Depression and Sleep

Developing an interpretable machine learning model for screening depression in older adults with functional disability

This study utilized data from the 2020 wave of the China Health and Retirement Longitudinal Study database, selecting 4322 participants aged 60 and above as the study sample. Important predictors of depression in older adults with functional disabilities were identified using LASSO regression, univariate logistic regression, and multivariate logistic regression. Five different machine learning algorithms-Logistic Regression, Random Forest, Gradient Boosting, K-Nearest Neighbors, and Naive Bayes-were employed to construct risk prediction models for depression in older adults with functional disabilities. The results indicated that Sleep duration, Age, Cognitive score, Gender, Residential area, Self-rated health, Arthritis, Gastrointestinal disease, Retirement status, Life satisfaction, Composite pain status, and Physical activity level were significant predictors of depression in this population. Both the Gradient Boosting model (accuracy: 0.69, precision: 0.70, recall: 0.79, F1-score: 0.74, AUC: 0.76) and the Logistic Regression model (accuracy: 0.68, precision: 0.68, recall: 0.79, F1-score: 0.73, AUC: 0.75) demonstrated good performance and strong generalizability. Additionally, SHAP interpretation was applied to the Gradient Boosting model to enhance the explainability of its predictions, while a nomogram was created for the Logistic Regression model to visually represent the predictive process, allowing for more intuitive understanding of the model's output. This study successfully developed a risk prediction model for depression in older adults with functional disabilities through machine learning. It provides a reference tool for community screening and clinical decision-making, helping to identify and manage depression risk within the older adults with functional disabilities.

Recent advances in biomimetic nanodelivery systems for the treatment of depression

Depression and cognitive disorders remain major challenges in healthcare, with conventional treatments often facing limitations such as slow onset, side effects, and poor drug delivery to the brain. Biomimetic nanodelivery systems, including nanozymes, cell membrane-based systems, and exosomes, have emerged as promising solutions to these issues. These systems leverage natural biological processes to enhance drug targeting, improve bioavailability, and regulate complex biological pathways. Nanoenzymes, with their catalytic properties, offer antioxidant and anti-inflammatory benefits, while cell membranes and exosomes provide efficient targeting and immune evasion. However, challenges remain, including the immaturity of large-scale production techniques, stability concerns, and incomplete understanding of their mechanisms of action. Moreover, the long-term safety, pharmacokinetics, and toxicity of these systems require further investigation. Despite these obstacles, the potential of biomimetic nanodelivery systems to revolutionize depression treatment is significant. Future research should focus on optimizing their preparation, improving drug targeting and release, and ensuring clinical safety. Multidisciplinary collaboration will be essential for advancing these systems from the laboratory to clinical practice, offering new therapeutic avenues for depression and other neurological disorders.

Subclinically Depressed Individuals Showed Less Trust after a Night of Sleep Deprivation

Insufficient sleep's impact on cognitive and emotional function is well-documented, but its effects on social functioning remain understudied. This research investigates the influence of depressive symptoms on the relationship between sleep deprivation (SD) and social decision-making. Forty-two young adults were randomly assigned to either the SD or sleep control (SC) group. The SD group stayed awake in the laboratory, while the SC group had a normal night's sleep at home. During the subsequent morning, participants completed a Trust Game (TG) in which a higher monetary offer distributed by them indicated more trust toward their partners. They also completed an Ultimatum Game (UG) in which a higher acceptance rate indicated more rational decision-making. The results revealed that depressive symptoms significantly moderated the effect of SD on trust in the TG. However, there was no interaction between group and depressive symptoms found in predicting acceptance rates in the UG. This study demonstrates that individuals with higher levels of depressive symptoms display less trust after SD, highlighting the role of depressive symptoms in modulating the impact of SD on social decision-making. Future research should explore sleep-related interventions targeting the psychosocial dysfunctions of individuals with depression.

Objective evaluation of major depressive disorder using sleep electroencephalography measured by an in-home portable one-channel device: a preliminary study

PURPOSE

Decreased delta and increased alpha wave activity during sleep may be specific pathophysiological features of major depressive disorder; however, their usefulness as biomarkers remains unclear. We examined the use of mean alpha and delta wave power value indices during sleep to identify major depressive disorder using a portable electroencephalography device.

METHODS

We compared the mean alpha and delta wave power value indices of six unmedicated patients with major depressive disorder and seven age- and sex-matched healthy controls using a portable electroencephalography device in this case-controlled study.

RESULTS

The ratio of the mean alpha power values for the non-rapid and rapid eye movement periods was significantly lower in the major depressive disorder group (1.3 ± 0.2) than in the healthy group (2.3 ± 0.6; P = 0.004). The ratio of the mean delta power values for the non-rapid eye movement and rapid eye movement periods did not differ between groups but negatively correlated significantly with the Hamilton Rating Scale for Depression score (r = -0.784, P = 0.002). The area under the receiver operating characteristic curve (95% confidence interval) of the mean alpha power ratio for non-rapid eye movement and rapid eye movement periods for distinguishing the two groups was 0.93 (0.78-1.00), and both sensitivity and specificity exceeded 85% at a cut-off value ≤ 1.71.

CONCLUSION

The alpha- and delta-related power value indices may capture different aspects of major depressive disorder pathology.

Association between occupational stress and depression among construction workers: The chain mediating of sleep disorders and anxiety

BackgroundDue to the unique nature of their work, construction workers are prone to mental health problems. However, few studies in China have explored the relationship between psychological variables about them.ObjectiveThe purpose of this study was to explore the relationship between occupational stress and depression and to analyze the mediating role of sleep disorders and anxiety.MethodsA stratified cluster sampling method randomly selected 1871 construction workers in Chongqing, China. The survey was conducted as a questionnaire. SPSS 25.0 software was used for data analysis and statistical description. SPSS PROCESS macro version 4.0 was used for the chained mediation effect test.ResultsThe detection rates of occupational stress, sleep disorders, anxiety, and depression among construction workers were 26.4%, 89.8%, 30.2%, and 18.7%, respectively. Analysis showed that these factors were positively correlated with each other. Mediation effect analysis showed that occupational stress directly influenced depression (β = 0.156, p < 0.001) and also had an indirect effect through sleep disorders and anxiety, with respective mediation effects of 4.48% and 47.93%. Sleep disorders and anxiety played a chain-mediating role between occupational stress and depression, with a mediating effect of 3.69%.ConclusionsOccupational stress affects depression directly and also indirectly through sleep disorders and anxiety. These results indicate that reducing occupational stress, sleep disorders, and anxiety may be effective in preventing depression.

Association between household sleep environment and sleep health characteristics in middle-aged adults: The CARDIA sleep study

OBJECTIVES

Household environmental factors and sleep hygiene may contribute to poor sleep health. We identified associations between household sleep environment (HHSE) and sleep health characteristics in White and Black adults.

METHODS

This study included cross-sectional data from the CARDIA sleep ancillary study at Year 35 (n=711). HHSE was assessed in two domains (sleep disruptors and sleep hygiene) using a questionnaire, and higher scores indicated more sleep disruptors or poorer sleep hygiene. Sleep outcomes included (1) self-reported sleep quality and daytime sleepiness and (2) actigraphy-measured sleep duration, sleep percentage, sleep timing (midpoint sleep time), and sleep regularity. We used robust regression to estimate differences in sleep outcomes corresponding to each 1-point increment in HHSE. Racial differences in associations of interest were examined by testing for interaction.

RESULTS

Participants' mean age was 61.5 (SD=3.6) years, 63% were women, and 36.7% were Black. After multivariable adjustment (β [95% CI]), more sleep disruptors (0.145 [0.04, 0.24]) and poor sleep hygiene (0.170 [0.10, 0.23]) were associated with self-reported poor sleep quality. Poor sleep hygiene was associated with actigraphy-measured shorter sleep duration (-1.397 [-2.73, -0.01]) and sleep irregularity (0.017 [0.01, 0.02]). In stratified analysis, more sleep disruptors were associated with poor sleep quality (0.320 [0.10, 0.53]) and greater daytime sleepiness (0.330 [0.11, 0.54]) only in Black participants.

CONCLUSIONS

Poor HHSE was related to self-reported poor sleep quality and to objective shorter sleep duration and sleep irregularity. Targeted interventions to mitigate sleep disruptors and promote good sleep hygiene may help to improve sleep health.

Analyses of Menopause and Its Related Symptoms on Sleep Quality Using a Novel Wearable Sheet-Type Frontal Electroencephalography Sensor, Haru-1

Objectives

Menopause affects sleep quality and contributes to depressive symptoms, but its precise impact on sleep remains unclear. To address this gap, we conducted detailed measurements of brain activity during sleep in pre- and postmenopausal women using a novel wearable sheet-type frontal electroencephalography (EEG) patch, Haru-1 (PGV Inc., Tokyo, Japan).

Methods

Hospitalized patients aged 30-50 years who had undergone bilateral salpingo-oophorectomy, as well as volunteer participants aged 40-60 years who underwent EEG monitoring at home, were enrolled in the study. EEG recordings were obtained during sleep. Participants were assessed for menopausal symptoms using the Simple Menopausal Index (SMI) and for depressive symptoms using the Quick Inventory of Depressive Symptomatology Japanese version (QIDS-J). Sleep parameters were calculated to investigate the relationships between menopause, menopausal symptoms, depressive symptoms, and sleep characteristics.

Results

A total of 174 participants were recruited, and data from 126 participants were included in the final analysis. Among 126 analyzed participants (mean age: 46.3 ± 7.3 years; 36 premenopausal, 90 postmenopausal), postmenopausal women had lower sleep efficiency (78% vs. 88%; p = 0.0065) and longer sleep onset latency (20 minutes vs. 8 minutes; p = 0.0203). The presence of menopausal symptoms (SMI ≥51) correlated with shorter deep sleep (9 minutes vs. 26 minutes; p = 0.0367), and depressive symptoms (QIDS-J ≥6) were associated with prolonged wake after sleep onset (56 minutes vs. 36 minutes; p = 0.0242).

