title: The association of sleep duration and depressive symptoms in rural communities of Missouri, Tennessee, and Arkansas.
abstract: OBJECTIVE
  To determine the association between sleep duration and depressive symptoms in a rural setting.
  
  
  METHODS
  We conducted a cross-sectional study using data from Wave 3 of the Walk the Ozarks to Wellness Project including 12 rural communities in Missouri, Arkansas, and Tennessee (N = 1,204). Sleep duration was defined based on average weeknight and weekend hours per day: short (<7), optimal (7-8), and long (>8). The primary outcome was self-reported elevated depressive symptoms. Multivariable logistic regression was used to estimate adjusted prevalence odds ratios (aPOR) and 95% confidence intervals (95% CI).
  
  
  RESULTS
  Elevated depressive symptoms were common in this rural population (17%). Depressive symptoms were more prevalent among subjects with short (26.1%) and long (24%) sleep duration compared to those with optimal (11.8%) sleep duration. After adjusting for age, gender, race, education, employment status, income, and BMI, short sleep duration was associated with increased odds of elevated depressive symptoms (aPOR = 2.12, 95% CI: 1.49, 3.01), compared to optimal sleep duration. Conversely, the association between long sleep duration and depressive symptoms was not statistically significant after covariate adjustment. Similar findings were observed when we excluded individuals with insomnia symptoms for analysis.
  
  
  CONCLUSIONS
  This study suggests that short sleep duration (<7 hours per night) and depressive symptoms are common among rural populations. Short sleep duration is positively associated with elevated depressive symptoms. The economic and health care burden of depression may be more overwhelming among rural populations, necessitating the need to target modifiable behaviors such as sleep habits to improve mental health.
authors: Department of Epidemiology, Saint Louis University School of Public Health, St. Louis 63104, USA. jjchang@slu.edu
authors: Jen Jen
authors: JJ
authors: Chang
authors: Joanne
authors: J
authors: Salas
authors: Katherine
authors: K
authors: Habicht
authors: Grace W
authors: GW
authors: Pien
authors: Katherine A
authors: KA
authors: Stamatakis
authors: Ross C
authors: RC
authors: Brownson
mesh_terms: D000328:Adult; D000368:Aged; D001131:Arkansas; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri; D015995:Prevalence; D012424:Rural Population; D012890:Sleep / Q000502:physiology*; D011795:Surveys and Questionnaires; D013714:Tennessee; D013997:Time Factors