Relationship between night-sleep duration and risk for depression among middle-aged and older people: A dose-response meta-analysis

Non-linear relationship between social jetlag and depressive symptoms among Chinese college students

This study aims to elucidate the relationship between social jetlag and depressive symptoms in college students, with a focus on identifying specific cut points that significantly heighten the risk of depression. A cross-sectional study was conducted among 2,006 students from Jiangsu College of Nursing between October and November 2024. Social jetlag was calculated based on the difference between the midpoints of sleep on workdays and weekends. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Multivariate logistic regression was applied to examine the relationship between social jetlag and depressive symptoms, adjusting for potential confounders. The prevalence of depressive symptoms (PHQ-9 ≥ 10) among participants was 10.1%. A non-linear relationship was observed between social jetlag and depressive symptoms, with the risk of depression increasing significantly beyond a threshold of 1.2 h of social jetlag. Specifically, individuals with social jetlag ≥ 1.2 h had 72% higher odds of depressive symptoms compared to those with lower levels (OR = 1.72, 95% CI: 1.24-2.38). Subgroup analyses revealed that this association was consistent across both grade and gender. Sensitivity analyses further affirmed the robustness of these findings. This study suggests a non-linear association between social jetlag and depressive symptoms in college students, with a marked increase in depression risk for those with social jetlag ≥ 1.2 h. Longitudinal studies are needed to clarify the causal pathways and identify modifiable factors for targeted interventions.

Depression symptoms in perimenopausal women with somatic pain: nomogram construction based on a logistic regression model

Objective

This study investigated the factors influencing depressive symptoms in women with somatic pain during the perimenopausal period in China and established and validated a nomogram prediction model.

Methods

The predictive model is based on data from the China Health and Retirement Longitudinal Study (CHARLS), which focused on individuals aged 45-59 years with somatic pain during the perimenopausal period. The study utilized participants from the CHARLS 2018 wave, 30 factors including individual characteristics, health behaviors, living environment, family economic status, and social participation, were analyzed in this study. To ensure the model's reliability, the study cohort was randomly split into a training set (80%) and a validation set (20%). The χ 2 tests and a Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis were used to identify the most effective predictors of the model. The logistic regression model was employed to investigate the factors associated with depressive symptoms in perimenopausal women with somatic pain. A nomogram was constructed to develop a prediction model, and calibration curves were used to assess the accuracy of the nomogram model. The model's performance was evaluated using the area under the curve (AUC) and decision curve analysis (DCA).

Results

In total, 2,265 perimenopausal women were included in the final analysis, of whom 1,402 (61.90%) experienced somatic pain. Multifactorial logistic regression identified marital status, pain distress, self-perceived general health, activities of daily living (ADL), sleep deprivation, life satisfaction, and air quality satisfaction, as predictive risk factors for perimenopausal women with somatic pain. The predictive model achieved an AUC of 0.7010 (95%CI = 0.677-0.725) in the training set and 0.7015 (95%CI = 0.653-0.749) in the validation set. The nomogram showed excellent predictive ability according to receiver operating characteristic (ROC) and DCA, and the model may help in the early detection of high-risk depression symptoms in perimenopausal women with somatic pain, thereby enabling the timely initiation of appropriate treatment interventions.

Conclusion

The nomogram constructed in this study can be used to identify the factors related to depression in women with perimenopausal somatic pain.

Association between eveningness and depressive symptoms in daytime workers: A cross-sectional analysis of the Aichi Workers' Cohort Study

Objectives

Eveningness (evening preference in chronotype) has been reported to be associated with a number of psychiatric problems. We examined a cross-sectional association between eveningness and depressive symptoms in daytime workers.

Methods

The subjects were 4410 civil servants (71.7% male, aged 18-69 years [mean, 43.5 years]) with no history of depressive disorder who did not perform shift work, and for whom there were no missing data. The association between eveningness, determined using the reduced Morningness-Eveningness Questionnaire, and depressive symptoms, determined using the shorter form of the Central Epidemiological Studies Depression scale, was assessed with logistic regression analysis adjusted for potential confounding factors (gender, income, living alone, breakfast intake, coffee consumption, drinking habits, exercise, smoking, working hours, sleep duration, and difficulty falling asleep).

