ArticleCureus2026
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.
Article in Cureus, 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
backgroundEczema/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.
methodsWe 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.
resultsEczema/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.
conclusionsThe 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.
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