Association between habitual weekday sleep duration and depressive symptoms among Chinese adolescents:The role of mode of birth delivery

Different correlation between depressive symptoms and sleep duration on weekdays/weekends among adolescents in Taiyuan, North China

OBJECTIVE

In Chinese adolescents, the co-occurrence of depressive symptoms and short sleep duration constitute a serious public health issue. This study investigates the association between depressive symptoms and sleep duration of Chinese adolescents on weekdays as well as weekends.

METHODS

A multistage random cluster selection was utilized to select 2660 adolescents in Taiyuan, China. The survey contents included demographic characteristics, sleep duration, and depressive symptoms.

RESULTS

About 41.95 % of students reported depressive symptoms with an average sleep duration of 7.71 ± 0.90 h. After adjusting for covariates, depressive symptoms were found to be positively correlated with sleep duration <6 h (OR = 1.88, 95 % CI: 1.20, 2.95) and 6 ~ h (OR = 1.61, 95 % CI: 1.18, 2.20) on weekdays, and sleep duration <6 h (OR = 2.10, 95 % CI: 1.17, 3.79) and 6 ~ hours (OR = 1.74, 95 % CI: 1.16, 2.62) on weekends compared with a sleep duration of 8 ~ hours. Only on weekdays, sleep duration of 7 ~ hours was positively correlated with depressive symptoms (OR = 1.39, 95%CI: 1.05, 1.84). On weekends, it was not associated with depressive symptoms (OR = 1.06, 95%CI: 0.82, 1.39). In subgroup analyses, female students (OR = 2.88, 1.97, 1.50) and middle school students (OR = 3.50, 2.07, 1.50) were more likely to experience depressive symptoms on weekdays with a sleep duration of <6 h, 6 ~ hours and 7 ~ hours.

LIMITATIONS

Sleep duration and depressive symptoms were self-reported measures.

CONCLUSION

The study highlights that short sleep duration (< 7 h) increases the risk of depressive symptoms among adolescents regardless of weekdays or weekends. Just on weekdays, the sleep duration of 7 ~ hours was a risk factor for depressive symptoms. Further, gender, grade, and the only-child played significant modification effects between depressive symptoms and sleep duration. To conclude, this study will assist in the effective promotion of the education of adolescents' sleep health.

Association of emotional and behavioral problems with sleep disturbance among Chinese adolescents: The moderation effect of academic performance

BACKGROUND

This study aimed to explore the association of emotional and behavioral problems with sleep disturbance among Chinese adolescents, and to test whether these associations vary with adolescents' academic performance.

METHODS

Data were from the 2021 School-based Chinese Adolescents Health Survey using a multistage, stratified-cluster, and random-sampling method to collect information from 22,684 middle school students in Guangdong Province, China.

RESULTS

Emotional problems (aOR = 1.34, 95 % CI = 1.32-1.36), conduct problems (aOR = 1.19, 95 % CI = 1.16-1.21), hyperactivity (aOR = 1.35, 95 % CI = 1.33-1.37), and peer problems (aOR = 1.06, 95 % CI = 1.04-1.09) were significantly associated with the increased risk of sleep disturbance among middle school students in Guangdong Province. The prevalence of sleep disturbance among adolescents was 29.4 %. There were significant interactions of emotional problems/conduct problems/peer problems/prosocial behavior with academic performance on sleep disturbance. Further stratification analyses by academic performance showed that adolescents with self-reported good academic performance had a higher risk of sleep disturbance than those students with self-reported average or poor academic performance.

LIMITATIONS

This study only included school students and used the cross-sectional design to preclude causality determination.

CONCLUSIONS

Our findings suggest that emotional and behavioral problems elevate the risk of sleep disturbance in adolescents. Adolescent academic performance plays a modulating role in these above-mentioned significant associations for sleep disturbance.

The associations between sleep duration, cognitive function, and depressive symptoms: An analysis of Chinese adolescents from China Family Panel Studies

BACKGROUND

The adverse impact of depressive symptoms on adolescents' physical and psychological health is becoming increasingly prominent. This study aims to examine the association between sleep duration, cognitive function, and depressive symptoms among Chinese adolescents.

METHODS

This study used data on a sample of 3724 adolescents collected from the China Family Panel Studies (CFPS). The multivariate logistic regression was conducted to estimate the association between sleep duration, cognitive function (measured by mathematics and vocabulary), and depressive symptoms among Chinese adolescents; the mediating effects of cognitive function were calculated by mediating model.

