Sleep behavior and depression: Findings from the China Kadoorie Biobank of 0.5 million Chinese adults

BACKGROUND: Mixed results have shown the association between sleep behavior and depression, but evidence relating the joint effect of sleep duration and sleep disturbances is limited, especially in Chinese population. METHODS: A total of 512,891 adults aged 30–79 years from China Kadoorie Biobank (CKB) were included. Depression was defined by Composite International Diagnostic Inventory-short form (CIDI-SF). Sleep duration and sleep disturbances, including difficulty initiating and maintaining sleep (DIMS), early morning awakening (EMA), daytime dysfunction (DDF) and any sleep disturbances (ASD), were obtained by a self-reported questionnaire. Logistic regression was applied to examine the association between sleep behavior and depression. RESULTS: About 23.1% of participants reported short sleep duration (≤ 6 h), and 5.1% reported long sleep duration (> 9 h). Compared with normal sleep duration (7–9 h), both groups were associated greater likelihood of having depression (short sleep: OR = 2.32, 95%CI: 2.14–2.51; long sleep: OR = 1.56, 96%CI: 1.34–1.81). Participants reported sleep disturbances were significantly associated with depression (odds ratios ranged from 3.31 to 4.17). Moreover, the associations tended to be stronger for those who reported both abnormal sleep duration and sleep disturbances (p for interactions < 0.05), especially for those who slept long. LIMITATIONS: The cross-sectional nature of the study design limits the interpretation of the results. CONCLUSIONS: Abnormal sleep duration and sleep disturbances were associated with depression. The associations were stronger for abnormal sleep duration accompanied with sleep disturbances, especially for a long duration. More attention should be paid on these persons in clinical practice.