-
摘要:
目的 探究睡眠时长和就寝时段对我国中老年人抑郁症状的独立影响及交互影响，为抑郁症状的预防和干预措施提供依据。 方法 利用2018年中国家庭追踪调查(China family panel studies, CFPS)数据，选取13 662名≥50岁中老年人作为研究对象，基于广义相加模型(generalized additive model, GAM)对睡眠时长、就寝时段和抑郁症状得分之间的非线性关系进行初步探索，使用多元logistic回归分析模型进一步分析睡眠时长、就寝时段和抑郁症状的相关性，并进行分性别和城乡的亚组分析及交互作用分析。 结果 研究对象中有34.83%的中老年人患有抑郁症状。睡眠时长 < 6 h、就寝时段异常(早于21:00或晚于23:00)均是抑郁症状的独立风险因素，睡眠时长和就寝时段对抑郁症状的风险存在交互作用，就寝时段异常且睡眠时长 < 6 h抑郁症状风险最高(OR=1.32, 95% CI: 1.08~1.60)。分性别、城乡的亚组分析验证了上述结果。 结论 医疗卫生机构专业人员及照护者应关注中老年人睡眠时长和就寝时段，采取有效的干预措施，减少抑郁症状的发生。 Abstract:Objective To explore the independent and interactive effects of sleep duration and bedtime on depressive symptoms among middle aged and older adults in China, and provide references for the prevention and intervention measures of depressive symptoms. Methods Using data from the 2018 China family panel studies(CFPS), 13 662 individuals aged 50 years and above were selected as the analytical sample. A preliminary exploration of the nonlinear relationships between sleep duration, bedtime, and depressive scores was conducted based on the generalized additive model (GAM). Further analysis of the correlations between sleep duration, bedtime their interaction, and depression symptoms was performed using multivariate logistic regression model, along with subgroup analyses by gender and urban-rural classification. Results 34.83% of middle-aged and older adults in study had depressive symptoms. Sleep duration < 6 hours and abnormal bedtime (earlier than 21:00 or later than 23:00) were independently associated with depressive symptoms. There was an interaction effect between sleep duration and bedtime on the risk of depressive symptoms. Those with abnormal bedtime and sleep duration < 6 hours had the highest risk (OR=1.32, 95% CI: 1.08-1.60). Further subgroup analyses by gender and residence confirmed the above findings. Conclusions Healthcare professionals and caregivers should pay attention to both sleep duration and bedtime among middle-aged and older adults. By implementing effective intervention measures, the occurrence of depressive symptoms can be reduced. -
Key words:
- Depressive symptoms /
- Sleep duration /
- Bedtime /
- Interaction effect
-
图 1 样本筛选流程图
CFPS: 中国家庭追踪调查。
Figure 1. Sample selection flowchart
CFPS: China family panel studies.
图 2 睡眠时长、就寝时段与抑郁症状得分的GAM分析
CES-D，流行病学调查中心抑郁量表；GAM，广义相加模型；在就寝时段和抑郁症状得分的GAM分析中(图 2B)，就寝时段在01:00~15:00的样本量过少(n=106，占0.77%)，无法估计出有效的结果，因此省略。
Figure 2. Analysis of sleep duration, bedtime and depressive symptom scores using GAM
CES-D, centre for epidemiological studies depression scale; GAM, generalized additive model; In the GAM analysis of bedtime and depressive symptom scores (figure 2B), the sample size for bedtime between the 01:00 and 15:00 was too small (n=106, 0.77%) to estimate a valid result and was therefore excluded from the analysis.
