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Chen J, Hua S, Huang L, Zhang X, Yao W, Xue Z. Exploring sedentary behavior, neutrophil-to-lymphocyte ratio, and depression: Mediation analysis in NHANES. Prog Neuropsychopharmacol Biol Psychiatry 2024; 136:111140. [PMID: 39265922 DOI: 10.1016/j.pnpbp.2024.111140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 09/08/2024] [Accepted: 09/09/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Sedentary behavior and depression have been linked to inflammation. However, the specific role of inflammation in the relationship between sedentary behavior and depression remains unclear. METHOD We examined associations among the inflammatory marker (neutrophil-to-lymphocyte ratio [NLR]), sedentary behavior, and depression in a robust, ethnically diverse sample (n = 29,769) from the National Health and Nutrition Examination Survey (NHANES). RESULT Our findings indicate that individuals experiencing depression and/or engaging in sedentary behavior show elevated levels of the NLR. Even after adjusting for confounding variables such as age, sex, and body mass index, sedentary behavior remains significantly associated with both depression and NLR levels. Additionally, our analysis reveals a non-linear relationship between NLR levels and depression, suggesting a complex interaction. Importantly, NLR partially mediates a modest yet statistically significant portion (1.920 %, p = 0.014) of the association between sedentary behavior and depression. CONCLUSION This study highlights the intricate interplay among sedentary behavior, inflammation, and depression, providing insights into potential avenues for intervention and management.
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Affiliation(s)
- Jing Chen
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiang Middle Road, Shanghai, People's Republic of China; Department of Pediatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiang Middle Road, Shanghai, People's Republic of China
| | - Shengyuan Hua
- Shanghai Children's Hospital, People's Republic of China; Shanghai Children's Hospital, School of Medicine, Shanghai Jao Tong University, People's Republic of China
| | - Lirong Huang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiang Middle Road, Shanghai, People's Republic of China; Department of Pediatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiang Middle Road, Shanghai, People's Republic of China
| | - Xinguang Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiang Middle Road, Shanghai, People's Republic of China; Department of Pediatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiang Middle Road, Shanghai, People's Republic of China.
| | - Wenbo Yao
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiang Middle Road, Shanghai, People's Republic of China
| | - Zheng Xue
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiang Middle Road, Shanghai, People's Republic of China; Department of Pediatrics, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiang Middle Road, Shanghai, People's Republic of China.
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Zeng Y, Li W, Chen X, You Z, Mai S, Lan X, Ning Y, Zhou Y. Mediating effect of inflammation on the relationship between sleep disruption and suicidal ideation in major depressive disorder. J Affect Disord 2024; 352:371-378. [PMID: 38401806 DOI: 10.1016/j.jad.2024.02.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/05/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Sleep disruption, particularly insomnia, is a notable characteristic of depression and is associated with an increased risk of suicide in patients diagnosed with major depressive disorder (MDD). Moreover, the pathophysiology of depression and suicide has been linked to inflammation, specifically proinflammatory cytokines. However, the complex interplay among these factors in individuals with MDD remains poorly understood. This study investigated the mediating role of inflammatory cytokines in the relationship between sleep disruption and suicidal ideation (SI), with a particular emphasis on gender differences. METHODS This study used a cross-sectional design in which 281 individuals diagnosed with MDD were recruited from psychiatric clinics. The main assessments included the evaluation of sleep disruption, inflammatory markers, and SI. The Beck Scale for Suicide Ideation (SSI) scores was employed to quantify SI, whereas HAMD-SLD, a component of the Hamilton Rating Scale (HAMD-17), was used to evaluate sleep disruption. Blood analysis was performed to measure inflammatory markers. RESULT For females diagnosed with MDD, significant associations between sleep disruption and the levels of IL-6 (B = 0.994, p = 0.013) and TNF-α (B = 1.986, p = 0.016) were found when IL-6 or TNF-α were considered as mediators in the regression model. In addition, IL-6 (B = 5.689, p < 0.001) and TNF-α (B = 9.916, p = 0.006) exhibited strong correlation with SSI scores. CONCLUSIONS The primary results of this study indicate that IL-6 and TNF-α could function as potential mediators in the relationship between sleep disruption and SI among female patients diagnosed with MDD. CLINICAL TRIAL Name of the registry: Zhejiang University Trial registration number: ChiCTR1800017626 Date of registration: 2018-08-07, 'Retrospectively registered' URL of trial registry record: https://www.chictr.org.cn/showproj.html?proj=27321.