Conclusions

Menopause was associated with reduced sleep efficiency and increased sleep onset latency. Detailed EEG analyses may contribute to a better understanding of the pathogenesis of menopausal symptoms and their impact on sleep.

Depressive symptoms, sleep-wake features, and insomnia among female students: The role of rumination

Depression symptoms are prevalent among nursing students, especially those in Asia. This study assessed the association between rumination and depression symptoms among female nursing students (N = 148) and the chain mediation role of sleep-wake indexes and insomnia symptoms. The data were collected from a battery of questionnaires and consecutive 7-day actigraphy data for analyzing sleep-wake indexes. About 54.1% of the participants had either mild or moderate depression symptoms. Most students (89.2%) had a delayed circadian phase, and circadian activity rhythm (CAR) was not ideal. The path mediation model underwent analysis using the PROCESS macros. The results showed that rumination in students is directly positively correlated with depressive symptoms (b = 4.831). Moreover, the association between rumination and depressive symptoms is sequent (moderating effect = 0.12, 95% CI [0.017, 0.410]). The proposed model in this study provides a foundation for improving educational programs on sleep hygiene and promoting mental wellness.

Inter-relationships of depression and anxiety symptoms among widowed and non-widowed older adults: findings from the Chinese Longitudinal Healthy Longevity Survey based on network analysis and propensity score matching

Background

Depression and anxiety are prevalent mental health issues among older adult widowed adults. However, the symptom-level relationships between these conditions remain unclear. Due to the high correlations and complex relationships among various symptoms, this study employs network analysis to explore differences in the network structures of depression and anxiety symptoms between widowed and non-widowed older adults.

Methods

Propensity score matching was used to identify widowed older adults with similar demographic characteristics. Data from 1,736 widowed and 1,736 matched controls were analyzed using the Chinese Longitudinal Healthy Longevity Survey (2017-2018). Depression and anxiety were measured by the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and the seven-item Generalized Anxiety Disorder Scale (GAD-7), respectively. Central and bridge symptoms were evaluated using expected influence (EI) and bridge expected influence (BEI), respectively.

Results

Network analysis revealed similarities in central symptoms between widowed and non-widowed older adults, with both groups exhibiting "Feeling depressed or down" (CESD3), "Feeling tense and having difficulty relaxing" (GAD4), and "Being unable to stop or control worrying" (GAD2) as core symptoms. However, differences emerged in bridge symptoms. In the widowed group, "Feeling anxious, worried, or distressed" (GAD1) was most strongly connected to "Felt lonely" (CESD8); "Worrying too much about various things" (GAD3) was strongly linked to "Feeling increasingly exhausted and useless with age" (CESD4); and "Feeling depressed or down" (CESD3) had a strong association with "Becoming easily annoyed or irritable" (GAD6). In the non-widowed group, "Feeling anxious, worried, or distressed" (GAD1) exhibited the strongest association with "Having good sleep quality" (CESD10); "Getting upset over small matters" (CESD1) was closely connected to "Feeling anxious, worried, or distressed" (GAD1); and "Worrying too much about various things" (GAD3) was most strongly connected to "Feeling depressed or down" (CESD3).

Conclusion

Common central and bridge symptoms highlight universal intervention targets. Addressing "Feeling depressed or down" in widowed and "Getting upset over small matters" in non-widowed older adults may help prevent depression-anxiety comorbidity. These findings support targeted interventions to improve mental health outcomes. Future research should evaluate tailored intervention effectiveness.

The association between adaptability and the symptoms of depression and anxiety in early adolescents: a network analysis in a longitudinal design

BACKGROUND

The co-occurrence of depression and anxiety is relatively more common among adolescents. Emerging evidence suggests that adaptability might affect this phenomenon. Network analysis can provide insight into the dynamics between symptoms of mental disorders. Therefore, we used network analysis 1) to explore symptom networks and 2) to investigate the association between adaptability and symptoms based on a longitudinal design.

METHODS

833 Chinese adolescents (449 males and 384 female) were recruited, with adaptability, depressive and anxiety symptoms measured at T1, 426 of them were followed up one year later at T2. Symptom networks were constructed for all participants and for the two groups based on their adaptability scores at T1. Furthermore, mediation analysis was performed to examine the relationship between adaptability and bridge symptoms at both timepoints.

RESULTS

Irritable and Guilty showed the highest expected value at T1 (p < 0.05). The high adaptability group's symptom network (HGN) was less connected than the low adaptability group's symptom network (LGN) (p < 0.001). Furthermore, Irritable (T1) and adaptability (T2) were sequential mediators (p < 0.001) between adaptability (T1) and Irritable (T2).

CONCLUSIONS

These findings suggest that adaptability might affect the network dynamics, underscoring its importance to the occurrence of depression and anxiety among adolescents. Irritable and Guilty being the bridge symptoms may indicate the interventions to target in adolescents with comorbid depression and anxiety.

Assessment of Depression and Its Association With Sleep Quality Among the General Population of Perambalur in Tamil Nadu, India: A Cross-Sectional Analysis

Background Sleep quality and depression represent significant public health concerns with complex bidirectional relationships. Despite extensive research in specific populations, comprehensive studies examining their association with general populations remain limited, particularly in developing regions. This study aimed to assess the prevalence of depression and poor sleep quality among the general population of Perambalur, Tamil Nadu, examine their interrelationship, and identify associated sociodemographic and behavioral factors influencing this relationship. Additionally, the study sought to analyze the impact of depression severity on sleep quality parameters and investigate potential risk factors affecting both conditions. Methodology A cross-sectional analytical study was conducted among 650 participants from Perambalur district, Tamil Nadu, India. Data collection involved face-to-face interviews using a structured questionnaire comprising sociodemographic profiles, the Pittsburgh Sleep Quality Index (PSQI) for sleep quality assessment, and the Patient Health Questionnaire-9 (PHQ-9) for depression evaluation. The questionnaire underwent forward-backward translation and pilot testing. Sleep quality was categorized using PSQI scores (>5 indicating poor sleep), while depression severity was classified as minimal (0-4), mild (5-9), moderate (10-14), moderately severe (15-19), and severe (20-27). Data analysis employed descriptive statistics, chi-square tests, and multivariable logistic regression, with p<0.05 considered statistically significant. Results The study population, with a mean age of 35.71±14.70 years, comprised 381 (58.6%) females and 269 (41.4%) males. The depression analysis revealed that 385 (59.2%) participants had minimal depression, 171 (26.3%) had mild depression, 62 (9.5%) had moderate depression, 27 (4.2%) had moderately severe depression, and five (0.8%) had severe depression. Poor sleep quality was reported by 142 (21.8%) participants. Sleep-related parameters showed 100 (15.4%) participants experiencing difficulty initiating sleep, 102 (15.7%) reporting midnight awakenings, and 34 (5.2%) using self-medication. Logistic regression identified self-medication (adjusted odds ratio (AOR)=8.45, 95% CI: 3.12-22.86) and moderately severe/severe depression (AOR=7.92, 95% CI: 3.45-18.19) as the strongest predictors of poor sleep quality. PSQI scores demonstrated progressive deterioration across depression severity levels, increasing from 3.2±1.8 in minimal to 11.3±3.2 in severe depression. A strong positive correlation was observed between PSQI and PHQ-9 scores (r=0.65, p<0.001). Conclusion The study establishes significant associations between depression severity and sleep quality, highlighting the need for integrated healthcare approaches. The identified sociodemographic risk factors and high prevalence of self-medication underscore the importance of targeted interventions and improved access to professional healthcare services, particularly focusing on vulnerable populations in both urban and rural settings.

The effects and mechanisms of chai shao jie yu granules on chronic unpredictable mild stress (CUMS)-induced depressive rats based on network pharmacology

ETHNOPHARMACOLOGICAL RELEVANCE

Chai Shao Jie Yu Granules (CSJY) is a renowned and time-honored formula employed in clinical practice for the management of various conditions, notably depression. Depression, a prevalent psychiatric disorder, poses challenges with limited effective treatment options. Traditional herbal medicines have garnered increasing attention in the realm of combating depression, being perceived as safer alternatives to pharmacotherapy.

AIM OF THE STUDY

To explore the effects and mechanisms of CSJY in chronic unpredictable mild stress (CUMS)-induced depression.

MATERIALS AND METHODS

Rat models of CUMS-induced depression were established, and the rats were randomly allocated into six groups: Control, CUMS, CUMS + Paroxetine (PX), CUMS + CSJY-L, CUMS + CSJY-M, and CUMS + CSJY-H. Throughout the study, the rats' body weight was monitored. Depression-related behaviors were assessed using the sucrose preference test (SPT) and open field test (OFT). High-performance liquid chromatography-mass spectrometry (HPLC-MS) measured monoamine neurotransmitters in the rat cortex and hippocampus. We measured adrenocorticotropic hormone (ACTH), corticosterone (CORT), and corticotropin-release hormone (CRH) levels in rat serum. Additionally, network pharmacology was employed to predict relevant molecular targets and potential mechanisms, followed by in vivo validation. Western blot analysis was conducted to evaluate the protein levels of 5-hydroxytryptamine/serotonin receptor 1A (5-HT1A) and Glutamate (Glu)-related proteins, such as p-GluA1, GluA1, p-GluN1, GluN1, p-GluN2A and GluN2A in the hippocampus.

RESULTS

In behavioral assessments, CUMS rats exhibited depressive behaviors, which were ameliorated by CSJY or PX treatment. Moreover, CSJY or PX treatment increased serotonin (5-HT) levels. It reduced the kynurenine/tryptophan (KYN/TRP) and gamma-aminobutyric acid/glutamate (GABA/Glu) in the hippocampus and cortex, as well as reduced serum levels of ACTH, CORT and CRH. Furthermore, CSJY or PX administration enhanced the decreased expression of p-GluN1/GluN1 while upregulating 5-HT1A and p-GluA1/GluA1 levels in the CUMS group.