表 1 不同抑郁情况分组的样本特征
Table 1. Sample characteristics by different depressive symptom groups
变量
Variable总计Total①
(n=13 662)抑郁症状 Depressive symptom① F/χ2值
valueP值
value无 No (n=8 903) 有 Yes (n=4 759) 睡眠时长 Sleep duration/h 321.002 ＜0.001 ＜6 1 499(10.97) 669(7.51) 830(17.44) 6~8 8 845(64.74) 6 070(68.18) 2 775(58.31) ＞8 3 318(24.29) 2 164(24.31) 1 154(24.25) 就寝时段 Bedtime 23.883 ＜0.001 正常 Normal 11 280(82.56) 7 454(83.72) 3 826(80.40) 异常 Abnormal 2 382(17.44) 1 449(16.28) 933(19.60) 性别 Gender 261.600 ＜0.001 女性 Female 6 863(50.23) 4 022(45.18) 2 841(59.70) 男性 Male 6 799(49.77) 4 881(54.82) 1 918(40.30) 年龄组/岁 Age groups/years 52.053 ＜0.001 50~＜60 5 884(43.07) 4 017(45.12) 1 867(39.23) 60~＜70 5 028(36.80) 3 216(36.12) 1 812(38.08) ≥70 2 750(20.13) 1 670(18.76) 1 080(22.69) 居住地 Residence 104.791 ＜0.001 农村 Rural 7 149(52.33) 4 374(49.13) 2 775(58.31) 城镇 Urban 6 513(47.67) 4 529(50.87) 1 984(41.69) 婚姻状况 Marital status 143.934 ＜0.001 有配偶 Married/cohabiting 11 986(87.73) 8 030(90.19) 3 956(83.13) 无配偶 Not married 1 676(12.27) 873(9.81) 803(16.87) 受教育程度 Education level 314.941 ＜0.001 未受过教育 No education 5 021(36.75) 2 828(31.76) 2 193(46.08) 小学 Primary school 3 403(24.91) 2 271(25.51) 1 132(23.79) 初中 Junior high school 3 244(23.74) 2 303(25.87) 941(19.77) 高中及以上 High school and above 1 994(14.60) 1 501(16.86) 493(10.36) 工作情况 Employment or not 22.757 ＜0.001 有 Yes 8 678(63.52) 5 783(64.96) 2 895(60.83) 无 No 4 984(36.48) 3 120(35.04) 1 864(39.17) 吸烟状况 Smoking status 64.850 ＜0.001 是 Yes 4 113(30.11) 2 886(32.42) 1 227(25.78) 否 No 9 549(69.89) 6 017(67.58) 3 532(74.22) 饮酒状况 Drinking status 80.932 ＜0.001 是 Yes 2 402(17.58) 1 756(19.72) 646(13.57) 否 No 11 260(82.42) 7 147(80.28) 4 113(86.43) 体育锻炼情况 Physical activity conditions 8.070 ＜0.01 是 Yes 7 111(52.05) 4 713(52.94) 2 398(50.39) 否 No 6 551(47.95) 4 190(47.06) 2 361(49.61) 自评健康状况 Self-rated of health status 443.652 ＜0.001 好 Good 2 671(19.55) 2 040(22.91) 631(13.26) 中等 Moderate 5 165(37.81) 3 627(40.74) 1 538(32.32) 差 Poor 5 826(42.64) 3 236(36.35) 2 590(54.42) 生活自理能力 Independent ability 151.968 ＜0.001 生活自理 Independent 12 989(95.07) 8 613(96.74) 4 376(91.95) 生活不自理 Not independent 673(4.93) 290(3.26) 383(8.05) 慢性病患病情况 Having chronic diseases or not 227.081 ＜0.001 是 Yes 3 627(26.55) 1 993(22.39) 1 634(34.33) 否 No 10 035(73.45) 6 910(77.61) 3 125(65.67) 注：年龄组、受教育程度、自评健康状况的组间差异比较使用秩和检验，其余变量使用χ2检验。
①以人数(占比/%)表示。
Note: Comparisons of between-group differences in age group, education, and self-rated health status variables were made using the rank-sum test, other variables were tested using the χ2 test.
① Number of people(proportion/%).