Results

Of the subjects, 529 (12.0%) had eveningness, and 1408 (31.9%) reported depressive symptoms. Depressive symptoms were reported more frequently by those with eveningness than by those with other chronotypes (57.3% vs 28.5%). The association between eveningness and depression (gender- and age-adjusted odds ratio, 3.27; 95% confidence interval, 2.71-3.95) was significant after adjustment for the other confounding factors (odds ratio, 2.40; 95% confidence interval, 1.96-2.95).

Conclusions

Our results suggest that eveningness is associated with depressive symptoms among day workers and that this association is independent of potential confounding factors. Further longitudinal studies are needed to examine the causal relationship.

The Association of Elevated Depression Levels and Life's Essential 8 on Cardiovascular Health With Predicted Machine Learning Models and Interpretations: Evidence From NHANES 2007-2018

Background and Objective: The association between depression severity and cardiovascular health (CVH) represented by Life's Essential 8 (LE8) was analyzed, with a novel focus on ranked levels and different ages. Machine learning (ML) algorithms were also selected aimed at providing predictions to suggest practical recommendations for public awareness and clinical treatment. Methods: We included 21,279 eligible participants from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. Weighted ordinal logistic regression (LR) was utilized with further sensitivity and dose-response analysis, and ML algorithms were analyzed with SHapley Additive exPlanations (SHAP) applied to make interpretable results and visualization. Results: Our studies demonstrated an inverse relationship between LE8 and elevated depressive levels, with robustness confirmed through subgroup and interaction analysis. Age-specific findings revealed middle-aged and older adults (aged 40-60 and over 60) which showed higher depresion severity, highlighting the need for greater awareness and targeted interventions. Eight ML algorithms were selected to provide predictive results, and further SHAP would become ideal supplement to increase model interpretability. Conclusions: Our studies demonstrated a negative association between LE8 and elevated depressive levels and provided a suite of ML predictive models, which would generate recommendations toward clinical implications and subjective interventions.

The joint effects of sleep duration and exercise habit on all-cause mortality among Chinese older adult: a national community-based cohort study

Abstract

This study examines the combined effects of sleep duration and exercise habits on all-cause mortality in older Chinese adults using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

Methods

Data were collected from 7231 residents aged 60 and above from the CLHLS. Participants were categorized based on their sleep duration (short sleep: <6 hours, normal sleep: 6-8 hours, and long sleep: >8 hours) and exercise habits (physically active, physically inactive, inactive-to-active, and active-to-inactive). The analysis was conducted over three follow-up periods (2011, 2014, and 2018). Cox proportional hazards regression models were used to assess the associations between sleep duration, exercise habits, and all-cause mortality.

Results

The results showed that compared to short sleepers, individuals with normal sleep (6-8 hours) had a slightly reduced risk of death, although this reduction was not statistically significant (HR = 0.97, 95% CI 0.87-1.08). In contrast, long sleepers (>8 hours) had a significantly higher risk of mortality (HR = 1.28, 95% CI 1.16-1.43). Regarding exercise habits, regular exercise or transitioning from inactivity to exercise significantly reduced mortality risk compared to those who did not exercise (HR = 0.74, 95% CI 0.66-0.83 and HR = 0.88, 95% CI 0.80-0.97, respectively). Notably, exercise habits did not significantly impact mortality among short sleepers, regardless of gender. However, both men and women with normal or long sleep experienced significant mortality benefits from regular exercise. Additionally, older women who transitioned from a sedentary lifestyle to physical activity during periods of long sleep demonstrated lower mortality rates.

Conclusion

Both sleep duration and exercise habits are associated with mortality risk among older Chinese adults, with notable gender differences in their combined effects. Targeted health policies that encourage improved sleep and exercise habits, while considering gender-specific needs, are essential to reduce mortality and enhance quality of life in this population.

Interaction effects of sleep duration and activities of daily living on depressive symptoms among Chinese middle-aged and older adult individuals: evidence from the CHARLS

Objectives

Evidence on the combined effect of sleep duration and activities of daily living (ADL) on depressive symptoms is scarce. This study aimed to explore the interaction effects between sleep duration and ADL limitations on depressive symptoms among Chinese individuals aged ≥45 years.