CONCLUSION

CSJY demonstrated the ability to alleviate depressive behaviors in CUMS-induced depression rats, potentially through the inhibition of the hypothalamic-pituitary-adrenal (HPA) axis, modulation of monoamine neurotransmitters, and glutamatergic neurons. These findings suggest that CSJY could serve as a promising treatment option for depression.

Association between sleep patterns and depression in older adults: a cross-sectional study using data from the National Health and Nutrition Examination Survey 2007-2014

OBJECTIVE

To assess the association between sleep patterns and sleep factors (sleep duration, trouble sleeping, sleep disorder) and the risk of depression in older adults.

METHODS

A total of 5636 participants (2754 men and 2882 women) aged 60 years and older from the 2007-2014 waves of the National Health and Nutrition Examination Survey (NHANES) were included. Sleep duration, sleep problems, and sleep disorders were assessed in the home by trained interviewers using the Computer-Assisted Personal Interviewing (CAPI) system. The combined sleep behaviours were referred to as 'sleep patterns (healthy, intermediate and poor)', with a 'healthy sleep pattern' defined as sleeping 7-9 h per night with no self-reported trouble sleeping or sleep disorders. Intermediate and poor sleep patterns indicated 1 and 2-3 sleep problems, respectively. Baseline characteristics of participants analysed using one-way logistic regression. Logistic multiple linear regression was used to assess the association of sleep factors and sleep patterns with the risk of depressive symptoms.Conduct subgroup analyses to ensure robustness of findings.

RESULTS

The overall prevalence of depression was 7.7% among the 5636 participants analysed, with the rate of depression in older women being 1.6 times higher than in older men. The prevalence of depression was higher in older adults with intermediate sleep pattern than in older adults with healthy sleep pattern (OR: 2.28, 95% CI: 1.71-3.03, p < 0.001). The prevalence of depression was higher in older adults with poor sleep pattern than in older adults with healthy sleep pattern (OR: 5.60, 95% CI: 4.25-7.39, p < 0.001). The findings were robust after controlling for sleep items in the PHQ-9.

CONCLUSION

This nationally representative survey showed a relationship between sleep patterns and depression in older adults. However, the study population was limited to Americans, and we recommend continued investigation of the causal relationship and mechanisms between the two in the future, and further expansion of data sources in order to assess the applicability of the findings.

Effects of physical activity on sleep quality among university students: chain mediation between rumination and depression levels

BACKGROUND

Colleges and universities are currently facing the major public health issue of poor sleep quality. Sleep quality must be taken seriously to maintain the students' emotional and physical well-being. Thus, this study sought to determine how university students' levels of physical activity related to the quality of their sleep, as well as to explore the mechanisms via which physical activity affects sleep and provide suggestions for improving it.

METHODS

A total of 883 university students from Ganzhou City, Jiangxi Province, China participated in the study. Their physical activity, sleep quality, ruminative thinking levels, and depression were assessed using various questionnaires.

RESULTS

Through the mediating effects of rumination and depression as well as the chain-mediated effects of these two factors, physical exercise changed the quality of sleep.

CONCLUSION

University students' sleep quality can be improved by increasing their physical activity and decreasing ruminative thinking and depression levels.

Longitudinal neurofunctional alterations following nonpharmacological treatments and the mediating role of regional homogeneity in subclinical depression comorbid with sleep disorders among college students

BACKGROUND

Clinical guidelines recommend nonpharmacological treatment (nPHT) as the primary intervention for subthreshold depression management. Counseling (CS) and electroacupuncture (EA) are two promising nonpharmacological approaches for improving both depression and sleep disturbance. However, the intrinsic neuroimaging mechanisms underlying the antidepressant effects of these nPHTs are not yet fully understood.

METHODS

We analyzed longitudinal resting-state functional magnetic resonance imaging (rs-fMRI) data from a randomized, single-blind clinical trial involving 96 first-episode, drug-naïve college students with subclinical depression and sleep disorders (sDSD; mean age 20.43 ± 2.72 years; 66.7% female) and 90 healthy controls (HCs; mean age 21.02 ± 2.68 years; 61.1% female). Participants with sDSD were randomly assigned to receive either scalp EA (n = 47) or CS (n = 49) for six weeks. The regional homogeneity (ReHo) and amplitude of low-frequency fluctuation (ALFF) before and after nPHT were calculated. Correlation and mediation analyses were performed to investigate the complex relationships between fMRI indicators and clinical symptoms.

RESULTS

The ALFF in the left paracentral lobule in sDSD patients presented an interaction effect between group and time following six weeks of nPHT. In the CS group, the ALFF in the left paracentral lobule decreased (p < 0.001), and in the EA group, it increased (p < 0.05). Compared with HCs, the baseline sDSD has many abnormal brain regions in terms of ALFF and ReHo. The whole-brain average ReHo was negatively correlated with depression scores (r = -0.26, p < 0.001) and sleep quality scores (r = -0.25, p < 0.001) and mediated the association between depression and sleep disorders [β = 0.2857, p < 0.001, 95% CI (0.23, 0.35)].

CONCLUSIONS

Nonpharmacological therapies provide different therapeutic outcomes in terms of the same rs-fMRI indicator. ALFF in the left paracentral lobule could be used as an imaging biomarker in nPHT selection. Rs-fMRI indicators are promising for understanding the neural basis of the complex relationship between subclinical depression and insomnia comorbidities in young adults.

A Meta-Regression of psychosocial factors associated with sleep outcomes in mindfulness-based intervention trials

OBJECTIVES

In this meta-regression, we aimed to explore associations between changes in psychosocial factors and changes in sleep disturbance during mindfulness-based interventions (MBIs). We also investigated participant-specific and methodological factors associated with sleep disturbance during MBIs.

METHOD

We utilized data from a published meta-analysis of 40 randomized controlled trials of MBIs (published from inception to 2020) with a sleep disturbance outcome measure in healthy and clinical adult populations. We conducted meta-regressions to test associations between sleep improvements following MBIs and psychosocial factors, as well as demographic and methodological factors.

RESULTS

MBIs were associated with significant reductions in sleep disturbance (SMD = -0.523; 95% CI = -0.678 to -0.368) and psychosocial factors (SMD = -0.213 - -0.894). Reductions in sleep disturbance were associated with reductions in stress (r = 0.74, p = .02) and depression (r = 0.90, p < .001).

CONCLUSIONS

MBIs improve sleep disturbance across a wide range of healthy and clinical populations. Stress and depression may be important psychosocial factors associated with sleep disturbance. Future RCTs should include measures of additional factors and should investigate longitudinal associations between psychosocial, demographic, and methodological factors with changes in sleep disturbance to test mechanisms and to identify "active ingredients" of MBIs.

Depression in middle-aged and older adults with hearing loss: the use and construction of a nomogram tool

Objective

This study aims to explore the influencing factors of depressive symptoms in middle-aged and older adult patients with hearing loss and to construct a nomogram risk prediction model.

Methods

A total of 2,729 middle-aged and older adult patients with hearing loss from the community were selected as the study subjects. Single-factor and multifactorial stepwise logistic regression analyses were used to screen influencing factors. Based on these predictive factors, a nomogram prediction model was constructed. The model's efficacy was validated using the area under the receiver operating characteristic curve (AUC) and 1,000 bootstrap resamples.

Results

Multifactorial logistic regression analysis revealed that age, gender, pain, cognitive abilities, daily living abilities, sleep duration, and self-rated health status are the main influencing factors for depressive symptoms. Based on these factors, the constructed nomogram model demonstrated good calibration (χ2 = 3.367, p = 0.909), with an AUC value of 0.741 (95% CI: 0.723-0.759), and a sensitivity of 0.683, showing good discriminative ability and accuracy.

Conclusion

The incidence of depressive symptoms is relatively high among middle-aged and older adult individuals with hearing loss. The model developed in this study can effectively identify middle-aged and older adult patients with hearing loss who are at risk of depressive symptoms. This provides strong empirical support for the early detection, diagnosis, and intervention of depressive symptoms in middle-aged and older adult patients with hearing loss.

Sleep and cancer mortality in the Cancer Prevention Study-II

PURPOSE

Sleep is a multi-dimensional human function that is associated with cancer outcomes. Previous work on sleep and cancer mortality have not investigated how this relationship varies by sex and cancer site. We investigated the association of sleep duration and perceived insomnia with site-specific and overall cancer mortality among participants in the Cancer Prevention Study-II.

METHODS

Sleep was collected at baseline in 1982 among 1.2 million cancer-free US adults. Cancer-specific mortality was determined through 2018. We used multivariable Cox proportional hazard models to calculate hazard ratios and 95% confidence intervals for overall and site-specific cancer mortality, stratified by sex.

RESULTS

Among 983,105 participants (56% female) followed for a median of 27.9 person-years, there were 146,911 primary cancer deaths. Results from the adjusted model showed short (6 h/night) and long (8 h/night and 9-14 h/night) sleep duration, compared to 7 h/night, were associated with a modest 2%, 2%, and 5% higher risk of overall cancer mortality, respectively, and there was a significant non-linear trend (p-trend < 0.01). This non-linear trend was statistically significant among male (p-trend < 0.001) but not female (p-trend 0.71) participants. For male participants, short and long sleep were associated with higher risk of lung cancer mortality and long sleep was associated with higher risk of colorectal cancer mortality. Perceived insomnia was associated with a 3-7% lower risk of overall cancer mortality.

CONCLUSION

Sleep is important to consider in relation to sex- and site-specific cancer mortality. Future research should investigate other components of sleep in relation to cancer mortality.

