of Fairlie’s decomposition was used to parse out differences into observed and unobserved components.

Results

After matching, our findings indicated that the prevalence of depressive symptoms in older rural-to-urban migrant workers was lower than older rural dwellers; and the prevalence of depressive symptoms in older rural-to-urban migrant workers was higher than older urban residents. Fairlie’s decomposition analysis indicated that type of in-house shower, sleeping time at night and ill in the last month were proved to be major contributors to the differences in depressive symptoms between older rural-to-urban migrant workers and older rural dwellers; self-reported health and sleeping time at night were proved to be major contributors to the differences in depressive symptoms between older rural-to-urban migrant workers and older urban residents.

Conclusions

Differences in depressive symptoms between older rural-to-urban migrant workers and their rural and urban counterparts did exist. Our findings contributed to a more reliable understanding in depressive symptoms among older rural-to-urban migrant workers. Our findings would be of referential significance for improving older rural-to-urban migrant workers’ depressive symptoms.

Associations between 24 h Movement Behavior and Mental Health in Office Workers

The associations between 24 h movement behavior, i.e., the way people distribute their time in different movement-related behaviors, on mental health are not well understood. This study applied a compositional data analysis approach to explore cross-sectional associations between device-measured moderate to vigorous physical activity (MVPA), light intensity physical activity (LIPA), sedentary behavior (SED), self-reported time in bed and mental health outcomes, i.e., depression or anxiety symptoms, burnout, mental wellbeing and stress, in office workers. ActiGraph accelerometers were worn for 24 h for at least 4 days to assess MVPA, LIPA, and SED. Sleep diaries were used in addition to identify time in bed. Analytic sample sizes for the different outcomes ranged from N = 345-370 participants. In this population of office workers with high levels of MVPA, the entire movement behavior composition was not associated to any of the mental health outcomes, but MVPA relative to all other behaviors was positively associated with mental wellbeing. This confirms the importance of MVPA for health relative to other movement-related behaviors.

Relationship between chronic diseases and sleep duration among older adults in Ghana

PURPOSE

Aging increases the prevalence of health problems that are often chronic, resulting in more sleep problems for people with poor health or chronic conditions. Relatively fewer studies have been conducted on the relationship between sleep duration and chronic conditions in Sub-Saharan Africa compared to Western or Asian populations. This study uses a nationally representative sample of older adults in Ghana to examine the association between sleep duration and chronic conditions.

METHOD

Data were gathered from the World Health Organization Study on Global AGEing and Adult Health (SAGE) Wave 1 in Ghana (n = 3617). Data on duration of sleep and chronic conditions were derived from self-reported data and validated symptom reporting. Multinomial logistic regression was conducted to examine the association between sleep duration and chronic conditions.

RESULTS

Women had a significantly longer period of sleep than men. Older people (> 60 years) were more likely than people under 60 years old to sleep for longer periods. The prevalence of stroke, depression, and chronic lung disease among long sleepers was high compared with short and medium sleepers. Our study found that respondents with stroke, arthritis, depression, chronic lung disease, asthma, and hypertension were likely to sleep for a long time.

CONCLUSION

This study showed a significant association between long hours of sleep and chronic conditions. To health professionals, paying particular attention to this association among older adults is medically important.

Independent and combined associations of sleep duration and sleep quality with common physical and mental disorders: Results from a multi-ethnic population-based study

Sleep duration and sleep quality are often linked to increased risk of mortality and morbidity. However, national representative data on both sleep duration and sleep quality and their relationship with chronic health problems are rarely available from the same source. This current study aimed to examine the independent and combined associations of sleep duration and sleep quality with physical and mental disorders, using data from the Singapore Mental Health Study 2016. 6,126 residents aged ≥18years participated in this epidemiological, cross-sectional survey. Sleep measures were assessed using the Pittsburg Sleep Quality Index while lifetime or 12-month medical and psychiatric diagnoses were established using the Composite International Diagnostic Interview 3.0. Both short sleep (<6hrs compared to 7-8hrs) and poor sleep were found to be independently associated with chronic pain, obsessive compulsive disorder and any mental disorder while poor sleep was additionally associated with major depressive disorder, bipolar disorder, generalized anxiety disorder and any physical disorder, when adjusted for confounders. Poor sleep combined with short sleep (≤6hrs/day vs 7-8hrs/day) was associated with the highest number of comorbidities among other sleep combinations. Sleep duration and sleep quality, when adjusted for each other, remained independently associated with both physical and mental disorders. Affective disorders may be more closely related to poor sleep quality compared to abnormal sleep duration. Our findings suggest sleep quality to be a more important indicator for psychological and overall health compared to sleep duration.