下载: 导出CSV
表 2 抑郁症状多元logistic回归分析
Table 2. Multivariate logistic regression analyses
变量 Variable 模型1 Model 1
OR值value (95% CI)模型2 Model 2
OR值value (95% CI)模型3 Model 3
OR值value (95% CI)睡眠时长 Sleep duration/h 6~8 1.00 1.00 1.00 < 6 2.27(2.00~2.56)① 2.20(1.94~2.49)① 2.05(1.81~2.33)① >8 1.11(1.00~1.22)② 1.07(0.97~1.18) 1.05(0.95~1.16) 就寝时段 Bedtime 正常 Normal 1.00 1.00 1.00 异常 Abnormal 1.16(1.02~1.32)③ 1.14(1.03~1.25)② 1.12(1.01~1.23)② 睡眠时长×就寝时段 Sleep duration/h×bedtime < 6×异常 Abnormal 1.33(1.01~1.75)② 1.32(1.00~1.74)② 1.32(1.08~1.60)② >8×异常 Abnormal 1.01(0.82~1.26) 0.99(0.80~1.23) 1.09(0.93~1.28) 注：模型1, 控制社会人口学特征；模型2, 进一步控制社会经济变量；模型3, 进一步控制健康行为和健康状况。
①P < 0.001；②P < 0.05；③P < 0.01。
Note: Model 1, controlling for socio-demographic characteristics; Model 2, further controlling for socio-economic variables; Model 3, further controlling for health behaviors and health status.
①P < 0.001；②P < 0.05；③P < 0.01.
下载: 导出CSV
表 3 基于性别分组的抑郁症状多元logistic回归分析
Table 3. Multivariate logistic regression analyses stratified by gender
变量
Variable男性Male
OR值value (95% CI)女性Female
OR值value (95% CI)睡眠时长 Sleep duration/h 6~8 1.00 1.00 < 6 1.84(1.49~2.26)① 2.20(1.86~2.58)① >8 1.09(0.94~1.26) 1.01(0.88~1.16) 入睡时段 Bedtime 正常 Normal 1.00 1.00 异常 Abnormal 1.08(0.89~1.30) 1.19(1.03~1.36)② 睡眠时长×就寝时段
Sleep duration/h×bedtime< 6×异常 Abnormal 1.52(1.03~2.26)② 1.18(1.01~1.38)② >8×异常 Abnormal 1.14(0.84~1.55) 0.77(0.56~1.05) 注：模型中控制了除性别外的所有协变量。
①P < 0.001；②P < 0.05。
Note: Controlling for all covariates except gender.
①P < 0.001; ②P < 0.05.
下载: 导出CSV
表 4 基于城乡分组的抑郁症状多元logistic回归分析
Table 4. Multivariate logistic regression analyses stratified by residence
变量
Variable城镇Urban
OR值value (95% CI)农村Rural
OR值value (95% CI)睡眠时长 Sleep duration/h 6~8 1.00 1.00 < 6 2.39(1.99~2.86)① 1.76(1.47~2.10)① >8 1.12(0.95~1.32) 0.99(0.88~1.12) 入睡时段 Bedtime 正常 Normal 1.00 1.00 异常 Abnormal 1.15(1.02~1.29)② 1.11(1.00~1.22)② 睡眠时长×就寝时段
Sleep duration/h×bedtime< 6×异常Abnormal 1.21(1.09~1.33)② 1.42(1.02~1.98)② >8×异常Abnormal 0.87(0.61~1.24) 1.00(0.76~1.33) 注：模型中控制了除居住地外的所有协变量。
①P < 0.001；②P < 0.05。
Note: Controlling for all covariates except residence.
①P < 0.001; ②P < 0.05.
