Observational studyBMC public health2026
Joint association of physical function and sleep duration with incident depressive symptoms among middle-aged and older Chinese.
Observational study in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo explore the independent, joint, interactive, and mediating effects of physical function (PF) and sleep duration (SD) on incident depressive symptoms (IDS) among Chinese adults aged ≥ 45 years, and to recommend appropriate PF-SD combination strategy to lower IDS risk.
methodsData were obtained from the China Health and Retirement Longitudinal Study (CHARLS), with a nine-year follow-up from 2011 to 2020. Physical function was assessed with a 9-item questionnaire, SD was self-reported, and IDS was defined by the Center for Epidemiological Studies Depression Scale ( CES-D). Cox regression, restricted cubic spline (RCS) model, Subgroup and sensitivity analysis, interaction, and mediation analyses were applied.
resultsAmong 6,189 community-dwelling adults (mean age 56.6 ± 7.9 years; 52.4% male), 1,815 incident IDS events (29.3%) were documented over 9 years of follow-up. Both physical dysfunction (PD) and short sleep duration (SSD) were independently associated with IDS (PD: HR = 1.37; SSD: HR = 1.15–1.34; all P < 0.05). The SSD–IDS association remained robust across PD and non-physical dysfunction (NPD) subgroups (HR = 1.13–1.38; all P < 0.05 except for midday nap duration [MND] < 30 min in NPD). Relative to the PD + SSD referent, all other combinations exhibited significantly lower hazard ratios (HR = 0.53–0.85; all P < 0.05). Restricted cubic spline analyses revealed non-linear relationships of total sleep duration (TSD) and nighttime sleep duration (NSD) with IDS (P for non-linearity = 0.002), with no further risk reduction beyond TSD > 8 h or NSD > 7.5 h (both P > 0.05). Mediation analysis indicated that TSD and NSD accounted for 3.55% and 4.0%, respectively, of the PD–IDS effect.
conclusionPD and SSD are independent risk factors for IDS among middle-aged and older Chinese, with PD + SSD combination conferring the highest risk. Recommended risk-mitigation strategies are: for NPD individuals, NSD ≥ 6 h; for PD individuals, NSD ≥ 6 h or MND ≥ 30 min. TSD and NSD partially mediate the PD-IDS relationship. Long sleep duration did not increase the risk of IDS.
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