Estimating the longitudinal causal effect of insufficient sleep on depressive symptoms: Evidence from the CHARLS study

IF 4.9 2区医学 Q1 CLINICAL NEUROLOGY

Journal of affective disorders Pub Date : 2025-05-29 DOI:10.1016/j.jad.2025.119543

Yaning Feng , Zhiyuan Yang , Xiaobo Lai , Liangying Yin

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引用次数: 0

Abstract

Background

The relationship between sleep and depression has been extensively explored; however, research on the long-term causal effects of chronic sleep insufficiency on depressive symptoms remains limited. This study employs advanced causal inference techniques to assess the longitudinal impact of sleep insufficiency on depressive symptoms, accounting for both time-invariant and time-varying confounders.

Methods

Data from the China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Sleep insufficiency was defined as <6 h of sleep per day. Longitudinal targeted maximum likelihood estimation (LTMLE) was used to examine the impact of persistent sleep insufficiency over 2 to 9 years on depressive symptoms, measured by the CESD-10 scale. Subgroup analyses by gender and age, as well as the effects of napping duration, were also conducted.

Results

The study included 4362 participants, with a mean age of 55.90 years (SD = 7.71). At baseline, 924 participants reported insufficient sleep. The average treatment effect (ATE) for depressive symptoms increased initially, peaking at 3.75 points at 7 years, then slightly declining to 3.66 points at 9 years. The ATE was higher in females (4.57) than in males (2.80). Napping for over 30 min was associated with reduced depressive symptoms. Sensitivity analyses confirmed the robustness of these findings.

Conclusions

This study provides evidence of the longitudinal causal effect of insufficient sleep on depressive symptoms. Over 9 years, ATE initially increased, plateauing after 7 years. Napping for over 30 min was linked to lower depressive symptoms, especially in those with insufficient nighttime sleep. Subgroup analyses showed stronger effects in females.

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估计睡眠不足对抑郁症状的纵向因果影响：来自CHARLS研究的证据

睡眠和抑郁之间的关系已经被广泛探索；然而，关于慢性睡眠不足对抑郁症状的长期因果影响的研究仍然有限。本研究采用先进的因果推理技术来评估睡眠不足对抑郁症状的纵向影响，同时考虑了时不变和时变混杂因素。方法对中国健康与退休纵向研究（CHARLS）的数据进行分析。睡眠不足定义为每天睡眠不足6小时。使用纵向目标最大似然估计（LTMLE）来检查持续睡眠不足2至9年对抑郁症状的影响，通过csd -10量表测量。研究人员还进行了性别和年龄的亚组分析，以及午睡时间的影响。结果共纳入4362例受试者，平均年龄55.90岁（SD = 7.71）。在基线时，924名参与者报告睡眠不足。抑郁症状的平均治疗效果（ATE）最初有所增加，7年时达到3.75分的峰值，9年时略有下降至3.66分。女性ATE（4.57）高于男性（2.80）。午睡超过30分钟与抑郁症状减轻有关。敏感性分析证实了这些发现的稳健性。结论本研究为睡眠不足对抑郁症状的纵向因果关系提供了证据。9年后，ATE开始升高，7年后趋于平稳。午睡超过30分钟与较低的抑郁症状有关，尤其是那些夜间睡眠不足的人。亚组分析显示，对女性的影响更大。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of affective disorders 医学-精神病学

CiteScore

10.90

自引率

6.10%

发文量

1319

审稿时长

9.3 weeks

期刊介绍： The Journal of Affective Disorders publishes papers concerned with affective disorders in the widest sense: depression, mania, mood spectrum, emotions and personality, anxiety and stress. It is interdisciplinary and aims to bring together different approaches for a diverse readership. Top quality papers will be accepted dealing with any aspect of affective disorders, including neuroimaging, cognitive neurosciences, genetics, molecular biology, experimental and clinical neurosciences, pharmacology, neuroimmunoendocrinology, intervention and treatment trials.