RESULTS

The study found that approximately 6.49 % of Chinese adolescents had depressive symptoms, with an average CES-D8 score of 4.27 (SD: 3.11). Adolescents who reported a sleep duration of <6 h/night (OR = 2.34; 95 % CI = 1.30, 4.24) were at a higher risk of depressive symptoms, and the adolescents who had higher mathematics scores (>75 %) were more likely to be at a lower risk of depressive symptoms. Besides, the cognitive function competitively mediated the effect of sleep duration on depressive symptom (indirect effect = 0.043; 95 % CI = 0.023, 0.064).

LIMITATIONS

This is a cross-sectional study; all questions were self-reported; the sleep variable only included the sleep duration.

CONCLUSIONS

Our study highlights that short sleep duration might increase the risk of depressive symptoms, and increasing cognitive function might reduce the occurrence of depressive symptoms in Chinese adolescents. The results displayed that sleep duration had a negatively direct effect on depressive symptoms, but the indirect effects of sleep duration on depressive symptoms via the cognitive function (i.e., mathematics and vocabulary tests) were significantly positive, indicating that the relationship between sleep duration and depressive symptoms was competitively mediated by cognitive function.

Sleep duration change from childhood to adulthood and adult depressive disorders in the Chinese population

BACKGROUND

Sleep deprivation may cause depressive disorders in both children and adults. However, the effects of sleep duration change from childhood to adulthood on adult depressive disorders are poorly documented. Using the China Family Panel Study (CFPS) data, we aimed to examine the association between sleep duration change from childhood to adulthood and adult depressive disorders in the Chinese population.

METHODS

Data were from 1172 children aged 10-15 years in 2010 who were followed up through 2018 based on the nationally representative and population-based CFPS. According to sleep duration in childhood and early adulthood, the sleep duration change was categorized into four groups: persistently insufficient sleep, sleep duration loss, sleep duration gain and persistently sufficient sleep.

RESULTS

After adjustment for potential covariates, compared with individuals with persistently sufficient sleep duration, those with sleep duration loss (OR = 1.98, 95% CI = 1.14-3.46) and persistently insufficient sleep (OR = 2.35, 95% CI = 1.43-3.88) had higher odds of depressive disorders in adulthood. In contrast, the odds of adult depressive disorders did not significantly increase in those with sleep duration gain (OR = 1.46, 95% CI = 0.88-2.41).

LIMITATIONS

Information on sleep duration was obtained through a questionnaire; the sample size of this study was not large; the generalizality of our findings to other populations should be caucious.

CONCLUSION

Persistently insufficient sleep duration and sleep duration loss from childhood to adulthood were associated with higher odds of adult depressive disorders, while those who were able to change their sleep duration from insufficient status to sufficient status didn't have an increased odds of adult depressive disorders.

Screening Depressive Symptoms and Incident Major Depressive Disorder Among Chinese Community Residents Using a Mobile App-Based Integrated Mental Health Care Model: Cohort Study

Background

Depression is associated with significant morbidity and human capital costs globally. Early screening for depressive symptoms and timely depressive disorder case identification and intervention may improve health outcomes and cost-effectiveness among affected individuals. China’s public and academic communities have reached a consensus on the need to improve access to early screening, diagnosis, and treatment of depression.

Objective

This study aims to estimate the screening prevalence and associated factors of subthreshold depressive symptoms among Chinese residents enrolled in the cohort study using a mobile app–based integrated mental health care model and investigate the 12-month incidence rate and related factors of major depressive disorder (MDD) among those with subthreshold depressive symptoms.

Methods

Data were drawn from the Depression Cohort in China (DCC) study. A total of 4243 community residents aged 18 to 64 years living in Nanshan district, Shenzhen city, in Guangdong province, China, were encouraged to participate in the DCC study when visiting the participating primary health care centers, and 4066 (95.83%) residents who met the DCC study criteria were screened for subthreshold depressive symptoms using the Patient Health Questionnaire-9 at baseline. Of the 4066 screened residents, 3168 (77.91%) with subthreshold depressive symptoms were referred to hospitals to receive a psychiatric diagnosis of MDD within 12 months. Sleep duration, anxiety symptoms, well-being, insomnia symptoms, and resilience were also investigated. The diagnosis of MDD was provided by trained psychiatrists using the Mini-International Neuropsychiatric Interview. Univariate and multivariate logistic regression models were performed to explore the potential factors related to subthreshold depressive symptoms at baseline, and Cox proportional hazards models were performed to explore the potential factors related to incident MDD.

