The Pendulum Swings Both Ways: Evidence for U-Shaped Association between Sleep Duration and Mental Health Outcomes
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Sample
2.2. Study Variables
2.3. Confounders
2.4. Statistical Analysis
3. Results
3.1. Description of the Sample
3.2. Sleep Duration and Mental Health by Subjective Health
3.3. Effect of Sleep Duration on Measures of Mental Health
3.4. Estimating Parameters in the Best Models
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Sleep Duration | p Value | |||||
---|---|---|---|---|---|---|---|
<7 h | 7 h | >7 h | |||||
N | % | N | % | N | % | ||
Gender | 0.103 | ||||||
Male | 141 | 36.34 | 154 | 39.69 | 93 | 23.97 | |
Female | 275 | 33.37 | 303 | 36.77 | 246 | 29.85 | |
Age group | 0.169 | ||||||
18–29 years | 49 | 28.32 | 62 | 35.84 | 62 | 35.84 | |
30–45 years | 212 | 35.16 | 229 | 37.98 | 162 | 26.87 | |
46–59 years | 131 | 38.3 | 126 | 36.84 | 85 | 24.85 | |
60 ≥ years | 25 | 32.05 | 31 | 39.74 | 22 | 28.21 | |
Lives with partner | 0.829 | ||||||
No | 151 | 33.48 | 171 | 37.92 | 129 | 28.6 | |
Yes | 263 | 35.21 | 277 | 37.08 | 207 | 27.71 | |
Education | 0.544 | ||||||
Secondary | 55 | 33.74 | 57 | 34.97 | 51 | 31.29 | |
Tertiary | 362 | 34.54 | 400 | 38.17 | 286 | 27.29 | |
Employment position | 0.013 | ||||||
Manager | 65 | 43.62 | 58 | 38.93 | 26 | 17.45 | |
Non-manager | 348 | 33.82 | 397 | 38.58 | 284 | 27.6 | |
Smoking | 0.593 | ||||||
Current smoker | 67 | 38.07 | 66 | 37.5 | 43 | 24.43 | |
Former smoker | 80 | 37.74 | 78 | 36.79 | 54 | 25.47 | |
Never smoked | 264 | 33.55 | 305 | 38.75 | 218 | 27.7 | |
Social support | 0.001 | ||||||
Severe lack | 61 | 47.66 | 49 | 38.28 | 18 | 14.06 | |
Moderate lack | 87 | 40.47 | 76 | 35.35 | 52 | 24.19 | |
Optimal support | 246 | 31.82 | 305 | 39.46 | 222 | 28.72 |
Variables | Subjective Health | p | |
---|---|---|---|
Less Than Good | At Least Good | ||
Gender (%) | 0.178 | ||
Male | 27.65 | 72.35 | |
Female | 31.46 | 68.54 | |
Age (years) | 43.72 | 40.97 | <0.001 |
Lives with partner (%) | 0.825 | ||
No | 29.69 | 70.31 | |
Yes | 30.29 | 69.71 | |
Education (%) | <0.001 | ||
Secondary | 44.17 | 55.83 | |
Tertiary | 28.16 | 71.84 | |
Employment position (%) | 0.638 | ||
Manager | 28.38 | 71.62 | |
Nonmanager | 30.27 | 69.73 | |
Social support (%) | <0.001 | ||
Severe lack | 51.56 | 48.44 | |
Moderate lack | 33.64 | 66.36 | |
Optimal support | 25.03 | 74.97 | |
Sleep duration (hours) | 6.62 | 6.91 | <0.001 |
Psychological distress (GHQ-12, %) | <0.001 | ||
Stressed | 52.90 | 47.10 | |
Not stressed | 27.01 | 72.99 | |
Sense of coherence (mean) | 63.10 | 68.37 | <0.001 |
Satisfaction with life (mean) | 7.55 | 8.38 | <0.001 |
Work ability (mean) | 8.1 | 8.7 | <0.001 |
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 gender | 1.000 | ||||||||||||
2 age | 1.000 | ||||||||||||
3 lives with partner | 0.284 * | 1.000 | |||||||||||
4 education | −0.107 | 1.000 | |||||||||||
5 employment position | 0.144 * | −0.317 * | 0.155 * | 0.128 * | 1.000 | ||||||||
6 smoking | 1.000 | ||||||||||||
7 social support | 1.000 | ||||||||||||
8 sleep duration | 0.129 | 1.000 | |||||||||||
9 subjective health | −0.120 | 0.137 * | 0.181 * | 0.140 * | 1.000 | ||||||||
10 psychol.stress | −0.103 | −0.112 | −0.304 * | −0.186 * | −0.306 * | 1.000 | |||||||
11 sense of coherence | 0.190 * | 0.200 * | −0.189 * | 0.352 * | 0.155 * | 0.232 * | −0.489 * | 1.000 | |||||
12 satisfaction w/ llife | 0.209 * | −0.130 * | 0.421 * | 0.183 * | 0.282 * | −0.458 * | 0.555 * | 1.000 | |||||
13 work ability | 0.101 | 0.203 * | 0.182 * | 0.263 * | −0.319 * | 0.358 * | 0.406 * | 1.000 | |||||
