Sleep-Related and Inflammation-Related Indirect Pathways in the Association Between Eczema and Depression: A Cross-Sectional Analysis of the National Health and Nutrition Examination Survey (NHANES) Database
The findings are consistent with a possible sleep-related indirect pathway between eczema/AD and depression, although the estimate did not meet the conventional two-sided significance threshold.
Abstract
Background: Eczema/atopic dermatitis (AD) is associated with depression, but the potential indirect pathways involving sleep disorders and peripheral inflammation remain uncertain. We examined sleep-related and inflammation-related indirect effects in the eczema/AD-depression association. Methods: We analyzed cross-sectional data from 2,071 adults aged 20-59 years who participated in the 2005-2006 National Health and Nutrition Examination Survey. Depression was defined as a Patient Health Questionnaire-9 score ≥10. Physician-diagnosed sleep disorder, the systemic immune-inflammation index (SII), and the aggregate index of systemic inflammation (AISI) were evaluated as potential indirect pathways. Survey-weighted linear probability models and 5,000 design-based Rao-Wu bootstrap replicates were used to estimate indirect effects on the risk-difference (RD) scale. Inflammation-related effects were additionally assessed using equivalence testing. Results: Eczema/AD was associated with a higher prevalence of depression (total-effect RD = 0.0689, 95% bootstrap confidence interval (CI) 0.0233-0.1142; two-sided P = 0.002). The sleep-related indirect estimate was positive but imprecise (RD = 0.00860, 95% bootstrap CI -0.00024 to 0.01888; two-sided P = 0.058). Indirect effects involving SII or AISI were negligible, and their 90% CIs were contained within the prespecified equivalence bounds of ±0.00689. Similar findings were obtained for the neutrophil-to-lymphocyte ratio, eosinophil count, total immunoglobulin E, and high-sensitivity C-reactive protein. Conclusions: The findings are consistent with a possible sleep-related indirect pathway between eczema/AD and depression, although the estimate did not meet the conventional two-sided significance threshold. Indirect effects involving the measured peripheral inflammatory markers were negligible relative to the prespecified equivalence margin. Because of the cross-sectional design, temporal ordering and causal mediation cannot be established.
ObjectiveThis study examined the association between the Systemic Inflammatory Response Index (SIRI) and depressive symptoms among emerging adults aged 18-25 years, with an emphasis on the indirect role of sleep duration.MethodThis cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2005-2023. A total of 6563 participants with complete data on the Patient Health Questionnaire-9 (PHQ-9), complete blood count parameters for SIRI calculation, and self-reported sleep duration were included. Depressive symptoms were defined as a PHQ-9 score ≥10. Weighted multivariable logistic regression, restricted cubic spline analysis, and bootstrap-based exploratory mediation analysis (n = 1000) were employed.ResultsOverall, 604 participants (9.2%) met the criteria for depressive symptoms. After full adjustment for covariates, SIRI demonstrated a significant positive association with depressive symptoms (Model 4: OR = 1.16, 95% CI = 1.02-1.33, P = 0.03). Participants in the highest SIRI quartile (Q4) exhibited 33% higher odds of depressive symptoms compared to the lowest quartile (Q1) (OR = 1.33, 95% CI = 1.09-1.61, P = 0.005). No significant nonlinearity was observed (P for nonlinearity = 0.066). Exploratory mediation analysis revealed a negative indirect effect through sleep duration (β = -0.009), accounting for approximately 6.2% of the total effect.ConclusionsHigher SIRI levels were associated with increased odds of depressive symptoms among emerging adults. Sleep duration played a modest suppressor role in this relationship, suggesting complex interactions between inflammation, sleep, and mental health warranting further investigation through prospective studies.
Yingying Zhang, Yunyun Zheng, Yuting Zhang et al.· International Journal of Psy...· 0 citations
Inflammation is increasingly being recognized as a central factor in the development of depression, a common and debilitating condition. However, the relationship between depression and systemic inflammation indices – systemic immune-inflammation index (SII), pan-immune-inflammatory value (PIV), and systemic inflammatory response index (SIRI) – is not fully understood. In this cross-sectional study, data from the National Health and Nutrition Examination Survey 2005 to 2018, including 22,936 adults in the United States, were analyzed using multivariate logistic regression, smoothed curve fitting, and threshold and subgroup analyses to examine the associations between SII, PIV, SIRI, and depression, as well as their potential nonlinear characteristics. The analysis revealed that a 1-unit increase in Ln(SII), Ln(PIV), and Ln(SIRI) was associated with 18.2%, 14%, and 9.5% higher odds of prevalent depression, respectively. Nonlinear “J-shaped” relationships were observed for all the 3 indices. The threshold effect analysis identified significantly higher odds for Ln(SII) > 6.187, Ln(PIV) > 5.581, and Ln(SIRI) > 0.95. The subgroup analysis showed that smoking, diabetes, and liver disease significantly modified these associations. SII, PIV, and SIRI are closely linked to depressive symptoms, suggesting that they could serve as accessible inflammatory correlates of depression. Longitudinal research is required to test their prognostic utility and unravel their underlying biology.
Guanwen Zhu, Jiawen Liu, Sijia Wang et al.· Medicine· 0 citations
HEI-2020 was inversely associated with PSD, with nonlinear and race-specific patterns and DI-GM showed a significant but inconsistent indirect association, suggesting a suppressive rather than mediating role.
Can Xing, Zhenhui Lu, Xiaoming Guo et al.· BMC Psychiatry· 0 citations
Diabetic kidney disease (DKD) is a frequent microvascular manifestation of diabetes. However, the associations between sleep disorders, sleep duration time (SDT), and DKD remain inadequately understood. This study seeks to examine the associations of sleep-related factors with the prevalence of DKD among Americans aged 45 and older.