Instability in daily life and depression: The impact of sleep variance between weekday and weekend in South Korean workers

South Korean workers have problems getting optimal sleep because they work excessively, and this affects their sleep duration and quality. To compensate for their lack of sleep on weekdays, South Korean workers have a different lifestyle on weekends, which is reflected by the terms 'Hot Friday' and 'Monday Sickness'. However, an irregular lifestyle may be a risk factor for poor health even if insufficient sleep during weekdays is supplemented by sleep on the weekend. The objective of this study was to analyse the association between depressive mood and sleep duration variance on weekdays and weekends among South Korean workers. Data from the 2016 Korea National Health and Nutrition Examination Surveys were used. Linear regression analysis was performed to determine the association between variance in sleep duration and the Patient Health Questionnaire-9 (PHQ-9) score. Additional sub-group analyses were performed to evaluate associations between variance in sleep duration and sex, marital status and perceived health status. The average sleep duration was 419.44 min on weekdays and 463.29 min on weekends. The average sleep duration on weekends was 11.73% longer than on weekdays. There was a positive association between variance in sleep and PHQ-9 score (per 1% increased, β = 0.002, p = .0074), and variance in sleep duration affected health regardless of the direction of the change (positive: increased sleep or negative: decreased sleep). Further, sub-group analyses showed that variances in sleep duration are associated with increased PHQ-9 scores in females and in individuals who were single or who had problems in their marriage. Our findings suggest that there is a relationship between variance in sleep duration and depressive symptoms among South Korean workers. Thus, healthcare professionals should suggest alternatives for optimal sleep duration and sleep methods to ensure the psychiatric health of workers.

Association between sleep duration and osteoarthritis and their prevalence in Koreans: A cross-sectional study

OBJECTIVE

To determine the association of radiological and symptomatic osteoarthritis with sleep duration in a representative sample of the Korean population.

METHODS

Using data from the national cross-sectional fifth Korea National Health and Nutrition Examination Survey 2010-2012. Of the 16,528 participants in KNHANES-V, 8,918 were adults aged≥ 50 years who had completed the survey questions on sleep duration and osteoarthritis, and had diagnostic X-ray results. We evaluated the association between sleep duration as the primary predictor for osteoarthritis involving the hip, knee, and spinal joints. A complex sample logistic regression analysis was performed to adjust for the covariates.

RESULTS

Proportions of participants with total daily sleep duration of ≤6 hours, 7-8 hours, and ≥9 hours were 47.1%, 45.2, and 7.7%, respectively. The rate of osteoarthritis diagnoses in the ≤6 hours, 7-8 hours, and ≥9 hours of sleep duration groups was 24.1%, 17.6%, and 21.8%, respectively (p <0.0001). The odds ratios (OR) were significantly higher in the ≤6 hours of sleep group than in the 7-8 hours of sleep group (OR, 1.20; 95% confidence interval [CI], 1.03-1.39; p = 0.02), but no significant difference in the ≥9 hours of sleep group was found after adjusting the confounding variables. When we compared knee joint pain (Numeric Rating Scale 0 versus 1-10) in participants with grade 2-4 Kellgren-Lawrence (KL) classification after adjusting these same confounding variables, the ≤6 hours of sleep group (OR, 1.32; 95% CI, 1.10-1.58) and the ≥9 hours of sleep group (OR, 1.41; 95% CI, 1.03-1.95) showed significantly higher ORs.

CONCLUSION

This study confirmed the significant association between sleep duration and osteoarthritis in adults aged ≥50 years. Participants' positive for both radiological (KL grade ≥2) and symptomatic osteoarthritis showed a strong association between knee joint pain and not enough sleep duration.