Using the Complex Network Model to Associate Nutritional, Psychological, and Physical Parameters and Aspects of Sleep with Depression Symptoms

Background/Objectives: Major depressive disorder is a significant public health concern linked to factors such as a low-quality diet, a sedentary lifestyle, and poor sleep quality, all of which contribute to its development; nevertheless, the existing literature lacks a comprehensive framework to effectively integrate these interrelated influences. Methods: To address this gap, we conducted a questionnaire-based study involving 411 individuals aged 18 to 74 and employed a weighted complex network model to clarify the associations among nutritional factors, physical activity levels, psychological parameters, and sleep profiles and depression. In addition to constructing networks that encompass distinct subgroups based on general context, sex differences (female vs. male), and four age categories, our network was designed with a clearly defined target: the score from the Beck Depression Inventory. Results: In all networks studied, psychological parameters (e.g., tension, depression, hostility, fatigue, confusion, and total mood disturbance) emerged as the most influential nodes in relation to the targeted node (Eigenvector centrality of approximately 0.30). Additionally, sleep quality was identified as the next most relevant parameter for the general network (Eigenvector = 0.25), while nutritional factors-particularly carbohydrates-demonstrated greater prestige within the male network (Eigenvector = 0.06). Nutritional parameters had a stronger influence on depressive symptoms among individuals aged 29-39 years (Eigenvectors = 0.09, 0.09, and 0.14 for energy, carbohydrates, and fat, respectively). Conclusions: This novel approach allowed for a clearer visualization of how the studied parameters impact depressive symptoms, revealing significant differences when certain aspects are examined independently across distinct groups.

Associations between Recession Hardships and Subjective and Objective Sleep Measures in the Midlife in the United States Study: Race and Gender Differences

Objectives

This study investigates the associations of retrospective reports of Recession hardships with 10-year changes in subjective and objective indicators of sleep, and whether these associations differ by race and gender.

Methods

501 adults (14.57% Black; 54.49% female) from the Midlife in the United States (MIDUS) study reported on the subjective Pittsburgh Sleep Quality Index (PSQI) across two waves (pre-Recession, collected 2004-2009; post-Recession, collected 2017-2022), as well as Recession hardships since 2008. A sub-sample of 201 adults (25.37% Black; 58.21% female) provided objective actigraphy-measured sleep data (total sleep time, sleep onset latency, sleep efficiency) across the two waves.

Results

Descriptive analyses revealed Black participants had higher average Recession hardships, poorer post-Recession PSQI scores, and poorer post-Recession actigraphy sleep quantity and quality compared to white participants. Females had higher average Recession hardships compared to males; and reported poorer post-Recession PSQI, but had better objective post-Recession sleep quantity and quality compared to males. Regression models showed Recession hardships (across overall events, and sub-domains of financial and housing hardships) were associated with poorer PSQI and actigraphy-measured sleep efficiency following the Recession, adjusting for sociodemographic covariates, corresponding pre-Recession sleep variables, and pre-Recession chronic conditions. There was no evidence for significant moderation by race on sleep outcomes. However, gender moderation indicated associations between housing hardships and poorer actigraphy-measured sleep efficiency were more apparent for females than for males.

Conclusions

Findings indicate that Recession hardships (particularly in financial and housing domains) may be manifested in poor sleep. Racial and gender groups may have differential exposure and sleep-related reactivity to Recession hardships.

The relationships between wanting to nap, actually napping, and depressed and anxious mood

Study Objectives

These studies disentangle the relationships between wanting to nap (nap desire), actually napping (nap behavior), and depressed and anxious mood. Study 1 partially replicated and extended findings connecting napping and depressed and anxious mood. Study 2 explored the distinction between nap desire and behavior using a new, larger sample and a different technique.

Methods

Study 1 used a longitudinal, multimethod approach to understand napping and mood among undergraduate students in the United States (N = 104). In Study 2, a cross-sectional survey was conducted on adults over 25 in the continental United States (N = 1406), including items from the DASS-21 and questions about nap desire and behavior.

Results

Study 1 found a significant relationship between same-day napping behavior and depressed mood (M nap = 1.61, SE nap = 0.08 vs. M no nap = 1.44, SE no nap = 0.06, p = .018) but not anxious mood (p = .766). Study 2 partially replicated those findings; Analysis of Covariance (ANCOVA) showed that napping desire had a significant effect on anxious (F(1, 1291) = 6.86, p = .009, partial η2 = .005) and depressed mood (F(1, 1291) = 13.46, p < .001, partial η2 = .010), accounting for age, gender, and restedness, but napping behavior did not add to that effect.

Conclusions

Wanting to nap is related to greater depressed and anxious mood, but actual napping did not add to that relationship. These results have implications for clinicians using sleep assessment as a screening tool for mental health and highlight the need for further research on napping motivation.

Association between sleep quality, depressive symptoms, and suicidal ideation in college students

Suicide among college students is a challenging problem globally. Yet, the association between sleep quality, depressive symptoms, and suicidal ideation remains unclear. This study aims to understand if depressive symptoms mediate the relationship between sleep quality and suicide ideation and whether the interaction between depressive symptoms and sleep quality on suicidal ideation is additive. A total of 1182 college students were recruited, and sleep quality, depressive symptoms, and suicidal ideation were assessed using questionnaires. Univariate analysis, logistic regression analysis, linear regression models, and the Sobel test were performed. The results showed that, among college students, poor sleep quality was positively associated with suicidal ideation, and the association was mediated through depressive symptoms. Moreover, there was a significant additive interaction between poor sleep quality and depressive symptoms on suicidal ideation. These findings suggest that, in the process of preventing and treating suicidal ideation in college students with sleep disorders, we should focus on the evaluation and intervention of depressive symptoms and adopt multidisciplinary team interventions for college students with sleep disorders and depression.

Effect of sleep quality on repetitive transcranial magnetic stimulation outcomes in depression

Introduction

While repetitive transcranial magnetic stimulation (rTMS) is effective for 50-60% of those treatment-resistant depression, it is critical to identify predictors of response for optimal patient selection to improve therapy. Insomnia is a known symptom of depression that is both correlated with depression severity and associated with poor antidepressant response. Therefore, understanding this relationship may open new opportunities for the optimization of rTMS treatment. We aimed to explore whether baseline sleep quality, specifically insomnia, is associated with rTMS outcomes in a naturalistic sample of 975 patients (age 18-90; 63.9% F) receiving a standard course of rTMS treatment from two outpatient TMS clinics located within psychiatric hospitals in the United States. One site additionally collected information on concurrent medication use on 350 patients; among these, we examined whether pharmacological treatment of insomnia affected TMS treatment response.

Methods

Depression was measured using the 30-item Inventory of Depressive Symptomology Self Report (IDS-SR) in site one and an abbreviated 16-item Quick Inventory of Depressive Symptomology (QIDS) derived from the IDS-SR in site two. Sleep disturbances were measured using three insomnia-related questions. Multilevel logistic regression was used to determine whether baseline insomnia scores were associated with TMS treatment outcome. Upon dichotomous categorization of the sample by insomnia and sleep-medication use, depression and sleep scores were analyzed across time using mixed repeated measures ANOVA.

Results

We found that sleep quality improves after TMS (p<.001) and correlates with improvement in non-insomnia related depression symptoms (r= .318, p<.001). We found that among those who had significant insomnia at baseline, those not using sleep medications had significantly worse post-treatment IDS-SR scores compared to those using sleep medications (p=. 021) despite no difference in final insomnia score.

Discussion

Together, our results suggest that while baseline insomnia is not associated with TMS effectiveness, treating insomnia may affect the trajectory of TMS therapy. Future prospective studies are needed to examine the effect of insomnia treatment alongside TMS for depression.

Insomnia-related rodent models in drug discovery

Despite the widespread prevalence and important medical impact of insomnia, effective agents with few side effects are lacking in clinics. This is most likely due to relatively poor understanding of the etiology and pathophysiology of insomnia, and the lack of appropriate animal models for screening new compounds. As the main homeostatic, circadian, and neurochemical modulations of sleep remain essentially similar between humans and rodents, rodent models are often used to elucidate the mechanisms of insomnia and to develop novel therapeutic targets. In this article, we focus on several rodent models of insomnia induced by stress, diseases, drugs, disruption of the circadian clock, and other means such as genetic manipulation of specific neuronal activity, respectively, which could be used to screen for novel hypnotics. Moreover, important advantages and constraints of some animal models are discussed. Finally, this review highlights that the rodent models of insomnia may play a crucial role in novel drug development to optimize the management of insomnia.

Changes in slow-wave sleep characteristics in Parkinson's disease patients with mild-moderate depression

INTRODUCTION

Depression and sleep disturbances are commonly seen non-motor symptoms in patients with Parkinson's disease (PD). This study used polysomnography to examine the relationship between mild-moderate depression in PD and sleep characteristics, particularly slow wave activities (SWA).

METHODS

59 PD patients were split into two groups: nd-PD (n = 27) (patients with PD without depression) and d-PD (n = 32) (patients with PD with mild-moderate depression). Their clinical features, polysomnography parameters, and demographics were evaluated. Early and late sleep SWA spectrum densities and overnight SWA decline in different brain regions were particularly analyzed.

RESULTS

Non-rapid eye movement 3 (N3) sleep duration and percentage were greater in the d-PD group. N3 percentage was linked to depression (p = 0.014). During late sleep, higher SWA (0.5-4Hz) in the frontal and central regions, higher low-SWA (0.5-2Hz) in the whole brain, central and occipital regions, and higher high-SWA (2-4Hz) in the frontal region was observed in the d-PD group. During early sleep, there was also higher low-SWA (0.5-2Hz) in the occipital region. Patients in d-PD group exhibited reduced overnight high-SWA (2-4Hz) decline (Δhigh-SWA) in the whole brain and occipital regions. Δhigh-SWA(2-4Hz) in the occipital region were associated with depression (p = 0.049).

CONCLUSION

PD patients with mild-moderate depression have impaired slow wave sleep, exhibiting as increased N3 sleep, SWA, and reduced overnight SWA decline. This implies that synaptic strength reduction during sleep and impaired synaptic homeostasis regulation may be associated with depression in PD. Reduced overnight high-SWA decline in the occipital region may serve as a novel electrophysiological biomarker for indicating depression in PD.

