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      Associations of perceived stress with loneliness and depressive symptoms: the mediating role of sleep quality

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          Abstract

          Background

          Whether perceived stress is associated with loneliness and depressive symptoms in general adults, and to what extent sleep quality mediates the associations, remains unknown. The aim of this study was to estimate the associations of perceived stress with loneliness and depressive symptoms, and the mediating role of sleep quality in these associations.

          Methods

          Cross-sectional data on 734 participants (aged 18–87 years) were analyzed. Perceived stress was assessed using the 10-item Perceived Stress Scale (PSS-10; range 0–40). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI; range 0–21). Loneliness was assessed using the three-item short form of the Revised University of California, Los Angeles (UCLA) loneliness scale (range 3–9). Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression (CESD-10) Scale (range 0–30). General linear regression models, multivariable logistic regression models, and formal mediation analysis were performed.

          Results

          After adjustment for age and sex, we found that with each 1-point increment in the perceived stress score, both the loneliness score (β = 0.07; 95% confidence interval [CI]: 0.06, 0.08) and depression score (β = 0.45; 95% CI: 0.40, 0.49) increased significantly. Robust results were observed when adjusting for more confounders. Furthermore, sleep quality mediated 5.3% (95% CI: 1.3%, 10.0%; P = 0.014) and 9.7% (95% CI: 6.2%, 14.0%; P < 0.001) of the associations of perceived stress score with loneliness score and depression score, respectively.

          Conclusions

          In general Chinese adults, perceived stress was positively associated with loneliness and depressive symptoms, and sleep quality partially mediated these associations. The findings reveal a potential pathway from perceived stress to mental health through sleep behaviors, and highlight the importance of implementing sleep intervention programs for promoting mental health among those who feel highly stressed.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12888-024-05609-2.

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          Most cited references53

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          A Global Measure of Perceived Stress

          Sheldon Cohen, Tom Kamarck, Robin Mermelstein (1983)
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            International physical activity questionnaire: 12-country reliability and validity.

            CORA L. CRAIG, ALISON L. MARSHALL, MICHAEL SJ??STR??M … (2003)
            Physical inactivity is a global concern, but diverse physical activity measures in use prevent international comparisons. The International Physical Activity Questionnaire (IPAQ) was developed as an instrument for cross-national monitoring of physical activity and inactivity. Between 1997 and 1998, an International Consensus Group developed four long and four short forms of the IPAQ instruments (administered by telephone interview or self-administration, with two alternate reference periods, either the "last 7 d" or a "usual week" of recalled physical activity). During 2000, 14 centers from 12 countries collected reliability and/or validity data on at least two of the eight IPAQ instruments. Test-retest repeatability was assessed within the same week. Concurrent (inter-method) validity was assessed at the same administration, and criterion IPAQ validity was assessed against the CSA (now MTI) accelerometer. Spearman's correlation coefficients are reported, based on the total reported physical activity. Overall, the IPAQ questionnaires produced repeatable data (Spearman's rho clustered around 0.8), with comparable data from short and long forms. Criterion validity had a median rho of about 0.30, which was comparable to most other self-report validation studies. The "usual week" and "last 7 d" reference periods performed similarly, and the reliability of telephone administration was similar to the self-administered mode. The IPAQ instruments have acceptable measurement properties, at least as good as other established self-reports. Considering the diverse samples in this study, IPAQ has reasonable measurement properties for monitoring population levels of physical activity among 18- to 65-yr-old adults in diverse settings. The short IPAQ form "last 7 d recall" is recommended for national monitoring and the long form for research requiring more detailed assessment.
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              Loneliness and social isolation as risk factors for mortality: a meta-analytic review.

              Julianne Holt-Lunstad, Timothy B Smith, Mark Baker … (2015)
              Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine possible moderators. We conducted a literature search of studies (January 1980 to February 2014) using MEDLINE, CINAHL, PsycINFO, Social Work Abstracts, and Google Scholar. The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone. Across studies in which several possible confounds were statistically controlled for, the weighted average effect sizes were as follows: social isolation odds ratio (OR) = 1.29, loneliness OR = 1.26, and living alone OR = 1.32, corresponding to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.
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                Author and article information

                Contributors
                Zuyun Liu: Zuyun.liu@outlook.com , zuyunliu@zju.edu.cn
                Xuan Ge: gxuan-xuan@163.com
                Yangzhen Lu: 1172373198@qq.com
                Journal
                Journal ID (nlm-ta): BMC Psychiatry
                Journal ID (iso-abbrev): BMC Psychiatry
                Title: BMC Psychiatry
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-244X
                Publication date (Electronic): 1 March 2024
                Publication date PMC-release: 1 March 2024
                Publication date Collection: 2024
                Volume: 24
                Electronic Location Identifier: 172
                Affiliations
                [1 ]Department of General Practice, Dongyang People’s Hospital, ( https://ror.org/04fszpp16) 322100 Jinhua, Zhejiang China
                [2 ]GRID grid.13402.34, ISNI 0000 0004 1759 700X, Center for Clinical Big Data and Analytics Second Affiliated Hospital, Department of Big Data in Health Science School of Public Health, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, , Zhejiang University School of Medicine, ; 310058 Hangzhou, Zhejiang China
                [3 ]School of Mathematical Sciences, University of Nottingham, University Park, ( https://ror.org/01ee9ar58) NG7 2RD Nottingham, UK
                [4 ]GRID grid.13402.34, ISNI 0000 0004 1759 700X, Department of General Practice, Sir Run Run Shaw Hospital, School of Medicine, , Zhejiang University, ; 310016 Hangzhou, Zhejiang China
                [5 ]Health Management Center, Dongyang People’s Hospital, ( https://ror.org/04fszpp16) 322100 Jinhua, Zhejiang China
                Article
                Publisher ID: 5609
                DOI: 10.1186/s12888-024-05609-2
                PMC ID: 10905934
                PubMed ID: 38429635
                SO-VID: ae1ddc82-3dc4-4d6f-9c11-51f22f1c5d3d
                Copyright © © The Author(s) 2024
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 26 October 2023
                Date accepted : 14 February 2024
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 72374180
                Funded by: “Pioneer” and “Leading Goose” R&D Programs of Zhejiang Province
                Award ID: 2023C03163
                Funded by: Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province
                Award ID: 2020E10004
                Funded by: Damian Health Tech (Hangzhou) CO., LTD
                Award ID: Kheng-20220141
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © BioMed Central Ltd., part of Springer Nature 2024

                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: perceived stress,loneliness,depressive symptoms,sleep quality,mediation
                Data availability:
                ScienceOpen disciplines: Clinical Psychology & Psychiatry
                Keywords: perceived stress, loneliness, depressive symptoms, sleep quality, mediation

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