The Association between Sleep Duration and Dizziness in Korean Women: The Korea National Health and Nutrition Examination Survey

BACKGROUND

The aim of this study was to investigate the association between sleep duration and dizziness in a representative Korean population.

METHODS

We analyzed data from the Korea National Health and Nutrition Examination Surveys (2010-2012). A total of 12,499 adults who completed otolaryngologic examinations were evaluated.

RESULTS

Both men and women with severely short sleep duration (≤ 5 hours) and severely long sleep duration (≥ 9 hours) tended to have higher dizziness prevalence. However, the adjusted odds ratio (OR) for sleep duration was only significant in women with dizziness after adjusting for confounders. Compared to that in an optimal sleep group (6-8 hr/day), the OR (95% confidence interval) for dizziness prevalence after adjusting for age and health behaviors (body mass index, smoking habit, alcohol consumption, level of exercise, metabolic syndrome, and tinnitus) was 1.473 (1.194-1.818) for the severely short sleep group (≤ 5 hr/day) and 1.472 (1.078-2.009) for the severely long sleep group (≥ 9 hr/day) only in women.

CONCLUSION

In the Korean population, dizziness was associated with shorter or longer sleep durations only among women. Further epidemiologic and experimental studies are necessary to clarify the impact of dizziness on sleep disorders.

Depression and psychological distress in US adults with atopic dermatitis

BACKGROUND

Symptoms of anxiety and depression appear to contribute to the overall burden of atopic dermatitis (AD). However, the burden of mental health symptoms and psychological distress in AD have not been fully elucidated.

OBJECTIVE

To determine the prevalence and predictors of depressive symptoms and psychological distress among US adults with AD and how they compare with psoriasis and other disorders.

METHODS

We analyzed the 2004-2015 Medical Expenditure Panel Surveys, a representative sample of US adults. Patient Health Questionnaire-2 (PHQ-2) and Kessler-6 index (K-6) scores assessed depressive symptoms and psychological distress, respectively.

RESULTS

Atopic dermatitis in adults is associated with increased odds of screening positive for depressive symptoms (PHQ-2 ≥2) (44.3% vs 21.9%; adjusted odds ratio [aOR] [95% confidence interval (CI)]: 2.86 [1.14, 7.16]) and severe psychological distress (K-6≥13) (25.9% vs 5.5%; 6.04 [2.28, 15.99]). Adults with vs without AD had increased K6 scores overall (linear regression, P = .04) and severe psychological distress in particular (K-6≥13; logistic regression; adjusted odds ratio [95% CI]: 6.04 [2.28, 15.99]). K-6 scores were associated with lower household income (linear regression; adjusted beta [95% CI]: 6.22 [0.88, 11.56]) and middle income (4.49 [0.39, 8.59]), but inversely associated with black (-7.36 [-11.70, -3.03]) and multiracial/other (-2.85 [-5.67, -0.03]) race/ethnicity.

CONCLUSION

Atopic dermatitis is associated with more depressive symptoms and psychological distress overall, and even worse than many other chronic diseases. These findings highlight the need for clinicians to consider screening for and monitoring mental health symptoms in AD patients. Future studies are needed to develop interventions to reduce psychological distress in AD.

Socioeconomic and lifestyle factors associated with depressive tendencies in general Japanese men and women: NIPPON DATA2010

Background

The gender-specific characteristics of individuals at an increased risk of developing depression currently remain unclear despite a higher prevalence of depression in women than in men. This study clarified socioeconomic and lifestyle factors associated with an increased risk of subclinical depression in general Japanese men and women.

Methods

Study participants were residents not receiving psychiatric treatments in 300 sites throughout Japan in 2010 (1152 men, 1529 women). Multivariable-adjusted odds ratios (OR) and 95% confidence intervals (95%CIs) for socioeconomic factors and lifestyle factors were calculated using a logistic regression analysis.