下载: 导出CSV
-
[1] Luo YN, Su BB, Zheng XY. Trends and challenges for population and health during population aging-China, 2015-2050 [J]. China CDC Wkly, 2021, 3(28): 593-598. DOI: 10.46234/ccdcw2021.158. [2] Lee S, Tsang A, Huang YQ, et al. The epidemiology of depression in metropolitan China [J]. Psychol Med, 2009, 39(5): 735-747. DOI: 10.1017/S0033291708004091. [3] 姜勤勤, 冯明明, 袁磊, 等. 我国抑郁症状老年人的失能现况及其影响因素分析——基于第8轮CLHLS数据[J]. 海军军医大学学报, 2023, 44(11): 1268-1275. DOI: 10.16781/j.CN31-2187/R.20230234.Jiang QQ, Feng MM, Yuan L, et al. Analysis of the disability status and influencing factors of elderly individuals with depressive symptoms in China based on the 8th round of CLHLS data [J]. Acad J Naval Med Univ, 2023, 44(11): 1268-1275. DOI: 10.16781/j.CN31-2187/R.20230234. [4] 张持晨, 李欣茹, 石磊. 多重慢病老年人睡眠时间与健康的双向关系——午睡行为的调节作用[J]. 人口与发展, 2023, 29(4): 162-172, 112.Zhang CC, Li XR, Shi L. Bidirectional relationship between sleep duration and health among the older adults with multimorbidity—the moderating effect of siesta behavior [J]. Population and peveoplant, 2023, 29(4): 162-172, 112. [5] Ribeiro JD, Huang X, Fox KR, et al. Depression and hopelessness as risk factors for suicide ideation, attempts and death: meta-analysis of longitudinal studies [J]. Br J Psychiatry, 2018, 212(5): 279-286. DOI: 10.1192/bjp.2018.27. [6] Cunningham JEA, Stamp JA, Shapiro CM. Sleep and major depressive disorder: a review of non-pharmacological chronotherapeutic treatments for unipolar depression [J]. Sleep Med, 2019, 61: 6-18. DOI: 10.1016/j.sleep.2019.04.012. [7] Li YZ, Sahakian BJ, Kang JJ, et al. The brain structure and genetic mechanisms underlying the nonlinear association between sleep duration, cognition and mental health [J]. Nat Aging, 2022, 2(5): 425-437. DOI: 10.1038/s43587-022-00210-2. [8] 申莉, 贾光耀, 李佳遇, 等. 基于中国健康与养老追踪调查的老年人疼痛、睡眠与抑郁关系研究[J]. 中国预防医学杂志, 2023, 24(2): 156-160. DOI: 10.16506/j.1009-6639.2023.02.012.Shen L, Jia GY, Li JY, et al. Study on the relationship between pain, sleep and depression in the elderly based on China Health and Retirement Longitudinal Study [J]. Chin Prev Med, 2023, 24(2): 156-160. DOI: 10.16506/j.1009-6639.2023.02.012. [9] Maglione JE, Ancoli-Israel S, Peters KW, et al. Depressive symptoms and subjective and objective sleep in community-dwelling older women [J]. J Am Geriatr Soc, 2012, 60(4): 635-643. DOI: 10.1111/j.1532-5415.2012.03908.x. [10] Paudel ML, Taylor BC, Diem SJ, et al. Association between depressive symptoms and sleep disturbances in community-dwelling older men [J]. J Am Geriatr Soc, 2008, 56(7): 1228-1235. DOI: 10.1111/j.1532-5415.2008.01753.x. [11] Sakamoto N, Nanri A, Kochi T, et al. Bedtime and sleep duration in relation to depressive symptoms among Japanese workers [J]. J Occup Health, 2013, 55(6): 479-486. DOI: 10.1539/joh.13-0074-oa. [12] 先德强, 倪志松, 赖晋锋, 等. 老年人睡眠时长与抑郁症状的关系[J]. 