Subclinical hypomanic experiences in young adults after sleep deprivation are independent of depressive disorders, chronotype or 5-HTTLPR polymorphism

INTRODUCTION

The acute antidepressant effect of sleep deprivation (SD) in patients with depressive disorders has been studied for more than 60 years. However, hypomanic mood swings after partial or total SD have also been described in people without diagnosed mental disorders. Studying this phenomenon in the general population may yield insights about the mechanisms of therapeutic SD, mania and bipolar disorders.

METHODS

A cross-sectional sample of young adults was recruited and classified into those who described having regularly occurring subclinical hypomanic experiences (ROHE) after SD and those who did not. History of psychiatric and physical illness, with screening for depression and mania, as well as alcohol or drug consumption, family history of depressive disorders or suicide, 5-HTTLPR polymorphism, and MEQ-SA chronotype were collected.

RESULTS

A total of 251 participants were included; 39.0% indicated regularly having subclinical hypomanic experiences after SD. These experiences were not associated with depressive or mania screening, history of psychiatric illness, family history, 5-HTTLPR polymorphism, or MEQ-SA chronotype.

CONCLUSIONS

ROHE after non-therapeutic SD seem to be a relatively common phenomenon in young adults, independent of depressive mood state. Our results suggest that therapeutic SD may depend on a physiological phenomenon of subclinical affective disturbance after SD that affects a part of the general population, independent of psychiatric diagnosis. Further studies could elucidate associated factors and contribute to our understanding of (hypo-)manic mood states.

Association between vitamin D, depression, and sleep health in the National Health and Nutrition Examination Surveys: a mediation analysis

OBJECTIVE

This study aimed to assess the association between vitamin D and sleep health and to investigate whether depression could mediate this relationship.

METHODS

A cross-sectional analysis was performed using the 2005-2014 US National Health and Nutrition Examination Survey (NHANES) data. The logistic regression models were conducted to evaluate association of serum vitamin D concentrations with sleep health and depression. Mediation analyses were conducted to investigate the mediated effects of depression on the association of vitamin D with sleep health.

RESULTS

In multivariate logistic models, vitamin D was found to be negatively associated with an increased risk of poor sleep health, with an odds ratio (OR) of vitamin D deficiency versus sufficiency was 1.256 (95% CI = 1.084-1.455). Additionally, univariate logistic models showed that vitamin D was also negatively associated with depression risk (vitamin D deficiency vs. sufficiency: OR = 1.699, 95% CI = (1.373-2.103). Further mediation analyses showed that the association of vitamin D with sleep health was mediated by depression, with the mediating effects of depression accounted for 44.56% of the total effects.

CONCLUSION

Vitamin D affects sleep health directly and indirectly through depression. The results suggest that interventions increasing intake of vitamin D should be prioritized to promote sleep health of persons with or at risk of depression.

Effects of three-duration Tai-Chi exercises on depression and sleep quality in older women

OBJECTIVE

This study aims to explore the effects of 24 weeks of three-duration Tai-Chi (TC) practice on depression and sleep quality in older women.

METHODS

A total of 124 older women were randomly divided into four groups: short-time group (SG, n = 31, mean age: 65.3), medium-time group (MG, n = 30, mean age: 65.7), long-time group (LG, n = 32, mean age: 64.9) and control group (CG, n = 31, mean age: 66.2). The Beck Depression Inventory (BDI) and Pittsburgh Sleep Quality Index (PSQI), and serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and 5-hydroxytryptamine (5-HT) were measured.

RESULTS

1) Within-group comparisons: Compared with the baseline, the 12th and 24th weeks showed reductions in TNF-α and IL-6 levels and increase in 5-HT level in the SG, MG and LG (p < 0.05). The LG at the 24th week had reduced BDI and PSQI scores (p < 0.05). Compared with the 12th week, the 24th week showed reductions in TNF-α and IL-6 levels (p < 0.01) and increase in 5-HT level (p < 0.05) in the SG, MG, and LG. 2) Between-group comparisons: The SG, MG, and LG had lower TNF-α and IL-6 levels and higher 5-HT level than the CG at 12th and 24th weeks (p < 0.05). At the 24th week, the LG had lower BDI and PSQI scores than the CG and lower TNF-α level than the SG and MG (p < 0.05). The MG had lower TNF-α levels than the SG in the 24th week (p < 0.01).

CONCLUSION

These results indicate that older individuals may undertake at least 12 weeks of TC exercise with a duration of 60 min per session to significantly improve depressive mood and sleep quality.

Home parenteral nutrition, sleep patterns, and depressive symptoms: Secondary analysis of cross-sectional data

BACKGROUND

Patients receiving home parenteral nutrition (HPN) are known to experience psychological distress and have profoundly disrupted sleep. The aim of this analysis was to examine the relationship between sleep patterns with depressive symptoms and HPN characteristics.

METHODS

The study was a secondary analysis of cross-sectional data examining sleep patterns using subjective and objective measures. Sleep was assessed by surveys and 7-day actigraphy. The Patient Health Questionnaire-8 was used to evaluate depressive symptoms. Participants provided information on HPN. Spearman correlations were calculated between sleep measures with depressive symptoms and HPN characteristics. Correlations were further examined in multivariable linear regression models.

RESULTS

Thirty-two adults (age = 53 years; 75% female; 94% White) were included. Lower sleep quality (r = 0.54-0.60; P < 0.001) and later sleep timing (r = -0.35; P = 0.049) were correlated with higher depressive symptoms. Sleep patterns were also correlated with several HPN characteristics (r = -0.47 to 0.51). In linear regression models, rate of infusion was associated with sleep duration (β = -0.004 [0.002] h; P = 0.046) in which each 100 mL/h was associated with 24-min shorter duration. Higher total energy was associated with lower sleep quality (β = 0.0004 [0.0002] log-unit; P = 0.042), and higher volume was associated with longer sleep onset latency (β = 0.0006 [0.0003] log-min; P = 0.049).

CONCLUSIONS

We provide evidence supporting the link between poor and later sleep with higher depressive symptoms and identify potentially modifiable infusion characteristics (notably, slower rate of infusion and lower total energy and volume) that, on further verification, may support sleep among those receiving HPN.

Psychiatric Characteristics, Symptoms of Insomnia and Depression, Emotion Regulation, and Social Activity among Swiss Medical Students

Background: Almost by default, young adult students are at increased risk of suffering from mental health issues, and this holds particularly true for medical students. Indeed, compared to the general population and non-medical students, medical students report higher scores for symptoms of depression. For Swiss medical students, research on the associations between psychiatric characteristics and symptoms of depression and insomnia, including cognitive-emotional processes and social activity, has been lacking so far. Given this, the aims of the present study were to relate self-declared psychiatric characteristics to symptoms of depression, insomnia, emotion regulation, and social activity. Methods: A total of 575 medical students (mean age: 22.4 years; 68.9% females) completed an online survey covering sociodemographic information (age and gender), study context (year of study), self-declared psychiatric characteristics and symptoms of depression, insomnia, emotion regulation (cognitive reappraisal vs. emotion suppression), and social activity. Data on insomnia sum scores and categories of historical samples (862 non-medical students and 533 police and emergency response service officers) were used for comparison. Results: Of the 575 participants, 190 participants (33%) self-declared psychiatric issues, such as major depressive disorder; anxiety disorders, including PTSD and adjustment disorders; eating disorders; ADHD; or a combination of such psychiatric issues. Self-reporting a psychiatric issue was related to higher symptoms of depression and insomnia and lower symptoms of social activity and cognitive reappraisal (always with significant p-values and medium effect sizes). Compared to historical data for non-medical students and police and emergency response service officers, medical students reported higher insomnia scores. In a regression model, current self-declared psychiatric issues, female gender, higher scores for insomnia, and lower scores for social activity were associated with higher scores for depression. Conclusions: Among a sample of Swiss medical students, the occurrence of self-declared psychiatric issues was associated with higher scores for depression and insomnia and lower cognitive reappraisal and social activity. Further, insomnia scores and insomnia categories were higher when compared to non-medical students and to police and emergency response service officers. The data suggest that medical schools might introduce specifically tailored intervention and support programs to mitigate medical students' mental health issues. This holds particularly true for insomnia, as standardized and online-delivered treatment programs for insomnia (eCBTi) are available.

Sleep architecture in idiopathic hypersomnia: the influence of age, sex, and body mass index

This study aimed to progress the understanding of idiopathic hypersomnia (IH) by assessing the moderating influence of individual characteristics, such as age, sex, and body mass index (BMI) on sleep architecture. In this retrospective study, 76 IH participants (38.1 ± 11.3 years; 40 women) underwent a clinical interview, an in-laboratory polysomnography with a maximal 9-h time in bed and a multiple sleep latency test (MSLT). They were compared to 106 healthy controls (38.1 ± 14.1 years; 60 women). Multiple regressions were used to assess moderating influence of age, sex, and BMI on sleep variables. We used correlations to assess whether sleep variables were associated with Epworth Sleepiness Scale scores and mean sleep onset latency on the MSLT in IH participants. Compared to controls, IH participants had shorter sleep latency (p = 0.002), longer total sleep time (p < 0.001), more time spent in N2 sleep (p = 0.008), and showed trends for a higher sleep efficiency (p = 0.023) and more time spent in rapid eye movement (REM) sleep (p = 0.022). No significant moderating influence of age, sex, or BMI was found. More severe self-reported sleepiness in IH patients was correlated with shorter REM sleep latency and less N1 sleep in terms of proportion and duration (ps < 0.01). This study shows that, when compared to healthy controls, patients with IH had no anomalies in their sleep architecture that can explain their excessive daytime sleepiness. Moreover, there is no moderating influence of age, sex, and BMI, suggesting that the absence of major group differences is relatively robust.