Results

Risk of depressive tendencies was significantly higher in men who were single and living alone (OR, 3.27; 95% CI, 1.56–6.88) than those married. The risk was significantly lower in women who were not working and aged ≥ 60 years (OR, 0.39; 95% CI, 0.22–0.68) and higher in men who were not working and aged < 60 years (OR, 3.57; 95%CI, 1.31–9.72) compared with those who were working. Current smoking was also associated with a significantly increased risk of depressive tendencies in women (OR, 2.96; 95% CI, 1.68–5.22) but not in men.

Conclusions

Socioeconomic and lifestyle factors were associated with an increased risk of depressive tendencies in general Japanese. Related factors were different by sex.

Electronic supplementary material

The online version of this article (10.1186/s12199-019-0788-6) contains supplementary material, which is available to authorized users.

Reallocating time spent in sleep, sedentary behavior and physical activity and its association with pain: a pilot sleep study from the Osteoarthritis Initiative

OBJECTIVE

Being physically active has broad health benefits for people with osteoarthritis (OA), including pain relief. Increasing physical activity (PA) requires reducing time in other behaviors within a fixed 24-h day. We examined the potential benefits in relation to pain from trading time in one type of wake or sleep behavior for another.

METHOD

In this cross-sectional study, we used isotemporal logistic regression models to examine the estimated effect on pain from replacing time in one behavior with equal time in another, controlling for sociodemographic and health factors. Stratified analysis was conducted by the report of restless sleep. Sleep and wake behaviors [sedentary behavior (SB), light PA, moderate PA] were monitored by accelerometer in a pilot study of 185 Osteoarthritis Initiative (OAI) participants. Outcomes were bodily pain interference and knee pain.

RESULTS

Moderate PA substituted for an equivalent time in sleep or other types of wake behaviors was most strongly associated with lower odds of pain (bodily pain interference odds reduced 21-25%, knee pain odds reduced 17-20% per 10-min exchange). These beneficial associations were particularly pronounced in individuals without restless sleep, but not in those with restless sleep, especially for bodily pain interference.

CONCLUSION

Interventions promoting moderate physical activities may be most beneficial to address pain among people with or at high risk for knee OA. In addition to encouraging moderate-intensity PA, pain management strategies may also include the identification and treatment of sleep problems.

Factors related with quality on sleep of daytime workers

Background

This study was conducted to identify the sleep status of daytime workers who do not work in shifts. This study analyzed factors affecting sleep duration and sleep quality.

Methods

This study was conducted on 1171 daytime workers at a manufacturing workshop. We used a self-administered questionnaire to investigate demographic variables, work type, working period, musculoskeletal symptoms and the Pittsburgh Sleep Quality Index to assess sleep. Regular health checkup was conducted for the worker’s clinical examination.

Results

The mean sleep duration was 6.36 h and the mean score on the Pittsburgh Sleep Quality Index was 4.46. Work type and obesity were related to sleep duration. Age, obesity and musculoskeletal pain were significantly related to sleep quality. The prevalence ratio of researcher group for short sleep duration was 1.27 (95% confidence interval: 1.02–1.58). The prevalence ratio of those aged 50 years and over was 0.47 (0.25–0.91) and of those in their 40s was 0.56 (0.35–0.91) for poor sleep quality compared to those in their 20s. The prevalence ratio of the obesity group for poor sleep quality was 1.53 (1.10–2.12). The prevalence ratio of musculoskeletal pain group for poor sleep quality was 1.92 (1.29–2.84).

Conclusions

Age, obesity and musculoskeletal pain were factors affecting the poor quality on sleep of daytime workers. In addition, work type related to short sleep duration.

Sleep behavior and depression: Findings from the China Kadoorie Biobank of 0.5 million Chinese adults

BACKGROUND

Mixed results have shown the association between sleep behavior and depression, but evidence relating the joint effect of sleep duration and sleep disturbances is limited, especially in Chinese population.

METHODS

A total of 512,891 adults aged 30-79 years from China Kadoorie Biobank (CKB) were included. Depression was defined by Composite International Diagnostic Inventory-short form (CIDI-SF). Sleep duration and sleep disturbances, including difficulty initiating and maintaining sleep (DIMS), early morning awakening (EMA), daytime dysfunction (DDF) and any sleep disturbances (ASD), were obtained by a self-reported questionnaire. Logistic regression was applied to examine the association between sleep behavior and depression.