Methods

Data were extracted from the China Health and Retirement Longitudinal Study (CHARLS) wave 2020. Sleep duration was self-reported. The Center for Epidemiological Studies Depression Scale and a 12-item scale were employed to estimate depressive symptoms and ADL limitations, respectively. Logistic regression analysis was conducted to examine the interaction effects between sleep duration and ADL limitations on depressive symptoms.

Results

Logistic regression found that short sleep (OR = 1.69, 95% CI: 1.57-1.83), long sleep (OR = 0.87, 95% CI: 0.79-0.95), and ADL limitations [basic activities of daily living (BADL), OR = 1.82, 95% CI: 1.66-2.01; instrumental activities of daily living (IADL), OR = 1.88, 95% CI: 1.71-2.07] were associated with depressive symptoms. Furthermore, synergistic interaction effects on the depressive symptoms risk were identified between short sleep and IADL limitations (RERI = 1.08, 95% CI: 0.57-1.59) or BADL limitations (RERI = 1.13, 95% CI: 0.60-1.65). Conversely, antagonistic interaction effects were observed between long sleep and IADL limitations (RERI = 0.88, 95% CI: 0.39-1.38) or BADL limitations (RERI = 0.76, 95% CI: 0.25-1.27) on depressive symptoms.

Conclusion

The study revealed significant interactions between sleep duration and ADL limitations on depressive symptoms, suggesting that enhancing ADL's function and ensuring adequate sleep duration could effectively prevent depressive symptoms.

Sleep quality and duration and frailty in older adults: a systematic review

Introduction

Sleep problems and frailty are associated with adverse health outcomes in older adults, including mortality, and constitute a major public health challenge.

Objective

This study investigated the association between sleep quality and duration and frailty in older adults, with emphasis on methods of evaluation.

Methods

This systematic review was guided by the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA). The Embase, Medline (Pubmed) and Cochrane libraries were searched, with no time restrictions for publications.

Results and discussion

Of the 17 studies included in this review, all published between 2009 and 2024, 13 were cross-sectional and only four were longitudinal. The Pittsburgh Sleep Quality Index and the Fried phenotype were widely used as methods to assess, respectively, sleep and frailty. Studies evaluating insomnia and frailty by the Fried phenotype all found an independent association. Poor sleep quality was independently associated with pre-frailty and frailty. Sleep onset insomnia, but not sleep maintenance insomnia, was associated with frailty. Short (5 h) and long (9 h) sleep duration were also associated with frailty. Poor sleep quality was associated with pre-frailty and frailty in older adults. The results show a wide diversity of methods for assessing both exposure (sleep quality) and outcome (frailty) and point to a need for further - especially longitudinal - research on the relationship between sleep and frailty.

Long and short sleep durations can affect cognitive function in older adults through the chain mediation effect of ADL and depression: evidence from CHARLS2018

BACKGROUND

Both long and short sleep durations may lead to cognitive decline in the elderly individuals, though the underlying mechanisms remain unclear.

AIMS

To explore the mediating mechanism of activities of daily living and depression on different sleep durations and cognitive function in older Chinese older adults.

METHODS

This retrospective study used data from 5,899 older adults who completed the 2018 China Health and Retirement Longitudinal Surveys. We used the PROCESS macro in SPSS to determine the chain mediating effect of ADL and depression on the relationship between different sleep durations and cognitive functions.

RESULTS

(1) There were significant correlations among sleep duration, ability to perform ADL, depression, and cognitive function. (2) For sleep durations ≤ 7 h/night or > 7 h/night, ADL and depression play a chain mediating role in the relationship between sleep duration and cognitive function.

CONCLUSIONS

Shorter or longer sleep durations were associated with cognitive decline by weakening ADL and worsening depression, which suggests that medical personnel should take action to correct abnormal sleep duration in older adults. Timely treatment of ADL impairment and depression may help prevent cognitive decline.

Reallocating time between movement behaviors has implications for post-secondary students' mental health and wellbeing

Objective: Examine the theoretical impact of reallocating time between self-reported moderate-to-vigorous physical activity (MVPA), recreational screen time, and sleep on psychological distress and mental wellbeing among post-secondary students. Participants: 24,742 post-secondary students (Mage=24.3 ± 7.72 SD years; 66.4% women) from Cycle 1 of the Canadian Campus Wellbeing Survey. Methods: Cross-sectional isotemporal substitution modeling. Results: Replacing 20 min of screen time with either sleep or MVPA was associated with lower psychological distress, greater mental wellbeing, lower odds of reporting mild-to-severe psychological distress and low mental wellbeing, except for reallocating screen time to sleep among students who exceed the sleep guideline recommendations. Reallocating time between sleep and MVPA revealed noteworthy patterns: replacing sleep with MVPA was associated with greater mental wellbeing but not lower psychological distress. Conclusions: Findings highlight the potential mental health benefits of replacing screen time with sleep or MVPA as an integrative whole day approach to promote campus wellness.