Results

Anxiety symptoms (adjusted odds ratio [AOR] 1.63, 95% CI 1.42-1.87) and insomnia symptoms (AOR 1.13, 95% CI 1.05-1.22) were associated with an increased risk of subthreshold depressive symptoms, whereas well-being (AOR 0.93, 95% CI 0.87-0.99) was negatively associated with depressive symptoms. During the follow-up period, the 12-month incidence rate of MDD among participants with subthreshold depressive symptoms was 5.97% (189/3168). After incorporating all significant variables from the univariate analyses, the multivariate Cox proportional hazards model reported that a history of comorbidities (adjusted hazard ratio [AHR] 1.49, 95% CI 1.04-2.14) and anxiety symptoms (AHR 1.13, 95% CI 1.09-1.17) were independently associated with an increased risk of incident MDD. The 5-item World Health Organization Well-Being Index was associated with a decreased risk of incident MDD (AHR 0.90, 95% CI 0.86-0.94).

Conclusions

Elevated anxiety symptoms and unfavorable general well-being were significantly associated with subthreshold depressive symptoms and incident MDD among Chinese residents in Shenzhen. Early screening for subthreshold depressive symptoms and related factors may be helpful for identifying populations at high risk of incident MDD.

Effect of cognitive behavioral therapy program on mental health status among medical student in Palestine during COVID pandemic

BACKGROUND

The COVID-19 pandemic had a profound psychological influence on everyone in society, and the impact it had on students, particularly medical students, cannot be underestimated. The main purpose of this study is to (1) determine the prevalence of mental disorders among medical students and their associated factors, and (2) examine the effectiveness of cognitive behavior therapy on mental health problems among medical students.

METHODS

Between March and May 2021, we conducted a randomized controlled study on two phases among medical students at An-Najah National University. Data were collected using an online questionnaire and the Arabic version of the 12-item General Health Questionnaire (GHQ-12). We also used the MEDAS tool to assess their Mediterranean Diet (MD) adherence. In the second phase, sixty-six students were recruited and assigned randomly to control and intervention groups. Intervention impact was assessed using 12-item General Health Questionnaire at two-time points; baseline, and 8 weeks post-intervention. The interventional model used was cognitive behavioral therapy, and the control group received no treatment.

RESULTS

A total of 329 students were included in the analysis of the first phase of the study. Approximately 28% of students had mental health problems. We found a significant relationship between good mental health status with a higher level of physical activity level, longer sleeping hours, and shorter entertainment time (p < 0.05). In the second phase of the study, a total of 91 students were included. Overall, using the CBT program showed a significant improvement in the outcome measures. At 8 weeks post-intervention, students had lower scores on total GHQ-12, depression, anxiety, and social dysfunction.

CONCLUSION

These findings propose that adequate attention must be paid to the mental health of medical students and that CBT programs can be used for the management of mental health problems among medical students.

Association Between Childhood Maltreatment, FKBP5 Gene Methylation, and Anxiety Symptoms Among Chinese Adolescents: A Nested Case-Control Study

BACKGROUND

Anxiety symptoms are common mental health problems among adolescents worldwide. This study aimed to explore (1) the longitudinal association between childhood maltreatment and anxiety symptoms, (2) the association between childhood maltreatment and DNA methylation of the FKBP5 gene, and (3) the association of DNA methylation of the FKBP5 gene with anxiety symptoms at follow-up.

METHODS

A nested case-control design was conducted to identify a case group and control group from a longitudinal study of adolescents aged 13-18 years in Guangzhou from 2019 to 2020. Adolescents with anxiety symptoms at baseline and follow-up were considered the case group, while those without anxiety symptoms at baseline and follow-up were considered the control group. The case and control groups were matched according to age and sex. Our study finally included 97 cases and 141 controls.

RESULTS

After adjusting for significant covariates, childhood emotional abuse was associated with subsequent anxiety symptoms (β = 0.146, 95% CI = 0.010~0.283); students with physical and emotional neglect were more likely to get a lower level of DNA methylation at most CpG units of FKBP5 gene (P < 0.05); FKBP5-12 CpG 15 methylation was associated with anxiety symptoms at follow-up (β = -0.263, 95% CI = -0.458~-0.069). However, after multiple hypothesis testing, childhood maltreatment was not associated with FKBP5 DNA methylation (q > 0.10); FKBP5 DNA methylation did not show an association with subsequent anxiety symptoms (q > 0.10).

