In a study of 4,656 individuals, an overall depression risk of 12.4% was identified.
The (CUS ratio) is positively associated with depression risk, particularly when the ratio exceeds 1.11.
When the CUS ratio is ≤ 1.11, an increase in the ratio is linked to a reduced depression risk.
For CUS ratios > 1.11, each unit increase in the ratio is associated with a 187% increase in depression risk.
The CUS ratio also correlates with the severity of depressive symptoms, showing a similar threshold effect at 1.11.
Individuals with lower education levels, those who are overweight, and those without diabetes may be more sensitive to changes in sleep patterns.
Simplified
BACKGROUND: Depression is a common global mental health issue, affecting around 3.8% of the population. It significantly impacts quality of life and social functioning, posing a major public health challenge. Sleep is a key factor influencing depression, with both sleep quality and quantity linked to mental health. However, sleep deprivation is widespread, and many people compensate by "weekend sleep recovery." The effects of sleep deprivation and weekend recovery on depression risk are unclear, as irregular sleep patterns may worsen depressive symptoms. This study introduces the "" (CUS ratio) to better understand the relationship between sleep patterns and depression.
METHODS: Cross-sectional data were obtained from individuals who participated in the 2021-2023 National Health and Nutrition Examination Survey (NHANES) and had complete data on CUS and the Patient Health Questionnaire (PHQ-9). Multivariable logistic regression was performed to assess the potential independent association between depression and the CUS ratio. Additionally, smoothing curve fitting, threshold effect analysis, subgroup analysis, and interaction tests were conducted.
RESULTS: A total of 4,656 individuals were analyzed, categorized by depression symptoms ( of 10 or higher), with an overall depression risk of 12.4%. In the adjusted model, the CUS ratio was significantly positively associated with depression risk (AOR = 1.75, 95% CI: 1.25-2.45), exhibiting a nonlinear threshold effect (inflection point at 1.11). When the CUS ratio ≤ 1.11, an increase in the ratio was associated with a reduced depression risk (AOR = 0.34, 95% CI: 0.13-0.89), whereas when the CUS ratio > 1.11, each unit increase in the ratio significantly increased depression risk by 187% (AOR = 2.87, 95% CI: 1.84-4.50). Individuals with education levels of less than 9th grade, some college or an Associate of Arts (AA) degree, those who are overweight (25 ≤ BMI < 30), and those without diabetes appeared more sensitive to fluctuations in sleep patterns. In the adjusted model for the severity of depressive symptoms, the CUS ratio was significantly positively associated with depression severity (Aβ = 0.19, 95% CI: 0.09-0.28), also exhibiting a nonlinear threshold effect (inflection point at 1.11). When the CUS ratio ≤ 1.11, an increase in the ratio was associated with a reduction in depression severity (Aβ = -0.35, 95% CI: -0.62 to -0.09), whereas when the CUS ratio > 1.11, each unit increase in the ratio significantly increased depression severity (Aβ = 0.36, 95% CI: 0.24-0.49). In particular, individuals without diabetes appeared more sensitive to fluctuations in sleep patterns.
CONCLUSIONS: This study suggests that maintaining a balanced sleep pattern, with a CUS ratio between 1 and 1.11, may help reduce depression risk and promote better mental health.
Key numbers
1.75
Adjusted Odds Ratio for Depression Risk Increase
CUS ratio positively associated with depression risk
1.11
Threshold Inflection Point
Inflection point for CUS ratio affecting depression risk
187%
Increase in Depression Risk Beyond Threshold
Each unit increase in CUS ratio above 1.11
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Declarations. Ethics approval and consent to participate: This study adheres to the ethical guidelines outlined in the Declaration of Helsinki. The data utilized were sourced from the publicly available, de-identified National Health and Nutrition Examination Survey (NHANES). NHANES follows the principles of the Declaration of Helsinki, including obtaining informed consent from participants and ensuring the confidentiality of their data. Since this research involves secondary analysis of NHANES data, no additional ethical approval or consent was required. The study received approval from the Ethics Review Board (ERB) of the National Center for Health Statistics (NCHS). Competing interests: The authors declare no competing interests.