The mediating role of sleep disturbance in the relationship between depression and cardiovascular disease

Background

Studies suggest that both depression and disrupted sleep disturbance are linked to cardiovascular disease (CVD). However, the precise role of sleep disturbance in the connection between depression and CVD is poorly understood. Therefore, we sought to examine the associations among these factors and further explore the mediating role of sleep disturbance in the association between depression and CVD.

Methods

This study included data from 29,831 adults (≥20 years old). Multifactorial logistic regression analyses were conducted to examine the relationships among depression, sleep disturbance, and CVD. Additionally, bootstrap tests were used to investigate whether the association between depression and CVD was mediated by sleep disturbance.

Results

Our research showed that individuals who experienced depression or sleep disturbance had a notably greater likelihood of developing CVD than those who did not have these issues (depression: OR: 2.21, 95% CI=1.96-2.49; sleep disturbance: OR: 1.74, 95% CI=1.6-1.9). Even after adjusting for potential confounders, depression was still positively associated with the risk of sleep disturbance (OR: 4.07, 95% CI=3.73-4.44). Furthermore, sleep disturbance significantly mediated the association between depression and CVD, with a mediating effect of 18.1%.

Conclusion

Our study demonstrated that depression, sleep disturbance, and CVD are interrelated. The increased risk of CVD among patients with depression may be attributed to the mediating role of sleep disturbance. This finding underscores the importance of interventions focused on sleep disturbances as a means to address the connection between depression and CVD.

Exploring the relationship between sleep patterns and depression among Chinese middle school students: a focus on sleep quality vs. sleep duration

Objective

This study aims to explore the relationship between sleep patterns and depressive symptoms among adolescents, examining variations in depressive symptoms across different sleep qualities, durations, and habits.

Method

A cross-sectional survey was conducted, gathering data from 8,775 Chinese adolescents on their demographics, lifestyle habits, sleep quality and duration, and depressive symptoms. The association between sleep parameters and depressive symptoms was analyzed using multivariate logistic regression.

Findings

The findings reveal a significant correlation between sleep quality/duration and depressive symptoms. Specifically, adolescents with poor sleep quality had higher depressive scores (mean score = 14.62, standard deviation = 5.71), significantly exceeding those with better sleep quality (mean score = 11.54, standard deviation = 4.69). Adolescents with shorter sleep duration also showed significantly higher depressive scores than those with moderate sleep duration. Importantly, adolescents experiencing both poor sleep quality and shorter sleep duration were at a significantly increased risk of depressive symptoms (OR = 4.04, 95% CI: 3.53-4.62, P < 0.001). Further analysis indicated that older age and lower family economic status were independent predictors of a higher risk of adolescent depression (OR = 1.22, 95% CI: 1.08-1.38, P = 0.001), whereas factors such as gender, ethnicity, residence, being an only child, and parental education levels were not statistically significant.

Conclusion

Among Chinese adolescents, poor sleep quality and shorter sleep duration are independent predictors of higher depressive symptom scores. Adolescents experiencing both of these conditions simultaneously have a significantly increased risk of depressive symptoms. Furthermore, older age and lower family economic status are also significantly related to an increased risk of depression in adolescents. These findings emphasize the importance of improving sleep quality and optimizing sleep duration for the prevention of adolescent depression. They also suggest the need for a comprehensive approach that addresses the multifaceted factors influencing adolescent mental health, including sleep patterns and socioeconomic disparities.

Understanding the sleep-pain relationship in patients with interstitial cystitis/bladder pain syndrome

INTRODUCTION

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic pelvic pain condition with critical symptoms of urinary urgency and frequency, persistent bladder-related pain, and reduced quality of life. Poor-quality sleep can lead to significant disturbances in daily life and increased pain in IC/BPS patients. Resilience, depressive symptoms, and pain catastrophizing have univariate associations with sleep and pain in IC/BPS, suggesting they may be mechanisms in this sleep and pain relationship.

METHODS

This online study recruited patients self-reporting a diagnosis of IC/BPS through support groups, social media posts (Facebook, Reddit, and Instagram), and urology clinic advertisements. Participants completed questionnaires on demographics, urologic symptoms, pain, pain catastrophizing, depressive symptoms, and resilience. Only those participants who met the RAND Interstitial Cystitis Epidemiology (RICE) criteria for IC/BPS diagnosis were included. A multiple mediation model was first examined, followed by a serial mediation model.

RESULTS

Seventy-four participants (Mage= 47.0, standard deviation [SD ] 16.7, range 18-83 years) met inclusion criteria. A multiple mediation model showed greater sleep disturbance was associated with greater pain severity through depressive symptoms and pain catastrophizing, but not resilience (b=0.79, bootSE =0.26, bootCI [0.33, 1.35]). A serial mediation showed that the sleep-to-pain relationship had a significant indirect effect through pain catastrophizing and depressive symptoms (b=0.78, bootSE =0.26, bootCI [0.35, 1.32]).

CONCLUSIONS

Findings suggest depressive symptoms and pain catastrophizing may be important psychosocial mechanisms in the sleep-to-pain relationship. These results help guide future sleep and pain research in IC/BPS and aid in developing and refining treatments.

Reduced coupling between global signal and cerebrospinal fluid inflow in patients with depressive disorder: A resting state functional MRI study

BACKGROUND

Depressed patients often suffer from sleep disturbance, which has been recognized to be responsible for glymphatic dysfunction. The purpose of this study was to investigate the coupling strength of global blood‑oxygen-level-dependent (gBOLD) signals and cerebrospinal fluid (CSF) inflow dynamics, which is a biomarker for glymphatic function, in depressed patients and to explore its potential relationship with sleep disturbance by using resting-state functional MRI.

METHODS

A total of 138 depressed patients (112 females, age: 34.70 ± 13.11 years) and 84 healthy controls (29 females, age: 36.6 ± 11.75 years) participated in this study. The gBOLD-CSF coupling strength was calculated to evaluate glymphatic function. Sleep disturbance was evaluated using the insomnia items (item 4 for insomnia-early, item 5 for insomnia-middle, and item 6 for insomnia-late) of The 17-item Hamilton Depression Rating Scale for depressed patients, which was correlated with the gBOLD-CSF coupling strength.

RESULTS

The depressed patients exhibited weaker gBOLD-CSF coupling relative to healthy controls (p = 0.022), possibly due to impairment of the glymphatic system. Moreover, the gBOLD-CSF coupling strength correlated with insomnia-middle (r = 0.097, p = 0.008) in depressed patients. Limitations This study is a cross-sectional study.

CONCLUSION

Our findings shed light on the pathophysiology of depression, indicating that cerebral waste clearance system deficits are correlated with poor sleep quality in depressed patients.

Effects of routine repetitive transcranial magnetic stimulation on the sleep duration of patients with treatment-resistant depression: A prospective cohort study

Aim

The aim of this study was to evaluate the short-term and long-term effects of routine repetitive transcranial magnetic stimulation (rTMS) on the sleep duration, depressive symptoms, and quality of life of patients with treatment-resistant depression (TRD).

Methods

In this prospective cohort study, 25 participants with TRD were assessed using the Insomnia Severity Index (ISI) and four sleep duration components of the Pittsburgh Sleep Quality Index (PSQI). Depression severity was measured with Hamilton's Depression Rating Scale (HDRS) and Beck's Depression Inventory (BDI-II), and patient-perceived quality of life with the 36-Item Short-Form Survey (SF-36). All of these measures were evaluated at baseline (T0), and immediately (T1), 6 weeks (T2), and 12 weeks (T3) after the end of intervention.

Results

At T1 endpoint, HDRS, BDI, SF-36, ISI, and three PSQI items (time to wake up, time taken to fall asleep, and Real Sleep Time) significantly improved, though these gains were reduced at follow-up endpoints (T2 and T3). Adjusting for confounders (age, sex, occupational status, BMI, and hypnotic medication) revealed that only improvements in HDRS, BDI, and time taken to fall asleep at T1 remained statistically significant. Linear regression analyses showed no significant association between reduced time taken to fall asleep and depression symptoms, suggesting rTMS can independently enhance this parameter, irrespective of depression resolution.

Conclusion

Routine rTMS therapy can potentially enhance sleep duration in TRD individuals, alongside improved depressive symptoms and quality of life. However, these benefits tend to decrease over long-term follow-up, emphasizing a more pronounced short-term efficacy of rTMS.

Movement Termination of Slow-Wave Sleep-A Potential Biomarker?

The duration of slow-wave sleep (SWS) is related to the reported sleep quality and to the important variables of mental and physical health. The internal cues to end an episode of SWS are poorly understood. One such internal cue is the initiation of a body movement, which is detectable as electromyographic (EMG) activity in sleep-electroencephalography (EEG). In the present study, we characterized the termination of SWS episodes by movement to explore its potential as a biomarker. To this end, we characterized the relation between the occurrence of SWS termination by movement and individual characteristics (age, sex), SWS duration and spectral content, chronotype, depression, medication, overnight memory performance, and, as a potential neurological application, epilepsy. We analyzed 94 full-night EEG-EMG recordings (75/94 had confirmed epilepsy) in the video-EEG monitoring unit of the EpiCARE Centre Salzburg, Austria. Segments of SWS were counted and rated for their termination by movement or not through the visual inspection of continuous EEG and EMG recordings. Multiple linear regression was used to predict the number of SWS episodes that ended with movement by depression, chronotype, type of epilepsy (focal, generalized, no epilepsy, unclear), medication, gender, total duration of SWS, occurrence of seizures during the night, occurrence of tonic-clonic seizures during the night, and SWS frequency spectra. Furthermore, we assessed whether SWS movement termination was related to overnight memory retention. According to multiple linear regression, patients with overall longer SWS experienced more SWS episodes that ended with movement (t = 5.64; p = 0.001). No other variable was related to the proportion of SWS that ended with movement, including no epilepsy-related variable. A small sample (n = 4) of patients taking Sertraline experienced no SWS that ended with movement, which was significant compared to all other patients (t = 8.00; p < 0.001) and to n = 35 patients who did not take any medication (t = 4.22; p < 0.001). While this result was based on a small subsample and must be interpreted with caution, it warrants replication in a larger sample with and without seizures to further elucidate the role of the movement termination of SWS and its potential to serve as a biomarker for sleep continuity and for medication effects on sleep.