四川精神卫生, 2023, 36(5): 453-459. DOI: 10.11886/scjsws20230219001.Xian DQ, Ni ZS, Lai JF, et al. Association between sleep duration and depressive symptoms inthe elderly [J]. Sichuan Mental Health, 2023, 36(5): 453-459. DOI: 10.11886/scjsws20230219001. [13] Yuan L, Xu Q, Gui J, et al. Decomposition and comparative analysis of differences in depressive symptoms between urban and rural older adults: evidence from a national survey [J]. Int Psychogeriatr, 2023: 1-12. DOI: 10.1017/S1041610223000078. [14] 谢宇, 胡婧炜, 张春泥. 中国家庭追踪调查: 理念与实践[J]. 社会, 2014, 34(2): 1-32. DOI: 10.15992/j.cnki.31-1123/c.2014.02.003.Xie Y, Hu JW, Zhang CN. The China family panel studies: design and practice [J]. Chinese Journal of Sociology, 2014, 34(2): 1-32. DOI: 10.15992/j.cnki.31-1123/c.2014.02.003. [15] Briggs R, Carey D, O′Halloran AM, et al. Validation of the 8-item Centre for Epidemiological Studies Depression Scale in a cohort of community-dwelling older people: data from The Irish Longitudinal Study on Ageing (TILDA) [J]. Eur Geriatr Med, 2018, 9(1): 121-126. DOI: 10.1007/s41999-017-0016-0. [16] Wu Y, Su BB, Chen C, et al. Urban-rural disparities in the prevalence and trends of depressive symptoms among Chinese elderly and their associated factors [J]. J Affect Disord, 2023, 340: 258-268. DOI: 10.1016/j.jad.2023.07.117. [17] 刘杰, 郭超. 锻炼情况对老年人实现适宜睡眠时长的影响[J]. 老龄科学研究, 2021, 9(11): 55-67. DOI: 10.3969/j.issn.2095-5898.2021.11.006.Liu J, Guo C. The effect of exercise on optimal sleep duration of the elderly [J]. Scientific Research on Aging, 2021, 9(11): 55-67. DOI: 10.3969/j.issn.2095-5898.2021.11.006. [18] Lin CY, Lai TF, Huang WC, et al. Sleep duration and timing are nonlinearly associated with depressive symptoms among older adults [J]. Sleep Med, 2021, 81: 93-97. DOI: 10.1016/j.sleep.2021.02.012. [19] Du XW, Liao JZ, Ye Q, et al. Multidimensional Internet use, social participation, and depression among middle-aged and elderly Chinese individuals: nationwide cross-sectional study [J]. J Med Internet Res, 2023, 25: e44514. DOI: 10.2196/44514. [20] 廖芳, 王维, 周波, 等. 中国老年人睡眠时长与抑郁症状关系的纵向队列研究[J]. 四川大学学报(医学版), 2022, 53(1): 109-113. DOI: 10.12182/20220160204.Liao F, Wang W, Zhou B, et al. Longitudinal cohort study of the relationship between sleep duration and depressive symptoms in older people in China [J]. J Sichuan Univ Med Sci, 2022, 53(1): 109-113. DOI: 10.12182/20220160204. [21] Facer-Childs ER, Middleton B, Skene DJ, et al. Resetting the late timing of 'night owls′ has a positive impact on mental health and performance [J]. Sleep Med, 2019, 60: 236-247. DOI: 10.1016/j.sleep.2019.05.001. [22] Chaput JP, Dutil C, Featherstone R, et al. Sleep timing, sleep consistency, and health in adults: a systematic review [J]. Appl Physiol Nutr Metab, 2020, 45(10 (Suppl 2)): S232-S247. DOI: 10.1139/apnm-2020-0032. [23] Nikbakhtian S, Reed AB, Obika BD, et al. Accelerometer-derived sleep onset timing and cardiovascular disease incidence: a UK Biobank cohort study [J]. Eur Heart J Digit Health, 2021, 2(4): 658-666. DOI: 10.1093/ehjdh/ztab088. -
点击查看大图
图(2) / 表(4)
计量
- 文章访问数: 98
- HTML全文浏览量: 33
- PDF下载量: 27
- 被引次数: 0