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Affiliation(s)
- Yexian Zeng
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Weicheng Li
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Xiaoyu Chen
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Zerui You
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Siming Mai
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Xiaofeng Lan
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Department of Psychology, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China.
| | - Yanling Zhou
- Department of Child and Adolescent Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China.
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Tutan D, Erdoğan Kaya A, Eser B. The relationship between neutrophil lymphocyte ratio, platelet lymphocyte ratio, and depression in dialysis patients. Medicine (Baltimore) 2023; 102:e35197. [PMID: 37713848 PMCID: PMC10508398 DOI: 10.1097/md.0000000000035197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/22/2023] [Indexed: 09/17/2023] Open
Abstract
Chronic kidney disease is a worldwide public health issue with rising incidence, morbidity/mortality, and cost. Depression and chronic renal disease often coexist, and psychological illnesses are associated with poor results. Early identification of depression reduces morbidity and death. Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are reported as practical biomarkers of inflammation and immune system activation. In this study, we aimed to determine the association of NLR and PLR with depression in dialysis patients. This study included 71 adults over 18 without known hematologic or oncologic disease, drug use, or chronic inflammatory diseases. Comorbid chronic diseases, laboratory data, and Beck depression inventory scores were prospectively recorded. A comparison of 2 groups according to the existence of depression was made, and a binomial logistic regression test was used to determine the association between the variables and the presence of depression after adjusting for confounding factors. A receiver operating curve analysis was used to differentiate groups with and without severe depression. Seventy-one patients met the study criteria, with 46 hemodialysis and 25 peritoneal dialysis patients. The majority had hypertension and diabetes mellitus, with 47.89% having minimal-minor depression and 52.11% having moderate-major depression. The 2 groups were similar regarding chronic diseases, with no significant differences in serum creatinine levels, glucose, lipid profiles, or electrolytes. However, when the NLR of the 2 groups was compared, the median was higher in patients with moderate or major depression. Multivariate analysis showed no significant differences between the groups in PLR, triglyceride to glucose ratio, and C-reactive peptide to albumin ratio. The best NLR cutoff value was 3.26, with 48.6% sensitivity, 88.2% specificity, 81.8% positive predictive value, 61.2% negative predictive value, and 67.6% test accuracy. Depression is one of the most common psychiatric conditions in dialysis patients and is linked to increased morbidity, mortality, treatment failure, expense, and hospitalization. NLR helped predict moderate-to-major depression in dialysis patients, even after controlling for confounding factors in multivariate analysis. This study indicated that an NLR successfully identified depressive groups, and patients with an NLR value >3.26 were 6.1 times more likely to have moderate or major depression.
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Affiliation(s)
- Duygu Tutan
- Erol Olçok Training and Research Hospital, Department of Internal Medicine, Çorum, Turkey
| | - Ayşe Erdoğan Kaya
- Erol Olçok Training and Research Hospital, Department of Psychiatry, Çorum, Turkey
| | - Bariş Eser
- Hitit University Faculty of Medicine, Department of Nephrology, Çorum, Turkey
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Shan M, Yang Z, Sun Z, Yang Y, Cheng Q, Pan Y. Association between platelet to lymphocyte ratio and depression and symptom severity among adults in the United States: A cross-sectional study. Heliyon 2023; 9:e20127. [PMID: 37809517 PMCID: PMC10559847 DOI: 10.1016/j.heliyon.2023.e20127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023] Open
Abstract
Background The pathogenesis of depression has not yet been fully understood. The association between platelet to lymphocyte ratio (PLR) and depression has been investigated in previous studies, however, the results were controversial. The objective of the study was to explore the potential relationship between PLR and depression and symptom severity. Methods A cross-sectional study was conducted based on the National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018. Totally 30,032 adults were analyzed, and 2480 reported depression. Depression and symptom severity were assessed with the Patient Health Questionnaire (PHQ-9). PLR was calculated as the ratio of platelets to lymphocytes. Multivariable weighted-logistic regression models and generalized additive model (GAM) were employed to evaluate the linear and nonlinear association between PLR and depression and symptom severity. Results There was a negative association for Q3 (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.68 to 0.99) when comparing participants for Q1 between 10-PLR and depression after fully adjusting the covariates; however, there was no significant association between 10-PLR and symptom severity. GAM showed that 10-PLR was associated with depression and symptom severity in a nonlinear manner. The inflection points were at 12.15. Subgroup analyses showed nonlinear relationships only in specific subgroups. Conclusions: PLR is associated with depression among adults in the United States. U-shaped nonlinear relationships and threshold effects were observed between 10-PLR and depression and symptom severity. Additionally, inflammatory mechanisms vary in different sociodemographic subgroups.
