A Five-year Follow-up Controlled Study Of Sleep Quality In Patients With Depressive Disorders In Shandong Province

Objective:In this study,we compared and analyzed the characteristics of sleep quality among patients with depressive disorder and high-and low-risk populations in Shandong Province,as well as the characteristics of sleep quality among the three subtypes of depressive disorder patients through a cross-sectional survey.And through follow-up study,we investigated the changes of sleep quality between depressive disorder patients and control population in Shandong Province over 5 years and the relationship between sleep quality and changes in disease diagnosis.In addition,risk factors were analyzed to explore the influencing factors of sleep quality and prognosis of depression patients in Shandong Province,and to construct a risk factor model for the sleep quality and prognosis of depressive disorder patients.Methods:This study was based on a cross-sectional study,the Fourth Epidemiological Survey of Mental Disorders in Shandong Province in 2015,in which 870 patients with depressive disorders diagnosed by SCID-I/P and 819 high-risk and 829 low-risk cases matched by GHQ-12 subgroups were selected from a stratified whole-group random sampling of 27917 adult residents for a 5-year follow-up controlled study.Subjects’ sleep quality and general information were collected using PSQI,GAF and general information questionnaires.The survey method was a household on-site survey,and the questionnaire was administered by uniformly trained psychiatric medical staff in a question-and-answer format.The final follow-up was completed in 2020 with 2030 cases,excluding those who were missed and failed to complete the survey for various reasons,837 cases in 2015 and 525 cases in 2020 for the study group,773 cases in 2015 and 556 cases in 2020 for the high-risk group,and 791 cases in 2015 and 641 cases in 2020 for the low-risk group.Data were entered and database was created using Epidata data,SPSS 22.0 was used to process the data,and descriptive analysis,chi-square test,Mann-Whitney,ANOVA,Kruskal-Wallis test,Pearson correlation analysis,and binary logistic regression analysis were used for statistical analysis.Results:1.In the three groups,the cross-sectional comparison revealed that in terms of the detection rate of sleep disorders:in 2015,the study group（62.49%）>the high-risk group（25.10%）>the low-risk group（11.38%）（χ2=513.063,P<0.01）;in 2020,the study group（50.29%）>the control group（27.16%in the high-risk group and 22.31%in the low-risk group）（χ2=113.449,P<0.01）;and in 2015 and 2020 PSQI scores for each factor and total scores were higher in the study group than in the control group.Longitudinal comparative analysis revealed that in the study group,the detection rate of sleep disorders was lower in 2020（50.29%）than in 2015（62.49%）;in terms of sleep quality,time to fall asleep,daytime dysfunction factor scores and total PSQI scores,it was lower in 2020 than in 2015;however,the high risk group had no significant sleep disorder and sleep quality during 5 years;the detection rate of sleep disorders in（22.31%）was higher in 2020 than in 2015（11.38%）in the low-risk group,and the scores of sleep quality,,time to sleep,sleep duration,sleep efficiency,sleep disorders,daytime dysfunction factor scores and total PSQI scores,the scores were higher in 2020.2.Comparing between subgroups within the study group,the detection rate of sleep disturbance in 2015 was 68.31%in the major depressive disorder group,which was significantly higher than 58.13%in the poor mood disorder group and 53.94%in the unspecified depressive disorder group（χ2=13.297,P<0.01）,and in terms of sleep quality,time to fall asleep,sleep disturbance,hypnotic medication use,daytime dysfunction factor scores and total PSQI scores,patients in the major depressive disorder group had the highest scores.In addition,the cross-sectional combined with follow-up survey revealed that the detection rate of sleep disorders in 2015 and 2020 was higher in the unremitting group than in the remitting group;in 2020,the unremitting group and the remitting group had higher sleep quality,time to fall asleep,sleep duration,sleep disturbance,daytime dysfunction and total PSQI scores than the remitting group in 2015;in 2020,the PSQI factor scores and total scores of the unremitting group were significantly higher than those of the remitting group in 2020.In 2020,the unmitigated group had significantly higher PSQI scores and total scores than the mitigated group.A longitudinal comparison of the subgroups in the study group revealed that in the unmitigated group,sleep duration,sleep efficiency,sleep disorder factor scores and total PSQI scores were significantly higher in 2020 than in 2015.In the remission group,the detection rate of sleep disorders,PSQI factor scores and total scores were significantly lower in 2020 than in 2015.3.In each subgroup of the control group,the follow-up results found that between those diagnosed with a current depressive disorder in 2020 and tho e without a psychiatric disorder diagnosis,The detection rate of sleep disorder,sleep quality,sleep duration,sleep duration,sleep efficiency and sleep disorder in the depression group were higher than those in the no-diagnosis group,daytime dysfunction factor and total PSQI score in 2015 and 2020,and in terms of hypnotic medication in 2020 factor scores,the depression group was higher than the no-diagnosis group.Follow-up results also found that among patients with a diagnosis of depressive disorder in 2020,sleep disorder detection rate,sleep quality,time to fall asleep,sleep duration,sleep efficiency,sleep disturbance,daytime dysfunction factor,and total PSQI score were all higher in 2020 than in 2015.In the no-diagnosis group,sleep disorder detection rate,time to fall asleep,sleep duration,sleep efficiency,sleep disorder,daytime dysfunction factor score and total PSQI score were higher in 2020 than in 2015.4.The analysis of risk factors associated with the study group in 2015 showed that the highest total PSQI scores were found on the subgroups of female,age≥60,jobless/unemployed,0 years of education,separated/divorced/widowed,having a physical illness,and GAF of 0 to 50 points.General data analysis conducted in 2015 between the 2020 remission group and the non-remission group showed that there were significant differences in the composition ratio of general data between the two groups in terms of gender,years of education,residence mode and GAF grouping.Further multifactorial analysis revealed that 0 years of education（OR=1.102,95%CI 1.035～1.172）and severe impairment in social functioning（OR=1.037,95%CI 1.020～1.055）were risk factors for the prognosis of depressive disorders.P<0.05 for the above results.Conclusion:1.This study showed that depressed patients with depressive disorders had poorer sleep quality than those without psychiatric disorders,with the worst sleep quality in patients with major depressive disorders,mainly in terms of PSQI scale scores in terms of difficulty falling asleep,difficulty maintaining sleep,early awakening,and decreased sleep quality.Among the high-and low-risk groups identified by the General Health Questionnaire,the poorer the level of mental and physical health,the poorer the sleep quality of those without psychiatric disorders.2.Depressive disorders and sleep quality have an interactive relationship;on the one hand,new onset depressive disorders,prolonged or recurrent depressive symptoms make patients’ sleep quality worse,while patients’ sleep quality improves when their depressive symptoms are reduced;on the other hand,improving sleep quality in patients with depressive disorders improves depressive symptoms and prognosis,and poorer sleep quality predicts a higher risk of new onset depressive disorders,or patients with depressive disorders have a worse prognosis.3.In univariate analysis,female,old age,joblessness/unemployment,illiteracy,separation/divorce/widowhood,physical illness,and severe impairment in social functioning were all risk factors for sleep quality in patients with depressive disorders.Female,illiteracy,living alone,and severe impairment in social functioning were risk factors for the prognosis of patients with depressive disorders.In the multifactorial analysis,illiteracy and severe impairment of social functioning were risk factors for the prognosis of patients with depressive disorders.Although sleep quality was predictive of depressive disorder recurrence in the univariate analysis,PSQI scores did not enter the multifactorial risk factor model for depressive disorder recurrence.