Lifestyle factors, physical health, and life satisfaction under different changes in depressive symptoms among Chinese community-dwelling older adults: A longitudinal analysis

BACKGROUND

The study aims to investigate the long-term impact of lifestyle-related factors and physical health on life satisfaction and depressive symptoms among Chinese community-dwelling older adults.

METHODS

Using data from the China Health and Retirement Longitudinal Study (CHARLS), the analytic sample of this study included 1,068 older adults who had participated in the surveys in both 2011 and 2018. Multivariate regression was employed to analyze both cross-sectional and longitudinal relationships between lifestyle-related factors, physical health, and subjective well-being - specifically depressive symptoms and life satisfaction. Additionally, the model tested how these factors correlate with life satisfaction across different groups of depressive symptom changes among older adults, categorized as not at risk of depression, intermittent depression, and chronic depression.

RESULTS

Multimorbidity was significantly related to baseline and follow-up depressive risk in older adults. Shorter sleep duration was associated with baseline depression risk. Current alcohol drinkers reported significantly more severe depressive symptoms than non-drinkers. At baseline, current smokers were more likely to have a lower degree of life satisfaction than nonsmokers. Among older adults with chronic depression at the 7-year follow-up, former smokers tended to have lower life satisfaction than nonsmokers.

CONCLUSIONS

Our findings identified drinking alcohol and having a shorter sleep duration as modifiable lifestyle-related risk factors for late-life depression and smoking as a detrimental factor for life satisfaction in older Chinese adults. Multimorbidity was a significant predictor of more depressive symptoms. Our findings have implications for future psychosocial interventions that target the alleviation of depressive symptoms and the promotion of life satisfaction in older Chinese people based on their different long-term mental and physical health conditions.

High levels of anxiety and depression in women farmers from Ecuador: A cross-section study in Coastal and Highlands regions

BACKGROUND

Previous studies have shown that women farmers are particularly vulnerable to mental health disorders such as depression and anxiety.

AIMS

This study aimed to investigate the prevalence of anxiety and depression in women farmers from Ecuador Coastal and Highlands regions.

METHOD

General Anxiety Disorder‑7 (GAD‑7) and Patient Health Questionnaire‑9 (PHQ‑9) were applied. In addition, self-reported number of children, days off, hours of work, pesticide use, sleep habits and years of work in agriculture, were also collected. This cross-sectional study occurred during 2023 with 443 women, for Coastal (197) and Highlands (246), respectively. Multivariable binary logistic regression models were performed to obtained adjusted odds ratios (aOR) and their 95% confidence intervals (95% CI).

RESULTS

34.5% of Coastal women had depression, while 27.2% of Highlands women had depression. 20.3% of coastal women farmers had anxiety, while in the Highlands 24.8% had anxiety. Coastal mestizo and montubio women exhibited lower probability of depression, but this was not significant in the Highlands. Coastal women farmers that did not have children showed lower odds of depression (aOR 0.05, 95% CI [0.01, 0.34]). A lower likelihood of depression was observed in coastal women that worked more than 8 hours (aOR 0.22, 95% CI [0.07, 0.72]). Women from the Highlands that had shortened sleep duration exhibited lower odds of depression and anxiety.

CONCLUSIONS

A higher proportion of depressed women farmers was observed in the Coast region and slightly higher numbers of anxiety cases in the Highlands. The number of children may cause workload and is correlated with depression in Coastal women.

A central role of sulcal width in the associations of sleep duration and depression with cognition in mid to late life

Study Objectives

Evidence suggests that poor sleep impacts cognition, brain health, and dementia risk but the nature of the association is poorly understood. This study examined how self-reported sleep duration, napping, and subjective depression symptoms are associated with the brain-cognition relationship in older adults, using sulcal width as a measure of relative brain health.

