Prospective relationships of mentally passive sedentary behaviors with depression: Mediation by sleep problems

Mats Hallgren; Davy Vancampfort; Neville Owen; Susan Rossell; David W Dunstan; Rino Bellocco; Ylva Trolle Lagerros

doi:10.1016/j.jad.2019.11.088

Prospective relationships of mentally passive sedentary behaviors with depression: Mediation by sleep problems

J Affect Disord. 2020 Mar 15:265:538-544. doi: 10.1016/j.jad.2019.11.088. Epub 2019 Nov 13.

Authors

Mats Hallgren¹, Davy Vancampfort², Neville Owen³, Susan Rossell⁴, David W Dunstan⁵, Rino Bellocco⁶, Ylva Trolle Lagerros⁷

Affiliations

¹ Epidemiology of Psychiatric Conditions, Substance use and Social Environment (EPiCSS), Department of Public Health Sciences, Karolinska Institutet, Stockholm 171 77, Sweden. Electronic address: mats.hallgren@ki.se.
² Department of Rehabilitation Sciences, University of Leuven, and University Psychiatric Center, Katholieke Universiteit Leuven, Belgium.
³ Behavioral Epidemiology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia; Swinburne University of Technology, Melbourne, Australia.
⁴ Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.
⁵ Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
⁶ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.; Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy.
⁷ Obesity Center, Academic Specialist Center, Stockholm Health, , Stockholm, Sweden; Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, 171 77 Solna, Sweden.

PMID: 31784118
DOI: 10.1016/j.jad.2019.11.088

Abstract

Background: As distinct from mentally-active sedentary behaviors (e.g. reading), passive sedentary behaviors (e.g. TV-viewing) have been linked to a higher risk of depression, but the underlying mechanisms are unclear. We examined the potential mediating role of sleep problems in prospective relationships of passive sedentary behaviors with major depressive disorder (MDD).

Method: In 1997, 43 863 adults were surveyed and responses linked to clinician diagnoses of MDD until 2010. The questionnaire included items on sedentary behavior and sleep problems (Karolinska Sleep Questionnaire). Cox proportional hazard models and the 'counterfactual approach' were used to identify potential mediating effects of sleep problems in the association of passive sedentary behavior and MDD.

Results: Of the total sample, 3,065 (7.6%) were excluded for having indications of depression at baseline. Of 33,116 participants with complete data (mean age = 51.3 years, SD = 15.7, 64% female); 472 (1.4%) incident cases of MDD were identified during the 13-year follow-up. In Cox regression analyses, higher durations of passive sedentary behavior (≥3 h/day versus <3 h/day) were associated with greater hazards of developing MDD (HR = 1.27; 95% CI = 1.01, 1.58). This relationship remained after adjusting for confounders (HR = 1.29; 95% CI = 1.03, 1.63). Adding sleep problems into the analysis significantly attenuated these relationships (HR = 1.25; 95% CI = 0.99, 1.57). The excess MDD relative risk of passive sedentary behaviors due to sleep problems was statistically significant.

Limitations: Measures of sedentary behavior, physical activity and sleep were self-reported.

Conclusion: Sleep problems appear to mediate detrimental associations of passive sedentary behavior with depression. Findings require further confirmation using objective measures.

Keywords: Depression; Exercise; Mediation effect; Sedentary behavior; Sleep.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Depression
Depressive Disorder, Major* / epidemiology
Female
Humans
Male
Prospective Studies
Sedentary Behavior
Sleep Wake Disorders* / epidemiology