A cross-sectional analysis was carried out utilizing the 2007–2014 National Health and Nutrition Examination Survey (NHANES) data. Four sleep-related variables were evaluated: continuous SDT, categorized SDT, self-reported sleep disorders, and clinically diagnosed sleep disorders. The associations of sleep-related factors with DKD were examined via weighted logistic regression models and subgroup analyses, with adjustments for multiple potential confounders. Possible nonlinear associations between SDT and DKD were explored using restricted cubic spline (RCS) functions. Propensity score matching (PSM) was applied to evaluate the robustness of the findings.
10,780 participants were included. The overall DKD prevalence was 11.5% (n = 1243). Both self-reported sleep disorders (Model 3: OR = 1.43, 95% CI 1.16–1.77, P < 0.05) and clinically diagnosed sleep disorders (Model 3: odds ratio (OR) = 1.56, 95% confidence interval (CI) 1.15–2.11, P < 0.05) were associated with a higher prevalence of DKD. Prolonged SDT (> 9 h) was also associated with a higher DKD prevalence (OR = 1.63, 95% CI 1.08–2.46, P < 0.05). RCS analysis demonstrated a U-shaped association between SDT and DKD (P for overall association = 0.001; P for nonlinearity < 0.001).
In this cross-sectional analysis, sleep disorders and abnormal sleep duration were associated with DKD. Sleep-related factors may warrant consideration in the comprehensive clinical assessment of individuals with diabetes. Longitudinal studies are required to clarify temporal relationships.
Lingjiang Liu, Shibei Zhang, Junlin Wu et al.· European Journal of Medical...· 0 citations
PURPOSE
We examined whether accelerometer-derived rest-activity rhythms (RAR) and multidimensional sleep metrics are associated with overactive bladder (OAB) and whether depression may partially account for this relationship.
MATERIALS AND METHODS
This cross-sectional study included 6,603 adults from the National Health and Nutrition Examination Survey (2011-2014). OAB was defined by an Overactive Bladder Symptom Score ≥ 3. Nonparametric RAR metrics-interdaily stability (IS), intradaily variability (IV), and relative amplitude (RA)-and sleep parameters were extracted from 7-day wrist-worn accelerometry. Depression was evaluated with the Patient Health Questionnaire-9. Survey-weighted logistic regression examined associations between RAR and sleep exposures and OAB. Mediation analysis quantified the potential indirect pathway through depression severity.
RESULTS
Weighted OAB prevalence was 21.4%. After full adjustment, each 0.1-unit increase in RA was associated with 17% lower odds of OAB (OR 0.83, 95% CI 0.79-0.88), while each 0.1-unit increase in IV was associated with 5% higher odds (OR 1.05, 95% CI 1.02-1.08). Higher sleep efficiency (OR 0.81 per 10% increase, 95% CI 0.73-0.90) and longer sleep duration (OR 0.95 per hour, 95% CI 0.91-0.99) were also inversely associated with OAB. IS, social jetlag and catch-up sleep showed no independent associations. Depression partially accounted for the RA-OAB relationship.
CONCLUSIONS
Weaker rest-activity rhythms and poorer sleep health are cross-sectionally associated with higher OAB prevalence, and depression may partially explain this relationship. These observational findings require prospective validation.
Inflammatory dysregulation has been implicated in depression; however, the association between the systemic inflammation response index (SIRI), a composite inflammatory marker derived from peripheral neutrophil, monocyte, and lymphocyte counts, and depression in the general adult population remains unclear. This study aimed to examine the association between SIRI and depression among adults from the National Health and Nutrition Examination Survey 2005 to 2016. This cross-sectional study included 24,188 adults with available data on the Patient Health Questionnaire-9 (PHQ-9), blood cell counts, and relevant covariates. SIRI was calculated as neutrophil count × monocyte count/lymphocyte count. Depression was assessed using the PHQ-9, with a score ≥10 indicating clinically relevant depressive symptoms. Multivariable logistic regression, restricted cubic spline analysis, threshold effect analysis, and receiver operating characteristic curve analysis were performed to evaluate the association, nonlinear relationship, and incremental discriminatory value of SIRI. Among 24,188 participants, 2055 (8.50%) had clinically relevant depressive symptoms. Higher SIRI was associated with increased odds of depression after multivariable adjustment (odds ratio = 1.07, 95% confidence interval: 1.02–1.13, P = .004). Compared with the lowest quartile, participants in the highest SIRI quartile had higher odds of depression (odds ratio = 1.26, 95% confidence interval: 1.10–1.44, P < .001). Restricted cubic spline analysis demonstrated a significant nonlinear association between SIRI and depression (P for nonlinear = .007). Threshold analysis identified an inflection point at approximately 2.58, below which higher SIRI was associated with increased odds of depression, whereas the association plateaued thereafter. Adding SIRI to the basic model slightly improved discrimination (area under the curve: 0.716 vs 0.725). Higher SIRI levels were associated with higher odds of clinically relevant depressive symptoms among adults from the National Health and Nutrition Examination Survey 2005 to 2016, with a nonlinear dose-response pattern. Given the modest effect size and limited improvement in discrimination, SIRI should be interpreted as an auxiliary peripheral inflammatory marker rather than a standalone screening or diagnostic tool. Further prospective studies are required to clarify causality and clinical relevance.
Qiongqiong Zhan, Yu Wu, Jiaojiao Sun et al.· Medicine· 0 citations