Quercetin attenuates brain apoptosis in mice with chronic unpredictable mild stress-induced depression

BACKGROUND

Depression is a common psychiatric disorder with limited effective treatments. Research suggests that depression involves apoptosis mechanisms. Quercetin (QUE) has been reported to have anti-apoptotic activities. In this study, we aimed to investigate the effects and mechanisms of QUE in chronic unpredictable mild stress (CUMS)-induced depression.

METHODS

After establishing mouse models of CUMS-induced depression, the mice were randomly assigned into four groups: control, CUMS, CUMS+QUE, and CUMS+Fluoxetine (FLX). The body weight of the mice was measured during the study. Then, depression-associated behaviors were evaluated using the sucrose preference test (SPT), novelty suppressed feeding test (NSFT), forced swim test (FST) and tail suspension test (TST). Apoptosis in the hippocampus and prefrontal cortex was determined using flow cytometry. Bcl-2 and Nrf2 protein expressions in the hippocampus and prefrontal cortex were also detected. Furthermore, Western blot was used to measure the protein levels of p-ERK, ERK, p-CREB, CREB, and Nrf2 in brain tissues.

RESULTS

QUE or FLX administration increased the body weight of the CUMS mice. Behavioral tests indicated that CUMS mice developed a state of depression, but QUE or FLX treatment improved their depression-associated behaviors. Meanwhile, QUE or FLX treatment decreased apoptosis in the hippocampus and prefrontal cortex. Furthermore, the decreased Nrf2 protein expression, ERK and CREB phosphorylation in CUMS group were enhanced by QUE or FLX administration.

CONCLUSION

QUE could attenuate brain apoptosis in mice with CUMS-induced depression, and the mechanism may be related to the ERK/Nrf2 pathway, indicating that QUE could be a potential treatment for depression.

Resting-State EEG Reveals Abnormal Microstate Characteristics of Depression with Insomnia

Previous research revealed various aspects of resting-state EEG for depression and insomnia. However, the EEG characteristics of depressed subjects with insomnia are rarely studied, especially EEG microstates that capture the dynamic activities of the large-scale brain network. To fill these research gaps, the present study collected resting-state EEG data from 32 subclinical depression subjects with insomnia (SDI), 31 subclinical depression subjects without insomnia (SD), and 32 healthy controls (HCs). Four topographic maps were generated from clean EEG data after clustering and rearrangement. Temporal characteristics were obtained for statistical analysis, including cross-group variance analysis (ANOVA) and intra-group correlation analysis. In our study, the global clustering of all individuals in the EEG microstate analysis revealed the four previously discovered categories of microstates (A, B, C, and D). The occurrence of microstate B was lower in SDI than in SD and HC subjects. The correlation analysis showed that the total Pittsburgh Sleep Quality Index (PSQI) score negatively correlated with the occurrence of microstate C in SDI (r = - 0.415, p < 0.05). Conversely, there was a positive correlation between Self-rating Depression Scale (SDS) scores and the duration of microstate C in SD (r = 0.359, p < 0.05). These results indicate that microstates reflect altered large-scale brain network dynamics in subclinical populations. Abnormalities in the visual network corresponding to microstate B are an electrophysiological characteristic of subclinical individuals with symptoms of depressive insomnia. Further investigation is needed for microstate changes related to high arousal and emotional problems in people suffering from depression and insomnia.

Quality of Life Among Older Adults With Frailty: A Structural Equation Modeling

PURPOSE

Frailty is a complex age-related clinical condition among older adults. Quality of life (QOL) among older adults with frailty is an important topic of interest. The current cross-sectional study aimed to develop a structural equation model to identify factors affecting QOL.

METHOD

A total of 180 older adults with frailty were recruited from general units in two hospitals in Fuzhou, China. Data were collected using the World Health Organization Quality of Life Brief Version, Pittsburgh Sleep Quality Index, Geriatric Depression Scale-15, and Simplified Coping Style Questionnaire. Structural equation modeling was used to analyze data.

RESULTS

The final model exhibited a good fit. Poor sleep quality was associated with depression, passive coping style, and poor QOL. Depression was also associated with poor QOL. Passive coping style was associated with better QOL.

CONCLUSION

This study demonstrated that sleep quality has direct and indirect effects on QOL of older adults with frailty through depression and passive coping style. Recommendations are that care providers pay attention to biological and physiological variables, symptom status, and functional status of older adults with frailty. This study also provides a theoretical basis for developing interventions that may lead to improvements in QOL among older adults with frailty. [Journal of Psychosocial Nursing and Mental Health Services, 62(5), 49-55.].

Sleep architecture and the incidence of depressive symptoms in middle-aged and older adults: A community-based study

BACKGROUND

Rapid eye movement (REM) sleep and three stages of non-REM (NREM) sleep comprise the full sleep cycle. The changes in sleep have been linked to depression risk. This study aimed to explore the association between sleep architecture and depressive symptoms.

METHODS

A total of 3247 participants from the Sleep Heart Health Study (SHHS) were included in this cohort study. REM and NREM sleep were monitored by in-home polysomnography at SHHS visit 1. Depressive symptoms was reported as the first occurrence between SHHS visits 1 and 2 (mean follow-up of 5.3 years). Multivariable logistic regression was used to investigate the relationship between sleep stages and depressive symptoms.

RESULTS

In total, 225 cases of depressive symptoms (6.9 %) were observed between SHHS visits 1 and 2. A significant linear association between NREM Stage 1 and depressive symptoms was found after adjusting for potential covariates. Multivariable logistic regression analysis showed that percentage in NREM Stage 1 was associated with the incidence of depressive symptoms (odds ratio [OR], 1.06; 95 % confidence interval [CI], 1.02-1.10; P = 0.001), as were time in NREM Stage 1 and depressive symptoms (OR, 1.02; 95 % CI, 1.01-1.03; P = 0.001). However, no significant association with depressive symptoms was found for other sleep stage.

LIMITATIONS

The specific follow-up time for depressive symptoms diagnosis was missing.

CONCLUSIONS

Increased time or percentage in NREM Stage 1 was associated with a higher risk of developing depressive symptoms. The early change in sleep architecture were important for incidence of depressive symptoms and warrants constant concerns.

Development and validation of the core life activities scale

Life activities profoundly influence well-being, mental health, and quality of life. The COVID-19 pandemic has heightened the importance of monitoring these activities for psychological and emotional health. However, existing measurement tools are limited, particularly for assessing psychological health. To address this gap, we developed and validated the Core Life Activities (CORE) scale, comprising five key factors (sleep, exercise, learning, diet, and social relationships) identified in neuroscience, cognitive psychology, and gerontology. In Study 1 (n = 1,137), exploratory and confirmatory factor analyses supported a single-factor structure with good model fit (χ2 = 6.377, df = 3, TLI = 0.992, CFI = 0.998, RMSEA = 0.031), demonstrating robust internal consistency (Cronbach's alpha = 0.776) and test-retest reliability (intraclass correlation coefficient = 0.522, p < 0.001). The CORE exhibited significant convergent validity with mental health screening tools for depressive and anxiety disorders and suicidality. Study 2 (n = 684) confirmed a significant correlation between CORE and the World Health Organisation Quality of Life Brief Version, complementing the convergent validity found in Study 1. In addition, discriminant validity was confirmed by a non-significant correlation with the COVID-19 Preventive Behavior Scale. The findings establish the CORE as a reliable and valid tool, offering a simple yet comprehensive measure for assessing core life activities with potential applications in diverse environments.

Decreased structural pathways mediating functional connectivity in obstructive sleep apnea

BACKGROUND

Obstructive sleep apnea (OSA) is a common sleep breathing disorder that is often accompanied by changes in structural connectivity (SC) and functional connectivity (FC). However, the current understanding of the interaction between SC and FC in OSA is still limited.

METHODS

The aim of this study is to integrate complementary neuroimaging modalities into a unified framework using multi-layer network analysis methods and to reveal their complex interrelationships. We introduce a new graph metric called SC-FC bandwidth, which measures the throughput of SC mediating FC in a multi-layer network. The bandwidth differences between two groups are evaluated using the network-based statistics (NBS) method. Additionally, we traced and analyzed the SC pathways corresponding to the abnormal bandwidth.

RESULTS

In both the healthy control and patients with OSA, the majority offunctionally synchronized nodes were connected via SC paths of length 2. With the NBS method, we observed significantly lower bandwidth between the right Posterior cingulate gyrus and right Cuneus, bilateral Middle frontal gyrus, bilateral Gyrus rectus in OSA patients. By tracing the high-proportion SC pathways, it was found that OSA patients typically exhibit a decrease in direct SC-FC, SC-FC triangles, and SC-FC quads intra- and inter-networks.

CONCLUSION

Complex interrelationship changes have been observed between the SC and FC in patients with OSA, which might leads to abnormal information transmission and communication in the brain network.

Hypersomnia as a predictor of response to intravenous ketamine/intranasal esketamine in treatment resistant depression

BACKGROUND

Sleep disturbances are highly prevalent in depressive episodes and are linked to higher mood severity and suicidal behaviors. Slow wave sleep (SWS) and REM sleep are compromised in depression. Current evidence suggests that rapid antidepressant effects of intravenous (IV) ketamine in patients with treatment-resistant depression (TRD) is mediated by its effects on SWS and REM sleep. Sleep phenotypes may help predict ketamine response.

METHOD

In this observational study, we investigated differences in rates of response among sleep phenotypes defined by QIDS-SR in a cohort of patients with TRD (n = 52) treated with IV ketamine or intranasal (IN) esketamine. Also, we explored a neurovegetative symptoms of atypical depression (NVSAD) phenotype and its association between response and change in QIDS-SR following the treatment with IV ketamine/IN esketamine.

