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      The association between sleep and depressive symptoms in US adults: data from the NHANES (2007–2014)

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      1 , 2 , 3 , 3 , , 1 , 2 ,
      Epidemiology and Psychiatric Sciences
      Cambridge University Press
      Cross-sectional study, depression, epidemiology, sleep

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          Abstract

          Aims

          To assess the association of sleep factors (sleep duration, trouble sleeping, sleep disorder) and combined sleep behaviours with the risk of clinically relevant depression (CRD).

          Methods

          A total of 17 859 participants (8806 males and 9053 females) aged 20–79 years from the National Health and Nutrition Examination Survey (NHANES) 2007–2014 waves were included. Sleep duration, trouble sleeping and sleep disorder were asked 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. And intermediate and poor sleep patterns indicated 1 and 2–3 sleep problems, respectively. Weighted logistic regression was performed to evaluate the association of sleep factors and sleep patterns with the risk of depressive symptoms.

          Results

          The total prevalence of CRD was 9.5% among the 17 859 participants analysed, with females having almost twice as frequency than males. Compared to normal sleep duration (7–9 h), both short and long sleep duration were linked with a higher risk of CRD (short sleep: OR: 1.66, 95% CI: 1.39–1.98; long sleep: OR: 2.75, 95% CI: 1.93–3.92). The self-reported sleep complaints, whether trouble sleeping or sleep disorder, were significantly related with CRD (trouble sleeping: OR: 3.04, 95% CI: 2.59–3.56; sleep disorder: OR: 1.83, 95% CI: 1.44–2.34). Furthermore, the correlations appeared to be higher for individuals with poor sleep pattern (OR: 5.98, 95% CI: 4.91–7.29).

          Conclusions

          In this national representative survey, it was shown that there was a dose-response relationship between sleep patterns and CRD.

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          Most cited references45

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          The PHQ-9: validity of a brief depression severity measure.

          While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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            Depression

            Major depression is a common illness that severely limits psychosocial functioning and diminishes quality of life. In 2008, WHO ranked major depression as the third cause of burden of disease worldwide and projected that the disease will rank first by 2030.1 In practice, its detection, diagnosis, and management often pose challenges for clinicians because of its various presentations, unpredictable course and prognosis, and variable response to treatment.
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              Major depressive disorder.

              Major depressive disorder (MDD) is a debilitating disease that is characterized by depressed mood, diminished interests, impaired cognitive function and vegetative symptoms, such as disturbed sleep or appetite. MDD occurs about twice as often in women than it does in men and affects one in six adults in their lifetime. The aetiology of MDD is multifactorial and its heritability is estimated to be approximately 35%. In addition, environmental factors, such as sexual, physical or emotional abuse during childhood, are strongly associated with the risk of developing MDD. No established mechanism can explain all aspects of the disease. However, MDD is associated with alterations in regional brain volumes, particularly the hippocampus, and with functional changes in brain circuits, such as the cognitive control network and the affective-salience network. Furthermore, disturbances in the main neurobiological stress-responsive systems, including the hypothalamic-pituitary-adrenal axis and the immune system, occur in MDD. Management primarily comprises psychotherapy and pharmacological treatment. For treatment-resistant patients who have not responded to several augmentation or combination treatment attempts, electroconvulsive therapy is the treatment with the best empirical evidence. In this Primer, we provide an overview of the current evidence of MDD, including its epidemiology, aetiology, pathophysiology, diagnosis and treatment.
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                Author and article information

                Journal
                Epidemiol Psychiatr Sci
                Epidemiol Psychiatr Sci
                EPS
                Epidemiology and Psychiatric Sciences
                Cambridge University Press (Cambridge, UK )
                2045-7960
                2045-7979
                2022
                08 September 2022
                : 31
                : e63
                Affiliations
                [1 ]Vanke School of Public Health, Tsinghua University , Beijing, China
                [2 ]Institute for Healthy China, Tsinghua University , Beijing, China
                [3 ]School of Nursing, Peking University , 38 Xueyuan Road, Haidian District, Beijing, 100191, China
                Author notes
                Authors for Correspondence: Shang Shaomei, E-mail: shangshaomei@ 123456126.com ; Liang Wannian, E-mail: liangwn@ 123456tsinghua.edu.cn
                Author information
                https://orcid.org/0000-0002-9435-8040
                Article
                S2045796022000452
                10.1017/S2045796022000452
                9483824
                36073029
                b9f95f6d-3944-4d60-b6d9-985ab6eed62b
                © The Author(s) 2022

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.

                History
                : 31 August 2021
                : 09 July 2022
                : 03 August 2022
                Page count
                Figures: 3, Tables: 2, References: 45, Pages: 9
                Funding
                Funded by: National key R&D Program of China
                Award ID: 2020YFC2008800
                Funded by: Sanming Project of Medicine in Shenzhen
                Award ID: SZSM202111001
                Categories
                Original Article

                cross-sectional study,depression,epidemiology,sleep
                cross-sectional study, depression, epidemiology, sleep

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