Annals of Occupational and Environmental Medicine

  • 제35권
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  • Pages.47.1-47.14
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  • 2023
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  • 1225-3618(pISSN)
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  • 2052-4374(eISSN)
대한직업환경의학회 (The Korean Society of Occupational & Environmental Medicine)
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Mediation analysis of chronotype, sleep-related factors, and depressive symptoms among workers: a cross-sectional study

  • Seo Young Kim (Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Hyo Jeong Kim (Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Seong-Sik Cho (Department of Occupational and Environmental Medicine, College of Medicine, Dong-A University) ;
  • Min Young Park (Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Mo-Yeol Kang (Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 투고 : 2023.08.15
  • 심사 : 2023.10.30
  • 발행 : 2023.12.31
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초록

Background: This study aimed to examine the impact of chronotype on depressive symptoms and explore the mediating effects of sleep quality, pre-sleep cognitive arousal, and social jetlag in a sample of wage earners. Methods: A total of 3,917 waged workers were surveyed online in July 2022. Logistic regression and mediation analysis were used to assess the relationship between chronotype (morningness, intermediate, and eveningness) and depressive symptoms (Patient Health Questionnaire ≥ 5), and the mediating effects of Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Pre-Sleep Arousal Scale (PSAS). All analyses were adjusted for age, education level, income level, marital status, coffee consumption, alcohol consumption, physical activity, occupation, employment status, and working hours to calculate odds ratios (ORs). Results: The chronotypes of all the participants were divided into morningness (4.7%), intermediate (93.5%), and eveningness (1.8%). Multiple logistic regression analysis showed an increased risk of depression in the eveningness chronotype (OR: 2.96; 95% confidence interval [CI]: 1.51, 5.86). Regarding the mediation analysis, ISI mediated 28.44% (95% CI: 16.39-40.5), PSQI for 31.25% (95% CI: 19.36, 43.15), and PSAS-Cognitive Score (PSAS-C) for 23.58% (95% CI: 10.66, 36.50) of the association between chronotype and depressive symptoms. However, social jetlag did not significantly mediate this relationship. (percentage mediated = 0.75%, 95% CI: -3.88, 5.39) Conclusions: Evening chronotypes exhibit an increased risk of depressive symptoms, which ISI, PSQI, and PSAS-C partially mediated. This suggests that interventions to improve sleep quality and maintain adequate sleep habits may effectively prevent and treat depression in employees with an eveningness chronotype.

키워드

과제정보

The authors appreciate the Occupational Safety and Health Research Institute for providing the raw data from the 6th Korean Working Conditions Survey.