RESULTS

94 % of patients reported sleep difficulties and 62 % reported more than one sleep phenotype with middle and early insomnia being the most prevalent. Individuals with baseline hypersomnia showed higher response rates and more pronounced improvements on their QIDS-SR score. Additionally, 15 % of patients presented with NVSAD phenotype; the majority of whom achieved response and had higher reductions on QIDS-SR. A trend towards faster response was identified for hypersomnia and atypical depression phenotypes.

LIMITATIONS

Observational study design and lack of a placebo group.

CONCLUSIONS

Our data indicate that patients with TRD who have baseline hypersomnia and atypical depression features experienced a more substantial reduction in depressive symptoms and are more likely to achieve response with ketamine/esketamine. This could serve as a future predictor for clinical response.

Effect of subanesthetic dose of esketamine on postoperative pain in elderly patients undergoing laparoscopic gastrointestinal tumor Surgery:A prospective, double-blind, randomized controlled trial

Purpose

Postoperative pain is prevalent and severe complication in elderly surgical patients. Multiple studies propose that a small dose of esketamine administered intraoperatively can alleviate postoperative pain and curtail opioid usage. We aimed to evaluate the impact of esketamine on postoperative acute pain among elderly patients with gastrointestinal tumors.

Patients and methods

This is a prospective, parallel-group, randomized controlled trial. Ninety patients aged 60 and above, undergoing resection of gastrointestinal tumors, were randomly assigned to two groups: esketamine group (Group S, a single dose of 0.25 mg/kg and 0.1 mg/kg/h infusion) and control group (Group C, saline). Visual Analogue Scale (VAS) pain scores were the primary outcome. Remifentanil consumption, instances of rescue analgesia, delirium, sleep quality, postoperative recovery quality, serum levels of inflammatory cytokines, and adverse events within 72 h post-surgery were secondary outcomes, respectively.

Results

Data of 87 of 99 eligible patients were analyzed. VAS scores at rest in Group S were lower than those in Group C at 6 h [1.2 (0.6, 1.6) vs 1.6 (1.0, 2.0), P = 0.003], 12 h [1.4 (1.0, 2.0) vs 2.0 (1.5, 2.0), P < 0.001], and 24 h [1.8 (1.3, 2.0) vs 2.2 (1.6, 2.6), P < 0.001] postoperatively. At 6 h post-surgery, VAS score during coughing was lower in Group S than Group C [2.0 (2.0, 2.3) vs 2.0 (2.0, 3.0), P = 0.009]. The instances of rescue analgesia were fewer in group S compared to group C (P = 0.007). Furthermore, the esketamine group showed improved sleep quality and QoR-15 score (P < 0.05) postoperatively.

Conclusion

Intravenous administration of esketamine as an adjunct to general anesthesia can decrease the intensity of pain for 24 h without additional adverse effects after laparoscopic gastrointestinal tumor surgery.

Association between sleep problems and functional disability in community-dwelling older adults

BACKGROUND

Sleep problems are frequently observed in older adults. They can lead to changes in the individual's physical, occupational, cognitive, and social functioning, compromising the performance of activities of daily living and contributing to the occurrence of functional disability. This study evaluated the association between sleep problems and functional disability in community-dwelling older adults.

METHODS

This was a cross-sectional study with data from 10,507 Brazilian community-dwelling older adults participating in the 2013 National Health Survey. The exposure variable was self-reported sleep problems in the last two weeks. The outcome measure was functional disability assessed from self-reported questionnaires, categorized into basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and defined as not being able to perform or having little or a lot of difficulty in at least one of the activities investigated in the domain of interest.

RESULTS

Older adults who reported sleep problems had 1.53 (95%CI: 1.34; 1.75) and 1.42 (95%CI: 1.26; 1.59) greater odds of having a disability in BADL and IADL when compared to individuals who reported having no sleep problems.

CONCLUSIONS

Older adults with sleep problems were more likely to have a functional disability, both in BADL and IADL. Thus, it is important to implement strategies to screen for sleep problems in older adults in primary health care as a preventive strategy for functional disability.

Cortical signatures of sleep are altered following effective deep brain stimulation for depression

Deep brain stimulation (DBS) of the subcallosal cingulate cortex (SCC) is an experimental therapy for treatment-resistant depression (TRD). Chronic SCC DBS leads to long-term changes in the electrophysiological dynamics measured from local field potential (LFP) during wakefulness, but it is unclear how it impacts sleep-related brain activity. This is a crucial gap in knowledge, given the link between depression and sleep disturbances, and an emerging interest in the interaction between DBS, sleep, and circadian rhythms. We therefore sought to characterize changes in electrophysiological markers of sleep associated with DBS treatment for depression. We analyzed key electrophysiological signatures of sleep-slow-wave activity (SWA, 0.5-4.5 Hz) and sleep spindles-in LFPs recorded from the SCC of 9 patients who responded to DBS for TRD. This allowed us to compare the electrophysiological changes before and after 24 weeks of therapeutically effective SCC DBS. SWA power was highly correlated between hemispheres, consistent with a global sleep state. Furthermore, SWA occurred earlier in the night after chronic DBS and had a more prominent peak. While we found no evidence for changes to slow-wave power or stability, we found an increase in the density of sleep spindles. Our results represent a first-of-its-kind report on long-term electrophysiological markers of sleep recorded from the SCC in patients with TRD, and provides evidence of earlier NREM sleep and increased sleep spindle activity following clinically effective DBS treatment. Future work is needed to establish the causal relationship between long-term DBS and the neural mechanisms underlying sleep.

Association between trajectories of maternal depressive symptoms and length of hospital stay, hospitalization costs, and adverse maternal and infantile outcomes: A longitudinal observational study

This study aimed to determine the trajectories of perinatal depression and their relationship with length of hospital stay (LOS), hospitalization costs, and adverse maternal and infantile outcomes. This longitudinal observational study included 525 participants. Perinatal depressive symptoms were assessed at four waves (from the first trimester to the postpartum period). LOS, hospitalization costs, and adverse maternal (sleep, fatigue, anxiety, perceived stress, and memory problems) and infantile outcomes of participants were obtained from medical records and self-reported questionnaires. Trajectories of perinatal depressive symptoms were explored with latent class growth analysis. Associations between trajectories and adverse maternal and infant outcomes were explored with multiple linear regression and binary logistic regression models. The participants' average age was 29.6 ± 3.9 years. Five heterogeneous developmental trajectories of perinatal depressive symptoms were identified as follows: high-level (7.05%), moderate-increasing (12%), remission (15.05%), moderate-level (37.14%), and low-level (28.76%). The average LOS was 5.78 ± 2.13 days, and the average hospitalization costs were 12,695.27 ± 5457.51 yuan. Compared with the trajectory of low-level depressive symptoms, the LOS, hospitalization costs, and likelihood of adverse outcomes of women with high-level and moderate-increasing depressive symptom trajectories increased. The findings capture the heterogeneity of perinatal depression in Chinese women. Women in the moderate-increasing and high-level trajectory groups had longer LOS, more hospitalization costs, and poor birth outcomes. Elucidating the trajectories of perinatal depression and their relationship with maternal and infant health outcomes provides important insights into the development of person-centred care planning for women during pregnancy and postpartum.

Systematic Metabolic Profiling of Mice with Sleep-Deprivation

Adequate sleep is essential for the biological maintenance of physical energy. Lack of sleep can affect thinking, lead to emotional anxiety, reduce immunity, and interfere with endocrine and metabolic processes, leading to disease. Previous studies have focused on long-term sleep deprivation and the risk of cancer, heart disease, diabetes, and obesity. However, systematic metabolomics analyses of blood, heart, liver, spleen, kidney, brown adipose tissue, and fecal granules have not been performed. This study aims to systematically assess the metabolic changes in the target organs caused by sleep deprivation in vivo, to search for differential metabolites and the involved metabolic pathways, to further understand the impact of sleep deprivation on health, and to provide strong evidence for the need for early intervention.

Sleep Disorders and Fatigue among Patients with MS: The Role of Depression, Stress, and Anxiety

Sleep disorders and fatigue represent prominent symptoms frequently experienced by individuals with multiple sclerosis (MS). Some psychological factors such as depression, stress, and anxiety seem to have a relationship with such problems. This study aimed to examine the role of depression, stress, and anxiety in predicting sleep disorders and fatigue among patients with MS. Employing a cross-sectional descriptive-correlational design, the study involved a sample size of 252 participants selected through purposive sampling based on inclusion and exclusion criteria. We utilized a demographic information questionnaire along with the Mini-Sleep Questionnaire (MSQ), Fatigue Severity Scale (FSS), and Depression, Anxiety, and Stress Scale (DASS-21) to collect data and analyzed them applying SPSS22, incorporating statistical measures including Pearson correlation and regression. The results of the Pearson correlation coefficient showed that sleep disorders had a positive and significant relationship with depression (r = 0.56; P < 0.001), stress (r = 0.40; P < 0.001), and anxiety (r = 0.52; P < 0.001). There was no significant relationship between age and the development of sleep disorders in total score (r = -0.001; P < 0.985), but age had a relationship with insomnia (r = -0.146; P < 0.021) and oversleeping (r = 0.153; P < 0.015). Age and fatigue did not have a significant relationship as well (r = -0.044; P < 0.941). In addition, fatigue had a positive and significant relationship with depression (r = 0.52; P < 0.001), stress (r = 0.48; P < 0.001), and anxiety (r = 0.54; P < 0.001). The results of the regression analysis also showed that depression, stress, and anxiety predict 0.37% of the total variance of sleep disorders (F = 48.34; P < 0.001) and 0.35% of the total variance of fatigue (F = 44.64; P < 0.001). Our findings suggest that depression, stress, and anxiety play a significant role in predicting sleep disorders and fatigue among patients with MS. This study has been reported in accordance with the TREND checklist for nonrandomized trials.