CONCLUSIONS

Childhood emotional abuse was associated with an increased risk of anxiety symptoms among Chinese adolescents. After multiple hypothesis testing, childhood maltreatment was not significantly associated with FKBP5 DNA methylation. DNA methylation of the promoter region of the FKBP5 gene was not a significant predictor of anxiety symptoms. More attention should be paid to the mental health of adolescents with childhood maltreatment.

Association of Nighttime Sleep Duration with Depressive Symptoms and Its Interaction with Regular Physical Activity among Chinese Adolescent Girls

Depression has become a major mental health concern among adolescents globally, and the relationship between depressive symptoms and nighttime sleep duration among adolescent girls remains unclear. This study aimed to examine the association between nighttime sleep duration and depressive symptoms among Chinese adolescent girls. This cross-sectional study, conducted in 2018, included 4952 girls aged 10-19 years from the eastern, central, and western regions of China. Depressive symptoms were assessed by the Patient Health Questionnaire-9, and categorized into depressive symptoms and non-depressive symptoms. Logistic regression models were used to estimate the odds ratios (ORs) of depressive symptoms. After adjustment for covariates, adolescent girls with a nighttime sleep duration of <7 h/night (OR = 2.28, 95% CI: 1.76-2.95) and 7 h/night (OR = 1.82, 95% CI: 1.48-2.24) were associated with increased risk of depressive symptoms, compared to those with a sleep duration of 8 h/night. An interaction between nighttime sleep duration and regular physical activity on the risk of depressive symptoms was observed (p for interaction = 0.036). Among both girls with and without regular physical activity, a sleep duration of <7 h/night was associated with increased odds of depressive symptoms, and the magnitude of the ORs among girls with regular physical activity was lower than those without regular physical activity. This study found a significant association of short nighttime sleep duration with increased risk of depressive symptoms, and demonstrates the importance of maintaining adequate nighttime sleep duration and ensuring regular physical activity in improving depressive symptoms among adolescent girls.

The Associations between Sleep Duration, Academic Pressure, and Depressive Symptoms among Chinese Adolescents: Results from China Family Panel Studies

Depressive symptoms are a common mental health problem among adolescents, which may affect their physical and mental health development and impose heavy burdens on individual families and society. This study aimed to examine the associations between sleep duration, academic pressure, and depressive symptoms among Chinese adolescents and to construct the mediation model to explore the mediating effect of sleep duration. The data are from the China Family Panel Studies (CFPS). Methodologically, the aforementioned associations were explored by constructing a structural equation model and applying multivariate multilevel logistic regression. In this study, we found that approximately 6.49% of the 3724 Chinese adolescents had depressive symptoms. Sleep duration of <6 h/night (OR = 2.39, 95%CI = 1.33-4.32) and high/maximum academic pressure (high: OR = 1.43, 95%CI = 1.02-1.99; maximum: OR = 2.43, 95%CI = 1.58-3.73) were both associated with an increased risk of depressive symptoms in adolescents. Meanwhile, the multiplicative interaction between sleep duration and academic pressure was significantly associated with depressive symptoms in adolescents (p < 0.001). The sleep duration played a partial mediating role in the relationship between academic pressure and depressive symptoms (a*b = 0.006, 95%BootCI = 0.001-0.012). Our study highlights that it is essential to mitigate the academic pressure of adolescents to increase their sleep duration and further reduce the occurrence of depressive symptoms by adopting corresponding preventive measures.