Methods

A canonical partial least squares analysis was used to obtain two composite variables that relate cognition and sulcal width in a cross-sectional study of 137 adults aged 46-72. We used a combination of ANCOVA and path analyses to test the associations of self-reported sleep duration, napping, and subjective depression symptoms with the brain-cognition relationship.

Results

We observed a significant main effect of sleep duration on sulcal width, with participants reporting 7 hours showing narrower sulci than other durations. This effect remained significant after including subjective depression as a covariate, which also had a significant main effect on sulcal width in the model. There was no significant effect of napping on sulcal width. In path analyses where the effects of age, self-reported sleep duration and depression symptoms were investigated together, sulcal width mediated the relationship between age and cognition. We also observed a significant indirect effect of sulci width in the subjective depression-cognition relationship.

Conclusions

Findings suggest that self-reported sleep duration and subjective depression may each be independently associated with brain morphology, which is related to cognitive functions. Results could help inform clinical trials and related intervention studies that aim at delaying cognitive decline in adults at risk of developing dementia.

Sleep-wake changes and incident depressive symptoms in midlife women

Our study aimed to investigate the relationship between sleep-wake changes and depressive symptoms events among midlife women. We enrolled 1579 women aged 44-56 years who had no clinically relevant depressive symptoms at baseline. Depressive symptoms were assessed at each visit using the Center for Epidemiologic Studies Depression scale. At the third and fourth follow-up visits, women reported their sleep habits. The sleep midpoint was defined as the time to fall asleep plus one-half of the sleep duration. Sleep-wake changes were determined by the difference in the midpoint of sleep between the third and fourth visits, which were 1 year apart. The median follow-up time was 7 years (range 1-7 years). Cox proportional hazard models were fitted to calculate hazard ratios and 95% confidence intervals for the incidence of depressive symptoms associated with sleep-wake changes. After adjusting for potential confounding factors, the hazard ratio (95% confidence interval) of depressive symptoms for severe sleep midpoint changes was 1.51 (1.12, 2.05) compared with mild sleep midpoint changes. This relationship remained statistically significant and changed little when additionally controlling for sleep duration, sleep quality, insomnia symptoms, use of sleep medications, use of nervous medications, glucose, insulin, lipids, dietary energy intake, and C-reactive protein. Our findings indicate that exposure to long-term severe sleep-wake changes increases the risk of depressive symptoms in midlife women.

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.

Impacts of physical activity, sedentary behaviour, and sleep on depression symptoms in Canadian older adults 65 years of age and above: a compositional data analysis of the Canadian Longitudinal Study on Aging

BACKGROUND

Daily time spent in moderate-to-vigorous physical activity (MVPA), light-intensity physical activity (LIPA), sedentary behaviour (SB) and sleep (collectively known as 'movement behaviours') are compositional, co-dependent variables. However, most studies examining effects of these behaviours on depression outcomes in older adults do not account for this. Study objectives were to use compositional data analysis methods to (1) examine the relationship between movement behaviour composition (daily time spent in MVPA, LIPA, SB, sleep) and depression symptoms, (2) estimate the extent to which changing time spent in any given movement behaviour within the movement behaviour composition was associated with changes in depression symptoms.

METHODS

5643 older Canadian adults ≥ 65 years of age from the Canadian Longitudinal Study on Aging were studied using a quasi-longitudinal study design. Exposure was baseline daily movement behaviours; time spent in MVPA, LIPA and SB were derived from self-reported Physical Activity Scale for the Elderly responses. Night-time sleep was self-reported separately. Outcome was depression symptoms at follow-up obtained using the ten item Center for Epidemiologic Studies Depression Scale. Compositional data analysis was used to investigate associations between movement behaviours and depression symptoms.

RESULTS

Movement behaviour composition was significantly associated with depression symptoms. Time spent in MVPA [exp(B) = 0.97 (95% CI: 0.94, 0.99)] and sleep [exp(B) = 0.91 (95% CI: 0.85, 0.97)] relative to the remaining movement behaviours were associated with lower depression symptoms scores. Relative time spent in SB was associated with higher depression symptoms scores [exp(B) = 1.09 (95% CI: 1.04, 1.15)]. Time displacement estimates revealed that the greatest change in depression symptoms scores occurred when time spent in MVPA was decreased and replaced with LIPA, SB, sleep or combination of these behaviours (+ 0.22 to 0.26 points increase on depression symptoms scores for 30 min/day displacements).