참고문헌

  1. Eaton WW, Anthony JC, Mandel W, Garrison R. Occupations and the prevalence of major depressive disorder. J Occup Med 1990;32(11):1079-87.
  2. Kessler RC, Frank RG. The impact of psychiatric disorders on work loss days. Psychol Med 1997;27(4):861-73.
  3. Adan A, Archer SN, Hidalgo MP, Di Milia L, Natale V, Randler C. Circadian typology: a comprehensive review. Chronobiol Int 2012;29(9):1153-75.
  4. Horne JA, Ostberg O. A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. Int J Chronobiol 1976;4(2):97-110.
  5. Lee S, Jung HN, Ryu J, Jung WC, Kim YM, Kim H. Relationship between chronotype and depressive symptoms among newly hired hospital nurses in the Republic of Korea. Ann Occup Environ Med 2022;34(1):e32.
  6. Raiha T, Nerg I, Jurvelin H, Conlin A, Korhonen M, Ala-Mursula L. Evening chronotype is associated with poor work ability and disability pensions at midlife: a Northern Finland Birth Cohort 1966 Study. Occup Environ Med. Forthcoming 2021.
  7. Horne CM, Watts AL, Norbury R. The influence of subjective sleep quality on the association between eveningness and depressive symptoms. Biol Rhythm Res 2019;50(4):534-42.
  8. Chiu WH, Yang HJ, Kuo PH. Chronotype preference matters for depression in youth. Chronobiol Int 2017;34(7):933-41.
  9. Antypa N, Verkuil B, Molendijk M, Schoevers R, Penninx BW, Van Der Does W. Associations between chronotypes and psychological vulnerability factors of depression. Chronobiol Int 2017;34(8):1125-35.
  10. Kitamura S, Hida A, Watanabe M, Enomoto M, Aritake-Okada S, Moriguchi Y, et al. Evening preference is related to the incidence of depressive states independent of sleep-wake conditions. Chronobiol Int 2010;27(9-10):1797-812.
  11. Muller MJ, Kundermann B, Cabanel N. Eveningness and poor sleep quality independently contribute to self-reported depression severity in psychiatric inpatients with affective disorder. Nord J Psychiatry 2016;70(5):329-34.
  12. Chan JW, Lam SP, Li SX, Yu MW, Chan NY, Zhang J, et al. Eveningness and insomnia: independent risk factors of nonremission in major depressive disorder. Sleep (Basel) 2014;37(5):911-7.
  13. Wittmann M, Dinich J, Merrow M, Roenneberg T. Social jetlag: misalignment of biological and social time. Chronobiol Int 2006;23(1-2):497-509.
  14. Cheng WJ, Puttonen S, Vanttola P, Koskinen A, Kivimaki M, Harma M. Association of shift work with mood disorders and sleep problems according to chronotype: a 17-year cohort study. Chronobiol Int 2021;38(4):518-25.
  15. Kroenke K, Spitzer RL. The PHQ-9: a New Depression Diagnostic and Severity Measure. Thorofare, NJ, USA: Slack Incorporated; 2002. 
  16. Cho YW, Song ML, Morin CM. Validation of a Korean version of the insomnia severity index. J Clin Neurol 2014;10(3):210-5.
  17. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28(2):193-213.
  18. Nicassio PM, Mendlowitz DR, Fussell JJ, Petras L. The phenomenology of the pre-sleep state: the development of the pre-sleep arousal scale. Behav Res Ther 1985;23(3):263-71.
  19. Puzino K, Amatrudo G, Sullivan A, Vgontzas AN, Fernandez-Mendoza J. Clinical significance and cut-off scores for the Pre-Sleep Arousal Scale in chronic insomnia disorder: a replication in a clinical sample. Behav Sleep Med 2020;18(6):705-18.
  20. Patterson F, Malone SK, Lozano A, Grandner MA, Hanlon AL. Smoking, screen-based sedentary behavior, and diet associated with habitual sleep duration and chronotype: data from the UK biobank. Ann Behav Med 2016;50(5):715-26.
  21. Aalto M, Tuunanen M, Sillanaukee P, Seppa K. Effectiveness of structured questionnaires for screening heavy drinking in middle-aged women. Alcohol Clin Exp Res 2006;30(11):1884-8.
  22. Bull FC, Maslin TS, Armstrong T. Global Physical Activity Questionnaire (GPAQ): nine country reliability and validity study. J Phys Act Health 2009;6(6):790-804.
  23. Kim KM, Han SM, Heo K, Kim WJ, Chu MK. Sex differences in the association between chronotype and risk of depression. Sci Rep 2020;10(1):18512.