RESULTS

About 23.1% of participants reported short sleep duration (≤ 6h), and 5.1% reported long sleep duration (> 9h). Compared with normal sleep duration (7-9h), both groups were associated greater likelihood of having depression (short sleep: OR = 2.32, 95%CI: 2.14-2.51; long sleep: OR = 1.56, 96%CI: 1.34-1.81). Participants reported sleep disturbances were significantly associated with depression (odds ratios ranged from 3.31 to 4.17). Moreover, the associations tended to be stronger for those who reported both abnormal sleep duration and sleep disturbances (p for interactions < 0.05), especially for those who slept long.

LIMITATIONS

The cross-sectional nature of the study design limits the interpretation of the results.

CONCLUSIONS

Abnormal sleep duration and sleep disturbances were associated with depression. The associations were stronger for abnormal sleep duration accompanied with sleep disturbances, especially for a long duration. More attention should be paid on these persons in clinical practice.

Sleep duration and its association with demographics, lifestyle factors, poor mental health and chronic diseases in older Chinese adults

This study investigated the total sleep time (TST) and its associated factors in an older Chinese adult population. Multistage stratified cluster sampling was used in this cross-sectional study. A total of 4,115 older adults aged 60 to 79 years were selected and interviewed. Sleep duration was classified as short (<7h per day), long (>8h per day) and medium sleep (7-8h per day). The total mean sleep time was 6.86±1.75h. Short and long sleepers accounted for 45.2% and 14.8% of the sample, respectively. Multivariate logistic regression analysis revealed that inadequate fruit intake and poor mental health were positively associated with short sleep, and married/cohabitation status and living in rural areas was negatively associated with short sleep. In addition, aged 75-79 years old, inadequate fruit intake, poor mental health and multi-morbidity were positively associated with long sleep. Ischemic heart disease, COPD and chronic gastroenteritis/peptic ulcer were positively associated with short sleep duration, while hyperlipidemia, hypertension, cerebrovascular diseases, and urolithiasis were positively associated with long sleep duration. Given the high frequency of aberrant sleep duration and its negative health impact, health professionals should pay more attention to sleep patterns in older people.

Factors increasing the risk for psychosocial stress among Korean adults living in rural areas: using generalized estimating equations and mixed models

Background

This study was conducted to analyze the distribution of the psychosocial well-being index among adults living in two rural communities in Korea and to examine its correlation with lifestyle variables such as sleep duration, regular exercise, and sedentary time.

Methods

Using the cohort data of the Atherosclerosis Risk of a Rural Area Korean General Population, this study examined 3631 participants living in Wonju and Pyeongchang in Gangwon Province; their preliminary data were established from 2005 to 2007 while their follow-up data were collected 3 years later. This study investigated demographic characteristics, lifestyle habits, disease history, Psychosocial Well-being Index-Short Form (PWI-SF) scores, sleep duration, regular exercise, and sedentary time during work. Using repeated measures ANOVA, this study examined how the variables and PWI-SF scores changed over the course of 3 years and identified the correlation between them based on mixed model analysis. Afterwards, using the generalized estimation equation, this study identified each variable's risk towards the PWI-SF high-risk group and performed a stratified analysis by occupation after dividing the participants into farmers and non-farmers.

Results

The PWI-SF high-risk group was found to be 18.9% of the participants from preliminary data and 15.5% from follow-up data. The odds ratio towards the PWI-SF high-risk group was 1.503 (95% CI 1.241-1.821) in the short sleep duration group and 1.327 (95% CI 1.136-1.550) in the non-regular exercise group. A stratified analysis by occupation showed that middle and long sedentary time in the white-collar group increased the risk toward the PWI-SF high-risk group.

Conclusions

Short sleep duration, no regular exercise, and long sedentary time in the white-collar group were identified as risk factors toward the PWI-SF high-risk group in the rural communities, and policy interventions are needed to address this issue.

