探索青少年睡眠問題和憂鬱之間的潛在雙向關係

憂鬱在青少年是一個常見的心理健康問題 (11.0%-26.6%)，並且與物質使用、人際關係、生理活動及睡眠有關，而青少年的睡眠問題在近年來有逐年增加的趨勢，並且可能造成憂鬱情緒的產生，不少研究已報告失眠及睡眠長度與憂鬱之間顯著的相關，但在這些研究中發現失眠及睡眠長度可預測憂鬱的發生，卻沒有反向的結果，其可能的原因為過去的研究沒有考慮到其他與睡眠問題及憂鬱有關的干擾及中介因子，例如：神經質人格特質、壓力以及3C產品使用，另外，也缺乏調查青少年憂鬱及其他睡眠面向關係的研究，因此本研究利用一年的前瞻性追蹤研究調查國中小學童不同面向之睡眠問題與憂鬱之雙向關係，並測量其他潛在之干擾因子(如：神經質人格特質以及自覺壓力)及中介因子(如：3C產品之使用)對睡眠及憂鬱關係之影響。在本研究中總共收集1,628位四到七年級的台灣國中小學童，主要利用憂鬱量表(the Center for Epidemiologic studies Depressive Scale, CES-D)及匹茲堡睡眠品質量表分別測量兩時點學童的憂鬱及睡眠狀況，壓力則使用自覺壓力量表進行測量，此外，也使用艾氏少年人格量表測量學童神經質程度，並且也收集3C產品使用習慣之資訊。羅吉斯回歸用於測量在校正過區域、性別、年級以及其他潛在干擾因子的影響後睡眠與憂鬱的關係。本研究在基點有相當比例的學生具有憂鬱 (17%)及睡眠不佳的狀況 (30%)，且追蹤一年後的憂鬱 (17%)及睡眠不佳 (29%)比例也與基點相似，每一個睡眠問題的面向與新發之憂鬱皆有顯著關係 (OR=2.05-3.52)，然而此關係卻容易受到自覺壓力及神經質人格特質的影響，但若是學童有持續一年的睡眠問題時，持續性睡眠問題可增加憂鬱之風險 (OR=3.10-7.34)，不受自覺壓力及神經質的影響。相反地，雖然研究也發現憂鬱會造成睡眠問題，不過此關係也同樣地在校正過壓力及神經質人格特質的影響後變為不顯著，即使學童有持續的憂鬱狀況，持續性憂鬱只對睡眠不佳、睡眠品質及白天功能失調有顯著影響 (OR=4.09和6.22)，另外，研究中也發現3C產品的使用 (如：每天平均使用3C產品的時間及因為使用3C產品而熬夜及減少睡眠長度)會調節憂鬱與睡眠的關係。總結研究的結果，會發現不同面向的睡眠問題與憂鬱有相互的關係，不過壓力及神經質為在探討睡眠及憂鬱的關係時兩個重要的干擾因子，青少年3C產品的使用則為在調查睡眠問題與憂鬱關係時一個重要的中介因子。

關鍵字

憂鬱；睡眠；神經質；壓力； 3C產品

並列摘要

Depression is a prevalent (11.0% to 26.6%) mental health problem in youth, which has several correlated factors, such as substance use, interpersonal relationship, physical activity, and sleep. Sleep problems in adolescents show increasing trend in recent years, and may contribute to the development of depressive mood in youth. Many previous studies examine the associations between depression and insomnia and sleep duration. They found that both insomnia and sleep duration predict depression, but not the reverse direction. Lack of association from depression to sleep problems may be due to a few reasons, such as not considering potential confounders or mediators. For instance, neuroticism, stress and 3C usage might be important factors related to depression and sleep problems. Furthermore, no studies examined the relationship between depression and other sleep dimensions in youth. Therefore, we conducted a prospective cohort study to investigate bi-directional relationships between different sleep dimensions and depression in youth. Possible confounders (neuroticism personality and stress) and mediator (3C usage) are also examined. We enrolled 1,628 students of grade 4-7 in Taiwan. Depression and sleep problems were assessed at baseline and one-year follow-up by the Center for Epidemiologic Studies Depression Scale, and Pittsburgh Sleep Quality Index, respectively. Stress was measured using perceive stress scale. We also used Junior Eysenck Personality Questionnaire to assess neuroticism. Information on 3C usage was collected. Multiple logistic regression models were used for association testing between depression and sleep problems after adjusted for region, gender, grade and potential confounders. We found a substantial proportion of students reported to have depression (17.2% & 17.0%) and poor sleeper (29.9% & 27.7%) at baseline and follow-up. Every sleep problem dimension at baseline was significantly associated with new onset of depression at follow-up (OR=2.05-3.52), but the relationships disappeared after adjusted for neuroticism and stress. On the other hand, persistent sleep problems significantly increased the risk of depression at follow-up (OR=3.10-7.34) even after confounders adjustment. The reverse associations from depression to sleep problems were also found initially (OR=1.67-3.92). Similarly, these associations became non-significant after adjusted for neuroticism and stress. Persistent depression predicted poor sleeper, poor sleep quality and daytime dysfunction at follow-up (OR=4.09 and 6.22) after confounders adjustment. Moreover, 3C product usage (e.g. hours of using 3C product per day and 3C delayed sleep) mediated the relationship between depression and sleep problems. In conclusion, sleep problems and depression have reciprocal effects, while neuroticism and stress are confounders for exploring the association between depression and sleep problems. 3C product usage among youth is an important factor to consider while investigate the relationship between depression and sleep problems.

並列關鍵字

depression ； sleep ； neuroticism ； stress ； 3C products usage

參考文獻

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探索青少年睡眠問題和憂鬱之間的潛在雙向關係

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