  24. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986;51(6):1173-82.
  25. Norbury R. Diurnal preference and depressive symptomatology: a meta-analysis. Sci Rep 2021;11(1):12003.
  26. Kivela L, Papadopoulos MR, Antypa N. Chronotype and psychiatric disorders. Curr Sleep Med Rep 2018;4(2):94-103.
  27. Au J, Reece J. The relationship between chronotype and depressive symptoms: a meta-analysis. J Affect Disord 2017;218:93-104.
  28. Hankin BL, Abramson LY, Miller N, Haeffel GJ. Cognitive vulnerability-stress theories of depression: examining affective specificity in the prediction of depression versus anxiety in three prospective studies. Cognit Ther Res 2004;28(3):309-45.
  29. Horne CM, Marr-Phillips SDM, Jawaid R, Gibson EL, Norbury R. Negative emotional biases in late chronotypes. Biol Rhythm Res 2017;48(1):151-5.
  30. Watts AL, Norbury R. Reduced effective emotion regulation in night owls. J Biol Rhythms 2017;32(4):369-75.
  31. Hasler BP, Buysse DJ, Kupfer DJ, Germain A. Phase relationships between core body temperature, melatonin, and sleep are associated with depression severity: further evidence for circadian misalignment in non-seasonal depression. Psychiatry Res 2010;178(1):205-7. 
  32. Keller J, Flores B, Gomez RG, Solvason HB, Kenna H, Williams GH, et al. Cortisol circadian rhythm alterations in psychotic major depression. Biol Psychiatry 2006;60(3):275-81.
  33. Horne CM, Norbury R. Exploring the effect of chronotype on hippocampal volume and shape: a combined approach. Chronobiol Int 2018;35(7):1027-33.
  34. Gorgoni M, Scarpelli S, Mangiaruga A, Alfonsi V, Bonsignore MR, Fanfulla F, et al. Pre-sleep arousal and sleep quality during the COVID-19 lockdown in Italy. Sleep Med 2021;88:46-57.
  35. Takano K, Tanno Y. Diurnal variation in rumination. Emotion 2011;11(5):1046-58.
  36. Bauducco S, Richardson C, Gradisar M. Chronotype, circadian rhythms and mood. Curr Opin Psychol 2020;34:77-83.
  37. Nowakowska-Domagala K, Juras-Darowny M, Pietras T, Stecz P, Mokros L. Chronotype and poor sleep quality in young adults - a pilot study on the role of rumination. Sleep Med 2022;100:206-11.
  38. Sladek MR, Doane LD, Breitenstein RS. Daily rumination about stress, sleep, and diurnal cortisol activity. Cogn Emot 2020;34(2):188-200.
  39. Toomey R, Panizzon MS, Kremen WS, Franz CE, Lyons MJ. A twin-study of genetic contributions to morningness-eveningness and depression. Chronobiol Int 2015;32(3):303-9.
  40. Lee JH, Kim SJ, Lee SY, Jang KH, Kim IS, Duffy JF. Reliability and validity of the Korean version of Morningness-Eveningness Questionnaire in adults aged 20-39 years. Chronobiol Int 2014;31(4):479-86.
  41. Muller MJ, Cabanel N, Olschinski C, Jochim D, Kundermann B. Chronotypes in patients with nonseasonal depressive disorder: distribution, stability and association with clinical variables. Chronobiol Int 2015;32(10):1343-51.
  42. Comas M, Solis Flores A, Lovato N, Miller CB, Bartlett DJ, Grunstein RR, et al. The relationship between anxiety, subjective and objective sleep, chronotype and circadian rhythms with depressive symptoms in insomnia disorder. Brain Sci 2023;13(4):613.
  43. Shin C, Ko YH, An H, Yoon HK, Han C. Normative data and psychometric properties of the Patient Health Questionnaire-9 in a nationally representative Korean population. BMC Psychiatry 2020;20(1):194.
  44. Min J, Jang TW, Lee HE, Cho SS, Kang MY. Social jetlag and risk of depression: results from the Korea National Health and Nutrition Examination Survey. J Affect Disord 2023;323:562-9.
  45. Lee EJ, Kim SJ. Prevalence and related factors of depression before and during the COVID-19 pandemic: findings from the Korea National Health and Nutrition Examination Survey. J Korean Med Sci 2023;38(10):e74.
  46. Kantermann T, Burgess HJ. Average mid-sleep time as a proxy for circadian phase. PsyCh J 2017;6(4):290-1.