CONCLUSIONS

Daily movement behaviour composition was associated with depression symptoms in older Canadians. Replacing time in MVPA with equivalent time from any other behaviour was associated with increased depression symptoms. Preserving time spent in MVPA may play a key role in mitigating and improving mental health in this demographic.

Association of cardiovascular health using Life's Essential 8 with depression: Findings from NHANES 2007-2018

OBJECTIVE

Few studies have explored the correlation between cardiovascular health (CVH) and depression. We aimed to investigate the relationship between CVH using Life's Essential 8 (LE8) and depression among US adults.

METHODS

16,362 individuals from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018 were included. The patient Health Questionnaire (PHQ-9) was utilized to recognized depression (PHQ-9 ≥ 10). LE8 was scored by four health behaviors (sleep, tobacco/nicotine exposure, physical activity and diet) and four health factors (body mass index, non-high-density lipoprotein cholesterol, blood glucose and blood pressure) and classified into low, moderate and high CVH groups. Weighted logistic regressions, restricted cubic splines and sensitivity analyses were utilized to investigate the correlation between LE8 and depression.

RESULTS

1306 subjects had depression (7.98% of the participants), of which 860 (7.42%), 305 (17.24%) and 141 (3.01%) had low, moderate and high CVH, separately. In the fully adjusted model, LE8 was negatively correlated with depression (OR: 5.50, 95% CI 3.92-7.71, P < 0.001). Furthermore, there were inversely dose-response relationships between LE8 and depression (overall P < 0.001).

CONCLUSIONS

Adhering to a high CVH, estimated by the LE8 score, was correlated with lower odds of depression.

Psychological aspects of rehabilitation nutrition: A position paper by the Japanese Association of Rehabilitation Nutrition (secondary publication)

Psychological aspects of rehabilitation nutrition affect physical, cognitive, and social rehabilitation nutrition. When depression is recognized, not only pharmacotherapy and psychotherapy, but also non-pharmacological therapies such as exercise, nutrition, psychosocial, and other interventions can be expected to improve depression. Therefore, accurate diagnosis and intervention without overlooking depression is important. Psychological aspects of preventive rehabilitation nutrition is also important because depression can be partially prevented by appropriate exercise and nutritional management. Even in the absence of psychological negatives, increasing more psychological positives from a positive psychology perspective can be useful for both patients and healthcare professionals. Positive rehabilitation nutrition interventions can increase more psychological positives, such as well-being, through cognitive-behavioral therapy and mindfulness on their own, as well as through interventions on environmental factors. Consequently, physical, cognitive, and social positives are also expected to be enhanced.

A longitudinal study on the change in sleep across three waves of the COVID-19 outbreaks in Hong Kong

In the year 2020, Hong Kong experienced four COVID-19 epidemic waves. The present study aimed to examine the transition of sleep disturbances and explore its associated factors across the later three epidemic waves. Among the 1138 respondents who participated in an online survey at the second wave (T1, April 2020), 338 and 378 participants also completed a follow-up at the third (T2, August 2020) and fourth waves (T3, December 2020), respectively. Participants completed the Insomnia Severity Index and an investigator-designed questionnaire regarding potential factors associated with sleep change such as perceived risk of being infected, economic stress, and confidence in the government and health care professional. Sample of this study were mainly female (67.7%), married (50.3%), young adults (54.2%) with tertiary education (81.6%). Maintaining normal sleep was the most prevalent trajectory of sleep of all three waves (50.5%), followed by persistent insomnia (17.2%) and remitted insomnia (9.0%). Besides female, older-age and lower education level, the results showed that increment in worry about family being infected (adjusted risk ratio, RR = 1.28), perceived interference of daily lives (adjusted RR = 1.19), and economic distress (adjusted RR = 1.24) were significantly associated with the development of clinical insomnia during the three epidemic waves. These factors were also associated with worsening of other sleep parameters. Insomnia being persistent across the three waves of COVID-19 outbreaks was common. Increasing economic distress, daily interference, and worry about family members being infected were associated with an increasing risk of clinical insomnia across the three COVID-19 outbreaks.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41105-023-00486-w.

Sleep and Depression in Older Adults: A Narrative Review

PURPOSE OF REVIEW

The sleep-depression association has been recognized for decades. Efforts to clarify this association continue at an increasing pace. This review summarizes recent research on the sleep-depression association in older adults.