Evaluation of psychosocial aspects in participants of cancer genetic counseling

Background

The instrument called “Hospital Anxiety and Depression Scale” (HADS) is frequently used to evaluate anxious and depressive symptomatology in patients who receive Cancer Genetic Counseling (CGC). However, this instrument cannot identify all of the psychosocial factors, such as the antecedents of the patients’ emotional states or their concerns. The objective of the present research was to compare cases detected with psychosocial alterations by means of HADS and a Psychological Health Interview (PHI).

Methods

A transversal analytical design was used. One hundred ten participants were included (97.3% females and 2.7% males). The average age was 45 years ±10 years.

Results

The PHI identified twice the amount of participants with psychosocial alterations than did HADS, which only detected 43% of these participants.

Conclusions

The results of our study suggest that the PHI should be applied in addition to HADS to identify participants who would require psychological support due to recurrent concerns.

Suicidality in sleep disorders: prevalence, impact, and management strategies

Sleep disturbances are associated with suicide-related thoughts and behaviors, and the incidence of sleep concerns and suicide has increased recently in the US. Most published research exploring the sleep-suicidality relation is focused on select sleep disorders, with few reviews offering a comprehensive overview of the sleep-suicidality literature. This narrative review broadly investigates the growing research literature on sleep disorders and suicidality, noting the prevalence of suicide ideation and nonfatal and fatal suicide attempts, the impact of several sleep disorders on suicide risk, and potential sleep-disorder management strategies for mitigating suicide risk. Aside from insomnia symptoms and nightmares, there exist opportunities to learn more about suicide risk across many sleep conditions, including whether sleep disorders are associated with suicide risk independently of other psychiatric conditions or symptoms. Generally, there is a lack of randomized controlled trials examining the modification of suicide risk via evidence-based sleep interventions for individuals with sleep disorders.

Association between osteoarthritis and mental health in a Korean population: a nationwide study

AIM

Osteoarthritis (OA) is a chronic disease and has become a major health problem in recent years. OA causes chronic pain and disability and can induce mental disorders such as stress perception, depression and suicidal ideation. We investigated the incidence of perceived stress, depressed mood and suicidal ideation in OA patients, using the 2010-2012 Korea National Health and Nutrition Examination Survey (KNHANES).

METHOD

A total of 8271 participants were included (3580 male and 4691 female). OA patients were defined as participants with knee/hip joint pain and radiographic changes of the knee/hip joints. Mental disorders included stress perception, depression and suicidal ideation. Odds ratios (ORs) and 95% confidence intervals (95% CIs) for mental disorders were calculated according to the OA.

RESULTS

In the multiple logistic regression model, compared to the non-OA group, the ORs of high stress perception, depression and suicidal ideation were 1.59 (95% CI 1.10-2.31), 1.52 (95% CI 1.01-2.29) and 1.90 (95% CI 1.33-2.72), respectively, in male, and 1.41 (95% CI 1.19-1.68), 1.27 (95% CI 1.04-1.54) and 1.49 (95% CI 1.25-1.78), respectively, in female.

CONCLUSION

OA is associated with impaired mental health. OA patients had high stress perception, depression and suicidal ideation. More numbers of male with OA had much more mental disorders than female with OA.

Demographic and Environmental Factors Associated with Mental Health: A Cross-Sectional Study

Relevant demographic and environmental conditions need to be understood before tailoring policies to improve mental health. Using community health survey data from 25 communities in Seoul, 2013, cross-sectional associations between mental health and community level environments were assessed. Mental health outcomes (self-rated stress levels (SRS) and depressive symptoms (DS)) were analyzed. Community environmental factors included green space, green facilities, and annual PM₁₀ level (AnnPM₁₀); socio-demographic factors included sex, age, education, labor market participation, comorbidity, sleep hours, physical activity, smoking, and drinking. A total of 23,139 people with the following characteristics participated: men (44.2%); age groups 19−39 (36.0%), 40−59 (39.4%), 60−74 (19.2%), and 75+ (5.4%). Women had higher odds ratios (OR) for SRS [OR 1.22, 95% Confidence interval (CI) 1.17–1.27] and DS [OR 1.55, 95% CI 1.42–1.71]. Regular physical activity predicted SRS [OR 0.90, 95% CI 0.84–0.95] and DS [OR 0.98, 95% CI 0.88–1.10]; current smoking and drinking were adversely associated with both SRS and DS. Higher accessibility to green space (Q4) was inversely associated with DS [OR 0.89, 95% CI 0.81−0.97] compared to lower accessibility (Q1). AnnPM₁₀, annual levels for particles of aerodynamic diameter <10 µm (PM₁₀), among communities was associated with poorer SRS [OR 1.02, 95% CI 1.00–1.04] by 10 μg/m³ increases. Therefore, both demographic and environmental factors should be considered to understand mental health conditions among the general population.