Impact of Sleep Duration on Depression and Anxiety After Acute Ischemic Stroke

Background: Abnormal sleep duration predicts depression and anxiety. We seek to evaluate the impact of sleep duration before stroke on the occurrence of depression and anxiety at 3 months after acute ischemic stroke (AIS). Methods: Nationally representative samples from the Third China National Stroke Registry were used to examine cognition and sleep impairment after AIS (CNSR-III-ICONS). Based on baseline sleep duration before onset of stroke as measured by using the Pittsburgh Sleep Quality Index (PSQI), 1,446 patients were divided into four groups: >7, 6-7, 5-6, and <5 h of sleep. Patients were followed up with the General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) for 3 months. Poststroke anxiety (PSA) was defined as GAD-7 of ≥5 and poststroke depression (PSD) as PHQ-9 of ≥5. The association of sleep duration with PSA and PSD was evaluated using multivariable logistic regression. Results: The incidences of PSA and PSD were 11.2 and 17.6% at 3 months, respectively. Compared to a sleep duration of >7 h, 5-6 h, and <5 h of sleep were identified as risk factors of PSA [odds ratio (OR), 1.95; 95% confidence interval (CI), 1.24-3.07; P < 0.01 and OR, 3.41; 95% CI, 1.94-6.04; P < 0.01) and PSD (OR, 1.47; 95% CI, 1.00-2.17; P = 0.04 and OR, 3.05; 95% CI, 1.85-5.02; P < 0.01), while 6-7 h of sleep was associated with neither PSA (OR, 1.09; 95% CI, 0.71-1.67; P = 0.68) nor PSD (OR, 0.92; 95% CI, 0.64-1.30; P = 0.64). In interaction analysis, the impact of sleep duration on PSA and PSD was not affected by gender (P = 0.68 and P = 0.29, respectively). Conclusions: Sleep duration of shorter than 6 h was predictive of anxiety and depression after ischemic stroke.

Associations Between Child Maltreatment and Depressive Symptoms Among Chinese College Students: An Analysis of Sex Differences

Background: Depressive symptoms and child maltreatment are both global public health problems among young adults. This study aimed to investigate the associations between five types of child maltreatment and depressive symptoms among Chinese college students, with a focus on potential sex differences. Methods: A cross-sectional study of a nationally representative sample of Chinese college students was conducted from March to June 2019 with a multistage, stratified cluster, random sampling method. In total, 30,179 college students from 60 colleges of 10 Chinese province-level regions completed standard questionnaires, including a history of child maltreatment and current depressive symptoms. Results: The prevalence of depressive symptoms among college students in China was 7.3%. After adjusting for control variables, physical abuse (adjusted odds ratio [aOR] = 1.20, 95% confidence interval [CI] = 1.17-1.23), emotional abuse (aOR = 1.21, 95% CI = 1.19-1.23), sexual abuse (aOR = 1.19, 95% CI = 1.16-1.22), physical neglect (aOR = 1.14, 95% CI = 1.12-1.16) and emotional neglect (aOR = 1.08, 95% CI = 1.07-1.09) were all positively associated with depressive symptoms. Notably, a cumulative effect of child maltreatment on depressive symptoms among Chinese college students was observed. Moreover, sex differences in the associations of emotional abuse, emotional neglect, and the number of maltreatment types with depressive symptoms were statistically significant (P < 0.05). Further stratification analyses showed that female students who experienced emotional abuse and emotional neglect had a higher risk of depressive symptoms than male students, and the cumulative effect of maltreatment types was stronger for females than males. Conclusion: Five types of child maltreatment and their co-occurrence were associated with an increased risk of depressive symptoms among college students. Furthermore, the effects of emotional abuse, emotional neglect and the number of maltreatment types on depressive symptoms were stronger for females than for males. These findings can promote understanding of the effects of child maltreatment on depressive symptoms, and prevention and intervention strategies for depressive symptoms should consider the type of child maltreatment and sex differences.

Association between sleep duration and quality and depressive symptoms among university students: A cross-sectional study

Sleep duration and quality have several effects on human health. Some previous studies have shown an association between sleep duration and quality and mental health, but the results of those studies were inconsistent. Additionally, studies on sleep duration and its impact on depressive symptoms specifically among young Chinese adults are limited. Hence, this study aimed to investigate the association between duration and quality of sleep and depressive symptoms among Chinese university students. We designed a cross-sectional study comprising 9,515 Chinese university students. Sleep duration and quality were assessed using a self-reported questionnaire. Depressive symptoms were assessed based on the Self-rating Depression Scale score. Logistic regression models were used to analyze the association between sleep duration and quality and depressive symptoms. The results showed that good sleep quality was associated with a lower prevalence of depressive symptoms. In the final adjusted model, the odds ratios and 95% confidence intervals for the prevalence of depressive symptoms in those with poor sleep quality compared with those with normal and good sleep quality were 0.88 (0.77, 1.01) and 0.82 (0.81, 0.96), respectively (p for trend = 0.014). Moreover, short sleep duration was associated with a higher prevalence of depressive symptoms based on the crude model and final adjusted model (p for trend = 0.048 and 0.042, respectively). Poor sleep quality and short sleep duration were associated with a higher prevalence of depressive symptoms in this study population. These results suggest that reduced sleep duration and quality may be risk factors for mental health disorders among university students.