RECENT FINDINGS

Research over the past 4 years has utilized cross-sectional, longitudinal, cohort, and intervention designs to examine these associations. Short (< 7 h) and long (> 8-9 h) sleep durations and insomnia symptoms are risk factors for depression in older adults. Similarly, short sleep, long sleep, insomnia symptoms, and depression are all risk factors for poorer health in late life, including increased risk of cognitive decline, falls, and poorer quality-of-life. Intervention studies have produced mixed findings, with some studies suggesting that sleep interventions may be potentially effective in improving both insomnia and mood symptoms. Intervention studies incorporating both behavioral and physiological measures of sleep, and larger and diverse samples may enhance the field's understanding of the complex interplay between sleep and mood in older adults.

Effects of Tai Chi on depression of middle-aged and older adults: an updated systematic review and meta-analysis

AIM

The objective of this study was to evaluate the efficacy of Tai Chi, a mind-body movement therapy originating from China, on depression in middle-aged and older adults.

METHODS

A systematic search was conducted in seven databases (Embase, Cochrane, Medline, Wanfang, SinoMed, Weipu date, CNKI) for Randomized Controlled Trials (RCTs) published until Apr 16, 2023. The quality assessment, heterogeneity analysis, subgroup analysis, and sensitivity analysis of 12 RCTs selected from the literature were performed. Meta-analyses were conducted using RevMan 5.4 software.

RESULTS

The study included 12 trials comprising 731 participants that met the inclusion criteria. The findings revealed that Tai Chi significantly improved depression in middle-aged and older adults [SMD = -1.21, 95% CI (-1.59, -0.83), I2 = 87.6%, P < 0.001]. Subgroup analysis revealed that the number of exercise weeks within the specified range, the total duration of exercise, and Tai Chi maneuvers had the greatest benefits on depression in middle-aged and elderly people. The results demonstrated that interventions lasting more than 24 weeks were more effective [SMD = -1.66, 95% CI (-2.28, -1.04), P < 0.05] than those lasting only 12 weeks [SMD = -0.73, 95% CI (-1.08, -0.38), P < 0.05]. The effect size was more significant when the total duration of the intervention was more than 2400 min [SMD = -1.31, 95% CI (-1.71, -0.92), P < 0.001], and when the 24-style Tai Chi exercise was selected [SMD = -1.06, 95% CI (-1.37, -0.75), P < 0.001], the difference was also statistically significant. Funnel plots combined with sensitivity analyses, Begg's and Egger's tests indicated no publication bias.

CONCLUSION

The study suggests that Tai Chi can be an alternative therapy for reducing depression in middle-aged and older adults. It is recommended to prolong the Tai Chi exercise period to more than 24 weeks, with a total exercise duration of more than 2400 min, and 24-style Tai Chi should be selected to achieve the best therapeutic effect in middle-aged and older adults with depression. It should be noted that there may be lower-quality studies in the RCT literature analyzed, which may limit the general applicability and credibility of the conclusions.

Nonlinear Associations between Physical Function, Physical Activity, Sleep, and Depressive Symptoms in Older Adults

The purpose of this study is to examine how physical function, physical activity, and sleep are related to depressive symptoms in older adults using a nonlinear model. The participants were 283 Korean older adults aged 65 and older who met the study inclusion criteria. Depressive symptoms were measured using the shortened version of the Geriatric Depression Scale in Korean (SGDS-K). Physical activity and sleep time were objectively quantified by continuously monitoring participants over 20 consecutive days using a triaxial accelerometer. Physical function was evaluated using five distinct measurements: grip strength, gait speed, the Timed Up and Go Test (TUG), the Six-Minute Walk Test (SMWT), and the Five Times Sit to Stand Test (FTSST). The SMWT, gait speed, and MVPA exhibited a nonlinear relationship with depressive symptoms. However, other physical functions showed linear relationships. Also, sleep time showed a U-shaped trend starting at approximately 390 min. After adjusting for age, sex, drinking, and smoking in the logistic regression model, SMWT, MVPA, and sleep time were significantly associated with depressive symptoms. The outcomes highlight the importance of considering multiple factors in understanding depression among the elderly, particularly the intricate interactions between these elements and biological rhythms.