Relationship of Sleep Duration with Sociodemographic Characteristics, Lifestyle, Mental Health, and Chronic Diseases in a Large Chinese Adult Population

STUDY OBJECTIVES

Pattern of sleep duration and its correlates have rarely been reported in China. This study examined the sleep duration and its relationship with sociodemographic variables, lifestyle, mental health, and chronic diseases in a large Chinese adult population.

METHODS

This cross-sectional study used multistage stratified cluster sampling. A total of 17,320 participants from Jilin province were selected and interviewed using standardized assessment tools. Basic socio-demographic and clinical data were collected. Sleep duration was classified as short (< 7 h per day), long (> 9 h per day) and medium sleep (7-9 h per day).

RESULTS

The mean age of the sample was 42.60 ± 10.60 y, with 51.4% being female. The mean sleep duration was 7.31 ± 1.44 h. Short and long sleepers accounted for 30.9% and 6.9% of the sample, respectively. Multinomial logistic regression analysis revealed that older age, current smoking, irregular meal pattern, lack of physical exercise, poor mental health, and chronic diseases or multimorbidity were positively associated with short sleep. Being married and living in rural areas were, however, negatively associated with short sleep. In addition, living in rural area, current smoking, current alcohol use and lack of physical exercise were positively associated with long sleep, while older age and lower education were negatively associated with long sleep.

CONCLUSION

Given the high frequency of short sleep and its negative effect on health, health professionals should pay more attention to sleep patterns in general health care. Nationwide epidemiologic surveys in China are needed to further explore the relationship between sleep duration and health.

Relationship between sleep quality and mental health according to demographics of 850 patients with chronic obstructive pulmonary disease

We aimed to study sleep problems in hospitalized chronic obstructive pulmonary disease patients and assess the relationship of sleep quality with mental health and demographics of patients. Our study sample consisted of 850 chronic obstructive pulmonary disease patients hospitalized in Masih Daneshvari Hospital. Demographic data were collected and the Pittsburgh Sleep Quality and mental health questionnaires were filled out for patients. The results showed that 5.9 percent were suffering from severe sleep problems, while 4.7 percent had severe mental problems. A strong positive correlation was found between the total scores of mental health and sleep quality ( p < 0.01). The prevalence of sleep and mental health problems was higher in females compared to males. Mental health and sleep quality play important roles in quality of life of chronic obstructive pulmonary disease patients.

Association between weight control failure and suicidal ideation in overweight and obese adults: a cross-sectional study

Background

Korea has the highest suicide rate in the OECD and is one of the few OECD countries whose suicide rates have not decreased in recent years. To address these issues, we investigated the effects of weight control failure on suicidal ideation in the overweight and obese populations.

Methods

We performed a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey (2008–2012) consisting of 6621 individuals 40 years of age or older. Logistic regression analysis was used to identify the relationship between weight control failure and suicidal ideation in the overweight and obese populations.

Results

A total of 6621 participants were analyzed in this study (overweight group: 2439; obese group: 4182). Among them, weight control failure (weight gain with weight loss efforts) was experienced in 962 obese (males 16.3 %, females 29.6 %) and 412 overweight individuals (males 9.1 %, females 23.4 %). Weight control failure was significantly associated with suicidal ideation in obese females (OR = 1.70, 95 % CI 1.21–2.39), but this association was not significant in obese males or in either sex of the overweight group.

Conclusions

Findings from this study suggest that weight control failure is associated with an increased risk of suicidal ideation among obese women. Furthermore, intervention programs that aim to address the prevalence of suicide, especially for obese women, are needed.