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Affiliation(s)
- Moshui Shan
- Department of Psychiatry, The 967th Hospital of the Chinese PLA Joint Logistics Support Force, Dalian, China
| | - Zhi Yang
- Department of Pharmacy, The 967th Hospital of the Chinese PLA Joint Logistics Support Force, Dalian, China
| | - Zhonghua Sun
- Department of Psychiatry, The 967th Hospital of the Chinese PLA Joint Logistics Support Force, Dalian, China
| | - Yi Yang
- Department of Psychiatry, The 967th Hospital of the Chinese PLA Joint Logistics Support Force, Dalian, China
| | - Qi Cheng
- Department of Psychiatry, The 904th Hospital of the Chinese PLA Joint Logistics Support Force, Changzhou, China
| | - Yu Pan
- Department of Medical Psychology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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Decker K, Murata S, Baig N, Hasan S, Halaris A. Utilizing the Systemic Immune-Inflammation Index and Blood-Based Biomarkers in Association with Treatment Responsiveness amongst Patients with Treatment-Resistant Bipolar Depression. J Pers Med 2023; 13:1245. [PMID: 37623494 PMCID: PMC10455950 DOI: 10.3390/jpm13081245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background: Inflammation is associated with depressive illness and treatment resistance. This study assessed a novel inflammatory index, the Systemic Immune-Inflammation Index (SII), in patients diagnosed with treatment-resistant bipolar depression (TRBDD) before and after treatment with escitalopram (ESC) and celecoxib (CBX) add-on or ESC and placebo (PBO), and compared them to healthy control (HC) subjects. (2) Methods: This is a secondary biological analysis from a double-blind randomized placebo-controlled trial of CBX augmentation in TRBDD. Our subsample with available complete blood count (CBC) data included 52 TRBDD subjects, randomized into an ESC + CBX, (n = 29), an ESC + PBO arm (n = 23), and an HC group (n = 32). SII was calculated from the CBC with differential (SII = platelets x neutrophils/lymphocytes) at baseline and end of treatment (8 weeks). Blood inflammation biomarkers, growth factors, and kynurenine metabolites were determined at both timepoints. Depressive symptom severity was the primary outcome, using the HAMD-17 rating scale score to quantitate treatment response and remission rates. (3) Results: Baseline SII did not discriminate TRBDD from HC, nor was it associated with HAMD-17 score at any timepoint, although it was significantly associated with lower baseline VEGF (p = 0.011) and higher week 8 levels of IL1-β (p = 0.03) and CRP (p = 0.048). Post-treatment HAMD-17 was not independently predicted using baseline SII unless an interaction with age was present (p = 0.003 was included), even after relevant adjustments. A similar effect was seen with baseline neutrophils. (4) Conclusions: While SII was not an independent predictor of treatment outcome, elevated baseline SII was a predictor of poor treatment response amongst older patients with TRBDD.
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Affiliation(s)
- Kyle Decker
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA; (K.D.); (N.B.); (A.H.)
- Stritch School of Medicine, Loyola University, Maywood, IL 60153, USA
| | - Stephen Murata
- Pine Rest Christian Mental Health Services, Michigan State University, Grand Rapids, MI 49548, USA
| | - Nausheen Baig
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA; (K.D.); (N.B.); (A.H.)
- Stritch School of Medicine, Loyola University, Maywood, IL 60153, USA
| | - Sakibur Hasan
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48824, USA;
| | - Angelos Halaris
- Department of Psychiatry and Behavioral Neurosciences, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA; (K.D.); (N.B.); (A.H.)