Mean (±SD) | n/a | 41.83 (11) | n/a | n/a | n/a | n/a | n/a | 6.83 (0.98) | n/a | 23.86 (4.04) | 66.77 (11.26) | 8.13 (1.65) | 8.52 (1.23) |
Min-max values | 223–85 | 1−12 | 15–43 | 23–91 | 1–10 | 2–10 |
Outcomes | Linear Model | Quadratic Model | Fractional Polynomial Model |
---|---|---|---|
Psychological distress | |||
sleep duration (p) | <0.001 | 0.002 | |
sleep duration squared (p) | n/a | 0.033 | n/a |
sleep duration (power → p) | n/a | n/a | 1 → <0.001 |
age (power → p) | 3 → <0.001 | ||
adjusted R2 | 0.130 | 0.133 | 0.134 |
RMSE | 0.933 | 0.931 | 0.931 |
AIC | 2745.9 | 2743.3 | 2740.9 |
Sense of coherence | |||
sleep duration (p) | <0.001 | 0.002 | |
sleep duration squared (p) | n/a | 0.018 | n/a |
sleep duration1 (power → p) | n/a | n/a | 2 → <0.001 |
sleep duration2 (power → p) | n/a | n/a | 3 → <0.001 |
adjusted R2 | 0.190 | 0.194 | 0.199 |
RMSE | 0.890 | 0.888 | 0.886 |
AIC | 2523.7 | 2520.1 | 2514.2 |
Life satisfaction | |||
sleep duration (p) | <0.001 | 0.021 | |
sleep duration squared (p) | n/a | 0.132 | n/a |
sleep duration (power → p) | n/a | n/a | 1 → <0.001 |
adjusted R2 | 0.224 | 0.225 | 0.224 |
RMSE | 0.871 | 0.871 | 0.871 |
AIC | 2673.9 | 2673.6 | 2673.9 |
Work ability | |||
sleep duration (p) | <0.001 | <0.001 | |
sleep duration squared (p) | n/a | <0.001 | n/a |
sleep duration (power → p) | n/a | n/a | −1 → <0.001 |
adjusted R2 | 0.075 | 0.086 | 0.079 |
RMSE | 0.958 | 0.952 | 0.955 |
AIC | 2903.4 | 2891.5 | 2898.0 |
Sleep as Main Effect Variable and Covariates | Outcome Indicators of Mental Health | |||
---|---|---|---|---|
Psychological Stress Estimate (SE) | Sense of Coherence Estimate (SE) | Life Satisfaction Estimate (SE) | Work Ability Estimate (SE) | |
Model | Frac. polynomial | Frac. polynomial | Quadratic | Quadratic |
sleep duration (hours) | n/a | n/a | 0.406 (0.18) * | 0.866 (0.15) *** |
sleep duration squared | n/a | n/a | −0.019 (0.01) | −0.051 (0.01) *** |
sleep duration power1 | −0.173 (0.03) *** | 0.096 (0.02) *** | n/a | n/a |
sleep duration power2 | n/a | −0.008 (0.002) ** | n/a | n/a |
gender (female vs male) | 0.096 (0.06) | 0.016 (0.06) | 0.196 (0.06) ** | 0.186 (0.06) ** |
age (years) | n/a | 0.013 (0.002) *** | 0.001 (0.002) | −0.003 (0.002) |
age (years) power | −0.017 (0.0004) *** | n/a | n/a | n/a |
living w/partner (yes vs no) | −0.051 (0.06) | 0.353 (0.06) ** | 0.352 (0.05) *** | 0.130 (0.06) |
education (tertiary vs secondary) | −0.073 (0.09) | 0.303 (0.10) ** | 0.300 (0.08) *** | 0.059 (0.10) |
employment position (manager vs non-manager) | −0.200 (0.07) ** | 0.341 (0.08) *** | 0.268 (0.06) *** | 0.401 (0.07) *** |
social support (optimal vs suboptimal) | −0.589 (0.07) *** | 0.639 (0.06) *** | 0.750 (0.06) *** | 0.401 (0.06) *** |
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Kósa, K.; Vincze, S.; Veres-Balajti, I.; Bába, É.B. The Pendulum Swings Both Ways: Evidence for U-Shaped Association between Sleep Duration and Mental Health Outcomes. Int. J. Environ. Res. Public Health 2023, 20, 5650. https://doi.org/10.3390/ijerph20095650
Kósa K, Vincze S, Veres-Balajti I, Bába ÉB. The Pendulum Swings Both Ways: Evidence for U-Shaped Association between Sleep Duration and Mental Health Outcomes. International Journal of Environmental Research and Public Health. 2023; 20(9):5650. https://doi.org/10.3390/ijerph20095650
Chicago/Turabian StyleKósa, Karolina, Szilvia Vincze, Ilona Veres-Balajti, and Éva Bácsné Bába. 2023. "The Pendulum Swings Both Ways: Evidence for U-Shaped Association between Sleep Duration and Mental Health Outcomes" International Journal of Environmental Research and Public Health 20, no. 9: 5650. https://doi.org/10.3390/ijerph20095650