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Wang X, Cao X, Yu J, Jin S, Li S, Chen L, Liu Z, Ge X, Lu Y. Associations of perceived stress with loneliness and depressive symptoms: the mediating role of sleep quality. BMC Psychiatry 2024; 24:172. [PMID: 38429635 PMCID: PMC10905934 DOI: 10.1186/s12888-024-05609-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/14/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Whether perceived stress is associated with loneliness and depressive symptoms in general adults, and to what extent sleep quality mediates the associations, remains unknown. The aim of this study was to estimate the associations of perceived stress with loneliness and depressive symptoms, and the mediating role of sleep quality in these associations. METHODS Cross-sectional data on 734 participants (aged 18-87 years) were analyzed. Perceived stress was assessed using the 10-item Perceived Stress Scale (PSS-10; range 0-40). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI; range 0-21). Loneliness was assessed using the three-item short form of the Revised University of California, Los Angeles (UCLA) loneliness scale (range 3-9). Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression (CESD-10) Scale (range 0-30). General linear regression models, multivariable logistic regression models, and formal mediation analysis were performed. RESULTS After adjustment for age and sex, we found that with each 1-point increment in the perceived stress score, both the loneliness score (β = 0.07; 95% confidence interval [CI]: 0.06, 0.08) and depression score (β = 0.45; 95% CI: 0.40, 0.49) increased significantly. Robust results were observed when adjusting for more confounders. Furthermore, sleep quality mediated 5.3% (95% CI: 1.3%, 10.0%; P = 0.014) and 9.7% (95% CI: 6.2%, 14.0%; P < 0.001) of the associations of perceived stress score with loneliness score and depression score, respectively. CONCLUSIONS In general Chinese adults, perceived stress was positively associated with loneliness and depressive symptoms, and sleep quality partially mediated these associations. The findings reveal a potential pathway from perceived stress to mental health through sleep behaviors, and highlight the importance of implementing sleep intervention programs for promoting mental health among those who feel highly stressed.
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Affiliation(s)
- Xiao Wang
- Department of General Practice, Dongyang People's Hospital, 322100, Jinhua, Zhejiang, China
| | - Xingqi Cao
- Center for Clinical Big Data and Analytics Second Affiliated Hospital, Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, 310058, Hangzhou, Zhejiang, China
| | - Jiening Yu
- Center for Clinical Big Data and Analytics Second Affiliated Hospital, Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, 310058, Hangzhou, Zhejiang, China
| | - Shuyi Jin
- Center for Clinical Big Data and Analytics Second Affiliated Hospital, Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, 310058, Hangzhou, Zhejiang, China
| | - Shengyi Li
- School of Mathematical Sciences, University of Nottingham, University Park, NG7 2RD, Nottingham, UK
| | - Liying Chen
- Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 310016, Hangzhou, Zhejiang, China
| | - Zuyun Liu
- Center for Clinical Big Data and Analytics Second Affiliated Hospital, Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine, 310058, Hangzhou, Zhejiang, China.
| | - Xuan Ge
- Health Management Center, Dongyang People's Hospital, 322100, Jinhua, Zhejiang, China.
| | - Yangzhen Lu
- Department of General Practice, Dongyang People's Hospital, 322100, Jinhua, Zhejiang, China.
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