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Cui S, Li J, Liu Y, Yao G, Wu Y, Liu Z, Sun L, Sun L, Liu H. Correlation of systemic immune-inflammation index and moderate/major depression in patients with depressive disorders: a large sample cross-sectional study. Front Psychiatry 2023; 14:1159889. [PMID: 37275977 PMCID: PMC10232846 DOI: 10.3389/fpsyt.2023.1159889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/02/2023] [Indexed: 06/07/2023] Open
Abstract
Objective To evaluate the clinical value of systemic immune-inflammation index (SII) based on peripheral blood neutrophil, lymphocyte, and platelet count in evaluating the subtype and severity of depression in patients with depressive disorder. Methods This retrospective cohort study was conducted in the Third People's Hospital of Fuyang City from January 1, 2020 to December 31, 2022. The data included sociodemographic information at admission, clinical data, discharge diagnosis and inflammatory markers. Patients were divided into low SII group and high SII group according to the optimal threshold of SII determined by receiver operating characteristic curve (ROC curve). Binary logistic regression was used to analyze the correlation between moderate/major depression and SII level. Results Compared to the low SII group, the high SII group had a higher age level (χ2 = 7.663, p = 0.006), more smokers (χ2 = 9.458, p = 0.002), more moderate/major depression patients (χ2 = 45.645, p < 0.001), and a higher proportion of patients with accompanying somatic symptoms (χ2 = 14.867, p < 0.001). In the final logistic regression model, after controlling for confounding factors, SII at admission was significantly associated with moderate/major depression [β =1.285, p < 0.001; odds ratio (95% confidence intervals) = 3.614 (2.693-4.850)]. Patients with high SII scores were 3.614 times more likely to have moderate/severe depression than those with low SII scores. We propose a cut-off value of SII =540.78 (sensitivity = 36.4% and specificity = 80.3%) according to the maximum Youden index. Conclusion Our research indicates that SII may be a useful, repeatable, convenient, and affordable index to identify moderate/major depression in depressive disorder.
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Affiliation(s)
- Shu Cui
- Department of Psychiatry, Third People’s Hospital of Fuyang, Fuyang, Anhui, China
| | - Juanjuan Li
- Department of Psychiatry, Third People’s Hospital of Fuyang, Fuyang, Anhui, China
| | - Yun Liu
- Department of Psychiatry, Third People’s Hospital of Fuyang, Fuyang, Anhui, China
| | - Gaofeng Yao
- Department of Psychiatry, Third People’s Hospital of Fuyang, Fuyang, Anhui, China
| | - Yanhai Wu
- Department of Psychiatry, Third People’s Hospital of Fuyang, Fuyang, Anhui, China
| | - Zhiwei Liu
- Department of Psychiatry, Third People’s Hospital of Fuyang, Fuyang, Anhui, China
| | - Liang Sun
- Department of Psychiatry, Third People’s Hospital of Fuyang, Fuyang, Anhui, China
- Department of Psychiatry, Chaohu Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Longlong Sun
- Department of Psychiatry, Third People’s Hospital of Fuyang, Fuyang, Anhui, China
- Department of Psychiatry, Chaohu Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui, China
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Yin J, Gong R, Zhang M, Ding L, Shen T, Cai Y, He S, Peng D. Associations between sleep disturbance, inflammatory markers and depressive symptoms: Mediation analyses in a large NHANES community sample. Prog Neuropsychopharmacol Biol Psychiatry 2023; 126:110786. [PMID: 37178815 DOI: 10.1016/j.pnpbp.2023.110786] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/16/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
Both depression and sleep disturbance have been linked to inflammation. However, the role that inflammation plays in the relationship between sleep disturbance and depression remains unclear. We examined pairwise associations between inflammatory markers (neutrophil-to-lymphocyte ratio [NLR] and C-reactive protein level [CRP]), sleep disturbance, and depressive symptoms in a robust, ethnically diverse sample (n = 32,749) from the National Health and Nutrition Examination Survey (NHANES). We found higher levels of inflammatory markers in participants with depression and/or sleep disturbance compared to those without depression or sleep disturbance. Sleep disturbance was positively associated with inflammatory markers and depressive symptoms even after considering a wide range of potential confounders (e.g., age, sex, body mass index). Inflammatory marker levels were nonlinearly associated with depressive symptoms and were positively associated with depressive symptoms after reaching the inflection point (NLR, 1.67; CRP, 0.22 mg/dL). Inflammatory markers mediated a marginal portion (NLR, 0.0362%, p = 0.026; CRP, 0.0678%; p = 0.018) of the potential effects of sleep disturbance on depressive symptoms. Our research showed that inflammatory markers, sleep disturbance, and depression are pairwise correlated. Increased inflammatory markers levels slightly mediate the association between sleep disturbance and depression.
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Affiliation(s)
- Jiahui Yin
- College of traditional Chinese medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Rongpeng Gong
- Medical College of Qinghai University, Xining, China
| | - Min Zhang
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Ding
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Shen
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiyun Cai
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shen He
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Daihui Peng
- Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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